Good afternoon. Thank you for inviting us today.
I am here to represent the medical centre side of the house. I'm a physiatrist, or a rehabilitation physician, at the Washington DC VA Medical Center. I will be talking briefly about some of our rehabilitation outreach efforts, our mental health services, and some of the transition services through the OEF/OIF/OND program.
To start with our rehabilitation system of care, following the onset of the wars in Afghanistan and Iraq, we started to see severely injured service members entering our system with severe traumatic brain injuries and multiple other injuries. The term “polytrauma” was coined to define these new, unique, complex patterns of injuries. Typically, with polytrauma, a service member has experienced a traumatic brain injury, which really drives or defines how the rehabilitation care is provided. Within our system, the VA is able to offer rehabilitative care for injured active duty service members through a memorandum of agreement with the Department of Defense. That has been in place since 1988. This was put in place specifically to provide traumatic brain injuries, spinal cord injury, and rehabilitation care for blinded service members.
That referral system was in place, and the system of care has matured as the conflicts have continued. It has now expanded to involve more outpatient care. The polytrauma system of care now includes over 100 specialized rehabilitation sites and teams across the country. The hallmark of our rehabilitation programs is that of an individualized, interdisciplinary plan of care for each veteran and active duty service member, and then to provide advanced rehab practices and equipment by linking specialized centres with centres and clinics throughout the country.
Our polytrauma system of care is a four-tiered system of care. The polytrauma rehab centres provide the acute in-patient rehabilitation care for the most seriously injured. We have polytrauma network sites at every one of the VA's regional organizations—our veterans integrated service networks—that provide both post-acute rehabilitation as well as outpatient rehabilitation. We have an additional 86 designated polytrauma support clinic teams that provide care throughout the system. This totals over 109 designated teams throughout the VA system of care. At every medical centre that does not have a fully designated team, there is an identified point of contact so that service members and veterans in need of care can be linked to the most appropriate and the closest area for care.
There is a map of the United States in my handout that shows all the locations for care. You can see this mirrors the population of the United States, so there is a higher concentration along with the higher density of population on the east coast.
We have a full continuum of specialized rehabilitation programs, including transitional rehab programs for those individuals who are independent with their activities of daily living but still need some assistance with wholly reintegrating back into the community. We have a defined emerging consciousness program for those individuals with severe traumatic brain injury who are either in a coma or vegetative state. We have a telehealth network that links all of our TBI teams across the country. We have an assisted technology program that provides specialized expertise that can assist in the rehab of severely injured individuals. We have driver's training programs. We have an entire amputation system of care that mirrors the polytrauma system of care. In addition, we have a blind rehab system of care. Finally, we have a mild TBI screening and evaluation program, which was put in place in April 2007.
Every service member who has left the Department of Defense with a separation date after September 11, 2001, is triggered for a traumatic brain injury screen and the electronic medical record. This is a four-question screen. If they answer yes to all of the questions, they are considered to have a possible traumatic brain injury, and then they are referred for a comprehensive in-person evaluation.
Since April 2007 we have screened more than 600,000 veterans. Approximately 20% will screen positive, and of those who complete an evaluation, about half will be diagnosed with having sustained a mild traumatic brain injury or a concussion. That equates to about 7.8% of the entire population that's screened. This is not a true epidemiologic study, but we have about 7.8% who wind up with a diagnosis of traumatic brain injury. Those who do receive a diagnosis are then referred to a team and receive an individualized interdisciplinary plan of care to meet their rehab needs.
Next I'd like to talk a bit about care management and our OEF/OIF/OND program. The goals of that program are to connect early with our newest veterans and to support reintegration into the home and community. As was mentioned before, this program tries to link individuals not only with VA services that are available but also with local resources in the community. They assist in identifying and addressing risk factors. Again, in our electronic medical record there's automated screening that is put in place: questions regarding high-risk psychosocial issues; questions about post-traumatic stress disorder, depression, and alcohol abuse; traumatic brain injury screening, as I mentioned before; and all veterans are also screened for military sexual trauma.
This care management team helps with the transition from DOD to VA. The partnership began in August 2003 and is present at all medical centres across the system. In addition, the VA has 33 liaisons who are either social workers or nurses who are embedded at military treatment facilities across the country.
There is additional care management and coordination between the Department of Defense and the VA. The VA has a new caregiver support program looking at the needs of the caregivers and families of wounded and seriously injured veterans. This program provides education on the caregiver support program and the role of our caregiver support coordinators. They help to collaborate with military case managers to identify potentially eligible service members and caregivers and then assist them with the application process.
Now I'd like to briefly cover some of the VA's mental health services. You can see that this table shows some data from 2005 to 2011. The total number of users of VA health care has increased over time, and so has the percentage of that population accessing VA for care who have received specialized mental health services. In fiscal year 2011, 25% of service users received specialized mental health services in the VA care.
We have multiple programs to promote access to mental health care. Those programs with a special mental health focus include our inTransition program that's run in tandem with the Department of Defense. We have VA's national awareness mental health campaign, which is called Make the Connection. We have a suicide prevention national awareness campaign, and we have a post-traumatic stress disorder coach mobile application that's available for Apple and Android phones. In addition, we have extensive automatic screening for various mental health issues: PTSD, depression, problems with alcohol use, and military sexual trauma.
There are multiple areas of specialty mental health services within the VA, including specialty outpatient clinics for PTSD care teams and substance use disorder teams. The VA has multiple residential rehabilitation treatment programs to help that population that has extensive comorbid diagnoses that expand across the mental health spectrum. We also have in-patient mental health care for those who are at risk to themselves or to others, and the hallmark of that care includes interdisciplinary team care as well.
Mental health is integrated at various sites throughout the VA. The most important is probably at the level of the primary care team, with primary care and behavioural health embedded within our patient-aligned care teams.
Within the rehabilitation spectrum of care, there are mental health professionals embedded on the polytrauma units, on our spinal cord injury units, and in our blindness rehabilitation centres of care.
This concludes my prepared remarks. I think we'll all be happy to move to questions right now.