[House Hearing, 113 Congress]
[From the U.S. Government Publishing Office]
AN EXAMINATION OF VETERAN ACCESS TO
TRADITIONAL AND ALTERNATIVE FORMS
OF MENTAL HEALTH THERAPY
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON HEALTH
of the
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED THIRTEENTH CONGRESS
SECOND SESSION
__________
WEDNESDAY, FEBRUARY 20, 2014
__________
Serial No. 113-52
__________
Printed for the use of the Committee on Veterans' Affairs
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COMMITTEE ON VETERANS' AFFAIRS
JEFF MILLER, Florida, Chairman
DOUG LAMBORN, Colorado MICHAEL H. MICHAUD, Maine, Ranking
GUS M. BILIRAKIS, Florida, Vice- Minority Member
Chairman MARK TAKANO, California
DAVID P. ROE, Tennessee JULIA BROWNLEY, California
BILL FLORES, Texas DINA TITUS, Nevada
JEFF DENHAM, California ANN KIRKPATRICK, Arizona
JON RUNYAN, New Jersey RAUL RUIZ, California
DAN BENISHEK, Michigan GLORIA NEGRETE McLEOD, California
TIM HUELSKAMP, Kansas ANN M. KUSTER, New Hampshire
MIKE COFFMAN, Colorado BETO O'ROURKE, Texas
BRAD R. WENSTRUP, Ohio TIMOTHY J. WALZ, Minnesota
PAUL COOK, California
JACKIE WALORSKI, Indiana
DAVID JOLLY, Florida
Jon Towers, Staff Director
Nancy Dolan, Democratic Staff Director
SUBCOMMITTEE ON HEALTH
DAN BENISHEK, Michigan, Chairman
DAVID P. ROE, Tennessee
JEFF DENHAM, California JULIA BROWNLEY, California,
TIM HUELSKAMP, Kansas Ranking Minority Member
JACKIE WALORSKI, Indiana CORRINE BROWN, Florida
BRAD R. WENSTRUP, Ohio RAUL RUIZ, California
GLORIA NEGRETE McLEOD, California
ANN M. KUSTER, New Hampshire
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
hearing records of the Committee on Veterans' Affairs are also
published in electronic form. The printed hearing record remains the
official version. Because electronic submissions are used to prepare
both printed and electronic versions of the hearing record, the process
of converting between various electronic formats may introduce
unintentional errors or omissions. Such occurrences are inherent in the
current publication process and should diminish as the process is
further refined.
C O N T E N T S
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Page
Wednesday, February 20, 2014
An Examination of Veteran Access to Traditional and Alternative
Forms of Mental Health Therapy................................. 1
OPENING STATEMENT
Dan Benishek, Chairman........................................... 1
WITNESSES
Kim Evans, Director Military Collaborative of Ventura County..... 5
Prepared Statement........................................... 32
Lyndsey Hale, Veteran Liaison, VITAS Innovative Hospice.......... 7
Prepared Statement........................................... 34
Julie Sardonia M.A., LMFT, Founder/Executive Director Reins of
H.O.P.E., H.O.P.E. for Warriors Program........................ 8
Prepared Statement........................................... 35
Mike McManus, USAF (Ret), Veteran Service Officer, Ventura County
Human Services Agency.......................................... 10
Prepared Statement........................................... 38
Donna M. Beiter, Director, VA Greater Los Angeles Healthcare
System, VISN 22, Veterans Health Administration, U.S.
Department of Veterans Affairs................................. 21
Prepared Statement........................................... 40
Accompanied by:
Daniel Flynn M.D., Oxnard Community-Based Outpatient Clinic,
VA Greater Los Angeles Healthcare System, VISN 22,
Veterans Health Administration, U.S. Department of
Veterans Affairs
Jane Twoombley, Ventura Vet Center, VA Greater Los Angeles
Healthcare System, VISN 22, Veterans Health
Administration, U.S. Department of Veterans Affairs
MATERIALS SUBMITTED FOR THE RECORD
The American Legion.............................................. 46
Letter From Ventura Vet Center................................... 50
AN EXAMINATION OF VETERAN ACCESS TO TRADITIONAL AND ALTERNATIVE FORMS
OF MENTAL HEALTH THERAPY
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Wednesday, February 20, 2014
U.S. House of Representatives
Committee on Veterans' Affairs,
Subcommittee on Health
Washington, D.C.
The subcommittee met, pursuant to notice, at 10:00 a.m., in
Grand Salon, California State University Channel Islands, 1
University Drive, Camarillo, California, Hon. Dan Benishek
[chairman of the subcommittee] presiding.
Present: Representatives Benishek and Brownley.
Dr. Benishek. The subcommittee will come to order.
OPENING STATEMENT OF CHAIRMAN DAN BENISHEK
Good morning, and thank you all for being here today.
I am Dr. Dan Benishek, a congressman from Michigan's 1st
District, the northern half of Michigan, and I am honored to
serve as the chairman of the Subcommittee on Health on the
House Veterans' Affairs Committee.
It is my pleasure to be joined here today by your
congresswoman and my colleague, the ranking member, Julia
Brownley. I am grateful for Ms. Brownley's hard work and
leadership on our subcommittee over the last year, and I am
grateful to have an opportunity to join her here in beautiful
Camarillo with all of you.
Yesterday I paid a visit to the West L.A. Department of
Veterans Affairs Medical Center. While I was there, I met with
the medical center's leaders, some of them who are here with us
this morning, and we toured the West L.A. campus to see
firsthand some of the programs and services that are available
to veterans here in the greater Los Angeles area.
Having spent 20 years as a surgeon at the Iron Mountain VA
Medical Center in my hometown of Northern Michigan, I enjoyed
working with many of the health care professionals and support
staff who have dedicated their careers to providing timely and
high-quality care. I would like to take a moment to personally
thank each and every one of them for their dedication to our
nation's veterans and their families.
It is clear from my visit yesterday and from the testimony
we are going to hear this morning that there are some very
exciting things going on here in Southern California for our
veterans.
Today we are going to hear from an array of local providers
and organizations about the steps that still need to be taken
both in this community and at others around the country to
improve the provision of mental health care to our veterans in
need using both traditional and, where appropriate, alternative
therapies and treatments. We will discuss ways that we can all
work together--Congress, VA, community-based groups, and
dedicated citizens like all of you who are in our audience
today--to increase effective and meaningful partnerships
between Federal programs and the community resources that are
increasingly stepping up to meet unmet needs, provide a
critical bridge to care, and help our veterans across America.
Although the Department of Veterans Affairs is tasked with,
as President Lincoln said, caring for him and now her who has
borne the battle, a Federal department cannot and should not
attempt to meet all our veterans' needs alone. We know from
recent research that more veterans seek care outside the VA
health care system than within it, and that a majority of our
veterans have access to private insurance or other health
coverage.
In order to fully and most effectively meet the needs of
today's veterans, VA must be willing to reach out and work with
responsible community partners and try, where suitable,
promising new approaches to care. I look forward to our
conversation this morning to hearing the ideas that we will
discuss here, and to bringing those ideas back to Washington so
we can start working in other communities around this country.
I thank you again for being here this morning and for your
dedication to our veteran neighbors.
Before I conclude my opening statement, I would like to ask
all of our veterans in the audience today to please stand, if
you are able, or raise your hand and be recognized.
[Applause.]
Dr. Benishek. Thank you so much for your service. It is an
honor to be here with you this morning.
With that, I will recognize your congresswoman and my
colleague and friend, Julia Brownley, for her opening
statement.
Ms. Brownley. Thank you, Mr. Chairman. And I want to thank
you particularly for continuing to keep the issues of access,
quality, and timely mental health services provided to our
veterans at the forefront of this subcommittee. Your work is
certainly extraordinary.
And I want to also thank Dr. Rush and the very great Cal
State Channel Islands and the Channel Islands community for
hosting us today. And I want to thank all of our witnesses
today for coming and talking with us about the critical issue
of veteran mental health access and treatments.
I would also like to thank all of you in the audience and
our veterans who are here today in support of our veterans, not
only here but across our country.
I believe caring for our veterans is the utmost
responsibility of our nation. As these brave men and women have
sacrificed so much, the country must ensure that adequate
resources are available and effective programs in place to
address the varied and individual needs of our veterans during
and after their very own unique and personal transition to
civilian life.
The mental health programs are particularly important in
light of the unique dangers and stress of the recent conflicts.
Long and multiple deployments and the nature of guerilla
conflict have taken their toll on our service members. The
spouses and families have borne the burden, as well. And we
cannot forget our older veterans, who suffer as well from the
traumas of war, and suffered before traumatic brain injury and
post-traumatic stress have become sort of the signature wounds
of the current Iraq and Afghanistan wars.
The Veterans Health Administration spent $6.2 billion on
mental health programs in Fiscal Year 2013 nationwide. It is
this committee's responsibility to ensure positive progress and
successful outcomes, and that this funding has been applied to
the goals for which it was intended and the programs are
working and improving for every veteran who needs them.
Today's hearing will examine the progress VA has made in
serving veterans here, right here in my own district of Ventura
County.
I want to thank the chairman once again for agreeing to
come and allowing the veterans in Ventura County to be heard.
Mr. Chairman, you will learn that we are very lucky folk
here in this county because we are a county that is determined
to properly look after our veterans. Our Ventura County
Military Collaborative, for example, operates mostly without
any Federal funding at all and relies on many, many volunteers
who hold a very deep and patriotic pride and responsibility
that our veterans deserve our service for the service that they
have sacrificed for our country and its freedom.
I look forward to hearing from the panels on how the use of
community programs and resources have assisted the Veterans
Health Administration in resolving access to care issues for
veterans and their families here in Ventura County and Greater
Los Angeles.
I also want to hear what further actions are needed to
increase effective and meaningful partnerships between the
community and the Department to provide needed services here
locally so our veterans can heal right here in their own
community.
I read with interest the testimony from the witnesses who
are experts in their own right. Ventura veterans have access to
a wide variety of programs and services, but we also need the
attention of the Department of Veterans Affairs on several
issues, such as wait times and local services. I am very
interested to hear about the availability and efficacy of
alternative therapies that are offered to our veterans here in
Ventura.
I would also like to hear about any recommended
enhancements to services that will assist our veterans in their
search for the right type of treatment for them and a timeline
that will eliminate any unmet needs here in Ventura County. I
am hopeful that this will be an honest, open discussion on ways
to provide the care needed through more partnering with the VA
and the private sector to increase the pool of providers and
other creative ways to address the gaps in mental health
treatment and services.
And finally, I would like to thank the Los Angeles VA for
being here today and for the dedication of so many VA employees
who provide quality mental health care to our veterans every
single day. Thank you for all that you do for our nation's
veterans. We just need to be absolutely committed and
understand that we need to do more.
And with that, Mr. Chairman, I will yield back.
Dr. Benishek. Thank you, Ms. Brownley.
We are going to begin the hearing today with our first
panel of witnesses who are already sitting at the table there.
I am going to yield to Ranking Member Brownley in a minute to
introduce the witnesses, but I would like to thank them all for
their presence today and for what they do for our veterans.
I would like to gently remind you that we are going to try
to stay on time. We have a little timer which turns yellow
after 4 minutes and then turns red after 5. We just want to
gently--we may go over a little bit because I think hopefully
we will have some good discussion--but try to keep that in
mind.
So with that, Ms. Brownley, would you please introduce our
panelists?
Ms. Brownley. Our first panelist is Kim Evans, who is the
Director and Founder of the Military Collaborative of Ventura
County. She is a military spouse and a licensed marriage and
family therapist, and the Director of Psychological Health for
the 146th Airlift Wing of the National Guard.
Our second panelist is Lyndsey Hale. Lyndsey is also a
military spouse. She is the second Vice President of the
American Legion Auxiliary Unit 741, the Ventura County Military
Collaborative board member, and a veterans' liaison for VITAS
Innovative Hospice Care.
Our third panelist is Julie Sardonia, Executive Director
and Founder of Reins of H.O.P.E., which stands for Human
Opportunity Partnering with Equines. I have recently had the
distinct pleasure of experiencing firsthand how this
organization has helped to heal so many of our heroes here in
Ventura County with great honor.
And the fourth and final panelist is Mike McManus. Mike is
the County of Ventura Veterans Services Officer. Mike himself
is an Operation Iraqi Freedom vet and retired after 20 years of
service. Every veteran in Ventura County knows Mike McManus,
and we are lucky to have him, and we all know the important and
selfless service that Mike provides here as a service officer
and brings that service to Ventura County.
So, thank you very much, Mr. Chair.
Dr. Benishek. Well, let's begin.
Thank you, Ms. Logie, Evans Logie. Please proceed with your
testimony. Thank you.
STATEMENTS OF KIM EVANS LOGIE, LMFT, DIRECTOR, MILITARY
COLLABORATIVE OF VENTURA COUNTY; LYNDSEY HALE, VETERANS
LIAISON, VITAS INNOVATIVE HOSPICE; JULIE SARDONIA M.A., LMFT,
FOUNDER/EXECUTIVE DIRECTOR, REINS OF H.O.P.E., H.O.P.E. FOR
WARRIORS PROGRAM; MIKE MCMANUS, USAF (RET), VETERAN SERVICE
OFFICER, VENTURA COUNTY HUMAN SERVICES AGENCY
STATEMENT OF KIM EVANS LOGIE
Ms. Evans Logie. Good morning. I am really nervous. I am
Kim Evans Logie, military spouse and licensed marriage and
family therapist. I am one of the leading mental health experts
in the state of California in regards to military and veterans'
issues. I have trained over 1,300 mental health professionals
on military mental health and have briefed over 8,000 service
members and their loved ones on pre- and post-deployment
issues.
I have worked as a TriWest embedded therapist, Joint Family
Support Assistant Program Military Family Life Consultant, and
the Director of Psychological Health for the 146th Airlift
Wing.
Last year I spent four weeks at Lackland Air Force Base
under Federal subpoena as a defense witness forced to testify
against one of my airmen who had been sexually assaulted.
I am the community liaison for the Ventura County Superior
Court Veterans Treatment Court and the Director of the Ventura
County Military Collaborative.
I have had the distinct pleasure of serving the men and
women of the United States military and know too well the
mental health issues associated with combat service and
military sexual trauma.
That being said, in Ventura County we use a combination of
inpatient, outpatient, alternative treatments, and homegrown
community-based support to help our veterans. For outpatient
clinics and services we utilize the Ventura Vet Center, because
they rock, for combat, substance abuse and military sexual
trauma veterans. We use the VA contracted facility at Oxnard
for psychiatric and mental health treatment, and we utilize the
VA at Sepulveda.
For inpatient services we utilize West L.A. VA; the Pathway
Home at Yountville, a privately funded facility which does
phenomenal work and is free to veterans; and Aurora Vista del
Mar, a local psychiatric facility which just received a VA
contract for their PTSD unit, but we are being told that intake
and referrals will have to come through West L.A. VA. Many
veterans will not be able to drive to LA for intake due to
transportation and/or medical issues, thus making the contract
virtually worthless.
The alternative forms of treatment in our local area are
the Soldiers Project, which provides free military mental
health; our Crisis Intervention Team training from our local
sheriff's department, which trains local law enforcement
officers to deal with military and veteran mental health
issues; the Ventura County Military Collaborative, which has
over 140 agencies working together to create a safety net of
care for military veterans and their families; and the Ventura
County Veterans Treatment Court, which provides wrap-around
services and treatment for local vets.
These services are funded primarily through grants or not
at all. The Ventura County Military Collaborative operates
without funding, relying on volunteers, donated meeting space,
and a community that does not hesitate to support it and its
yearly military veteran expo.
As far as the role traditional and alternative forms of
therapy play in our veteran recovery process, it is my belief
that without proper care and coordinated mental health care I
have no doubt that the men and women who serve our great nation
would end up in situations much worse than we are currently
seeing.
Our service members and their families are tired, they are
scared, and they are proud. Consistency, training, caring and
knowledge of community resources are imperative for all
clinicians working with veterans. These are the cornerstones to
successful military mental health treatment.
