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Statewide TBI Webinar Series

Join the Statewide TBI Webinar Series to learn about veteran culture, unique needs of veterans with TBI, and fostering collaboration between VA and community organizations. Featuring expert presenters and interactive features.

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Statewide TBI Webinar Series

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  1. Statewide TBI Webinar Series Veteran Culture & VA Service Coordination Bay Area and Central CA April 22, 2011 • Teleconference: • 1-888-450-5996 • PASSCODE: 326087# ^ CATBI.org Logo ARRA Grant Funded (11/2009-9/2011)

  2. Webinar Features • Chat • Step Out • Closed-Captioning • Change Layout • Polls • Audio

  3. Agenda and PresentersBay Area and Central California • Doug Chandler • Brock McNabb • Dr. Cynthia Boyd • Laura Gomez • Chris Lopez • Welcome • Veteran and Military Culture • What’s Unique about Vets w/ TBI • Service Coordination • Veteran Outreach & Perspective • Questions and Answers • Wrap-up Discussion • Technical Support • Neal Albritton – IT Consultant • Crystal Loutzenhiser – TBI Project Assistant

  4. Purpose of webinar • Fostering collaboration and cross referral between VA and community organizations to better serve the unique needs of veterans, veterans with TBI and multiple disabilities. • Connecting Independent Living culture with veteran culture • Webinar Participants Welcome

  5. Brock McNabb • A Readjustment Counseling Specialist with the U.S. Dept. of Veterans Affairs. • He works as a counselor on the Mobile Vet Center, conducting education and outreach. • Brock served six years as a combat medic for the U.S. Army’s 1st Infantry Division. Veteran and Military Culture C.C ^ Vet Center Logo U.S. Dept. of Veterans Affairs.

  6. COMBAT CULTURE Photo of Three Soldiers>>

  7. Understanding the language • RPG – Rocket Propelled Grenade • IED – Improvised Explosive Device • TBI – Traumatic Brain Injury • PTSD – Post Traumatic Stress Disorder • Poly Trauma – Multiple Injuries • COS - Combat Operational Stress • MST – Military Sexual Trauma • BATTLE MIND • GWAT – Global War on Terror • OEF - Operation Enduring Freedom • OIF - Operation Iraqi Freedom • OND – Operation New Dawn • Post 9/11 Veterans • In Theatre / Down Range • MOS – Military Occupational Specialty • DD214 - Discharge from Active Duty Form 214 • www.rivervet.com/oif_glossary.htm

  8. Post War Readjustment Army Pfc. Joseph Dwyer carrying injured Iraqi child 2003 >>

  9. Comrades in Arms Army Specialist Zachary Boyd in I love NY pink boxers in fire fight in Afghanistan 2009

  10. BATTLE MIND Combat skills and battle mindset that sustained survival in the combat-zone • Buddies (cohesion) vs Withdrawal at home • Accountability vs Control • Targeted Aggression vs Inappropriate Aggression • Tactical Awareness vs Hyper Vigilance • Lethally Armed vs Locked and Loaded at home • Emotional Control vs Anger/Detachment

  11. BATTLE MIND • Mission Operational Security vs Secretiveness • Individual Responsibility vs Survival Guilt • Non-Defensive Combat vs Aggressive Driving • Discipline and Ordering vs Conflict BATTLEMIND skills are key to survival in combat but may lead to problems in when transitioning to civilian life

  12. Readjustment Counseling for Combat Veterans from yesterday… Photo of three Soldiers helping a wounded comrade>>

  13. …and combat veterans of today. Photo of three Armed soldiers in desert>>

  14. …and their families. Blue Star Family Gold Star Family

  15. REGIONAL VET CENTERS/VISN 21 VET CENTERS • 232Vet Centers Nationwide • 23 Vet Centers in California • 19 Vet Centers in VISN 21 • 12 Vet Centers in California VISN 21 • 50 Mobile Vet Centers Nation Wide Vet Center Van >

  16. Cynthia Boyd, PhD • Neuropsychologist and Co-Senior Scientific Director of the Defense and Veterans Brain Injury Center at Naval Medical Center San Diego. • She conducts neuropsychological evaluations on active duty service members with suspected traumatic brain injury. What is Unique about Veterans with TBI ? Defense and Veterans Brain Injury Center Naval Medical Center San Diego

  17. Military: Severe TBI Neuroimaging is abnormal Medically evacuated out of theatre Require intensive rehabilitation Unlikely to return to full duty status Persistent impairments in functioning Restricted to DVBIC use only

  18. Military: Moderate TBI Neuroimaging is usually abnormal Typically evacuated out of theatre Less intensive rehabilitation services Return to duty rates are variable At risk for disciplinary issues, work performance problems, and family distress Restricted to DVBIC use only

