1. The NAMI-Department of Veterans Affairs / Family-to-Family Partnership Susan J. McCutcheon, RN, EdD Director, Family Services, Women’s Mental Health and Military Sexual Trauma Office of Mental Health Services Department of Veterans Affairs July 7, 2009

2. Uniform Mental Health Services in VA Medical Centers and Clinics Family Services

3. Uniform Mental Health Services in VA Medical Centers and Clinics Minimal clinical requirements for VHA Mental Health Services: Providers discuss family involvement with patient at least yearly & at inpatient discharge Treatment plan to identify family contact or reason for lack of contact Providers must seek consent from veterans to contact families in the future, as necessary

4. Uniform Mental Health Services in VA Medical Centers and Clinics Minimal clinical requirements for VHA Mental Health Services: Family consultation, family education or family psychoeducation for veterans with serious mental illness must be provided at VA Medical centers and very large CBOCs Opportunities for these family services must be available to all veterans with serious mental illness on site, by telemental health, or with community providers through sharing arrangements, contracting, or non-VA fee basis care

5. Family Education (FE)

6.  Treatment team provides factual information necessary to support the veteran and partner  Offered in many formats, regularly scheduled and conducted over time including:  By professionals (e.g., SAFE Program)  By trained family members (e.g., NAMI Family-to-Family Education Program)

7. Family Education (FE) VHA-NAMI Memorandum of Understanding Family-to-Family Education (FFEP)

8. VHA – NAMI Memorandum of Understanding  Offer NAMI Family-to-Family Education Program (FFEP) in:  At least one VHA facility in each state  During a two year period starting June 2008  Collaborative effort between the VA and NAMI on national, state and local levels  Selected VHA facility and local NAMI affiliate will then serve as model to continue this partnership throughout all networks

9. VHA – NAMI Memorandum of Understanding The first VHA FFEP classes were held Fall’08 Currently planning VHA FFEP classes for Late Winter/Early Spring’09 Any VAMC can partner with their local NAMI affiliate to offer FFEP in their facility outside of the MOU

10. VHA – NAMI Memorandum of Understanding VHA OMHS shall: Identify VHA facility most likely to succeed and serve as a model for the rest of the state Identify VHA employee as the FFEP POC Ensure the VHA facility collaborates with local Vet Center Participate in monthly VHA FFEP POC Conference Calls

11. VHA – NAMI Memorandum of Understanding VHA OMHS shall: Ensure the selected VHA selected facility informs veterans and staff about FFEP Assist with enrolling families into FFEP Reproduce the FFEP Manual and Handouts Reserve an appropriate meeting space for the FFEP with Adequate parking Develop PTSD “Take Home Packet”

12. VHA – NAMI Memorandum of Understanding NAMI Shall: Identify a NAMI affiliate POC to work with the VHA FFEP POC at the selected facility in the state Ensure that a representative from the NAMI Education Dept participate in planning and communication among and between states and VHA sites in the project

13. VHA – NAMI Memorandum of Understanding NAMI Shall: Ensure that there are FFEP teachers for the selected VHA site Ensure that a NAMI affiliate POC assists VHA in informing veterans & VA staff of availability of FFEP If VA family enrollment does not meet the minimum required number for a FFEP, assist with recruitment/ enrollment of community family members to fill class

14. VHA – NAMI Memorandum of Understanding Other Considerations: Matching a motivated VHA facility with a NAMI affiliate with appropriate resources to teach FFEP will be a mutual decision between VHA OMHS and NAMI The process for enrolling family members into the FFEP will be a local decision based on the established practice of the NAMI affiliate

15. VHA – NAMI Memorandum of Understanding Other Considerations: VHA has an extensive Community Residential Care Program – veterans residing in group homes Frequently these placements are long term and the group home sponsor becomes part of the veteran’s “family” When such a relationship exists, the group home sponsor may enroll in the FFEP

16. VHA-NAMI MOU: Designated Sites STATEVAMC CITYSTATEVAMC CITY AlabamaTuskegeeHawaiiHonolulu AlaskaAnchorageIdahoBoise ArizonaPhoenixIllinoisChicago/Hines ArkansasLittle RockIllinoisMarion/Ft. Wayne CaliforniaSan FranciscoIndianaIndianapolis CaliforniaLong BeachIowaDes Moines/Knoxville ColoradoDenver/PuebloKansasTopeka ConnecticutWest HavenKentuckyLouisville DelawareWilmingtonLouisianaNew Orleans FloridaTampaLouisianaAlexandria GeorgiaAtlantaMaineTogus Completed Fall 2008 Completed Spring/Summer 2009

17. VHA-NAMI MOU: Designated Sites (con’t) STATEVAMC CITYSTATEVAMC CITY MarylandBaltimoreNew MexicoAlbuquerque MassachusettsBedfordNew YorkSyracuse MichiganDetroitNew YorkNew York Harbor MinnesotaMinneapolisNorth CarolinaDurham MississippiBiloxiNorth DakotaFargo MissouriSt. LouisOhioColumbus MontanaFt. HarrisonOklahomaMuskogee NebraskaOmahaOregonPortland NevadaLas VegasPennsylvaniaPittsburgh New HampshireManchesterPuerto RicoSan Juan New JerseyLyonsRhode IslandProvidence Completed Fall 2008 Completed Spring/Summer 2009

18. VHA-NAMI MOU: Designated Sites (con’t) STATEVAMC CITYSTATEVAMC CITY South CarolinaColumbiaVirginiaSalem South DakotaSioux FallsWashingtonDC TennesseeMountain HomeWashingtonSeattle/Puget Sound TexasDallasWest VirginiaClarksburg TexasAmarilloWest VirginiaMartinsburg TexasHoustonWisconsinMadison UtahSalt Lake CityWyomingCheyenne VermontWhite River Junction WyomingSheridan Completed Fall 2008 Completed Spring/Summer 2009

19. Completed Initiative Initiative In Process Not Completed San Francisco Long Beach New York Harbor Syracuse Dallas Amarillo Houston NOLA Alexandria Sheridan Cheyenne Marion Chicago/Hines Clarksburg Martinsburg

20. Legal Implications Family Services

21. Definition of Family Family According to federal law, eligible individuals who may be provided family services for immediate family members are: Members of the immediate family Guardian of a veteran Individual in whose household such veteran certifies an intention to live

22. PL 110-387 Veterans’ Mental Health and Other Care Improvement Act of 2008  Sec 301 amends 38 USC 1782  Adds marriage and family counseling to services for family members of all veterans eligible for VA care  Rescinds prior stipulation that services which include family members for veterans receiving non-service connected treatment are contingent on initiation during an inpatient stay

23. Training Initiatives Family Services

24. Training for Family Services by End of FY2008  Family Psychoeducation (FPE), Behavioral Family Therapy (BFT), or Multiple Family Group Therapy (MFGT)  133 staff trained in care provision  15 staff trained to be BFT or MFGT trainers  Family Consultation  15 Staff trained in care provision  35 Local Recovery Coordinators trained as Network Family Education Consultants to facilitate implementation of:  SAFE Program  NAMI Family-to-Family Education Program

25. Ongoing Initiatives / Next Steps Meeting requirements of UMHSP: Providers discussing family involvement with patient yearly and at inpatient discharge Treatment plan to identify family contact or reason for lack of contact Further dissemination of family education, family consultation and family psychoeducation models Compliance with PL 110-387

26. Thank you for supporting Veterans! For additional information or questions Contact Susan J. McCutcheon at susan.mccutcheon@va.gov