I would also like to point out that the VA is doing some
great things. We have Paul Gaines, our local VA homeless
outreach representative, who I believe never sleeps. He
interfaces with community agencies and law enforcement to help
find veterans shelter and mental health/substance abuse
treatment.
Greg Cain is our VA Jail Outreach Coordinator and a key
player at the Ventura County Veterans Treatment Court. He works
24/7 to get our local vets into resources that they need.
Charles Green is the face of VA for many of our National
Guard and Reservists. He arranges clinics and briefings to help
enroll our local service members and does the VA outreach for
Ventura County from Los Angeles.
The obstacles we face. Exclusions of licensed marriage and
family therapists at VA facilities, which hire licensed
clinical social workers instead. Both are Master's degree
clinicians.
We have lengthy waits at our local clinic for psychiatric
and mental health services. We have veterans completing an
inpatient program at West L.A. VA, which has no apparent
coordination of care with local resources for their return to
Ventura County. We have a need from our localized services
through VA grant per-diem funding, and we need to create a
sense of community with our local vets when their treatment may
involve multiple facilities at multiple locations.
In closing, having been involved with military mental
health for over 10 years, I am so impressed by what we have
accomplished. The stigma which was so prevalent when I first
started has disappeared in most units and commands, especially
those who have embraced an embedded therapist model. I am proud
of the work that we have done, and it has made a difference. We
are saving lives.
I thank you for your time and for your caring about those
who have served this country in its time of need. Thank you.
[The prepared statement of Kim Evans Logie appears in the
Appendix]
Dr. Benishek. Thanks. You did a great job.
Ms. Evans Logie. Thank you.
Dr. Benishek. Ms. Hale, you may proceed with your
testimony. You have 5 minutes.
STATEMENT OF LYNDSEY HALE
Ms. Hale. Good day. My name is Lyndsey Hale. Again, I am a
military spouse, 2nd Vice with the American Legion Auxiliary
Unit 741, a Ventura County Military Collaborative Board member,
and a veterans' liaison for a hospice provider.
Regarding mental health and resources for our veterans, it
is especially meaningful for those veterans who left comrades
on the field of battle as they enter their senior years near
end of life.
There is a quote from Will Rogers that goes, ``We can't all
be heroes. Some of us have to sit on the curb and clap as they
go by.'' Although in more recent years we do our share of
clapping, recognizing and honoring our veteran, we need to do
more to provide the resources and support for our veterans in
regards to mental and spiritual health, particularly as they
near end of life.
There are over 21 million living veterans, 45 percent of
which are over 65 years of age, according to the Census.gov
website. As a military spouse, daughter of a Vietnam-era
veteran, and granddaughter of World War II veterans, I am
humbled to be able to speak in regards to the need for
resources and support for our veterans of any age, and
particularly to advocate today for our elderly veterans.
In the American Legion Auxiliary outreach and in working in
hospice, I hear many stories through visiting and speaking to
our veterans that they have never told or not brought up in
years. These veterans of war are holding memories of horrors
one, like myself, who has not seen battle, cannot comprehend.
I was speaking to a World War II veteran, a Pearl Harbor
survivor, who told me he had three times been spared his life
during World War II while he watched his comrades in arms die,
while he had to pick up their remains and count the bodies. He
told me that the third time his life was spared, he was on a
ship at sea and had just left his post to go back to the galley
for coffee. While he was in the galley, the ship was attacked.
Later, as he was walking the ship with the lieutenant and
pulling dog tags for those that had been killed, he came to his
post where he should have been, and there in his place was the
lower half of a man's body. The man covering his seat was
literally cut in half by the explosion from the torpedo that
hit the ship. He said that he started laughing hysterically at
this point and he lost it. He said his lieutenant then slapped
him in the face to bring him back to reality.
This World War II hero told me that he would never forget
those images, and that now that he is in his late 90s, they
come to him more and more. This is just one of the many stories
I have heard. Other stories involve questions and remorse for
those they may have killed in battle. These World War II
veterans wonder what will come of their souls as they leave
this life.
I believe our veterans often just need to get these stories
off their chest, things that they have never spoken of to
anyone for fear of the judgment that would follow. I can't tell
you how many times I have heard a spouse say, ``Yes, he served
in the war, but he never talks about it.''
PTSD is a common term these days that we are trying hard to
address and assist our returning troops with. I personally have
had many a friend come home in recent years broken from war. We
need to continue to support and grow our resources for our
military and veterans of recent wars. In saying that, we cannot
forget the veterans of our past wars such as our World War II
vets. They came home to a nation as heroes, yes, but there was
no diagnosis for their mental well-being. There was no PTSD
support. They often just stifled it, at times self-medicated
and moved on. The bonus for this World War II and Korean
Conflict generation was that many of our men and families were
touched by it or involved directly in it, and so they had
comfort in numbers, unlike today.
However, as this tough, proud generation ages, they have
questions and fears that they have never been able to address.
Our veteran that returns home from combat, that buried their
brother in arms, may not have lost an arm or a leg, but they
are not whole. As I said earlier, we cannot all be heroes. But
as military veterans who stood up to protect our country, it is
our job to not just sit on the curb and clap but to then stand
up for our veterans as they come home.
As an American Legion Auxiliary member, I know that our
American Legionnaires and Auxiliary members are constantly
thinking about better ways to reach out to our senior veterans
through our vet-to-vet volunteers, finding ways to recruit
local military to visit our elderly veterans and get them
information on programs such as the We Honor Our Veterans
Program, the Spirit of '45 Movement, resources such as our
H.O.P.E. for Warriors, the local vet center, county veterans'
service office, our Oxnard Family Circle veterans services. We
bring these to support our greatest generation, but we need
more awareness and support in our health care community and the
general public.
I ask you today to help find a way to reach out to our
Greatest Generation veterans through increasing friendly
visitor programs as this is a generation that responds to
people-to-people interactions, so we can let them know that
there are support and resources for them too, and that it is
okay for them to talk about their time in service.
Thank you for your time and attention to these matters and
your work on making a difference in the lives of our veterans
and their families.
[The prepared statement of Lyndsey Hale appears in the
Appendix]
Dr. Benishek. Thank you, Ms. Hale. Nice job.
Ms. Sardonia, you are recognized for 5 minutes.
STATEMENT OF JULIE SARDONIA
Ms. Sardonia. Thank you and good morning, Chairman Benishek
and Ranking Member Brownley.
On behalf of Reins of H.O.P.E., as the Executive Director
and Founder, I have gratitude by sharing our story here today
about our Equine Assisted Psychotherapy Program, H.O.P.E. for
Warriors.
Imagine this. You are a Navy Sea Bee, just back from your
second deployment in Afghanistan. You feel forgotten half the
time and alone much of the rest. To your invisible wounds of
PTSD you have applied anti-depressants, sleeping medications
and alcohol. Not one provides a lasting balm, but a series of
links in a human chain will soon land you in an arena standing
next to a horse named Chrome. He is big and white and muscled,
but he is gentle, and in him, with a bit of human help, you
begin to find a vessel to hold your grief and your anger.
You return for another session, and another, and each time
you pat Chrome goodbye, you are closer to the person you were
before war.
When you re-enlist, you hold your ceremony in the arena
that gave you yourself back, with Chrome and his buddies
bearing witness to the transformation that has brought you home
to wholeness.
Reins of H.O.P.E. was established in 2006 as a non-profit
serving our local at-risk youth population. Our tool is Equine
Assisted Psychotherapy and Learning. All of our licensed mental
health therapists and equine specialists are trained and
certified by EAGLALA, which is Equine Assisted Growth and
Learning Association. It is the world's largest and most
professionally respected association for this type of
psychotherapy. They set the standard of care. They have over
4,000 members in 49 countries. It also has the EAGLALA Military
Services Designation, which we are a part of, that ensures that
all practitioners must complete specialized training in various
mental health issues with the military.
Even though equine assisted psychotherapy is a new
discipline of 15 years, EAGLALA is committed to helping build a
body of evidence-based, peer-reviewed research.
In January of 2011, Reins of H.O.P.E. launched the H.O.P.E.
for Warriors Program to provide active-duty veterans,
reservists, and all their family members with no-cost,
unlimited, confidential sessions to fill the increasing need
for vital, readily accessible mental health services. We
provide on-the-ground sessions for individuals, couples,
families, groups, overnight retreats for women, and team-
building sessions. This program accounts for 80 percent of our
non-profit program.
Our sessions between client and horse allow exploration of
thoughts, feelings and behaviors, and fosters trust, resilience
and adaptability. These inevitably lead to better problem
solving, improved communication, and healthier relationships.
Many clients have told us that out in our arena, horses have
created the only space where they feel safe to talk about their
military experiences and issues. It is actually a natural
connection.
Like us, horses are herd animals whose survival depends on
constant communication. Unlike humans, horses are prey animals.
They must stay constantly vigilant. Uniquely responsive to
their surroundings, they sense emotional energy around them and
often mirror it, which allows for insights and metaphors for
our military members to deal with their thoughts and their
behaviors.
They also model for the client a new way of being. Powerful
yet gentle, these animals are effective ambassadors of nature,
as well as apt teachers in awareness--that is, being in the
present moment, calming oneself quickly, setting appropriate
boundaries, and learning to trust. These are coping skills that
are key to healing and health.
Transition, reintegration, depression, PTSD, military
sexual trauma, substance abuse, anger and grief are all helped
by this relationship between horses and human.
Josette Wingo, our World War II Navy veteran, she states,
``I realize how being with the gentle, intuitive horses and
their calming effects can have life-changing possibilities.
Their effect on me was almost instantaneous.''
Larry, our Vietnam veteran, stated, ``It allows me to relax
enough to be able to communicate with people freely. I feel
like I am worth something there. They really care, and I want
to see this program expand to other veterans.''
H.O.P.E. for Warriors Program has conducted over 684
clinical hours and over 530 sessions at no cost to any family
member or veteran. We are solely funded by community donors,
foundations and grants. It is our intention and mission never
to turn away a veteran in need, and we seek a collaborative
relationship with the VA and their providers so we can provide
this vital program.
Our further goal is to increase the awareness of
alternative treatment. We are effective and an appropriate
level of care for our veterans. So in order for us to reach out
and help our growing population, we collaborate with Fleet and
family services, Ventura Vet Center, Vista del Mar, Oxnard
Family Circle, SART, and the Military Collaborative.
You may be wondering about that Sea Bee that I shared. Her
name is Sarah Hedge. She is right over there. She is a second-
class petty officer. After working with Chrome, she returned to
serve two more deployments, and she states, ``I attribute my
healing process of PTSD to the relationship with the horses and
the specific activities out in the arena. They helped get my
life back, and I am happy.''
Thank you for the opportunity to introduce Reins of
H.O.P.E. and H.O.P.E. for Warriors program today.
[The prepared statement of Julie Sardonia appears in the
Appendix]
Dr. Benishek. Thank you very much.
Mr. McManus, you may proceed with your testimony.
STATEMENT OF MIKE MCMANUS
Mr. McManus. Good morning, Chairman Benishek, Ranking
Member Brownley. Thank you for the opportunity to provide
information to the committee regarding mental health care
services to Southern California veterans through the Greater
Los Angeles Department of Veterans Affairs Healthcare System.
My name is Mike McManus and I am the County of Ventura
Veteran Services Officer. My staff and I connect fellow
veterans, their dependents and survivors with Federal and state
benefits, as well as local resources. One of our primary
responsibilities is connecting veterans with VA disability
compensation for such conditions as post-traumatic stress,
traumatic brain injury, and for conditions resulting from
military sexual trauma. We also assist veterans enroll in VA
health care and refer them to local and regional treatment
resources.
The Veteran Services Office has five accredited personnel
who interview veterans, file the appropriate benefit claim,
advocate on behalf of the veteran, and make needed referrals to
other service providers. We also have support staff to include
our interns that enable us to meet our client needs. The
Veteran Services Office has conducted a variety of outreach
activities to inform the veteran community about their earned
benefits. The office currently operates out of the main office
and nine field offices to make it as convenient as possible for
our veterans to meet with us.
In Fiscal Year 2011/2012, the office saw 1,839 veterans.
However, last fiscal year, 2012/2013, office staff had seen
3,572 veterans. In Fiscal Year 2010/2011, the Veteran Services
Office connected county veterans with $3.89 million in Federal
benefit payments, but by Fiscal Year 2012/2013, those benefit
payments totaled over $8.75 million.
In addition to being the county's veteran service officer,
I am also a retired Unites States Air Force Senior Master
Sergeant. I spent the last seven years of my 20 years in the
military as a First Sergeant, with one deployment for Operation
Iraqi Freedom in 2003. As a First Sergeant, I had overall
supervision over all enlisted personnel within my units. I
advised the unit commanders on matters affecting their enlisted
force to include issues involving mental health and substance
abuse, and those conditions' impact on the service member,
their families, their career, and the unit.
Ventura County veterans needing mental health care can
receive treatment from the two psych doctors and one social
worker at the Oxnard Community-Based Outpatient Clinic, the VA
clinic. Veterans can also seek counseling from the four
clinicians at the Ventura Vet Center.
Ventura County has over 41,000 veterans, thousands more
National Guard, Air National Guard, and Navy and Marine Reserve
personnel who are eligible for VA mental health care after
serving a deployment. Navy Base Ventura County's active-duty
Navy personnel, who are combat veterans, can also receive
mental health care from the Vet Center.
In essence, you have tens of thousands of veterans and
military personnel in Ventura County, and many of these
individuals will seek mental health care from the seven people
providing mental health treatment from the VA.
Clearly, there is a large unmet need. The VA clinicians
providing mental health care in Ventura County do an
extraordinary job; there are simply too few of them. As
outreach to the military and veteran community increases from
organizations such as my office, the Ventura County Veteran
Services Office, and through the Ventura County Military
Collaborative, the number of veterans seeking services
increases.
Veterans routinely tell my staff and I how they can only
see the psychiatrists at the Oxnard VA Clinic every other
month, or maybe once every third month. The option to be seen
by a clinician at Sepulveda exists. However, in many cases we
are referring to combat veterans with post-traumatic stress
driving the I-405, which only adds to their stress and their
anxiety.
Ventura Vet Center staff have done an amazing job trying to
meet the mental health needs of our veterans. However, there
are only four clinicians. I wholeheartedly encourage the VA to
add clinicians to the Oxnard VA Clinic and to the Ventura Vet
Center. In addition, clinicians could then provide treatment
during evening hours and on weekends. This will improve access
to care for veterans who are going to college, who may be
recovering from service-connected injuries, as well as those
who might be employed.
In addition to increasing the number of clinicians at the
Oxnard VA Clinic and the Ventura Vet Center, the VA needs to
explore partnerships with community programs and resources, and
more quickly assess and adopt alternative mental health
treatments. I would suggest the VA establish contracts with
mental health and substance abuse counselors for inpatient and
outpatient treatment in Ventura County. An example of such
cooperation is the newly awarded VA contract to Aurora Vista
del Mar to provide post-traumatic stress treatment. Previously,
they treated veterans eligible for Tricare. The VA contract
will now enable a much larger pool of county veterans to
receive the benefit of their services.
Inpatient and intensive outpatient resources' availability
in Ventura County will greatly benefit our county's veterans.
Programs such as that at Aurora Vista del Mar would allow
veterans to remain in Ventura County nearer their support
structures and enable some to continue their employment while
receiving outpatient care. This option would not be appropriate
for all veterans and some would certainly still receive
treatment through one of the programs at the VA Medical Center
in Los Angeles. In many instances, however, treatment provided
in-county is the option best suited to the veteran.
One example of how the option of in-county treatment could
benefit veterans is through the Ventura County Superior Court's
Veteran Court. Veteran Court focuses on treatment, not
incarceration, of our combat veterans with post-traumatic
stress, traumatic brain injury and the resulting behavior
problems, substance abuse issues, and run-ins with law
enforcement. Currently, most veterans in Vet Court needing
inpatient or intensive outpatient treatment go to the VA
Medical Center in Los Angeles. Ventura County veterans deserve
the option to receive inpatient and intensive outpatient
treatment in their home county. We have high hopes that the
Aurora Vista del Mar program will offer these options.
