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The Virginia Wounded Warrior Program: a model for outreach and treatment.

The Virginia Wounded Warrior Program

In the summer of 2007, the Joint Leadership Council of Veterans Services Organizations in Virginia (JLC) recognized the urgency of addressing the needs of veterans returning from Iraq and Afghanistan with problems caused by combat and deployment stress and traumatic brain injuries. On-going discussions and advocacy among the Virginia Department of Veterans Services, the U.S. Department of Veterans Affairs, the Virginia Departments of Behavioral Health and Developmental Disabilities ("DBHDS") and Rehabilitative Services, representatives of the community services boards ("CSBs"),(i) and others, as well as the strong leadership of the JLC, resulted in legislation and funding that was approved unanimously by the General Assembly of Virginia and the Governor in 2008.(ii) This legislation created the Virginia Wounded Warrior Program, a statewide delivery and response system for veterans, members of the National Guard and Reserves, and their families needing behavioral health, primary healthcare, rehabilitative services and community support.

Today, the Virginia Department of Veterans Services is led by CDR Paul Galanti, USN (Retired). CAPT Catherine Wilson, USN (Retired), Executive Director of the Virginia Wounded Warrior Program (VWWP), leads the VWWP and reports directly to Mr. Galanti. Five Regional Directors, all of whom have extensive military or state government experience combine their unique backgrounds in healthcare, behavioral healthcare, training, human resources and human services to lead the regionally contracted programs provided by locally based VWWP staff. These staff partner with local health, mental health and rehabilitative services providers, nonprofit and veterans services organizations and other community-based resources. VWWP staff are based in CSBs and have regional responsibility for outreach and connections to services for veterans and their families. The VWWP regions, illustrated in Figure 1, are almost identical to the CSB health planning regions.

The regional programs offer case management, care coordination, linkages to healthcare, behavioral health care and veterans benefits, including financial assistance and employment services. Services include comprehensive assessment of individual and family needs, screening and referral for post traumatic stress disorder or traumatic brain injury, mental health and substance abuse treatment, peer and family support groups, marriage and family therapy and outreach and community education. VWWP services may vary depending upon the regional needs and makeup of the local programs. All of the VWWP programs have strong connections with the Veterans Affairs Medical Centers, the local vet centers, the community-based outpatient clinics and other local veteran-serving organizations.

[FIGURE 1 OMITTED]

In State Fiscal Year 2011, the VWWP served 3,617 veterans and family members, a 119% increase over SFY 2010. Employing the time and talents of the Executive Management Team, Resource Specialists, Peer Specialists and five dedicated VWWP Regional Coordinators, VWWP was active and visible at 615 community events reaching more than 20,000 Virginians. This includes briefings estimated to have reached 6,550 military personnel and their families.

VWWP provides services to veterans of any era and their family members. Many veterans seek assistance initially for concerns including employment or help with finances. Once a VWWP staff member begins to work with the veteran and his or her family it may become evident that other services are needed, such as healthcare or behavioral healthcare. Veterans and family members associated with all branches of service are provided assistance. The majority of those served are male, but increasingly women are seeking and receiving help from the regional programs.

Service delivery to veterans and their families has evolved in the 5 VWWP Regions based on a development strategy of community participation and involvement. If veterans are not enrolled in VA healthcare and are eligible, they are always encouraged to seek services from the VA. Some circumstances may prevent veterans from seeking services from the VA, such as: distance to a VA Medical Center, vet center or community based outpatient clinic; the veteran has not yet enrolled in service and needs immediate attention; unwillingness to seek help from the VA; VA eligibility status; or discharge status. In these instances, VWWP will assist the veteran with connections to services through local providers, including the local CSBs. The Regions have evolved into diverse service models that respect the differing resources in their communities. They are a unique blend of outreach, public education, clinical care, resource development and community support.

