OEF/OIF/OND Care Management Hampton VAMC

1. OEF/OIF/OND Care Management Hampton VAMC

3. John S. Williams, LCSW OEF/OIF /OND Social Work Case manager

4. Overview • Seamless transition • Combat veteran • Case management • Post Traumatic Stress Disorder

5. Combat Veterans • 5 years free medical care following separation from active duty for service connected issues • Combat related illness or injury • Any injury that cannot be clinically ruled out as being related to combat duty.

6. Care Management Team • Program Manager • RN Clinical Case Manager • Transition Patient Advocate • SW Case Managers • VA/DOD Liaison @ Ft Eustis • MTF liaison • Army Wounded Warrior Liaison • Health Benefits Advisor • Program Support Assistant • ServMH Team

7. Responsible for coordination of care to meet the health, psychosocial, and social needs of the veterans Ensures appropriate referrals for treatment to be provided within 30 days from initial assessment Mental Health needs are addressed within 24 hours OEF/OIF/OND Care Management Team

8. Care Management Purpose • To transition the care of service members and their families from the Military Treatment Facility (MTF) to the VA and or community. • VA HealthCare can be provided under • Sharing Agreements • TRICARE (180 days of TRICARE TAMP to access VA care)

9. Care Management Purpose • Service Members must be discharged/separated/terminal leave • To assure that the care is as seamless as possible.

10. WHO ARE COMBAT VETERANS • Veterans who have been involved in combat since November 11, 1998 • This includes National Guard and Reservists • Areas of combat Include Afghanistan and Iraq as well as other areas. • Federal employees deployed to Afghanistan and Iraq

11. WHO ARE COMBAT VETERANS • Imminent Danger pay, hazardous duty pay • Many Combat veterans are not aware of the care at the VA

12. Areas of Combat • Afghanistan • Iraq • Bosnia • Saudi Arabia • Kosovo • Kuwait • Areas surrounding the Persian Gulf & Guantanamo Bay • Coast of Africa • Any where a service member may receive combat pay, imminent danger pay • The Pentagon 9-11

13. How a combat veteran gets into Care Management? • Direct referral with Military Treatment Facility (MTF) case managers to ensure a smooth transition into the VA health care system • Self referral • Consults from other sources • Referral from eligibility • Outreach-Fort Eustis WTU, CBWTU, Portsmouth Naval Hospital Mental Health • Demobilization with the Navy • Post Deployment Health Reassessment • Yellow Ribbon Programs

14. Services Available • Primary and specialty medical care • Rehabilitation care including Polytrauma level 3 and chronic spinal cord injury • Traumatic Brain injury screening and referral and treatment • Readjustment and Transition programs • Post-Deployment Mental Health services • Suicide Prevention Program

15. Services Available • Substance abuse Treatment • Mental Health evaluation and treatment • Women Veteran Services • Military Sexual Trauma Counseling • Class 2 Dental benefits are available • 24 Hour Emergency Care • Case Management of severely injured, seriously ill and high risk veterans and others as needed.

16. Post Traumatic Stress Disorder • Session Goals • Overview • Battle Mind • What is PTSD

17. Causes Of PTSD • Combat/Military Exposures • Childhood Abuse (Sexual/Physical) • Terrorist Attacks • Assaults • Serious Accidents • Natural Disasters

18. What Is A Trauma? • Event That Involves Death or Threatened Death or Serious Injury • Feelings of Fear, Horror, Helplessness • Resilience Is Most Common Outcome

19. Variables That Impact Who Has PTSD • Proximity • Relationship with Victims • Training/Mind Set • Post Trauma Environment • Previous Trauma • Multiple Trauma (Pre-Morbid) • Genetics

20. How People Cope With PTSD—Clues For You • Drinking • Driving Fast • Sleep Problems – Night Work – Peeping/Perimeter Watch • Startle Easily--Stimulants • Flashbacks/Hallucinations • Depression/Crying

21. Post Deployment Stress Reactions Less Severe Combat Operational Stress Reactions Adjustment Disorders Acute Stress Disorder Post Traumatic Stress Disorder Most Severe

22. What Is PTSD? • Actual Death or Threatened Death or Serious Injury • Most Often Not About Killing Enemy • Personal Loss of Unit Member Most Common Trauma • 1) FEELINGS ABOUT IT • Terror • Helplessness • Horror • 2) Persistent Re-Experiencing • 3) Avoidance/Isolation • 4) Keyed Up/Hyper-Aroused

23. Typical OEF/OIF/OND Stressors • Ambushes (58-89%) • Incoming Rockets/Artillery (84-86%) • Small Arms (66-93%) • Shooting at Enemy (27-77%) • Killing Enemy (12-48%) • Killing Non-Combatants (1-14%) • Seeing Dead/Remains (39-93%) • Seeing Dead/Injured Americans (30-65%)

24. NO ONE IS IMMUNE TO OPERATIONAL STRESS – “BATTLE MIND” • Improves Quickly With • Rest • Food • Reassurance • Reintegration With The Unit • Most COSR Resolve Quickly • 50% of Those With PTSD Get Better In 3 Months (DoD Statistics) • What To Expect In A Returning War Fighter… Battle Mind

25. Battle Mindset • Look out for each other • Only people to understand you • Cohesive in battle

26. Discipline & Ordering VS Conflict • In Combat • Survival depends on discipline and obeying orders • Home • Inflexible ordering leads to conflict with family, friends and co-workers

27. Mission OPSEC VS Secretiveness • Battle Mindset • Only talk to those who need to know, unit members • Home • Avoid sharing ANY information about your deployment

28. Targeted VS Inappropriate Aggression • Battle Mindset • Lethal split second decisions keep you and your buddies alive • Anger keeps you alert, awake and alive • Home • Snap at wife/kids/co-workers • Overreact to minor insults

29. Emotional Control VS Detachment • Battle Mindset • Controlling your emotions is critical to mission success • Home • You are detached • You are uncaring • You only show anger

30. Treatment Interventions • Medications • Substance Abuse Treatment • Cognitive Therapy (Group and Individual) • Stress Inoculation Training • Exposure Therapy (PE/CPT) • Food Not Mentioned, Experience Shows Otherwise

31. Questions/Comments