Veteran Services During COVID-19: Continuing Care Through Telehealth

Michelle Baker

Signal sat down with Mike Richardson, WWP’s Vice President of Mental Health, to discuss how in the wake of COVID-19, the organization is transitioning from in-person programs and building upon existing partnerships to continue providing care to warriors at home.

Wounded Warrior Project (WWP) is a charity and veterans service organization that offers a variety of programs, services and events for wounded veterans and service members who incurred a physical or mental injury, illness, or wound while serving in the military on or after September 11, 2001.
SG: Tell us about WWP’s mission.
Richardson: Our mission is to honor and empower wounded warriors, and we are delivering on that mission through a goal of engaging veterans holistically and meeting them where their needs are.  Self-reported PTSD, anxiety, and depression have consistently ranked among the most prevalent health challenges faced by veterans who register for WWP’s programs, and younger veterans – those between 18 and 34 years old – have the highest rate of suicide in the country.  While we offer more than a dozen programs to warriors and their families, our mental health services have been specifically designed to run along a continuum that includes direct non-clinical programming as well as funded partnerships to provide direct clinical support.  Having this flexibility allows us to meet warriors where their mental health care needs are, whether they be in more acute crisis, require additional coping skills, or intensive psychoeducation to increase resilience.  As an organization with national reach, this translates into both face-to-face and daily virtual support.
SG: What’s on the horizon for telehealth and veterans? How has this changed due to COVID-19?
Richardson: While the pandemic has caused us to be innovative and translate many of our in person programmatic engagements into virtual engagements, in many ways WWP is positioned to meet unique critical needs that surfaced as a result of social distancing requirements and travel restrictions.
For instance, several years ago WWP began funding and partnering with eHome, a nationwide network that provides virtual clinical interventions as well as specialized treatment tracks in areas like post-traumatic stress and substance abuse.  At the time WWP developed this relationship to provide resources for veterans who had limited mental health resources in their home communities or were geographically isolated. Before COVID-19, WWP had already expanded that relationship to provide it as an option for more veterans. When the pandemic struck and it was clear that the impact and need for social isolation would be great, we were able to expand that pre-existing relationship to meet new needs and challenges that our warriors were facing. Many of these virtual innovations and programs would be powerful add-ons as aftercare for our other programs once we return to face-to-face engagements.
SG:  How is the Department of Veterans Affairs fitting into the equation?
Richardson: In many ways, VA is leading the way as a pioneer in telehealth.  In 2018, VA implemented new rules to allow their providers to practice telehealth over state lines regardless of where in the United States the provider or the veteran patient are located.  Demand for telehealth care has surged during COVID-19 and while much of that may very well be due to necessity, there are surely thousands of veterans who have now used these services for the first time.  And as veterans – just like many non-veterans – have struggled with mental health challenges during this unprecedented disruption, the heightened accessibility to mental health care and suicide prevention services offered through the VA has unquestionably helped connect more veterans to care faster and easier than if they had to rely on other health systems.
SG: Can you share an example of a telehealth experience or innovation that might not have happened without COVID-19?
Richardson: After suspending all in-person programming shortly after COVID-19 began spreading, we saw an incredible and swift transition to serving warriors virtually.  In the first few weeks, we placed over 14,000 calls to check in with warriors and were able to place more than 650 of them into WWP programs to meet their most pressing needs.  Combined, we were able to help warriors “feel” our presence even when isolated.  This is crucial to a population who is already overrepresented in the population of those suffering with PTSD.  A central theme for PTSD is isolation and heightened awareness, alertness, or vigilance.  The need for social isolation may have artificially exacerbated the isolation component and impact of PTSD, while the constant media bombardment of growing cases, deaths, and hospitalizations may have increased hyper-alertness in some already anxious warriors.  The pandemic also brought travel restrictions and hospital closures or restrictions to COVID-19 cases. As a result, much needed clinical resources that veterans would have traveled to prior to the pandemic were no longer viable resources. WWP was able to meet some of those needs through the expansion of their relationship with eHome to provide clinical treatment virtually. Conceptually, this has allowed warriors to engage in treatment as we wait for hospital resources to open so that they may transition to those. This may have prevented a great deal of mental health crises.
SG: How has telehealth improved access to care for veterans?
Richardson: Aside from our experience helping connect warriors to mental health services during COVID-19, VA recently testified that their health system has seen a 1,200% increase in video health visits between March and July, and patient satisfaction surveys are indicating that over 80% think that the care was as effective or even more so than in-person meetings with masks.  Anecdotally, we know many warriors began using telehealth for the first time over the past several months – perhaps by necessity – and are more inclined to use it moving forward.
From our vantage point at WWP, engagement with virtual mental health resources through telehealth has removed what some considered an insurmountable barrier to care- access to quality care from home. This may be especially true for those who are remotely isolated from resources or those who could not otherwise engage in such resources for logistical reasons (i.e., childcare).  For instance, mothers are no longer limited to engaging with mental health providers only when and if they can coordinate childcare.  This may be a partial reason why at WWP we have seen an increase in women warriors’ engagement via virtual programming.
The simple ability to receive care without leaving the home also addresses two issues we see in the military and veteran community.  For one, it may help overcome a long-held stigma of being seen at a mental health providers office (i.e., being identified as “mentally weak”).  Second, some suffering from severe PTSD may encounter severe anxiety in the form of agoraphobia when traveling outside of their home. As such, they may avoid getting much needed assistance. Through virtual engagement, providers can engage with these warriors until they reach a point in their recovery when they are able to comfortably travel.  In short, telehealth has broken down barriers to access of much needed mental health services for a host of veterans who may have and have gone without those much-needed service.
SG: Do you have any predictions about the future of telehealth for veterans or the military more broadly?
Richardson: Telehealth platforms have improved, and clinicians are feeling more comfortable offering telehealth services, so I do believe it will stay.  We’ve seen growth in the amount of trainings available to clinicians to hone their skills and comply with all HIPAA requirements, which should help ease anxiety for veterans and nonveterans alike who may be skeptical of engaging in telehealth. WWP is looking at keeping permanent virtual programs in our repertoire to accommodate veterans in rural areas as well as those struggling with anxiety over coming to in-person events.  On the public policy side, legislation recently passed out of the Senate (S. 785) including new grant-making authority for VA to build upon its partnerships with organizations to deliver increased telehealth capabilities to veterans through community grants.  We’ve seen impressive work like this already being done through the VA’s ATLAS program, which has taken the innovative approach of expanding their clinical footprint through telehealth hubs at VFW posts and Walmart stores.  This is a strategy that has been particularly helpful in making care more accessible to veterans living in rural areas, where mental health interventions can be lifesaving.

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