Jeff M. Hall, MSW, LCSW, MAJ (Ret) Rural OIF/OEF Outreach Coordinator Twin Ports VA Outpatient Clinic 3520 Tower Ave Superior, WI /17/2011 1

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1 1/17/ /17/ Jeff M. Hall, MSW, LCSW, MAJ (Ret) Rural OIF/OEF Outreach Coordinator Twin Ports VA Outpatient Clinic 3520 Tower Ave Superior, WI /17/2011 3

2 Twin Port VA Outpatient Clinic Providers: 5 Physician, 2 Physician Assistant, 1 Psychiatrist, 2 Clinical Nurse Specialists, 3 Licensed Independent Clinical Social Workers Lab, X ray, Pharmacy & Dietician Approximately 6000 patients Dr Clyde Markon, Medical Director Dr. Alami, Mental Health Director *Approx 22% of Staff are Vets 1/17/

3 7 Analysis of VA Health Care Utilization among Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) Veterans VA Office of Public Health and Environmental Hazards December 2010 Quarter FY

4 Updated Roster of OEF and OIF Veterans Who Have Left Active Duty 1,250,663 OEF and OIF Veterans have left active duty and become eligible for VA health care since FY ,442 (~53%)* Former Active Duty troops 584,221 (~47%) Reserve and National Guard *Percentages reported are approximate due to rounding. Quarter FY VA Health Care Utilization from FY 2002 through 2010 (4 th Qtr.) among OEF and OIF Veterans Among all 1,250,663 separated OEF/OIF Veterans 625,384 (~50%)* of total separated OEF/OIF Veterans have obtained VA health care since FY 2002 (cumulative total) 589,151 of 625,384 (~94%) evaluated OEF/OIF patients have been seen as outpatients only by VA and not hospitalized 36,233 of 625,384 (~6%) evaluated OEF/OIF patients have been hospitalized at least once in a VA health care facility *Percentages reported are approximate due to rounding. Quarter FY VA Health Care Utilization for FY (4 th Qtr.) by Service Component 666,442 Former Active Duty Troops in DMDC roster 338,176 (~51%)* have sought VA health care since FY 2002 (cumulative total) 584,221 Reserve/National Guard Members in DMDC roster 287,208 (~49%) have sought VA health care since FY 2002 (cumulative total) *Percentages reported are approximate due to rounding. Quarter FY

5 Comparison of VA Health Care Requirements 625,384 OEF/OIF Veterans utilized VA health care between FY 2002 and FY 2010 (through 4 th Qtr.), 398,981 Veterans accessed this care during the past year 1. Represents about 7% of the 5.74 million individuals who received VA health care during FY Quarter FY Demographic Characteristics of OEF and OIF Veterans Utilizing VA Health Care % OEF/OIF Veterans* (n = 625,384) % OEF/OIF Veterans* (n = 625,384) Sex Unit Type Male 88.1 Active Duty 54.1 Female 11.9 Reserve/Guard 45.9 Birth Year Cohort Branch Air Force Army Marines Navy Rank Enlisted 91.3 Officer 8.7 * Percentages reported are approximate due to rounding. A range of birth years is now being reported rather than a range of ages to capture with greater precision the age distribution of OEF/OIF Veterans utilizing VA health care. This began with the 3rd Qtr FY 2009 report. Quarter FY Frequency of Possible Diagnoses among OEF and OIF Veterans Diagnosis (Broad ICD-9 Categories)* Frequency Percent Infectious and Parasitic Diseases ( ) 90, Malignant Neoplasms ( ) 7, Benign Neoplasms ( ) 35, Diseases of Endocrine/Nutritional/ Metabolic Systems ( ) 182, Diseases of Blood and Blood Forming Organs ( ) 20, Mental Disorders ( ) 313, Diseases of Nervous System/ Sense Organs ( ) 262, Diseases of Circulatory System ( ) 123, Disease of Respiratory System ( ) 153, Disease of Digestive System ( ) 219, Diseases of Genitourinary System ( ) 85, Diseases of Skin ( ) 123, Diseases of Musculoskeletal System/Connective System ( ) 339, Symptoms, Signs and Ill Defined Conditions ( ) 304, Injury/Poisonings ( ) 170, *These are cumulative data since FY 2002, with data on hospitalizations and outpatient visits as of September 30, 2010; Veterans can have multiple diagnoses with each health care encounter. A Veteran is counted only once in any single diagnostic category but can be counted in multiple categories, so the above numbers add up to greater than 625,384; percentages add up to greater than 100 for the same reason. Percentages reported are approximate due to rounding. Quarter FY

