AHEC Project for the Behavioral Health of Veterans, Service ...

MAY 2013 

AHEC Project for the Behavioral Health of Veterans, 

Service Members, and Their Families 

SPECIAL 

PUBLICATION 

Courtesy of the 

Journal of the 

National AHEC 

Organization 

nationalAHEC.org 

nationalAHEC.org

Message from 

the Journal 

Co-Editor 

As we publish this special 

issue of the Journal near 

Memorial Day, it is a perfect 

time to reflect on the sacrifices 

Joel E. Davidson, MA, MPA 

that all our uniformed 

personnel have made 

throughout our country’s history. While this issue focuses 

on the veterans from the Iraq and Afghanistan conflicts, 

we want to dedicate it to all veterans who have served our 

nation and thank them for their service. 

NAO Editorial Board 

Robert J. Alpino, MIA* 

Sandra Carr Hayes, DrPH 

Daphne Byrd-Verizzani, MEd 

Ronald Cossman, PhD 

Joel E. Davidson, MA, MPA, Co-Chair* 

Kathy English, BBA 

Veronnie Faye Jones, MD, PhD, MSPH 

David Gross, MPA 

Brenda F. Mitchell, BA 

Andrea Evans Novak, PhD, RN-BC, FAEN 

Kenneth L. Oakley, PhD, FACHE 

Rosemary Orgren, PhD, Co-Chair 

* Co-Editors of this issue 

Table of Contents 

Message from the Journal Co-Editor 2 

Message from the Executive 

Director of NAO 3 

AHEC Project for the Behavioral 

Health of Veterans, Service Members, 

and Their Familes 4-8 

Serving Those Who Have Served: Educating 

Community Healthcare Providers Working 

with Service Members, Veterans, and Their 

Families 9-10 

Serving Those Who Serve— NW Illinois 

AHEC Hosts Veterans Mental and Behavioral 

Health Training 11 

NWMO AHEC Focuses on Military Service 

Members and Their Families 12 

OP Tempo Increases Likelihood of Post- 

Traumatic Stress Disorder (PTSD) and 

Traumatic Brain Injury (TBI) 13 

Enhancing Services for South Dakota Military 

Personnel and Their Families: Yankton Rural 

AHEC, Veterans Affairs, and South Dakota 

National Guard Join Forces 14 

Understanding the Sacrifice: Western States 

Summit on Caring For Brain and Psychological 

Health Injuries 15 

Headquarters Editor: Jenny Kasza 

2 


Message from 

the Executive 

Director of 

NAO 

The importance of this 

special edition of the Journal 

of the National AHEC 

Robert M. Trachtenberg, MS 

Organization—which focuses 

on the AHEC Project for 

the Behavioral Health of Veterans, Service Members, 

and their Families—cannot be overstated. AHECs in 

every corner of the country—through an important and 

valuable partnership between the Health Resources and 

Services Administration (HRSA), the National AHEC 

Organization (NAO), and the Area Health Education 

Center (AHEC) Training and Consultation Center 

(A-TrACC)—are deeply engaged in working to impact 

the delivery of healthcare services for veterans, service 

members, and their families coping with post-deployment 

mental and behavioral health and substance abuse issues 

in the civilian sector with the overarching goal of better 

serving returning soldiers and their families. 

I can think of a no more compelling and timely national 

issue—and one that impacts people from nearly 

every county in the United States—than addressing 

the behavioral and mental health issues of veterans, 

particularly those who have returned from Iraq and those 

who are returning from Afghanistan. I am delighted 

that the National AHEC Organization has undertaken 

this very important work. As you will read in this special 

edition, you will see that through a national collective 

effort, AHECs are making a significant difference for 

veterans’ health through “Train-the-Trainer” workshops, 

followed by ongoing training by AHECs providing 

continuing education in their communities. Additionally, 

monthly webinars have been provided to AHECs 

throughout the country by nationally renowned experts 

on wide-ranging veterans’ topics such as: A Public Health 

Perspective of Issues of Returning Service Members; 

Military Culture; Post-Traumatic Stress Disorder; 

Traumatic Brain Injury; Substance Abuse Among 

Veterans; Connecting the Faith-Based Community and 

Behavioral Health Professions; TRICARE; Rural Mental 

Health; and Suicide. 

As we enter phase II of our work, our goals over the next 

12 months are to: 

• Increase the number of participating AHECs 

• Enhance marketing and outreach to train providers 

at Federally Qualified Health Centers and 

Community Health Centers 

• Support AHECs’ ability to provide continuing 

education (CE) credit for training events 

• Continue to develop an AHEC learning community 

on veterans’ mental and behavioral health needs and 

existing clinical resources through monthly webinars 

and ongoing technical assistance (TA) 

I am certain we will make outstanding progress on our 

phase II goals, as they are vitally important to reaching 

more providers and enhancing care for veterans. I 

invite you to read this comprehensive edition—and see 

firsthand the critically important work AHECs are 

doing throughout the country for our veterans. 

3 


AHEC Project for the 

Behavioral Health of 

Veterans, Service 

Members, and Their Families 

Kyle Peplinski, MA; Carol Trono, MA; Gretchen Forsell, MPH, RD, 

LMNT; Sheryl Pacelli, MEd; & Mary Wainwright, MS, RN 

Introduction 

Since October 2011, the Health Resources and 

Services Administration (HRSA), the National AHEC 

Organization (NAO), the Area Health Education Center 

(AHEC) Training and Consultation Center (A-TrACC), 

and AHECs nationwide have been working to impact 

the delivery of healthcare services for veterans, service 

members, and their families coping with post-deployment 

mental and behavioral health and substance abuse issues 

in the civilian sector with the overarching goal of better 

serving returning soldiers and their families. 

HRSA’s scope of work for the project included providing 

technical assistance, competency and curriculum 

development, and training to AHEC grantees with 

an extensive evaluation component to measure the 

effectiveness of the technical assistance and identify areas 

of practice improvement among providers trained through 

these efforts. 

The culminating product of the first phase of the project 

was a “Train-the-Trainer” program developed and 

implemented by A-TrACC. This “Train-the-Trainer” 

program equipped AHEC program and center staff with 

the skills and information needed to provide professional 

continuing education (CE) to civilian primary care, mental 

and behavioral health, and other healthcare providers, 

giving them the knowledge and skills needed to recognize 

and address this disparity. The curriculum provided 

during the “Train-the-Trainer” sessions also incorporated 

veterans’ mental health training activities from the North 

Carolina AHEC program and the Citizen Soldier Support 

Program (CSSP)—two programs that have led the nation 

in developing CE to train healthcare providers on this 

topic. 

As of December 2012, this effort has resulted in over 4,000 

civilian primary care, mental/behavioral health, and other 

providers attending CE programs offered by AHECs on 

the needs of this special population. The project’s goal is to 

reach 10,000 providers through CE by September 30, 2013. 

Need 

The AHEC Veterans Mental Health Project (VMH) 

stemmed from extensive internal discussions at HRSA 

and between HRSA and the Substance Abuse and Mental 

Health Services Administration (SAMHSA) about the 

need for a specific initiative to meet the needs of civilian 

healthcare professionals in providing high-quality, 

culturally competent care to the veteran population. 

HRSA staff and NAO leadership have long promoted 

using existing expertise and resources to address this need, 

firmly believing that the AHEC network is an expeditious 

and effective vehicle for getting information into the 

hands of providers. As a result, HRSA incorporated this 

work into the A-TrACC contract. 

Veterans face substantial need for enhanced and 

specialized behavioral health care due to both aboveaverage 

prevalence of Post-Traumatic Stress Disorder 

(PTSD) and Traumatic Brain Injury (TBI), but also due 

to issues related to reintegration into civilian and family 

life. Studies show that between 37% and 50% of veterans 

returning from Iraq and Afghanistan since 2001 have 

received a diagnosis of a mental health disorder (Brancu, 

et al., 2011; Cohen, et al., 2010). Additionally, alcohol 

misuse, alcoholism, and other substance abuse disorders 

are reported among veterans at significant rates (Seal, et 

al., 2009). 

Assessment of Needs 

As a first step in this project, A-TrACC completed an 

assessment to determine geographic areas within the 

AHEC network with the highest need for this training 

among civilian health providers. Utilizing existing NAO 

Post-Traumatic Stress Disorder/Traumatic Brain Injury 

Workgroups and other resources, A-TrACC established 

criteria for determining geographic need and collected and 

analyzed data to assess those needs. 

Sixteen geographic areas were identified. Key factors 

considered in the assessment were: 

• the total number of active and reserve service members 

and their dependents listing zip codes in a specified 

region at the time of their post 9/11 deployment; 

• the ratio of Department of Veteran Affairs (VA) 

facilities in a state to the total number of deployed 

service members from that state; 

• the ratio of total deployed from each AHEC center’s 

service region to its total state population, and 

4 


• the ratio of total deployed from each AHEC center’s 

service region to the population of that region. 

The AHEC Centers serving each of those 16 geographic 

areas were contacted and encouraged to participate in the 

project, and all agreed to do so. Meetings were held with 

Center representatives and their respective Program Offices 

to review the assessment, explain the opportunity, and 

confirm their participation (See Figure 1). 

Figure 1: AHEC Centers Serving Identified Priority Areas for Continuing Education 

HRSA 

Region 

AHEC Service Region 

Location 

Region 1 Eastern Connecticut AHEC Hartford, CT 

Region 2 Northern New York AHEC Canton, NY 

Region 3 Eastern Virginia AHEC Norfolk, VA 

Region 4 West Florida AHEC Crestview, FL 

Magnolia Coastlands AHEC 

West Kentucky AHEC 

Southern AHEC 

Statesboro, GA 

Region 5 Northwest AHEC Polo, IL 

Madisonville, KY 

Hattiesburg, MS 

Region 6 Southwest AHEC Lawton, OK 

Texas AHEC East, Waco Region 

Waco, TX 

Region 7 Omaha AHEC Omaha, NE 

Region 8 Central Colorado AHEC Aurora, CO 

Region 9 Southeast Arizona AHEC Nogales, AZ 

San Diego Border AHEC 

Honolulu AHEC 

Train-the-Trainer Workshops 

Chula Vista, CA 

Honolulu, HI 

A-TrACC provided 10 regional one-day workshops in 

January, February and March 2012, to implement “Trainthe-Trainer” 

CE modules for invited AHEC staff. A 

highly qualified curriculum development and training team 

implemented the workshops (See Figure 2). 

Included in the training curriculum were seven learning 

objectives: 

• Introduction to the A-TrACC Veterans Mental Health 

Project; 

• Scope of the problem; 

• Military culture; 

• Behavioral health issues, clinical guidelines and 

treatment, and barriers to care; 

• Veterans Administration and other resources; 

• “Boots on the Ground”—telling the lived experience of 

military veterans, and 

• How to develop and implement a CE offering. 

The goal of training 200 AHEC staff was exceeded by 

training 232 AHEC staff, 15 AHEC partner staff, and 

43 guests. Additionally, A-TrACC conducted a oneday 

workshop in conjunction with the NAO National 

Conference in July 2012. This workshop’s 28 attendees 

brought total attendance for all the “Train-the-Trainer” 

workshops to 318 (See Figures 3 and 4). 

These workshops equipped participants to facilitate CE 

programs for civilian primary care, mental and behavioral 

health, and other healthcare providers, building upon 

existing curriculum developed by the North Carolina 

AHEC and the CSSP. Participants left the workshop 

with slides and handouts to support development of CE 

trainings that include the following required learning 

objectives: 

Figure 2: Train-the-Trainer Curriculum Development and Training Team 

Team Lead Program Location Region 

Sheryl Pacelli, MEd 

Bob Goodale, MBA 

Carol Giffin- 

Jeansonne, EdD 

South East AHEC 

Citizen Soldier Support Program, Univ. of North 

Carolina Chapel Hill 

Western Colorado AHEC 


Wilmington, 

NC 

Chapel Hill, NC 

Grand Junction, 

CO 

Mimi McFaul, PsyD Western Interstate Commission on Higher Education Boulder, CO 6,7,8 

1,3,4,7 & at NAO 

1,2,3,4,5,7 & at 

NAO 

6,8,9,10 

James P. Kelly, MD The National Intrepid Center of Excellence Bethesda, MD 6,8,9 & at NAO 

Nicola Winkel, MPA Western Interstate Commission on Higher Education Phoenix, AZ 7, 9, 10 

Gretchen Forsell, 

MPH 

Northern Nebraska AHEC Norfolk, NE 5,7 

Carol Trono, MA Texas East AHEC Galveston, TX 2 

5

• Discuss the extent of behavioral health issues in service 

members returning from combat; 

• Explain the importance of knowing about military 

culture; 

• Discuss the common behavioral health issues seen in 

service members; and 

• List the reasons for asking patients about their military 

service or the military service of close family members. 

Ongoing Training for AHECs Providing Continuing 

Education 

To complement the “Train-the-Trainer” workshops, 

A-TrACC developed monthly online trainings to create 

a learning community that augments and enhances the 

curriculum presented in the workshops. Recordings of these 

webinars are posted on thee A-TrACC website at 

Figure 3: Train-The-Trainer (TTT) Workshop Data By HRSA Region 

HRSA 

Region 

States in 

Region 

*AHEC 

Programs 

in Region 

AHEC 

Centers 

by Region 

VMH TTT 

Workshop 

Sites 

TTT Host Center 

Region 1 6 6 21 Boston Berkshire AHEC 

Region 2 2 2 12 Buffalo 

Erie Niagara Area 

Health 

Region 3 4 5 24 Baltimore Eastern Shore AHEC 

http://bhpr.hrsa.gov/grantsareahealtheducationcenters/ta/ 

trainings/index.html. New webinars are being presented 

through September 2013. 

Webinar topics include: 

• A Public Health Perspective of Issues of Returning 

Service Members; 

• Military Culture; 

• Post-Traumatic Stress Disorder; 

• Traumatic Brain Injury; 

• Substance Abuse Among Veterans; 

• Connecting the Faith-Based Community and 

Behavioral Health Professions; 

• TRICARE; 

• Rural Mental Health; and 

• Suicide. 

Attendees 

29 - AHEC Staff/Partners 

01 - Guests 


04 - Guests 


11 - Guests 

VMH Trained 

AHEC Centers 

12 (57%) 

9 (75%) 

7 (29%) 

Region 4 8 13 47 Tampa Gulfcoast North AHEC 23 - AHEC Staff/Partners 22 (47%) 

Region 5 6 6 36 Chicago 

Chicagoland AHEC 


16 - Guests 

24 (69%) 

Region 6 5 8 37 Dallas 

Texas AHEC East – 

DFW Region 


04 - Guests 

26 (70%) 

Region 7 3 5 17 Omaha 

Central Nebraska 



7 (44%) 

Region 8 6 5 18 Denver 

Central Colorado 



03 - Guests 

13 (72%) 

Region 9 4 5 33 Los Angeles 

California AHEC 

Program 


04 - Guests 

10 (30%) 

Region 10 4 3 12 Portland 

Oregon AHEC 

Program 


6 (50%) 

NAO San Antonio NAO 28 - AHEC Staff/Partners 4 add’l centers 

Totals | 48 States w/ AHECs | 58 AHEC Programs | 257 AHEC Centers | 11 TTT Workshops 

318 Attendees (36% greater than goal) | 140 (54%) AHECs Trained 

*Includes Territories and DC 


6

Figure 4: AHECs Trained to Provide CE for Civilian Health Professionals on Behavioral/ 

Mental Health of Veterans/Service Members and Families Interactive Map http://batchgeo. 

com/map/00740402dc934a680a35edca0b6dbad9 

In the first year of the program, 34 webinar and workshop 

sessions were offered for 1,002 total participants. As noted 

in Figure 5, all of the participants (100%) in the veterans’ 

mental health sessions reported the training effectively 

 year of the program, 34 webinar and workshop sessions were offered for 1,002 total  

presented information on related topics (Somewhat 

s. As noted in Figure 5, all of the participants (100%) in the veterans’ mental health sessions  

Effective, Effective, or Very Effective rating). Almost of 

he training effectively presented information on related topics (Somewhat Effective, Effective,  

the participants (99%) reported an increase knowledge 

ective rating). Almost all of the participants (99%) reported an increase in knowledge  

regarding each topic presented (Agree or Strongly Agree), 

each topic presented (Agree or Strongly Agree), and 99% reported an intention to make  ongoing. 

ents in the services their AHECs offer regarding veterans’ mental health (Somewhat Agree,  

and 99% reported an intention to make improvements trongly Agree).  the services their AHECs offer regarding veterans’ mental 

health (Somewhat Agree, Agree, or Strongly Agree). 

eterans Mental Health Project Training Evaluation Summary  

s Summary  Figure 5: Veterans Mental Health Project Training Evaluation 

Summary for 34 Sessions 

Effectiveness  Increase Knowledge  Intent to Change  

  

64% Very Effective  

34% Effective  

2% Somewhat Effective  

0% Not Very Effective  

0% Ineffective  

  

53% Strongly Agree  

46% Agree  

      

0% Neither Agree/Disagree  

1% Disagree  

0% Strongly Disagree  

viding Continuing Education   

enters began planning and offering their CE programs in the spring of 2012, A‐TrACC provided  


technical assistance where needed. This included helping to develop agendas, adapt  

  

32% Strongly Agree  

51% Agree  

16% Somewhat Agree  

1% Disagree  

0% Strongly Disagree  

AHECs Providing Continuing Education 

As AHEC Centers began planning and offering their 

CE programs in the spring of 2012, A-TrACC provided 

individual technical assistance where needed. This included 

helping to develop agendas, adapt resources, connect with 

potential partners, and find speakers through local VAs 

and/or military facilities. This type of assistance is currently 

In the first year of the project (September 30, 2011 through 

September 29, 2012), 93 AHEC centers nationwide 

fulfilled Memoranda of Understanding with NAO and 

received additional financial support for the development 

and implementation of their CE offerings. HRSA and 

A-TrACC’s goal is to increase the number of participating 

centers in the second year of the VMH project. 

To encourage greater ease of use and increased 

participation of AHEC centers, A-TrACC revised and 

reorganized the training materials from the “Train-the- 

Trainer” workshops into an online toolkit. Centers that 

were unable to send staff to last year’s workshops can now 

access the information needed to plan and implement 

trainings on the A-TrACC website at http://bhpr.hrsa.gov/ 

grants/areahealtheducationcenters/ta/index.html. 

7

The toolkit includes fully developed curricula for one-hour 

and four-hour trainings with agendas, slides, speaker notes, 

and handouts that have been pre-approved by the Post- 

Graduate Institute for Medicine (PIM) for 1 and 4 hours’ 

credit respectively for physicians, nurses, social workers, 

marriage counselors, and family therapists. This option 

was developed to streamline the process of getting CE 

credit for these programs for all participating centers and 

especially for those with limited experience and resources 

in this area. Centers choosing to provide credit through 

PIM can do so through an expedited process and for a $500 

fee. The toolkit minimizes the number of staff and the 

amount of time and resource investment needed to offer 

these trainings so that all AHEC centers have the resources 

needed in order to participate. 

A-TrACC developed AHEC-specific evaluation tools and 

methods to determine the effectiveness of the “Train-the- 

Trainer” workshops and the resulting CE programming 

on improving the competency and practice of healthcare 

providers. The evaluation process and tools were approved 

by the Office of Management and Budget in July 2012. 

The evaluation methodology for this project includes 

commitment to complete assessments both at the 

immediate conclusion of a CE offering and again within 

30 days after the offering through a brief follow-up e-mail 

survey implemented by AHEC staff with a randomly 

selected sample of 2% of participants. For each CE 

offering, AHEC staff compiles and submits a final report of 

aggregate responses to A-TrACC. 

Conclusion 

By the end of the first year of the project on September 

29, 2012, AHECs trained over 2,700 health professional 

participants. A number of AHECs that were new to 

providing CE were able to participate in the project and 

anecdotal evidence about their participation is encouraging. 

Many AHECs reported building new partnerships through 

the project and noted an overwhelming appreciation 

for the training from their participants. While several 

AHEC centers reported barriers to the effectiveness of 

their training, A-TrACC provides ongoing individualized 

technical assistance aimed at overcoming these challenges. 

HRSA and A-TrACC are continuing this important project 

over the next contract year (September 2012-September 

2013) and will be providing more resources, trainings, 

and technical assistance to support AHEC Programs and 

Centers in carrying out this project. 

Kyle Peplinski, MA, is HRSA Project Officer, 

AHEC Training and Consultation Center 

(A-TrACC) Public Health Analyst, U.S. 

Department of Health and Human Services, 

Health Resources and Services Administration, 

Bureau of Health Professions 

Carol Trono, MA, is Program Manager, AHEC 

Training and Consultation Center (A-TrACC) 

Coordinator II, and Texas AHEC East. 

Gretchen Forsell, MPH, RD, LMNT, is Project 

Manager, AHEC Training and Consultation 

Center (A-TrACC) and Executive Director of 

the Northern Nebraska AHEC. 

Sheryl Pacelli, MEd, is Consultant, National 

AHEC Organization Veterans Mental Health 

Project and Pace Consulting and Associates. 

Mary Wainwright, MS, RN, is Director, 

AHEC Training and Consultation Center 

(A-TrACC) and Deputy Director of the Texas 

AHEC East. 

REFERENCES 

Brancu, M., Straits-Tröster, K., & Kudler, H. (2011). Behavioral health 

conditions among military personnel and veterans: Prevalence and best 

practices for treatment. North Carolina Medical Journal, 72(1): 54-60. 

Cohen, B. E., Gima, K., Bertenthal, D., Kim, S., Marmar, C. R., & Seal, 

K. H. (2010). Mental health diagnoses and utilization of VA non-mental 

health medical services among returning Iraq and Afghanistan veterans. 

Journal of General Internal Medicine, 25(1): 18-24. 

Seal, K. H., Metzler, T. J., Gima, K. S., Bertenthal, D., Maguen, S., 

& Marmar, C. R. (2009). Trends and risk factors for mental health 

diagnoses among Iraq and Afghanistan veterans using Department 

of Veterans Affairs health care, 2002-2008. American Journal of Public 

Health, 99(9): 1651-1658. 

8 


Serving Those Who Have 

Served: Educating Community 

Healthcare Providers 

Working with Service 

Members, Veterans, and Their 

Families 

Bennie Pettit and Fay Brown 

Nathan “Nate” Moore understands the importance of 

well-trained community healthcare professionals who serve 

wounded warriors and their families. Two years of therapy 

in his Greenville, South Carolina community helped the 

veteran of combat in Afghanistan and Iraq overcome severe 

injuries and hold his family together. 

Nate’s story is commonplace, yet no less heart-wrenching 

and life-changing. During a 2009 seven-month tour of duty 

in Afghanistan, the Marine infantry regiment team leader 

suffered four severe concussions during a 20-hour firefight. 

Determined not to abandon his fellow Marines, the 

Combat Engineer, whose job it was to search for improvised 

explosive devices (IEDs), kept returning to the field after 

each injury, striving to keep his men alive. 

Following the battle, Nate was medically 

evacuated and received treatment at his small 

local base, then spent three months receiving 

treatment at a larger base in Afghanistan. He 

returned home medically retired. Attempting to 

re-enter his life as he left it in Greenville, Nate 

realized he needed additional help. He suffered 

from Post-Traumatic Stress Disorder (PTSD), 

traumatic brain injury, and post-concussion 

syndrome. His memory was gone, his ability 

to think and reason had left him, and his 

relationship with his wife was disintegrating 

as his illnesses became more severe. 

Seven months of treatment in 

Charlottesville, Virginia provided help for 

Nate’s recovery, but the separation from 

his family was harmful. “It was like being 

deployed once again,” Nate says. 

Once back in Greenville, he contacted Major Charlie Hall, 

a West Point grad and Marine Corps non-medical case 

manager for post-9/11 combat vets in South Carolina and 


Georgia. Major Hall arranged for Nate to receive therapy 

through a local rehabilitation hospital. For two years Nate 

faithfully attended local therapy sessions, and his wife 

received therapeutic help as well, learning about PTSD and 

Nate’s sometimes misunderstood behavior. 

“Local therapy is awesome,” Nate responds gratefully. 

“Our family is together now. Family members need PTSD 

education and therapy, too, not just the veteran. Spouses 

can be traumatized when receiving news their loved one is 

injured. I am thankful my wife was able to get help.” 

Nate credits his outstanding local therapists for his life 

today. Life is good. So good in fact, that the Moores 

welcomed their first child in early December, a baby boy, 

Connor, and look forward to a wonderful future together as 

a recovered wounded warrior family. 

Nate’s story was shared in trainings provided to a wide 

variety of civilian community healthcare professionals 

in Upstate South Carolina. Partnering with the 

National AHEC Organization, Health Resources and 

Services Administration, and the Greenville Veterans 

Administration Outpatient Clinic, Upstate AHEC 

in Greenville sponsored two continuing education 

opportunities entitled, “Serving Those Who Have Served: 

Educating Community Healthcare Providers Working with 

Service Members, Veterans and Their Families,” which 

was designed for civilian licensed mental health providers 

including primary care providers, psychologists, social 

workers, psychiatrists, 

licensed nurses, 

marriage 

and family 

therapists, and 

other healthcare 

professionals who 

provide services to 

military personnel, 

veterans, and their 

families or who 

plan to actively treat 

wounded warriors. 

The purpose of the 

continuing education 

program was to increase 

knowledge and improve 

diagnosis and treatment practices for civilian healthcare 

professionals who treat veterans with behavioral/mental 

health issues; to better understand the military culture 

of veterans, service members and their families; and to 

During Upstate (SC) AHEC’s training for healthcare providers in July 

2012, more than 80 participants heard veterans’ testimonials of their mental 

health struggles after returning from Iraq and Afghanistan. 

9

Corporal Nathan R. Moore, USMC, left, shares 

his story with course participants while fellow veterans Sgt. Gabe 

Henderson, center, and Major Charlie Hall look on. 

increase access to culturally competent care. Sgt. Gabe 

Henderson (Boiling Springs); Cpl. Nathan Moore 

(Greenville); SSgt Charlie Pannell (Anderson); Stacey 

Good, LISW-CP; Lynda Cox, PsyD; and Major Charlie 

Hall served as presenters. In addition, three veterans and 

one spouse provided “Boots on the Ground” testimonials 

that described experiences deployed service members 

may have encountered as they entered into harm’s way to 

defend our country, our way of life, and our constitution. 

Information on available resources was also shared. 

The trainings were attended by more than 100 participants 

in July and November 2012. Feedback from the sessions 

was positive and demonstrates the level of satisfaction with 

the training sessions: 

Thanks to the training 

provided by the Upstate 

AHEC, the Greenville 

healthcare community 

is ready to help more 

returning veterans like 

Nate Moore return 

to a productive and 

rewarding civilian life. 

• Great job on training! 

• Very helpful to have actual veterans speak. 

• Great program! I think that this course should 

continue in order to educate medical professionals 

to be prepared to care for the rising population of 

veterans. 

• Thank you for offering this class. It was very helpful to 

understanding military veterans’ needs. 

Bennie Pettit is an Education Consultant. 

• Thank you for this moving and informative program. 

This session was most informative and enjoyable. 

• Keep finding such quality speakers. Very good 

course—very appropriate and timely! 

• Thanks to the training provided by the Upstate 

AHEC, the Greenville healthcare community is ready 

to help more returning veterans like Nate Moore 

return to a productive and rewarding civilian life. 

Fay Brown serves as Center Director of the 

Upstate AHEC in Greenville, South Carolina. 

10 


Serving Those Who 

Serve: NW Illinois AHEC 

Hosts Veterans Mental 

and Behavioral Health 

Training 

Teresa Strum, RN, MSN 

The Northwest Illinois Area Health Education Center 

(NW Illinois AHEC) was selected as one of the centers 

to participate in a nationwide AHEC initiative to educate 

healthcare professionals about veterans’ mental and 

behavioral health issues. After attending the Train-the- 

Trainer session in Chicago, the NW Illinois AHEC formed 

a partnership with Jason’s Box—a non-profit organization 

whose mission is to improve the health and well-being of 

military men and women—to reach out to their multiple 

healthcare and military organization partners. Jason’s Box 

also provided the continuing education credit for physicians, 

nurses, and social workers who were trained. 

The training itself, titled “Serving Those Who Serve: Helping 

Civilian Healthcare Professionals Identify, Understand, and 

Assist Military Service Members with PTSD and TBI,” was 

provided in July of 2012. Key presentations were made 

by Dr. Joseph Troiani, Director Mental Health Division, 

Will County Health Department and Associate Professor, 

Adler School of Professional Psychology; Nicole Younge, 

TRICARE Education Specialist from Scott Air Force Base; 

and U.S. Army Retired Stephen D. Blake, who shared his 

own moving story on what it is like to be deployed, then 

reintegrate into civilian life. 

There were 59 individuals in attendance for the training. 

The evaluations were overall very positive, with 89% 

indicating that they strongly agreed or agreed that there 

was an increase in knowledge about mental/behavioral 

health issues that afflict veterans/service members and 

their families. Following this session, a service member and 

physician at Scott Air Force Base indicated that of all the 

workshops and training sessions he has attended, this was by 

far the best. A follow-up survey showed that over 57% of the 

participants started asking their patients/clients if they, or 

any close family members, have served or are serving in the 

military, with another 36% reporting that they planned to 

implement this practice. In addition, Jason’s Box has started 

to implement a system at the local healthcare facilities 

where patients will be asked upon arrival in the Emergency 

CSM (R) Stephen Blake shares his story of leading his troops in a war zone and 

reintegrating into civilian life upon return during the “Serving Those Who Serve…” 

presentation, Rock Island, Illinois. 

Department (ED) if they are a veteran. If they answer yes, 

a brief mental health assessment is performed and they are 

provided with the option of wearing a special wrist band 

identifying them as a veteran during their stay. 

The initial training was so well received that the NW 

Illinois AHEC decided to hold it again at a rural 

community college. This session was provided on 

November 9 to kick off Veterans Day weekend and, 

again, was a huge success. There were 76 individuals in 

attendance for this session, many of whom were Family 

Practice physicians and their nursing staff. The second 

largest group participating was members of the clergy. As 

in the first session, the evaluations were very positive with 

92% indicating that they strongly agreed or agreed that 

there was an increase in knowledge of veterans/service 

members and their families’ mental/behavioral health 

issues. Although a follow-up survey has not yet been 

conducted, several physicians have contacted the AHEC 

indicating that they felt the training was excellent and well 

worth their time. Office nurses have also called, indicating 

that they have started identifying service members and 

their families in their practice with positive results. 

The Illinois AHEC network is now preparing to provide 

the training at the state capital in Springfield. As one of the 

presenters noted, we do not have a switch to turn off the 

way of life during deployment after returning. Sometimes, 

time and someone to listen are what is needed to return to 

life before deployment. By asking the question—Are you 

a veteran or the family member of a veteran?—we can begin 

serving those who serve. 

Teresa Strum, RN, MSN, is the Executive 

Director of the Northwest Illinois AHEC. 

11 


NWMO AHEC Focuses on 

Military Service Members 

and Their Families 

Paula Overfelt 

The speakers from left: Colonel Tim 

Karcher, Director U.S. Army Wounded 

Warriors Program; Andrea Zartman, PhD, 

Neuropsychologist, VA, North Texas Health 

Care System; LCDR Pamela Herbig-Wall, 

RN, NC, USN, PMHNP-BC, Psychiatric 

Nurse Practitioner, Camp LeJeune, NC 


Prior to attending the 

Area Health Education 

Center (AHEC) Training 

and Consultation Center 

(A-TrACC) Trainthe-Trainer 

session in 

Omaha, Nebraska on 

implementing veterans’ 

mental health programs for 

civilian health providers, 

Northwest Missouri 

AHEC (NWMO AHEC) 

staff didn’t know what to 

expect and did not have 

any experience with this 

type of continuing education activity focused on military service 

members and their families. The Train-the-Trainer session 

was so helpful in preparing the NWMO AHEC, located 

in St. Joseph, MO, to follow through in creating a training event. 

On June 22, 2012, the NWMO AHEC training event, 

Military Family Wellness: Boots on the Ground, was held. The 

70 participants were primarily behavioral health providers, care/ 

case managers, with a few nurse practitioners and nurses in the 

mix. The first speaker was Brigadier General John D. Owens, 

a family medicine physician in our area, brought to us through 

the efforts of Phil Pringle, Director of Psychological Health for 

the 139th Airlift Wing of the Missouri Air National Guard, 

which is located in St. Joseph. Phil continued our program and 

brought in a panel of formerly deployed OIF (Operation Iraqi 

Freedom), OEF (Operation Enduring Freedom), and OND 

(Operation New Dawn) service members. The program was 

concluded by Nakoke Wooley, Lead Child and Youth Program 

Coordinator for the Missouri National Guard Child and Youth 

Program. The participation of Mrs. Wooley, a former service 

member, was extremely important since the NWMO AHEC 

region in the state has the largest population of dependents of 

military personnel in the state. 

The top three improvements these healthcare providers 

desired to make with their military/service member clients and 

their families were to: (1) increase their own knowledge and 

awareness of military members/families, (2) improve their work 

with these patients, and (3) improve the quality of their overall 

patient assessment skills with this patient population. A followup 

survey to determine these providers’ interest in additional 

continuing education on this subject matter was overwhelmingly 

in support of more training. 

The program began with Pledge 

of Allegiance and Color Guard. 

Before follow-up education began, NWMO 

AHEC received a call from a nursing 

professor at Missouri Western State University 

regarding a conference they were planning. 

The accrediting body for nursing programs 

had recently recommended that curriculum 

around veterans’ mental health issues be added. 

Connecting with the Joining Forces Initiative, 

the planning committee for the annual nursing 

honor society’s conference discovered the involvement of 

AHEC and made the contact. NWMO AHEC immediately 

became involved. This professor had attended the June 22 

event and is a reservist herself. Two of the speakers had 

local connections—first, the brother-in-law of one of the 

nursing professors, Colonel Tim Karcher, Director U.S. 

Army Wounded Warrior Program. The second speaker 

was Dr. Andrea Zartman, neuropsychologist, Veterans 

Administration North Texas Health Care System, the 

daughter of one of the nursing professors. While watching 

PBS one evening, the professor found the third speaker, 

Lt. Commander Pamela Herbig Wall, Psychiatric Nurse 

Practitioner. Dr. Zartman called and invited her—and she 

came. Phil Pringle and his staff at the 139th Airlift Wing 

were also involved in this program. 

The exciting result of this second event in October 2012, 

Joining Forces: Partners in Care, is that 200 nursing students 

are aware of veterans’ mental health issues before they begin 

their practice; this knowledge will be part of their patientcare 

foundation for the rest of their career. The trainees’ 

response to the question regarding what they would improve 

about the training session was overwhelmingly centered on 

their need to listen and improve their communication skills 

with military/service members and their families. 

The evaluations of the two sessions provided the following: 

Strongly Agree Or Agree Responses Professionals Students 

Increased knowledge of military culture 98% 98% 

Increased knowledge of veterans’/service 

members’ and their families’ mental/ 

behavioral health issues 

Will now ask if patient or family 

members serve/served in military 

Before this session, asked if patient or 

close family members served in military 

96% 98% 

96% 78% 

68% 20% 

Most recently, on April 17, 2013, 21 physicians, psychiatrists, 

nurse practitioners, behavioral health professionals, and 

social workers of the regional federally qualified health 

center (Northwest Health Services) attended a session 

“Psychological Health Needs of the Military” as part of their 

quarterly provider meeting. Phil Pringle and another service 

member from the 139th Airlift Wing, St. Joseph, MO were 

present to speak with the providers. 

Paula Overfelt is the Executive Director of the 

Northwest Missouri AHEC. 

12

OP Tempo Increases Likelihood 

Of Post-Traumatic Stress 

Disorder (Ptsd) And Traumatic 

Brain Injury (Tbi) 

Brian P. Jakes, Sr. 

While Louisiana enjoys a preponderance of military units and 

Department of Defense assets within its borders, the “OP 

TEMPO” or Operations Tempo (activities/duties required of 

personnel) assigned to those units increases the likelihood of 

multiple combat deployments. Multiple deployments increase 

the chances that service members and their family members will 

be diagnosed with Post Traumatic Stress Disorder (PTSD) or 

Traumatic Brain Injury (TBI). 

This requires that Louisiana and other states with many 

Department of Defense units and installations be prepared 

to provide high levels of community awareness, appreciation, 

understanding, and appropriately trained personnel for the 

treatment of PTSD and TBI. 

Louisiana is currently home to 325,992 veterans, of which 38,711 

are veterans of the Afghanistan and Iraq wars. Louisiana, a 

relatively small and essentially rural state, provided more military 

personnel to these conflicts than 35 other states. It is estimated 

that 11,652 Afghanistan and Iraq veterans in Louisiana have some 

type of mental health disorder with 3,366 Afghanistan and Iraq 

veterans unserved and another 1,346 unserved ‘other’ veterans in 

the state. 

The call to provide evidence-based screening and treatment 

(cognitive behavioral therapy) to military personnel, families 

and veterans needing mental health care for PTSD or TBI as a 

consequence of multiple deployments and other stressors placed 

upon military personnel and their families is essential. Currently 

there is a dearth of trained behavioral health specialists who are 

adequately trained to understand and deal with PTSD and TBI. 

The RAND Center for Military Health Policy Research, in their 

landmark 2008 study, “Invisible Wounds of War,” concluded 

that we could save $3,000 to $12,000 per person, depending on 

condition, if they entered into evidenced based treatment. The 

national annual cost savings of evidence-based treatment would 

be $192,341,627. The study concluded that the average treatment 

cost per case is $3,443. The alternative for not treating our 

veterans is unacceptable and more veterans will become homeless 

and unemployed. This only adds additional behavioral health costs 

once unserved veterans are identified and agree to treatment. 

Louisiana AHEC program was invited to join with other 

partners to help develop a comprehensive program to strengthen 

our behavioral healthcare system and services. Louisiana was in 

the third round of states invited to participate and attend the 

SAMHSA Policy Academy. The overarching goal of the Policy 

Academy is to develop effective and sustainable state strategic 

action plans and to establish coordinated and integrated systems 

of care to deal specifically with PTSD and TBI. These goals 

are coupled with cultivating effective outreach and engagement 

strategies for rural populations while conducting environmental 

scans, gap analyses, and data assessments. 

In addition to AHEC, partners include: The Governor’s Office, 

The Louisiana Department of Health and Hospitals (Office 

of Behavioral Health), The Louisiana Department of Veterans 

Affairs, the State Adjutant General, the Reserve Community- 

Employer Support of the Guard and Reserve (ESGR), State and 

local legislators, academic health centers, a community provider 

representative, and representatives from Medicaid, Prevention 

Services, Workforce Development, and retired military. 

SAMSHA and the partners strongly recommended using 

the AHEC A-TrACC Veterans’ Mental Health Project 

emphasizing continuing education training on PTSD and TBI 

for community-based clinicians. The project is well along in 

its development. The Louisiana AHEC centers quickly seized 

the opportunity to commit early to training a minimum of 500 

community clinicians with a possibility of training as many as 

1,500 in the state of Louisiana. 

Southeast Louisiana AHEC (SELAHEC) and Southwest 

Louisiana AHEC (SWLAHEC), long committed to 

understanding PTSD and TBI and the training of clinicians, 

have completed the necessary documents for the memorandum 

of understanding (MOU) required by the AHEC A-TrACC 

initiative. SELAHEC held its first training on April 26, 2013, 

for 18 medical residents and followed it with training on May 

1 for 185 senior medical students at Louisiana State University. 

Other planned training includes Traumatic Brain Injury at 

behavioral health centers for nursing staff and for communitybased 

providers. 

This is just the beginning of the training that will take place to 

help Louisiana’s healthcare professionals provide the mental and 

behavioral care that is so necessary to treat our veterans. 

REFERENCES 

Tanielian, T., & Jaycox, L. H. (2008). Invisible Wounds of War: Psychological and 

Cognitive Injuries, Their Consequences, and Services to Assist Recovery. RAND 

Center for Military Health Policy Research. 

Brian P. Jakes, Sr., is with the Southeast 

Louisiana AHEC. 

With the assistance of the federal Substance Abuse and Mental 

Health Services Administration (SAMHSA) Service Members, 

Veterans and their Families Policy (SMVF) Program, the 

13 


Enhancing Services for South 

Dakota Military Personnel 

and Their Families: Yankton 

Rural AHEC, Veterans 

Affairs, and South Dakota 

National Guard Join Forces 

Chauntel Wright, MPA; and Sandy Korkow Stockholm, MPA 

“He who did well in war, earns the right to do well in peace.” 

-Robert Browning 

A recent study indicates one in three service members 

returning from Afghanistan or Iraq have suffered a brain 

injury or are now battling a mental health condition. Key 

findings of this RAND Corporation study note nearly half 

who need treatment seek it and just more than half who are 

treated get “minimally adequate care” (American Medical 

Association, 2012). Adding to these issues, a majority of 

South Dakota (SD) service members are returning home 

to rural and remote communities where services are very 

limited or not available. 

