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Full text of "Social services for Vietnam veterans and their families : current programs and future directions : hearing before the Subcommittee on Oversight and Investigations of the Committee on Veterans' Affairs, House of Representatives, One Hundred Third Congress, second session, May 18, 1994"

(V) SOCIAL SERVICES FOR VIETNAM VETERANS AND 
\/ THEIR FAMILIES: CURRENT PROGRAMS AND 



\ 



FUTURE DIRECTIONS 



Y 4. V 64/3: 103-48 

Social Services for Vietnan Veteran. . . 

HEARING 

BEFORE THE 

[SUBCOMMITTEE ON 
OVERSIGHT AND INVESTIGATIONS 
OF THE 

COMMITTEE ON VETERANS' AFFAIRS 
HOUSE OF REPRESENTATIVES 

ONE HUNDRED THIRD CONGRESS 
SECOND SESSION 



MAY 18, 1994 



Printed for the use of the Committee on Veterans' Affairs 

Serial No. 103^8 




<$m*f; mm 

N0V 2 199t> 



U.S. GOVERNMENT PRINTING OFFICE 



WASHINGTON : 1995 



For sale by the U.S. Government Printing Office 
Superintendent of Documents, Congressional Sales Office. Washington, DC 20402 
ISBN 0-16-047634-8 



(V) SOCIAL SERVICES FOR VIETNAM VETERANS AND 
\\/ THEIR FAMILIES: CURRENT PROGRAMS AND 
FUTURE DIRECTIONS 



\ 



Y 4. V 64/3: 103-48 

Social Services for Vietnan Veteran... 

HEARING 

BEFORE THE 

SUBCOMMITTEE ON 
OVERSIGHT AND INVESTIGATIONS 

OF THE 

COMMITTEE ON VETERANS' AFFAIRS 
HOUSE OF REPRESENTATIVES 

ONE HUNDRED THIRD CONGRESS 
SECOND SESSION 



MAY 18, 1994 



Printed for the use of the Committee on Veterans' Affairs 

Serial No. 103^8 







NOV 2 



©ft 



U.S. GOVERNMENT PRINTING OFFICE 



WASHINGTON : 1995 



For sale by the U.S. Government Printing Office 
Superintendent of Documents. Congressional Sales Office. Washington. DC 20402 
ISBN 0-16-047634-8 



COMMITTEE ON VETERANS' AFFAIRS 
G.V. (SONNY) MONTGOMERY, Mississippi, Chairman 



DON EDWARDS, California 

DOUGLAS APPLEGATE, Ohio 

LANE EVANS, Illinois 

TIMOTHY J. PENNY, Minnesota 

J. ROY ROWLAND, Georgia 

JIM SLATTERY, Kansas 

JOSEPH P. KENNEDY, II, Massachusetts 

GEORGE E. SANGMEISTER, Illinois 

JILL L. LONG, Indiana 

CHET EDWARDS, Texas 

MAXINE WATERS, California 

BOB CLEMENT, Tennessee 

BOB FILNER, California 

FRANK TEJEDA, Texas 

LUIS V. GUTIERREZ, Illinois 

SCOTTY BAESLER, Kentucky 

SANFORD BISHOP, Georgia 

JAMES E. CLYBURN, South Carolina 

MIKE KREIDLER, Washington 

CORRINE BROWN, Florida 



BOB STUMP, Arizona 
CHRISTOPHER H. SMITH, New Jersey 
DAN BURTON, Indiana 
MICHAEL BILIRAKIS, Florida 
THOMAS J. RIDGE, Pennsylvania 
FLOYD SPENCE, South Carolina 
TIM HUTCHINSON, Arkansas 
TERRY EVERETT, Alabama 
STEVE BUYER, Indiana 
JACK QUINN, New York 
SPENCER BACHUS, Alabama 
JOHN LINDER, Georgia 
CLIFF STEARNS, Florida 
PETER T. KING, New York 



Mack G. Fleming, Staff Director and Chief Counsel 



SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS 



LANE EVANS, Illinois, Chairman 



MAXINE WATERS, California 
BOB FILNER, California 
LUIS V. GUTIERREZ, Illinois 
JAMES E. CLYBURN, South Carolina 
MIKE KREIDLER, Washington 
JILL LONG, Indiana 



THOMAS J. RIDGE, Pennsylvania 
SPENCER BACHUS, Alabama 
TERRY EVERETT, Alabama 
JACK QUINN, New York 



(II) 



CONTENTS 



Page 

OPENING STATEMENTS 

Chairman Evans 1 

Hon. Thomas J. Ridge 2 

WITNESSES 

Calkins, Carl, Professor of Psychology, University of Missouri at Kansas 

City 38 

Prepared statement of Dr. Calkins 129 

Felton, Leslie 29 

Prepared statement of Ms. Felton 110 

Figley, Dr. Charles R., Professor and Director, Psychosocial Stress Research 

Program and Family Therapy Center, Florida State University 6 

Prepared statement of Dr. Figley 71 

Harkness, Dr. Laurie, Chief of the Psychiatrist Rehabilitation Program, Social 

Work Service, VA Medical Center, West Haven, Ct 48 

James, Thomas, Managing Director, Community Outreach to Vietnam Era 

Returnees 20 

Prepared statement of Mr. James 95 

La Count, Peter, Project Coordinator, Vietnam Veterans Family Support 

Project, Kennedy-Krieger Institute, accompanied by Leslie Felton 28 

Prepared statement of Mr. La-Count Ill 

Law, Dr. David H., Acting Associate Deputy Chief Medical Director for Clini- 
cal Programs, Department of Veterans Affairs 47 

Prepared statement of Dr. Law 151 

McCarthy, Frank, President, Vietnam Veterans Agent Orange Victims, Inc. ... 43 

Prepared statement of Frank McCarthy 145 

McKelroy, Michael, Project Coordinator, Veterans Assistance Project, Term 

of Advocates for Special Kids 24 

Prepared statement of Mr. McKelroy 105 

Pencer, Eileen, Vice President, Chief Program Officer, Lower Eastside Service 

Center 11 

Prepared statement of Ms. Pencer 78 

Peterson, Hon. Pete, a Representative in Congress from the State of Florida ... 3 

Reaves, Milton, Vietnam veteran 22 

Prepared statement of Mr. Reaves 102 

Reiss, John, Associate Director, Institute for Child Health Policy, University 

of Florida 41 

Prepared statement of Dr. Reiss 135 

Rhoades, Dennis K, Executive Director, Agent Orange Class Assistance 

Program 4 

Prepared statement of Mr. Rhoades 65 

Schroeder, Thomas, Executive Director, Rock Island County Council on Addic- 
tions, accompanied by Tony Gonzalez, Program Supervisor, Vietnam Veter- 
ans and Families Assistance Program 13 

Prepared statement of Mr. Schroeder 87 

St. Clair, Peggy, Service Coordinator, Project Access, University of Arkansas .. 30 

Prepared statement of Ms. St. Clair 115 

(HI) 



Page 
IV 

Smith, Bryan C, Director, National Information System, University of South 

Carolina 32 

Prepared statement of Dr. Smith 121 

Swope, Raymond, Deputy Executive Director, Universal Family Connection, 

Inc 14 

Prepared statement of Mr. Swope 91 

MATERIAL SUBMITTED FOR THE RECORD 

Manual: 

"Extract from Vet Centers' Direct Service Operations Manual," submitted 

by Dr. Figley 77 

Study: 

Families of Vietnam Veterans With Post-Traumatic Stress Syndrome: 
Child Social Competence and Behavior," submitted by Chairman 

Evans 53 

Written committee questions submitted by Chairman Evans and their re- 
sponses: 

Department of Veterans Affairs 155 

Thomas Schroeder, Rock Island County Council On Addictions, East 

Moine, IL 251 

Carl Calkins, University of Missouri — Kansas City 253 

Charles R. Figley, Ph.D., Florida State University 257 

Milton Reaves, veteran 261 

Dennis K. Rhoades, Agent Orange Class Assistance Program 262 

Eileen Pencer, Lower Eastside Service Center, Inc., New York, NY 267 

Thomas James, Community Outreach to Vietnam Era Returnees, Char- 
lottesville, VA 271 

Raymond Swope, Universal Family Connection, Inc., Chicago, IL 272 

Peggy St. Clair, Project Access, University of Arkansas 273 

Bryan C. Smith, Ed.D, NationaL Information System, University of South 

Carolina 275 

John Reiss, Ph.D., Institute for Child Health Policy, University of Flor- 
ida 279 

Peter La Count, Vietnam Veterans Family Support Project, Kennedy- 
Krieger Institute, Baltimore, MD 285 



SOCIAL SERVICES FOR VIETNAM VETERANS 
AND THEIR FAMILIES: CURRENT PRO- 
GRAMS AND FUTURE DIRECTIONS 



WEDNESDAY, MAY 18, 1994 

House of Representatives, 
Subcommittee on Oversight and Investigations, 

Committee on Veterans Affairs, 

Washington, DC. 
The subcommittee met, pursuant to call, at 8:30 a.m. in room 
334, Cannon House Office Building, Hon. Lane Evans [chairman of 
the subcommittee,] presiding. 
Present: Representatives Evans, Long, Ridge, and Quinn. 
Also Present: Representatives Peterson and Velazquez. 

OPENING STATEMENT OF CHAIRMAN EVANS 

Mr. Evans. Today, the subcommittee expects to receive some 
very important testimony on the provision of social services to Viet- 
nam veterans and their families. We will hear from those who 
know best about this subject. Well hear from those who provide 
these services, from those who support these services and from 
those who receive them. We expect to learn much about what is oc- 
curring today, what has already been accomplished and what re- 
mains to be done. 

VA has traditionally viewed veterans as individuals and the care 
and services it has provided to veterans has generally been individ- 
ual in nature. VA has treated veterans for their individual needs. 
As a result, VA has not always recognized that veterans can also 
be fathers or mothers, sons or daughters, sisters or brothers, aunts 
or uncles, husbands or wives, or workers or bosses. Veterans have 
been viewed generally as men and women who don't have signifi- 
cant personal relationships with other people. 

Fortunately, this incomplete view of veterans has begun to 
change and much of this change has been brought about by veter- 
ans themselves. Veterans know they can both influence and be in- 
fluenced by those with whom they have important relationships. 
Veterans are not one dimensional. 

Many Vet Centers, for example, provide services to veterans and 
to other individuals with whom veterans have important relation- 
ships. These important services provided to spouses, significant 
others and the children of veterans also serve veterans. 

Since its inception, the Agent Orange Class Assistance Program 
has been instrumental in focusing attention on the reality of the 
lives of Vietnam veterans and their families. By providing critically 

(l) 



needed support and encouragement to service providers, Agent Or- 
ange Class Assistance Program has made possible the delivery of 
services important to both veterans and their families. 

The history of the Agent Orange Class Assistance Program is not 
yet complete; its legacy not yet written. But its positive impact on 
the provision of services to veterans and their families is already 
well established. 

Today we want to learn about projects and programs that have 
been supported and encouraged to serve our veterans and their 
families. We want to identify some of these services and we want 
to hear from those who have received them. We hope to learn much 
from those who will testify today. 

Most of those who will testify today have never appeared before 
a committee of the Congress. To each of you we extend an espe- 
cially warm welcome. You are truly the most important people in 
this hearing room this morning. With you, there would be no con- 
gressional hearing. Today we are here to listen. If an occasional 
question is asked, its purpose will be to clarify statements or to 
gather more information. 

If anyone should be nervous about testifying, please keep in 
mind that you're among friends. Every man and woman who serves 
on this subcommittee has chosen to do so because of their commit- 
ment to our Nation's veterans. We certainly appreciate the sac- 
rifices you made when you put on the uniform of our country. We 
also recognize the sacrifices made by family members of those who 
wore the uniform. 

The prepared statement of each witness will be included in its 
entirety in the written record, without objection. Each witness is 
again requested to observe the 5-minute rule and to limit their oral 
remarks to 5 minutes. The red light on the table will signal the end 
of the 5-minute period. 

Before calling the members of our first witness panel, I would 
like to recognize the gentleman from Pennsylvania, the Ranking 
Minority Member, for any comments he would like to make. 

OPENING STATEMENT OF HON. THOMAS J. RIDGE 

Mr. Ridge. Thank you, Mr. Chairman. I do have a brief state- 
ment. 

Let me first of all thank you for scheduling today's hearing and 
thank the witnesses for their very important and valuable testi- 
mony. 

In reading through your written testimony, I'm reminded of the 

fjhrase, and I must paraphrase it now, no man or woman is an is- 
and. A Vietnam veteran cannot separate problems he or she expe- 
riences because of the war from their relationship with their 
family. 

We will have compelling testimony today as to how problems as- 
sociated with service in Vietnam lingers and dramatically affects 
the soldier and the family. I believe that the members of this com- 
mittee, Republicans and Democrats alike, recognize that when an 
individual puts on a uniform, when he or she returns home from 
faraway places having served their country, that individual and 
that experience is often carried into the family relationship and 
that individual's spouse and/or children sometimes have to endure 



and live with that experience in a lot of different ways. That's why 
your testimony today is very important and very helpful to us. 

I commend the Agent Orange Class Assistance Program, not only 
for their recognition of the necessity for family-centered services, 
but also for making available grants that place a special emphasis 
on service to families with children with developmental or other 
chronic disabilities. I also commend the recipients of these funds 
for their dedication in meeting the social service needs of Vietnam 
veterans and their families. 

I look forward to hearing the oral testimony of our distinguished 
witnesses, Mr. Chairman, and I thank them for appearing here be- 
fore us today. 

Mr. Evans. Thank you. We always appreciate the assistance of 
Congressman Ridge, who is a combat veteran of Vietnam. 

I'd like to yield of the gentleman from New York for any remarks 
he might like to make. 

Mr. Quinn. Thank you, Mr. Chairman. I have prepared remarks 
that I'll enter into the record, but want to welcome all of our panel 
members here today and thank you, Mr. Chairman and Mr. Ridge 
for opening remarks and for calling the hearing. 

You said just a minute ago not to be nervous, that you're here 
with family members — you're here for family members. But we 
view our Committee as family members as well, and we look for- 
ward to all the testimony and appreciate the time they're spending 
here today. 

Mr. Evans. Thank you for being with us. 

Members of our first witness panel this morning are Dennis 
Rhoades and Dr. Charles Figley. Please come forward to the wit- 
ness table at this time. 

Before formally introducing Dennis, I am pleased and honored to 
recognize a good friend and colleague, a former member of this 
committee and subcommittee, Congressman Pete Peterson to intro- 
duce Dr. Figley. 

STATEMENT OF HON. PETE PETERSON, A REPRESENTATIVE 
IN CONGRESS FROM THE STATE OF FLORIDA 

Mr. Peterson. Thank you, Mr. Chairman. It is a real pleasure 
to be back here before my old subcommittee. I would like to say 
that having worked with this staff, I think they demonstrate the 
height of staff professionalism here, and I miss this committee very 
much. 

But I'm here today to introduce a good friend and real pioneer 
in the issue of PTSD and the family relationships crucial to the re- 
adjustment of Vietnam veterans. I could actually testify here as 
well as perform the introduction of my good friend Charles Figley 
from FSU, which is in my district. I personally have suffered 
through some of the things that will be discussed today. My family 
very definitely has. What you're going to hear, I think, is that the 
family unit is the best source of rehabilitative services that we can 
provide and that we must help them help their members. 

Dr. Figley is a renowned author and probably the first person to 
have identified the problems of PTSD. He and I talked several 
years ago when I first got involved in the study of this issue, and 
I was amazed at the depth of his knowledge. He's carried that 



through his work on this important issue of how we deal with 
stress within the family element. I am more than pleased to intro- 
duce him to this panel who, I know will give him the privilege of 
presenting to you information that you'll be able to use and dis- 
seminate through the United States. 

Thank you. 

Mr. Evans. I thank the gentleman from Florida for that intro- 
duction. For people who don't know, Pete Peterson served over 6 
years in the Hanoi Hilton and is very helpful to this committee on 
a continuing basis as we explore issues such as this one, not only 
for the veterans themselves, but their families as well. 

The other member of this panel is Dennis Rhoades who is Execu- 
tive Director of the Agent Orange Class Assistance Program here 
in Washington, DC. Both Dennis and Michael Leaveck, who have 
assisted this subcommittee in its preparation for today's hearing, 
have served in Vietnam beyond the call of duty. 

We recognize your contributions on behalf of all Vietnam era vet- 
erans and thank you for your compassionate and dedicated service. 

We understand, Dennis, that you and Dr. Figley both have other 
commitments this morning. We thank you for your participation 
and you will not be detained any longer than is necessary this 
morning. As I said earlier, your entire statements will be made 
part of the record, without objection, and you may summarize your 
remarks. 

STATEMENTS OF DENNIS K. RHOADES, EXECUTIVE DIRECTOR, 
AGENT ORANGE CLASS ASSISTANCE PROGRAM; AND DR. 
CHARLES R. FIGLEY, PROFESSOR AND DIRECTOR, 
PSYCHOSOCIAL STRESS RESEARCH PROGRAM AND FAMILY 
THERAPY CENTER, FLORIDA STATE UNIVERSITY 

STATEMENT OF DENNIS K. RHOADES 

Mr. Rhoades. Thank you, Mr. Chairman. I appreciate the sub- 
committee's invitation to appear today to discuss alternative mod- 
els for providing needed social services to Vietnam veterans and 
their families. 

As you are well aware, the Agent Orange Class Assistance Pro- 
gram is a network of 72 programs which operates nationwide, in 
all 50 States plus the District of Columbia and Puerto Rico. In the 
course of our 5V2 years of operation, we have provided services to 
over 150,000 persons. 

This week — and that is the commitment to which you referred, 
Mr. Chairman — we are conducting a national symposium which 
will permit us to assess and distill the experience of our network 
in providing services to Vietnam veterans and their families, as 
well as to assess the public policy implications. We're holding this 
event precisely because the problems of clients we serve neces- 
sitated the development of service methodologies which differ con- 
siderably from the traditional veteran program service models. 

My written testimony outlines the course of the litigation and the 
development of the subsequent settlement and I'd like briefly to 
highlight a few points in that testimony. 

First of all, we faced several constraints in developing the Agent 
Orange Program. The first constraint was that no program could 



be funded which provided for large-scale research into the causal 
relationship between agent orange and any health effects. The rea- 
son that happened was that this was a lawsuit settlement between 
the chemical companies and the plaintiffs. 

The second constraint we had, which is why we have been absent 
from visiting with you up on the Hill more than we otherwise 
would have wanted, is because the Second Circuit Court in affirm- 
ing the settlement and the distribution plan prohibited us from po- 
litical activity. So, we apologize. We've been strangers to the com- 
mittee more than we wanted to be, but we're here at your invita- 
tion and we are happy to provide whatever information you need. 

Our program's basic design was dictated by the nature of the 
plaintiff class. The plaintiff class not only consisted of Vietnam vet- 
erans, but also included their parents, their spouses and their chil- 
dren. Our great emphasis on children with health problems — devel- 
opmental and other chronic disabilities — also stems from the fact 
that this was one of the most prominent problems that Judge 
Weinstein heard about in the fairness hearings following the settle- 
ment. It certainly dominated the phone calls and letters we re- 
ceived in the early days of the program. So, ultimately, the network 
that we did design had a number of characteristics, but chief 
among them was that it was family-centered. We were a settlement 
which had to deal with families. We had to be family-centered. 

We learned a lot about families. For one thing, most human serv- 
ices in the United States over the last 5 to 10 years are recognizing 
that you have to heal the family before you can heal the individual. 
Dr. Figley will discuss this issue in detail shortly. 

The second thing we had to do was we had to leverage services. 
We only had $52 million, which as you are well aware dealing with 
multi-billion dollar budgets every year, is not a lot of money. How 
could we stretch that $52 million to help the most people in the 
best ways? The key is service coordination. No, we couldn't pay for 
a lot of surgery or a lot of direct services. What we could do was 
employ service coordinators to help the families access the system. 

I have said in my written testimony that dealing with Medicaid, 
for example, is a very frustrating experience for a lot of people. It's 
the most user-unfriendly law Congress ever passed. In one state 
the instent application is 42 pages long. For our families, a lot of 
them, they couldn't deal with it. 

I think finally the last characteristic of our program is its com- 
munity-based orientation. We're community-based because most 
human services outside of the Department of Veterans Affairs and 
Social Security are delivered at the State and community level. As 
you are well aware, that's been going on for 20 years. So, you need 
to know the other service providers who are operating in the local 
community, in order to get services for our families that very often 
manifest a variety of needs. 

I'm not going to comment at any length about our specific pro- 
grams because I'm being followed by service providers that can 
speak far more eloquently about the kinds of work they do than I 
ever could. But I would say that less than 2 weeks ago we marked 
the tenth anniversary of the settlement. Next month we're marking 
the 50th anniversary of the GI Bill. Though many have quarreled 
and will continue to quarrel about whether a settlement should 



6 

have been reached at all, I believe we've accomplished some impor- 
tant tasks with the limited settlement resources at our disposal. 
But our efforts are time limited and the settlement funds are finite 
and not renewable. We can't come back to Congress and ask you 
for another appropriation. Our program doesn't work that way. Ul- 
timately the care of our veterans and their families is the respon- 
sibility of the government, and I know Jeff Lande made that obser- 
vation at our session yesterday. Hopefully, the testimony to follow 
me will help illuminate what that responsibility is and how to ap- 
proach that responsibility most effectively. I want to thank you 
once again for your investigation. 

[The prepared statement of Mr. Rhoades appears on p. 65.] 
Mr. Evans. Dennis, thank you. We appreciate your testimony. 
Dr. Figley. 

STATEMENT OF DR. CHARLES R. FIGLEY 

Dr. Figley. Thank you, Mr. Chairman. You have my written 
comments. 

I would first of all send greetings from our president, Sandy 
Dellenbert. Also, Coach Bowden would send his greetings, but he's 
a little preoccupied with a Sports Illustrated story that came out 
recently. 

Among other things, what I do at FSU is direct the AOCAP 
Project, the Vietnam Veterans Families Project. It's within the con- 
text of FSU's Marriage and Family Therapy Center. The center 
treats generally inactive cases of about 200 at any one time. 

First of all, before I go any further, I'd like to also acknowledge 
an important funding source for this project that recognized that 
it's important to focus on families and that is the National Veter- 
ans Foundation. In the audience is Mr. Shad Mishad and Patty Di- 
amond. They came through for funding to provide us with impor- 
tant resources to further our research and to essentially develop a 
model, part of which I'm presenting today. 

Mr. Evans. Doctor, the Chair would ask Shad and Patty stand 
up and be applauded for their work. 

Dr. Figley. Thank you. It's interesting because Mr. Meshad also 
was an innovator. He essentially was the architect of what is now 
called the Vet Centers, the Readjustment Counseling Program. 
Part of my remarks identify that program, but there is a supple- 
ment that I hope will be part of the record and I'm not sure if you 
have this in front of you. It is an extract from the vet center's Di- 
rect Service Operations Manual. 

(See p. 77.) 

This is an example of what I am emphasizing this morning to 
suggest that the vet center program, even though it started out in 
an excellent way, is off the mark. They have not gone far enough. 
What I'm suggesting is that the vet center, the Veterans' Adminis- 
tration and the Federal Government have been anti-family with re- 
gard to the services to veterans. In this manual, they include a de- 
scription of the services provided by the vet center. It says screen- 
ing for PTSD, in all cases counseling and/or psychotherapy for 
PTSD when indicated, employment education and counseling, job 
finding assistance, and here's the kicker, family counseling when 
needed for readjustment of the veteran. So, if you're a wife or a 



child who has been beaten up by a vet as a result partly of his or 
her substance abuse or PTSD directly related to the war, you can- 
not go, you will be turned away by any Federal Government serv- 
ices associated with veterans. 

The other element, it says significant other. Significant others 
are seen if necessary to provide adequate readjustment counseling 
services to the veteran. This suggests, explicitly suggests that fam- 
ily members are not perceived as veterans of a war, that they are 
not perceived as being affected by the war and they clear are. 

As Pete Peterson said, we have lots of examples and lots of re- 
search to show that trauma is infectious, that we bring home, 
whether it is from a war or from a rape or from a victimization, 
from a natural disaster, we bring these Kinds of frightening experi- 
ences back to the family and they absorb that. They absorb it be- 
cause they love the person who is affected, that they care about 
that person and also the person who is affected in this case by 
PTSD, war-related PTSD, is dysfunctional. They're ineffective as a 
father or as a mother or as a son. 

It's interesting that the VA in the outreach program has been 
permitted to see family members. That's very much an important 
innovation and that happened only in 1992 as a result of the Gulf 
War. In my written testimony, I summarized a congressionally 
mandated study. It was — you required the VA to do a study of the 
Vietnam War era generation. In addition to finding 15 percent ac- 
tive PTSD among Vietnam veterans, they also looked at the family 
members. If I can identify very quickly among the findings that 
they found, they essentially found that — I'm sorry. I can't find it 
right now. I know it fairly well. They found that there is a higher 
divorce rate among Vietnam veterans. They tend to be married for 
a shorter length of time. There is the higher incidence of — com- 
pared to non-combat veterans or non- Vietnam theater veterans, a 
higher incidence of marital discord, a higher incidence of family 
conflict, a higher incidence of wife and child abuse, a higher inci- 
dence of demoralization among the spouses and the children, a 
higher incidence of behavioral difficulties among the children. 
What this suggests is that we have to look beyond the veteran. We 
have to say that the families are the last remnants of war and that 
we have a responsibility to them. 

If we have a family-centered program, whether it is mental 
health or physical medical health, it's cost effective because they 
live with that veteran everyday, 24 hours a day frequently. They 
know when he's troubled or when she is troubled. 

I want to thank the subcommittee for inviting me. As you might 
guess, I have a lot more to say. I have the written statement and 
I'll be happy to answer any questions you have. 

[The prepared statement of Dr. Figley appears on p. 71.1 

Mr. Evans. Doctor, thank you very much. 

Several witnesses today refer to secondary traumatic stress. This 
is what you're referring to. 

Dr. Figley. Yes. 

Mr. Evans. In the VA studies which report on the research done 
at centers on PTSD, is this term used in any of the literature? 

Dr. Figley. No, it is not. 

Mr. Evans. It's not? Who originated the term? 



8 

Dr. Figley. I did. 

Mr. Evans. You did? 

Dr. Figley. Yes. 

Mr. Evans. Have you been in contact with VA professionals in- 
volved in the research? 

Dr. Figley. Absolutely. As a matter of fact, the Center for PTSD, 
their director, Dr. Matt Friedman, who has a Ph.D. and M.D., he 
will be — he is well aware of the research that has emerged not only 
in this country but in Israel, quite aware of the secondary affects 
of trauma on families and on relationships and children. They are 
very interested in initiating research in that area. As a matter of 
fact, he will be with me as a member of the faculty of a worldwide 
teleconference on the 23rd of June which focuses on — we're calling 
it compassion fatigue. It not only affects those husbands and wives 
and children of Vietnam veterans and other veterans, but also 
those who research them, those who treat them. They also are af- 
fected by the difficulties, the manifestations of PTSD. 

Mr. Evans. I know you have another commitment so I'll yield to 
my other colleagues for questions. 

Mr. Ridge. Mr. Rhoades, could you tell us how many veterans 
and their survivors have received payments from the Agent Orange 
Class Assistance Program since its inception? 

Mr. Rhoades. Well, as far as the Assistance Program is con- 
cerned, we don't do direct payments. We provide services. I am pre- 
pared, however, to tell you about the payment program 

Mr. Ridge. Please. 

Mr. Rhoades [continuing]. Which is the other part of the settle- 
ment. 

Mr. Ridge. Please. 

Mr. Rhoades. To date, as of the 13th of May, 36,055 people have 
received payments from the payment program. That breaks down 
to 25,967 veterans and 10,088 survivors. The money involved for 
that comes to a total of $131.8 million for the veterans and $23.5 
million for the survivors. 

Mr. Ridge. What does that break down to in terms of average 
payment? 

Mr. Rhoades. The average payment for both is about $4,300.00. 
The maximum payment for survivors is about $3,500.00. Maximum 
for veterans is about $12,000.00. 

Mr. Ridge. What does a veteran or his survivor have to dem- 
onstrate in order to get that sum? 

Mr. Rhoades. They have to demonstrate total disability of some 
sort or another by Social Security standards, and the fact that they 
were in Vietnam at a place where Agent Orange was sprayed. That 
determination is made by documentation submitted and evaluated 
by the Stellman's at Columbia University who did the Agent Or- 
ange study for The American Legion. 

Mr. Ridge. The second part of the settlement dealing with the 
assistance program and the foundation that you set up, have you 
been able to generate any financial assistance from other organiza- 
tions in support of your effort? Have you just had to rely on those 
limited finite resources that you referred to in order to get the job 
done? 



9 

Mr. RHOADES. Well, I think a lot of our organizations are begin- 
ning to do that. They're beginning to generate funds. You'll hear 
very soon from Eileen Pencer of the Lower Eastside Service Center 
and they've been very successful in New York City in generating 
funds. But to be candid, a lot of our organizations are not actively 
going out after funds. The resources that we have made available 
to our programs are very hard to replace simply because of the size 
of the grants we've made in order to create effective programs. 

Mr. Ridge. Do you have any idea in terms of the outreach how 
many veterans and families you've been able to assist? 

Mr. Rhoades. A little over 150,000. I hedge that figure a little 
bit because there is some duplication of— not duplication of serv- 
ices, but what might be otherwise be called double counting pri- 
marily because we have a National Information System which 
serves as a clearinghouse, as well as individual projects to whom 
the National Information System refers clients. So, it's around 
150,000, probably about 50,000 of whom are children. 

Mr. Ridge. Thank you. 

Dr. Figley, I applaud your work and thank you for appearing as 
well as Mr. Rhoades. 

I think everybody on this committee probably deals in a very spe- 
cial way with Vietnam veterans when they come into their office 
looking for some kind of assistance. I know I do and I suspect just 
about everybody on the committee does as well. This whole notion 
of family-centered assistance is one that I think, had the VA talked 
to those of us who deal in many instances on a regular basis with 
soldiers affected by PTSD and who see the impact on the families, 
we would have been able to make the recommendation of family- 
centered assistance to them. 

I've got a good vet center. I'm aware of some very good vet center 
operations throughout the Commonwealth of Pennsylvania. But ob- 
viously you and I believe that they should expand their outreach. 

What specific recommendations would you make immediately to 
the VA and to these vet centers in recognition of the need for more 
family-centered, government supported help to Vietnam veterans? 

Dr. Figley. That's an excellent question and I don't know if I can 
answer it. Really, the answer really has to do with a paradigm 
shift. If you look at all of the regulations that the vet centers, for 
example, and the medical centers and the inpatient treatment cen- 
ters for PTSD throughout the system, there is no mention of fami- 
lies. There is a discussion about significant others. It really does 
take a complete shift. I don't see how piecemeal it could be done. 

If you look at your own vet center, if you go in and you ask them 
candidly and off the record, they'll tell you they see families. 

Mr. Ridge. You're right, they do. 

Dr. Figley. They see them illegally perhaps. They don't count 
them, but they do it because they know they have to, that that's 
the way to get the job done. So, maybe a short-term solution is to 
urge the VA and to provide them with the resources obviously to 
do it, to count the family members and children just as they would 
veterans. That would be a start, at least. 

Mr. Ridge. Thank you very much, gentlemen. 

Mr. Evans. The gentleman from New York. 

Mr. Quinn. Thank you, Mr. Chairman. 



10 

Thank you for your testimony, all three of the panel members as 
well as our colleague, Pete. 

Mr. Rhoades, you mentioned that this situation is one in which 
you can't come back to the Congress or the committee for more ap- 
propriations. It's not a budget situation which we understand. You 
also mentioned that later on, witnesses will make some suggestions 
about that because ultimately the government is responsible for 
our veterans. I support that concept, as well as does the committee. 

Can you briefly give me a synopsis of what some of those sugges- 
tions might be in terms of how the government, who is responsible 
for our vets, might be able to address this funding situation? 

Mr. Rhoades. Well, I think first and foremost, I think the Fed- 
eral Government really needs to adopt a family-centered approach 
to dealing with many of the issues of veterans. I find it fairly ironic 
that the vet centers now have authority to deal with the families 
of Persian Gulf vets, but not any other generation of vets. I think 
that's something that needs to be remedied, for starters. 

Above and beyond that, I suppose that the kind of work we do 
deals with child health issues. One of the concerns that is being de- 
bated out at the national symposium is the whole issue of health 
care reform. It is astonishing to observe when a family has a child 
with a severe disability. So, I think that needs to be taken in con- 
text as Congress considers the health care reform issue because 
children with long-term disabilities require a lot of care, it's often 
quite expensive and it bankrupts a lot of families. 

Mr. Quinn. Thank you very much. 

Mr. Evans. Just one other question. The military during the Per- 
sian Gulf War learned a few things, I think, from the Vietnam ex- 
perience in terms of developing family support groups before people 
were sent overseas and then sending people over in units so that 
they had a sense of identity with their fellow soldiers and so forth. 
Are those things useful, do you think, as preventative medicine? 

Dr. Figley. Absolutely. As a matter of fact, the VA, to their cred- 
it, was well prepared before these men and women returned and 
they had a family component. They went beyond just including the 
spouse and the children, they were concerned about the parents as 
well. 

The thing that's so striking, all of us know that Lou Puller killed 
himself a week ago. We have a wall devoted to all those men and 
women who lost their lives. But there's no wall for families. There's 
no wall for the wives and the children who lost loved ones over 
there and are still losing them today. In many ways, the Gulf War 
provided a context for the way to do it correctly and that is to start 
before they come back, primary prevention. 

Mr. Evans. Thank you very much. 

Congressman Peterson, good to have you on board again today 
and I look forward to working with you on these issues. 

Dennis and Dr. Figley, thank you very much for your testimony. 
It's been very valuable to us. 

Mr. Rhoades. Thank you, Mr. Chairman. 

Mr. Evans. The members of our second witness panel are Eileen 
Pencer, Thomas Schroeder, Tony Gonzalez and Raymond Swope. 



11 

Eileen is Vice President and Chief Program Officer and Director 
of Vietnam Veterans Family Services Center, Lower Eastside Serv- 
ice Center, Incorporated, New York City, NY. 

Thomas is Executive Director, Rock Island County Council on 
Addictions, RICCA, located in East Moline, IL, my district I'm 
proud to say. He's accompanied by Vietnam vet Tony Gonzalez, 
Program Supervisor of Vietnam Veterans and Family Assistance 
Program. 

Raymond is with the Universal Family Connection, Chicago, IL. 

Each of your written statements will be made part of the record 
and we will ask you to summarize from them. Eileen, once you're 
situated, we'll start with you. 

STATEMENT OF EILEEN PENCER, VICE PRESIDENT, CHIEF 
PROGRAM OFFICER, LOWER EASTSIDE SERVICE CENTER; 
THOMAS SCHROEDER, EXECUUVE DHtECTOR, ROCK ISLAND 
COUNTY COUNCIL ON ADDICTIONS, ACCOMPAMED BY TONY 
GONZALEZ, PROGRAM SUPERVISOR, VffiTNAM VETERANS 
AND FAMHJES ASSISTANCE PROGRAM; AND RAYMOND 
SWOPE, DEPUTY EXECUITVE DHtECTOR, UNP7ERSAL FAMDLY 
CONNECTION, INC. 

STATEMENT OF EILEEN PENCER 

Ms. PENCER. Thank you, Chairman Evans. 

Chairman Evans and members of the subcommittee, I would like 
to give you an overview of a very effective family service program 
called the Vietnam Veterans Family Services Center at Lower 
Eastside Service Center in New York City which provides treat- 
ment and other services to Vietnam veterans and their loved ones. 

The WFSC started up with funding from the Agent Orange 
Class Assistance Program in 1990 to fill a formerly unmet need 
with the guiding principle that veterans requiring assistance can 
be most effectively helped in the context of their families. Our serv- 
ices are provided through a geographically dispersed service deliv- 
ery network that leverages off of the well organized veterans' com- 
munity as well as existing social services available through the VA, 
State and city agencies. 

Currently, VVFSC operates through an integrated service deliv- 
ery model with VA vet centers where we have established satellite 
clinics and where our family therapists are outposted. The prin- 
cipal benefit of our partnership lies in the complementarity of serv- 
ices that bridge the gap in services to families, who, based upon VA 
eligibility requirements, are otherwise ineligible. As a result of this 
synergy, both the quality of services provided to Vietnam veterans 
by the VA and the effectiveness of family treatment provided by 
our Center are immeasurably enhanced. Neither the VA nor our 
Center can accomplish alone what we have been able to accomplish 
together. 

Our Center utilizes a systems approach to treat the entire family 
constellation. We firmly believe that the entire family's participa- 
tion in the resolution and restorative process is critical; responsibil- 
ity for effecting and maintaining change cannot rest with the vet- 
eran alone. Our family therapists provide individual, couples and 
family therapy; group therapy for children, adolescents, adult chil- 



12 

dren of Vietnam veterans and women; PTSD, secondary PTSD 
counseling and education, as well as case management services. 

WFSC's greatest contribution to the veterans' community is in 
its service to our target population — veterans' children. Services 
provided to address veterans children's physical, emotional, behav- 
ioral and developmental needs are not part of the mission of tradi- 
tional veterans' services as furnished by the VA and are not pro- 
vided by the mental health community at large for many reasons, 
including lack of awareness, lack of training and lack of funds. In 
our program, usually for the first time in their lives, children ex- 
plore sensitive personal and family issues with the guidance of pro- 
fessionals trained to deal with the special difficulties that veterans' 
families must deal with. 

There is a direct benefit to veterans as well through our collabo- 
rative team model. For example, the psychiatrically impaired vet- 
eran suffering from PTSD who may have previously refused to take 
his psychotropic medication often becomes more aware of the im- 
pact of his recalcitrance and becomes compliant out of concern for 
his family's safety; substance-abusing homeless veteran, motivated 
by reunification with his child, becomes drug free and economically 
self-sufficient; and the veteran newly-aware of the horrific effects 
of domestic violence on his family can be induced through effective 
modeling to break the cycle of destructive behavior he finds himself 
in. 

These are all apparently small victories perhaps, but they im- 
prove the quality of life for entire families and reduce the prob- 
ability that such veterans and their families will become burdens 
on their community. 

I encourage you to consider the model we have established as a 

Earadigm for the provision of services to veterans and their fami- 
es. We respectfully submit that our experience has shown that 
such services can be an indispensable springboard to recovery for 
veterans and their families. As such, programs such as the VVFSC 
are simultaneously an investment in the futures of veterans and 
their families and an expression of appreciation by our society to 
those who have served to protect us. 

I now look forward to answering your questions. 

[The prepared statement of Ms. Pencer appears on p. 78.] 

Mr. Evans. Ms. Pencer, we've been joined by Congresswoman 
Velazquez, a strong advocate for veterans in her district and I'd 
like to recognize her for any remarks she'd like to make. 

Ms. Velazquez. Thank you, Mr. Chairman. I want to welcome 
Ms. Eileen Pencer and publicly congratulate you for the extraor- 
dinary work that you are doing in New York, not only in the Lower 
Eastside, but in New York City. 

Ms. Pencer, Mr. Chairman, joined the Lower Eastside Service 
Center in 1990 as supervisor and family therapist of the Vietnam 
Veterans Family Services Center and was responsible for the devel- 
opment of this program from its inception. She was promoted to 
Assistant Director of Treatment Programs in 1991 and was respon- 
sible for agency-wide outreach and client recruitment. As a result 
of her extensive outreach into the Vietnam veterans' services net- 
work, the program became a strong presence in the New York vet- 
erans' community. Her training and experience in special education 



13 

and marriage and family therapy contributed to the Vietnam Vet- 
erans Family Services Center's family and child focus. 

Ms. Pencer's work on behalf of the veterans of New York City 
has been outstanding and I am most pleased to have her here to 
share her experience so that this committee could benefit in terms 
of the services that we must offer to the veteran community in this 
nation. 

Thank you. 

Mr. Evans. Thank you. The Congresswoman and I know that 
people testifying today are front line soldiers. So, we appreciate 
your being with us for awhile today. We know you have many other 
important responsibilities, but we appreciate hearing from you and 
from your constituent. 

Ms. Velazquez. Thank you, Mr. Chairman. 

Ms. Pencer. Thank you. 

Mr. Evans. Now we'll hear from one of my constituents, Tom 
Schroeder. 

STATEMENT OF TOM SCHROEDER 

Mr. Schroeder. Thank you, Mr. Chairman, members of the sub- 
committee. 

My name is Tom Schroeder and I'm the Executive Director of the 
Rock Island County Council on Addictions, which is a traditional 
substance abuse and family service agency in Congressman Evans' 
district in Illinois. 

With me today is Tony Gonzalez. Antonio is our program super- 
visor with our Vietnam Veterans and Families Assistance Program 
funded by the Agent Orange Class Assistance Program. Tony is a 
two tour veteran of the Vietnam War and a 21 year Army career. 
He rose to the rank of command sergeant major. Tony and his 
staff, who are also Vietnam-era veterans, bring to this project a 
really unique not only service but passion for their work. The dif- 
ference between this project and other projects that our Agency has 
been involved with has been mainly that sense of ownership, that 
sense of really compassion that these gentlemen and the people in- 
volved in the program, the advisors, bring to their work. 

We have found in our experience that most traditional family 
service agencies like ours have viewed the Vietnam veteran in a 
very unique way. Basically they've not known how to deal with the 
Vietnam veteran, not known how to treat the Vietnam veteran and/ 
or his family and have tried to take the Vietnam veteran and move 
the veteran in a way that they would try to create change in that 
veterans life that the veteran is not prepared to change and not 
willing or able to carry forth. Consequently, the family becomes a 
victim just as the veteran has. 

In chemical dependency, we talk about how families of chemi- 
cally dependent people become as affected or in many cases more 
affected than the chemically dependent person. Our experience in 
working with Vietnam veterans in this short time in our Vietnam 
Veterans Family Assistance Program has been that that is even 
more true with the Vietnam veteran and their family. 

People that have been run through the traditional system have 
been turned away by many organizations because they can't be 
helped, have been misdiagnosed, gone through the process of trying 



14 

to be changed and molded into a pattern that doesn't fit that family 
and doesn't effectively help that family. These families become des- 
perate, they become angry, they become in many cases unwilling 
to even trust us or work with us. We have found through our case 
management approach working with the entire family that these 
people that work in our program very doggedly go about working 
with each individual case, each individual situation. In many ways, 
it's unbelievable the amount of effort that it takes to work people 
through a system. Frankly, it's unbelievable the amount of effort 
it takes to work through the VA system and the Medicaid system 
to help a family to get payment, to get services. 

What we've been able to prove, I think, in our short existence, 
which has been just since 1992, that Vietnam veterans and their 
families have some very, very special needs, that the traditional 
family service system and family service networks have not been 
able to meet those needs. But it takes programs like this in order 
to effectively deal with Vietnam era veterans and their families. 

We also have come to believe in working with this program that 
this program is an example for the rest of family service, that this 
effort, this system, the way that we case manage and work with 
families and individuals and doggedly go about pursuing outcomes 
for people is the way that we should look at treating all issues that 
families deal with. I especially believe it's the way we should begin 
to deal with and treat chemical dependency and that's something 
that this program has brought to our organization, a new approach 
to dealing with individuals and dealing with families. 

Unfortunately, the Agent Orange Class Assistance Program has 
a very short life. In our case, in our community, we are going to 
work very, very hard to try to make certain that this program does 
not die because in my 15 years of experience in family service orga- 
nizations, this program is a shining example for the country and 
it's a way that we need to go about beginning to treat all issues 
and all situations that affect families. 

Thank you. 

[The prepared statement of Mr. Schroeder appears on p. 87.] 

Mr. Evans. Thank you, Tom. 

Mr. Swope. 

STATEMENT OF RAYMOND SWOPE 

Mr. Swope. Thank you, Chairman Evans and members of the 
House Veterans Affairs Subcommittee. Thanks for inviting me here 
this morning to present testimony on the topic of social services for 
Vietnam veterans. 

My name is Raymond Swope. I am a Vietnam veteran. I was 
wounded twice in Vietnam. I'm currently Deputy Executive Direc- 
tor of Universal Family Connection, a non-profit community-based 
social service organization located in Chicago, which would serve 
the City of Chicago as well as the suburbs. 

As the Deputy Executive Director, I've been in social work for 15 
years and a licensed clinical social worker for 13 years. I'm a mem- 
ber of the Academy of Certified Social Workers and a Board cer- 
tified diplomate. All these experiences would mean nothing without 
my experience in Vietnam. Being a deputy executive director, and 



15 

providing services for veterans in the veterans' community, without 
my experiences in Vietnam, wouldn't have been possible today. 

I think because of our unique relationship with the Agent Or- 
ange Class Assistance Program and our prior experiences in deal- 
ing with families at the community-based level, we have been able 
to establish significant relationships with other veterans' organiza- 
tions throughout the City of Chicago and suburbs, as well as com- 
munity-based organizations, legal clinics and other social service 
providers. Through our linkages and through our agreements, we 
have been able to provide intensive on-going case management 
services. Although this is our bread and butter, this is something 
we've been doing even before we received a grant from the Agent 
Orange Class Assistance Program, AOCAP only added additional 
depth for the services for Vietnam Veterans Agent Orange Class 
Assistance Program. 

In the past 3 years, with our relationships with the Class Assist- 
ance Program, we have seen over 600 families per year. When the 
families are referred to us, the veterans present problems, physical 
ailments, mental and emotional problems. They have been diag- 
nosed with posttraumatic stress disorders, they have been diag- 
nosed with major psychotic disorders. They have been diagnosed 
with major depression, bipolar disorders, substance abuse and gen- 
erally a combination of all. The families seem to also suffer the 
same similar type of problems that the veterans also present. 

I've also found time and time again that most of the veterans at 
this particular time when they are referred to us, they have really 
been disenfranchised from their families. The family linkages that 
now exist between the veteran and their family is really fragile, al- 
most non-existent. I think the only thing that really keeps them to- 
gether, when there is a family support system intact, is basically 
just hope and optimism. 

The veterans complain that they have went to the VA repeatedly 
for assistance and no one has really done anything to help them 
or their families. When they heard about us, this seems to have 
been the something for them that said "Well, I'm going to try one 
more time." For some reason, we have been able to at least provide 
that positive impetus to — positive intervention. For some reason 
it's been working. I know, being a social worker, that the founda- 
tion is the family and it's the key to success because once the fami- 
lies start coming together, then the veterans seem to be making 
positive strides toward working on their problems. 

