Veterans Affairs Committee on April 1st, 2008

[The Chair, Conservative, Rob Anders]

Good afternoon, ladies and gentlemen. This is yet another meeting of our committee on veterans affairs.

Mr. Stoffer wants to be recognized, and I am eyeing him with trepidation and wondering what he's up to.

Mr. Stoffer.

[Peter Stoffer, NDP, Sackville—Eastern Shore, NS]

This is a quick point of order to thank Todd Russell and the great people of Labrador and Newfoundland. Happy birthday to them. We thank them for allowing us into their province 59 years ago on April 1.

[The Chair, Conservative, Rob Anders]

Well, there you go. That's good to know.

Just so our witnesses know how this whole show works, we are into the study of our veterans health care review and veterans independence program. Our witness, Helen Gough, is an occupational therapist and military spouse.

On the way it generally works, you get 20 minutes. You can mix and match that--you can do 15 and your husband can do five--or you can hog all the time and just have him there for moral support. That's perfectly fine.

Then we will open it up to questions. It's all predetermined and pre-ordained stuff that we bargained about early in the term. The question time goes to the various parties for seven or five minutes, depending on the round. I'll announce when their time comes up.

So the floor is yours.

[Helen Gough, Occupational Therapist and military spouse, As an Individual]

Good afternoon. My name is Helen Gough and I would like to thank you for allowing me to be a witness here today.

I'm speaking today first as a military spouse and secondly as an occupational therapist. My opinions don't reflect those of the Canadian Association of Occupational Therapists, DND, the Canadian Forces, or Veterans Affairs. I'll be speaking for approximately 10 to 15 minutes, and hopefully your questions will reflect my statements today.

I will share with you, based on the experience I have acquired through my personal and professional involvement with these organizations, a few recommendations to improve the services provided to veterans.

I commend the efforts of this committee. In particular, I'd like to thank Ron Cannan for his support of veterans, particularly in the Okanagan region.

The work of this committee and the final report and recommendations will be important to military families. It's important for Veterans Affairs services to reflect the reality of the various stages veterans find themselves in. By reviewing the veterans independence program and the health care concerns of veterans young and old, the standing committee identifies the importance of operating within the culture of the Canadian Forces.

Understanding the CF culture is the key to successful integration of health care services and is an excellent way to appreciate the unique health care issues of veterans and their families. Canadian Forces culture encompasses—and health care professionals should understand—living and working in a military environment, typical mental and physical injuries sustained by veterans, posting experiences, the chain of command and unit cohesion, and Veterans Affairs programs and criteria, just to name a few.

As Veterans Affairs probably has already identified, the term “veteran” includes various different types of Canadian Forces members. I conceptualize four branches under the broad term “veteran”: first, the regular or reserve Canadian Forces veteran who has served Canada overseas, such as my wonderful husband here; second, veterans releasing or retiring; third, veterans medically releasing due to physical or mental issues; and the last branch is dedicated to our senior veterans, the ones I serve on a daily basis.

Each of these four veteran types requires unique services from Veterans Affairs and the Canadian Forces. Each veteran type has an organizational culture, climate, value, and ethos. They also have diverse stressors on their health that require sensitive and specific programs. The military family will respond best to approaches that reflect the current situation of veterans. I believe there are tangible methods to this.

Although each type of veteran has individual needs, one component remains consistent. All these veterans are moving away or have moved away from Canadian Forces services. Whether the move is due to a CF posting—which I've done now coming on to four times—a medical release, or a voluntary retirement, each relocation to a new area away from familiar resources provides unique challenges. Creating a clear bridge between the Canadian Forces, Veterans Affairs, and community health programs means veterans and their families can have access to consistent health care professionals who are knowledgeable of the Canadian Forces culture and their specific family situation.

