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Partnerships, Collaborations Help Heal Veterans

Soon after researchers and military leaders realized the rising rates and damage of traumatic brain injury and post-traumatic stress to Afghanistan and Iraq combat Veterans, they responded.

Scientists worked to detect the biological disruptions in the brain triggered by combat injuries, and they identified a host of physical and mental conditions linked to the invisible wounds of war. In turn, researchers and health care providers implemented innovative programs to help heal Veterans.

At the same time, military leaders improved mental health assessment tools for troops and developed prevention programs for traumatic brain injury (TBI) and post-traumatic stress (PTS). They elevated mental fitness to the same level of importance as physical fitness, and made strides in breaking a stigma that still prevents many military personnel and Veterans from seeking care for combat-related stress.

But researchers, military leaders, and policymakers are not content to rest on their laurels. Instead, they confront the realities for Veterans today and look ahead to challenges and potential solutions.

At the October 15, 2015 eighth annual The Brain at War conference, sponsored by NCIRE—The Veterans Health Research Institute, General George W. Casey, Jr. offered the stark reality: Of the 2.5 million U.S. military who served in Iraq and Afghanistan, more than 50,000 have been wounded and some 500,000 have traumatic brain injury or post-traumatic stress—or both.

And if the history and length of ideological conflicts are a lesson, “we’re closer to the beginning of the struggle than to the end,” said Casey, who was Chief of Staff of the U.S. Army from 2007 to 2011 and is widely credited with restoring and transforming a war-weary Army.

”This really puts the challenge, not just on the VA, but on all of us, as a country,” said Casey.

Conference keynote speaker The Honorable Matthew S. Collier, Special Executive for Strategic Partnerships at the Department of Veterans Affairs, said the number of Veterans seeking health care is increasing. That is fueled, in part by the aging Veteran population, more than a decade of recent war, higher survival rates of the wounded, and more sophisticated methods for identifying and treating Veterans’ medical issues.

“Veterans’ demands for services and benefits have exceeded VA’s capacity to meet it,” said Collier, a West Point graduate who served as an infantry officer in the Army.

Mr. Collier was brought to the Office of Veterans Affairs by Secretary Robert McDonald to find creative solutions. Now, Collier leads a strategic partnerships program with a mission of “leveraging resources external to the VA on an effective and consistent basis” to improve the Veteran experience.

Collier noted that the “gold standard” for establishing partnerships is NCIRE, whose key collaborators include the San Francisco Veterans Affairs Medical Center (SFVAMC), the University of California, San Francisco (UCSF), and the Department of Defense (DOD).

In the last several months, the new MyVA program has met with more than 100 different organizations and companies to connect them to various VA experts, said Collier. As a result they have established several partnership agreements, including: a $4 million pilot project with the national Elks Lodges to address Veterans’ homelessness in Washington DC, Chicago and New York City; a mental health hospital collaboration with the Wounded Warriors Project in Los Angeles, Atlanta, Chicago and Boston; and a collaboration with Team Rubicon, which teams Veterans and first responders who provide emergency and disaster relief.

Around the country, firms committed to public service benefit Veterans by offering expertise and resources. At The Brain at War conference, Sarah Hardin, who leads the Deloitte & Touche Corporate Citizenship program in Los Angeles, discussed a partnership with the University of Southern California’s Center for Innovation and Research on Veterans and Military Families and the Los Angeles Veterans Collaborative.

The groups are collaborating on the nation’s first large-scale comprehensive survey of Veterans needs and services, which will inform policymakers of the steps needed to resolve critical issues for Veterans. “It lights the way to better understand our Veterans’ needs even before they become an issue for the Veteran,” said Hardin. Deloitte will start a similar study and project in 2016 in San Francisco and Chicago, she said.

Veteran support groups and Veterans themselves certainly understand the value of partnerships. Conference speaker Justin Constantine, Marine Lieutenant Colonel (Ret.), was shot in the head in 2006 by a sniper while on routine combat patrol. During his remarkable recovery, he benefited from the care of many Veterans groups, and, today, he is committed to the Veterans’ cause as an inspirational speaker, advisor and team builder.

An attorney as well as decorated war Veteran, he is on the board of directors of several organizations, including the Wounded Warriors Project and Give an Hour, which develops national networks of volunteers to provide mental health counseling for troops, Veterans, and families affected by the post-9/11 conflicts.

Many of these services and resources weren’t available a decade ago, said Constantine. But as he visits communities across the country, he still sees a critical need for physical, mental and social care for Veterans and their families. He said the lessons on collaboration learned at The Brain at War will be helpful to Veterans organizations with which he is affiliated.

At the conference, SFVAMC and UCSF researchers discussed partnerships that have led to new technologies and treatments for some of the most common and troubling conditions suffered by combat Veterans, including tinnitus (ringing in the ears), chronic pain, and sleep disorders. Scientists are finding that the roots of these conditions – sometimes linked to TBI and PTS – lie deep in the brain. Experts -- ranging from neuro-radiologists and psychiatrists to surgeons and otolaryngologists -- now collaborate in multi-disciplinary clinical studies to help Veterans who are struggling with these conditions.

Phiroz Tarapore, SFVAMC staff physician and UCSF assistant professor of neurological surgery, described TRACK-TBI, an NIH-funded study of some 3,000 patients with mild to severe brain injuries at 11 research sites in the U.S. Clinical, imaging, proteomic and genomic data are collected to build a “precision medicine” approach to TBI and a knowledge network for those studying and treating TBI, said Tarapore.

In addition to the some 125,000 post-9/11 Veterans with TBI, some 1.7 million people in the U.S. seek care for TBI in the U.S., and one-third of all injury-related deaths are caused by TBI. TRACK-TBI is supported by government, academic, private companies, non-profits and philanthropic partners. The project ties into a larger initiative, which includes the National Institutes of Health, Department of Defense, the Canadian Institutes of Health Research, and the European Commission.

“This is an international, collaborative effort, involving hundreds of partners all over the world,” said Tarapore. “This is no different from how we solve other complex problems.”

The challenges facing today’s combat Veterans are complex. Researchers, health care providers, military leaders and Veterans advocates are among many segments working to heal the physical and mental wounds of combat Veterans. These essential sectors, however, must share knowledge and reach out for wider expertise and resources. 

Wide, creative and bold collaborations are needed to return health and well-being to Veterans and their families.  And speakers at the 2015 Brain at War conference offered examples and roadmaps for fruitful partnerships.

LINKS to videos from the 2015 The Brain at War are available HERE.


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