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OT Emerging Area - Veterans

Occupational Therapy, Veterans, and the Wounded Warrior project.
by

Matthew Ceran

on 11 October 2012

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Transcript of OT Emerging Area - Veterans

By: Stephanie Cutlip, Kelly Dunlay, Haleigh Murray, Rebecca Newsome, and Matthew Ceran Operation Wounded Warriors Contributing Factors Re-Integration Social Political Geographical Demographics History 101 Roots started in WWI as Reconstruction aides
Provided activity and motivation for wounded/disabled servicemen improving physical and mental health Evolution of Occupational Therapy and the Military The issues of veteran care will continue to grow as there are 1.5 million Americans currently serving in armed forces and 22.7 million veterans.
Provided care includes treating TBI, PTSD, and help with polytrauma.

Of those, about one in ten (~2,387,000) served during the Gulf War Era II (Post-9/11) and nearly two-thirds of veterans in that era are currently under the age of 35.

Recent studies have shown that the military is failing to diagnose, treat, and document brain injuries in veterans. Studies have also shown that Tricare--the insurance-style program for for nearly 4 million active-duty military and retirees--will not cover cognitive rehabilitation therapy.

PTSD: diagnosis increased six fold from 2003-2008 Why this area? Injury and Illness PTSD November 21, 2011: VOW to Hire Heroes Act
Returning Heroes Tax Credit
Wounded Warriors Tax Credit
July 12, 2012: Veterans Skills to Jobs Act
Easier for veterans to put their skills to work and manufacturing companies to hire thousands of returning service members
August 31, 2012
Executive Order that strengthens suicide prevention and improves mental health services for veterans, service members, and military family members American Recovery and Reinvestment Act
Provided the VA with more than $1.4 billion to improve services provided to veterans
Joining Forces Initiative
Gives service members and their families opportunities and support
August 5, 2011
President Obama announced new commitments that will provide a comprehensive plan to lower veteran unemployment
November 7, 2011
President Obama introduced new resources created to help veterans translate their military skills for the civilian workforce Work as a therapeutic medium has been a core concept since the inception of occupational therapy.
Provides a sense of security, belonging and self-esteem; it is a role with which all Soldiers can identify.

OT’s role with veteran’s health care in the past focused on the aging and disabled veteran population.
Now working with physical as well as psychological injuries.

Specific skills training in the area of work readiness includes work habits, values, interests, work skills, and vocational exploration, along with the “just right” fit
MOHO

Unemployment rate for veterans ages 18-24 is approximately 21 percent.
Employers apprehensive about hiring due to mental status
Veterans fired due to altercations with co-workers
If bad economic conditions (can trigger PTSD)
About 1 in 4 (633,000) veterans who served in Gulf War-era II reported having a service-connected disability
Of these, 80.0 percent were in the labor force in August 2011. Demographics There are approx. 22,234,000 veterans in U.S.

Women make up ~8% of veteran population

As of 2011, more than 1.5 million Americans have served in Iraq

About 17% of our nation's 2.4 million veterans who served during Gulf War era II (post 9/11) are women.
compared to only 3% of veterans from WWII, the Korean War, and the Vietnam era Geographical Social Overwhelming at first
Social stigma that military veterans can go "AWOL"
Many mental problems
Guilt/depression/aggression
Victims of government
Emotional shutdown/isolation
Hard for them to go to places in community
Driving
Strangers
People like to help veterans
Not sure how
Veterans don't want/think they need help Work and Employment Models
&
Services Models 1917 1990 1939- -Based on the individual's growth as a person rather than solving their problem
-Change occurs as an individual strives to self actualize Client Centered Service Delivery 12% of the 1.6 million OEF-OIF soldiers have sustained a mild TBI (mTBI)

mTBI symptoms usually subside within 3 months post-injury
symptoms remain in 10-30% of mTBI cases

