Returning Combat Veterans Seamless Transition Program

1. North Florida/South Georgia Veterans Health System Returning Combat Veterans Seamless Transition Program Transition Care Management Service

2. North Florida/South Georgia Veterans Health System 39th Annual Florida Association of Veteran Education Specialists June 12, 2013 Seamless Transition Program Kathleen Yacovelli, RN, MSN Program Manager Terri Turner Transition Patient Advocate

3. North Florida/South Georgia Veterans Health System

4. Catchment Area • North Florida/South Georgia VA Covers 52 counties • The NF/SG VHS currently has 2 Medical Centers (Gainesville and Lake City) • 3 large Outpatient Clinics (Jacksonville, Tallahassee, the Villages) • 8 Community Based Clinics in (Lecanto, Marianna, Ocala, Valdosta, Palatka, St. Augustine, St. Mary’s, and Waycross). • The Catchment Area in total is the size of the state of South Carolina

5. Healthcare Services • Primary Care • Inpatient and Outpatient Treatment • Mental Health: Depression, Substance Abuse, PTSD, Military Sexual Trauma, TBI • Pharmacy Services • Women’s Health Program • Prosthetics • Homeless Veterans Outreach • Residential Treatment • Plastic /Reconstructive Surgery

6. OEF/OIF/OND Acronyms • OEF – Operation Enduring Freedom (Afghanistan, 10/1/01-Present) • OIF – Operation Iraqi Freedom (Iraq, 3/17/03-8/31/10) • OND – Operation New Dawn (Iraq, 9/1/10-Present)

7. OEF/OIF/OND Combat VeteransSeamless Transition Program This is a special VA program to meet the needs of our newest Veterans returning from combat in Iraq, Afghanistan and many other hostile fire areas. Teresa Turner Patient Advocate 1-800-324-8387 x4797 Julie Rattley L.M.S.W. Case Manager 1-800-324-8387 x4190 Dorothy Arias RN Case Manager 904-470-6900 ext. 1322 Paul E. Crouch L.C.S.W., CCM Case Manager 1-800-324-8387 x4589 Kathleen Yacovelli RN, MSN OEF/OIF Program Manager 1-800-324-8387 x5510

8. Mission and Purpose • Provide seamless, quality health care services and benefits to Veterans who are injured or wounded from combat or military operations as they transition back to civilian life with their loved ones • Promote effective coordination and management of health care services and benefits between DOD & VA • Establish processes to optimize health care treatment and outcomes • Utilize outreach for education and expansion of VA services within the community

9. OEF/OIF/OND Population • 1,604,359 OEF/OIF/OND Veterans have left active duty and become eligible for VA health care since FY 2002 • 899,752 (~56%) have obtained VA health care since FY 2002 (cumulative total)

10. OEF/OIF/OND Veterans in NFSGVHS • Cumulative Total: 19, 241 • Since October 1, 2012: 7,061 New Combat Veterans seen at NFSG VHS • Our team case manages 220 • Of those, 110 are seriously ill or injured • 58% of them are 29 or younger • 14% Female 86% Male

11. Severely Ill/Injured • Mental Illness • TBI • Spinal Cord Injury (SCI) • Blind • Amputee • Burns • Terminal Illness/Injury • Other:

12. Overview of Seamless Transition Care Management Services • The OEF/OIF/OND Program provides transition care management, coordination of health care services and case management • Care provided by the Case Managers includes: • Initial screening • Facilitation of care • Referrals • Education • Outreach

13. Case Management Screening • Is done at the first visit to a VA provider • Case management screening is performed by social workers, psychologists, nurses or other licensed providers who routinely conduct psychosocial assessments. • All Severely Ill/Injured (SI)Veterans are case managed for life • Non-SI Veterans are case managed until transitioned to Primary Care

14. Doubts Video

15. Scope of the Issue • 2.5 million service members have served in Iraq and Afghanistan (Office of Public Health Veterans Health Administration, Department of Veterans Affairs, September 30, 2012.) • “The war in Iraq remains very personal. Over 75% of Soldiers and Marines surveyed reported being in situations where they could be seriously injured or killed; 62-66% knew someone seriously injured or killed; more than one third described an event that caused them intense fear, helplessness or horror.” --From the Office of Surgeon General Mental Health Advisory Team (MHAT) IV, Final Report, Nov 06

16. Most Common Health Issues Seen in Returning Combat Veterans: • Musculoskeletal Disorders • Post Traumatic Stress Disorder (PTSD) • Traumatic Brain Injury (TBI) • Adjustment Disorders • Depression • Symptoms, Signs and Ill-Defined Conditions Note: “Symptoms, Signs and Ill-Defined Conditions” is NOT a “mystery illness” but rather a “placeholder” indicating a clinical issue in the early stages of work-up.

