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OCE Community Partnership Challenge

2018 VHA Community Partnership Challenge Winners Celebrate “Return on Partnership”

Every year, VHA holds a national contest to spotlight successful partnerships between VA medical facilities and nongovernmental organizations. The contest brings attention to the collaborative efforts taking place in local communities to serve Veterans, their families, caregivers, and survivors. Under this year’s Return on Partnership contest theme, VA medical facilities were encouraged to submit entries that demonstrate how their partnerships are paying off for Veterans and advancing VA’s mission. The three winning facilities are the Central Texas Veterans Health Care System, Phoenix VA Health Care System, and VA San Diego Healthcare System. Their partnerships were among more than 100 entries from across the country.

A smiling Veteran receiving food from one of the mobile pantries
A Veteran receiving food from one of the mobile pantries

In their contest entry, "Joining Hands, Feeding Veterans,” the Central Texas Veterans Health Care System (CTVHCS) described their partnership with the Central Texas Food Bank. Together, they serve their local area Veterans by ensuring that they have sufficient amounts of food. Since August of 2017, the mobile pantries have distributed nearly 87,000 pounds of food, which equates to more than 72,000 meals for Veterans and their families.

One Veteran says he relies on the pantry to help him when he may not be able to afford groceries. “Even though I receive foods stamps, it is not enough to make it through the month. I am glad for programs like yours that help me out.”


A smiling Veteran receiving food from one of the mobile pantries
Team AMVETS volunteers

Since 2009, the Phoenix VA Health Care System has partnered with the Arizona Coalition for Military Families to create an ecosystem of support for Veterans and their families throughout Arizona. One of the key results of this collaboration is the Be Connected program, which brings together important stakeholders from the public and private sectors to address the elevated suicide risk of Arizona Veterans. Since its launch, Be Connected has helped more than 1,400 individuals through its support line, over 1,000 resources have been mapped on the online platform, and the program has trained and equipped more than 3,300 community members as Military/Veteran Resource Navigators. Even more compelling than the numbers though are the testimonials from the people Be Connected has helped. “Be Connected did what no one else has,” said one Vietnam Veteran, “you gave me hope.”

The VA San Diego Healthcare System and Team AMVETS™ Welcome Home partnership was developed in 2012 to help California’s homeless Veterans by transforming their new residences into real homes by providing them with furniture, household items, cooking utensils, and appliances. Team AMVETS has donated over $500,000 in San Diego County, and close to $2 million in Southern California. More than 5,000 Veterans have been served since the inception of the partnership. Some Veterans have been so grateful for the assistance that they now volunteer at the Team AMVETS™ warehouse, joining nearly 5,000 other Welcome Home partnership volunteers across the region.

Operation: Hero-Animal Bond

Operation: Hero-Animal Bond event encourages Veterans to keep pets for their own health and well-being

Golden-haired dog wearing a badge for certified assistance dogs.
A certified assistance dog at the Operation: Hero-Animal Bond event held at the Perry Point VA Medical Center.

On November 14, 2018, an Operation: Hero-Animal Bond event was a first initiative to meet the operation’s mission: to inform Veterans about the benefits of petkeeping and volunteering with animals, which promotes health and well-being through the human-animal bond. The Veterans Health Administration (VHA) and the Humane Society of the United States (HSUS) partnership, Operation: Hero-Animal Bond, fosters relationships between Veterans in need of companionship and animals in need of good homes.

VHA’s Office of Community Engagement (OCE) collaborated with the HSUS to host the event during Veterans Month at the Perry Point VA Medical Center, part of the VA Maryland Health Care System (VAMHCS). About 100 people participated in the event, including Veterans and their pets and representatives from VHA, local shelters and rescues, and community-based businesses. That day, petkeeping was the focus.

Representatives of Cecil County Animal Services, Maryland Animal Sanctuary & Rescue, Canine Humane Network, Pets for Vets, and two PetSmart stores provided information on petkeeping. They encouraged Veterans to consider adopting or fostering a pet as well as volunteering with local animal shelters and humane societies.

The Operation: Hero-Animal Bond event emphasized that Veterans can reap important health benefits from the companionship of animals. Research1,2, shows that spending time with animals can reduce blood pressure, heart rate, stress hormones, and feelings of isolation. The event also promoted volunteering at animal rescue and shelter sites, which can improve Veterans’ well-being by encouraging community interaction and social integration.

Jill Murray of OCE said the event was a great success, mentioning two Veterans who received direct assistance onsite. One Veteran brought a dog he had adopted two days before, which had not yet received vaccinations. Cecil County Animal Services was able to meet with the Veteran onsite to arrange for the needs of his new pet. Another Veteran, who sought to arrange for required community service, was able to make an immediate connection with a local shelter where she will volunteer her time.

“That’s exactly what this partnership is about: to improve Veterans’ health and well-being by making petkeeping and volunteering less confusing and more accessible for Veterans,” Ms. Murray said.

Dr. Heidi Ortmeyer, a VAMHCS Research Physiologist and Investigator with the Geriatric Research and Education Clinical Center, said that the Veterans she spoke with that day were enthusiastic and interested in learning more about companion dog and cat programs in the community. “Our programs serve as a win-win for our communities — providing companionship for our Veterans seeking a furry friend and saving the lives of companion animals!” she said.

