ALFONSO R. BATRES, PH.D., M.S.S.W.
CHIEF READJUSTMENT COUNSELING OFFICER
VETERANS HEALTH ADMINISTRATION
DEPARTMENT OF VETERANS AFFAIRS
COMMITTEE ON VETERANS' AFFAIRS
U. S. HOUSE OF REPRESENTATIVES
July 27, 2005
Mr. Chairman and Members of the Committee, I appreciate the opportunity to appear before you today to discuss the Vet Center program of the Department of Veterans Affairs (VA) and the role it plays in providing care and services to veterans returning from Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF).
The Vet Center program is a special Veterans Health Administration (VHA) program designed to provide readjustment counseling to veterans exposed to the uniquely stressful rigors of military service in a combat theatre of operation. In terms of service mission, readjustment counseling consists of a holistic system of care that provides professional readjustment counseling to help veterans cope with and transcend the psychological traumas of war, and a number of other community-based services to help veterans improve the whole range of their post-military social, economic and family functioning. The Vet Centers are a unique complement to VA’s arsenal of medical center-based PTSD programs by combining professional readjustment counseling for war trauma with family services, outreach and community coordination of care. The treatment of PTSD is a core mission of VA and of the Vet Center program.
The law authorizes the Vet Centers to provide services to veterans’ family members as a core component of readjustment counseling. Veterans’ family members are eligible for care at Vet Centers and are included in the counseling process as necessary to address the whole range of adjustment issues stemming from the veterans’ military experience and/or post-deployment homecoming readjustment. Specifically tailored in every community to meet the specific needs of the local veteran population, the Vet Centers promote early intervention to help veterans stabilize post-deployment readjustment problems and family relations through community outreach, education, preventive health care information and extensive case coordination and referral activities.
In terms of facilities, VA’s Vet Center program consists of 207 community-based Vet Centers nation-wide, operating in the community outside of the larger medical facilities, in easily accessible, consumer-oriented facilities. Vet Centers are staffed by small multidisciplinary teams that are highly responsive to the needs of the local veterans. By original intent the Vet Centers were designed to promote veterans helping veterans. Nationally, a majority of Vet Center service providers are themselves veterans, most of whom served in a combat theater of operations. Vet Centers also tailor services delivered to meet the specific cultural and psychological needs of the veteran populations they are serving by promoting representative diversity among the staff. Also, every Vet Center has at least one VHA qualified mental health professional on staff. Over 60 percent of all Vet Center service providers are licensed mental health professionals. The Vet Center program reports the highest level of veteran satisfaction recorded for any VA program. For the last six years, over 99 percent of veterans using the Vet Centers consistently reported being satisfied with services received and responded that they would recommend the Vet Center to other veterans.
VA’s authority to provide readjustment counseling to eligible veterans was established by law in 1979 to alleviate the specific psychological symptoms and social readjustment problems that arose from veterans’ traumatic combat experiences in Vietnam. Today, in the anniversary of the program’s 25th year, the Vet Centers are providing outreach and readjustment counseling to all veterans that served during any war or in an area during a period of armed hostility. Since the inception of this authority in 1979, the Vet Center program has served over 2 million veterans, and on an annual basis the Vet Centers see approximately 130,000 veterans and provide over 1,000,000 visits to veterans and family members.
In FY 2004 the Vet Centers served 125,737 veterans and provided 1,031,765 visits to veterans and family members. For the first two quarters of FY 2005 the Vet Centers system-wide served 76,567 veterans and provided 505,901 visits to veterans and family members. A continuation of this rate of service delivery for the remainder of the year will produce 153,134 veterans served and 1,011, 802 visits provided. This represents an increase in veterans seen of 21.7%.
Following Secretarial direction in the wake of hostilities in Afghanistan and Iraq, the Vet Centers commenced in 2003 to actively outreach and extend services to the new cohort of war veterans returning from OIF and OEF. To date the Vet Centers have provided substantive services to over 20,000 veteran returnees from OEF and OIF. Given a continuation of the current rate of service delivery, the Vet Centers collectively will have served over 25,000 OEF/OIF veterans cumulative by the close of FY 2005. For FY 2005 this amounts to approximately 14,000 OEF/OIF veterans that will have been served by the end of the year. This represents approximately 9% of the projected Vet Center workload for 2005. In addition, this number represents only those veterans with a case file at the Vet Center. It does not represent a large number of OEF/OIF veterans contacted by Vet Center staff via outreach activities. A significant amount of outreach activity was not recorded because the encounters do not include sufficient substantive one-on-one interaction with Vet Center staff to enable collecting veterans’ demographic data.