Focus of Efforts

In 2011 the Governor's Cabinet Secretaries of Veterans Affairs and Homeland Security, Public Safety and Health and Human Resources signed an inter-Secretariat letter of support for the VWWP. The letter reinforced the collaborative efforts of an Interagency Agreement signed at the inception of the VWWP. The Agreement governs the work of a powerful Interagency Executive Strategy Committee that includes the relevant agency heads in the three Secretariats as well as the Adjutant General of Virginia and the Director of the Veterans Integrated Services Network (VISN 6) that administers VA services in Virginia. Throughout its existence, VWWP has benefitted from an ongoing strong commitment to an integrated and collaborative approach when dealing with the many issues that face the veterans and their families. The Commonwealth has been recognized as a leader in this area by putting legislation, funding and passion into this effort.

Collaboration with the Virginia National Guard

Although media coverage has been extensive on the impact of long and multiple deployments on active duty military service members and their families, there has been a resounding toll on the Virginia National Guard and Reserves. Since September 11, 2001, over 14,000 Virginia National Guard members have been deployed to Iraq and Afghanistan. Most have now returned home or will be returning home within the next few months. The Virginia National Guard is working hard to ensure that Guard members are able to transition home to their jobs, communities and families. The stressors of military life and deployment have affected these families, including long and multiple deployments where a spouse may become a single parent for a year or more. For children, the impact of loss of one or in some cases both parents as well as family structure and routine create significant issues. For the spouse left at home, financial responsibilities must be managed alone. Civilian jobs may be affected due to extended time away. Additional stress is added by the effects of post traumatic stress, traumatic brain injury, or physical injuries.

VWWP has participated in Guard sponsored Yellow Ribbon Reintegration events across the Commonwealth. These events are held prior to deployment and upon return home. Community support providers are present to let the Guard members and families know what services are in place to support them while deployed and when they return home. Locally VWWP staff have reached out to the Guard units in their regions and participated in events at the armories and in the community. VWWP has developed a close working relationship with the Virginia National Guard Director of Psychological Health for assisting with care coordination for Guard or family members needing treatment services. In addition, the program has participated in de-briefings that occur after a Guard member's suicide, as well as being a close partner in crisis response, suicide prevention and resiliency. All VWWP peer and family support groups are open to Guard members and their families, as well as VWWP sponsored veteran and family retreats and couples retreats. The Virginia National Guard has recently launched a program called "Partners in Care" where the Guard chaplains are reaching out to local congregations, providing them training and developing a system for directing Guard members and families in need of community support to churches who can provide assistance through food pantries, child care, after school programs, services to homeless persons, etc. The Virginia Wounded Warrior Program serves as a resource to the chaplains as well as the churches for connections to healthcare, behavioral healthcare and other community support.

Reentry for Incarcerated Veterans

There are approximately 2,000 veterans incarcerated in Virginia state prisons. While the numbers of veterans in local jails is not known, research indicates that between 7 and 10% of jail inmates are veterans. Governor McDonnell's Reentry Initiative included a focus on the needs of veterans reentering communities from incarceration. Working with agency partners from the VA, Virginia Departments of Corrections, Correctional Education, Behavioral Health and Developmental Services, Department of Planning and Budget, House Appropriations and Senate Finance Committees and veteran members, VWWP recently revised an existing "Reentry Roadmap for Veterans Incarcerated in Virginia." In Virginia and in other states, this guidebook had been provided previously only to veterans incarcerated in state prisons. In an unprecedented partnership with VISN 6 of the VA and with the VISN 6 Healthcare for Veterans Reentry Specialist, the guidebook was updated with resource information for veterans in jail as well as those in prisons. The Guidebook was printed, produced on CD and distributed to all prisons, jails and regional jails in the Commonwealth. A primary benefit of the Guidebook is to provide veterans with a link to the Virginia Wounded Warrior Program in the locality where they plan to return upon release. The guidebook can be accessed on the VWWP website, www.WeAreVirginiaVeterans.org.

