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UNCLASSIFIED

Department of Veterans Affairs Caring for Those Who Served in Seamless Transition

Marianne Mathewson-Chapman PhD, ARNPVA Office of Seamless Transition

USDOL-VETS 2007 CompetitiveGrantees Training Conference

August 7-9, 2007

National Guard and Reserves Combat Veterans

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The Reality of War

The New Generation of Veterans Returning to Hometown America

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Outline• Seamless Transition from DoD to VA to community

• …………………….Caring for the War Wounded

• Categories of War Injuries

Severely Injured (TBI, SCI, Blind, Amputee, PTSD, Burn) Severely Injured (TBI, SCI, Blind, Amputee, PTSD, Burn)

Medical Holdover and CBHCO: (Warriors in Transition)Medical Holdover and CBHCO: (Warriors in Transition)

Hidden/Lingering WoundsHidden/Lingering Wounds

• Unique Challenges for National Guard and Reserve

• Geographical Dispersion, State Coalitions and Role of Transition Assistance Advisors in each state

• Outreach Programs

• Recommendations to Enhance Employment

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1515

Transitioning from DoD to VA to the CommunityBattlefield

VA at MTF

VA OIF/OEFProgram Managers

(2004)

2005

Recovery and Health Continuum of Care

State CoalitionsTransition Assistance Advisors

Family Programs

State CoalitionsTransition Assistance Advisors

Family ProgramsOutreach

PEB and PDHRA

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Categories of War WoundedSeamless Transition Process

Category 1:Category 1:Severely InjuredSeverely InjuredCategory 1:Category 1:Severely InjuredSeverely Injured

11 MTF Liaisons at:

•Brooke AMC, Balboa

•Eisenhower AMC

•Madigan AMC

•Bethesda NNMC, WR

•Ft. Carson, Ft Hood

• Camp Pendleton

• Gordon and CFI

VA full time VA Social Worker VBA Benefits Counselor

Tampa VAMC

Transition

Severely Injured:• TBI• SCI

•Amputee•Severe disfigurement

•Burns•PTSD

Category 2:Category 2:• Medical Hold/holdover

• Community Based Healthcare Organization

(CBHCO)

Category 2:Category 2:• Medical Hold/holdover

• Community Based Healthcare Organization

(CBHCO)

Category 3:Category 3:Hidden Wounds atPost deployment

Category 3:Category 3:Hidden Wounds atPost deployment

VA Liaisons/POC

•VHA facilities: 157

•VBA ROs: 57

• 4 Polytrauma Centers

• 2 WRIISC, 207 Vet Centers

Veterans Tracking

Application

DoD

VA

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Category 1: Severely Injured

• VA Liaison for Healthcare (10 MTFs) and adding 7 more

• Veterans Integrated Service Network (VISN) POCs (21)

• VA Medical Center OIF/OEF Program Manager at 157 VA facilities

• OEF/OIF Case Managers

• Transition Patient Advocates (TPA)

• VBA Regional Offices OEF/OIF Coordinators in each state-57

• Readjustment Counseling Services (Vet Centers 206+) for outpatients

• VA Inpatient mental health/suicide prevention coordinators

• VA Liaison for Healthcare (10 MTFs) and adding 7 more

• Veterans Integrated Service Network (VISN) POCs (21)

• VA Medical Center OIF/OEF Program Manager at 157 VA facilities

• OEF/OIF Case Managers

• Transition Patient Advocates (TPA)

• VBA Regional Offices OEF/OIF Coordinators in each state-57

• Readjustment Counseling Services (Vet Centers 206+) for outpatients

• VA Inpatient mental health/suicide prevention coordinators

New Positions at MTF, VAMC and Regional Office

“Walk on in”

VTA

DoDVA

VTA

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New DoD/VA Medical Center Positions

OEF/OIF Nurseand Social W orker

Case M anagers

Other Case M anagersVIST , SCI, W om en

Veterans, polytraum a

T ransitionPatient

Advocate(s)

VA M edical CenterOEF/OIF

Program M anager

VA LiaisonHealthcare

at DoD

VA and Community

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Category 2: WTU/Med Hold/CBHCO

