Overcoming barriers to care for returning Veterans: Expanding services to college campuses
By Armstrong, Keith | |
Proquest LLC |
INTRODUCTION
The need to expand mental health and social work care available to Veterans in the community and for increased
Veteran students arrive on campus with a military background that includes unique experiences, knowledge, skills, and codes of behavior. Factors that can influence adjustment from military service to student life include the amount of time between discharge and entry into college, differences between military and civilian culture, balance between academic and other life responsibilities, and psychological consequences of combat or other trauma exposure. Military culture, which emphasizes service, respect, camaraderie, structure, discipline, and order, can differ from that of civilian or traditional college student life [7]. While military life can bring its own challenges and stressors, there are also significant benefits, such as having stable housing and income, healthcare, and support from superiors and/or peers, as well as generally more consolidated, centrally located or familiar resources. Loss of one's social network and need to obtain one's own housing, healthcare, and source of income can compound an often challenging cultural transition from the military to the college campus.
Less than 10 percent of U.S. citizens serve in the military [8], and many civilian students may lack an understanding of the servicemember's experience. Thisdisconnect is compounded by the often nontraditional status of student Veterans, who are typically older and often need to balance family (including parenting responsibilities), work, and academic demands. Indeed, nearly half (49.4%) of servicemembers and Veterans who have deployed to
An estimated 25 percent of returning OIF/OEF/OND Veterans have mental health diagnoses, including posttraumatic stress disorder (PTSD) [13], and many of these Veterans may also be diagnosed with cognitive disorders due to blast-related traumatic brain injury (TBI) [14]. Both of these conditions can impair concentration and memory, placing Veterans at higher risk for academic problems. Moreover, a recent study of 628 student Veterans found that almost half (46%) reported thoughts of suicide and 20 percent of these reported having a plan for suicide [15]. Of the student Veterans surveyed, a significant number endorsed experiencing anxiety (35%), depression (24%), and PTSD symptoms (46%). Student Veterans have also been found to engage in increased health risk behaviors; a recent survey of 8,651 students found that student Veterans endorsed more safety-, tobacco-, and alcohol-related risk behaviors than civilian students [16]. Recent epidemiologic data support the preventative value of access to care, reporting that male Veterans under 30 who access VHA healthcare services are less likely to complete suicide than Veterans who do not utilize VHA care [17]. Taken together, these findings suggest a strong need to ensure that student Veterans, particularly those deployed under OIF/OEF/OND, can easily access adequate mental health, medical, and social work services.
While mental health, medical, and social work services may potentially improve Veterans' overall functioning and achievement of their academic goals, there are significant barriers to receiving needed services. Veterans may be unaware that they are eligible for medical, mental health, and other services through the VHA and may also have difficulty navigating the complex web of support services and resources provided across governmental (federal, state, county), private, and nonprofit agencies. Approximately 56 percent (899,752) of all separated OIF/OEF/OND Veterans have used VA healthcare since
NEW MODEL OF CARE: VETERANS OUTREACH PROGRAM AT
Since the implementation of
Established in 2010, the concept behind theSFVAMC's VOP at CCSF is to provide a "one-stop shopping" experience at a convenient location on campus where Veterans can access information; enroll in VA healthcare on-site; and receive a comprehensive range of mental health services (including evidence-based psychotherapy, psychiatric evaluation, and medication management) and assistance in navigating VHA, college campus, and community services. The evidence-based individual and couples therapies provided on-siteinclude cognitive behavioral therapy (CBT) for depression, CBT for insomnia (CBT-I), cognitive processing therapy for PTSD and prolonged exposure (PE) for PTSD, CBT for attention deficit hyperactivity disorder, and emotionally focused couples therapy. Educational presentations are provided through the program to Veterans, staff, and faculty at CCSF on a variety of subjects such as readjustment and postdeployment issues, transition to the academic setting, wellness and fitness, sleep improvement, relationship improvement, from stress to success, suicide prevention, TBI, service and companion animals, online resources that can be used personally and professionally, smoking cessation, and employment.
