Evidence of meeting #18 for Veterans Affairs in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was way.
Liberal
Bob Bratina Liberal Hamilton East—Stoney Creek, ON
Could I ask you, in terms of your own service—and I'm not looking for the particular incidents that would create problems for you—for an overview of the nine years you served?
Liberal
Bob Bratina Liberal Hamilton East—Stoney Creek, ON
Nine and a half. Where were you, and what sort of things did you do in that time?
As an Individual
Pretty much all of my work was done either in a training capacity, a command capacity, or a logistical capacity here in Canada. I never made it overseas. I never ended up on a deployment.
Liberal
Bob Bratina Liberal Hamilton East—Stoney Creek, ON
The point is that incidents will occur, whether you're deployed in different places, through the training process and so on. It's a rigorous program.
As an Individual
That is correct, as is the nature of our training and the nature of our exercises where we apply our training, learn what's working and what isn't, check our training, and get better at it. Even that, because of the nature of military service, is an incredible dangerous undertaking. That's why, for medics, when we deploy in support of training exercises, we're on there testing our own skills and the basic things that we need to know, and we're also there doing real-time medical support. When bad things happen it's the medics who are dealing with it. It goes beyond our training.
Liberal
Alaina Lockhart Liberal Fundy Royal, NB
I have a few questions for Ms. Northey.
I wanted to talk to you a little about outcomes, because we have talked about those, and I'm sure you've read that the ombudsman has talked about those as well. What are your views on what the outcomes should look like for our veterans? I know we all have an opinion, but I'd like to hear what your perspective is on that.
As an Individual
I just drew a graph. There are two aspects, I think, in the outcomes. The first aspect is that when a client signs up for any program or service, what has to be asked is “What are your expectations as a client of this program?” The second aspect that has to be clear is “What is the purpose of this program?” The client signs up based upon that. For example, if it's to get a job, “Am I getting a job?” If it's to become stable or to have a greater family reconnection, then in the end, the outcome, should be establishing not if they have completed the program, which is an output, but rather whether the purpose of the program has aligned with the outcome. When you look at an outcome, if you're talking about veteran-centric programming, a true outcome has to look at the client's perspective right from the beginning.
I did an exercise with a lot of organizations, and I said let's assess your mission statements, which in the charity field is critical, because it tells what exactly the purpose of your organization is. I will tell you that at least 50% of those organizations were not aligned with what people thought, and it was an eye-opener. If you look at some of the veterans who are coming in with PTSD, with anxiety, or with any other form of depression, then you have to be clear on what the purpose of that program is. It's the outcome, the end result, that measures that purpose. If there's an alignment, you've reduced anxiety. It's like an experience I had at the Mayo Clinic. They told me what that outcome was going to be, and it reduced my anxiety.
An outcome is not based on number of programs served, it's not based upon the number of people who have completed the program, and it's not based on the number of people enrolled in the program. Those are all good, by the way, and that's not to say that these are bad measures, but at the end of the day, if you're going to a doctor, what is your outcome? You hope to be cured, and you hope to have some way to manage your future. If the doctor just says, “Well, thanks for coming out”, and if you haven't been given me any solutions, then how are you going to feel? That's typical of a lot of the service organizations across Canada, and it's not just with veterans and DND. Unfortunately, it's widespread.
Liberal
Alaina Lockhart Liberal Fundy Royal, NB
I think that's one of the things that cause frustration for veterans and also cause stress for those working for the department, case managers. We've kind of built this house and then put all these additions on it, but they don't necessarily have doors to get from one addition to the other or windows looking out.
The veterans aren't the only ones who are frustrated, and they're frustrated because sometimes their case manager can't get them through the whole house. I'm just using that as an analogy. Then we see burnout in the staff as well and less impact there.
I want to go back. You talked about this idea of having a purpose as being very meaningful, and I wanted to relay an anecdote about a conversation I had recently with someone who does therapy. They were telling me that they had tried a pilot project in which they had a group of veterans who volunteered with some World War II vets. By having a program with that objective, and I don't know that they have the numbers to prove this yet, but at least anecdotally, veterans who had been suffering with extreme PTSD, after just three months of being in a program from which there were outcomes and through which they had a purpose, saw that reduced to mild and they were functional.
It doesn't always have to be a huge complicated program. It can be as simple as, as you said, setting the outcomes, having a purpose and then having sine leadership to guide you through that such that you're confident that what's being done and managed is for you. I think those are just great points that have come from your testimony and some of the other things we've heard recently, so thank you.
Conservative
Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK
Thank you, Mr. Argue, for coming. I'm very appreciative that you came up to talk to us.
One person once said to me, never say sorry if you've done nothing wrong. I want to say that to you. Never say sorry if you've done nothing wrong, and you've done nothing wrong. I appreciate your being here.
I am wondering if you could tell me a little bit more, if you don't mind, and should anything I say at any point in time...just give me that sign and I'll move to something else.
You talked about your knee injuries. I'm just wondering if you could expand on that a little bit for me.
As an Individual
I have one knee that 25% of my cartilage was removed from in 1989. The other knee was run over by an MLVW. The rear tire hit it. Also, Veterans Affairs sent me for one of those psychological reassessments. I've been sent for two. At the second one, the psychologist told me that I don't have PTSD but I have really bad anxiety because I'm frustrated that I can't do what I used to be able to do. I can't go out that much.
Veterans Affairs bought me a scooter so I can get out with it. But because of the health conditions I have, I'm just trying to do what I can do. I'm just trying to tell people that they're going to get frustrated at times. They're going to get angry. Yes, I do swear like a sailor. I admit that. But at the same time, I'm just trying to inspire other people because I feel....
When I did talk radio, I did it at co-op radio, it was just down in East Hastings, the poorest postal code in Canada. I used to walk down that street and I'd see people shooting up. I'd see some of the most talented people in the world. They were on the streets. Everyone has a story to share. I saw Canada crumbling right there because we weren't there to help out the people. I've seen the same thing within the veteran community. There's so much that needs to be done. There are so many talented people. They're just looking for an outlet. They're looking for something to bring them out. I'm just trying to inspire people.
I also wanted to add that I've gone through about seven or eight caseworkers because of moving. I've dealt with the Vancouver office and the Hamilton office and now the Toronto office. The way I was treated in the Hamilton office, I felt was probably one of the most appalling ways you could ever treat anyone who served in the Canadian military. What happened? I don't wish to get into it, but I do hope it's changed because an awful lot of us veterans have been treated pretty badly there.
The Toronto office has made up for it. Basically I am very grateful for the caseworker that I was working with, Sonya Wakefield. At the same time, I realize I'm no longer working with a caseworker because I'm on PIA.
Conservative
Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK
Thank you.
You mentioned places to share your stories and for people to come together and do that. I've talked with a number of people around the table about the issues of.... When we talked about our World War I, World War II, and Korean War vets, often they had the Legion where they had a chance to share those stories. We don't see that as much today. Whether it's a result of technology or not—there will always be debate as whether that's right or wrong—we're not seeing that. Can you expand on what you think might be of some value?
As an Individual
There are different groups out there. There is Veterans Voices of Canada run by Al Cameron. He does interviews with World War II and Korean War veterans. I'm doing the occasional interviews at a local Legion branch here. I've done interviews with Mike Holmes, Enrico Colantoni, and Rory Sinclair, the president of the St. Andrew's Society. I'm hoping to get the consul general from Italy to come out.
I also did an interview in the past with a World War II veteran who was a photographer. He worked for the RECCE part of the Royal Canadian Air Force. He took a picture one time of Winston Churchill. Jack Ford was his name. The story he shared was that Winston Churchill lands on the airfield and has a cigar in his mouth and is scowling at everything. The moment that Jack brings the camera up to take a picture, Winston Churchill brings his cigar down and he's smiling. To me those stories need to be shared right now.
If the Legion or Veterans Affairs could create that, it could even be a web porthole, where people could come and describe what they did in the military and what they have lived through. It could be used as an outlet for veterans to start reconnecting with old friends and, at the same, to show them that they're not alone and help them battle through any mental health issues they may be dealing with. Most importantly, it could show people that they have succeeded. Everyone who has served in the military has succeeded.
Conservative
Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK
They have. It's so true. We see that with our Canadian Olympic team and with other things in Canada where everyone signs a flag or we do these things. I think what I'm hearing you suggest is something that I'd call a “living wall”. We have memorials and why not have a living wall where people can post that information as you suggest. People are inclined to do that. It would provide different opportunities, whether it's in written or technological form, such as Twitter, etc. That's a great idea. Thank you very much.
Mr. Callaghan, many of the questions I had for you have been answered by other people, but I have one last question. You talked about filling out forms with doctors. I hate to tell you that I am a doctor, and so I know the answer to this question already. Who pays for those forms?
As an Individual
It depends on what form it is. There are some forms where there is confusion even with the doctors about whether they are able to bill VAC. With the SISIP forms, are they able to bill SISIP? Depending on which form it is and on the doctor and their awareness, you end up getting a different answer. If you're using a walk-in clinic, a lot of walk-in clinics have never dealt with Veterans Affairs before and don't know what they can submit a bill for and what they can't submit for. There's not always that much direction.
I didn't look through the forms that I got this morning too closely because they were a little bit overwhelming, but I don't recall actually seeing any instruction to the doctors on whether or not the doctors could file for reimbursement to VAC or if I may end up being on the hook for that. It's not always that clear, and this also creates some barriers. We're not sure if I am going to have to dish out $100 for a doctor to fill out these forms that SISIP is demanding yet again, even though they've already classified me as permanently disabled, or is my doctor able to actually submit it to SISIP for coverage? It's not always clear, and this is for SISIP and VAC. So maybe that's something that needs to be worked on.