Continued Care at Military Treatment Facility. Case management in Warrior Transition Unit (WTU)

Reserve/Guard may live at Home, receive rehabilitation at VAMC near home. Case management from CBHCO

Military Treatment Facility and Warriorin Transition Units (WTU)

Live at Home

Treatment at Treatment at locallocal VAMC VAMC

Guard/Reserve with caseManagement from community based healthCare organization (CBHCO)

MEB/PEB determination

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Category 2: Warrior Transition Units

Community Based Health Care Organizations (CBHCO)

PR

CBHCO Detachment and Case Manager Locations

Arkansas(KS-LA-MO-NE-OK-TX)

California(ID-NV-OR-WA)

Florida(GA-SC)

Massachusetts(CT-ME-NH-NJ-NY-PA-RI-VT)

Wisconsin (IA-IL-IN-MI-MN)

Utah(AZ-CO-MT-ND-NM-SD-WY)

Virginia(DC-DE-MD-NC-OH-WV)

Alabama(KY-MS-TN)

8 Sites8 Sites8 Sites8 Sites

Active Duty Status with Maximum 300 per siteActive Duty Status with Maximum 300 per site

Sacramento

Riverton UT

Camp Robinson, AR

Huntsville, AL

Orlando, FL

Virginia Beach, VA

ConcordMA

Rock Island Arsenal, IL

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Mobilized: 88,084 Demobilized: 534,965 Total:

623,049Reserve

ComponentsARNG USAR ANG USAFR USNR USMCR USCGR Total

Currently

Mobilized

49,535 27,643 945 276 5,087 4,297 301 88,084

Demobilized

To Date:

240,529 147,578 35,375 32,418 33,432 36,763 8,870 534,965

Total

Mobilized

To Date:

290,064 175,221 36,320 32,694 38,519 41,060 9,171 623,049

Reserve Components: Noble EagleEnduring Freedom and Iraqi Freedom

Reserve Components: Noble EagleEnduring Freedom and Iraqi Freedom

++Includes Mobilized and Demobilized more than once

Mobilized: Involuntary active duty in a Federal Status (10 USC 12302) that authorizes the use of Reserve Forces for up to 24 months

18 July 2007 Services Daily Mobilization Report

Former Active duty now veterans………….292,289

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Army Medical DepartmentArmy Medical Department

R eserve A ffairs D irect orateR eserve A ffairs D irect orate

Sol die rs O n Poi nt for the Na ti on… Persu as ive i n Peace , Inv in c ibl e in W ar

–A C –479,000 –42,00 0 – 9%

–A RNG –350,600 –90,00 0 – 26%

–U SAR –207,000 –57,00 0 – 28%

–A F a cti ve–A ir Gu ard–A FR

–N avy A C–N R

– 13%– 37%– 42%

– 10%– 32%

Graying of the Force

Over age 40

351,000106,00072,300

367,00087,00087,000

The Aging Force

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VA and NG State Coalition

MOU between VA and NG (May 2005)

Access to Troops and Families of National GuardAccess to Troops and Families of National Guard

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Why High Risks for Guard/Reserve

• Guard/Reserve Units are dispersed to remote areas

• Limited family support programs in community

• First deployment and multiple deployments

• Leave civilian jobs for 1 ½ years and frequent mobilizations

• Post-Deployment readjustment issues and the

stigma of mental health

• Demobilization station is not near hometown/community

• Hometown is not near NG/Reserve armory or VA (rural)

• Service related disabilities: delay in tx or claims

• Returning Home: High divorce rate, jobless,

• Homeless and delay seeking medical/mental health

• Lack understanding family/employer of challenges

• Limited knowledge of VA healthcare/benefits

• Display high risk behaviors and alcohol/drug abuse

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NGB/VANGB/VALiaisonLiaison

NG Joint StaffNG Joint Staff

NGB/VANGB/VALiaisonLiaison

NG Joint StaffNG Joint Staff

National GuardSTATE JOINT FORCE HEADQUARTERS

National GuardSTATE JOINT FORCE HEADQUARTERS

VA/NG Transition Assistance AdvisorVA/NG Transition Assistance Advisor

State DirectorsOf VA

State DirectorsOf VA Adjutant

GeneralAdjutantGeneral

Governor’sOffice

Governor’sOffice

VA ServicesVA Services

NCANCA VBAVBA

NG/VA TAA’s NetworkNG/VA TAA’s Network Services and Benefits Services and Benefits

