The Membership Organization of State Offices of Rural Health
Multifaceted Educational Outreach to Improve PTSD Care of Rural Veterans – Mary Bernardy
Working with Rural Veterans – SORH Successes – Adams and Merrell
NOSORH Rural Veterans Health Guide for SORH
Have you considered how to make simple steps to working with your VHA resource center or VISN in your region? If you’ve thought about it but aren’t quite sure how, a new resource guide is designed just for you. The new guide was developed as part of a contract with the VHA Office of Rural Health and is now available on the NOSORH website here. The new guide provides information for SORHs on VHA resources, facts about the health needs of veterans, ideas for partnerships and best practices, and Top 10 suggested activities that SORHs can engage in to address the health care needs of rural veterans. We’re planning a webinar in May to review the guide and share SORH examples of SORH VHA collaboration; stay tuned for more information about the webinar. Later this year, an environmental scanning tool will be released to help SORHs assess rural veteran resources.
If you’d like to learn more about projects the VHA ORH has funded around the nation, check out the 2012 National Rural Health Day presentation on Cultural Awareness While Serving Rural Veterans, which provides an overview of projects.
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Back to April Branch
If rural veterans are going to get more access to good care, there must be more collaboration between the Veterans Administration and non-VA providers, according to Gloria Vermie, Director of the Iowa State Office of Rural Health (IA SORH). To aid in that effort, Vermie has worked to develop a collaborative relationship between her Office and the Veterans Rural Health Resource Center-Central Region, (VRHRC-CR) located in Iowa City.
“Maybe because my dad was a veteran, it has kept it upfront for me,” Vermie said. When the Iowa City VA got a grant from the Veterans Health Administration’s (VHA) Office of Rural Health to be a resource center for the central region of the United States, Vermie contacted them. “I spent some time talking with them about rural health care in Iowa and about Critical Access Hospitals. I put them on my distribution list, and they invited me to meetings.” Since then, Vermie has been to meetings where she was one of the few non-VA people in attendance, and where she has served as a guest panelist speaking about rural Iowa.
The result of the collaboration, Vermie said, is that the SORH has a better understanding of VA resources, and the VA has a better understanding of rural Iowa and non-VA resources, as well as the barriers rural veterans may face in getting the care they need. For example, Vermie said, “if a veteran goes to a rural hospital and not a VA hospital, the rural hospital may not get paid. Also if an ER physician calls the VA for medical records on a veteran that has just come in, they can’t always get those records.”
The Co-Managed Care Toolkit, developed by the VRHRC-CR, helps to address such communication issues. The toolkit provides a set of resources and tools to help non-VA providers navigate the VA system when they have a patient who is seeing both a VA provider and a non-VA provider. Vermie recommends that CAHs and RHCs download the toolkit and put it in a binder. “I wish I could get it to all of them right now,” she said. The toolkit is for all non-VA providers, whether in the Central Region or not.
Additionally, the IA SORH has been involved and has supported VRHRC-sponsored trainings and community resource fairs, veterans’ foster care and mental health initiatives. “When they contacted me and said they were sponsoring a community resource fair on non-VA resources in the community, I recommended they provide information on dental care for children, including the I-Smile program,” Vermie said. To help the VA get the word out about the VA’s Medical Foster Homes program, the IA-SORH office has hosted webinars about it.
“Not all SORHs are involved with the VA—yet every state has veterans,” Vermie said. “I sensed there was a huge chasm that needed to be crossed between VA and non-VA providers tobetter coordinate our programs. I think the VA is doing huge things, trying to bridge a big divide. The relationship that the IA SORH has had with the VRHRC-CR has resulted in both groups continuing to move forward. I think it has been enlightening for them and us.
Through a federal grant program, the Alaska State Office of Rural Health (AK SORH) is expanding telehealth technology and mental health services for veterans in the state. Alaska is one of three states (including Montana and Maine) awarded $300,000 for the second three-year cycle of the Flex Rural Veterans Health Access Program; (it was awarded funds in the first program cycle as well). The program is part of an ongoing collaboration between HHS and the Department of Veterans Affairs (VA) towards implementing an information infrastructure for rural health. “The federal mandate is to provide access of care closer to home and develop increased collaboration between the VA and local providers,” according to Tracy Speier, Health and Social Service Planner and RVHAP Director at the AK SORH.
Speier said that the focus on veterans is important in Alaska because the state has the number one veterans population, per capita, in the country. And telehealth is essential in a frontier area like Alaska, Speier said, because there is no road system in much of the state–most of its towns are accessible only by boat or small aircraft or, in the winter, snowmobile or dogsled. Speier gave an example of a veteran in a rural community in Southeast Alaska who has been getting care at a VA clinic in Anchorage. A one-hour visit there required three days of travel due to airline schedules-one day to travel to Anchorage, one day for her appointment, and one day to travel back. “I don’t think people realize how vast Alaska is,” Speier said. “Now through telehealth, she can meet with her counselor through video conferencing technology.”
In the last year and a half, the AK SORH has developed a telehealth network from the ground up in seven rural, remote communities in Southeast Alaska; trained 150 community-based providers on military culture PTSD, TBI and military sexual trauma in Juneau, Anchorage and Fairbanks; sponsored VA-approved PTSD treatment training to 19 behavioral health providers; and trained health administrators from non-tribal community health centers, Community CAH, and CMHC state-wide on how to do business with the VA. “This develops an increased collaboration between the VA and rural clinics in order to increase access to and quality of care for veterans in rural communities,” Speier said. “This could be duplicated in other areas with a commitment by the VA to work with non-VA clinics.”
Over the next three years, the AK SORH plans to work to identify veterans who are enrolled in public assistance programs in the state, to help them access VA and other benefits. “It has been challenging to identify veterans in need of services,” said Pat Carr, AK SORH director. “Many providers don’t ask people if they are veterans.” The AK SORH plans to use the PARIS (Public Assistance Reporting Information System) system in this effort. Carr said that other states that have worked with their public assistance agencies to implement this model “have saved significant funding.”
NOSORH hosted a Learning Community Call on Working with Rural Veterans on September 26th (in which Speiers described the Alaska program). Click here for a recording.
Incorporating Veterans into Rural Health Employment (J. Perimutter)
Alaska State Office Widens Outreach to Rural Veterans – The Branch: November 2013
Iowa SORH Works for Rural Veterans Through Collaboration with VHA – The Branch: August 2013