Partnering with other non-VA service providers to expand
the availability of treatment would greatly benefit our
veterans. We are fortunate in Ventura County to have the equine
therapy program, Reins of H.O.P.E, that has proven itself
invaluable to our combat veterans and others who have
experienced military-related trauma. A VA contract or the
possibility of a quick fee-basis referral would greatly help
meet the need for mental health treatment.
The VA's willingness to assess and accept alternative
treatments is what is called for to meet the needs of our
veterans. A couple of programs in Ventura County are meditation
therapy and farming. Healing in America, of Ojai, California,
offers meditation services as a way for veterans to heal. In
addition, Veteran Farmers of America in Ventura is developing a
program and has experienced promising early results that have
shown the benefits of their farming intern program.
The VA should actively solicit data on the effectiveness of
complementary and alternative therapies so that veterans can
get the best access to the mental health care that they need.
Alternative therapies in conjunction with VA-provided care need
to work in concert with one another to meet veterans' needs.
Our veterans have earned such care.
Thank you again for this opportunity.
[The prepared statement of Mike McManus appears in the
Appendix]
Dr. Benishek. Thank you very much, Mr. McManus. I truly
appreciate your comments.
I am going to yield myself about 5 minutes for my comments
and some questions for the panel.
First of all, Ms. Hale, your testimony struck me because it
reminded me of a pet project of mine, the Veterans History
Project. You are relating the stories of--I am not sure if
people here are aware, but the Library of Congress has a
Veterans History Project that encourages young people
especially to interview a veteran just to get their story, and
I would encourage that program for people that you know, not
only the veterans but the young people that can take a history,
basically, from veterans, and get a veteran to meet a young
person, and let a young person get to know some of the
experiences our veterans have had. So I just wanted to kind of
promote that project because it is near and dear to my heart.
Ms. Logie, you talked about some of the obstacles in your
testimony, working with VA there, and maybe you can expand on
that. ``Obstacles we face,'' is the way you put it in your
written testimony. Could you expand a little bit about those
things that you mentioned in your testimony?
Ms. Evans Logie. Sure. The waits at our local clinic for
psychiatric and mental health services, I have had waits up to
four months for medication refills for anti-depressants for
some of our National Guard members. So I have actually sent
some back to their local facility. So if they are from San
Francisco, I have actually sent them back to San Francisco.
They have driven back to San Francisco to get their medications
because we have had a backlog here locally.
That happened a couple of times, and then I actually don't
refer there anymore.
Dr. Benishek. So is there good communication between the
immediate medical center and the local clinic? You also
mentioned that, too, that you are concerned about the follow-up
from the local care and the overall care from the medical
center.
Ms. Evans Logie. There are two different issues. We have
West L.A. VA, where a lot of our veterans go for inpatient
treatment. That is primarily where they go, especially from our
Veterans Court, and we do have follow-up through RGO outreach
coordinator, Greg Cain. He is excellent with follow-up. But
what we don't seem to have is any type of formal treatment plan
in place that I have seen.
So, say, the domiciliary releases one of our members, one
of our veterans from inpatient treatment. There does not seem
to be a liaison with our vet center in Ventura County saying,
hey, Bob is being discharged, we would like him to do
individual outpatient, or what type of substance abuse groups
do you have, or anything like that.
As far as our local clinic, I hate to say it but today was
the first time I have met anyone from our local clinic, from
Ventura County.
Dr. Benishek. That seemed to me to be an underlying theme
of all the testimony here, that getting care done locally here
in Ventura County seems to be an issue, and the communication
between--you know, I come from a rural area, too. So sometimes
we have to drive hours to get to the VA medical center. Here,
getting on the 405 seems to be the issue, you know what I mean?
So I certainly understand. Why don't they have more access to
local providers? Not only that but Mr. Lewis, who I talked to
earlier, mentioned that he is trying to get some physical
therapy here but doesn't want to get on the 405 for three hours
to get physical therapy on a regular basis. Why can't he get
that right here?
How could they do that better? I know VA has got a program
coming up. I don't know what it is called. The PC3? Where they
are going to try to get more people involved. Obviously, it
doesn't sound like it has been working very well. Does anyone
else have any comments?
Mr. McManus. Mr. Chairman, we deal a lot with the Oxnard
Clinic and the administrator, Laurie Berry, and the doctors
there, and they are doing some good things. However, again, in
my testimony, between veterans and active-duty Guard and
Reserve, we are talking over 50,000. I think it is merely a
numbers type of thing, just the access. There is only a certain
volume they can handle with the current staffing. If the
staffing doesn't increase, just the sheer physical layout of
the clinic has probably reached its maximum. I am sure the VA--
--
Dr. Benishek. Is that the Oxnard Clinic, then?
Mr. McManus. The one in Oxnard. Yes, sir.
And another big thing is just the ability to have someone--
we used to have an individual there who would do what we call
intake and eligibility. In other words, are you even eligible
for VA health care. They had an individual that was there
probably two-and-a-half years ago now. However, when he left,
the clinic lost the ability to do the intake and the
eligibility. So now it is either done online or it is mailed
down to West L.A. so they can determine if someone is even
eligible for VA health care.
So one of the things that would be helpful is if they
actually had an intake and eligibility individual right there
in the clinic. That would also help address some of the issues
with referrals to Aurora Vista del Mar and those kinds of
things. So I think one place to start might be an intake and
eligibility individual in the clinic.
Dr. Benishek. All right. Thank you.
Mr. McManus. Thank you.
Dr. Benishek. We are going to go back and forth a little
bit because my 5 minutes went by so fast. I am going to yield
to Ms. Brownley for 5 minutes. She may have some questions, as
well.
Ms. Brownley. Okay. I have a lot of questions, but a
limited amount of time. I want to thank, again, all of you for
being here and everybody here in the audience, because
everybody who is here all have a direct concern about how we
are providing for our veterans here in Ventura County. So thank
you very, very much.
Ms. Evans, you don't mind if I call you Ms. Evans?
Ms. Evans Logie. No, that is fine.
Ms. Brownley. Okay. I just wanted to follow up, too, on
your testimony when you talked about the outreach component and
that really we are not doing any local outreach, that the
outreach takes place out of the West L.A. facility.
Can you talk a little bit about that? I am presuming it
means that that outreach is probably not as effective. But if
you could just talk a little bit further about that.
Ms. Evans Logie. Okay. In Ventura County with the
Collaborative, we have 140 agencies on board. So we have what I
think we would all say is an incredible network of care here
locally. Included in that network of care are our three big
guns out of L.A., which is Charles Green, Greg Cain, and Paul
Gaines. They are there. They are the face of VA in Ventura
County, whether you are on a military installation, whether you
are at the jail, whether you are at a Collaborative meeting.
They are everywhere.
My understanding is our local clinic at Oxnard has never
had an outreach individual hired for that clinic. One of the
other issues--like my husband just got rated through VA. All of
his stuff was done in L.A., for his rating, and other areas. We
were never given a list of local services. No one ever said,
hey, you guys are in Camarillo, the Oxnard Clinic can do this
for you. I imagine we could go find it online, but it would
make sense to say ``This is your local clinic, this is when it
is open, here is our flyer, now go online,'' and there is none
of that.
So in my world, unfortunately, they don't really exist
because I don't interact with them, ever. I am going to change
that. I am sure it will change after today.
Ms. Brownley. Very good, very good.
And in terms of the equine therapy, I witnessed it, so I
have a good sense of why it is, indeed, successful. Ms.
Sardonia, if you would just talk a little bit about--because I
certainly heard from some vets when I visited you. Just talk a
little bit about the vets that you were serving and some of
their stories and the reasons why they are coming to you and
how their therapy has been virtually unsuccessful in a more
traditional environment.
Ms. Sardonia. Sure. Thank you for the opportunity. We do
provide our services to active duty and veterans and their
families. So we are seeing not only the veterans but the
spouses. We are seeing grandchildren such as Larry, who lives
with them. He is a Vietnam veteran. We see children because
they are affected, as well.
The stories that I hear, countless stories from everyone
who is participating, is the fact that they do try traditional
talk therapy. I am a traditional talk therapist, a marriage and
family therapist of 21 years. I know it works, and I want to be
able to use our services as adjunctive with VA providers or
other MFTs or LCSWs or psychiatrists and psychologists in the
community to do adjunctive work so that it is a team effort.
So the majority of what we are working on they seem to be
receiving from equine-assisted psychotherapy as addressing
healthier coping skills. And because it is an action-based
program, they are just not talking about it, they are now able
to do it. So as you witnessed there, they are actively working
with horses who are large animals who are very intuitive, who
are helping them work through some of their stories they have
never shared before, such as a lot of our men and women, and
they feel comfortable talking to a horse.
And it is not just talking to them. It is moving. It is
doing. It is feeling. They are getting the ability to learn
healthy coping skills. Whereas a horse would die out in public
or in nature because of hyper-vigilance or whatnot, these men
and women are learning how to be less hyper-vigilant by
learning healthy coping skills to calm down, like a horse does.
So when we have men out there with road rage or hearing
loud noises that remind them of bombs and they are hiding
underneath the table, they are saying if I didn't go to Reins
of H.O.P.E. and learn how to calm myself down like a horse, I
would have done a lot more damage out there. I hear story after
story.
I also hear that a lot of our participants may have taken
their life if they didn't continue because they didn't want to
go to a therapist. They didn't want to go to the VA because it
was too hard or they couldn't get in, like Mr. Lewis. It takes
a long time to get down there, even though he goes there. He
comes up twice a week, once for our veterans group and once for
individual therapy.
So we have men and women coming more than once a week
because they feel this alternative work is helping them feel
more comfortable sharing, being able to tell their story,
feeling heard, not to mention decreasing some of their anxiety
and depression. The minute they walk with a horse they feel--if
I were to take their blood pressure, it would have been calm.
So I would love to be able to have a collaborative
relationship with the VA to show that this does work. As you
witnessed, you would really have to see it to understand it.
There is research to back it up, and I can share that at a
later time through the website with statistics.
Ms. Brownley. And if there was a collaboration and there
was additional funding, is there a demand that you are not
being able to meet at this particular point in time?
Ms. Sardonia. We are not turning away anybody. I am
increasing my staff because of the increase of men and women
and children who want to come. So instead of just having
morning sessions, we are having morning sessions and then
taking a break and bringing in a new herd, and there are
professionals in the afternoon. We did get a large grant to do
retreats for women veterans, which we are hosting our second
one this Monday and Tuesday for women in California.
So the demand is becoming greater, and so we may be trying
to increase into Santa Barbara. We are hearing people say
please bring Reins of H.O.P.E. to Santa Barbara for our
veterans up there, as well as closer into Camarillo. I have
heard we might put an arena in Somas so it is not as difficult
for some to drive to Oaji.
Gas is difficult. We have men and women driving from--I
have a gentleman driving all the way from China Lake Air Force
Base to come out. Four hours he drove in the snow with his wife
and his daughter because he did not want to see a VA therapist
on base. He came four hours in the snow on a Friday, and he
said this is the only thing that is helping keeping him sane in
order to continue to work.
Ms. Brownley. Thank you. Thank you very much.
Ms. Sardonia. Thank you.
Ms. Brownley. And, Mr. McManus, you talked a little bit
about a new relationship with Aurora Vista del Mar, and I know
Ms. Evans also talked about the fact that our folks might have
to go to L.A. to be assessed to see if they can utilize the
services there. That sounds like an impediment to me. You
already mentioned a local intake at the Oxnard Clinic would be
helpful as well.
But can you talk a little bit about what the possibilities
would be with regards to this partnership and contract?
Mr. McManus. Well, I certainly think we can move quickly to
determine someone's eligibility for VA health care, and then
hopefully increase the number of psych docs at Oxnard Clinic to
put in that consult to quickly refer the veteran to Aurora,
where it is an inpatient post-traumatic stress treatment and
those types of things, as opposed to sending not just our Vet
Court individuals but any veteran that needs that particular
level of care.
But just using our Vet Court folks, instead of everyone
being channeled down to L.A. for inpatient or intensive
outpatient treatment, the veterans have the ability to receive
that treatment here in-county, especially if intensive
outpatient treatment is what is required. And if you are able
to use a Ventura County resource in order to fulfill either the
probation requirement of the Vet Court or someone just needs
that level of care that is not associated with the Vet Court,
if you have to drive down to West L.A./Sepulveda for PTSD
counseling and it is in the middle of the day, you could very
well run the risk of losing your job.
However, if it is provided here in-county, it is much less
of a burden on the individual, and certainly gas and those
types of things. So I think being able to streamline the
referral process will greatly enhance the ability for us to get
our county veterans into a county resource provided in the
county.
Ms. Brownley. Thank you.
Mr. Chair, I apologize that I exceeded my time, but I
appreciate the opportunity.
Dr. Benishek. That is all right. I have a few more
questions, too.
Ms. Brownley. Yes, okay. Very good.
Dr. Benishek. Since it is only the two of us, I think maybe
we will do another round of questions. There is still enough
time to get the second panel going, so that is no problem.
I am going to yield myself 5 minutes for a second round of
questions.
What is the most common complaint and compliment that you
hear from them about local veterans when you interact with the
care and services from the Greater L.A. health care system?
Give me a couple of examples of some good things and some--I
think we are hearing about this lack of local care as the key
issue, what I think I am hearing today.
Maybe, Ms. Evans Logie, could you tell me?
Ms. Evans Logie. Yes. As far as the care that my veterans
receive at West L.A. VA and Sepulveda, it is exceptional. I
mean, you have a group of dedicated men and women, and
seemingly more so every year. The level of caring, which is how
I gauge effectiveness, it is inspiring to see.
I think some of the concerns that my veterans have locally,
and our Guard and Reservists, the mileage. My husband was told
to go for an intake two hours away, not a big deal for us. I
mean, he has a job. We both have jobs. But when you start to
think about perhaps a veteran who doesn't have a job and who
has to make three separate copies of medical records, my
husband's medical records were $70 a copy, and we had to make
three copies because the original two were lost.
Then you have transportation costs. We filled out a form
that was hidden online from VA to get reimbursed for mileage,
and that was six months ago. We haven't done that again. He had
nine separate trips to VA to be looked at for nine separate
injuries, which was great, and I am really glad they did that.
But if you are impoverished, if you are in pain, if you have
substance abuse issues, you don't have reliable transportation,
these are all incredible barriers.
We are doing wonderful things. We can do some things
better. So I think as far as the treatment goes, everyone that
I have talked to is fairly happy with their treatment. The
issues are really the distance.
Dr. Benishek. Right, right. Thanks.
Ms. Hale, do you have any comment?
Ms. Hale. Well, I would just like to echo that, that
especially my elderly veterans don't drive, and definitely
don't drive far. So getting someplace far away isn't an easy
thing. A lot of our vets don't really want to go to the doctor,
or don't believe in going on a regular basis. So for them to go
and be told to go, and finally agree to go, and then now it is
out of their comfort zone and it is out of their area, it is
much more likely that they are not going to go. So that is why
we have less of them using the resources than we have.
Dr. Benishek. Ms. Sardonia, do you have an official
relationship with VA? Or is all your stuff outside VA? That is
the impression I got.
Ms. Sardonia. Yes, it is all grassroots, no funding other
than our community donors and our fundraiser and our grants.
Dr. Benishek. The VA doesn't use your services as an
adjunct?
Ms. Sardonia. No. I haven't gotten direct referrals,
although our women's veteran retreat that we are doing with
women from the VA and L.A. are coming, and one of the social
workers is going to come and help evaluate the program, so
hopefully that will open the door for more.
The information I get from a lot of our veterans is there
are good things coming from the VA, but it is the wait and the
travel. A majority of my gentlemen and women that are here are
disabled, so driving there, driving long distances again.
But I would like to share personally, my father is a Korean
War veteran in the Navy, who is here, who has cancer, and the
VA has been outstanding for my father. He is here today because
of that, and he can attest to the treatment that he is
receiving from the VA. My dad is here, so I can say personally
that helps.