OT can intervene in several areas:
Client and family education
Vision
Cognition
Resumption of life tasks/roles
Emotional well-being TBI 700+ US military bases worldwide
In WV, Veterans =12.2% of population
Women make up 1.6 % of WV veterans Mental Health-----------Physical disabilities-------------------------------------------------------Holistic---- Acute: immunizations, health screenings, inpatient and outpatient mental health and substance abuse treatment, and medical and surgical services

Long-Term: Geriatric Evaluation, Adult Day Health Care, Respite Care, Home Care, Hospice/Palliative Care VA Covered Services Readjustment Counseling and Outreach Services
-available to veterans who served in combat zone
-through Vet Centers--community-based counseling centers
-services also available to family for military related issues
-little to no cost to family

Veterans Crisis Line
-toll-free, confidential
-for veterans, family, and friends
-can discuss anything, from coping with mental health issues to difficulty with relationships or transitioning back to civilian life

Caregivers and Veterans Omnibus Health Services Act of 2010
-provides certain medical, travel, training, and financial benefits to caregivers of certain veterans seriously injured during service on or after 9/11/01 Some services provided May qualify for VA health care benefits if:
-served in active military, naval, or air service
-separated under any condition other than dishonorable

VA Health Care Enrollment Priority Groups:
-Veteran completes an application, then their eligibility is verified
-Veteran will be placed in a priority group based on eligibility status
-Priority groups range from 1-8, with 1 being the highest priority

Can use private health insurance as a supplement to VA benefits.

**VA health care is NOT considered a health insurance plan. Reimbursement with:
Cara Damm OTR/L Professional Perspective Political Political Soldiers with "shell shock" respond to inpatient/outpatient services
Term "shell shock" would later become know as PTSD
Profession starts to shift focus from mental health to physical disabilities 1945 1942-1960 Rehabilitation movement
- after the development of Medicare/caid
- initially developed for wounded soldiers
- acknowledgment of OT as vital to soldier recovery
- reorganization of Veterans Administration to allow for rehab 1946 Hill-Burton Act
federal aid provided for construction of rehab hospitals
required to offer PT, OT, psychological, social and vocational rehab Americans with Disabilities Act (ADA)
- push for EBP in treatment, return to occupations Present Red Cards 34 years old.
Served 2 terms in Iraq (2004 until 2008)
Married 6 months before deployment
Wife pregnant at the time.
Now has three children (aged 8, 4, & 2)
Only survivor of suicide bomber MVA
Three closest comrades killed
Trouble re-integrating at first
Isolation from family
Nightmares
Marital problems
Now engages with family
Still experience anxiety in public
Recently diagnosed with PTSD Bill MOHO Model
Systemic, holistic approach for clients with varying needs and populations across the lifespan

Stresses the importance of the mind/body connection and how motivation and performance of occupations are interconnected

Major focus for practice: On the client and how environment contributes to one's source of motivation, patterns of behavior, and performance Purple Cards 38 years old
Wife and 2 daughters
Involved in a vehicle explosion while serving in Iraq in 2009
Suffered a TBI and injuries to both of my feet
Still suffers from STM loss and balance issues
Often forgetful
Loss of social interactions.
Unsafe driver Lieutenant Joseph Brown Green Cards 23 years old
Join the military after high school
Served 4 years in Iraq
Suffered severe burns to from an IED blast
Worked and quit from local grocery store
Hard time adjusting to civilian life Kate Blue Cards 35 y/o returning war veteran.
Left leg, below the knee amputation.
No prosthetic leg
Ambulates with crutches
Worried about social stigma
Wishes to return to pre-deployment form in the community
Includes: running errands, attending his children's soccer games, and watching football with his buddies at a local sports bar.
Has a strong support system
Fear of being treated "differently" impeding participation Jim 3 Categories of symptoms
Re-experiencing
Avoidance
Hyper-arousal