I have outlined some unique things that I think could definitely 
help the Vietnam veterans and their families as well as their chil- 
dren because the children do seem to suffer the most. Children 
come to us with diagnoses of hyper or hypoactive disorders, with 
many physical ailments, which I know you've heard many of them. 
The school complains about the children's behavior in school. They 
describe the child as non-attentive in school, or having an attention 
deficit disorders. The teachers cannot control them or the child 
seems to be withdrawn or isolated from others. 

When I have visited schools as part of the school staffings, some 
of the preschool teachers have asked me, "What could be possibly 
wrong with this child? We have medical records in front of us and 
the medical records seem to indicate that there is no specific prob- 



16 

lem that requires special education. Why is this child perhaps act- 
ing differently?" When we review the records and especially those 
of our Vietnam veterans, we know that there is a strong possibility 
or there is a strong linkage that this child is an offspring of a vet- 
eran who was exposed to Agent Orange. Once we make this im- 
pression upon the teachers and the staff, then they seem to modify 
at least their educational procedures toward the children. 

I think in order for us to be effective, I'm talking about Universal 
Family Connection, we have to draw on various techniques of inter- 
vention. We use several models in order to be eclectic in approach. 
We use the psychodynamic approach. We use the humanistic ap- 
proach, basic family counseling and intervention. But more impor- 
tantly, we do case coordination and I think that's the key, case co- 
ordination with other veterans' services. We obtain prior records of 
the client from other agencies that provided services for the veter- 
ans. We go to the VA hospital and check out whether or not the 
veteran was provided direct services and what type of services. We 
try to reduce or prevent duplication of services. 

I'm just going to summarize this quickly, I think the Department 
of Veterans Affairs should be reconfigurated to accommodate more 
comprehensive service strategies. I think there should be a con- 
certed effort that should be developed to provide a positive relation- 
ship and linkages (agreements) with appropriate local, State and 
community resources, both public and private, to more effectively 
address the needs of the veterans. I also think the Department of 
Veterans Affairs, particularly in the areas of counseling, needs to 
look more directly at rehabilitation and vocational guidance as well 
as employment programs for the veterans and their family. 

I think the Department of Veterans Affairs, as well as the De- 
partment of Labor for veterans, should adopt strategies to maxi- 
mize their efforts to develope contracts for services with the appro- 
priate community-based, not for profit social services agencies. I 
also think that those agencies that are charged with changing 
things, should really examine and look thoroughly at the intensive 
family-centered case coordination models for case management to 
ensure that the Vietnam veterans and their families receive the 
necessary services that they require. 

I thank the members for listening to me this morning. 

[The prepared statement of Mr. Swope appears on p. 91.] 

Mr. EVANS. Thank you, Raymond. We appreciate your testimony. 

Eileen, you indicated that about 85 percent of the children that 
you treat are suffering from the secondary effects of PTSD. Is that 
also the experience of the other members of the panel? 

In Rock Island and Chicago do 85 percent of the children also 
suffer from secondary trauma? 

Mr. Schroeder. That's a very high percentage. We can't come up 
with an exact percentage, but it would be at least that high, I 
would guess. 

Mr. Evans. Will each of you please describe the effects you've 
seen in children relating to education? 

Mr. SWOPE. Well, I've definitely seen, because we are involved 
with similar programs throughout the City of Chicago in elemen- 
tary schools and high schools. But being specifically involved in 
State pre-kindergarten programs and Head Start programs, we see 



17 

the little children before they go into the primary grades. We have 
seen them ranging from, as I say, physical ailments which we know 
that is easily recognizable, but more importantly the behavioral 
problems which somewhat disassociate them from the normal child 
development, which also is bared out by the Chicago Early Assess- 
ment, which is a screening instrument that the pre-schools do use 
to help assess the normal development of a child in contrast to 
their peers. We have seen significant impairments with them, espe- 
cially in terms of attention deficits, being able to manipulate cer- 
tain types of three or four pieces puzzles which normally three and 
four year olds should be able to do, following instructions, respond- 
ing appropriately to authority figures. These type of symptoms we 
see as early as 3 and 4 years of age, that we know is an insidious 
process and is going to get worse as they get older. 

As a family-oriented agency, we see families range — as long as 
there's a child in the family under the age of 18, we see them from 
birth through age 17. So, we're able to examine the whole spectrum 
of child development. 

Mr. Evans. Eileen? 

Ms. Pencer. The symptoms of secondary PTSD that we see in 
our children are not dissimilar to the symptoms of PTSD that we 
confront with veterans. In many instances, as Mr. Swope has sug- 
gested, we deal with schools to provide secondary PTSD education 
because schools are not at all trained to deal with these children. 
We also educate the mental health community regarding the symp- 
toms of secondary PTSD which can range from attention deficit hy- 
peractivity disorder to learning difficulties which may result in spe- 
cial education placement and associated difficulties. 

Mr. Evans. Tom or Tony? 

Mr. Schroeder. I think the only thing that I'd like to add is that 
in our case where we're working with children who are identified 
in school systems or diagnosed as learning disabled, attention defi- 
cit, behavior disorder, the school systems want to try to get a diag- 
nosis here that works and they want to work with the family. I 
serve on the school board in my local community and we're finally 
getting our school counselors and social workers and psychologists 
to ask questions about whether or not there's a Vietnam veteran 
in that family. These people are very open to wanting to work with 
that family and try to learn more information, which I think is 
very positive. 

Mr. Evans. What will happen to each of your programs, which 
is helping us fill a critical gap as the VA confirms in its testimony, 
as Agent Orange Class Assistance Program money is phased out? 
What do you think will happen when that occurs? 

Mr. Swope. Well, since 1984, Universal Family Connection has 
off and on been working with veterans, initially with readjustment 
counseling for any veteran. Of course, over the past 3 years, we've 
been involved more directly with Vietnam veterans. 

Our program is going to diminish with our involvement with the 
veterans unless they're referred to us for other types of problems, 
for other family-related problems. They must live in our service 
areas that are covered by other governmental contracts, for exam- 
ple the Department of Children and Family Services, the Depart- 
ment of Human Services. If these individuals or veterans do not 



18 

live in our catchment area, then we have to send them to St. Else- 
where for services. But there is no other place to send them besides 
the vet centers which have not provided family services for the vet- 
eran. So then, of course, there's going to be a big void. These fami- 
lies are not going to be served. 

Mr. Evans. Eileen. 

Ms. Pencer. Dennis Rhoades, in his testimony, referred to the 
fact that Lower Eastside Service Center is very strongly committed 
to continuation of this program. Herbert Barish, First Vice Presi- 
dent, as well as Carolyn Rainer, Board Mmber and Poject Coordi- 
nator, who is here with us today, have worked very hard in this 
regard. For example, Lower Eastside Service Center was awarded 
a $25,000 development grant from New York City Memorial Fund, 
$20,000 from the Disabled American Veterans and $65,000 from 
the van Amerigan Foundation. But we all know that this will not 
maintain the program for years to come. 

We're also currently working on-site at VA Vet Centers to pro- 
vide family services. However, once we leave the Vet Centers, these 
services will no longer be available for our families. 

Mr. Evans. Tom. 

Mr. Schroeder. In our case, it is my belief that a grant of this 
magnitude, in our case it's $150,000.00, is very difficult to find in 
a local community. Our United Way can't come up with one penny 
for any new services because they've been strapped and not able to 
meet their goal. Any of our local foundations also have a very dif- 
ficult time funding more than $5,000.00 or $10,000.00 to a pro- 
gram. I believe money is going to drop from the sky on this one 
in that this is a nation-wide network that you won't find like this 
anywhere in human services and that somebody is going to find 
this to be very attractive and want to continue these services, espe- 
cially if we can prove outcomes. If we can show people and hold up 
that we have affected positively families and individual veterans. 
But this is going to be something that someone will step forward 
and take responsibility for. 

Mr. Evans. The Chair yields to the gentleman from Pennsylva- 
nia. 

Mr. Ridge. How successful have you been in soliciting and get- 
ting the assistance of local social service agencies to assist you in 
meeting these families needs? I think, Ms. Pencer, you talked about 
educating them to the problem and that's very important, but I'm 
even more interested in how successful your three organizations 
have been to integrate your effort with existing social service agen- 
cies to help particularly with regard to the children. Could you 
each comment? 

Mr. SWOPE. I can comment on that. I think we have been ex- 
tremely successful at recruiting veterans. That has not been a 
problem for us because we have linkage agreements with the veter- 
ans hospitals, with many of the community social services centers 
throughout the City of Chicago, legal clinics, the Social Security 
Administration. That has not been the problem of recruiting. In 
order to elicit significant coordination of services with other mental 
health providers, it has been extremely difficult because based 
upon their contracts, they have limitation in the type of services 
that they can provide. However, I think that we've been successful 



19 

with our clientele for the most part, trying to provide that continu- 
ity of care through case coordination. However, there were not 
enough dollars to provide the type of linkages and the kind of case 
coordination that we would have liked to have seen from the com- 
munity. One of the things they wanted us to do was to provide fol- 
low-up services. That's the thing, the follow-up on the clients, be- 
cause things take time. Working with just the Department of Vet- 
erans Affairs takes time. Often times by the time we complete cer- 
tain types of documentation is required by the Social Security Ad- 
ministration, the veterans can become lost. Many of them dis- 
appear. Many of them are homeless and we can't find them again. 

But I think we have made an impact and we were able to do a 
positive job. Trying to assess the positive outcome, can be very dif- 
ficult for us at this time, at least for our agency. But I think that 
was one of our unique things, the case coordination with other so- 
cial service agencies and the case management concept that we 
were using and I think it was successful. 

Ms. Pencer. Sadly, mental health service agencies do not con- 
sider it their responsibility to provide such services. Thus, part of 
what we have accomplished is to alert direct care and administra- 
tive staff to the fact that Vietnam veterans and their families re- 
quire their help. 

Mr. Ridge. Sergeant Major? 

Mr. Gonzalez. Thank you. 

Mr. Ridge. Oh, listen, I was just a staff sergeant. I know who 
to defer to any time. 

Mr. Gonzalez. Thank you and good morning. 

In our case, we have been very successful in using the human 
services agencies that are in our community. The fear from our cli- 
ents is that once we are gone, that they are going to be treated 
again like numbers and not like persons. We are trying to empha- 
size that. It is going to be a pity if we have to go away. Our most 
powerful weapon that we have in our programs is the ability to be 
able to advocate for these people, to include going with them to the 
human services agencies if they want us to. We even go to their 
houses and pick them up and bring them back. I'm telling you, it 
makes a big difference to be treated like a person and not just like 
another number. 

Mr. Ridge. I think all of us on this committee feel that caring 
for veterans after they've taken the uniform off is a continuing cost 
of defense. We sometimes fail in recognizing that. I'm very inter- 
ested in your professional experiences. Could you tell me whether 
or not the veterans themselves have been or are getting some dis- 
ability from the VA based on PTSD. What percentage of the veter- 
ans you're dealing with, who have these psychological problems, 
have been recognized as being disabled by the VA? My thinking 
being, of course, that if we're to look to an expanded family-cen- 
tered approach, that maybe we could enhance that approach by 
qualifying family members whose father or mother has been recog- 
nized by the VA as having that disability and maybe following up 
on it. 

So, could you tell me the percentage of veterans that you're deal- 
ing with whose psychological problems have been identified and ac- 
cepted by the VA, depending on what region of the country you're 



20 

in, and that in and of itself is a problem. It took a long time for 
the VA to recognize that PTSD even existed. 

Mr. Gonzalez. It's still a problem to try to process a claim 
through the complex and time-crippled claims' system of the De- 
partment of Veterans Affairs, especially trying to prove PTSD. Be- 
cause we encounter problems, we have become strong advocates in 
helping veterans develop and process claims for PTSD, including 
assisting the veteran through the claims process from the begin- 
ning to the end. From our clientele, about 28 percent of the veter- 
ans suffer from PTSD, but only 8 percent are getting some kind of 
benefits for 10 percent, 30 percent, or 50 percent for PTSD. Al- 
though it is only a little bit of money, it comes in handy. You see, 
most veterans already come upon employment difficulties; not to 
mention, the problems they confront if they happen to be suffering 
from coping complications as the result of PTSD. 

Mr. Swope. I would be hard pressed to come up with any signifi- 
cant numbers, but I can let you know we have been very successful 
at having diagnoses changed from preexisting diagnosis that were 
given through the veterans hospital to posttraumatic stress dis- 
order. This allowed benefits to have been increased. Out of the vet- 
erans that we have seen, I can guarantee that's been a significant 
number. But to put an exact number, I would really be hesitant on 
indicating that now. It has been significant. 

Ms. Pencer. It would be difficult to identify a precise number. 
But you raise an important issue, one that needs to be framed as 
a comprehensive problem since it is not only specific to the veteran. 
Part of our work, as all of us have stated, is to advocate for the 
veteran when the veteran applies for that benefit since we all know 
how difficult the process can he. 

Mr. Ridge. Thank you. 

Mr. Evans. We thank this panel very much for its important tes- 
timony and appreciate your participation. 

We will now stand in recess for a period of about 5 minutes. 

[Recess.] 

Mr. Evans. The members our next panel are Thomas James, Mil- 
ton Reaves and Michael McKelroy. Thomas is managing director, 
Community Outreach to Vietnam Era Returnees in Charlottesville, 
VA. Milton is from Charlottesville, VA. Michael is project director 
of Veterans Assistance Project, Team of Advocates for Special Kids, 
Anaheim, CA. 

Again, each of your statements will be included in the record in 
its entirety, without objection, so ordered. You are invited to sum- 
marize from your prepared remarks. 

Mr. James, we'll begin with you. 

STATEMENTS OF THOMAS JAMES, MANAGING DIRECTOR, 
COMMUNITY OUTREACH TO VIETNAM ERA RETURNEES; MIL- 
TON REAVES, VIETNAM VETERAN; AND MICHAEL McKELROY, 
PROJECT COORDINATOR, VETERANS ASSISTANCE PROJECT, 
TEAM OF ADVOCATES FOR SPECIAL KIDS 

STATEMENT OF THOMAS JAMES 

Mr. James. Okay. Thank you, sir. 



21 

My name is Tom James. I'm a veteran and co-founder and man- 
aging director for a private non-profit community-based counseling 
agency for Vietnam veterans and their families. We service 37 ju- 
risdictions in the mountain regions of Virginia and West Virginia. 
Our agency was founded in 1979 by my wife, with the sole purpose 
of offering services to veterans and their families. 

Over the years we have served over 6,000 veterans and family 
members. Our clients represent a broad range of professions and 
experiences. All share a common denominator and that's concern 
for their families. The vet sees his family as his squad. These fami- 
lies have faced hardships, be it financial, emotional or dealing with 
the medical conditions of the children and/or the veteran. They 
have faced these hardships as a family unit. What affects one, af- 
fects all. 

The veteran is the gatekeeper for services to himself and his 
family. An agency offering services to this population must have an 
understanding of the veteran's perception of his or her community 
in order to access the family. You must meet the veteran on his 
own terms. Most vets don't trust organizations or most government 
agencies. An agency must be able to develop the trust with the vet- 
eran in order to facilitate change. It is a great deal to ask a veteran 
to give up the tools he has developed to survive over the years. He 
learned the meaning of fear and helplessness while in combat and 
he has developed his own means of controlling his environment so 
as to never have to face such fear and helplessness again. 

Our experience has shown that other conventional mental health 
agencies serving the general population consider veterans as unco- 
operative and difficult to engage in the counseling process. Many 
have rigid intake procedures and extended waiting lists for serv- 
ices. Most veterans are turned off by such a process and the agency 
is, in turn, turned off by the veteran. Many who do enter these 
types of services fall through the cracks. 

It has been a difficult process to keep our doors open. We receive 
funding through the VA Readjustment Counseling Program, the 
VA Fee Service Program and through private donations or con- 
tracts with corporate EAPs. We are always juggling resources and 
evaluating our programs to maximize our cost effectiveness. Flexi- 
bility is our password and key to survival of our programs. During 
all this, our case load has continued to grow and is larger now than 
it's ever been. 

For the purpose of this hearing, I will quickly highlight how 
much of the funding is available for families of Vietnam veterans. 
The contract program allows for reimbursement for spouses on cer- 
tain occasions, but due to the limited monies available to the vet 
centers and contracts programs, little if any funding is available. 
It boils down to a choice between paying for the veteran or for his 
or her spouse. 

The VA has attempted to try to figure out ways to do it. They 
had a formula once of one visit for the spouse per ten visits by the 
veteran. On some occasions they have reimbursed for spouse 
groups on a very specified period of time. And on occasions they 
nave approved individual services for spouses facing extraordinary 
situations. Our primary means of servicing families over the 15 
years is to offer it free or pick up donations to fill that need. We 



22 

have found that veteran families do not make good poster kids for 
finding money. It has always been an uphill battle to continue our 
family services. 

Since 1989, with the AOCAP funding, our family program serv- 
ices were expanded to include monthly children's play groups, in- 
formational groups for children of veterans, support groups for 
teenagers, plus weekly spouse groups at each of our three offices. 
Individuals and couples counseling for spouses and children are 
also provided. We also do special workshops, debt management, fi- 
nancial management where we have bankers come in. We do stress 
management, communication skill workshops for the families. 
COVER staff also provides case management services to meet the 
social service needs of the entire family. 

We were able to purchase three outreach vehicles to go the veter- 
ans' homes and deal directly with the family. These vehicles run 
weekly routes throughout our region. We drive family members to 
needed medical appointments. We developed a food bank to deliver 
to families during hard times. Staff members have assisted clients 
in repairing and maintaining necessary farm equipment. Our case 
managers negotiate with hospitals on forgiving sizeable medical 
bills faced by veterans' families with children with disabilities. 

We are now part of a national network of local, State and na- 
tional agencies interested in the special needs of veterans and their 
families and lend significant support to our clients. Imagine an 
agency having the capacity to call another agency in Georgia to as- 
sist in acquiring a computer for a disabled child, and simulta- 
neously calling an agency in Connecticut to assist in working with 
hospitals and forgiving and decreasing medical bills. On the same 
day have the ability to call the Legal Center in Washington, DC 
on behalf of our client to assist in applying for Social Security bene- 
fits for children and to be able to offer all these services while sup- 
porting the individual family members through counseling. 

Our 15 year passage and evolution has placed us in a position 
to offer extensive and encompassing service to the veterans' fami- 
lies. We offer such services in a region with limited resources for 
the veteran. COVER is an example of what the VA's readjustment 
counseling contract program was established to accomplish. It has 
taken patience and commitment. The extensive services that 
COVER provides cannot continue on good intentions or staff dedi- 
cation alone. Without a stabilization of funding for VA's contract 
program and a commitment to the family services, these services 
will vanish and veterans and their families will have their hopes 
dashed once again. Agencies like ours will die a slow but certain 
death through a series of cuts here and cuts there, until all the 
good that's been done and created will just be so much history. 

Thank you sir. 

[The prepared statement of Mr. James appears on p. 95.] 

Mr. Evans. Thank you, Mr. James. 

Mr. Reaves. 

STATEMENT OF MILTON REAVES 

Mr. Reaves. Good morning, Chairman Evans and members of 
the subcommittee. 



23 

In my testimony, I will not be reading word for word of every- 
thing. I will prefer through it because I feel I am a true example 
of my testimony which I want to give and which I have experience. 

My name is Milton Reaves and I'm a Vietnam vet. Infantryman 
is where I served in Vietnam. I am the owner of, and proud owner 
I might add, of a Purple Heart. I had personally not heard of 
PTSD, didn't know what was going on with me upon my return 
from Vietnam. I do know one thing, that my behavior pattern from 
as a country boy living out in a rural area had changed somewhat. 
I saw some authority figures as being somehow not quite right with 
me. Coming from a killing field right back into society with no one 
telling me at any point, "Milton, you no longer need to steal a hel- 
met. Milton, you no longer need to this weapon." I experienced all 
types of resentment, anger, rage, and not really thinking anything 
was abnormal with Milton. I was okay. It was everyone else who 
had the problem, not me. 

To make a long story short, I have been divorced twice. I have 
four children. Two of those children have accompanied me here 
today, a nine year old and a ten year old. There's a daughter that's 
aged 20 and a son that is 25. 

I went through all types of problems, encounter with the law, 
into the Virginia State Penitentiary at one point because of my ir- 
rational behavior. I also had a tendency to continue to repeat that 
pattern of behavior. I discovered from some friends of mine who 
were Vietnam vets as well who told me about an organization 
called COVER. I developed a drinking problem in which these indi- 
viduals told you, "You need to go talk to these people. They're there 
in place to help you, Milton," and I just didn t see me having the 
problem. Finally I went to COVER and perhaps COVER was the 
best thing that could have ever happened to Milton Reaves because 
he, Milton Reaves, was headed down a road to destruction, disas- 
ter. COVER helped me — took a person like me who is an alcoholic, 
helped him find a program, committed me to that program, walked 
me through those stages or processes in which I had to deal with 
in getting into a recovery program. There was some counter of 
being a divorcee of trying to obtain custody of my children after I 
successfully completed the program within the alcohol problem in 
which I had. COVER helped me go through the program of an in- 
take meeting where I was allowed to have the custody of my kids. 
COVER appointed me an attorney. This attorney was an ex- Viet- 
nam vet himself who understood my behavior and was able to 
present to the courts my past behavior to help me obtain the cus- 
tody of my children. 

I feel, Mr. Chairman, organizations as COVER, from my personal 
experience, Mr. Evans, that they should be in place. I shouldn't 
have to feel as I have felt, sir, in situations where I have went to 
the VA and felt like they were doing me a favor. I was wounded. 
I earned this. I don't feel they are giving me anything, with all due 
respect to everyone. I earned it. It should be there, sir. 

My children, my son, one son that's present here today who has 
a psychiatric problem at times with his behavior. My question is 
why is there not hair growing on my leg? Why is it that in the 
summer I can scratch and I will receive welts, water blisters on my 
arm. Whether Agent Orange did that or not, I feel, sir, in my end- 



24 

ing, that I need to say that these programs are well needed to be 
in place. If it's something that someone has a question about num- 
bers as we play with, no, sir, not numbers, I earned it. It should 
be there. 

I ask, please let these programs be existing for the vets because 
we need them, sir. And thank you in ending. 

Mr. Evans. Mr. Reaves, would you ask your kids to stand up? 

Mr. Reaves. Yes. Evan and Milton, would you please stand for 
the committee? 

Mr. Evans. It takes a lot of courage for you to come forward be- 
fore a congressional hearing and make that kind of personal state- 
ment, but it really gives us good ammo as we fight for programs 
on posttraumatic stress disorder to have that kind of human testi- 
mony. So, we appreciate it very much and salute you for your cour- 
age. 

Mr. Reaves. Thank you, sir. 

[The prepared statement of Mr. Reaves appears on p. 102.] 

Mr. Evans. Let me yield to the Congresswoman from Indiana for 
any remarks. 

Ms. Long. Thank you, Mr. Chairman. I simply want to commend 
you for holding this hearing and also the panelists. This is quite 
a group of panelists that we re going to have today and thank them 
for their testimony. 

Mr. Evans. I thank the Congresswoman for her attendance. 

Mr. McKelroy. 

STATEMENT OF MICHAEL McKELROY 

Mr. McKelroy. Thank you, Chairman Evans and members of 
the subcommittee. Thank you very much for allowing me to be here 
this morning and present some testimony. 

My name is Mike McKelroy. I'm a Master Sergeant in the U.S. 
Marine Corps. I'm retired. I'm a combat vet with three combat 
tours in Nam. I'm presently employed by Team of Advocates for 
Special Kids, which is an Agent Orange Class Assistance Program. 
I'm the project coordinator for this program. Our mission at TASK 
is to help parents access through the special education services for 
these children we've been talking about this morning and also to 
get the support services for these children. 

I am also a receiver from Agent Orange Class Assistance Pro- 
gram as well as now a provider of services. If it had not been for 
this program, I wouldn't be sitting here this morning and have the 
privilege of talking to everyone. As I said, I retired 23 years in the 
Corps. If you'd ask me 9 years ago did I have PTSD, did I have 
a drinking problem, I would have told you no. I didn't believe in 
PTSD and my drinking was fine. 

I've got five children, my wife Anita and myself, three boys, two 
girls. Michael, Jr., Daniel, Robert, Anna and Kathleen. My wife 
Anita and my son Robert are here with me this morning. They're 
my backbone. My family is my backbone. 

We retired in 1985 and moved to Riverside, CA. Then, my son, 
Mike, Jr., started attending school in the Alvord School District 
right there in Riverside. He began having some basic problems, 
learning, discipline problems, things of this nature there. We held 
meetings with counselors, principals. We had a teacher tell Michael 



25 

that, "You're going to fail in life. Just don't bother attending 
school." I can truthfully say I had a principal tell me to my face 
and my wife was sitting there, that all Michael needed was the hell 
beaten out of him and that would force him to learn. 

Well, we didn't do any of the things they suggested, but were cry- 
ing for help. My wife was constantly on the phone to the school, 
constantly being down there and nothing helped. Mike quit school 
at 15. Mike went into the juvenile justice system for taking his 
mother's car for a joyride. We figured, that's great, we've got some 
help now. The judge is going to order Mike to go to school. The 
judge did that. Mike still didn't go to school. At 17 years old, Mi- 
chael served 15 days in juvenile hall for a violation he committed 
at 15. 

Danny started having problems. Danny did make it through jun- 
ior high school because the system put him on home teaching. If 
you're familiar with home study, that's one hour a day, one day a 
week. His first year in high school, he got in trouble and was ex- 
pelled. If it had not been for TASK, my marriage would have been 
completely destroyed because we were already told, "You're bad 
parents. That's the reason your boys are acting this way." We 
would have not had a family. 

We didn't have anywhere to turn to but TASK, through the 
Agent Orange Program. We turned to them. I finally realized, Con- 
gressman Evans, that Congress had passed a law, 94-142, that 
protects my kids. The system didn't tell me about this law. They 
didn't say my children had rights to free appropriate education be- 
cause they have disabilities. No one in the system told me this. 

Then what happened is — it's very complicated when you're deal- 
ing with these things. I deal with this everyday with parents. This 
is the last resort. These programs are the last resort that parents 
have. They hear about it, as Milton did, from someone else. This 
is not advertising such as the VA or United Way would do. This 
is word of mouth. "Hey, brother, go there. They can give you help." 
I had another Vietnam veteran tell me about this program and now 
I'm there. 

You know, it's been 9 years. Mike, Jr. is married, three children. 
Danny is married, one child. He started his own business. He 
works 10 to 12 hours a day, 6 days a week. Anna and Kathleen 
are doing great. My son Robbie is doing wonderful. My wife and me 
have a very strong marriage. We have five grandchildren. 

I've heard a lot this morning about questions on what should be 
done. The main thing that should be done is anything that has to 
deal with the entire family because you cannot treat the symptoms 
of disease, you must treat the disease. 

In closing, I'd just like to read something. One of the parents 
found out that I was coming here this morning and wrote a letter. 
This child in 9th grade had been expelled from school, 9th grade. 
Another Vietnam veteran. "If it were not for TASK, my son would 
not be allowed to go to public school. I would have to pay for his 
education, which we cannot afford. My husband is an unemployed 
Vietnam veteran. We own our own home, pay our taxes on time. 
I have a part-time job which barely gets us by. Our son had an un- 
fortunate incident at school and was suspended for 5 days. He was 



26 

not allowed to return to school, to the Los Angeles Unified School 
District." 

Basically at the end, this mother says, "So, to sum it up, who 
cares about the kids? They don't get a second chance to correct 
something that is not even in their control. That's why the dropout 
rates are so high and the only place the kids can turn to is to 
streets, drugs and gangs," and I see this as now a care provider. 
I would have lost my family. I would have been out there on the 
streets, I'll tell you that right now. My children would have been 
in the adult correctional facilities and you, me as taxpayers would 
have been picking up the bill. 

Thank you for allowing me to be here and please, we need it. 
Thank you. 

[The prepared statement of Mr. McKelroy appears on p. 105.] 

Mr. EVANS. Thank you, Mr. McKelroy, and I salute you for your 
personal statement. 

Based on your testimony, if it had not been for the help of your 
respective agencies, you might still be in the wilderness, so to 
speak, in terms of grappling with these problems, maybe still in de- 
nial that they even existed. Is that essentially correct? 

Mr. McKelroy. I would have, sir. Yes, sir. I would have denied 
it. My wife would blame me. I would blame her. I wouldn't have 
a family and I'd be heavy into my old alcohol. 

Mr. Reaves. Chairman Evans, I would say the same thing. I 
didn't see myself having a problem. The thing that I personally feel 
comfortable with COVER is that there are other Vietnam vets 
there who are counsel staff members that I can relate to, not some 
individual, with all due respect, that went to some ivy league col- 
lege and read a book to tell me about what I experienced in the 
killing field. I can talk to an individual at COVER who walked the 
same trail I went down. 

Had it not been for the organization COVER, I know I would 
have been headed down the road to either the graveyard or to the 
penitentiary. Just that simple. And I am grateful that they are 
there. I pray that they will always be there, because I have met 
many Milton Reaves out there that are still out there that haven't 
even come up to the table, as I finally have 20 some years later. 
But it's better late than never, sir. 

Mr. Evans. How old were you when you left the military? 

Mr. Reaves. I was approximately 21 years old, 22, somewhere 
around there, sir, if I remember correctly. I discharged from Fort 
Meade. 

My point is I have experienced, Chairman Evans, all the endures 
of hardship that one can go through and I'm a living example 
today, a man who came from an alcoholic, a man who had a less 
than honorable discharge, a man who went to the penitentiary, a 
man who served his country and almost died giving his life for this 
country now has his children and hopefully on the road to recovery 
due to the thanks of COVER. That's the only people who have 
helped me, not the VA. They feel — sometime I have been felt like 
that's my enemy, and it shouldn't be that way, sir. It shouldn't be 
that way at all. I earned this. The other Vietnam vets earned it 
and vets of America who served this country earned it, sir, and 
thank you for that. 



27 

Mr. Evans. Mr. McKelroy, you had these problems while you 
were still in the Marine Corps, I take it? 

Mr. McKelroy. Yes, sir, but I didn't recognize the problems. I 
handled myself just outstanding on duty. I made 

Mr. Evans. Submerged it, maybe? 

Mr. McKelroy. Sir? 

Mr. Evans. Submerged your problems into your work? 

Mr. McKelroy. Yes, sir. I made E-8 in less than 20 years. Like 
I said, I had a good wife that stood beside me no matter what hap- 
pened. That's the one thing that really helped me was my wife, and 
then when Robert came along it has helped me, but I denied that 
there was anything wrong with me. It took me a long time to say, 
yes, I've got problems. 

Mr. Evans. We are grappling not only on this committee but also 
on the Armed Services Committee, on which I also serve, with try- 
ing to assist career people in terms of getting help, whether it be 
for PTSD or most recently those who may be having problems with 
the Persian Gulf Syndrome, as it's been called. 

What can we do to give people more assurances who are making 
the military a career that they're not going to be drummed out of 
the military for complaining about the problems that they have? 
What kind of protections can we give those folks? 

Mr. McKelroy. I would suggest, sir, that it needs to be an open 
forum. Right now I know for a fact some friends of mine that did 
have alcoholic problems, turned themselves in and they stayed the 
same Rankin was forced out. They say it doesn't affect. It does. I 
think the counseling should be in effect there. 

It's hard for you when you spend 20 odd years giving orders to 
get out here into society and realizing that you're a dime a dozen, 
and that is a big problem also on the PTSD is getting out and real- 
izing that 20 years of your life is no longer. You can't get up in the 
morning for something you love to do. I feel that before a man re- 
tires there should be some counseling for him and his family, be- 
cause the family is the unit. Without that family, we're going to 
continue having all kinds of problems. 

Mr. Evans. We thank you. We realize your service to our country 
didn't stop the day you left the military. To both of you, we appre- 
ciate your testimony. 

Mr. James, you report in your prepared statement that your fear 
is that what has been created will some day disappear before it's 
completed its mission. 

Mr. James. Yes, sir. 

Mr. Evans. What will happen to vets such as these two or others 
who have not yet been reached if your organization and others like 
it disappear? 

Mr. James. Well, we've been around for 15 years and I think 
probably what will happen is what happened the way we lived 
prior to 1989. When my wife founded this agency, she envisioned 
the vet and the family member. Without the family, the vet has got 
no connection to anything. 

We had to shoestring the family service program. I said in my 
statement that they don't make good poster kids. There's no money 
out there. I mean, we have been dealing with State conventional 
mental health agencies, community service boards and all those or- 



28 

ganizations, agencies, foundations, whatever. What we've had to do 
is go after contracts to pay to see the vets, and we keep our over- 
head down so we can keep seeing the spouses and the children. 

The program that I described to you that exists right now will 
not exist at the end of the AOCAP grant. I can see no funding that 
is now available. I don't care what foundations say. I don't care 
what a lot of other folks say. The reality is this is going down. And 
it's taken a lot of time to develop. It's taken a lot of energy. And 
it will not stay. 

Mr. Evans. Thank you. 

I want to thank you all very much. 

Mr. James. Thank you, sir. 

Mr. Evans. You've added to our knowledge. 

Mr. Evans. Peter La Count, accompanied by Leslie Felton, Peggy 
St. Clair, and Dr. Brian Smith are the members of our next witness 
panel. 

Peter is Project Coordinator, Vietnam Veterans Family Support 
Project, Kennedy-Krieger Institute, Baltimore, MD. He's accom- 
panied by Leslie Felton of Baltimore, MD. 

Peggy is Service Coordinator, Project Access, University of Ar- 
kansas, University Affiliated Program, Little Rock, Arkansas. 

Dr. Smith is Director, National Information System, Columbia, 
SC. 

Again, your statements will be included in their entirety in the 
printed record of this proceeding, without objection, so ordered, and 
you are invited to summarize from your prepared remarks. 

Peter, well start with you and in the order of introduction. 

STATEMENT OF PETER LA COUNT, PROJECT COORDINATOR, 
VIETNAM VETERANS FAMILY SUPPORT PROJECT, KENNEDY- 
KRIEGER INSTITUTE, ACCOMPANIED BY LESLIE FELTON; 
PEGGY ST. CLAIR, SERVICE COORDINATOR, PROJECT AC- 
CESS, UNIVERSITY OF ARKANSAS; AND BRYAN C. SMITH, DI- 
RECTOR, NATIONAL INFORMATION SYSTEM, UNIVERSITY OF 
SOUTH CAROLINA 

STATEMENT OF PETER LA COUNT 

Mr. La Count. Good morning, Mr. Chairman and Committee 
members. 

My name is Peter La Count and I am the Project Coordinator for 
the Vietnam Veterans Family Support Project at the Kennedy 
Krieger Institute in Baltimore, MD. 

Funded by AOCAP, the Project provides to families service co- 
ordination, home-based professional services, financial assistance to 
help families purchase needed services, educational workshops and 
support groups for parents. 

Leslie Felton is the head of a household receiving such services 
from our project. She has two children: Melissa, age 10, and Devin, 
age 9, who are here today with us. The father, a Vietnam veteran, 
no longer lives with the family. Since 1991, the family has received 
from our project family counseling, occupational therapy, and fi- 
nancial assistance. 

Given that, I'd like to introduce to you Leslie Felton. 



29 

STATEMENT OF LESLIE FELTON 

Ms. Felton. Good morning, Mr. Chairman and Committee mem- 
bers. 

My name is Leslie Felton. 

The services that WFSP provides to families has made a great 
difference in my family's life. My father, all six of my brothers, and 
many uncles are in the military. 

Veterans and their families do have unique social needs. Many 
family problems of Vietnam vets come from drugs and abuse. These 
are issues that other family members cannot always address or 
fight. If a vet doesn't trust anybody, how do you fight that as a 
family member? If the vet has PTSD, how do you fight that as a 
family member. Some issues the family cannot deal with on its own 
and the vet needs convincing that he or she needs help as well. 

The vet, spouse and kids tend to stick together no matter the 
horrors. A non-vet family with drug and violence in the family split 
up to save the spouse and the children from harm, but my family 
always made excuses for my mate's abusive behavior because he 
was a vet. He was never at ease with anybody. He became abusive 
and neglectful to the family. He was also an alcoholic and drug 
abuser. He was always in the attack mode because of his training. 
If we try to wake him up, he may attack us thinking he was back 
in Vietnam. He was always ready to fight, even though there was 
no war. It came to a point when I thought my life was in danger. 
I kept saying this situation cannot go on forever. 

Even in this day and time when everybody is confessing every- 
thing, the family of a Vietnam vet will not often talk about their 
troubles to others. There are so many avenues for the vet to get 
help, but the veteran's family has little recourse if the vet is not 
willing to have help for himself. 

I don't know where else I could have gotten the assistance I've 
received had it not been for WFSP. How would our family's life 
have been different if these services weren't available? I've asked 
myself this question many times. 

It is easy to condemn an abusive parent, but I could easily have 
been one because I did not know how to deal with my children. We 
went through a great strain when my ex-husband became ill and 
left home. I believe that if I had not received support services for 
the kids, they would have ended up living with another family 
member for I would have been completely unable to handle the sit- 
uation at home. 

The support services have allowed the kids and I to listen to the 
feelings, emotions and outcries we all were having. Before receiving 
family therapy, we were used to being called the Bickersons. The 
kids and I had problems communicating because communication is 
not just two people talking back and forth but it is also listening. 
The therapy helped me to deal with some of my anger concerning 
their father, the kid's questions about their Dad, and the divisions 
between me, him, and the children. We were all in a great deal of 
pain and did not know how to deal with it. 

The staff at WFSP really listened to our needs and helped us 
through some very tough times. The services have helped us func- 
tion better as a family. 



91-084 0-95 



30 

Melissa is now doing great in school, as well as Devin. She used 
to struggle so hard until both of us got frustrated. Educators came 
to our home and taught me how to get the services at the school 
that my daughter had the right to receive. 

The support services have helped me to graduate from college 
with my AA degree in education. 

Our family is one of the fortunate ones. We were able to be 
linked with services that helped us to become a healthy, produc- 
tive, viable and loving family, whereas we could have been the 
exact opposite. I have gained a lot of confidence in myself and my 
ability to raise my children. 

I thank you for the opportunity to speak before your Panel and 
I hope my testimony is helpful in your endeavors. 

[The prepared statement of Ms. Felton appears on p. 110.] 

Mr. Evans. It certainly is very helpful, Ms. Felton, and we appre- 
ciate your appearing before us today. 

Peggy* will you place that microphone directly in front of you, 
please? 

STATEMENT OF PEGGY ST. CLAIR 

Ms. St. Clair. Chairman Evans, members of the House Veterans 
Affairs Subcommittee, thank you for the opportunity to address you 
today concerning the social service needs of Vietnam veterans and 
their families. 

My name is Peggy St. Clair and I'm the wife of a Vietnam vet. 
My husband, Lance, served a tour of duty in 1970. Upon his return 
home, his wife gave birth to a stillborn child and a child with a dis- 
ability. I've given birth to stillborn twins and two children with dis- 
abilities. My family lives in Mountain Home, a small community of 
9,000 in the mountain and lake country of north central Arkansas. 
For the past year, I've been employed as a service coordinator for 
a program funded by the Agent Orange Class Assistance Program 
at the University of Arkansas, University Affiliated Programs. 

Today I will address many of the points listed in your hearing 
invitation within the context of my overall testimony. I will relate 
to stories of my families and the stories of several families with 
whom I work. I hope this will illustrate the complexity of the social 
service needs we are experiencing over 20 years after the Vietnam 
war. The results of an informal survey of Vietnam vets in norther 
Arkansas will also be discussed. 

The birth of our daughter, Grace, in 1975 was the beginning of 
our journey through the maze of social services. Grace was born 
with spina bifida and has been diagnosed as having severe mental 
retardation and llq-chromosome deletion, Bernard's syndrome, and 
leukodystrophy. We were bewildered and overwhelmed by all these 
problems. We didn't have any idea of where to go for help. When 
she was 8 months old we were told to institutionalize her and go 
on with our lives. They weren't sure if she would live or, if she did 
live, what quality of life she would have. 

For 2 years in a rural county in California we received no serv- 
ices. By moving 15 miles over the county line, within 60 days we 
had a health nurse and a service coordinator at our door asking 
what they could do to help. They didn't even know where to start. 



31 

It took them several days to assist me in setting up a plan of ther- 
apy and appointments to help Grace. 

Hank, our service coordinator, accompanied me to appointments 
and coached me on how to get the information I wanted and need- 
ed from these professionals. These people became our friends, 
showing a genuine concern for Grace and our family. As I gained 
the skills to advocate for our child, Hank relinquished his role to 
me. When crises arose, though, he was always there. These profes- 
sionals helped us through a maze of agencies and services for pro- 
viding us with good useful information. They looked at all our fam- 
ily needs, not just Grace's. Thus, they allowed us to become inde- 
pendent, not dependent. 

Grace has graduated from high school and lives in her own 
apartment with the help of a live-in caregiver. She attends a day 
service center for training and in her free time is in the community 
with her friends. She comes home for brief times and celebrations, 
but this kid prizes her new independence. The help Hank and 
other professionals gave us 17 years ago allowed us to choose a 
much more professional and easier life for this child. 

Many referrals that I get come as a result of crisis situations 
that have developed because problems have gone unaddressed over 
the years. One such case is the family of a vet who is 100 percent 
disabled and has been receiving help from the VA for over 10 
years. They called me when their 13 and 9 year old children had 
threatened suicide and they were told it would take 3 months to 
get them help. We talked that day and the next morning they 
called again. The 13 year old had taken an overdose of medication 
and they were told again they had to wait the 3 months for their 
appointment. By that afternoon I had the children evaluated and 
admitted to the hospital for treatment. Within a week, even though 
they were 100 miles away, I had all the emergency services that 
this family needed set up. Their big concern, why did it take so 
long to get help? 

Two other cases that I work with resemble each other. These 
young men needed training. They were told by their school coun- 
selors that they were able to only do manual labor due to their spe- 
cial education. After a phone call to Rehab. Services, these boys 
will be entering college under a special program in the fall. 

As you can see, my work sometimes only takes a phone call or 
packet of information to get services. Other cases require hours of 
coordination between agencies and professionals. With a history 
and philosophy of family-friendly community-based service coordi- 
nation in the University Affiliated Program, I have been able to 
successfully address the needs of families of Vietnam vets. These 
veterans are independent, proud, and generally distrustful of sys- 
tems. 

In the last 12 months in my 12 county area I've received 57 re- 
ferrals concerning Vietnam vets and their children with disabil- 
ities. As you'll look at the breakdown of these referrals, you'll see 
that these vets still have major needs today. 

Last year Lance and I traveled 156 miles to Little Rock to get 
his Agent Orange physical. During this physical we gave them a 
detailed family history including the disabilities of our children and 
Lance's health problems. Not one family referral was made. I 



32 

thought this was unusual and asked my clients that I work with. 
They said they'd never been asked if they needed family services 
either. Asking Vietnam vets in the local area, I got the same con- 
clusion. 

I made an informal survey and these conclusions come from my 
experience. These were some of the suggestions that they have 
made. 

They would like to see better communication between the client 
and the VA, individualized care by the VA, more accessible serv- 
ices, family intervention by the VA, referrals for service coordina- 
tion when the family member has a child with a disability, and a 
directory of systems available for them. You'll find these in an ex- 
panded version in the last 2 pages of my testimony. 

These suggestions fortify my convictions which are holistic, fam- 
ily-friendly and community-based services are what vets want 
today. 

Thank you. 

[The prepared statement of Ms. St. Clair appears on p. 115.] 

Mr. Evans. Thank you, Peggy. We appreciate your testimony. 

Dr. Smith. 

STATEMENT OF BRYAN C. SMITH 

Dr. Smith. Thank you very much, Chairman Evans, for inviting 
me for this testimony. 

I have been personally moved by the statements that I've heard 
before my testimony and I'd like to depart from my prepared text 
and say a couple things. 

I'm not here to bash the vet centers. We work well with vet cen- 
ters. The vet centers are not well prepared to deal with children 
with disabilities. One vet center said to a veteran that they were 
not issued a child when they enlisted. 

The family centered approach is essential for families that have 
children with disabilities. We talk about PTSD and I heard the 
question raised about disability payments. And while the disability 
payment goes to the veteran, that doesn't mean it goes to the fam- 
ily- 

The other question dealing with what happens after AOCAP, we 
are part of a network and we are a national program that serves 
that network. If that network doesn't exist, sir, we will not exist. 
Our service, the service we have provided has helped 15,000 veter- 
ans, family members, and 8,000 of those have been children. 

What I'd like to do is go back to my text now and say some 
things that I feel are designed to get your attention. 

The veteran or family member who calls us is often in a family 
constellation that is struggling with the debilitating consequences 
of PTSD, conditions that despite their destructive power are still 
largely under-recognized and inadequately treated. Therapists in 
the network have described working with many children, most of 
whom are now approaching adulthood, who have grown up in an 
atmosphere where parents' untreated PTSD demands that they 
walk on eggshells to maintain some kind of tranquility at home. 
Many of them have been exposed for years to substance abuse, 
angry outbursts and domestic violence. The effects of this are being 
manifested today in the children of Vietnam veterans as secondary 



33 

PTSD. In fact, it truly marks a second generation of individuals af- 
fected by a disorder that requires a level of awareness to diagnose 
and a commitment of time and resources to treat. 

Compounding this issue is the common characteristic of families 
that affects their ability to obtain services and presents implica- 
tions for organizations that work with them. Many demonstrate a 
reluctance to initiate involvement with the organizations that could 
potentially assist them. They exhibit a peculiar distrust of and fail- 
ure to pursue assistance from agencies that give even the slightest 
appearance of government affiliation. 

Individual grantees working in various parts of the country were 
recently asked to provide their perspectives on several broad ques- 
tions about Vietnam veterans that they have helped. There has 
been an almost unanimous identification of the prerequisite need 
to develop trust. These issues are playing a role in how these fami- 
lies interact or fail to interact with the service delivery system. 

The reluctance of Vietnam veteran families to follow-through 
with referrals to organizations that potentially could address some 
of their unmet needs was a phenomenon that we investigated 2 
years ago. It was perplexing to find that the lack of self- advocating 
behaviors is present even in situations where families appeared to 
be in desperate need of services and the usual obstacles such as 
cost or availability of services were not issues. Quite simply, for a 
variety of reasons, the veteran family itself presents one of the 
largest single barriers to accessing those services. 

Some obstacles facing these families can be overcome. Note- 
worthy evidence of this has been seen in the fact that families were 
more likely to follow through with referrals when a local grantee 
was involved in a service coordinating capacity. 

