Transcript Operation Iraqi Freedom/Operation Enduring Freedom

Operation Enduring Freedom/
Operation Iraqi Freedom
(OEF/OIF): Access to Care
by Cara Garcia, LMSW
Phoenix VA Health Care System
Operation Enduring Freedom/Operation Iraqi Freedom
• Over 1.6 million U.S. Forces have deployed to Iraq and Afghanistan.
• 49% Former Active Duty Troops
• 51% Reserve and National Guard
• More than 347,750 (40%) have sought care from the VA.
• Over the next several years, as more come off of active duty status, the
number served at the VA is expected to increase by as much as 700,000
• The Carl T. Hayden VA Medical Center in Phoenix currently has
enrolled over 9,000 OIF/OEF veterans
• OEF/OIF Veterans make up 6% of the VA’s current health care
population (5.5 million veterans are treated annually)
VHA Office of Public Health and Environmental Hazards, August 2008
Demographic Characteristics of OEF/OIF
Utilizing VA Health Care
• Age Group:
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<20: 6%
20-29: 52%
30-39: 23%
>40: 19%
• Sex:
• Male: 88%
• Female: 12%
• Branch:
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Air Force: 12%
Army: 64%
Marine: 13%
Navy: 11%
• Unit Type:
• Active: 48%
• Reserve/Guard: 52%
• Rank:
• Enlisted: 92%
• Officer: 8%
VHA Office of Public Health and Environmental Hazards,
August 2008; National Center for Veteran Analysis and
Statistics (NAVAS) February 2008
OEF/OIF: Department of Defense
Statistics
• Casualties as of 11/03/2008: 4,814
• Wounded in Action as of 11/03/2008: 33,325
• Wounded but able to Return To Duty: 18,125
Retrieved 11/04/2008, from http://www.defenselink.mil/news/casualty.pdf
Mental Health:
• Mental Health is the 2nd largest illness treated at the VA for
OEF/OIF Veterans (#1 is Orthopedic injuries)
• More than 100,000 combat veterans have been treated for
mental health related conditions since 2001. Over half were
for PTSD.
• There have been an even greater number of veterans treated at
the Vet Center and in private mental health agencies ( both not
included in these figures)
Gregg Zoroya, October 18, 2007
Mental Health:
• “More than one in four U.S. Troops have come home from the
Iraq War with health problems that require medical or mental
health treatment.”
Zoroya, October 18, 2005
• Primary OEF/OIF symptoms and diagnoses being treated at the VA
include:
• PTSD: 75,719
• Nondependent Abuse of Drugs: 21,201
• Depressive Disorders: 50,732
• Neurotic Disorders/Anxiety: 40,157
• Alcohol/Drug Dependence: 12,780/5,76
VHA Office of Public Health and Environmental Hazards, August 2008
Traumatic Brain Injury (TBI)
“Signature injury” of this war:
• Blast injuries are the number one cause of injury or death in Iraq
• 69.4% of Wounded In Action caused by Blast or Explosion
• 62% of Blast Injuries result in Traumatic Brain Injury (TBI)
• 85% of TBI’s are closed Head Injuries
• This means only 15% have visible wounds
• The symptoms closely resemble those of PTSD and can be easily overlooked
by medical staff not well versed in recognizing and diagnosing brain injury.
Tuli, August 2007
Post Traumatic Stress Disorder
• Over 59,000 VA-documented PTSD cases for OEF/OIF
• # 1 mental health diagnosis being treated at the VA for OEF/OIF veterans
(Gregg Zoroya, October 18, 2007)
• OEF/OIF Veterans ages 18-24 are more likely to receive mental health treatment
and/or receive a diagnosis of PTSD than those OEF/OIF Veterans who are age 40 or
older. (Seal, et al., March 12,2007)
Experts think PTSD occurs:
• In about 30% of Vietnam veterans, or about 30 out of 100 Vietnam veterans.