VAMHCS, the HSUS, OCE, and local community shelters and rescues are expanding the Baltimore-based Operation: Hero-Animal Bond program throughout Maryland. Additionally, five VA medical centers across the country are in various stages of participating in the pilot partnership project. VHA announced the Operation: Hero-Animal Bond partnership in December 2017 and will continue to work with the HSUS to create mutually beneficial relationships between Veterans and animals. VHA and the HSUS are also developing an Adoption Tool Kit and rollout plan for the Operation: Hero-Animal Bond program.

For more information, please visit va.gov/healthpartnerships.

1. Brooks, H. L., Rushton, K., Lovell, K., Bee, P., Walker, L., Grant, L., & Rogers, A. (2018). The power of support from companion animals for people living with mental health problems: a systematic review and narrative synthesis of the evidence. BMC psychiatry, 18(1), 31. doi:10.1186/s12888-018-1613-2.

2. Beetz, A., Uvnäs-Moberg, K., Julius, H., & Kotrschal, K. (2012). Psychosocial and psychophysiological effects of human-animal interactions: the possible role of oxytocin. Frontiers in psychology, 3, 234. doi:10.3389/fpsyg.2012.00234.

Salute to the Human-Animal Bond 

Veterans, volunteerism, and animal welfare take center stage at the 2018 Animal Care Expo

Staff from the VHA Office of Community Engagement, MoKan Pet Partners and the U.S. Humane Society presented a workshop on the importance of the human-animal bond at the Animal Expo, the largest annual gathering of animal welfare professionals in the United States.
Staff from the VHA Office of Community Engagement, MoKan Pet Partners and the U.S. Humane Society presented a workshop on the importance of the human-animal bond at the Animal Expo, the largest  annual gathering of animal welfare professionals in the United States.

Nearly 150 people gathered to learn about how adopting and fostering companion animals and volunteering at shelters and rescues better the lives of Veterans, but it was really Suzi Q who stole the show. The female St. Bernard mix was there with her owner, Mr. John LaRoe, President of Mo-Kan Pet Partners, to participate in the annual Animal Care Expo. Suzi Q and LaRoe visit Veterans at the Kansas City VA Medical Center to provide animal therapy, comfort and companionship.

Dr. Heidi Ortmeyer, Ph.D., VA Research Physiologist and Executive Director of Eskie Rescuers United; Amy Nichols, Vice President Companion Animals at the Humane Society of the United States; Heather Luper, LCSW-C, and Dr. Jamie Davis, Ph.D., of VHA Office of Community Engagement (OCE) presented on the importance of developing partnerships between local VAs and animal rescues and shelters. These partnerships encourage Veteran volunteerism at animal rescues and shelters, introduce animal-assisted activity programs to VA Medical Centers (VAMC), and support Veterans’ health and well-being through fostering and adopting pets.

“In our work, we wanted to find a way to help both Veterans and dogs,” Dr. Ortmeyer said. She is the primary investigator in a pilot study to evaluate the effects companion rescue dogs have on Veterans’ health based on non-invasive measures such as heart rate. A Veteran who participated in the study said of his experience, “Caesar is a great companion dog. He keeps me busy and active. He’s someone to watch out after you, and you look out for them. I would recommend this program to all Veterans.”

Another Veteran, who is a part of the adoption program Dr. Ortmeyer oversees, noted that he used to have no desire to get up in the mornings. Now, his dog Sophie licks his face until he gets out of bed to start the day. “Sophie has changed my life from the moment I met her. Instead of being too anxious to go out in public I get excited to take her out.” the Veteran said.

The annual Animal Care Expo is the largest educational conference and trade show for animal welfare professionals. The focus of the conference is to foster professional development and make connections so animal welfare experts can learn from each other. The VA-HSUS workshop featured presentations about how the human-animal bond and public-private partnerships help Veterans. Attendees learned about existing programs from OCE representatives and community partners that could be applied in developing their own community-based outreach and partnership initiatives with local VA facilities.

“Partnerships provide an innovative way to improve the health and quality of life for Veterans. Fostering and adopting animals and volunteering at community shelters and rescues enhance the quality of life for Veterans and pets alike. The collaboration between VA and the HSUS provides a valuable means of reaching Veterans who use VA health care services as well as those who do not,” said Dr. Davis.

“The HSUS is proud to be partnered with the VA to support our Veterans through the incredible power of the human-animal bond. Pets are an integral part of our lives and both of our organizations believe there are tremendous benefits that can be derived from facilitating more pet adoptions to Veterans, creating Veteran volunteer programs in animal shelters and rescues, and opportunities for Veterans to foster pets that are still in search of their forever home,” said Ms. Nichols from HSUS.

OCE staff also visited the Kansas City VA Medical Center that partners with Mo-Kan Pet Partners. The group, including Mr. LaRoe and Suzi Q, provides pet visitation and pet therapy to Veterans throughout the hospital including the Behavioral Health Units. This pilot partnership may be expanded further to offer patients in more VA facilities a chance to experience the positive effects of the human-animal bond.

"Suzi Q and I get a lot of positive feedback from Veterans, their caretakers and their loved ones we visit at Kansas City VA. That makes me feel like we're making an important contribution to their well-being. But for Suzi Q, she just loves all her people there. So far as she's concerned, this is the most fun she knows how to have with her fur on," said Mr. LaRoe.