It is the belief of the Class Assistance Program that veterans and 
their families can benefit greatly from quality case management 
and information referral services to ensure quality and equal ac- 
cess to services and benefits that are already available. This oper- 
ational policy has amplified the effect of the settlement funds, fos- 
tered development of clients' skills in using community programs 
and services, and represents a more holistic and integrated ap- 
proach to serving people. 

Service coordination is based on a family-centered empowerment 
model in which services are oriented toward the family rather than 
toward an individual such as a veteran or a child with a disability. 
Because veteran families in need of services are characterized by 
a high incidence of family dysfunction, psychological problems and 
alienation, it is probably only marginally effective to offer single- 
faceted services such as counseling or rehabilitation. 

The veterans' reluctance to self-advocate and their wide array of 
unique problems are the primary reasons why a specialized net- 
work of veteran family-focused services is needed. The service co- 
ordination to help the families connect with these services is criti- 
cal. Service coordination not only provides an avenue for more ef- 
fective service delivery through integrated family-focused ap- 
proaches. It also facilitates the leveraging of services on behalf of 
veteran families. 

We studied leveraging outcomes and its cost effectiveness to de- 
termine what impact these activities have made. Conducted at the 



34 

end of 1993, data were collected for members of the plaintiff class 
who had entered the network through our system. A benefit-cost 
ratio showed that for every class assistance program dollar spent 
on services and equipment there was a $27.58 return in outcomes 
leveraged through either financial assistance or services received. 
This occurred although no grantee had operated with a specific 
mission of leveraging monies. The greatest proportion of these le- 
veraged funds and services were for veterans' children, primarily 
from education and SSI. 

Veteran families are a unique group of people with a wide array 
of human service needs. The challenge they present for service pro- 
viders lies in the fact that any family with such a diverse range 
of needs generally has difficulty obtaining help from the complex 
web of agencies and convoluted assortment of professionals that 
comprise the community-based service system. Veteran families are 
frequently unable to navigate this service system successfully on 
their own. 

In conclusion, I would like to point out the undeniable fact that 
the traditional service delivery system, which demands effective 
family functioning to successfully use its services, rarely meets the 
needs of many of the veterans' children and families with whom we 
have dealt. Instead, it pressures the families to adapt to the service 
delivery system. Neither more of the same, nor organizational re- 
structuring of the system alone are strategies that can meet the 
veteran families' diverse needs. We have seen compelling evidence 
that the family-focused approach and service integration offer 
promising avenues worthy of exploration for the future. 

Thank you very much. 

[The prepared statement of Dr. Smith appears on p. 121.] 

Mr. Evans. Thank you, Dr. Smith. 

You made an important point in your off-the-cuff remarks con- 
cerning the network. I've asked several of the agencies if they're 
likely to succeed if funding isn't available. But I take it not only 
those agencies would suffer and their clients would suffer, but also 
those agencies that continue to exist wouldn't have the availability 
of resources and information that would exist through that network 
to the extent that it does now. 

Dr. Smith. That's correct. We're a national support service and 
without that service, if we didn't have the network, we would not 
provide that service. 

Mr. Evans. So a program could survive and maybe have the 
same level of funding, but not be resource-rich because of the depri- 
vation of those resources? 

Dr. Smith. That's correct. 

Mr. Evans. How do the needs of Vietnam veterans and their 
families for case management and service coordination compare 
with others who need social services? Why are Vietnam veterans 
different? 

Dr. Smith. Vietnam veterans are different. They have different 
problems and possibly the most different aspect is the fact that the 
parents have disabilities themselves, usually PTSD. I think it's ex- 
tremely difficult for a family with a child with a disability to access 
all the services and obtain services by themselves. But when the 



35 

family itself is dysfunctional and has difficulty surviving, it adds 
another level of difficulty to get services. 

Mr. Evans. And maybe because of the veterans' disdain for bu- 
reaucracies generally? 

Dr. Smith. It's a very difficult process. They need advocates and 
that's what the network has been providing. 

The other aspect is that many veteran families have many chil- 
dren with disabilities. Many of the children have multiple disabil- 
ities, and I think all of those dimensions make it very difficult. 

Mr. Evans. Peggy, have you found the same to be true? 

Ms. St. Clair. Yes, sir, a lot of my families. It has to be the 
whole family, I've found, and it's going from generation to genera- 
tion. Right now I'm treating a daughter of a vet and her children, 
all with ADHD and PTSD, and so it keeps going. You have genera- 
tion to generation. 

Mr. Evans. In the case of Agency Orange screening, there are 
specific questions. I've never had one myself, to be honest with you, 
but there are specific questions about family history which in the 
instance that you cited basically should have caused a reaction by 
the VA to refer people who have these kinds of problems to other 
social service agencies? 

Ms. St. Clair. I would think so. We gave them all of Grace's 27 
handicaps. We gave them our son's handicaps, my step-daughter's. 
He never once, and I didn't tell him what my position was, asked, 
do you need help? Do you need BDS contact or do you need social 
service contact or do you have a decent house to live in? Are all 
these child needs met? He wrote it down and went on and that was 
it. 

Mr. Evans. Leslie, when did you first contact the Vietnam Veter- 
ans Family Support Project and what prompted you to do so? 

Ms. Felton. It was back in 1991. What had happened is I had 
recognized as well as Melissa's teacher that she was having some 
difficulties in school. The school attributed it to she just wasn't ap- 
plying herself. Even her pediatrician had attributed it to I was see- 
ing things and she wasn't applying herself. 

When we went to one of the Kennedy-Krieger offices called the 
Learning Center, it was a social worker there who referred us. 
When I was explaining about my family's problems, my husband's 
background, that he had been exposed to Agent Orange and his 
readiness all the time for combat even though he was no longer in 
a war situation, she referred us to WFSP's family support pro- 
gram. 

Mr. Evans. Had you gone to any other social service agencies be- 
fore that and not received 

Ms. Felton. Only thing I had tried before was working through 
the pediatrician to see if he knew of any avenues of any types of 
situations, of any types of services that could help us to find out 
what is going on. But, like I said, he just kept thinking there 
wasn't any problem going on at all and that we just needed to go 
on with our lives instead of just trying to deal with the situation 
at hand. He felt there wasn't a problem other than to continue on 
with your life, everything will work out fine. 



36 

Mr. Evans. We really want to thank you and Peggy for personal- 
izing this. It helps convey the message in real human terms. We 
appreciate your honesty and courage in coming forward. 

The Gentleman from Pennsylvania is now recognized. 

Mr. Ridge. I'm sorry, Mr. Chairman, that I was delayed and 
didn't hear all the testimony. 

I have a couple of generic questions, though, that I think are 
very relevant and based on your experience you might be able to 
answer. 

Ms. Felton, I did not read your entire testimony. I looked at it 
and I saw your children are 8 and 10. Mine are 6 and 8. I have 
to ask you some personal questions to get you to put on the record 
some of your observations that are relevant to, I think, this 
inquiry. 

Was your husband a combat veteran? 

Ms. Felton. As far as I understood it, yes. 

One of the situations that's not in the testimony is that my hus- 
band is almost 12 years my senior, so what I know I only know 
from his conversations. I don't know actual situations. I only know 
from dreams or shouts and dreams or things that he has said to 
me when I have approached him about different things that have 
gone on. But, yes, he said he was. 

Mr. Ridge. And how did your children relate to his experience 
as a soldier? I mean, my children knew I was a soldier. How do 
your children relate to the experience their dad had as a soldier? 
Is it a positive for them? Were they proud of it? The children really 
suffer most. Spouses, of course, also suffer. A couple of witnesses 
talked earlier about the real trouble and the trauma the children 
experience and I'm curious as to how your children related to their 
dad's experiences being a combat soldier. 

Ms. Felton. Well, my son, I guess this sounds biased, but he 
kind of glorified it. He wants to go into the military himself. In 
fact, he wants to just drop school now and then go into the mili- 
tary. But they really thought of it as a position of honor. And also 
because I have other family members, brothers, who are in the 
service, they thought it was a great thing to be in the military and 
they still do. That has not changed, but that's only through time 
and I believe our counseling because in the beginning my daughter 
did not share that opinion of it being wonderful. She thought of it 
as something that really just hurt people, that just churned people 
around. But now through counseling she has realized it is not real- 
ly something that will do damage or, if it does do damage, there 
are avenues to get help. She doesn't see it as a bad thing anymore. 
But my son still thinks it's a wonderful institution and glorifies it, 
and he glorified their father for being in the military. 

Mr. Ridge. Your testimony doesn't reflect when your husband 
left. Would you be kind enough to say how long he's been absent 
from the home? 

Ms. Felton. Almost 8 years now. He left approximately when 
my son was 6 months old because he felt as though he didn't want 
to handle the situation with two children. And with my daughter 
having a problem now with learning disabilities and her epilepsy, 
he still doesn't address the problem. In fact, he's even neglectful. 
In a situation when they asked for him to come in to help her with 



37 

her psychological needs, he flew and it was almost a year before 
we heard from him again when I had asked him to attend to help 
us. 

Mr. Ridge. So he has not been readily available to be part of any 
kind of group counseling or anything like that? 

Ms. Felton. No, not at all. In fact, at one time he had even 
called the Veterans' Administration and — I mean, the WFSP office 
and said he's not a vet, that he didn't want to have my children 
in any type of services whatsoever and he actually told them that 
I was lying. He really just made a big scene over the phone with 
one of the social workers there. 

Mr. Ridge. Anybody else care to comment? 

I'm particularly concerned about the impact of all this on chil- 
dren because I have seen first-hand in my congressional district 
servicemen who've been diagnosed as having PTSD. VA has at 
least acknowledged the problem and yet the help is really limited, 
not only for the veteran but obviously for the family. It has affected 
the relationship with children. The children don't pick their par- 
ents. These are the children of Vietnam veterans who absorb and 
endure and live with part of that emotional trauma and have to ad- 
just to it. Yet there's not a lot of outreach, there's not a lot of co- 
ordination. That's what you are doing and doing so well, and that's 
why I'm particularly pleased to have your testimony. 

Anybody else care to share any other comments? 

Ms. St. Clair? 

Ms. St. Clair. I can tell you this. We just went through it again. 
My husband is also a Desert Storm veteran, and so my youngest 
children — my son is severe ADHD and when he went to Desert 
Storm, since then we've had a terrible time with him. In fact, he'll 
be going down to Children's probably as an inpatient when I get 
back. He used to think let's play guns, let's play soldiers, and then 
when Dad went again this was a big thing. But it affects the chil- 
dren forever. 

My step-daughter last Friday delivered our first grandchild and 
the whole 9 months she worried to death that her child was going 
to have disabilities, so it goes on and on forever. You look at the 
kids and the trauma, and we put up like pictures from Desert 
Storm, kids don't want them up there. They don't want to be re- 
minded at all of anything that's going on. They asked how come 
Grace has what she has. We don't know. They tell us it's possibly 
caused by Agent Orange, but we don't know. And all of her cases 
are so rare that they can't tell us. We've had genetic testing that 
they can't find anything, no reason why these children have dis- 
abilities, so it carries on for a long time. 

Mr. Ridge. Dr. Smith? 

Dr. Smith. ADHD is Attention Deficit Hyperactive Disorder. 
What we see with a lot of children is the learning disability with 
violence and what we're describing here is kind of a condition. 
Compared to other groups that we've served there are a large num- 
ber of children with Attention Deficit Disorder with violence, and 
that's unusual. The other groups have hyperactivity. 

The divorce rate is high. The second marriage divorce rate is 
high. That doesn't mean that all veterans who have divorced have 
lost interest in the earlier families. We receive calls from veterans 



38 

who care about all their families, particularly when the children 
have disabilities, and they've heard about the program and they 
want to find out if they can provide some help for that family. So 
while the situations sometimes sound abandoning to the family, 
this is not always the case. There is a sense of responsibility and 
blame that still exists that the cause of the problem was brought 
home from their service and that they feel a responsibility for that 
problem still. 

Mr. Ridge. One final question, Ms. Felton. Did your husband 
ever seek help from the VA or disability assistance for PTSD, and 
what was the VA's response? 

Ms. Felton. One time when I was discussing with him Melissa's 
situation of depression she suffered, very deep depression, she at 
that time was maybe eight, about eight, and I had told him about 
it and I said, well, maybe since you won't come with us to seek help 
or to help Melissa, maybe you should go and seek some help your- 
self. 

He went to the Veterans in Baltimore. They did a psychological 
on him and according to him they said that there was nothing 
wrong with him. The problem was our fault. We weren't adjusting 
to him. We were being neglectful to him. That is what he said that 
the VA had told him, that there was nothing wrong, and that they 
also told him that there was not enough evidence out that Agent 
Orange affected you in any way, because my husband also has can- 
cer, and there was not enough evidence out there that Agent Or- 
ange affects you in any way. This is what he said that they had 
told him and that they gave him a pat on the back and some infor- 
mation and sent him home. 

Mr. Evans. I want to thank this panel for very good testimony. 
It's very helpful to us. Appreciate your time. Thank you very much. 

The members of our next witness panel are Dr. Carl Calkins, Dr. 
John Reiss, and Frank McCarthy. 

Dr. Calkins is President of the American Association of Univer- 
sity-Affiliated Programs and a Professor at the University of Mis- 
souri at Kansas City. 

Dr. Reiss is Associate Director, Institute for Child Health Policy 
in Gainesville, Florida. 

Frank is a member of the Board of Advisors, Agent Orange Class 
Assistance Program and President of the Vietnam Veterans Agent 
Orange Victims, Incorporated. 

Dr. Calkins, we will start with you. 

statements of carl calkins, professor of psychol- 
ogy, university of missouri at kansas city; john 
reiss, associate director, institute for child 
health policy, university of florida; and frank 
McCarthy, president, Vietnam veterans agent or- 
ange VICTIMS, INC. 

STATEMENT OF DR. CARL CALKINS 

Dr. Calkins. Thank you for the introduction. I appreciate the op- 
portunity to speak to you today, Chairman Evans and members of 
the subcommittee. 



39 

You have my written testimony and the topic is social services 
for Vietnam veterans and their families, current programs and fu- 
ture directions. I'm going to attempt to speak to you directly and 
not from my paper, which will probably be substantially more in- 
teresting, and 111 try and be very succinct and incorporate all 
major points. 

What I would like to describe to you is the effect of the AOCAP 
programs and the systems that these programs interfaced with. In 
addition, I will describe why some changes were able to take place 
in those human and social services that made a difference. So, real- 
ly, the issue that I want to address is systems change, the kind of 
change activities that were provided and how the AOCAP program 
precipitated some of these. 

I am Professor of Psychology and Director of the Institute for 
Human Development, which is a university- affiliated program. We 
are also the recipient of an AOCAP project, as a grantee. The pro- 
gram is called MOWERS, the Missouri Vietnam Veterans Edu- 
cation and Resource System. I will try and summarize for you some 
of the outcomes of working at both the national level and State 
level. 

Three things happened in particular that may be of interest to 
you. One, there was a partnership formed between AOCAP, the 
American Association of University-Affiliated Programs, and the 
Administration on Developmental Disabilities under Health and 
Human Services. That partnership, I think, has been critical in im- 
plementing the overall kind of — or the intended outcomes of what 
AOCAP's goals were. Those goals were targeted on children with 
disabilities, on families of Vietnam veterans and also on building 
a national support network. 

The American Association of University-Affiliated Programs is a 
network of some 58 programs across the country that are funded 
through the Administration on Development Disabilities. Their 
purpose is design programs, support change and improve system of 
services for people with disabilities and their families. This was a 
real appropriate kind of partnership. What happened, my first en- 
counter with AOCAP was in about 1989 when it ioined with the 
Administration on Developmental Disabilities and AAUAP. Several 
contracts were let to individual university-affiliated programs, 13 
across the country, which our program was one, and then a larger 
contract was let to the American Association of University-Affili- 
ated Programs to build a national support network. You've heard 
testimony about the national support network for families. That's 
one of the important national outcomes. 

I think there are three levels that change took place as a result 
of this program. One at the systems level where people receive and 
manage human services, how does that all take place. The second 
is at the family level and it's at this level where lifestyles are really 
determined. You heard some of the previous testimony that stated, 
"I would not have made it if it was not for my family." Then at the 
individual level where choices are made and really the quality of 
life is determined for everybody. 

I mentioned to you the partnership and the match. Out of that 
partnership, university-affiliated programs look in particular on 
how to change and build the capacity of systems. From our pro- 



40 

gram in Missouri, MOWERS, the Missouri Vietnam Veterans 
Education and Resource System, we learned basically five things, 
that there were five needs and five appropriate kind of responses 
to those needs. Let me just summarize those real quickly for you. 

The first was the need for sensitivity and respect. There was a 
lot of frustration, a lot of anger with the families that we dealt 
with and it all evolved around really getting an appropriate re- 
sponse from individuals at agencies and understanding how to 
work with that. 

Dr. Jean Ann Summers in our program summarizes the appro- 
priate response of an agency that attends to the issue of sensitivity 
and respect. She says that, "It implies total honesty and integrity, 
making no promises that one is unable to keep, following through 
without fail and taking some immediate action that responds to a 
family's expressed or perceived need rather than just a service pro- 
vider s perception of a family's need." That's an important distinc- 
tion when you respond to individual needs. 

The second need is the need to be recognized as a family. You've 
heard a lot of testimony about this, in many cases these are facili- 
ties with multiple challenges. Now, what that ends up meaning is 
that you have a dad with PTSD, a mom with secondary affects 
from the PTSD. You have children with disabilities. The family is 
challenged at several levels and then the car breaks down. The ap- 
propriate intervention at that point is the car needs to be fixed and 
this is where our program was responsive. People won't attend to 
appointments, won't attend to counseling or other things until what 
they perceive is the most important need is attended to. That may 
well be the car. 

So, in many cases, these families were encountering what we call 
stress pileup. It just gets worse and worse and worse and you have 
to attend to the most important thing, regardless of wnat your 
service guidelines say that you can do. 

The third need is the need for social support in the community. 
Basically, this is the "sense that others that have had like experi- 
ences, and provide a great deal of support and encouragement for 
you to move ahead and interact with systems." That means other 
families of children that have disabilities were very helpful. Other 
Vietnam veteran families were very helpful in encouranging to 
even participate in the services. 

The fourth need, and you really wouldn't think that this would 
be a need, but it's a need for information and training. That need 
relates to information on how to deal with various systems. The 
problem is it's not all put together and it is very confusing and 
frustrating for families. 

The fifth need is the need for advocacy and the appropriate re- 
sponses that you need is to match either with the AOCAP program 
staff that we have or with supports from peers for people to effec- 
tively make it through the maze of these human services. They've 
been described like a minefield where you can step on a mine at 
any point and kind of get knocked out of the game. Families of chil- 
dren with disabilities experience this and veterans' families experi- 
ence this across both of those systems of services. 

The real issue was that before AOCAP there wasn't an external 
force to bring these services together, to define the services and to 



41 

really be an assist in making it through the service delivery sys- 
tem. That's what needs to continue. Many times we had to train 
staff of existing human service agencies, veterans agencies on just 
how to deal with people. You wouldn't think that you would have 
to do that, but we do. That relates to the final need that I want 
to bring out to you and that's the need to move the system from 
a dependency model to an empowerment model. This is why in 
many cases the programs don't work or aren't effective or people 
won't participate in them. 

You can think of the dependency model as this. If you're trying 
to convince an agency that you're 70 percent disabled or 100 per- 
cent disabled, you go to all that justification and they say, "We fi- 
nally agree, you're a total wreck." The point of it is there's no fu- 
ture orientation. In an empowerment model in the services that we 
relate it to, one Vietnam veteran dad said, "The most positive expe- 
rience that I had in my life was when you sat down with my son, 
who is disabled, and did a personal futures plan." It looked at the 
child and the family strengths and it offered a hope for the future 
and that's what many of the social services and veterans-related 
services don't offer and I think that's where we need to move the 
next step. I think you can accomplish this through training, 
through community-based support services and through moving to- 
ward an empowerment model. 

Thank you. 

[The prepared statement of Dr. Calkins appears on p. 129.] 

Mr. Evans. Thank you, doctor. 

Dr. Reiss. 

STATEMENT OF DR. JOHN REISS 

Dr. Reiss. Chairman Evans and members of the subcommittee, 
thank you for inviting me to present testimony here today on the 
topic of social services for Vietnam veterans and their families, cur- 
rent programs and future directions. 

My name is John Reiss and I am the Associate Director of the 
Institute for Child Health Policy at the University of Florida. I'm 
also an Assistant Professor of Pediatrics and hold a doctoral degree 
in Counseling Psychology. 

In my written testimony I describe in detail the system of care 
that children with special health care needs and their families 
need. Briefly, this system is family-centered, collaborative, commu- 
nity-based, culturally competent, care coordinated, comprehensive 
and accountable. 

The development of such systems has been the focus of the U.S. 
Public Health Service's Maternal and Child Health Bureau and 
state Title V Children with Special Health Care Needs programs 
since 1987 when former Surgeon General Koop launched his na- 
tional campaign to reform health care for America's special needs 
children and their families. 

Since 1989, AOCAP has made a significant contribution to this 
effort, focusing on the development of consumer friendly and 
consumer responsive systems of care for Vietnam veteran families, 
including those with children with special needs. 

From my perspective, because many of the staff are themselves 
Vietnam veterans, AOCAP projects have a special understanding of 



42 

Vietnam veteran families and the veterans themselves, and the 
care coordination and the advocacy services that AOCAP provides 
serves as glue that holds together the fragmented pieces of a serv- 
ice system. 

In addition, AOCAP is founded on the philosophy that the family, 
rather than an individual family member, is the unit of care. This 
is especially important when working with children with special 
needs. 

I also feel that Title V Children with Special Health Care Needs 
programs are also effective in serving Vietnam veterans who have 
children with special needs. Title V programs don't only pay for 
needed health care services, they also help to assure that providers 
work together in a coordinated fashion and work with families as 
partners in making decisions and providing care. However, Title V 
agencies, just like most Federal and State agencies, do not ask or 
gather information about the military service of parents. Therefore, 
these programs do not have specific data on the effectiveness of 
their services for Vietnam veteran families, nor do they have serv- 
ices that are typically focused specifically on this population. 

In 1992, the Maternal and Child Health Bureau asked me to fa- 
cilitate a work group comprised of AOCAP and Title V Children 
with Special Health Care Needs programs to promote collaboration 
between these programs and to assure optimal use of resources and 
to support the institutionalization of the lessons learned through 
AOCAP. The finding of this work group indicate that while these 
projects currently do do a good job, they could do a better job if 
they work more closely together to take advantage of each other's 
unique knowledge, experience and skills. 

The work group has developed a detailed plan of action and the 
details are in my written testimony. Briefly, this plan involves 
working together to increase the awareness and understanding of 
the special health and social service needs of Vietnam veterans' 
families with children with special needs, ensuring that these fami- 
lies have access to all available health and social services, and also 
ensuring that services for these families and their children pro- 
motes independence, productivity and empowerment of the child 
and family. 

It is now up to the staff of Title V programs and AOCAP projects 
to put into action that plan. However, in my opinion, these efforts 
could be enhanced through federal guidance. That is, for example, 
Vietnam veterans' families with children with special needs could 
be identified as a population in need of special attention and the 
various research, service and training grants that are currently ad- 
ministered through federal programs as administered through the 
Maternal and Child Health Bureau, the Administration on Chil- 
dren and Families, the Department of Education, Rehabilitative 
Services Administration and the Department of Veterans Affairs. 
This would help to target existing service, research and training re- 
sources on this population and this would help to document the 
number of Vietnam veteran families with children with special 
needs and would also describe the extent to which their needs are 
not appropriately addressed. 

In addition, federal resources are also needed to support collabo- 
rative Title V, AOCAP, care coordination, health and social service 



43 

programs, the training of providers to increase their knowledge and 
skills to work effectively with Vietnam veterans' families with chil- 
dren with special needs, the training of families themselves about 
the availability of and how to access health care services, social 
services and support programs. 

Also, from my perspective, the Department of Veterans Affairs 
also needs to modify its perspective and change its paradigm so 
that it's more in keeping with the principles of family-centered, 
community-based culturally competent care. 

Thank you again for the opportunity of presenting testimony and 
I hope you find this useful. 

[The prepared statement of Dr. Reiss appears on p. 135.] 

Mr. Evans. Doctor, thank you very much. Your testimony is ap- 
preciated.. 

Mr. McCarthy. 

STATEMENT OF FRANK McCARTHY 

Mr. McCarthy. Chairman Evans, members of the subcommittee, 
I thought coming here today it would be very easy for me to do 
this. I've done it so many times. I find it exceedingly difficult for 
me to speak here now at this time. My mouth is drying up. My 
heart is pounding. I've testified before the 96th Congress, the 97th 
Congress, the 98th Congress, the 99th Congress, the 100th Con- 
gress, the 101st Congress, the 102nd Congress and now we have 
the 103rd Congress. I feel like I should be testifying before the 
House Ethics Committee, the House Judiciary Committee. 

I've been President of Vietnam Veterans Agent Orange Victims 
for 17 years. I've watched the organization that I represent initiate 
this lawsuit that created these programs that you have heard 
today, help these families that needed to be helped. I've watched 
my 68 chapters run by veterans who were dying of cancer, dying 
of neurological damage, immunological damage, have watched 
them all go down the tubes because they couldn't continue provid- 
ing the services for the families suffering and dying because it was 
too expensive, it's too cost effective. They died and the chapters 
died with them. 

We initiated this lawsuit not for an amount of money. There was 
never an amount of money involved. It was to create a foundation, 
an AOCAP that would go on forever, providing the services that 
you've heard today. That's not going to happen. It's not going to 
happen because the judicial system failed us, like all those other 
Congresses failed us, because they haven't been able to solve the 
dispute of whether Agent Orange causes any problems or not, even 
though we all know it does, like we know cigarettes cause cancer. 
The vets know that, the American public knows that. But all those 
Congresses have failed us, all those previous administrations have 
failed us. Otherwise, AOCAP wouldn't need to exist. These people 
wouldn't be providing those services they're providing now. 

All those veterans who have died of all those cancers that could 
have been detected early if the VA would have provided that cancer 
information, like the testicular guide I put in my written state- 
ment. We put that guide out because veterans were dying of testic- 
ular cancer, the pure example of the kind of programs and services, 
aside from what you've heard here today. We put that guide out 



44 

because veterans needed to check themselves and those who got 
the guide and checked themselves and saw that lump and went to 
the hospital lived. They got operated on, they lived. Those who 
didn't get the guide, died. 

The VA told me that that guide was an alarmist, it was inac- 
curate, not a proper interpretation of medical issues of Agent Or- 
ange. But all their hospitals, every single hospital bought that 
guide because they needed something to give the veteran that 
Central Office wouldn't give them. They bought them by the tens 
of thousands. We took the money that we got from those VA hos- 
pitals and made more guides and gave them out to veterans for 
free. They came to us and said, "Thank you. I had that guide, I saw 
that lump and my life was saved." I'll be haunted forever by those 
who told me, "It's too late for me. I didn't get the guide. I'm going 
to die. But thanks anyway." 

That's what these people are doing every day. You've heard all 
this testimony. Lives are being saved everyday because of this liti- 
gation, because one judge said, "I'm not going to watch this suffer- 
ing. I'm not going to listen to the Second Circuit Court of Appeals 
who took it from an Agent Orange suit and made into a Vietnam 
vet suit covering all the issues." He said, "I'm going to do some- 
thing." 

Dennis and Mike, the AOCAP Board and everybody got together 
and this is what you see. Kids lives are being saved everyday. 

Now, that money is going to be gone soon and these people for 
the most part, you heard them say, they're not going to exist, some 
of them. I'm going to be here. What am I going to do, Mr. Chair- 
man and members of the subcommittee, and I wish I could shake 
every door in this building and all the other buildings like it, what 
am I going to do when the money runs out for AOCAP in June of 
1995? I know what I'm going to do. I'm going to be burying more 
veterans unnecessarily. I'm going to have to look into the eyes of 
more kids and say, "Sorry, kid. I know your birth defect isn't re- 
paired, but I've got 10,000 other kids lined up behind you and 
you're going to have to wait." I'm not going to have any money. 

My recommendations here are plain and simple. I'm not asking 
the VA to do anything. I'm not asking the Congress to do anything. 
I demand as a human being who has seen the catastrophe of Agent 
Orange and the way this government and this judicial system has 
treated them, I demand you force the VA to do what they're doing 
or fund them. There is no other moral imperative. You have to. I'm 
not asking, I'm demanding as a human being. You've got to do this. 
I'm going to be alone when this is gone and I don't know what the 
tell the veterans. I don't know what to say. 

Mr. Ridge, I'm going to speak to him personally because he had 
some questions about the litigation. A lot of veterans think it's a 
sellout. If they could see the lives that these people have saved, 
they would never say that. If they could count the hundreds of mil- 
lions of dollars that the Veterans Leadership Program has gotten 
them in compensation, they wouldn't say that. You can't put an 
amount of money on one life that one of these have saved and 
they've saved tens of thousands of lives. 

It's going to be gone and what's the VA going to do? Nothing, not 
in my book. They have adhered to an unconscionable position 



45 

that^-unprecedented in the VA system, "You prove to me that 
Agent Orange caused it," and they're doing the same thing to our 
kids, the Desert Storm veterans. They're our kids. They're us. It's 
the same thing. "Oh, it's in your head. Send them to the shrink. 
Oh, we don't know. We've got to study it," and start another study. 

Well, we were supposed to stop that with the Vietnam War. 
Didn't we learn that from the Vietnam War? Didn't we learn from 
Agent Orange? Obviously we didn't because we're doing it to our 
kids. Where is it going to end? Where's the ugly face of war going 
to stop? We've got to do something now and the VA has the respon- 
sibility and Congress has the responsibility to force the VA because 
they won't do anything that Congress doesn't force them to do. 

So, my plea is to end the controversy. The vets don't care wheth- 
er Agent Orange caused it or not. The public don't care whether 
Agent Orange caused it or not. It's time that we took a moral posi- 
tion and do what AOCAP has done. We've shown the way. It's the 
VA's responsibility. 

I said I'd never appear before the House again. I'm here because 
I know you care, Mr. Chairman. That's the only reason. I'm here 
for those people because they're trying their hearts out everyday 
and they're succeeding. They're doing it. We've got to help them to 
continue on because the money is going to go. It's as simple as 
that. 

Thank you. 

[The prepared statement of Mr. McCarthy appears on p. 145.] 

Mr. Evans. Thank you, Frank. That's very moving testimony. We 
appreciate your contributions today. 

I think it's fair to point out that while these funds are drying up, 
the Agent Orange Class Assistance Program and even the com- 
pensation portion of the suit have helped far more many Vietnam 
veterans, tne dependents and their families than the U.S. govern- 
ment has. I think the record is very clear that we wasted over $50 
million on studies of this through the CDC, the Veterans' Adminis- 
tration and elsewhere and only find that many of those studies 
were rigged to fail and purposely flawed and that money could 
have been used directly for these kinds of programs. 

We thank you for being in the trenches. Even before I got to Con- 
gress, I knew about your hard work. Unfortunately, its going to 
have to continue and I have to count on you to come here again 
probably next year and fight as we phase out the settlement pro- 
gram and fight for the money we need. 

So, we appreciate your testimony and your continued strong ad- 
vocacy of Vietnam veterans and now Persian Gulf veterans, as you 
say. That's the next battle as well. 

Dr. Calkins, you raised the issue of an empowerment approach 
and I think that's the real shift of paradigm that we need here in 
terms of looking at how we provide services. The five or so factors 
that you indicated, they start with empowerment, with sensitivity 
and respect, gaining information about the services available, the 
advocacy programs. They're all empowering kinds of things. 

Could both of you tell us how the VA might try to adapt this 
kind of approach into its system? 

Dr. Calkins. I don't know that we have that long. No, not to be 
cryptic, but it really takes a substantial amount of shift in ideology 



46 

to put in place an empowerment model. When the entire eligibility 
of a system is based on deficits, you don't treat people toward their 
strengths and toward their capacities. You look at those deficits 
and that becomes the way that you interact with them. So, it would 
take massive amounts of retraining and this is not just true in vet- 
erans' organizations, but this is true also in human service organi- 
zations. We're finding that those deficit models don't lead people to 
wellness. They don't lead people, they become more debilitating. I 
think retraining, redirecting the funds away from structures that 
are heavily bureaucratic and heavily encumbered with their own 
procedures. 

What community-based organizations do is they do whatever it 
takes. They also listen, I think finally, directly to what the people 
who are the consumers say the needs are. This is something that 
we as organizations don't often do. We have a set of, "This is what 
your needs probably are and we'll get you these services." But if 
you really listen to what people's needs are, they're willing and 
committed to work with you and that's how you make that shift 
too. So, they need to be part of the service delivery system. 

Dr. Reiss. I guess I'd like to build on two things that you said. 
One has to do with flexibility and the other has to do with involv- 
ing consumers or parents. The flexibility of funds, I think, is criti- 
cal. I think one of the reasons that AOCAP has been able to do 
what it can do is because it has a modest amount of resources that 
it can use to fill in the gaps when other existing resources aren't 
able to address the needs. But they're also able to work with all 
the available social health and support systems to say, "We're get- 
ting somebody to pay the electricity, we're getting somebody else to 
provide transportation." They're the glue. TheyYe the ones that 
bring that together. 

I know within bureaucracies, state and Federal Government, 
there are clear restrictions as to how many units of care you can 
provide to an individual, how many units of care you can provide 
to a spouse. Giving systems the flexibility to address the needs and 
do what's needed I think is critical. 

The other thing that's happened with the family-centered care 
movement, especially with children with special needs, is many or- 
ganizations now utilize parent advisory boards and, in fact, give 
them concrete, explicit power and responsibility that helps shape 
the service system and also to actively participate in the provision 
of services. AOCAP uses Vietnam vets and their families as care 
coordinators and care providers. I think institutionalizing, giving 
Vietnam vets and their families significant responsibility and 
power to provide advice and also have the opportunity of having 
oversight in terms of the allocation of resources, I think resource 
and money and power go together. If they're just an advisory board 
that says, "You ought to do this or you ought to do that," things 
aren't going to change. If an administrator needs to get the ap- 
proval of an advisory board to allocate resources to a need program 
or to new services, I think that's the way you'll see change. 

Mr. Evans. I want to thank this panel very much for their im- 
portant testimony. Thanks for your time and energy. 

The members of our final witness panel represent the Depart- 
ment of Veterans Affairs. Dr. David Law is Acting Associate Dep- 



47 

uty Chief Medical Director for Clinical Programs. He is accom- 
panied by Dr. Laurie Harkness, Chief Psychiatrist, Rehabilitation 
Section, Social Work Services at the VA Medical Center, West 
Haven, CT. 

Doctor, we're ready when you are and your entire statement will 
be made part of the record. 

STATEMENT OF DR. DAVID H. LAW, ACTING ASSOCIATE DEP- 
UTY CfflEF MEDICAL DLRECTOR FOR CLINICAL PROGRAMS, 
DEPARTMENT OF VETERANS AFFAIRS; ACCOMPANIED BY 
DR. LAURLE HARKNESS, CHD3F OF THE PSYCHIATRIST RE- 
HABHJTATION PROGRAM, SOCIAL WORK SERVICE, VA MEDI- 
CAL CENTER, WEST HAVEN, CT 

STATEMENT OF DR. DAVTO LAW 

Dr. Law. Certainly. Thank you. 

I'm pleased to represent the Veterans Health Administration and 
to discuss what the Department of Veterans Affairs does to assist 
veterans and their families using social services. 

Mr. Chairman, the terrible impact of war and military service on 
families has been recognized throughout our Nation's history. It's 
been experienced directly by millions of our citizens and has been 
a very personal experience for many present at this hearing. 

An important VA mission is to provide for the military-related 
social service needs of our veterans. To meet those needs, the VA 
has implemented programs that deal with posttraumatic stress dis- 
order, substance abuse and family violence. While VA only has au- 
thority to provide direct treatment to family members as a collat- 
eral treatment for the veteran in certain mental health, rehabilita- 
tion and long-term care programs, VA does respond to the other 
needs of veterans' families indirectly through well-established re- 
ferral networks and community agency partnerships. Clinical staff 
assigned to VA medical centers, outpatient clinics, community- 
based veteran centers and veterans benefits counselors in our VA 
regional offices and hospitals provide such primary linkage and re- 
ferral services to community agencies and other programs. 

Also, among the social services most frequently provided directly 
for our veteran patients, are those impacting on the family. Name- 
ly, advanced discharge planning, information and referral, case 
management and family consultation. In the last 3 months alone, 
nearly one quarter of a million veterans received these specific 
services from our VA social workers. 

In rural and smaller communities, finding appropriate agencies 
with the right services available for the veteran s family members 
becomes a challenge. Managing a case encompasses much more 
than just providing high quality health care to the veteran. It 
means getting the family the services it needs so that they can sup- 
port the veteran during and following a course of VA hospitaliza- 
tion or outpatient care. Also, without effective coordinated case 
management services, some families at high social risk may not re- 
ceive services at all. 

Mr. Chairman, we in VA applaud the Agent Orange Class Assist- 
ance Program or AOCAP for its outstanding work with families 
and children of Vietnam veterans. As you have noticed and noted, 



48 

it's filled a critical gap in service delivery to a highly needful popu- 
lation of veteran families by providing a full range of these commu- 
nity social services which are so essential for the effective delivery 
of health care to veterans and the healthy functioning of their fam- 
ilies. 

We also appreciate the networking we've been able to establish 
with the community agencies funded by AOCAP. They are skilled 
in working with the families and disabled children of Vietnam vet- 
erans. We ve collaborated with many of those agencies to meet the 
psychological and social needs of veterans, especially those whose 
children were undergoing concurrent medical care in the commu- 
nity. 

With them, we have learned that programs which best meet the 
social service needs of veterans and their families share certain 
characteristics. First, they systematically address the biological, 

Esychological, social and vocational needs of the veteran. Then, 
ased on a family needs assessment, they incorporate a holistic ap- 
proach and seek solutions through the use of the family itself, 
through VA programs and through community resources. The suc- 
cessful programs focus on healthy family relationships. They en- 
courage independence and personal responsibility. They use volun- 
teers and program graduates and they provide case management 
and coordinated services. 

The full text of my testimony, Mr. Chairman, outlines several ex- 
amples of locally developed VA programs designed to strengthen 
the family unit based on these principles. 

Mr. Chairman, this concludes my testimony. However, my col- 
league, Dr. Harkness, has some comments to make and then we 
would be pleased to address your questions. 

[The prepared statement of Dr. Law appears on p. 151.] 

Mr. EVANS. Doctor. 

STATEMENT OF DR. LAURIE HARKNESS 

Dr. Harkness. Hi. I'm here to share my experience of the last 
17 years working at the West Haven VA. I was head of the out- 
patient PTSD clinic for a number of years before I took over my 
present position. 

There are a lot of caring, very concerned people who work at the 
VA. I'm there because I want to be there. I enjoy my job and I also 
feel like I not only serve the veterans that served this country, but 
I am teaching others how to provide services to them in a high 
quality way. 

Now, the VA is only one of a group of people that have become 
real experts in understanding the multi-problems of Vietnam veter- 
ans who suffer from PTSD. We do acknowledge that PTSD not only 
affects the veteran, but it affects the entire family system. I myself 
spent 3V2 years gathering data for the first study ever done to ex- 
amine the impact of PTSD on the family system and specifically I 
looked at the impact of a father's PTSD on the children and a num- 
ber of variables of children's development. 

We do offer treatment for spouses and for families, but we cannot 
be experts in everything. One of the things that VA has, and I have 
to say only in recent years, begun to do is to collaborate and work 
with those people that do have the expertise, for example in the 



49 

treatment of children with multiple disabilities or other sorts of 
emotional problems. I think that is a direction that the VA does 
need to continue to develop in working with community agencies 
and facilities who have those expertise. 

We also are very aware that the way to bring people home from 
Vietnam and to help them have the energy and the motivation and 
the strength to not only take responsibility for their symptoms and 
learn to manage their symptoms is to develop two things. One is 
meaningful family and social relationships and the other is mean- 
ingful activities to do with their days. If you don't have anything 
meaningful to look forward in your day, you're not going to feel 
very good about yourself and you're not going to be a very good 
parent or spouse. 

Now, my own research did find that the group of children that 
I studied, and believe me it was a very, very painful 3V2 years be- 
cause I heard some of the most horrific stories and experienced 
some of the most painful children's day to day struggles, found that 
these children did have many problems, did resemble more a clinic- 
seeking sample than a normal sample, and that they already are 
identifiable at risk for later problems. What we at the VA are try- 
ing to do is work with these children and with their families, like 
I say, to link them to not only people in our agency but in the com- 
munity that can help address these problems in a preventative way 
rather than later when they're fullblown. 

Now, we also work very closely with other people in the commu- 
nity. We work very closely with veterans' service organizations to 
help teach them how to understand and to deliver the services that 
these families need. I myself do a lot of work with the schools in 
my community. I run workshops for teachers, for children, for fami- 
lies about the affects of PTSD and the affects of violence on the 
family system and on the learning process. I actually myself ran 
a group for children who were school bullies because we know that 
kids cannot learn in the classroom if there are kids there that are 
terrifying them. 

We work very closely with getting grants for housing, but not 
just housing for individuals, which I think is historically what peo- 
ple have done. We're in the process of building a house with HUD 
money that is for Vietnam veterans and their families. In the proc- 
ess of planning this facility, what we did was we involved the vet- 
erans and their families in the process. One of the things they told 
me that I wouldn't have thought of was that they needed a common 
room, thev needed washers and driers not in their apartments, but 
they needed it in a social room where they would have to go out 
of their apartments and interact with other people to help them 
overcome the social isolation and the tendency for social with- 
drawal. 

I work very closely with AOCAP. I'm one of their family provid- 
ers, as well as I run half day psycho-educational problem solving 
workshops with the Shriver Center out of Boston. I'm not the only 
one that does this, there are a lot of other VA employees that do 
this. 

Yes, the VA has to work very hard to break down the negative 
stereotypes that have developed over the years and it did take us 
a long time to understand how to help — not only how to under- 



50 

stand PTSD, but how to help and work with the veterans and their 
families. But I also think at this point that is breaking down and 
that the collaborations and partnerships that are beginning are 
part of the answer to helping families get better treatment and get 
on with their lives. 

Mr. Evans. Doctor, thank you. 

Doctor, we appreciate what you're doing at West Haven, but I'm 
not sure that's being duplicated throughout the other 171 VA medi- 
cal centers. 

Dr. Harkness. I do a lot of public talking with other VA medical 
centers and I do know that this is happening in a growing number 
of VA's throughout the country. I would be less than honest if I 
didn't say that not everywhere I go they totally agree with what 
I'm saying about the importance of working with the family system 
as well as with the veteran. Sometimes it is difficult the way the 
VA reimbursement system is set up for people to feel like they 
have the resources to serve the families directly in the VA medical 
centers, which is why what I say is don't give up at that point. I 
say look in your community and find what resources you can link 
with and then work with those resources to make sure that not 
only do they understand the multi-level needs of these families, but 
make sure that the families link up with these facilities. 

Mr. Evans. In these talks, do you actually identify the effects 
posttraumatic stress disorder on the kids as secondary PTSD or 
use terms of that nature? 

Dr. Harkness. I actually don't use the term secondary PTSD be- 
cause I actually think many of these children are primarily trau- 
matized by living in these families and that they are having PTSD 
in and of itself that's a result of that interaction. 

Let me just say one thing. In my study, I had originally thought 
it would be the severity of the father's PTSD that would be most 
highly correlated with problematic child behavior. In fact, the one 
variable that accounted for 60 percent of the variance was the pres- 
ence or absence of violent behavior. So, in my talks and when I 
work with my veterans, what I say to them is that you can have 
PTSD, we can teach you how to struggle and how to manage these, 
but if you beat your children, you're destroying them as well. I 
think that that is a very important message that we need to get 
out to the community and is actually what I'm going to be talking 
about tomorrow at the AOCAP symposium. 

Mr. Evans. I appreciate your attendance. In a nutshell, as I 
won't be there, what might the VA be able to do that it isn't doing 
now particularly in terms of shifting to an empowerment kind of 
strategy with the family-oriented, community-based kinds of serv- 
ice? 

Dr. Harkness. The first is the continuing ongoing education of 
people to ask the right questions. We happen to be part of the Yale 
system, so that we're always having training people come in. I'm 
always part of that orientation program. 

The second is to make sure that the resources are available and 
to invite the veteran to bring their family in as part of the evalua- 
tion assessment period, not only part of the later treatment. 

The third is to work with the agencies in the community that 
have the expertise in learning disabilities and other areas, make 



51 

sure that they know about PTSD, about how it affects the family 
system and about the problems that these families deal with. 

Mr. Evans. Dr. Law, in your statement you indicated, as I've 
quoted before, that AOCAP has filled a critical gap. As AOCAP 
phases out, what will the VA do to meet the needs to continue the 
filling of that gap? 

Dr. Law. That's a perplexing problem. VA is strongly supportive 
of any way that we can keep the AOCAP activities going. As you 
well know, VA is not permitted to do a number of the things that 
AOCAP does. I think some of the lessons that have been learned 
will be very useful. Now, already, I think there's ongoing training, 
continuous ongoing training for all of our 800 plus readjustment 
counseling service staff on a continuing basis dealing with family 
counseling. Our Social Work Service, all of its 4200 plus social 
workers throughout the country, get ongoing education and ongoing 
training in family counseling including national televised pro- 
grams, as part of the social work leadership training programs. So, 
the recognition that these things have to play a much greater role 
in solving the problems is there. 

I don't think that the VA has the capability or the support to do 
what AOCAP does. I think the VA is more and more discovering 
that it must be dependent on community facilities and must inter- 
act intimately with community facilities and must make the point 
that veterans and their families are not just the responsibility of 
the VA, but that they are active members of the community. I 
think our social workers and readjustment counseling people are 
actively trying to integrate the care of the veterans and their fami- 
lies into existing community agencies and organizations. And, of 
course, AOCAP has been a model for that. 

Mr. Evans. My time has expired and I have a number of other 
questions which 111 submit to you in writting for your responses. 
Those questions and your answers will also be made part of the 
record. 

Thank you very much for your testimony. 

That concludes our hearing. I want to thank everyone that has 

Earticipated. It's been a very helpful hearing, not only for the Mem- 
ers of Congress who attended, but also for the Department of Vet- 
erans Affairs whose representatives were present for the entire 
hearing and we appreciate that. We think it's very helpful in terms 
of making an impact on the VA as well as this body to have the 
benefit of the testimony presented today. 

