[House Hearing, 111 Congress]
[From the U.S. Government Publishing Office]
U.S. DEPARTMENT OF VETERANS AFFAIRS
MEDICAL CARE: THE CROWN JEWEL
AND BEST KEPT SECRET
=======================================================================
HEARING
before the
SUBCOMMITTEE ON HEALTH
of the
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED ELEVENTH CONGRESS
FIRST SESSION
__________
MAY 19, 2009
__________
Serial No. 111-22
__________
Printed for the use of the Committee on Veterans' Affairs
U.S. GOVERNMENT PRINTING OFFICE
49-920 WASHINGTON : 2009
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COMMITTEE ON VETERANS' AFFAIRS
BOB FILNER, California, Chairman
CORRINE BROWN, Florida STEVE BUYER, Indiana, Ranking
VIC SNYDER, Arkansas CLIFF STEARNS, Florida
MICHAEL H. MICHAUD, Maine JERRY MORAN, Kansas
STEPHANIE HERSETH SANDLIN, South HENRY E. BROWN, Jr., South
Dakota Carolina
HARRY E. MITCHELL, Arizona JEFF MILLER, Florida
JOHN J. HALL, New York JOHN BOOZMAN, Arkansas
DEBORAH L. HALVORSON, Illinois BRIAN P. BILBRAY, California
THOMAS S.P. PERRIELLO, Virginia DOUG LAMBORN, Colorado
HARRY TEAGUE, New Mexico GUS M. BILIRAKIS, Florida
CIRO D. RODRIGUEZ, Texas VERN BUCHANAN, Florida
JOE DONNELLY, Indiana DAVID P. ROE, Tennessee
JERRY McNERNEY, California
ZACHARY T. SPACE, Ohio
TIMOTHY J. WALZ, Minnesota
JOHN H. ADLER, New Jersey
ANN KIRKPATRICK, Arizona
GLENN C. NYE, Virginia
Malcom A. Shorter, Staff Director
______
SUBCOMMITTEE ON HEALTH
MICHAEL H. MICHAUD, Maine, Chairman
CORRINE BROWN, Florida HENRY E. BROWN, Jr., South
VIC SNYDER, Arkansas Carolina, Ranking
HARRY TEAGUE, New Mexico CLIFF STEARNS, Florida
CIRO D. RODRIGUEZ, Texas JERRY MORAN, Kansas
JOE DONNELLY, Indiana JOHN BOOZMAN, Arkansas
JERRY McNERNEY, California GUS M. BILIRAKIS, Florida
GLENN C. NYE, Virginia VERN BUCHANAN, Florida
DEBORAH L. HALVORSON, Illinois
THOMAS S.P. PERRIELLO, Virginia
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
hearing records of the Committee on Veterans' Affairs are also
published in electronic form. The printed hearing record remains the
official version. Because electronic submissions are used to prepare
both printed and electronic versions of the hearing record, the process
of converting between various electronic formats may introduce
unintentional errors or omissions. Such occurrences are inherent in the
current publication process and should diminish as the process is
further refined.
C O N T E N T S
__________
May 19, 2009
Page
U.S. Department of Veterans Affairs Medical Care: The Crown Jewel
and Best Kept Secret........................................... 1
OPENING STATEMENTS
Hon. Harry Teague................................................ 1
Chairman Michael H. Michaud, prepared statement of............... 37
Hon. Henry E. Brown, Jr., Ranking Republican Member.............. 3
Prepared statement of Congressman Brown...................... 38
WITNESSES
U.S. Department of Veterans Affairs, Paul J. Hutter, Chief
Officer, Legislative, Regulatory, and Intergovernmental
Affairs, Veterans Health Administration........................ 28
Prepared statement of Mr. Hutter............................. 61
______
Altarum Institute, Ann Arbor, MI, John King, Co Director,
Veterans Community Action Teams Mission Project................ 14
Prepared statement of Mr. King............................... 52
American Psychological Association, Jeffrey W. Pollard, Ph.D.,
ABPP, Director, Counseling and Psychological Services, George
Mason University, Fairfax, VA.................................. 22
Prepared statement of Dr. Pollard............................ 59
Easter Seals, Inc., Randall L. Rutta, Executive Vice President,
Public Affairs................................................. 20
Prepared statement of Mr. Rutta.............................. 55
Give an Hour, Bethesda, MD, Barbara Van Dahlen Romberg, Ph.D.,
Founder and President.......................................... 16
Prepared statement of Dr. Romberg............................ 46
Iraq and Afghanistan Veterans of America, Reynaldo Leal, Jr.,
Representative................................................. 5
Prepared statement of Mr. Leal............................... 40
National Association for Uniformed Services, Richard A. ``Rick''
Jones, Legislative Director.................................... 7
Prepared statement of Mr. Jones.............................. 42
Trilogy Integrated Resources, San Rafael, CA, Bruce Bronzan,
President...................................................... 18
Prepared statement of Mr. Bronzan............................ 45
Vietnam Veterans of America, John Rowan, National President...... 4
Prepared statement of Mr. Rowan.............................. 38
SUBMISSIONS FOR THE RECORD
Florida Department of Veterans' Affairs, Rear Admiral LeRoy
Collins, Jr., USNR (Ret.), Executive Director, statement....... 70
Stearns, Hon. Cliff, a Representative in Congress from the State
of Florida, statement.......................................... 70
MATERIAL SUBMITTED FOR THE RECORD
Hon. Michael H. Michaud, Chairman, Subcommittee on Health,
Committee on Veterans' Affairs, to Hon. Eric K. Shinseki,
Secretary, U.S. Department of Veterans Affairs, letter dated
June 3, 2009, and VA Responses................................. 72
U.S. DEPARTMENT OF VETERANS AFFAIRS
MEDICAL CARE: THE CROWN JEWEL
AND BEST KEPT SECRET
----------
TUESDAY, MAY 19, 2009
U.S. House of Representatives,
Committee on Veterans' Affairs,
Subcommittee on Health,
Washington, DC.
The Subcommittee met, pursuant to notice, at 2:08 p.m., in
Room 334, Cannon House Office Building, Hon. Harry Teague
presiding.
Present: Representatives Teague, Snyder, Donnelly,
Perriello, and Brown of South Carolina.
OPENING STATEMENT OF CHAIRMAN MICHAUD, AS PRESENTED BY HON.
HARRY TEAGUE
Mr. Teague [presiding]. The Subcommittee on Health will now
come to order. I would like to thank everyone for coming today.
This Subcommittee on Health hearing will assess the U.S.
Department of Veterans Affairs' (VA's) responsibility to
conduct an outreach program to veterans of all eras, including
internal coordination that takes place between the Veterans
Health Administration (VHA) and other administrations of the
Department. We also seek a more complete understanding of the
VA's outreach efforts and strategies, as well as the funding
spent on these outreach activities.
Today there are over 23 million veterans who have served
this country. Of this total, the VA estimates that the number
of veterans enrolled in the VA health care system will reach
8.3 million in 2009, and that the VA will treat nearly 6
million of the enrolled veteran population. Six decades
separate the newest generation from the oldest generation, and
9 million veterans are over the age of 65. According to the
VA's Center for Minority Veterans, the minority veteran
population comprises approximately 15 percent of the Nation's
23.4 million veterans. Women veterans are included in these
minority groups as well.
This demographic data illustrates the sheer number of
veterans who stand to benefit from improved VA outreach
efforts. Additionally, it shows the importance of outreach
strategies which must be individualized to meet the unique
needs of subpopulations of veterans. For example, outreach
strategies for older veterans should differ from that of
younger veterans. Additionally, the outreach methods for rural
areas may differ from that of urban areas. The VA is also faced
with the challenge of developing effective outreach strategies
which are culturally competent and thus able to overcome
potential cultural barriers.
Briefly recounting the legislative history of enacted
legislation on outreach brings us to the Vietnam War. During
the Vietnam War, increased awareness of veterans not receiving
adequate information about health care benefits resulted in
Congress enacting the Veterans Outreach in Congress Service
Program, VOSP. To address this concern Congress charged the VA
with the responsibility of actively seeking out eligible
veterans and providing them with benefits and services. Under
the current law, the Secretary is responsible for advising each
veteran, at the time of discharge or release, of all benefits
the veteran may be eligible for.
Next, Public Law 107-14, the Veterans Survivor Benefit
Improvement Act, VSBIA, was enacted in 2001 to further expand
outreach to eligible dependents. This law also provided that
the Secretary ensure the availability of outreach services and
assistance through the internet, veterans publication, and the
media.
Finally, Public Law 110-389, or the Veterans Benefits
Improvement Act of 2008, was enacted last year. Section 809 of
this law gives the Secretary the authority to advertise in
national media.
Despite these legislative authorities, the VA has a self-
imposed ban against paid public advertising, including public
service announcements which was only removed recently in June
of 2008. Although the existing statute does not prohibit the VA
from conducting media outreach, the VA has only implemented a
single media campaign on suicide prevention to the
Subcommittee's knowledge. VA has struggled in the past with
effective outreach service. For example, pamphlets and other
outreach material are often located in the VA's own medical
center, which means that this important information does not
reach those veterans who do not already utilize VA's services.
Another example is a memorandum issued on July 18, 2002, by
the VA Deputy Under Secretary for Health for Operations and
Management to all Veterans Integrated Services Networks (VISN)
of the VHA prohibiting marketing geared toward increasing
enrollment. This was an effort to limit the fast growing demand
for health care services, which exceed the VA resources.
We also know that some veterans service organizations
(VSOs) accuse the VA of not providing outreach to veterans and
dependents in accordance with the law. Nearly 18 months later a
second memorandum was issued by VHA instructing the directors
to ensure that their facilities were in compliance with the
responsibilities outlined in the outreach program.
Clearly, these are serious issues deserving of this
Subcommittee hearing today. The Subcommittee looks forward to
hearing from the witnesses of the panel as we embark on this
important task of exploring effective ways to improve outreach
to our deserving veterans.
I now recognize Ranking Member Brown for any opening
statement that he may have.
[The prepared statement of Chairman Michaud appears on p.
37.]
OPENING STATEMENT OF HON. HENRY E. BROWN, JR.
Mr. Brown of South Carolina. Thank you, Mr. Chairman. I
will be brief. I know we have 9, 8 minutes and 55 seconds
before the votes are closed. When our servicemembers come home
from the battlefield they think about getting back to their
families and their civilian lives. Often they do not think
about connecting with the VA. Yet, the process of transitioning
back to the civilian world can be challenging for veterans and
their families. I am deeply troubled when I hear stories about
a veteran not knowing what services exist, where services can
be obtained, and whether they are eligible for those services.
Central to the mission of the VA is to reach out to make
every veteran aware of what services are available to support
them and assist them in using these services. That is why it is
so important that we are holding this hearing today to examine
how effective VA existing outreach is, and what more can be
done to ensure that our Nation's heroes know and have access to
the benefits and services they need and deserve.
It is encouraging that a high percentage of our returning
warriors are seeking VA for their health care needs than in any
previous war. I do want to commend former Secretary of Veterans
Affairs, Dr. James Peake, for the great strides he made to
improve outreach and the coordination of care for our veterans.
Under his strong leadership, the VA launched a number of
outreach initiatives, including lifting restrictions on
advertising to promote awareness of VA programs and services,
rolling out a new public service campaign about suicide
prevention, establishing the Combat Veterans Call Center to
telephone returning veterans to provide information about VA
services, opening new rural outreach clinics, and expanding VA
internet presence through YouTube, Facebook, and MySpace to
reach younger veterans.
I would like to thank all of the witnesses for taking the
time to appear before the Subcommittee today. I look forward to
hearing about issues you see and ideas you have for improving
VA's outreach, and relationships with the U.S. Department of
Defense (DoD), State, local communities, and private
organizations to help link veterans to VA services.
Thank you, Mr. Chairman, and I yield back my time.
[The prepared statement of Congressman Brown appears on p.
38.]
Mr. Teague. Thank you, Mr. Brown. At this time, we will
recess to go vote, and we will come back as soon as possible
after the votes.
[Recess.]
Mr. Perriello [presiding]. At this time I would like to
introduce the first panel. John Rowan, National President of
Vietnam Veterans of America (VVA); Reynaldo Leal, Jr.,
Operation Enduring Freedom and Operation Iraqi Freedom (OEF/
OIF) veteran and Representative of Iraq and Afghanistan
Veterans of America (IAVA); and Richard A. Jones, Legislative
Director of the National Association for Uniformed Services.
You may please take your seats. Thank you so much for joining
us today. Mr. Rowan, if you can please begin?
STATEMENTS OF JOHN ROWAN, NATIONAL PRESIDENT, VIETNAM VETERANS
OF AMERICA; REYNALDO LEAL, JR., REPRESENTATIVE, IRAQ AND
AFGHANISTAN VETERANS OF AMERICA (OEF/OIF VETERAN); AND RICHARD
A. ``RICK'' JONES, LEGISLATIVE DIRECTOR, NATIONAL ASSOCIATION
FOR UNIFORMED SERVICES
STATEMENT OF JOHN ROWAN
Mr. Rowan. Good afternoon, Mr. Chairman.
Mr. Perriello. Good afternoon.
Mr. Rowan. And thank you very much. It is good to see
everybody. We have submitted testimony which I will not read
verbatim. I would just like to say a few words about this
particular subject. And I had an opportunity to read my
colleagues' testimony and Mr. Michaud's testimony, and the
others. So I noticed that many of them are focusing on the
efforts by the VA to reach out to the newer veterans coming
back from OEF/OIF. And while we would agree that there has been
a lot of activity in that regard, and that certainly the VA is
doing a lot of effort to reach out to those veterans, we still
have some concern, even, about how effective that is. But we
must say just generally, for all the veterans that the VA is
supposed to serve, we believe they are doing a woefully
inadequate job.
Certainly for my veterans, the Vietnam Era veterans, and
even for the Persian Gulf veterans from 1991, war changed
somehow. And even if we go back to the World War II period, or
even World War I with the gassing of the veterans in World War
I, and of course in World War II we saw the atomic veterans.
But when it came along to Vietnam, we had strange exposures to
Agent Orange, for us. For the Persian Gulf veterans, of course,
had all of these crazy things going on between the sarin gas
and the oilfield fires, and depleted uranium shells, and it was
like a toxic wasteland over there, which seems to be hanging
around, by the way. From conversations that I have had with
some Iraq and Afghanistan veterans that seem to run into these
same situations. And of course, they have had other situations
added on with anthrax shots and other kinds of things.
The real problem is that most of us who walked off the
battlefield unscathed, and for some extent even those who may
have been wounded or hurt but went through rehab and felt like,
``Okay, I got wounded but now I have my prosthetic device, or
whatever, and I can move on with my life,'' did not realize
that 30 or 40 years later we could have, literally, diseases
affecting us from our exposure from 30 and 40 years earlier
that are literally killing us. Vietnam veterans are dying at a
very high rate. We have very high rates of diseases like
prostate cancer, diabetes, non-Hodgkin Lymphoma, and lung
cancer, and a myriad of other different cancers. The number of
diseases is becoming significant.
Because of this we created a Veterans Health Council. We
will get each one of the elected representatives here a copy of
this package. This Veterans Health Council is a group of health
care providers in the private sector, academic institutions,
advocacy organizations, some of our friends in the
pharmaceutical industry, and others who have come together to
try to explain to the private sector that 80 percent of the
veterans are being treated by them and not by the VA. And that
these veterans are basically going under the radar and they do
not realize that the person sitting across the desk from them,
the patient that they are talking to, the man or the woman, may
have suffered exposures from their military service that are
now impacting their health. Or, that because of those exposures
they need even more concern about certain areas of interest
such as Prostate Specific Antigens (PSA) screenings. PSA
screenings may be important to all us old guys that turn over
50, and for those of us who are even over 60, but it is really
important for Vietnam veterans. Because we are three times more
likely to get prostate cancer than our peers.
So it is because of those programs and those problems that
we are trying to create this program utilizing a Web site
called veteranshealth.org. And we have created some fliers that
we have worked with folks to reproduce. Not only to talk about
the Vietnam veterans but also to talk about the Persian Gulf
veterans and the OEF/OIF veterans. Because all of these
veterans need to understand that they need to look at things
many years after they get out. And so we would, we are really
concerned that the VA needs to be forced to do the outreach
that they say they do. And they need to talk not only to the
new vets going home but to those of us who have been home as
many as 40 years. And we are clogging the Veterans Benefits
Administration (VBA), frankly, as much as the new kids with all
of these service-connected disabled veterans.
And so frankly, we call upon you and your colleagues in the
Subcommittee to take a look at creating legislation in that
regard and we would certainly be happy to answer any questions
you may have. Thank you.
[The prepared statement of Mr. Rowan appears on p. 38.]
Mr. Perriello. Thank you very much, Mr. Rowan. Mr. Leal?
STATEMENT OF REYNALDO LEAL, JR.
Mr. Leal. Mr. Chairman and Members of the Subcommittee,
thank you for inviting me to testify today on behalf of Iraq
and Afghanistan Veterans of America the Nation's first and
largest nonpartisan organization for veterans of the current
conflicts. I would like to thank you all for your unwavering
commitment to our Nation's veterans.
My name is Reynaldo Leal and I served in Iraq as a Marine
infantryman with 3rd Battalion 5th Marines. And during my first
tour, I participated in some of the Iraq War's heaviest
fighting during Operation Phantom Fury in Fallujah. And after
that mission was complete, I assisted in securing the first
democratic elections in that city.
I was deployed for a second time 8 months after my first
tour and conducted counter insurgency operations along the
Euphrates River. As an infantryman, I did my job well and
performed my duties with honor.
When I was discharged from the Marine Corps in February
2008, there were two questions I feared the most. What was it
like over there? And, did you kill anyone? Anxious about
returning home, I delayed going back to South Texas for as long
as possible. I could not bear the thought of being around
familiar faces, and that fear led me to push away those who
cared about me the most.
As my wife prepared for the birth of our first child, I
struggled with flashbacks and painful insomnia, which spiraled
into a debilitating depression that alienated my family and
threatened my marriage. I knew that my wife was suffering as
much as I was and that I was not the same person she had fallen
in love with. Suicide was not an option for me. But every day
made me more and more anxious. It turned out I was suffering
from a devastating invisible wound, post-traumatic stress
disorder, or PTSD.
My struggle with PTSD left me dependent on the VA for
mental health care. And since there is no VA hospital close to
my home in Edinburg, Texas, I have to either travel 5 hours
each way to the nearest VA hospital in San Antonio or take my
chances at our local VA clinic. The lack of funding for a
permanent VA psychologist at this clinic pits me against my
fellow veterans of all generations for limited appointment
slots.
Unfortunately, my experience is not unique. According to a
2008 RAND study, nearly 20 percent of Iraq and Afghanistan
veterans are experiencing symptoms of PTSD or major depression,
but less than half are getting adequate treatment. PTSD is a
silent killer for this generation of veterans. Left untreated,
it has the potential to destroy marriages, careers, and in far
too many cases, lives. In January of this year, the U.S. Army
reported that 24 soldiers in Iraq and Afghanistan committed
suicide, a figure that surpassed all combat deaths in those two
theaters combined.
But numbers and statistics are only part of the picture.
This new generation of veterans is being left to fend for
themselves because of an antiquated system that cannot seem to
find a way to reach out to them. There are not any visible
outreach campaigns to get these young men and women through the
door of their local VA facility. When I was struggling with
PTSD, there was never a sense that the VA was trying to reach
out to me, or that anyone even understood. For me, there was
the Corps, and then there was nothing. I felt that I had been
abandoned and the fact that I had served my country honorably
meant nothing. I did not know about the claims system. I did
not know about the 5 years of medical care for Iraq and
Afghanistan veterans. And I did not know that there were others
that were going through the same situations that I was.
It was not until I saw IAVA's ``Alone'' ad on television
and joined communityofveterans.org that I felt someone was
trying to reach out to me. It is the responsibility of the
Federal Government, and the Department of Veterans Affairs, to
make sure every veteran feels this way.
But are we doing everything we can to reach out to the
veterans who have done so much for us? The VA has taken some
important steps, especially setting up suicide hotlines, but
the answer is still no. We owe it to our veterans to provide
the best mental health resources available and currently we are
falling too short of that goal. By fully funding the VA health
care budget 1 year in advance, we could provide a simple
solution that would give VA hospitals and clinics across the
country the ability to provide stable care for decades to come.
With the ability to plan ahead, these hospitals and clinics
could meet critical staffing and equipment needs so that
veterans like me are not left waiting. President Obama recently
reiterated his support for advanced funding of the VA health
care and we are glad to hear it. With the strong support of the
President, and bipartisan leadership of Congress, advanced
funding can and must move forward this year.
Real action cannot come at a more critical time. As we saw
just last week with the tragic events of Camp Liberty, our
servicemen and women are under an incredible strain. As a
Nation, we must have the same emphasis on giving our veterans
the necessary tools to readjust to civilian life as we have in
giving them the tools to survive in combat.
Make no mistake about it, the veterans of this country want
nothing more than to become successful and productive Members
of the society we fought so hard to defend. Thank you.
[The prepared statement of Mr. Leal appears on p. 40.]
Mr. Perriello. Thank you so much for your service to this
country, and for your service to this Committee today, with
your testimony. Mr. Jones.
STATEMENT OF RICHARD A. ``RICK'' JONES
Mr. Jones. Mr. Chairman, Members of the Subcommittee, on
behalf of the National Association for Uniformed Services I am
pleased to be here today as you examine the veterans health
care system and its outreach to veterans. Your work is critical
to ensure that VA outreach strategies bring the best possible
care to returning troops, and a seamless transition to their
well-earned civilian life.
Approximately 6 million veterans annually come to VHA for
all or part of their personal health care. With the draw down
of troops from the battlefield of Iraq, VA is likely to face
increased enrollments. Through the last quarter of fiscal year,
for example, 2008, over 400,000 Operation Enduring Freedom and
Operation Iraqi Freedom veterans have used VA. And with passage
of Public Law 110-329 last year, VA likely will have expanded
enrollment of newly eligible veterans. Those are the Priority 8
veterans.
As we work toward enrolling these qualified veterans, who
desire to do so, into the VA system, we must ensure that all
veterans returning from combat areas are aware of, and if
possible already signed up for, their 5 years of VA medical
care. We recognize, however, that some long-term health
conditions, such as post-traumatic stress disorder or Traumatic
Brain Injury (TBI) may not manifest conditions until many years
later. Therefore, we encourage further opening of access to
sick and disabled veterans beyond the current 5-year allowance.
Recent Congressional successes in providing increases in VA
spending present the Department with an opportunity to advance
an awareness of VHA accessibility and a readiness to meet
health care needs. We applaud all that has been done to date.
However, we can do better. In some cases, a successful outreach
can be a matter of life and death. Veterans need to hear that
VA is part of our Nation's commitment to them. They need to
hear that with appropriate care they can tackle stress and get
themselves back on track.
Of course, there is financial cost to improve outreach. But
if we do not make the investment and we do not make veterans
aware of the benefits and services available to them, there is
a hidden cost in lives lost, families disrupted, long suffering
and homelessness, stress, and related problems for decades to
come. We have learned that over the years. The Persian Gulf
effort is one of those lessons.
We urge the Subcommittee to continue its excellent work
with other champions in the Congress to ensure resources are
ready, not only for the provision of a veteran's earned benefit
but for the veteran's awareness of these services as well. It
is important that we do so. After all, these brave men and
women have shouldered a rifle, risked everything to accomplish
their mission and protect freedom and our own country from
harm.
As you know, Mr. Chairman, these brave men and women did
not fail us in their service to country. They did everything
our country asked and more. Our responsibility is clear. We
must uphold our promises and provide the benefits they earned
through honorable service in the military. Mr. Chairman, you
and your Members of the Subcommittee are making progress. We
thank you for your efforts and look forward to working with you
as you work to protect and strengthen and enhance the benefits
that we provide these great men and women. Thank you very much.
[The prepared statement of Mr. Jones appears on p. 42.]
Mr. Perriello. Thank you, Mr. Jones, for being such a great
resource and advocate with this Committee, in helping us
understand ways that we can certainly improve and continue to
hold feet to the fire and make sure we are reaching out to
folks.
Mr. Rowan, you referred to the outreach as being woefully
inadequate. And Mr. Leal, your story in many ways both captures
everything wrong and also captures some hope. Wrong in that no
one was reaching out to you at first. Hope in that that IAVA ad
was able to reach you. I have seen those ads; they are
powerful. I have talked to returning OEF/OIF veterans in my
district about those and other ads.
The first question I have is, while we know the woefully
inadequate side is there, what are the success stories we need
to build on? What are the most successful examples of outreach
that we need to be taking to scale either through the VSOs or
directly through the communications of the VHA?
Mr. Leal. Well, I think from the young veteran's
perspective, IAVA and their ad campaigns, and
communityofveterans.org, which is sort of like a Facebook for
veterans, it really brings out what we do. We do not go to, at
least the young veterans that I know, we do not go to halls, we
do not do things that way, not this generation, not that it is
a wrong way to do it. But we just do not, we communicate
through the internet. We communicate through networks, through
network sites and different things like that. So the fact that
IAVA went electronically, they went out in the internet and
they went out in TV ads and did their outreach in that way,
really helped bring these new generation of veterans, these
young veterans, and let them know that there was somebody out
there for them. And let them know that they were not alone. And
I think if the VA can look at somebody, or an organization, to
try to outreach to young veterans, it would be IAVA and what
they are trying to do today.
Mr. Perriello. And a quick follow up before we go to Mr.
Rowan. Is your sense that those are going to be better run in
terms of tone, and a type of engagement, if they are
independent but supported by the VHA? Or would you encourage
that kind of online outreach, including the social networking
functions, within the VHA itself ? Do you think that these
organizations are going to be better able to build that kind of
networking?
Mr. Rowan. Well I would think that even some of us old dogs
learn some new tricks. And you would be surprised. It is
amazing to me how many of my members have Facebooks and all
kinds of things, and do use the internet. And, as I said, we
created a Web site called veteranshealth.org. We are hoping to
reach out and get our members, get veterans out in the public
sector out there to reach out to learn about the illnesses that
affect them from all the recent wars.
IAVA did a wonderful program. The thing is that the VA
should have doing that program instead of IAVA. I mean, they
were just lucky enough that someone was willing to give them a
grant, and they were able to produce a very nice public ad that
certainly has reached out to their colleagues. It is just sad
that they had to rely on public sector, private-sector
donations to do that. Meanwhile, the VA spends billions on
health care, does nothing on outreach. And we think that is
wrong.