• In as many as 10% of Gulf War (Desert Storm) veterans, or in 10 veterans out of 100.9
• In about 6% to 11% of veterans of the Afghanistan war (Enduring Freedom), or in 6 to
11 veterans out of 100.
• In about 12% to 20% of veterans of the Iraq war (Iraqi Freedom), or in 12 to 20
veterans out of 100.
National Center for Post Traumatic Stress Disorder February 27, 2008
VA Hospital Benefits and Services for
OEF/OIF
• Combat veteran eligibility: served after 11 November 1998, and were deployed to Iraq
or Afghanistan, entitled to five years of free VA medical care for conditions potentially
related to military service.
• Five-year period of health care begins on date of separation from active military service
• To access VA’s Health Care System, enroll at a VA Health Care Facility by completing a
10-10EZ form. Forms are also online at w
010ez.
https://www.1010ez.med.va.gov/sec/vha/1010ez/showForm.aspmed.vhttps:
//ww.1010ez.med.va.gov/sec/vha/1010e/vha/1010ez/
• Must also provide a copy of most recent DD Form 214 (military discharge papers). This
DD214 must show (1) combat veteran status, (2) type of discharge (honorable, other
than honorable, etc), and (3) if dental exam was completed
• VA Website: www.va.gov
Importance of Early Enrollment
• Five (5) years from date of discharge to enroll at the
VA Medical Center.
• Waiting until AFTER the 5 year window, one might
not be eligible for care. Eligibility after the 5-year
window is based on several factors, with one main
factor being income. If income is too high, one may
not be eligible.
• Once enrolled, you are always enrolled. After the 5
years expires, you may have a co-pay, but you are still
enrolled.
Process
• Once enrolled, Vet will receive 2 initial
appointments:
• (1) Primary Care: Vet will be assigned to an OEF/OIF
provider. He/she will screen Vet and refer Vet to specialized
care as needed (such as orthopedics, dermatology, podiatry,
etc.)
• (2) Post-Deployment Health Clinic: This appointment will
assess any possible readjustment concerns. It serves as a fast
track to other services such as Post Traumatic Stress Disorder
Clinic, Psychiatric Services/Medication Management and/or
Family Counseling.
Clinical Reminders
Iraq and Afghanistan Post Deployment Screen:
assess for possible issues that may arise in this unique population.
Included are:
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PTSD Screening
Depression Screening
Alcohol Screening
Screening for gastrointestinal issues
Unexplained fever
The occurrence of rash or other skin problems
Presence of symptoms including fatigue, muscle/joint pain,
headaches lasting longer than three months and interfering
with daily activities and work.
Clinical Reminders
Traumatic Brain Injury Screen
• Experience/Exposure to Events
Such as blasts, vehicle accidents, falls, etc.
• Immediate Symptoms
Such as Loss of Consciousness, feeling dazed, head injury, not
remembering event, etc
• If problems began or got worse
Such as headaches, dizziness, sensitivity to bright light,
memory problems, etc
• Presence of symptoms in last week
Such as those listed in former
VA Medical Centers
Phoenix VA Health Care System – Phoenix
Northern Arizona VA Health Care System – Prescott
Southern Arizona VA Health Care System – Tucson
Community Based Outpatient Clinics
17 Total in Arizona
Anthem
Bellmont
Buckeye
Casa Grande
Cottonwood
Globe-Miami
Green Valley
Kingman
Lake Havasu City
Mesa
Payson
Safford
Show Low
Sierra Vista
Sun City
Tucson
Yuma
Vet Centers
6 Total in Arizona
Chinle
Phoenix
Hotevilla
Prescott
Mesa
Tucson
OEF/OIF Wednesday Night Groups at the
Phoenix VA Hospital
• Every Wednesday night (except holidays) in the ACC
basement of the Phoenix hospital from 5:30 – 7:00pm
• 1. Informational Meeting: Available for veterans and/or family members.
• Answer specific questions related to benefits through the VA Hospital and the VA
Regional Office.