Learn More

Read about VA’s expansion of veterinary benefits to service dogs working with Veterans with mobility issues related to mental health concerns


VA Announces Partnership with The Humane Society of the United States

VA’s Office of Community Engagement (OCE) recently facilitated a national strategic partnership between the Veterans Health Administration (VHA) and The Humane Society of the United States (The HSUS) to improve the quality of life for both Veterans and animals. Shared partnership goals include promoting opportunities for Veterans to volunteer at and adopt animals from local animal shelters, animal rescues and humane societies.

The partnership between VHA and The HSUS aims to improve the health and well-being of Veterans through promoting the human-animal bond, pet keeping and other healthy interactions with animals. Other expected results are a greater understanding of pet ownership and responsibility and more Veteran involvement in the community.

“There are many benefits to pet ownership for both Veterans and to animals in need of care and shelter,” said VA Secretary David J. Shulkin. “The greatest benefit for both can be a more fulfilled quality of life. We are pleased to work with The HSUS on this important initiative and are excited about its potential to create more opportunities to serve.”

Learn more

YMCA Partnership

National Recreation Therapy Week: Partnerships provide opportunities for Veterans moving towards wellness

A Veteran is holding a heavy bag still while another Veeteran practices boxing punches
A Veteran boxing with a heavy bag as part of the Strength and wellness program

When he first enrolled in the Veterans Strength and Wellness Program at the San Francisco VA Health Care System medical center, the Vietnam War Veteran couldn’t lift his arms above his head, much less play basketball and tennis everyday as he did in the past. Recreation therapist and program coordinator Chris Geronimo said they would work together on an exercise program that focused on what he could do and avoid exercises that caused pain from old injuries and inactivity.

After completing his first twelve-week session of the Strength and Wellness program at the Presidio YMCA, the Veteran agreed to enroll in another 3-month session. “Eight years later, this man is still a member there. He plays in a pick-up basketball game there four days a week. He’s playing against 20 and 30-something year old guys,” Geronimo said.

The San Francisco VA Medical Center offers recreation therapy to Veterans in its Strength and Wellness Program through a partnership with the San Francisco-area YMCAs and local private yoga studios. Through this partnership, enrolled Veterans use the YMCA space for exercise, personal training and group exercise programming. YMCA staff lead some of the Veteran program classes, while in other classes are led by VA staff members.

A group of Veterans hold up their large foam rollers after completing a strength and wellness class.
Veterans participating in a Strength and Wellness group

The goal of recreation therapy is to use activity-based interventions to assist Veterans with illness and disabilities to recover from injury or illness and improve their health and well-being. Recreation therapists work with people with physical illness and injury as well as mental health concerns.

“Recreation therapy can be looked at as one of the best anti-depressants out there. It’s one of the best tools we have to combat anxiety,” Geronimo said.

Many Veterans with mental health concerns are relieved to find treatment options that involve movement and activity to add to talk-based or medication therapies. Because working out and playing sports is already an important part of their lives, some younger Veterans feel less stigma about getting care at a YMCA instead of going to a VA medical center or mental health clinic, according to Geronimo. In his experience, the YMCA recreation therapy partnership can be a great first step in getting Veterans more involved in their own care.

Tennis Recreation
for Veterans

The U.S. Tennis Association
supports Veterans and service members
during the USTA tournaments leading
up to the U.S. Open.
Veterans can find discounted
tickets and participate in
tennis clinics at the tournaments.
The next tournament is
July 27th in Atlanta.

Every year, VHA holds a national contest to spotlight successful partnerships between VA medical facilities and nongovernmental organizations. The contest brings attention to the collaborative efforts taking place in local communities to serve Veterans, their families, caregivers, and survivors. Under this year’s Return on Partnership contest theme, VA medical facilities were encouraged to submit entries that demonstrate how their partnerships are paying off for Veterans and advancing VA’s mission. The three winning facilities are the Central Texas Veterans Health Care System, Phoenix VA Health Care System, and VA San Diego Healthcare System. Their partnerships were among more than 100 entries from across the country.

To learn more about recreation therapy and partnerships and the VA, please visit:

Medical Legal Partnerships

During Veterans Month, VA celebrated a commitment to legal services for Veterans

Male speaking at podium with Department of Veterans of Affairs seal on the front.
Acting Deputy Secretary, Jim Byrne delivering remarks at the VA Medical Legal Partnerships Celebration and Recognition Ceremony on November 5, 2018.

Before he worked with a pro bono attorney – one who does not charge clients for legal services – to address his medical and legal needs, Veteran Patrick Taylor was in a tough spot. He faced food insecurity as he prepared to undergo extensive surgery.

But everything changed for the better when he was connected with an attorney, Antoinette, through a Medical Legal Partnership (MLP) at Mr. Taylor’s Veterans Affairs (VA) facility. He’s just one of the Veterans who has benefitted from an MLP.

MLPs are formal partnerships between attorneys and VA medical facilities. Through these partnerships, lawyers can train VA health care teams to screen Veterans for unmet legal needs. Then, the medical teams refer Veterans to on-site legal clinics, where attorneys provide pro bono services on a variety of legal issues. Services available to Veterans through MLPs include counseling on Veterans benefits and Social Security, family law, guardianship, landlord-tenant disputes, and elder law.

These available services on-site at the VA have been particularly helpful to Veterans at risk of or experiencing homelessness. Since VA’s MLP Taskforce formed in early 2016, the number of MLPs at VA facilities has grown from five to 27.

VA’s Medical Legal Partnerships were the focus of an event at VA’s Central Office in Washington, D.C., on November 5, 2018. The day was a celebration of VA’s expanding array of MLPs and a recognition ceremony of the attorneys who have served at the Washington DC VA Medical Center’s legal clinic.

