Chairman Michaud and Distinguished Members of this Subcommittee, the National Military Family Association (NMFA) would like to thank you for the opportunity to present written testimony for the record on ‘Heroes at Home Act of 2007.’ We thank you for your focus on the many elements necessary to ensure quality health care and mental health care for our wounded/ill/injured service members, veterans, and the families who care for them; and, recognizing the important role caregivers play in the care of their loved one.

NMFA will discuss on several issues of importance to wounded/ill/injured service members, veterans, and their families in the following subject areas:

1. Wounded Service Members Have Wounded Families
2. Who Are the Families of Wounded Service Members?
3. Caregivers
4. Mental Health

Wounded Service Members Have Wounded Families

NMFA asserts that behind every wounded service member and veteran is a wounded family. Spouses, children, parents, and siblings of service members injured defending our country experience many uncertainties. Fear of the unknown and what lies ahead in future weeks, months, and even years, weighs heavily on their minds.

Transitions can be especially problematic for wounded/ill/injured service members, veterans, and their families. The Department of Defense (DoD) and the Department of Veterans Affairs (VA) health care systems, along with State agency involvement, should alleviate, not heighten these concerns. It is NMFA’s belief the government must take a more inclusive view of military and veterans’ families. Those who have the responsibility to care for the wounded service member must also consider the needs of the spouse, children, parents of single service members, siblings, and especially the caregivers. According to the VA, “‘informal’ caregivers are people such as a spouse or significant other or partner, family member, neighbor or friend who generously gives their time and energy to provide whatever assistance is needed to the veteran.”

Who are the families of Wounded Service members?

In the past, the VA and the DoD have generally focused their benefit packages for a service member’s family on his/her spouse and children. Now, however, it is not unusual to see the parents and siblings of a single service member presented as part of the service member’s family unit. In the active duty, National Guard, and Reserves almost 50 percent are single. Having a wounded service member is new territory for family units. Whether the service member is married or single, their families will be affected in some way by the injury. As more single service members are wounded, more parents and siblings must take on the role of helping their son, daughter, sibling through the recovery process. Family members are an integral part of the health care team. Their presence has been shown to improve their quality of life and aid in a speedy recovery.

NMFA recently gathered information about issues affecting our wounded service members, veterans, and their families through our Healing Adventure Operation Purple Camp in August and a focus group held this March at Camp Lejeune. They said following the injury, families find themselves having to redefine their roles. They must learn how to parent and become a spouse/lover with an injury. Spouses talked about the stress their new role as caregiver has placed on them and their families. Often overwhelmed and feeling as if they have no place to turn to for help.

Caregivers

Caregivers need to be recognized for the important role they play in the care of their loved one. Without them, the quality of life of the wounded service members and veterans, such as physical, psycho-social, and mental health, would be significantly compromised. They are viewed as an invaluable resource to DoD and VA health care providers because they tend to the needs of the service members and the veterans on a regular basis. And, their daily involvement saves DoD, VA, and State agency health care dollars in the long run.

Caregivers of the severely wounded, ill, and injured services members who are now veterans have a long road ahead of them. In order to perform their job well, they must be given the skills to be successful. This will require the VA to train them through a standardized, certified program, and appropriately compensate them for the care they provide. NMFA is pleased with the ‘Heroes at Home Act of 2007’ legislation that will provide for the training, certification, and compensation for injured service members or veterans with TBI. TBI has become the signature wound of this current conflict; however, the legislation should be flexible and allow for the expansion of training, certification, and compensation to encompass other injuries. Often, our wounded service members and veterans present with more than one type of injury. This legislation places VA in an active role in recognizing caregivers’ important contributions and enabling them to become better caregivers to their loved ones. It is a win win for everyone involved.

The VA currently has eight caregiver assistance pilot programs to expand and improve health care education and provide needed training and resources for caregivers who assist disabled and aging veterans in their homes. These pilot programs are important, but there is a strong need for 24-hour in-home respite care, 24-hour supervision, emotional support for caregivers living in rural areas, and coping skills to manage both the veteran’s and caregiver’s stress. These pilot programs, if found successful, should be implemented by the VA as soon as possible and fully funded by Congress. However, one program missing is the need for adequate child care. Veterans can be single parents or the caregiver may have non-school aged children of their own. Each needs the availability of child care in order to attend their medical appointments, especially mental health appointments. NMFA encourages the VA to create a drop-in child care for medical appointments on their premises or partner with other organizations to provide this valuable service.

