A National Newsletter for Veterans and their Health Care Providers U.S. Department of Veterans Aairs Oce of Patient Care Services Post-Deployment Health Services WRIISC Advantage FALL/WINTER 2016 celebrating 15 years of SERVING VETERANS Learn more about: Our CLINICAL SERVICESOur RESEARCH HIGHLIGHTSOur EDUCATION efforts foren VETERANS and PROVIDERS
2 | FALL/WINTER 2016 WRIISC Advantage | 3Celebrating15 YEARS OF SERVING VETERANSThis edition of WRIISC Advantage focuses on celebrating our 15 years of serving Veterans. The Department of Veterans Affairs (VA) War Related Illness and Injury Study Center (WRIISC) is a National Resource dedicated to providing post-deployment health expertise to Veterans and their medical providers through clinical care, research, education, and risk communication. Since our inception in 2001, the WRIISC has: Delivered Clinical Service to 23,000+ en Veterans Educated en 200,000+ health care personnel & researchers Advanced research activities in a portfolio worth $40 Million+ Published en 345+ en peer-reviewed research articles History of the WRIISCOVER 15 YEARS AGO, in response to Public Law 105-368, VA contracted with the National Academy of Sciences (NAS) to develop a plan for establishing National Centers for the study of war-related illnesses and postdeployment issues. On November 5, 1999, the NAS recommended that VA establish centers for the study of war-related illnesses similar in structure to VAs Geriatric Research, Education, and Clinical Centers. In 2001, after a competitive review process, the first two WRIISC centers were established; one at the Washington, DC VA Medical Center and the other at the East Orange Campus of the VA New Jersey Health Care System. To provide wider coverage and easier access for Veterans, an additional WRIISC was authorized and became operational at the VA Palo Alto Health Care System in Palo Alto, CA in February 2008. e three-part mission at the WRIISC: clinical, research, and education has always worked together to better understand the health issues facing deployed Veterans, provide state-of-the art care and services to Veterans, and educate providers, Veterans, their caregivers, and family members. rough clinical care, we determine gaps of knowledge in Veterans' care and this helps us ONE OF THE FIRST WRIISC s WAS ESTABLISHED IN 2001 AT EAST ORANGE, NJidentify and gen erate important research questions. Our research focuses on understanding underlying disease mechanisms that can contribute to evidence-based treatments and tools to improve Veteran health and clinical care. Our clinical care and research produce new health information that we share with providers and patients through education. Our educational programs for providers also improve patient outcomes by sharing knowledge about new approaches and best practices. WRIISC postdeployment expertise includes: chronic multisymptom illness (CMI), such as Gulf War Illness (GWI), deployment-related environmental and occupational exposures (various toxins, airborne hazards including smoke from burnpits, medical prophylactic [or preventative] measures, and infectious agents), traumatic brain injury (particularly mild injuries with long-term consequences), and posttraumatic stress disorder (PTSD). Since our inception, the WRIISC has developed strong relationships with premiere academic and government institutions throughout the United States. ese collaborations continue to help strengthen and support our WRIISC program goals.Clinical Program Accomplishments Our WRIISC sta members focus on evaluating and assisting Veterans with chronic, dicult to diagnose medical, or unexplained symptoms. To best serve Veterans and better equip their providers to provide ongoing care, we updated our referral process so that all Veterans referred to our Center receive a thorough medical review and recommendations for next steps, including possible additional services from the WRIISC. Referred to as an eConsult we conduct the same thorough chart review as we do for Veterans seen in comprehensive evaluations. This results in personalized recommendations for next steps from our team of clinicians. A multidisciplinar y o r team-based approach has always been our signature f o r comprehensive evaluation as we work with VAs Patient Aligned Care Teams to improve overall Veteran care. e WRIISC Comprehensive Multidisciplinary Evaluation is for Veterans with chronic medically unexplained health concerns that have been well worked up and are possibly related to deployment. VA providers can refer Veterans through an interfacility consult or IFC. Our WRIISC team coordinates a multisymptom assessment and provides diagnostic and treatment recommendations that cross a wide spectrum of symptoms and body systems. e evaluation applies highly specialized medical expertise, often giving new hope to patients with post-deployment health concerns while allowing for in-depth clinical evaluations that inform best practices to be shared with VA providers. The WRIISC's team-based approach to clinical evaluation provides an integrated summary of the Veterans health concerns and diagnoses. We