I want to thank the Majority and the Minority staff for their 
hard work as well. 
With that, this hearing is now adjourned.. 
[Whereupon, at 11:30 a.m., the hearing was adjourned.] 



APPENDIX 



Families of Vietnam Veterans 
With Post-Traumatic Stress Syndrome: 
Child Social Competence and Behavior 



Laurie Harkness, Ph.D. 

Chief, Psychiatric Rehabilitation Program 

Veterans Affairs Medical Center 

West Haven, CT 06516 

Assistant Clinical Professor of Social Work in Psychiatry 

Yale University School of Medicine, New Haven, CT 

Earl L. Giller, M.D., Ph.D. 

Associate Director of Clinical Research 

Pfizer Incorporated 

East Point Road 

Groton, CT 06340 

Abstract 

Aspects of combat-related post-traumatic stress disorder (PTSD) in Vietnam veterans may affect their 
children's dei'elopment. In this study, researchers assessed the influence of the severity of the father's 
PTSD symptomatology, level of family functioning, and the presence or absence of violent behavior in 
the veteran father on the child's social competence and behavior patterns. Forty families involving 
eighty-six children ages six to sixteen were recruited for the study. Fathers were assessed through 
various instruments to determine combat exposure and severity of PTSD symptoms. Both veteran 
fathers and their wives independently completed family function assessments and child behavior 
questionnaires. The children's teachers also completed child behavior questionnaires. 

Results indicate that many children demonstrated problematic belwvior and were at risk for develop- 
ing more severe psychiatric disorders. A child whose father is violent is more likely to have additional 
behavior problems, poorer school performance, and lower social competence than a child whose father is 
not violent. Violence is most strongly related to lower socioeconomic status, larger family size, and 
unemployment or underemployment. Violent belwvior in the father has a great impact on general family 
functioning, which has significant influence on the child's functioning. Clinicians should identify high- 
risk families and children and treat children by emphasizing their separateness from their father and that 
they arc not responsible for their father's behavior or pain. Longitudinal follow-up studies should be 
conducted to assess the risks in various age groups and examine the family outcome following treatment. 



(53) 



54 



Families of Vietnam Veterans With Post-Traumatic Stress 
Syndrome: Child Social Competence and Behavior 



JL he relationship of a father's war experiences and subsequent post-traumatic stress 
disorder (PTSD) to family life has generated growing concern. Flashbacks, nightmares, and 
startle responses, along with irritability, violence, depression, and substance abuse are among 
the most common and most disturbing symptoms of combat-related PTSD. These all have an 
impact on interpersonal and family relationships. Many of these families appear to have 
suffered from the well-known profound and prolonged psychological effects that many 
veterans experience. However, relatively little has been done to investigate the characteristics 
and problems of the children in the families that Vietnam War veterans formed in the post-war 
period. This study examines aspects of PTSD in Vietnam veterans that may affect their 
children's development. Investigation of these children is essential in order to comprehend the 
long-term implications of the experiences of veterans with combat-related PTSD. 

Studies of children of Holocaust survivors and children of psychiatrically disturbed parents 
have clearly suggested that the psychological reverberations of traumatic events may persist 
into the next generation. An individual's PTSD becomes part of the entire family system and 
can affect other family members. The effects of trauma on the second generation can occur in 
many ways, both subtle and overt. Children can experience the impact of their parent's 
traumatic symptoms of anxiety, depression, withdrawal, or anger (Beardslee et al., 1983; 
Weissman et al., 1984; Krystal, 1968), hear repeatedly about their father's war experiences 
(Robinson and Winnik, 1978), observe how other people treat their father, be overprotected 
(Sonnenberg, 1974), adopt their parent's reactive attitudes of bitterness or suspicion, or feel 
pressure to compensate for their parent's deprivation and suffering (Levine, 1982). Deficits in 
the children have been documented in many areas, including cognitive-intellectual functioning 
(Rolf, 1972; Erlenmeyer-Kimling et al., 1981), social-interpersonal functioning (Beisser, Glasser, 
and Grant, 1967; Erlenmeyer-Kimling, 1975), and affective functioning (Weissman et al., 1984; 
Beardslee et al., 1983). However, some research with trauma survivors has shown that the 
consequences are not necessarily pathologic (Krell, 1982). Some children can shelter them- 
selves from the negative impact of the environmental and familial sequelae of traumatic 
experience. They have the capacity to elicit positive responses from parents, friends, and 
teachers. Thi risks associated with parental PTSD can also be buffered by constitutional 
characteristics of the child. 

Recently, several authors have reported their clinical impressions on the impact of 
combat-related PTSD on the children of Vietnam War veterans. Haley (1983) observed that 
child-rearing seems to emphasize the veteran's working through the transition from the 
"reflex" of combat aggressiveness to adaptive, nondestructive aggression in their current lives 
Her emphasis is more on how to help the veteran father deal with the young child than on 
actual child developmental issues. Rosenheck (1985a), after encountering several troubled and 
symptomatic children whose fathers were being treated for PTSD, described a process he 
called "secondary traumatization" to characterize the relationship between the father's combat 
experiences and subsequent stress disorder and children's problems 

In cases of secondary traumatization, the child, exposed to the father's svmptoms of PTSD, 
especially the flashbacks, nightmares, and vivid memories that the veteran father continuously 
relives and often even reenacts, identifies with the parent and experiences in fantasy the same 
kinds of events his or her parent actually lived through. This study investigates these impres- 
sionistic findings through empirical research. 

To date, the only published empirical study to investigate the impact of PTSD on children 
has been the National Vietnam Veterans Readjustment Study (NVVRS) (Kulka et al., 1990). 
The NVVRS found that children of Vietnam veterans with PTSD do tend to have more behav- 



55 



ioral problems than do children of Vietnam veterans without PTSD and that they resembled a 
clinic-seeking sample of age mates rather than a normative sample That study also found that 
these families reported more marital problems, more problems related to parenting, lower 
family adjustment, and more family violence than is found in families of those without PTSD 
That study concluded that living with a veteran suffering with PTSD appears to have a signifi- 
cant negative impact on the psychological status and well-being of their spouses or coresident 
partners and their children (Kulka et al., 1990, p. 20). We examined which variables contrib- 
uted to the variance in child behavior scores: the severity of specific PTSD symptoms or other 
associated problems. Results of this study are important in helping clinicians identify where to 
focus their clinical interventions: on PTSD, on the family, or on violence. 

In an unpublished paper, Harkness and Giller (1992) reported the results of a study that 
examined spousal reports of their marital relationships in a group of forty Vietnam veterans 
with PTSD and their wives. Many of the couples reported problems in family functioning, 
including communication patterns, expressions of intimacy (cohesion), and problem-solving 
abilities (adaptability). A large number of couples described their family patterns of interac- 
tion as disengaged and rigid. Variables that most influence the level of familv functioning 
were identified and discussed. 

A major finding of the study was the powerful effect in the family of current violent 
behavior. Violent behavior was found to be even more influential than either the severity of a 
father's PTSD or the level of family functioning. The presence of violence not only makes the 
family system as a whole at risk for extreme dysfunction but the individual children in these 
families at risk for developing maladaptive behaviors and dysfunction (Harkness and Giller, 
1992). This present study assessed the influence of the severity of the father's PTSD 
symptomatology, the level of family functioning, and the presence or absence of violent 
behavior in the veteran father on the child's social competence and behavior patterns. These 
independent variables (severity of PTSD, level of family functioning, and violence) have been 
proposed in the clinical literature to be important to a child's development. 

Subjects and Procedure 

After describing the study to the veteran father and obtaining his informed consent, he re- 
ceived the Structured Clinical Interview for DSM-III-R (SCID) (for PTSD) (Spitzer and Will- 
iams, 1985) and Schedule for Affective Disorders and Schizophrenia (SADS) (Endicott and 
Spitzer, 1978) diagnostic interviews. If the veteran was diagnosed as having PTSD by 
DSM-III-R criteria and did not meet research diagnostic criteria (Spitzer, Endicott, and 
Robbins, 1978) for schizophrenia or bipolar illness and gave written informed consent, he was 
further interviewed about his war experiences using the Jackson Interview (Keane et al., 1985), 
Figley's Structured Interview for PTSD (Figley, 1977), Horowitz, Wilner, and Alvarez's Impact 
of Events Scale (1979), and the VESI Stress Questionnaire (Wilson and Drauss, 1980). These 
instruments were used to assess combat exposure and severity of PTSD symptoms. He was 
also asked to complete a demographic questionnaire that included questions about 
psychosocial adjustment since the war. 

A time was then scheduled to meet with the other members of his family, including all 
children above the age of six, pending the willingness of the wife and children to participate. 
These meetings occurred either at a local U.S. Department of Veteran Affairs Medical Center or 
at a Vietnam Veteran Outreach Center (Vet Center). 

Of the forty-eight veterans recruited from Vietnam Veteran Outreach Centers, Vietnam 
Veterans of America chapters, and from the local VA Medical Center's Outpatient Mental 
Hygiene Clinic, forty-two met the inclusion criteria. Two wives refused to participate in the 
study. In the forty families who completed the study, all eightv-six children ages six to sixteen 
participated. 

After explaining the purpose of the study to the family and obtaining informed consent, 
each member was asked to complete the Family Adaptability Cohesion (FACES II) (Olson et 



56 



al., 1982) and the Parent-Child Communication Scale (Olson et al., 1982) as the measures of 
family function. To assess child functioning, two variations of the same form were used: the 
Achenbach Child Behavior Checklist (CBCL) (Achenbach and Endlbrook, 1983) and the 
teacher's form of the Child Behavior Checklist, the TBCL (Achenbach and Endlbrook, 1983). 
Both self-administered questionnaires measure the social competencies and behavioral prob- 
lems of children ages four to sixteen, as reported by their parents or teacher. The nine behavior 
scales derived from the 118 behavioral problem items are: schizoid or anxious, depressed, 
uncommunicative, obsessive-compulsive, somatic complaints, social withdrawal, hyperactive, 
aggressive, and delinquent. Derived from these are two more general factors called internaliz- 
ing and externalizing behaviors. 

With the parent's signed release of information, each child's teacher was asked to complete 
the TBCL. The TBCL behavior and competence scales that teachers score differ from those the 
parent scores. Behavior and competencies not evident to parents may be of great concern to 
teachers. Therefore, teachers are asked to provide competence information that focuses on the 
provision of special services, repetition of grades, ratings of academic performance, and on 
four general adaptive characteristics: how hard the child works, how appropriately the child 
behaves, how much the child is learning, and how happy the child is. Although the parents' 
and teachers' scores cannot be directly compared, together they give a better picture of child 
competence and behavior patterns. The higher the child's score for any scale, the more prob- 
lematic the child's behavior. 

Data are presented in two ways. Raw subscale scores are used to report on specific sex and 
age groups and to compare them with both a normative and clinic-seeking group of age mates. 
Second, to compare groups other than by age and sex, e.g., by severity of PTSD, T scores were 
used to allow comparison across age and sex groups. 

Results 

The children in this study resembled a clinic-seeking sample on many of the CBCL scales. For 
girls ages six to eleven, all but one behavior scale score was similar to those of a clinical 
sample. For girls ages twelve to sixteen, all the subscale mean scores were in the clinical range 
except the immature/hyperactive, schizoid, and delinquent scale scores, which were between 
the clinical and non-clinical values. For boys ages six to eleven, all the behavior scale scores 
were in the clinical range; and for boys ages twelve to sixteen, most of the behavior scale scores 
were in the clinical range. The only scales not in the clinical range in the male ages twelve to 
sixteen group were the immature behavior and obsessive/compulsive behavior subscales, 
which fell between the non-clinical and clinical scores. For all groups, internalizing and 
externalizing factor scores were in the clinical range (Table 1). On the total competence scale, 
this sample scored in the clinical range mainly due to their low activity subscale scores (Table 
1 ). On both the social and school competence subscales, this sample scored between the 
clinical and non-clinical scores. 

Effect of Severity of PTSD 

To examine the effect of the severity of father's PTSD symptoms and level of family function- 
ing on CBCL scores, several additional analyses were performed. Using T scores, a 2 x 3 
ANOVA (severity x level of family functioning) showed a main effect of level of family func- 
tioning on both the Internalizing and Externalizing Behavior Scale scores (Table 2). Tukey 
post-hoc t-tests revealed that children from lower functioning families (as measured by the 
FACES II), regardless of the severity of the father's PTSD symptoms, scored significantly 
higher (more problematic) than children from higher functioning families on both the Internal- 
izing and Externalizing Behavior Scales. No significant main effect of severity of PTSD or 
interaction between severity of PTSD and level of family functioning was found on any of the 
other scores. When family mean CBCL T scale scores, rather than individual child T scores, 
were used, a 2 x 3 ANOVA (severity of PTSD x level of family functioning) showed a main 



57 



Table 1. Child Behavior Checklist Scale T Scores for This Study and Other Normative and 
Clinical Samples (Values Are Mean + SD) 





Current Study 


Clinical Sample 


Nonclinical Sample* 
(n = 300) 


Girls 6-1 1(n=46) 
Internalizing 
Externalizing 
Social Competence 


63.4 ±9.7' 
63.5±11.r 
40 3 ±1.51* 


67.0 ±9.1 

68.1 ±9.5 
36.7 ±10.0 


51.3 + 9.1 
510 + 9.5 
51.1 ±9.7 


Girls 12-16 (n=34) 
Internalizing 
Externalizing 
Social Competence 


60.0 + 8.7* 
57.4 + 8.6* 
44.7 + 16.9- 


64.3 ±8.4 
64 + 8.6 
36.9 ±9.8 


49.8 + 80 
49.4 + 7.5 
50.9 ±10.0 


Boys 6-11 (n=22) 
Internalizing 
Externalizing 
Social Competence 


63.6 + 9.7* 
65.5 + 9.9' 
39.8+ 13.4* 


65.6 ± 8.9 
68.1 +8.7 
37.0 ±9.0 


51.2 ± 9 1 

51.0 + 9.3 
51 0± 10.0 


Boys 12-16 (n=22) 
Internalizing 
Externalizing 
Social Competence 


62.0 + 9.3 " 
59.6 ±10.1 
40.8 ±11.0* 


64.7 + 8.2 
66.2 + 8.1 
35.5 + 9.2 


51.3 + 9.0 

51.4 + 8.9 
50.9 + 10.1 


* Ratings comparable to 


clinical sample as reported by Achenbach and Endlbrook, 1983 





Table 2. CBCL Individual Children T Scores Compared by Severity of Father's FTSD 
Symptoms and Level of Family Functioning (Values Are Means + SD) 

Low Mild High F 



Internalizing 
Mild PTSD 
Severe PTSD 


65.4 + 10.2 
66.7 ± 8.5 


59.2 + 8.2 
59.1+7.1 


57.0 + 7.8 
58.3 ±7.8 


Externalizing 
Mild PTSD 
Severe PTSD 


63.8 + 12.2 
65.3 ± 9.0 


60.3 + 9.3 
60.1 ±8.9 


56.3 + 8.8 

55.4 ±8.0 


Social Competence 
Mild PTSD 
Severe PTSD 


39.4 + 19.6 
39.6 ±10.1 


44.2 + 14.8 
41.8 + 12.8 


42.9+10.0 
41.9 + 12.9 



effect of level of family functioning only on the internalizing behavior factor (Table 3). Tukey 
post-hoc t-tests revealed that children from lower functioning families, regardless of the 
severity of PTSD symptoms, scored significantly higher than children from higher functioning 
families on the internalizing behavior scale. No significant main effect of severity of PTSD or 
interaction between severity of PTSD and level of functioning was found on this scale. No 
significant difference was found among groups on the externalizing behavior or social compe- 
tency scale T scores. 



58 



Table 3. CBCL Family T Scores Compared by Severity of Father's FTSD Symptoms and 
Level of Family Functioning (Values Are Means + SD) 

Low Mild High F 



Internalizing 








Mild PTSD 


B1.5±10.2 


58.6+ 5.2 


57.9+ 5.0 


Severe PTSD 


67.9 ± 7.0 


59.0 ± 4.0 


58.3 +_ 6.7 


Externalizing 








Mild PTSD 


59.1 + 10.2 


60.0+ 7.3 


58.4+ 6.5 


Severe PTSD 


66.3 ± 6.9 


58.5 ± 9.7 


55.4+ 4.8 


Social Competence 








Mild PTSD 


43.9 ±13.6 


416+_ 9.2 


44.7+ 8.3 


Severe PTSD 


38.9 ± 5.4 


43.9+12.2 


41.9+14.0 


Violence 









851 



Because of the effect of paternal violent behavior on family functioning found in the previous 
study (Harkness and Giller, 1992), children were grouped by presence or absence of current 
violent behavior in the father. Significant differences were found on the Internalizing and 
Externalizing Behavior Scale T scores (Table 4), the school performance scale T score, and total 
competency scale T score. Children ages six to eleven from families with a violent father were 
more aggressive and delinquent; girls this age were more socially withdrawn. These problems 
seem to increase for the older children. Not only were both boys' and girls' behavior scale 
scores in the clinic-seeking sample range, but the scores of boys ages twelve to sixteen were 
higher than the clinic-seeking sample. 

Table 4. CBCL Scale T Scores for Children from Families with Violent vs Nonviolent 
Fathers as Reported by Fathers and Mothers (Values Are Mean + SD) 





Nonviolent 


Violent 


t 


P 




(n=102) 


(n= 


70) 






Behavior Scales 














Internalizing 


59.2 + 


7.9 


67.1 


+ 9.5 


5.73 


.0001 


Externalizing 


58.7 + 


.91 


66.0 


±10.5 


4.76 


.0001 


Social Competence Scales 














Activity 


41.5 + 


12.0 


39.4 


+ 10.2 


1.28 


.201 


Social 


44.6 + 


9.2 


41.5 


+ 14.0 


1.59 


.114 


School 


46.8 + 


12.7 


42.2 


+ 13.9 


2.16 


.032 


Total Competency 


43.3 + 


14.5 


37.9 


+ 12.7 


2.59 


.011 



School 

Of the eighty-six children who participated m the study, 64 percent of their teachers completed 
and returned the teacher's TBCL. In terms of their overall social competence and behavior 
mean scale scores, these fifty-five children were similar to the full sample of the eightv-siv 

When teachers' and parents' internalizing and externalizing scores were compared, it was 
found that the teachers saw these fifty-five children as significantlv less internalizing and 
externalizing than did either of their parents (Table 5), i.e., less anxious, less socially with- 
drawn, less nervous, less inattentive, and less aggressive. When compared with scale norms, 
the teachers' scores saw this group of children as falling between the non-clinic-seeking and 



clinic-seeking sample. On the behavior subscale scores, when teacher's mean T scores for each 
behavior scale were compared first by severity of father's PTSD and then by level of family 
functioning, no significant differences were found between groups. 

Table 5. Comparison Among Mother's, Father's and Teacher's Mean T Scores on CBCL 
Internalizing and Externalizing Behavior Scales (Mean + SD (n=55)) 

Mother Father Teacher F P 

Internalizing 62.6+ 9.6 60.3 + 9 2 54.0+ 9.0 12.60 0001 

Externalizing 61.2+10.9 60.1+10.6 52.8+11.9 9.39 .0001 

Comparison: Mother=Father>Teacher 



When teacher's mean scale T scores for each behavior scale were compared by presence or 
absence of violent behavior in the father, however, significant differences were found in many 
behavior scale scores (Table 6). Children from families with violence were significantly more 
anxious, unpopular, inattentive, and aggressive. There was also a strong tendency for them to 
be more socially withdrawn, immature, and self-destructive. In the area of social competence, 
teachers reported a tendency for the children of fathers with severe PTSD to perform less well 
academically than children of fathers with mild PTSD (p=.065). Teachers also reported that 
these children do not learn as much (p=.087). No difference was found between groups on 
comparison of hard working, appropriateness of behavior, or happiness. Teachers reported no 
significant differences in social competency scores among children from low-, middle-, or high- 
functioning families. A tendency (p=.085), however, was found for children from low-func- 
tioning families to be less happy than children from higher functioning families. 

Table 6. Teacher's CBCL Behavior Scale T Scores for Children from Families with 
Nonviolent and Violent Fathers (Values Are Mean + SD) 





Nonviolent 


Violent 


t 


P 




(n=33) 


(n=22) 






Anxious 


56.9+ 3.3 


59.9+ 5.5 


2.31 


025 


Social Withdrawal 


57.4+ 4.2 


60.9+ 8.3 


1.84 


072 


Unpopular 


57.4+ 4.8 


62.5+ 8.9 


2.47 


017 


Obsessive/Compulsive 


59.0+ 6.8 


62.8+ 9.0 


1.15 


262 


Inattentive 


56.9+ 3.7 


60.8+ 7.8 


2.17 


035 


Immature 


56.6+ 2.7 


62.7+ 7.6 


1.90 


070 


Self-Destructive 


59.3 ± 5.2 


62.8+ 7.1 


1.97 


054 


Aggressive 


57.0+ 4.4 


62.5 + 10.1 


2.42 


019 


Nervous 


60.6 + 10.2 


61.6+ 7.6 


.31 


760 



There were a number of significant differences between the violent and nonviolent group- 
ings (Table 7). Children from families with violent fathers performed significantly more poorly 
academically, did not learn as much, and tended to be less happy. There was a tendency for 
them to behave less appropriately. Thus, as with the parents' reported scores, violence seems 
to be more of a discriminating variable in children's social competencies than severity of PTSD 
symptoms. 



Table 7. Teacher's TBCL Social Competency Scale Scores for Children from Families with 
Nonviolent and Violent Fathers (Values Are Mean + SD) 

Nonviolent Violent I p 
(n=33) (n=22) 

Academic Performance 3.5 ±0.8 2.7 ±0.7 3 70 .0001 

Externalizing 4.4 ±1.7 3.7 ±1.8 1.33 .190 

Behaving Appropriately 4.5 ±1.6 3.6 ±1.6 1.88 .066 

Learn Much 4.8 + 1.4 3.8 ±1.7 2.25 .029 

Happy 4.6 + 1.3 3.8 ±1.6 1.98 .058 



Discussion 

This study of eighty-six children from forty families found that many children resemble a 
clinic-seeking sample of age mates on many problematic behavior scales, and are, therefore, 
identifiable as children "at risk" for developing more severe psychiatric disorders. In general, 
parents saw their children as depressed, anxious, somatizing, schizoid, uncommunicative, 
hyperactive, aggressive, and delinquent, with boys being perceived as having slightly more 
problems. Within this "high-risk" group, a lower level of family functioning and current 
violent behavior in the father were found to be significantly associated with the behavior 
problems of the children. 

It is important to note that teachers saw a subgroup of fifty-five of these eighty-six children 
as significantly less behaviorally problematic than did the children's parents, rating them as 
more similar to the non-clinic seeking normative sample. This may reflect parental concerns 
and preoccupations that heavily weigh their observations. It may also be that when the child 
is in the family environment, he or she is triangulated into a dysfunctional family role, but 
outside the family, the same child, without role expectations, may behave differently. 

Parental perceptions can influence children's behavior; if parents see their child as prob- 
lematic, the likelihood of the child behaving that way is increased. In this study, very few 
differences were found between father's and mother's perceptions of child behaviors and 
social competencies. This was surprising because in the survivor literature, particularly in 
researching the Holocaust, several writers (Rakoff, Sigal, and Epstein, 1965; Sigal, Silver, and 
Rakoff, 1973) hypothesized that the survivor parent(s) tended to be either overly harsh and 
judgmental, to hold high expectations for their children, or to be overly lenient in their percep- 
tions of them. 

A major finding of this study, supported by both the parent and teacher ratings, was that 
children from families with a violent father were significantly more likely than children from 
families where the father was not violent to have more behavior problems, poorer school 
performance, and lower social competence. Girls ages six to eleven years with violent fathers 
were more frequently perceived as socially withdrawn and delinquent. All mean scores for 
girls ages twelve to sixteen from families with a violent father were in the clinical range, with 
externalizing behavior aggressive scale score and all internalizing behavior scores (anxious/ 
obsessive, schizoid, depressed /withdrawn, and immature/hyperactive) significantly higher 
than for girls with nonviolent fathers. For younger boys with a violent father, all externalizing 
behavior scores were significantly higher than for boys ages six to eleven with a nonviolent 
father; boys ages twelve to sixteen with a violent father showed all behavior scale scores 
higher than even the clinic-seeking mean. 

Teachers' scores corroborated this perception. They reported these children as demonstrat- 
ing poorer academic performance, not learning as much, not behaving appropriately, and less 
happy than their peers. They also reported them as more anxious, socially withdrawn, un- 
popular, inattentive, immature, self-destructive, and aggressive. Violent behavior has a 
powerfully destructive effect on children, and this effect in these families appears to be more 



61 



influential than either the father's PTSD or the level of family functioning. In this studv, 
violence was most strongly related to lower level of family functioning (families with lower 
cohesion and adaptability), lower socioeconomic status, larger family size, and unemployment 
or underemployment. In addition, a prominent symptom of PTSD, social isolation and 
alienation, is another social and family factor that often increases the likelihood of family 
violence (Steele, 1978). Violent behavior in the father was shown to have a great impact on 
general family functioning, which, in this study, has significant influence on the child's func- 
tion. Research has shown that veterans with PTSD experience a high incidence of marital 
discord and domestic violence as well as higher unemployment, drug and alcohol abuse, and 
social isolation (Figley, 1977). The causal relationship among these variables is unclear. For 
example, does the unemployment lead to increased symptoms (substance abuse, violence, and 
social isolation) or does an increase in symptoms lead to unemployment and thus influence 
general family functioning and child behavior? 

Clinical Implications 

To date, the connections between violent behavior, PTSD, and child development has not been 
a focus of significant professional attention. This study represents the first work to examine 
the transgenerational effects of combat-related PTSD on the veteran's family system, especially 
on children's social competence and behavior patterns. The findings of this study raise 
questions about preventive programs not only for children of combat veterans with PTSD who 
are from lower functioning families or whose fathers are violent, but also raise questions about 
children in general from families where there is violence. Effective intervention and treatment 
begins with identifying these families and, therefore, the children in these families as "high 
risk" and identifying, through an early comprehensive assessment, specific problem areas. 
This assessment needs to focus on individual and family dynamics, including violence, which 
always has a negative effect on family stability and emotional tone. Individual, couple and 
family therapy may all be necessary, dependent upon the individual case and family circum- 
stances. Clearly, treatment considerations will vary depending on who is the focus of treat- 
ment. 

Many child behaviors reported by the parents resemble behaviors exhibited by the father, 
e.g., depression, anxiety, low frustration tolerance, and outbursts of anger. In working with 
these children, clinicians need to be sensitive to the presence of these behaviors in the father as 
they diagnose and treat the child. The strengthening of ego functions should be a major focus 
of treatment with these children with an emphasis on reality-testing, increasing frustration 
tolerance, and encouragement of verbalization as an alternative to reenactment. These chil- 
dren need to recognize their separateness from their fathers and be helped to discover that 
being different from their dad would be what would make him most proud. They need to 
become aware that they are not responsible for their parents' behavior and pain and do not 
need to feel guilty about it. They can thus gain needed distance from the intensity of family 
interactions and begin to address their own developmental concerns more appropriately. 

The whole question of family and its role in the psychosocial generational transmission of 
trauma needs to be more clearly explored. During development, a child is subjected to an 
array of factors that affect him or her. These factors include the quality of the parents' interac- 
tion with each other and with the child, the mother's personality and her reactions to the 
father's PTSD, and the influence it has on the family life, the family dynamics, the child's 
constitution, and other life circumstances. These factors may aggravate or ameliorate particu- 
lar potential problems. 

From the studies of Holocaust survivors, children of psychiatrically disturbed parents, and 
this study, it is clearly important to continue to identify early those factors that make these 
children "high risk" and also continue to develop a knowledge base for the future that will 
guide clinicians toward more optimum interventions. Finally, longitudinal follow-up studies 
are needed that both assess further the risks in the different age groups and examine what 
happens to these families and children with treatment. 



91-084 0-95-3 



62 



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64 



Weissman, M.M., J.K. Leckman, D.G. Gammon, and B. Prusoff. 1984. Depression and anxietv 
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Author Contact Information 

To obtain a copy of this paper please contact: 

Laurie Harkness, Ph.D. 

Chief, Psychiatric Rehabilitation Program 

Veterans Affairs Medical Center 

West Haven, CT 06516 



Earl L. Giller, M.D., Ph.D. 

Associate Director of Clinical Research 

Pfizer Incorporated 

East Point Road 

Groton,CT 06340 



65 



STATEMENT 
of 

DENNIS K.RHOADES 

EXECUTIVE DIRECTOR 

AGENT ORANGE CLASS ASSISTANCE PROGRAM 

before the 

SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS 

COMMITTEE ON VETERANS AFFAIRS 

UNITED STATES HOUSE OF REPRESENTATIVES 

May 18, 1994 



Mr. Chairman, I appreciate the Subcommittee's invitation to appear 
today to discuss alternative models for providing needed social services to 
Vietnam veterans and their families. My name is Dennis Rhoades and I 
serve as the executive director of the Agent Orange Class Assistance Program 
(AOCAP). In that capacity I have overseen the development of a network of 
72 programs which provide broad based social services to Vietnam veterans 
and their families in all fifty states plus the District of Columbia and Puerto 
Rico. In the course of AOCAP's five and a half years of operation, this 
network has provided services to over 150,000 persons. 

As you are aware, Mr. Chairman, this week AOCAP is conducting a 
National Symposium, which will permit us to assess and distill the 
experience of our network in providing services to Vietnam veterans and 
their families and to assess the public policy implications of our efforts. We 
are holding this event precisely because the problems of the clients we serve 
necessitated the development of service methodologies which differ 
considerably from traditional veterans program service models. 

In order to understand why they differ, it may be useful to review 
AOCAP's development and the lawsuit settlement which created it. 

The Agent Orange Product Liability Litigation began in 1978, when a 
Vietnam veteran filed a lawsuit against the United States government and 
numerous chemical companies that manufactured herbicides, including 
Agent Orange, used as defoliants in the Vietnam War. Many other veterans 
soon filed similar lawsuits. The plaintiffs claimed that exposure to Agent 
Orange and other dioxin-contaminated herbicides caused injuries and death 
to veterans as well as miscarriages for their spouses and birth detects among 
their children. The lawsuits were transferred by the Multi-District Litigation 
Panel to the United States District Court, Eastern District of New York 
Ultimately, the case was certified as a class action and the plaintiff class was 
defined as all persons who served in the United States, New Zealand and 
Australian armed forces between 1961 and 1972 and who were injured by 
exposure to Agent Orange or other phenoxy herbicides while in or near 
Vietnam. The class also includes the parents, spouses, and children of the 
veterans. 

On May 7, 1984, the day the trial was to have begun, the attorneys for 
the plaintiff class and the chemical companies agreed to settle the case for $180 
million. After ruling that the settlement was fair and reasonable, the 
supervising judge, jack B. Weinstein, worked with an advisory board of 
Vietnam veterans to design a distribution plan that made the best and fairest 
use of the limited settlement fund. The Court solicited and received advice 
from hundreds of individual veterans and veterans organizations. 



66 



Throughout, the Court was constrained by the relatively small size of 
the settlement fund in comparison with a plaintiff class that included not 
only the three million veterans who served in Vietnam, but also their 
families. The Court initially announced the distribution plan in an opinion 
issued on May 28, 1985. The plan had two major components. 

The largest component, the Agent Orange Veteran Payment Program, 
is currently distributing cash payments to totally disabled Vietnam veterans 
and to the spouses or children of deceased Vietnam veterans. To be eligible 
for a payment, the applicant must show that the veteran meets a Court- 
approved test of exposure to Agent Orange and that the disability or death was 
not caused by traumatic, accidental or self-inflicted injury. The Court 
allocated $170 million of the settlement fund to the Payment Program. 

The second, and more unusual component of the distribution plan was 
the creation of a foundation which would provide services to the class 
through grants to human service organizations. Although the United States 
Second Circuit Court of Appeals would later proscribe the use of an 
independent, private foundation, it upheld the concept of distribution of a 
portion of the settlement funds in the form of grants, as long as such funding 
was conducted under the supervision of the District Court. In June of 1988, 
the Supreme Court upheld the settlement and distribution plan, as revised by 
the Second Circuit Court. The District Court appointed me executive director 
in December of 1988, as well as an unpaid, ten member Board of Advisors, all 
but one of whom is a Vietnam veteran. The Agent Orange Class Assistance 
Program (AOCAP) began operation the following month 

In developing the -Assistance Program as the distribution plan 
envisioned it, we faced several constraints For example, no program could 
be funded which involved research into the causal relationship between 
Agent Orange exposure and health effects. This, in effect, removed us nearly 
entirely from the ongoing debate about agent orange. In addition, the ruling 
of the Second Circuit Court of Appeals explicitly prohibited any political 
activity. For this reason, our relationship with the Congress, as well as other 
policy making bodies in the Federal government, has necessanlv been very 
limited. 

In addition to these constraints, we also confronted a number of 
challenges. First, since the settlement was the result of a nationwide class 
action, we were required to develop a program which was truly national in 
scope. Second, such a program needed to serve the entire class, which 
included not only the 2.5 to 3 million veterans who served in Vietnam, but 
also their parents, spouses and children Although the $52 million set aside 
by the court for AOCAP represented a substantial investment in Vietnam 
veterans and their families, the very size oi the class and the diversity o( 
needs presented a formidable challenge in equitable distribution ol these non- 
renewable resources. 

This latter question ol need and program locus was central to our 
efforts from AOCAP's earliest days. While both the advisory board and the 
court recognized many worthy needs, they were at the same time concerned 
that by distribution of funds into too many service areas the settlement would 
not achieve a positive lasting impact on the class. Our choices were 
numerous, as reflected in the proposals submitted in response to an August 
1988 Request for Proposal (KIT) issued by the Court-appointed Special Master 
for the Settlement, Kenneth R. Feinberg, shortly after the Supreme Court 
ruling. In addition to requesting funding for local memorials and research 
projects, the 147 proposals we received posed solutions to many problems, 
from homeless advocacy and employment and training programs, to a "cure" 
for agent orange poisoning (and Post Traumatic Stress Disorder) through 
massive injections o! vitamin C. 



67 



The proposals we received were thus not, in their totality, an accurate 
barometer of need, but instead reflected institutional interests and issues 
which were not necessarily congruent with those needs. Working with our 
advisory bdard, we sought to discover those areas in which a demonstrable 
need was clearly unmet and in which, with AOCAP's limited resources, the 
funds could do the greatest good. 

The need which was most apparent to us at the outset was for services 
for Vietnam veterans' children with health problems. As the subcommittee 
is well aware, throughout the course of the Agent Orange debate, veterans 
have expressed concern for the health of their children. Moreover, nearly 
sixty percent of all of the telephone calls and correspondence from the public 
as we began operation concerned child health issues, most particularly the 
financial burden in providing adequate health care 1 remember talking on 
the telephone with numerous families, main ol whom were so tar into debt 
owing to hospital and doctor bills, they were being evicted from their homes. 
While it was not, and is not, appropriate for the .Assistance Program to judge 
the cause of any given disability, we believed that it was AOC AP s 
responsibility to attempt to address the very real needs of these children and 
their families. 

Understandably, alter five years of court appeals, the expectations of 
Vietnam veterans and their families about our program's service's were high. 
AOCAP thus began its grant making within three months of the program's 
startup, before we had even acquired a permanent office. Still wrestling with 
establishing long range goals, vve developed a a set of criteria lor our initial 
selections which has served us well for the past five sears: (1) that the grants 
reflect a broad geographic distribution; (2) that grants be made to 
organizations with proven records of successful services in the community; 
(3) that AOCAP funding would neither duplicate existing services nor replace 
public monies; and (4) that initial grants would place a special emphasis on 
services to families with children with developmental or other chronic 
disabilities. 

In consultation with our Advisory Board and the court, we carefully 
studied and monitored the progress of those organizations to which we had 
distributed funding. As the number ol grants we developed and supervised 
grew, the more apparent it became that there was a real commonality in 
service approaches among our most effective programs. These approaches 
were guided by the following principles: 

Family Centered Service. The very nature of the plaintiff class - 
consisting of the Vietnam veteran and his or her family as co-equal partners - 
seemed to dictate a family-oriented approach to the provision ol services. In 
this, AOCAP was not alone: for the past several years, human service 
providers have acknowledged that empowering the family empowers the 
individuals in the family. Dr. Charles Figley, who is to follow me on this 
panel, discusses this issue m some detail Moreover, our projects were 
finding that many veterans were accessible only though providing help to 
their families. After twenty years, many ol the most disadvantaged Vietnam 
veterans had become mistrustful of agencies which purported to serve them 
as individuals. But while they might eschew seeking or receiving help for 
themselves, they would rarely, if ever, deny that assistance to their families, 
regardless oi any institutional prejudices they might have .And since family 
centered services are holistic in their verv nature, the veteran received the 
help that he or she might otherwise have spurned. 

Service Coordination Main of the Vietnam veterans and their 
families who visited our projects had multiple needs: income supplement for 
high doctor and hospitalization bills, basic preventative health care, mental 



68 



health, adaptive equipment, etc. Resources to meet these needs were 
available, but often difficult to access. Medicaid, for example, has been rightly 
characterized as the most user-unfriendly program ever adopted by Congress. 
In one particular state, the initial application for care is forty-two pages long. 
The need to maneuver through the welter of applications for service, 
changing eligibility requirements, and resistant bureaucracies is for many 
families an insurmountable barrier. Many have simply given up. The ability 
of a well trained service coordinator to guide a family through the maze 
necessary to meet multiple needs is therefore invaluable. In addition, given 
AOCAP's limited resources and the extent of the need for help, the ability of a 
project to leverage resources was clearly critical to its success. In this area, our 
projects have enjoyed considerable success. Dr. Bryan Smith will discuss later 
this morning the surprising extent to which the Vietnam Veterans Family 
Assistance Network has been able to find resources for its clients which far 
exceed AOCAP's funding investment. 

Community-Based Service. Service coordination succeeds best when 
the services offered by an agency are a part of an integrated delivery system in 
the community. This, Mr. Chairman, is as true for veterans as it is for anyone 
else. Each community differs in its needs and systems designed to meet those 
needs. As members of this subcommittee are well aware, the trend toward 
decentralization of programs is now over a generation old. Large scale 
national categorical programs are becoming rarer as we approach the end of 
this century. Service coordinators need not only to have a basic generic 
understanding of available services, they also need a knowledge of eligibility 
requirements peculiar to a given program at the state or local level. Effective 
service coordinators constantly work to develop key agency contacts with 
whom they can establish a good working relationship. 

Cultural Competence. Each veteran and family member is also as 
product of their community. Their needs and attitudes are shaped by that 
community. This is particularly the case with minority veterans. Developing 
the cultural competence which acknowledges differences between and within 
communities in order to tailor effective programs for Vietnam veterans and 
their families has been a vital element in our grant development efforts. 

As we began to build these principles into our new grants and grant 
renewals, a coherent network of services, reaching from Fairbanks, Alaska to 
Brevard County, Florida began to emerge. Rather than operating in isolation, 
our projects started collaborating in serving individual clients, as well as 
working to resolve common problems. In the New England area, the AOCAP 
grantees formed a consortium and developed a common intake form. 
Similar collaborative systems were established in the midwest, the Rocky 
Mountain states and within state in both California and New York. These 
regional consortia were not the full extent of network collaboration. Later 
this morning you will hear from Tom James and Dr. Bryan Smith concerning 
agencies in widely different geographic areas coming together to support the 
needs of individual families. 

Mr. Chairman, I do not mean to suggest that our network is 
homogeneous or that we have developed grants based on a rigid template In 
fact, there is considerable diversity among the agencies which comprise our 
network. These organizations fall into four general categories: veterans 
organizations, disability service agencies, family service programs and 
national support projects. 

Veterans organizations comprise about a third oi current AOCAP 
grantees. In addition to the I5-state family assistance program of The 
American Legion, AOCAP provides funding to 23 community based veterans 
projects, whose primary mission is to meet the service needs of Vietnam 
veterans. AOCAP grants have expanded the service capabilities of these 



69 



organizations, which traditionally have provided help only to individual 
veterans. AOCAP funding has permitted these agencies to serve the broader 
needs of Vietnam veterans and their families, with particular emphasis upon 
services to children with disabilities. 

Twenty-four AOCAP programs are operated by agencies serving 
persons with disabilities. They include University Affiliated Programs for 
Children with Developmental Disabilities (UAPsj, national disability 
organizations, parent advocacy agencies, and local chapters of organizations 
such as United Cerebral Palsy and the Association for Retarded Citizens. 

Twenty grantees are agencies whose primary mission is counseling, 
either general family therapy, or problem-specific services such as substance 
abuse recovery programs. Family assistance agencies (many of which, 
incidentally, began as service agencies for returning veterans of World War I 
and their families) have shown keen interest in participating in the 
Assistance Program since its beginning, and often specialize in service 
coordination, a critical need of Vietnam veterans and their families. 

Five national support projects provide the core of the consultation, 
technical assistance, training and other support services to the network of 
AOCAP-funded community projects in order for those projects to access the 
tools, skills and expert advocacy necessary to serve individual clients. These 
projects range from the National Veterans Legal Services Project, with their 
expert knowledge of the veterans benefits system and veterans law to the 
Access Group project of the United Cerebral Palsy Association and their state 
of the art knowledge regarding assistive technology for persons with 
disabilities. Each of these projects provides a significant level of direct 
services to Agent Orange Class Members as well. Also included among the 
national support projects is the National Information System (N1S) at the 
University of South Carolina. The NIS is an advice and counseling system 
accessible through a toll-free telephone line which helps families develop 
strategies for serving the needs of their children and link up with appropriate 
resources in their communities or anywhere they may be available. NIS 
counselors are well trained and educated in the field of developmental 
disabilities, and they work from a nationwide database of over 100,000 service 
providers in seeking out sources of help for Vietnam veterans' children. 

Tied together through AOCAP's electronic mail system, which we call 
VETnet, the Vietnam Veterans Family Assistance Network, is capable of 
providing services to Vietnam veterans and their families in need 
throughout the United States. The best example of that capability is tound in 
our National Outreach Initiative. This initiative was designed to contact all 
of the original agent orange settlement claimants who submitted claims based 
upon the health problems oi their children. 

Following tlie May 1984 settlement agreement, but prior to the 
development of the distribution plan, approximately 250,000 claims were tiled 
against the settlement. During the period of higher court appeals, these 
claims records languished in the basement of the Federal District Courthouse 
in Uniondale, New York. Once the settlement was finally approved, all 
claimants were notified of the provisions oi the Payment Program. Yet, many 
of the claims were not made by veterans with various medical conditions, but 
were made by families on behalf of their children. Using students from a 
nearby law school, these claims were disaggregated from the larger group, and 
their addresses were sent to NIS. Serving as a clearinghouse, NIS began two 
years ago sending registered letters to the last known address of these families. 
Upon making contact with the family, the NIS screenedJThat family's 
presenting needs and referred that family either to an AOCAP grantee or to 
another appropriate agency, depending upon what services were being 
sought. As of last week, Mr. Chairman, we will have finished our effort to 



70 



contact and provide services to all 76,000 families with claims filed on behalf 
of children. 

Mr. Chairman, I am aware that many of the panelists who will follow 
me are either AOCAP service providers or Vietnam veterans and their 
families who have been helped by through their assistance. 1 have attempted 
here only to provide the subcommittee with a broad overview of the AOCAP 
system and its development, a context for understanding why the service 
models which have evolved from our five year effort really do present a 
meaningful alternative to more traditional methodologies. 

Mr. Chairman, less than two weeks ago marked the tenth anniversary 
of the Agent Orange settlement. Though many have quarreled, and will 
continue to quarrel , about whether a settlement should have been reached at 
all, I believe we have accomplished some important tasks with the limited 
settlement resources at our disposal. But our efforts are time-limited, the 
settlement funds finite and not renewable. Ultimately the care our veterans 
and their families need, like the problems associated with Agent Orange, is 
the responsibility of government. 1 respectfully ask that you bear this in 
mind, as you hear from the service providers and their clients who follow. 

Once again, thank you for inviting me to this hearing. 



71 



STATEMENT 

Of 

CHARLES R. FIGLEY 

PROFESSOR AND DIRECTOR 

PSYCHOSOCIAL STRESS RESEARCH PROGRAM & FAMILY THERAPY 

CENTER 

FLORIDA STATE UNIVERSITY-TALLAHASSEE, FLORIDA 

before the 

SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS 

COMMITTEE ON VETERANS AFFAIRS 

UNITED STATES HOUSE OF REPRESENTATIVES 



May 18, 1994 



72 



Mr. Chairman, I am honored to be invited by the Subcommittee to assist you 
in your critical work on behalf of Vietnam war veterans and other veterans to insure 
that they receive high quality, cost-effective social services. My name is Dr. Charles 
R. Figley. I am a professor at Florida State University. I am an elected Fellow in five 
professional associations including the American Psychological Association and the 
American Association for Marriage and Family Therapy. At FSU I direct a nationally 
recognized therapy center which includes a family therapy clinic and a stress 
reduction clinic, and a very special project, the Vietnam Veteran Families Project. The 
project has been funded in large part by the Agent Orange Class Assistance 
Program and by the National Veterans Foundation of Los Angeles. We have been 
active in developing a highly efficient antidote to PTSD. 

I am here today, Mr. Chairman, to support Congressional efforts to make 
government more family-friendly. I hope to provide support for this effort by 
emphasizing the need for family-centered veteran services, especially medical and 
mental health services. My hope is that this Committee will be instrumental in 
insisting, as part of their oversight function, that such characteristics be part of any 
health and mental health services package, especially those that focus on the long- 
term needs of war veterans. For the bulk of my time I would like to identify five 
characteristics of family-centered services. First I would like to provide some rationale 
for adopting a family-centered approach. 

Members of Congress and most Americans are members of families. All had 
parents, most have nurtured or are nurturing children. Our families are, most often, our 
lives; our most precious resource; the most sacred of treasures. When our children 
are happy, it makes us happy; when they are sad, we are sad. And our partner, our 
spouse, our friend-irrespective of our living arrangements-know us better than 
nearly anyone else, often knows us better than we know ourselves. Family 
members are precious. When they are ill it is extremely stressful for us. 