Prevalence of PTSD
Afghanistan = 6 – 11%
Iraq = 12 – 20%

Not only affects military personnel
Family and friends affected as well

OT contribution
Sensory processing, cognition, and emotional regulation abilities all affected Yellow Cards Alyssa 40 years old
Active duty military OT Works in a Warrior Transition Unit
I serve wounded warriors who sustain poly-trauma
Two or more physical and/or cognitive injuries
Includes TBI, PTSD, amputations, vision and hearing loss, nerve damage, multiple bone fractures, infections, and any other injuries sustained during active duty. References Physical
Gunshot wounds
Head injury/TBI
Lost limbs
Fractures
Nerve Damage
Hearing/Vision Loss Top Military Health
Concerns
Mental
•PTSD
•Depression
•Anxiety
•Substance abuse Policies that promote veteran employment Homeless Veterans' Reintegration Program (HVRP)
Est. 1987
Assists in reintegrating homeless veterans into meaningful employment within the labor force and to stimulate the development of effective service delivery systems that will address the complex problems facing homeless veterans.
Veterans' Employment and Training Service (VETS)
Offers employment and training services to eligible veterans through a non-competitive Jobs for Veterans State Grants Program.
Funds provided to each state's Workforce based on number of veterans
Uniformed Services Employment and Reemployment Rights Act (USERRA)
Protects civilian job rights and benefits for veterans and members of Reserve components.
Enforces laws
Gold Card initiative
Provides unemployed post-9/11 era veterans with the intensive and follow-up services they need to succeed in today's job market.
Joint effort of the Department of Labor's Employment and Training Administration (ETA) and the Veterans' Employment and Training Service (VETS). Brett Simpson Project manager Understand where they’re coming from
-wars are different, where individuals are stationed in the same wars are different
-stressors (attacks, lack of supplies, climate/terrain of the land)
-length of time served, number of deployments
Understand their medical concerns
-physical, mental, multiple
-appearance, depression, substance abuse, social stigma
Understand their support system
-family, friends, occupations
-supportive, distance, employed/unemployed
Understand their goals
-client centered treatment
-walk, drive a car, dance, etc (amputation)
-return to work (now unemployed)
- reconnect with family, friends (helping them to understand – PTSD, depression, etc)
-return to occupations/hobbies Social Re-integration Group Cases Pick 3 interventions for your specific case study More wounded service members survive severe and complicated injuries than ever before due to more sophisticated body armor, helmets, and medicine.
Warrior Transition Units
Polytrauma network
5 polytrauma rehabilitation centers
18 polytrauma network sites
85 polytrauma support clinics Polytrauma As the number of returning veterans increase, so does the need for services such as Occupational Therapy

The veterans of today will are who we will be treating
Important to understand the holistic approach

