Editor’s note: As David B. Hoyt, MD, FACS, Executive Director of the American College of Surgeons (ACS) explained in his March 2012 “Looking forward” column, the College is participating in a national program known as Joining Forces.* Through this participation, the ACS is partnering with a number of other health care organizations to help ensure that the veterans returning from the wars in Iraq and Afghanistan receive the compassionate care they need and deserve.
As part of this effort, the Bulletin is publishing occasional articles based on interviews with ACS Fellows and other individuals who are actively involved in Joining Forces for purposes of helping other surgeons learn what they can do to help and what initiatives they might consider implementing in their institutions. This article provides an update on the status of the Joining Forces initiative based on an interview with the program’s Executive Director, U. S. Navy Capt. Brad Cooper.
In May 2011, U.S. Navy Capt. Bradley Cooper was on his way to the Pentagon when he received a phone call from the White House asking him to interview for the job of Executive Director of the then-newly launched Joining Forces program. Captain Cooper said that—as a third-generation service person who has done 10 overseas deployments and who is still on active duty—he was honored and excited to be given this opportunity.
“At the end of the day, I gravitate toward projects that really deliver in a positive way, and I saw that the First Lady [Michelle Obama] and [Second Lady] Dr. [Jill] Biden really had a vision to deliver greater support from America to military members and military families,” he said.
He was particularly impressed that Ms. Obama, Dr. Biden (an EdD), and their staffs had been in touch with thousands of military members and their families to determine how the private sector could best assist veterans and their loved ones in leading productive civilian lives. As a result of this outreach, they determined that the three pillars of Joining Forces would be employment, education, and wellness.
Milestones in wellness
Needless to say, the pillar that the ACS is most capable of and committed to reinforcing is the one centered on wellness. As Dr. Hoyt stated in his column on Joining Forces, only about half of the nation’s veterans seek their care at Veterans Affairs (VA) or Department of Defense (DOD) hospitals and health care facilities.* According to Captain Cooper, veterans who seek health care services outside of the VA system do so for various reasons, including living a good distance from a VA hospital or clinic.
“About 10 to 20 percent of those veterans who served overseas have PTSD [post-traumatic stress disorder] or TBI [traumatic brain injury]. We came to the conclusion that until we at least can give health care providers throughout the nation some rudimentary knowledge of what PTSD and TBI are, we were never going to be able to holistically address this problem,” he said. “We’d have the 50 percent who go to the DOD and VA facilities get themselves on a positive trajectory, while the other half would be going to health care providers throughout the country who have little to no understanding of these problems. What’s their outcome likely to be? It’s probably not going to be as positive.”
To ensure that more health care professionals understand how to provide appropriate care to veterans living with these conditions, “We convened the leadership of major medical associations around the country in January to see where each association could educate their members and constituencies on PTSD and TBI,” Captain Cooper said.
Surgeons specifically need to be aware of how PTSD and TBI manifest themselves in patients, so that when they have contact with patients who are facing these challenges, they understand what types of care these individuals require. “So, let’s say I’m a surgeon in Des Moines [IA], and I’ve had contact with a veteran who has done two or three or four tours of duty in Iraq and Afghanistan. Just to be able to have a conversation with some awareness of what PTSD and TBI are puts me in a position where I’m able to understand what types of care this veteran needs to seek. I’m able to say, ‘There are certain health care providers in the area that you need to see,’” Captain Cooper explained.
“In the surgeons’ case, they don’t need to be on the same level of understanding as a psychiatrist or licensed counselor, but having a fundamental, basic knowledge of PTSD and TBI would certainly be helpful toward ensuring that their patients get the care they need,” he added.
To help ensure that more health care professionals possess at least this rudimentary understanding of PTSD and TBI, Joining Forces convened a group of more than 30 medical organizations in Washington, DC, this past January and asked them to educate all of the members of their associations and disciplines about these conditions.
Health care association initiatives
The College has accepted that charge and has responded through the development of a Web page, which contains links to sites that may be useful to surgeons who want to learn more about how they can assist returning veterans and their families. In addition, the College is developing a new section of the Advanced Trauma Life Support® manual, which will focus on PTSD. And, as mentioned in previous Bulletin pieces regarding Joining Forces, the College will present a panel discussion at the 2012 Clinical Congress titled “Joining Forces: How We Can Help Our Returning Veterans.” (See sidebar on at the end of this article for details.)
Other medical organizations that have partnered with the College through Joining Forces are doing their part to ensure that health care professionals are better equipped to care for veteran populations. The Association of American Medical Colleges (AAMC), for example, has established a collaborative network to exchange critical research and cutting-edge discoveries in PTSD and TBI. This network, called iCollaborative, contains approximately 58 examples of educational resources that medical schools and training centers are sharing and incorporating into their curricula.