Mr. Chairman, scholars like myself who study the family are impressed by its 
power to inspire, depress, protect, hide, influence, hurt, preoccupy, and obsess its 
members. The family is a system. As such, it functions well or not so well by virtue 
of those who are its members. With "good families" members can prosper; the 
opposite is true for "bad families." Unfortunately, mental health professionals mostly 
see the "bad families", or at least that is the way portrayed by many clients. Enough 
clients to convince psychotherapists that families do more harm than good. Yet, the 
great majority of households and families function well. More than 75% of Americans 
treasure their family and family life over all else. Most college students cite parents as 
the most consistent source of social support. We are born, we live, and we die in 
families and are better off for it, by and large. 

As a traumatologist I know that when we are exposed to highly stressful 
situations, families play a vital role in the recovery process. As an intimate social 
support system, family members promote recovery in at least four separate and 
related ways: They are (1 ) detecting traumatic stress; (2) confronting the trauma; (3) 
urging the recapitulation of the catastrophe; and (4) facilitating resolution of the 
trauma-inducing conflicts. We are all, nearly always, trying to figure out and help other 
family members-even when they don't want it. 

When a war veteran returns he (or she) is shaken up physically and mentally. 
This shaking is transmitted to the family in various ways. The recovery works in the 
same way, only in reverse. Family members are connected to each other. The 
family system is like a giant spider web, the connections linking family members 
vibrate with each shock to the system. The family is a very unique system. Think 
about your own family. Family members are connected to one another, at varying 
times and intensities in at least five ways emotionally, genetically, socially, 
economically, and physically. Thus shaking endured by the family affects all aspects 
of the family system. Research suggests that this systemic shaking, referred to by 



73 



scholars as secondary traumatic stress or compassion fatigue, a form of burnout, is 
frequently found among combatants traumatized in the line of duty in combat. 

Mr. Chairman, as you know, the special study of the Vietnam war generation, 
mandated by Congress, illustrated this phenomenon. The study, conducted by the 
Research Triangle Institute of North Carolina, under the direction of Dr. Richard Kulka, 
has become one of the most important community mental health studies ever 
conducted. 

Among other things, the research team found that combat stress is 
"infectious." The research team conducted interviews the spouses or partners 
living with the war veterans. Nearly everyone asked participated and answered all 
the questions. Among other things, the research team found that households with a 
war vet suffering from PTSD was significantly different from households with a war 
vet who was not suffering from PTSD. 

Partners/Spouses with diagnosed with PTSD in contrast to those without, 
have the following characteristics: (1 ) Married More Often, (2) Fewer Years Married; 
(3) Higher Estimates of PTSD in Partner; (4) Higher Readjustment Problem Index 
Score; (5) Lower Life Functioning (6) Higher Marital Problems Index; (7) Higher 
Standard Family Violence Index ; (8) Alternate Family Violence Index; (9) Standard 
Family Violence Index for Partner/Spouse; (10) Alternate Family Violence Index for 
Partner/Spouse; (11) Higher Childhood Behavior Problems Index; (12) Higher 
Alternate Childhood Behavior Problems Index; (13) Lower Subjective Well-Being 
of the Partner/Spouse; (14) Higher PERI Demoralization Score of the S/P; and (1 5) 
Higher Incidence of S/P Felt Like Nervous Breakdown. 

Those households with war vets with PTSD appear to be less happy and 
satisfied, to have more general distresses, including feelings as though they might 
have a nervous breakdown, have children with various behavioral problems, 
members who are more demoralized than households without PTSD. Also, they 
report more marital problems and more family violence than in families of those 
without PTSD. 



Mr. Chairman, there is a human side to all of this. Examples abound where a 
war veteran has PTSD and, somehow, the family functions quite well. 

Gail Davies, a colleague and friend, and her family is a good example. She 
served as a nurse in Vietnam between 1969-1970 in Quang Tri Province at the 
Medical Evacuation Hospital. She has noted recently that partly because of her 
Vietnam war experiences she treated her twin sons differently. Though they appear 
to not have suffered any from it, she notes the times within the family that the war 
played a negative part. She experienced periods during which she felt she 
behaved over-protective and fearful for them. At times she would withhold 
information, especially that information which related to her war experiences. Their 
high school years and their graduation from high school were also very stressful for 
the family. This she partly attributes to the parallels between their ages and the ages 
of the combat soldiers she cared for in Vietnam. The stress contributed to increased 
anger, distancing and arguing between all family members. 

Gary May, long-time friend and veteran advocate is currently a fellow Social 
Work professor at another university (Southern Indiana University). He was one of 
the first to educate his fellow social workers to the plight of Vietnam veterans. He 
was a member of the faculty of the first national training conducted by the VA on the 
topic more than 1 5 years ago. Gary lost part of both legs in Vietnam. One day not 
long ago, after struggling for years to walk using his prosthetic legs, Gary made a 
decision. He decided that walking around in prosthetic legs takes too much energy. 
He saves energy these days by riding in a wheel chair. His family recognized the 
shift right away. Gary's children have seen him in many moods-the highs and lows- 
but they know what he did in the war and his life after it means something. 

Michelle Mitchell is 24 from Tampa. She was five years old when her 
father, Michael, died in Vietnam near Tarn Ky. Her mother claims she looks a lot like 
him. She said in an interview: 

"When I turned eighteen, my mother gave me a hope chest filled with Dad's 
things. Every time we look into it, we both cry. There re letters Mom sent that he 
never received. One was postmarked on the day he died." (Santoli, A. "We Never 
Knew Our Fathers" Parade Magazine . May 27, 1 990, page 21 -22.) 



74 



A final example is a composite of numerous cases. Doug Johnson has two 
teenage girls and a younger son. He has been a contractor for three years and is 
doing very well with 5-8 employees. Doug was diagnosed with PTSD when he 
was 30, this was over 10 years after leaving Vietnam. His family knew about his 
problem long before that. His 12-year old son once found him huddling in a hallway 
closet looking frightened and confused. Although Doug regained consciousness 
quickly, his son was shocked by it. And this would not be an isolated incident over 
the years. Now with proper diagnosis, Doug is treated and fully recovered. His 
family is still recovering. 

These families deserve programs that consider the circumstances and needs 
of all its members. In terms of medical care, for example, being family-centered 
means services performed first by a family physician. The family physician should 
know everybody in the family by name and disposition. Family-centered mental 
health means the same thing. The therapist looks for strengths and attempts to help 
the family identify and correct unwanted patterns or problems affecting everyone. 
Family stress increases in times of transition, such as the birth, death, or departure of 
a family member. 

A family-centered approach adopts a systems perspective which is 
committed to improving the quality of human services. As a result practitioners are 
not only concerned about the client family's immediate environment, but also 
environments in which members work, play, are educated, and the community and 
nation within which they live. 

Practitioners always attempt to increase the power and sense of control 
within the family by helping to realize and solve their own problems. Practitioners 
view their clients within a larger, community context and, with the family's permission 
collaborate with other professionals with some responsibility over the welfare of the 
family (e.g., physician, dentist, teachers). This also extends to sharing insights and 
important clinical methods and innovations with one's fellow professionals at 
conferences and through professional publications. 

This family-centered paradigm can be applied to a program at the local or 
regional level, but it can also be applied at the national level. The only example of a 
national family-friendly or family-centered approach to the delivery of services is the 
AOCAP system. Because of the National Symposium schedule, many of those 
associated with the AOCAP system are here today. They will describe their own 
program and, collectively, provides a description of the architecture of this nation- 
wide system. Let me discuss a few of its characteristics that make it so important as a 
national model. 

Veteran's services have traditionally been designed to meet the veteran's 
needs - the veteran has been the only recipient of the services. The families of 
these veterans, while being valued in our society, have been excluded as 
beneficiaries by these service providers. AOCAP recognized from the beginning 
the powerful role of the family in service delivery. They recognized the role of the 
family in the health of it's members is a concept which has emerged only within the 
past 40 years. 

AOCAP's national program can serve as one model for a family-centered 
service delivery system. This grant-funded national network of independent 
programs was established to address the needs of Vietnam veteran families. In 
large measure, it's uniqueness lies in the fact that it was developed in response to 
needs of veterans rather than capitalizing on the capacities of the service delivery 
system. AOCAP has not been limited in it's responses by traditional bureaucratic 
structures, layers of hierarchical managers, standardized policies and procedures, and 
intimidation. It was not organized around the traditional central administrative office 
which mandated traditional methods of operation. 

What AOCAP asked of the network of grantees was commitment to meeting 
the needs of veterans in their communities, in whatever way possible, drawing on 
their own professional and personal experiences within their communities. There 
was support for creating new, non-traditional programs, specialized programs, 
broad-based programs, and networking between programs. Administrative 
support for sharing information with other grantees has been demonstrated through 
the AOCAP national and regional conferences. 

What has emerged from this novel approach of serving Vietnam veterans 
has been a national network of family and children focused programs. Just a glance at 



75 



the list of projects names from around the country reveals the family and child focus: 
Portland, Indiana's Community and Family Services; Green Bay, Wisconsin's Family 
Service Association of Brown Co.; Anaheim, California's Team of Advocates for 
Special Kids; Hawaii's Learning Disabilities Association; Tallahassee, Florida's 
Vietnam Veteran Families Project, and so many others. 

AOCAP has been able to accomplish what traditional veteran service 
programs have been unable to. These individual projects have been designed in 
the communities where the veteran lives. The project's are staffed with individuals 
familiar with the community, with family values common in that community, with area 
resources, and how to access those resources for their clients. Additionally, they 
were linked to a national network of AOCAP providers which enabled these case 
managers to seek and find resources beyond their geographic boundaries. In a 
sense, AOCAP programs have been the link between resources in the community 
and beyond the community. 

Some may question the wisdom of making government programs more 
family friendly. Adopting a family-centered approach to veteran services is (1 ) good 
social policy, (2) cost-effective, (3) humane, and (4) it helps pay our debt to war 
veterans. 

* It is good health policy because the preponderance of evidence shows that 
treating the family as a system reduces costs, increases family morale, increases 
medical compliance, and increases the treatment effectiveness. 

* It is cost-effective because families first go to a family-oriented health or 
mental health practitioner to insure that presenting problems can be remedied 
without a specialist or hospitalization. Much of family-centered care is preventive: 
good psychoeducation about parenting, sexual development, nutrition, exercise, 
and family communication. Research has confirmed the importance of this preventive 
approach in reducing health care utilization rates. 

* It is humane because families suffer from war-related stressors too. They 
need the recognition of this. 

* Perhaps as importantly as any other reason, it repays our Nation's debts. 
Lincoln was not the first to remind the nation of these debts in his Second 

Inaugural Address on a chilly March 4 in 1 865. In the body of this speech was a 
message. It urged the country to bind up the nation and take care of those who were 
our protectors in that great struggle. Because if we do not attend to those most hurt 
by our war, we will fight them again. It was one of the first and most powerful 
discussions of a veteran's family. In the middle of the address he stated, 

"With malice toward none; with charity for all; with firmness in the right, as God 
gives us to see the right, let us strive on to finish the work we are in; to bind up the 
nation's wounds; to care for him who shall have borne the battle, and for his widow, 
and his orphan - to do all which may achieve and cherish a just and lasting peace 
among ourselves, and with all nations." 

Today I will suggest that we owe a debt. The debt is owed not just to those 
who bore the battle, but also to those who bore the battle of the battle: veterans 
families. These families who are left to grieve what the war has taken from them, like 
Michelle Mitchell and her mother. And even if veteran families are a healthy as Gary 
May's, they deserve services that take everyone into account. 

In conclusion, Mr. Chairman, what is most important is our confirmation as a 
Nation that we collectively recognize: 

that the wake of trauma is long-lasting and pervasive; 

that war is a unique stressor but the effect is generally the same as 
other highly stressful events; 

but that war is both highly stressful and profound; 

and that war is frightening and long-lasting; 

that one of the most affected is the war veteran family; 



76 



that adopting a family-centered approach to veteran services is cost 
effective, humane, and good public policy. 

Therefore, any program for the veteran should focus on his family unit who are 
fellow war veterans, once removed. 

Mr. Chairman, thank you for your attention and your invitation. 



77 



EXTRACTS FROM VET CENTERS' DIRECT SERVICE 
OPERATIONS MANUAL 

Collectively these [social and psychological] services are 
designed to assist veterans resolve war-related 
psychological difficulties and attain a well adjusted post-war 
work and family life. Vet Center services include: 

(1) Screening for PTSD (post-traumatic stress disorder) in 
all cases; 

(2) Counseling and / or psychotherapy for PTSD when 
indicated; 

(3) Employment and educational counseling; 

(4) Job-finding assistance; 

(5) Family counseling when needed for the readjustment of 
the veteran ; and 

(6) Multiple activities designed to broker services for 
veterans. 

(Source: Vet Centers' DIRECT SERVICE OPERATIONS MANUAL, Page 3-1) 



c. Significant Others. Significant others are seen if 
necessary to provide adequate readjustment counseling 
services to the veteran. 

(Source: Vet Centers' DIRECT SERVICE OPERATIONS MANUAL, Page 4-1) 



78 



Statement of 



EILEEN PENCER 

Vice President, Chief Program Officer 

and Director of the 

Vietnam Veterans Family Services Center 

Lower Eastside Service Center, Inc (LESC) 

New York City, New York 



Before the 

Subcommittee on Oversight and Investigations 

of the 

House Veterans' Affairs Committee 



May 18th, 1994 



79 



Chairman Evans and Members of the Sub-Committee, thank you for 
inviting me to testify before you today. I would like to give you an 
overview of a very effective family service model for the provision of 
treatment and other services to Vietnam Veterans and their loved ones 
that we have developed at Lower Eastside Service Center (LESC). It is 
considered by many in the New York veterans' community as an 
indispensable resource, and clearly, LESC's Vietnam Veterans Family 
Services Center (WFSC) fills a formerly unmet need. LESC recognizes 
the value of helping veterans in the context of their families and, 
through Agent Orange Class Assistance funding, addresses their needs 
through the use of a geographically dispersed service delivery network. 

I am currently Vice President, Chief Program Officer of LESC. a 
private, community-based, non-profit organization in New York City 
providing substance abuse, mental health. HIV and TB services. I am 
responsible for the supervision of all treatment programs. I joined 
LESC in 1990 and participated in the development of the WFSC as 
Supervisor and Family Therapist. My educational background (post- 
graduate degrees in Special Education and Social Work) and 
experience in special education, marriage and family therapy were 
contributing factors to the development of a program with a 
family/child focus. 

WFSC. an Agent Orange Class Assistance Program grantee agency. 
was the first of its kind in the New York metropolitan area and at its 
inception was essentially the only family-centered Vietnam Veterans' 
resource in the metropolitan area". Currently. WFSC has developed and 
implemented a collaborative, integrated sen-ice delivery model with the 
VA Veterans Outreach Centers, where we have established satellite 
clinics and where our family therapists provide services. 

Our funding through the Agent Orange Class Assistance Program 
will be ending within the next two years, with the result that the 
families of veterans to whom we provide services may be deprived of 
such services permanently. It is imperative that funding be continued 
to enable community-based organizations such as ours to continue to 
provide family treatment for Vietnam veterans. 



OVERVIEW OF LESC: 

Throughout its thirty-five year history. LESC has remained loyal to 
its original mission of providing services for individuals and families 
with substance-abuse related problems such as addiction, mental 
illness. HIV and TB. Today. LESC is recognized as a pioneer in the field 
of substance abuse and is one of the largest non-hospital based 
substance abuse treatment centers in New York City. 

Using a coordinated model of care. LESC provides comprehensive 
outpatient services through the WFSC. as well as through its Mental 
Health Clinic, Methadone Treatment Program and HIV - Counseling. 
Testing. Referral. Partner Notification /Primary Care/Directly Observed 
Preventive Therapy Program. Residential services are provided through 
the Short Stay Methadone and Su Casa Methadone to Abstinence 
Programs. 

LESC's ongoing determination to broaden its continuum of care to 
the community led counseling staff to recognize that Vietnam veterans 
presented a different profile and that their distinct needs required 
specialized services. In the process of networking and interfacing with 
a broad range of service providers, they became familiar with the 
veteran's specialized network of care and developed informal 
affiliations with veterans' service organizations. These same 
organizations would later support the establishment of the WFSC. 



80 



GENESIS OF WFSC: 

Veterans' families are often significantly affected by the problems 
affecting veterans, including Post-Traumatic Stress Disorder (PTSD). 
secondary PTSD. substance abuse or other dysfunctional behaviors. 
United States District Court Judge Jack B. Weinstein. presiding judge 
in the settlement of the Agent Orange Class Action lawsuit, directed 
services to those associated with the veteran, primarily the children, 
spouses and parents. The Agent Orange Class Assistance Program was 
established in 1984 to distribute funds and services to programs 
throughout the United States, to reach out to these categories of the 
veteran population. 

At the same time. LESC recognized in 1989 that Vietnam veterans 
and their families did not receive adequate services and decided to 
enter into a partnership with the Vietnam veterans community to 
provide such services. Through this partnership, the WFSC was 
established in August 1990 to provide treatment for Vietnam veterans, 
their wives and significant others and most importantly, their children. 
From its inception, the WFSC's goals have included veteran 
community collaboration, service coordination and family-centered, 
systems treatment. 

Overview of WFSC Services: 

The WFSC is a comprehensive family treatment and referral center 
based in lower Manhattan and is thus centrally located and easily 
accessible to all mass transportation systems. Program staff consist of 
three full-time certified clinical social workers, a part-time 
Administrative Assistant and a Security Guard. Taking into account 
the veteran's war experience as a major contributing factor to family 
dysfunction, WFSC staff provide case management, counseling. 
referral assistance and advocacy services to Vietnam veterans' families. 
Counseling services include individual, couples and family therapy; 
group therapy for children, adolescents, adult children of Vietnam 
veterans and women; PTSD and secondary PTSD education/counseling. 
Special emphasis is placed on the secondary effects of PTSD in 
children, with referrals facilitated for those whose school performance, 
functioning and behavior may be indicative of psychological, 
developmental, and/or learning disabilities. 

WFSC utilizes a family-centered "systems" approach to treat the 
entire family constellation. Addressing members of the veteran's family 
as equal partners removes the veteran from the role of "identified 
patient" and source of pathology, and shifts the restorative 
responsibility onto the veteran's interpersonal network, the family. We 
firmly believe that the entire family's participation in the resolution 
and restorative process is critical; responsibility for effecting and 
maintaining change cannot rest with the veteran alone. 

Our clients represent a broad cross-section of the New York 
metropolitan area veterans' population: the formerly homeless, those 
receiving public assistance, the working poor, the struggling middle- 
class. Primarily residing in the inner-city, with multiple levels of stress 
brought on by a prevalence of violence, crime and substance abuse, 
these families are 42% White. 36% African-American and 22% 
Hispanic. 

In addition to the range of therapeutic services, children and their 
families are granted temporary reprieve from their daily stress to 
participate in family-oriented group experiences within this 
community-based environment. For example, each December, WFSC 
staff hold a Christmas/Hanukkah party for children that begins with 
recreational activities, therapist-led carol singing and distribution of 
holiday stockings and gifts and ends with WFSC's Security Guard 
acting as Santa Claus. The WFSC represents a unique family resource 
with a distinctly human approach for this community. 



81 



WFSC/VA VET CENTERS' COLLABORATIVE MODEL: 

An overriding goal of the WFSC has been that of integrating family 
services into the established resource network of veterans' community 
services. We have found that by establishing linkages with a broad 
range of veterans' service providers we are better able to coordinate 
case management services and facilitate effective service delivery. In 
keeping with this goal. WFSC staff have successfully gained Vietnam 
veterans' community support by working on-site at VA Vet Centers, 
where WFSC has established satellite clinics and where WFSC family 
therapists are currently outposted. WFSC family therapists function as 
an integral part of the VA Vet Center treatment team, share in case 
conferences, receive and make referrals and collaborate in shared 
cases. We also collaborate in accessing much-needed resources for our 
respective clients through a coordinated system of case management 
services. This partnership brings myriad benefits to our work with 
veterans and their families, including proximity to their home 
communities and services' networks and increased effectiveness in our 
advocacy on their behalf. 

There is a direct benefit to veterans as well through our 
collaborative team model. Our program efforts often enhance veterans' 
self-esteem and functioning as responsible parents. For example, the 
psychiatrically-impaired veteran suffering from PTSD becomes 
compliant with his psychotropic medication out of concern for his 
family's safety: the substance abusing, homeless veteran, motivated by 
the prospect of reunification with his child, becomes drug-free and 
economically self-sufficient: the veteran newly-aware of the consequent 
effects of domestic violence on his family instead models positive, 
cooperative behavior and breaks the cycle of destructive behavior. An 
effective, coordinated team now provides the full range of treatment for 
veterans suffering from PTSD. and/or substance-abuse, reducing 
associated problems such as domestic violence and secondary PTSD. 

For WFSC and VA Vet Center staff, this partnership provides 
opportunities for collaborative learning, as well. For example, in 1991, 
we were invited to present on "Domestic Violence" at a VA Vet Center 
Clinical Conference: for three consecutive years, we have been invited 
to present at the veteran-sponsored Annual Conference of the Still 
Hidden Client". Our participation is always well-received by a 
community that values our contributions and recognizes the 
importance of family services programs such as ours. The WFSC is 
proud to have forged this collaborative vehicle, which is an innovative 
model of a productive relationship between a community-based 
organization and a federal agency. 

Bridging the Gap in Veteran-Family Services Treatment: 

The principal benefit of our partnership with the VA lies in the 
complementarity of services that bridge the gap in services to families, 
who. based upon VA eligibility requirements are otherwise ineligible 
for these services. Thus." while the VA Vet Center's focus is on the 
"veteran," with services developed in accordance with the veteran's 
needs: the WFSC's focus is on the "family," with services tailored to 
meet client-family needs. The implications of this complementarity are 
far-reaching and a source of significant gain for families, who, were it 
not for the WFSC. would be totally without services. The following 
outlines the VA Vet Centers' gap in services to veteran-families that the 
WFSC has effectively bridged. 

Currently, in VA Vet Centers, the veteran-family may receive 
services only as a direct adjunct to the veteran's treatment; family 
service eligibility is contingent upon the veteran being the primary 
client. Services may be provided for members of the immediate family 
~ if such services are determined to be essential to the effective 
treatment and readjustment of the veteran. Consequently, the family is 
ineligible for services if the veteran is unwilling or unmotivated to seek 
treatment, or if the family lives apart from the veteran through 
separation, divorce or incarceration. The family may also become 
ineligible for continuation of services should the veteran withdraw 



82 



from treatment or should his/her marital situation change. Thus, the 
family will only remain eligible for service continuation if their 
participation is essential to the treatment of the veteran. 

Veteran-family survivors are also ineligible for family services at 
the VA Vet Centers. For example, widows and children of veterans 
killed in action, prisoners of war, missing in action or whose deaths 
occurred following the war. are not entitled to grief therapy or grief- 
resolution. "Gold Star Mothers" who lost sons/daughters and paid the 
highest price for their country are also ineligible for services. Prior to 
the inception of the WFSC. these categories of families requiring 
specialized veteran-related services were routinely referred for 
standard mental health services to traditional social service centers. 

Without recourse to specialized family service programs such as 
the WFSC, these families wounds will never heal. These in-need 
families would again be referred to traditional community mental 
health agencies lacking professionals specially-trained in second 
generation effects of FrSD. war trauma counseling and with limited 
knowledge of veterans' community resources. 

OUR TARGET POPULATION: VETERANS' CHILDREN: 

WFSC's greatest contribution to the veterans' community is in its 
service to our target population - veterans' children. Our service menu 
is without parallel within either the traditional veterans' services 
system or the larger mental health community in addressing veterans' 
children's physical, emotional, behavioral and developmental needs. 
This includes facilitating referrals for diagnostic assessment, 
screening and specialized services. In accordance with our systems 
approach, we enter into collaborative relationships with all other 
systems involved in the child's care and develop an overall treatment 
plan that ensures service coordination and continuity of care. We 
believe that multi-faceted services, consisting of client-centered case- 
management and counseling are most effective in addressing these 
children's complex constellation of needs. 

Since, approximately 85% of our children and adolescents have 
their initial therapy experience at the WFSC. we exercise both skill 
and caring to engage the child's participation and cooperation in the 
treatment process. Thus, often for the first time, within either 
individual, family and/or group counseling, children and adolescents 
vent their feelings and explore longstanding, sensitive, family issues 
such as the veteran's PTSD. substance abuse or domestic violence. 

The WFSC provides a broad range ol treatment options for 
children based upon their age. functioning, and their physical and 
emotional development. Approximately 20% of children receiving 
services are between the ages of three through eight. They freely 
communicate private, innermost thoughts using paint, collage or 
dollhouse play, while they engage in "play" therapy. Approximately 57% 
of children receiving services are between the ages of nine through 
nineteen and engage in behavioral or psychodynamic therapy. Many 
are referred due to acting out in school, brought on by stress from a 
dysfunctional home environment. WFSC therapists work closely with 
school guidance counselors and teachers (e.g. PTSD education) to 
resolve ongoing behavioral and emotional problems. Whether treatment 
is behavioral or psychodynamic. the team effort between WFSC 
therapists and school professionals is critical to accomplish treatment 
objectives. 

Of the 173 children seen at the WFSC since its inception, 
approximately 25% are learning disabled, (underachieving and 
hyperactive); 85% are emotionally disturbed (secondary effects of PTSD, 
substance abuse, domestic violence); approximately 20% are in special 
class and/or attend special schools. With the help of the WFSC and its 
case management, treatment and referral services, these "special 
needs" children receive help regarding veteran-related issues, 
otherwise unavailable to them in their school or community. 



83 



CASE EXAMPLES: 

In assessing and treating children at the WFSC, we consider the 
multiple factors impacting upon them, especially their family 
relationships and home environment. We strengthen and empower the 
caretaking abilities of parents, and strive to improve relationships 
among family members as they struggle with the following issues. 

Secondary Effects of PTSD: 

~ Approximately 85% of the children we treat arc suffering from the 
secondary effects of PTSD or "secondary traumatization" (suffering 
related to veteran's war experience) and' are referred for treatment of 
this disorder. For example, a 12-year old whose over-identification with 
his veteran father exacerbated a severe cardiac problem, was referred 
by his cardiologist for treatment of secondary traumatization. The 
extent of the secondary effects became apparent, when in the course of 
a session, the fire alarm sounded, forcing all occupants to evacuate the 
building. Shortly afterwards, firemen arrived, determined it to be a 
false alarm and deemed the building safe for re-entry. While all other 
occupants returned, father and son did not. They stood, huddled 
together, in a highly agitated state near the fire-engines. This incident 
marked the beginning of treatment work in that father and son. for the 
first time, acknowledged the secondary transmission of PTSD. 

~ Approximately 30% of WFSC veterans have sought inpatient 
treatment for psychiatric disorders. PTSD and substance abuse. For 
example, one warm and committed father of 8 children, with a history 
of psychiatric medication non-compliance would, during these phases, 
gradually develop psychotic symptoms. In the course of one of these 
episodes, following his 18-year old daughter's reporting that she had 
been raped, he attempted to strangle her. In family sessions, his 
children were educated about their father's PTSD,' specifically, about 
the risk of violent reactions brought on by flashbacks to the war, and 
provided assistance in identifying behavioral signs signaling relapse. 
With the cooperation of the veteran and his family, the WFSC Family 
Therapist developed an exhaustive behavioral inventory checklist that 
demonstrated for them the subtle and more obvious signs of relapse. 
This checklist, posted on the refrigerator, provided family members 
with an assessment tool to determine if their father required 
immediate psychiatric intervention and. ultimately, provided the family 
with some sense of control. 

Emotional Withdrawal: 

~ One of the symptoms of FfSD. "emotional withdrawal." causes the 
veteran to distance himself from family members and avoid intimacy. 
Within family therapy, children who personalize the rejection and 
blame themselves are able to verbalize feelings and request 
clarification. For example. A., a 16-year old son of an emotionally 
withdrawn veteran reported in therapy having had an extremely distant 
relationship with his father and attributed his father's rejection to 
flaws in his appearance. With the help of the WFSC therapist. A. 
summoned the courage to ask his father if his impressions were 
accurate and learned that his father's behavior was a function of his 
PTSD and longstanding difficulties tolerating intimacy ~ not his own 
inadequacies. This action dramatically increased A.'s self-esteem and 
was an impetus in his directly confronting relationship issues from 
that point on. 

- The WFSC also provides group treatment for adolescents between 
the ages of 12 through 15 suffering from secondary traumatization. 
The focus of this group is upon the adolescents' unexpressed anger 
towards their emotionally withdrawn veteran fathers and their 
profound feelings of abandonment and loss. The following example will 
highlight the benefits of early intervention and its effectiveness in 
treating secondary traumatization: Following the departure of 15-year 
old group member. B.. who elected to join an after-school tennis class 
rather than continue in group counseling, group members were 
encouraged to express through art (e.g. clay modeling, drawing, writing) 
their feelings about the loss. What followed was an outpouring of 



84 



emotion that corresponded to the deeply-felt feelings of rejection they 
experienced with their fathers. To begin, Adolescent C, drew the 
attention of the group when he masterfully shaped a clay model of B, 
with racket in hand, on a tennis court. At the suggestion of Adolescent 
D.. C. shaped a clay model of B.'s opponent and. strategically, placed a 
clay machine gun aimed at Model A, in the opponents hands. When the 
model of the opponent was completed, C acting on this model's behalf, 
proceeded to violently smash, with his fist. Model B. until all that 
remained was a lump of clay. In a moving interchange, following the 
discussion, each member described the anger they felt towards B. in 
relation to the anger they felt towards their fathers. One by one. they 
also agreed that, similar to their fathers, they shared a fascination with 
machine guns. With each passing session, these adolescents 
articulated, more and more, the details of their shared experience and, 
with the support of the group, steadily worked towards their common 
goal of repairing their ruptured relationships with their veteran 
fathers. 

Substance Abuse: 

~ Approximately 80% of WFSC's veterans have substance abuse 
problems, are in recovery or have died from substance-abuse related 
problems. For example, one veteran who became homeless and lost all 
contact with his family as a result of substance abuse began his 
rehabilitation at the B'orden Avenue Veterans Shelter in New York City. 
He was referred to the VYFSC where, in weekly family meetings, we 
provided him the only opportunity to be with his 5-year old son. Week 
after week, in these supervised visits, they built the foundation of a 
relationship that would define the son s development from then on. 
This strong father-son bond was the catalyst in the veteran's eventual 
move to independent living, full time employment and regular 
unsupervised visits. 

- The WFSC pre-schoolers' group for children, ages 4 through 6. 
focuses upon substance abuse and the effects this has had on family 
relationships. The group consists of a 4-year learning-disabled male, a 
5-year old female with a suspected brain tumor, and two sisters, ages 4, 
and 6. whose mother was hospitalized with a substance-abuse related 
illness. These children all live in single-parent families; their veteran 
fathers have been absent for many years due to chronic substance- 
abuse. In a play session on the topic of family roles, the children were 
asked to select a preferred family role, in preparation for their favorite 
activity, "doll-house play.'' As the children settled into activity, it 
became clear that since all declined to play the lather role, this role 
would be rotated. Doll-house play began with an animated physical 
fight between Father and Mother Doll, and ended with Father "Doll lying, 
forgotten, on the kitchen floor and the children deliberating: "What to 
do with Daddy Doll"? The discussion that followed, demonstrated that 
the children's confusion in deciding upon what to do with Daddy Doll" 
was based upon a lack of familiarity and positive experience with a 
father figure. 

Domestic Violence: 

~ Teenagers who witness repeated incidents of domestic violence often 
develop a skewed view of marital relationships in general and 
appropriate behavior between intimates in particular. Unless these 
teenagers learn differently, there is significant likelihood that they will 
model their parents' dysfunctional behavioral patterns. For example, 
following participation" in family therapy at the WFSC. a 19-year old 
female, who had grown up in a home with a high incidence of domestic 
violence (verbal and physical abuse) requested individual therapy 
services. In addition to 'working on increasing her self-esteem, she 
determined to break a pattern of negative programming which was 
affecting her relationship with her boyfriend, In therapy sessions with 
him, she discovered that she was modeling her father's behavior, that 
her boyfriend's behavior more closely resembled her mother's, and that 
their relationship was evolving into a modified version of her parents' 
relationship. This knowledge subsequently motivated her to alter her 
own behavior patterns and interrupt the destructive cycle of domestic 
violence. 



85 



CASE MANAGEMENT/SERVICE COORDINATION: 

Central to our work with children is case management or service 
coordination to access resources related to developmental disabilities, 
special health conditions, academic and emotional problems, including 
referrals to. and service coordination with, school-based educational 
psychologists or community based service centers tor diagnostic 
assessment, developmental screening and family support services. In 
addition, WFSC staff have access to a national veterans' service 
network, the "National Information System" of the University of South 
Carolina, that provides on-going consultation services for disabled 
children of Vietnam veterans. Utilizing a client-centered 
"empowerment" model, we actively help and support these families' 
efforts to negotiate systems, model effective negotiation skills, and 
ensure that families and children receive their entitlements. 

CASE EXAMPLES: 

Learning Disabilities: 

- The Family Therapist meets with the family to assess family 
functioning, in addition to facilitating and following up a referral for 
their child's educational/psychological evaluation. These meetings 
provide relevant information about the impact of the child's disabilities 
upon the family in addition to providing information about the impact 
of the parental relationship upon the child. For example, Mr. and Mrs. 
F.. (who share custody of their 12-year old learning disabled son) 
requested a referral for educational and psychological evaluations to 
determine whether their son continued to need special class placement. 
Recognizing that their conflicted relationship may be adversely 
affecting their son's school performance, they also agreed to attend 
short-term counseling to improve interpersonal communication. This 
intervention, focusing upon parent-parent and parent-child behavioral 
patterns, was a key factor in the subsequent improvement of their 
son's academic performance and resulted in his being mainstreamed 
into a regular class the following year. 

Physical Disabilities/Emotional Disabilities: 

- It is not uncommon for a child with a physical disability to develop 
concurrent emotional difficulties. Such was the case, with H.. a 12-year 
old with Tourette's Syndrome and attention deficit hyperactivity 
disorder, who according to all family members' reports was responsible 
for the chaotic home environment. While the presenting problem was 
that of locating a "special needs" residential school for him, it became 
clear that there were also many other case management needs 
requiring immediate attention. "These included, but were not limited to, 
consultation with the special education class teacher, psychiatrist and 
neurologist as well as liaison work with a school placement social 
worker. In the final family session, before leaving for residential school, 
H. sincerely apologized for the pain and sorrow he had brought onto 
the family, which included having tortured and killed the family pet. 
This case management work, coupled with the bebaviorally-focused 
family treatment, assisted greatly in normalizing family life. 

School Case Management: 

Children of Vietnam veterans often reflect their father's difficulties 
with large bureaucracies and find our large public schools insensitive 
to their needs. A particularly moving case was that of J., a sensitive 17- 
year old who sought treatment after he witnessed the drug-related 
murder of a neighborhood friend. In therapy, he described a childhood, 
punctuated by his alcoholic father's physical abuse and a history of 
academic difficulties, exacerbated by an inability to adjust to the large, 
impersonal school and indifferent personnel. J. worried that he. too, 
would be lost to drugs and violence and sought to actively prevent this. 
Realizing that this school could not meet J's academic and emotional 
needs, the Family Therapist and J., researched alternative public 
schools and succeeded in locating a small student-centered community 
school. The caring and concern of the staff so impressed the Family 



86 



Therapist that when another WFSC client, a 15-year old female, was 
unjustly expelled from a parochial school, the Family Therapist 
accessed the same resource. These children flourished and thrived in 
the small, student-centered, school environment sensitive to their 
special needs. 



RECOMMENDATIONS: 

Based upon WFSC experience over the nearly four years since 
Agent Orange Class Assistance Program began developing a functional 
model and speaking as an Administrator and Family Therapist who 
has witnessed first-hand the benefits and effectiveness of our service 
delivery model. I respectfully submit the following recommendations: 

INTEGRATION OF FAMILY SERVICES: 

It is important to recognize that integration of family-centered 
service delivery with overall veteran service delivery is key to providing 
comprehensive services. This critical goal can be achieved by 
formalizing and strengthening current affiliations, structurally 
integrating a family-centered focus into overall service delivery, and 
converting family-centered service delivery from short-term to long- 
term practice. 

To provide family-centered services, programs must focus upon 
incorporating the needs of veterans in the context of their families and 
on accommodating the needs of families and family members where 
possible. The shift towards a balanced service delivery approach, with 
its consideration of veteran needs in the family context, would expand 
the treatment focus to include the family and elevate these services 
from auxiliary to primary status. Developing a partnership with the 
veterans' services network would enable family therapists to 
participate in service planning and program development and give a 
voice to those experienced in delivering comprehensive 
family/children's services. Thus, from the screening interview and 
development of the treatment plan through to delivery of treatment 
care, the needs of the veterans' family system (including the children) 
would be paramount, requisite and indisputably essential to the 
treatment and readjustment of the veteran. 

We believe that the WFSC's framework of service relationships 
represents a model of effective interfacing between a community- 
based organization, VA Vet centers and the veterans' services network 
and points to an important future direction in the social services field. 
Implementation of models such at this would maximize the results of 
effective cooperation, expand on the established framework of service 
relationships and best serve the special needs of this community. 

Thank you once again for the opportunity to testify before your 
committee. I encourage you to consider the model we have established 
as a paradigm for the provision of services to veterans and their 
families. We respectfully submit that our experience has shown that 
such services can be an indispensable springboard to recovery and a 
safe haven for veterans and their families. As such, programs such as 
the WFSC are simultaneously an investment in the futures of veterans 
and their families and an expression of appreciation by our society to 
those who have served to protect us. 



87 



STATEMENT OF 



Thomas D. Schroeder 

Executive Director, Rock Island County Council on Addictions (RICCA) 
East Moline, Illinois 

accompanied by: 

Tony Gonzalez 

Program Supervisor, 

VIETNAM VETERANS AND FAMILIES ASSISTANCE PROGRAM 

managed by RICCA 



Before the 

Subcommittee on Oversight and 

Investigations of the House of the Veterans 

Affairs Committee 



May 18, 1994 



88 



Chairman Evans and Members of the Subcommittee, we feel 
privileged and grateful to be given this unique opportunity to present 
testimony concerning "Social Services for Vietnam Veterans and 
Families" and how our program is able to deliver those services to the 
veterans of Vietnam and their loved ones. 

I'm Tom Schroeder, Executive Director of the Rock Island County 
Council on Addictions and with me is Tony Gonzalez, a two tour veteran 
of Vietnam and the Vietnam Veterans and Families Assistance Program 
Supervisor. Our testimony will address what our program accomplished, 
how we were able to provide services to the Agent Orange Class 
Members in our community, and the questions you have asked in the 
context of our program. 



Ho\ 



' did we get started ana what have we accomplished? 



The program started just as a vision. A vision that was made possible 
because of your support, Mr. Chairman, the support from RICCA, the 
Agent Orange Class Assistance Program (AOCAP), local Veteran Service 
Organizations, the Vietnam veterans - but most importantly, their children 
and family members. 

The $150,000 grant our agency received from the AOCAP came as a 
blessing to our community. It came to our rescue at a time when 
resources in our community were scarce, agencies were closing 
because of lack of funding, and the ones that were still open were 
overcrowded or poorly operated. 

The Vietnam Veterans and Families Assistance Program, serving five 
counties of Western Illinois and Eastern Iowa, opened in December 1992. 
During our first year, we established the goal of helping 1 50 Vietnam 
veterans and their family members. In actuality, by January 31 , 1994, we 
served 234 veterans, 107 family members, and 65 children for a total of 
406 visits of clients calling for our services. We found ourselves 
overwhelmed by the range of issues and problems these families face 
each day. 

Motivated by the response of Vietnam veterans and families, ana 
with the purpose of providing an outlay of relief for the many issues 
presented to us, keeping in mind that most of the problems are linked to 
the their service in support of the Vietnam War, we immediately 
implemented a client-centered problem resolution approach. 

Our approach emphasizes crisis intervention, and starts providing 
assistance to best support Veterans and their family members by 
providing: Prompt identification of resources available within the 
community, help with the application process and accessibility to 
facilities; awareness and assistance in the applications for benefits from 
federal agencies and the Agent Orange Payment Program. Counseling 
is provided either in our facility or their residence, with emphasis on child- 
parent conflict resolution and how to improve communication with a 
Vietnam veteran parent suffering from Post Traumatic Stress Disoraer. 

Employment search assistance and guidance is provided, 
specifically concentrating on how to improve job seeking skills. In 
conjunction with employment counseling, assistance is given in locating 
suitable housing, in many cases even an overnight shelter for those that 
are homeless, or coordination of rent assistance through the various 
Veteran Assistance Commissions. Vietnam veterans or their family 
members needing immediate medical care for unattended illnesses 
are linked to health centers, along with continued coordination of other 
help for health problems, and for the full spectrum of diseases and 
disorders. 



The program works to coordinate legal problems resolution, and 
guide veterans recently released from prison back into the community. 
For members in need of substance abuse intervention or treatment, 
linkage is made to RICCA's Alcoholism and Drug Dependence 
Counseling Center. Mental Health services are coordinated for 
individuals dealing with ongoing suicidal ideation and attempts. 

Perhaps the most precious service provided to members is the 
advocacy in working through the sometimes disheartening paperwork 
and bureaucracy of the Department of Veterans Affairs (VA) and the 
Social Security Administration (SSA). Our strong advocacy with VA and 
SSA is extremely valuable in the coordination of services for our clients. 
We feel that if we leave it to the overcrowded agencies, the needs of 
our clients will not be met. 

Except for VA, during the months of our program has been in place, 
we've found that even the agencies with good intake procedures 
neglect to address the issue of military service, let alone service in 
Vietnam. Not asking this pertinent information leads to mis-diagnosis of 
services needed, fails to consider alternative benefits available, and 
adds to an already troubled family. 

Family Services 

The families served by our program significantly differ from the issues 
and presenting needs of other families served by other agencies in that 
the ongoing trauma, stress, and physical and emotional wounds related 
to PTSD or their family members are rarely addressed or even discussed 
at medical or social services agencies where they have sought help. 
Consequently, the families are confused, angry, desperate and 
sometimes cynically hesitant to trust or believe in the ability of our 
program to provide assistance. 

The lone exception to this systemic blowout that our families 
experience is the work of the local Moline, Illinois Veterans Center of the 
Department of Veterans Affairs. The Veterans Center is effective in 
addressing most of the needs of the Vietnam Era veteran through their 
services, but is limited by their hours of operation, caters mostly to 
veterans, and is handicapped in its ability to serve the family, especially 
as a wholistic unit. 

Because of this weakness in the system, a strong linkage and 
relationship has been forged between the Vets Center and our program 
to meet the needs of the whole family. In collaboration, we work to 
share information, coordinate all members of the family are receiving, 
thus, cutting down or eliminating bureaucratic stonewalling. 

We have come to believe, through our experiences, that the 
families, specially children, of Veterans of the Vietnam War need an 
empathetic harbor where they can relate their frustrations and pain, and 
enact a plan of assistance. Far too often, the families are tossed from 
one agency or program to another, perhaps receiving a fragment of 
assistance, but never feeling that their issues were addressed 
comprehensively and with dignity. Labels have been attached to their 
children, and multiple diagnosis rendered by professionals, without once 
the experiences of the Vietnam Veteran considered as a causal or 
contributing factor. 

Our program is staffed by Veterans with service in Vietnam. We 
operate with a simple premise; "Walk through our doors and we will 
greet you and your family with kindness and empathy. Your issues will be 
treated with respect and seriousness. We will provide the assistance, or 
help you find it. We are here to serve at your convenience, not ours". If 
you need us to open at night or on weekends to accommodate your 
needs, we will. If coming to our facility causes hardship, we will come to 
your residence. Our brochure reminds our clients that our function is 



90 



4 
"Helping Vietnam Veterans, especially families, cope with the aftermath 
of a conflict long gone by". 

We need to understana that we serve a very unigue group. This 
group served our country proudly, endured the hardship of an 
unpopular war, and came back to be ridiculed by the same citizens 
they served, supported, and fought for. 

Prior to the formation of the Vietnam Veterans and Families Assistance 
Program, the families of Vietnam Veterans were serviced in multiple 
service settings on a "catch as catch can" basis with no consistency and 
services received in response to crisis. 

Our program allows for Vietnam Veterans and their family members 
to enter the service system through one point, a triage assessment 
process that understands, case manages and plans based on the 
experiences and issues, physiologically and psychologically, of Vietnam 
Veterans and members of their families. The family is treated as a 
wholistic unit, with case management and planning coordinated around 
each family member with concern for the impact on the unit. 

Our accomplishments are best illustrated by mentioning the following 
comments of appreciation from 3 of our clients: 

" Your program saved me and my boy a lot of heartaches. It facilitated 
finding a source for adaptive eguipment, help me process the 
paperwork, and stayed with us the whole way". 
Disabled Vietnam veteran, single father, Rock Island, IL". 

Your case-management, personal touch, and excellent family 
counseling helped our family of three stay together". 
Divorced mother of 2, Iowa. 

Your advocacy helped me tremendously when it came time to sort 
through numerous papers and forms needed to be identified and 
submitted to VA when my husband died". 
Vietnam veteran's widow, Mercer County, IL 

To provide some sort of recreational activity, our program, in 
coordination with Wilderness Inquiry from Minneapolis, Minnesota, the 
Easter Seals Foundation - Camp Sunnyside of Des Moines, Iowa, and 
Universal Family Connection of Chicago, put together a 
canoe/camping trip for children of all abilities and their parents at Camp 
Loudthunder Boy Scouts Reservation. This joint effort not only saved 
money, but also made it possible for us to set up a meaningful event that 
none of us would have been able to do alone. Although a little wet and 
wrinkled, all 21 campers loved the experience. 

To help bring a smile to a few of our class members having 
problems making ends meet, in partnership with the Vietnam Veterans of 
America, Chapter 669, Moline, IL, we coordinated and delivered 
Christmas food baskets last December for six needy families. They were 
all very thankful that we cared enough to think of them. 

Conclusion 

As you can see Mr. Chairman, we have tried to be as innovative as 
possible, at the same time, operate a cost efficient and vitally needed 
service delivery program that is meeting the needs in the veteran 
community. It is going to be a tremendous loss when this program 
disappears in 1995. Subject to your questions, this concludes our 
testimony. Thank you for allowing us to share the story of our program 
with you. 



91 



TESTIMONY 
of 



RAYMOND SWOPE, LCSW, ACSW 
Deputy Executive Director 



Universal Family Connection, Inc. 
Chicago, Illinois 



Before the 
Subcommittee on Oversight and Investigations 
U.S. House of Representatives 
Veterans Affairs Committee 



May 18, 1994 



92 



Chairman Evans and members of the House Veterans Affairs 
Subcommittee, thank you for inviting me to present testimony here 
today on the topic of "Social Services For Vietnam Veterans and their 
Families: Current Programs and Future Directions". 