Many policies and services that can help veterans Conclusion Acord-Vira, Amanda. "History of Practice Trends of OT." Morgantown, WV. 08/26/2010. Lecture.
American Occupational Therapy Association. (nd) Veterans’ and wounded warrior’s mental health. Retrieved from:
www.aota.org/practitioners/practiceareas/emerginingareas/MH/Veteran.aspx
AOTA. (nd). Veteran and wounded warrior care. Retrieved from: www.aota.org/practitioners/practiceareas/emergingareas/RDP/veteran.aspx
AOTA. (nd). Military occupational therapy helps wounded warriors and civilians alike. Retrieved from: www/prnewswire.com/new-releases/military-
occupational-therapy-helps-wounded-warriors-and-civilans-alike-58692067.html
Bureau of labor statistics. United States department of labor, (2012). Employment situation of veterans summary (USDL-12-0493). Retrieved from website:
http://www.bls.gov/news.release/vet.nr0.htm
Cara Damm, OTR./L (personal communication, October 4, 2012)
Champagne, T., Koomar, J., & Olsen, L. (2010). Occupational therapy's role with posttraumatic stress disorder. [Fact Sheet]. Retrieved from
http://www.aota.org/Consumers/Professionals/WhatIsOT/MH/Facts/PTSD.aspx.
Davis, Diana. "Who's Who in OT? Philosophy and Founders." Morgantown, WV. 08/25/2010. Lecture.
Kessler, Amanda. "History of OT in Mental Health." Morgantown, WV. 8/30/2011. Lecture.
Meet a warrior: Joe Caley. (2011). Retrieved from Wounded Warrior Project website: http://www.woundedwarriorproject.org/mission/meet-a-warrior/joe-
caley.aspx
Morneault, J. A. (2011, May 11-12). Head protection: Advanced planning brief to industry. Retrieved from U.S. Army Natick Soldier Research, Development,
& Engineering Center website: http://nsrdec.natick.army.mil/APBI/Ballistic%20Helmets%20and%20Accessories/2011_APBI-Head_Protection_BreakoutSessionBrief.APMvFinal.pdf
National Center for Veterans Analysis and Statistics. (2012, August). Department of veterans affairs statistics at a glance. Retrieved from U.S. Department of
Veterans Affairs website: http://www.va.gov/vetdata/docs/quickfacts/Homepage-slideshow.pdf
National Public Radio. (2010, May 10). A snapshot of the new veteran. Retrieved from National Public Radio website:
http://www.npr.org/templates/story/story.php?storyId=126573303
Nelson, K. A. (2012, July 18). Army, NFL collaborate on traumatic brain injury helmet sensors. Retrieved from U.S. Army website:
http://www.army.mil/article/83879/
Proponency office for rehabilitation and reintegration. U.S. Army, Office of the surgeon general health policy & services. (2009). Occupation therapy’s role in
the warrior transition unit: Returning soldiers to productive living. Retrieved from website: http://www.armymedicine.army.mil/r2d/OT in WTU.pdf
Radomski, M. V., Davidson, L., Voydetich, D., & Erickson, M. W. (2009). Occupational therapy for service members with mild traumatic brain injury.
American Journal of Occupational Therapy, 64, 646-655.
Sayer, N., Noorbaloochi, S., Frazier, P., Carlson, K., Gravely, A., & Murdoch, M. (2010). Reintegration problems and treatment interests among iraq and
afghanistan combat veterans receiving va medical care. Psychiatric services, 61(6), 589-597.
Stoller, C., Greuel, J., Cimini, L., Fowler, M.S, & Koomar, J. (2012). Effects of sensory-enhanced yoga on symptoms of combat stress in deployed military
personnel. The American Journal of Occupational Therapy, 66, 59-68.
U.S. Department of Veterans Affairs Veterans Health Administration. (2012, January). Health care benefits overview 2012 (VHA Publication No. P95996).
Retrieved from U.S. Department of Veterans Affairs website: http://www.va.gov/healthbenefits/resources/publications/IB10-185-health_care_benefits_overview_2012_eng.pdf
United States Department of Veteran Affairs. (2012). PTSD Overview. Retrieved from http://www.ptsd.va.gov/public/pages/fslist-ptsd-overview.asp
United States department of labor. Veterans' employment & training service, (n.d.). DOL's Fiscal Year 2011 USERRA Report to Congress. Retrieved from
website: http://www.dol.gov/vets/programs/userra/#.UHRjjZjR7Nm
United States department of labor. Veterans' employment & training service, (n.d.). New employment initiatives for veterans. Retrieved from website:
http://www.dol.gov/vets/goldcard.html
United States department of labor. Veterans' employment & training service, (n.d.). VETS Employment Services Fact Sheet. Retrieved from website:
http://www.dol.gov/vets/programs/empserv/employment_services_fs.htm#.UHRjppjR7Nl
United States department of labor. Veterans' employment & training service, (n.d.). VETS HVRP Fact Sheet 4. Retrieved from website: http://www.dol.gov/vets/programs/hvrp/homeless_veterans_fs.htm#.UHRjNJjR7Nk
Yamkovenko, S. (2012) The new wounds of war: polytrauma care and occupational therapy. OT
Practice,16(12), 13-18. Thank you for your time! We will now try to answer any
questions you may have.
Full transcript