Mental Health

Families’ needs for a full spectrum of mental health services — from preventative care and stress reduction techniques, to individual or family counseling, to medical mental health services—will continue to grow. It is important to note if DoD has not been effective in the prevention and treatment of mental health issues, the residual will spill over into the VA health care system. The need for mental health services will remain high for some time even after military operations scale down and service members and their families’ transition to veteran status. The VA must be ready. They must partner with DoD and State agendies in order to address mental health issues early on in the process and provide transitional mental health programs. They must maintain robust rehabilitation and reintegration programs for veterans and their families that will require VA’s attention over the long-term.

NMFA is especially concerned with the scarcity of services available to the families as they leave the military following the end of their activation or enlistment. They may be eligible for a variety of health insurance programs, such as TRICARE Reserve Select, TRICARE, or VA. Many will choose to locate in rural areas where there may be no mental health providers available. We ask you to address the distance issues families’ face in linking with mental health resources and obtaining appropriate care. Isolated veterans and their families do not have the benefit of the safety net of services and programs provided by MTFs, VA facilities, CBOCs, and Vet Centers. NMFA recommends the use of alternative treatment methods, such as telemental health. The ‘Heroes at Home Act of 2007’ provision for telemental health will provide an additional benefit to this population. Another solution is modifying licensing requirements in order to remove geographical practice barriers that prevent mental health providers from participating in telemental health services outside of a VA facility.

NMFA appreciates the ‘Heroes at Home Act of 2007’ inclusion of an outreach and public awareness provision. The VA must educate their health care and mental health professionals, along with veterans’ families of the effects of mild Traumatic Brain Injury (TBI) in order to help accurately diagnose and treat the veteran’s condition. Veterans’ families are on the “sharp end of the spear” and are more likely to pick up on changes contributed to either condition and relay this information to VA providers. VA mental and health care providers must be able to deal with polytrauma—Post-Traumatic Stress Disorder (PTSD) in combination with multiple physical injuries. NMFA appreciates Congress establishing the National Center of Excellence and the Defense Center of Excellence. Now, it is very important for DoD and VA to partner in researching TBI and PTSD. We believe the VA needs to education their civilian health care providers on how to identify signs and symptoms of mild TBI and PTSD. And, as the VA incorporates Project Hero, they must educate civilian network mental health providers about our military culture.

NMFA strongly suggests standardized training, certification, and compensation for caregivers of injured service members or veterans with TBI.

NMFA recommends the use of alternative treatment methods, such as telemental health; and, the modification of licensing requirements to remove geographical practice barriers that prevent mental health providers from participating in telemental health services outside of a VA facility.

The VA must educate their health care and mental health professionals, along with veterans’ families of the effects of mild Traumatic Brain Injury (TBI) and Post-traumatic Stress Disorder (PTSD) to help accurately diagnose and treat the service member’s condition. The VA needs to encourage more education for civilian health care providers on how to identify signs and symptoms of mild TBI and PTSD. NMFA recommends spouses and parents of returning service members and veterans’ need programs providing education on identifying mental health, substance abuse, suicide, and traumatic brain injury.

NMFA recommends Congress require Vet Centers and the VA to develop a holistic approach to veteran care by including their families in providing mental health counseling and programs.

NMFA would like to thank you again for the opportunity to present testimony for the record on the ‘Heroes at Home Act of 2007’ for service members, veterans, and their families. Military families support the Nation’s military missions. The least their country can do is make sure service members, veterans, and their families have consistent access to high quality mental health care in the DoD, VA, and within network civilian health care systems utilizing alternative treatment methods, such as telemental health. Wounded service members and veterans have wounded families. The caregiver must be supported by the VA by providing training, certification, and compensation for the care of their loved one. The system should provide coordination of care DoD, VA, and State agencies working together to create a seamless transition. We ask Congress to assist in meeting that responsibility.