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Witness Testimony of Ms. Shannon Middleton, Veterans Affairs and Rehabilitation Commission, Deputy Director for Health, American Legion

Mr. Chairman and Members of the Subcommittee:

Thank you for this opportunity to present The American Legion’s views on the current and future services provided by Vet Centers. Vet Centers provide a necessary service and are an important resource for combat veterans experiencing readjustment issues, especially those who do not live in close proximity to a Department of Veterans Affairs (VA) medical facility.   

Current and Future Services Provided by Vet Centers

Vet Centers are a unique, invaluable asset to the VA health care system.  They were designed to provide services exclusively for veterans who served in theaters of conflict, or experienced military sexual trauma.  Because Vet Centers are community based and veterans are assessed the day they seek services, they receive immediate access to care and are not subjected to wait lists.  They provide mental health counseling to not just the veteran, but those in his or her support system — like the spouse and children.  Services are provided in a non-clinical environment, which may appeal to those who would be reluctant about seeking care in a medical facility.  A high percentage of the staff, more than 80%, are combat veterans and can relate to the readjustment issues experienced by the those seeking services. 

Vet Centers assist veterans with enrollment into the VA health care system.  They provide timely assessments and referrals to the local VA medical centers (VAMCs) to ensure a continuum of care.  Furthermore, their services encompass more than mental health issues, providing assistance with applying for VA benefits, providing employment counseling, participating in homeless veteran stand-downs, working non-traditional hours or contracting services for the veteran’s convenience.  Vet Centers have also expanded their services to accommodate the growing needs of veterans and their families, such as providing bereavement counseling to family members of servicemembers who die in combat.

As a tacit rule, Vet Centers never turn anyone away, providing alcohol and drug assessments, or referrals to other VA or community programs, even for those who are not eligible for care.

Since Vet Centers provide such an important service to combat veterans, The American Legion visited several of them to see how their resources are meeting the increasing demand of returning combat veterans.  Mandated by Resolution 206, entitled “Annual State of VA Medical Facilities Report”, The American Legion publishes an annual report on VA medical centers and other health care facilities.  This report is a compilation of information gathered from a series of site visits conducted by appointed System Worth Saving Task Force Members and The American Legion’s National Field Service Representatives. 

Since the initial report in 2003, each year’s report has focused on different facilities.  Past reports have covered VA medical centers (VAMCs) and Community Based Outpatient Clinics (CBOCs).  The System Worth Saving report is delivered each year to the President of the United States, the leadership of the Department of Veteran Affairs, members of Congress and to the public.   

The 2007 System Worth Saving Report will focus on select Vet Centers and select Polytrauma Centers.  Task Force members and National Field Service staff visited several Vet Centers around the nation to see how they were servicing veterans, with emphasis on outreach to veterans who served in Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF).  National Field Service Staff selected 46 Vet Centers that were located near demobilization sites in Arizona, California, Colorado, Florida, Illinois, Indiana, Maryland, Massachusetts, Minnesota, Missouri, Nevada, New York, Ohio, Oregon, Puerto Rico, South Carolina, Texas, Virginia, and Washington State. Since many returning servicemembers would most likely reside near the site of demobilization, the Vet Centers selected had particular significance. 

Information collected on the respective Vet Centers include: number of veterans seen within the Vet Center’s catchment area; a breakdown by war era of the veterans seen – when possible; budget; staffing; outreach activities; physical plant issues; and, challenges as identified by staff and management.  In an effort to ascertain the effects of OIF on utilization of services and available resources, the Task Force and National Field Service Staff solicited information on enrollment, fiscal, and staffing issues for fiscal year (FY) 2003 — the year OIF began — and FY 2006.

The Vet Center

The Vet Center site visit reports differ among the Vet Centers visited.  In general, they all have extensive outreach plans that reach many counties in their respective regions.  Most have at least one position for a GWOT Technician.  Most are active in participating in National Guard/ Reserve demobilization activities, to include providing availability at post deployment health reassessment activities and conducting briefings about Vet Center services. 