Vet Center OEF/OIF veteran PTSD-related cases are reconciled against VHA medical center-based information and included in the cumulative VHA report of all veterans provided with PTSD services. As reported by VHA, the Vet Centers provided services to 3,596 OEF/OIF veterans for PTSD issues from 2003 through the end of the third quarter in FY 2005.
Following Secretarial direction in August 2003, the Vet Centers also initiated a program to provide bereavement counseling to surviving family members of Armed Forces personnel who died while on active duty in service to their country. The Vet Centers are now actively providing bereavement counseling to military family members whose loved ones were killed in Afghanistan and Iraq. Since inception of the program, over 400 cases of active duty, military-related deaths have been referred to the Vet Centers for bereavement counseling, resulting in services provided to over 600 family members. This is a new component of the Vet Center mission.
As an integral part of its defined service mission, the Vet Centers provide a unique outreach function within VHA. A primary service provided by the Vet Center program is to locate, inform, and professionally engage veterans and family members as to VA benefits and services as they return from theaters of combat operations. The Vet Center program’s capacity to provide outreach to veterans returning from combat operations in OEF and OIF was augmented by VHA’s Under Secretary for Health (USH) in February 2004. Specifically, the Vet Centers hired and trained a cadre of up to 50 new outreach workers from among the ranks of recently separated Global War on Terrorism (GWOT) veterans at targeted Vet Centers. Augmented Vet Center outreach is primarily for the purpose of providing information that will facilitate the early provision of VA services to returning veterans and their family members immediately upon their separation from the military. These positions are located on or near active military out-processing stations, as well as National Guard and Reserve facilities. New GWOT veteran hires augment Vet Center services by providing briefing services to transitioning servicemen and women regarding military-related readjustment needs, as well as the complete spectrum of available VA services and benefits. Based upon the success of the initial GWOT veteran outreach program as implemented in 2004, the Under Secretary for Health authorized the hiring of an additional OEF/OIF veteran outreach workers. The Vet Centers are now engaged in hiring 50 more GWOT veteran outreach workers.
This Vet Center program initiative is of the caliber of a Best Practice Model. Veterans helping veterans is a central feature of the Vet Center program throughout its 25 years of service to homecoming war veterans. Nothing can replace the immediate rapport generated by veterans with similar military experiences. These initial outreach encounters provide the initial stage for healing and successful readjustment, as well as set the stage for a seamless transition to their home community and into local VA care. This Vet Center initiative also promotes early intervention and preventive educational activities of value to veterans and family members to help stabilize their life situations and prevent the more debilitating onset of chronic war-related PTSD.
The Vet Centers have extensive experience working with veterans to overcome negative attitudes and stigmas typical of combat veterans related to accessing professional assistance. Community outreach and other accommodations to improve access to care for veterans are essential to veterans’ readjustment. This is true both from the standpoint of ensuring timely provision of services for new eras of veterans returning from combat and peace-keeping missions, as well as, for overcoming psychological and cultural barriers to care. With particular reference to socially alienated, war traumatized veterans, the “avoidance symptoms” associated with PTSD can in some cases function as a psychological barrier to care. This barrier can be diminished by using a safe and accepting therapeutic setting, allowing PTSD treatment to begin. Cultural barriers to the receipt of PTSD treatment exists in some local communities, socio-economic groups, and ethnic groups. These barriers include traditional negative attitudes concerning the accessing of mental health services. In this regard, Vet Center counselors are especially effective in forging alliances with local veterans through outreach contacts in the community prior to initiating more formal individual and/or group counseling at the Vet Center.
Vet Center community-based outreach, preventive education and brokering of care also provides many veterans with a point of contact for access into the larger VA system health care and benefits programs. The Vet Centers make over 200,000 veteran referrals annually to VA medical centers and regional offices combined. In return the Vet Centers receive less than 50,000 of these referrals. Comprehensive analysis of Vet Center workload at the end of each fiscal year shows that approximately 30 to 40 percent of Vet Center unique clients are not seen in any other VHA facility. These veterans constitute a core group of frequent users who access care specifically for psychological trauma, to include war-related PTSD, and most Vet Center visits are devoted to this core group of veterans.
It was also the express purpose of the Vet Center program that services be readily available and accessible and that all unnecessary barriers to care be removed. Veterans are always welcome to stop by their local Vet Center at any time. Vet Center staff members are always available to welcome veterans and family members, and to provide useful information about available services. As Vet Centers have no waiting lists, veterans may be seen by a counselor the same day they stop by or call for an appointment. The Vet Centers also maintain nontraditional after-hours appointments to accommodate veterans’ work schedules.
To locate their local Vet Center, veterans can consult the yellow pages, as well as the federal government listings. In both places the listing is under “Vet Center”. Vet Centers are also listed in the following web site: www.va.gov/rcs.
Mr. Chairman, this concludes my statement. I will am now available to answer any questions that you or other members of the Committee may have.