POCVISN/RO

POCVISN/RO

State VSO State VSO

County Service Officer

County Service Officer

OSD MSIC

OSD MSIC

TRICARETRICARE

Family Readiness VolunteersFamily Readiness

Volunteers

Army Community

Svce

Army Community

Svce

WFPCWFPC

ESGRESGR

Financial ServicesFinancial

Services

FACsFACs

NG Chaplains

NG Chaplains

Civilian Medical CommunityCivilian

Medical Community

SFPDSFPD

AW2: Marine4LifeSafe Harbor

Palace HART

AW2: Marine4LifeSafe Harbor

Palace HART

NationalGuard Services

NationalGuard Services

DoDServices

DoDServices

Returning to the State: All Service Members and Familyand the Safety Net

Child and Youth SvceChild and

Youth Svce

TrainingSupport

Information ServicesServices

VHAVHA

Fed, State, Local & Private Orgs.Fed, State, Local & Private Orgs.

LegalServicesLegal

Services

Military MedicalCommunity

Medical Hold(CBHCO)

Military MedicalCommunity

Medical Hold(CBHCO)

VISN VISN

National VSO

National VSO

Community ServicesCommunity Services

State MentalHealth and Substance Abuse Svce

State MentalHealth and Substance Abuse Svce

CommunityMental

Health Svce

CommunityMental

Health Svce MilitaryOne

Source

MilitaryOne

Source

VA/NGB Liaison

VA Office of Seamless Transition

VA/NGB Liaison

VA Office of Seamless Transition

206Vet

Center

206Vet

Center

VISNMental Health

VISNMental Health

VBA ROVBA RO

VAMCVAMC

MTFs

EducationEducation

Loan GLoan G

InsuranceInsurance

VREVRE

C&P

OIF/OEFPMsOIF/OEF

PMs

TPAsTPAs

Case ManagersCase Managers

DOLDOL

WomenHealthWomen

Health

WomenBenefits

FamilyPrograms

FamilyPrograms

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Support for Members/Families the State Level

EducationEducation

MonitorHomeless

Employment

MonitorHomeless

Employment

RehabilitationRehabilitation

Transition Assistance Advisors (TAA)

DisabilityBenefits

DisabilityBenefits

Sta

te V

eter

ans

Aff

airs

Dir

ecto

rs

Fam

ily Pro

gram

s

CoordinationWith

Family Programs

CoordinationWith

Family Programs

CounselingCounseling Health CareHealth Care

CoordinationCoordinationWith CBHCOWith CBHCOCoordinationCoordinationWith CBHCOWith CBHCO

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• Brochures:– Summary of Guard/Reserve VA Benefits

– VA Benefits Wallet Cards

– VHA summary of Healthcare

– OIF/OEF Newsletter on healthcare

– Vet Center and Women’s Health Program

• MOU with National Guard and Initiatives with other Reserves

• Training tools: – Veterans Health Initiatives(VHI series)

– My HealtheVet, Webpage, Displays, videos

• Training conferences:– VA/Transition Assistance Advisors (Feb 2007)

– Evolving Paradigms National Conference (2007)

• Letter from Secretary VA, USH,USB to:– Service Member

– Adjutants General

– RO/VISN and VAMC Directors

• Brochures:– Summary of Guard/Reserve VA Benefits

– VA Benefits Wallet Cards

– VHA summary of Healthcare

– OIF/OEF Newsletter on healthcare

– Vet Center and Women’s Health Program

• MOU with National Guard and Initiatives with other Reserves

• Training tools: – Veterans Health Initiatives(VHI series)