focus on the next steps a Veteran can take to manage their health concerns and make recommendations for their providers as part of the long-term care of the Veteran. Coordinating assessments across multiple departments and specialties over a 3to 5-day visit allows our team to address the big picture of health. Each Veteran receives an extensive assessment which typically includes a history and physical, neurological and mental status evaluations, occupational and environmental exposure assessments, a psychological/ neuropsychological evaluation, social work assessment, and a health education session including a focus on integrative health modalities. Other specialty services are consulted as needed to address Veterans' specic medical concerns. Over the course of the evaluation, Veterans receive assessments and consultations that would otherwise require several months to schedule and complete at their home VA facility. Moreover, those appointments would require multiple trips, making specialty referrals dicult. A WRIISC visit may include an enhanced evaluation for airborne hazards concerns consisting of: an environmental exposure assessment, education on health effects and the latest research ndings, and specialty testing at the Airborne Hazard Center of Excellence (AHCE) established in 2013 at the NJ WRIISC. The AHCE pioneers the effort to better understand potential health effects of airborne hazards exposure for Veterans. This center also leads VA in addressing concerns of returning Servicemembers by providing the most recent, up-to-date knowledge. "The many providers listened and evaluated my condition(s) to the fullest extent possible. They provided a path to follow. Thank you from the bottom of my heart for all the help.Another service available to deployed Veterans referred by their providers is an Environmental Exposure Assessment to address Veteran concerns about a particular military-related occupational or environmental exposure and its possible health eects. ese can be done in person or by phone by a specialist in the eld of Environmental Exposure concerns.
4 | FALL/WINTER 2016 WRIISC Advantage | 5 We are proud of our record in serving Veterans. Upon completion of the comprehensive evaluation, 97% of the 111 Veterans who completed the satisfaction survey would recommend our program to other Veterans. Veterans also responded with overwhelmingly positive ratings to other survey questions: Did the WRIISC listen carefully to you (overall)? Did the WRIISC team explain things in a way that was easy to understand? Did the WRIISC team seem to know the important information about your medical history? Did the WRIISC team show respect for what you had to say? Did the WRIISC team talk with you about specic things you could do to manage your condition(s)? Standalone Clinical Services roughout the years, we have also oered a variety of services to local Veterans. Current services vary by site but include: Neurology, Mental Health Services, Social Work, Integrative Medicine, Gulf War and Agent Orange Registry examinations, and Health Education. Research Highlights Our unique team of researchers and clinicians always worked side-by-side to use research to improve clinical care. We are dedicated to conducting research to improve war-related health problems. WRIISC research projects cover everything from basic science and epidemiology, to human physiology, to treatment studies, implementation, and health outcomes. Recent research highlights: We continue to lead the way in research aimed at GWI and CMI we currently have 10 funded projects targeting issues facing Veterans of Operation Desert Storm/Desert Shield (ODS/S) with increased success in recruiting Veterans for these important studies. We have two funded clinical trials addressing pain with novel treatment approaches. One studies yoga and the other investigates non-invasive brain stimulation (repetitive Transcranial Magnetic Stimulation [rTMS]). We focus on PTSD in eight of our research grants with studies looking at the impact of co-morbid health conditions such as traumatic brain injury (TBI), sleep disorders, and genetics, and how PTSD aects memory, social cognition, and impulse control. Our treatment studies examine novel interventions such as yoga breathing for PTSD and brain stimulation for depression. Several studies are utilizing the skills of neuropsychologists, neurologists, psychiatrists, and psychologists on our WRIISC team to advance the knowledge base in the areas of cognition and cognitive rehabilitation. Assessments of cognitive abilities/ improvement are also included in several treatment studies. As TBI is a top concern to post-deployment Veterans, we actively engage in research eorts to develop innovative diagnostic and treatment methods. We work to develop new brain imaging methods to help detect and characterize subtle changes in the brain that may occur with mild TBI and co-morbid psychiatric illnesses. Our research team develops new and improved treatments such as treating vestibular dysfunction with a portable brain stimulator and utilizing rTMS stimulation to improve cognition in