veteran community partnerships fy 13 annual report

Ve t er a n C om mun i t y Pa rt n ersh i p s F Y 1 3 A n n ua l R ep ort

V e t e r a n C o m m u n i t y P a r t n e r s h i p s F Y 1 3 A n n u a l R e p o r t 1

Overview

Department of Veterans Affairs is the largest integrated healthcare system in the United States. Yet streamlined coordination of access to healthcare services for Veterans can still be a challenge. The facts are:

• Currently, there are over 23 million Veterans in the United States, nearly 9 million Veterans are enrolled in VA, and over 6 million of these access and utilize clinical VA services and supports.

• Most enrolled Veterans are “dual-users,” meaning that they access both VA and non-VA services and programs in order to meet their health and support needs.

• 79% of enrolled Veterans have an additional type of health insurance in addition to their VA benefits.

From these statistics alone, it is clear that there is a great need for strong and healthy partnerships to be developed and nurtured among VA and community providers, agencies and service organizations, in order to ensure the provision of the coordinated quality healthcare that Veterans and their families deserve.

To address that goal, a Veteran-Community Partnership (VCP) can provide an innovative, flexible, relevant and useful initiative to assist a VA facility establish and nurture community partnerships to facilitate access to and coordination of the broad spectrum of healthcare needs of Veterans and their families.

Veteran-Community Partnership is a model of collaboration developed by the VHA’s Geriatrics & Extended Care Services to assist Veterans’ seamless access to, and transitions among, the full continuum of non-institutional extended care and support services available in VA and the community. Veterans and their caregivers are the primary stakeholders and targets of VCP efforts. Although originally developed to foster enhanced continuity of care for elderly Veterans, the VCP model is applicable to the full range of Veteran populations, and can be tailored to address specific issues, populations, topics or programs.

At its core, a VCP is a coalition of Veterans and their caregivers, Department of Veterans Affairs (VA) facilities, community health providers, non-governmental organizations, individuals, and agencies working together to support Veterans, their caregivers, and families. The VCP model of collaboration provides a mechanism to integrate knowledge and action for the combined mutual benefit of all those involved.


The goal of VCP is to create a network of support in order to:

• Increase choice and awareness of quality programs and services available for Veterans and their caregivers;

• Educate participants and the community regarding services and supports available to Veterans and their caregivers within and beyond VA;

• Strengthen relationships among VA and local communities and provide support for common goals;

• Promote seamless transitions and coordination of care for Veterans, regardless of the site or source of delivery; and ultimately

• Enhance and improve the quality of care for Veterans.


History and Background

The concept of community collaboration and partnership is neither radical nor new. Expanding on the successful Hospice-Veteran Partnership (HVP) initiative, Geriatrics and Extended Care (GEC) Services established the VCP initiative as part of its strategic plan (approved by the Acting Under Secretary in 2009) to focus on promoting seamless access to and transitions among the full continuum of non-institutional extended care and support services available in VA and the community. In addition, since family caregivers play an indispensable role that is essential to the care and lives of Veterans, caregivers are a primary target of VCP efforts.

During the initial development of the VCP initiative (FY 10 and FY 11), the following three pilot sites were selected and developed to assess the concept’s feasibility and outcomes:

1. VISN 1: Manchester (NH) VAMC 2. VISN 2: Albany (NY) VAMC 3. VISN 11: Battle Creek (MI) VAMC

Within one year of their initiations, each of the three VCP pilots reported overwhelming support from their communities. Each created a viable model meriting broader dissemination. Each VCP had set up a steering committee comprised of VA staff and leaders within community/state organizations. Each established its own unique structure, focus and functions according to the needs identified by its respective community. As one of the VCP Pilot Site coordinators stated,

“ We have humanized VA in this area and torn down many walls and built bridges because of our Veteran Community Partnership. I have more people calling from community organizations to refer Veterans who have never enrolled and accessed their VA benefits. And I have more information about community organizations that can provide quality services for our Veterans and caregivers if not available at VA.”

