Post-Deployment Case Study Interprofessional version

VETERANS HEALTH ADMINISTRATION Case Study: Triage Tina, a 24-year-old Caucasian female Army reservist, presents for a new patient visit to your clinic. She just returned from deployment 6 months ago and is new to the VHA system. 2

VETERANS HEALTH ADMINISTRATION Q1: What logistic concerns do you have for a recently returned Veteran at her first primary care visit? 3

VETERANS HEALTH ADMINISTRATION What brought her to the VHA? Has she connected with the OIF/OEF case management team? Has she been informed of the time-sensitive access she has immediately upon return (e.g., dental, etc.)? 4 Q1: What logistic concerns do you have for a recently returned Veteran at her first primary care visit?

VETERANS HEALTH ADMINISTRATION Case Study: Triage (continued) Tina says that she is new to the VHA, but has already met with an OEF/OIF case manager. Her biggest health concern is that she has been having trouble sleeping. As you query Tina’s family history, she reveals that she grew up in a rural farming town in California. She is the oldest of three daughters. Her father, a truck driver, passed away in a work-related accident when she was 9 years old. Her mother has been working at a local elementary school. Tina joined the military at age 19 after completing her GED. 5

VETERANS HEALTH ADMINISTRATION Q2: Based on her family history, what are Tina’s psychosocial risk factors? 6

VETERANS HEALTH ADMINISTRATION Q2: Based on her family history, what are Tina’s psychosocial risk factors? Loss of her father Coping − Depending on how did she learned to cope, this could be a strength or a weakness. Does she engage in risk-taking behavior? What about substance use? Why did she choose to complete a GED rather than attend high school? 7

VETERANS HEALTH ADMINISTRATION Team Huddle What do you want to know about Tina’s deployment activities? 8

VETERANS HEALTH ADMINISTRATION Where was she deployed? What did she do while deployed? Any injuries or health issues sustained during deployment? – Trauma (combat, MST) – Exposures, fumes – Blasts, TBI, embedded fragments – Caffeine, tobacco, alcohol use 9 Discussion Points

VETERANS HEALTH ADMINISTRATION Tina was deployed to Iraq. Her responsibilities included driving a truck for transporting equipment and supplies. She often drove the truck in hostile territories. She was the only female in her unit. She was stationed in Iraq for 12 months and has recently returned to California. She mentions being near a blast that tipped her truck over though denies any personal injury, including embedded fragments, from this accident. Case Study (continued) 10

VETERANS HEALTH ADMINISTRATION What are her potential deployment exposures? 11 Team Huddle

VETERANS HEALTH ADMINISTRATION 12 Extreme temperatures Heavy gear Driving long distances Moving heavy equipment Hygiene issues Combat exposure Interactions with male counterparts Note: She was a truck driver, like her father. This might have increased her sense of danger and risk. Discussion Points

VETERANS HEALTH ADMINISTRATION Q3: What would you like to know about her post-deployment life? 13

VETERANS HEALTH ADMINISTRATION Q3: What would you like to know about her post-deployment life? What is her current military status/potential for redeployment? What is her living situation? What is her social support system? Is she in school? Working? How is she adjusting to civilian life? 14

VETERANS HEALTH ADMINISTRATION Tina has been home for about a year and is staying with her sister. She is in the reserves, but does not think she will be redeployed since there are members of her reserve unit who have not yet been deployed. She is taking some college courses online and is interested in forensics. Case Study (continued) 15

VETERANS HEALTH ADMINISTRATION What aspects of her post-deployment life put Tina at risk? 16 Team Huddle

VETERANS HEALTH ADMINISTRATION How stable is her living situation? How stable are her finances? Why is she taking college courses online vs. attending classes in person? 17 Discussion Points

VETERANS HEALTH ADMINISTRATION Tina states that she had no health issues prior to deployment. Her family history is negative for any significant medical conditions. She denies any fevers, rashes, or GI complaints including nausea, vomiting, and diarrhea. Her depression, substance use, MST, and PTSD post-deployment screens are negative. Tina complains of sleep disruption (difficulty falling asleep and staying asleep), headaches, and irritability. Case Study (continued) 18

VETERANS HEALTH ADMINISTRATION Q4: How would you address Tina’s chief complaints? 19

VETERANS HEALTH ADMINISTRATION Explore presence of TBI symptoms: – Memory problems? – Difficulty concentrating? – Headaches, loss of balance, dizziness? – Sleep problems? – Fatigue, irritability? Consider referral for TBI consultation Discuss basic symptom management for her sleep disruptions, headaches, and irritability Q4: How would you address Tina’s chief complaints? 20

Addressing Post-Deployment Issues in Primary Care Patients are likely to present first to primary care, which provides an important opportunity for: – Early detection – Risk reduction – Addressing mind and body health – Facilitating referrals Employ a screening pattern: – Pre-military life – Military experiences – Post-deployment experiences – Adjustment process vs. adjustment disorder – Substance use and disordered eating patterns 21