My name is Raymond Swope. I am a combat Vietnam Veteran, and I am an 
accredited Licensed Clinical Social Worker presently on the staff of 
Universal Family Connection, Inc. (UFC), a not-for-profit community- 
based social service organization, serving the Chicago metropolitan area 
as well as the south suburbs. At UFC I hold the position of Deputy 
Executive Director, and believe me that in this position not one day goes 
by that I don't give thanks for my combat training and the skills that I 
acquired while serving in Vietnam. Because of our agency's magnificent 
partnership with the Agent Orange Class Assistance Program (AOCAP), I 
have had the privilege of building numerous essential networks with; 1. 
not-for-profit Vietnam Veterans community-based organizations 
(CBOs); 2. Vietnam Veterans and Developmental Disabilities Groups; 3. 
other veterans groups; 4. social service communities, as well as; 5. 
Veterans law centers, all of which through our links are able to provide 
the total and unique social services that Vietnam Veterans and their 
families need. As a Vietnam Veteran the experiences which I, UFC and 
many others have had with the Vietnam Veterans Community through the 
AOCAP Program are what I would like to speak about and share with you 
this morning. 

Some selected issues, expected to be examined by the subcommittee and 
which are outlined in your hearing announcement, which I believe, 
through my experience with our project funded by AOCAP, represent 
significant areas of unmet needs among Vietnam Veterans and their 
families. 

In the past three years UFC had the unique opportunity to provide 
comprehensive case management social services to a multifaceted group 
of Vietnam Veterans, their families and their children. Many veterans 
served were suffering from physical ailments associated with their 
exposure to the chemical defoliant Agent Orange. But they also suffered 
from mental and emotional disorders associated with their experience in 
Vietnam complex. Many had pre-existing diagnosis of Post Traumatic 
Stress Disorders. At the same time, their families suffered from 
similar problems associated with their experience with the veterans. 

When the veteran was referred to us for family services, the veteran 
was disenfranchised from their family. They were either divorced or 
separated, or the boundaries that still existed were so fragile or 
traumatic that it was only hope that kept them together. 

The children of the veteran seemed to suffer most. These young and 
little people present problems in mood disorder, behavioral disorders, 
physical limitations, and social intangibleness. They have been 
diagnosed with attention deficit disorders, hyper or hypo active 
disorders, learning disabilities, and children with special needs. 
Physically, they have been described as having soft bone tissue, 
underdeveloped bodies, or birth defects. 

These children required and need ongoing intervention and assistance. 
Most coming from the mother and little if any from Veterans 
Associations. 



93 



In serving a client population with needs as diverse as those of the 
Agent Orange Plaintiff Class, it has always been apparent that Vietnam 
Veterans and their families have unique social service needs which are 
related to their military service and experiences. It is further apparent 
that in order for these unique human service needs to be met 
successfully, it is necessary for these services to be provided through 
partnerships with Comprehensive Community-Based Organizations which 
have historically had only minimal contact with Veterans at best. The 
goals of UFC's Vietnam Veteran's assistance program within the network 
is to ameliorate the severe problems encountered by the population as 
they attempt to readjust to civilian life. Our experience with veterans 
has taught us that many barriers confront the Vietnam War Veteran as 
he/she attempts to maintain a normal existence and family life. 
Naturally, the problems faced by the Veterans affect his family 
reunification and growth. 

UFC has been very successful in meeting the veterans and their families 
unique social service needs by drawing on various therapeutic forms of 
treatment, such as psychodynamic, humanistic, family-centered case 
management, structural communication and behavioral therapy. 
Additionally, intensive case-coordination is utilized to insure that the 
Vietnam Veterans and their families needs are approached in a holistic 
manner, using an ecological perspective of servicing. 

All of this leads me into another very important issue: Is the VA 
providing veterans and their families needed social services, and does 
the VA coordinate the delivery of social services to veterans and their 
families with other social service providers? 

UFC has worked with veterans since 1984. Initially with veteran in the 
area of readjustment counseling. We found that few VA sponsored 
providers that delivered family centered counseling. We were told time 
again by the VA that we were the first to see them as a family unit. 
They have sought services from the VA on many fronts, but due to the 
lack of case coordination, nothing was done , and in most cases there 
was duplication of services. The VA Hospitals, the Vet Centers, and the 
local veterans organizations failed to tie together the family and social 
needs of the veteran. 

When UFC provided readjustment counseling to the veterans family we 
were successful because we used the family case management approach. 
We have repeated this process with our Agent Orange service delivery 
program. We obtain records, documents, verifications, and statements 
from VA providers, the Social Security Administration, former 
employers and most importantly, from the veterans family. The 
fragmentation that currently exists with VA service providers makes 
them ineffective. A system must be designed to be flexible and 
progressive in its approach to service delivery. An effective delivery 
system should not be an impediment but rather a bridge that connects all 
service systems. 

The following are a number of general Veteran public policy 
recommendations which, once again, are based on our experiences gained 
through the AOCAP network or program, but are not rooted in any 
specific legislative proposals. 

The Department of Veterans Affairs should be re-configured to 
accommodate more comprehensive service strategies. Equally 
important, a concerted effort should be made to develop service 
relationships and even agency agreements with appropriate state, local 



91-084 0-95 



94 



and community social service resources, both private and public, in 
order to more effectively address the needs of Veterans and their 
families. 

Inclusion of Families in Service System 

The Department of Veterans Affairs in particular, and especially in the 
aspects of counseling, rehabilitation and vocational guidance programs 
and employment services, should be charged with reorienting its 
program to consider the needs of the the Veterans in the context of his 
or her family, and to accommodate the needs of that family and family 
members where possible. 

The Department of Veterans Affairs, as well as the Department of Labor 
Programs for Veterans should adopt strategies to maximize the 
interface and contract for services with appropriate community-based, 
not-for-profit social services agencies. 

Intensive family-centered case-coordination/case management, should 
be utilized to insure that the Vietnam Veterans and their families needs 
will be approached in a holistic manner, using an ecological perspective 
of servicing. 

Naturally, our service approach is based on preserving the family, 
stabilizing family conflicts which may break them up, and reunification 
of the family where possible. 

The adoption of even parts of any of the preceding recommendations 
would necessitate the adoption of modern social service strategies and 
especially counseling models. Intensive training and some re- 
configuration of existing program would be imperative. 

In closing veterans have told me over and over again how they wish they 
could give their family something else instead of heartaches. They want 
to leave something, a gift, a legacy, a positive remembrance. For many, 
this has been made possible through our case management family 
approach at the community level. 

Thank you once again for the opportunity to present testimony before 
your committee. 



95 



TESTIMONY OF 

THOMAS JAMES 

MANAGING DIRECTOR 

COMMUNITY OUTREACH TO VIETNAM ERA RETURNEES 

(C.O.V. E.R.I 

CHARLOTTESVILLE, VIRGINIA 



BEFORE THE 

HOUSE VETERANS AFFAIRS COMMITTEE 

SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS 



MAY 18, 1994 



96 



GOOD MO RNIN G CHAIRMAN EVANS AND MEMBERS OF THE 
SUBCOMMITTEE. MY NAME IS THOMAS JAMES. I AM A VIETNAM VETERAN 
AND THE CO-FOUNDER AND MANAGING DIRECTOR OF A PRIVATE, NON- 
PROFIT, COMMUNITY BASED COUNSELING AGENCY FOR VIETNAM 
VETERANS AND THEIR FAMILIES. I AM ALSO AN ATTORNEY PRACTICING IN 
CHARLOTTESVILLE, VIRGINIA. 

MY AGENCY IS CALLED C.O.V.E.R., COMMUNITY OUTREACH TO VIETNAM 
ERA RETURNEES AND WE ARE BEGINNING OUR FIFTEENTH YEAR OF 
SERVICE TO VIETNAM VETERANS AND THEIR FAMILIES. WHAT BEGAN AS 
THE GRADUATE SCHOOL PRACTICUM OF MY WIFE, MARY COATES JAMES 
GREW TO A FULL-TIME VOLUNTEER EFFORT ON HER PART. SHE 
MAINTAINED THIS VOLUNTEER EFFORT FOR TWO YEARS. SHE WAS THE 
DRIVING FORCE IN CREATING THE SPIRIT AND MISSION OF OUR AGENCY. 
THE SPIRIT AND MISSION SHE INSTILLED HAS EVOLVED INTO AN AGENCY 
WHICH CURRENTLY HAS THREE OFFICES, THREE OUTREACH VEHICLES, A 
STAFF OF TWELVE SERVING THIRTY-SEVEN JURISDICTIONS IN CENTRAL, 
WESTERN, AND SOUTHWESTERN VIRGINIA AS WELL AS THE EASTERN 
MOUNTAINS OF WEST VIRGINIA. 

I BELIEVE THE EXPERIENCE OF MY AGENCY AFFORDS ME THE 
QUALIFICATIONS TO SPEAK BEFORE THIS COMMITTEE ON THE TOPICS YOU 
HAVE OUTLINED FOR TODAY'S HEARING. MY HOPE IS TO TRANSLATE OUR 
FIFTEEN YEARS OF EXPERIENCE INTO INFORMATION YOU MAY FIND 
VALUABLE IN FUTURE POLICY DECISIONS. 

OUR SERVICE REGION IS PRIMARILY RURAL. THE APPALACHIAN REGION 
OF VIRGINIA IS PART OF OUR CATCHMENT AREA. OUR CLIENTS ARE NOT 
WEALTHY, AND LIVE FROM PAY CHECK TO PAY CHECK. MANY HAVE 
AGRARIAN RELATED EMPLOYMENT WITH A FEW OWNING FARMS. THE 
FARMS ARE SMALL; FORTY TO FIFTY ACRES. MANY RAISE CATTLE OR 
DAIRY WITH SOME GROWING TOBACCO. MOST LIVE IN MOUNTAIN 
SETTINGS FAR FROM THE LARGER TOWNS IN OUR REGION. A PORTION OF 
OUR CLIENTS WORK IN FACTORIES OR SLAUGHTER HOUSES. OUR AREA IS 
KNOWN AS ONE OF THE POULTRY CAPITALS OF THE UNITED STATES AND 
CONSTRUCTION RELATED PROFESSIONS ENCOMPASS THE LARGEST 
SEGMENT OF EMPLOYMENT FOR OUR CLIENTS. MANY ARE SELF-EMPLOYED 
CONTRACTORS OR SUBCONTRACTORS, SKILLED LABOR AND ARTISANS. 
WE HAVE ALSO SEEN ATTORNEYS, BANK EXECUTIVES, CORPORATE 
EXECUTIVES AND AN OCCASIONAL MINISTER AS CLIENTS. MANY ARE EX- 
LAW ENFORCEMENT OFFICERS WHO CHOSE TO LEAVE THEIR RESPECTIVE 
DEPARTMENTS. ALL CLIENTS REGARDLESS OF THEIR PROFESSIONS SHARE 
ONE COMMON DENOMINATOR: CONCERN FOR THEIR FAMILIES. 

I BELIEVE IT IS SAFE TO SAY THAT EIGHTY PERCENT OF OUR VETERAN 
CLIENTS ARE MARRIED AND HAVE CHILDREN. MANY ARE ON THEIR 
SECOND AND THIRD MARRIAGES WITH CHILDREN FROM EACH 
RELATIONSHIP. THESE FAMILIES HAVE FACED THEIR SHARE OF HARDSHIP; 
BE IT FINANCIAL, EMOTIONAL OR DEALING WITH MEDICAL CONDITIONS OF 
THEIR CHILDREN OR THE VETERAN. IT IS ALSO WORTH NOTING THAT A 
SIGNIFICANT PORTION OF THE VETERANS WHO ARE DIVORCED AND AS OF 
YET NOT REMARRIED HAVE CUSTODY OF THEIR CHILDREN. AS STATED 
EARLIER, MANY LIVE IN THE MOUNTAINS OF A RURAL COMMUNITY. WHEN 
I SAY RURAL, I DO NOT MEAN 'COUNTRY-SUBURBAN' RURAL AS IN 
COMMUNITIES WrTHIN URBAN RINGS OF MAJOR CITIES. I AM SPEAKING OF 
AN EXISTENCE WHERE YOUR NEIGHBOR MAY BE ONE MILE AWAY. SOME 
VETERANS ARE THE ONLY RESIDENTS ON MOUNTAINS OR FOOTHILLS NEAR 
THE BLUERJDGE. THEY HEAT WITH WOOD STOVES AND MANY COOK WITH 
A WOOD STOVE. THEY KEEP ONE OR TWO PIGS FOR SLAUGHTER EACH 
YEAR AND THEY HUNT FOR MUCH OF THEIR FOOD. TV FOR MANY IS 
UNAVAILABLE AND IN SOME CASES AVOIDED. SUCH CLIENTS MAINTAIN A 
FULL-TIME JOB AND HAVE TO SPEND LONG HOURS AFTER WORK 
MAINTAINING THEIR HOMES AND PROPERTY. AGAIN, I WANT TO STRESS, 
SUCH WORK IS NOT LIKE MOWING LAWNS OR CUTTING SHRUBS; RATHER 
IT IS CHOPPING WOOD FOR THE STOVE, MENDING FENCE LINES, EARLY 
MORNING HUNTING OR FISHING, AND GENERAL REPAIRS ON THE HOUSE. 

WE HAVE LEARNED MANY LESSONS OVER THE YEARS IN DEALING WITH 
THIS POPULATION. THE CARE OF VETERANS AND THEIR FAMILIES REST 
UPON THE FUNDAMENTAL FOUNDATIONS OF OBLIGATION AND 



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3 
COMMITMENT. THE GOVERNMENT HAS THE OBLIGATION TO LEGISLATE 
AND INSURE CARE FOR THOSE WHO HAVE FOUGHT OUR WARS, AND THE 
ACTUAL CARE PROVIDER MUST HAVE THE COMMITMENT TO OFFER 
SERVICES UNDER DIFFICULT AND UNIQUE CONDmONS. THE VETERAN 
POPULATION WE SERVE HAS NEEDS WHICH INCLUDE BOTH 
PSYCHOLOGICAL THERAPY TO HEAL THE EMOTIONAL WOUNDS OF COMBAT 
AND SOCIAL SERVICE ORIENTED CASE MANAGEMENT TO ADDRESS THE 
HERE AND NOW LEGACY OF THOSE WOUNDS BOTH ON THE VETERAN AND 
THE FAMILY. THE DIFFICULTY IN MEETING THESE NEEDS STEM FROM THE 
UNIQUE CHARACTERISTICS AND QUALrTIES OF THE VETERANS 
THEMSELVES. 

THE VETERAN IS THE GATEKEEPER FOR SERVICES TO HIMSELF AND HIS 
FAMILY. AN AGENCY MUST HAVE THE UNDERSTANDING OF THE 
VETERAN'S PERCEPTION OF HIS COMMUNrTY IN ORDER TO ACCESS THE 
FAMILY. THE VETERAN DOES NOT TRUST ORGANIZATIONS OR 
GOVERNMENT AGENCIES. HE OR SHE IS APPREHENSIVE ABOUT 
INTERACTING WTTH ANYONE, LET ALONE A FORMALIZED AGENCY OR 
INSTITUTIONALIZED BUREAUCRACY. THE VETERAN WILL TEST THE 
SERVICE PROVIDER TO ASCERTAIN HOW THE AGENCY OPERATES. HE OR 
SHE WILL LOOK FOR AN ANSWER TO THE QUESTIONS OF: "HOW FAR WILL 
THESE PEOPLE GO AND HOW COMPETENT ARE THEY?", OR: "CAN I TRUST 
THESE PEOPLE WITH MYSELF AND MY FAMILY?". THE WORD TRUST HAS A 
DEEPER AND MORE COMPREHENSIVE MEANING TO A VETERAN THAN TO A 
CIVILIAN. TRUST IS SYNONYMOUS WITH THE ABILITY TO SURVIVE. 

THE DIFFICULTY IN ENGAGING WITH THE VETERAN CLIENT TAKES ON 
OTHER TRAITS. THE VETERAN HAS PROBLEMS MAKING SCHEDULED 
APPOINTMENTS. HE OR SHE.AS DESCRIBED EARLIER IS WORKING FULL- 
TIME AND BASICALLY WORKING A SECOND FULL-TIME JOB IN 
MAINTAINING HIS PROPERTY. HE LIVES AN ISOLATED LIFE-STYLE AND IN 
MOST CASES IS UNAWARE OF PROGRAMS AND BENEFITS. THE VETERAN 
LIVES IN GEOGRAPHICALLY ISOLATED AREAS AND HE LIVES THERE BY 
CHOICE AND NOT CHANCE. HE IS NOT ACCUSTOMED TO SHARING 
FEELINGS OR DISCUSSING EXPERIENCES WITH A STRANGER. HE IS SO 
INVOLVED WITH PROVIDING FOR HIS FAMILY AND DEALING WITH DAY TO 
DAY LIFE STRESSORS THAT HE DOES NOT EVEN CONSIDER EMOTIONAL 
ELEMENTS OF HIS LIFE OR HIS FAMILY. HE IS AMBIVALENT REGARDING 
SEEKING TREATMENT. IT IS A GREAT DEAL TO ASK A VETERAN TO GIVE UP 
THE TOOLS HE HAS DEVELOPED TO SURVIVE OVER THE YEARS AND TO 
ACCEPT A DIFFERENT AND POSSIBLY BETTER SYSTEM TO DEAL WITH HIS 
COMMUNITY, FAMILY AND SELF. HE LEARNED THE MEANING OF FEAR AND 
HELPLESSNESS WHILE IN COMBAT, AND HE HAS DEVELOPED HIS OWN 
MEANS OF CONTROLLING HIS ENVIRONMENT SO AS TO NEVER HAVE TO 
FACE SUCH FEAR AND HELPLESSNESS AGAIN. 

THE VETERAN IN MANY CIRCUMSTANCES IS FINDING HIMSELF TOO OLD TO 
'KEEP PUSHING THE WHEELBARROW AT WORK. HE SEES HIMSELF AS 
FACING A FUTURE WITH FEW JOB OPPORTUNITIES. THE VETERAN 
ADJUSTED HIS LIFESTYLE TO THE COMMUNITY HE FACED WHEN HE 
IMMEDIATELY RETURNED HOME FROM VIETNAM; A VERY INHOSPITABLE 
WELCOME HOME; A HOMECOMING WHICH OFFERED LITTLE VALIDATION 
FOR HIS SERVICE TO HIS COUNTRY OR TO THE PERSONAL COST 
ASSOCIATED WITH FIGHTING A WAR. HE HAS FOUND WAYS TO DISTANCE 
HIMSELF FROM HIS COMMUNITY. HE HAS LEARNED TO UTILIZE THESE 
METHODS EFFECTIVELY AND AS A CONSEQUENCE HAS THE ABILITY TO 
TURN OFF THE MAJORITY OF PEOPLE HE MAY COME IN CONTACT WITHIN A 
NON-SOCIAL SETTING. SIMPLY STATED, THE VETERAN IS NOT THE IDEAL 
CLIENT FOR A CONVENTIONAL, GENERAL MENTAL HEALTH SETTING OR 
FOR A FORMAL, INSTITUTIONALIZED, INFLEXIBLE, MEDICAL MODEL, 
BUREAUCRACY. 

OUR EXPERIENCE HAS SHOWN THAT OTHER CONVENTIONAL MENTAL 
HEALTH AGENCIES SERVING THE GENERAL POPULATION CONSIDER 
VETERANS AS UNCOOPERATIVE AND UNWILLING TO ENGAGE IN THE 
COUNSELING PROCESS. THE AGENCIES HAVE DEVELOPED A RIGID INTAKE 
PROCESS AND IN MANY CASES HAVE EXTENDED WAITING LISTS FOR AN 
INITIAL MEETING. THEY HAVE ESTABLISHED A SYSTEM SUITED FOR THE 
SERVICE PROVIDER NEEDS AND NOT TO THE SPECIFIC NEEDS OF THE 
CLIENT. MANY VETERANS ARE TURNED OFF BY THE INTAKE PROCESS AND 
IN MANY CASES THE AGENCY WILL BE TURNED OFF BY THE VETERAN. 
VETERANS,OUR EXPERIENCE SHOWS, ONCE IN SUCH A SYSTEM FALL 



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4 
THROUGH THE CRACKS, AND IN MANY CASES THE AGENCIES ARE NOT 
MOTIVATED TO SEARCH FOR DIFFICULT CLIENTS WHEN THEY HAVE AN 
ABUNDANCE OF A GENERAL POPULATION OF COMPLIANT CLIENTS. SOME 
PROVIDERS FROM SUCH AGENCIES HAVE ALSO VOICED THEIR FEAR OF 
VETERANS BASED ON WHAT THEY HAVE HEARD ON THE NEWS OR IN 
GENERAL DISCUSSIONS. 

OUR AGENCY, AS MANY ACROSS THE NATION.UNDERSTANDS THE 
NECESSARY ISSUES TO ADDRESS WOTi A VETERAN. THE PROBLEM IS THE 
EXTENT AND CONTINUITY OF PROGRAMS WE OFFER IS BASED ON 
FUNDING. OUR FUNDING IS PRIMARILY THROUGH GOVERNMENT 
CONTRACTS, GRANTS, AND DONATIONS. WE HAVE HELD CONTRACTS 
UNDER THE READJUSTMENT COUNSELING CONTRACT PROGRAM SINCE 
1982. WE ALSO ARE REIMBURSED FOR BILLINGS UNDER THE VA'S FEE 
SERVICE PROGRAM. OUR AGENCY HAS RECEIVED YEARLY GRANTS FROM 
THE AGENT ORANGE CLASS ASSISTANCE PROGRAM SINCE 1989. WE HELD A 
CONTRACT FOR TWO YEARS WITH THE EMPLOYEE ASSISTANCE PROGRAM 
FOR A FEDERAL LAW ENFORCEMENT AGENCY. WE ALSO RECEIVE SMALL 
PRIVATE DONATIONS THROUGH SPECIAL EVENTS FUND RAISERS SUCH AS 
A YEARLY BASKETBALL GAME WITH AN AREA RADIO STATION, AND "RUN 
FOR COVER", A DISTANCE RUN WHERE THE WINNER RECEIVES A PAIR OF 
OLD COMBAT BOOTS. 

OUR HISTORY HAS BEEN A SERIES OF PEAKS AND VALLEYS IN TERMS OF 
FUNDING, AN EXPERIENCE SHARED BY MOST COMMUNITY BASED 
AGENCIES. VETERANS DO NOT MAKE GOOD "POSTER BABIES" FOR FUND 
RAISING. IT IS DIFFICULT TO ACQUIRE DONATIONS AND ONE MUST BE 
CREATIVE IN SPONSORING FUND RAISERS. WE HAVE SURVIVED BUDGET 
CUTS AND CONTRACT RE-ORGANIZATIONS AS WELL AS CHANGES IN THE 
REIMBURSEMENT FORMULA UNDER THE V.A. CONTRACTS. WE HAVE 
FACED CUTS RANGING FROM 30% TO 60% IN MONIES AVAILABLE FOR 
PAYMENT OF SERVICES RENDERED TO VETERANS. WE HAVE BEEN ABLE TO 
ABSORB SUCH CUTS AND STILL MAINTAIN THE SAME LEVEL OF SERVICES 
TO VETERANS AND THEIR FAMILIES. OUR CLIENT LOAD, HOWEVER, HAS 
ENJOYED CONSISTENT GROWTH. WE HAVE SERVED THOUSANDS OF 
VETERANS AND THEIR FAMILIES AND CURRENTLY HAVE A CASE LOAD 
GREATER THAN EVER BEFORE. WE PROJECT THIS EXTENSIVE CASE LOAD 
TO CONTINUE TO INCREASE. 

WE RECEIVED OUR FIRST CONTRACT FROM THE VA IN 1982. THE ELEMENTS 
OF THE CONTRACT HAVE BASICALLY REMAINED THE SAME OVER THE 
YEARS. THE CONTRACT ALLOWS US TO OFFER SERVICES TO A VETERAN 
FOR ONE YEAR FROM THE DATE HE OR SHE ENTERS OUR OFFICE. AT THE 
END OF A YEAR WE CAN REQUEST AN EXTENSION OF SERVICES BASED ON 
CLINICAL NEEDS FOR APPROVAL BY THE REGIONAL OFFICE OF THE 
CONTRACT/VET CENTER PROGRAM. THE CONTRACT REQUESTS THE 
UTILIZATION OF GROUP AS THE PRIMARILY MEANS OF SERVICE AS 
OPPOSED TO INDIVIDUAL SESSIONS. IF WE WISH TO HAVE A CLIENT IN 
BOTH GROUP AND INDIVIDUAL SERVICES, WE MUST MAKE A SPECIAL 
TREATMENT PLAN SUBJECT TO APPROVAL BY THE VET CENTER REGIONAL 
OFFICE. WE MUST ALSO HAVE CLIENTS SIGN A SHEET FOR EACH VISIT. THE 
SIGNATURE SHEET IS SENT TO THE VAMC'S BILLING OFFICE FOR PAYMENT. 
THE CONTRACT SPECIFICALLY BARS ANY ADVERTISEMENT AS OUTREACH 
IN THE COMMUNITY WE SERVE AND, MOST IMPORTANTLY, FOR PURPOSES 
OF THIS HEARING, LITTLE IF ANY FUNDING IS AVAILABLE FOR FAMILIES OF 
THE VETERAN UNDER THE VA CONTRACT. 

THE V.A. FEE SERVICE PROGRAM, ANOTHER SOURCE OF FUNDING, 
REIMBURSES FOR SERVICES TO VETERANS WITH SERVICE CONNECTED 
DISABILITIES. THE VETERAN MUST LIVE OUTSIDE OF A SPECIFIED RADIUS 
FROM A V.A. MEDICAL CENTER. WE BILL AT A SET RATE FOR INDIVIDUAL 
AND A SEPARATE RATE FOR GROUP SESSIONS. THERE ARE NO FUNDS 
AVAILABLE THROUGH THIS PROGRAM FOR FAMILY SERVICES. 

IN 1989 WE RECEIVED OUR FIRST GRANT FROM THE AGENT ORANGE CLASS 
ASSISTANCE PROGRAM. THE GRANT AFFORDED US THE ABILITY TO 
STRENGTHEN OUR ALREADY EXISTING FAMILY SERVICE COMPONENT. WE 
OFFERED OCCASIONAL SPOUSE SUPPORT GROUPS AND EDUCATIONAL 
WORKSHOPS FOR CHILDREN OF VETERANS. WE HAD A CLINICAL 
PSYCHOLOGIST WITH EXTENSIVE EXPERIENCE IN WORKING WITH 
CHILDREN WHO OFFERED INDIVIDUAL SERVICES TO CHILDREN OF OUR 
CLIENTS AT A DISCOUNT AND TO MANY ON A GRATIS BASIS. WE 



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FORMULATED A PROGRAM FOR FAMILIES BASED ON A SHOE STRING' 
BUDGET. WE BELIEVED THAT TREATING FAMILIES WAS AN INTEGRAL PART 
OF DEALING WTTH THE VETERAN. NO MATTER WHAT PERSONAL ISSUES A 
CLIENT MUST DEAL WITH IN COUNSELING; HE OR SHE STILL EXISTED IN A 
FAMILY. THE FAMILY IS SEEN BY THE VETERAN AS HIS SQUAD; A SQUAD 
THAT HE IS RESPONSIBLE TO PROTECT. MANY VETERANS CAN BE SEEN AS 
OVER-PROTECTIVE OF THEIR CHILDREN. I HAD ONE VETERAN TELL ME 
HOW rr FELT TO TAKE HIS CHILD TO A PLAYGROUND. HE STATED "MOST 
PEOPLE SEE rr AS A PLACE FOR CHILDREN TO PLAY, I SEE IT AS A PLACE 
WHERE THEY CAN BE HURT FALLING OFF THE PLAYGROUND EQUIPMENT". 

SINCE 1989, UNDER OUR AOCAP GRANT, OUR FAMILY PROGRAM'S SERVICE 
WAS EXPANDED. OUR CHILDRENS' SERVICES WAS ENHANCED TO OFFER 
MONTHLY CHILDREN'S PLAY GROUPS. STAFF TAKE CHILDREN OF VETS ON 
CAMPING TRIPS, BOWLING TRIPS, ICE SKATING, NATURE HIKES AND 
OTHER FORMS OF RECREATION. WE OFFER INFORMATIONAL GROUPS FOR 
CHILDREN OF VETERANS. A CREDENTIALED STAFF MEMBER AND A 
VETERAN STAFF MEMBER CO-LEAD A TWO HOUR SESSION DESCRIBING THE 
VIETNAM WAR AND THEIR FATHER AND MOTHER'S EXPERIENCES IN A 
GENERAL CONTEXT. THE PARENTS SPEND THE SAME TIME PERIOD WITH A 
STAFF MEMBER IN OUR RECEPTION AREA DISCUSSING GENERAL TOPICS OF 
THEIR CHOICE. WE OFFER SUPPORT GROUPS FOR TEENAGERS. WEEKLY 
SPOUSE GROUPS ARE OFFERED AT EACH OF OUR THREE OFFICES. 
INDIVIDUAL COUNSELING TO SPOUSES AND CHILDREN ARE PROVIDED, AND 
COUPLES COUNSELING IS OFFERED. NUMEROUS SPECIAL TOPIC 
WORKSHOPS FOR FAMILIES ARE SCHEDULED WHICH MAY INCLUDE A 
BANKER OR AN ACCOUNTANT OFFERING FINANCIAL MANAGEMENT AND 
DEBT MANAGEMENT ISSUES. COMMUNICATION SKILLS AND STRESS 
MANAGEMENT ARE EXAMPLES OF OTHER TOPICS PRESENTED. STAFF 
PROVIDES CASE MANAGEMENT SERVICES TO MEET THE SOCIAL SERVICE 
NEEDS OF THE ENTIRE FAMILY. 

WE WERE ABLE TO PURCHASE THREE OUTREACH VEHICLES TO GO TO THE 
VETERANS HOME AND DEAL DIRECTLY WITH THE FAMILY. THESE 
VEHICLES RUN WEEKLY ROUTES THROUGHOUT OUR REGION. WE DRIVE 
FAMILY MEMBERS TO NEEDED MEDICAL APPOINTMENTS. WE DEVELOPED A 
FOOD BANK TO DELIVER FOOD TO FAMILIES DURING HARD TIMES. ON 
OCCASIONS STAFF MEMBERS HAVE ASSISTED CLIENTS IN REPAIRING AND 
MAINTAINING NECESSARY FARM EQUIPMENT. OUR CASE MANAGEMENT 
NEGOTIATES WITH HOSPITALS ON FORGIVING SIZEABLE MEDICAL BILLS 
FACED BY VETERAN FAMILIES WITH DISABLED CHILDREN. WE HAVE 
ASSISTED FAMILIES IN FINDING COMPUTERS AND OTHER NECESSARY 
EQUIPMENT FOR THEIR DISABLED CHILDREN. WE COORDINATE AND CASE 
MANAGE REFERRALS FOR CHILDREN TO CHILDREN REHAB HOSPITALS AT 
SPECIAL DISCOUNTED RATES. WE HAVE DEVELOPED A PROGRAM WHERE 
VETERANS AND THEIR FAMILIES CAN RECEIVE PHYSICALS BY AREA 
PHYSICIANS AT DISCOUNTED RATES. 

WE NOW ARE A PART OF A NATIONAL NETWORK OF LOCAL, STATE- WIDE 
AND NATIONAL AGENCIES INTERESTED IN THE SPECIAL NEEDS OF 
VETERANS AND THEIR FAMILIES AND LEND SIGNIFICANT SUPPORT TO OUR 
CLIENTS. IMAGINE AN AGENCY HAVING THE CAPACITY TO CALL ANOTHER 
AGENCY IN GEORGIA TO ASSIST IN ACQUIRING A COMPUTER FOR A 
DISABLED CHILD AND SIMULTANEOUSLY CALLING A SEPARATE AGENCY 
IN CONNECTICUT TO ASSIST IN WORKING WITH HOSPITALS IN FORGIVING 
AND DECREASING MEDICAL BILLS. ON THE SAME DAY, HAVE THE ABILITY 
TO CALL A LEGAL CENTER ON BEHALF OF THE SAME CLIENT, IN 
WASHINGTON DC, TO ASSIST IN APPLYING FOR SOCIAL SECURITY 
BENEFITS FOR THE CHILD. AND, TO BE ABLE OFFER COUNSELING AND 
SUPPORT TO ALL MEMBERS OF THE FAMILY WHILE ACCOMPLISHING THE 
CASE MANAGEMENT GOALS. THIS SCENARIO IS BASED ON AN ACTUAL 
CASE AND IS ILLUSTRATIVE OF MANY OF THE CASES HANDLED BY OUR 
AGENCY. IT EXEMPLIFIES THE TOTALITY OF THE SERVICES WE CAN OFFER. 

CASE MANAGEMENT IS A SUBSTANTIAL INGREDIENT IN THE HEALING 
PROCESS FOR THE VETERAN AND THE FAMILY. WE ARE ABLE TO BRING 
VALUED SUPPORT TO THE FAMILY AND SERVE AS A BRIDGE OR BUFFER FOR 
THE VETERAN IN DEALING WITH OUTSIDE AGENCIES. WE BECOME THE 
"POINT" OR THE GUIDE FOR THE FAMILY THROUGH THE PROCESS. WE 
SERVE AS A MEANS FOR THE VETERAN AND FAMILY TO VENTILATE ANY 
FRUSTRATIONS, AND WE ARE SEEN AS A SAFE PLACE TO BRING THEIR 
ANGER AND PAIN. WE ARE ALSO A BACKUP RESOURCE FOR THE TIMES 



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THEY ARE GIVEN THE RUN AROUND BY ANY OFFICE OR AGENCY. WE 
CHECK OUT THE APPROPRIATENESS AND COMPETENCY OF THE OTHER 
AGENCIES AND ARE ABLE TO GAGE THE POTENTIAL DIFFICULTIES AND 
PREPARE OUR CLIENT FOR THE PROCESS. WE CAN OFFER SUPPORT IN 
INSURING THAT SUCH AGENCIES ARE FULFILLING THEIR OBLIGATIONS. 
AS AN EXAMPLE, WE MET WITH A SCHOOL ADMINISTRATOR TO DISCUSS 
THE PROBLEMS A VETERAN'S CHILD WAS HAVING WITH A SPECIAL 
EDUCATION PROGRAM. IT SEEMED THE SCHOOL WAS NOT OFFERING THE 
DEGREE OF SERVICES MANDATED BY THE STATE AND FEDERAL 
GOVERNMENTS. OUR INTERVENTION LED TO THE SCHOOL EXPANDING THE 
SERVICES TO OUR CLIENTS CHILD. THE VETERAN LATER STATED THAT 
WITHOUT SUCH INTERVENTION AND HELP HE COULD NOT HAVE ACHIEVED 
THE SAME RESULTS. WE OFFER SUPPORT AND ENCOURAGEMENT FOR THE 
FAMILY DURING THE PROCESS. WE MAKE THE COMMITMENT TO "WALK 
THE ROAD WITH THEM". 

IT IS IMPORTANT TO NOTE THAT UP UNTIL 1989, THE ONLY MEANS FOR 
FUNDING FOR PRIVATE AGENCIES OFFERING COUNSELING TO VETERANS 
WAS THROUGH THE VA'S READJUSTMENT COUNSELING CONTRACT 
PROGRAM, I.E: VET CENTERS AND CONTRACTORS. THE PROGRAM WAS AND 
CONTINUES TO BE PRIMARILY FOCUSED ON THE VETERAN. THE CONTRACT 
IN THE EARLY STAGES OF ITS EVOLUTION, ALLOWED FOR REIMBURSED 
SERVICES TO A SPOUSE BASED ON A FORMULA OF ONE PAID VISIT FOR THE 
SPOUSE PER TEN VISITS BY THE VETERAN. ANY REIMBURSEMENT WAS AT 
THE DISCRETION OF THE VA'S REGIONAL OFFICE. I AM SURE THEY FACED 
LIMITED RESOURCES AND WERE FORCED TO MAKE DIFFICULT DECISIONS IN 
WHETHER OR NOT TO APPROVE PAYMENT. THE MAJORITY OF SERVICES TO 
A FAMILY BY A CONTRACTOR WAS ON A GRATIS BASIS. AS TIME PASSED 
THE VA ATTEMPTED TO ALLOW CONTRACTORS ON A SELECTIVE BASIS TO 
OFFER REIMBURSED SERVICES TO SPOUSES. THESE EXPERIMENTS WOULD 
LAST AT BEST FOR TWO TO THREE MONTHS. THE VETERAN ALSO HAD TO 
SIGN A RELEASE WHICH ALLOWED HIS/HER SPOUSE TO RECEIVE SERVICES 
UNDER THE CONTRACT. THE REASON FOR SUCH A RELEASE WAS THAT 
MONIES UNDER THE CONTRACT WAS EARMARKED ENTIRELY FOR THE 
VETERAN AND IN ORDER TO HAVE MONEY PAID FOR THE SPOUSE THE 
VETERAN HAD TO APPROVE THE REDISTRIBUTION OF FUNDS FOR THE 
SPOUSE. 

IT IS WORTH NOTING THAT OVER THE YEARS THE CONTRACT HAS 
INCREASED ITS COVERAGE OF VETERANS FROM DIFFERENT ERAS. THE 
CONTRACT ONLY COVERED VIETNAM VETERANS IN 1982. IT NOW COVERS 
VETERANS FROM VIETNAM, LEBANON, GRENADA, PANAMA, AND DESERT 
STORM. THE COVERAGE FOR DESERT STORM OFFERS A MORE 
COMPREHENSIVE PACKAGE OF SERVICE THAN FOR VIETNAM VETERANS. 
THE CONTRACT ALLOWS FOR DIRECT SERVICES TO SPOUSES OF DESERT 
STORM VETERANS. WE BILL DIRECTLY FOR SERVICES TO SUCH SPOUSES. 
WE CANNOT, AT THIS TIME, BILL FOR VIETNAM VETERAN SPOUSES AT ALL. 

THE VA CONTRACT PROGRAM TAKES INTO ACCOUNT THE DIFFICULT 
NATURE OF SERVING VETERANS. THE CONTRACT REQUIRES A VETERAN BE 
SEEN WITHIN FIVE DAYS OF HIS OR HER FIRST CONTACT. THEY REQUIRE A 
SYSTEM WITHIN THE CONTRACTOR'S AGENCY WHICH INSURES FOLLOW- 
UP AND MAKES IT DIFFICULT FOR A VETERAN TO FALL THROUGH THE 
CRACKS. THE CONTRACT SOLICITATION REQUIRES THE CONTRACTOR TO 
EXTENSIVELY ILLUSTRATE PAST HISTORY OF SERVICE TO VETS, NATURE 
OF SERVICE, AND A BREAKDOWN OF EXPERIENCE WITH VETS FOR EACH 
STAFF MEMBER. THE CONTRACT ALSO REQUIRES A SHOWING OF 
COMMITMENT TO SERVICE VETERANS AND THE ABILITY AND WILLINGNESS 
TO GO THE EXTRA STEP FOR A VETERAN. THE VA BACKS UP ITS DEMANDS 
ON CONTRACTORS THROUGH MANAGEMENT OF CONTRACTS BY TEAM 
LEADERS AT VET CENTERS. OUR EXPERIENCE HAS SHOWN THE TWO TEAM 
LEADERS WE CURRENTLY WORK WITH ARE HIGHLY COMPETENT AND 
DEDICATED. WE HAVE BEEN ABLE TO DISCUSS CLIENTS' NEEDS AND 
JOINTLY CREATE APPROPRIATE TREATMENT PLANS FOR THE VETERAN. 
THE RESULTS HAVE BEEN VERY EFFECTIVE. 

THE VET CENTER PROGRAM'S STORE-FRONT, INFORMAL APPROACH IS 
VALUED BY THE VETERAN. THE VETERAN, ON THE OTHER HAND IS BOTH 
FEARFUL AND FRUSTRATED IN DEALING WITH THE VA'S MEDICAL 
CENTERS. THE INTAKE PROCESS CAN TAKE HOURS, AND MANY VETERANS 
HAVE DESCRIBED THE PROCESS AS CREATING MORE ANXIETY AND RAGE 
THAN THE PROBLEM WHICH BROUGHT THEM TO THE HOSPITAL IN THE 



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FIRST PLACE. MANY VETERANS LEAVE THESE FACILITIES BEFORE THE 
INTAKE PROCESS IN COMPLETED. WE HAVE FOUND THESE HOSPITALS TO 
NOT COMMUNICATE OR SHARE INFORMATION ON OUR CLIENTS WHEN WE 
HAVE REFERRED THEM TO THE HOSPITALS, AND IN SOME CASES THE 
HOSPITALS DO NOT EVEN COMMUNICATE WITH EACH OTHER IN TERMS OF 
MEDICATION MODIFICATION OR CHANGES. A VETERAN WILL BE ADMITTED 
TO ONE HOSPITAL AND SUBSEQUENTLY RELEASED AFTER IN-PATIENT 
TREATMENT. HE THEN RETURNS HOME AND IS GIVEN AN APPOINTMENT 
WrTH ANOTHER HOSPrTAL CLOSER TO HIS HOME. THAT HOSPITAL WILL 
CHANGE HIS MEDICATION WITHOUT INFORMING THE OTHER HOSPITAL OR 
WITHOUT INFORMING THE AGENCY PROVIDING OUT-PATIENT SERVICES. IT 
CAN TAKE MONTHS TO RECEIVE REQUESTED CLINICAL RECORDS FOR A 
CLIENT AFTER FILING THE APPROPRIATE RELEASES OF INFORMATION BY 
THE CLIENT. THESE VA MEDICAL CENTERS ARE SEEN BY THE VETERAN 
CLIENT AS UNWELCOME, COLD AND ISOLATED INSTITUTIONS, AND THESE 
FACILITIES DO NOT OFFER ANY SERVICES TO FAMILIES. 

OUR FIFTEEN YEAR PASSAGE AND EVOLUTION HAS PLACED US IN A 
POSITION TO OFFER EXTENSIVE AND ENCOMPASSING SERVICES TO THE 
VETERAN AND FAMILY. WE OFFER SUCH SERVICES IN A REGION WITH 
LIMITED RESOURCES FOR THE VETERAN. OUR HISTORY IS AN EXAMPLE OF 
WHAT THE VA'S READJUSTMENT COUNSELING CONTRACT PROGRAM WAS 
ESTABLISHED TO ACCOMPLISH AS SET OUT IN LEGISLATION AND POLICY 
DECISIONS MANY YEARS AGO. IT HAS TAKEN PATIENCE AND COMMITMENT 
TO REACH THIS POINT. WE, AS ANY PRIVATE COMMUNITY BASED AGENCY, 
HAVE SURVIVED THROUGH BOTH GOOD AND BAD TIMES BY OUR ABILITY 
TO ACCOMPLISH OUR GOAL: SERVICE TO VETERANS AND THEIR FAMILIES. 
IF WE DO NOT DO OUR WORK WELL, THE VETERANS AND THEIR FAMILIES 
WILL GO ELSEWHERE OR NOWHERE AT ALL, AND WE WILL NOT SURVIVE. I 
BELIEVE THAT OUR FIFTEEN YEAR HISTORY IS A TESTIMONY TO THE 
QUALITY OF OUR WORK. MY FEAR IS THAT WHAT HAS BEEN CREATED WILL 
SOMEDAY DISAPPEAR BEFORE IT HAS COMPLETED THE MISSION. 

THE EXTENSIVE SERVICES THAT AGENCIES LIKE COVER PROVIDES CANNOT 
CONTINUE ON GOOD INTENTIONS AND STAFF DEDICATION ALONE. 
WITHOUT A STABILIZATION OF FUNDING FOR THE VA'S CONTRACT 
PROGRAM AND A COMMITMENT TO FAMILY SERVICES. PROGRAMS LIKE 
OURS WILL DIE ON THE VINE, THE SERVICES WILL VANISH, AND VETERANS 
AND THEIR FAMILIES WILL HAVE THEIR HOPES DASHED ONCE AGAIN. 
AGENCIES LIKE OURS CAN AND WILL DIE A SLOW BUT CERTAIN DEATH 
THROUGH A SERIES OF CUTS HERE AND CUTS THERE UNTIL ALL THE GOOD 
WE HAVE CREATED WILL BE JUST SO MUCH HISTORY. 

THAT CONCLUDES MY TESTIMONY, MR. CHAIRMAN. THANK YOU AGAIN 
FOR INVITING ME HERE TODAY. I WOULD BE HAPPY TO ADDRESS ANY 
QUESTIONS YOU MIGHT HAVE. 



102 



TESTIMONY OF 



MILTON REAVES 
VIETNAM VETERAN 



BEFORE THE 

SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS 

HOUSE VETERANS AFFAIRS COMMTTTEE 



MAY 18, 1994 



103 



GOOD MORNING CHAIRMAN EVANS AND MEMBERS OF THE COMMITTEE. 
THANK YOU FOR INVITING ME TO TESTIFY HERE TODAY. 

MY NAME IS MILTON J. REAVES. I SERVED AS A LIGHT WEAPONS 
INFANTRYMAN IN VIETNAM. I WAS WOUNDED AND RECEIVE 10% 
SERVICE CONNECTED DISABILITY FOR THOSE WOUNDS. I AM 46 YEARS 
OLD AND HAVE BEEN TWICE DIVORCED. I HAVE THREE CHILDREN, AGES 
9,10 AND 18. I AM ALSO HAVE SERVED TIME IN THE VIRGINIA STATE 
PENITENTIARY. MY LIFE HAD BEEN A HISTORY OF BRUSHES WITH THE 
LAW AND LIVING FAST AND EASY. I DRANK A LOT AND ALWAYS 
SEEMED TO BE IN A FIGHT. THE COPS KNEW WHO I WAS AND I STILL 
DID NOT KEEP A LOW PROFILE. UP UNTIL THE LAST FEW YEARS, I 
NEVER REALLY COMPLETED ANYTHING WELL OR FELT COMFORTABLE 
WITH WHERE I WAS GOING. 

