1. 1 UNCLASSIFIED Department of Veterans Affairs Caring for Those Who Served in Seamless Transition Marianne Mathewson-Chapman PhD, ARNP VA Office of Seamless Transition USDOL-VETS 2007 Competitive Grantees Training Conference August 7-9, 2007 National Guard and Reserves Combat Veterans

2. 2 The Reality of War The New Generation of Veterans Returning to Hometown America

3. 3 Outline Seamless Transition from DoD to VA to community …………………….Caring for the War Wounded Categories of War Injuries Severely Injured (TBI, SCI, Blind, Amputee, PTSD, Burn) Medical Holdover and CBHCO: (Warriors in Transition) Hidden/Lingering Wounds Unique Challenges for National Guard and Reserve Geographical Dispersion, State Coalitions and Role of Transition Assistance Advisors in each state Outreach Programs Recommendations to Enhance Employment

4. 4 Transitioning from DoD to VA to the Community Battlefield VA at MTF VA OIF/OEF Program Managers (2004) 2005 Recovery and Health Continuum of Care State Coalitions Transition Assistance Advisors Family Programs State Coalitions Transition Assistance Advisors Family Programs Outreach PEB and PDHRA

5. 5 Categories of War Wounded Seamless Transition Process Category 1: Severely Injured Category 1: Severely Injured 11 MTF Liaisons at: Brooke AMC, Balboa Eisenhower AMC Madigan AMC Bethesda NNMC, WR Ft. Carson, Ft Hood Camp Pendleton Gordon and CFI VA full time VA Social Worker VBA Benefits Counselor Tampa VAMC Transition Severely Injured : TBI SCI Amputee Severe disfigurement Burns PTSD Category 2: Medical Hold/holdover Community Based Healthcare Organization (CBHCO) Category 2: Medical Hold/holdover Community Based Healthcare Organization (CBHCO) Category 3: Hidden Wounds at Post deployment Category 3: Hidden Wounds at Post deployment VA Liaisons/POC VHA facilities: 157 VBA ROs: 57 4 Polytrauma Centers 2 WRIISC, 207 Vet Centers Veterans Tracking Application DoD VA

6. 6 Category 1: Severely Injured VA Liaison for Healthcare (10 MTFs) and adding 7 more Veterans Integrated Service Network (VISN) POCs (21) VA Medical Center OIF/OEF Program Manager at 157 VA facilities OEF/OIF Case Managers Transition Patient Advocates (TPA) VBA Regional Offices OEF/OIF Coordinators in each state-57 Readjustment Counseling Services (Vet Centers 206+) for outpatients VA Inpatient mental health/suicide prevention coordinators VA Liaison for Healthcare (10 MTFs) and adding 7 more Veterans Integrated Service Network (VISN) POCs (21) VA Medical Center OIF/OEF Program Manager at 157 VA facilities OEF/OIF Case Managers Transition Patient Advocates (TPA) VBA Regional Offices OEF/OIF Coordinators in each state-57 Readjustment Counseling Services (Vet Centers 206+) for outpatients VA Inpatient mental health/suicide prevention coordinators New Positions at MTF, VAMC and Regional Office “Walk on in” VTA DoD VA VTA

7. 7 New DoD/VA Medical Center Positions VA Liaison Healthcare at DoD VA and Community

8. 8 Category 2: WTU/Med Hold/CBHCO Continued Care at Military Treatment Facility. Case management in Warrior Transition Unit (WTU) Reserve/Guard may live at Home, receive rehabilitation at VAMC near home. Case management from CBHCO Military Treatment Facility and Warrior in Transition Units (WTU) Live at Home Treatment at local VAMC Guard/Reserve with case Management from community based health Care organization (CBHCO) MEB/PEB determination

9. 9 Category 2: Warrior Transition Units Community Based Health Care Organizations (CBHCO) PR CBHCO Detachment and Case Manager Locations Arkansas (KS-LA-MO-NE-OK-TX) California (ID-NV-OR-WA) Florida (GA-SC) Massachusetts (CT-ME-NH-NJ-NY-PA-RI-VT) Wisconsin (IA-IL-IN-MI-MN) Utah (AZ-CO-MT-ND-NM-SD-WY) Virginia (DC-DE-MD-NC-OH-WV) Alabama (KY-MS-TN) 8 Sites Active Duty Status with Maximum 300 per site Sacramento Riverton UT Camp Robinson, AR Huntsville, AL Orlando, FL Virginia Beach, VA Concord MA Rock Island Arsenal, IL