• VA Regional Office present every other Wed of the month to assist with filing
claims, checking into your current claim, claim appeals, filing for other benefits,
etc.
• Find out about other resources and services available to veteran and family
• Led by OEF/OIF social worker/case manager and Transition Patient Advocate
OEF/OIF Wednesday Night Groups
• 2. OEF/OIF Support Group: provides education and support for
OEF/OIF service members.
• Led by PTSD readjustment counselor and a substance abuse addictions counselor.
• (*SE Clinic in Mesa also offers OEF/OIF Veterans Support Group)
• 3. OEF/OIF Family Support Group: provides education and support for
OEF/OIF family members, friends, significant others, etc.
• Led by OEF/OIF Outreach Social Worker and OEF/OIF family therapist
• (*SE Clinic in Mesa also offers a family OEF/OIF support group on Thursdays
evenings)
*Kids Corner is available
Southeast Clinic (SEC)
• OEF/OIF Veterans Support Group: (closed
group, meets at 3pm on Thursdays)
• OEF/OIF Family Support Group: (open meeting,
meets on Thursdays from 5:30 – 7:00pm)
***Social worker at the SE Clinic can make referrals
to a support group.
Also beginning TBI Clinic and TPA services
National Suicide Prevention Hotline
1-800-273-TALK (8255)
Press “1” for Veterans
Other VA Groups, Services, and
Resources Available
• SAC Program: Offered at both the SE Clinic and VA Medical Center.
Addresses substance abuse issues and can satisfy some court mandated
treatment requirements.
• Military Sexual Trauma: Is offered through the Vet Center and the
VA Medical Center. Individual and group counseling available.
• Marriage and Family Counseling: Offered at both the SE Clinic and
the VA Medical Center.
• Speech/Language Pathology: work with OEF/OIF vets with deficits in
memory, attention/concentration, verbal expression, auditory comprehension, voice,
motor speech and/or swallowing as a result of TBI/polytrauma.
• Once evaluated, patients are provided speech/language/cognitive therapy to improve
these skills and may be appropriate for memory aids (day planners, PDA’s).
• They have also been able to provide them with computer therapy software for their
home use.
Other VA Groups, Services, and
Resources Available
• Anger Management Classes: Any OEF/OIF vet with
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anger issues qualifies. These classes also fulfill the obligation for
those veterans who are court ordered for anger management
treatment.
OEF/OIF Families of Fallen Heroes: Family
Bereavement Support Group.
The Vet Center: offers counseling to combat vets, as well as
to any veteran who has experienced MST. They also provide
bereavement counseling for veterans as well as family members,
located in Phoenix & Mesa
Amputee Support Group: This groups if for amputees or
those facing an amputation.
Other VA Groups, Services, and
Resources Available
• Pain Clinic: no established pain clinic at our VA; can fee base out
to community clinics
• Chronic Pain Management Group: This group
is offered through medical psychology.
• Brain Boosters: for those OEF/OIF vets with a more
mild or moderate TBI; this is a 10-week course
• Topics covered include TBI education, memory skills,
attention, executive functions, sleep hygiene, PTSD,
emotions, personality, etc.
• Family members (adults) are also encouraged to attend
OEF/OIF Team at Phoenix VA
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Brenda Burke: OEF/OIF Pharmacist
James Christensen: OEF/OIF PA in Primary Care
Debbie Dominick: OEF/OIF Program Manager
Sheri Evans: OEF/OIF Nurse Case Manager
Cara Garcia: OEF/OIF Community Outreach Social Worker
Dr. Michael Garrett: OEF/OIF Secondary TBI medical doctor
Jose Hernandez: OEF/OIF Administrative Assistant
Cherie Maxson: OEF/OIF Nurse Case Manager
Joan McCarthy: OEF/OIF Marriage and Family Counselor
Michael Owens: OEF/OIF Social Work Case Manager
Jay Rathbun: OEF/OIF Marriage and Family Counselor
Dr. Anais Sonder: OEF/OIF Primary Care Physician
Adriana Tarazon: OEF/OIF Psychologist
John Thompson: OEF/OIF Transition Patient Advocate
Pat Tuli: OEF/OIF Social Work Case Manager
Books Worth Reading on the Topic
• Courage After Fire (2006)
Keith Armstrong, Suzanne Best, & Paula Domenici
• Down Range: to Iraq and Back (2005)
Bridget Cantrell & Chuck Dean
• While They’re At War: The True Story of American
Families on the Homefront (2006)
Kristin Henderson
Additional Information
Service Connection
“Disability compensation is a monetary benefit paid to veterans who are disabled by an
injury or illness that was incurred or aggravated during active military service. These
disabilities are considered to be service-connected. Disability compensation varies with
the degree of disability and the number of veteran’s dependents, and is paid monthly.”