6 Frequency of Possible Mental Disorders among OEF/OIF Veterans since Total Number of OEF/OIF Disease Category (ICD code) Veterans 2 PTSD (ICD-9CM ) 3 167,295 Depressive Disorders (311) 122,175 Neurotic Disorders (300) 102,767 Affective Psychoses (296) 72,952 Alcohol Dependence Syndrome (303) 33,660 Nondependent Abuse of Drugs (ICD 305) 4 27,714 Specific Nonpsychotic Mental Disorder due to Organic 21,533 Brain Damage (310) Special Symptoms, Not Elsewhere Classified (307) 20,026 Sexual Deviations and Disorders (302) 17,034 Drug Dependence (304) 16,799 1 These are cumulative data since FY ICD diagnoses used in these analyses are obtained from computerized administrative data. Although diagnoses are made by trained health care providers, up to one-third of coded diagnoses may not be confirmed when initially coded because the diagnosis is provisional, pending further evaluation. 2 A total of 313,670 unique patients received a diagnosis of a possible mental disorder. A Veteran may have more than one mental disorder diagnosis and each diagnosis is entered separately in this table; therefore, the total number above will be higher than 313, This row of data does not include information on PTSD from VA s Vet Centers or data from Veterans not enrolled for VA health care. Also, this row does not include Veterans who did not receive a diagnosis of PTSD (ICD ) but had a diagnosis of adjustment reaction (ICD-9 309). 4 This category currently excludes: 85,671 Veterans who only have a diagnosis of tobacco use disorder (ICD-9CM 305.1); 20,834 Veterans who only have a diagnosis of alcohol abuse (ICD-9CM 305.0);and 15,939 Veterans who have diagnoses of both tobacco use disorder and alcohol abuse (ICD-9CM and 305.0), but no other ICD-9CM 305 diagnoses. Quarter FY Combat Stressors Seeing dead Being shot bodies at Being attacked/ ambushed Receiving rocket or mortar fire Know someone killed/ seriously injured Iraq Army 95% 93% 89% 86% 86% Iraq Marines 94% 97% 95% 92% 87% Afghanistan Army 39% 66% 58% 84% 43% Many Disorders Mimic Each Other Depression Operational Stress/ COSR Post Traumatic Stress Disorder/MST Traumatic Brain Injury Hopelessness X X X X Helplessness X X X X Worthlessness X X X X Anxiety X X X Physical Symptoms X X X X Anger/Irritability X X/X X/X X/X Sleep Disorders X X X X Re-experiencing X Avoidance/Numbing X/X X/X Arousal/Agitation X X/X /X Memory Problems X X X X Alcohol/*Drug Abuse X X X/X X Personality Changes X X X X Grief/Guilt X X X X Spiritual Turmoil X X X X

7 Reason Why Veterans Don t Seek Mental Health Care Concern over being seen as weak Concern about being treated differently Concern that others would lose confidence in them Concerns about privacy They prefer to rely on family and friends They don't believe treatment is effective Concerns about side effects of treatments Problems with access, such as cost or location of treatment Presenting Needs & Concerns 1. Physical Health: Back, Knees, Muscular skeletal, TBI, Sleep, Vision, Pain 2. Psychological & Mental Health: Combat Trauma and Reintegration issues= PTSD, Depression, Substance Abuse 3. Psychosocial : Martial, Family and Social relationships, Financial, Work and Vocational challenges 1/17/ /17/

8 Physical Signs and Symptoms Common Fatigue Jumpiness Aches and pains Upset stomach, nausea Diarrhea or constipation Changes in eating ( ) Changing sleep patterns ( ) More Serious Flinching Startle reaction Shaking/Trembling Limbs/Eyes/Ears don t work normally/ right Spaced out 22 Cognitive (Thinking) Signs and Symptoms Common Poor concentration Difficulty making decisions Forgetfulness (short term) Flashbacks Nightmares Denial More Serious Disregard for rules/regs Thoughts of self harm or harming others (suicidal or homicidal thoughts) Long term memory loss Loss of motivation Violent nightmares involving actual violence upon waking 23 Behavioral Signs and Symptoms Common Zoning out in meetings/class Failing deadlines/exams Arguments/fights with others Tardiness /absenteeism Denial there are problems Avoiding triggers I don t care attitude Hides true feelings Intimacy and relationship difficulties Job/Family difficulties Increased irritability/anger 24

9 Emotional Signs and Symptoms Common Frustrated/ angry Lowered Self esteem Worried Keyed up Guilty, ashamed Depressed/ withdrawn Grief Numb Tearful Confused Sense of loss of control More Serious Panic attacks Feeling a sense of dread Flat expression Regression Immobilizing depression 25 PTSD Treatments. Talk Therapy: Cognitive Behavioral Therapy ( most effective) Types of CBT: Exposure therapy Cognitive Restructuring Medications. Can relieve s/s and make it possible to participate in therapy.

10 Including Spirituality m=1&rr=rr833&srt=d&echorr=true 28 Values Separate Paths Veterans core beliefs about the world around them significantly change as a result of their deployment. Family members core beliefs about the world around them do not experience a parallel change. 29 Our National Values Truth Life Liberty Pursuit of happiness Peace and security Equality of opportunity Responsibility Justice and fairness 30

11 Christian Values The biblical teachings of Christ include Renunciation of violence: "If a man strikes you on one cheek, turn the other cheek." Forgiveness of sins: "Forgive us our trespasses, as we forgive those who trespass against us. Unconditional love: "Love your enemies and pray for those who persecute you" * 31 How have family members changed? More independent Used to making their own decisions New friends/relationships Children may be significantly different New routines New perspectives Changes in the environment I was angry for months, my wife and kids had grown without me How do you tell somebody they need help? 1/17/

12 Veterans of Operations Enduring & Iraqi Freedom VA provides enhanced enrollment opportunity and five years of cost free health care to veterans who served in a theater of combat operations, for any injury or illness associated with this service. 1/17/ Veterans of Operations Enduring & Iraqi Freedom VA provides enhanced enrollment opportunity and five years of costfree health care to veterans who served in a theater of combat operations, for any injury or illness associated with this service 1/17/ Where to Get Assistance Eligibility Contact Information (612) VA Nurse Toll free Monday through Friday 4:00 p.m. 8:00 a.m. OEF/OIF program VA Benefits (VBA regional Office) Minneapolis VA Medical Center (612) National Suicide Prevention Line (MN) TALK 1/17/

13 Dental Care Cost free one time treatment of dental conditions for recently separated veterans who: Served for 90 days or more Apply within 180 days of separation, and DD214 does not indicate necessary dental care was provided within 90 days of release or discharge. 1/17/ /17/ VA Medical Clinics Available Twin Ports VA OPC Superior Hibbing CBOC Hayward WI. CBOC Rice Lake WI. CBOC 1/17/

14 QUESTIONS 1/17/