To continue with the development of the VCP initiative in FY 12 and FY 13, the National Hospice and Palliative Care Organization (NHPCO),because of their long term experience with developing the national HVP initiative and community coalitions across the country, was contracted to work with the VA GEC office. The overall focus of the contract was to apply lessons learned from the pilot experiences to expand and create sustainability for the national VCP initiative.

Specific goals for the VCP initiative, set by its Stakeholder Council (see next page) in FY 13, were to:

• Conduct quarterly national steering committee meetings; • Train twelve new VCP sites;• Develop and disseminate training tools and resources; • Participate in four key national and/or regional meetings/conferences; and • Establish a national “home” for VCP.

This report provides a cumulative summary of the key accomplishments, benefits and challenges of the VCP – and specifically focuses on FY 13 activities and plans for FY 14.


Key Accomplishments

National Stakeholder Council

The engagement and commitment of the VCP National Stakeholder Council established in FY 11 have continued to provide the foundation to bolster and support ongoing development of the VCP initiative. During FY 13, quarterly in-person or virtual meetings were held to refine and follow a strategic plan for VCP. Members of the VCP National Steering Committee are representatives of:

• Disabled American Veterans • National Alliance for Caregiving • VHA Office of Care Management and Social Work• VHA Hospice-Veteran Partnership • Administration for Community Living • National Association for Area Agencies on Aging • Leading Age• Baltimore VA’s Geriatric Research Education and Clinical Center • VHA Offices of Primary Care Services and Operations• VHA Office of Nursing Services• VHA Geriatrics and Extended Care Services• National Hospice and Palliative Care Organization

VCP Development

The original three VCP pilot sites that began in FY 11 offered ongoing inspiration and support for the development of new VCPs. During FY 12, an additional 14 new VCPs were established within VA facilities from VISNs 8 and 11. By the end of FY 13, eight VCPs were established within VA facilities from VISN 6, and one was established in VISN 4.

At the end of FY 13, there are a total of 26 VCP sites:

• Involving six VISNs - 1, 2, 4, 6, 8, 11; • In eleven states (Florida, Illinois, Indiana, Michigan, New Hampshire, New York,

North Carolina, Pennsylvania, Puerto Rico, Virginia and West Virginia); and • Associated with 26 VA medical centers.


VCP Training and Technical Assistance

A VISN-wide training model was created to develop new VCP sites in FY 12. It was continued for FY 13. The VCP training provided the opportunity for two assigned coordinators from each VA facility to learn how to build and establish a VCP within their facility and community. The VISNs targeted for the VCP trainings were selected initially based on the interest and support of their VISN’s GEC leaders. The GEC leadership within each VISN sponsored a one-day in-person training that was facilitated by Dr. Kenneth Shay (VHA Geriatrics and Extended Care Services) and Gwynn Sullivan (NHPCO).

In FY 12, two VISN-wide VCP trainings were held. The VISN 8 VCP training was held in January 2012 and was attended by two representatives from each of seven VA facilities. The VISN 11 VCP training was held in May 2012 and also had two representatives attend from each of seven VA facilities.

During FY 13, a VISN-wide VCP VISN 6 training was held in June 2013 and was attended by two representatives from each of eight VA facilities. Representatives from VA’s newly established Office of Community Engagement and from the VA Rural Health Resource Center—Western Region also attended the training to learn about the VCP training model, its application, and the potential for broader implications in VHA.

Overall, the evaluations from VCP trainings have been positive and repeatedly reflect successful trainee assimilation of the value of building and maintaining internal and external relationships. The average cumulative evaluation score of all three VCP VISN trainings was rated 4.32 (1/lowest - 5/highest scale).

Specific comments in the evaluations included:

• “ I am very excited about this initiative because I feel that this gives the VA an opportunity to integrate into the world of care and not be seen as a giant looking down at others.”

• “ Helped inspire my already established efforts, and it made me feel that I am not alone in integrating VA into communities”

• “ The training was quite informative and it offered best practices and new innovative concepts to forge relationships internally within the VA as well as in the community.”