Dr. Benishek. The VA folks in L.A. are here. They are here,
so hopefully they will respond to this opportunity.
Ms. Sardonia. Absolutely. Thank you.
Dr. Benishek. Mr. McManus, anything else besides what you
have already said?
Mr. McManus. I just want to call attention to the fact that
Laurie Berry, who is the administrator of the Oxnard CBOC, she
is very responsive when we have issues. Certainly, one of the
bigger issues is just the ID cards, and they have issues with
the software and the camera and things of that nature, which
has gone on month after month after month.
So after a veteran finally is determined eligible and
enrolled in VA health care, Sepulveda couldn't take their
picture for an ID card, Oxnard couldn't take a picture for
their ID card, things like that, which isn't necessarily going
to bar them from care. However, just simple things like that,
the frustration. You walk into the Oxnard CBOC to get your
picture, the software is out, the camera is down. Walk into
Sepulveda, nothing at Sepulveda.
So they are making some strides, and I believe Sepulveda's
cameras are back up and running, and the software and things
like that, and supposedly the staff over at the Oxnard CBOC has
been trained, so hopefully that has occurred.
But I just want to call out that Laurie Berry is the
administrator. She is very responsive when things do come up,
and to control what she can. It is a contract clinic. So again,
you have not only the bureaucracy of VA and that kind of thing
but also of her ultimate boss, and the contract as well. So
there are some interesting complications provided by that.
But also Monica Walters, who is the social worker over
there, she is extremely busy, very responsive, but there is
only one of her. So if they could clone her and get maybe two
or three, that would be wonderful.
But there are definitely some good people doing some good
things. The level of care that we hear for the most part coming
from Sepulveda and West L.A., vets are very happy with that. Of
course, there are always going to be exceptions, like with any
health care. But overall I would say most veterans are happy
with the level of care that they get.
Just to echo Kim's comments, Paul Gaines, who does a lot
of--I mean, they issue him a van and he drives all over, Kern
County, L.A. County, Santa Barbara, to find these veterans that
are homeless and things like that.
So there are a lot of really good people doing some good
things within the VA. It just seems when you look at it in
total, the bureaucracy sometimes can even prevent some of the
really good performers from doing the best that they could at
their jobs, let alone a veteran looking up at this big
bureaucracy not knowing exactly what to do.
Dr. Benishek. Right, right. Thank you.
Well, I will yield another 5 minutes to Ms. Brownley to see
if she has any more questions.
Ms. Brownley. Well, thank you. I think it is interesting to
hear the testimony from everyone and thinking about the
potential partnerships so that we are providing more services
in the community, but also the outreach and what that means in
terms of really connecting all of the services that we do have
here.
The military collaborative has done a great job, but just
reflecting to think if we had a true partnership and resources
from the VA so that we could really energize that voice and
make it louder so that our veterans here in Ventura County
really are aware of the services.
And we have great safety nets, like the Veterans Court,
which is an extraordinary thing that happens here in Ventura
County, all done by volunteers, many of them sitting here on
the dais, where our military folks who are suffering, who get
into trouble, who are arrested and go to court, this court
provides help and resources to those individuals so that they
can provide access to help and support, as opposed to being
locked up in jail. These are people who have served our country
and are suffering and need our help, and it is a great safety
net I think for the community for the most downtrodden who have
now gotten themselves into trouble and to actually have access
again to help.
But if we could have a partnership there, I have seen that
work. I have gone and watched it myself. If we had more
resources there, there is a lot more work to be done and there
are a lot more of our veterans who are coming through there
that need our help and support and that level of caring that
you talked about in terms of the way you evaluate a program.
Having that kind of dedication and level of care is really
critical.
I wanted to just quickly ask about transportation because
we are going back and forth to West L.A. Is transportation
adequate? Is it not at the right times?
Mr. McManus. Well, certainly there is the Disabled American
Veterans, they provide a van. They provide some transportation
at different pickup points throughout the county, primarily
Ventura and Simi Valley for transportation down to Sepulveda or
West L.A.
There is also a bus that starts at the Santa Barbara VA
Clinic and goes to our Oxnard CBOC and then down to Sepulveda,
West L.A., and then reverses.
However, if you have an appointment, you can get on the bus
and things like that. So there is some available. However, I am
sure there are always improvements that could be made in that
particular process.
Ms. Brownley. Do you think the transportation issues impede
veterans from utilizing or going to VA care? It is, ``the bus
is not convenient for me, I am a little embarrassed to get on
the bus.'' Do you think that impedes access to service?
Mr. McManus. I have heard from some vets ``I am not riding
the bus,'' and usually it is our post-traumatic stress vets and
things like that, where they are riding the bus with other
veterans, but it is just not an environment that they enjoy
because it is certainly going to go even slower than if they
were to drive their own car down the 405. So we have heard some
feedback as far as that goes from several different vets where
they simply will not take it. They rely, then, on seeing Doc
Blakus and Doc Flynn over at the Oxnard CBOC, who have done
some very good things for our veterans. Again, you just have a
very large pool of veterans going just to see two psych docs.
Then they also have come to rely on either medication for
Julie's program, Reins of H.O.P.E. and things like that, as an
alternative to going down and riding the bus, or even just
driving themselves down to Sepulveda. Sepulveda has the walk-in
PTSD clinic, but a lot of vets, if you need walk-in and it is
an urgent-type situation, it doesn't matter if there is
transportation or not down to Sepulveda, you still have that
timeframe to get down there where we need something more
localized to address those urgent types of situations.
Ms. Brownley. Yes. I can't imagine that there are a lot of
people coming from Ventura taking a bus to go to the walk-in
service at Sepulveda.
And in terms of services for women specifically in Ventura
County for mental health, I think sometimes there is a distinct
difference between the needs of women veterans and their mental
health care needs and men. Is there any special treatment for
women here, or services for women?
Ms. Hale. Julie's program at Reins of H.O.P.E. with her
events, which is fantastic for female veterans to be able to
come to a retreat, that center is for military sexual trauma
for both women and men, but there are no actual specific women
veteran programs in Ventura County that are just strictly for
females, that I am aware of.
Ms. Brownley. And are there any other alternative therapies
in Ventura County? I know Reins of H.O.P.E., the answer is no.
But are there any other alternative therapies that have any
partnership or relationship with West L.A. or the VA?
Mr. McManus. Not that I am aware of.
Ms. Brownley. Thank you. I yield back.
Dr. Benishek. All right. Thanks.
This panel is excused. I really appreciate you all taking
the time to be here today, and feel free to contact the
committee about concerns that maybe we didn't address today.
So, I thank you for your participation, and you are
excused.
I would ask the second panel to come up. Thank you.
Thank you. I would like to welcome our second and the final
panel to the witness table.
Okay.
Ms. Beiter, you are going to be testifying and then calling
upon the other witnesses if you need help with questions, as I
understand it. Is that correct?
So thank you all for being here this morning and for the
services you provide our veterans here in Southern California.
Ms. Beiter, if you would like to proceed with your
testimony, that would be great.
STATEMENTS OF DONNA M. BEITER, DIRECTOR, VA
GREATER LOS ANGELES HEALTHCARE SYSTEM, VISN 22, VETERANS HEALTH
ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS;
STATEMENT OF DONNA M. BEITER
Ms. Beiter. Thank you. Well, good morning, Chairman
Benishek and Ranking Member Brownley, and members of the
committee.
Dr. Benishek. Do you have your microphone on?
Ms. Beiter. I thought I had it on. Okay, I will start
again.
Good morning, Chairman Benishek and Ranking Member
Brownley, and members of the committee. Thank you for the
opportunity to discuss the Greater Los Angeles Healthcare
System, which we call GLA, our commitment and accomplishments
in providing veterans high-quality, patient-centered care and
being a leader in health care transformation; specifically,
improving mental health outcomes and access to mental health
services and programs.
I am accompanied today by Dr. Dean Norman, our Chief of
Staff at Greater Los Angeles; Dr. Daniel Flynn, a psychiatrist
at our Oxnard CBOC; and Jane Twoombley, a Team Leader at the
Ventura Vet Center. I will begin my testimony with an overview
of the GLA health care system and then focus on our
comprehensive mental health programs.
GLA is accredited by the Joint Commission and is one of the
largest and most complex facilities within VA. We serve
Veterans throughout Kern, Los Angeles, San Luis Obispo, Santa
Barbara, and Ventura counties.
In Fiscal Year 2013, GLA treated over 86,000 veterans, with
over 28,000 receiving care in our mental health programs. Since
the beginning of Operation Enduring Freedom/Operation Iraqi
Freedom and New Dawn, we have enrolled over 20,000 Iraq and
Afghanistan veterans, with 9,700 of these veterans treated in
Fiscal Year 2013. Of the Iraqi and Afghanistan veterans treated
in Fiscal Year 2013, 30 percent received care in our mental
health programs.
GLA has been involved in several major redesigns of our
health care programs over the last few years, characterized by
completing the move to a new patient-centered primary care
delivery model called Patient Aligned Care Teams, or PACT. This
PACT team is comprised of a medical provider, a nurse care
manager, and a clinical and administrative coordinator, all of
whom care for and assist the veteran with navigating their
whole health experience. The team focuses on engaging the
veterans in their own care and giving them skills and goals
they can attain to improve their health.
As a leader in health care transformation, GLA has been
designated a National Center of Innovation for Patient-Centered
Care. The focus of our Center of Innovation is to develop and
spread integrative health and healing alternative initiatives,
such as Tai Chi, acupuncture, mindfulness-based stress
reduction, guided imagery, and breathing/stretching/relaxation.
Part of our plan for 2014 includes opening an integrative
health and healing center with a specialty in pain management.
The integrated pain management team will be interdisciplinary
and will include tele-consultations and tele-classes in
addition to on-site care and classes in a healing environment.
Mental health services at GLA are unified under an
interdisciplinary Mental Health Care Line. GLA mental health is
expanding its implementation of the recovery model, which is
patient-centered, empowers veterans, and works with veterans to
attain the highest level of independent functioning possible.
Comprehensive treatment programs for substance use
disorders are available at our three major sites, including
intensive outpatient programs based on the Matrix Model, a
cognitive behaviorally-oriented approach, as well as opioid
treatment programs, methadone maintenance or suboxone
treatment.
GLA offers an extensive variety of traditional and non-
traditional mental health services. Services include evidence-
based pharmacotherapy and evidence-based psychotherapy for the
treatment of a wide range of mental disorders including post-
traumatic stress disorder, anxiety disorders, mood disorders,
including depression and bipolar disorder and schizophrenia.
Inpatient mental health care is provided at the West L.A.
site, where there are currently 45 operational inpatient beds
available to veterans who are in need of acute inpatient care
due to the severity of their mental health condition.
As veteran demand for outpatient mental health appointments
has grown, GLA has strived to build capacity and keep up with
the demand at the Oxnard Clinic. Staffing and space issues have
posed limitations, and we have deployed a number of strategies
to keep up with our patient needs. One of the innovations to
increase capacity at the Oxnard Clinic is the expansion of our
clinical video tele-mental health. This allows veterans to come
into the clinic and see a mental health provider based at a
distant site.
GLA and the Oxnard CBOC make use of multiple community
programs and resources. This includes many different faith-
based and non-profit programs. VA believes it is vitally
important that we network with our community partners in the
delivery of health care and other services. These community
partners have been strong allies in our efforts, and we
appreciate their contributions to our veterans' health and
welfare.
In conclusion, VHA, GLA, and the Oxnard Clinic are
committed to providing the high-quality care that our veterans
have earned and deserve, and we have continued to improve
access and services to meet the mental health needs of
veterans. We appreciate the opportunity to appear before you
today. We would like to thank the subcommittee members for your
interest in quality care for our veterans, and we appreciate
the resources Congress provides VA to care for veterans.
My colleagues and I are happy to respond to any questions
that you may have.
[The prepared statement of Donna M. Beiter appears in the
Appendix]
Dr. Benishek. Thanks for your testimony. Let me ask you a
couple of things.
You heard the testimony from the first panel.
Ms. Beiter. Yes.
Dr. Benishek. I think the gist of it was, frankly, there
doesn't seem to be enough care locally. Nobody wants to drive
up to VA three hours for an appointment. So it sounds like from
your testimony that you are partnering with everybody to make
it all work, but why aren't there more options available at
Oxnard? Mr. McManus seemed to think that there were not enough
people there to handle that. As I understand it, VA had some
kind of a task force to hire, I don't know, 1,600 mental health
professionals within the last two years, and 300 support staff
across the country. So how many additional mental health
providers and support staff were added in Ventura County as
part of this effort?
Ms. Beiter. We are planning on doubling our staff. We
already have hired some of them.
Dr. Benishek. Have you doubled your staff in the last two
years?
Ms. Beiter. In the last two years? No, we have not. Our
plan is to have it doubled by the end of this month. So we will
have six.
Dr. Benishek. So how many staff have you hired in the last
two years?
Ms. Beiter. We have hired probably three-and-a-half FTE,
but we have used a lot of fee-basis staff and local tenants.
What our plan is is to have six full FTE functioning in the
Oxnard Clinic by the end of this month.
Dr. Benishek. How many are there now?
Ms. Beiter. Right now there are four.
Dr. Benishek. Four.
Dr. Flynn, You are in Oxnard, right?
Dr. Flynn. That is correct, Mr. Chairman.
Dr. Benishek. Has your staff increased? Are you seeing more
patients than you used to there, or what is the status there?
Dr. Flynn. When I first came on in 2011, I was a fee-basis
part-time psychiatrist. The existing psychiatrist----
Dr. Benishek. I know the feeling.
Dr. Flynn. I'm sorry, sir?
Dr. Benishek. I said I know the feeling of being a part-
time fee basis provider. That is what I did.
Dr. Flynn. I empathize with that, sir.
Between myself and Dr. Blakus, we had a total of 0.9
psychiatrists, and we were very, very busy during that time.
But in the last month, another full-time equivalent has been
brought on, Dr. Castillo, essentially doubling our capacity.
That began last month, and I am happy to say that as of this
week I am extending my hours from 0.4 up to approximately 0.8
or 0.9, which will be a full-time position.
Dr. Benishek. Do you have a hard time filling your staff?
Have you been actively looking and you just can't find people,
or what is exactly the problem?
Ms. Beiter. I would say that in the last six months we have
been recruiting to increase our staff in Oxnard. What really
has happened to us is we have really expanded greatly with our
patient population in Oxnard. We have had an increase in mental
health veteran needs in Oxnard that, to be very honest, we
really didn't anticipate. So as we have seen it grow and
maintain that growth, we have over the last six months tried to
put more staff in.
The other issue we have there is space. We outgrew the
clinic. When we projected the clinic, we did not expect, again,
as many veterans using it as we have seen.
Dr. Benishek. How many patients a day are going through
that clinic for all purposes?
Ms. Beiter. Currently we have----
Dr. Benishek. Approximately.
Ms. Beiter.--56,000.
Dr. Benishek. Fifty-six patients a day?
Ms. Beiter. Excuse me. A day? I don't know how many go
through a day.
Dr. Flynn, do you know?
Dr. Flynn. I don't have that number.
Ms. Beiter. Last fiscal year in Oxnard we enrolled--we had
9,154.
Dr. Benishek. It is hard for me to judge. I can judge how
many patients come through the clinic a day because I know what
a clinic is and I know how many patients I can see in a day. So
I am just trying to get an idea.
Are there any other adjunct providers besides the
psychiatrist, Dr. Flynn, for mental health care at Oxnard?
Dr. Flynn. We have Monica Walters, who is the social worker
that was mentioned before, and we also have a psychologist
currently, two psychologists now, Dr. Kay Sotto and Dr. Kaiser.
Those are both full-time psychologists.
Dr. Benishek. Okay.
Ms. Beiter. One just started this month, the second
psychologist.
Dr. Benishek. The other question that one of the veterans I
talked to today here mentioned was his inability to get local
physical therapy in Ventura. He didn't like the fact that he
needs almost daily physical therapy, and he just didn't like
the idea of having to go to West L.A. to get that physical
therapy. Apparently, the application that he applied for for
the fee basis care allowed him one physical therapy visit a
month, but he needs it three times a week or something, and he
couldn't figure out how to get it done and who would approve
the fee basis care.