  19. Military: Mild TBI • Neuroimaging is normal • AKA concussion • Brief LOC or brief period of confusion • Frequently medically managed in theatre and returned to duty • Typically do not require rehabilitation • At risk for disciplinary issues , changes in work performance and family discord • Changes may not be evident in theatre Restricted to DVBIC use only

  20. Blast-Related TBI • Pathophysiology of blast-related TBI is complex and not fully understood • Rapid pressure changes create shear and stress forces that lead to trauma such as concussion, or more severe TBI • Blast waves can move objects and people, causing penetrating injuries or blunt trauma • Effects of explosion are likely to be intensified in a confined space Restricted to DVBIC use only

  21. Blast-Related TBI Blast Injuries account for more than 50% of mild TBI seen by DVBIC Restricted to DVBIC use only

  22. Physical Symptoms of TBI 80% of all TBI’s are mild Dizziness Fatigue Headaches Impaired hearing Impaired vision Problems with balance Sensitivity to light Sensitivity to noise <<Image: Arrows going in varied directions Restricted to DVBIC use only

  23. Cognitive Symptoms Impaired memory Trouble concentrating Difficulty finding words Slowed overall processing Impaired organizational and problem solving skills <<Image: Complicated Maze Restricted to DVBIC use only

  24. Behavioral Symptoms Reported Following Concussion/ mTBI Difficulty being around people Personality changes Irritability, frustration, “short-fuse” May result in “acting out” behavior <<Image: Arrows going in varied directions Restricted to DVBIC use only

  25. Pathophysiology of mTBI/concussion • A “neurometabolic cascade” leaves the brain in a state of neurophysiologic disarray during the acute phase after injury • Functional Neuroimaging studies in animals and humans have demonstrated the brain’s return to normal neurophysiologic functioning within days to weeks • mTBI is a transient process followed by spontaneous recovery Restricted to DVBIC use only

  26. Education • To address misperceptions about the course of recovery • Compensatory strategies • Normal vs. abnormal changes in behavior • Irritability • Domestic Violence Restricted to DVBIC use only

  27. Symptoms of PTSD & TBI TBI PTSD Headache Flashbacks CognitiveDeficits Nausea vomiting Depression Re-experiencing phenomenon Anxiety Dizziness Avoidance Sensitivity to light or noise Irritability Hyper vigilance Insomnia Nightmares Fatigue Vision Problems Restricted to DVBIC use only

  28. Symptoms Not Shared Between Concussion and PTSD • Concussion • Headache • Dizziness/vertigo/balance problems • Reduced alcohol tolerance • Sensitivity to light & noise • PTSD • Flashback/ intrusive memories • Increased startle response • Hypervigilance Restricted to DVBIC use only

  29. Co-morbid Complications PTSD TBI Chronic Substance Alcohol Medication Pain Abuse Restricted to DVBIC use only

  30. Important Facts Blast exposure does not equal TBI Exposure to trauma does not equal PTSD Multiple deployment increase vulnerability for blast and trauma exposure Multiple concussions increase vulnerability to persistent impairment and longer recovery TBI and co-existing psychiatric disorders interact to result in worse outcome Restricted to DVBIC use only

  31. Future Concerns • Adjustment to civilian life • Occupational concerns • Self-medication • Irritability associated with both brain injury & PTSD can lead to aggression • Increases the probability of violent behavior • What services are available to address these concerns Restricted to DVBIC use only

  32. Laura Gomez, LCSW • OEF/OIF Program Manager for the Department of Veteran Affairs Palo Alto Care System • Ms. Gomez provides care management for the severely injured veterans in this healthcare system. • Laura assists in transitioning active duty and recently discharged veterans into the VA Healthcare system. The Role of Social Work and Care Management Dept of Veteran Affairs Logo VA Palo Alto Health Care System

  33. Optimal Post Combat • Provide an easy, single point of entry for care • Honor & acknowledge veteran’s combat service • Provide “One stop shopping” for physical, psychosocial, and mental health assessment • Help to de-stigmatize mental health care • Develop clinical expertise in post-combat care • Provide coordination of care

  34. Who are the OEF/OIF Veterans? • Since October 2001, approximately 2.04 million U.S. troops have been deployed to OEF/OIF conflicts • 34% of combat veterans have been deployed 2-4 times (9-16 months) • Veteran’s ages range from 18 years of age to 65, with an average age of 24 (41.7%). ^ Photo of 6 active duty military men in a tent << Department of Defense: Defense Manpower Data Center. (2008) VHA, Office of Public and Environmental Hazards. (May 2008)

  35. Demographics of OEF/OIF Veterans? VHA Office of Public Health and Environmental Hazards February 2010 (through 4th Quarter FY09