VWWP has hired a dedicated Reentry Specialist in Region 5, Hampton Roads, Northern Neck and Middle Peninsula and Eastern Shore, who reaches out directly to the incarcerated population. Other regions are making connections with incarcerated veterans in state prisons and local jails. These connections are being reinforced by the Criminal Justice Partners Training being conducted across the Commonwealth.

Criminal Justice Partners Training

In partnership with DBHDS, VWWP was awarded a federal grant from the Virginia Department of Criminal Justice Services to create a targeted educational program for attorneys, community corrections staff, magistrates, special justices, judges and other professionals working in criminal justice. The purpose of the training is to help criminal justice professionals understand the behavioral health impacts of the wars in Iraq and Afghanistan on military service members and their families. The Criminal Justice Partners Training is being presented currently by VWWP staff and local veterans across the Commonwealth. Six sessions are being held in each of the 5 VWWP Regions.

To date, participants have been police, sheriffs, local probation and parole officers, magistrates, staff who work in local community corrections offices such as pre-trial staff, jail services staff, and local forensic services staff who work in the CSBs, etc. One unexpected byproduct of the trainings is that the criminal justice professional community is filled with prior military service members. The training really touches a cord with this group. In one training session, the VWWP Regional Director and Peer Specialist noticed that the group was particularly somber. One individual in the audience had asked some pointed questions which seemed to indicate his unhappiness with the training. At the end, he introduced himself as a retired officer with the local Sheriff's department and a combat Vietnam veteran. He said that this was the best veterans training he had ever been to and that VWWP had "nailed the topic".

These sessions have led to connections between police officers and VWWP resource specialists who have intervened with veterans contemplating suicide or with family members who needed that one connection to get their loved one to seek treatment.

Addressing Homelessness

In response to Governor's Executive Orders 10 and 29, VWWP staff supported the Office of the Secretary of Veterans Affairs and Homeland Security in developing initiatives to reduce homelessness among veterans and their families in the Commonwealth. The 2012-2014 biennial budget includes funding for two positions at the Department of Veterans Services to address the issues of homeless veterans.

To fulfill U.S. Secretary of Veterans Affairs Shinseki's commitment to end homelessness among veterans, all of the VAMCs in Virginia have conducted Homeless Summits engaging community partners, including VWWP, to work together to provide service to homeless veterans and to prevent homelessness. VWWP Regional Consortia staff work closely with representatives from the VA and numerous local social service agencies to directly assist veterans and their families who are homeless or at risk of homelessness. Despite these efforts, according to the Point In Time (PIT) survey of persons who are homeless, which is conducted annually on a nationwide basis in January, the number of homeless veterans identified in the PIT count in Virginia increased from 886 in 2010 to 931 in 2011, an increase of five (5) percent.

Services to homeless veterans present unique challenges. Among these is the need to reestablish identity to obtain housing, employment, mental health treatment, and support services. The Veterans ID card being issued this month by DVS and the Virginia Division of Motor Vehicles (see .www.virginiaforveterans.com.) may help to address this issue, as well as other collaborative efforts to establish residency for homeless veterans. Often homeless veterans lack income so their housing options are limited and many need case management services to be successful. A complicating factor is that permanent supportive housing slots can take months to secure due to overwhelming need. VWWP staff work to assist the veteran in coordinating connections to community housing and supportive resources.

While many community-based agencies devote considerable resources and effort to serve homeless veterans on a daily basis, one program was particularly successful in expanding its array of services for veterans in 2011. Virginia Supportive Housing, based in Richmond, obtained a VA Supportive Services for Veteran Families (SSVF) grant which will provide homeless veterans and their families with a wide range of supportive services. VWWP Region 4 Resource Specialists work closely with Virginia Supportive Housing to connect veterans and families who are eligible for this support.

Figure 2 provides contact information for the VWWP Executive Team across the Commonwealth. Contact information for local program coordinators can be found on VWWP's website www.WeAreVirginiaVeterans.org.

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Author:Mead, Martha
Publication:Developments in Mental Health Law
Date:May 1, 2012
Words:2267
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