• “ Well put together. Great toolkit provided.”

• “ Loved that it was interactive rather than PowerPoints.”

• “ Excited about learning more from others and working with the VA partners/community to open communication.”

• “ Very comprehensive. Good tools and modeling of process. Good balance between instruction and discussion.”

• “ Would like more training with the group. Was excellent, presenters were helpful.”


Ongoing technical assistance was also made available for all VCP coordinators through bi-weekly phone meetings and individual meetings as requested. The bi-weekly calls also provided a national networking venue for all the VCP coordinators to share successes, lessons learned and challenges.

Training Tools and Resources

The signature resource for training VCP site coordinators is the VCP Toolkit, initially drafted in FY 11. The Toolkit was updated and revised in FY 13 based on feedback from the VCP coordinators, the VCP Stakeholders Council, and the newly-formed VA Office of Community Engagement (OCE). The revised Toolkit provides step-by-step guidance on forming a VCP and specific materials that each VCP can adapt to use for its own needs. Information from the VCP Toolkit was also adapted for the VA’s Mental Health Summit Toolkit, which was issued by OCE to assist sites fulfilling the early summer pledge to Congress by the Under Secretary of Health that each VA Medical Center would convene a community mental health summit before the end of September.

In addition to the Toolkit, the following additional resources have been created and disseminated to all VCP coordinators:

• VCP logo (available in color or in black /white)• VCP Fact Sheet• Event Planning Guide • Action Plan template • VCP PowerPoint template for VA and community presentations• VCP: VA & Communities Working Together

The VCP Toolkit and other resources are available at www.WeHonorVeterans.org/vcp.

Outcomes

An annual evaluation of the VCP initiative was completed in September 2013; all VCP coordinators were requested to complete an assessment of the project and their progress stemming from the training. Nineteen of the 26 VCPs (73%) completed the assessment. The majority reported that they continue to actively develop a VCP within their respective VA and community. The average time per week that the VCP coordinators reported spending on VCP activities was two hours, with a range of one to four hours.


According to the assessment results, the range of issues that the VCP sites are addressing with their mission and strategic focus were:

• Aging/Geriatrics • Caregiving Support• Access to Services • Mental Health• Dementia• Disability• Homelessness• Healthy Living• Rural Veterans• Returning Veterans

The partnerships that have been generated internally (within VA) and externally (within their communities) are unique to each VCP depending on its mission, strategic focus and established relationships. VA services/programs involved with VCP include:

• Caregiver Support • Voluntary Services• Seamless Transition Program (OIF/OEF/OND)• Hospice and Palliative Care• Care Management/Social Work Service• Geriatrics and Extended Care • Home Health• Home-based Primary Care• Mental Health• Medical Foster Home• Women’s Health• Dementia Care• Nursing• Public Affairs• Volunteer Services• Outreach• Homelessness• And others (depending on the mission and strategic focus)


Community organizations and agencies involved with the VCPs include:

• Area Agencies on Aging• Long term care facilities• County Councils on Aging • State Veteran’s Homes• Local Hospitals• Home Care services• Senior Centers • Disabled American Veterans • Brain Injury Association• Easter Seals• Aging and Disability Resource Centers• Community Mental Health Centers• Nursing & Rehabilitation Centers• Local Counseling Centers (county and private)• Local Legal Aid Offices• Alzheimer’s Association• Hospice• Meals on Wheels• Red Cross • AARP• Universities/colleges• And Others (depending on the mission and strategic focus)

The majority of the VCPs are still in the early phases of development. The main foci of many are to establish and nurture relationships through monthly, bimonthly or quarterly meetings. One-third of VCPs have a formal structure in place with a designated steering committee. Some have designated workgroups in place that focus on specific projects.