“One of the reasons we wanted to get the schools together is because some of their efforts on treating PTSD and TBI have been somewhat ‘siloed.’ For example, they’re doing great research at Wake Forest University [in Winston-Salem, NC], but how does that information get shared? The AAMC already had an existing collaborative network, so they rejiggered that network slightly to accommodate the Joining Forces network. Then we used that network to release government information on procedures, policies, and guidelines for treating PTSD and TBI into the private sector,” Captain Cooper said.
“In terms of specific examples, the University of Pittsburgh [PA] is doing great research work on PTSD and TBI. They did a study and then they posted it a couple of months ago on the AAMC portal so that other institutions could see their results. I think we will see more of that as we move forward. That’s a quantum leap from what we had before in terms of sharing this kind of information,” he added.
Other health care organizations are doing their part as well to spread the word about how their members can help veterans. Examples include the following:†
- The American Medical Association (AMA) established a website that contains resources to assist physicians in assessing and treating veterans and their families. As the owner of the nation’s largest continuing medical education (CME) credit system, the AMA will encourage other groups and institutions that offer CME programs to offer courses addressing these issues. The AMA also is offering programs on these topics and is disseminating to its members educational information to increase physician awareness regarding critical mental health issues affecting the military.
- The National Board of Medical Examiners is working with other Joining Forces partners to incorporate health issues affecting service members and veterans into the broad range of examinations it prepares for the education and licensure of medical students, practicing physicians, and other health care professionals.
- The American Academy of Neurology (AAN) is advocating for programs that support veterans and their caregivers, publishing articles for members on the need to increase their capacity and expertise regarding PTSD and TBI, developing further CME on the diagnosis and treatment of veteran patients, and providing tools and resources on TBI and concussion medicine.
- The American Academy of Pain Medicine presented five symposia on pain management in veterans during the organization’s annual meeting and formed a special interest group for military and VA health care professionals.
- The American College of Emergency Physicians is highlighting veterans’ issues at its annual government services symposium and formed a task force charged with expanding PTSD and TBI awareness.
- The American Osteopathic Association has committed to providing educational sessions on military and veteran medicine at its conferences and is disseminating articles on PTSD, TBI, and post-combat depression.
Employment and education
Joining Forces is making significant progress with respect to the other two pillars of the program, especially employment. “We’ve probably seen the most growth in employment. In the last year, we’ve had about 2,100 companies that have hired or trained 125,000 veterans and military spouses just through Joining Forces, and these same companies have committed to hiring another 250,000 in the next couple of years,” Captain Cooper said. Companies that have committed to providing employment to former military personnel include Boeing, Brink’s, The Disney Company, General Electric, Hewlett-Packard, Honeywell, Lockheed Martin, NBC Universal, Comcast, Sears Holdings, Siemens Corporation, and Wal-Mart.†
Job placement after military service is of paramount importance to ensuring that all aspects of their lives can continue to be fulfilling. “Obviously, when you have a job and an income the other things in your life are going to be much more vibrant. You can’t just talk about someone’s mental health without looking at their life more holistically—without talking about their job and, quite candidly, their education,” Captain Cooper noted.
Joining Forces encourages companies, organizations, and institutions to hire veterans for the dedication and quality of work they are likely to bring to the workplace. “At the end of the day, it makes good business sense because of the talent that you’re hiring,” Captain Cooper said. “We’ve used that from a message standpoint to spread the word that we’re not looking for companies to hire veterans because it’s patriotic, which is nice, but because of the type of talent they get.”
With regard to the third pillar—education—Joining Forces has focused largely on fulfilling the needs of the children of service members. Organizations are increasing the number of educators who are trained in issues that affect military children, including frequent moves, parental separation, and so on.
They also are disseminating best practices for supporting veterans who are pursuing college educations. Last April, for instance, the U.S. Department of Education hosted a community college summit focused on ways colleges can foster supportive learning environments for veterans.
In addition, Joining Forces has presented a public awareness campaign featuring Tom Hanks, Oprah Winfrey, Steven Spielberg, as well as major league baseball players, NASCAR drivers, and representatives of other national institutions, in an effort to educate Americans about all that veterans and their families have given over the last decade.
“Joining Forces has very much evolved based on the feedback we’ve gotten and the milestones we’ve reached, in some cases much faster than we thought. We always knew that the three pillars were solid. What could be achieved was unknown. We clearly live in a grateful nation, but how grateful and how understanding of the issues that impact veterans, for example in terms of the role of employment, was unknown,” Captain Cooper said. It is now clear that “there is a sea of goodwill out there, and we’re always looking for ways to help translate that goodwill and desire to help into ways that are meaningful and impactful.”
*Hoyt D. Looking forward. Bull Am Coll Surg. 2012;97(3):4-6.
†The White House. Joining Forces Accomplishments. Available at: http://www.whitehouse.gov/sites/default/files/docs/joining_forces_first_anniversary_accomplishments.pdf. Accessed July 12, 2012.