The VA Office of General Counsel (OGC) and the VHA Office of Community Engagement (OCE) co-sponsored the event, during which representatives from VA, the Navy, and the Departments of Labor, Justice, Defense, and Homeland Security, among other agencies, signed a joint statement in support of improving Veterans’ access to free legal services.

The statement read, in part: “Recognizing the contributions that personnel of our agencies can make to address Veteran homelessness, we come together to note our joint commitment to encourage and further the provision of volunteer legal services to Veterans.”

Veterans, many of them experiencing homelessness, ranked affordable legal assistance high on their list of unmet needs in a 2016 VA survey. On November 13, 2017, VA — along with the American Bar Association, the Veterans Consortium, and the National Law School Veterans Clinic Consortium — signed another agreement aimed at improving Veterans’ access to free legal services.

Lara K. Eilhardt of OGC, who leads the VA MLP Taskforce, explained after the ceremony how legal issues directly affect Veterans’ health. For example, a Veteran experiencing stress because of a child custody dispute cannot fully focus on recovering from a health issue.

“Many do not realize that having a driver’s license revoked is a significant legal issue Veterans face that affects their health,” Ms. Eilhardt said. “If their license is revoked, they can’t get to a job, they can’t get to medical appointments.”

At the November 5 ceremony, Richard J. Hipolit, Deputy General Counsel for Veterans Programs, presented certificates of appreciation to 12 government attorneys who have provided pro bono services at the Washington DC VA Medical Center. Eighteen other local attorneys will receive certificates of recognition.

Nombeko Payne of OCE, who helped organize the event, spoke about VA’s goal of making Veterans aware of MLPs.

“Once the awareness is out there, many people are able to go and take those steps forward in getting help,” Ms. Payne said.

For more information on free legal clinics in VA facilities, visit va.gov/ogc/docs/LegalServices.pdf.

United Through Reading

Honoring Children of Veterans and their Families through Literacy and Connection

A child reading a book is guided through the book by their parent, a service member, via videophone.
A child reading a book is guided through the book
by their parent, a service member, via videophone.

April 2018 is the Month of the Military Child. During this month, military families and their children are honored for the daily sacrifices they make and the challenges they overcome while they are apart.

United Through Reading (UTR) unites military members and Veterans with their children through the read aloud experience. This program allows Veterans who are separated from their families to share an everyday moment, like story time, with the children in their lives through video recordings. UTR sends the video along with a companion copy of the book, so children can play the recording of their Veteran parent, grandparent or caregiver and read along. 

UTR, a national nonprofit organization, was created to build family bonds and cultivate a love of reading for military children during separations. A 2016 study by the National Academies of Sciences, Engineering and Medicine notes that parenting practices, such as shared book reading, lead to positive childhood outcomes, both academically and emotionally. More than 2 million military beneficiaries have been served through UTR.

Through the UTR partnership, Veterans build connections with their children and grandchildren, enhancing their relationships and well-being. The Veterans Health Administration’s (VHA) goal is to provide excellent heath care with a focus on working collaboratively with Veterans and their loved ones to benefit the whole health of the patient, including relationships with loved ones.

The VHA/UTR partnership offers these recorded reading sessions to Veterans who may be separated from their families during extended medical treatment or while in residential care. For example, Veterans participating in the Mental Health Residential Rehabilitation Treatment Programs (RRTP) can be away from their families from a few weeks to more than a year, in some cases.

Andrew Tomacari, RRTP Program Manager at the Battle Creek VA Medical Center, said the UTR program has been quite meaningful for the Veterans who have made recordings. Some have requested to participate again to make more videos for their young family members. Tomacari added that the UTR program has become an additional tool for increasing family engagement and reaching individualized treatment goals.

VHA and UTR began recording stories with Veterans in early 2018 at the Battle Creek VAMC in Michigan with the help of Volunteer Services. There are plans to expand the program later this year to the VA Medical Centers in Prescott, Arizona, and Orlando, Florida. As the partnership grows and interest builds, more VHA sites are expected to join with UTR to offer the program to Veterans and their families.

“To care for him who shall have born the battle and for his widow, and his orphan.” — Abraham Lincoln 

Learn More

New Partnership With United Through Reading Connects Veterans and Families

Veterans who receive care away from their families now have a unique opportunity to remain connected.  A new partnership between the Veterans Health Administration (VHA) and United Through Reading (UTR) allows Veterans to share everyday moments of reading with their children or grandchildren, regardless of distance.

Bonding Through Books

UTR, a San Diego-based nonprofit organization, was created to build family bonds during military separations through shared story time. A 2016 study by the National Academies of Sciences, Engineering, and Medicine states parenting practices such as shared book reading lead to positive child outcomes. Through VHA’s new partnership with UTR, Veterans can now increase family bonds and childhood wellness by reading together.

The VHA Office of Community Engagement (OCE) facilitated the memorandum of agreement (MOA) between VHA and UTR. The joint effort aims to connect Veterans in Mental Health Residential Rehabilitation Treatment Programs (MH RRTP) with the children in their lives through video-recorded readings. The UTR program is particularly well-suited for Veterans in MH RRTPs since these admissions can last weeks to more than one year in some cases.

