Ask the Question: Introduction

Transcript of video:

Thank you so much for your interest in providing culturally and clinically competent care to veterans, service members, and their families. 
The Ask the Question Toolkit is intended to aide senior management and health care administrators, clinical providers and leaders, 
case managers and care coordinators, directors, managers, cultural diversity leaders, marketing managers,
public relations managers, grant and charitable funds managers, and even IT support 
to work together to improve access to and quality of care for veterans, service members, and their families. 

The Ask the Question Toolkit was born in a conference room in the State House of NH where a dozen or so professionals and citizens from all corners of health care, public service, and private sector industries came together every month to serve the NH Legislative Commission on PTSD & TBI

After a survey of NH’s veterans and service members, a few common and deeply impactful themes came to light. 
1) that veterans and service members did not feel understood by the health care providers who were serving them, 
2) that the VA cannot do it all, and that many of them chose not to get their care through the VA  
3) that the impact military service has on the family was often misunderstood or ignored by the health care service industry and other settings. 

One of the driving forces behind the development of this Toolkit was the fact that the majority of veterans eligible for VA services choose to get their care in the private sector. This is true across the country. This factor alone exemplifies the need for civilian health care and service providers to be educated and prepared to recognize the unique culture of the military, the possible and common exposures, and the types of medical conditions often associated with military service. 
It’s no surprise that civilian health care and service providers are often unfamiliar with the nuances of this population. The vast majority of health care professionals have no military background and minimal exposure to military culture.  With less than 1% of the US population having served in the military and the largest portion of those who serve coming from lower middle income to working class families, the culture gap between health care professionals and those who serve is wide.

Many who have never served in the military may not be aware that the training and physical demands of service alone, even without deployments or combat, often contribute to unique physical ailments, injuries, and chemical exposures that can result in health problems over the duration of that individual’s life. 
Hearing loss, arthritis, cancers, migraines, joint deterioration, and chronic pain frequently develop along with other associated conditions at a much younger age than is typical for the civilian population. Not to mention the psychological, behavioral, and emotional characteristics of service, deployments, and combat. 
You might be saying to yourself, “I don’t think we even have any veterans or military people that come to our clinic” and you may be right… but you’re probably wrong. Have you ever asked? Do any of your intake forms ask the question “Have you or anyone in your family ever served in the military?” Many people who have served don’t self-disclose. Some don’t believe it’s of any importance to their health, others may fear encountering stereotypes or stigma associated with military service, politics, and war. And still others don’t believe that the nature of their service qualifies or is deserving of appreciation or acknowledgement.  You won’t know unless you ask, and you won’t get the answers you need unless you ask the right questions. 

So- why should your health care or service delivery setting take special care with veterans, service members, and their families? Well, let’s first consider that it is simply the right thing to do. Preparing your facility and providers to deliver culturally competent and informed care is a way to thank those who have served for their commitment and sacrifice. 

Second, if your facility or providers accept Veterans Choice, Tricare, or Martins Point- it is your responsibility as a facility to be prepared to provide competent and informed care to the individuals associated with that coverage. Accepting those exclusive coverages is a promise to those who have served that you are prepared to meet their unique needs. 

Third, care capacity is needed in the private sector. In many states, VA accessibility whether it be proximity or capacity is a chronic challenge. NH is no exception. Due to this challenge in NH, an exemption was provided at a national level to allow all veterans enrolled in the VA to use Veterans Choice to get care in their communities- with no restrictions based on proximity or availability of services at the nearest VA. Therefore, non-government health care facilities and service providers must be equipped to meet the needs of this population. 
But most importantly, preparing your facilities and providers to serve this population saves lives. Those who have served may exhibit symptoms that are difficult to understand without the context of past military experience and exposures. These differences can be relevant at any point in the individual’s life cycle, whether it be 20 days after discharge or 40 years after a combat deployment. Without investigation by the provider into possible injuries and exposures, many symptoms and conditions can go unacknowledged, undiagnosed, and untreated, leading to health care alienation, worsening conditions, and even permanent disability or death. 

Thank you again for taking steps toward a more inclusive, competent, and clinically informed health care and service environment for veterans, service members and their families.