There are currently a number of innovative and well-delivered programs offered to veterans and their families. It's obvious that Veterans Affairs has listened to the recommendations provided by military families, military members, and researchers. Veterans Affairs and the Canadian Forces should be proud of their present host of active health care professionals and their efforts to promote well-researched, evidence-based services that are all client centred. Through my work with VAC, I can speak to numerous examples, as I work as an occupational therapist who assists the senior veterans to live in their homes as long and as independently as possible.

There lies, however, a gap of consistency of health care services between the Canadian Forces bases and those offered by VAC and the community health care sector. With a coordinated effort between the Canadian Forces bases, Veterans Affairs, and the community health care professionals, consistency of health care services can be found. Most of the recommendations, I suggest, have already been created. They just need to be connected.

I'd like to provide two examples of issues that are not being addressed as effectively as they could be.

The first relates to what normally comes to mind when you are addressing the reintegration of a soldier from a foreign posting. For a fictional example, let's take a sergeant who has returned from Afghanistan after sustaining a severe concussion and shoulder injury due to a roadside bomb that took the life of two of his younger troopers. Coming home, he went through rehabilitation under a team of health care professionals made up of enlisted and civilian medical personnel. His family has been receiving counselling and using the teen centre supports at the military family resource centre.

Due to periods of depression, chronic pain, and a desire to try something new, the sergeant and his family decided it would be best for him to medically release and relocate to a rural town in northern Manitoba, where his family lives.

The veteran leaves the military and relocates, taking his family with him. He continues to struggle with his health care issues, and he struggles to find work. Over time, his issues turn into anxiety; however, because he has not had a consistent mental health or physical health clinician screening at various times in his new location, the sergeant and his wife and family have little support.

Hypothetically speaking, if there were a military occupational therapist enlisted on the base, they would know of the impending release of the soldier and his family.

The military occupational therapist can take the first step to assist in the transition by searching out a community occupational therapist prior to the release. Providing there is no Veterans Affairs district office in that area, the community occupational therapist is contacted. An in-service and a Veterans Affairs service handbook are provided, and telephone conversations between the veteran and the occupational therapist begin in order to establish rapport, a technique shown to improve treatment outcomes. These three tools provide consistency and ensure competency of health care.

A releasing treatment plan can also be created between the military occupational therapist and the community occupational therapist. Any resources the sergeant and his family were using on the base are documented, and the community occupational therapist attempts to seek out similar resources prior to the relocation to ensure that there is little lag in services.

The occupational therapist could then arrange an initial meeting with the family in their home, screening for additional needs. The occupational therapist is looking specifically at his various chronic mental and physical limitations and seeing how they are impacting on his ability to obtain a job, to re-engage in his role as a husband and a father, and to manage the routine of personal hygiene and house management, such as paying bills—all these little things that we take for granted. The OT will also make sure he is engaging in recreational activities.

Occupational therapy treatments are targeted at the barriers to his successfully engaging in those types of occupations. These screenings can be done periodically in his new location. Outcome measures could be used to ensure success in the treatments offered.

These services—the community occupational therapist's—are already being offered to individuals in the public. There needs, however, to be an individual who links the community occupational therapist and the Veterans Affairs occupational therapist with the family, prior to their leaving the base. l feel this can be done successfully by Veterans Affairs and the Canadian Forces.

For my second example, l will deal with the less-apparent need for consistent support in the physical and mental well-being of soldiers, particularly as they move away from the Canadian Forces resources and deal with the day-to-day issues of military life. This is my life, actually.

The challenges, both adventurous and stressful, include postings, ongoing back-to-back training, and operational tours over relatively short periods of time, as my family has done for almost 10 years with this gentleman here. Add to this the stress of normal family life, such as typical teenage issues, impacted by the need to engage in a new peer group due to postings and the results of frequent parental absences, as well as stressful reunions, caregiver burnout, and missed employment opportunities, as l have seen in my position as a social service worker.

On the Canadian Forces bases, continuous supports are available. They're excellent. The close connection of the military families, the military family resource services, and the military primary health care unit are very useful when needed.