17. Definitions • PTSD: History of exposure to a traumatic event (actual or threat of death, serious injury or threat to physical integrity of oneself and others), meeting two criteria and symptoms • From 3 clusters: Intrusive recollections, avoidant/numbing symptoms, hyper-arousal. • The person’s response involved intense fear, helplessness or horror. • TBI (Traumatic Brain Injury):occurs when a sudden trauma causes damage to the brain. TBI can result when the head suddenly and violently hits an object, or when an object pierces the skull and enters brain tissue. Symptoms of a TBI can be mild, moderate, or severe, depending on the extent of the damage to the brain.

18. PTSD and Community Behavior • Military men and women preparing for combat are trained to be on guard, react immediately, to be aggressive, to be violent. When they return home, they are expected to be relaxed, think first and react slowly in a non-violent manner. • One Veteran explained it this way. “During combat, I was in the habit of protecting everyone with my gun. I was in charge of taking care of dangerous situations. When I came back from Iraq, it took me a long time to remember that we have policeman I can call upon for assistance. It took time for me to adjust to the idea of someone else handling dangerous situations for me.”

19. PTSD When Veterans return home, they have many stressors to deal with. These include issues related to: • Substance abuse • Financial distress • Employment • Housing • Divorce • Disabilities/VA claims • Family re-adjustment • Community re-adjustment • Loss of military support • Loss of important purpose

20. Civilian and Combat PTSD What is the difference between civilian and combat PTSD? • Multiple traumas in a short time • Trauma is man-man vs. natural disasters • The combat sufferer is both victim and perpetrator of Violence.

21. TBI (Traumatic Brain Injury) and the Brain • Traumatic Brain Injuries result in lesions in various areas of the brain • The location of the lesion may influence; social perception, self control, judgment, and mood • TBI may impair the ability to inhibit violent behavior

22. Other factors to consider • Hearing loss is common among Veterans, so they may not hear what you say. • Survivor guilt is common for those who survive when others die or become seriously wounded. Self blame can contribute to self sabotage, destructive behavior, suicide • Panic attacks are common among warriors who are subconsciously triggered to enter a fight or flight mode. • Nightmares and insomnia contribute to daytime irritability • Depression contributes to suicidal ideation

23. Suicide PreventionSigns and Symptoms WARNING SIGNS • Threatening to hurt or kill self • Looking for ways to kill self • Talking or writing about death, dying or suicide • Hopelessness, feeling like there’s no way out • Self-destructive behavior or acting reckless • Increasing drug or alcohol abuse Additional WARNING SIGNS • Anxiety, agitation, mood swings • No reason for living, no sense of purpose in life • Difficulty sleeping or sleeping all the time • Rage, anger • Seeking revenge • Giving away possessions • Withdrawing from friends, family and society

24. Goals of the Seamless Transition Program • Enhance outreach • Increase appropriate referrals • Reduce stigma • Promote healthy outcomes/Resilience/Recovery • Strengthen families • Decrease military attrition • Decrease disability • Increase consumer and provider satisfaction • Transform the post deployment health system

25. How Can you help your student Veteran obtain VA benefits? • Establish a solid relationship with the VA Medical Center located in your geographic area • There is an OEF/OIF/OND Seamless Transition Team at every VA Medical Center in the state of Florida and across the nation – take advantage of their resources • Establish contacts with Veteran Service Officers and encourage your student Veterans to apply for compensation for any illnesses or injuries they may have incurred while on active duty • Become active in your local Collegiate Veterans Society, Student Veterans of America or a Veteran club/organization on campus

26. Thank you for your Service!

27. Transition Care Management Service NFSGVHS Questions?