10. 10 Mobilized: 88,084 Demobilized: 534,965 Total: 623,049 Reserve Components ARNGUSARANGUSAFRUSNRUSMCRUSCGRTotal Currently Mobilized 49,53527,6439452765,0874,29730188,084 Demobilized To Date: 240,529147,57835,37532,41833,43236,7638,870534,965 Total Mobilized To Date: 290,064175,22136,32032,69438,51941,0609,171623,049 Reserve Components: Noble Eagle Enduring Freedom and Iraqi Freedom Reserve Components: Noble Eagle Enduring Freedom and Iraqi Freedom ++Includes Mobilized and Demobilized more than once Mobilized: Involuntary active duty in a Federal Status (10 USC 12302) that authorizes the use of Reserve Forces for up to 24 months 18 July 2007 Services Daily Mobilization Report Former Active duty now veterans………….292,289

11. 11

12. 12 VA and NG State Coalition MOU between VA and NG (May 2005) Access to Troops and Families of National Guard

13. 13 Why High Risks for Guard/Reserve Guard/Reserve Units are dispersed to remote areas Limited family support programs in community First deployment and multiple deployments Leave civilian jobs for 1 ½ years and frequent mobilizations Post-Deployment readjustment issues and the stigma of mental health Demobilization station is not near hometown/community Hometown is not near NG/Reserve armory or VA (rural) Service related disabilities: delay in tx or claims Returning Home: High divorce rate, jobless, Homeless and delay seeking medical/mental health Lack understanding family/employer of challenges Limited knowledge of VA healthcare/benefits Display high risk behaviors and alcohol/drug abuse

14. 14 NGB/VALiaison NG Joint Staff NGB/VALiaison National Guard STATE JOINT FORCE HEADQUARTERS National Guard STATE JOINT FORCE HEADQUARTERS VA/NG Transition Assistance Advisor State Directors Of VA State Directors Of VA Adjutant General Adjutant General Governor’s Office Governor’s Office VA Services NCA VBA NG/VA TAA’s Network Services and Benefits POC VISN/RO POC VISN/RO State VSO County Service Officer OSD MSIC OSD MSIC TRICARE Family Readiness Volunteers Family Readiness Volunteers Army Community Svce Army Community Svce WFPC ESGR Financial Services Financial Services FACs NG Chaplains NG Chaplains Civilian Medical Community Civilian Medical Community SFPD AW2: Marine4Life Safe Harbor Palace HART AW2: Marine4Life Safe Harbor Palace HART National Guard Services National Guard Services DoD Services DoD Services Returning to the State: All Service Members and Family and the Safety Net Child and Youth Svce Child and Youth Svce Training Support Information Services VHA Fed, State, Local & Private Orgs. Fed, State, Local & Private Orgs. Legal Services Legal Services Military Medical Community Medical Hold (CBHCO) Military Medical Community Medical Hold (CBHCO) VISN National VSO National VSO Community Services State Mental Health and Substance Abuse Svce State Mental Health and Substance Abuse Svce Community Mental Health Svce Community Mental Health Svce Military One Source Military One Source VA/NGB Liaison VA Office of Seamless Transition VA/NGB Liaison VA Office of Seamless Transition 206 Vet Center 206 Vet Center VISN Mental Health VISN Mental Health VBA RO VAMC MTFs Education Loan G Insurance VRE C&P OIF/OEF PMs OIF/OEF PMs TPAs Case Managers DOL Women Health Women Health Women Benefits Family Programs Family Programs

15. 15 Support for Members/Families the State Level Education Monitor Homeless Employment Monitor Homeless Employment Rehabilitation Transition Assistance Advisors (TAA) Disability Benefits Disability Benefits State Veterans Affairs Directors Family Programs Coordination With Family Programs Coordination With Family Programs Counseling Health Care Coordination With CBHCO Coordination 57

