Integrative Community Health Plan

Integrative Community Health Plan

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Integrative Community Health Plan

The veterans that served in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) came back from home, some with mental issues and others relatively unscathed. The main mental issues faced by these veterans are posttraumatic stress disorder, suicidal ideation, depressive disorders, and substance abuse disorders. This integrative community health plan devises how veterans with mental health challenges can be helped at the community level.  

Capacities, Strengths, and Needs of Individuals within Veterans

The veterans that served in the Global War on Terror in Iraq and Afghanistan were drawn from an All-Volunteer force. Although most of them were as young as 17 years old, the group of interest is much older (aged between 45 and 64 years old). Some of these veterans had careers before enlisting and were drawn from diverse disciplines and industries. In addition, they augmented their skills while on tour in Afghanistan and Iraq, to include hard competencies such as handling of assorted artillery and soft skills like, conflict resolution, leadership, communication, relationship building, problem-solving, mentoring, and many others. Besides, this cohort has strengths, such as living in harsh conditions, working in diverse teams, dealing with a multicultural community, and other similar attributes.

Many of the veterans faced several problems on returning home from their tours in Afghanistan and Iraq. The challenges included mental health issues, physical injuries, finding work, reconnecting with family members, and returning to school and college (Institute of Medicine, 2013). These issues have created health needs that need to be addressed urgently so that the veteran can reintegrate into society and lead wholesome lives. While the veterans receive medical attention, they have outstanding health-related and social needs that could be addressed through an integrative community health plan. The health needs include psychological treatment, psychosocial support, prevention of substance abuse and recidivism in posttraumatic stress disorder (Institute of Medicine, 2013; O’malley, 2020). Other needs are related to aging and include long-term care for those experiencing moral injuries, diabetes, hypertension, and other non-communicable diseases (O’malley, 2020).

Dimensions and Differentiation in Diversity and How These Differences May Influence Relationships within Veterans

Human beings are a diverse group whose relationships are influenced by gender, age, race, social-economic status, academic achievement, and many others. In addition, they may have different attributes that differentiate one group from the rest of society. These attributes of differentiation include special skills and unique experiences. These dimensions and attributes can influence how one group relates with the rest of society

Veterans are a distinct social group that should be considered as having unique attributes. Although they are unique in many aspects to the rest of society, veterans’ diversity dimensions include gender, race, age, marital status, education, and sexual orientation, which affect their relations with the rest of a community or society (Gonzalez & Simpson, 2021). For instance, this group of veterans comprises middle-aged or older individuals who are predominantly white males. However, they have distinctive attributes that differentiate them from the rest of society. These differentiators include special skills and the unique experiences gathered from their tours in Afghanistan and Iraq. Specifically, although the veterans gathered and practiced many hard and soft skills in a harsh and difficult environment, they also experienced unique happenings not common back at home. These experiences include working in hot and harsh terrains, living with communities of predominantly Islamic faith and Arabic culture, living in perpetual fear of attacks from insurgents, experiencing repeated gunfire and loud bands, witnessing their colleagues being injured and dying (Watkins, Sprang & Rothbaum, 2018). These experiences can influence the relationships between the veterans and their community at home. For instance, although they are embraced as heroes in their community, they may have difficulties enjoying the company of the civilian community members because they do not have much in common regarding experiences. They may also have entrenched camaraderie, which cannot be replicated in their communities. Besides, they may have tendencies or behaviors that could alienate them from their peers. For instance, they may be apprehensive with loud bangs and people that look a certain way, thus making them keep looking at what is around them all the time Gonzalez & Simpson, 2021). Similarly, they may be unusually quiet even in a social setting, thus making others uneasy with their extended silence. Besides, they may be easily provoked when approached in certain ways, making others uncomfortable with their presence. They may also avoid talking about their experiences with community members because they feel that the civilians would not relate to or understand their experiences. Therefore, they appear very evasive of some sensitive discussions.

Specific Mental or Behavioral Health Needs of Military Veterans

Veterans have specific mental health needs. Specifically, because of their traumatic experiences in Afghanistan and Iraq, they may develop depressive disorders, posttraumatic stress disorder, substance abuse disorders, and suicidal ideation (National Academies of Sciences; Engineering; and Medicine, Health and Medicine Division, Board on Health Care Services, & Committee to Evaluate the Department of Veterans Affairs Mental Health Services, 2018).  

Community Health Policy that Impacts Veterans

The Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018 is a federal policy that promotes community care for veterans. This legislation was designed to expand the veterans’ access to healthcare within the facilities of the Veterans Affairs Department (VA) and communities, promoting skilled healthcare professions in VA facilities, and expanding the caregivers’ benefits. In turn, this legislation authorized the establishment of the Community Care Program. This program aims at enabling veterans to access healthcare services from private community-based facilities. This policy replaced and augmented the Veterans Access, Choice and Accountability (Choice) Act of 2014, which had established the Veterans Choice Program, by increasing federal funding by an additional $5.2 billion (Ogrysko, 2018). However, veterans need to be eligible for this service by signing up with the Veterans Health Administration.   