How soon is this PC3 thing going to happen? To me, the VA
has been telling me that is supposed to be the answer to
getting the community-based care started. Is that true, or is
that ever going to happen? Can you go over that a little bit?
Ms. Beiter. That has started to happen effective this
January. We have been working with TriWest, which is going to
be the vendor we work with in our area. I really believe that
listening to the first panel and hearing that they see a need
for having much more local care, I think PC3 is going to really
help us do that.
The two things that I think will help us, we are going to
do a lot more tele-mental health so that patients don't even
have to leave their home. We are getting ready to work with
what is called Jabber technology, which is like Skype, for
mental health care, where patients can be in their own home,
our veterans, and connect to a provider.
But PC3 is patient-centered community care. It is a new
program for us to use.
Dr. Benishek. I am familiar with that. I just don't like
the fact that we are waiting for this to happen and it never
happens. I hear from individual cases. It is very frustrating
for me to see those individual cases and it doesn't happen, and
I would like you to work on this fellow here. I am going to
give Ms. Brownley his contact information, make sure this
fellow can get his local care.
Ms. Beiter. We would be happy to follow up on that.
Dr. Benishek. But I think for the amount of time, I want
Ms. Brownley to have an opportunity to speak, and hopefully we
will have time for a few more questions.
Ms. Brownley. Thank you, Mr. Chair.
So just to follow up on the staffing issue that we were
talking about, just for the record if you could provide us with
the amount of patients that you have and roughly what is the
daily patient rate here would be helpful to have.
So I know back in 2012, the Office of Inspector General
made some recommendations to the VA regarding staffing and made
some suggestions to conduct a staffing analysis to be able to
assess these vacancies and what is really needed in terms of
numbers to support communities across the country, quite
frankly.
So I am just wondering if there have been those staffing
analyses done for Ventura County. I think there is one thing we
can all agree on is that we are under-staffed and we don't have
enough professionals here in the county to meet the demand. But
have we done any kind of analysis to know? You said you were
going to double the staff. I wasn't quite sure when you said
when we were going to double the staff.
Ms. Beiter. We will be up to six full-time FTE for mental
health care by the end of this month.
Ms. Brownley. By the end of this month.
Ms. Beiter. We have the last person coming on February
24th.
Ms. Brownley. Okay. So is that an additional four more FTEs
that are coming on by the end of the month?
Ms. Beiter. No. One came on in the beginning, in January,
and we have another one coming on February 24th, and Dr. Flynn
is increasing his hours, and that will bring us to six total
FTE for mental health, and that is just for the mental health
component.
Ms. Brownley. Right, right. So have you done any sort of
analysis to know? Is that going to be adequate, do you believe,
for----
Ms. Beiter. We think it is adequate for today, and we think
that using PC3 and doing some contracts, probably by the end of
March we will get to what we think the target should be,
meeting the 14-day requirement for wait times. But I think that
what we are seeing in terms of the growth pattern, we are
probably going to continue to see this grow. So we are going to
have to monitor this very, very closely and stay on top of it
and probably end up having to move some more staff into this
area.
But the big problem I have with that is space, which is why
we have tried to do more tele-mental health. The clinic, we
have actually moved three people out of their offices. One
person is working out of her car right now so that we could
move tele-health and another mental health office in the clinic
that we have.
It is a contract clinic, and the contract is up for renewal
in March. We have already started talking about it. Our plan is
to double the size for mental health and increase some of the
primary care side also.
Ms. Brownley. I can assure you that there is not a space
issue in Ventura County, that if you need additional space, we
will find additional space for you. We have lots of resources
here.
Ms. Beiter. That is great.
Ms. Brownley. And we will absolutely provide--if we need
additional space, we will find additional space.
On the patient-centered community care, I have a similar
deep interest in this, as the Chair does, because it doesn't
matter whether we are in Washington or here in Ventura County,
the one consistent thing is veterans want services that are
closer to home and in their community. It is a consistent cry
for help, and I do believe that if we effectively move forward
with this patient-centered community care that we can
accomplish that.
I am sure that from your vantage point, as you said, West
L.A. is very large. You have a large area to service. It is
very complex. Is there a particular plan specifically for
Ventura County, as it would be for Kern County and other
counties that you are responsible for?
Ms. Beiter. Absolutely. We started meeting in January on
this, and----
Ms. Brownley. Working in West L.A.?
Ms. Beiter. Within GLA at the executive level, talking with
TriWest in terms of what our overall needs are. Of course, the
areas that we are looking at, Oxnard is a very important area
because of our wait times, which we find unacceptable, and we
are really trying to do anything we can to get those wait times
down.
So what we have talked to them about is providing
outpatient substance use disorder treatment, inpatient
substance use disorder detox, inpatient mental health
hospitalization, and then contracting with providers.
I just actually heard yesterday morning that there are 15
mental health providers already on contract with TriWest. So we
should be able to immediately start working with those. But
even if we don't have a contract, the way it is set up we can
do it very quickly.
So I feel very encouraged between getting ready to do a new
contract for space and having this possibility, and at the same
time we are starting the Jabber technology. We are working on
that right now, very soon. We are estimating by the end of
March our wait times will be down to our standard, because they
are unacceptable at this point and I really want to admit that.
It really is unacceptable.
Ms. Brownley. Well, I am glad to hear that you are focused
on that, because the wait times are way too long.
But I would certainly like to invite you to the community
so that there could be some collaboration in your planning and
implementation of community care, because I think again we have
a large military collaborative, lots and lots of providers and
resources that I know would love to have your attention, and I
think there could be some great collaboration and we could find
probably some economies of scale and some efficiencies towards
making that happen. So I would certainly like to see if we
could begin to have that kind of conversation and implementing
that.
Ms. Beiter. Yes, absolutely. I totally agree with you. I
mean, we do have some good community partnerships already going
on in Ventura County, but clearly, listening to the first
panel, we have a lot more that we can build on.
Ms. Brownley. Yes, and I think that could be just the
beginning of a longer conversation, and I think that that would
be really terrific.
Just in terms of the suggestions from the previous panel,
just an intake person at the Oxnard facility, and also this
whole issue with the new contract, the VA contract with Aurora
Vista del Mar, which is great, but can we bring the intake here
locally for that rather than having to travel all the way to
West L.A.? Is that a possibility?
Ms. Beiter. I think that we absolutely need to look into
that as a possibility, because I think as we start working with
these contracts we really have to make sure that we are
coordinating what we are doing. So I am very happy to take a
look at that and see why we couldn't do that.
Dr. Benishek. Is there any reason why you couldn't just do
it? I mean, apparently there was somebody at one time, and now
they are not there. So why can't we just commit to making that
happen?
Ms. Beiter. We probably can just do it.
Dr. Benishek. Can you commit to making that happen?
Ms. Beiter. I think so. I think we can commit to that, yes.
Dr. Benishek. Okay.
Ms. Brownley. Thank you, Mr. Chair.
So in terms of alternative therapies, I think our one
witness who talked about our equine therapy here, I have been
there, and it is really an extraordinary program. So I am
wondering, from your vantage point, I know the VA is on a
broader basis looking at alternative therapies. I think the
West L.A. facility is looking at alternative therapies. How can
we better partner with Reins of H.O.P.E. here, that is
extraordinary, that we can have a better partnership with the
VA?
Ms. Beiter. Well, I think we can absolutely do that. As you
know, we are a Center of Innovation, and we have focused on
integrative health and healing modalities, and I am personally
very passionate about that, being a nurse. What we are really
trying to do as we move forward in our new programming in the
VA is really offer our veterans choices, because certain
therapy will work for one and not necessarily for another.
So we are really trying to expand the choices that our
veterans have, and we have really tried to do that at West L.A.
for the VA, actually. We are one of their pilot sites to really
implement a lot of those programs. And the success we have had
and the satisfaction from our veterans is just unbelievable,
and it makes you want to do more and more.
We are just ruling a lot of these out now to our CBOCs.
Part of our Oxnard issue has been space.
Ms. Brownley. We can solve that problem.
Ms. Beiter. But I really do believe that--actually, we had
some plans to do some things in Oxnard in April. But listening
again to the panel, I think there are even much more
partnerships. And I firmly believe as we move forward in health
care, it is really going to be about community partnerships and
really leveraging each of our resources to the best that we
can, for our veterans.
So I am very supportive of that, and I think we can do lots
of follow-up with all of the community partners.
Ms. Brownley. Well, that would be great, and I concur with
your statements. I think the tele-health is a good option, and
I think it will be very, very helpful for some, not all.
Ms. Beiter. Exactly.
Ms. Brownley. I always stand sort of fearful that this is
going to be the panacea and the solution that is going to fill
in the gaps, but we have to have a variety of services to meet
all of the individual needs and what our veterans are going to
be most comfortable participating in.
Ms. Beiter. I totally agree with that.
Ms. Brownley. The Veterans Court here, I would love to
invite you to come out and see what is happening there. It is
extraordinarily successful. I know that there are other models
throughout the State of California and across the country.
Again, I think this is a great safety net that the community
provides, and everyone who is involved, including Ms.
Twoombley, who participates in that, volunteers their time to
do that.
Again, I think this is an extraordinary place for
partnership because they are open and willing to service many,
many more, and they work as a collaborative team. They are
looking at the individual, trying to put the resources
together. It is this team approach. But we could really use
resources and help to expand upon that now. It is a completely
voluntary effort now. It would be extremely helpful. I would
love for you to come and see actually what takes place there.
Where am I? Am I okay with time?
Dr. Benishek. We are over, so don't worry about it.
Ms. Brownley. Okay.
Dr. Benishek. Could I ask a couple of questions?
Ms. Brownley. Okay, you ask.
Dr. Benishek. Ms. Beiter.
Ms. Beiter. Yes?
Dr. Benishek. You mentioned that you are going to meet this
14-day goal at the end of March. What is happening now?
Ms. Beiter. With the new providers that we have just hired,
we will be able to fill up their panels, and we are also going
to be looking at some PC3 providers. But we think with the
staff that has come on board--and maybe Dr. Flynn can even
address that--we feel we will be able to get very close, if not
right on there, and we are going to continue to look at that
and monitor it, because our goal is to get within our VA
standard by the end of March.
Dr. Benishek. Well, maybe at the end of March you can
update the committee on where you are at. That would be
appreciated.
Ms. Beiter. We can do that.
Dr. Benishek. Okay?
Ms. Beiter. Okay.
Dr. Benishek. I have a question for Ms. Twoombley is it?
Ms. Twoombley. Twoombley.
Dr. Benishek. Twoombley. You work at the Vet Center, then?
Ms. Twoombley. Yes, Chairman.
Dr. Benishek. What is your staffing situation?
Ms. Twoombley. We have four full-time counselors, a full-
time outreach worker, one part-time outreach worker, and an
office manager.
Dr. Benishek. I mean, how are your wait times? Do you need
more staff? What is the situation?
Ms. Twoombley. We are actually adding one more staff member
within the next probably three months. The wait time for--we
are very fortunate. The wait time for our clients right now is
three to five days for intake.
Dr. Benishek. Okay. Well, got to go to a couple of vet
centers in my district, and it is a little bit different from
the VA hospitals. It is a separate thing, and I know it was
managed by VA. I was so pleased by the atmosphere there. There
were guys that had actually been through the problems helping
other veterans.
Ms. Twoombley. Yes, sir.
Dr. Benishek. That, to me, is a really great----
Ms. Twoombley. It is the same here.
Dr. Benishek. Yes, it is a really great setting, I think.
So I just want to be sure that you feel as if you are getting
enough. I think your funding is different----
Ms. Twoombley. We are part of the VA. Our funding is a
little bit different. Right now, our staff is--again, we are
increasing. We have plans to increase our space in Fiscal Year
2014 or 2015, and we will be able to offer Tai Chi, yoga, and
things like that within probably, hopefully a year, a year-and-
a-half, which would be more alternative things for our center.
We offer a variety of groups----
Dr. Benishek. What would it take for you to incorporate
something like equine therapy? Who approves that kind of stuff?
I am not familiar with it myself, but how is that application
so you can actually refer somebody to them?
Ms. Twoombley. Well, that is a great question, Mr.
Chairman. We actually refer to Reins of H.O.P.E. currently, and
we refer to Operation Healing Waters, which is a similar group.
It is a fly-fishing group. So we do refer to those kinds of
alternatives.
Dr. Benishek. Okay. All right. Thanks.
I am going to yield back to Ms. Brownley for any final
questions she may have.
Ms. Brownley. Well, I just wanted to follow up on one line
of questioning, too. If you would just comment a little bit on
what your outreach looks like for your facility.
Ms. Twoombley. Okay. Our full-time outreach worker actually
is here. I just want to point him out. He is an Iraqi vet, and
he goes to a variety of outreach events. He partners with the
community colleges, with the universities. He partners with the
Navy base, with the wing. He attends events at--help me out
here, Isaac.
Ms. Brownley. Whenever I am out, I see him.
Ms. Twoombley. Yes, he is at all events. So he is out there
trying to get the word out that we do provide services for
combat veterans and for veterans who have experienced military
sexual trauma, that we provide post-traumatic stress groups,
all kinds of different help for them at the Vet Center.
Thank you for acknowledging him.
Ms. Brownley. Very good.
Well, I think most of my questions have been answered, and
I am very excited about the prospect of having had this meeting
as a starting point of a conversation and continuing that in
terms of how we can better partner here with all of the
resources that we do indeed have here, and the partnerships I
think that can be developed with the VA, and the partnership on
outreach and addressing some of the very specific issues that
were raised here today in terms of intake at the Oxnard
facility, the Aurora Vista del Mar issue, and seeing the plan.
You had mentioned that there is a specific plan for the area.
If you could share the plan with me, I would appreciate that.
I would just like to begin the work and scheduling some
time where we can continue this meeting and have our community
providers here, and we can further the conversation and I think
create some better partnerships here and service our veterans
in a better way, and that is why we are all here.
I certainly do thank the VA for their work and help.
Sometimes it might sound like we are being overly critical. We
don't mean to, because we know that you are equally as
committed to servicing our vets, and I think the collaboration
is really the key to our future success, and we all want to
continually improve until we know that we are servicing our
veterans in the very best way possible.
Do you have concluding----
Dr. Benishek. I have a few things to say.
Ms. Brownley. Okay. Great. Thank you, Mr. Chair.
Dr. Benishek. I think that is the last of the questions.
The panel is excused.
Thank you to all our witnesses and to the audience members
for joining today's conversation. It has been a pleasure for me
to spend the morning here in Southern California with you all.
I hope that the VA staff here today will listen to the
comments of the first panel and incorporate a lot of their
ideas going forward. We have a few inquiries we will expect
some answers to in the future.
With that, I ask unanimous consent that all members have 5
legislative days to revise and extend their remarks and to
include extraneous material.
Without objection, so ordered.
Dr. Benishek. This hearing is now adjourned.
[Whereupon, at 11:50 a.m., the subcommittee was adjourned.]
APPENDIX
Prepared Statement of Kimberly Evans Logie, LMFT and Military Spouse
I am Kim Evans Logie, Military Spouse and licensed Marriage
and Family Therapist. My husband has served 24 years in the
military, been to multiple combat deployments as an active duty
and reservist. We recently spent almost two years getting his
rating and enrolled with VA. I am one of the leading mental
health experts in the state of CA in regards to Military and
Veteran mental health. I have trained over 1300 CA mental
health professionals on military mental health issues and have
briefed over 8000 service members and their loved ones on pre
and post deployment issues.
I have worked extensively with Active Duty, National Guard
and Reserve components as a TriWest embedded therapist, Joint
Family Support Assistant Program (JFSAP) Military Family Life
Consultant (MFLC), Director of Psychological Health (DPH) for
the Air National Guard and Purple Camp Therapist to name a few.