MY MILITARY SERVICE ENDED WITH A LESS THAN HONORABLE 
DISCHARGE. UPON MY RETURN FROM VIETNAM I TOOK AN ARMY TRUCK 
FOR A SPIN, BROKE RESTRICTION AND HAD PROBLEMS WITH CIVIL AND 
MILITARY AUTHORITIES. I AM PROUD OF ONE THING FROM THE 
MILITARY, MY COMBAT INFANTRY BADGE FOR SERVING IN COMBAT 
WITH THE NINTH INFANTRY DIVISION. I SERVED EIGHT MONTHS 
BEFORE BEING HIT. I ALSO SPENT YEARS DEALING WITH THE ARMY IN 
GETTING MY DISCHARGE UPGRADED. 

I HAD HEARD OF COVER FOR A FEW YEARS. FRIENDS OF MINE HAD GONE 
THERE FOR SERVICES AND SAID I SHOULD ALSO TRY IT. I DIDN'T UNTIL 
LATE 1987 . I WAS FACING CHARGES AND DID NOT HAVE ANY PLACE TO 
TURN. MY CHILDREN LIVED WITH THEIR MOTHER AND I WAS NOT 
CLOSE TO MY PARENTS OR BROTHERS AND SISTERS. I FINALLY LISTENED 
TO KENNY, A VET FRIEND WHO HAD BEEN GOING TO COVER AND GAVE IT 
A SHOT. I DID NOT HAVE MUCH OF A CHANCE TO WORK WITH THE 
GROUP BECAUSE I WAS CONVICTED AND SENTENCED FOR A CHARGE. I 
WENT TO THE STATE PRISON IN STAUNTON. BUT, COVER WAS RUNNING 
GROUPS AT THE PRISON AND I WAS ABLE TO KEEP SEEING THEM WHILE 
IN CONFINEMENT. MY GIRLFRIEND WAS ALSO ABLE TO SEE A 
COUNSELOR AT COVER WHILE I WAS IN PRISON. I WAS RELEASED FROM 
PRISON IN MAY OF 1990. I THEN BEGAN TO PARTICIPATE IN COVER'S 
COMBAT GROUP WITH TOM AND INDIVIDUAL SERVICES WITH SWEP, A 
TWO-TOUR MARINE IN RECOVERY ON STAFF WITH COVER. I ALSO 
ATTENDED THEIR WEEKLY VET'S SUBSTANCE ABUSE GROUP. 

COVER GAVE ME A SAFE PLACE TO COME. I COULD COME IF I HAD AN 
APPOINTMENT OR NOT. I COULD COME JUST TO SIT AND READ OR DRINK 
COFFEE. I HAD A PLACE TO GO TO WHEN THINGS FELT TIGHT. I FOUND 
DIFFERENT WAYS TO DEAL WITH HASSLES THAN I DID BEFORE. I COULD 
ALWAYS TALK TO THE FOLKS THERE ABOUT ANYTHING THAT MIGHT 
HAVE COME UP. THEY WORKED WITH ME IN HOW TO DEAL WITH MY 
CHILDREN AND HOW TO DEAL WITH MY EX- WIFE IN TERMS OF THE KIDS. 
THEY WORKED WITH ME ON NAM AND MY ANGER. WHILE AT WORK I 
WAS AWARDED EMPLOYEE OF THE QUARTER. I RODE A BIKE WHEREVER 
I WENT BECAUSE I HAD LOST MY DRIVERS LICENSE. I FELT I ALWAYS. 
NO MATTER WHAT, HAD A PLACE TO GO. 

WHEN I GOT IN TROUBLE THE LAST TIME, COVER FOUND ME AN 
ATTORNEY IN CHARLOTTESVILLE. HE ALSO WAS A COMBAT VETERAN. I 
WAS FACING FIVE YEARS IN PRISON. THE ATTORNEY AND COVER WERE 
ABLE TO ARRANGE FOR GETTING MY TIME REDUCED TO TIME SERVED 
PLUS TWO AND A HALF MONTHS AND I WAS HOOKED UP WITH 



104 



COMMUNITY DIVERSION PROGRAM. THEY ALSO HOOKED ME UP WITH AN 
IN-PATIENT ALCOHOL TREATMENT PROGRAM FOR 28 DAYS. COVER SET 
UP MY AFTERCARE. IN 1993 I SUCCESSFULLY COMPLETED THE CDI 
PROGRAM, I PAID OFF ALL MY COURT FINES EARLY. WORKED FULL TIME, 
I CREATED A SMALL BUSINESS AND RECEIVED A SUB CONTRACT FROM 
THE CITY OF CHARLOTTESVILLE. 

THEY ALSO HELPED MY CHILDREN TO UNDERSTAND ME AND MY PAST 
AND FOR ME TO UNDERSTAND THEM. MY CHILDREN ARE HAPPY AND 
EXCTTED TO LEARN WHERE I HAVE COME FROM AND WHAT I DO NOW. 
THIS WAS BROUGHT ON BY THE COUNSELORS. MY ABILITY TO GAIN 
CONFIDENCE IN MYSELF AND TO MAKE CHANGE IN MY LIFE IN MANY 
WAYS WAS BASED ON SERVICES TO MY CHILDREN AND GIRLFRIEND. 
THEY LEARNED WHERE I WAS GOING AND WHAT I NEEDED TO DO AND I 
LEARNED WHAT THEY NEEDED AND HOW WE COULD ALL WORK 
TOGETHER. YOU CANT MAKE CHANGES IN YOUR LIFE UNLESS THE ONES 
CLOSE TO YOU ARE ON THE SAME PAGE. EVERYONE HAS NEEDS AND ONE 
CANT MAKE CHANGES WITHOUT THE OTHERS BEING INVOLVED. 

COVER THROWS EVENTS FOR FAMILIES. THEY HAVE A CHRISTMAS 
PARTY EVERY YEAR WITH SANTA AND DINNER. MY KIDS HAVE A GREAT 
TIME AND GET TO MEET OTHER CHILDREN. THEY HAVE PICNICS AND 
OUTINGS FOR THE CHILDREN. MY SONS MET WITH A COUNSELOR ON A 
WEEKLY BASIS. THEY HAD A PLACE TO TALK ABOUT THEIR NEEDS. I 
HAD A PLACE TO COME AND UNDERSTAND THEIR NEEDS. 

HANK CHILDRESS, MY ATTORNEY AND COVER HELPED WITH MY GETTING 
CUSTODY OF MY CHILDREN. THEY GUIDED ME THROUGH THE PROCESS 
AND WERE THERE WHEN I HAD PROBLEMS WITH THE SYSTEM. I HAD A 
BAD EXPERIENCE WITH AN INTAKE SERVICE WORKER AT JUVENILE AND 
DOMESTIC SERVICES. SHE WAS RUDE AND DISRESPECTFUL AND MADE 
STATEMENT ABOUT VETS IN GENERAL. WHEN I TOLD MARY JAMES AT 
COVER, SHE IMMEDIATELY WROTE A LETTER TO THE DIRECTOR AND 
FOLLOWED IT UP WITH A CALL. THE DIRECTOR EVENTUALLY 
APOLOGIZED AND THE WORKER WAS REMOVED FROM MY CASE. I FOUND 
OUT LATER THAT COVER WAS INVITED TO PRESENT A TRAINING 
PROGRAM TO THE JUVENILE AND DOMESTIC SERVICES' WORKERS. COVER 
BACKED ME UP WHEN I NEEDED HELP WITH SOMETHING I COULD NOT 
DEAL WITH ALONE. I NOW HAVE FULL CUSTODY OF MY TWO SONS. 

HAD IT NOT BEEN FOR COVER, I SERIOUSLY BELIEVE MY ROAD WAS 
HEADED FOR DESTRUCTION. COVER TURNED MY LIFE AROUND. I MET A 
COUNSELOR WHO WALKED THE SAME PATH AND HAD THE ABILITY TO 
GET ME TO SEE THAT IT WAS NOT SO MUCH THE OUTSIDE WORLD THAT 
WAS THE PROBLEM. I ALSO HAD RESPONSIBILITY FOR MY ISSUES. I 
NEEDED TO FEEL I HAD POWER TO MAKE CHANGE. 

I STILL STRUGGLE WITH SOCIETY'S BIAS AS A VIETNAM VET, AN 
AFRICAN AMERICAN MALE AND BEFORE COMING TO COVER MY 
RESPONSE TO THAT BIAS WAS RAGE, INDIFFERENCE, AND OUTRIGHT 
AGGRESSION. TODAY, I AM STAYING SOBER, BEING THE BEST FATHER I 
CAN BE, WORKING MY PROGRAM AND TAKING IT ONE DAY AT A TIME. 

THANK YOU ONCE AGAIN FOR INVITING ME HERE TO TESTIFY ABOUT THE 
ISSUES OF VIETNAM VETERANS AND THE PROGRAMS THAT HELP THEM. 
I WOULD BE VERY HAPPY TO ANSWER ANY QUESTIONS YOU MIGHT 
HAVE. 



105 



Statement of 

Michael McKelroy 

Project Coordinator, Veterans Assistance Project 

Team of Advocates for Special Kids (TASK) 



Before 

The Subcommittee on Oversight and Investigations 

House Committee on Veterans Affairs 



May 18th, 1994 



106 



Chairman Evans and Members of the Sub-Committee, Good 
Morning. Thank you for allowing me to present testimony here 
today on "Social Services for Vietnam Veterans and Their 
Families: Current Programs and Future Directions." 

My Name is Michael McKelroy MSGT . USMC RET. I am a combat 
disabled Vietnam Veteran, with three tours in Nam, 66, 67, 68 
and back, to the world in 69. I'm presently employed by TASK 
- Team of Advocates for Special Kids, Anaheim, California, as 
the Vietnam Veterans Assistance Project Coordinator. TASK is 
an Agent Orange Class Assistance Program grantee. 

TASK'S main mission is to help parents access the education 
services and other support service systems for children with 
disabilities and provide support to families. In my testimony 
this morning I will address some selected issues that, based 
on my family's personal experience, represent significant 
needs and concerns among the Vietnam Veterans and their 
families . 

Let me begin with my story: My wife, Anita, and I have 5 
children. Our children are two daughters, Anna and Kathleen, 
and three sons, Mike Jr., Daniel, and Robert. We've always 
been a "military family." In 1985, I retired from the USMC 
after 23 years in the Corps. The family moved to Riverside, 
California . 

At age 14 Mike Jr. began to have serious learning and 
discipline problems at Arizona Intermediate School in the 
Alvord School District . There were conferences with teachers 
and the principal. One teacher told Mike Jr. that he would 
never make it in school and he ought not to bother to attend. 
Mike had been suspended and received numerous on campus 
suspensions. Mike's mother was in constant communication 
with the school but it reached the point that Mike didn't 
want to go to school and had no self-esteem. We went to the 
school system and begged for help, and talked to the school 
principal, school counselor and teachers. The response to 
our cry for help was to be told that Mike was just lazy. 
They said that it appeared to the school professionals that 
it was obvious that mother and father were having marital 
problems and that was the reason that Mike was having the 
problems at school. The principal stated to the parents that 
all Mike needed was the hell beaten out of him and that would 
straighten him up and besides family problems were not the 
schools business. They never addressed his learning 
disabilities . 

Mike dropped out of school at age 15 years and it wasn't long 
before he also became a part of the Juvenile Justice System 
for taking his mothers van for a joy ride. The judge ordered 
him to go to school, but he didn't. At age 17 he served 15 
days in juvenile hall for failing to go to school. In the 
meantime his two sisters had finished high school and started 
their own life and Daniel had started having problems at 
school. With Daniel the systems solution was to put him on 
home study. He did complete Jr. High School and started High 
School but was expelled his first year. Daniel didn't finish 
high school. Later, both these boys were evaluated 
independently and were found to have learning disabilities. 
The parents worst fears were that these two boys would spend 
most if not all of their lives in the juvenile and adult 
justice system. By this time the pressure in the family had 
reached a boiling point. The family was about to break up. 
The school professionals' statements had become reality - 
there were marital problems between mom and dad. We blamed 
one another and felt that we were failures as parents. There 
was no one and nowhere for the family to turn. We didn't 
know about learning disabilities or Public Law 94-142 that 



107 



Congress passed that law that protects these children, and 
the system wasn't about to tell us about this law or inform 
us of our children's' rights to a Free Appropriate Education. 

I didn't trust anyone that wasn't ex-military and had not 
done their time in the Nam, because, after all, if they had 
not been there, they were just hippies, druggers, and draft 
dodgers. I didn't believe that anyone could have PTSD . My 
drinking was starting to become a problem, stress on the 
family was tremendous, and there seemed to be no hope for 
this Vietnam veteran's family. 

As I stated at the beginning of my testimony, this started in 
1985, and now it's 1994. What has happened to this Vietnam 
veteran's family in these nine years? Mike Jr. is 21, 
married, the father of three children and finally has a job 
at $8.00 an hour. He doesn't have a high school education 
and still has some problems but he attempts to deal with 
them. Daniel is also married, has one child, and has started 
his own carpet cleaning business, working 10-12 hours a day 6 
days a week. Anna has one son and Kathleen is attending 
college. As for Robert, he also has learning disability, but 
he is doing outstanding in school. Mom and Dad found help 
for themselves and their children, are proud grandparents, 
have a strong marriage and a family that stands by each other 
no matter what happens . 

Three members of this family are here this morning; my wife, 
Anita, my youngest son, Robert, and me. How was it that my 
family was able to stay together and make things work, when 
other families in this day and time fall apart? The answer 
to this question is not complicated. It is because of the 
Agent Orange Class Assistance Program and TASK being a 
grantee that enabled my family to stay a family. When I 
found TASK, quite by accident, I was able to talk to another 
Vietnam Vet, who understood where I was coming from, and who 
also had a child with similar problems. For the first time, 
I realized that the children had a disability. We were 
referred to a very supportive counselor, we took TASK 
trainings and workshops, we made use of their referral 
system, and they helped me keep my son from being expelled 
and got him some assistance. Because of this program, my 
youngest son has the opportunity to be successful in school. 
But most important, my family, all of my family, sons, 
daughters, grandchildren, daughters-in-law, sons-in-law, are 
solidly united as a family should be. My wife and I are now 
employed by TASK, and Robbie spends many hours when school is 
"off track" in the office, picking up all kinds of 
information. He has called his own Individualized 
Educational Plan (IEP) meetings when he felt his educational 
program was inappropriate. 

At this time, I would like to address the following issues 
that concern the items in your hearing invitation from the 
point of view of a vet and his family who have been there: 

"Are some programs more successful in meeting the social 
service needs of veterans and their families? What types of 
programs are more successful? Why are they more successful?" 
The programs that address the total needs of the veterans and 
their families are more successful. The best example of this 
kind of program would be TASK and any program that works with 
the whole family or has effective liaisons with other 
programs. Often professionals start treatment of the veteran 
and assume that this will make the veteran whole again. They 
tend to look only at the war experience of the veteran. From 
personal experience I can say that the whole family must be 
treated to effect a cure or change in the veteran. It is 
only through programs that understand this that the treatment 
will work and the veteran and the family will be whole again. 



108 



These programs do best when they provide support for the 
veterans, their wives and children. 

"Do veterans and their families have unique social service 
need? How are these unique needs related to military service 
and experience?" Veterans and their families are a unique 
group in themselves, especially the Vietnam Veterans, and 
their families. Problems often began when a veteran returned 
home, especially with a career military person. These folks 
may have spent years giving orders, but never acknowledged or 
even understood that he or she had a problem based on combat 
experience. Vietnam Vets struggle to deal with his or her 
own baggage from the war. With the additional stress of 
family problems, money problems, and adjustment are added, 
the vet feels that there is no one to talk to unless that 
other person has had the same combat experience. The vet 
knows that "if you haven't been there then you don't know 
what I'm about." Getting the vet to admit that he or she has 
PTSD and seek counseling for himself and the family is very 
difficult. Some times, just getting the vet to acknowledge 
that the war is over can be like climbing a mountain without 
shoes . 

"Do social service providers generally understand these 
unique needs? What are the consequences of not recognizing 
these needs?" 

Most social services providers have no idea what makes a 
Vietnam Veterans family unique unless they have been trained 
in this area or have been there themselves. From my own 
personnel experience I can state that if TASK, through the 
AOCAP,had not understood the unique needs of my family and 
been willing to work with me and my family I would have lost 
my family. The chances are that I would be one of the 
homeless veterans that you hear about. My sons would have 
been in the justice system and dependent upon the government 
for support. Most of the veterans' families with whom I deal 
daily have similar problem. The consequences of not 
recognizing and dealing with these needs results in children 
in the criminal justice system, welfare dependency, 
homelessness, broken marriages, suicide, and dependency on 
the mental health systems if the veteran can find his way 
through that system. 

"Is there coordination among the providers of social services 
to veterans and their families? How do veterans and their 
families benefit from the networking of services and 
professional service -coordination?" 

The AOCAP grantees network, collaborate, and utilize each 
other's expertise. This is especially true in California, 
where seven grantees are all networking and working towards 
one goal: making the vet and the family whole. As an 
example, the El Monte American GI Forum, which provides 
counseling and assessment, often requests that TASK attend 
IEP meetings as advocates for the family in addition to 
someone from the Forum providing family counseling. TASK and 
El Monte may refer vets to Southern California Veteran 
Service Council in Santa Monica for concrete services for the 
child, such as eye glasses and dental services. Vietnam 
Veterans of San Diego may provide assessments for children 
served by TASK and TASK may drive to San Diego to attend the 
IEP. I assist Vietnam Veterans of California - Santa Rosa 
Office and Sacramento Office with Standowns in Sacramento 
area and assistance with education issues. My family has 
attended three standowns. Grantees, such Swords to 
Plowshares in San Franciso call for technical assistance on 
educational issues. All of us in California work to 
coordinate our efforts to enhance the services provided the 
vet and the family. Some of our families are referred to 
AOCAP grantees across the nation because of their unique 
expertise . 



109 



Among other social service providers, this collaboration is 
not evident, nor is there an understanding of various 
services available to the veteran. We rarely receive a 
referral from the VA. Referrals we receive from other 
agencies, such as mental health, AFDC, department of 
developmental services, etc. are based purely on a need for 
assistance at the child's IEP . There is no recognition that 
one of the parents is a veteran, or that problems connected 
to combat may be influencing the child. There are cases when 
an agency knows the father is a veteran and they blame all of 
the child's difficulty or disability on the home life and 
wash their hand of any responsibility for the child. 

"Does VA generally recognize military service-related unique 
social service needs of veterans and their families?" 
The VA has failed and will continue to fail in their attempts 
to help the vet until they recognize the military-related 
unique social service needs of the veterans and their 
families. If my family and I had to depend on the VA for 
help that was needed to make my family whole, then I wouldn't 
have a family. The VA needs to realize that the Vietnam 
veterans' families are very unique and require services that 
address the needs of the whole family, not just the vet's 
needs. The AOCAP programs address the unique needs of the 
Vietnam veteran's family by bringing all of the AOCAP service 
programs together, sharing information resources and 
referrals to other AOCAP programs. When the VA realizes that 
this is the way to provide the services, then the VA programs 
will succeed and families will be saved. 

"Is VA providing veterans and their families needed social 
services?" No. They provide treatment for substance abuse 
counseling and PTSD counseling for the veteran only, but do 
not even offer this service to family members, nor is there a 
referral service for families. 

"Does VA coordinate the delivery of social services to 
veterans? Does VA coordinate the delivery of social services 
to veterans and their families with other social service 
providers?" 

To my knowledge, vets do not leave VA with a list of social 
services agencies offering various help to them and their 
families. I have never received a single referral from the 
VA, and that's a shame. The different AOCAP programs 
throughout the United States could be the biggest asset the 
VA has to ccordinate the delivery of needed services to the 
vet and the family. Saving time and money for the taxpayer, 
but more importantly, saving the vet and the vet's family. 

I believe, based on working with these families for four 
years and on my own personal experience, that social service 
agencies and/or the VA cannot effect lasting results when 
treating the veteran unless they treat and provide services 
to the entire family. If they do not it is like doctor 
treating only the symptoms of a disease and not the cause. 

Thank you very much for this opportunity to present to you 
this morning about issues that concern Vietnam veterans and 
their families. I would be happy to answer any questions you 
might have . 



110 



Statement of 

Leslie Felton 

Parent of a child receiving services from the 

Vietnam Veterans Family Support Project (WFSP) 

Kennedy-Krieger Institute, Baltimore, Maryland 

Accompanied by 

Peter La Count, Project Coordinator, WFSP 

Kennedy-Krieger Institute 

Before the 

Subcommittee on Oversight and Investigations 

House Veterans Affairs Committee 

May 18, 1994 



Ill 



Peter La Count: 

Good morning Mr. Chairman and committee members. My name 
is Peter La Count. I am the Project Coordinator for the Vietnam 
Veterans Family Support Project (WFSP) at the Kennedy Krieger 
Institute in Baltimore, MD. Funded by the Agent Orange Class 
Assistance Program. WFSP provides family-centered support services 
for families of Baltimore-area Vietnam Veterans who have children 
with disabilities. The services provided include: 

* coordination of services 

* home-based professional services 

* financial assistance to help families purchase needed services 

* educational workshops and support groups for parents 

Leslie Felton is the head of a family that has been receiving 
services from WFSP since July. 1991. Leslie has two children: 
Melissa, aged 10 and Devin, aged 9. Melissa has been diagnosed with 
Rolandic Epilepsy, sensory motor problems, and learning disabilities. 
The children's father, a Vietnam veteran, no longer lives in the home. 
The family has received educational services, family counseling, 
occupational therapy, and financial assistance services from VVFSP. 
Leslie and her family are an excellent example of how WFSP has 
helped the family over barriers stemming from their unique needs as a 
family of a Vietnam Veteran. Without WFSP, Leslie's family may very 
well have fallen through the cracks of the developmental disabilities 
and veterans assistance systems. 

At this time, I would like to introduce the Committee to Leslie 
Felton who will talk about how these support services have benefitted 
her family. 



Leslie Felton: 

Good morning Mr. Chairman and Committee members. My name 
is Leslie Felton. I am the spouse of a Vietnam Veteran and mother of 
two children, one with a disability. The services that WFSP provides 
to families has made a great difference in my life. As Mr. La Count 
stated before, over the three years that my family has been involved 
with the program, we have received a wide array of services. The 
services that we have received from WFSP are as follows: 

I. Family Therapy 

Before receiving family therapy, we used to be the "Bickersons." 
The children and I did not know how to talk to one another. The kids 
and I had problems communicating because communication is not just 
two people talking back and forth. "We did not really listen to the 
feelings, emotions, and outcries that we were all having. All of us were 
feeling a great deal of pain and did not know how to deal with it. The 
family therapy helped to evaluate the face value of every word, and 
every value behind the words. The therapy helped me to deal with 
some of my anger concerning their father." the kids' questions about 
their dad, and the divisions between me. him. and the children. 

If this therapy had not been available. I do not know where I 
could have gone to get help. I suppose that we could have gone to an 
out patient clinic or I could have paid expensive co-payments: however, 
if we had done these things it could have really hurt us financially. 
Besides, having the therapist come to my home was such a great 
benefit. She was able to come to our home during a time that was 
convenient for us. If we had gone to a clinic. I might have had to take 
the kids out of school or go at some other inconvenient time to satisfy 
the clinic's schedule. 



112 



II. Occupational Therapy 

It has helped me deal with seeing how my daughter Melissa was 
having difficulty. I thought that the difficulty that Melissa had in 
organization, hand writing, fear of riding a bike, and in throwing a ball 
was because she was not trying hard enough. The therapist taught 
Melissa and me that it was not that she did not want to do certain 
things, but that she needed help and guidance in doing them. Now she 
rides a bike and does not have as much difficulty with her 
handwriting. She is more organized with her school work and is a 
neater dresser. Melissa is also doing much better in school. Again, 
having the therapist come to my home made things a lot easier, also. I 
am a single parent trying to take care of my children and go to school. 
It would have been very stressful having to take a bus for an hour ride, 
with two children, to an office or a clinic for the occupational therapy. 
When the therapist can come to my home, I feel more relaxed, it saves 
me time, and the sessions were much more productive. 

III. Educational Advocacy 

Before Melissa received tutoring and help in school from WFSP. 
she received "Unsatisfactory" grades in math from the first through the 
fourth grades. Now with resource help, she went from an 
"Unsatisfactory" to "Good"--a major, major accomplishment. Melissa 
and I and her schools had fought about math for years. Now that both 
Melissa and I are aware of her rights, the school system cannot push 
us around anymore. I am now able to attend school meetings and 
advocate for the services that I know my child has the legal right to 
receive. 

The WFSP educator gave me some ideas on how I could help 
Melissa at home. I bought a blackboard so that Melissa and I could do 
some of her math homework together. Having me help Melissa by our 
working together on her most difficult subject helped Melissa feel more 
relaxed and helped me to feel like I could take a more active part in her 
education. 

IV. What types of programs are more successful when working with 
families of veterans? 

Programs that help the family to assess their strengths and 
weaknesses or the family's needs and help you sort out what are the 
most significant issues, the greatest success when working with 
families of Vietnam Veterans. Staff persons who take into account 
what the family thinks is important in the helping process are more 
effective than those who treat families as if they are the same as all 
other families. From these lists of strengths and weaknesses, the staff 
people can help the family to develop a family program to fulfill those 
needs. Once this family plan is developed, everybody involved can 
adjust for the individual needs of the adults and children. 

Also important are programs that view the family as a unit, but 
also recognize that there are distinct individuals in the family who 
have particular needs. The individuals may have problems like PTSD 
or substance abuse which are issues that can not be addressed only by 
working with the family. That individual must get help in realizing 
that he or she has a problem that is affecting the entire family. 
Effective programs when working with veterans recognize the needs of 
the family as a whole and the unique issues of the individuals in the 
family. 

V. Why are programs like these more effective when working with 
families of veterans? 

Programs that try to include all members of the family avoid a lot 
of confusion that might occur otherwise. Some programs that only 
work with the adults, or the children in the family, and leave out one or 
the other ending up making the omitted members of the family feeling 
left out. By including all members of the family in decisions regarding 
the family, everybody feels as though they are part of the unit. If 



113 



everybody feels as though they are important to the well being of the 
family, then there is a greater chance of everybody's needs being met. 

VI. Do Veterans and their families have unique social service needs? 

Yes. Many family problems of a Vietnam veteran come from 
drugs and abuse which are issues that the other family members can 
not fight. If the veteran has PTSD how do you fight that? If the veteran 
has problems with his or her own feelings of security because he 
doesn't trust anybody-how do you fight that? Even something so 
common place as the mailman knocking on the door and the veteran 
panicking over who is at the door adds a lot of stress to the family. 

There are many issues with the families of Vietnam veterans that 
the family can not deal with on its own. The veteran needs to be 
convinced that he or she needs help. too. 

The veteran, the spouse, and the kids tend to stick together no 
matter what kinds of horrors are going on in the family. This is not 
always a good thing. A non-veteran family with issues of abuse or drug 
addiction might split up in order to save the spouse or children from 
harm. In our family, I always ended up making excuses for my ex- 
husband's abusive behavior. I kept saying that this situation can not 
keep going on forever. Instead of removing myself from the situation, I 
stayed with him longer than was probably safe for us to do so. I think 
this same situation happens in a lot of families of Vietnam veterans. 
Even in this day and age where everybody is confessing about 
everything, the family of a Vietnam Veteran will not often talk about 
their family problems to others. If you don't talk about things, then the 
family problems can not get fixed. 

I come from a military family. My father, all six brothers, and 
uncles are all in the military. It is only natural that I would meet and 
marry somebody with a military background. In observing the training 
that they have to go through, people in the military are taught to be 
sharp and ready in all situations. 

My ex-husband's readiness made it difficult for us as a family. 
He was always ready to fight even though there was no longer a war. 
This "readiness" that he learned put him always on edge. As a family, 
we felt we had to prove to him that we were not the enemy. We all 
wanted to support him. but we could never prove it enough that we 
were on his side. If the veteran is never willing to trust, then you can 
never do enough to prove your love for him. 

VII. How would our family's life be different if service from WFSP 
had not been available? 

I have asked myself this question over the many months. If there 
were no services available from WFSP. things would be a thousand 
times worse. It is easy to condemn an abusive parent, but I could have 
easily have been one because I did not know how to deal with my kids. 
We all went through quite a strain after their father became ill and left 
home. I believe that if we had not had this program . the kids would 
have ended up living with another family member or I would have been 
completely unable to handle the situation at home. Furthermore, with 
help from WFSP support services. I have since graduated from college 
with a bachelors degree in elementary education. 

VIII. How had being a spouse of a Vietnam Veteran impacted upon 
my and my children's lives? 

As a Vietnam Veteran who went through combat, my ex-husband 
was never at ease with anybody. He never trusted anyone. And after 
we had been together for a while, we became a possession to him. My 
ex-husband became abusive to us as a family. Not so much to the kids, 
but he was neglectful and to this day he is neglectful. My ex-husband 
was exposed to Agent Orange. He was in the area where it was sprayed 
and he was sprayed with it. He has cancer as a result of Agent Orange. 
My ex-husband is also an alcoholic and has a drug addiction problem. 
Furthermore, he is always in the attack mode. If we tried to wake him 



114 



up when he was asleep, he would try to attack us--just as if he were 
back in Vietnam. Ensuring our family's stability took more time than 
he was willing to give us. Soon it came to a point where we thought 
that our lives were in danger. He had become an abuser in several 
different ways. Being the spouse of a Vietnam Veteran has always been 
difficult. There are so many avenues for the veterans to get help, but 
for the veterans' family, there really are not a great deal of services 
available. I do not know of anywhere else that I could have gone to get 
the support that I have received through WFSP. As far as I know these 
services are not available through any other organization. As a family 
it is very difficult to get services if the veteran is not willing to work 
with the family. 

Our family was one of the fortunate ones. We were able to be 
linked up with the services that helped us to become a healthy, 
productive and loving family. We quite possibly could have been the 
exact opposite. Without this program, I don't know what 1 would have 
done. 1 have gained a lot of confidence in myself and my ability to 
raise my children. This program gave me the tools I needed to help my 
family over some very emotionally difficult obstacles. 

Thank you once again for the opportunity to present testimony 
before your Committee. I hope you find this testimony useful. I would 
be very happy to answer any questions you might have. 



115 



Testimony of 



Peggy St. Clair 

Wife of a Vietnam veteran and 

Service Coordinator for Project Access 

University of Arkansas, University Affiliated Program 

Little Rock, Arkansas 

Before the 

Subcommittee on Oversight and Investigations 

House Veterans Affairs Committee 



May 18, 1994 



116 



Chairman Evans and members of the House Veteran's Affairs 
Subcommittee, Thank you for the opportunity to address you today 
concerning the social services needs of Vietnam veterans and their 
families. My name is Peggy St. Clair and I am the wife of a Vietna 
vet. My husband, Lance St. Clair, served a tour of duty in Vietnair 
1970. He also served elsewhere in Indochina. Upon his return to t 
United States, he married. His wife gave birth to a stillborn chil 
to a child with a disability. They divorced and we were married. 
gave birth to stillborn twins and two children with disabilities, 
family lives in Mountain Home, a small community of 9, 000 nestled 
in the mountain and lake region of extreme north central Arkansas. 
For the past year, I have been employed as a service coordinator fo 
a program funded by the Agent Orange Class Assistance Program 
(AOCAP) at the University of Arkansas University Affiliated Prograir 

Today, I will address many of the points you listed in your hearing 
invitation within the contest of my overall testimony. I will rela 
the story of my family and the stories of several families with 
whom I work. I hope that this will illustrate the complexity of th 
social service needs we are experiencing over 20 years after the 
Vietnam war and the types of programs and services that are 
necessary to address these needs. I will also indicate some of the 
barriers that have been encountered by families from unresponsive 
service systems. The results of an informal survey of Vietnam vets 
in northern Arkansas will also be discussed to address an even 
broader view of possible strategies to meet needs. 

The birth of our daughter, Grace, in 1975 was the beginning of our 
journey through the maze of social services. Grace was born with 
spina bifida, a malformation in the spinal cord that resulted in lo 
body weakness. She has been diagnosed as having severe mental 
retardation and llq-chromosome deletion which is so rare that she 
is one of only 14 of documented cases. She also has Bernard's 
syndrome, a platelet disorder that won't let the blood clot, and 
leukodystrophy. Leukodystrophy was the subject of a recent 
popular film, Lorenzo's Oil. 

We were bewildered and overwhelmed by all of these problems. 
Medical expenses were astronomical. We did not have any idea 
where to go for help. When Grace was 8 months old, we were told 
by well meaning professionals to place her in an institution and go 
on with our lives. They were not sure if she would live. If she di 
beat the odds and survive, they could not predict the quality of he 
life. We chose to take her home not knowing what to expect. For 
two years we received no services in our rural county. When we 
moved 15 miles into another county, a public health nurse and a 
service coordinator from a regional developmental disabilities 
center were on our doorstep within 60 days asking what they could 
do to help. There were so many different problems I didn't even 
know what to ask for. It took several days for them to assist me i 
setting up a plan of therapy and doctors' appointments. They 
arranged for a physical therapist to come to our home to work with 
Grace. Hank, our service coordinator, accompanied me to 
appointments and coached me in how to get the information that I 
wanted and needed from the physicians and other service providers. 
The service coordinator, nurse, and therapist became our friends, 
showing a genuine concern for Grace and our family. As I gained th 
skills to be the advocate for our child, Hank slowly relinquished h 



117 



role to me. When new crises arose, Grace's introduction to public 
school for example, Hank was there. He attended the first 5 or 6 
Individualized Educational Plan meetings with us, allowing me to 
take charge a little more with each one. Hank remains a very dear 
friend. These professionals helped us through a maze of agencies 
and services, provided us with good useful information, looked at a 
of our family needs - not just Grace's and helped us to become 
independent - not dependent. At this time, Grace has completed 
high school and lives in her own apartment with the help of a live- 
caregiver. She attends a day service center for training. During 
free time she is out in the community with her friends. Our young 
adult daughter loves coming home for brief visits and celebrations 
but prizes her new independent life-style. The social service 
support provided by our service coordinator 17 years ago allowed us 
to chose a future for Grace and our family much different than the 
one predicted when she was born. 

With this history and the philosophy of family-friendly, community- 
based service coordination of the University of Arkansas Program, I 
have been able to successfully address the needs of the families of 
Vietnam vets that I work with in north central Arkansas. The 
veterans in this area are independent, proud, and generally 
distrustful of "systems". My status as the wife of a veteran has 
helped with the credibility. Since I have been employed by the 
University of Arkansas University Affiliated Program 12 months ago, 
I have received 57 referrals concerning Vietnam veterans who have 
children with disabilities. Most of the referrals have come direct 
from families as a result of our public awareness program and 
word-of-mouth from other families. These referrals have resulted in 
Individualized Family Service Plans for 25 families. Thirty-one 
families required information and referral to link them to 
appropriate social service organizations. A total of 44 families, 
including 33 vets, 20 children with disabilities, and 12 other fami 
members have benefited this year from our program in the 12 
county area I serve. Our state-wide AOCAP-funded program has 
provided services to over 171 families since May, 1992. It is evid 
from the number of referrals received that families of Vietnam vets 
still have major needs that are exacerbated by the age of the 
children. As children of Vietnam vets become adolescents and young 
adults, services are less available, problems become more complex, 
and families often become overwhelmed and tired of pushing the 
system. Also many families have exorbitant back medical bills, 
week of hospitalization averages tens of thousands of dollars. The 
cost of multiple prescription drugs alone can bankrupt a family. A 
example is my daughter's leukodystrophy prescription, called 
Leucovorin. Leucovorin costs $1500 per month. Frankly, we don't 
have that kind of money at the end of each month. However, this 
treatment successfully halted bone marrow changes and has now 
been discontinued. When faced with the choice of their children's 
health or financial solvency, families feel they really have only o 
choice - their family. 

Many of the referrals are the result of crisis situations that have 
developed because problems had not been addressed over the 
years. In November, the wife of a veteran who is 100% disabled 
contacted me. Her 13 and 9 year old children had threatened 
suicide. She had tried to get appointments at the local mental 
health facility to have the children evaluated. She was told that 
they could not be seen for three months. There was no heating fuel 
and all utilities were scheduled to be disconnected within the next 



118 



two weeks. I began to work on the problems. The next morning she 
called again. She had to take her daughter to the emergency room 
the previous night. Her 13 year old had taken an overdose of 
medication. The family was told again by the emergency room 
personnel that they would have to wait three months for help. I 
started making calls as soon as I completed my conversation with 
the mother. By that afternoon the children were evaluated at the 
local mental health facility and admitted to a hospital for treatme 
During the next few days I made arrangements with different 
private organizations and government social service agencies to 
provide funds to pay the utility bills, buy heating fuel, and gasol 
for the car so that the family could attend family counseling. I a 
worked with the local Department of Human Services to get them 
emergency Medicaid, and Social Security benefits for the children. 
Even though this family was over 100 miles away, we were able to 
get the help that they so desperately needed. 

The family still has needs but the mother feels that our program 
helped keep her family together. The mother has learned how to 
access new services that are helping her family. But she is 
concerned that it took her so long to get the help she needed for h 
family. Her husband has been going to the VA for 10 years but ther 
has never been an effort to either address the family's needs for 
counseling nor the basic needs for decent living conditions. 

The next family that I would like to tell you about involves a 17 y 
old young man who has a developmental delay. He has been in 
special education since the first grade. His family called to fin 
what their child's options were after he left high school this year 
They stated that they had not received any transition services froir 
the school and in fact had been told that "the boy will only be goo 
for manual labor the rest of his life". The father is a disabled 
veteran who is currently trying to work a few hours a day to get 
back into the job force. They were discouraged, frustrated, and fe 
that they had no options. I referred this family to Rehabilitation 
Services and the young man will receive tutoring during the summer 
and be allowed to enter college in the fall under a special program 
for students with disabilities. The father will also be receiving 
assistance from Rehabilitation Services to locate the training he 
needs to work again. This family questions why they had not been 
prepared for their son's transition from public school into a train 
program. They now have the knowledge and skills to advocate for 
their 16 year old son who is also enrolled in Special education. 

The last family that I would like to bring to your attention is ver 
similar to the previous one except that the family did not learn of 
their son's learning disability until after his graduation from hig 
school. Their son had never been in Special education, but they we 
told that he could not pass the college entrance exams because of 
mild retardation. The father could not believe that his son had be 
allowed to pass through school without being told there was a 
problem. Rehabilitation Services is working with this young man to 
diagnose his learning disability and assist him with further traini 

As you can see, some of my work with families involves only a 
phone call or a packet of information. Others require hours of 
coordination of services between groups and agencies to provide for 
the needs of each family. I have collaborated with 75 groups, 
physicians, and private individuals during the past year. Ongoing 



119 



coordination and referrals will hopefully reduce the number of cris 
situations experienced by families. 

Last year my husband and I traveled the 156 miles necessary to 
reach the VA hospital in Little Rock. Our trip took over three hou 
Lance had his Agent Orange physical to help determine if a 
dermatological condition and other health problems may be due to 
his exposure to herbicides in Vietnam. This exam also included a 
family history. We gave them detailed information on all of our 
children's disabilities and my husband's health problems. Not one 
referral was made for family services. 

I thought this was an unusual practice and talked to other vets who 
stated that their families had never been asked if they needed 
services either. My concern led me to survey the families that I 
work with and 50 veterans from a local Vietnam veteran' s 
organization to determine the role the VA should play in meeting th 
social service needs of families. The results concur with conclusi 
from my experience. 

These suggestions are: 

1. Better communication between the VA and the client. 
Communication should be between people. Even in such as vast 
system, clients need to feel that they 'are heard, and understood 
as individuals by individuals, that there is continuity of 
relationships (not a "take a number" approach) and that forms 
and documentation' don't become more import ant than people. 

2. Individualized care of the veteran. The plan of care for each 
veteran should reflect his/her needs and problems. Just as the 
lives of individuals are unique, so should be the approaches to 
intervening. Cookie cutter or assembly-line solutions are not 
accepted. Why spend time, money, and effort prescribing 
treatment that is unacceptable and will not be followed? 

3. More accessible services. We have to travel 156 miles to Littl 
Rock to the VA. That may not sound far in freeway miles but the 
distance from Mountain Home to Little Rock is two-lane, 
mountainous road with numerous small communities along the 

way. Most of the citizens of our rural state face similar 
transportation problems. Just driving in the city is enough to 
intimidate clients even if they have access to a vehicle, gas 
money and can afford to miss work. The VA in Arkansas is in the 
process of setting up satellite clinics. Texarkana will have th< 
first. Mountain Home is scheduled for the second. More of these 
are necessary for a vital VA system. 

4. Family intervention by the VA. The mental and physical health 
the veteran's family should not be ignored by the VA. One of th< 
most needed interventions is for counseling. Families, children, 
and spouses should be included in the treatment of the veteran. 
The physical health of the families must not be ignored. The 
veteran's health needs are addressed by the VA depending upon 
his "category". If the veteran is 100% disabled as the result o: 
service related disability, CHAMPVA, may be requested for his 
dependents. Most veterans do not qualify for this service. Som< 
resources can be located for children, but the spouses of the 
veterans are offered no supports or resources. CHAMPVA should 
be an option for all families. 

5. Referrals for service coordination when a family has a child wi 
disabilities. As my personal story showed, service coordination 
an valuable service to families. Navigating the supersystems of 



120 



the VA, Medicaid, and SSI takes special knowledge, time, and 
patience that families in crisis do not have. Service coordinate, 
can assure the families that they are receiving all the services, 
supplies and therapy to which they are entitled. Even if a fami: 
has Medicaid for example, the family may not understand what 
all is covered under the program. Families rarely receive all tl 
services and resources to which they are entitled or that they 
need to fully address their needs. 
6. A directory of services available to the vet and his/her family 

These suggestions fortify my convictions that services which are 
holistic, family-friendly, and community-based are what families 
need and want. They need to be able to have an agency that is 
willing to address all of the family needs concerning them. Most o 
these families had been involved in a band-aid approach by many of 
the agencies they have contacted. Few, if any agencies, prior to 
AOCAP really tried to look at the big picture. 

Services also need to be available locally or have outreach 
components. For many families in northern Arkansas, distance is a 
major barrier to services. If services can be coordinated and 
networks established that link to support the veterans and their 
families, many of these problems can be addressed in a timely and 
effective way. 

Thank you for your time and attention. I stand ready to answer any 
questions you may have about my testimony. 



121 



Testimony of 
Bryan C. Smith, EdD 
Center for Developmental Disabilities, 
University of South Carolina School of Medicine 



Before the 
House Veterans' Affairs Subcommittee on Oversight and 
Investigations 



May 18, 1994 



122 



Chairman Evans and members of the Subcommittee: 

Thank you for inviting me to present testimony on the 
topic of "Social Services for Vietnam Veterans and Their 
Families." 

I am the Director of the National Information System, a 
national information and referral project designed to 
connect families with children with disabilities who need 
services or information to the community resources that 
can provide them. The National Information System is part 
of the South Carolina University Affiliated Program and is 
currently funded by the Agent Orange Class Assistance 
Program. We began ten years ago as a federally funded 
demonstration project and since then we have concentrated 
our efforts on th'ee separate populations. The latest, and 
possibly the most challenging has been families who believe 
they may have been affected by a veteran's exposure to 
Agent Orange during military service in Vietnam. At the 
outset, we thought that working with veteran families 
would be no different from working with other families 
having children with disabilities. The information and 
referral process and method would be the same; with the 
only difference being one or both parents were Vietnam 
veterans. It was quickly evident that the Vietnam 
experience placed strains on family structures that created 
situations that were decidedly unique. Little did we realize 
how multifaceted this population is and how complicated it 
would be to connect them with services. 

Our primary objectives are to establish mechanisms by 
which effective communication and information sharing can 
occur; and to serve in a problem-solving capacity for 
veterans and their families. We focus on information 
related to childrens' disabilities and other health 
conditions and on the organizations that comprise the 
service delivery system. We provide assistance through a 
staff trained to understand and untangle the intricacies of 
the disability, health, and social service delivery systems. 
They help families identify and prioritize needs, explain the 
benefits and services available to them, and often give 
insight into issues related to a child's development. Most 
importantly, the staff helps the families understand how 
various agencies and processes work and how families can 
best navigate through various bureaucracies to access the 
services to which they are entitled. To make referrals, the 
staff uses a comprehensive database of over 115,000 
services that includes Medicaid, Title V programs, special 
education programs, early intervention services, and private 
resources such as parent support groups, disability-related 
organizations, and pharmaceutical foundations. 

Specific examples of the services we provide range from 
the somewhat simple task of referring a family to a 
disability-related support group to the more complicated 
mission of problem-solving and resolution. For example, 
we recently coordinated a full range of services for a 
veteran with an infant daughter who, hospitalized since 
birth, faced a 600 mile trip to another state to receive a 
liver transplant. In this case, we worked with the family 



123 



and Class Assistance Program grantees to coordinate air 
transportation for the child and family, investigated 
Medicaid reciprocity between the states, arranged housing, 
and enlisted various veteran and philanthropic 
organizations to provide financial support for expenses not 
covered through insurance, Medicaid, or other family 
resources. 

The National Information System is a central part of the 
Class Assistance Program's network of service providers. 
Each member of this network is connected to all others by 
electronic mail, which facilitates transmission of 
casenotes, or family intake records, where we also list the 
referral resources we recommended to the families. The 
effectiveness of this network is sustained by the 
collaboration between our programs. An example of this 
level of cooperation is a national outreach initiative where 
we mailed personalized letters to approximately 75,000 
members of the Agent Orange plaintiff class who had filed 
a claim on behalf of a child with a disability. The letter 
encouraged veterans and family members to contact us 
through our toll-free lines so that we could help them 
connect with appropriate services. We refer to Class 
Assistance Program grantees and transmit casenotes in 
situations where the grantee is able to provide some needed 
services, particularly service coordination. 

Because of the role and position of the National 
Information System in relationship to other grantees and to 
families entering the network, we are able to provide 
descriptive data about the Vietnam veteran callers that 
point out significant, unique needs of this population. The 
data shows the most frequently needed assistance is for 
various types of support services (92.8%). From mid- 1989 
to the present, the period captured in these statistics, 
there have been almost as many referrals (13,026) for 
support services as there have been clients (15,759). Not 
everyone needed this type of service, but some needed more 
than one of 28 different types of support services, including 
advocacy (13.8%). The next greatest service need was for 
financial assistance services (79.7%), followed by medical 
diagnosis and evaluation services (29.3%); and counseling, 
including psychiatric counseling (27.7%). Throughout the 
history of this activity, a dominant service need of 
veterans' families has been financial assistance services, 
primarily to help pay medical bills, including outstanding 
bills and pending ones. A service coordinator in the Chicago 
area recently summed up what he saw as the most frequent 
need of the families as "money... money to go to therapy, 
money to buy food, clothing, medicine, just basic things." 
Since grantees and other service providers have limited 
budgets and very few resources to help in this area, 
entitlement programs are a key source of assistance that 
veterans' families can access to help themselves. Although 
complex eligibility criteria often exist, families are 
assisted by grantees serving as effective advocates in 
overcoming this obstacle. 