16. 16 Brochures: –Summary of Guard/Reserve VA Benefits –VA Benefits Wallet Cards –VHA summary of Healthcare –OIF/OEF Newsletter on healthcare –Vet Center and Women’s Health Program MOU with National Guard and Initiatives with other Reserves Training tools: –Veterans Health Initiatives(VHI series) –My HealtheVet, Webpage, Displays, videos Training conferences: –VA/Transition Assistance Advisors (Feb 2007) –Evolving Paradigms National Conference (2007) Letter from Secretary VA, USH,USB to: –Service Member –Adjutants General –RO/VISN and VAMC Directors Brochures: –Summary of Guard/Reserve VA Benefits –VA Benefits Wallet Cards –VHA summary of Healthcare –OIF/OEF Newsletter on healthcare –Vet Center and Women’s Health Program MOU with National Guard and Initiatives with other Reserves Training tools: –Veterans Health Initiatives(VHI series) –My HealtheVet, Webpage, Displays, videos Training conferences: –VA/Transition Assistance Advisors (Feb 2007) –Evolving Paradigms National Conference (2007) Letter from Secretary VA, USH,USB to: –Service Member –Adjutants General –RO/VISN and VAMC Directors Toolkit Office of Seamless Transition Outreach Toolkits for VA Education and Awareness Campaign to Veterans, Families and VA Staff Video Broadcasts Brochures VHI WEB PAGE Training Programs 2 years if free VA healthcare for service related illness/injury 90 days For Dental treatment http://www.va.gov Education/Awareness Campaign Plan and Communication/Distribution Plan for Outreach to Guard/Reserve and family New Technology: Webcasts, Podcasts, Multi-Media Technology for electronic toolkits “Walk on in”

17. 17 Recommendations Education and Awareness of Service Members, Family Members, clinicians, federal and state employers Longitudinal Study on employment challenges Closer links of Employment Specialists with ESGR Coordinators at VAMC with OIF/OEF Program Managers Participating with the state coalitions and MOU Employment Coordinators participate in PDHRA events, family programs, job fairs, reunions, and unit events Support legislation for home station reintegration Closer ties with VA VRE programs Robust Reintegration Programs at home station Education and Awareness of Service Members, Family Members, clinicians, federal and state employers Longitudinal Study on employment challenges Closer links of Employment Specialists with ESGR Coordinators at VAMC with OIF/OEF Program Managers Participating with the state coalitions and MOU Employment Coordinators participate in PDHRA events, family programs, job fairs, reunions, and unit events Support legislation for home station reintegration Closer ties with VA VRE programs Robust Reintegration Programs at home station

18. 18 QUESTIONS ? VA Office of Seamless Transition 202-273-7822 VA Office of Seamless Transition 202-273-7822 Caring for Guard/Reserve Through ……………….Seamless Transition

19. 19 2007 Task Force, GAO and Commission Reports to the President Togo West’s Commission on Care of War Wounded at Walter Reed VA Secretary Nicholson’s: Returning GWOT Heroes: 25 Recommendations Bob Dole Commission Final Report GAO reports

20. 20 Resources Basic VA Benefits Questions: www.va.govwww.va.gov or 1-877-222-VETS (8387) VA Office Seamless Transition- (202-273-7822) DoD VA Program Coordination Office (703-681-0039) Military Severely Injured Center ( 1-888-774-1361) severelyinjured@militaryonesource.com Army Wounded Warrior Program (1-800-833-6622) www.armyds3.orgwww.armyds3.org Marine for Life (1-866-645-8762) injuredsupport@M4L.usmc.milinjuredsupport@M4L.usmc.mil Air Force Palace HART (1-888-774-1361) severelyinjured@militaryonesource.com severelyinjured@militaryonesource.com Navy Safe Harbor (1-888-774-1361) severelyinjured@militaryonesource.com severelyinjured@militaryonesource.com Military One Source ( 1-800-342-9647) (24/7) www.militaryonesource.comwww.militaryonesource.com

21. 21 VA OIF/OEF Healthcare Utilization Summary SW Asia Veterans Who Separated From Active duty:, 174 OEF/OIF veterans 631, 174 OEF/OIF veterans and are eligible for VA care since FY 2002-2006 Totals Use VHA Component 292,289): (101, 259) Former Active duty 147,020): (41,090) Reserves 191,865) (62,739) National Guard 631,174 205, 097 32% or 205,097 evaluated by VA from 2002-2006 represents 4% of 5.3 million veterans in any one year Total Female Veterans: …. 65,231 % Combat Women Veterans enrolled in VHA care…......36.2% ( 3rd quarter 2006)