The Governor's Focus on Returning Combat Veterans and their Families

Welcome to NC’s Partnership for Combat Veterans and Their Families

On behalf of the federal, state, local, professional, and consumer organizations that have partnered together to ensure that North Carolina’s returning combat veterans and their families receive the best and most updated services available, co-chairs Michael Lancaster, MD, chief of clinical policy, NC Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMH/DD/SAS) and Harold Kudler, MD, associate director of the Veterans Affairs Mid-Atlantic Mental Illness, Research, and Clinical Center (MIRECC) welcome you.

North Carolina ranks fifth in total military personnel per capita, fourth in active duty military personnel per capita, and thirty-eighth in Reserve and National Guard. There are currently 120,000 active duty personnel based at one of seven military bases or deployed overseas. North Carolina is likely to receive another 25,000 active duty members by 2011. Another 25,000 soldiers, marines, and airmen live in all 100 counties of North Carolina and serve in the National Guard or Reserve Forces. Most of the active duty military, Reserve, and National Guard have served in Operation Iraqi Freedom (OIF) or Operation Enduring Freedom (OEF). Military service also affects their families prior to, during, and post deployment, with deaths, injuries, and disabilities taking their toll. An estimated 103,118 children and adolescents of active duty members, National Guard, and Reserves live in North Carolina. In addition to active military, another 770,080 veterans live in North Carolina, of which more than 117,000 are in receipt of service connected disability compensation from the US Department of Veterans Affairs. That places North Carolina sixth in military retiree population and ninth in veteran population in the country.

In 2009, the North Carolina General Assembly charged the North Carolina Institute of Medicine (NCIOM) with studying “the adequacy of mental health, developmental disabilities, and substance abuse services funded with Medicaid funds and with State funds that are currently available to active, reserve, and National Guard members of the military, Veterans of the military, and their families, and the need for increased State services to these individuals.” The study is to be completed by the end of fiscal year 2010-11 and is being supported through substance abuse prevention and treatment block grant funds from SAMHSA (http://www.nciom.org).

Accomplishments

Governor’s Summit in 2006—nearly 90 individuals attended the conference, which resulted in recommendations to the Governor regarding individuals’ access to services, outreach to military personnel, educational linkages and interagency collaboration, and training of professionals.
Governor’s Letter—a personalized letter sent by the North Carolina Governor’s Office to every OEF/OIF veteran in the state, thanking them for their service and expressing the Governor’s desire to serve each new veteran and their family. Veterans are provided toll free numbers for Care-Line and N.C. Department of Health and Human Services. From March 22, 2007 through August 9, 2010 25,983 letters have been mailed.
Care Line—a toll free number, available two shifts a day, 7 days a week, in English and Spanish, linking callers to services in government, faith-based, for-profit and non-profit agencies. Please call 1-800-662-7030 (English/Spanish) or 1-877-452-2514 (TTY). The Office of Citizen Services of the NC Department of Health and Human Services (DHHS) began monitoring calls by Veterans and their families in March 2007. From March 2007 to August 2010, a total of 15,503 calls were made by Veterans or their family members. Of these calls, 466 resulted from the caller seeing one of the Veteran-related public service announcements.
The DMH/DD/SAS and the Governor’s Institute on Alcohol and Substance Abuse have staffed the Governor’s Focus on Returning Combat Veterans and their Families by providing logistical support for meetings and developing a website, http://veteransfocus.org, in 2007. This website was completely redesigned in 2009, with the addition of resources for health care providers, including evidence-based practices in the treatment of post-traumatic stress disorder, substance abuse and traumatic brain injury and in the prevention of suicide and homelessness. Between July 1, 2009 and June 30, 2010, usage of the website has been tracked, with 40,000 visitors.