  36. The Role of OEF/OIF Case Managers • Meet with OEF/OIF veterans • Complete psycho-social assessment • Provide educational materials regarding resources and coping strategies • Determine the need for seriously ill or injured care management • Determine if intense case management needed for the non-severely injured • Ensure veterans have contact information for the OEF/OIF team for future reference

  37. What is Case Management? • Case management • Key in that it is the RELATIONSHIP that provides the support and encouragement to returning veterans • “Medical mentoring: • Explain the need for certain treatment approaches and being sensitive to the veteran’s personal style and the need for his buy-in • Collaborating with the patient’s treatment team providers throughout the healthcare system

  38. What is Case Management? • Assists with applying or accessing service • Connection benefits • GI Bill • Voc Rehab • Social Security benefits • DoD or Community grants • Collaborate with the legal system to engage returning combat veterans into treatment and assist veterans that have served sentences back into society • Collaborate with VA and Community Providers • Appointment coordination • Resolving VA billing issues

  39. How case management can help … • Manage multiple consults and/or no-shows • Assist with structure in personal or family life • Manage multiple contacts through same day clinic or ER • Manage multiple mental health issues & suicidal ideation • Vocational challenges • Educational challenges

  40. VA Collaborators • Polytrauma Rehabilitation Center (PRC): Inpatient Acute Care • Polytrauma Transitional Rehabilitation Program (PTRP): Residential/Outpatient Day Program • Polytrauma Network Site (PNS): Outpatient Evaluative Clinic • Vet centers • Women’s Trauma Recovery Program (WTRP) • Men’s Trauma Recovery Program (MTRP) • OEF/OIF Family Program

  41. VA/DoD Collaborators • State Department of VA Affairs • Military One Source (DoD) • The Army Wounded Warrior (AW2) Program • State National Guard Program – Transition Assistance Advisors: list located at • http://oefoif.vssc.med.va.gov/Communications/Pages/default.aspx

  42. Veteran Resources • Coming Home Project: www.cominghomeproject.net/ • The Pathway Home: www.thepathwayhome.org • Vets4Vets: info@vets4vets.us • Operation Purple Family Retreats: www.Militaryfamily.org/our-programs/operation-purple • Marin Services for Women: www.arineserviceforwomen.org • Swords to Plowshares: www.stp-sf.org

  43. VA SIERRA PACIFIC NETWORK OEF/OIF Program Managers • Laura Gomez, Palo Alto OEF/OIF Program 650.493.5000 X60007 • Katie Debus, Livermore OEF/OIF Case Manager at x35393 • Paul Symmonds, Mod/Sonora OEF/OIF Case Manager at 42622 • Oona Houston, Livermore OEF/OIF Case Manager at x35495 • Raquel Morales, San Jose/Mont OEF/OIF Case Manager at x77629 • San Francisco VA Medical CenterCarrie Bancroft, LCSW(415) 221-4810, x4405

  44. Chris Lopez • Former Readjustment Counseling Specialist with the U.S. Department of Veterans Affairs. • U.S. Army veteran infantryman, medically retired after he was wounded with a TBI and back injury in Iraq in a fire fight. • Chris is on the CCCIL TBI Advisory Committee Veteran OutreachStand Downs and Collaborative

  45. Contacting and Networking • Goal: To create a working network of contacts within and outside the Veteran Affairs in order to provide a continuum of care.

  46. Networking within the VA system: • Outlining all of the veteran service providers within your catchment area. • Veteran Centers and Veterans Hospitals. • Establish contact with directors, public affairs officers, and outreach coordinators.

  47. Veteran Service Office Groups: • VFW’s – Veterans of Foreign Wars • American Legions • DAV - Disabled American Veterans • Military Order of the Purple Heart • Veteran Service Offices

  48. Outside Contract Services: • Family Readiness Program Workers • Individual Unit Readiness workers in catchment area • Family Assistance Network Coordinators (1-800-449-9662)

  49. Military Organizations: • Contact local National Guard Command Staff • Family Readiness Program workers • Retention Officers • Local Recruiting Stations/Reserve Centers • Career Counselors (Naval and Marine Corps) • Transitional Assistance Programs “Taps” Coordinators • Clearing briefs for active duty soldiers being released from duty.

  50. Military Special Interest Organizations: • Militaryonesource.com (1-800-342-9647) • Joint Support Operation Center (1-888-774-1361) • Stand Downs: • Created to work with homeless veterans of any era that are in need of assistance. http://www.nchv.org/page.cfm?id=122 • Local and Statewide Collaborative. • Designed to bring share resources together in an environment http://www.militaryconnection.com/pdfs/mary-ellen-commendation.pdf

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