And we think we need to reach out to our veterans. When we
talk about suicides, I still have Vietnam veterans committing
suicide. And we would, nobody knows how many Vietnam veterans
killed themselves within the first few years after the War. I
know personally, one of my things that I always say, I knew
more people who died after the War than in the War. And a lot
of that had to do with drug abuse but a lot of that drug abuse
was fueled by PTSD. And was really trying to kill themselves in
other ways.
So I would just encourage, again, as part of our ideas of
getting some sort of legislation out there, some sort of
funding, either through the VA directly or by the VA through
VSOs or community-based organizations, to do the kind outreach
we need to reach out to all the veterans, whether they came
home 40 years ago or 40 days ago. It does not really matter.
Mr. Perriello. Mr. Rowan, following up, the VA has
discussed their collaboration with veterans services
organizations, an effort aimed at expanding their outreach, has
the VA really been working with the Veterans Health Council?
Mr. Rowan. No.
Mr. Perriello. Following up on that, what would you say is
your vision of a comprehensive VA outreach effort? What does
that dream, comprehensive effort look like?
Mr. Rowan. Well, I think we need a couple of things. We
need to talk about educating medical personnel, both inside the
VA and in the private sector, about veterans health-related
issues. Getting them to understand they have to ask the
question, ``Did you serve in the military?'' of men and women,
of course now today given the high percentage of women. And
then depending on the answer, have to then ask follow-up
questions depending on where they served, when they served,
what kind of work they did, how much they could be affected by
PTSD, for example. All of those things that a doctor should ask
of anybody. When they ask you, for example, what did you do for
a living? If you may have been exposed to certain asbestos, or
something, if you were in a particular line of work. Or worked
in an area that was really polluted, or secondhand smoke. Just
like any other patient they need to ask those veterans, the 80
percent of them that are sitting today, going to a private-
sector physician, who I guarantee never asked them the question
and in their patient history has no questions about military
service. That is what we need to do. And the VA needs to do
that. And inside the VA, frankly, they need to do that better.
They need to do the patient history that they do not take as
well as they should. So even inside the VA they do not ask
enough questions about combat exposure, for example.
Mr. Perriello. Mr. Jones, similarly to you, when you think
about what a comprehensive VA outreach effort could look like,
the gaps that are not being filled right now, what do you see
as part of that vision?
Mr. Jones. Well, I hate to look backward into history but
there was a time at the VA when there was an enormous number of
folks who were enrolling in the Veterans Health Administration
that had to be cut off. That cut, when they made that ban and
prohibited certain veterans from seeking service in the system
that was developed for them, has sent a shock signal into the
veterans community. That has to be overcome. But we still
recognize that today, though, VHA serves uniquely some 6
million veterans, nearly 8 million veterans are enrolled in the
system. So at one point, VHA was doing a credible job of
reaching out to veterans and letting them know about the
availability. But recent decisions within the past decade have
put a dent in that message. That message has to be recaptured
and that would be my vision. I think the VHA, the medical
centers, have done an extraordinarily good job in the past, but
they have been handcuffed in the most recent past from
searching out veterans and doing it through the stand downs
that contribute to bringing veterans in from their
homelessness. These are areas where VHA and the Veterans
Affairs have been most helpful in making veterans aware of the
services provided in the health care system.
Mr. Rowan. I would like to add something to that, too,
about the Category 8s, which I think is extremely important.
Yesterday's zero-connected disabled veteran may be tomorrow's
service-connected disabled veteran. And I am the classic
example of that. I had, I never had a service connection, ever,
when I walked away from the Air Force 40-some odd years ago.
But I am now a 90 percent disabled veteran because of diabetes
related to my connection to Agent Orange, having served in
Vietnam, and my neuropathy, and other secondary conditions. So
I went from a zero to 90 overnight, at the age of, it should
have been 48, by the way, which is when I first got diagnosed
with diabetes. But it was not until I was almost 58 when they
finally gave it to me as a presumptive disease. So that was a
big mistake, as was pointed out earlier. Because if they stay
in the system, and they should be aware of things. But even
then, I, when I was doing service rep work, had clients who
were being treated by the VA for diabetes, who were Vietnam
veterans, and the VA never told them, ``By the way, go file a
claim for a service-connected disability.''
Mr. Perriello. In terms of the outreach that is going on
right now, there is a certain amount of urgency in the sense
that, in the Vietnam era, people were not treated early and
cases became exacerbated because of the lack of care. Given the
urgency with the folks coming home, what are the programs that
are easiest for us to take to scale right away in terms of
getting that outreach going right now?
Mr. Rowan. I will just add that I think that one of the
programs that we have seen that is starting to reach out is
reaching out again into the private sector, particularly in the
mental health community. The other thing is we need to talk
about the whole picture, of the family of these veterans. Many
of these veterans today, unlike my generation when most of us
were single, most of them today are married. A lot of them have
children. You need to have a family practice, almost, to deal
with the mental health issue that is occurring. Because it is
not just the veteran. It is the veteran and the impact to their
family. It is the wife or husband, for that matter, who has
been sitting home for a year, dealing with all the family
issues, etcetera. It is the children who are dealing with an
absentee parent for a year. And also, coming home with, you
know, Daddy or Mommy who is not quite the same as when they
left. And so the idea of working with community-based mental
health programs, and taking care of the whole family picture,
would go a long way to doing that. Especially with the fact
that so many of these veterans today are from the rural
communities. And as Sarge said here, he had a tough time
finding one near him because of rural Texas. It is a hard
place, and rural upstate New York is in the same ballpark. Or
Montana. Everywhere you go. Arkansas. You got it, it is going
to be a tough time finding help.
Mr. Perriello. Well I have a lot of rural Virginia in my
district and we have similar issues. Let me just ask one last
question, Mr. Leal, to you. You know, coming from the ``just
say no'' generation myself, there is a big difference between
the effectiveness of the early anti-smoking ads that were
written by adults and the later truth campaign ones written by
actual teenagers in terms of effectiveness. How much of the
problem right now is that we are simply not getting the message
out? How much of it is that the message is not being written in
a way that really connects with the younger generation of
veterans? Do we do a good job of getting the message out, we
just need better message delivery? Or is it both?
Mr. Leal. I think it is a little bit of both. It has to be
better. If your only message trying to get out to this
generation of veterans is written on a pamphlet that is inside
the VA clinic, how are we ever going to get it? How are we ever
going to find it? How are we ever going to know about it?
Unless 1 day somebody comes up to us and says, ``Hey, you need
help.'' And by that time, where are we? In what position are we
by that time when somebody actually approaches us and says, you
know, ``Ray, you are not the same guy I knew before you left.''
Is that, that is the point where we have to actually go into
the VA, where we see that it has been enough. And that is where
we find the pamphlet. It cannot be that way. It cannot continue
that way. It has to be, it has to be before we go, when we come
back, and everywhere in between. We have to be, there has to be
something there to remind our veterans and to remind us that we
are still, we are wanted and that people understand where we
are coming from. And that there are programs out there to help
us. Without that, you are going to continue seeing what you are
seeing. If you continue to write pamphlets that are inside the
facilities where we will never be able to see them unless we
go.
Mr. Jones. The best institutions that are ready, shovel
ready so to speak, for making veterans aware of the system are
the veterans, the health care system itself. But there must be
incentives there. What incentive is there for a medical care
center to reach out to the veterans community to bring in
additional veterans if they themselves are already stressed, if
they lack doctors, if they lack the care, if they do not have
the ability to hire caregivers. You need to get the hiring in
place and to assure these communities that you will back them
up. That the resources will be there if they will help make
veterans aware that the system is ready to help them.
Individuals serve the system. And individuals, if you just
pack too many demands on top of them, will break. So you have
to have additional resources and personnel to reach out to
veterans as well. The best system in place now to do the job is
the veterans health care system. They can do a great job but
they lack the incentive, until they have the resources in
order. Now, Congress has done a terrific job over the last 3
years in pumping up the resources and making veterans and
veterans health care a priority to this Nation. We applaud you
for that. So perhaps those resources are there. But I do keep
reading about doctor shortages. And those doctor shortages are
not only lacking in the overall community but they are missing
in the veterans health care system as well.
Mr. Leal. If I may say something about that, sir? That is
exactly why advance appropriations is so important. If we
cannot even make sure that we have enough people to take care
of these veterans that you want to outreach to, where is the VA
going to be? How can they, how can they set money aside to
outreach if they cannot even set money aside to make sure that
there are two more psychologists at my clinic? I think that is
important. That is why advance appropriations is so important.
If you force the VA to outreach and they just continue to, I
guess, shred medical records because they are getting all these
people coming in and they cannot really adequately treat them,
we have to see that it is more than just outreach. It has to be
an overarching strategy to make sure that everyone gets the
care they absolutely need.
Mr. Perriello. With that, let me turn to my colleague Mr.
Snyder and see if he has any questions for the panel.
Mr. Snyder. Thank you, Mr. Chairman. I will just ask one. I
know we got behind with votes and you have other panels. If I
am trying to sell cars, I figure my best target to sell cars is
the family that walks into my car dealership. It costs me a
whole lot more money and a whole lot more effort to try to
reach the person that is raking the leaves in their backyard,
and I am trying to catch them with a radio ad or that night
watching TV and they are falling asleep. How much of this
burden on outreach do you think should be on the military while
the family is still in the military, in terms of informing them
about veterans and veterans benefits, and what is available out
there for them, versus how much should the burden be on the VA
health care system after the veteran is out?
Mr. Jones. Clearly the military system is an important
element in making future veterans aware of what is available.
The screening must occur. There must be, we would like to see a
better screening of individuals as they leave.
Mr. Snyder. Right.
Mr. Jones. We would like to see more information provided
to families of what to look for with regard to various symptoms
that may lead toward discovery of problems in health. So the
families need to receive an awareness package of some sort. I
am not sure exactly how families are brought into this
transition, because the transition is usually military
deployment to the demob base, and you are gone, you are out.
And in instances of National Guard, you are far away from your
family when that demob occurs. So I am not sure exactly how
that works. But you are exactly right. The family needs to know
what the symptoms are so they can help the individual that they
love get back on track.
Mr. Rowan. I would add that that is true. And I think that
they, the military, plays a heavy role. And we keep talking
about the seamless transition issue, which would take the
health records right out of the military into the VA. But the
real problem still gets to be with this exposure question that
often does not manifest itself until years later.
I recently had a cousin of mine who is an Iraq veteran. He
is 42 years old. He was a seabee reservist, did two tours in
Iraq. And he has now got a Hodgkin's Lymphoma in his shoulder
that he believes may be related to toxic exposure that he had
dealing with toxic waste sites. Now that did not occur until 2
years after he was already back home, sitting back to work,
back in his civilian life, you know, going to some meetings
once in a while. But if he does not, if we do not have a
continual education process over time they are not going to
understand the connection between their military service and
some of these things that do not manifest themselves until much
later. And that is certainly true, it is obviously way too late
for all of us Vietnam veterans, and even the Persian Gulf
veterans. I mean, they are long out. Even the ones who were,
many of them who may have been, you know, people who were, you
know, 20-year and 30-year personnel, many of them are all still
gone now. There is no Vietnam vets left hardly in the military,
and there are very few even Persian Gulf vets left.
So it is a big issue, still. And so while the seamless
transition thing is a good thing, and certainly a major
improvement over our day, and certainly made simpler, perhaps,
by the utilization of computerization, it still does not get
past the point, we still have to do a continuing education
process.
Mr. Snyder. Thank you.
Mr. Perriello. I want to thank you all for your expertise,
for your time, and for your service. Again, we really
appreciate all the ideas you have brought to us. This is an
urgent issue and we hope to be able to move forward on this and
make a difference in the lives of those who have served our
country. So with that, I dismiss the panel with our thanks.
Now let me call the second panel. Bruce Bronzan, President,
Trilogy Integrated Resources; Barbara Van Dahlen Romberg,
Founder and President, Give an Hour; John King, Co-Director,
Veterans Community Action Teams Mission Project, Altarum
Institute; Randall L. Rutta, Executive Vice President, Public
Affairs, Easter Seals; Jeffrey W. Pollard, Ph.D., Director of
Counseling and Psychological Services, George Mason University,
American Psychological Association (APA); accompanied by
Michael Johnson, Military and Veterans Liaison, George Mason
University.
Mr. King, we will begin with you.
STATEMENTS OF JOHN KING, CO DIRECTOR, VETERANS COMMUNITY ACTION
TEAMS MISSION PROJECT, ALTARUM INSTITUTE, ANN ARBOR, MI;
BARBARA VAN DAHLEN ROMBERG, PH.D., FOUNDER AND PRESIDENT, GIVE
AN HOUR, BETHESDA, MD; BRUCE BRONZAN, PRESIDENT, TRILOGY
INTEGRATED RESOURCES, SAN RAFAEL, CA; RANDALL L. RUTTA,
EXECUTIVE VICE PRESIDENT, PUBLIC AFFAIRS, EASTER SEALS, INC.;
AND JEFFREY W. POLLARD, PH.D., ABPP, DIRECTOR, COUNSELING AND
PSYCHOLOGICAL SERVICES, GEORGE MASON UNIVERSITY, FAIRFAX, VA,
ON BEHALF OF AMERICAN PSYCHOLOGICAL ASSOCIATION; ACCOMPANIED BY
MICHAEL JOHNSON, MILITARY AND VETERANS LIAISON, GEORGE MASON
UNIVERSITY
STATEMENT OF JOHN KING
Mr. King. Thank you, Mr. Chairman, Mr. Snyder, staff. We
appreciate the opportunity to testify to you today. With me
today is Dr. Lauren Thompson. She is a Deputy Group Director
and a corporate sponsor of an innovative initiative titled
Veterans Community Action Teams. I will further describe that.
We call it VCAT. I will describe that in my testimony. Mr.
Lincoln Smith, the Chief Executive Officer of Altarum Institute
sends his greetings and regrets he could not be here with you
today. He applauds your leadership in taking care of veterans
and their families.
Altarum is a nonprofit health systems research consulting
organization serving public and private clients. The Institute
combines research and analysis with business acumen in
providing comprehensive systems-based solutions for complex
problems. Altarum is a nonprofit health systems research
consulting firm. Last year they initiated three mission
projects and committed $8 million to address childhood obesity,
to foster innovations in community health centers, and to
develop veterans community action teams. Since 2002, more than
870,000 servicemembers have transitioned from active duty to
veteran status. They have joined the ranks of 23 million
veterans. The multifaceted needs of both young and older
veterans have created large service requirements on the
Veterans Health Administration. We commend the VHA for their
valiant efforts to improve access while maintaining the high
quality of care that veterans deserve. However, we believe that
no one entity can solve the complex problems of outreach to
improve access to VHA services.
Altarum's focus through the VCAT project is to build
integrated community-based service networks to strengthen the
safety net for veterans and their families who are experiencing
issues and/or suffering the invisible wounds of war. We strive
to complement the efforts of VHA by building bridges for well
integrated community service providers to the national level
VHA providers. We envision VHA's outreach as a top down effort
and the integrated community providers' outreach efforts as a
bottom up.
We know that VHA uses the media, web-based tools, and holds
public events to encourage access to their medical centers,
CBOCs, and veteran centers, and more. Veterans and their
families often seek a wide range of community services when
they need assistance. They go to churches, community health
centers, housing authorities, public assistance, and many other
services. The coordination, collaboration, and integration of
these service providers focused on the immediate needs and the
rights and benefits of the veterans community will complement
VA's best efforts.
The VCAT project will develop a collaborative community-
based model to integrate the outreach and delivery of services
for veterans and their families. The project will test this
model in selective pilot communities to demonstrate the value
of community-based system of care for improving accessibility,
scope, and quality of services available to veterans and their
families.
The strategies employed to connect the current generation
with services needs to be different than those used with past
generations, because the methods by which this new population
receives and processes information is vastly different.
Consistent with the previous testimony of Mr. Leal, and efforts
of IAVA, we agree that networks of service providers must
connect in like manner to the communication and social networks
of the younger generation.
Altarum recognizes the Nation's indebtedness to the
families of our country's defenders. As mentioned before, the
sacrifices of families are much greater than the general public
either understands or appreciates. The well-served, well-
informed family is better able to survive and thrive, and to
assist their veteran Members when in need.
While our overarching goal is to improve the lives of
veterans and their families, it is also our hope that the model
we develop and the lessons we learn from our demonstration
project will help inform other communities. Ultimately, we
would like the VCAT model of community-based service
integration to be replicated in other communities across the
Nation. We hope to serve and share with you the lessons we
learn and offer policy and programmatic change that may lead to
increased outreach and access to all benefits and services for
veterans and their families.
Thank you. That concludes my comments.
[The prepared statement of Mr. King appears on p. 52.]
Mr. Perriello. Thank you, Mr. King. And my apologies for
the personal disruption. Next, we will be going to Dr. Van
Dahlen Romberg.
STATEMENT OF BARBARA VAN DAHLEN ROMBERG, PH.D.
Ms. Romberg. Good afternoon. Thank you for this opportunity
to provide this testimony. As the founder and president of Give
An Hour, a national nonprofit organization providing free
mental health services to our returning troops, their families,
and their communities, I am well aware of the many issues that
now confront the men, women, and families within our military
community.
Our Nation is confronting an emerging public health crisis.
Since the conflict in Iraq began, nearly 1.9 million
servicemembers have deployed. Many of these men and women have
deployed more than once, some as many as four or five times. As
those who have fought will attest, everyone is changed by the
experience. Some suffer physical wounds that require medical
attention. Others suffer wounds of war that are not always easy
to see. As a Nation, we must provide comprehensive, long-term
care for all of those affected by their experience of combat,
and we must embrace the reality that combat stress and other
psychological consequences of war are normal human reactions.
VA funding for the past 4 years is at unprecedented levels.
We cannot assume that more money, more staff, more outpatient
clinics, more Vet Centers, more clinics on wheels, and more
organizational restructuring will enable the VA to meet the
mental and physical health care needs facing this generation of
combat veterans. This is a public health crisis that will take
more than extended outreach. If returning troops are to truly
and successfully reintegrate into our communities, then our
communities must be involved in the solution.
The issue is bigger than the efficacy of the VA's current
outreach efforts. The issue is, how can we systematize a broad
range of services to sustain care for our veterans over the
long term? Further, it is impossible to discuss this issue
without also discussing DoD's response to the men, women, and
families who serve. While the VA and DoD operate as if there
are two populations that require care, military personnel and
veterans, there is really just one. Too many returning warriors
get caught between the two systems and fail to receive the care
they need, when they need it.
No single agency, organization, or sector can adequately
care for our returning warriors. I am proposing the development
of a new kind of public works project and have outlined the
support for such a program in great detail in my written
statement. The need is clear: over 300,000 men and women have
already returned from Iraq and Afghanistan with symptoms of
severe depression or post-traumatic stress. Over 320,000 have
suffered traumatic brain injuries. The Army calculates the
current suicide rate is the highest in its history, a rate that
is higher than the civilian rate. Seventeen percent of soldiers
returning to War for another tour could have a traumatic brain
injury. Many of our returning troops turn to substance abuse to
ease the pain of wounds that they cannot see and they do not
understand. Good kids end up in jail for crimes that no one
believed them capable of committing. Divorce is on the rise in
the military community, with about one in every five married
servicemembers filing for divorce since 2001.
There is a tremendous need for a full range of easily
accessible mental health services for our veterans. Many live a
great distance from formal VA services and many are reluctant
to seek mental health services because of a perceived stigma.
We need to develop additional education and treatment programs
for servicemembers who suffer traumatic brain injuries. We need
to develop programs that support employers who want to hire
veterans, as well as veterans who want to be productive members
of society. We need to develop programs specifically focused on
the unique needs of women who serve, including programs that
treat victims of sexual assault. We need to develop programs
that train police, fire fighters, paramedics, and judges about
veterans and the issues that come home with them.
Our military culture promotes pride and inner strength
along with self-reliance and toughness. Only through education
and practice can veterans learn to face their fears and work
through the understandable pain associated with the experience
of war. Systems charged with providing care for those who
serve, including the VA and DoD, have failed in their efforts
to reach those in need. Both DoD and VA have been reluctant to
forge critical relationships with community-based organizations
that have developed over the last 6 years. Opportunities have
been missed for innovative collaborations that could have saved
lives and healed families.
The best solution is a new kind of public works project. We
need a system that can streamline and simplify the process of
providing and receiving all manner of care for returning
warriors and their families within their own communities. We
need a plan that ensures our communities are able to assist and
support veterans and their families so that their lives are
working for them. In 1933, the Public Works Administration in
an effort to heal our Nation's Depression-ridden economy. The
goal was to heal our economy and ensure that our citizens were
free to lead productive lives. Now we need to design and
implement a similar public works project for the 21st century
that will weave together the resources needed to heal our
military community and ensure that our military personnel are
free to lead productive lives.
But what do we need to do first? Bring together individuals
representing organizations and entities that interact with
veterans and military personnel. Form a group with these
representatives to study efforts currently underway, including
innovative and successful community programs. The primary task
of this group will be to develop a plan that will serve to
guide our communities throughout the country in their efforts
to coordinate care. This group can assist with the
implementation and the metrics needed to understand the success
of this program.
We have the resources, we have the vision and the
commitment to ensure that our veterans and their families
receive the care they need and deserve through a new kind of
public works project. Thanks to the efforts of dedicated people
working in and across our country we have the potential to
create this based on these organizations so that we can provide
comprehensive long-term care to those who serve our country.
This is a historic and unique opportunity to harness our
Nation's resources and care for our military community. Thank
you.
[The prepared statement of Dr. Van Dahlen Romberg appears
on p. 46.]
Mr. Perriello. Thank you very much, Doctor. And now, Mr.
Bruce Bronzan.
STATEMENT OF BRUCE BRONZAN
Mr. Bronzan. Thank you very much, Mr. Chairman and Members.
I am Bruce Bronzan. I was a Program Director for Mental Health
at the county level, and then a County Supervisor, and a
California State Assemblyman with a 20 career in politics. I
chaired the Health Committee and the Mental Health Committee.
When I left elective office, I formed a partnership with Afshin
Khosravi, who is behind me here in the audience, and we worked
with the State of California with pilot projects called the
Network of Care to try to do something different at the local
level. Specifically, how do we get people more aware of all of
the services that are available to them, regardless of the silo
funds that connect to a given agency, Federal, State or local.
The other way of looking at it is how do we connect a community
more to the people in need within that community? There is
actually a form of community organizing, county by county in
the State of California.
This project called the Network of Care turned out to be
quite successful. A Network of Care for mental health was
developed almost 8 years ago. It spread all over California
almost instantly, and then around the United States. And now it
is in almost 30 States and some 500 locales. The Network of
Care in aggregate reaches some 65 percent of the United States
population and manages a total of 127,000 services that it
serves up to people locally, in their own community.
During the work on the Network of Care for mental health we
became acutely aware of the severe strain that is being
exhibited by both community mental health, DoD, and VA services
for the returning soldier. And we were asked some time ago by
Congressman Kennedy and Congressman Farr, friends of mine, and
a number of veterans leaders and mental health leaders across
the country to do one specifically for veterans. After 3 years
of work, the first two State/national models are ready to go.
Maryland's has been launched about 4 weeks ago under the
leadership of Lieutenant Governor Anthony Brown, who himself is
the highest ranking elected official who is an Iraqi veteran.
And this Friday at noon, in California, Governor Arnold
Schwarzenegger will launch the California version of the
Network of Care in each and every county in both States.
So what I am here to show you is something very different.
I know, Mr. Chairman, the title of this hearing. But what we
are going to show you, and have been asked to show you, is
something different. And that is, rather than looking at
outreach through the lens of any given silo funded agency, look
at outreach through the lens of a veteran and their family and
what they need in the community in which they reside. It is a
different model, but it is quite exciting. If we could turn on
the screen? Okay.
[Slide.]
Mr. Bronzan. What I am going to show you is the Los Angeles
version, which is going to be officially launched Friday but
you will see it ahead of everybody. This, by the way, in both
Maryland and California, was a process that was quite
extraordinary. The veterans community and military leaders
reached out across the space to the mental health community,
and they joined hands to try to do something important
regardless of their agencies' parochial interests for the
veteran. And I think you will see it had remarkable results.
On this homepage you see Governor Schwarzenegger,
Lieutenant Governor Brown will also appear in a couple of days
on the Maryland site, but I could just play a moment here for
you. Do we have sound? Oh, we do not. Oh, do not worry.
Okay, well what he does is he gives a greeting saying how
important it is for us to pay attention to the returning
soldier and how they cannot be neglected, and that we have to
reach out as members of a community to anyone that returns from
War. These other tour guides are all veterans from different
conflicts, different theaters of war, different backgrounds.
Each one of them explains, as a veteran to a veteran, why it is
important to use certain portions of the site. For example, the
Vietnam veteran here, a good friend of ours down in San Diego,
explains that when you are in crisis, you need help, it is okay
to seek help and to deal with whatever situation you are facing
right at that moment. Andre here, another good friend of ours
from another part of the State, the Bay Area, talks about the
fact that there is no shame in seeking shelter if you do not
have it. Do not sleep out under the bridge, get some help. They
direct the veterans who, or their family members who come to
the site, to these buttons right here as the most important
services that the site offers.
With one click, this is every single crisis intervention
that is available, regardless of agency, in their own
community, community by community, starting with the suicide
prevention hotline. Relative to homelessness, it is every
single shelter and homeless provision in their own community,
with one click. Relative to employment assistance, there is not
only every single agency that serves veterans relative to
employment, we have a partnership with VetJobs, a remarkable
organization, headed by a veteran himself. And what we do is
collaborate with this organization. They seek out jobs that are
available to veterans, specifically for veterans. And what we
do is bring it into each individual local community. So a
veteran can choose a particular category, click search, and
what is brought up into this window are the actual specific
jobs that are currently, that day, available to veterans that
they can find in their own community. It is quite a remarkable
service. To the best of my knowledge it has never existed in
our history before.
Last, the fourth button that is on the homepage connects
the person with whoever their county veterans services officer,
often people extremely knowledgeable in helping them navigate
the system. However, many of our returning soldiers simply do
not know who they are or how to contact them. We put the name,
the address, the phone number, and the email address with one
click.
Relative to the rest of this homepage, there is community
announcements. We allow, we give a tool to the community mental
health director as well as the veterans service officer where
they can post up information directly, 24 hours a day, to their
own community. Nationwide news from around the country, we cull
through about 2,000 periodicals and post the top articles up
every single morning at 6:00 eastern standard time. Exquisite
translations that are both hand and culturally perfect, as well
as audio/video presentations of those translations for family
members who may not have literacy in a given language.