Aimed at improving combat veterans’ healthcare in rural 

medically underserved areas, the Yankton Rural Area 

Health Education Center (YRAHEC) joined forces with 

the Department of Veterans Affairs (VA) Sioux Falls and 

the SD Army National Guard to organize two conferences 

in 2012. With more than 72,000 SD veterans spanning 

generations, front-line caregivers have a high level of 

interest in providing effective treatment for this population. 

On May 30, 2012 in Sioux Falls, 63 providers attended 

the Second Annual Improving Combat Veterans Care: Post 

Deployment. This free conference featured Retired Major 

General Robert T. Bray with 41 years of experience in Fire 

Service and the Army National Guard. Conference topics 

included learning how to ask questions to identify veterans 

and their families, gaining a better understanding of military 

culture, and discussing mental/behavioral issues concerning 

veterans and their families. 

The second conference, “Working with Service Members & 

Veterans: Clinical & Cultural Competencies for Mental Health 

Providers,” was also held in Sioux Falls August 22-23, 

2012. More than 100 healthcare providers participated in 

this two-day continuing education conference focused on 

improving the care for service members and veterans. Holly 

O’Reilly, PhD, Cognitive Behavioral Therapy Trainer, 

of the Center for Deployment Psychology, provided 

attendees with information concerning sleep problems 

related to deployment (insomnia), military culture/ 

deployment cycle, and etiology, assessment and treatment 

of post-traumatic stress disorder (PTSD). After attending 

the session, one participant commented, “I have a better 

understanding of their culture, therefore my approach will 

be different.” 

To capture a large audience of providers, both conferences 

were offered at affordable rates. Registration for the 

one-day conference was free and offered 6.25 continuing 

education credits (CEUs). There was a minimal $15 fee 

for the two-day conference which offered 10.75 CEUs for 

psychologists, counselors, marriage and family therapists, 

social workers, and alcohol and drug abuse professionals. 

Echoing the continuing education needs for practitioners 

caring for veterans, the YRAHEC, VA, and SD Army 

National Guard will coordinate two additional conferences 

in 2013. The location, speakers, and details are in the 

process of being established and will be posted on the 

YRAHEC website, www.yrahec.org. 

REFERENCES 

Invisible Wounds, American Medical Association Wire, March 21, 2012. 

Chauntel Wright, MPA, is in charge of Special 

Projects at the YRAHEC. 

Sandy Stockholm, MPA, serves as Data 

Coordinator of the YRAHEC. 

14 


Understanding the Sacrifice: 

Western States Summit 

on Caring for Brain and 

Psychological Health 

Injuries 

Carol Giffin-Jeansonne, EdD 

Sadly, many returning military personnel have come back 

from Iraq and Afghanistan with brain and psychological 

injuries. More than 50% will receive their care from 

civilian healthcare workers and need support from family 

and friends in order to transition back to a civilian way of 

life. Yet many, perhaps most, civilian healthcare providers 

and community members know little about military 

culture, head or psychological injury, or how to recognize 

their signs and symptoms, let alone how to respond 

appropriately. Western Colorado Area Health Education 

Center (WCAHEC) believes it is critical to address 

these issues, and in response hosted its second Head 

and Psychological Health Injury Conference in October 

2012. WCAHEC partnered with the National Intrepid 

Center of Excellence (NICoE) and the National AHEC 

Organization, along with several state AHECs including 

Texas, Nebraska, California, Utah, Oregon, and Alaska. 

Regional partners included the majority of hospitals 

across WCAHEC’s 13-county region, county health 

departments, and business partners, and the program 

was part of the nationwide AHEC Veterans’ Mental 

Health Project. The Summit on Caring for Brain and 

Psychological Health Injuries featured national experts on 

brain and psychological health injuries as well as a muchdecorated 

veteran of the wars in Iraq and Afghanistan. 

The Summit targeted healthcare professionals 

(medical and behavioral) and members of the general 

community—teachers, parents, coaches, law enforcement, 

and veterans and their families were also encouraged 

to attend. The skills and knowledge gained through 

treatment on the battlefield in Iraq and Afghanistan 

are relevant and apply to the more than 4.5 million 

civilian head injuries suffered in the U.S. every year as 

well. "It’s so very important that all of us understand the 

very real danger and frequency of U.S. head injuries," 

stated Dr. Carol Giffin-Jeansonne, Executive Director of 

WCAHEC. "The Centers for Disease Control estimate 

1.7 million diagnosed head injuries every year, while 

experts on head injury estimate the real numbers are 

closer to over 4–5 million," she added. 

Senator Michael Bennet kicked off the Summit and 

was followed by presentations by Dr. James Kelly, a 

neurologist who helped write the book on concussion 

guidelines widely used in athletic and military settings, 

and Director of the NICoE based at Walter Reed 

National Military Medical Center; U.S. Army Retired 

Colonel David Sutherland, past Special Assistant to the 

Chairman of the Joint Chiefs of Staff, U.S. Department 

of Defense Warrior and Family Support Office; 

and Dr. Kelly Phillips-Henry, a Psychologist and 

AspenPointe, Chief Operating Officer. The day 

culminated with a wide-ranging discussion between the 

100-plus-member audience and the three presenters 

joined by Retired Sergeant Jared Bolhuis, that included 

a Question and Answer session on recognizing 

signs and symptoms; sharing insights gained from 

experiences; and discussion about the travails of dealing 

with military behavioral and medical issues in civilian 

life. The audience and presenters cited the discussion as 

very important to the overall benefit of the program. 

With support from the Colorado Traumatic Brain 

Injury Trust Fund and other partners, the morning 

sessions and continuing medical education units were 

free of charge. Others in the community—teachers, 

coaches, parents, veterans and their families, clergy, 

counselors, elected officials, and others said they 

benefited from the inspiration and education provided. 

“Understanding the issue can pave the way to helping 

our loved ones,” says Giffin-Jeansonne. 

Carol Giffin-Jeansonne, EdD, is Executive 

Director of the WCAHEC. 

15

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