Off base is another matter. Military families are isolated from this support and unsure of what resources to turn to. This is particularly important when there are overseas assignments or absences for training periods. The lack of a consistent, military-focused outreach person, a person who understands what the family is going through, adds to the challenges being faced.

Civilian professionals, as competent as they are, cannot really understand the typical concerns of the military spouse or the culture of the Canadian Forces in general. Oftentimes, recommended courses of action are not practical or realistic in a military context. For example, before my husband came back to Canada, he had pre-arranged counselling while on decompression leave in Cyprus to assist with his hyper-vigilance and my anxiety over reintegration, and to assist with repairing our relationship due to the long periods of separation we have experienced over the past five years. This counsellor was well advised in trauma relief, and also gave us strategies for reintegration. However, my husband and I spent so much time explaining our current situation and the culture of the Canadian Forces, I sometimes wonder if I ended up developing a better sense of the Canadian Forces than of our marriage and our relationship.

What would have been helpful for our family, and for others in a similar situation, is having one primary health clinician stationed and embedded within the Canadian Forces to connect us to a health professional in the community that we were relocating to. This clinician could have kept tabs on our family as we moved through the various stages of relocation and reintegration. As health problems crop up, we are much more likely to seek out a clinician with whom we have built up a rapport and who understands the situation. I'm sure that other Canadian Forces families who are frequently moving, or are being released from the military, might say the same thing.

I believe that occupational therapists, placed strategically within Canadian Forces bases, could assist with this situation. I feel that OTs can provide a link between the Canadian Forces, Veterans Affairs, and the public health sector. I believe that whether they are being medically released as soldiers or retiring veterans, or are being posted away from garrison, all military personnel and their families should have this. Occupational therapists can be one small piece of the puzzle to assist in bridging this gap, as they are able to successfully screen for and treat both the physical and mental health issues that affect soldiers in their everyday life—and they can refer as appropriate.

This is nothing new. There are examples of various organizations in Canada and other countries that recognize and value the role of occupational therapists among veterans. These examples move away from the typical, more traditional view of what occupational therapists do in Veterans Affairs, such as what I provide for senior veterans.

For example, the United States Army has military occupational therapists. These occupational therapists have established a strong mission and vision and have a deployable role overseas—including in Iraq—as members of combat stress teams. On garrison, these military occupational therapists provide mental and physical rehabilitation.

In the United Kingdom, occupational therapists are key players in acute trauma wards, doing discharge planning at the Royal Centre for Defence Medicine for wounded service personnel. The occupational therapists are actually currently advocating for the enlistment of a military occupational therapist, as they recognize the need for occupational therapists to understand the culture of that population.

In Montreal, the National Centre for Operational Stress Injury employs an occupational therapist who is committed to developing the front-line role of OTs within the operational stress injury clinic. As you know, the clinic services releasing military members and regular and reserve veterans.

In the Okanagan, there currently is an occupational therapist on the VAC rehabilitation team, providing consultations, alongside other health professionals, on appropriate services for injured veterans.

Also, the Canadian Association of Occupational Therapists has plans to initiate conversations with the Department of National Defence to conduct a needs assessment on a Canadian Forces base and, hopefully, within the military family resource centres, which you had represented here a number of weeks ago.

In your report to Parliament, l would like to ask you to consider the following recommendations.

The first is that Veterans Affairs Canada create a clear link between the Canadian Forces and the Canadian health sector by assisting those veterans leaving supports from the Canadian Forces base and relocating to the community.

One way this can be done is by creating a comprehensive service handbook for employees, health care professionals working with or for Veterans Affairs, and medical supply stores, physicians, and pharmacists who service senior veterans not yet connected to the VIP program.

The second recommendation would be that Veterans Affairs recognize the diverse skills of occupational therapists in assisting various types of veterans suffering from mental and physical limitations who are relocating to the community, and appoint one person to identify a community occupational therapist prior to the relocation of any veteran being released.

These two recommendations, which could deliver cost savings over the utilization of a third party resource—as much as I hate to say that since I am a third party resource—are already in place. The information and the key players simply need to be coordinated.