The range of activities of the VCPs in addition to regular meetings includes:

• Information sharing between the VA and Community partners• Attending or sponsoring outreach, education events and/or health fairs• Developing collaborative resource materials• Participating in the VA sponsored Mental Health Summits

The benefit that the VCP coordinators report about the VCP initiative that is of most value is developing/strengthening relationships and communication between VA and community organizations and agencies. This outcome has increased VA’s involvement with community activities


and vice versa, and streamlined care to meet the needs of Veterans and caregivers. The VCP coordinators also report increased referrals and improved service plans for Veterans and increased support for caregivers. One VCP coordinator specifically stated that establishing a VCP, “conveyed a message to community providers that VA is open to working with partner agencies, that VA is open to feedback and is invested in improving processes to help Veterans get the care they need.”

The biggest challenge for the VCP coordinators is their limited time to devote to VCP, given their other duties. More time commitment is required at the beginning stages of developing a VCP, in order to engage internal VA partners and recruit external community partners. Once that base is identified, the goal is for all members of the VCP to establish a structure of joint leadership and together, to develop a plan of action so the VA point of contact is not solely responsible. Also, a source of funds to support printed materials, meetings and events would greatly help VCPs gain more momentum.

A second, repeatedly-heard challenge to new VCPs is internal ambivalence toward the activity on the part of other staff within the VAMC whose responsibilities include interface with community organizations and services. For this reason, the VCP toolkit and the VCP trainings emphatically encourage participants to begin their VCP journeys by identifying and then joining forces with like-minded community-involved VA staff within the facility, in order to bring a cross-section of VA perspectives and affiliations to the initial meetings with community partners. It has been a universal experience that the community participants are highly motivated to initiate a proposed VCP; if that enthusiasm and engagement is not matched by VA’s involvement, the initiative starts off under a significant disadvantage.”

For FY 14, the VCPs’ coordinators plan to continue developing partnerships, identifying their strategic foci (often based on a community needs assessment), and then to implement an action plan to match the needs of Veterans and caregivers in their respective communities. Several VCPs are already planning events and developing local resource guides.

National Conferences and Meetings

During FY 13, VCP was featured at the following conferences and meetings:

• Hampton Roads VCP conferences – November 19, 2012 and April 18, 2013 • Hospice Veteran Partnership, VA Special Interest Workgroup monthly meetings• VA Caregiver Support Program Specialists – April 18, 2013• HRSA’s Advisory Committee on Interdisciplinary Community-Based Linkages

– April 22, 2013

In addition, multiple meetings were held with the VA Rural Health Resource Center--Western Region, resulting in development of a collaborative proposal that was then submitted (and approved) for FY 14 Office of Rural Health Funds. Also, multiple meetings were held with Dr. Jennifer Lee and staff from the newly developed VA Office of Community Engagement, resulting in ongoing collaboration and mutual sharing of information and resources.

V e t e r a n C o m m u n i t y P a r t n e r s h i p s F Y 1 3 A n n u a l R e p o r t 1 0

Benefits and Challenges

The progress of the VCP initiative affirms the continuing need for strong and healthy partnerships among VA and community providers, agencies and service organizations to provide coordinated quality healthcare for Veterans and their families. VCP provides a sound mechanism to integrate knowledge and action for the combined mutual benefit of all those involved, and for those for whom they care. Specifically, VCP serves to:

• Enhance and improve the quality of care for Veterans;• Identify programs and services to support family caregivers;• Promote seamless transitions within the continuum of care;• Increase awareness in the community regarding the unique needs of Veterans, VA

benefits and programs;• Educate VA on programs and services in the community; and • Strengthen relationships between VA and community partners.

Another characteristic and strength of the VCP model is that each VCP site is designed so that it can develop its own blend of activities, to best serve the Veterans and caregivers in its area based on its location, resources, and service agencies. This allows more freedom and flexibility for each VCP to develop according to the unique needs of its community.

The challenges of developing a national VCP initiative within VA reflect the same challenges faced by the community VCP: competing priorities and lack of time and resources. A major hurdle that continues to need attention is differentiating and coordinating VCP with complementary yet different VA outreach programs and efforts. Typically, VA-directed outreach programs focus on promoting VA services, but VCP seeks to bring community partners together, to allow the partnership to create its own agenda and activities on behalf of Veterans. Many of the sites are faced with having to reinforce that message within their own facilities, finding creative ways to join together with other VA departments to expand community engagement efforts.