Last year I spent 4 weeks at Lackland Air Force Base under
federal subpoena as a defense witness FORCED to testify against
one of my Airmen who had been sexually assaulted. I am
currently the Coordinator for the Ventura County Superior Court
Veterans Treatment Court and the Director of Ventura County
Military Collaborative. I have had the distinct pleasure of
serving the men and women of the US military both pre and post
deployment and know well the mental health issues associated
with combat service and military sexual trauma.
In Ventura County we use a combination of inpatient,
outpatient, alternative treatments and homegrown community
based support to help our veterans.
For outpatient clinics and services we utilize:
The Ventura Vet Center for combat, substance abuse and
MST veterans
The VA contracted clinic in Oxnard for psychiatric and
mental health treatment
The VA at Sepulveda
The Vet Center at Sepulveda VA
For inpatient services we utilize:
The Domiciliary, Haven, New Directions etc. at West LA
VA
The Pathway Home at Yountville: a privately funded
facility, which does phenomenal work and is free for veterans.
We do have a PTSD unit at a local psychiatric
hospital. Aurora Vista Del Mar just received a VA contract but
we are being told that intake and referral will have to come
through West LA VA. This may make the use of our local facility
prohibitive. Most of our veterans would not be able to drive to
LA for intake, due to transportation and/or medical issues.
The alternative forms of treatment in our local area are:
The Soldiers Project which provides free military
mental health
Reins of Hope a leader in equine assisted therapy
Healing in America using energy healing to help
veterans
Crisis Intervention Team (CIT) training for our local
law enforcement officers in dealing with military and veteran
issues.
Ventura County Military Collaborative which has over
140 agencies (government, non-profit and VA contracted) working
together to create a safety net of care for military, veterans
and their families through a variety of modalities.
Ventura County Veterans Treatment Court providing wrap
around services and treatment vs incarceration and is making
profound strides in helping veterans by utilizing local
agencies through the Collaborative.
These services are funded primarily through grants. The
Ventura County Military Collaborative operates without any
funding at all relying on volunteers, donated meeting space and
a community that doesn't hesitate to support it. In addition,
the Collaborative produces the MilVet Expo, a free yearly event
focused on bringing services to active duty, national guard,
reservists, veterans, retirees and their loved ones. This event
is produced with zero dollars and the gracious support of
community partners.
The role traditional and alternative forms of therapy play
in veterans recovery process:
Without proper and coordinated mental health care I have no
doubt that the men and women who serve our great nation would
end up in situations much worse than we are currently seeing.
Our service members and their families are tired, they are
scared and they are proud. Consistency, training and knowledge
of community resources are imperative for all clinicians
working with veterans. Consistency is essential to building
trust, which is a hallmark of successful mental health
treatment. This is the bare minimum needed to aid those men and
women who have given so much.
I would like to point out that the VA is doing some great things:
We have Paul Gaines, our local homeless outreach
representative, who I believe never sleeps. He is everywhere in
Ventura county interfacing with many community agencies and law
enforcement to help find veterans in need of shelter and mental
health/substance abuse treatment. He takes these veterans to
West LA VA for inpatient services.
Greg Cain is our Jail Outreach Coordinator and a key
player at the Ventura County Veterans Treatment Court. He works
24/7 to get our local Vets into beds at West LA VA. He speaks
with family members, public defenders, district attorneys and
anyone else who will listen about the wide array of services
for veterans.
Charles Green is the face of VA for many of our
National Guard and Reservists. He arranges clinics and
briefings to help enroll our local service members and answer
their questions while they are still in the military.
The obstacles we face:
Lengthy waits at our local clinic for psychiatric and
mental health services. I had to refer an Airman back to San
Francisco VA for a medication refill as the wait was over 4
months to see a Psychiatrist at the Oxnard clinic.
No outreach from our local VA clinic. All outreach and
support comes from West LA VA.
Veterans completing an inpatient program at West LA VA
with no apparent coordination of care for their return to
Ventura County.
The need for more localized services through grant
funding and/or support from the VA.
Creating a sense of community with our local vets when
their treatment may involve multiple facilities at multiple
locations.
Having been involved with military mental health since 2003
I am so impressed with what we have accomplished. The stigma
that was so prevalent when I first started has disappeared in
most units, especially those who have embraced an embedded
therapist model. I am proud of the work that we have done and
it has made a difference! We are saving lives.
I thank you for your time and for your caring about those
who have given so much.
Prepared Statement of Lyndsey Hale
Our Greatest Generation Veterans--Health/Psyche/Social
Needs
Good day, my name is Lyndsey Hale, I am a Military Spouse,
the 2nd Vice for the American Legion Auxiliary unit 741, a
Ventura County Military Collaborative Board Member, and a
Veterans Liaison for a hospice provider.
Regarding mental health and resources for our veterans it
is especially meaningful for those veterans who left comrades
on the field of battle as they enter their senior years or near
end of life.
There is a quote from Will Rogers that goes, ``We can't all
be heroes, some of us have to sit on the curb and clap as they
go by.'' Although in more recent years we do our share of
``clapping'', recognizing and honoring our veteran, we need to
do more to provide the resources and support for our veterans
in regards to mental and spiritual health particularly as they
near end of life.
I know that we do not see ourselves as a ``warrior''
nation. However, over the years we have been thrust into
numerous conflicts during which we have always had those
willing to answer the call of their country. Many of those
never returned alive.
There are over 21 millions living Veterans, 45% of which
are over 65 years old according to www.census.gov.
As a Military Spouse, daughter of a Vietnam era veteran,
and granddaughter of WWII veterans, I am humbled to be able to
speak in regards to the need for resources and support for our
veterans of any age, and particularly to advocate today for our
elderly veterans. In the American Legion Auxiliary outreach and
in working in hospice I hear many stories from veterans that
they have never told or not brought up in years. These veterans
of war are holding memories of horrors one, like myself, who
has not seen battle, can comprehend.
I was speaking to a WWII veteran, a Pearl Harbor Survivor,
who told me he had three times been spared his life during WWII
while he watched his comrades in arms die. While he had to pick
up their remains and count the bodies . . . He told me that the
third time his life was spared he was on a ship at sea and had
just left his post to run back to the galley for coffee . . .
while he was in the galley the ship was attacked. Later as he
was walking the ship with a Lieutenant, and pulling dog tags of
those that had been killed he came to his post where he should
have been, and there in his place was the lower half of a mans
body . . . the man covering his seat was litterly cut in half
by the explosion from the torpedo that hit the ship. He said he
started laughing hysterically at this point as he just lost it.
His Lieutenant then slapped him in the face to bring him back
to reality . . . This WWII hero told me he would never forget
those images and that now as he is in his late 90's they come
to him more and more.
This is just one of many stories I have heard. Other
stories involve questions and remorse for those they may have
killed in battle . . . These WWII veterans wonder what will
come of their souls as they leave this life. I believe our
veterans often just need to get these stories off their chests
. . . things they have never spoken of to anyone for fear of
the judgment that would follow. I can't tell you how many times
I have heard a spouse say, yes he served in the War, but he
never talks about it. PTSD is a common term these days that we
are trying hard to address and assist our returning troops
with. I personally have had many a friend come home in recent
years broken from war. We need to continue to support and grow
our resources for our military and veterans of recent war. In
saying that, we can not forget the veterans of our past wars
such as our WWII vets. They came home to a nation as heroes,
yes, but there was no diagnosis for their mental well being,
there was no `PTSD' support . . . often they just stifled it,
at times self medicated and moved on. The bonus for this WWII
and Korean Conflict generation was that many of our men and
families were touched by it or involved directly in it and so
they had comfort in numbers. However, as this tough proud
generation ages they have questions and fears they have never
been able to address.
As an American Legion Auxiliary Member I know that our
American Legionnaires & Auxiliary members are constantly
seeking better ways to reach out to our Veterans and get them
information on programs such as the We Honor Veterans Program,
the `Spirit of '45, movement, resources such as the local
VetCenter and County Veterans Service Office to help bring
support to our greatest generation, but we need more awareness
and support in our health care community and the general
public. I ask you today to help find a way to reach out to our
Greatest Generation veterans and let them know there are
support and resources for them too and that it is okay to talk
about their time in the service.
Thank you for your time and attention to these matters and
your work on making a difference in the lives of our Veterans
and families.
Lyndsey N. Hale
Prepared Statement of Julie Sardonia
Chairman Benishek, Ranking Member Brownley, and
Distinguished Members of the Subcommittee:
On behalf of Reins of H.O.P.E.(Human Opportunity Partnering
with Equines) as its Founder and Executive Director, I offer
gratitude for the chance to share information on our Equine
Assisted Psychotherapy Program, H.O.P.E. for Warriors, serving
our active duty service members, veterans, reservists and their
families.
Reins of H.O.P.E. was established in 2006 as a non-profit
serving Ventura County's at risk youth population. Our tool:
Equine Assisted Psychotherapy and Learning sessions (EAP). Our
client roster has grown steadily each year since, as has the
number of sessions offered.
All of our Licensed Mental Health Therapists and Equine
Specialists are trained and certified by EAGLALA, Equine
Assisted Growth and Learning Association. As the world's
largest and most professionally respected association for this
kind of psychotherapy, EAGLALA sets the global standard for
care. It has more than 4,000 members in 49 countries and has
certified the staff of over 600 treatment programs. They have
established The EAGLALA Military Services Designation, which
ensures that practitioners complete specialized training in
order to have cultural fluency in the military community.
Though equine assisted psychotherapy is a relatively new
discipline, EAGLALA is committed to building a body of
evidence-based, peer reviewed research. For a listing of
research and studies please visit: www.EAGLALA.org/research.
The EAGLALA model, [Ret] Col. Jimmy L. Walters affirmed,
``uses the horse to gain insight into behaviors and
perceptions. The horses' reactions provide unbiased, real time
feedback, breaking through the barriers that many military
members experience in conversations with others who cannot
begin to understand what we feel . . . Equine assisted
psychotherapy provides a strategy for dealing with trauma in a
way that makes sense to military service members.''
In January 2011, Reins of H.O.P.E. launched the H.O.P.E.
for Warriors Program to provide active duty service members,
veterans, reservists, and their families with no cost,
unlimited, confidential EAP sessions to fill the increasing
need for vital, readily accessible mental health services. We
offer individual, groups, families, couples, overnight retreats
and team building sessions. This popular program accounts for
80% of our non-profit clinical hours and continues to grow.
Reins of H.O.P.E. sessions take place on the ground in
outdoor settings. No riding is involved. Sessions with the
horses allow exploration of thoughts, feelings, and behaviors
and foster trust, resilience, adaptability. These inevitably
lead to better problem solving, improved communication, and
healthier relationships. Many clients have told us that our
arena and horses have created the only space where they feel
safe to talk about their military experiences and issues. These
clients connect naturally with horses since, like us, horses
are herd animals whose survival depends on constant
communication. Yet unlike humans, horses, as prey animals, must
stay constantly vigilant. Extraordinarily sensitive to their
surroundings, they can sense emotional energy around them and
often mirror it. They are therefore catalysts for insights on
patterns of thought and behavior. They also offer clients the
experience of a new way of being. Powerful yet gentle, these
animals are effective ambassadors of nature as well as apt
teachers in awareness--that is, being in the present moment,
calming oneself quickly, setting appropriate boundaries and
learning to trust--coping skills key to healing and living a
healthy lifestyle.
The H.O.P.E. for Warriors Program takes head-on issues of
transition, reintegration, depression, PTSD, suicide, MST,
substance abuse, anger, grief and loss.
At Reins of H.O.P.E., our goal is to increase the awareness
of Alternative Treatment Modalities, such as Equine Assisted
Psychotherapy in the mental health community. But we need the
recognition from the VA that alternative therapies are
effective and an appropriate level of care for our veterans. In
order to reach and help heal our increasing veteran population
we pride ourselves in our collaborative and adjunctive form of
therapy that we provide with our referral base organizations
such as, Fleet and Family Services from US Navy base Ventura
County, Aurora Vista del Mar Hospital Military Program, Ventura
Vet Center, FOCUS, Oxnard Family Circle Veterans Program and
SART.
Since 2011, the H.O.P.E. for Warriors Program has conducted
over 684 clinical hours and serviced over 530 equine sessions
at no cost, funded solely by our broad-based community donors,
foundations and grants. It is our intention and mission never
to turn away a veteran in need of mental health services. We
seek a collaborative relationship with the VA and their mental
health providers to fulfill our mission: to provide our
veterans with a vital program.
A few of our clients' voices join mine:
Josette Wingo, WWII Navy Wave: ``Equine Therapy at Reins of
H.O.P.E. is a warm, validation program which can have an almost
instantaneous effect on returning veterans who might be dealing
with PTSD or . . . other trauma. These difficulties often
impede readjusting and [a] return to their best lives. In the
short time I have been participating, I realize how being with
the gentle, intuitive horses and their calming effects can have
life changing possibilities.''
Retired Col. George Compton, US Army (Advisory Board
Member): ``I am an absolute believer in the H.O.P.E. for
Warriors Program. Without this program we'd have more veterans
in jail and in trouble.''
David Parker, Retired Master Sergeant E-8 US Army: ``This
program has been a positive influence in my life. I have
learned healthy coping skills to finally deal with my anger
management issues. It has changed my life for the better.''
Larry, Vietnam veteran: ``I don't associate very well with
other people and when we go out to the horse program it allows
me to relax enough to be able to communicate with people
freely. I feel like I am worth something instead of a piece of
trash. I am very impressed with their program and would like to
see it expand more to help other vets. They really care.''
Rebecca, US Army Bronze Star Iraq Veteran: ``Participating
in the INNPower Retreat for women veterans I found friendship
and a safe place to fall when it's really needed, which I have
not found since I left active duty. A lot of women soldiers
feel forgotten.''
Sarah Hedge, Active duty Seabee, 2nd class petty officer:
``I attribute my healing process of PTSD to the relationship
with the horses and the specific activities which helped me
gain my life back. I am off all antidepressants, sleeping meds
and alcohol . . . I am happy.''
Sir Winston Churchill once said, ``There is something about
the outside of a horse that is good for the inside of a man.''
Thank you for the opportunity to present our Reins of
H.O.P.E. Program. It is our honor to serve and give back to our
service members, veterans and their families who have fought
for our Nation's freedom. I invite you to come up to Ojai as
did Congresswoman Brownley to experience firsthand how our
horses are healing heroes with honor.
Respectfully Submitted,
Julie Sardonia, M.A., LMFT,
Founder/Executive Director
Prepared Statement of Mike McManus, Veterans Service Officer, Ventura
County Human Services Agency
Good morning, Chairman Benishek, Ranking Member Brownley,
and Members of the Committee. Thank you for the opportunity to
provide information to the Committee regarding mental health
care services to Southern California veterans through the
Greater Los Angeles Department of Veterans Affairs (VA)
Healthcare System.
My name is Mike McManus and I am the County of Ventura,
Veteran Services Officer. My staff and I connect fellow
veterans, their dependents, and survivors with federal and
state veterans' benefits and local resources. One of our
primary responsibilities is connecting veterans with VA
disability compensation for such conditions as Post Traumatic
Stress, Traumatic Brain Injury (TBI), and for conditions
resulting from Military Sexual Trauma. We also assist veterans
enroll in VA health care and refer to local and regional
treatment resources.
The Veteran Services Office has five accredited personnel
who interview veterans, file the appropriate benefit claim,
advocate on behalf of the veteran, and make needed referrals to
other service providers. We also have support staff to include
interns that enable us to meet client needs. The Veteran
Services office has conducted a variety of outreach activities
to inform the veteran community about benefits. The office
currently operates out of the main office and nine field
offices to make it as convenient as possible for veterans to
meet us. In Fiscal Year 11/12 the office saw 1,839 people,
however, by Fiscal Year 12/13 office staff had seen 3,572
people (source: VetPro). In FY 10/11 the Veteran Services
Office connected county veterans with 3.89 million dollars in
federal benefit payments, but by FY 12/13, those benefit
payments totaled over 8.75 million dollars (source: California
Department of Veterans Affairs Annual Report to the
Legislature).