– My HealtheVet, Webpage, Displays, videos

• Training conferences:– VA/Transition Assistance Advisors (Feb 2007)

– Evolving Paradigms National Conference (2007)

• Letter from Secretary VA, USH,USB to:– Service Member

– Adjutants General

– RO/VISN and VAMC Directors

ToolkitOffice of SeamlessTransition

Outreach Toolkits for VA Education and Awareness Campaign to Veterans, Families and VA Staff

Video

BroadcastsBrochures

VHI

WEB

PAGE

Training

Programs

2626Office of Seamless TransitionOffice of Seamless Transitionhttp://www.va.govhttp://www.va.gov

2 years if freeVA healthcarefor servicerelated illness/injury

2 years if freeVA healthcarefor servicerelated illness/injury

90 days For Dental treatment

90 days For Dental treatment

http://www.va.gov

• Education/Awareness Campaign Plan and Communication/Distribution Plan for Outreach to Guard/Reserve and family

• New Technology: Webcasts, New Technology: Webcasts, PodcastsPodcasts, , Multi-Media Technology for Multi-Media Technology for electronic toolkitselectronic toolkits

“Walk on in”

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Recommendations

• Education and Awareness of Service Members, Family Members, clinicians, federal and state employers

• Longitudinal Study on employment challenges

• Closer links of Employment Specialists with ESGR Coordinators at VAMC with OIF/OEF Program Managers

• Participating with the state coalitions and MOU

• Employment Coordinators participate in PDHRA events, family programs, job fairs, reunions, and unit events

• Support legislation for home station reintegration

• Closer ties with VA VRE programs

• Robust Reintegration Programs at home station

• Education and Awareness of Service Members, Family Members, clinicians, federal and state employers

• Longitudinal Study on employment challenges

• Closer links of Employment Specialists with ESGR Coordinators at VAMC with OIF/OEF Program Managers

• Participating with the state coalitions and MOU

• Employment Coordinators participate in PDHRA events, family programs, job fairs, reunions, and unit events

• Support legislation for home station reintegration

• Closer ties with VA VRE programs

• Robust Reintegration Programs at home station

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QUESTIONS ?VA Office of Seamless Transition

202-273-7822VA Office of Seamless Transition

202-273-7822

Caring for Guard/Reserve Through Caring for Guard/Reserve Through ……………….Seamless Transition ……………….Seamless Transition

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2007 Task Force, GAO and Commission

Reports to the President

• Togo West’s Commission on Care of War Wounded at Walter Reed

• VA Secretary Nicholson’s: Returning GWOT Heroes:

25 Recommendations

• Bob Dole Commission Final Report

• GAO reports

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Resources• Basic VA Benefits Questions:

www.va.gov or 1-877-222-VETS (8387)

• VA Office Seamless Transition- (202-273-7822)

• DoD VA Program Coordination Office (703-681-0039)

• Military Severely Injured Center (1-888-774-1361) severelyinjured@militaryonesource.com

• Army Wounded Warrior Program (1-800-833-6622) www.armyds3.org

• Marine for Life (1-866-645-8762) injuredsupport@M4L.usmc.mil

• Air Force Palace HART (1-888-774-1361) severelyinjured@militaryonesource.com

• Navy Safe Harbor (1-888-774-1361) severelyinjured@militaryonesource.com

• Military One Source ( 1-800-342-9647) (24/7) www.militaryonesource.com

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VA OIF/OEF Healthcare Utilization Summary

SW Asia Veterans Who Separated From Active duty:

631, 174 OEF/OIF veterans, 174 OEF/OIF veterans and are eligible for VA care since FY 2002-2006

Totals Use VHA ComponentTotals Use VHA Component

• 292,289): (101, 259) Former Active duty

• 147,020): (41,090) Reserves

• 191,865) (62,739) National Guard

• 631,174 205, 097 32% or 205,097 evaluated by VA from 2002-2006

represents 4% of 5.3 million veterans in any one year

• Total Female Veterans: …. 65,231

• % Combat Women Veterans enrolled in VHA care…......36.2% (3rd quarter 2006)