Indiana ASPIN Veteran's Services

Description

During this program period, Indiana was home to more than 455,000 veterans and supplied the 4th largest deployment of Army Guard soldiers in the United States. Suicide among these veterans was high — Indiana ranked 4th in the nation in National Guard member suicides, yet only 20th in the amount of federal dollars received for veteran services.

Indiana currently is home to approximately 325,000 veterans, a figure that has declined in recent years. However, the Indiana National Guard maintains a robust force structure. Indiana continues to monitor and respond to elevated suicide risks among Guard and veteran populations.

ASPIN Veteran's Services (formerly known as the Indiana Veterans Behavioral Health Network) provided mental healthcare services to Indiana veterans who were 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 five rural community mental health centers and two addiction providers. It offered clinical care through 50 offices in the state and behavioral health integration through the work of its Community Health Worker (CHW) program.

The mission of ASPIN Veteran's Services was to develop veteran expertise among affiliated providers. Through a matrix of services, the program cared for both insured and uninsured veterans by placing teleconferencing units at six rural community mental health centers. This allowed veterans to receive care in a timely manner without having to leave their home communities. These units allowed 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 had 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 was later sustained with funds from monthly provider fees contracted on a 5-year basis.

Services offered

ASPIN Veteran's Services provided veterans with:

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

Clinicians were 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 had to 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 completed archived online 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

The program 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. As a result, 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 adopt similar telehealth units to provide mental services in other states. The program was honored as a national best practice by Veterans Integrated Services Region 11 and was nominated as a best practice by the Veterans Administration.

For further details about ASPIN Veteran's Services:

• Leveraging telebehavioral health services for rural veterans, NRHA National Horizons, 2018

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

Challenges

The main challenges surrounding this program included:

• 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 instead remained constant. To address this, 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. During this time period, ASPIN navigators 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 replicate this model, communities should consider the following before implementing:

• Develop relationship with the local VA Office
• Ensure strategic goal alignment with affiliated partners
• Hire clinicians who understand military culture and health issues
• Exercise patience with government bureaucracy
• Seek out funding sources beyond the VA
• Maintain regular meetings with providers and the VA to ensure smooth operations
• Conduct regular access studies at remote sites to ensure policies are being followed

Contact Information