Our service in
gratitude for theirs
Emory has risen to the challenge of the needs presented by America's veterans, constantly innovating to provide them better health care and legal services.
Ingrid Duva (left), Corrine Abraham, and Michael Saenger are fellows in a program that engages nurses and physicians in quality improvement research at the Atlanta VAMC.
It had been the case that veterans with dementia entered the Atlanta Veterans Affairs Medical Center (VAMC) through multiple pathways, either via their primary care physician or various specialists. Until, that is, Corrine Abraham of the Nell Hodgson Woodruff School of Nursing and Anne Tomolo of the School of Medicine saw a better way.
Their vision attracted a $1.5 million, three-year award from the Department of Veterans Affairs to establish the Specialty Care Education Center of Excellence for Cognitive Disorders, codirected by Abraham and Tomolo. In addition to coordinating care, it provides a platform for teaching Emory nursing students, medical residents and fellows, and social-work students from other schools as part of interprofessional teams.
“The center will help bridge the gap for patients by integrating telehealth and shared appointments with team members specializing in neurology, psychiatry, geriatrics, palliative care, and social work,” says Abraham, who is coordinator of evidence-based practice and innovation in nursing at the VAMC. “Students will learn about specialty care for cognitive disorders with an emphasis on teamwork, collaboration, and quality improvement.”
“It's important to have an entity that brings specialists and students together around patients and their families,” says Tomolo, who is chief of quality medicine and site director for postgraduate training in quality and safety at the VAMC. “The other crucial piece is integrating quality improvement into the curriculum so that students learn how to build a clinical model and improve practice together.”
Instead of being evaluated by different specialists in different locations at different times, veterans first are assessed via phone by a nurse coordinator before they come to the VAMC for a clinic visit. Next, specialists in neurology, geriatrics, psychiatry, and eventually palliative care will decide as a group how to manage patients through shared appointments. After seeing patients, the care group will meet to develop a plan and refer veterans and caregivers to VA and community resources. The nurse coordinator will follow up regularly by phone to help manage their care.
During clinic visits, nurses and social workers will meet with family caregivers to assess their needs. One option for caregivers will be Tele-Savvy, an online distance-learning education program for dementia caregivers developed by Emory nursing professor Ken Hepburn and colleagues. The program provides self-guided individual instruction and connects groups of caregivers for weekly chats online.
For more information on Emory’s ongoing and extensive support for veterans, see Veterans at Emory.
and building bridges
The Emory Law Volunteer Clinic for Veterans holds “Military Mondays” sessions at Starbucks to meet with veterans in a casual, accessible setting. Here, Marcus Azevedo, who will graduate from Emory Law in 2018, and Mallory Ball, a 2015 graduate, talk with a client.
Twice a month, on “Military Mondays,” the Starbucks across from Ponce City Market becomes the satellite office of Emory School of Law’s Volunteer Clinic for Veterans (VCV).
Students Martin Bunt 14L and Rachel Erdman 14L, along with Professor Charles Shanor and Lane Dennard — director emeritus of the clinic, adjunct professor, and retired partner with King & Spalding — founded the VCV with the vision of providing pro bono legal services for US veterans and their families.
Through the support of the Military-Veterans Section of the Georgia Bar Association and the Military Legal Assistance Program, the student-run clinic provides free legal assistance to area veterans struggling to find their way in the system. The clinic assists in negotiating the often-overwhelming bureaucracy of seeking disability-benefit claims before both the VA and subsequent appeals proceedings.
Many veterans have resumed civilian life with service-related injuries, including PTSD and traumatic brain injury, which can create barriers to self-advocacy. Others grapple with legal issues related to their disability claims, discharge upgrades, or other civil matters.
“We can help," says Drew Early, an Atlanta attorney and codirector of the VCV, who teaches veterans law as an adjunct professor at the law school. “I work with smart, eager students and local attorneys who volunteer their time to respond to a tremendous need in the state that’s not being met by conventional procedures, which can be ponderous and overwhelming,” says Early, who is a West Point graduate and retired US Army lieutenant colonel.
“Georgia has 776,000 veterans by the VA’s count,” says Early. “When you add to that active-duty military associated with the nine different bases in Georgia, and family members, there are potentially about two million people out there who could be eligible for VA benefits — yet there is only one VA office in the state to handle all of that.”
Some of the victories the VCV has won have been life-changing for its clients.
The VA denied pension benefits to the widow of an Iraq War combat veteran with four minor children. On appeal, the clinic argued she was entitled to a pension because her husband’s service-connected disability was a significant cause in his death. She was granted $2,638 per month, $26,000 in back pay, and her children were granted GI Bill educational benefits and health care.
Another client was a US Army veteran with traumatic brain injury and related disabilities, which were the result of an ambulance accident during her service. Although she was originally rated at 70 percent disability by the VA, she then was notified that her disability rating would be reduced to zero. The clinic appealed, and the result was a 100 percent disability rating, with monthly payments of more than $3,000 and back pay in the amount of $76,000. The ruling was especially significant because the veteran had lost her new home due to her inability to work. The VA award allowed her to purchase a new home.
The VCV has been honored with the 2014 Law School Excellence in Access to Justice Group Award from the State Bar of Georgia Access to Justice Committee. AmeriCorps has supported the clinic by providing funds for two Equal Justice Works Fellows. The clinic also received the 2014 Emory University Most Outstanding Service Volunteer Organization award.
Keely Youngblood 16L, an Equal Justice Works AmeriCorps Legal Fellow, is one of the student volunteers. “Veterans law is a quickly evolving field with a lot of room for nuanced arguments and legal creativity,” Youngblood says. “In my position as a fellow, I get to see students grow more empowered as they learn to take ownership of their legal analysis, and I get to see veterans grow more empowered when they come to the clinic and find energetic people ready to listen.
“When veterans are reintegrating to society, I think they have a really long bridge to build,” she says. “Sometimes it feels no one is available to help them. The clinic cannot build the whole bridge, but I do think the clinic uses its resources well to help veterans lay a lot of the bricks."
A year in,
with more successes
Emory’s Veterans Program takes a collaborative approach to healing PTSD, TBI, and other anxiety-related conditions, beginning with a comprehensive assessment conducted by top specialists in the fields of psychiatry, psychology, neurology, rehabilitation medicine, and wellness.
The Emory Veterans Program (EVP) has continued its outstanding work connecting veterans and their families with timely, effective mental health care.
Barbara Rothbaum, director of the EVP, has been treating people with PTSD since shortly after the condition became an official diagnosis recognized by the American Psychiatric Association in 1980. As professor of psychiatry and behavioral science at Emory School of Medicine and director of Emory’s Trauma and Anxiety Recovery Program, she has pioneered the application of virtual-reality exposure therapy to the treatment of such disorders since joining the Emory faculty in 1990.
Her work and Emory’s innovative programs in treating PTSD led to Emory’s selection for the Warrior Care Network, and the EVP opened its doors in September 2015. In February 2016, it began piloting a two-week intensive outpatient program that asks patients to commit to an exhaustive schedule addressing their psychological and physical health, and helps them build coping and relationship skills to handle stressful situations at home and in the world. Once they complete the program, Emory’s staff coordinates with a team in the vet’s home community to ensure proper follow-up care.
During the program, veterans from around the country stay at a nearby hotel and spend carefully scheduled days filled with therapy, education, family and relationship counseling, sleep disorder management, yoga, and other activities designed to help them regain control over their thoughts, emotions, and lives. The program also connects veterans to the work of Emory Law’s VCV and outside resources.
Another key component of the program is the employment of outreach coordinators, all combat veterans themselves, which provides a sense of connection and level of comfort to program participants.
“Military folks are trained in avoidance, in emotional detachment and disengagement, and when you get into this treatment, they are asked to confront the things they most want to avoid,” Rothbaum says. “When you get into the hard parts, it takes a lot of courage, a lot of bravery to continue even when you are scared. We’ve seen difficult cases with patients I’m not sure would have made it through treatment if we only saw them one or two times a week.”
Just ask Matt Barnes, who suffered symptoms of PTSD since before leaving Iraq and had been discharged from the US Marines for drug use little more than a year after returning from overseas.
For Barnes, the program gave him a chance to regain control of a life warped by the aftermath of his war experiences. Part of his motivation was the impending birth of his son, Nikalus, who was born July 15, 2016.
“My daughter, Abby, is almost 12, and she’s grown up seeing Daddy like this. I don’t want my son growing up seeing me like that. I want him to be a better man than I am,” Barnes says. “Going through the program is the best decision I’ve ever made.”