Veterans with TBI. As a leader in the area of Integrative Medicine research, we have two funded grants to study complementary and alternative treatments for Veterans of ODS/S. Notably, the positive results from recent research in Integrative Health and Wellness were a driving factor in the successful opening of the Integrative Health and Wellness program at the DC VAMC. Our investigators are leaders in their areas of expertise presenting at national and international conferences. ey have also served on grant review panels for the VA, Department of Defense (DoD), and National Health Institute (NIH). In addition, they have received recognition at national conferences for their work in TBI and PTSD and by Secretary Robert MacDonald for their VA-funded research related to Gulf War Veterans concerns. e VA and national press have taken note of all of our contributions geared towards advancing the health of Veterans and have requested interviews and highlighted our projects in several publications. 99% 97% 90% 98% 93% Veterans' Top Complaints Examples of Active WRIISC Research Studies 2. Neurological 3. Fatigue 4. Mental Health 5. Cognition 6. Respiratory 7. Sleep A Multimodal Evaluation of the Comparative Efcacy of Yoga versus a 1. Pain Patient-Centered Support Group for Treating Chronic Pain in GWI Diagnosis of Late-stage, Early-onset, Small-ber Polyneuropathy Examination of Cognitive Fatigue in GWI Using Functional Magnetic Resonance Imaging Breathing Meditation Intervention for PTSD Cognitive Rehabilitation for GWI Airborne Hazards Exposure and Cardiorespiratory Health of Veterans Integrative Medicine for Sleep, Health Functioning and Quality of Life in Veterans with GWI NJ WRIISC developed and distributed an educational tool called the STAR Well-Kit (SWK), a set of videos designed to introduce and encourage Integrative Health and Wellness practices. To date, more than 11,000 SWKs have been distributed clinically (with over 20 thousand requested) and the SWK is now available on our WRIISC website, the Ofce of Patient Centered Care and Cultural Transformations (OPCC&CT) website, and YouTube. Lessons learned from research on the SWK can be found in two recent research publications. Findings can be applied to dissemination of any new educational tool within a health care setting! Educating Providers and Veterans Education and risk communication remain at the heart of all of our eorts. Over the years, our team established educational services for Veterans and their providers at the local, regional, and national levels with the goal of advancing health care for Veterans. We have provided clinical education in classes designed specically for Veterans by WRIISC experts on a number of topics. ese include: Classes on environmental exposures from various deployments and other Domestic Military Exposure Concerns and Sessions on general health and wellness after deployment including Integrative Health and Wellness, Managing Chronic Symptoms, and Managing CMI. The WRIISC regularly mentors postgraduate fellows and graduate or under graduate students. We also sponsor fellowship seminars, trainee webinars, grand rounds sessions, and journal club meetings for staff members. Veterans seen at the WRIISC for a comprehensive e valuation always receive personalized one-on-one health education and/or health education materials to support their complex symptom management and overall health. ese include fact sheets developed by the WRIISC. We also publish this WRIISC Advantage newsletter tri-annually which focuses on health concerns and exposure topics prevalent in the Veteran community. Our WRIISC website also serves as a resource for Veterans and the health care community.
6 | FALL/WINTER 2016 WRIISC Advantage | 7 In addition to educating Veterans, we serve as an educational resource to VA clinicians by equipping providers with up-to-date information on key topics in post-deployment health. Over the last 15 years, we used multiple training methods to reach as many providers as possible. We produced VA Employee Education System (EES)-sponsored webinar series, Live Satellite Broadcasts which are also available on the Internet and DVD, in-person conferences and "Train the Trainer" seminars where attendees are trained to advance education and how to share their training with a wider network of providers. Recent eorts are focused on making post-deployment health education available online and on-demand for both VA and community providers. Our education eorts covered a wide range of critical postdeployment health issues including: % enBest practices and research ndings on GWI; % enCMI assessment, treatment and management; % enEnvironmental exposures, including airborne hazard concerns; % enIntegrative health and wellness, including behavioral medicine; approaches to treating pain, nutritional psychology, and yoga meditation; % enCognitive problems including memory problems; % enSocial reintegration issues; and % enTBI. Future DirectionsWhile we hope you enjoyed a look back on some of our accomplishments throughout the past 15 years, rest assured that our focus remains on the future. Our