Federal Benefits for Veterans and Dependents 2008 Edition
Veterans Benefits Administration
3333 N. Central Ave
Phoenix, AZ 85012
1-800-827-1000
My Contact Info:
Cara Garcia, LMSW
OEF/OIF Community Outreach Social Worker
Phone: 602-277-5551, x7499
Email: [email protected]
Address: 650 East Indian School Road, Phoenix, AZ
85012
The End
•QUESTIONS?
•COMMENTS?
•THANK YOU!
Bibliography
Armstrong, Keith; Best, Suzanne, & Domenici, Paula. (2006). Courage After Fire.
Berkeley, CA: Ulysses Press.
Cantrell, Bridget C and Dean, Chuck. (2005) Down Range to Iraq and Back.
Seattle, WA: Wordsmith Publishing.
Donn, Jeff and Hefling, Kimberly. (September 29, 2007).Coming Home WoundedThe Price. Associated Press
Henderson, Kristin. (2006). While They’re At War: The True Story of American
Families. New York, NY: Houghton Mifflin Company
National Center for PTSD. How Common is PTSD?
www.ncptsd.va.gov/ncmain/ncdocs/fact_shts/fs_how_common_is_ptsd.html?printable-template=factsheet
retrieved September 30, 2008
Seal, Karen; Bertenthal, Daniel; Miner, Christian; Sen, Saunak; & Marmar, Charles. (2007,
March 12). Bringing the War Back Home: Mental Health Disorders Among 103,788 US Veterans
Returning from Iraq and Afghanistan Seen at Department of Veterans Affairs Facilities. Archives of
Internal Medicine, 167, 476-482.
Street, Amy and Stafford, Jane (2005). Military sexual trauma: Issues in caring for veterans.
National Center for PTSD. Retrieved November 2, 2007 from
http://www.ncptsd.va.gov/ncmain/ncdocs/manuals/iraq_clinician_guide_ch_9.pdf?opm=1&rr=rr1519&srt=d
&echorr=true
Bibliography
Tuli, Patricia (2007, August) The OIF/OEF Virtual Clinic, Carl T. Hayden VA Medical Center.
Power Point Presentation,Slide 5.
U.S. Casualty Status. Retrieved Februrary 11, 2008 from
http://www.defenselink.mil/news/casualty.pdf.
VHA Office of Public Health and Environmental Hazards. January 2008. Analysis of VA Health Care
Utilization Among US Global War on Terrorism (GWOT) Veterans. Power Point Slides, Retrieved
February 11, 2008.
Walter Reed Army Institute and Research Land Combat Study. (No date provided). From
2007 Presentation on Divorce and Marital Concerns of OIF.
Zoroya, Gregg. (2007, October 18). Veteran Stress Cases Up Sharply. USA Today.
Retrieved October 19, 2007 from
http://www.usatoday.com/news/washington/2007-10-18-veterans-stress_N.htm
Zoroya, Gregg. (2005, October 18).One in Four Iraq Vets Ailing On Return. USA Today.
Retrieved November 5, 2007, from
http://www.usatoday.com/news/world/iraq/2005-10-18-troops-side_x.htm?POE=NEWISVA