The program's convenient location on campus and the broad range of services provided aim to lessen previously cited barriers to seeking care. Outreach has been provided to over 1,058 Veterans on campus, and over 373 student Veterans have been enrolled in local VHA healthcare. Approximately 46 percent of the Veterans seen for healthcare-related services in the VOP have served in
Institutional Support and Collaboration
Creating an effective program requires commitment and investment from both the medical center and the college. Our program received funding for staffpositions through both the local VA medical center and the VHA Veterans Integration to Academic Leadership (VITAL) program. In 2011, the
Our CCSF partners have welcomed the provision of VHA services on campus and have provided confidential office space and additional resources (e.g., office equipment, parking). Student Veterans are frequently balancing multiple roles at one time (e.g., student, employee, parent), and ease of access to services (e.g., convenient location) can be a key factor. Proximity of the program space to the location where other VA services are processed or provided (e.g., VBA GI Bill benefits, Veteran Academic Counselors, and/or VA Certifying Officials) provides an excellent opportunity for outreach as Veterans are coming to the office to find out about their educational benefits or waiting to meet with an academic advisor to develop their educational plans. In this context, an intervention such as asking a Veteran if he or she is enrolled in VHA healthcare can be a very nonthreatening way to inform Veterans of their healthcare benefits; assist with VHA enrollment; and schedule medical, social work, or mental health appointments. This proximity also provides an opportunity to inform student Veterans about other campus and community resources that support Veterans' academic success or other goals. Collaboration with campus academic readiness and support programs, such as campus Disabled Student Programs and Services (DSPS), tutoring services, library services, Veteran's academic counselors, VBA GI Bill certifying officials, and student Veteran groups can also foster academic success for Veterans.
Privacy and Compliance
Establishing a secure and confidential office for delivery of VHA services on campus requires a number of critical steps. These include developing a memorandum of understanding between VHA and the college, ensuring The Joint Commission and Health Insurance Portability Accountability Act compliance, designing and maintaining a confidential office space, and working with both VHA and college safety officials to ensure that safety and disaster plans meet federal, state, and county requirements.
Working outside of the medical center context requires attention to management of high-risk situations, including procedures for managing suicidal or homicidal ideation and intent. It is also beneficial to develop a behavioral emergency policy that is consistent with procedures at the VHA, but incorporates elements unique to work on the college campus (e.g., notifying campus police, outlining procedures for placing involuntary holds).
Outreach to Faculty and Nearby Campuses
VA providers can collaborate with campus faculty and staffto develop and implement strategies for creating a "Veteran-friendly" campus. These interactions mayinclude communication with faculty and staffthrough formal avenues such as faculty presentations (on topics such as military culture and/or how to support student Veterans on campus), and through informal interactions such as meetings with faculty in specific departments who would like to better respond to Veteran needs on campus or consultation with individual professors as issues arise. Outreach can also be conducted through presentations to other nearby colleges and universities.
Within the VOP program, feedback is solicited from both campus staffand student Veterans on a regular basis. Additional metrics are also being assessed, including Veteran satisfaction with services and academic goals and retention rates in mental health care for Veterans who have engaged in treatment. Future program goals include expansion of the program, including increased outreach to surrounding colleges and universities, increased provision of training to college campus faculty and staff, and delivery of additional psychoeducational seminars and programs to Veterans.
VETERANS SERVED: CASE EXAMPLES
The following are composite case examples of student Veterans seen in our program. Identifying information has been altered to protect the confidentiality of the students.