The main content of this site is in these huge portals
here. By the way, in spite of the fact of it being rather clean
and simple looking, these are very, very deep sites. This took
a great deal of work locally. The site you are looking at is
about 250,000 pages deep. There is about 3 million lines of
code that run it, and it is upgraded every single day. In the
service directory, the service directory is every single
service, Federal, State, and local, every not for profit,
community-based organization, non-Government organization at
the Federal level, every single thing in the United States and
in that community. If you notice the search engine, it does not
really care what agency it is from, what silo fund, or what
bureaucracy it belongs to. It goes by what a person needs. So,
as you drill down into these categories, you find everything
that is relative to that particular concern and it is refreshed
on a regular basis.
When you get to an actual file, with one click you could
drop that file into a personal health record. In the library
section-oh, by the way, I am really sorry, I want to show you
this. Just before we got started, we were approached by
Military OneSource and a variety of organizations that formed
together to form a joint family assistance program. We said,
``We would be glad to help you. What is the situation?'' They
said, ``Well, we have great programs but nobody knows we
exist.'' Which is something that we have heard all over the
country. So what we have done is integrate their information
into, with one click, into this site. And here are all of these
family support programs with 24-hour hotlines and for the first
time they can be broadcast into each and every local community
for people to find that they are there.
The library function is a huge library. It took a great
deal of Maryland's and California's money to build it. It has
4,000 topics and some 35,000 separate articles. If you were to
print it, it would be about 50,000 pages long. And if you were
to print it, it would be that long. And it is refreshed four
times a year.
Mr. Perriello. Can you wrap up in the next 30 seconds?
Mr. Bronzan. Yes, thank you. We have a full blown social
networking program that is commercial free, a legislative
advocacy tool, every assisted device that is made in North
America, every link in the United States that is not-for-profit
or Government sponsored, some 20,000, and a full blown HL7
certified personal health record that is a consumer-based
record, not a provider-based one. Thank you, Mr. Chairman.
[The prepared statement of Mr. Bronzan appears on p. 45.]
Mr. Perriello. Thank you very much. Mr. Rutta?
STATEMENT OF RANDALL L. RUTTA
Mr. Rutta. Sure, thank you, Mr. Chairman. It is a pleasure
to be here today to speak on behalf of Easter Seals. Easter
Seals, like the VHA, actually has a significant interest in
helping our veterans, particularly veterans with disabilities.
We are concerned about the thousands of injured servicemembers
that are returning every month to this country looking to
reintegrate into the community and lead their lives
successfully. We are also concerned about other veterans who
are working, they are raising families, they are aging in
place, veterans of past conflicts, who have service-connected
disabilities and other needs, and could use our help. We very
much appreciate the good work of the VHA and the Veterans
Affairs Department overall. Their broad spectrum of public
benefits and private supports that are available to veterans is
impressive, but we know that at any given time there are
veterans with needs that fall through the cracks that are not
getting the services they need, when they need them, where they
need them.
We do recognize that the VA is vast and complex. It is
charged with an enormous responsibility, a large mission, a
large and diverse constituency. And like any organization, be
it the VA or providers like Easter Seals, that presents some
challenges that can be daunting. You need to overcome
fragmentation, bureaucracy, self-contained service strategies,
all of which really stand in the way of person-centered,
veteran-centric, readily and consistently available services.
We did note that in 2007 the GAO commended the VA for its work
anticipating the needs of OEF and OIF veterans. But we saw and
have shared in our concerns the VA not necessarily really
reaching out to veterans in a way that they truly understood
the services that where available to them; assuring that there
was equal access, particularly in areas like rural areas where
their facilities might not reach; and also were better at
noting the implementation of infrastructure as opposed to
services being delivered or the utilization of that
infrastructure.
For 90 years Easter Seals has served people with
disabilities including veterans and their families. We serve
about 1.3 million people every year, including veterans. And
actually just this past 2 years, we have really made a
concerted effort to reach out and identify veterans much in the
way those other members of the previous panel and this panel
have said is important. Community-based agencies absolutely
have a role to play as a partner with the VHA, as an extender
of their reach, and as an information resource that they can
benefit from.
Now we understand that as veterans fall through the cracks
this is nothing new. People with disabilities oftentimes fall
through the cracks. What we do not want is for that to continue
to happen for veterans. It really is unacceptable. Let me just
share a few things that are captured in our statement but I
would like to have you note right now.
Obviously no one organization can be all things to all
people, and so my most important point would be to the VHA, to
the Veterans Affairs Department, and to Congress in its role
supporting that agency, please do everything possible to engage
the community and the resources within the community to
leverage infrastructure, tap best practices, build capacity and
share, in the same way that the VA is a tremendous resource
with regard to medical education, in the same way the community
can be a laboratory, a pilot test, a partner, in helping
veterans, particularly those with disabilities.
Easter Seals supports the Gateway Initiative that was
launched by the VA under former Secretary Peake. As far as we
know, this initiative is still in place. It is an attempt to
put a liaison office in place at the VA for organizations like
Easter Seals to know who to talk to to better understand what
are the current priorities, what are the activities, what kinds
of things might we do to support and echo the good work of the
VA. And so we would encourage the VA to continue to fully
implement and support that Gateway Initiative.
We also see that the VA has implemented 50 mobile clinics,
primarily dedicated to helping veterans, particularly those
living kind of far afield from the facility-based systems, with
their mental health services. Easter Seals and others have
offered to host those VA clinics when they come into town, be a
partner in outreach making sure that enough people know about
those services that they are fully utilized. And then be
present in the community when that mobile clinic leaves so that
those veterans and their families have continuity of care, some
follow along services, a way to connect back to the VA that
provided those services originally.
We applaud the VA and the VHA for its efforts to reach out
to younger veterans in ways that are meaningful to them. They
are doing great things with regard to their Web site and
leveraging social networking tools, much as we are trying to do
as a nonprofit organization. We also say probably the most
important thing we found is that to connect with veterans you
have to reach them early, you have to reach them in the context
of their family. These individuals respond very well to us when
we engage in pre-deployment and post-deployment activities, and
we are there as the individual transitions from military
service. And so they recognize us as partners and friends to
them bringing them into the VA system as a collaborator.
So I would just encourage you to keep the community-based
systems very much in mind as something for the VHA to reach out
to, to partner with, contract with, outsource, and leverage in
whatever way possible. We will certainly be there as a partner
and a friend. Thank you.
[The prepared statement of Mr. Rutta appears on p. 55.]
Mr. Perriello. Thank you so much, Mr. Rutta. Now we will go
to Dr. Pollard.
STATEMENT OF JEFFREY W. POLLARD
Mr. Pollard. Mr. Chairman, please allow me to express
appreciation for the opportunity to speak on behalf of the
150,000 members and affiliates of the American Psychological
Association regarding outreach activities for veterans on
college campuses. I am the son of a decorated World War II
veteran captured on December 7, 1941, released in September
1946, and buried in Arlington National Cemetery. I have spent
30 years working as a psychologist committed to the mental and
behavioral health of students on college campuses. Meeting the
needs of increasing numbers of our Nation's veterans,
particularly on college and university campuses, is extremely
significant to me.
Our ability to diagnose and treat combat-related mental and
behavioral health problems, including depression, traumatic
brain injury, and post-traumatic stress disorder, has improved
dramatically in recent years. Estimates suggest that between a
quarter and a third of all veterans returning from Operation
Enduring Freedom and Operation Iraqi Freedom will display
symptoms of mental disorder within a year of leaving military
service. Many of these veterans are expected to benefit from
the new Post-9/11 GI Bill by furthering their education at our
Nation's colleges and universities. These facts point to the
important role that colleges and universities must play in our
national efforts to meet the mental and behavioral health needs
of our servicemembers and veterans.
During the past year, George Mason University has been
involved in a number of important activities to enhance our
outreach to military personnel and veterans on campus. First we
hired Mr. Michael Johnson to serve as our full-time Military
and Veterans Liaison in our Military Veterans Office. Mr.
Johnson, who has accompanied me here today, is a veteran of 17
years, both as an enlisted member and an officer in the United
States Marine Corps. Mr. Johnson and his colleagues in the
Military and Veterans Office currently serve approximately
1,000 active duty, Reserve, National Guard, and veteran
students, offering assistance and information regarding issues
such as veterans services and academic counseling, as well as
information about the many benefits to which they are entitled
through State and Federal Government programs.
In addition, George Mason University has recently completed
a needs survey of our military and veteran student population
and established connections between the new Military and
Veterans Liaison and virtually every component within the
University. We have also established the Mason Military
Outreach Group, which is a collaboration of students, faculty,
and staff in support of our servicemembers, veterans, and their
families. Further, the Mason Veteran Peers Initiative involves
a group of veterans who are working with counseling and
psychological services to provide peer support to veteran
students.
Last month, George Mason University was one of only 20
institutions of higher education awarded a Success for Veterans
Award Grant sponsored by the American Council on Education and
the Walmart Foundation. This $100,000 grant will help George
Mason University Military and Veterans Office evolve further
into a compliance-coordinated one-stop resource and support
center to ensure academic, psychological, and transition
support. We are grateful for this award. However, like most
grants it will not cover the predicted level of need and it is
time limited.
Just as the community mental health system is stretched far
too thin, so are college and university mental health
resources. In fact, campus mental health faces significant
systematic challenges, including an insufficient number of
service providers, such as psychologists, psychiatrists, and
case managers. Data indicate that students on college and
university campuses are increasing arriving with more severe
preexisting mental and behavioral health patterns, or develop
these health concerns during their college careers. The
increasing civilian mental and behavioral health needs on
campus make it even more challenging for colleges and
universities to provide sufficient services and support for the
growing population of servicemembers and veterans on campus.
While we at George Mason and our colleagues at colleges and
universities around the country have been taking important
steps to reach out to servicemembers and veterans on campus,
much work remains ahead. I would like to provide a few
recommendations that may help our institutions of higher
learning meet the mental and behavioral health needs of our
military and veteran student population.
First, sufficient resources must be made available to
support targeted efforts on campus to address mental and
behavioral health needs among servicemembers and veterans,
including the concern of suicide. In recent years some,
important Federal initiatives have been created through the
Substance Abuse and Mental Health Services Administration
(SAMHSA) to address the national problem of increased mental
and behavioral health concerns on campus, including suicide.
However, much more needs to be done.
Senators Durbin and Collins and Representative Schakowsky
have recently introduced the Mental Health on Campus
Improvement Act and its programs will complement SAMHSA's
Campus Suicide Prevention Program to offer the full range of
prevention and intervention services currently needed on
college and university campuses. In addition, this legislation
calls on grant applicants to include a plan, when applicable,
to meet the specific mental and behavioral health needs of
veterans attending institutions of higher education.
Second, continuing education and training opportunities
must be readily available for colleges and university mental
and behavioral health professionals regarding some of the
unique deployment and reintegration issues facing
servicemembers, veterans, and their families. Both the
Department of Defense and the Department of Veterans Affairs
have unique knowledge and expertise in this domain.
I recently had the privilege of attending a week-long
training conducted by the DoD's Center for Deployment
Psychology, in which leading experts in the field provided
clinical training regarding the deployment cycle, trauma and
resilience, behavioral health care for the severely injured,
and the impact of deployment on families. These are high
quality programs and are worthy of continued attention and
support.
Third, we must develop mechanisms to conduct appropriate
outreach to servicemembers and veterans who are beginning their
post-secondary education online. Such online education
opportunities may present unique challenges for our military
and veteran students because of their potential isolating
effect. Servicemembers and veterans who are enrolled in online
education programs and experiencing mental and behavioral
health problems are often more isolated than their on-campus
colleagues, and this isolation can be contraindicated for their
healthy readjustment and recovery.
APA and the psychology community looks forward to
continuing work with Congress, the VA, the DoD, and the
veterans service community to welcome home our men and women in
uniform, and to ensure that they receive the mental and
behavioral health services and support on college and
university campuses and in the larger community that they so
honorably have earned. Thank you.
[The prepared statement of Mr. Pollard appears on p. 59.]
Mr. Perriello. Thank you, Dr. Pollard. Congratulations to
George Mason on the grant, and thank you for the heroism and
sacrifice of your father as well.
Mr. Pollard. Thank you.
Mr. Perriello. Let me begin by asking a question of the
panel. Many of you talked about the importance of the VA
forming partnerships with the VSOs and other private groups to
help reach more veterans, and community-based strategies. Could
you say a little more about whether the barriers to that right
now are primarily a cultural mindset? Is it bureaucratic and
regulatory? Is it financial? And what specifically could the VA
be doing better to develop those kinds of partnerships and
community-based strategies you note?
Ms. Romberg. I think it is all of the above that you
mentioned. Maybe the least being financial, in terms of it has
to start with conversations and dialog. And thus far, while in
our case, our organization, initially the message was that the
VA responded that they had it covered in terms of the mental
health care. That was 4 years ago. As time has gone on, we have
developed a really nice relationship with the VA
philosophically in terms of that we exist, and that we can be a
resource. But there has been no systematic relationship formed
so that throughout the country VA hospitals know about the free
mental health services that our providers give. I think that it
has, there has to be some conversations at the very top to
change the culture, to open the doors. Not just with VA, but
DoD as well, so that we can look at, I mean, just listening to
this panel there are so many tremendous opportunities and
organizations out there. Here in Maryland, there are some
programs in Montana, in California, collaborative efforts. But
they do not function together. No group or no State is able yet
to access and speak to others in the other States so that we
have a comprehensive system.
So outreach is important, but if the people then do not
know where to go from that initial point of outreach to the
various organizations, the Easter Seals, George Mason
University, for somebody with the GI Bill. So it really needs
to be at the top level, that a change in culture and a
structure needs to be developed so that we can knit these
together.
Mr. Bronzan. Yes, I think it is a great question and it is
a very important thing. I mean, in our work in these two
States, county by county, we found two kinds of folks. There
were some that were very inbred in their thinking that if they
did not, whether it is VA or DoD or a private agency, that if
they did not make it they did not want to do it. Or, if they
could not control it they did not want to do it. And they did
not really want to collaborate with anyone. But there are
others who are, I think, of a much more newer thinking. That
they cannot do it alone. They have to reach out and they have
to work with other people, especially community-based
organizations where people live. And it is that group that we
worked with, and were fortunate enough in the two States
because there was an outpouring of it.
In fact, we had one State director, VA director, say to us
that what he liked about the Network of Care as one model is
that it was outside the VA and it was easier to connect with
all the community-based organizations on behalf of the vet,
which is a rather extraordinary comment that I am not sure you
would have heard just a few years ago. So I think there is a
new generation of thinking. And that thinking has to be
encouraged and supported so that these two sides can reach
across the space to each other and help the veteran in a more
meaningful way.
Mr. Rutta. I would definitely agree with what has been
said. I think two other perspectives. One, the Easter Seals
really takes an individualized but family centered approach.
And I think the VHA and the VA generally would do well to
really look at the veteran in terms of the context of family,
and how the family truly can be supportive and actually help
the system overcome the resiliency training that many of these
veterans carry from their military days where it is difficult
for them to accept help, difficult for them to identify a
problem. And so the extended family and organizations that they
trust, like ours, can actually be a partner to the VA in that
effort. But the VA has to recognize that important role of
family in the holistic support of the veteran.
The other piece would be for older veterans there is a lot
of collaboration with the community-based organizations around
adult day services. Although the Veterans Affairs Department
and VHA does indeed offer adult day services themselves, they
do frequently outsource that service within a tremendous amount
of information sharing and mutual learning that occurs, which
benefits the veterans and their families. There are some 1,300
other adult day centers that are out there that could really be
a partner to the VA in maybe diverting some older veterans who
might otherwise end up in VA supported nursing homes or in
hospitals, helping them stay in the community. So reach out to
the aging network, the Administration on Aging as a partner, in
that natural other system of care that could be a partner to
them.
Mr. Perriello. Let me ask a follow up question to that. You
know, I represent a district that includes Charlottesville,
Virginia, the University of Virginia, a very highly educated
small town with a lot of hospital care. But it also goes to the
North Carolina border. About two-thirds of my district is
highly rural. How much of a discrepancy are you finding in
interest in these strategies for, say, rural versus urban? And
how much in terms of need are you seeing in geographical
discrepancies?
Ms. Romberg. Well there is a tremendous need in the rural
communities. We are now developing State initiatives, and our
first State initiative was with West Virginia because they have
so few resources available. We are also working in Arkansas for
the same reason. So the need, again, to develop a strategy to
link together. That is what is missing. There has not been,
yet, a strategy from, for our country to step up. This is not a
VA issue. It is not a DoD issue. It is not a community-based
resources issue. It is a national issue. And until we figure
out a strategy and a plan to organize who is available in the
rural communities--it is very doable. We are starting to look
at that in States like West Virginia. Something very
innovative, like working with the Council of Churches. Because
they are who, those folks, the ministers, the pastors, they
often see the veterans and their families first. But who do
they contact to develop an approach in that way, is critical
for those rural communities. Because there is not anyone there
to provide services.
Mr. Bronzan. In our work, because we are statewide in many
States, we are able to do surveys and learn some things. And it
is very interesting, the Network of Care, looking at rural and
urban. In the urban areas the sites are used more than all
other mental health services in the county combined. But in the
rural areas, they are used as much as three times as much as
they are in the urban areas. And it is because modern internet
technology is a way for people who are in rural, isolated areas
to get information and to connect with other people.
So it should never be underestimated, the value of internet
technology, to gain information in the rural area. They use it
very heavily.
Mr. Rutta. And I would just say for Easter Seals, because
we are a nationwide organization, we have a special interest in
outreach to rural residents with disabilities. In fact, almost
20 years ago, we worked with Congress to create a program
called AgrAbility. It helps farmers and ranchers with
disabilities. A significant percentage of those individuals are
veterans. And what we found is, they frequently encountered the
geographic barriers. They were not able to tap the VA services
as often as they would like. And in some instances, those local
VAs, often working through the State veterans office, would
indeed engage Easter Seals or others in helping those veterans.
And it would just provide some continuity, a watchful eye,
someone to help that veteran and their family stay connected in
a way that really benefited the larger organization.
I know in Iowa our AgrAbility Program has got a contract
with the VA to help do the home assessments and modifications.
It is a wonderful role for us to play. It is a modest
reimbursement to us, but critical, and that would be something
we would like to see replicated. But what was mentioned on the
panel is that that is often a case that has to be made, you
know, medical facility by medical facility, very locally. It
would be good to have that leadership from Central Office.
Mr. Pollard. In preparation for our conversation today, I
spoke to my colleagues in counseling centers across the country
using our listserv and asked them about their concerns. And it
was interesting to hear from communities that are more rural
and more separated having spent 23 years on a college campus
that was quite rural before coming to Virginia. What I found
was that there is tremendous concern on campuses that are
distanced from resources that the Government provides, and that
there is, that concern runs along these lines. One or two,
three or four, veterans with high need could throw the
resources in some of these colleges into a very difficult
position. There is no way for them to really cope with some of
the special needs that our returning veterans are displaying.
And they are tremendously concerned. Some of the most heartfelt
outreach from some of my colleagues came from places that
talked about the fact that it may cost them literally thousands
of dollars a week to accommodate a soldier who lost hearing
because of a, you know, an explosion nearby. And these small
universities are already on a very tight string, and that kind
of cost puts them in a position where they are beyond their
ability to, you know, the tuition does not take care of it. So
they are very, very concerned that the returning vet on some of
these campuses, especially with the GI Bill, is just not going
to help. They are going to be going in negative territory.
Mr. King. The observation I would make is that, you know,
the VCAT initiative is all about assessing communities, looking
at the fabric of that community, the chemistry of the service
providers that make services accessible to veterans. It was
mentioned in the Network of Care and on the previous panel that
one of the essential ingredients to a high functioning
community is the accredited service officers, and the role they
play, whether they are State, county, or national service
organizations. And whether you are rural or urban, to be able
to have veterans referred to someone who will serve as their
legal advocate, develop a well-developed claim ready to rate,
and produce the outcomes that basically requires the Federal
Government, then, to perform. Those are pretty essential
ingredients to sustainable outcomes for veterans and for the
community. It is a return on the investment. If you cannot
figure it out from here and here, let us help you understand
from the pocketbook about how important it is to pursue the
rights and benefits of veterans and their families.
Mr. Perriello. I really want to thank you all again for
your contributions. I think it will be interesting to see, as
Mr. King and Mr. Bronzan discussed the extent to which the
internet does bridge this gap. Not just the establishment of a
Web site but the interactive components of Web 2.0 technology,
the social networking, telemedicine, and other issues, and how
that may prove to be part of this conversation. Where it is not
simply a producing of information but a dialog. We really
appreciate all of your comments. Thank you for your time. And
with that, I will dismiss the panel.
Let me call up Paul Hutter, Chief Officer, Legislative,
Regulatory, and Intergovernmental Affairs for the VHA;
accompanied by Ev Chasen, Chief Communications Officer,
Veterans Health Administration; John Brown, Director of
Operation Enduring Freedom and Operation Iraqi Freedom Outreach
Officer for the VHA; and Emily Smith, Deputy Assistant
Secretary for Intergovernmental Affairs and the Officer of
Public and Intergovernmental Affairs at the VA.
Mr. Hutter, thank you for joining us. You may begin.
STATEMENT OF PAUL J. HUTTER, CHIEF OFFICER, LEGISLATIVE,
REGULATORY, AND INTERGOVERNMENTAL AFFAIRS, VETERANS HEALTH
ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS;
ACCOMPANIED BY EV CHASEN, CHIEF COMMUNICATIONS OFFICER,
VETERANS HEALTH ADMINISTRATION; JOHN BROWN, DIRECTOR; OPERATION
ENDURING FREEDOM AND OPERATION IRAQI FREEDOM OUTREACH OFFICER,
VETERANS HEALTH ADMINISTRATION; AND EMILY SMITH, DEPUTY
ASSISTANT SECRETARY FOR INTERGOVERNMENTAL AFFAIRS, OFFICER OF
PUBLIC AND INTERGOVERNMENTAL AFFAIRS, U.S. DEPARTMENT OF
VETERANS AFFAIRS
STATEMENT OF PAUL J. HUTTER
Mr. Hutter. Mr. Chairman, thank you for providing me this
opportunity to discuss VHA's outreach activities to veterans. I
am accompanied today by Emily Smith, Deputy Assistant Secretary
for Intergovernmental Affairs; and to my right Ev Chasen, who
is VHA's Chief Communications Officer; and on my immediate
left, John Brown, Director of the VHA OEF/OIF Outreach Office.
VA's mission is to care for those who have borne the
battle, to honor those who have worn the uniform by providing
them the highest quality health care and benefits available.
This mission can only be accomplished when veterans know the
full range of services we offer. VA is committed to reaching
out to veterans and their families where they are to support
these ends. This includes not only reaching into rural
communities but entering virtual communities and establishing
communications and connections there as well.
Before I move on, Mr. Chairman, I want to say on behalf of
the Department, I want to thank Mr. Leal of the previous panel
for his service and his sacrifice, and appreciate this
testimony and suggestions concerning outreach. I also thank Mr.
Rowan, Mr. Jones, and Mr. Johnson for their service and their
suggestions on behalf of veterans. And I also want to extend
out thanks to the previous panel, the Members of the previous
panel who are not veterans, who are still dedicated to their
mission and to help us reach out to veterans in an effective
way.
My written statement, which I ask to be submitted for the
record, highlights four forms of outreach. Direct outreach to
separating servicemembers, program specific outreach, outreach
to rural areas, and outreach using new technologies. In the few
minutes I have now, I would like to show you some examples of
the outreach we are doing and the new initiatives that we have
underway.
I would like to begin by showing two public service
announcements (PSAs) that VA has produced and are currently
airing across the country. The first features Deborah Norville,
a two-time Emmy Award winner. The second features Gary Sinise,
an Academy Award winner, whose portrayal of Lieutenant Dan in
the movie Forrest Gump put an unforgettable voice and face to
veterans returning from Vietnam. Mr. Sinise's PSA is directed
toward veterans, and Ms. Norville's is aimed at the family
members of veterans who may be in need of VA's suicide
prevention hotline. With the Chair's permission, I would like
to show those two videos now.
[PSA video featuring Deborah Norville shown. Text of PSA
video by Deborah Norville appears below:]
L ``You may be seeing warning signs of depression or
suicide. Some of these warning signs can be that the veteran
seems disconnected from family or friends, starts to give away
prized possessions, displays anger or rage, or overreacts to
problems. The VA is reaching out to help so please reach back.
If your loved one is a veteran, and if you even think you see
these warning signs, call 1-800-273-TALK and press one. That is
1-800-273-TALK and press one. Do not second guess yourself.
Reach out for help.''.
[PSA video featuring Gary Sinse was not shown due to
technical difficulties.]
Mr. Hutter. Cannot get it to go? Okay. Mr. Chairman, the
second PSA announcement from Mr. Sinise has in the last 6
months between October 13, 2008, and April 13, 2009, this PSA
was broadcast more than 8,700 times by 155 stations in almost
100 markets. During this same time period, VA's suicide
prevention hotline received approximately 50,000 calls across
the Nation, an increase of approximately 25 percent based on
the previous 6 months.
Last year, VA advertised the suicide prevention hotline on
buses and Metro trains in the Washington, DC, area resulting in
a significant increase in calls to the hotline from the area.
This year we have begun advertising in Spokane, Washington, and
will soon advertise on public transit systems in Miami, Los
Angeles, San Francisco, Oakland, Phoenix, Las Vegas, and Dallas
metropolitan areas, all locations where the suicide rate among
veterans is higher than the national average. In addition, VA
is working with a company to purchase advertisements on 20,000
buses nationwide. You have probably seen the advertisements VA
displayed on Metro buses and railcars. Here are two pictures of
our advertising in the Spokane, Washington, public transit
system.
So this, again, is focused on the suicide prevention
hotline. In addition to these 20th century forms of outreach,
VA has leaped into the 21st century by developing Web sites
accessible to mobile devices, and by venturing into portions of
the cyber community where veterans are most likely to
congregate or visit. Thirty years ago VA's outreach strategy
was to visit the local VFW or, more recently, VVA halls. Today
we post blogs and videos accessible to veterans wherever they
are.
We have two images of VA's Web site as viewed on a mobile
handheld device. So this is available on an iPod or something
similar as well. First you can see an easy to use menu with
information at the touch of a button. Second, you can see a
news story, complete with image, that provides information to
veterans about benefits or services that strike their interest.
We understand veterans are busy and may need information on the
go. So we are adapting our systems to meet their needs. These
sites are available through any cell phone or other handheld
device with internet access.
The next slide provides a demonstration of VA's presence on
Second Life, a free, three-dimensional, virtual world where
users can socialize and interact with one another. VA offers
information and points of contact where veterans or family
members can learn more about our programs. The following slide
shows VA's Facebook page.