I am also a retired Unites States Air Force Senior Master
Sergeant. I spent the last seven years of my 20 years in the
military as a First Sergeant with one deployment for Operation
Iraqi Freedom in 2003. As a First Sergeant I had overall
supervision over all enlisted personnel with my units. I
advised the unit commanders on all matters affecting their
enlisted force to include issues involving mental health and
substance abuse, and those conditions, impact on service
members, their families, their career, and the unit.
Ventura County veterans needing mental health care can
receive treatment from the two psychiatrists and one social
worker at the Oxnard Community Based Outpatient Clinic (VA
clinic). Veterans can also seek counseling from the four
clinicians at the Ventura Vet Center.
Ventura County has over 41,000 veterans, thousands more
National Guard, Air National Guard, and Navy and Marine Reserve
personnel who are eligible for VA mental health care. Navy Base
Ventura County's active duty Navy personnel, who are combat
veterans, can also receive mental health care from the Vet
Center.
In essence you have tens of thousands of veterans and
military personnel in Ventura County and many of these will
seek mental health care from the seven people providing mental
health treatment for the VA.
Clearly there is a large unmet need. The VA clinicians
providing mental health care in Ventura County do an
extraordinary job, there are simply too few of them. As
outreach to the military/veteran community increases from
organizations such as the Ventura County Veteran Services
Office and the Ventura County Military Collaborative, the
number of veterans seeking services increases.
Veterans routinely tell my staff and I, how they can only
see the psychiatrists at Oxnard VA clinic every other month or
in some cases every three months. The option to be seen by a
clinician at Sepulveda exists, however, in many cases we are
referring to combat veterans with Post Traumatic Stress and
driving the I-405 only adds to their stress and anxiety.
Ventura Vet Center staff has done an amazing job trying to meet
the mental health needs of our veterans. However, they are only
four clinicians. I whole-heartedly encourage the VA to add
clinicians to the Oxnard VA clinic and Ventura Vet Center. The
additional clinicians could then provide treatment during
evening hours and on weekends. This will improve access to care
for veterans going to college, recovering from service-
connected injuries, who are employed, etc.
In addition to increasing the number of clinicians at the
Oxnard VA clinic and Ventura Vet Center, the VA needs to
explore partnerships with community programs, resources, and
more quickly assess and adopt alternative mental health
treatments. I would suggest the VA establish contracts with
mental health and substance abuse counselors for inpatient and
outpatient treatment in Ventura County. An example of such
cooperation is the newly awarded VA contract to Aurora Vista
Del Mar to provide treatment for Post Traumatic Stress.
Previously, they treated veterans eligible for Tricare. The VA
contract will now enable a much larger pool of county veterans
to benefit from their services.
In-patient and intensive out-patient resources availability
in Ventura County will greatly benefit the county's veterans.
Programs such as what Aurora Vista Del Mar offers would allow
veterans to remain in Ventura County nearer their support
structures and enable some to continue their employment while
receiving out-patient care. This option would not be
appropriate for all veterans and some would receive treatment
through one of the programs at the VA Medical Center (VAMC) in
Los Angeles. In many instances however, treatment provided in-
county is the option best suited to the veteran. One example of
how the option of in-county treatment could benefit veterans is
through the Ventura County Superior Court's Veteran Court. Vet
Court focuses on treatment, not incarceration, of our combat
veterans with service caused Post Traumatic Stress, Traumatic
Brain Injury and the resulting behavior problems, substance
abuse issues and run-ins with law enforcement. Currently, most
veterans in Vet Court needing in-patient or intensive out-
patient treatment go to the VA Medical Center in Los Angeles.
Ventura County veterans deserve the option to receive in-
patient and intensive out-patient treatment in their home
county. We have high hopes for the Aurora Vista Del Mar program
offering these options.
Partnering with other non-VA service providers to expand
the availability of treatment would greatly benefit our
veterans. We are fortunate in Ventura County to have an equine
therapy program (Reins of H.O.P.E. in Ojai, CA) that has proven
itself invaluable to our combat veterans and others who have
experienced military-related trauma. A VA contract or the
possibility of a quick Fee Basis referral would greatly help
meet the need for mental health treatment.
VA's willingness to assess and accept alternative
treatments is what's called for to help meet the need for care.
A couple of examples in Ventura County are meditation therapy
and farming. Healing in America (Ojai, CA) offers its
meditation services as a way for veterans to heal. In addition,
Veteran Farmers of America (Ventura, CA) is developing a
program and has experienced promising early results that have
shown the benefits of their farming intern program.
The VA should actively solicit data on the effectiveness of
complimentary and alternative therapies so they can provide
access (contract, Fee Basis referral, etc) for veterans needing
mental health care. Alternative therapies in conjunction with
VA provided care need to work in concert with one another to
meet veterans' needs. Our veterans have earned such care.
Thank you again for this opportunity.
Points of contact from organizations reference above:
Aurora Vista Del Mar, Dr. Pilar Sumalpong, Ph.D., 805-653-
6434 ext. 205, [email protected]
Reins of H.O.P.E, Julie Sardinia, 805-797-5539,
[email protected]
Healing in America, Roger Ford, 805-640-0211,
[email protected]
Veteran Farmers, Mary Maranville, 805-746-0606,
[email protected]
Prepared Statement of Donna Beiter, Director, Greater Los Angeles
Healthcare System
Good morning, Chairman Benishek, Ranking Member Brownley,
and members of the Committee. Thank you for the opportunity to
discuss the VA Greater Los Angeles Healthcare System's (GLA)
commitment and accomplishments in providing Veterans high
quality, patient-centered care and being a leader in health
care transformation; specifically, by improving mental health
outcomes and access to mental health services and programs. I
will begin my testimony with an overview of GLA and then focus
on our comprehensive mental health programs.
Greater Los Angeles Healthcare System Overview
GLA is accredited by The Joint Commission and is one of the
largest and most complex facilities within VA. We serve
Veterans throughout Kern, Los Angeles, San Luis Obispo, Santa
Barbara, and Ventura counties. GLA is located in West Los
Angeles, California with large ambulatory care centers in
downtown Los Angeles and Sepulveda; Community-Based Outpatient
Clinics (CBOC) located in Bakersfield, Gardena, East Los
Angeles, Lancaster, Oxnard, Santa Maria, Santa Barbara, and San
Luis Obispo; and a clinic in development in the San Gabriel
Valley. In fiscal year (FY) 2013, GLA treated 86,438 Veterans
with 28,070 receiving care in our mental health programs. Since
the beginning of Operation Enduring Freedom/Operation Iraqi
Freedom/Operation New Dawn (OEF/OIF/OND), GLA has enrolled
20,696 Iraq and Afghanistan Veterans, with over 9,700 Veterans
treated in FY 2013. Of the Iraq and Afghanistan Veterans
treated in FY 2013, 30 percent received care in our mental
health programs.
GLA has been involved in several major redesigns of our
health care programs over the last few years, particularly by
completing the move to a new patient-centered primary care
delivery model called Patient Aligned Care Teams (PACT). A PACT
team is comprised of a medical provider, nurse care manager,
and a clinical and administrative coordinator, all of whom care
for and assist the Veteran with navigating his or her whole
health experience. The team focuses on engaging Veterans in
their own care by helping Veterans identify and set goals, and
by teaching them skills they can use to improve their health.
The PACT team works together to ensure access and communication
with the Veteran and coordination with the rest of the health
care organization and the Veteran's local community. Along with
and consistent with the overall PACT model, primary care-mental
health integration has been an integral part of primary care at
GLA with mental health providers embedded in primary care
settings. Additionally, GLA has implemented both general tele-
health and also tele-mental health services to Veterans in our
catchments area.
As a leader in health care transformation, GLA has been
designated a National Center of Innovation for Patient-Centered
Care. The focus of our Center of Innovation is to develop and
spread integrative health and healing alternative initiatives,
such as Tai Chi, acupuncture, mindfulness-based stress
reduction, guided imagery, and breathing/stretching/relaxation
exercises. Our plan is to continue to expand these initiatives
as a standard part of care for all Veterans at all GLA sites
utilizing tele-technology, Web based platforms, and train-the-
trainer approaches. Our plan is that these alternative care
therapies will be available at the Oxnard, Santa Maria, and
Bakersfield clinics by April 2014.
GLA has implemented new innovative strategies in the area
of eliminating Veterans' homelessness. GLA collaborates with
numerous community partners to end homelessness among Veterans,
such as Los Angeles City, Los Angeles County, the Department of
Housing and Urban Development (HUD), Public Housing Authority,
and many other community partners. A 28 percent reduction in
Veterans' homelessness in LA City and LA County between 2010
and 2012 was achieved through these successful community
partnerships. We continue to target the most chronically
homeless Veterans with a focus on getting the most vulnerable
Veterans off the streets and into permanent housing using a
Housing First approach.
Mental Health Care
Mental health services at GLA are unified under an
interdisciplinary Mental Health Care Line (MHCL). GLA's MHCL is
expanding its implementation of the Recovery Model which is
patient-centered, empowers Veterans, and works with Veterans to
attain the highest level of independent functioning possible
for each Veteran. GLA provides an extensive range of mental
health outpatient services at three major sites (West Los
Angeles, Los Angeles Ambulatory Care Center, and Sepulveda
Ambulatory Care Center) as well as the eight CBOCs.
Comprehensive treatment programs for substance use
disorders are available at the three major sites, including
intensive outpatient programs based on the Matrix Model (a
cognitive behaviorally-oriented approach) as well as Opiate
Treatment Programs (methadone maintenance or Suboxone
treatment). The Harm-Reduction Model is also utilized at the
three main campuses. Alcohol detoxification is available for
homeless Veterans at the West Los Angeles campus. Negotiations
are in the final stages to make inpatient detoxification
services available to all Veterans (including non-homeless
Veterans and Veterans withdrawing from drugs other than
alcohol) at a community-based facility in the GLA basin through
the TriWest contract program as part of VA's Patient-Centered
Community Care (PC3) initiative. GLA is also in the process of
developing a partnership with Kern County Mental Health to
provide inpatient detoxification for Veterans who are enrolled
in the Bakersfield Clinic. GLA will be making substance use
disorder treatment, inpatient mental health treatment, and
specialized outpatient mental health treatment available to
Veterans at northern CBOCs through the PC3 program, and
contracts are being negotiated with TriWest. This will help
Veterans who live at a distance from the three major campuses
obtain these services closer to their homes.
In addition to comprehensive substance use disorder
treatment, GLA offers an extensive array of traditional and
non-traditional mental health services. Services include
evidence-based pharmacotherapy and evidence-based psychotherapy
for the treatment of a very wide range of mental disorders
including post-traumatic stress disorder, anxiety disorders,
mood disorders (including depression and bipolar disorder) and
schizophrenia. Among the evidence-based psychotherapies that
are available are cognitive behavior therapy for depression,
acceptance and commitment therapy for depression, cognitive-
behavior therapy for insomnia, prolonged exposure therapy and
cognitive processing therapy for post-traumatic stress
disorder, and social skills training for patients with serious
mental illness, such as schizophrenia. GLA mental health staff
have been trained in a number of other evidence-based
psychotherapies as well, integrated behavioral couples therapy,
motivational interviewing and enhancement, and problem-solving
therapy consistent with VA's evidence-based therapy initiative.
In addition, as described earlier, complementary and
alternative medical practices such as mindfulness-based stress
reduction are incorporated into many mental health clinics and
programs.
Primary Care-Mental Health Integration (PC-MHI) has been
available to Veterans at the West Los Angeles Medical Center
since its inception in 2007 and at the Sepulveda Ambulatory
Care Center, where the emphasis is on giving patients same-day
access when needed and close collaboration with primary care
providers to promote both mental health and medically-healthy
behaviors. PC-MHI has recently become available at the Los
Angeles Ambulatory Care Center campus and is in the process of
being implemented at the Santa Maria, Oxnard, and Bakersfield
CBOCs. GLA currently has two Veterans Transition Centers/Post-
Deployment Clinics where mental health services are provided to
OEF/OIF/OND Veterans in an integrated primary care setting at
the Sepulveda and West Los Angeles sites. Separate clinics for
meeting the mental health needs of female Veterans are
available at the three major sites in primary care settings.
Inpatient mental health care is provided at the West Los
Angeles Medical Center where there are currently 45 operational
inpatient beds available to Veterans who are in need of acute
inpatient care due to the severity of their mental health
condition.
GLA also has a long-established Domiciliary Residential
Rehabilitation Treatment Program, which has 296 operational
beds. The Domiciliary is located at the West Los Angeles
Medical Center and serves Veterans from all GLA facilities as
well as from other VA facilities in Veterans Integrated Service
Network (VISN) 22 (e.g., VA Southern Nevada Healthcare System
in Las Vegas). The Domiciliary offers residential treatment
programs for Veterans who have experienced post-traumatic
stress disorder (PTSD), for Veterans who are homeless, for
Veterans with substance use disorders, and for Veterans who are
attempting to return to competitive employment. Our Domiciliary
also can accommodate Veterans who prefer to receive care in a
single-gender setting.
Oxnard Mental Health Clinic
As Veteran demand for outpatient mental health appointments
has grown, GLA has strived to build capacity and keep up with
the demand at the Oxnard Mental Health Clinic. Staffing and
space issues have posed limitations, and we have deployed a
number of strategies to keep up with demand and meet our
patients' needs. Since October 1, 2013, each week approximately
eight to ten new Veterans are seen for mental health services
at the Oxnard Clinic. Additionally, we provide care to 1,152
established mental health patients for whom we provide ongoing
care. To improve access and increase our capacity for mental
health services at the Oxnard Clinic, we have brought on
additional mental health providers, including permanent, fee
basis, and locum tenens providers. With the addition of these
new mental health providers, we will meet current demand.
A limited number of offices are available in the current
space at the Oxnard Clinic, and as demand for mental health
care services grew, office space became increasingly
insufficient. In preparation for the upcoming contract
renegotiations, mental health space will be more than doubled.
In the interim, we consolidated other clinical work and moved
two administrative staff out of a shared office to increase the
mental health working space to five individual rooms and one
group room.
One of the innovations to increase capacity at the Oxnard
Clinic is the expansion of clinical video tele-mental health.
This technology allows Veterans to come into the clinic and see
a mental health provider who is based at a distant site. This
fiscal year, tele-mental health providers have provided care to
100 unique patients in the first quarter, FY 2014 alone,
whereas they provided care to a total of 155 unique patients
during the previous year. Staffing for Oxnard tele-mental
health is currently the equivalent of a 0.5 full-time
equivalent (FTE) remote provider. We have also been part of a
VISN project with our partners at the VA San Diego Healthcare
System to offer evidence-based intensive psychotherapy to
Oxnard patients via tele-health at the Oxnard Clinic with
expert providers located in San Diego. Currently, we are
developing an implementation plan to deploy Jabber, one of VA's
latest innovations where patients who need counseling can be
evaluated from their homes on their own personal computer
screens.
Our process of electronic consultation allows review of the
specific Veteran's needs and referrals electronically and
telephonically, as appropriate. Some patients' needs can be met
through email with the primary care provider on the same day or
through a phone call. Veterans can be seen at any VA facility
if they have an urgent need, and if they choose to travel
(potentially with reimbursement or via VA transportation). In
cases where we have fallen behind in timeliness, we have
offered this option to Veterans in Oxnard, and they have been
seen sooner at Sepulveda or Santa Barbara. So far this year, we
have received 246 consults, which are new, returning, or
multidisciplinary (to psychology, psychiatry, and social work).
We are actively scheduling these patients with the new staff
recently brought on board.
Oxnard Homeless Veterans/Veterans Justice Outreach Program
Ending Veterans homelessness is a national initiative
involving VA, HUD, Federal, state, local authorities, and
community partners. In Oxnard, the HUD-VA Supportive Housing
voucher program and Homeless Outreach team have been focusing
on connecting homeless Veterans to VA services. The Homeless
Outreach team is also connected with the Veterans Justice
Outreach Program. We are in preliminary discussions with the
courts to bring Veterans out of jail and into homeless
programs. Veterans need to participate and successfully
complete a treatment program and take the needed steps to
return to productive lives to demonstrate to the Judge their
desire to turn their lives around and become productive
citizens. Successful completion of their program is an
alternative to incarceration and results in charges being
stayed or dropped. We are exploring potential substance use
disorder treatment programs for homeless Veterans to support
their recovery process. Currently, we have fee-basis funding
for Veterans who need substance use disorder treatment or other
residential mental health treatment in Ventura County. In the
near future, we will have TriWest contracts through PC3 for
community programs appropriate for Veteran care.