Case 1
A young male Navy Veteran, Mr. W., who had served in OEF and OIF, was waiting to meet with a Veterans Academic Counselor at CCSF in the waiting room just outside the VOP. A VOP Clinical Social Worker provided outreach services to Mr. W., inquiring if he was enrolled in or interested in learning more about VHA healthcare. Mr. W. expressed interest and was invited to discuss healthcare options confidentially inside the VOP office. In the office, Mr. W. expressed interest in establishing care with a primary medical provider and reported that he was experiencing insomnia that interfered with his daily functioning. Upon being informed of various healthcareoptions, Mr. W. accepted a primary care appointment at the VA medical center and agreed to schedule a mental health appointment for treatment of insomnia at the CCSF VA office because of the convenience of seeing a provider on campus. Mr. W. was subsequently enrolled in VHA healthcare and provided with a primary care appointment at the medical center. He returned for a follow-up visit and received a comprehensive psychiatric interview and medication evaluation. A treatment plan was developed, which included treatment for his insomnia using CBT-I. Additional biopsychosocial stressors emerged during the course of therapy after Mr. W. lost his housing. Mr. W. was referred by VOP staffto the VAMC's Health Care for Homeless Veterans program and was provided with housing close to campus in a transitional housing program for Veterans with mental health issues. With adherence to CBT-I treatment principles and with his new living situation, Mr. W. reported that his symptoms of insomnia greatly improved. At the conclusion of the academic semester, Mr. W decided to move to a new city where he would have more psychosocial support. VOP staffconnected him with the OIF/OEF Program Manager in the new location and provided Mr. W. with medical and mental health referrals to the local VA. Mr. W. was able to make a smooth transition to new providers at the local VA medical center and continues to attend college in his new location. Mr. W. consistently praised the quality and convenience of services provided through the CCSF VOP and SFVAMC. The complex biopsychosocial needs of this Veteran, who had previously been unaware of his eligibility for healthcare or other VHA benefits, were addressed by providing mental health services, advocacy, and case management on campus. The availability of VOP staffand resources on campus likely contributed to Mr. W.'s ability to meet his academic goal to remain in college during this difficult period.
Case 2
VOP staffprovided outreach services to
Case 3
VOP staffprovided comprehensive services for a recently hospitalized (for a suicide attempt) OIF Veteran, Ms. J., diagnosed with panic disorder and PTSD, who was attending CCSF. VOP staffprovided psychotherapy, medication management, and case management needs. VOP staffcollaborated with DSPS staffto ensure Ms. J. was given appropriate accommodations in her classes. She successfully completed her coursework at CCSF and was accepted to a graduate program. Ms. J. was incredibly grateful for the services we provided her. She conveyed that she would not have successfully engaged in this level of care if we were not located on campus.
RECOMMENDATIONS: A CALL TO ACTION
1. VA medical centers and Vet Centers (
2. Bringing multidisciplinary outreach, social work, and mental health services to campuses enables VA providers to be in a unique position of providing early intervention and preventative services to Veterans in a location where they are more likely to be able to follow through with mental health care.
3. Providing outreach services on campus allows VHA to raise Veterans' awareness of healthcare services that they may not have realized they were eligible for. Given the mandate for health insurance with the implementation of the Affordable Care Act (see www.va.gov/health/aca/), it is crucial to inform eligible servicemembers of their VA health benefits.
CONCLUSIONS
There are tremendous advantages to providing mental health and social work services on college campuses. Through this preventative model of care, services can be offered early after military service, fostering behaviors that can improve health outcomes, promote overall well-being and academic success, and reduce disability. It is not always feasible or practical to implement a comprehensive outreach and mental health program similar to that described. While our program offers a combination of outreach, on-site enrollment, social work services, individual and couples evidence-based psychotherapies, and psychiatric medication management, there are other programs that differ in their provision of services. For example, other
Mental health providers both within VHA and in the community, as well as college faculty and staff, can promote student Veteran wellness and functioning. Avenues for outreach and collaboration with Veterans on campus include developing a
In recent years, resources have been developed to facilitate the support of student Veterans.
Two additional Web sites have been developed recently by VHA and the
These are valuable resources to support the efforts of mental health professionals who would like to promote success among student Veterans. Our nation's Veterans have often made great sacrifices in serving our country. Through supporting student Veterans in their academic and life goals, we can do our part to help them succeed and to serve them.
ACKNOWLEDGMENTS
We acknowledge and thank the student Veterans, the faculty, and the staffat CCSF who have supported our collaborative efforts to provide services to Veterans on campus. We thank
This article and any supplementary material should be cited as follows:
McCaslin SE, Leach B, Herbst E,
http://dx.doi.org/10.1682/JRRD.2013.09.0204
ResearcherID/ORCID:
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1Mental Health Service, SFVAMC,
2Department
*Email: [email protected]
Copyright: | (c) 2013 Superintendent of Documents |
Wordcount: | 5245 |
Traumatic brain injury, posttraumatic stress disorder, and pain diagnoses in OIF/OEF/OND Veterans
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