“Like children separated from their deployed military parents, children of Veterans in extended care may experience high levels of emotional difficulties during family separation and show symptoms of anxiety,” according to Sally Zoll, Chief Executive Officer of UTR. “Even though our program is not complicated, we believe it could have a profound effect on the emotional wellness of Veterans and their children and potentially reduce the stress and anxiety caused by separation.”

Partnership In Practice

Here’s how the partnership works: 

  • UTR will provide a selection of books enjoyed by children of all ages for Veterans to use in their recordings.
  • A trained UTR volunteer will assist the Veteran in making his or her private recording.
  • Voluntary Services coordinates UTR volunteer activities at VA medical centers.
  • VA medical centers use laptop computers with recording software and suitable rooms for recording at participating facilities.
  • Once the recording is complete, the UTR volunteer will give the Veteran the video and the book, which is then mailed or delivered to the family at no cost to Veteran.

The videos can be viewed whenever a child wants to spend special, uninterrupted time with their Veteran loved one. The readings also help maintain family connections that can be disrupted when a Veteran must receive treatment away from home. This can be especially important for Veterans during inpatient rehabilitation and may even enhance the recovery process. 

VHA and UTR are rolling out recording opportunities in early 2018 beginning in Prescott, Arizona; Orlando, Florida; and Battle Creek, Michigan. As interest builds, more VHA sites are expected to join with UTR to offer the program to Veterans and their families.

Dr. Mary Beth Skupien, Director of the Battle Creek VA Medical Center, said they have moved forward with integrating UTR into residential mental health and substance abuse treatment.  She said many Veterans have struggled since separating from the military and have developed strained relationships with their families, children and grandchildren. 

While Veterans are receiving care through the Battle Creek VA Psychosocial Residential Treatment Program for up to 90 days, they have the opportunity to reconnect with their children or grandchildren through the UTR Program. 

“One Veteran who participated in UTR offered, ‘I have not seen my family in a while and I loved it; it helped me feel connected.’” Dr. Skupien said.

Learn More

Intermediate Care Technician Program

First VHA Expert Field Intermediate Care Technician of the Year Award goes to hurricane responder

Man with red, short-sleeve, collar shirt. The left of the man’s shirt reads, H. Velazquez, ICT. The right of the man’s shirt has a blue, red and black seal that reads, VA Caribbean Healthcare System and San Juan Puerto Rico.
Henry Velazquez, honored as the 2018
Intermediate Care Technician of the Year.

Henry Velazquez, an Intermediate Care Technician (ICT) and former Army Medic, was one of the first to volunteer when Hurricane Maria hit Puerto Rico in 2017. Using his medical evacuation (known as medevac) experience transporting wounded military personnel, he worked countless hours caring for people injured in the storm. A Casualty Care Unit Leader for the Veterans Health Administration (VHA) Caribbean Healthcare System (VACHS), Mr. Velazquez is the first recipient of the VHA Under Secretary for Health’s Expert Field Intermediate Care Technician of the Year Award.

VHA Chief of Staff Lawrence Connell presented the award in a virtual ceremony on November 15, 2018, attended by Mr. Velazquez’s family members, friends, VACHS leaders, and fellow VHA staff. Mr. Connell spoke about Mr. Velazquez’s dedication, commitment, and skills, noting that these qualities set him apart even among the outstanding competition for the first annual award. Mr. Connell also highlighted Mr. Velazquez’s contributions to VACHS and the survivors of Hurricane Maria.

“Let me congratulate you on this achievement,” said John Wagner, the Department of Veterans Affairs (VA) Principal Deputy Assistant Secretary, Office of Public and Intergovernmental Affairs. At the ceremony, Mr. Wagner presented Mr. Velazquez with the VA Secretary’s Challenge Coin, a token awarded to people for their hard work and excellence. “There was keen competition. I know you are not surprised by that, since the best and brightest former Medics and Corpsmen are filling the VA Intermediate Care Technician role,” Mr. Wagner said.

The submission letter nominating Mr. Velazquez detailed his exceptional attributes: He exemplifies the success of the ICT Program. He is highly respected by his co-workers and patients and recognized as an excellent ICT mentor in San Juan, Puerto Rico. His military experience with difficult and unusual clinical scenarios has proven invaluable to VACHS.

In times of emergency, VACHS is designated to receive victims evacuated from the U.S. Virgin Islands. During the acute period of Hurricane Maria, Mr. Velazquez led other ICTs as they worked extended shifts and overtime hours to support the emergency department. For close to two weeks following the hurricane, he worked long hours coordinating and leading the Patient Reception Team, which includes ICTs and other team members who may not have medevac experience.

In this role, Mr. Velazquez oversaw the reception and transfer of more than 90 people to local hospitals within the San Juan metropolitan area. In the aftermath of the hurricane, he continues to play a leadership role within the department and is constantly looking for ways to contribute to the care of Veterans.

Across the VHA health care system, thousands of Veterans benefit every day from the ICT program. ICT employees, who are military-trained Medics and Corpsmen serving as clinicians, deliver health care services to their Veteran comrades at 25 VHA medical facilities across the country. ICTs often work in emergency departments and can be found in multiple clinical settings where their special skills and training are beneficial. These clinical areas include mental health, geriatrics, primary care, and surgical services.

The ICT program is a part of VA’s Transitioning Military Personnel initiative. The initiative serves as a pipeline for well- trained clinical staff who can be hired as VA medical professionals; it also creates a civilian career path for former Medics and Corpsmen to apply skills honed in the military to care for other Veterans.