Finding a “national home” for the VCP initiative continues to be an imperative and top priority for longer-term program survival. Since VCP has an established momentum, the plan is to continue to explore sustainability options. For FY 13 and FY 14, VCP is being funded by the T-21 non-institutional long term care initiative. A proposal for ongoing support as part of the transition to sustainment of the New Models of Care/Non-Institutional Alternatives to Extended Care “transformation” that has supported VCP rollout to date includes support for VCP through FY19 received endorsement from VHA’s Office of Patient Care Services; as of the writing of this report, its status is still under consideration by the Under Secretary for Health.


Opportunities

Two major opportunities within VA helped to elevate the VCP initiative within VA this year:

1. The creation of VA’s Office of Community Engagement; and2. Collaboration between VCP and Rural Veterans Outreach Program.

First, VA’s newly developed Office of Community Engagement, spearheaded by Jennifer Lee, MD, a Special Assistant to the Office of the Under Secretary for Health, provided encouraging and welcomed affirmation for the VCP as a national initiative. Dr. Lee attended the VCP VISN 6 training and attended the VCP Stakeholder’s Council FY 14 Strategic Planning meeting. Her involvement has helped to increase the visibility of VCP among VA leadership. Also, VCP is represented on VA’s National Community Partnership Workgroup and is now being highlighted as a model program for the VA in establishing community partnerships. Ongoing collaboration with the Office of Community Engagement will continue for FY 14.

A second opportunity was generated from ongoing meetings with the VA Rural Health Resource Center–Western Region. A joint proposal between the Geriatrics and Extended Care Services (10P4G) and the Veterans Rural Health Resource Center-Western Region received funding (from the Office of Rural Health) for FY 14 to leverage the strengths of both programs, ORH’s Rural Veteran Outreach (RVO) and GEC’s Veteran-Community Partnerships (VCP). The goal of the collaborative project is to facilitate inter-professional and interagency linkages within rural areas in order to improve outreach to Veterans and facilitate optimal utilization and access to both VA and non-VA health and support services by Veterans. Specifically, this project will:

• Implement VCP coalitions in 4 rural communities; • Support planning and implementation of RVO activities (e.g., Benefits Workshop,

Outreach Events) in each community; and • Develop a framework for measuring impact of the project on non-institutionalized

care utilization by Veterans in these settings.

Both of these opportunities provide new venues for expanding the applicability and reach of the VCP model which, in turn, can/will hopefully be adapted to address other key, multisystem issues of Veterans and their families.


Plans for FY 14

With funding secure through FY 14, the plans for VCP are to continue to engage more national partners, create more VCP sites and sustain VCP as a national initiative long term. Based on a strategic planning meeting held with the VCP National Stakeholder Council in September 2013, specific goals for 2014 include:

• Increase partnerships within VA and other non-VA national organizations/ programs;

• Continue training and education efforts of VCP within VA and other non-VA organizations;

• Develop resources to support VCP development and education;• Identify outcome measures for each VCP to track; and• Ensure sustainability of national VCP initiative.

Overall, it is our hope that VCP will continue to grow a sustainable initiative and network that will enhance the quality of care and services for Veterans and their families as well as enlighten communities about our Veterans’ unique needs.


Acknowledgements

The Geriatrics and Extended Care Services would like to express its gratitude to Leadership across the Department of Veterans Affairs and to the programs and individuals below for supporting the important and groundbreaking efforts of the Veteran Community Partnership to improve care for all Veterans and their families. We thank you for your support.