sta continuously looks for ways to further advance our threepart mission to improve the lives of Veterans who served the US in a theater of combat and may now suer with debilitating conditions. As part of Post Deployment Health Services within VA Patient Care Services, we will continue to promote better communication among Veterans, the providers of direct patient care, and our post-deployment experts. e WRIISC will continue to improve the care of Veterans! Around the WRIISC NewsNJ WRIISCHappy 15th Birthday, WRIISCNJ WRIISC STAFF recently gathered to celebrate 15 years of the WRIISC's dedication to improving the lives of Veterans. NJ WRIISC Director Dr. Drew Helmer hosted a brief meeting discussing the history of the WRIISC while touching on some of the Centers main accomplishments throughout the years. e NJ WRIISC team has continued to grow tremendously over the years; weve hired six new research assistants in the past 6 months to sta newly funded research projects! NJ WRIISC now has over 50 clinicians, researchers, educators, support personnel, trainees, and students collaborating to optimize the health of combat-deployed Veterans, especially those with dicult-to-diagnose or medically unexplained symptoms. We take pride in all of our accomplishments and the progress the WRIISC has made at all of its three sites. CA WRIISCPhone-based Meditation Class Increases Access to WRIISC CareSINCE 2010, more than 2,000 Veterans have been referred to yoga at the CA WRIISC and the center increased access to yoga as a specialty service by providing yoga through clinical video telehealth to Veterans who receive care at community clinics. To date, more than 3,800 yoga sessions have been delivered through this method. A phone-based Yoga Nidra meditation class was recently launched for all VA enrolled Veterans, no matter which part of the country they reside in an eort to increase access. e meditation class is based on iRest yoga nidra meditation, an evidence-based practice developed by Dr. Richard Miller and provided by iRest trained instructors from the CA WRIISC. Veterans call in to a secure phone line and join the class from the comfort and safety of their own home. All Veterans can be referred by their local clinician to the IFC WRIISC Yoga Wellness program in the computerized patient record system (CPRS). Feedback has been positive and provides the WRIISC with another tool to increase access to high quality specialty care. For more information, please check out: http://www.WarRelatedIllness. va.gov/clinical/integrative-health/ca/. DC WRIISCContinuing to GrowIN JUNE 2012, the DC WRIISC led a group of volunteers in the inaugural planting of what would become the "All Veterans' Garden. is exciting new endeavor, spearheaded by Dr. Katharine Bloeser, a Social Worker, was announced in the Fall 2012 WRIISC Advantage Newsletter. Since that time, the garden and the Veterans and volunteers who work there have flourished. The program expanded to include larger garden plots, and participation from several clinical departments across the DC VAMC. In realizing the strong therapeutic benefit of this program, and to better meet the clinical needs of the Veterans, the DC WRIISC partnered with Recreation Therapy. Now, the "All Veterans' Garden is a clinical consult and a permanent offering in the DC VAMC. The DC WRIISC is proud to have initiated and nurtured this program and excited to watch it continue to grow. VETERANS PLANT VEGETABLES IN THEIR "ALL VETERANS' GARDEN." WRIISC AdvantageFALL/WINTER 2016Produced by the War Related Illness and Injury Study CenterEditor: Susan L. Santos, PhD, MS Assistant Editor: Christina Rumage-Miller, MSPH Graphic Artists: Florence B. Chua, MS Jose B. Chua, BS Contributors: Louise Mahoney, MS, RYT Christina Rumage-Miller, MSPH Lauren Roselli, BA Susan L. Santos, PhD, MS Patrick Sullivan, MA 1-800-722-8340 War Related Illness and Injury Study Center Department of Veterans Affairs Washington, DC VA Medical Center Room 3B 203, Mail Stop 127 50 Irving St., NW Washington, DC 20422-0002 1-888-482-4376 War Related Illness and Injury Study Center Department of Veterans Affairs Palo Alto Health Care System 3801 Miranda Ave. Mail Code 151Y Palo Alto, CA 94304-1290 1-800-248-8005 War Related Illness and Injury Study Center Department of Veterans Affairs New Jersey Health Care System 385 Tremont Ave. Mail Stop 129, 11th oor East Orange, NJ 07018-1023 For comments or concerns regarding this newsletter, please contact us at: 1-800-248-8005 or firstname.lastname@example.org.
This n of 30% ewsletter contains a post-consumer was minimum te. Department of Veterans Affairs (VA)en New Jersey Health Care System 385 Tremont Ave., Mail Stop 129 East Orange, NJ 07018 1-800-248-8005 www.WarRelatedIllness.va.gov U.S. Department of Veterans Aairs Oce of Patient Care Services Post-Deployment Health Services ATTENTION READER: Do you prefer to receive the WRIISC Advantage newsletter electronically? Email us at email@example.com with your full name and preferred email address. See more by visiting:www.WarRelatedIllness.va.gov Visit our website for more information about the WRIISC: