2017/06/26 1 Well Well Well Well-Being of Canadian Armed Being of Canadian Armed Being of Canadian Armed Being of Canadian Armed Forces (CAF) Veterans Forces (CAF) Veterans Forces (CAF) Veterans Forces (CAF) Veterans Dr. Cyd Courchesne, OMM, CD, MD Director General Health Professionals Chief Medical Officer, Veterans Affairs Canada Dr. Jim Thompson MD Research Medical Advisor Research Directorate, Veterans Affairs Canada OEMAC Annual Conference St. John’s, Newfoundland June 2017 1. Describe Canadian military Veteran health issues. 2. Understand the role of Veterans Affairs Canada in supporting the well-being of the CAF Veteran population 3. Clarify your role as an occupational health specialist in the care of Canadian military Veterans. 2 Components: ◦ Regular Force: full time. ◦ Primary Reserve Force: part time, some with periods of full time service including operational deployments. Service Elements: ◦ Army, Navy, Air Force. Military Service is unique: ◦ Unlimited liability: can be lawfully ordered into harm’s way, 7x24. 3
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CC JT Occ Health CAF Vets OEMAC June 2017 no notesoemac.org/.../09/CC-JT-Occ-Health-CAF-Vets-OEMAC-June-2017-Handout.pdf•Declining numbers ... spiritually 4. Life 44.. ... CC JT
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2017/06/26
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WellWellWellWell----Being of Canadian Armed Being of Canadian Armed Being of Canadian Armed Being of Canadian Armed
1. Employment 1. Employment 1. Employment 1. Employment or or or or other meaningful other meaningful other meaningful other meaningful activityactivityactivityactivity
Engaged in activities that are beneficial and meaningful to them
3. Health3. Health3. Health3. Health Functioning well physically, mentally, socially and spiritually
4. Life 4. Life 4. Life 4. Life skills skills skills skills & & & & preparednesspreparednesspreparednesspreparedness
Have the skills and knowledge to adapt and live well
5. Social 5. Social 5. Social 5. Social integrationintegrationintegrationintegration In mutually supportive relationships and are engaged in their community
� Surveys in 2010, 2013 and 2016 of the well-being of CAF Veterans who released from service since 1998.
� Large samples, nationally representative.
� Not just those participating in VAC programs.
� Regular and Reserve Force.
Veteran = Former CAF member
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1. Most doing well in terms of mental health, employment, income, life satisfaction and adjustment to civilian life.
2. Significant number of Class C (deployed) Reservists and Regular Force Veterans have chronic physical and mental health problems and related disability, double or more the Canadian general population.
3. Reserve Class A/B (non-deployed) Veterans on average not much different from young adults in the Canadian general population.
No Health ConditionsNo Health ConditionsNo Health ConditionsNo Health ConditionsMental onlyMental onlyMental onlyMental onlyPhysical only Physical only Physical only Physical only Both Physical and MentalBoth Physical and MentalBoth Physical and MentalBoth Physical and Mental
Canadian Forces Operational and Trauma Stress Support Centers
(OTSSC)
OTSSCEdmonton
OTSSCOttawa
OTSSCValcartier
OTSSCHalifax
OTSSCPetawawa
OTSSCGagetownOTSSC
Esquimalt
OSIC CHUQ
OSIC Carewest
OSIC Royal Ottawa
OSIC Vancouver
OSIC Edmonton
OSIC Deer Lodge
Horizon HealthOSIC
Fredericton
OSIC Parkwood
OSI Residential Treatment Clinic
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National Operational Stress Injury (OSI) Clinic Network
� Access to specialized treatment centers/facilities
� Arrangement with 7 specialized treatment facilities with in-patient programs
� National network of registered MH professionals
� 4,000 MH professionals
� 300 community clinical care managers
� VAC Assistance services
� Pastoral outreach
� Case managers� 214.4 FTEs
� 100 persons co-located in JPSU/IPSCs (24)
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CROMIS:Client-Reported Outcomes
Management Information System
Presentation to the Deputy MinisterJanuary 27, 2015
David F. Ross, Ph.D.Manager (A) , National OSI Clinic Network Clinical Coordinator
Operational Stress Injury National Network (OSINN)VAC
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Key Elements of Client-Reported Outcomes Management Information System (CROMIS)
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PTSD ChecklistO.Q. 45.2
Assessment for Signal Clients
OQ-Analyst
platform
(DENOMINALIZED SOCIDEMOGRAPHIC INFO)
• Tracking
– ‘real-time’, ‘vital-signs’ outcomes tracking (analogous to blood pressure or EEGs in medicine)
• Reporting
� Reliable Change index
� Selected anxiety and depressive symptoms� Social integration� Vocational integration
� Critical Items...available immediately)
-30
-25
-20
-15
-10
-5
0
5
10
15
20
25
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Ch
an
ge
in
OQ
-45
Sco
re
• 92 Steadily improved (59%)• 18 Deteriorated early and then improved (12%)• 41 Steadily Deteriorated (26%; )• 5 Improved early and then deteriorated (3%)
Distinct trajectories emerged
Compared to providers NOT USING OQ....
OQ Feedback to Clinicians ONLY
OQ Feedback toClinicians & Consumers
OQ + ASC Feedback to both Clinicians and Consumers
MORE CURE 1.7 X 2.0 X 2.4x more
LESS STAGNATION
1.2x 1.4X less
LESS HARM 2.2X 1.4X 3.7X less
Solid evidence that regular use translates to reliable “real-time” benefits to OSIC clients
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OSI Clinics make a real difference, learn from real outcomes, build better programming
Aggregated Results from first network CROMIS analysis , January 2015)
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Critical 3-Year Window
� VAC Research Directorate, in collaboration with DND, CAF Health Services, Statistics Canada and the Canadian Institute of Military Veteran Health Research◦ Life After Service Studies (LASS) 2016 and 2019.
� Longitudinal followup to LASS 2013.
◦ Mental health in transition to civilian life:
� Five-year longitudinal study of MH in CAF members.
� Two-year study of impact of operational stress injuries on families.
◦ Veteran suicide surveillance.
� CFHS Mental Health Centre of Excellence◦ VAC Psychologist in the CoE.
◦ Research in areas of personalized medicine ( PGMs vs RPGs).
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Magnetic Resonance Imaging (MRI)
for brain structure and function Magnetoencephalography (MEG)
for brain function
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Caudate &
ACC:
Implicated in
amygdala /
autonomic
regulation
Dorsal ACC:
Fear regulation / extinction
Visual cortex:
Co-activation between visual cortex
and amygdala where amygdala
enhances visual processing of salient
stimuli
Orbital frontal cortex:
Implicated in evaluating
salience of stimuli and is
important in decision
making and learning
response
(Todd, et al., Biological Psychiatry, In Revision)
Neuroimaging Neuroimaging Neuroimaging Neuroimaging in PTSDin PTSDin PTSDin PTSD
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� Consolidation of MH under DGHP◦ Mental Health Strategy 2015-2020◦ Establish VAC Mental Health Directorate
� Director + Chief of Psychiatry
� Roll out of CROMIS (1st report March 2015)
� Expansion of:◦ OSI Clinic network◦ OSI Social Support network◦ Case Manager complement
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� Research gives clear picture of nature of the well-being of CAF Veterans.
� VAC works closely with CAF and DND to support the well-being of CAF Veterans.
� Occupational Health physicians have important roles in supporting the well-being of Canadian military Veterans.