A really minor point, but perhaps a sign of how things have shifted, is that while SISIP gives us prepaid envelopes when they send out documents and ask us to send them back, Veterans Affairs does not. We have to go out and get our own bloody stamps. It's such a minor thing, but sometimes you have difficulty getting out of the house on any given day or there's a time limit on getting these forms back, and you can't make it to a store to get a stamp and you're at risk of having benefits cut because you can't manage that day to get to the store and get a dollar stamp. It's an artificial barrier that's almost.... It's disgusting.
I do want to go back to the previous question you asked Reginald about the different forms of connection that veterans can get. There is no end of social media groups on Facebook and other platforms that are devoted to connecting veterans with each other. Some of the best peer support ones are on there. Send up the Count, run by Brian Harding and his colleagues, is one of the most fabulous, outstanding methods of peer support that actually gets us drawn in and get us opening up.
Jamie MacWhirter with PTSD Buddies is going across Canada right now trying to get even more word out on there. It's another peer support group that is actually working.
The Legion—and this comment is going to result in my getting hate mail—has perhaps run out of time. Part of the reason they are not seen by the young generation joining up is that we are not made to feel welcome. We have not been made to feel welcome for quite some time. The changes that occurred.... The way the World War II veterans were treated by the World War I veterans is a similar story. The way the Korean War veterans were treated by the World War II veterans is a similar story. But the problem here right now is that it's not the peacekeeping veterans and the Korean War veterans and a handful of World War II veterans who are treating us badly when we try to go in, but the sheer number of people who have never served who are in positions of power and who make us feel so unwelcome that we turn around and ask, “Why the hell should we be part of this?” With social media, we don't need brick and mortars groups. We are able to connect.
I use social media for a lot for my research and I'm in connection on a daily basis with soldiers and veterans from all over the world. I don't need a Legion to do this. The Legion is more of a barrier.
Conservative
Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK
Thank you.
Having been a doctor filling out forms, I say in response to the question of who sets my regulations that it's the regulatory bodies. Then it's a question of who's going to pay what I expect to get paid, so I understand that part and I appreciate your comments.
There's one last thing I'll just ask Ms. Northey. I'm very interested in your concept of outcomes, and I know you sort of answered some of that in response to Ms. Lockhart. You talked about demographics, and a lot of the research might be more demographic in nature. I'm interested in knowing the parameters a little bit more in depth. Ms. Lockhart, you sort of answered my question, but in your outcomes, what sort of parameters are you looking for?
As an Individual
I'm not sure whether I clearly understand the question, when you say “parameters”. When I look at measuring outcomes, I look at there being a starting point of the process and the end process. The end process isn't just measuring the process. The actual end, which I call an outcome, is measuring the purpose of the start, of the reason why we're in the process. I'm not sure if that's what you mean by the parameters you are looking for?
Conservative
Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK
I think it does. Your answer, in a way, to Ms. Lockhart, was more about expectations of the client and purpose of the outcome type of thing. I think you answered what I was looking for, which I didn't feel I got from the earlier answer, so I appreciate that.
As an Individual
If I can add just one more point, we use a term called “continuous improvement” all the time. To me continuous improvement is that if each client did not meet that outcome, there are then grounds for continuous improvement. It should not be based upon a performance measure so much. I don't want to confuse this too much, but performance measures are sometimes called “process measures”. I see a lot in government. I see the time it took for a client to go from A to B. Those are all good, but at the end of the day, you want to know if a client met exactly what they were expecting to meet. The time period becomes part of that performance measure, but that comes in at the back end. It's not your outcome. You're not aiming to deliver a service on time or deliver a service. For sure as an organization you want to do that, but as a client going through you go in there based on the expectation you have of that program. I suspect that the two gentlemen sitting beside me, if they were signing up for a program or signing up for a form, would be thinking, what is this form supposed to do for me? That's their expectation. If the form is to get them pharmacology, if the form is to get them CBT, cognitive behavioural therapy, if the form is to get them psychiatric help, at the end of the day, did they get all of that, and were their needs met? Whether you want to call it an outcome or whether you want to call it a measure against their objective or a goal—everybody has terms—if you forget all and throw the terms aside, it's, at the end of the day, whether the client's expectations were met.
Conservative
Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK
That's right. There are two different entities: the services that are provided and the health care point of view. When you're doing health care, it's helpful that you've got the specialists and the right practitioner for the right assessment at the right time. You can judge that part. But when we look at the services that we provide, and part of what our discussion here is about is providing those services not just the health care part of it, I like your concept and taking the same analogy for health care and putting it into the delivery of those services.
As an Individual
If I could just add one more point, for all of you, as a committee, or for organizations, when you're assessing one agency against another, when you're looking at whether an agency met the client's expectations or the outcomes were as expected, you're now measuring across. Typically, what we tend to measure is whether the agency is well-known, whether the agency has been around for a long existence, whether the agency is serving more clients, not whether the quality of their service is measuring what the clients are expecting.