The recognition and virtual award ceremony for the Expert Field Intermediate Care Technician of the Year is one of the many Veterans Month events coordinated by the VHA Office of Community Engagement this year.

For More Information:

CCI Innovations

National PTSD Awareness Month Spotlight: Service Dogs

VHA expands veterinary benefits for eligible Veterans with chronic mobility limitations associated with a mental health condition.

A doctor discussing treatment options with a patient
A service dog on the job.

It’s not just physical conditions that can impair a person’s mobility. Mental health conditions can also make it difficult to fulfil the essential activities of daily living, such as running errands and getting to appointments.

The U.S. Department of Veterans Affairs (VA) has expanded the veterinary health benefit through the Mental Health Mobility Service Dog Initiative. This initiative authorizes the veterinary health benefit for service dogs of Veterans with chronic mobility limitations associated with a mental health condition. This effort is a joint collaboration between the VA Offices of Mental Health Services and Prosthetic and Sensory Aids Service, coordinated by the Center for Compassionate Care Innovation (CCI).

VA does not provide service dogs. Rather, VA refers Veterans to accredited service dog organizations. VA provides the veterinary health insurance benefit to eligible Veterans with service dogs obtained from organizations accredited by either Assistance Dogs International or the International Guide Dog Federation. Service dogs undergo years of training to be able to perform specific tasks, whether they are guiding someone with anxiety and posttraumatic stress disorder (PTSD) through a crowded subway platform or interrupting someone experiencing a panic attack.

The VA benefit offers comprehensive veterinary insurance coverage for the service dog to ensure it is healthy and able to perform its duties. Coverage includes annual visits for preventative care, dental cleanings, urgent/emergent care and prescription medications. The benefit does not include grooming, boarding or other routine expenses.

CCI created a comprehensive information sheet for Veterans who may be candidates for the expanded veterinary health benefit under the Mental Health Mobility Service Dog Initiative.

For more information and to learn how to apply, please download the information sheet.

Posted June 22, 2018

Mental Health Awareness Month: Suicide Prevention through Engagement

Breaking Down Barriers to Treatment Options May Engage Veterans and the Community

The rate of suicide among Veterans is a concern and a top priority clinical priority for the Veterans Health Administration (VHA) that requires a focused, national approach to engage with all Veterans. There is a great need not only to address suicide among Veterans already getting care from VHA, but also to engage the broader Veteran population.

“There isn’t one way to deal with [suicide], or even one way to think about it. What we need to do is look at the groups of people at risk of suicide and develop different strategies for different groups,” said Dr. Harold Kudler, Acting Assistant Deputy Under Secretary for Health for Patient Care Services.

Some of the health factors that contribute to suicide risk include major depression, alcohol or drug use disorders, chronic illness, posttraumatic stress disorder (PTSD), and chronic pain—associated with long term use of opioids and other medications that can be habit-forming. Many Veterans are diagnosed with a combination of these health concerns.

VHA has studied these conditions for nearly 100 years and is the leading expert in the field, Dr. Kudler said. However, there remains a lot of work to be done to understand these conditions and how they relate to suicide risk. That creates a challenge for Veterans and their healthcare providers who must balance waiting for scientific research to validate new treatments with finding solutions to improve health and well-being now.

Engaging Veterans Through Care Expansion

One avenue along which VA engages Veterans experiencing these conditions is the Center for Compassionate Care Innovation (CCI). This Center is designed to collaborate with VA and non-VA hospitals and clinics to offer emerging therapies using small scale clinical demonstration projects as a response to Veterans’ requests for alternatives for difficult-to-treat health concerns including PTSD, traumatic brain injury, and chronic pain. Through these clinical demonstrations, the VHA provides care access and options for Veterans who want to explore emerging treatments for which research is ongoing in the wider scientific community, particularly after evidence-based treatments have not met desired therapeutic outcomes.

“CCI stands for partnering with Veterans,” Dr. Kudler said. “It’s breaking down barriers and helping form the kinds of alliances that cross old boundaries that [VHA] didn’t used to cross very easily. I think that’s truly valuable.”

Other VA resources include VHA Office of Mental Health and Suicide Prevention’s Be There campaign to combat Veteran suicide, which offers online education and a 24/7 hotline for Veterans, their loved ones, and community members who may be concerned about a Veteran. The online educational resources also may help community members who simply want to know more about Veterans and suicide.

Veterans share their stories of recovery to help others who are facing similar challenges in the Make the Connection outreach campaign developed by the Office of Mental Health and Suicide Prevention. These stories may help family members and friends better understand the experiences of Veterans, as well, and potentially assist loved ones to identify warning signs of a mental health crisis or even a possible suicide attempt.  In some cases, there is time to intervene between symptoms of a mental health crisis and an attempt. 

“People who commit suicide often practice a lot, even if it’s just through mental rehearsal,” said Dr. Jamie Davis, Health Systems Specialist at VHA CCI.

Engaging the Community

Engaging with the larger community about Veterans and their individual health concerns is imperative for suicide prevention initiatives, according to Dr. Kudler. Only 20 percent of health care providers outside of VHA ask patients if they are a Veteran, according to a recent study by the Rand Corporation of providers in New York State. According to the report, 2.3 percent of those providers were able to provide clinically competent care that can address the needs of Veterans and active duty Service Members.