VACO and VISN Offices

• Barbara Hyduke (Office of Patient Care Services)• Jorge Cortina, MD (VISN 6)• Randy Jackson (VISN 6)• Sam Nasr, MD (VISN 8)• Lauren Olstad (VISN 8)

VHA Hospice and Palliative Care Program

• Scott T. Shreve, DO• Christine Cody

VHA Office of Community Engagement

• Jennifer Lee, MD• Lelia Jackson• Nicole Katikos, MHA• Joleen Clark and the Community Engagement Workgroup

VHA Rural Health Western Resource Center

• Nancy Dailey, RN• Bret Hicken, PhD• Randall Rupper, MD• Christopher Turner


VCP National Steering Committee

• Adrian Atizado, Disabled American Veterans • Gail Hunt, National Alliance for Caregiving • Nicole Johnson, VHA Office of Care Management and Social Work• Diane Jones, Ethos Consulting, Hospice-Veteran Partnership • Meg Kabat, VHA Office of Care Management and Social Work• Greg Link, Administration on Aging • Sandy Markwood, National Association for Area Agencies on Aging • Peter Notarstefano, Leading Age• Helaine Resnick, Baltimore Veteran’s Administration Geriatric Research Education and

Clinical Center • Joanne Shear, VHA Office of Primary Care• Brenda Shaffer, VHA Office of Nursing Services• Kenneth Shay, VHA Geriatrics and Extended Care Services• Gwynn Sullivan, National Hospice and Palliative Care Organization

VCP Site Coordinators

VISN 1:

• Kristin Maxwell – VA Medical Center Manchester, NH

VISN 2:

• Ryan Mooney – Albany Stratton VA Medical Center, NY

VISN 4:

• Deborah Goral, Sandra Blakowski, MD – VA Pittsburgh Healthcare System, PA

VISN 6:

• Allison Bond, Charles Cooley – Ashville VA Medical Center, NC• Jim Nelson, Gavin Vanhoose – Beckley VA Medical Center, WV• Christy Knight, Cedric Windley – Durham VA Medical Center, NC• Joyce Hawkins, LaVondra Pye – Fayetteville VA Medical Center, NC • Yvonne Bailey, Jeffrey Pearson – Hampton VA Medical Center, VA• Suzanne Shirley, Samantha Olive-Ghorashi - Hunter Holmes McGuire VA Medical Center, VA• Nancy Short, Ocie Fidler – Salem VA Medical Center• Debra Volkmer, Edwina Gray-Wright - Salisbury - W.G. Hefner VA Medical Center, NC


VISN 8:

• Amy Sapien, Jennifer Fehr - Bay Pines VA Healthcare System, FL• John Mendez, PhD, Katherine Cipriano - Miami VA Healthcare System, FL• Kathleen Mulvehill, Sheila Stacks - North Florida/South Georgia Veterans Health

System, FL• Jose Oscar Rivera, Charlie Antoni - Orlando VA Medical Center, FL• Alfredo Santiago, Idalisse Colon-Ferrer, San Juan- VA Caribbean Healthcare System,

PR• Cindy Clements, Elizabeth Provenzano - Tampa Bay- James A. Haley Veterans’

Hospital, FL• Loretta Cowell, Sandi Karnbach - West Palm Beach VA Medical Center, FL

VISN 11:

• Mary Hyduke-Rundall, Deborah Hinson - VA Ann Arbor Healthcare System, MI• Jim Arringdale, Kirsten Dzialo - Battle Creek VA Medical Center, MI• Amber Mason-Dixon, Mary Ceasar - Detroit- John D. Dingell VA Medical Center,

MI• Emily Sheldon, Debra Bell - VA Illiana Health Care System, IL• Tammy Bolen, Phyllis Beaman - Indianapolis VA Medical Center, IN• Amy Sczerbowicz, Dan Bishop - VA Northern Indiana Health Care System, IN• Anne Milko-Delpier, Julie Csongradi - Saginaw VA Medical Center, MI

National Hospice and Palliative Care Organization (Contractor)

• Kathy Brandt• John Mastrojohn III• Dr. Galen Miller• Gwynn Sullivan• Rebecca Trout• Ken Van Hoy

For more information, contact:

Kenneth Shay Director of Geriatric Programs

VA Office of Geriatrics and Extended Care (10P4G) [email protected]

veteran community partnerships fy 13 annual report

Documents