Workforce Development

- Issues of Women Returning from Combat addressed readjustment issues unique to women returning from combat, child development issues, gender-specific roles and treatments, and mental health resources (415 professionals attended 8 full-day workshops from February to June 2010)
- Caring for Veterans at the End of Life discussed the emotional, social, spiritual, and moral injuries sustained by Veterans and how these impact end-of-life care and the value of providing prognoses to patients so end-of-life strategies can be developed (61 mental health professionals attended a two-day workshop in Greensboro on April 19, 2010)
- Traumatic Brain Injury: B.I. 101 provided information to increase knowledge and skills of professionals that work with individuals who have experienced TBI, with a special emphasis on military and veterans (13 professionals attended a full-day workshop in Fayetteville on June 22, 2010)
- The DMH/DD/SAS and BHRP have co-sponsored the workshop, PTSD, Substance Abuse, and Returning OEF/OIF NC Guard and Reserve Veterans. This workshop addresses issues faced by returning combat Veterans that substance abuse professionals need to know. A total of 583 substance abuse professionals attended 14 full-day training events from 2006 to 2009, and 14 substance abuse professionals attended a 20-hour course in August 2009. Two full-day training events are scheduled in Asheville and Greensboro during the spring of 2010. A new advanced 20-hour course, for those professionals who completed the basic course, will be conducted at the Summer School sponsored by the North Carolina Foundation for Addiction Studies in August 2010.
- The DMH/DD/SAS, the VISN 6 Mental Illness Research, Education and Clinical Center (MIRECC), the NC Area Health Education Centers, and the Citizen-Soldier Support Program at the University of North Carolina have partnered to develop a series of educational programs for healthcare professionals, behavioral health professionals, and clergy. These programs are briefly described below.
- - Post Deployment Mental Health Issues: Working with Veterans of Iraq and Afghanistan and their Families provides evidence-based practices in the assessment of PTSD. A total of 105 physicians, nurse practitioners, and physician assistants attended the nine 2-hour workshops.
  - Painting a Moving Train addresses trauma and PTSD in a military context, developing a therapeutic alliance with combat Veterans and their families, the impact of mobilization, deployment, and redeployment on family relationships, and the process of BATTLEMIND (1,035 social workers, counselors, case managers, psychiatric nurses, family therapists, and substance abuse counselors at 15 all-day training events in 2008 and 2009)
  - Traumatic Brain Injury: Invisible Wounds of War discusses the care of military service members with undiagnosed brain injury, understanding of military culture, and TBI screening, treatment, and resources (n=626 mental health professionals at nine full-day workshops in 2008 and 2009)
  - Working Miracles in People’s Lives (n=169 physicians, behavioral health professionals, social workers, and clergy at four full-day workshops in 2009)
  - Advanced Therapeutic Techniques for Treating out Military Personnel and their Families provided advanced skill training in Prolonged Exposure Therapy and Cognitive Processing Therapy to address the needs (e.g., PTSD, depression, and substance abuse) of trauma-exposed veterans and their families (60 mental health professionals attended a full-day pilot workshop in Asheville on December 1, 2009, with another workshop to be conducted in FAyetteville on August 18, 2010.
  - Issues of Women Returning from Combat addresses readjustment issues unique to women returning from combat, child development issues, gender-specific roles and treatments, and mental health resources. A total of 415 professionals attended the 8 all-day workshops.
  - Caring for Veterans at the End of Life will discuss the emotional, social, spiritual, and moral injuries sustained by Veterans and how these impact end-of-life care and the value of providing prognoses to patients so end-of-life strategies can be developed (two full-day workshops are scheduled in April 2010)
  - Traumatic Brain Injury: B.I. 101 provided information to increase knowledge and skills of professionals that work with individuals who have experienced TBI, with a special emphasis on military and veterans (13 professionals attended a full-day workshop in Fayetteville on June 22, 2010)
  - Forward March: Moving Children Forward in Challenging Times will provide information on how to meet the needs of military families. This two-day conference will be conducted in Fayetteville on September 16-17, 2010.
  - Effects of War on Military Families, online course sponsored by the Greensboro AHEC (21 physicians)
  - Treating the Invisible Wounds of War Series: Part 1 – Posttraumatic Stress Disorder , online course sponsored by the Greensboro AHEC (278 mental health providers)
  - Treating the Invisible Wounds of War Series: Part 2 -Traumatic Brain Injury , online course sponsored by the Greensboro AHEC (87 mental health providers)
  - Treating the Invisible Wounds of War Series: Part 3 – Issues of Women Returning from Combat, online course sponsored by the Greensboro AHEC (9 mental health providers)
  - Identifying Signs of Head Trauma in Military Veterans during Routine Dental Visits is currently being developed as an online course and will be available in October 2010
  - Invisible Wounds of War (3 hour webinar) (n=178 mental health professionals)
  - What Primary Care Providers Need to Know about Mental Health Issues Facing Returning Service Members and Their Families (1 hour webinar) (n=92 primary care providers)
  - Veterans and Traumatic Brain Injury (1 hour webinar) (n=137 primary care providers)