Working with Military Families in the community Harold Kudler, M. D. ( Harold.Kudler@va )

1. Working with Military Families in the community Harold Kudler, M. D. (Harold.Kudler@va.gov) Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC) Department of Veterans Affairs Department of Psychiatry and Behavioral Sciences, Duke University

2. Where Do the Veterans of Iraq (OIF/OND) and Afghanistan (OEF) and their families Live? • Citizen Soldier Support Program - UNC Chapel Hill • -- Provides mapping of OIF/OEF Veterans and their dependents: • http://www.unc.edu/cssp/datacenter/

3. 106,264 AD Service Members

5. The Rural Dimension • Rural Veterans • 41% of all VA enrollees • 39% of enrolled OEF/OIF/OND Veterans • 53% of Veterans in VISN 6 • Rural Service Members (including Guard and Reserve) and their families are less likely to have access to a local mental health professional 

6. OEF/OIF/OND Veterans In VA As of September 30, 2012: 1.56 million of 2.5 million total OEF/OIF/OND Veterans eligible for VA services 56% (866,182) have already sought VA care Three most common health issues: Musculoskeletal Mental Health Symptoms, Signs and Ill-Defined Conditions

7. Mental Health among OEF/OIF/OND Veterans Possible mental health problems reported among 53.6% (464,685 ) of the 866,182 eligible OEF/OIF/OND Veterans who have presented to VA Provisional MH diagnoses include: PTSD 250,242 (29% of all who presented to VA) Depressive Disorder 194,503 Affective Psychoses 117,530 Neurotic Disorders: 171,260 Alcohol Dependence: 55,897 Nondependent Abuse of Drugs: 40,147 Tobacco Use Disorder 123,742

8. Our Focus: Deployment MH Chronic Pain Depression TBI MST PTSD Job Homeless Grief Family SUD

9. VA Has Programs addressing each and all these issues but… • If only 56% of OIF/OEF/OND Veterans and 27% of ALL Veterans use VA health services, what about the rest - and what about their family members? • Are community providers and programs prepared to help?

10. Key Findings of Serving Those Who Have Served • 56% of community providers don’t routinely ask patients about being a current or former member of the Armed Forces or a family member • Only 29% of providers agreed with the statement: “I am knowledgeable about how to refer a Veteran for medical or mental health care services at the VA”

11. Needed:On behalf of service members, veterans and their familiesMilitary and Veteran friendly principles and practices as part of a public health intervention

12. Ongoing NC Initiatives • The Governor’s Focus on Service Members, Veterans and their Families • http://www.veteransfocus.org/ • NC as a mentor state in U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) national Paving the Road Home Program • NC Institute of Medicine Report identifying gaps in services and policy • http://www.nciom.org/publications/?honoring-their-service-a-report-of-the-north-carolina-institute-of-medicine-task-force-on-behavioral-health-services-for-the-military-and-their-families • Recommendations now NC law! • http://www.ncga.state.nc.us/EnactedLegislation/SessionLaws/PDF/2011-2012/SL2011-185.pdf

13. Treating the Invisible Wounds of Warwww.aheconnect.com/citizensoldier • Free, accredited on-line trainings: • Military Families • Deployment Mental Health • Deployment Primary Care • Women Veterans • Employment Assistance Programs • 14,000+ community providers and stakeholders have completed at least one training • New National AHEC Grant to train 70,000 more community providers

14. Searchable Provider Database at www.WarWithin.org • 1,500+ providers nationally • 1,200+ providers in NC • -- 96 of 100 NC counties • Developed by the Citizen Soldier Support Program in partnership with the VISN 6 MIRECC

16. Keys to Building Military-Friendly Practices & Health Systems • Ask each patient “Have you or someone close to you served in the military?” • Train providers/students to ask • Flag military experience (including military family status) in medical records in a way that it is noted at each clinical encounter • Champion in VISN 6/Reward in BC/BS • Train all staff on military cultural competence and basic deployment mental health

17. Keys to Building Military-Friendly Practices and Health Systems • Connect providers with support on military medical issues including • National Military/Veteran Health Programs • VA’s National Center for PTSD • List trained providers/programs in a national referral database accessible to: • Warfighters and family members in need of referral • Providers, employers, college officials, congregational leaders and other stakeholders seeking consultation or to make a referral

18. Draft Version of the First 4 Questions from the VA Office of Academic Affiliations Military Health History Pocket Cards (http://www.va.gov/oaa/pocketcard/) As They Might be Adapted for Use in an Electronic Health Record d. Other aspects of your life? 1.Have you or someone close to you served in the military? 2. When and where did you/he/she serve? 3. What do/did you/he/she do in the military? 4. Has your/his/her military experience affected your: a. Health? b. Family? c. Work? d. Other aspects of your life? If your patient answers “Yes” to any of these questions, ask: “Can you tell me more about that?”

19. Key VA Websites for Community Providers • http://www.mentalhealth.va.gov/communityproviders • New from VA Office of Mental Health • http://maketheconnection.net • For Veterans, families and providers • http://www.ptsd.va.gov/ • VA’s National Center for PTSD

20. Painting a Moving Train

21. The big blue button

22. The Vision There will be No Wrong Door to which ANY Service Member, Veteran or family member can come for the right help With your help, this is an achievable goal!