Many Vet Centers have community partnerships and participate in their local college work-study programs, allowing OIF/OEF veterans who are enrolled in college to assist with administrative tasks at the Vet Centers.

Although most were satisfied with their facilities, indicating recent upgrades and new furniture, a few indicated space challenges such as being forced to use remote parking due to the location of the leased space, having inadequate office space, and needing a new facility because the owner of the leased building was planning other use for the space.

The Vet Centers all work with Veteran Service Organizations (VSO) to provide assistance for veterans in filing claims; some Vet Centers even reserve space for service officers to make weekly visits.  They all illustrated productive referral systems between the Vet Center and the local VAMCs.

Some Vet Centers have tailored their programs to accommodate veterans and families that speak languages other than English as a first language, or those who practice other customs.  Some Vet Centers indicated that they needed to enhance their services to accommodate cultural differences and to target rural, women and minority veterans.  Since many combat veterans visit Vet Centers because of urging from family members, The American Legion believes that enhancing outreach to target minorities is an important aspect to minority veterans accessing Vet Center services. 

Staffing of Vet Centers

In general, the Vet Centers visited by The American Legion had the same staff composition, usually a four-person team to include a team leader, office manager, social worker, and a psychologist or mental health counselor.

However, a few indicated that limited staffing was an overall challenge, given an anticipated influx of returning OIF/OEF veterans in the catchment area.  Some Vet Centers shared GWOT Technicians and sexual trauma counselors with other Vet Centers, or had a part time staff member. 

Some Vet Centers had vacancies because the GWOT Technician, as well as other key staff members, had been or would be soon deployed again to serve in Iraq or Afghanistan. 

A few indicated the need for a family therapist or a military sexual trauma counselor.  Some of the vacancies had been funded but not filled as management was seeking qualified individuals to hire.

Still other Vet Centers indicated that they just needed staff augmentation to handle existing and anticipated workloads.

The American Legion believes that all Vet Centers need to be fully staffed to ensure that combat veterans seeking care for readjustment are afforded the same standard of quality care, no matter which Vet Center they utilize, this includes cross training staff to speak other languages when necessary — or hiring qualified bilingual staff — and training staff to learn different mental health specialties.

VA’s 23 New Vet Centers

The most important aspect of the Vet Centers is that it provides timely accessibility.  Since Vet Centers are community-based and veterans are assessed within minutes of their arrival, eligible veterans are not subjected to long wait times for disability claims decisions to determine eligibility for enrollment, or long wait times for available appointments.  The Vet Center can provide immediate attention to the veteran, either directly or through contracted care when necessary.  VA’s plan to create 23 new Vet Centers within the next two years will bring the number of Vet Centers to 232.  This will improve access to readjustment services for many combat veterans and their families, some of which reside in underserved areas.  The American Legion believes that VA needs to ensure that future Vet Centers are positioned to reach as many rural veterans as possible.

Although Vet Centers have extensive outreach plans, more outreach is needed to reach other groups of veterans who may not know they are eligible to use Vet Centers or those who may not be familiar with the program in general.  Many veterans learn of Vet Centers by word of mouth.  Reaching veterans residing in rural areas will be a challenge. Surely, the 100 new Vet Center GWOT outreach coordinators that will be hired will also enhance outreach to eligible veterans. 

The American Legion will do all it can to inform, not only veterans and their families, but also all other advocates about the service provided by Vet Centers as well.  Combat veterans facing readjustment issues require immediate access to mental health assessment and counseling.  Vet Centers make this possible.  Making more communities aware of Vet Center services will likely improve the quality of life for many families.

Again, thank you Mr. Chairman for giving The American Legion this opportunity to present its views on such an important issue. We look forward to working with the Subcommittee to address the needs of all veterans.