These recommendations will respond to the needs of Canadian veterans and their families, as noted by the prime directive of Veterans Affairs.

The recommendations will also provide veterans with familiar, consistent, and culturally sensitive mental and physical health clinicians and build a clear bridge between the CF and VAC programs.

The creation of the handbook itself would provide health care professionals with a well-established consistent message of programs available through VAC, and provide the clinicians with evidence-based treatment lists specific to each health profession.

Again, l would like to remind the committee that l speak to all of this as an independent military spouse and occupational therapist. It's an honour to speak with you today.

Thank you for your attention.

My hope is that l am able to provide the committee with meaningful and tangible strategies to assist with the development of a program that l use in my daily professional life and that l will personally use in the future.

Thank you. I will be pleased to respond to any of your questions.

[The Chair, Conservative, Rob Anders]

Thank you very much.

Now we go first to the official opposition, which is the Liberal Party of Canada.

Mr. Valley has seven minutes.

[Roger Valley, Liberal, Kenora, ON]

Thank you very much, Mr. Chair.

Thank you very much for that presentation. Thank you for your service. Thank you to your husband for his service. Quite often we have witnesses come before us whom someone intimidated. It's clear that's not the case with you. You're very passionate about what you do, and you made an excellent presentation, so thank you for that.

I normally ask questions about remote ridings and remote areas. You touched on one in your examples, and I'll get to that in a minute. There was a very interesting article in the Edmonton Journal by a lady who has presented here before. I'm not sure if it was in person or over the phone, but it was by Norah Keating. She talked a lot about the issues that the family has to deal with.

Can you just give us some kind of insight? We know that often those who come back have traumatic injuries. There are people who have lost limbs, who have lost the use of parts of their body. This is not just starting; we've been aware of the impact on the families for quite a while. In your profession, how do you deal with some of the stresses, which we can't even begin to think of, on the spouse, on the children, on the extended family, first of all in areas that have services, such as some of those you have mentioned, and then in areas that don't have services, such as northern Manitoba?

[Helen Gough]

Are you asking what you would do as an occupational therapist or if there are services available?

[Roger Valley, Liberal, Kenora, ON]

What would you do if you had a family that was in that situation? You're dealing with the service person. Whether of not he's discharged at this point yet is immaterial. How do you deal with the extended problems, past those of the individual who was injured?

[Helen Gough]

As an occupational therapist, if you're providing an in-service to them and they have the cultural background, which is the service handbook, they would be able to go and they would have an understanding of what programs they would be able to refer to. Occupational therapists have regions that are already established, as you know. So the family, along with the veteran, would become the clients. That's how I see it. So they would be on the roster of this community occupational therapist. They would be on the roster even before they get there. The barrier would be gone because they would be on the roster.

[Roger Valley, Liberal, Kenora, ON]

Is it automatic that the family is part of that whole system?

[Helen Gough]

I'm hoping it will be, because I think that's an extension of what a soldier is when he goes. An occupational therapist looks at the roles that are lacking, that are not being met day to day because of an operational stress injury. So when you do an assessment from an occupational therapist's standpoint, you're actually looking at roles that aren't developing, and obviously one of the roles of the soldier is to be a husband, or a spouse, or a father, so you're going to help them get back into those routines.

It's all about routines when they get back and they're isolated. That's what an occupational therapist will do. So if you're looking at a role that involves being a father, you're going to be looking at the children; you're going to be looking at the spouse. I definitely feel that occupational therapists need to look at more than just the individual himself; it's a family unit.

[Roger Valley, Liberal, Kenora, ON]

I want to go to your example of northern Manitoba. My riding is Kenora in northern Ontario. It's very similar, with a lot of the issues of remote sites. I want to again thank you for your recommendations, because too often we don't get clear direction from our witnesses. You were excellent in making your recommendations.

You mentioned northern Manitoba and somebody who has taken medical discharge—and correct me when I go off the track here. They moved for a job closer to family. Because they're at a remote site, there may not be anybody there, but an occupational therapist is going to call them because they're aware of the situation. You mentioned that anxiety builds--it could be job-related, family, who knows what.

How do you react? We deal with veterans all the time and some of the people you mentioned. You deal with the elderly. All those issues are there, and anxiety and all these problems are mounting. You're on the phone, and because of the remote location you could be hundreds of miles away. When somebody already has a problem, as you mentioned, how do you make it work?

[Helen Gough]

Regarding my vision of how this would work, it would be preplanned before they moved. You know the release of the soldier is coming. There's somebody on the base who's already doing treatment. There's a wonderful health care team there already, and they have a treatment plan.

That treatment plan needs to be branched out into the community. It can't just lag behind for six months or a year; it needs to be preplanned before he leaves. Of course there will be additional stressors once they get there, but if a releasing treatment plan is coordinated between a military health care team and the occupational therapist in the community before they get to that location, ideally it will create fewer barriers for treatment and will be offered once they get there.

[Roger Valley, Liberal, Kenora, ON]

Thank you for that vision. Things may work well in an urban setting, but when we get to the small, isolated communities of 5,000, and the fly-in locations with 1,000 or 250, we hope your vision can be broadened to reach everyone who needs that service.

[Helen Gough]

Absolutely.

[Roger Valley, Liberal, Kenora, ON]

I think you said your field is the elderly veteran. As members of Parliament—and I've said this many times in this committee—we have trouble reaching out and knowing who our veterans are. You're talking about a system that starts when they're still in service. Are you able to track them all when they leave, or do you lose track of some of them when they go?

When somebody is released from service and they go to northern Ontario, for example, how successful are you at following them when they need help?

[Helen Gough]

I receive referrals. I can drive up to three and a half hours to see a veteran. This is for senior veterans who are living in the community.

I have a recommendation on that.

[Roger Valley, Liberal, Kenora, ON]

Please go ahead.

[Helen Gough]

It's that travel hours be included in the direct therapy time. I have about six hours to work with a veteran. Typically it isn't so bad if they're in a community that I live near. But rural veterans get less therapy time because my travel is included. Travel hours should be considered under a different allotment of therapy time to provide the same level of treatment. That might resolve a small part of it with regard to some of the rural senior veterans.

There are some younger veterans in northern B.C. They tend to cluster up there, so I hear, maybe isolating themselves a little because of some of the OSI issues they're dealing with. I'm very passionate about that area and would definitely like to see something developed. I would be more than excited to be a travelling OT and pick up these veterans living in remote areas.

As an occupational therapist, I have some different skills that other OTs could learn as well, like frequency capacity evaluations that can be done to help them get onto....

I'm sorry, I think I'm going through your time here.

[The Chair, Conservative, Rob Anders]

You can go on as you wish. You're our guest. I'm clearly indicating to Mr. Valley that his time is up.

[Helen Gough]

Okay.

A lot of them have pain management issues, and there are certain programs that can be built up. I would love to see one, three, or maybe ten OTs--the more the better--who can go out there and target the new guys being released.

[Roger Valley, Liberal, Kenora, ON]

How do we get you to northern Ontario? You don't have to answer that.

[The Chair, Conservative, Rob Anders]

I'm sure she'd be happy to answer it in the next round.

Thank you very much.

It is now the Bloc Québécois' turn. Mr. Perron, you have seven minutes.

[Gilles-A. Perron, Bloc, Rivière-des-Mille-Îles, QC]

Good afternoon, Madam. Thank you for your presentation. However, I believe that your presentation—and correct if I'm wrong—represented nothing less than an ideal. Your work has certainly allowed you to realize that civilians have the same needs as members of the Canadian Forces when they leave their jobs. How can we help our military personnel when we know that throughout this great country there is a huge shortage of professionals, be they physicians or members of your profession?

Please give me the answer.

[Helen Gough]

Wow. If I understand your question, you're asking why the military would be getting these services versus why....