Mental Health Performance Metrics
VHA has developed many metrics to monitor performance in
the delivery of mental health services. These monitors include
the following:
1) Patients who are discharged from acute inpatient mental
health treatment should receive follow up contact within 7
days. VHA's goal is that 75 percent of Veterans in this
category should have such contact within 7 days. Through the
first 4 months of FY 2014, GLA has successfully contacted 86.5
percent of Veterans discharged from acute inpatient mental
health treatment for follow up within 7 days of discharge.
2) Qualifying Veterans should have a Mental Health
Treatment Coordinator (MHTC) assigned to them. VHA's goal is
that 87 percent of qualified Veterans should be assigned an
MHTC. GLA had 89.6 percent of qualifying Veterans assigned to
an MHTC as of December 2013.
3) OEF/OIF/OND Veterans diagnosed with PTSD are expected to
have eight evidence-based psychotherapy sessions, an approach
to therapy supported by research findings where the findings
provide evidence that is effective, over a 14-week period.
VHA's target is 83.3 percent of Veterans will receive eight
sessions in a 14-week period. Although in first quarter, FY
2014, GLA was at 57 percent, the December 2013 data was at 86.8
percent.
4) In FY 2013, VHA redefined access measures for new and
established (i.e., received mental health care in the last 24
months) Veterans in mental health care. For Veterans who have
established mental health treatment, VHA tracks the percentage
of Veterans who are able to schedule an appointment within 14
days of their desired date, which is VHA's goal. The FY 2014
target for this is 95 percent. During this fiscal year, GLA
MHCL has achieved that goal 96.8 percent of the time. At the
Oxnard CBOC, the goal is met 91 percent of the time.
5) For Veterans who are new to mental health care, the GLA
tracks VHA's goal of having Veterans complete an initial
appointment in 14 days or less from when they made the request
for the appointment. VHA's target is 70 percent. Targets were
adopted in roughly November of 2013 after reviewing the
baseline performance in 2012. The Access and Clinic
Administration Program (ACAP) and Office of Informatics and
Analytics (OIA) were asked to suggest targets. VHA analyzed
performance levels, variation, trends, and used standard
methods (methods used to establish other targets) to arrive at
the current goal levels. For FY 2014, the GLA MHCL has provided
this level of access 56 percent of the time and 40 percent of
the time at the Oxnard Clinic. VA intends to add new staff to
improve these percentages and decrease wait times for
appointments over 45 days. Any Veteran in crisis presenting to
the CBOC or calling in is seen immediately.
Ventura County Community Partnerships
GLA and the Oxnard CBOC make use of multiple community
programs and resources. This includes many different faith-
based and non-profit programs. VA believes it is vitally
important that we network with our community partners in the
delivery of health care. These community partners have been
strong allies in our efforts, and we appreciate their
contributions to our Veterans' health and welfare.
Suicide Prevention
GLA has three full-time Suicide Prevention Coordinators
(SPC) located at the West Los Angeles, Sepulveda, and Santa
Maria sites. The SPCs provide ongoing information, education,
and consultation to GLA administrators, leaders, and staff
regarding policy related to suicide prevention and risk
reduction, including the identification and assessment of risks
for suicide, safety planning, follow up, and engagement in care
and crisis/emergency responses. SPCs also respond to national
Veterans Crisis Line referrals, aggregate suicide data with GLA
and VISN 22 VA facilities, participate in root cause analyses
of suicide-related events and Environment of Safety rounds, and
provide regular outreach to state and community agencies, local
colleges, Veterans Service Organizations, and health, safety,
employment, public affairs, and military-related events.
Conclusion
VHA, GLA, and the Oxnard Clinic are committed to providing
high-quality care our Veterans have earned and deserve, and we
have continued to improve access and services to meet the
mental health needs of Veterans. We appreciate the opportunity
to appear before you today and the resources Congress provides
VA to care for Veterans. My colleagues and I are happy to
respond to any questions you may have.
Statement of The American Legion, United States House of
Representatives, Health Subcommittee of the Committee on Veterans'
Affairs, Field Hearing on ``An Examination of Veteran Access to
Traditional and Alternative Forms of Mental Health Therapy'', February
20, 2014
Tim Hecker joined the Army at 18 and soon decided to make a
career of it. He served 22 years in all, in and out of combat,
rising to the rank of master sergeant. In the summer of 1990,
he married his high-school sweetheart, Tina, and the couple had
three children.
Then Tim couldn't remember having married Tina. He couldn't
tell his sons apart. Their names escaped him. Injuries suffered
in two separate roadside-bomb explosions in a span of two
months in Iraq in early 2008 left him with a traumatic brain
injury and severe post-traumatic stress. He was no longer the
man Tina had married.
Frustrated with her husband's descent and the lack of
progress with traditional care, Tina went online and found
information about hyperbaric medicine. Following a phone call
and an initial interview, Tim was selected to be part of a
pilot study on the use of hyperbaric oxygen therapy (HBOT) for
Traumatic Brain Injury (TBI) and Posttraumatic Stress Disorder
(PTSD). He claims the treatments have given him back most of
his pre-injury life.
``By the fourth treatment, I started feeling like a new
person,'' he says at his home in West Edmeston, NY. ``I was
more aware. I could see things. The deeper I got into the
treatments, my cognition started to come back--my motor skills
and my balance. My vision started to improve. The biggest
benefit was my emotional control.''
``We're talking a 180-degree turn around,'' Tina says.
``There are days when he's almost back to normal with his
personality.''
The preceding story is a condensed version of one of the
many veteran stories The American Legion encountered while
researching and compiling The War Within, \1\ a landmark
report published by The American Legion to highlight the
findings of the TBI and PTSD Committee founded in 2010. It is
illustrative of the possibilities presented by one of many
potential alternative therapies for some of the emerging wounds
of modern warfare, TBI and PTSD. As veterans struggle to cope
with these conditions, sometimes alternative therapies offer
solutions traditional therapies cannot provide. For this reason
The American Legion believes the Department of Veterans Affairs
(VA) must be at the forefront of cutting edge care, to include
alternative therapies, if they are to truly serve the veterans
who suffer from the modern wounds of war.
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\1\ http://www.legion.org/publications/217301/war-within-treatment-
traumatic-brain-injury-and-post-traumatic-stress-disorder
---------------------------------------------------------------------------
Background
The American Legion has continued to be concerned with the
unprecedented numbers of veterans returning from the wars in
Iraq and Afghanistan suffering from TBI and PTSD, categorized
as the ``signature wounds'' of these conflicts. The American
Legion believed that all possibilities should be explored and
considered in an attempt to finding treatments, therapies, and
cures for TBI and PTSD to include alternative treatments and
therapies and they need to make them accessible to all
veterans. If these alternative treatments and therapies are
deemed effective they should be made available and integrated
into the veterans' current health care model of care.
As a result The American Legion established the TBI and
PTSD Committee in 2010 comprised of American Legion Past
National Commanders, Commission Chairmen, respected academic
figures, and national American Legion staff. The committee is
focused on investigating existing science and procedures as
well as alternative methods for treating TBI and PTSD that are
not being employed by the Department of Defense (DoD) and VA
for the purpose of determining if such alternative treatments
are practical and efficacious.
During a three year study the committee met with leading
authorities in the DoD, VA, academia, veterans, private sector
mental health experts, and caregivers about treatments and
therapies veterans have received or are currently receiving for
their TBI and PTSD symptoms. As a result of the study, the
committee released their findings and recommendations in a
report titled ``The War Within.'' ``The War Within'' report
highlights these treatments and therapies and also identifies
findings and recommendations to the DoD and VA.
Key Highlights and Findings of the Report
Some of the critical findings of The War Within included:
Most of the existing research for the last several
years has only validated the current treatments that already
exist--VA and DoD research is not pushing the boundaries of
what can be done with new therapies, merely staying within an
environment of self-confirmation bias.
There seems to be a lack of fast track mechanisms
within DoD and VA to employ innovative or novel therapies--a
standardized approach to these therapies could help service
members and veterans gain access to care that could help them.
While some VA Medical Centers (VAMCs) do offer
complementary alternative medicine (CAM) therapies, they are
not offered in a consistent or uniform manner across all 152
VAMCs nationwide--VA struggles with consistency and needs
better guidance.
In addition to those findings, the TBI and PTSD Committee made some
recommendations for the way forward:
Congress needs to provide oversight and funding to DoD
and the VA for innovative TBI and PTSD research that is being
used successfully in the private sector health care systems
such as hyperbaric oxygen therapy, virtual reality exposure
therapy, and non-pharmacological treatments and therapies. \2\
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\2\ Resolution #108: Request Congress Provide the Department of
Veterans Affairs Adequate Funding for Medical and Prosthetic Research
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Congress needs to increase DoD and the VA research and
treatment budgets in order to improve the research, screening,
diagnosis, and treatments for TBI and PTSD.
DoD and VA need to accelerate their research efforts
in order to effectively and efficiently diagnose and develop
evidence-based TBI and PTSD treatments.
Continued Efforts
The American Legion's efforts to assess the care and
treatments available for veterans suffering from TBI and PTSD
are not limited to the efforts of the TBI and PTSD Committee.
In 2003, The American Legion established the System Worth
Saving Task Force to conduct ongoing, on-site evaluations of
the Veterans Health Administration (VHA) medical system.
Annually, System Worth Saving visits provide Legionnaires,
Congress and the public with an in-depth, boots on the ground
view of how veterans are receiving their health care across the
country.
Over the last several years, the System Worth Saving
reports have examined the full spectrum of VHA care, but
specifically have noted several things about how VHA delivers
on complementary and alternative medicine (CAM) in their
facilities.
VA medical centers throughout the VA health care system are
committed, dedicated, and compassionate about treating veterans
with TBI. Many medical centers throughout the country have
found successful complementary and alternative methods for the
treatment of TBI and PTSD such as hiking, canoeing, nature
trips, equine, and music therapy. \3\ While some systems like
the El Paso VA Healthcare System offer several CAM solutions,
such as yoga, guitar lesions, sleep hygiene and other
practices, other locations such as the Pittsburgh VA and
Roseburg VA Healthcare System are more limited, offering only
acupuncture in Pittsburgh, and acupuncture for pain management
through the fee basis program in Roseburg. \4\
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\3\ 2011 SWS-``Transition of Care from DoD to VA''
\4\ 2014 SWS-``Past, Present and Future of VA Health Care''
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In addition to the ongoing System Worth Saving Task Force
visits, The American Legion is taking the lead for veterans by
aggressively pursuing the best possible treatment options for
veterans on multiple fronts.
Hearing From Veterans About Their Treatment
On February 3, 2014, The American Legion launched a TBI and
PTSD survey online in order to evaluate the efficacy of the
veterans' TBI and PTSD care, treatments, and therapies and to
inquire if they are receiving and benefiting from CAM treatment
offered by the DoD and VA. The survey will assist The American
Legion to better understand the experiences of veterans who
receive care throughout the VA health care system.
William Detweiler, Past National Commander and Chairman of
the TBI and PTSD Committee stated, ``The American Legion is
very concerned by the unprecedented number of veterans who
suffer from these two conditions . . . We firmly believe that
both VA and DoD need to act aggressively in adopting all
effective treatments and cures, including alternatives being
used in the private sector, and make them available to our
veterans nationwide . . . By completing this survey, veterans
across America will have the opportunity to tell the true story
of the types of care and treatments that they are actually
receiving for PTSD and TBI. The survey will greatly help The
American Legion in its efforts to advise the Administration,
Congress, DoD, VA on the best possible care and treatments for
these injuries.''
The survey is available online at: www.legion.org
Symposium
On May 21, 2014, The American Legion is hosting a TBI and
PTSD Symposium entitled ``Advancing the Care and Treatment of
Veterans with TBI and PTSD.'' The symposium aims to discuss the
findings and recommendations from the TBI and PTSD veteran's
survey, hear directly from service members, veterans, and
caregivers on their TBI and PTSD experiences, treatments and
care, and determine how the Administration, Congress, DoD and
VA are integrating complementary and alternative treatments and
therapies into current models of veterans' health care.
Conclusion
As America progressed through the first decade of the 21st
century as a nation at war, an evolving understanding of the
nature of the wounds of warfare emerged. As understanding of
the wounds of war continues to emerge, veterans must be
reassured that the care they receive, whether serving on active
duty in the military, or through the VA Healthcare system in
their home town, is the best treatment available in the world.
To combat the physical and psychological wounds of war,
sometimes the old treatments are not going to be the most
efficacious.
Just as new understanding about the nature of these wounds
emerges, so too must the new understanding about the best way
to treat these wounds continue to adapt and evolve. Veterans
are fortunate to have access to a health care system designed
to treat their wounds, but that system must recognize that
different treatments will have differing levels of
effectiveness depending on the individual needs of the wounded
veteran. There is no silver bullet. There is no single
treatment guaranteed to cure all ailments. With a national
policy that respects and encourages alternative therapies and
cutting edge medicine, veterans have the best possible shot to
get the treatment they need to continue being the productive
backbone of society their discipline and training prepares them
to be.
The American Legion looks forward to working with the
Committee, as well as VA, to find solutions that work for
America's veterans. For additional information regarding this
testimony, please contact Mr. Ian de Planque at The American
Legion's Legislative Division, (202) 861-2700 or
[email protected].
Letter From Ventura Vet Center
February 25, 2014
From: Team Leader, Ventura Vet Center 10RCS/4B-0643
Ventura Vet Center, 790 E. Santa Clara St. #100,
Ventura, CA 93001,
(805) 585-1860 and Fax (805) 585-1864
To: Honorable Dan Benishek and Honorable Julia Brownley
Subj: Supplemental Remarks to Congressional Field Hearing
Chairman Benishek and Congresswoman Brownley:
The following information is submitted as an extension to
my remarks at the 20 February 2014 Field Hearing addressing
Veteran Access to Traditional and Alternative Forms of Mental
Health Therapy in Camarillo, California.
Scheduling Veterans for Intakes: Veterans seeking
counseling services at the Ventura Vet Center are normally
scheduled for an intake appointment within 3-5 days, as stated
in the remarks at the Hearing. However, if the Veteran is a
walk-in to the Vet Center seeking initial services, a staff
member will spend time with them to gather initial information
and to schedule an appointment for an extended intake. The
staff member can also identify the Veteran's eligibility and if
they are not eligible, make an appropriate referral. If the
Veteran calls the Vet Center to make an initial appointment and
no clinical staff is available to speak to them, the Veteran
will receive a return call the same day. The Vet Center has
recently (January 2014) expanded their hours to include evening
hours 3 nights a week (Monday through Wednesday), until 2000,
and Saturdays from 0800 to 1630.
Outreach: The Ventura Vet Center has access to one of 70
Mobile Vet Centers that are stationed across the United States
and is another tool utilized in outreach efforts. The Mobile
Vet Center is a standalone RV unit that includes a counseling
room to accommodate privacy at Outreach Events. One of the
Mobile Vet Centers is normally used by our Vet Center at larger
outreach events.
Marriage and Family Therapists: Testimony of one of the
witnesses during the hearing stated that the Department of
Veterans Affairs (VA) does not hire Marriage and Family
Therapists. I am a Licensed Marriage and Family Therapist and I
am an employee of the VA (one of many within Readjustment
Counseling Services.) VA Handbook 5005/41, Part II, Appendix
G42 was updated 28 September 2010 and outlines the basic
requirements for employment as a Veterans Health Administration
Marriage and Family Therapist, which are prescribed by statute
in 38 U.S.C. Sec. 7402(b)(10), as amended by section 201 of
Public Law 109-461, enacted December 22, 2006.
Thank you for the opportunity to supplement my remarks to
the Field Hearing.
Respectfully Submitted
Jane Twoombley, LMFT
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