Services for Veterans and Returning Soldiers

1. Services for Veterans and Returning Soldiers A Brief Overview of Service Needs, Service Gaps, and Collaborative Efforts for in New York State

2. Conferences Scheduled During a Three Month Time Span • IPDA Conference in January • Erie County next week • SUNY New Paltz Institute for Disaster Mental Health • VA Trainings • Syracuse • Albany • Not to mention the numerous conferences that focus on PTSD

3. Identified Needs • Major need for transitional services • Legal issues: divorce, custody • Financial: Debt and unemployment • Educational Certification • Services to dependents/families • Rural issues • Increase in demand on Addiction services

4. Identified Needs (continued) • Active Duty vs. Veteran • Multiple deployments: stress from knowing you have to prepare to return • Ramifications of Active Duty seeking behavioral health treatment – Stigma on Steroids • Discharge problems • Debriefing-signing statement of being ok before one has the time to experience life after the military. • Discharged with a diagnosis and the VA not recognizing it. • “Bad Paper” preventing treatment

5. Identified Needs (continued) • Increased Regional Office Staff to provide educational certification and review disability claims • Post-concussive syndrome and TBI require primary health care and behavioral health care • Domestic violence issues • Process to facilitate referrals to/from each system

6. Barriers to CollaborationPerceptions from VA and Community • Tendency of VA to treat community agencies with condescension • Recent increase in VA seeking additional staff has created some animosity • Reluctance on the part of VA to address specific projects or integrate services • Community resistance to influx of veterans from out of the area

7. Barriers (continued) • Sharing resources • Rules and Regulations cited as “unbendable” • Traditional “turf” wars • Costs • No state-wide initiative (Vietnam Commission) • Attitudes

8. Collaborative Projects • Erie County • Veterans’ Court • Housing initiatives to forestall homelessness • Cattaraugus County • Establishing working relationship with the local VA Outpatient Clinic • New York City

9. Collaborative Projects • Jefferson County • Working with Active Duty and families • Allegany-Chemung-Steuben Counties, DePaul Addictions, and the New York State Office of Alcoholism and Substance Abuse Services

10. DePaul Program Rationale Program Rationale is based on: • Needs of the Veteran and Local Population • Need to Build Cost Efficient Medicaid Service System and Control Medicaid Cost • Need to Engage Addiction Patients in Follow-Up Care

11. Program Elements • Program Elements • 25 Bed Medically Supervised Inpatient Withdrawal Service • Serves Veteran and Local Population in Steuben, Chemung, Allegany and Schuyler Counties • Priority Admission for Veterans • Treatment of Dual Diagnosis • Treatment of Methadone and Cocaine Withdrawal as well as alcohol, cannabis and other drugs.

12. Elements (cont.) • Early Detection of Psychiatric Disease. • Early Detection of Methamphetamine Use. • Utilization of Motivational Enhancement to engage in Treatment. • MOU’s with Inpatients and new Downstate Veteran’s Residence (Samaritan Village) to ensure continuum of care. • 24/7/365 Admissions

13. Staffing • MD’s in Internal Medicine and Psychiatry • 4.0 FTE Nurse Practitioners (1.0 with Psychiatric specialty) • RN,LPN Staffing • Program Director • Unit Aides • Admission/Discharge Coordinator • Billing Specialist • 2.5 FTE Therapists (MSW, CASAC)

14. Projected Outcomes • Provide Dedicated Local Resource to VA Health System and Region for Detox and Engagment • Engage 55% of all Admissions in Continuing Care • Reduce Regional Medicaid Costs for Detox by 20% by January 2007. • Create “Ease of Entry” to Detox Services for all stakeholders.