Healthcare for veterans topic of TRUST retreat

What characteristics come to mind when one thinks of a veteran? That they are patriotic, heroic and might struggle in some way due to what they have seen while deployed. What comes to mind when you think of military culture? That those in the military are disciplined but exhibit a comradery with fellow service members. And what resources do we have to support our veteran population? The Veterans Administration.

These were the questions — and answers — that kicked off the most recent TRUST retreat in early February, when pharmacy, nursing, social work, public health and medical students came together to learn about a veteran’s perspective in healthcare.

The Rural and Underserved Service Track (TRUST) is a collaboration between the School of Pharmacy and Pharmaceutical Sciences (SOPPS), Decker College of Nursing and Health Sciences, the College of Community and Public Affairs’ Department of Social Work, SUNY Upstate Medical University, and the community.

“Our TRUST program, conceived and spearheaded by Clinical Assistant Professor of Pharmacy Practice Bennett Doughty, provides crucial training to students across the healthcare spectrum, helping them better understand how to treat patients from our most vulnerable populations,” said SOPPS Dean Kanneboyina Nagaraju. “The students who come together for this program will be prepared to work in teams with other healthcare providers to offer the best care for patients.”

“I’m very thankful for all the support from my interprofessional colleagues who have made this track possible, but also to the donors who have been very generous in supporting our continual development and growth as well as our students,” said Doughty. “Through their generosity, we have been able to expand the number of students we recruit, award more than half our students with educational scholarships and support all materials for our service activities.”

The program has grown to about 80 students, who attend four retreats each academic year for two years, and participate in at least two community outreach activities per semester. Retreats, held Sunday afternoons, cover topics such as accessing reproductive healthcare, providing care to people with intellectual and developmental disabilities, delivering appropriate care to the LGBTQ+ population, delivering services to refugees, the aging population and healthcare, working with patients with substance use disorder, and exploring rural and urban health.

The veterans’ perspective retreat was typical of others: a look at the veteran population over time, providers talking about how they work with the veteran population, a panel of veterans talking about their healthcare experiences and time for questions and answers following each presentation. Students also worked in interdisciplinary groups of six on a case study about how to assess the needs and provide appropriate care to a 71-year-old veteran with high blood pressure and diabetes.

Jessica Isaac, downstate experiential coordinator at clinical assistant professor for the School of Pharmacy and Pharmaceutical Sciences, introduced the best practices for healthcare in veteran population topic do participants, followed by the veterans’ panel.

Three veterans made up the panel, each with varying military experience including multiple deployments and roles including in special forces and as a combat medic. Each member of the trio is affiliated with Clear Path for Veterans, a nonprofit organization based in Chittenango, N.Y., that provides programming and direct services to support veterans as they transition back to non-military life.

All three, who serve as peer mentors for Clear Path, spoke of the major challenges veterans face simply trying to navigate the complex Veterans Administration system. It can be confusing and overwhelming, they said, even though the care may be great.

The VA is made up of three separate branches that “may as well speak in foreign languages to each other” they said, and if a veteran doesn’t know that, accessing appropriate care can be difficult.

“We do a lot of advocating for veterans to take the emotion out of it and help veterans navigate through these problems,” they said.

The vets’ message to students? “Have patience and understanding when dealing with veterans and don’t talk down to them. If they’re asking for help, it’s because they need it.”

The workshop also included a presentation by Ann Canastra, recovery coordinator for the Syracuse Veterans Administration. A licensed mental health counselor, she said her job is to help people live their best lives.

Canastra discussed both the components of recovery as it relates to mental health and substance use disorder as well as the goals of recovery:

• Help vets and the VA system understand that mental health is essential to overall health.

• Create a mental health system that is veteran- and family-driven.

• Eliminate any disparities, stigma or discrimination associated with mental illness.

• Promote full access to recovery-oriented services at every VA location and at every point of contact with veterans.

• Ensure that excellent recovery-oriented care is delivered and that the VA system builds the body of knowledge about recovery.

• Collaborate and connect with the veteran community; connection to meaning is essential to recovery.

She also spoke about stigma and what she termed the stigma roulette for mental and substance use disorders. “Providers and policy makers should reduce the stigma surrounding substance abuse, challenge providers and communities to be aware of unintentional/implicit bias, and use appropriate language in conversations when discussing mental and substance disorders to decrease stigma by removing labels and using person-first language,” she said.

She urged the students to treat patients with science and evidence-based strategies, speak out against stigma and discrimination, keep hope alive, treat patients with dignity, partner with peer recovery specialists and be mindful of the language surrounding mental and substance use.

Students next broke into 10 cross-disciplinary groups of six to work through a case study of a 71-year-old veteran presenting at a VA primary care clinic. The veteran has Type 2 diabetes, high blood pressure, post-traumatic stress disorder, is a smoker and has other health problems. The vet also lives alone, has no health insurance, eats poorly and walks, rides a bike or uses public transportation to get around.

With the goal of integrating their professional knowledge across pharmacy, nursing, public health, social work and medical disciplines, the students talked through their responses to the following questions and discussion points:

• What are your initial impressions of this case?

• What other questions might you have for this veteran?

• Identify the veteran’s needs (including medical, social, etc.) and begin ranking them, based on priority, for intervention.

• With your prioritized list, identify which profession(s) may be best suited to address each need that your group identified.

• What existing resources and/or strengths can help to meet the veteran’s presenting needs?

• What interventions might each profession use to harness these strengths and address the various needs your group identified and ranked?

Following a debriefing, the retreat wrapped up with a networking dinner.

The next retreat will be held in late April on delivering appropriate care to the LGBTQ+ population.