Indiana ASPIN Veteran's Services

Description

Indiana is home to more than 455,000 veterans and supplies the 4th largest deployment of Army Guard soldiers in the United States. But suicide among these veterans is high - the state Indiana ranks 4th in the nation in National Guard member suicides, but ranks 20th in the amount of federal dollars received for veteran services.

ASPIN Veteran's Services (formerly known as the Indiana Veterans Behavioral Health Network) provides mental healthcare services to Indiana veterans who are otherwise unable to receive VA assistance in rural areas. The program was formed by the Affiliated Service Providers of Indiana Network (ASPIN), a nonprofit behavioral health network made up of 7 rural community mental health centers and 3 addiction providers. It offers clinical care through 50 offices in the state and behavioral health integration through the work of its community health workers program.

The mission of ASPIN Veteran's Services is to develop veteran cultural competence among affiliated providers. Through a matrix of services, the program cares for both insured and uninsured veterans by placing teleconferencing units at 6 rural community mental health centers. This allows veterans to receive care in a timely manner without having to leave their home communities. These units allow veterans to access VA clinical providers who are familiar with military mental health issues. ASPIN Veteran's Services was the first in the nation to facilitate partnerships between the VA and a private providers.

This program has partnerships with multiple organizations, including:

• The Richard L. Roudebush Veterans Administration Medical Center
• VISN 10
• Hamilton Center Inc.
• Valley Oaks Health
• Centerstone of Indiana
• Community Howard Regional Health
• Indiana National Guard
• Indiana Department of Veteran Affairs
• Indiana Division of Mental Health Addiction

ASPIN Veteran's Services was originally funded by a 2011-2014 Federal Office of Rural Health Policy Rural Health Network Development grant. It is now sustained with funds from monthly provider fees that are contracted on a 5-year basis.

Services offered

ASPIN Veteran's Services provides veterans with:

• Access to trained VA mental and behavioral health therapists
• Diagnosis and treatment of issues surrounding military healthcare and rural healthcare

Clinicians are provided with:

• Training on military culture and behavioral health issues that occur after deployment
• Guidelines on how to achieve a military-friendly designation

In order to access services, veterans must be eligible for VA benefits and be scheduled by their VA clinicians.

Results

Over the 3-year FORHP grant period, the training for clinical providers was effective in the following ways:

• 256 providers were directly trained via live webinars
• 115 providers have taken online archived trainings via the IVBHN Learning Management System
• 6 organizations applied for, received, and maintained Military Ready designations, which provide service to 29 of the 92 counties in Indiana

This program has facilitated over 3,000 appointments, helping hundreds of veterans:

• June 2012-May 2013: 95 appointments, 3 locations
• June 2013-May 2014: 248 appointments, 8 locations
• June 2014-May 2015: 597 appointments, 8 locations
• June 2015-May 2016: 681 appointments, 8 locations
• June 2016-May 2017: 507 appointments, 8 locations
• June 2017-May 2018: 579 appointments, 8 locations
• June 2018-May 2019: 410 appointments, 6 locations
• June 2019-September 2019: 82 appointments, 6 locations

At the close of the grant period (April 20, 2014), these telebehavioral health units had helped veterans avoid driving to the VA office in Indianapolis to receive care. Because of this, veterans saved more than 704 hours of drive time and $19,834 in cost based on the federal mileage reimbursement rate.

The success of this model led the VA to use similar telehealth units to provide mental services in other states. Since its inception, the program has been honored as a national best practice by Veterans Integrated Services Region 11 and has received nomination as a best practice with the Veterans Administration.

Publications that give further detail about ASPIN Veteran's Services:

• Leveraging telebehavioral health services for rural veterans, NRHA National Horizons, 2018
• Formation of Indiana Veterans Behavioral Health Network, National Cooperative of Health Networks, 2014
• Public-Private Partnership Increases Access to VA Behavioral Health Care Services for Rural Veterans in Indiana VHA Office of Rural Health quarterly newsletter The Rural Connection, 2012

The ASPIN Network's Community Health Worker Program is also featured as one of RHIhub's Rural Health Models & Innovations.

Challenges

The main challenges surrounding this program have been:

• Wireless connectivity with the VA for telehealth stations
• Long site approval process
• IT security issues
• Aging equipment
• VA staff turnover

With the implementation of telehealth services, the behavioral health network had hoped the number of uninsured veteran consumers would decrease, but it has instead remained constant. To address this dilemma, the network applied for and was awarded a HRSA Benefits Counseling grant to hire navigators to assist veterans and their families in health insurance enrollment. To date, ASPIN navigators have outreached to over 17,200 veterans and helped over 1,990 veterans and helped over 4,420 veterans and their families acquire health insurance.

Replication

To make the most of this model, communities should consider the following before implementing:

• Develop relationship with the local VA Office
• Ensure similar strategic goals with affiliated partners
• Make sure hired clinicians understand military culture and military health issues
• Have patience with government bureaucracy, which tends to be slow
• Seek out funding sources in addition to the VA
• Maintain regular meetings with providers and the VA to ensure a seamless operation
• Conduct regular access studies to the remote sites to ensure policies are being followed

Contact Information

Kathy Cook, CEO/President
ASPIN
ASPIN Veteran's Services
317.471.1890
kcook@aspin.org