Ethical Implications of the Policy for Veterans

Although the MISSION Act expands the veterans’ access to community care services, it requires the eligibility of the individual veterans, which raises some ethical questions. For instance, ineligible veterans cannot access the community services provided under this program, denies some veterans who may need such services desperately. In the same vein, the veterans must sign with the healthcare insurance provider beforehand to ensure that the cost of the healthcare services is paid for by the Veterans Affairs Department (VA) (Ogrysko, 2018). This may deny those that have not signed in with a health insurance provider to be denied community care services, which may be discriminatory. In addition, the funding of community care services for veterans has become discretionary rather than mandatory as in the previous program (Ogrysko, 2018). Therefore, some community care services may be better funded than others, despite their importance and demand.

Theory of Human Behavior and the Social Environment in Advanced Generalist Practice That Can Be Applied to Veterans

The social cognitive theory can help explain the thoughts, perceptions, and behaviors of veterans during and after active military service. This theory explains how people learn to change throughout their lifetimes. According to this theory, people learn new behaviors by observing others when interacting socially and from other environmental influences (Miller, 2017). Theory is applicable to veterans because it explains the behavior they acquired during their Afghanistan and Iraq tours and how some of these behaviors are incompatible with civilian life thereafter. For instance, the veterans learn a highly-physical lifestyle, which may be difficult to maintain in civilian life. Unfortunately, the Veteran Affairs Department does not have sufficient resources to support lifestyle needs of veterans (Miller, 2017). In turn, this drastic change of environment during civilian life can predispose veterans to psychological challenges, which compounds their difficulty in reintegrating back to civilian life. 

Strategies for Engaging the Population in the Intervention Process

Veterans can be engaged using focus groups. Focus groups are a good forum for sharing experiences, identifying needs, proposing solutions, and creating buy-in for the community health programs in their midst. Healthcare professionals could attend these meetings to help guide the brainstorming process and guide the discussions. The findings of such forums would help identify those that need help and those that can help their colleagues.

Recommendation of a Community-Based Health Care Reform Intervention

Using other veterans in the community to care for veterans with psychological challenges is the community-based healthcare reform intervention recommendation. Some veterans return home from tours without any effect on their mental and physical wellbeing, while others suffer from their traumatic experiences. Although both groups find it challenging to secure employment, mentally fit veterans can be deployed to care for their psychologically challenged colleagues in a peer support format (Shalaby & Agyapong, 2020). This would be a win-win intervention because the mentally well veterans understand the issues confronting their colleagues with mental health issues and would be actively engaged in their communities as a form of employment.

Explain How to Evaluate the Community-Based Health Care Reform Intervention

Key performance indicators would help evaluate the performance and efficaciousness of the proposed Community-Based Health Care Reform Intervention. The metrics would include the number of veteran volunteers and enrollees, the number of referrals to specialized healthcare services, the number of suicides committed by veterans, the incidences of domestic violence perpetrated by the veterans, and the number of hospitalizations of the veterans. Any change in this numbers would help indicate how well the intervention of combating the psychological challenges experienced by the veterans. For instance, a reduction in the suicide cases would indicate success for the intervention, while no change or a reduction of such numbers would indicate the intervention’s failure.

Conclusion

A community healthcare intervention can help address the enduring mental health challenges experienced by OEF and OIF veterans. Although the MISSION Act has expended access to healthcare services to veterans, those not eligible will be left out. A veteran volunteering interventions, in which the healthy veterans can help care for those experiencing mental health challenges in a formalized community health program is recommended. This would help address the mental issues of their colleagues that are not eligible to Community Care Program under the VA.

References

Gonzalez, J. A., & Simpson, J. (2021). The workplace integration of veterans: Applying diversity and fit perspectives. Human Resource Management Review, 31(2), 100775.

Institute of Medicine (2013). Returning home from Iraq and Afghanistan: Assessment of readjustment needs of veterans, service members, and their families. National Academies Press.

Miller, G. B. (2017). Use of social cognitive theory to understand veterans’ postservice physical activity behavior. Doctoral dissertation, Walden University. Retrieved from https://scholarworks.waldenu.edu/cgi/viewcontent.cgi?article=5340&context=dissertations.

National Academies of Sciences; Engineering; and Medicine, Health and Medicine Division, Board on Health Care Services, & Committee to Evaluate the Department of Veterans Affairs Mental Health Services. (2018). Evaluation of the Department of Veterans Affairs mental health services. National Academies Press.

O’malley, K. A., Vinson, L., Pless Kaiser, A., Sager, Z., & Hinrichs, K. (2020). Mental health and aging veterans: How the veterans health administration meets the needs of aging veterans. Public Policy & Aging Report, 30(1), 19-23.

Ogrysko, N. (2018). Trump signs VA MISSION Act into law, though funding questions remain. Federal News Network. Retrieved from https://federalnewsnetwork.com/veterans-affairs/2018/06/trump-signs-va-mission-act-into-law-though-funding-questions-remain/

Shalaby, R. A. H., & Agyapong, V. I. (2020). Peer support in mental health: literature review. JMIR Mental Health, 7(6), e15572.

Watkins, L. E., Sprang, K. R., & Rothbaum, B. O. (2018). Treating PTSD: A review of evidence-based psychotherapy interventions. Frontiers in Behavioral Neuroscience, 12, 1-9. https://doi.org/10.3389/fnbeh.2018.00258