Here you can see images of VA's winter sports clinic, a
great venue for outreach and inspiration, where VA partners
with our colleagues at Disabled American Veterans to support
the rehabilitation of wounded or injured veterans.
I am also proud to say that even bureaucrats can use
YouTube. VA now posts videos with stories or services that
impact the lives of veterans.
And finally, Mr. Chairman, VA has also created a new Web
site for returning veterans that provides useful information
about eligibility, benefits, health care, and other services.
This Web site features a blog with comments from veterans and
family members. We recognize we must develop social networking
strategies, including nontraditional outlets, and a wide
variety of new media to communicate VA's message about our
services.
I want to point out, Mr. Chairman, that on the right side
of this you see what is called a panel, and the more visible
areas are the ones that veterans have clicked on to get those
services. And that gives us an indication of how many, I am
told that the word is not hits but encounters, on that
particular part of the Web site.
The other thing I wanted to mention is that the social
networking sites that I mentioned earlier are also available
from this central location, this central Web site.
These new technologies have entered into health care
delivery. One VA facility has begun piloting a program that
uses text messaging to help veterans send their home-based
blood pressure readings to their clinicians. Researchers found
veterans who used this text messaging achieved their blood
pressure goals 2 weeks sooner than those who used other
methods.
More broadly, VA could not serve veterans to the degree it
does without the immeasurable help of veterans service
organizations (VSOs), faith-based, and community groups. I
would like to thank the Committee for inviting Mr. Leal as well
as the representatives of the other panels to share their
views. Because we see these hearings as an opportunity for
exchanging information and for listening to those who matter
most to us, our veterans.
VA maintains constant contact and holds regular meetings
with VSOs and groups at all levels of the organization to
provide information about VA's programs and offerings while
soliciting feedback about concerns present in the community.
Working with these community partners helps significantly
expand VA's reach to millions of people who may not otherwise
hear of our offer of care and service.
In conclusion, Mr. Chairman, VA understands that different
veterans will receive messages in different ways and at
different times. It is our duty to notify veterans of the
repayment our Nation offers in gratitude for the sacrifices
they have made. We must continue programs that are successful
and develop new methods when our current measures are
insufficient. Our mission is to reach out to family members,
employers, community stakeholders, Reserve and National Guard
units, and veterans to make sure they know how to access help
when they need it.
Thank you again, Mr. Chairman, for the opportunity to
testify. My colleagues and I are prepared to answer any
questions that you may have.
[The prepared statement of Mr. Hutter appears on p. 61.]
Mr. Perriello. Thank you very much to you, Mr. Hutter, and
to your team for being here today. It is exciting to see that
the VA is working hard on the new technologies and other areas
to break ground. Let me ask a few follow up questions. One is,
with the increase in calls to the call centers, this is
obviously a very urgent topic to all of us. My understanding
from your submitted testimony is that you have had over 660,000
calls, but only been able to speak with about 160,000 folks.
What is the strategy for follow up being conducted with those
that you do not reach?
Mr. Hutter. Mr. Chairman, I am going to defer that question
to my colleague, Mr. Brown, who can address that directly.
Mr. Brown. Thank you, Mr. Hutter. Mr. Chairman, we started
the call center, combat veteran call center, in May of 2008,
that was directed by Secretary Peake. Our attempt was to go
back to October 2001 for all of those individuals, OEF/OIF,
servicemembers that have separated, since October 2001 through
December 2008. We had a twofold purpose. The first purpose was
to call the servicemembers that we knew were injured. And that
amounted to about 15,600. They were either severely injured, or
they were ill or impaired. The purpose of that was to call them
to find out whether their case managers were doing the right
thing by them, whether they were actually being seen on time,
and to ask whether they had any other issues that needed to be
addressed, such as benefit issues. All of these things were
documented. The second population were clearly those who had
separated and had not had an encounter with the VA health care
system. That was the 550,000 population.
To date, your numbers are correct. The numbers that we
submitted are on target. Out of the 660,000 that we have
attempted to call, we have spoken with 160,000. This does not
include the messages that have been left on answering machines
or messages left with loved ones. If you look at that
percentage it is not 24 percent, it is 74 percent.
Our leadership, to include Mr. Hutter, thought it would be
best that we show real numbers, the veterans that we actually
spoke with. That is important. The attempt now is to look for a
search engine, a database that would review financial records,
Internal Revenue Service (IRS) records, and update phone
numbers, and we will try to call him again.
Mr. Hutter. Mr. Chairman, if I could add to that answer?
One of the things that you may have noted in our written
testimony is that we are reaching out particularly to Reserve
and National Guard servicemembers as they return in an
iterative way. As they come back, Mr. Brown and our colleagues
at our 153 medical centers are reaching out to each of these
Reservists and National Guardsmen and signing them up, if you
will, by filling out an enrollment form, our 1010EZ. And they
are filling that out as they come back. We are then taking
those forms and Fedexing them now, soon to be sending them
electronically, to the medical centers where they will receive
care. Because as they come to a demob center they are not
necessarily going to receive care in that particular locus.
So the idea, then, is to sign them up as they come in. We
have now approximately a 93 percent enrollment rate based upon
those folks that have come back using either the demobilization
process--strike that. The demobilization event, or the post-
deployment health assessment event, or the post-deployment
reassessment event. And these occur iteratively because of the
fact that as the soldier, sailor, airmen, Marine, Coast
Guardsmen come back they are not particularly interested
immediately after they get off the airplane or train in signing
up for VA health care. So what we do is we track them and hit
them at iterative spots. So we get to the teachable moment when
they are most poised to listen to our message and realize the
benefit.
Mr. Perriello. Sticking, for a moment, with this issue of
the new technology communication, your fourth category, what
indicators are you looking at for whether this is actually
working? Is it number of friends on Facebook? And also, related
to that, to what extent is this largely hitting our most recent
veterans versus Vietnam vets and others who are also accessing
the same technology?
Mr. Hutter. Mr. Chairman, I am going to defer that question
to Mr. Chasen who is VA's guru of the web.
Mr. Chasen. Paul, I do not think I accept that title. But I
can answer the question, sir. There are several measurements
that we are using. The most important one is the American
Customer Satisfaction Index, and you have seen these on Web
sites. As you click on a Web site it asks, ``Would you take a
moment and take a survey for us?'' We have that on all our Web
sites. If you click six times, you reach the sixth click, you
are asked to take a survey. We take those surveys very
seriously. They provide us information both on customer
satisfaction and on the kind of information that those who are
looking at the Web site are looking for, and whether they have
what we need.
We have had, I think, mixed success. Our ratings, other
Federal agencies do the same thing, our ratings are now in the
middle of the pack. We certainly hope to do better and to
continue to do better.
As far as Facebook goes, our best measurement, and we have
been live on Facebook for about 6 months but we have actually
been publicizing it only for the last couple because of cyber
security issues. We have 1,800 fans. We hope to get a lot more.
I do not know what to judge that against, other than the entire
population of veterans. But we do look at it. We are looking
for continued increase, not necessarily a number.
The other thing that you asked about is who is using it.
The answer from ACSI is veterans of all ages. Some of our
sites, the OEF/OIF Web site, obviously, is for veterans of Iraq
and Afghanistan. But what we found is that in our more general
portals and information that we have a lot of Vietnam veterans,
some World War II veterans and family members. Everybody uses
the web now. It is not just something for our newest veterans.
Mr. Perriello. Well, 1,500 fans out of 23 million veterans
does not jump off the page at me. I think I may have more
friends than that on Facebook. But it is early in the process
and I think looking at the strategies that have been more or
less successful, and having some experimentation there is a
good thing.
If I can also ask the panel to address some of the concerns
and frustrations that were raised in the earlier panels? And
specifically, comment on the issue of more partnership with
communities and community-based strategies from the last panel.
Mr. Hutter. Mr. Chairman, as the Easter Seals
representative indicated, in the last Administration we
attempted to create a collaborative relationship with many of
the community-based organizations that offered help, but did
not know exactly where and how to connect and how to provide
that help. As a result, we created a gateway and an ombudsman
position whereby that person would take the good efforts and
offers from community-based organizations and would direct
those organizations to where the VA could use that help the
most. And although the new Administration is working on this it
is a work in progress and a partnership in progress. But we
have taken the first steps to get that organized.
Mr. Chasen. Mr. Chairman, if I could add, tomorrow morning,
this evening I am going to get on a plane to fly to Houston.
Tomorrow morning I am going to be speaking to VA's great effort
in collaborative work with communities and community
organizations which is our voluntary service program. We do
have 140,000 volunteers. We do have, I think the number is 59
organizations who work with us and provide volunteer support to
our hospitals and clinics, and to veterans. We are very, very
grateful for that. I am not sure it is the model for the new
issues that were raised, but we certainly have long had a great
deal of involvement with community organizations and groups.
Ms. Smith. I would also like to add, if I could, first of
all prior to coming to VA I was, I am, a licensed clinical
social worker and ran a community mental health center in rural
Iowa. So much of what our panel spoke to I related to from my
prior experience.
I have only been at VA for a little under 60 days. I have
been incredibly impressed with the efforts that, across VA, are
being made on behalf of our veterans, and the outreach that is
taking place. There is a strong desire by the Secretary and by
my boss, Tammy Duckworth, to coordinate those efforts
throughout VA and the outreach that we are doing. We would also
like to look at opportunities, in fact the Secretary tasked me
just last Friday with coming up with a list of all the
community organizations nationally that are interested in
partnering with VA. So there is a huge desire to build those
relationships as we move forward as a new Administration.
Mr. Perriello. Thank you. And we certainly appreciate Ms.
Duckworth's service to her country as well. Some of the VSOs
have expressed concern--this is another metrics question--about
how the VA tracks outreach expenditures. Could you say a little
more about how the VA budgets and funds outreach activities? Is
funding allocated on a facility-by-facility basis? And how has
that been trending during the OEF/OIF period?
Mr. Hutter. If I could attack that question from VHA's
perspective and perhaps defer to Ms. Smith with respect to the
Administration's intent overall? With respect to VHA we use the
medical centers as our bases of outreach. Each of our medical
centers, for example, has an OEF/OIF program coordinator,
whereby they provide outreach to the community and participate
in the various welcome home events, the yellow ribbon program
that is described in my written testimony, and partnering with
DoD activities in the local communities. In terms of
expenditures, then, that is those expenditures are rolled up,
if you will, from the field based operations up through the
networks and up to the headquarters in terms of those
activities.
That is certainly the basis not only of reaching out to
OEF/OIF veterans but also with respect to any other targeted
groups that we need to provide outreach for. Mr. Chasen
mentioned our voluntary services coordinators and others in the
medical centers who also do this outreach and the welcome home
activities, and partner with community-based groups to reach
out to older era veterans, or past era veterans, if you will.
And so it is primarily a field-based operation that gets rolled
up to the headquarters.
Ms. Smith. I think the Secretary's vision for outreach for
VA will look like a centralized management structure with
decentralized execution. So hopefully, we will move to a point
where much of our outreach is funded from one source.
Mr. Perriello. Right now most of the media campaign that
has been run has been focused on suicide and suicide
prevention. There is an obvious sense of urgency there. Is
there a sense of moving into other issues that need to be
communicated? Other health and benefits issues? Or is the
current plan to focus primarily on that?
Mr. Hutter. Mr. Chairman, I will take just a moment to
discuss that and then turn it over to Mr. Chasen. There are
several programs that are teed up right now and ready to move
out. And I would like to defer to Mr. Chasen to describe at
least one of those in detail.
Mr. Chasen. Thanks, Paul. Mr. Chairman, first of all the
suicide prevention program has a very, very simple message
which is to get that number to a veteran or a loved one when he
or she needs the number. So it is an ongoing program that will
not stop, that we will continue to find new ways to get that
information in front of people. That being said, we are
working, and Dr. Victor Wahby who is in the audience behind me
is responsible for some of these programs. We are looking at
the issue of destigmatization of mental illness, which is very
important to us. And we will be rolling out products related to
that. We are going to be working on health literacy. Last year
we did a considerable amount of work to try to inform veterans
about the dangers of diabetes and the need to exercise and eat
healthy. And we will continue to use the power of the media and
our ability to mount campaigns to try to keep veterans
healthier through the media.
Mr. Perriello. One of the things that I hear a lot
anecdotally from veterans, and from those who have had some of
the experiences we have heard about today, is that there has
been at least as much success if not more reaching the families
of veterans as reaching the veterans themselves. What
strategies are we seeing to reach those families? Is there any
indication that there is more or less success in those outreach
efforts?
Mr. Hutter. Again, Mr. Chairman, we go back to the very
successful efforts that we have had in reaching veterans as
they come home, and iteratively reaching out to them. The
Yellow Ribbon Program is a DoD program that we are heavily
invested in as partners with DoD. And we talk to veterans and
their families before the veterans deploys. We talk to families
during the deployment phase so that we can get the family when
the veteran is out of the country. Thirdly, we talk to families
not at the demobilization but at welcome home events and at
events that are targeted at the 30-day, the 60-day, and the 90-
day mark after the veteran returns from deployment. All of
these events are attempts to make sure that that families are
aware of the health care benefits that the veteran is entitled
to. For example, the 5 years that the veteran can use VA health
care without otherwise being eligible. Also, the 180 days of
dental care that the veteran is entitled to. These are numbers
and programs that resonate with the families. And so that they,
even if it does not resonate with the veteran upon return,
their family members will prompt the veteran to take advantage
of these programs when they come back. So if you look at the
deployment cycle as a circle, we are invested in every axis, if
you will, of that circle along a radius so that the veteran and
the family gets that advantage.
One other point that I would like to make. We recently had
a Post-Deployment Health Reassessment (PDHRA) event in
Indianapolis for the 76th Brigade Combat Team that came back.
About 3,200 soldiers came back, and we did the post-deployment
reassessment at that location. Those reassessments were
conducted at VA hospitals in Indianapolis itself, Fort Wayne,
and in Evansville. The soldiers were able to see not only what
a VA medical center looked like, but were also able to see how
much VA employees cared about them and made sure that they
understand what a warm welcome and a warm battlefield handoff,
if you will, there was between military health care, DoD health
care, and VA health care. During that weekend, there were,
tragically, a soldier was indicating suicidal tendencies. But
that soldier was able to be taken care of right there on the
spot during that reassessment program. Another soldier
indicated homicidal tendencies. And we were able to get him
into health care and into mental health care immediately
onsite. So my point, sir, is that the VA's forward leaning and
working closely with DoD is enabling that family to see what
the advantages of VA health care are.
Mr. Perriello. Thank you very much for that answer. Thank
you again for your time today. We really appreciate it. The
Subcommittee will be sending follow up questions for the
record. And with that, this hearing is adjourned.
[Whereupon, at 4:45 p.m., the Subcommittee was adjourned.]
A P P E N D I X
----------
Prepared Statement of Hon. Michael H. Michaud, Chairman,
Subcommittee on Health
I would like to thank everyone for coming today.
This Subcommittee on Health hearing will assess the VA's
responsibility to conduct an outreach program to veterans of all eras,
including internal coordination that takes place between the Veterans
Health Administration and the other administrations of the Department.
We also seek a more complete understanding of the VA's outreach efforts
and strategies, as well as the funding spent on these outreach
activities.
Today, there are over 23 million veterans who have served this
country. Of this total, the VA estimates that the number of veterans
enrolled in the VA health care system will reach 8.3 million in 2009
and that the VA will treat nearly 6 million of the enrolled veteran
population. Six decades separate the newest generation from the oldest
generation and 9 million veterans are over the age of 65. According to
the VA's Center for Minority Veterans, the minority veteran population
comprises approximately 15 percent of the Nation's 23.4 million
veterans. Women veterans are included in these minority groups as well.
This demographic data illustrate the sheer number of veterans who
stand to benefit from improved VA outreach efforts. Additionally, it
shows the importance of outreach strategies which must be
individualized to meet the unique needs of sub-populations of veterans.
For example, outreach strategies for older veterans should differ from
that of younger veterans. Additionally, the outreach methods for rural
areas may differ from that of urban areas. The VA is also faced with
the challenge of developing effective outreach strategies which are
culturally competent and thus, able to overcome potential cultural
barriers. Briefly recounting the legislative history of enacted
legislation on outreach brings us to the Vietnam War. During the
Vietnam War, increased awareness of veterans not receiving adequate
information about health care benefits resulted in Congress enacting
the Veterans Outreach Services Program (VOSP). To address this concern,
Congress charged the VA with the responsibility of actively seeking out
eligible veterans and providing them with benefits and services. Under
the current law the Secretary is responsible for advising each veteran
at the time of discharge or release of all benefits the veteran may be
eligible for.
Next, Public Law 107-14, the Veterans' Survivor Benefits
Improvement Act (VSBIA) was enacted in 2001 to further expand outreach
to eligible dependents. This law also provided that the Secretary
ensure the availability of outreach services and assistance through the
internet, veterans publications, and the media.
Finally, Public Law 110-389 or the ``Veterans' Benefits Improvement
Act of 2008'' was enacted last year. Section 809 of this law gave the
Secretary the authority to advertise in national media.
Despite these legislative authorities, the VA has imposed a self-
imposed ban against paid public advertising, including Public Service
Announcements which was only removed recently in June of 2008. Although
the existing statute does not prohibit the VA from conducting media
outreach, the VA has only implemented a single media campaign on
suicide prevention to the Subcommittee's knowledge.
VA has struggled in the past with effective outreach services. For
example, pamphlets and other outreach materials are often located in
the VA's own medical center, which means that this important
information does not reach those veterans who do not already utilize VA
services. Another example is a memorandum issued on July 18, 2002 by
the VA Deputy Undersecretary for Health for Operations and Management
to all Veterans Integrated Services Networks of the VHA prohibiting
marketing geared toward increasing enrollment. This was an effort of to
limit the fast growing demand for health care services which exceeded
the VA's resources.
We also know that some Veteran Service Organizations accused the VA
of not providing outreach to veterans and dependents in accordance with
the law. Nearly 18 months later a second memorandum was issued by VHA
instructing the directors to ensure that their facilities were in
compliance with responsibilities outlined in the outreach program.
Clearly, these are serious issues deserving of this Subcommittee
hearing. Today, the Subcommittee looks forward to hearing from the
witnesses of the panels as we embark on the important task of exploring
effective ways to improve outreach to our deserving veterans.
Prepared Statement of Hon. Henry E. Brown, Jr., Ranking Republican
Member, Subcommittee on Health
Thank you Mr. Chairman.
When our servicemembers come home from the battlefield, they think
about getting back to their families and their civilian lives. Often,
they do not think about connecting with the Department of Veterans
Affairs (VA).
Yet, the process of transitioning back to the civilian world can be
challenging for veterans and their families. And, I am deeply troubled
when I hear stories about a veteran not knowing what services exist,
where services can be obtained, or whether they are eligible for those
services.
Central to the mission of the VA is to reach out to make every
veteran aware of what services are available to support them and assist
them in using these services. And, that is why it is so important that
we are holding this hearing today to examine how effective VA's
existing outreach is and what more can be done to ensure that our
Nation's heroes know and have access to the benefits and services they
need and deserve.
It is encouraging that a higher percentage of our returning
warriors are seeking VA for their health care needs than in any
previous war. And, I do want to commend former Secretary of Veterans
Affairs, Dr. James Peake, for the great strides he made to improve
outreach and the coordination of care for our veterans. Under his
strong leadership, the VA launched a number of outreach initiatives
including: lifting restrictions on advertising to promote awareness of
VA's programs and services; rolling out a new public service campaign
about suicide prevention; establishing the Combat Veteran Call Centers
to telephone returning veterans to provide information about VA
services; opening new rural outreach clinics; and expanding VA internet
presence through ``You Tube'', ``Facebook'' and ``MySpace'' to reach
younger veterans.
I would like to thank all of the witnesses for taking the time to
appear before the Subcommittee today. I look forward to hearing about
issues you see and ideas you have for improving VA's outreach and
relationships with the Department of Defense, states, local communities
and private organizations to help link veterans to VA services.
Thank you, Mr. Chairman. I yield back my time.
Prepared Statement of John Rowan, National President,
Vietnam Veterans of America
Good afternoon, Chairman Michaud, Ranking Member Brown, and Members
of this distinguished Subcommittee. On behalf of the Members of Vietnam
Veterans of America and our families, I am pleased to offer VVA's views
on outreach activities of the Department of Veterans Affairs.
The VA, by any standard, does an entirely inadequate job of
reaching out to veterans and their families to inform them of the
benefits to which they are entitled by virtue of their service, and
health conditions that may derive from their time in service. I can't
tell you how many calls and e-mails we get from veterans, or their
loved ones, with questions about illnesses that may be associated with
their exposure to Agent Orange (dioxin) during their tour of duty in
Vietnam. I can't tell you how many times, when we meet with veterans
and talk about health and health care issues, we are greeted with
something akin to astonishment because no one has ever mentioned this
to them before.
Almost 80 percent of veterans do not use the VA for their health
care. While most veterans have insurance that enables them, and their
families, to go to private physicians of their choice, many of these
folks are only a paycheck or two away from losing their insurance.
Posters that decorate walls and pamphlets that populate kiosks at VA
medical centers and outpatient clinics do not reach these folks. Nor do
the video productions that are supposed to be run on televisions in the
waiting areas of these facilities: Veterans waiting to be seen by a
clinician watch CNN, or ESPN, or Oprah.
It is precisely because the VA has, in our estimation, fallen down
on the job that VVA, in concert with dozens of health advocacy
organizations, health care firms, and others concerned about improving
the health of our Nation's veterans, has created the Veterans Health
Council. The Council aims to fill a void that has long threatened to
become an abyss. By working together, we hope to reach out to veterans
and their families to inform them not only of the benefits to which the
veteran is entitled by virtue of having donned the uniform, but about
those diseases and other maladies that may derive from their time in
service. We hope, too, to reach out to the wider health care community,
to educate them about such health care conditions. It is our hope,
through the Council's Web site, www.veteranshealth.org, and the Web
sites and publications of our partners, that we might reach hundreds of
thousands of veterans who otherwise might not know that the disease
that is plaguing them and eating away at their savings may be
associated with their service in Vietnam, or Korea, or Kuwait, or Iraq,
or Afghanistan, and that they are eligible for treatment and may
qualify for disability compensation and pension as well as other
benefits from the VA.
You in Congress have been most generous in the past few years in
providing the funds that the VA health care system needs to meet the
demand for its services. But we ask you: Can you discern, from the VA's
budget submission, how much money is being allocated for outreach? We
have long supported the efforts of Senator Russ Feingold to enact into
law the requirement that there be a line-item amount for outreach not
only for the entire department but also for its individual entities.
The Senator's bill this year, S. 315, the Veterans Outreach Improvement
Act of 2009, would require the Secretary of Veterans Affairs to
``establish a separate account for the funding of the outreach
activities of the Department, and shall establish within such account a
separate subaccount for the funding of the outreach activities of each
element of the Department.''
While we have every confidence that Secretary Shinseki and his team
will endeavor to make far greater efforts at outreach, we nevertheless
believe that what is needed from Congress is legislation that would
require the VA to devise with a coordinated outreach plan attached to
budget numbers. Mr. Feingold's bill, if enacted, is not enough,
although it ought to be part of such legislation. Additionally, this
legislation would:
mandate that a veteran's military medical/health history
(please see attached) be part of his/her treatment record if a veteran
uses VA facilities or is able to and chooses to go to private
clinicians;
require that clinicians ask, in the patient history that
all of their patients fill out, if that patient ever served in the U.S.
military and, if so, a series of follow-up questions to learn if the
veteran was wounded or otherwise exposed to trauma, or was exposed to
blood, or participated in any experimental projects, or was exposed to
noise, chemicals, gasses, demolition of munitions, pesticides, or
special paints; and
require that all VA clinicians, particularly primary care
providers, take and receive certification for the VA's Veterans Health
Initiative curriculum every 3 years.
In conclusion, I want to reiterate: Far too many of our veterans
simply are unaware of what they are entitled to and, more importantly,
are ignorant about health issues that are associated with their time in
service. It's about time that we do something to fix this situation.
VVA and the participants in the Veterans Health Council are doing our
part. We hope that Congress will recognize the situation and do what is
needed to rectify it.
Mr. Michaud, and Mr. Brown, thank you for holding this very
important hearing. I would be more than pleased to answer any questions
you may pose.
Appendix: Military History Card
Military Health History Pocket Card
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
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What is the Military Health History
Pocket Card? The Military Health History
Pocket Card is a pocket-sized
resource to provide all VA
health professions trainees a
guide to understanding health
issues that are unique to
veterans.
------------------------------------------------------------------------
Who should receive the Military Health History Pocket Card?
All health professions trainees.
How is the Military Health History Web site used?
It provides background information related to the questions on the
Pocket Card. Summaries of veterans' health issues as well as links to
other Web sites are provided.
The Card can be used to capitalize on many learning opportunities:
Give trainees better understanding of the veteran's
perspective.
Encourage trainees and staff to take more careful,
veteran-centered histories.
Stimulate case discussions augmented by information found
on the Web site.
Consider discussing issues presented on the card during
daily work rounds or informal case-based conferences.
http://www.va.gov/oaa/pocketcard/FactSheet.asp
Prepared Statement of Reynaldo Leal, Jr., Representative, Iraq and
Afghanistan Veterans of America, (OEF/OIF Veteran)
Mr. Chairman and Members of the Subcommittee, thank you for
inviting me to testify today. On behalf of Iraq and Afghanistan
Veterans of America (IAVA), the Nation's first and largest non-partisan
organization for veterans of the current conflicts, I would like to
thank you all for your unwavering commitment to our Nation's veterans.
My name is Reynaldo Leal, and I served in Iraq as a Marine
Infantryman with the 3rd Battalion 5th Marines. During my first tour, I
participated in some of the Iraq War's heaviest fighting during
Operation Phantom Fury in Fallujah, and after that mission was
complete, I assisted in securing the first democratic elections in that
city. I was deployed for a second time, 8 months after my first tour,
and conducted counter-insurgency operations along the Euphrates River.
As an Infantryman, I did my job well and performed my duties with
honor. After my two combat tours, I returned stateside seemingly
unscathed, one of only two men in my platoon with that good fortune.
But coming home from war was much harder than I imagined. I was
still in the Marine Corps, and I remember being good at our Urban
Combat training. Not because I was a natural at it, but because when I
began to hear the popping and yelling I felt that I was back in
Fallujah. I could feel and see myself fighting the enemy again. It
would always take me a while to get back to reality after these
training exercises.
When I was discharged from the Marine Corps in February 2008, there
were two questions I feared the most: ``What was it like over there?''
and, ``Did you kill anyone?'' Anxious about returning home, I delayed
going back to south Texas for as long as possible. I couldn't bear the
thought of being around familiar faces, and that fear led me to push
away those who cared about me the most. As my wife prepared for the
birth of our first child, I struggled with flashbacks and painful
insomnia, which spiraled into a debilitating depression that alienated
my family and threatened my marriage. I knew that my wife was suffering
as much as I was, and that I wasn't the same person she had fallen in
love with. Suicide wasn't an option for me, but everyday made me more
and more anxious. It turns out I was suffering from a devastating
invisible wound: Post-traumatic stress disorder (PTSD).
My struggle with PTSD left me dependent on the VA for mental health
care. Since there is no VA Hospital close to my home in Edinburg,
Texas, I have to either travel 5 hours each way to the nearest VA
hospital in San Antonio or take my chances at our local clinic. The
lack of funding for a permanent VA psychologist at this clinic pits me
against my fellow veterans for limited appointment slots. If I can't
get through on the first of the month to book an appointment, or if
both of the psychologist's 2 daytime slots are full, I'm out of luck
until the next month.
Unfortunately, my experience is not unique. According to a 2008
RAND study, nearly 20 percent of Iraq and Afghanistan veterans are
experiencing symptoms of PTSD or major depression. But less than half
are getting adequate treatment.
PTSD is the silent killer for this generation of veterans. Left
untreated, it has the potential to destroy marriages, careers and, in
far too many cases, lives. In January of this year, the U.S. Army
reported that 24 soldiers in Iraq and Afghanistan committed suicide; a
figure that surpassed all combat deaths in those two theaters combined.
That alarming statistic does not include other branches of services
like the Marines, or veterans who have already come home from the war.
But the numbers and statistics are only part of the picture. This
new generation of veterans is being left to fend for themselves because
of an antiquated system that cannot seem to find a way to reach out to
them. There aren't any visible outreach campaigns to get these young
men and women through the door of their local VA facility. If they
don't know about their benefits, or even where their clinic or hospital
is, how can they get the help they need?
When I was struggling with PTSD, there was never a sense that the
VA was trying to reach out to me or that anyone even understood. For
me, there was the Corps and then there was nothing. One day I had the
best health care and support system available for both me and my
family, and the next day it was gone. I felt that I had been abandoned
and that the fact that I had served my country honorably meant nothing.
I didn't know about the claims system, I didn't know about the 5 years
of medical care for Iraq and Afghanistan veterans, and I didn't know
that there were others that were going through the same situations that
I was. It wasn't until I saw IAVA's ``Alone'' ad on television and
joined Community of Veterans that I felt someone was trying to reach
out to me.
It is the responsibility of the Federal Government and the
Department of Veterans Affairs to make sure every veteran feels this
way. But are we doing everything we can to reach out to the veterans
who have done so much for us? The VA has taken some important steps,
especially setting up a suicide hotline, but the answer is no.
We owe it to our veterans to provide the best mental health
resources available, and currently we are falling far too short of that
goal. At my VA hospital in San Antonio, the psychologist only works 2
days a week because that Texas clinic, like many VA clinics and
hospitals throughout the country, has to stretch its funding to make
sure the money lasts the whole year. They don't know how much funding
they'll have next year because the VA budget is routinely passed late.
In fact, in 19 of the past 22 years, the budget has not been passed on
time.
So despite the fact that the VA's mental health budget has doubled
since 2001, thanks to the dedication of veterans' supporters in
Congress, the VA is still forced to ration care for the almost 6
million veterans that depend on its services.
By fully funding the VA health care budget 1 year in advance we
could provide a simple solution that would help give VA hospitals and
clinics across the country the ability to provide stable care for
decades to come. With the ability to plan ahead, these hospitals and
clinics could meet critical staffing and equipment needs, so that
veterans like me are not left waiting. President Obama recently
reiterated his support for advance funding of VA health care, and we
were glad to hear it. With the strong support of the President and
bipartisan leadership of Congress, advance funding can and must move
forward this year.
Real action cannot come at a more critical time. As we saw just
last week with the tragic events at Camp Liberty, our service men and
women are under incredible strain. As a Nation, we must have the same
emphasis on giving our veterans the necessary tools to readjust to
civilian life as we have in giving them the tools to survive in combat.
Make no mistake about it, the veterans of this country want nothing
more than to become successful and productive Members of the society we
fought so hard to defend.
Very Respectfully.
Prepared Statement of Richard A. ``Rick'' Jones, Legislative Director,
National Association for Uniformed Services
Chairman Michaud, Ranking Member Miller, and Members of the
Subcommittee:
On behalf of the National Association for Uniformed Services
(NAUS), I am pleased to be here today as you examine the effectiveness
of VBA outreach efforts. Your work is critical to ensure that VA
outreach strategies bring the best possible care to returning troops
and a seamless transition to their well-earned civilian life.
The National Association for Uniformed Services celebrates its 41st
year in representing all ranks, branches and components of uniformed
services personnel, their spouses and survivors. NAUS Membership
includes all personnel of the active, retired, Reserve and National
Guard, veterans community and their families. We also serve as the main
contact for the Society of Military Widows, a support organization for
women whose husband died in military service or in retirement. We
support our troops, honor their service, and remember our veterans,
their families and their survivors.
It is well known that the Department of Veterans Affairs Veterans
Health Administration (VHA) is the largest provider of health care in
the Nation. Approximately 6 million veterans annually come to VHA for
all or part of their personal health care.
As we take a measure of satisfaction in the quality of care
provided at VHA hospitals and clinics, it is important to recognize
that many veterans continue to view VA care through the eyes of a past
era when VA care was sub-par or in some instances not realizing that
the system is available to them.
While we can never fully repay those who have stood in harm's way,
a grateful Nation has a duty and obligation to provide benefits and
health care to its veterans as a measure of its share of the costs of
war and national defense.
As the National Association for Uniformed Services assesses the
effectiveness of VHA outreach, we believe it is important that we first
have an understanding on the number of OEF/OIF troops using the
Department's health care system.
At present, nearly 2.0 million troops have served in the two
theatres of operation since the beginning of the conflicts in Iraq and
Afghanistan. In addition, with the drawdown of troops from the
battlefields of Iraq, VA is likely to face increased enrollment.
Through the last quarter of fiscal year 2008, 400,304 separated
Operation Enduring Freedom and Operation Iraqi Freedom veterans have
used VA health care. And with passage of Public Law 110-329, VA will
develop provisions for expanded enrollment for certain Priority 8
veterans.
In fact, the final rule for the regulation of accepting these newly
eligible veterans is June 15, 2009, which is just around the corner.
Expansion of Priority 8 Veterans
Public Law 110-329 provides funding to allow an approximate 10
percent expansion on the numbers of Priority 8 veterans enrolled and
treated at VA medical facilities. The proposed regulations were
published in the Federal Register on Jan. 21, 2009, and are expected to
be finalized by mid-June.
Eligibility will be based upon means testing and will be
geographically based to allow for the variances in cost of living in
the various regions of the country.
VA expects approximately 266,000 additional Priority 8 veterans to
be enrolled in FY 2010. We are pleased to hear the VA's Under Secretary
For Health state that Priority 8 enrollment is not capped. Any veteran
who meets the requirement will be enrolled in the VA health care
system. We applaud the effort to end the enrollment ban on veterans.
The budget submission provides more funding to continue this
expansion so that by fiscal year 2013 an additional 500,000 qualified
veterans will gain access to VA.
Although not specifically addressed in the budget, we would hope
that part of the funding for outreach would be used to ensure that
everything possible is done to bring awareness of the change in policy
to those newly qualified veterans.
The National Association for Uniformed Services is concerned that
well-meaning intentions of the VA might not be enough to spread the
word on the expansion of benefits to veterans who have been denied VA
medical access for over 6 years.
Many Priority 8 veterans tried to enroll after the January 17,
2003, prohibition and were denied, therefore, access to VHA care. We
believe that the VA plan to mail all individuals previously denied
enrollment is a good first step. We are hopeful that there will be
follow-up to make sure measures are taken to contact those veterans.
Enrolling those qualified veterans who desire to do so into the VA
medical system should be a very high priority.
In addition, we must ensure that all veterans returning from combat
areas are aware of and if possible, already signed up for their 5 years
of VA medical care. Both of these sets of veterans need to be aware of
their benefits.
We do recognize, however, that some long-term health conditions,
such as post-traumatic stress disorder or traumatic brain injury, may
not manifest conditions until many years later. Therefore we encourage
further opening of access to sick and disabled veterans beyond the
current 5-year allowance.
Of course, Veteran and Military Service Organizations will gladly
help spread the word to their memberships and others. That way we can,
together, be better assured that more veterans will be advised of the
changes.
VA Budget Outreach Initiatives
The National Association for Uniformed Services is encouraged that
the fiscal year 2010 veterans' budget request has numerous outreach
programs that will help get the message about VHA to many more veterans
and survivors.
These initiatives include reaching out to veterans who live in
rural areas of America. The funding requested would allow the VA to
more aggressively reach out to these veterans and to possibly set up
additional rural outreach clinics to help reach our National Guard and
Reserve troops. There is also funding requested for more aggressive
tactics to reach those who have mental health issues with expansions of
outreach services at Veterans Clinics.
The budget also includes additional funding for outreach by the
newly created Office of Survivor Assistance (OSA) to help serve the
numerous survivors who may not have the information on benefits they
may be entitled to or apply for.
Advancement in Battlefield Medicine
As is well known, advancement in battlefield medicine has improved
the chances of survival in warfare. However, many of our present day
wartime casualties suffer from multiple severe injuries such as
amputation, Traumatic Brain Injury (TBI) and post-traumatic stress
disorder (PTSD). Care for these individuals requires an intense
management of treatment for their injuries and special consideration of
their families who stand by these returning heroes.
Reports from VA indicate that, from fiscal year 2002 through the
end of 2008, 39 percent (325,000) of the total separated OEF/OIF
veterans have obtained VA health care. Among this group, 96 percent
were evaluated and been seen as outpatients only, not hospitalized. The
remaining 4 percent (13,000) OEF/OIF patients have been hospitalized at
least once in a VA health care facility.
Last year, VA informed the National Association for Uniformed
Services that of the OEF/OIF veterans who have sought VA health care
approximately 166,000 were former active duty troops and 159,000 were
Reserve and National Guard Members. The population seeking care is
nearly half active duty and half Reserve Component troops.
In total, over the last 6 years VA reports that 6 percent of the
5\1/2\ million veterans in the VA medical care system are veterans of
the most recent military conflict, OEF/OIF veterans.
The Department attributes the rate of VA health care used by recent
veterans to two major factors. First, the department says that recent
combat veterans have ready access to the VA system, which is free of
charge for 5 years following separation. In addition, the Department
attributes a high rate of veteran-participation is due to an extensive
outreach effort developed by VA to inform veterans of their benefits,
including ``a personal letter from the VA Secretary to war veterans
identified by DoD when they separate from active duty and become
eligible for VA benefits.''
The National Association for Uniformed Services applauds efforts
under the direction of the Department to establish a dedicated outreach
program directed at nearly 570,000 Afghanistan and Iraq combat
veterans. The effort, according to VA, is to make sure these veterans
are aware of VA's medical services and other benefits for which they
are entitled.
The VA Outreach program targets OEF/OIF veterans who have been
separated from military service but have not sought VA care or
services. We encourage the VA health care community to continue its
efforts to inform veterans and their families, as well as the medical
community, about the availability of VA health care.
The National Association for Uniformed Services asks VA it leave no
stone unturned to reach these veterans.
In examining the effectiveness of the outreach effort, it is
important to recognize the stark difference in today's VA's efforts
compared to those used in the recent past several years.
While we commend the positive change in expression and tone, we
remain attentive to see that the most recent effort and the improved
tone it reflects does not fail. Clearly there are concerns. Though the
system is clearly no longer our grandfather's VA system, negative
residue from a previous more closed-minded attitude remains within the
system.
Last year, for instance, we received callous reports about a
message issued from a VA Medical Center, in Temple, Texas, that
suggested time and money could be saved if diagnosis of PTSD were
stopped or deeply discounted in its degree of severity.
A PTSD program coordinator and psychologist at the Olin E. Teague
Veterans Center sent an email with the subject line ``Suggestion'' to
several VA staffers working with PTSD cases. The email suggested that
VA doctors and clinicians give altered diagnosis to patents exhibiting
symptoms of PTSD in order to save time and money. In the email, the
staffer said, ``We really don't . . . have time to do the extensive
testing that should be done to determine PTSD.''
While VA has long since repudiated the wrong-headed message, it
does represent a concern we all should share, namely that VA care may
be arbitrary, directed more by budget considerations than the
consideration of the treatment necessary for the health of the men and
women who served in the Armed Forces.
The incident is deeply troubling because veterans not only need to
hear about the services they earned and deserve; they need to know that
once they come to VA their exams are completed and their services are
delivered.
Awareness of Services
Mr. Chairman, as we head toward Memorial Day next week, your
Subcommittee takes a good, well-traveled road. In sending young men and
women to defend our Nation, it is important that we let them know what
our great and generous country provides them following their service.
Indeed, it is critical.
It is clear to the National Association for Uniformed Services that
veterans are generally more aware about the availability of benefits
and services than they were four to 6 years ago. But the value of
timely, reliable outreach programs cannot be understated.
Six years ago, for instance, the Administration was deeply opposed
to spending resources aimed at making veterans aware of the benefits
and services available at the Veterans Department. And facilities were
in decline.
At one point in that past period, a former Secretary of Veterans
Affairs told the Nation that the Department budget was adequate. ``Not
a nickel more is needed,'' he said. However, only a month later the
Secretary reversed his statement to tell the Nation that his Department
would fall $1\1/2\ billion short of the resources needed to carry
veterans services through the remainder of the year.
Prior to this revelation, the National Association for Uniformed
Services and other associations had presented ample witness to
deficiencies throughout the system. We pleaded with Congress and the
Administration that funding levels were totally inadequate and, if not
addressed, would lead to critical reductions in the availability of
veterans health care services, cuts in veterans education benefits, and
logjams in veterans disability claims for service connected injury or
illness.
During that period, things were so bad that a memorandum sent out
by the Deputy Under-Secretary for Operations and Management (July 19,
2002) actually directed all of its health care providers to stop
marketing VA programs to veterans.
In basic, the July 2002 memo said too many veterans were coming in
for services and VA was spending too much money. It directed VA
officials across the country to ``Stop Outreach to Veterans.'' VA
employees were directed to stop participating in VA health fairs, Stand
Downs and related outreach events that informed veterans about programs
available to them. Medical facilities were prohibited even from putting
out newsletters informing veterans about the services they were legally
entitled to receive.
We are thankful that we are beyond that deeply troubling period. If
similar incompetence were in place today, many of OEF/OIF would
struggle alone with their symptoms and illnesses following deployment.
Stress and the Risk of Health Issues
Studies conducted by The Army surgeon general's Mental Health
Advisory Team clearly show that our troops and their families face
incredible stress today. According to the Department of Defense (DoD),
27 percent of noncommissioned officers on their third or fourth tour
exhibited symptoms commonly referred to as post-traumatic stress
disorder. That figure is far higher than the roughly 12 percent who
show those symptoms after one tour and the 18\1/2\ percent who
demonstrate these disorders after a second tour.
And among the approximately \1/2\ million active-duty soldiers who
have served in Iraq, more than 197,000 have deployed more than once,
and more that 53,000 have deployed three or more times.
A recent Rand Corp. study suggests that almost half of these
returning troops will not seek treatment. Many of these veterans do not
believe they are at risk or they fear that admitting to a mental health
problem will mean being stigmatized. Yet if these brave individuals and
their families are made aware of access to VA facilities, to which they
are entitled, they are likely to find a treatment therapy that leads to
health.
If not addressed, stress symptoms can compound and lead to more
serious health consequences in the future.
Congress Champions Resources for VA
Recent Congressional successes in provided increases in VA spending
presents the Department with an opportunity to advance an awareness of
VHA accessibility and readiness to meet health care needs.
We applaud all that has been done to date. While commendable, we
can do better and should do more. In some cases, a successful outreach
can be a matter life and death. Veterans need to hear that VA is part
of our Nation's commitment to them. They need to hear that with
appropriate care, our veterans can tackle stress and get themselves
back on track.
NAUS believes that your interest in targeting information to
veterans marks a turning point in outreach efforts. We are optimistic.
But it is clear that more needs to be done, including followthrough
throughout the VA system, within the veterans community and in our
educational assistance programs.
Of course, there is a financial cost to improved outreach. But as
important is the fact that if we do not make veterans aware of the
benefits and services available to them, there is a hidden cost in
lives lost, families disrupted and long suffering in homelessness and
related problems for decades to come.
We urge the Subcommittee to continue its excellent work with other
champions in this Congress to ensure resources are ready not only for
the provision of a veteran's earned benefits but for the veteran's
awareness of these services as well. It is important that we do so.
After all, these brave men and women shouldered a rifle and risked
everything to accomplish their mission, to protect another people's
freedom and our own country from harm.
As a Nation, we need to understand that the value of their service
is far greater than the price we pay for their benefits and services.
Appreciation for Opportunity to Testify
As a staunch advocate for veterans, the National Association for
Uniformed Services recognizes that these brave men and women did not
fail us in their service to country. They did all our country asked and
more. Our responsibility is clear. We must uphold our promises and
provide the benefits they earned through honorable military service.
Mr. Chairman, you and the Members of your Subcommittee are making
progress. We thank you for your efforts and look forward to working
with you to ensure that we continue to protect, strengthen, and improve
veterans benefits and services.
Again, the National Association for Uniformed Services deeply
appreciates the opportunity to examine with you outreach efforts to
veterans, families and survivors on the benefits available to them.
Prepared Statement of Bruce Bronzan, President,
Trilogy Integrated Resources, San Rafael, CA
Serving Those Who Served
Maryland and California have taken an important step as national
models in the way of local web portals that use the most advanced
communication and internet technology to form a bridge between all
Federal, state, local, and non government services and veterans and
their families. It is called the Network of Care. The launching of the
sites in Maryland was led by Lieutenant Governor Anthony Brown. The
California launch will be led by Governor Schwarzenegger this coming
Friday.
The Network of Care project has been a creative joint effort
between the mental health and veteran's leadership in Maryland and
California, the state and county governments, and Trilogy Integrated
Resources.
Last, this service is, in fact, an excellent ``transition''
resource of the first order. Every single veteran is able to access
this comprehensive resource in their own community thus representing
the most complete, permanent, and continuously accessible place for
information and assistance possible. Given that within the Network of
Care we currently have the database 120,000 service providers covering
65 percent of the Nation, this model can be replicated into every local
jurisdiction in the United States within a year.
DEMO OF THE NETWORK OF CARE
1. Home Page
--Crisis intervention, Shelter, employment,
2. Service Directory
3. Library
4. Social Networking
5. Legislate
6. Assistive Devices
7. Links
8. Personal Health Records
Prepared Statement of Barbara Van Dahlen Romberg, Ph.D.,
Founder and President, Give an Hour, Bethesda, MD
Thank you for this opportunity to provide testimony regarding the
Department of Veterans Affairs' current outreach efforts for OEF/OIF
veterans. It is an honor to appear before the Subcommittee on Health of
the House Committee on Veterans' Affairs and to offer my assistance to
those who serve our country.
As the Founder and President of Give an Hour, a national nonprofit
organization providing free mental health services to our returning
troops, their families, and their communities, I am well aware of the
many issues that now confront the men, women, and families within our
military community.
There is little doubt that our Nation is confronting an emerging
public health crisis. It has been 6 years since the conflict in Iraq
began. Since that time, nearly 1.9 million servicemembers have
deployed. Many of these men and women have deployed more than once;
some, as many as four or five times. National Guardsmen and Reservists
compose approximately half our Nation's fighting force. As those who
have experienced war will attest, everyone is changed by the
experience. Some suffer physical wounds that require medical attention
and care. Others suffer wounds of war that are not always easy to see.
As a Nation, we must provide comprehensive, long-term care for all of
those affected by their experience of combat, and we must embrace the
reality that combat stress and other psychological consequences of war
are normal human reactions to horrific experiences.
My area of expertise is the young men and women who are returning
OIF and OEF veterans. 58 percent are 29 years old or younger. If we
expand this demographic to include one additional age range, then 80
percent of our fighting force is 39 years old or younger. Clearly, a
huge number of young veterans with young families need our care now.
Our Government is clearly working hard to assist this generation of
combat veterans and families. VA funding for the past 4 years is at
unprecedented levels and continues to grow. We cannot assume, however,
that more money, more staff, more outpatient clinics, more Vet Centers,
more ``clinics on wheels,'' more organizational restructuring, and more
(and different) leadership will enable the VA to meet the mental and
physical health care needs facing this generation of combat veterans.
We see from all the statistics, which I will cover shortly, that this
is a public health crisis that will take more than extended outreach.
Yes, current outreach efforts are clearly insufficient. But even if the
current outreach efforts were sufficient, it is evident that the system
does not have the capacity to meet the growing and ongoing needs of OIF
and OEF veterans who are experiencing a full range of ongoing physical
and mental health concerns upon returning home. Finally, even if
outreach efforts were sufficient and the VA had the capacity to meet
most of the needs of returning servicemembers, this solution would
still be inadequate. If returning troops are to truly and successfully
reintegrate into our communities, then our communities must be involved
in the solution. So the issue is bigger than the efficacy of the VA's
current outreach efforts. The issue is how we can systematize a broad
range of services to sustain care for our veterans over the long term.
A current article in Health Affairs (May/June 2009) by behavioral
scientists from the Rand Corp. addresses the problems associated with
providing adequate mental health care for returning OEF/OIF veterans.
Although the article focuses on mental health care--arguably the most
pressing current need within the military community--the conclusions
drawn are applicable for the entire range of services necessary to care
for our returning troops and their families. The authors note,
``Improving the quality of mental health benefits and services in the
DoD and VHA is undoubtedly a key step in improving care for this
population. However, they are only part of the systems of care needed
to address the mental health problems of returning veterans.
Improvements in access to and quality of community based services
outside of the DoD and VHA will also be very important.''
Consistent with the findings of this most recent offering by Rand,
I propose the development of a new kind of public works project. Before
describing this project in detail, I would like to provide the
Committee with the story behind the need for such a program.
But before doing that I need to make one additional point. Although
this Committee's focus is on the outreach efforts of the VA, I will
frequently make reference throughout my testimony to the Department of
Defense and its efforts to care for those who serve. It is impossible
to discuss issues affecting our veterans without discussing DoD's
response to the men, women, and families who serve. While the VA and
DoD operate as if there are two populations that require care--military
personnel and veterans--there is really just one. Too many returning
warriors get caught between the two systems and fail to receive the
care they need when they need it. The failure of coordination between
these two bureaucracies erodes the sense of trust that returning troops
have in our military and in our Government. No amount of outreach can
overcome the potential damage that is done by what is often experienced
as a betrayal.
Background
According to a 2008 Rand Corp. study, over 300,000 men and women
have already returned from Iraq and Afghanistan with symptoms of severe
depression or post-traumatic stress. Over 320,000 have suffered a
traumatic brain injury. And only about half of these men and women have
sought treatment.
There are on average 18 suicides a day among America's 25 million
veterans, with more than one-fifth of those being committed by patients
undergoing treatment by the VA. Army officials calculate the suicide
rate at 20.2 per 100,000 soldiers, the highest in its history--a number
that exceeds the civilian rate for the first time since the Vietnam
War. Last year, our Nation lost more Soldiers and Marines to suicide
than to combat deaths.
Roughly 20 percent of U.S. combat troops who fought in Iraq or
Afghanistan come home with signs they may have had a concussion, and
some do not realize they need treatment. In fact, 17 percent of the
soldiers returning to war (for another tour) could have a traumatic
brain injury. The lifetime risk of suicide among those who have
suffered a moderate to severe traumatic brain injury is three to four
times higher than among those who have not.
Many of our returning troops turn to substance abuse to ease the
pain of the wounds that we can't see and they don't understand. Parents
routinely contact Give an Hour reporting concerns about a son or
daughter who returned home from the war and began drinking or drugging
heavily. Family members are frightened and uncertain about how to help
prevent the dangerous deterioration they see. And they have reason to
be concerned. Sadly, we are already seeing a number of this newest
generation of veterans joining the ranks of the homeless on our
streets.
Some veterans are getting into minor, and major, scrapes with the
law and becoming entangled in the judicial system. Countless stories
have been told in media reports of ``good kids'' who end up in jail for
crimes that no one believed them capable of committing. Fortunately,
several Veterans Courts have sprung up throughout the country, where
veterans are assessed for symptoms of combat-related psychological
injuries and given treatment in addition to, or instead of, jail time.
While the veteran's court is a superior solution to the alternative, it
does not address the underlying issue--that many men and women who are
willing to die for their country are not receiving the care they need
and deserve.
One young woman telling her story in the hope that it will allow
others to receive help was 17 years old when she joined the Army. She
served in the fourth rotation of Operation Enduring Freedom in
Afghanistan in 2003. Her experience left her with severe post-traumatic
stress and, unfortunately, she returned to a community that did not
reach out to her. She felt confused and ashamed of the symptoms she
experienced. She began using drugs and ended up homeless, living out of
her car. Eventually, she sought care through the VA, but the experience
was not a positive one and she turned to our organization for help.
Fortunately, she found a provider who helped her understand what was
happening to her, and she began to rebuild her life. Today, at 25, she
proudly reports that while she still experiences symptoms of post-
traumatic stress, the symptoms no longer control her life. She is
married and has a beautiful baby girl. Although this young woman has
become a successful Member of her community, her painful story is all
too typical of what we hear from the men and women returning from these
conflicts.
Clearly the toll on military families is tremendous. Of those
deployed, more than 800,000 are parents with one or more children. Of
these, 40 percent have been deployed more than once. Almost 35,000
troops have been separated from their children for four or more
deployments. More than 2 million children have a parent who has been
deployed; 40 percent of these children are younger than age five.
Children whose parents have post-traumatic stress are at a higher risk
of themselves developing symptoms of post-traumatic stress, anxiety,
and depression. And studies have linked depression, anxiety, and
emotional disorders in children to a parent's deployment.
Furthermore, when deployments began, reports of abuse quickly
jumped from 5 in 1,000 children to 10 in 1,000. Children from military
families are twice as likely to die from severe abuse as other children
are, and rates of abuse and neglect rise dramatically (40 percent)
during the time the soldier is deployed.
Divorce is also on the rise in the military community with about 1
in every 5 married servicemembers filing for divorce since September
2001. In a November 2008 study, Army spouses were seen to have rates of
mental health problems comparable to the rates among soldiers.
And parents who proudly launched their adult children into the
world find themselves in the distressing position of watching their son
or daughter fail in their efforts to reintegrate into their
communities. One mother spoke to me about her son, who committed
suicide after returning home from his tour of duty. While he appeared
withdrawn and quiet, his family never suspected the depth of his
despair. This grieving mother reported that her son had been through so
much during the war that her family just wanted to give him some space.
She felt such sadness that she hadn't known the right questions to ask.
Needed Services
Returning veterans and their families need access to a number of
services to ensure that they are able to move forward in their lives
once they return to our communities.
Mental health treatment. There is a tremendous need for effective
and accessible treatment for the full range of mental health issues
affecting those who serve, including post-traumatic stress, substance
abuse, depression, anxiety, suicide, marital difficulties, family
conflict, sexual dysfunction, behavioral and emotional symptoms in
children, and domestic violence. There are also additional
difficulties: many veterans live a great distance from formal VA
services, and even those in closer proximity are often reluctant to
seek mental health services because of a perceived stigma associated
with treatment. We need to implement an ongoing screening program so
that all who serve are periodically assessed for signs of psychological
strain associated with their service.
Traumatic Brain Injury (TBI) programs. There is a need to develop
additional educational programs for servicemembers who suffer a TBI and
their family members. Similarly, we need to expand, improve, and
accelerate the delivery of neuropsychiatric services for all veterans,
especially those returning from OEF/OIF. Finally, we need to make
mental health services, rehabilitation, and job training opportunities
available to those who have suffered a TBI.
Care, training, and support for our wounded. Our wounded warriors
receive the finest medical care available in the world while in our
military facilities. Too often, however, they do not receive the
continuity of care they need once they return to their communities. We
must develop better coordination with community resources to ensure
that our wounded (and their families) successfully heal from their
physical and psychological injuries. In addition, we must provide
appropriate job training and ongoing support once these wounded
warriors return to the job force.
Women's support. We need to develop programs specifically focused
on the unique needs of women who serve, including programs that treat
victims of sexual assault.
Employment. Employers want to hire veterans but often fear they are
poorly prepared to support returning warriors. We need to develop
programs that support the employers who want to hire veterans as well
as the veterans who want to be productive Members of society.
Police, judicial, and first-responder training. Many returning
veterans find their way into the criminal justice system as a result of
their combat experience. We need to continue to develop programs that
train police, firefighters, paramedics, and judges about veterans and
the issues that come home with them.
Benefits and compensation. The system that determines benefits and
compensation needs to be reworked. The current system leaves many
veterans feeling dismayed, dismissed, or distressed, as they struggle
to determine what benefits and compensation they are entitled to.
Financial management. Many military families are poorly prepared to
manage their finances, causing additional strain and distress. We need
to develop programs to train the military community--especially the
youngest Members who serve--how to make good financial decisions.
Public education. Many veterans do not realize there are a variety
of services and peer support opportunities available in their own
communities that could be beneficial to them. There is also a dire need
to educate family members about the unique needs and conditions of
returning veterans.
While the list of the services needed clearly presents us with a
tremendous challenge, it is also true that we have a remarkable
opportunity before us--the opportunity to create a comprehensive system
of integrated care for the brave men, women, and families who sacrifice
so much and ask so little.
Barriers to Care
Several factors contribute to our failure to adequately care for
returning veterans and their families. Some of these factors lie within
the systems responsible for providing appropriate care, while others
stem from deep-seated beliefs and conflicts within the military culture
and our society regarding the acknowledgment of needs and limitations.
Regarding mental health care, these barriers are well known and
documented. As discussed in the most recent study by Rand, the
attitudes and beliefs of military servicemembers and veterans prevent
them from seeking mental health care. Our military culture promotes
pride and inner strength along with self-reliance, toughness, and the
ability to brush off ailments or injuries. In addition, as humans, it
is not our nature to turn toward emotional pain. We tend to deny
problems until they overwhelm us. Sometimes, being overwhelmed provides
us with the opportunity to address our struggles, but often we continue
to deny their existence and continue to live an impaired or diminished
life. Only through education and practice can veterans learn to face
their fears and work through the understandable pain associated with
the experience of war. Our society does not yet embrace this concept
and so we do little to encourage our returning warriors to address
their invisible wounds.
The internal barriers that keep our warriors from seeking
appropriate care for mental health concerns also play a role in
preventing them from seeking assistance for other needs such as
financial assistance, employment difficulties, and ongoing physical
care. While it seems self-evident that someone who is in need of
physical therapy for an injury suffered in conflict would follow up
with recommendations for additional care, the decision to pursue care
is often intertwined with other psychological reactions to seeking
care, needing ongoing care, or being ``less than'' they once were.
Moreover, if that care is difficult to find or access, and if it is
recommended by someone the veteran has little if any relationship with,
the likelihood of compliance with the recommendation is severely
diminished.
Systems charged with providing care for those who serve--including
the VA and DoD--have failed in their efforts to reach those in need.
Not that the task is simple, indeed it is extremely complex and labor
intensive. Nonetheless, along with a strategic and innovative public
education program, outreach is a critical component of a successful
effort to care for the military community. While there are a few
exceptions to this rule, too often these systems expect our veterans to
come to them. As a result, many veterans and families who might benefit
from the truly effective programs housed within never even know the
programs exist.
Similarly, both DoD and VA have been reluctant to forge critical
relationships with community-based organizations that have developed
over the last 6 years to fill some of the clear gaps in care.
Opportunities have been missed for innovative collaborations that could
have saved lives and healed families.
As is true of DoD, there are many honorable and dedicated
individuals within the VA who are working diligently to serve our
veterans. Certainly, some VA systems receive praise for their efforts
and ingenuity. In addition, the VA Medical Centers clearly provide the
best medical care in the world. The problem comes when warriors and
family members leave the medical units and return to their communities.
They complain that there is little continuity of care or collaboration
with community efforts; that they must drive long distances to reach
the VA in order to receive services; that they wait for months or years
for their disability claims to be resolved.
Ultimately, it appears that at this time the VA is severely limited
in its ability to create a successful and comprehensive system of care
for our veterans. I recently spoke with a colleague who is in a senior
position at a VA Medical Center in the Northeast. This mental health
professional is a well-respected expert in post-traumatic stress and
has been an advocate for the care provided by the VA for years. He told
me in a moment of brutal honesty, ``This is a disaster.'' I asked what
he meant by the statement, and he replied that he saw far too many
veterans falling through the cracks and feared that the OEF/OIF
generation would surely be ``lost.'' This was a very sobering admission
from a man who has spent his professional life working within and
championing the VA.
The Big Problem: Operating without a Comprehensive System
No single agency, organization, or sector can adequately care for
our returning warriors. Several organizations--governmental and
nonprofit--have attempted to organize the vast array of programs and
services now available to servicemembers and veterans. But most of
these efforts have resulted in cumbersome lists of available resources
that do little to advance the mission of providing easy, accessible
care to those who serve. Efforts to reach out to military personnel and
their families can be successful only if we have a system in place that
can reach everyone who serves and provide ongoing support to them. If
we are willing and able to knit the available resources together into
an integrated system of care that is available within our communities,
we will succeed in our effort to provide for those who serve.
The Best Solution: A New Kind of Public Works Project
To effectively and efficiently care for our veterans, we need a
system that can streamline and simplify the process of providing and
receiving all manner of care for returning warriors and their families
within their own communities. We need a plan that ensures our
communities are able to assist and support veterans and their families
so that their lives are ``working'' for them. There is no question that
our citizens, our communities, and our Government supports the
returning troops and their families. Everyone wants to help. The
problem has been a lack of a coherent plan that will guide communities
in this effort.
In 1933, the Public Works Administration was formed in an effort to
heal our Nation's depression-ridden economy. Designed to provide
unemployed workers with wages as well as to stimulate various
industries, the PWA's main focus was to design and implement large-
scale construction projects. The goal was to heal our economy and
ensure that our citizens were free to lead productive lives. Now we
need to design and implement a similar public works project that will
weave together the resources needed to heal our military community and
ensure that our military personnel are free to lead productive lives.
We have the resources to assist our returning veterans and their
families. We have the desire to care for those who serve. We now need
to organize and coordinate efforts across the country to assist our
military personnel. With this public works mindset we can more
effectively fill the current gaps in care, reduce the duplication of
services, and enhance programs that are innovative and effective.
Next Steps
To realize the vision of a public works project that supports our
returning troops and their families in their communities, the following
steps are necessary:
1. Bring together individuals representing organizations and
entities that interact with veterans and military personnel including
but not limited to the VA, the DoD, nonprofit and nongovernmental
organizations, community-based mental health programs, public health
organizations, higher education institutions, the faith-based
community, law enforcement entities, and the U.S. Chamber of Commerce.
2. Form a working group with these representatives to study
efforts currently under way including innovative and successful
community coordination programs in Rhode Island, California, New York,
Colorado, and Montana, to name a few.
3. Assign this working group the primary task of developing a
strategic plan that will serve to guide our communities in their
efforts to coordinate care among service providers for the military
community and to engage in outreach to military citizens.
4. Direct the working group to assist with nationwide efforts to
implement the strategic plan. While state and local communities will
refine the plan to fit the specifics of their population, the working
group will be able to provide guidance and support as needed.
5. Develop metrics to assess the implementation and effectiveness
of this public works project. The strategic plan should be refined as
data are gathered on the success of its efforts.
Two technologically based initiatives currently being developed
promise to contribute to the success of the public works project to
support our military community.
The Network of Care is an impressive platform that has already been
shown to be effective in delivering a variety of services to millions
of Americans throughout the country. One of the network's components,
the Network of Care for Behavioral Health, is itself an award-winning
Web-based service developed by the California Department of Mental
Health in partnership with Trilogy Integrated Resources and San Diego
County Mental Health. The comprehensive Web portal spread rapidly
throughout the country and now is implemented in more than 25 states
over 400 local areas and is one of the leading ``transformation grant
strategies'' in the Nation.
At the request of congressional, military, veteran, and mental
health leaders, Trilogy began the development of the special portal for
veterans. The following information, from the network's project
statement, provides a description of how it works and its potential to
become the cornerstone for a national response to the needs of our
veterans.
The states of California and Maryland in conjunction with
Trilogy, the creators of the Network of Care, are developing a
virtual community and locally based Web portals for
comprehensive, one-stop information resources specifically
targeted to returning vets, other service personnel, their
families and their communities. In addition to a comprehensive
directory of all local, state and Federal services and support
groups, the portal will contain innovative, user-friendly
technology for: information-sharing and social networking,
educational training programs, interactive recovery tools and
strategies, best practices from around the Nation, and consumer
based, interactive Personal Health Records. This valuable
locally based service will serve as a critical information
bridge for the individual veteran to tie together for the first
time, all Federal, state and local service as well as programs
and veterans themselves from all over the United States.
The project has the formal support of the National Association of
State Mental Health Program Directors, the National Association of
County Behavioral Health Directors, the National Alliance on Mental
Illness, andMental Health America.
Maryland launched the Network of Care for Veterans and
Servicemembers site in March. California will launch its site on May
22. Once established in Maryland and California, the program will be
available for replication throughout the country. Funding is currently
being explored in order to create a nationwide application. The cost
for ongoing maintenance will be the responsibility of each local
jurisdiction.
Patients Like Me, founded in 2004 by three MIT engineers, is a
privately funded company dedicated to making a difference in the lives
of patients diagnosed with life-changing diseases or conditions. The
goal of the company is to enable people to share information that can
improve the lives of these patients. Accordingly, the creators of
Patients Like Me developed a method for collecting and sharing real
world, outcome-based patient data. In addition, they are establishing
data-sharing partnerships with doctors, pharmaceutical and medical
device companies, research organizations, and nonprofit organizations.
The company's creators are now developing a new version of their
Web site, called Warriors Like Me, specifically for veterans, who will
be able to share information with one another regarding treatments and
procedures they find effective or promising. Providers and researchers
will be able to access this data to determine best practices for
conditions affecting those who serve, such as post-traumatic stress and
traumatic brain injury.
The effort to create a comprehensive and well-coordinated system of
care within our communities for our veterans and their families can
only be as successful as our efforts to educate those in need about the
issues they face and the resources that are available.
A significant public education campaign must accompany the public
works project. Many different organizations have launched public
awareness and educational efforts since the beginning of the wars in
Afghanistan and Iraq. Many have been creative and compelling. It is not
clear how effective any have been. While any one public education
campaign can be effective in educating those who serve about the
conditions they face and activating them to access the services
available to them, successful outreach occurs when a variety of
approaches are utilized. As with most complex situations, one size will
not fit all. Technology has its advantages, but sometimes the human
touch is required to make a connection and ensure follow through.
To give but one example: Give an Hour recently provided the mental
health support for a conference attended by many OEF/OIF veterans. One
of our providers encountered a veteran who shared some of her personal
struggles. Our provider offered to connect this young woman with a
mental health professional in her city who participates in our network.
The young woman accepted the offer and in a lovely e-mail message noted
that she probably would not have followed through with the idea of
counseling if our provider hadn't gone the extra mile to direct her to
someone offering care.
Conclusion
We have the resources, the vision, and the commitment to ensure
that our veterans and their families receive the care they need and
deserve. Thanks to the efforts of dedicated people working in and
across organizations and localities all over the country, we have the
potential to create an effective community-based, cohesive, and
organized service delivery system capable of providing comprehensive,
long-term care to those who serve our country. This is a historic and
unique opportunity to harness our Nation's resources and care for our
military community.
Prepared Statement of John King, Co Director, Veterans Community Action
Teams Mission Project, Altarum Institute, Ann Arbor, MI
Good afternoon, Chairman Michaud, Ranking Member Brown, and Members
of the Subcommittee.
Thank you for inviting Altarum Institute to testify before this
oversight hearing of the Subcommittee on Health. We appreciate the
opportunity to offer our views on VA Medical Care: The Crown Jewel and
Best Kept Secret. In our testimony today, we will address the methods
and activities through which we have observed the Veterans Health
Administration (VHA) communicating the availability of services to
veterans. We also will share our observations regarding the differences
in outreach strategies for the current generation of new veterans
versus those used for older veteran populations.
Altarum Institute (Altarum) is a nonprofit health systems research
and consulting organization serving Government and private-sector
clients. We provide objective research and tailored consulting services
that assist our clients in understanding and solving the complex
systems problems that impact health and health care. Our unique model
combines the analytical rigor of a research institution with the
business acumen of a traditional consultancy to deliver comprehensive,
systems-based solutions that meet unique needs.
In 2008, Altarum launched its Mission Projects Initiative,
committing more than $8 million in internal resources to three critical
areas of societal need. The purpose of the initiative is to solve
pressing health care issues using our systems methods at the
institutional, organizational, and community levels in partnership with
the public and private sectors, with the goal of improving the quality
of life for millions of Americans.
Our Mission Projects are focused on three areas: developing systems
changes to prevent childhood obesity, fostering innovation in community
health centers, and facilitating integration and coordination of
community health and social services for veterans and their families.
Today's testimony will focus on the last area.
As you are well aware, since 2002, we have seen a tremendous influx
of servicemembers transitioning from active duty to veteran status.
More than 870,000 servicemembers have separated from the active
military and Reserve Component forces and transitioned to civilian
life. These newly created veterans are returning to communities
throughout the country after having served in Operation Enduring
Freedom (OEF) and Operation Iraqi Freedom (OIF). These returning
veterans and the existing population of aging veterans have
multifaceted service requirements that are generally met by a number of
independently administered services. Their requirements include health
care, vocational rehabilitation, employment and training, care giving,
social services, housing, and independent living assistance, to name
just a few.
Current public and private initiatives providing these services to
veterans and their families have limited resources, not only to reach
out and administer their programs to this growing population, but to
integrate their services with other complementary programs being
offered in the community. The increasing number of new initiatives,
when added to an already confusing array of existing organizations and
services, often leaves veterans and their families searching for the
programs and services that best meet their needs. It is the absence of
the integration of these services that presents the greatest challenge
to veterans and their families, who are forced to navigate a complex
web of care and programs that often are not well coordinated. This
situation forces undue stress and burden on those who we believe are
the most deserving of our support.
We believe that veterans and their families deserve access to an
integrated system of community services to achieve economic security,
receive better health care, and improve their overall quality of life.
With improved communication, coordination, and integration, a
streamlined and responsive community-based system will enhance access
to public, private, nonprofit, and volunteer services for veterans and
their families. In turn, community service organizations will be more
efficient and effective at delivering services, optimizing existing
resources, and enhancing the population and community development.
It is our observation that no one entity can meet all of these
requirements. Altarum's Veterans Community Action Teams (VCAT) Mission
Project was started specifically to strengthen the web of care that
currently exists for veterans and their families. Through the VCAT
project, Altarum works with community service providers and advocates
who not only understand the National debt to veterans and their
families but are also the ones in the best position to render the
appropriate services.
The VCAT project will develop a collaborative, community-based
model to integrate the outreach and delivery of services from public,
private, and nonprofit organizations to veterans and their family
members. The VCAT project will test this model in selected pilot
communities to demonstrate the value of the community-based system of
care for improving the accessibility, scope, and quality of services
available for veterans and their families. Multiple governmental
agencies, nongovernmental organizations, and community-based
organizations are being invited to collaborate.
Currently, VCAT project leaders are communicating with leaders of
communities with large veteran populations as well as public, private,
and nonprofit organizations within those communities to establish the
VCAT project pilot site(s). Strategic partnerships are already under
way to ensure that the VCAT model will have long-term sustainability in
the demonstration communities. Altarum will continue the VCAT project
in partnership with the selected pilot communities through the end of
2010.
Altarum's focus through the VCAT project is concentrated on
building integrated community-based service networks that strengthen
service ``safety nets'' for veterans and family members who are
experiencing readjustment issues and/or suffering the ``invisible
wounds'' of war.
Based upon our collaborations with VHA in our search for the first
VCAT pilot community, we have observed a significant level of
cooperation and coordination among the VHA; the Veterans Benefit
Administration; the Department of Defense; State, county, and local
governments; and public and private organizations. The VCAT initiative
is an effort to complement the work of the VHA by building bridges from
community-level services to the National-level efforts of outreach and
access. The footing for these bridges will be built from the community
up, namely through the coordination, the collaboration, and ultimately
the integration of the community providers. The community providers
include Federal, State, and local governments; private and nonprofit
organizations; and voluntary service providers. Some of the services
include community mental health, spiritual wellness, law enforcement,
education and training, and legal advocacy (including Veterans Service
Organizations or VSOs).
VHA accomplishes outreach to the veteran population through the
media and network efforts of the Veterans Affairs Medical Centers,
community-based outpatient clinics, and veteran centers and through
partnerships with public and private VSOs. All of these outreach
efforts are focused on connecting veterans and their family members to
the health care services provided by VHA. This high level of
collaboration has the additional result of connecting veterans and
families with organizations that offer other programs and services that
are not necessarily health related (e.g., job placement centers,
housing assistance, childcare providers). Our plan is to look at
current ``best practices'' and to provide assistance to further
integrate the community service providers. The goal is to develop
models that can serve as guides for other communities to replicate the
development of highly integrated community service networks. In the
face of financial constraints on the Nation, which are felt especially
at the community level, the efficacy of this initiative will enhance
integration of existing programs and more effective and efficient use
of associated resources.
The outreach strategies employed to connect the current generation
of OEF/OIF veterans with services needs to be different than those used
with past generations. The methods used by this new population to
receive and to process information are vastly different. What has not
changed is the tendency of veterans (past and present) to base their
trust of service organizations on familiarity; they trust other
veterans and servicemembers and those to whom their trusted comrades
refer them. It is the method by which they share this information that
is different and that must drive the changes that the VHA and all other
veteran service organizations must make in their outreach efforts. Our
observation is that it is no longer adequate to simply create and
launch a Web site of an organization's services or even a portal to
connect veterans to many organizations' services. The current
generation of veterans communicates through social networks that
connect individuals based upon common interests, requirements, and
mindset. Outreach is accomplished by connecting organizations and
networks of providers in like manner to the social networks of the
younger veterans.
While our VCAT project will have a particular focus on OEF/OIF
veterans and their families in the immediate future, we believe that
well-integrated community providers will have the inherent capacity to
serve all veterans regardless of age. The VCAT project has been up and
running for almost a year; we are applying our existing knowledge and
learning new information on the complex needs of veterans and their
families to better understand the multifaceted services arena.
Community providers need the collaborative support from all levels of
Government and private partners so that they can ``wrap'' their
services around veterans and their families. Services need to be
seamless to ensure that no veteran or family member is lost as
servicemembers transition from active duty to veteran status and
continue to access services throughout their lives. The ease of access
to services for veterans is the ultimate outcome that integrated
communities are striving toward.
The early evidence from our initial engagement of public and
private partners within our potential VCAT pilot communities supports
our hypothesis that the key to improving the delivery of services to
veterans and families is the integration and improved collaboration of
service providers. The degree to which the delivery of services is
enhanced and outreach is improved within a community is directly
related to the level of communication, coordination, and collaboration
of public and private service providers from all levels within that
community. Barriers to communications must be eliminated, bridges of
relationship between all VSOs need to be built, and cooperation across
those bridges must be promoted.
While our overarching goal is to improve the lives of veterans and
their families, it is also our hope that the model that we develop and
the lessons that we learn from our demonstration project will help
inform other communities. Ultimately, we would like the VCAT model of
community-based service integration to be replicated in other
communities across the Nation. We hope to share with you the lessons
that we learn from the VCAT project soon and offer policy and
programmatic changes that may lead to increased outreach to veterans
and their families.
In conclusion, we see the VCAT project as a great opportunity to
support and assist our Nation's veterans in receiving the care,
support, and services that they need, ensured by an integrated network
of organizations and service providers. As a nonprofit organization,
Altarum Institute is committed to its mission: We serve the public good
by solving complex health care systems problems to improve human
health. I can imagine no greater reward than to help fulfill this
mission by serving those who have given so much in service to our
Nation.
Mr. Chairman, this concludes my statement. I will be pleased to
respond to any questions.
Thank you.
Prepared Statement of Randall L. Rutta, Executive Vice President,
Public Affairs, Easter Seals, Inc.
Chairman Michaud, Ranking Member Brown, Members of the
Subcommittee, on behalf of Easter Seals, thank you for the opportunity
to come before you today to share our views on issues relating to the
Department of Veterans Affairs' Veterans' Health Administration and its
outreach to and care of our Nation's veterans. My name is Randall Rutta
and I am Easter Seals' Executive Vice President of Public Affairs.
NEED
The crisis facing our Nation in meeting the physical and mental
health needs of the 1.8 million members of the armed forces who served
in Iraq and Afghanistan, as well as the needs of 23.4 million other
veterans, is overwhelming and continues to grow. Thousands of injured
servicemembers are returning home to communities nationwide with hopes
of transitioning to a successful civilian life. While a broad spectrum
of public benefits and private resources exist across the country, many
servicemembers and veterans with disabilities are encountering barriers
to accessing health care, job training and employment, housing,
recreation and transportation as they transition back into their
civilian communities. Nationwide, many communities are simply not fully
equipped to respond appropriately and effectively to this population's
unique needs, nor are they aware of how to best coordinate with
military and veterans systems in the process. These barriers often
limit the ability of veterans and their families to live, learn, work,
and play as full participants in civilian community life.
In 2008, the RAND Corp released a study indicating that 1 in every
5 returning OEF/OIF servicemembers expressed indicators for post-
traumatic stress disorder (PTSD) and 1 in every 5 had some level of
Traumatic Brain Injury (TBI). This observation warrants concern as PTSD
and TBI are among the leading medical conditions facing our returning
heroes. According to Dr. Evan Kanter, a staff physician for the VA, who
wrote in a November 2007 study by Physicians for Social Responsibility,
titled ``Shock and Awe Hits Home,'' that ``as many as 30 percent of
injured soldiers have suffered some degree of traumatic brain injury.''
These combat injuries significantly complicate a veteran's ability to
successfully transition from active duty to civilian life. Moreover,
unlike injuries to a soldier's limbs, injuries to a soldier's brain are
often difficult to diagnose and treat in a timely manner, and are often
not apparent until months later.
In a GAO report, the VA was commended for its efforts to prepare to
meet these demands. However, concerns were noted about ensuring that
all veterans have ``equal access'' when wide geographic territories
define a service catchment area. Concern was also expressed about the
efficacy of several service strategies that appeared to build
infrastructure, but did not provide direct service. Issues of access to
and availability of fundamental services and supports are unfortunately
a common part of daily experiences for an individual living with a
disability in our country. It is reasonable, then, to conclude that
such challenges will be a part of life for a veteran with a service-
connected disability. Easter Seals believes that these barriers need
not be inevitable for these veterans - or for the broad population of
individuals with disabilities. We are committed to creating and
implementing solutions to these challenges in work and in life, so that
all veterans with disabilities have the opportunity to lead full and
productive lives.
EASTER SEALS BACKGROUND
For 90 years, Easter Seals has been providing and advocating for
services that change and improve the lives of those living with
disabilities and their families. With a network of 78 affiliate
organizations, we are the Nation's largest provider of disability
related services to individuals with disabilities and their families--
touching the lives of more than 1.3 million people annually. We have a
long history of helping veterans with disabilities through job training
and employment opportunities, adult day services, medical
rehabilitation, home modifications for accessibility needs, and
recreation. Easter Seals is positioned to offer military and veterans
systems of care with viable options to support and augment current
transition and reintegration efforts. Additionally, Easter Seals has
former servicemembers in leadership positions to guide program
development and to train staff on how to be attuned to military and
veteran cultural issues. In fact, Easter Seals has made Military and
Veterans Initiatives a foundational pillar of Vision 2010, which is the
guiding mission for the organization's current work and resource
allocation priorities.
The vision of our Military & Veterans Initiative is that
Easter Seals is a recognized and trusted partner with the
Departments of Defense and Veterans Affairs, and is a
significant source of essential information, services and
support for America's military servicemembers, veterans with
disabilities, and their families.
EASTER SEALS CURRENT SERVICE CAPACITY AND EXPERIENCE
Currently, Easter Seals provides a broad range of community-based
services and supports--job training & employment, childcare, adult day
services, medical rehabilitation, mental health services,
transportation, camping & recreation, respite and caregiver services,
and accessibility solutions and technology for home, work, and
independent living--to military servicemembers and veterans with
disabilities, and their families in civilian programs throughout the
Nation. A summary of a few of these activities follows.
Job Training & Employment
Historically, Easter Seals has had considerable experience with the
VA in providing employment related services to veterans with
disabilities. Our affiliate in Hartford, CT provides vocational
evaluations and assessments to veterans with disabilities. Easter Seals
in Middle Georgia provides direct work experience for veterans with
disabilities. With grant funding from the McCormick Foundation, Easter
Seals headquarters is developing an educational curriculum to train
employers on best practices for hiring, retaining, managing and
accommodating veterans with disabilities, especially those with PTSD,
TBI, and amputations that are trying to reenter the workforce. A number
of Easter Seals' corporate partners are pursuing strategies to hire
veterans with disabilities throughout their organizations nationwide.
Adult Day Services
Several Easter Seals affiliates have contracts with the VA to
provide adult day services to older veterans and are exploring
potential opportunities for veterans with disabilities, specifically
for younger veterans with significant injuries. Easter Seals Greater
Washington-Baltimore Region operates a new intergenerational facility
that delivers comprehensive services in Silver Spring, Md.,
approximately one mile from Walter Reed Medical Center. Plans call for
the center to have resources for veterans and their families to support
them during their time Washington, D.C. and in transition to their
respective hometowns across the country.
Community OneSource TM
A significant disconnect in the continuum of care exists between
active duty recovery at military treatment facilities and post-
discharge reintegration to civilian life and life with a disability for
servicemembers with disabilities and their families in communities
nationwide. The report issued by the President's Commission on Care for
America's Returning Wounded Warriors supports the implementation of a
comprehensive ``Recovery Plan'' that will help servicemembers obtain
essential services promptly and in the most appropriate care facilities
in the Departments of Defense and Veterans Affairs, and civilian
settings. Easter Seals is responding to the Commission's call to action
for civilian settings by developing and implementing a ``Community
OneSourceTM'' reintegration model program.
Community OneSourceTM is a dynamic national initiative
that will support successful community reintegration of America's
wounded, ill or injured servicemembers and veterans and their families.
The program's approach fosters systems change throughout the country to
rally and support communities and regions in responding to the needs of
this deserving population, while specifically establishing points of
contact that will coordinate and provide services and supports to
families. Community OneSourceTM leverages, integrates, and
builds community capacity through convening and collaborative efforts
amongst Federal, state, and local public and private systems and
providers of service to meet specific needs for information,
assistance, case management, system and resource navigation, and
essential services from active duty demobilization or discharge to
civilian status and successful community integration.
SUGGESTED IMPROVEMENT AREAS
Easter Seals recognizes and applauds the good work that the
Veterans Health Administration (VHA) does for our Nation's veterans
community. The VHA has 7.8 million veterans enrolled in its health care
system and provided 5\1/2\ million unique patient visits in 2007. In an
effort to reach the entirety of today's 23.4 million veterans, Easter
Seals commends the many and varied communication and outreach
strategies that VA utilizes to inform its service population. Efforts
such as active participation in demobilization briefs (Transition
Assistance Program, Disabled Transition Assistance Program),
partnerships with Veteran Service Organizations, combined efforts with
state VA efforts (county outreach coordinators), the implementation of
online strategies, and the use of traditional media, public service
announcements, brochures, billboards, and others have heightened public
awareness and gone far to informing today's veterans of the
availability of support and care provided through the VA.
Despite these good efforts, a strategic resource has yet to be
fully leveraged in this process-- capitalizing on the infrastructure,
established networks, and grassroots reach of community-based
organizations such as Easter Seals.
1. Collaboration: No one organization can provide all the services
that an entire segment of a population needs--and the VA cannot be all
things, to all veterans, in all places. Veterans and their families are
not all located conveniently near VA facilities, many live in rural
areas where they are geographically isolated from VA services.
Additionally, the VA does not maintain a full compliment of services at
every one of its facilities nationwide, creating service gaps for those
whose needs cannot be met locally.
Recommendations: VA should use community-based NGOs as a
vehicle for both outreach AND service delivery. The VA must
reach out to community-based NGOs to leverage their best
practices and service capacity in meeting the needs of veterans
and their families in areas where VA services either do not
exist, are inaccessible, or are insufficient through
partnerships and outsourcing. This would allow the VA to
formally recognize the capacity, ability, and desire of the
community-based sector to serve veterans and their families.
Additionally, VA should develop a strategic plan for teaming
with and leveraging the Nation's human service system in
meeting their mission.
2. NGO Access: Many Federal agencies have an established point of
contact to facilitate organizational partnerships, learning, and team
efforts. They serve are liaisons for understanding and supporting the
organization's strategic vision and service needs. The VA has a Veteran
Services Organization (VSO) liaison that acts as an entry point for
accessing to VA internal agencies for the VSOs.
Recommendation: In support of the VA's Gateway Initiative,
VA needs to hire an NGO liaison, VA Ombudsman to fully realize
this entry point for interacting with the VA and outside
organizations seeking to help veterans. This staff Member would
not only understand VA and veteran needs, but also the NGO
system--including how to interpret their desire to partner and
leverage resources.
3. Mobile Vet Centers: The VA has established 50 mobile Vet
Centers that specifically target veterans in more remote areas where VA
mental health services do not exist. While Easter Seals applauds the VA
for thinking outside the box with this initiative, we would ask what
happens to veteran needs after the mobile Vet Center leaves the
community.
Recommendations: The VA should formally partner with local
community NGOs like Easter Seals to host the mobile Vet Center
during its visit, and contract for services that ensure
continuity of care before and after the visit. Then once the
mobile Vet Center leaves, the local community based NGO would
be able to provide a level of follow up services to the veteran
and/or family. Such a partnership should include outreach for
VA services conducted by the NGO.
4. Younger Veterans: The VHA has taken a number of steps to reach
younger veterans, initiating age appropriate strategies to accomplish
this objective. Online efforts such as a section within the VA's Web
site designed explicitly for Operation Enduring Freedom and Operation
Iraqi Freedom veterans and My HealtheVet provide useful and relevant
health care and benefits information. The VA has also initiated
strategies to leverage the power of web-based social networking to
reach out to younger veterans, with a growing presence on Facebook,
informational videos on YouTube and involvement with Second Life. The
involvement of OEF/OIF coordinators in reintegration events such as
Stand Downs and Yellow Ribbon Reintegration events also targets getting
information to today's younger veterans as they seek to shift into
civilian life.
Recommendations: While these efforts are both appropriate
and strategic, the VA could enhance their outreach efforts to
younger veterans through increasing activities designed to
target a veteran's family--their parents or spouse. One unique
strategy that has proven effective for National Guard Members
is Easter Seals New Hampshire's Veterans Count program, where
Easter Seals, in partnership with the Guard and New Hampshire's
Department of Health and Human Services, initiates contact with
Guard Members and their families pre-deployment. The Veterans
Count staff then work with these families to prepare them for
deployment, support the family while the servicemember is
deployed, and then are positioned to support them post-
deployment because of time invested with the family over the
prior 18 to 20 months. Such an approach significantly reduces
the likelihood that a veteran will fall the cracks or be lost
in the bureaucratic process in their attempts to return to
their families. Easter Seals is then able to ensure that the
veteran and his or her family is connected with the resources
they need to successfully transition back into civilian life.
This early intervention model provides a unique boots on the
ground approach to outreach and is one that Easter Seals would
like to see implemented across the country.
5. Older Veterans Strategies: While Easter Seals applauds the
efforts of the VHA to develop appropriate and targeted approaches to
reaching younger veterans, we remain concerned that older veterans are
not receiving similar organizational attention. While some older
veterans will likely be able to found through younger veteran
approaches, many of the over 9 million veterans who are 65 and above
will not benefit from these efforts, particularly those who are low-
income, have limited access to health care or lack access or skills to
utilize current technologies. This short-coming results in those most
in need of services and supports being left out or looked over by the
very system designed to meet their needs.
Recommendations: VHA should actively pursue a collaborative
relationship with the administration on Aging (AoA) and create
joint marketing and outreach strategies and materials which
leverage the national network of senior services under the
authority of AoA. Such a partnership could result in such
outreach efforts as including information in Meals on Wheels
deliveries about age appropriate veterans benefits for
beneficiaries of this AoA service. Additionally, VHA should
create partnerships with senior service organizations to
utilize their networks across the country to provide
information to seniors served by their systems. Further, local
VHA facilities such as Vet Centers, Veterans Hospitals and
Outpatient Clinics should actively reach out to local Area
Agencies on Aging to install outreach strategies within their
service delivery mechanisms and facilities such as senior
centers or activities buildings.
Finally, VHA should establish strategic relationships with
our Nation's adult day service network, which provides service
to over 150,000 seniors daily through a network of over 3,400
local centers. While adult day service is a fairly new offering
from the VA, being added to the veteran benefit package through
the Millennium Health Act 1999, the larger adult day service
market has been strong for decades, and projects significant
growth in the coming years as our Nation's baby boomers age and
desire the services provided by this industry. Many of the 9
million senior veterans are likely to need and receive these
services. Easter Seals has worked with the VHA for a number of
years on promoting the use of ADS within the community of
veterans accessing VA services. We have also encouraged the VA
to more actively engage the non-VA ADS network as strategic
partner that could both extend information about VA benefits
and provide quality services to older veterans. Non-VA ADS
staff should be trained to identify, refer as appropriate and
meet the unique service needs of older veterans; the VA is the
logical entity to lead such efforts.
6. Insular Culture: Many of the systems and departments providing
services to veterans within the VA operate in a very insular manner,
most notably at the local level. Specific functions are carried out in
silos and stop short of shepherding the veteran to much needed
additional resources during their community-based transition, continued
recovery and rehabilitation. Often times Veterans Integrated Service
Network (VISN) staff reflect this insular operational methodology in
attitudes concerning the use and value of utilizing local NGOs to meet
veterans' needs. One significant outcome of this cultural insularity is
lost opportunity, for the VA to meet its objectives and, sadly, for the
veteran who either gets lost in the system or cannot access the full
array of available services in his or her community. More often than
not, our local affiliates' experience in attempting to partner with the
local VA is met with initial resistance and then inability to execute.
Recommendations: The VA must encourage key decision-makers
in each VISN to embrace collaborative relationships to meet the
needs of veterans within their service delivery region. VHA
community leaders should partner with other local community
NGOs to help meet the needs of the veterans they serve. Easter
Seals offers services and supports that can augment those
provided by VHA, especially when the veteran transitions to his
or her home community. Additionally, Easter Seals would
recommend systemic VA organizational culture change that
changes the service delivery approach to veteran-centric.
SUMMARY
America's warriors serve their country, fully, bravely and without
question. Now, all Americans must rise together to fulfill our promise
to care for those who have borne the battle and sacrificed so much, by
assuring that our veterans have access to the services they need,
wherever they live. Just as it takes a village to raise a child, so too
does it take a village to welcome a veteran back home.
As Executive Vice President of one of the Nation's largest
nonprofit disability health care organizations, I can say with an
unwavering confidence that the VA has much to gain by embracing
community-based organizations, like Easter Seals, in collaborative
relationships that compliment the current array of Federal and state
outreach and service efforts to our struggling veterans. It is these
community-based organizations that hold the infrastructure to help meet
this urgent need and should be viewed as an ally to further supplement,
and not supplant, the efforts of the VA. Easter Seals is poised to
substantially expand assistance to servicemembers and veterans with
disabilities and their families. We have proven service solutions in
place or within easy reach to address these immediate and long-term
needs. The central challenge facing us in bringing needed information,
services and supports to this population is the limited extent, to
date, on the part of the Departments of Defense and Veterans Affairs to
partner and outsource at substantial levels with private, nonprofit
service providers to seed and sustain financial resources to conduct
pilot projects and replicate effective models of service delivery
nationwide that promote success in attaining individual and family
goals and full community participation.
As Secretary Shinseki stated earlier this year during his Senate
confirmation hearing ``. . . three fundamental attributes mark the
starting point for framing a 21st Century Organization: people-centric,
result-driven, and forward-looking.'' A 21st Century VA must reach out
across the table to community-based organizations to leverage best
practices and local infrastructure in order to provide more effective
services and supports to America's heroes and their families . . .
Easter Seals has its hand extended.
Thank you again for the opportunity to address this Committee and
for all that you do for our Nation's veterans. I would be pleased to
respond to any questions that you may have.
Prepared Statement of Jeffrey W. Pollard, Ph.D., ABPP, Director,
Counseling and Psychological Services, George Mason University,
Fairfax, VA, on behalf of American Psychological Association
Mr. Chairman and Members of the Subcommittee, please allow me to
express appreciation for the opportunity to speak on behalf of the
150,000 members and affiliates of the American Psychological
Association regarding outreach activities to veterans on college
campuses. I am the son of a decorated WWII veteran captured on December
7, 1941, released in September 1945, and buried in Arlington National
Cemetery. I have spent 30 years working as a psychologist committed to
the mental and behavioral health of students on college campuses.
Meeting the needs of the increasing numbers of our Nation's veterans--
particularly on college and university campuses--is extremely
significant to me.
Our ability to diagnose and treat combat-related mental and
behavioral health problems, including depression, traumatic brain
injury, and post-traumatic stress disorder has improved dramatically in
recent years. Estimates suggest that between a quarter and a third of
all veterans returning from Operation Enduring Freedom and Operation
Iraqi Freedom will display symptoms of a mental disorder within a year
of leaving military service. Many of these veterans are expected to
benefit from the new Post-9/11 GI Bill by furthering their education at
our Nation's colleges and universities. These facts point to the
important role that colleges and universities must play in our national
efforts to meet the mental and behavioral health needs of our
servicemembers and veterans.
During the past year, George Mason University has been involved in
a number of important activities to enhance our outreach to military
personnel and veterans on campus. First, we hired Mr. Michael Johnson
to serve as our full-time Military and Veterans Liaison in our Military
and Veterans Office. Mr. Johnson, who has accompanied me to today's
hearing, is a veteran of the United States Marine Corps, where he
served for 17 years as both an enlisted Member and an officer. Mr.
Johnson and his colleagues in the Military and Veterans Office
currently serve approximately 1,000 active duty, reserve, National
Guard and veteran students, offering assistance and information
regarding issues such as veteran services and academic counseling, as
well as information about the many benefits to which they are entitled
through state and Federal Government programs. The office also assists
veterans in adapting to collegiate life, connecting them to each other,
and supporting them as they pursue their studies.
In addition, George Mason University has recently completed a needs
survey of our military and veteran student population and established
connections between the new Military and Veterans Liaison and virtually
every component within the university. We have also established the
Mason Military Outreach group, which is a collaboration of students,
faculty and staff in support of our servicemembers, veterans, and their
families. Further, the Mason Veteran Peers (MVP) initiative, involves a
group of veterans who are working with Counseling & Psychological
Services to provide peer support to veteran students.
Last month, George Mason University was one of only 20 institutions
of higher education awarded a ``Success for Veterans Award Grant''
sponsored by the American Council on Education and the Wal-Mart
Foundation. This $100,000 grant will help George Mason University's
Military and Veterans Office evolve further into a comprehensive,
coordinated one-stop resource and support center to ensure academic,
psychological, and transition support. We are grateful for this award.
However, like most grants, it will not cover the predicted level of
need, and it is time limited. Furthermore, our university may be unable
to continue the program upon completion of the grant. Unfortunately,
servicemembers and veterans attending colleges and universities that
have not received such grant funding will not be able to benefit from
the additional support to aid in the successful completion of their
academic work.
Just as the community mental health system is stretched far too
thin, so are college and university mental health resources. In fact,
campus mental health faces significant systemic challenges, including
an insufficient number of service providers, such as psychologists,
psychiatrists, and case managers. Funding for colleges and universities
to provide the specialized mental and behavioral health care required
by many servicemembers and veterans is unavailable. As more
servicemembers and veterans are utilizing college and university mental
health services, these facilities are experiencing the strain of
increasing caseloads and case management needs.
Data indicate that students on college and university campuses are
increasingly arriving with more severe preexisting mental and
behavioral health problems or developing these health concerns during
their college careers. The increasing civilian mental and behavioral
health needs on campus make it even more challenging for colleges and
universities to provide sufficient services and supports for the
growing population of servicemembers and veterans on campus.
While we at George Mason University and our colleagues at colleges
and universities around the country have been taking important steps to
reach out to servicemembers and veterans on campus, much work remains
ahead. I would like to provide a few recommendations that may help our
institutions of higher learning to ensure that we are doing all that we
can to meet the mental and behavioral health needs of our military and
veteran student population.
First, sufficient resources must be made available to support
targeted efforts on campus to address mental and behavioral health
needs among servicemembers and veterans, including risk of suicide. In
recent years, some important Federal initiatives have been created
through the Substance Abuse and Mental Health Services Administration
(SAMHSA) to address the national problem of increased mental and
behavioral health concerns on campus, including suicide.
While these SAMHSA grants currently support education and outreach
efforts related to suicide prevention on college and university
campuses, there are currently only 49 programs in place to create
greater awareness about suicide and strengthen suicide prevention
efforts. Much more needs to be done. Initiatives are underway to enable
SAMHSA to support direct services for students on campus, an increasing
number of whom will be servicemembers and veterans, so that the full
range of their mental and behavioral health needs can be met.
Senators Durbin and Collins and Representative Schakowsky have
introduced the Mental Health on Campus Improvement Act (S. 682/H.R.
1704) and its programs will complement SAMHSA's Campus Suicide
Prevention program to offer the full range of prevention and
intervention services currently needed on college and university
campuses. In addition, this legislation calls on grant applicants to
include a plan, when applicable, to meet the specific mental and
behavioral health needs of veterans attending institutions of higher
education. This bill would also establish a College Campus Task Force,
which includes representation from the Department of Veterans Affairs,
to discuss mental and behavioral health concerns on college and
university campuses.
Second, continuing education and training opportunities must be
readily available for college and university mental and behavioral
health professionals regarding some of the unique deployment,
reintegration, and readjustment issues facing servicemembers, veterans,
and their families. Both the Department of Defense (DoD) and the
Department of Veterans Affairs (VA) have unique knowledge and expertise
in this domain. I recently attended a week-long training conducted by
the DoD Center for Deployment Psychology in which leading experts in
the field provided critical training regarding the deployment cycle,
trauma and resilience, behavioral health care for the severely injured,
and the impact of deployment on families. These are high quality
training programs that are worthy of continued attention and support.
Third, we must develop mechanisms to conduct appropriate outreach
to servicemembers and veterans who are beginning their postsecondary
education online while deployed or upon their return from service. Such
online education opportunities may present unique challenges for our
military and veteran students, not because these education programs are
unworthy or ineffective, but because of their potential isolating
effect. Servicemembers and veterans who are enrolled in online
education programs and experiencing mental and behavioral health
problems are often more isolated than their on-campus colleagues, and
this isolation can be contraindicated for their healthy readjustment
and recovery.
APA and the psychology community looks forward to continuing to
work with Congress, the VA, the DoD, and the veterans service community
to welcome home our men and women in uniform and ensure that they
receive the mental and behavioral health services and supports--on
college and university campuses and in the larger community--that they
have so honorably earned.
Prepared Statement of Paul J. Hutter, Chief Officer; Legislative,
Regulatory, and Intergovernmental Affairs, Veterans Health
Administration, U.S. Department of Veterans Affairs
Mr. Chairman and Members of the Subcommittee, thank you for
providing me this opportunity to discuss the Veterans Health
Administration's (VHA's) outreach activities to Veterans. I am
accompanied today by Ev Chasen, VHA's Chief Communications Officer,
John Brown, Director of the VHA Operation Enduring Freedom and
Operation Iraqi Freedom (OEF/OIF) Outreach Office, and Emily Smith,
Deputy Assistant Secretary for Intergovernmental Affairs, Office of
Public and Intergovernmental Affairs. VA's mission is to care for those
who have borne the battle--to honor those who have worn the uniform by
providing them the highest quality health care and benefits possible.
This mission can only be accomplished when Veterans know the full range
of services we offer. VA is committed to reaching out to Veterans and
their families where they are to support these ends; this includes not
only reaching into rural communities, but entering virtual communities
and establishing connections there as well. My testimony today will
highlight four forms of outreach VHA is conducting: direct, traditional
outreach to separating servicemembers; program-specific outreach;
outreach to rural areas; and outreach using new technologies.
Outreach to Separating Servicemembers
VHA currently maintains a variety of programs to respond to the
specific needs of separating OEF/OIF servicemembers to assist them in
transitioning from military service to Veteran status. The Department
of Veterans Affairs (VA) and the Department of Defense (DoD) have
established a comprehensive, standardized enrollment process at 60
demobilization sites (15 Army, 3 Navy, 3 Marines, 3 Coast Guard and 36
Air Force). Through this process, VA has contacted more than 41,000
Members of the Reserve and National Guard and enrolled more than 38,000
of them for VHA health care. DoD provides VA with dates, numbers of
servicemembers demobilizing and locations for demobilizing events. At
these events, VHA staff representatives from the local VA medical
center, benefits specialists and Vet Center counselors provide
standardized 45-minute briefings during mandatory demobilization
events. During the briefing, VA representatives provide demobilizing
servicemembers information about health care enrollment and
eligibility, including the most recent expansion extending VA health
care enrollment period to 5 years to those servicemembers who served in
combat following their separation from active duty. They are also
educated about the period of eligibility for dental benefits, which
Congress recently extended from 90 days to 180 days following
separation from service, through the National Defense Authorization Act
for Fiscal Year 2008.
VA streamlined this enrollment process and, during the
demobilization events, VA representatives show Veterans how to complete
the Application for Health Benefits (1010EZ). This begins the
enrollment process for VA health care. VHA staff members also discuss
how to make an appointment for an initial examination for service-
related conditions and answer questions about the enrollment process.
VA representatives collect the completed forms at the end of each
session. VA staff at the supporting facility match the 1010EZ with a
copy of the Veteran's DD Form 214, the discharge papers. Presently,
data from these forms are entered into the Vista health record system.
An email is sent to the Veteran's preferred facility to complete the
enrollment. A new process has been developed through a pilot program at
Ft. Bragg to overnight all records from each of the 60 sites to VA's
Health Eligibility Center to complete the enrollment process. A letter
is then sent from the Health Eligibility Center to the Veteran
verifying their enrollment.
In response to the growing numbers of Veterans returning from
combat in OEF/OIF, the Vet Centers initiated an aggressive outreach
campaign to welcome home and educate returning servicemembers at
military demobilization and National Guard and Reserve sites. Through
its community outreach and brokering efforts, the Vet Center program
also provides many Veterans the means of access to other VHA and VBA
programs. To augment this effort, the Vet Center program recruited and
hired 100 OEF/OIF Veterans to provide the bulk of this outreach to
their fellow Veterans. To improve the quality of its outreach services,
in June 2005, the Vet Centers began documenting every OEF/OIF Veteran
who received outreach services. The program's focus on aggressive
outreach activities has resulted in the provision of timely Vet Center
services to significant numbers of OEF/OIF Veterans and family members.
Every VA medical center has established an OEF/OIF Program. The
Program Manager, usually a social worker or nurse, manages programs for
OEF/OIF Veterans, coordinates the efforts of clinical case managers and
Transition Patient Advocates, links with military treatment facilities
to ease transfers of patients and works with the Veterans Benefits
Administration (VBA) to track claims. Each VISN has also identified an
OEF/OIF Program Manager to coordinate inter-facility issues and
practices. OEF/OIF case managers initiate contact with patients and
families before they transfer from a military treatment facility (if
they have received care there, otherwise, they work with patients and
their families as they present for care) and assist an
interdisciplinary team assigned to treat the Veteran's medical needs.
The OEF/OIF case manager is responsible for planning and coordinating
all of the patient's health care needs.
In May 2008, VA began a Veteran Call Center Initiative to reach out
to OEF/OIF Veterans who separated between FY 2002 and December 2008. We
are now reaching out to Veterans who have separated through March 2009.
The Call Center representatives inform Veterans of their benefits,
including enhanced health care enrollment opportunities and determine
if VA can assist in any way. This effort initially focused on
approximately 15,500 Veterans VA believed had injuries or illnesses
that might need care management. The Call Center also contacted any
combat Veteran who had never used a VA medical facility before. Almost
38 percent of those we spoke with requested information or assistance
as a result of our outreach. The Call Center Initiative continues
today, focusing on those Veterans who have separated since 2001. As of
May 6, 2009, VA has called 660,000 Veterans and spoken with more than
160,000 of them. We have sent almost 36,000 requested information
packages to Veterans.
Another area in which VA is supporting OEF/OIF transition is
through the Yellow Ribbon Reintegration program. VA has assigned a
full-time liaison with the Yellow Ribbon Reintegration Program office
in DoD to facilitate VA support of the development and implementation
of the program. The Yellow Ribbon Reintegration Program is currently
active in 54 states and territories, and engages servicemembers and
their families during the pre-, during and post-deployment stages,
including 30, 60, and 90 days after deployment. At the local level, VA
supported 275 Reserve and Guard Yellow Ribbon Events during FY 2008 and
through mid-February 2009. A total of 39,000 servicemembers have
attended these events, along with 25,000 members of their families.
VHA has been providing support to DoD's Reserve and National Guard
(RC) Post-Deployment Health Reassessment (PDHRA) Initiative since its
beginning in November 2005. VA has supported over 1,850 PDHRA events at
local Reserve and National Guard Units along with supporting referral
efforts from DoD's 24/7 PDHRA Call Center operation. The RC PDHRA
initiative has generated over 57,000 referrals to VA medical centers
and over 24,000 referrals to Vet Centers during this time.
For severely injured Veterans and servicemembers, VHA has stationed
27 social work or nurse case manager liaisons at 13 military treatment
facilities across the country to identify and address the patient's
clinical needs as they transfer from a DoD facility to a VA facility.
Similarly, VA houses approximately 90 military liaisons in VHA
facilities to provide on-site, non-clinical support for Veterans or
servicemembers at VA's Polytrauma facilities and other locations.
In October 2007, VA partnered with DoD to establish the Joint VA/
DoD Federal Recovery Coordination Program (FRCP). Federal Recovery
Coordinators identify and integrate care and services for the seriously
wounded, ill, and injured servicemember, Veteran, and their families
through recovery, rehabilitation, and community reintegration. The FRCP
is intended to serve all seriously injured servicemembers and Veterans,
regardless of where they receive their care. The central tenet of this
program is close coordination of clinical and non-clinical care
management across the lifetime continuum of care.
Program-Specific Outreach
VHA's program offices and facilities also engage in outreach in
their own areas in coordination to increase awareness of benefits and
services they offer. VA employs management tools to ensure control and
oversight of promotion efforts through coordinated messages with valid
and up-to-date information. VHA's Chief Business Office is undertaking
efforts to increase awareness of the Universal Health Service Plan task
force recommendations, including a streamlined health benefits
application web portal and other robust communication products.
