STATEMENT OF
KRISTIN DAY, LCSW
CHIEF CONSULTANT, CARE MANAGEMENT AND SOCIAL WORK SERVICE
OFFICE OF PATIENT CARE SERVICES
DEPARTMENT OF VETERANS AFFAIRS
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES HOUSE OF REPRESENTATIVES

February 28, 2008

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Good morning, Mr. Chairman and members of the Subcommittee. Thank you for the opportunity to discuss mental health treatment for families and the Department of Veterans Affairs' ( VA's) efforts to support those who support our veterans. I am accompanied by Dr. Ira Katz, Deputy Chief, Patient Care Services Officer for Mental Health in the Veterans Health Administration ( VHA) and Dr. Alfonso Batres, Director of the Readjustment Counseling Service. I would like to request my statement be submitted for the record.

VA supports caregivers, including caregivers of wounded or ill veterans, by providing assessment, counseling and training related to the caregiver's ability to provide adequate care. Specifically, this includes education about the veteran's illness or disability, either mental or physical, and referral to community agencies for services VA is unable to offer. We offer visits to assess the adequacy of the home environment and the need for home equipment or modifications and can offer the same for vehicles. VA can contract for adult day health care up to eight hours per day, five days per week to allow family members to leave home for work or leisure.

As more fully described below, VA provides limited services to immediate family members, which includes: members of the immediate family, the legal guardian of a veteran, or the individual in whose household the veteran certifies an intent to live. The law provides in general that the immediate family members of a veteran being treated for a service-connected disability, may receive counseling, education, and training services to the veteran's family in support of that treatment. We diligently extend these services under those circumstances. Likewise, if a veteran is receiving hospital care for a non-service connected disability, VA is authorized to provide those services, as are necessary in connection with that treatment, if the services were initiated during the veteran's hospitalization and their continuation on an outpatient basis is essential to permit the discharge of the veteran from the hospital. Outside of our hospital system, VA's Vet Centers also provide family counseling to family members in furtherance of a post-combat veteran's successful readjustment to civilian life.

A number of caregiver and family support groups also meet with family members at our facilities to address caregiver burnout or depression. In so doing they help address the individual counseling needs of family members that fall beyond VA's limited caregiver authority. Thankfully, many veterans remain independent in the community because of neighbors, friends, and others who step in and provide assistance when family members cannot.

VA supports the families of our veterans every day, but we must continue to adjust not merely to clinical advances, but to demographic ones as well. The aging of our veteran population also represents unique challenges, and we are working with community-based resources to respond to their needs.

Our Voluntary Service continues to provide needed support and guidance. Generous donations to VA Voluntary Services by Veterans Service Organizations, businesses, and other organizations allow VA to assist families with temporary lodging, free or discounted meals, transportation, and entertainment for veterans' family members, among other such needs.

The Civilian Health and Medical Program of the Department of Veterans Affairs ( CHAMPVA) is a comprehensive health care program in which VA shares the cost of covered health care services and supplies with eligible beneficiaries. CHAMPVA provides coverage, provided the dependents are not otherwise eligible for DoD TRICARE benefits, to the spouse or widow(er) and to the children of a veteran who is rated permanently and totally disabled due to a service-connected disability, was rated permanently and totally disabled due to a service-connected condition at the time of death, died of a service connected disability, or died on active duty. CHAMPVA provides broad health coverage and includes a $50 annual deductible and 25% co-payment for services.

Turning to specific VHA program areas, family members of patients in our Polytrauma System of Care are actively engaged by VA clinicians and staff regarding treatment decisions, discharge planning, and therapy sessions, as appropriate, so they can help their loved one learn to be as independent as possible when he or she returns home. The designated traumatic brain injury ( TBI) and Polytrauma case manager assigned to every veteran and active duty service members receiving care in VA's Polytrauma System of Care coordinates support-efforts to match the needs of each family.

Over the past few years, VA Mental Health Services includes families in over 500,000 units of service. This includes involvement of families in mental health evaluations, participation in treatment planning, and collaboration in monitoring treatment outcomes. Families can be seen when their involvement is included in a treatment plan designed to benefit the veteran, as discussed above. One example is family psycho-education, an intervention providing information to families about the patient's illness and training on how to respond to symptoms and problem behaviors. Although the intervention is with the family, research strongly supports the benefits to the veteran.

In August 2007, VHA selected eight caregiver assistance pilot programs across the nation at total cost of approximately $5 million. The goal of these pilots is to explore options for providing support services for caregivers in areas where such services are needed and where there are few other options available.

In addition, a new position in the VHA Care Management and Social Work Service has been created to develop a more systemic approach to serving caregivers. The position of Caregiver Support National Program Manger has just been filled. This individual will spearhead an internal interdisciplinary Advisory Group tasked with developing educational tools and training modules to assist VA staff in supporting our caregivers as they support our veterans.

In October 2007, VA partnered with the Department of Defense ( DoD) to establish the Joint VA DOD Federal Recovery Coordinator Program ( FRCP). VA hired an FRCP Director, a FRCP Supervisor and eight Federal Recovery Coordinators ( FRCs) in December 2007. The FRCs are currently deployed to Water Reed and Brook Army Medical Centers as well as National Navel Medical Center at Bethesda. Two additional FRCs are currently being recruited and will be stationed at Brook Army Medical Center and Balboa Naval Medical Center in San Diego. The FRCP is intended to serve all seriously injured service members and veterans, regardless of where they receive their care. The central tenet of this program is close coordination of clinical and non-clinical care management for severely injured service members and their families across the lifetime continuum of care.

As briefly alluded to above, Vet Centers, administered by VA's Readjustment Counseling Service, provide family counseling for military-related problems that negatively affect the veteran's readjustment to civilian life. Indeed, within the context of the Vet Center service model, families are central to the combat veteran's care. Family members are usually the first to realize the effects of possible war-related problems, especially among National Guard and Reserve members. Effective intervention through preventive family education and counseling helps many returning veterans stabilize their post-military family lives.

Veterans who served in a combat theater are eligible for readjustment counseling, even if they have not enrolled for health care benefits. Family services at our Vet Centers are not time limited and are available as necessary for the veteran's readjustment throughout the life of the veteran. Vet Centers have full latitude to professionally include family members in the treatment process as long as this is aimed at post-war readjustment for the veteran. Spousal counseling groups are conducted at many Vet Centers to help spouses cope more effectively with the veteran's war-related problems, including PTSD, substance use, depression, anxiety disorders, grief, anger management, social alienation, unemployment, or other conditions.

Professional family readjustment counseling at Vet Centers is provided by licensed social workers, psychologists, and nurse psychiatric clinical specialists with additional professional training for marriage and family counseling. In locations where a Vet Center does not have staff with expertise in family counseling, our teams provide clinical assessments, preventive behavioral health education, basic counseling, and referrals to local VA or other qualified family counselors in the community. These Vet Centers are well-networked with local human service providers.

In the event a service member dies while on active duty, Vet Centers provide bereavement services to the surviving family members. Between 2003 and the end of FY07, Vet Centers have assisted 1,713 family members and 1,136 families of fallen service members, 807 (71%) of whom were in-theater casualties in Iraq or Afghanistan.

VHA works diligently to support veterans, their families and their caregivers. Often without the support of these dedicated family and friends many veterans would not be able to maintain their independence or their preferred community-based lifestyle.

Thank you again for the opportunity to appear here today. My colleagues and I would be happy to answer any questions you may have.