ban counterparts. Specifically, they have lower health-related quality-of-life scores and a higher prevalence of physical illness compared with urban veterans. “Accessing care for rural veterans is a challenge for both the private sector and the VA,” Dr. Holliday said. “We’ve moved in the last 10 years in the VA from being mainly a hospital-based organization, where everything has to come to us, to moving out and creating smaller community clinics in a lot of areas. We also have a mobile van that delivers medical and mental health care as it drives a route through the rural areas.” In January, VISN 17 started contracting with some local mental health and mental retardation centers in rural counties to provide additional points of care, Dr. Holliday says. Still, many rural veterans will end up seeking care in prima-
ry care physicians’ offices or local emergency rooms, he says. And some may not be able to access VA services because of less than honorable discharges, Ms. Moles says. “Over four or five years, shamefully, kids were getting dis-
charged for a personality disorder — which is less than honor- able — and come to find out, it’s PTSD,” she said. Because of that less than honorable discharge, they must
seek medical or mental health care in the private sector, she says. “So they are in our emergency rooms, they are in our urgent care clinics, and they are in our primary care offices.”
Asking the right question ISV is developing three separate training courses, each tar-
geting health care professionals, educators, and students, and corporate management and employers. A fourth course is a 30-minute military cultures module designed specifically to educate the public. ISV is working with a group of military vet- erans and clinical experts, including a Navy SEAL commando, U.S. Air Force flight medics, Navy psychiatrists, trauma experts, and primary care physicians. Ms. Moles says they focus on these areas because they are the primary issues affecting every returning veteran: health care, higher education, and jobs. Some 40 percent of return- ing veterans go back to school; most of those who don’t, enter the workforce.
The clinical training program, called the Veteran Emer- Online services for veterans
gency Treatment Screening Tool Training, is aimed at physi- cians, first responders, emergency care personnel, nurses, and other health care professionals. The course addresses the medical needs of military veterans and their fami- lies, military culture, veteran servic- es and the challenges of veteran re- integration in civilian life, and crisis intervention.
Most veterans know they can access medical, mental health, and other support services through the U.S. Department of Veterans Affairs (VA). But they may not be aware of a whole network of state and local vet- eran support organizations that may be available in their communities. Stephen Holliday, PhD, chief mental health officer for the VA’s Veter-
ans Integrated Service Network 17 in San Antonio, says an organization called TexVet: Partners Across Texas maintains a searchable database of public and private sector organizations that provide services for veterans. The website is
www.texvet.com. TexVet’s database includes state and local organizations that can
help veterans with health and wellness issues, as well as education, employment opportunities, and crisis hotline numbers. The database also includes information on peer-to-peer support, readjustment help, post-traumatic stress disorder, and more. Dr. Holliday says information on veteran support services is available
via telephone from 211 Texas, a program operated by the Texas Health and Human Services Commission. Information on how to access 211 Texas is at
www.211texas.org. Additional information about support services for veterans is at
www.armedzilla.com, an online social networking site. The site includes information on groups such as the Wounded Warrior Project, I SUPPORT VETS, and more.
24 TEXAS MEDICINE March 2012
The course also provides an in- depth discussion of mild traumatic brain injury among returning veter- ans and how it affects their medical needs. It also explores myths sur- rounding PTSD. Dr. Evenhouse says the course will train physicians, particularly emergency physicians, to ask the right questions. “If you don’t understand whom
you’re dealing with, if you don’t know what the reasonable questions to ask are, you just miss out on what could be critical information,” he said. “So the whole tool is designed around asking that first question: Have you served or are you serv- ing in the U.S. military? If they say yes, then the training program that I SUPPORT VETS puts on will take you through a series of screening questions that you can ask, and the training program teaches you about what the answers mean and the next steps.” Dr. Evenhouse says asking that first question will create a better ex-
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