One way to address the needs of Veterans, family members, and providers is through education and outreach. The Psych Armor Institute, a military non-profit organization, offers S.A.V.E training. This training is a free 25-minute online course designed for community members to understand Veteran suicide risk, warning signs, and meaningful ways to help. This training was developed by VHA’s Office of Mental Health and Suicide Prevention. To ensure the community is engaged, if everyone who works with Veterans completes the training and asks one other person to take the training, the result will be broader awareness of risks and intervention techniques. Through this education, a family member or co-worker may feel empowered to talk with a Veteran about the Veteran’s experience of service and the issues they may be facing since coming home, identify risk factors, and encourage the Veteran to seek help.

“There is a need for us to mobilize as a nation to do this job well,” Dr. Kudler said.

Posted June 18, 2018

Magnetic Therapy Continues to Attract Interest

Posttraumatic stress disorder (PTSD) represents a significant health concern for millions of Veterans and their families and friends. The exact number of U.S. Veterans diagnosed with PTSD changes and varies by service era.1

As part of its mission to promote new treatment options for Veterans, the VA Center for Compassionate Care Innovation (CCI) supported the expanded use of Transcranial Magnetic Stimulation (TMS) treatment at the Providence VA Medical Center in Rhode Island.

A Veteran being treated with TMS by Dr. Noah Philip.
A Veteran being treated with TMS
by Dr. Noah Philip.

TMS treatments are approved by the U.S. Food and Drug Administration to treat depression. An electromagnet, essentially a wire wrapped around a solid coil, is charged with electricity and then placed over specific points on the skull. This creates a very powerful magnetic field that can positively affect brain cells. While TMS is typically used to treat depression, there is growing evidence that it can help Veterans with PTSD.

A major advantage of TMS therapy is that it is a noninvasive procedure and it does not involve surgery or sedation of any kind. Dr. Noah Philip, MD, Director of Psychiatric Neuromodulation at Providence VA, has been involved with the TMS treatments since they were first offered. He said that with the help of CCI, they were able to purchase a critical new component for the stimulator last year which allows them to reduce the time needed for treatments and gives them the ability to see more patients.

Numerous studies have stated that the positive effects of TMS can last well after the usual treatment phase of a few weeks. Side effects are generally minor and include: headache, tingling and lightheadedness immediately after treatment.2

“We can now deliver faster stimulation treatments and we are really happy with that,” Dr. Philip said. “Another real improvement is that the equipment is now much quieter, which can reduce the anxiety level of Veterans who are bothered by loud noises and increase their comfort level during the treatment.”

Since 2013, 150 patients have received TMS therapy at the Providence VA Medical Center and Dr. Philip is usually asked to evaluate new patients every week, including Veterans seeking treatment for PTSD. Dr. Philip attributes the increased interest in the therapy over the past year to communications outreach from the VA and through word-of-mouth conversations among Veterans.

“A Veteran will do the treatment, experience the positive results, and then they share how it has helped them with other Veterans,” Dr. Philip said. “We are also receiving requests from other VA facilities within the VISN who do not have their own TMS equipment.”

Ben Kennard is a VA technician and 20-year Veteran of the U.S. Army, who has been directly involved with the TMS treatments. “With the majority of the Veterans I have seen, TMS really works. Anybody that is suffering from depression should at least give it a try and see how it works for them. It gives us another treatment option, especially for those Veterans who have issues with taking medications.”

Kennard said that as a Veteran helping other Veterans, their shared experience can help reduce the anxiety some may feel starting an unfamiliar treatment. He said one patient from last year sticks in his memory because Kennard could tell he was very anxious about beginning the treatments.

“Initially he kept making jokes all the time and I think that was the anxiety showing through. After several treatments his demeanor completely changed and he was still joking, but it was because he was much happier,” Kennard said.

Dr. Philip said they are continuing to work on ways to improve their operations to meet the demand for PTSD treatments. “My hope is that we will be able to provide treatments that last 10 minutes, down from the 45 minutes it usually takes. It might even give us the capability to have an ‘open-door’ clinic, which would enable us to help many more Veterans who have busy work and life schedules. It is great to have an effective non-medication treatment to help Veterans, and I think we can do even better,” Dr. Philip said.

CCI is an entry point for safe and ethical innovations that may be successful in treating a subset of Veterans diagnosed with certain health conditions that have not responded to evidence-based therapies. CCI looks for new treatments, or novel approaches to existing therapies, that may improve Veterans’ health and well-being and, if effective, be adopted by VA.

Posted June 18, 2018 | Learn More:
For more information on the treatment of PTSD at the VA, visit https://www.ptsd.va.gov/index.asp
Link to this article on VAntage Point: https://www.blogs.va.gov/VAntage/49058/veterans-ptsd-treated-transcranial-magnetic-stimulation/

References

  1. Wisco et. al. Posttraumatic Stress Disorder in the US Veteran Population: Results from the National Health and Resilience in Veterans Study. J Clin Psychiatry 2014;75(12):1338-1346
  2.  Philip NS, Barredo J, Frank M, Tyrka AR, Price LH and Carpenter LL. Network Mechanisms of Clinical Response to Transcranial Magnetic Stimulation in Posttraumatic Stress Disorder and Major Depressive Disorder. 2018 Feb 1;83(3):263-272

National PTSD Awareness Month Spotlight: Stellate Ganglion Block, A New Treatment Option for Veterans Diagnosed with PTSD

Could an outpatient procedure for pain relief help treat anxiety and other symptoms of posttraumatic stress disorder (PTSD) for Veterans?