Perhaps the most notable example of program-specific outreach VHA
has done is the Suicide Prevention public service announcements (PSAs)
featuring Gary Sinise and Deborah Norville. In the 6 months between
October 13, 2008 and April 13, 2009, the PSA featuring Gary Sinise was
broadcast more than 8,700 times by 155 stations in almost 100 markets.
During this same time period, VA's Suicide Prevention Hotline (1-800-
273-TALK) received approximately 50,000 calls across the Nation, an
increase of roughly 25 percent based on the previous 6 months when the
Hotline received approximately 40,000 calls. Last year, VA advertised
the Suicide Prevention Hotline on buses and metro trains in the
Washington, D.C. area, resulting in a significant increase in calls to
the hotline from the area. This year, we have begun advertising in
Spokane, WA, and will soon advertise on public transit systems in the
Miami, Los Angeles, San Francisco/Oakland, Phoenix, Las Vegas and
Dallas metropolitan areas (all locations where the suicide rate among
Veterans is greater than the national average). In addition, VA is
working with a company to purchase advertisements on 20,000 buses
nationwide.
More broadly, VA could not serve Veterans to the degree it does
without the immeasurable help of Veterans Service Organizations (VSOs),
faith-based and community groups. VA maintains constant contact and
holds regular meetings with VSOs and organizations such as the Knights
of Columbus, the American Red Cross, and the Salvation Army (among
others) to provide information about VA's programs and offerings while
soliciting feedback about concerns present in the community. Working
with these community partners helps significantly expand VA's reach to
millions of people who may not otherwise hear of our offer of care and
service.
Our facilities also conduct local outreach that, while essential,
often goes unheralded. These efforts are possible because of the
dedicated work of VA professionals who have established relationships
with local communities, and their work continue to pay dividends. For
example, in April alone:
The Little Rock VA Medical Center participated in two
Post-Deployment Health Assessments for Members of the 39th Infantry
Brigade of the Arkansas Army Guard; of the more than 850 soldiers
screened, we initiated 252 new case appointments;
The West Palm Beach VA Medical Center participated in an
outreach activity at the Palm Beach Community College, providing
information to students who are Veterans on enrollment, benefits and
employment;
The VA Central Texas Health Care System joined the Family
Readiness Group of the 126th Forward Surgical Team for a welcome home
celebration at Fort Hood as the Unit returned from a tour in
Afghanistan;
The VA Palo Alto's Polytrauma Rehabilitation Center and
the Men's Trauma Recovery Program held a small town hall meeting for
all active duty soldiers being cared for in these programs, providing
information on Medical Boards and other DoD issues related to their
time at VA;
The Indianapolis, Fort Wayne and Evansville, Indiana
Medical Centers hosted Post Deployment Health Reassessments for the
76th Brigade Combat Team for over 2,800 soldiers who returned from Iraq
in December 2008; and
The VA San Diego Health Care System participated in a
demobilization briefing at Camp Pendleton that approximately 800
Marines attended.
Mr. Chairman, these are but a few of the many actions taken by VA
staff Members to inform Veterans and to establish contact with them. I
highlight these cases not to draw special attention to these facilities
or any specific program, but as evidence of a trend too often missed.
VHA Directive 2007-017, enacted in May 2007, requires each VA medical
center to host an annual ``Welcome Home'' event for OEF/OIF Veterans
and active duty servicemembers, their families, and the community at
large. These events are well-attended and offer health screenings,
benefits information, and increase awareness about programs such as
VA's Safe Driving Initiative.
The Department's Safe Driving Initiative is an innovative effort
designed to address an important concern. VA has determined that motor
vehicle crashes are a leading cause of death among combat Veterans
during the first years after their return home, and is working with the
Department of Transportation and DoD to reduce these accidents. We have
begun a new program designed to identify needed research and to
increase awareness of the importance of safe driving among newly-
demobilized Veterans. The program has included a summit meeting among
leading researchers, posters, a soon-to-be-released Public Service
Announcement featuring race driver Richard Petty, a Web site, and other
activities. During calendar year 2009, every VA medical center has been
tasked to hold a safe driving event to inform returning Veterans of the
need to drive safely.
Our Vet Centers also provide services and points of access to
Veterans in communities across the country. Vet Centers welcome home
Veterans with honor by providing quality readjustment counseling in a
supportive, non-clinical environment. By the end of FY 2009, VA will
have 271 Vet Centers and 1,526 employees to address the needs of
Veterans; any county in the country with more than 50,000 Veterans will
have services available through a Vet Center. A fleet of 50 Mobile Vet
Centers are being put into service this year and will provide access to
returning Veterans and outreach to demobilization military bases,
National Guard and Reserve locations nationally. This type of outreach
spans across the range of areas covered today, as these Mobile Vet
Centers utilize new technologies to reach younger Veterans, those
immediately separating, those in rural or remote areas, and those in
need of services.
Rural Health Outreach
Particularly important to VA is outreach to geographic areas,
particularly rural and highly rural communities. Both the Office of
Rural Health (ORH) and Veterans Integrated Service Networks (VISNs)
participate in outreach efforts for these populations. VISN Rural
Consultants collaborate with local communities to educate, support case
management, and increase awareness. Additionally, VA's Rural Health
Resource Centers serve as regional satellite offices and educational
repositories to expand and develop relationships with academic
institutions and a range of other partners in communities across the
country. VA understands that successful outreach must be tailored to
local needs and conditions, and one of ORH's primary aims has been to
support this approach.
ORH is supporting expansion of the Mental Health Care Intensive
Care Management-Rural Access Network for Growth Enhancement (MHICM-
Range) Initiative to provide community-based support for Veterans with
severe mental illness. VA has been adding mental health staff to CBOCs,
enhancing our capacity to provide tele-mental health services and using
referrals to Community Mental Health Services and other providers to
increase access to mental health care in rural areas. ORH collaborated
with the South Central Mental Illness Research, Education and Clinical
Center in VISN 16 to fund four research studies investigating clinical
policies or programs that improve access, quality and outcomes of
mental health and substance abuse treatment services for rural and
underserved Veterans.
VA has also taken the lead in opening new rural health care
facilities, such as Rural Outreach Clinics. Last September, VA
announced the opening of 10 new Rural Outreach Clinics this Fiscal
Year; four of these are currently operational, including sites in
Houlton, ME; Perry, GA; Juneau, AK; and The Dalles, OR. VA utilizes
Rural Outreach Clinics to offer services on a part-time basis, usually
a few days a week, in rural and highly rural areas where there is
insufficient demand for full-time services or it is otherwise not
feasible to establish a full-time CBOC. Rural Outreach Clinics offer
primary care, mental health services, and specialty referrals. Each
Rural Outreach Clinic is part of a VA network and meets VA's quality
standards. Veterans use Rural Outreach Clinics as an access point for
referrals to larger VA facilities for specialized needs.
VA recently announced a Mobile Health Care Pilot Project in VISNs
1, 4, 19, and 20. The health care vans associated with this program
will be concentrated in 24 predominately rural counties, where patients
would otherwise travel long distances for care. VA is focusing on
counties in Colorado, Maine, Nebraska, Washington, West Virginia and
Wyoming. This pilot will collaborate with local communities in areas
our mobile vans visit to promote continuity of care for Veterans. It
will also allow us to expand our telemedicine satellite technology
resources and is part of a larger group of mobile assets. ORH is
developing evaluation methodologies and measures to determine the
effectiveness of this program and to identify areas for improvement.
Outreach Using New Technologies
VHA is not limiting itself to traditional forms of outreach. In
order to become a 21st century VA, we must add to the past methods used
in communicating to reach a new generation of Veterans. By fostering
and creating linkages across offices and throughout the Department, VA
is harnessing new technology and venues, including Twitter, Second
Life, Facebook, YouTube, and the television channel MTV to provide
information to younger Veterans where they are most likely to see it
and in media familiar to them. We have adapted our Web site to be
viewable on mobile devices (m.va.gov) so Veterans and others can
receive up to date information on VA services and locations wherever
they are. VA is also employing public service announcements to raise
awareness about VA, and has launched a new initiative to provide
colleges and universities with information concerning the health care
needs of returning Veterans. This latter effort provides training and
education materials for administrators and students to help foster more
accommodating academic environments for Veterans.
VA has also created a new Web site for returning Veterans that
provides useful information about eligibility, benefits, health care,
and other services (http://www.oefoif.va.gov/). This site also features
a blog with comments from Veterans and family members (http://
www.blogs.va.gov/returningservicemembers/). We recognize we must
develop social networking strategies, including nontraditional outlets,
and a wide variety of new media to communicate VA's message about our
services.
These new technologies have even entered into health care delivery.
One VA facility has begun piloting a program that uses text messaging
to help Veterans send their home-based blood pressure readings to their
clinicians. Researchers found Veterans who used text messaging achieved
their blood pressure goals 2 weeks sooner than those who used other
methods.
Conclusion
VA understands different Veterans will receive messages in
different ways and different times. It is our duty to notify Veterans
of the repayment our Nation offers in gratitude for the sacrifice they
have made. We must continue programs that are successful and develop
new methods when our current measures are insufficient. Our mission is
to reach out to family members, employers, community stakeholders,
Reserve and National Guard units and Veterans to make sure they will
know how to access help when they need it. Thank you again for the
opportunity to testify. My colleagues and I are prepared to answer any
questions you may have.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Statement of Rear Admiral LeRoy Collins, Jr., USNR (Ret.) Executive
Director, Florida Department of Veterans Affairs
Mr. Chairman and distinguished Members of the Subcommittee, thank
you for the opportunity to provide a statement to address the Veterans
Health Administration's outreach to veterans.
Florida has almost 1.8 million veterans. The Florida Department of
Veterans Affairs (FDVA) is a state veterans' service agency created by
the Florida Legislature following a successful constitutional
initiative to authorize this department. We provide information,
advocacy and quality long term health care services to our veterans. We
maintain strong positive working relationships with both the Veterans
Health Administration (VHA) and the Veterans Benefits Administration
(VBA) leadership in Florida.
We are an arm of state government which has statutory
responsibilities concerning state veterans benefits and citizen
services, as well as service delivery responsibilities representing
veterans in their dealings with the claims process in VBA. FDVA
continues to expand veterans' facilities and services in Florida,
primarily through the growth in the State Veterans Homes program and
through new outreach programs to contact more of the veteran population
in Florida. As a result of strong advocacy on behalf of veterans and
dependents, their economic and health status is improved with benefits
earned through military service to our Nation. FDVA currently employs
912 staff members.
The primary challenge our Veterans Claims Examiners (VCEs) have in
Florida is timely access to VA information concerning veterans,
particularly those wounded in combat, returning to our state. Improved
case information flow to state government is needed and vital to
improving the timely delivery of state benefits information to these
warriors and families. Our Florida Seamless Transition Program, the
first of its kind in the Nation and adopted nationwide by the VA in
February 2007, has helped, but more must be done. Electronic contact
information of our state's veterans upon separation would be a
desirable enhancement (e.g. e-mail address on the DD 214 form).
Enhanced outreach to veterans in large population states deserves
more attention and resources to meet the needs of our newest generation
of veterans. We appreciate the VA's efforts to keep the various state
departments of veterans' affairs better informed on key topics of
interest. We hope the VA will provide the states with an electronic
list of the names, addresses and e-mail addresses of Veterans who claim
that state as their home of record. Our newest veterans communicate via
electronic social networking and tend to keep their electronic lines of
communication consistent. Sharing this vital link is essential.
We support the transitional efforts of the VA under Secretary of
Veterans Affairs Eric K. Shinseki. His Veteran-centric approach to
incorporate new technologies in the operation of the department should
pay huge dividends, and Florida enthusiastically endorses his focus on
modernizing outreach. In addition, we hope that the success of the
Public Service Announcement by actor Gary Sinese on Veteran suicide
prevention will lead to other high-visibility PSAs on Post-Traumatic
Stress Disorder and Traumatic Brain Injury.
Furthermore, we appreciate the VA's response to the Post 9/11 GI
Bill, but believe the agency should fund and certify campus veterans'
representatives, as they did following the Vietnam War. These campus
VET-REPs can help veterans facilitate access to substance abuse and
mental health services, enrollment in health care, issue resolution,
claims development and advocacy. The hour is late to get this VET-REP
effort underway nationwide in time to implement the new G.I. Bill in
August 2009. FDVA convinced the Florida legislature to approve a VET-
REP position for each state college and university campus, but the
funding for the initiative eluded us. We believe the VET-REP issue
needs your attention.
Thank you for the opportunity to comment. This Subcommittee's
efforts to improve America's benefits and services to our veterans is a
noble cause.
Statement of Hon. Cliff Stearns, a Representative in Congress from the
State of Florida
Thank you, Mr. Chairman.
I am pleased to be here this afternoon to examine the status of the
Veteran Health Administration's outreach efforts to all categories of
veterans. The VA has a wealth of resources and services available to
those who served our Nation, but these resources are wasted if no one
knows about them. Unfortunately, that is what we often hear from our
constituents and the veteran service organizations that represent them.
Admiral LeRoy Collins, Jr. (Rear Admiral, U.S. Navy Reserve,
Retired), who is the Executive Director of the Florida Department of
Veterans Affairs, has submitted a statement for the record on the
status of the VHA's outreach to veterans in the State of Florida, and I
would like to highlight a few of his key points.
Florida is home to the second largest veterans population in the
country, which is almost 1.8 million veterans. The goal of the Florida
Department of Veterans Affairs (FDVA) is to provide information,
advocacy, and quality long-term health care services to veterans.
Additionally, the FDVA regularly and effectively communicates with the
VHA and VBA leadership in Florida. These strong working relationships
go a long way to ensuring veterans in Florida know about the VA's
services. However, it would be helpful if the VA could provide all
states with an electronic list of the names, addresses, and e-mails of
veterans who claim that state as their home of record. Sharing this
information is essential to ensuring that claims examiners have timely
access to key information and can reach specified groups of veterans.
Importantly, Admiral Collins states that enhanced outreach to
veterans deserves more attention and resources in order to meet the
needs of our newest generation of veterans--those returning from Iraq
and Afghanistan. The VA Secretary should be regularly using national
media outlets to advertise VA services and draw attention to key health
issues. Many also believe there is a need for more ``high visibility''
public service announcements such as the recent PSA by actor Gary
Sinese on Veteran Suicide Prevention. The VA should create other
effective PSAs on Traumatic Brain Injury (TBI) and Post-traumatic
stress disorder (PTSD) to help erase the stigma associated with these
increasingly prevalent behavioral disorders.
The VA should never have to be pushed by Congress to legislate
outreach efforts. I hope this hearing today affords us the chance to
have a better dialogue with the VA on the need for differentiated
outreach strategies to address the dynamic group of veterans in its
health care system.
MATERIAL SUBMITTED FOR THE RECORD
Committee on Veterans' Affairs
Subcommittee on Health
Washington, DC.
June 3, 2009
Honorable Eric K. Shinseki
Secretary
U.S. Department of Veterans Affairs
810 Vermont Avenue, NW
Washington, D.C. 20240
Dear Secretary Shinseki:
Thank you for the testimony of Paul Hutter, Chief Officer for
Legislative, Regulatory and Intergovernmental Affairs of the Veterans
Health Administration at the U.S. House of Representatives Committee on
Veterans' Affairs Subcommittee on Health Oversight Hearing on ``VA
Medical Care: The Crown Jewel and Best Kept Secret'' that took place on
May 19, 2009.
Please provide answers to the following questions by July 15, 2009,
to Jeff Burdette, Legislative Assistant to the Subcommittee on Health.
1. In your testimony you mentioned a pilot program currently being
conducted at Fort Bragg. In this program, VA seeks to expedite
enrollment by overnighting records from demobilization sites to VA's
Health Eligibility Center. Has this program been effective in
streamlining the enrollment process?
2. Your testimony largely centered on outreach efforts targeting
OEF/OIF veterans.
a. What programs does VA have that focus on Vietnam veterans
and other such populations?
b. How do programs targeting specific veterans groups differ
from each other.
3. You mentioned that VA has harnessed new technology such as
Twitter, Second Life, Facebook, and YouTube. Can you elaborate on VA's
efforts toward utilizing these new mediums?
4. Can you talk a bit about how local outreach conducted by VA
facilities fits into the structure of VA's overall effort? What does
the central office do to support these local efforts?
5. Some VSOs have noted the outreach efforts that will be required
by VA's upcoming effort to expand enrollment in VHA among veterans in
priority group 8. Is there a plan in place to notify veterans in this
group that they may be eligible for enrollment?
6. What are the roles and responsibilities with respect to
outreach for the communications director for VHA? How does this compare
to the roles and responsibilities of the now defunct office of Deputy
Undersecretary for Coordination?
Thank you again for taking the time to answer these questions. The
Committee looks forward to receiving your answers by July 15, 2009.
Sincerely,
MICHAEL H. MICHAUD
Chairman
__________
Question for the Record
The Honorable Michael H. Michaud, Chairman
Subcommittee on Health
House Committee on Veterans' Affairs
Department of Veterans Affairs Medical Care: The Crown Jewel
and Best Kept Secret
May 19, 2009
Question 1: In your testimony you mentioned a pilot program
currently being conducted at Fort Bragg. In this program, VA seeks to
expedite enrollment by overnighting records from demobilization sites
to VA's Health Eligibility Center. Has this program been effective in
streamlining the enrollment process?
Response: The Veteran Health Administration (VHA) Chief Business
Office (CBO) Health Eligibility Center (HEC) proposed to VHA Outreach
Office that the HEC provide additional administrative assistance to the
medical center staff currently engaged in providing demobilization
(DEMOB) site support. The pilot program which was initiated at Fort
Bragg, North Carolina, commenced on May 1, 2009, and is expected to run
through August 31, 2009. The goal of the pilot is to streamline the
Department of Veterans Affairs (VA) enrollment process, reduce the
administrative workload of VA's staff and improve Veterans'
satisfaction with timely enrollment into VA health care. Once the pilot
program is complete, VA will evaluate its effectiveness and determine
whether to expand the program nationwide. We expect to make that
decision by October 1, 2009.
Since May 1, 2009, the HEC staff has successfully processed all
enrollment applications submitted from the DEMOB site pilot program at
Fort Bragg, North Carolina, within 72 hours of receiving these
applications.
Question 2(a): Your testimony largely centered on outreach efforts
targeting OEF/OIF Veterans. What programs does VA have that focus on
Vietnam Veterans and other such populations?
Response: VA has developed a great number of initiatives in
response to the unique health issues and concerns of Veterans of the
Vietnam War. Perhaps more than for any other U.S. military deployment,
the Vietnam War generated a lasting and vivid impression among Veterans
and all Americans about the environmental impact of this war on those
who served. Today, VA has made it easier for Vietnam Veterans and, in
some cases, their children to receive benefits and services for any
illnesses or injuries they suffer that may be related to herbicide
exposure.
Eligible Vietnam Veterans have access to VA's comprehensive health
care system that includes programs specially tailored to their special
concerns and needs. In 1978, VA established a special health
examination registry known as the Agent Orange Registry examination, in
response to mounting concerns about health effects from herbicide
exposure among Vietnam Veterans. The program offers a medical
examination at all VA health care facilities, as well as the chance for
Veterans to discuss their health concerns with a knowledgeable health
care provider. The Agent Orange Registry is a computerized record of
these examinations, and as of June 2009, the program has provided for
more than 542,174 individual Vietnam Veterans, including over 8,000
women Vietnam War Veterans. Each VA medical center has an environmental
health clinician responsible for conducting Agent Orange Registry
examinations, and an environmental health coordinator responsible for
coordinating the exam and reporting results. Any Veteran who had active
military service in the Republic of Vietnam between 1962 and 1975, and
who expresses a concern relating to exposure to herbicides, may
participate in the registry.
VA is also working to ensure that all Veterans who served on the
ground and inland waterways of Vietnam are aware of the conditions for
which they may be presumptively service-connected. The Veterans
Benefits Administration (VBA) and VHA are working together to identify
in-country Vietnam Veterans who have received treatment in a VA
facility for a condition related to herbicide exposure, but have not
applied for disability compensation. Last year, approximately 28,000
``in-country'' Vietnam Veterans were contacted and provided with
information on the presumptive disabilities associated with agent
orange exposure and where to apply for VA benefits for these
conditions.
Since the end of the Vietnam War, VA has developed many ways to
communicate with Veterans about these issues, including:
The Agent Orange Review newsletter mailed to every
Vietnam Veteran who has used VA. In 2004, the circulation of the
newsletter increased to nearly 800,000 copies mailed to Veterans'
homes. The last newsletter was published in August 2008 and a new one
is in preparation and will be published this summer. It is also
available on our Web site;
An agent orange Web site;
A national toll-free telephone number;
The popular Federal Benefits for Veterans and Dependents
and Survivors booklet, and
A series of agent orange fact sheets, agent orange
brochures, and agent orange posters distributed throughout VA.
VA's Web site for agent orange-related matters is at www.va.gov/
AgentOrange, which has virtually all of VA's outreach material for
Vietnam Veterans, including all the newsletters, brochures and posters,
as well as information about special programs such as the Agent Orange
Health Registry.
Similar programs are in place for radiation-exposed Veterans, and
Gulf War Veterans, as well as Veterans of Operation Enduring Freedom
and Operation Iraqi Freedom (OEF/OIF).
Question 2(b): How do programs targeting specific Veterans groups
differ from each other?
Response: The programs only differ in areas of concentration, i.e.,
radiation vs. agent orange. VA programs may target specific populations
of Veterans, for example, minority and women Veterans, but benefits and
services are open to eligible Veterans from every period of service.
Eligible Veterans of every era have comprehensive health care benefits
through VA from basic primary care issues to the most extensive
traumatic brain injury care network in the world. Disability
compensation, education, home loan guaranty, insurance and vocational
rehabilitation are also available to Veterans who met the entitlement
criteria.
Question 3: You mentioned that VA has harnessed new technology such
as Twitter, Second Life, Facebook, and YouTube. Can you elaborate on
VA's efforts toward utilizing these new mediums?
Response: VA began establishing a Web 2.0 presence on Facebook,
YouTube and Second Life in May 2008. The Second Life virtual world
presence was recently enhanced from a small ``office'' to an ``island''
in May 2009. VA currently has three official Facebook accounts, VA, VHA
and a Welcome Home (event) page, with plans to stand-up a fourth
account for VBA in the near future. VA also has one official YouTube
channel with over 50 videos posted and 1,076 subscribers to date. A
Twitter account was recently enabled in May 2009 and VA currently has
570 followers which include many National Veterans Service
Organizations. There is also a returning servicemember blog and a tag
cloud on www.oefoif.va.gov.
VA is currently planning to redesign its Web sites over the next 2
fiscal years. The redesign project will be focused primarily on content
and usability. Improvements to the Web site will allow additional
mediums of communication or Web 2.0 tools to be added.
Question 4: Can you talk a bit about how local outreach conducted
by VA facilities fits into the structure of VA's overall effort? What
does the Central Office do to support these local efforts?
Response: Aside from the more obvious support of staffing, VHA's
central office provides detailed guidelines, up-to-date information and
coordination of research for the staff in the field who reach out to
our Veterans each day. Nearly 20 different program offices function
within VA's central office to concentrate on issues of homelessness,
rural health, minority and women Veterans, research, quality and
safety, and other programs designed to acquaint Veterans with the
services and benefits offered by the Department. These offices work
directly with field staff in order to ensure that Veterans in local
communities have the most relevant and updated information and are
treated with proven evidence-based practices.
To further enhance the coordination between central office and the
field stations, the Office of Public and Intergovernmental Affairs
(OPIA) is responsible for overseeing and coordinating all outreach
activities Department-wide.
Question 5: Some VSOs have noted the outreach efforts that will be
required by VA's upcoming efforts to expand enrollment in VHA among
Veterans in priority group 8. Is there a plan in place to notify
Veterans in this group that they will be eligible for enrollment?
Response: Yes. VA is engaged in the implementation of a
communications and outreach strategy that leverages technology and
partnerships with other stakeholders to educate Veterans and their
families about Priority 8 eligibility.
Direct Veteran Contact: VA has contacted, by mail, the
approximately 420,000 Veterans who previously tried to enroll for
health care benefits but were rejected because of their income level.
The letter explains that eligibility requirements have changed and
provides Web-based and paper enrollment options for Veterans to use. VA
will also use micro-targeting to mail to an additional 150,000 Veterans
who have not previously applied but live in low-income neighborhoods.
If this test mailing is successful, VA will expand the universe to
reach out to more Veterans using additional micro targeting criteria.
Web Content: VA has developed and released Web content
and tools to help communicate with Veterans, their families, and other
stakeholders. This content has been deployed to VA's Web sites, other
Government sites, and sites such as Wikipedia.
Expanded Web Outreach and Communications: VA is
currently developing additional approaches to perform targeted Web-
based outreach and communications.
Media: VA has placed op-eds and Web-based stories about
Priority 8 in targeted media outlets. VA is also using traditional
media sources and bloggers to communicate. VA is in the process of
contracting with a public relations firm to develop additional outreach
strategies to reach Veterans who might be eligible. Strategies will
likely include a highly targeted, paid media campaign.
Partnering with Veteran Service Organizations (VSO),
State Veterans Affairs Directors, County Veterans Service Officers, and
Other Stakeholders: VA has partnered with stakeholders to communicate
with the Veterans they serve. VA has educated stakeholders about the
new eligibility criteria and placed content, links, and even Web-based
eligibility calculators on its Web sites. VA is in the process of
identifying other stakeholders to partner with. For example, the Office
of Congressional and Legislative Affairs will provide a widget and an
eligibility calculator that Members of Congress can post on their own
Web sites.
Question 6: What are the roles and responsibilities with respect to
outreach for the communications director for VHA? How does this compare
to the role and responsibilities of the now defunct office of Deputy
Undersecretary for Coordination?
Response: VHA's chief communications officer supports, OPIA in the
public affairs aspects of VA outreach, including news releases,
internet communications and the possible use of paid advertisements to
reach Veterans of all eras. VHA's Office of Legislative, Regulatory and
Intergovernmental Affairs (OLRIA) is responsible for outreach to OEF/
OIF Veterans. The chief communications officer manages overall outreach
policy and encourages VHA field organizations to implement advertising
and direct contact campaigns to ensure that the opportunities for
benefits and services are communicated to all Veterans. VHA's OLRIA
organization manages 11 different outreach programs focused on
returning OEF/OIF Veterans to ensure their awareness of VA benefits and
services, and to provide a ``warm hand off'' to Veterans from military
health care to VA health care. These three offices have worked in the
past, and will continue to do so in the future, to prepare and
implement plans to reach out to Veterans and their families, informing
them of the health care benefits they have earned. VA is unfamiliar
with any position titled the ``Deputy Undersecretary for Coordination''
currently or in the recent past.