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Goal is to improve care for service members, veterans, loved ones

By JULIE MINDA

While Dr. James DelVecchio surely has treated countless members of the military, veterans and military family members, in the past he was only aware of that fact when his patients or their loved ones volunteered that information to him.

DelVecchio says, "When I was aware that I was caring for a military member, or family member, I had essentially no background to understand much of the terminology and lingo used in the different branches of the military, nor the unique cultural 
environment in which they served." He might have used that information to build rapport and put his patient at ease or to inform his clinical assessment of a patient with an acute condition.

DelVecchio is chairman and medical director for the emergency departments at Maryland's Holy Cross Hospital in Silver Spring and Holy Cross Germantown Hospital in Germantown, which are in a region with a large military and veteran population.

DelVecchio says training offered by Trinity Health's new Military and Veterans Health Program opened his eyes to the fact that physical, emotional and mental trauma that members of the military sustained during their service — however much time has elapsed — can be the cause of current pain and suffering. When clinicians know about those physical and mental scars, they can gain insight into the conditions affecting their patients now.

Currently in limited rollout in three Trinity Health markets, the Military and Veterans Health Program includes staff training on military culture, new protocols to identify military members and their families as such in their electronic medical records, and other steps to ensure those who serve and their families receive optimal care.

Jolissaint

Dr. Greg Jolissaint, the Trinity Health vice president heading the Military and Veterans Health Program, says the health system has high hopes for the initiative, which is bound for systemwide implementation. He says, "We expect to increase the speed of both diagnoses and treatment, improving outcomes, increasing patient satisfaction, and — in mental health crises — decreasing risks of harm to self or others."

War's lasting toll
Lauren Hild is senior director of clinical support services at Holy Cross Hospital. It is about 10 miles outside Washington, D.C., a region with a large population of active duty service people and veterans.

She says her experience as a student in the train-the-trainer course and now as a trainer herself has been illuminating. "As I learned in the training, the military environment can be a debilitating one. In many cases, military personnel have endured the physical and psychological trauma of war — and, we shouldn't forget, a training environment filled with challenge. They might return from their deployments with disabling injuries, PTSD and/or other challenges a civilian might never even be able to imagine."

She says service members' absence from their homes — and sometimes their presence upon return — may wreak emotional and financial havoc on their families. When service members return home with physical or emotional injuries, their families become caregivers.

Trainers encourage their students to ask questions of patients who are connected to the military and of those patients' loved ones, seek understanding and keep in mind everyone will have a different situation. Hild says the training will help all providers explore the potential interface between their patients' military background and their conditions.

Jolissaint says some of the conditions potentially related to military service include undiagnosed or poorly treated post-traumatic stress disorder; traumatic brain injury perhaps caused by blasts in the field; pulmonary conditions related to exposure to burn pits; and, for Vietnam War vets, conditions related to exposure to Agent Orange.

Jolissaint, a retired U.S. Army colonel, says having information on hand about these and other conditions and knowledge of military culture will improve communications between providers and patients and build trust between them, which should lead to better patient engagement and compliance with treatment plans.

Competency building
The program is the brainchild of Dr. Norvell Coots, president and chief executive of Holy Cross Health in Silver Spring. He is a retired brigadier general and former commanding general and chief executive of regional health command in Europe. Coots proposed the cultural competence training idea to Trinity Health leadership a year ago; the system quickly approved, and then Jolissaint was recruited to develop it. Under Coots' and Jolissaint's leadership, the system then identified a third-party vendor to develop the cultural competency training program, create the program and its curriculum and develop business processes to support it.

Coots

Early this year, the vendor and Trinity Health began to train staff volunteers as instructors, and those volunteers have been training their colleagues since the spring. About 300 employees have received the training, Jolissaint says. The goal is to train an additional 2,000 within the next year. The bulk of the activity is happening at hospitals and affiliated outpatient and long-term care sites in Maryland and Pennsylvania, but Trinity Health plans to roll out the training to all of its 94 hospitals and other facilities by mid-2022.

The training is not mandatory, but it is strongly encouraged for managers, providers and support staff in the Trinity hospitals' emergency rooms, medical/surgical nursing units, hospitalist programs and outpatient facilities most likely to come in contact with military members or their families. The provider training includes two to four hours of distance learning modules as well as two to three hours of in-person training led by an employee who has completed the train-the-trainer course.

Flying the flag
The Military and Veterans Health Program also includes efforts to demonstrate to military members and their families that they are welcomed and valued.

Jolissaint adds, "From the minute a patient walks into a pilot site facility, they will know that Trinity Health is proud to serve those who are affiliated with the military.

"They will see military service flags prominently displayed in high traffic areas, and they will also see meaningful information posters displayed in prominent locations.

"Most importantly, they will encounter health care providers who understand the unique nature of their backgrounds compared to the general population," he says.

The hospitals have put in place business processes to support the program. Now receptionists and registration personnel are trained to ask pertinent questions about patients' military service or connections and enter that information into the patients' medical records so that the patients' providers can follow up on such information in more detail when talking with the patients.

Jolissaint says, "This additional knowledge will help (the providers) ascertain the root causes of problems sooner, and it will allow them to deliver the correct intervention sooner and in a culturally sensitive manner."

Trinity has been providing care to military members since the early days of its founding congregations. The Sisters of the Holy Cross cared for wounded soldiers — both Union and Confederate — in the Civil War.

Coots says the program "brings us back full circle to the origins of our health systems by providing compassionate care to those who have served, and their family members, in the most welcoming and understanding way possible."

Copyright © 2018 by the Catholic Health Association of the United States
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