The VHA Center for Compassionate Care Innovation (CCI) is leading a clinical demonstration effort with the VA Long Beach Healthcare System to offer stellate ganglion block (SGB) — a widely used therapy to treat complex pain syndromes affecting the head, face, neck or arms — to a specific set of patients with severe symptoms of PTSD, such as anxiety and hypervigilance.

A doctor discussing treatment options with a patient
A doctor discussing treatment options with
a patient.

To support the clinical demonstration, CCI has created an informational video and patient information sheet, and is raising awareness that the treatment is now available to Veterans in Southern California who meet the indications for treatment. So far more than 20 Veterans have been treated at the facility.

Although data varies, VA research and other studies estimate that between 10 and 30 percent of Veterans experience PTSD now or will experience it during their lifetime.

Long Beach VA Veterans receiving SGB for other health conditions report positive effects on their PTSD symptoms that last several weeks or longer.

Dr. Michael Alkire, Chief of Anesthesiology at VA Long Beach, said he hopes SGB may lessen symptoms such as hyperarousal long enough to allow Veterans to return to traditional PTSD therapies like talk therapy. The men and women who receive SGB through the support of the clinical demonstration have all tried first line treatments but have not found significant relief for their PTSD symptoms.

“If we can use this procedure to provide a month’s worth of relief for some patients, it may clear the way for further improvements using existing evidence-based PTSD therapies that previously didn’t work as well,” said Dr. Alkire

Blocking Pain Signals

During the SGB procedure, a health care provider injects a local anesthetic into a bundle of nerves located at the base of the neck. Although the exact way SGB works for PTSD is not yet known, it is thought that this temporarily “blocks” pain signals from the body to the brain and may reset the “fight or flight” response that can become over reactive in people living with PTSD. SGB is safe when given by a trained provider.

Dr. Christopher Reist, Associate Chief of Staff for Research and a staff psychiatrist at the Long Beach VA, noted that SGB has the potential to add to the range of emerging PTSD therapies, which include new medicines, acupuncture, mindfulness and other approaches.

“SGB could be a motivation for Veterans to reach out to us for help,” Reist said. He appreciated CCI for supporting VHA’s efforts to offer innovative treatments to Veterans living with chronic conditions such as PTSD.

VA established CCI to be an entry point for safe and ethical innovations that may be successful in treating a subset of the Veteran population diagnosed with certain health conditions that have not responded to evidence-based therapies. CCI focuses on these and other health concerns that may be resistant to standard treatments such as thoughts of suicide, traumatic brain injury, PTSD and chronic pain.

Posted June 18, 2018 | Learn More:

Request for Information (RFI) On Health Innovations for Suicide Prevention

Please Note: This RFI closed on June 18, 2018. CCI is no longer accepting submissions for this RFI.

The Center for Compassionate Care Innovation (CCI) wants to hear from internal and external stakeholders about treatments focused on reducing the risk and/or incidence of suicide, as well as reducing risk factors significantly correlated with suicide such as chronic pain, depression, and substance abuse. 

Today, May 21, 2018, The Department of Veterans Affairs (VA) Veterans Health Administration (VHA) released a Request for Information (RFI) on FedBizOps. The RFI will be open until June 18, 2018 for anyone to respond to including Veterans, professionals in academia, private sector health care stakeholders, and internal VA healthcare innovators. CCI welcomes any and all responses about innovations; treatments that may already be available within VA but are not available broadly, or may not currently be available in VA. VHA and CCI will use this information to gain a better understanding of emerging therapies in the healthcare industry that support VA priorities, such as reducing the number of Veteran suicides. 

Visit FedBizOps before June 18, 2018 to share your innovation with CCI and support Veterans and VA!

Posted May 15, 2018 | Learn More at
Link to RFI on FedBizOps: https://www.fbo.gov/spg/VA/ISC/OISC/36C77618Q9148/listing.html

VA Exploring Alternative Treatments for TBI and PTSD

CCI has made two innovative treatments available to Veterans diagnosed with posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI). Providers at VA’s Long Beach Healthcare System have begun using stellate ganglion block (SGB) to treat Veterans with PTSD symptoms. SGB is an established outpatient treatment for complex pain and may ease PTSD symptoms, such as feelings of anxiety and constantly being on alert. The VA Boston Healthcare System, Jamaica Plain campus, has begun using light emitting diode (LED) therapy to treat Veterans diagnosed with TBI. The LED therapy is available for use in the home, which makes it more convenient for Veterans participating in the therapy.

Posted Dec. 7, 2017 | Learn more at
https://www.va.gov/opa/pressrel/pressrelease.cfm? id=3986

VA to Provide Hyperbaric Oxygen Therapy to Some Veterans with Chronic PTSD

CCI has facilitated the use of hyperbaric oxygen therapy (HBOT) to treat a small number of Veterans diagnosed with posttraumatic stress disorder (PTSD) who have not responded optimally to at least two evidence-based therapies. HBOT is a procedure that increases oxygen in the body, under pressure, to encourage healing. Providers from the Eastern Oklahoma VA Health Care System and the VA Northern California Health Care System will partner with HBOT providers at the Tulsa Wound Care and Hyperbaric Center at Oklahoma State Medical Center in Tulsa, Oklahoma, and the David Grant Medical Center on Travis Air Force Base, California, respectively, to provide this care. 

Posted Nov. 29, 2017 | Learn more at
https://www.va.gov/opa/pressrel/pressrelease.cfm?id=3978