1. Services for Veterans and Returning Soldiers A Brief Overview of Service Needs, Service Gaps, and Collaborative Efforts for in New York State

2. Conferences Scheduled During a Three Month Time Span IPDA Conference in January Erie County next week SUNY New Paltz Institute for Disaster Mental Health VA Trainings –Syracuse –Albany Not to mention the numerous conferences that focus on PTSD

3. Identified Needs Major need for transitional services –Legal issues: divorce, custody –Financial: Debt and unemployment –Educational Certification Services to dependents/families Rural issues Increase in demand on Addiction services

4. Identified Needs (continued) Active Duty vs. Veteran –Multiple deployments: stress from knowing you have to prepare to return –Ramifications of Active Duty seeking behavioral health treatment – Stigma on Steroids Discharge problems –Debriefing-signing statement of being ok before one has the time to experience life after the military. –Discharged with a diagnosis and the VA not recognizing it. –“Bad Paper” preventing treatment

5. Identified Needs (continued) Increased Regional Office Staff to provide educational certification and review disability claims Post-concussive syndrome and TBI require primary health care and behavioral health care Domestic violence issues Process to facilitate referrals to/from each system

6. Barriers to Collaboration Perceptions from VA and Community Tendency of VA to treat community agencies with condescension Recent increase in VA seeking additional staff has created some animosity Reluctance on the part of VA to address specific projects or integrate services Community resistance to influx of veterans from out of the area

7. Barriers (continued) Sharing resources Rules and Regulations cited as “unbendable” Traditional “turf” wars Costs No state-wide initiative (Vietnam Commission) Attitudes

8. Collaborative Projects Erie County –Veterans’ Court –Housing initiatives to forestall homelessness Cattaraugus County –Establishing working relationship with the local VA Outpatient Clinic New York City

9. Collaborative Projects Jefferson County –Working with Active Duty and families Allegany-Chemung-Steuben Counties, DePaul Addictions, and the New York State Office of Alcoholism and Substance Abuse Services

10. DePaul Program Rationale Program Rationale is based on: 1.Needs of the Veteran and Local Population 2.Need to Build Cost Efficient Medicaid Service System and Control Medicaid Cost 3.Need to Engage Addiction Patients in Follow-Up Care

11. Program Elements 25 Bed Medically Supervised Inpatient Withdrawal Service Serves Veteran and Local Population in Steuben, Chemung, Allegany and Schuyler Counties Priority Admission for Veterans Treatment of Dual Diagnosis Treatment of Methadone and Cocaine Withdrawal as well as alcohol, cannabis and other drugs.

12. Elements (cont.) Early Detection of Psychiatric Disease. Early Detection of Methamphetamine Use. Utilization of Motivational Enhancement to engage in Treatment. MOU’s with Inpatients and new Downstate Veteran’s Residence (Samaritan Village) to ensure continuum of care. 24/7/365 Admissions

13. Staffing MD’s in Internal Medicine and Psychiatry 4.0 FTE Nurse Practitioners (1.0 with Psychiatric specialty) RN,LPN Staffing Program Director Unit Aides Admission/Discharge Coordinator Billing Specialist 2.5 FTE Therapists (MSW, CASAC)

14. Projected Outcomes Provide Dedicated Local Resource to VA Health System and Region for Detox and Engagment Engage 55% of all Admissions in Continuing Care Reduce Regional Medicaid Costs for Detox by 20% by January 2007. Create “Ease of Entry” to Detox Services for all stakeholders.