Those Vietnam veterans who made successful 
readjustments after the war and have families without 
complicated health problems are not likely to call the 



124 



National Information System. Generally, this type of 
service is tapped by families who have been unable to find 
satisfactory local resources to help them or when they 
perceive the problem to be beyond their ability to solve. 
For example, skin rashes and irregular immunological 
responses are commonly reported conditions that sound 
minor in comparison to many other acute or chronic 
diseases. But in this population, they are often very 
serious, even disabling, occurring in many family members 
and persisting for many years. Many veterans report their 
children have never been without the conditions and that 
they have been unable to find effective treatment. 

The life situations that the callers have identified 
include a pattern of disability and chronic illness, social 
problems, and poverty that seem unparalleled in comparison 
to other families with whom we have had experience. The 
combination of various conditions, the service needs and the 
social milieu in which these families find themselves, is 
quite different from those who have used other information 
and referral services similar to the National Information 
System. The veterans' own disabling conditions place 
additional strains on family structures that are unique, and 
the family faces disadvantages in the form of isolation, 
economic deprivation, and the lack of access to adequate 
services. An equally notable characteristic of these 
families is the frequent presence of more than one child 
with multiple handicapping conditions. 

Our staff has interviewed over 15,000 Vietnam veteran 
family members and have drawn some general observations 
on them. They reflect that most of these Vietnam veteran 
families: 

• were already on multiple waiting lists to receive 
services from community service providers; 

• had been denied help by an average of more than five 
agencies; 

• had low income levels and limited financial resources; 

• lived in urban inner cities or in remote rural areas; 
were not self-advocating; 

• did not access some of the services to which they 
were entitled. 

Our records also revealed that many Vietnam veteran 
families reported that they: 

were frustrated and angry; 

were divorced and remarried one or more times; 

had feelings of helplessness; 

felt themselves to be victims; 

felt their situations were hopeless; 

were disenfranchised and anti-institutional; 

were not members of a support network for their 

children. 



A tally of the conditions and service needs does not begin 
to capture the toll that has been taken on families or the 
complexity of problems that are unique to Vietnam veteran 
families; problems that require special consideration in 
working with these families. There are three issues that I 
would like to discuss briefly that we, and our colleagues 



125 



throughout the network have seen as pervasive, 
interconnected problems for many of these families. 

The Vietnam veteran or family member who calls us is 
often in a family constellation that is struggling with the 
debilitating consequences of primary and secondary PTSD, 
conditions that despite their destructive power, are still 
largely under-recognized and inadequately treated. 
Therapists in the network have described working with many 
children, most of whom are now approaching adulthood, who 
have grown up in an atmosphere where the Vietnam veteran 
parent's untreated PTSD demands that they "walk on 
eggshells" to maintain some measure of tranquility at home. 
Many of them have been exposed for years to substance 
abuse, angry outbursts, and sometimes, domestic violence. 
The effects of this are being manifested today in the 
children of Vietnam veterans as what has been 
characterized as secondary PTSD. In fact, it truly marks a 
second generation of individuals affected by a disorder that 
requires a level of awareness to diagnose and a commitment 
of time and resources to treat. 

Compounding this issue is perhaps an even more common 
characteristic of the families that affects their ability to 
obtain services and presents implications for organizations 
that work with them. Many Vietnam veteran families, 
while needing a wide range of services, demonstrate a 
reluctance to initiate involvement with the organizations 
that could potentially assist them. They exhibit a 
particular distrust of and failure to pursue assistance from 
agencies that give even the slightest appearance of a 
governmental affiliation. Individual grantees, working in 
various parts of the country, were recently asked to provide 
their perspectives on several broad questions about the 
Vietnam veteran families that they have helped. There was 
an almost unanimous identification of the prerequisite need 
to establish a level of trust with the families they assisted 
before any progress could be made. For many families, the 
nature of the war, the age of the veterans during their 
service, readjustment issues, and negative attitudes toward 
Vietnam veterans appear to have compounded feelings of 
isolation and unsuccessful reassimilation into society for 
many families who are contacting us. These same issues 
are playing a role in how their families interact, or rather 
do not interact, with the service delivery system. 

The reluctance of Vietnam veteran families to follow 
through with referrals to organizations that potentially 
could address some of their unmet needs was a phenomenon 
that we investigated on a small scale two years ago. It was 
perplexing to find that their lack of self-advocating 
behaviors is present even in situations where families 
appeared to be in desperate need of services and the usual 
obstacles, such as cost or availability of services were not 
issues. Quite simply, for a variety of reasons, the veteran 
family itself presents one of the largest single barriers to 
their accessing needed services. I sampled a variety of 
service providers to get their perspective on what they saw 
as possible barriers to families obtaining services. The 
reasons they gave as most important were: families are 
unable to pay for services (no insurance or Medicaid); 



91-084 0-95 



126 



families do not think these services are necessary; and 
families have difficulties with transportation. From the 
providers' perspective, the "fault" is the veteran's, yet 
there are many barriers to these families. 

In reality, these barriers may be present as a consequence 
of membership in a combination of subgroups, such as 
persons of minority or low socioeconomic status or people 
residing in geographic areas where accessible services are 
scarce. Many attributes that we have observed are also 
characteristics of a disadvantaged population. Health- 
related laws and policies in the U.S. have defined 
"disadvantaged" in various ways, but generally the category 
includes those who, by virtue of racial or ethnic heritage, 
economic status, or other factors, do not have access to the 
health care system. This definition would, in many cases, 
include the Vietnam veteran families that contact us. If the 
Vietnam veteran family was considered to be a 
disadvantaged family and not thought of as a veteran 
family, their lack of follow-through would not be 
considered to be so unusual. 

While some obstacles facing these families are more 
problematic than others, many can be overcome. Noteworthy 
evidence of this has been seen in the fact that families 
were more likely to follow through with referrals when a 
local grantee was involved in a service coordinating 
capacity. It is a belief of the Class Assistance Program 
that Vietnam veterans and their families who are eligible 
for various programs and services can benefit greatly from 
quality case management and information and referral 
services to ensure equal access to services and benefits 
that are already available. This operational policy has 
amplified the effect of settlement funds, fostered 
development of clients' skills in using community programs 
and services, and represents a more holistic, integrated 
approach to serving people. Service coordination is based 
on a family-centered empowerment model in which services 
are oriented toward the family, rather than toward any 
individual, such as the veteran or child with a disability. 
Because Vietnam veteran families in need of services are 
characterized by a high incidence of family dysfunction, 
psychological problems and alienation, it is probably only 
marginally effective, at best, to offer single-faceted 
services such as counseling, rehabilitation or veterans 
benefits advocacy. The veterans' reluctance to self- 
advocate and their wide array of unique problems are the 
primary reasons why a specialized network of veteran 
family-focused services is needed, and service coordination 
to help the families connect with services, is critical. 

The Class Assistance Program has funded projects that 
have been successful in making these connections by 
enhancing their abilities to interface with a broad range of 
service providers. Many grantees have been able to 
construct service configurations that are innovative, 
comprehensive and far more productive and effective than 
any strategies employed to date by other traditional 
veterans' services in their attempts to help many of the 
same clients. In most cases, the network of grantees is 
now employing a true "family systems approach" in the 



127 



provision of services to Vietnam veterans and their 
families. While the use of this service protocol is certainly 
new, and perhaps even radical, in its application to this 
population, its effectiveness has been clearly demonstrated. 
Service coordination not only provides an avenue for more 
effective service delivery through integrated, family- 
focused approaches, it also facilitates leveraging goods and 
services on behalf of the Vietnam veteran families. We 
studied leveraging outcomes and its cost effectiveness to 
determine what impact, if any, these activities have made. 
The study was undertaken to be presented at the National 
Symposium this week. It has undergone and passed close 
scrutiny including several blind reviews to establish 
scientific credibility. I will make a copy of this study 
available to the committee, if you wish. Conducted at the 
end of 1993, data were collected from members of the 
plaintiff class who had entered the network through the 
National Information System. The results of the study 
showed an impact ratio of .036 between costs and monetary 
outcomes. A ratio of 1.00 means that cost and outcome are 
equal; while a ratio greater than 1.00 signals that the costs 
outweighed the outcomes. A ratio less than 1.00 suggests 
that outcome is greater than the monetary costs accrued. 
By taking the net benefits and dividing them by the net 
costs, a benefit cost ratio showed that for every Class 
Assistance Program dollar spent on services and equipment 
for this study group, there was a $27.58 return in outcomes, 
leveraged through, either financial assistance or services 
received. This occurred although no grantee had operated 
with a specific mission of leveraging monies. The greatest 
proportion of these leveraged funds and services were for 
veteran's children; primarily from education and SSI. 

Vietnam veterans and their families are a unique group of 
people with an assorted array of human service needs. The 
challenge they present for service providers lies in the fact 
that any family with such a diverse range of needs 
generally has difficulty obtaining help from the complex 
web of agencies and convoluted assortment of professionals 
that comprise the community-based service system. 
Veterans' families are frequently unable to navigate the 
service system successfully on their own. 

Speaking as a professional with many years of experience 
in human services, I would like to take this opportunity to 
articulate some general policy recommendations that I see 
as critical to the futures of these families and to many 
others who face similar problems. These recommendations 
reflect many discussions with my colleagues at the 
University of South Carolina and with members of the Class 
Assistance Program network. We share a conviction that 
these issues must be addressed. We recommend the 
following: 

1. If more comprehensive service strategies are to be 

realized, Veterans' services at a Federal level must be 
coordinated with other primary human service agencies 
such as the Department of Health and Human Services' 
Administration on Developmental Disabilities and 
Maternal and Child Health Bureau, as well as the 
Department of Education's Office of Special Education 



128 



and Rehabilitative Services and Office of Special 
Education Programs. Equally important, a concerted 
effort should be made to develop cooperative 
relationships, and even formal interagency agreements, 
between appropriate state, local and community human 
service resources, both private and public, to more 
effectively address the needs of veteran families. 

The Department of Veterans Affairs should be charged 
with reorienting programs to address the needs of the 
veteran within the context of the family and to fit the 
needs of family members, where possible. Too many 
problems of the veteran impact the family, and too many 
problems of the family impact the veteran, for there to 
be two totally separate systems of care, i.e., the VA for 
the veteran and public or private providers for the other 
family members. The efficacy of approaching the family 
as the primary unit for service and the critical 
difference that can be made through the provision of 
service coordination was verified by our studies. We 
saw that when a veteran family needed help and received 
some form of service coordination from a grantee, the 
family was more likely to follow-through with 
recommended referrals Hian was a veteran family not 
helped by a local grantee. The situation is particularly 
critical when the person needing services is a child 
dependent upon other family members to take action to 
obtain those services. Failure to adequately address the 
multiple dimensions of the complex, unique needs of 
these families may well create diminished life chances 
and ultimately a negative, generational consequence. 



In conclusion, I would like to point out the undeniable 
fact that the traditional service delivery system, which 
demands effective family functioning to successfully use 
its services, rarely meets the needs of many of the 
veterans' children and families with whom we have dealt. 
Instead, it pressures the families to adapt to the service 
delivery system. Neither more of the same, nor 
organizational restructuring of the system alone are 
strategies that can meet the veteran families' diverse 
needs. We have seen compelling evidence that family- 
focused approach and service integration offer a promising 
avenues worthy of careful and thorough exploration for the 
future. 

Thank you once again for the opportunity to present 
testimony before this Subcommittee. 



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Statement of 

CARL F. CALKINS 

Professor of Psychology 
University of Missouri at Kansas City 

Director of the UMKC 

Institute for Human Development 

A University Affiliated Program 

President of the American Association of 
University Affiliated Programs 

Before the 

Subcommittee on Oversight and Investigations 

of the 

House Veterans Affairs Committee 



May 18, 1994 



130 



Chairman Evans and Members of the Committee, thank you for 
inviting me to present testimony here today on the topic of "Social 
Services For Vietnam Veterans and their Families: Current Programs and 
Future Directions". 

My name is Dr. Carl F. Calkins. I am a professor of Psychology and 
Director of the Institute for Human Development at the University of 
Missouri at Kansas City, a University Affiliated Program. I am also President 
of the American Association of University Affiliated Programs. One of our 
programs is funded by a grant from the Agent Orange Class Assistance 
Program (AOCAP) entitled, "The Missouri Vietnam Veterans Education 
and Resource System" (MOWERS). 

I appreciate the opportunity to speak with you today. The information 
that I am going to share with you describes some critical human service 
outcomes that the AOCAP has produced for Vietnam Veterans, their 
families and, in particular, their children who have disabilities. These 
outcomes suggest that a difference can be made at three levels; the 
systems level, where people receive and manage human services that 
are available; the family level, where lifestyles are significantly affected; 
and at the individual level, where choices are made and where quality 
of life is determined. 



The first encounter that I had with AOCAP was in 1989. At that time, I was 
invited to assist in the formation of a partnership between the Health and 
Human Services-Administration on Developmental Disabilities, The 
American Association of University Affiliated Programs, and AOCAP. The 
essence of the partnership was the recognition that a number of Vietnam 
Veteran Families had children with disabilities and were having difficulty in 
accessing services. 

Under federal law, the Administration on Developmental Disabilities 
(ADD) is mandated to provide leadership and support that will improve 
the quality of life for persons with developmental disabilities and their 
families. This is accomplished by establishing, in every state and territory, 
a planning council, a protection and advocacy council and a university 
affiliated program (UAP). These agencies are then directed to provide 
state-wide planning, an effective state-wide advocacy network, and a 
university linked state-wide demonstration, training, technical assistance, 
and information dissemination program, respectively. In terms of UAPs, 
there are 58 programs across the country that apply their expertise to 
improve services and systems of services. The UAP network is supported 
by a national office in Washington, D.C., the American Association of 
University Affiliated Programs (AAUAP). 

There was a natural match between the goals of the AOCAP program 
and the disabilities network. These were, 1) services for families, 2) 
services for children with disabilities and 3) national support programs. 
Thus, the partnership forged a good match to assist in coordinating, 
identifying, or creating resources for families and children with disabilities. 
The result was a contract from AOCAP to AAUAP, to provide technical 
assistance at the national level and coordinate information 
dissemination efforts across the country. In addition, AOCAP contracted 
with 13 individual UAPs to demonstrate how case management or 
building the necessary linkages between veterans services, the 
developmental disability systems and other social services could take 
place. What has emerged is a framework for requisite systems change 
and necessary services for veterans, their families, and their children. 

The results of these programs is quite informative to policy makers and 
those concerned with the management of more consumer beneficial 
and cost effective service programs. Over the next 2 days, a 
conference describing these outcomes and the full array of AOCAP 



131 



programs is being presented here in Washington. It is entitled, "The 
Legacy of Vietnam Veterans and their Families: Survivors of War-Catalysts 
for Change". My purpose in talking with you is to describe some of what 
we have learned from those programs within the UAPs. As I mentioned in 
my opening remarks, changes are taking place at the service systems 
levels (local and state), at the family level, and for individuals. 

Since my UAP has an AOCAP-funded service program, let me first 
describe what we have learned from the Missouri Vietnam Veterans 
Education and Resource System (MOWERS). For the last two years, we 
have been providing comprehensive family service coordination, 
information and educational services. We serve two very different types 
of clientele who hold little in common in terms of current lifestyle. One 
aspect of the population is rural, located in the south central part of 
Missouri known as the Ozark Mountain Area. The economy is poor and 
much of the population is undereducated. A number of the families 
have either lived in the area for generations or veteran fathers took their 
families and "went to the woods" as part of their reaction to the Vietnam 
war. The other group is urban and reside in the Kansas City metropolitan 
area. Some of these families are homeless and are a culturally diverse 
population. 

While there is considerable diversity in lifestyles of these two groups, 
their perceived needs were consistent in regard to human services. 
They are: 1) the need for sensitivity and respect, 2) the need to be 
recognized as a family, in many cases, with multiple challenges, 3) the 
need for social support and community, 4) the need for information, and 
5) the need for advocacy. Let me make a few brief comments about 
each of these needs and the necessary human service responses. 



Sensitivity and Respect 

The predominant emotion that those veterans demonstrated was 
anger. They and their families perceived that the "system" had 
betrayed them both in their military life and in their civilian life. They 
often recited a litany of experiences with both Veterans' and health 
or social services agencies where claims were lost or mishandled, 
rejected, rough or insensitive treatment by organizations and, in 
some cases, by the community at large. Whether these are all real 
or true, we cannot prove, but it is significant that so many perceived 
and reported very similar sets of experiences. It also suggests the 
employees of provider systems must be well trained and follow the 
very best practices in their work with veterans and their families. As 
Dr. Jean Ann Summers states, "It implies total honesty and integrity 
making no promises one is unable to keep, following through 
without fail, and taking some immediate action that responds to a 
family's expressed or perceived needs rather than just a service 
provider's perception of family needs." It also implies personalized, 
individual attention-at systems level, small community-based 
programs people can trust. 

Need to be recognized as a family, in many cases, with multiple 
challenges 

Many of the families we worked with were experiencing problems 
"all at once". The Veteran father may be unemployed and or have 
a partial disability for physical or emotional problems related to 
PTSD; the wife may be showing effects of "secondary" PTSD; and 
one or more of the children may have physical, emotional or 
learning related disabilities. What we have learned concerning 
these families is that one problem can be a barrier to solving others. 
For example, the father's difficulties with anger may impede his 
ability to advocate effectively for his children; the mother's 
emotional challenges may impede her ability to respond to her 
husband, and so on. Second, the total "stress pile up" effect is such 
that the family is living on the precipice of crisis at all times. For 
example, a relatively minor crisis such as a flat tire can lead - 



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because there are no alternatives and because the family "fuse" is 
so short - to a missed appointment with the school, to a denial of 
services because of the missed appointment, to a family argument 
about whose fault it was, to a crisis hotline call. The approach that 
works with these families is a single, responsive point of entry to 
services to put a package of services together. Many times these 
initial services are short term and informal rather than formal service 
system responses. 

The need for social support and the community 

The perception that "others who have had a similar or related 
experience provide a great strength and support" was a constant 
reminder throughout any attempt to provide services. By and large 
Veterans' wives, sons, daughters or other family members 
responded well when peers were involved. This need has also 
been consistently expressed and responded to by families of 
children with disabilities in general. Some of the singular most 
effective programs we encountered were Sons and Daughters of 
Vietnam Veterans and Parent to Parent groups for families of 
children with disabilities. The implication for human services is often 
called consumer driven services. The point is, the more others of like 
background are involved in the design and delivery of those 
services, the more sensitive, appealing, and responsive those 
services will be. When their peers are involved, there is also the 
added confirmation that the veterans and their families are truly a 
part of the community at large. 

The need for information and training. - 

There were continuing reguests by families for information, whether it 
was about a disability, about a condition or at the most 
fundamental level (i.e., how does the system work?). Likewise, there 
was continuing anger that walking through the system hurdles was 
like walking through a mine field. One could be stopped 
completely at any given moment. It seems almost unbelievable in 
this day and age with information networks that there could be so 
much inconsistency in training and competency of the workers 
There is also a need for up-to-date knowledge and for 
coordinated efforts between veterans and human service 
systems/providers. There are many reports of very different 
responses to the same basic request. The implications of this need 
require that all agency personnel must be well trained and respond 
to requests for information quite diligently. Leadership of veterans 
and human service providers at the local and state level must 
understand and provide effective leadership with priorities and 
action to develop coordination between systems. MOWERS staff in 
many cases had to supplement existing information to or figure out 
how a service system worked before a system could be accessed. 
Breakdowns often occurred where a service provider did not take 
the time to accurately pinpoint the exact nature of the information 
being requested. Agency techniques for taking calls, matching 
information to requests and follow up to requests were critical needs 
that, while often overlooked, could be corrected with training. In 
most cases, MOWERS staff did this directly. 

The need for advocacy 

In the simplest sense the need for advocacy was reflected by 
providing active help and guidance about the family's rights and 
procedures for accessing services. An example of a more 
complex situation, involved going to a meeting with school officials 
because a veteran was concerned about how he might react to a 
school official who was saying his child could not get physical 
therapy. The form of this advocacy took place with MOWERS staff 
and with peers who had experienced similar problems. In many 
cases, the response of a service provider was markedly different 
with someone who had already been through "the mill", so to 
speak, present. The clear human service implication for advocacy, 



133 



speaks to the issue that for whatever reasons human services are 
not empowering and still over laden with Pureaucratic or non- 
responsive procedures and personnel. 

These are the five basic needs and responses to human services of 
what we have encountered with MOWERS on behalf of Vietnam 
Veterans, their families, and children with disabilities. The overall 
conclusion that we make from our experience is that, through sound 
service coordination, the needs of Vietnam vets, their families and 
children can be effectively and efficiently met. The AOCAP projects 
across the country met similar challenges, results, and successes. The 
results have fine-tuned and coordinated diverse systems responses for a 
large number of families. Our problem is that we still do not have a 
capacity, a commitment, and a plan of action within these service 
systems to assume responsibility for sustaining the needed coordination 
and integration to provide the services AOCAP has found to be 
beneficial and effective for these vets and their families. The partnerships 
mentioned in the beginning of this testimony have become a forum for 
what is working. AOCAP was right on the mark in establishing families as a 
focal point for services. Service coordination facilitated these 
outcomes. The family is now considered by most human service 
programs as the focal point for effective, integrated services. 

• The problem facing Vietnam vets/families/children before 
AOCAP was lack of access to services, lack of coordination 
between services, and lack of preparation of staff to deal with 
issues/needs and to collaborate with families. 

• AOCAP has demonstrated that these deficiencies can be 
removed, families can be served; 

• However, these changes were introduced/induced externally 
by AOCAP resources; 

• Potential for Action - the systems coordination worked because 
of externally induced actions (service coordinators financed by 
AOCAP). AOCAP's resources will soon be depleted, therefore 
the stimulant or agent for the coordination will leave. Action is 
needed in the remaining days of AOCAP's support is how to 
orderly and effectively transition these learnings and service 
actions from external to internal resource commitments to the 
client and responsibility for service coordination between 
Veteran's Administration, Education and all other human service 
systems accountable to sustain the benefits (consumer and 
costs that has been demonstrated by AOCAP resources). 

• There needs to be directives/mandates given to the federal 
agencies and from them to their state counterparts to mandate 
coordination and benefits to veterans and their families/children. 

• Because of the effectiveness of these service strategies, UAPs 
will certainly carry on with the recognition of the unique needs of 
Vietnam veterans and their families, and to accommodate to 
those needs to the extent funding will permit. 

• UAPs will continue to inform other human service agencies 
regarding the needs of Vietnam veterans and the effectiveness 
of the models and strategies employed by projects funded 
under the AOCAP umbrella. 

In conclusion, I would like to point out one more pervasive need in 
Human Services and its implication for policy makers. That is, the need to 
move from a dependency model to an empowerment model. Much 
of the criteria for eligibility in Veterans services, Disability Related Services , 
and other social services seeks a deficit as its primary determinant. That 
deficit may be physical-mental or even functional in terms of working or 



134 



being a contributing member of the community. When the entire focus 
of related services provides only support targeted on defects, there is 
an overwhelming sense by the family that nothing positive can happen. 
When services are couched with empowerment, self-determination, 
and future oriented planning, another proactive sense takes over. This 
was most poignantly reflected by a Veteran dad who described a 
personal futures planning session for his child as the most positive thing 
that has happened ever in terms of services for his family. This technique 
seeks to find the child's and families' strengths and plan in regards to 
those outcomes. This process of building on strengths is not new. 
However, it is the essence of a wellness model. Many human services 
are moving in this direction. It requires that human services look to 
abilities rather than just disabilities. When this perspective is more fully 
embraced, human services as well as their recipients will be more 
responsive. The Agent Orange Class Assistance Program has brought 
the need for movement from a dependency model to an 
empowerment model both a reality and a necessary promise that 
should be kept in the future. 



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Statement of John reiss, Ph.D. 



Associate Director 
Institute for Child Health Policy 



Assistant Professor of Pediatrics 
University of Florida 



Facilitator 
AOCAP/Title V Working Group 



BEFORE THE SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS 
OF THE HOUSE VETERANS AFFAIRS COMMITTEE 



MAY 18TH, 1994 



INTRODUCTION 

Chairman Evans and Members of the Committee, thank you for inviting me to 
present testimony here today on the topic of "Social Services for Vietnam Veterans and 
Their Families: Current Programs and Future Directions". 

My name is John Reiss. I am the Associate Director of the Institute for Child Health 
Policy (ICHP) at the University of Florida, and have a faculty appointment as an 
Assistant Professor of Pediatrics in the University of Florida College of Medicine. I have 
also served on the faculty of the University's Department of Community Health and 
Family Medicine, Family Practice Residency Training Program. I hold a doctorate in 
Counseling Psychology. 

My work with the Agent Orange Class Assistance Program has been carried out as 
part of a grant from the USPHS Maternal and Child Health Bureau (MCHB). This grant 
support's ICHP's National Center for Policy Coordination in Maternal and Child 
Health. The mission of this National Center is to: 

• Provide an equitable forum for interaction between the Maternal and 
Child Health Bureau (MCHB) and other organizations regarding policy 
initiatives on behalf of children with special health care needs (CSHCN) 
and other children with special needs 1 by coordinating and capitalizing 
upon the critical mass of knowledge and skills which currently exist in 
diverse settings, including: local, state, and federal agencies; educational 
institutions; special projects; professional organizations; philanthropies; 
voluntary health organizations; and advocacy groups (the broader MCH 
community). 



CSHCN are individuals, age birth to 21, who have health problems that require more than routine 
and basic care. Children with other special needs are individuals, age birth to 21, who may not havt 
chronic health problems, but have psychosocial, social, and learning problems that will affect their 
overall growth and development. 

Tacel 



136 



• Establish and implement a strategy to enhance timely interactive 
communication, including telecommunication efforts between MCHB and 
leaders and policy-makers concerned with CSHCN, for the purpose of 
disseminating new information relevant to CSHCN policy and programs 
in the public and private sectors at local/state/national levels; and 

• Develop a technical assistance (TA) capacity and provide assistance to 
State CSHCN Programs in their efforts to initiate statewide public/private 
partnerships in a community-based, family-centered, culturally-competent 
system of primary and special health care services for all children. 

More specifically, staff of the Center is to work in support of MCHB in fulfilling its 
roles and responsibilities 2 to: 

• Assure the provision of comprehensive services needed for CSHCN who 
require targeted efforts. 

• Assure that CSHCN and their families receive services in systems which 
promote healthy growth and development and which support integration 
into community life. 

• Expand and enhance the capacity of public/private partnerships at the 
national, regional, state and local levels to collect, integrate, and use 
quantitative and qualitative analysis of MCH data to develop strategies, 
implement plans and evaluate program performance. 

• Expand and enhance the capacity at the state, regional and local levels for 
high quality MCH service delivery. 

• Expand links among federal/state/local public and private levels and 
sectors. 

• Improve community-based maternal and child health, education and 
social systems to foster the development of coordinated, culturally- 
competent, comprehensive care. 

• Assure that State CSHCN Programs have developed an infrastructure 
which fully integrates the services for CSHCN and their families, 
including primary care, into a comprehensive community-based system of 
services with particular emphasis on improving the capability and 
enhancing the capacity of state agency leadership for meeting the needs of 
such children and their families. 

• Assure that State CSHCN Programs provide rehabilitation services for 
blind and disabled children under age 16 who receive Supplemental 
Security Income (SSI) under Title XVI of the Social Security Act to the 
extent medical assistance for such services is not provided under Title XIX 
(Medicaid). 

• Meet Year 2000 Health Objective 17.20, to build family-centered, 
community-based, coordinated systems, comprehensive, culturally 
competent systems of services in all 50 states by the year 2000. 

In 1990, MCHB asked the Institute's National Center to coordinate and support the 
Supplemental Security Income (SSI)/Children with Special Health Care Needs 
(CSHCN) Work Group. This work group coordinates the activities of federal and state 
programs and advocacy groups that serve SSI beneficiaries and applicants (blind and 
disabled children). During the last four years, the work group has designed and 



These roles and responsibilities are derived from the Year 2000 National Health Objectives, Omnibus 
Budget Reconciliation Act of 1989 (OBRA '89) Surgeon General's 1987 Call to Action, and MCHB's 
draft strategic plan for use of discretionary funds authorized under OBRA '89. 
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137 



implemented a national strategy for informing parents and coordinating agencies at the 
federal, state and local levels, including parent and advocacy organizations about the 
SSI Program. 

In the Fall, 1992, leadership of MCHB asked the National Center to undertake a 
similar effort on behalf of the children of Vietnam era veterans. In keeping with its 
mandate to forge effective public and private partnerships at the federal, state and local 
levels, MCHB worked with the leadership of AOCAP to initiate this working group to 
promote collaboration among state Title V CSHCN Programs, AOCAP grantees, and 
others. The initial meeting of the Work Group was held in December, 1992. 

In my testimony this morning I will address many of the issues that have been posed 
by the subcommittee. I will do this by first describing the characteristics of the system 
of care which I, and others in the child health community, believe is needed. I will then 
outline the strengths and needs of the current systems of health and social services for 
Vietnam Veterans. My comments and recommendations are reflective of the work of 
the AOCAP/Title V Work Group membership; those who have hands-on day-to-day 
experience in working to meet the needs of children with special needs and their 
families. I hope that this testimony does justice to the dedication and commitment of 
the work group members, and clearly demonstrates that the complex needs of these 
children and families cannot be adequately met unless: 1) the service system focuses on 
the strengths as well as the needs of children and families; 2) the service system is 
encouraged to collaborate to serve the family as a whole (and not allowed to fragment 
the family according to organizational needs); and 3) sufficient long-term flexible 
resources are made available to support these families and the organizations that serve 
them. 

WHAT IS NEEDED 

As a counseling psychologist I know that, in order to be effective, helping 
professionals must strive to enhance the capability of those for whom we work, so that 
families can make their own decisions, set their own priorities and reach their own 
dreams. Further, since the family is the fundamental building block of our society, 
professionals and service agencies must focus on the family-as-a-whole as the unit of 
care. We must not allow categorical funding streams, or professional and 
organizational turf battles impede progress toward the development of service systems 
that children with special needs and their families really need; community-based 
service systems that: meet the health and health-related needs of all children and their 
families; address the physical, psychological, and social aspects of care; provide 
individualized attention for their special health care and related needs; and link health 
care and services with other needed services and programs including, but not limited to 
early intervention, educational, vocational, and mental health services. 

As recently articulated by the leadership of the USPHS Maternal and Child Health 
Bureau, families need systems that are collaborative, family-centered, community- 
based, culturally competent, care-coordinated, comprehensive, universal, accessible, 
developmentally-oriented, and accountable. More specifically, such systems have the 
following characteristics: 



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138 



Collaborative 

At the state level, such systems are characterized by collaboration between 
State MCH and CSHCN programs, other relevant State health and non- 
health agencies, and provider and consumer groups to provide the 
impetus that will facilitate the development of service systems at the 
community level. Such systems also promote the institutionalization of 
family-centered, culturally competent and coordinated care at the 
community level. 

At the community level, such systems are characterized by public-private 
partnerships that link health-related and other community resources to 
form an organized network. 

In addition, such systems promote the participation of a broad range of 
families in the systems development process in order to assure that the 
systems address needs as seen from the family point of view 

Family-Centered 

Such system recognize the importance of the family and reflect this in the 
way services are planned and delivered. It facilitates parent/professional 
collaboration, responds to family needs, recognizes and builds on 
individual and family strengths, and respects the diversity of families. 

Community-Based 

Such systems respond to needs identified by the community and draw 
from the community to address needs. Services are provided in or near 
the home community to the extent possible. The area encompassed by a 
community depends on a number of factors including population density, 
political subdivisions, existing arrangements for provision of services, and 
availability of resources. 

Culturally Competent 

Such systems are organized so as to be sensitive to culture and competent 
to serve culturally diverse groups. Cultural competence refers to a 
program's ability to honor and respect culturally related beliefs, values, 
interpersonal styles, attitudes, and behaviors of families including the 
multicultural staff who are providing services. It incorporates these 
values at the policy, administration, and practice level. Multi-language 
materials and translation services are made available as needed. 

Care-Coordinated 

Within such systems, the array of services is coordinated to assure 

timeliness, appropriateness, continuity, and completeness of care. 

Comprehensive 

Such systems encompass primary (including prevention), secondary, and 
tertiary health care and address physical health, mental health, oral health, 
nutrition, health promotion, monitoring of development,, parent/patient 
guidance, early intervention, and family planning. Such systems also 
address needs for emergency medical, substance use/abuse, specialized 
mental health, educational, vocational, social, recreational, and family 
support services. 

Universal 

Such systems are concerned with all children, adolescents, and their 
families in the community whether served by private providers or public 
programs. This includes children and adolescents with, or at risk for 
disabilities, chronic conditions, health-related educational problems, and 
health-related behavioral or emotional problems. 



Tage 4 



139 



• A cc es sible 

Such systems address the issue of physical access by assuring that services 

are located conveniently and are augmented, as appropriate, by home 

visiting, mobile services, school-based health services centers, satellite 

services, and other means to bring care closer to consumers. 

Such systems address the issue of temporal access by assuring that a wide 

choice of service hours is made available. 

Such systems also address the issue of financial access by assuring that 

arrangements are made for financing mechanisms that bring needed 

services within the reach of all. 

• PeveloprnentaJly-Qriented 

Such systems takes into account the different kinds of needs that children, 
adolescents, and their families have at different stages of development by, 
for example: 

Helping expectant parents, new parents, and those who will provide care 
and services to understand the development of infants and young 
children- 
Addressing health-related behaviors with school-age children and youth; 
Providing adolescent services in an atmosphere of trust and honoring 
wishes for confidentiality in all appropriate circumstances. 

• Accountable 

Such systems assure a mechanism to provide information concerning the 
performance and utilization of the community-based system of services. 

Strengths and issues 

Through the Work Group it is evident that many AOCAP funded projects and state 
Title V Program for Children with Special Health Care Needs (CSHCN) share a 
commitment to serve children and families with special needs and to support the 
development of the type of effective systems described above. 

AOCAP Projects, as a whole, have been effective in addressing unmet social services 
needs of veterans and their families. Because many of the staff are, themselves, 
Vietnam Veterans, AOCAP Projects have special expertise and experience in 
recognizing and understanding the specific, unique problems of Vietnam veterans and 
their families. The projects are also successful because they are designed to maximize 
and leverage resources, and to build networks not only for a specific client, but for all 
Vietnam Veterans. The care coordination and advocacy services that these project 
provide can serve as the glue that brings the pieces of the fragmented service system 
together in a coordinated fashion. In addition, AOCAP is founded on the philosophy 
that the family, rather than an individual family member should be the unit of care. 
This is especially important when serving children with special needs. Since the 
AOCAP Projects are also supported through private, but time limited funding, they 
have great flexibility. However, this type of funding also imposes a need for the 
Projects to institutionalize their activities through longer-term, more stable projects. 

AOCAP Project staff feel that their Projects are more successful than more other 
services, such as those offered through the Veteran's Administration. The reported 
shortcoming of VA services include: the focus of the VA on the individual Vietnam 
Veteran rather than on the Veteran within the context of the family as a whole; the VA's 
"institutional" approach, which focuses on the services provided through the VA and 
fails to access or coordinate with services provided in the community; and the VA's 
"medical model" which focus on identifying and providing a short-term cure for 
problems rather on enhancing the ability of the Veteran and the family to participate in 
long-term growth and development. 

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140 



It is my belief that state Title V CSHCN Programs have also been effective in 
addressing the needs of veterans and their families. Because Title V Programs are 
legislatively mandated to facilitate the development of family-centered, community- 
based, culturally competent, coordinated system of care for CSHCN and their families, 
these Programs are making available the types of services Vietnam Veteran families 
need. The philosophical basis of these state programs is to focus and build on the 
strengths of families, and to involve families not only in decision making about the care 
of their child but also in policy and program development for the service system as a 
whole. 

However, to the best of my knowledge, these programs to not gather data regarding 
military service. Therefore, these programs do not have data on the effectiveness of 
their services for Vietnam Veteran families; nor do they have services that are 
specifically focused on this group. Thus, the children of Vietnam Veterans are one of 
many "special populations" for which Title V has a responsibility. 

Barriers and Issues 

Through the Work Group, a number of barriers were identified that limit the 
effectiveness of AOCAP Projects and Title V CSHCN Programs in addressing the needs 
of CSHCN from the families of Vietnam Veterans. 

BARRIERS TO COORDINATION. In general, it was noted that interorganizational 
coordination is difficult to achieve and requires a significant level of planning and on- 
going effort. It was also noted that organizations that have a legislative, funding, or 
programmatic mandate to coordinate were much more likely to work effectively with 
other agencies on behalf of families. In addition, a number of specific organizational 
factors were identified as barriers, some of which were particularly relevant to AOCAP 
Projects, and some to Title V Programs. 

Specific factors associated with AOCAP Projects included: AOCAP staff's limited 
knowledge of pediatric health care needs and standards; limited experience with child 
health care systems, including state Title V CSHCN Programs; and limited information 
about alternative funding sources. Title V Program factors include: Title V and MCHB's 
limited focus on and experience with Vietnam Veteran families; limited knowledge of 
Post Traumatic Stress Disorder (PTSD) and the extent to which this syndrome affects 
services and resources needed; and limited information about AOCAP and its grantees. 
It was also recognized that differences across state Title V Programs, in terms of 
program name, eligibility criteria, and services poses a barrier to AOCAP's 
understanding and access to these programs. 

VETERAN'S FAMILIES Needs and ISSUES A number of family factors were also 
identified as barriers to children and families access to needed services. Some of these 
issues were particularly relevant to families of Vietnam Veterans. General family 
factors included: families' lack of awareness of available resources and services; 
families' failure to identify their child's problems and needs; and families' reluctance to 
accept and/or report their child's problems. Issues that were identified as related to the 
Vietnam veteran family member's war experiences were the veteran's distrust of 
governmental agencies and programs; the impact of Post Traumatic Stress Disorder on 
the family's ability to address the needs of a child with special needs; and the 
psychological impact of knowing that exposure to Agent Orange may have caused the 
child's health or developmental problems. 



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Task force Findings 

In order to address these issues, it was agreed that AOCAP grantees, Title V CSHCN 
Programs, and other projects supported by MCHB need to: 1) understand each 
program's mission, roles, and responsibilities; 2) understand the special health and 
social problems of Vietnam veterans and their families; 3) know about the broad range 
of services and resources available to address these problems through collaborative 
program efforts; and 4) develop and implement methods for effectively utilizing these 
resources through appropriate referrals. In order to overcome the barriers identified in 
the previous section, AOCAP/ MCHB Working Group members agreed that efforts 
needed to be made to achieve the following goals. 

• Increase the awareness and understanding of health/ and social service 
organizations, professionals and veteran services groups about the special 
health and social services needs of Vietnam veterans' families. 

• Ensure that Vietnam veterans' children who have special needs access and 
maximize all health and social service program benefits available to them, 
including insurance and entitlement programs. 

• Ensure that services for Vietnam veterans' children with disabilities are 
family centered, comprehensive and coordinated, and provided in a 
manner that promotes the increased independence, productivity, and 
empowerment of the child and family. 

GOAL 1: INCREASING AWARENESS 

In regard to the first goal of increasing the awareness and understanding of health 
and social service organizations, professionals and veteran services groups about the 
special health and social services needs of Vietnam veterans' families, it was recognized 
that this involves both documenting the special needs of CSHCN from Vietnam 
Veteran's families and increasing the awareness of professionals and organizations at 
the Federal, state and local levels about these special needs. 

With regard to the documentation of the special needs of CSHCN from Vietnam 
Veteran's families, it was recommended that data from AOCAP supported National 
Information System be analyzed to determine the incidence and prevalence of special 
problems and needs of Vietnam veteran families and compared to similar populations 
(as served by Title V CSHCN Programs); and b) that data on services provided to 
veterans' families with CSHCN through AOCAP and other health and social services 
agencies be collected and analyzed. 

In order to provide this information/data to AOCAP grantees, state Title V CSHCN 
Programs and other public and private programs that serve CSHCN, it was 
recommended that a variety of strategies be used. Recommended strategies included 
developing a series of fact sheets and a more formal training curriculum to assist health 
professionals and veteran services groups in identifying and recognizing the special 
health and social services needs of Vietnam veterans' families. The fact sheets and the 
curriculum would then be made available to a broad range of professionals and 
organizations including American Legion Post Service officer (through state and county 
schools and conferences), State Veterans' Affairs Commissions, university veterans' 
advocates, University Affiliated Program (UAP) faculty and students, Title V CSHCN 
leadership and staff; and MCHB-SPRANS grantees. It was also recommended that 
informational articles be published in magazines and journals that reach the veteran, 
health, and social service communities. 

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Goal 2: Ensure access to Care 

In regard to the second goal, of ensuring that Vietnam veterans' children who have 
special needs access and maximize all health and social service program benefits 
available to them, it was recognized that this involves both outreach to families and the 
provision of information and referral services 

The recommended strategies for implementing a joint Title V/ AOCAP outreach 
effort involved: a) selecting one or two states in which to develop a demonstration 
outreach program and identifying the current outreach activities of Title V, AOCAP, 
and other veterans' organizations in these states; b) jointly identifying where outreach 
coordination is possible and developing guidelines for implementing a coordinated 
outreach program; c) developing a joint prototype intake/application form that 
includes questions regarding Vietnam veteran status, training intake staff on 
implementing the intake/application form and conducting a needs assessment of 
identified AOCAP-eligible families; and d) disseminating the guidelines at meetings 
and conferences of the organizations involved. 

It was also recommended that selected AOCAP grantees work with selected Title V 
CSHCN-affiliated clinics, and serve as an on-site resource for veterans' families that are 
being served. The recommended strategies for implementing this effort involve, first 
identifying one or two Title V CSHCN clinics with large patient loads (urban and rural) 
and assigning a AOCAP veterans' advocate who would assist veterans' families in 
meeting their basic needs; then developing and implementing compatible (AOCAP and 
Title V) protocols for referrals that includes service coordination and follow-up with 
AOCAP grantees, Title V CSHCN Programs, Supplemental Security Income (SSI) 
Program, special education, mental health, and vocational rehabilitation programs. It 
was recommended that training for AOCAP grantees and other veterans' groups then 
be implemented to ensure their awareness of all health and social service resources that 
may be available to veterans in their respective states. Such training could be carried 
out in collaboration with state Title V Programs, University Affiliated Programs, state 
veteran services officers and others with expertise in health and social service resources 
in their states. 

It was also recommended that AOCAP Projects be made aware of and be listed as 
part of the State 1-800 Information and Referral services that are administered by each 
state Title V and Part H programs for infants and toddlers. 

GOAL 3: ENSURING FAMILY-CENTERED CARE 

In regard to the third goal of ensure that services for Vietnam veterans' children with 
disabilities are family centered, comprehensive and coordinated, and provided in a 
manner that promotes the increased independence, productivity, and empowerment of 
the child and family, it was recognized that MCHB and Title V CSHCN Programs is a 
significant resources. As noted above, a primary mission of MCHB and Title V CSHCN 
Programs is to promote the development of such systems of care. 

It was recommended that AOCAP grantees be made aware of the information and 
training resources that have been developed through Title V Block Grant SPRANS 
Project funding to support the development of family-centered, community-based, 
coordinated, culturally competent systems of care. Information should also be provided 
about the various federal, state and local initiatives for children with special needs, 

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143 



including Healthy Start, Part H of Public Law 99-457 (IDEA), and the American's with 
Disabilities Act (ADA). 

It was also recommended that special emphasis be placed on improving veterans' 
families' access to quality primary and preventive care, including dental, vision, 
hearing, and immunizations services. Such efforts could include the development 
and /or dissemination of : a) a protocol for AOCAP intake screening that includes 
preventive issues (e.g., questions regarding children's immunizations and dental and 
eye examinations); b) parenting education and peer counseling materials to increase 
families' understanding of the need for primary and preventive care; c) a process of 
referrals to ensure that primary care providers to whom agency refers are competent 
and knowledgeable about PTSD and other problems unique to Vietnam veterans and 
their families; and d) a protocol for Title V programs to assist AOCAP grantees with 
identifying strategically located, competent health providers. 

It was also recommended that AOCAP grantees be provided with information about 
the activities of MCHB and state Title V Programs to promote a) the formation of self- 
help support groups of families that empower these families to deal with their own 
problems and facilitate access to the system and b) the participation of families in the 
design, monitoring and evaluation of services provided through AOCAP grantees. 

Summary and Recommendations 

Based on the findings of the AOCAP/Title V Work Group, and on my experience on 
several other state and federal'work group, it is my personal observation that current 
systems of services for children with special needs and their families are often 
characterized by duplication and fragmentation, and often do not make optimal use of 
available personnel and financial resources. Developing coordinated, family-centered 
systems is a complex, problematic process that involves addressing complex inter and 
intra agency program and policy issues. The primary problems encountered in systems 
change are to: 

• Get the organizations and agencies responsible for addressing problems to 
reach consensus on the nature and extent of the common problems that they 
are facing and how they should be addressed; 

• Overcoming organizations concerns about protecting their own identities, 
ideologies, roles and resources; and 

• Getting agencies to address problems jointly by combining personnel and 
resources 

The findings of the AOCAP/Title V working group constitute a draft statement of 
consensus regarding the problems of Vietnam Veteran families and their children with 
special needs and the ways in which AOCAP and Title V can work together to address 
these problems. Now, it is up to the staff of Title V Programs and AOCAP Projects to 
accept the challenge and to focus a measure of their limited financial and personnel 
resources on setting priorities and taking collaborative actions at the state and local 
levels. 



Tage 9 



144 



In my opinion, the efforts of AOCAP and state Title V CSHCN Program to address 
the needs of Vietnam Veteran families and their children with special needs could be 
significantly enhanced through: 

• Additional resources, to be made available to joint Title V CSHCN/AOCAP 
initiatives to enhance the availability and coordination of comprehensive, 
coordinated, family-centered health and social services to Vietnam Veterans 
families with children with special needs. 

• Additional resoufces targeted to support joint Title V CSHCN/AOCAP/ 
Veteran's organization training efforts designed to improve the knowledge and 
skills of a broad range of providers to effectively work with Vietnam Veterans 
families with children with special needs in addressing their health and social 
service needs. 

Additional resources targeted to support joint Title V CSHCN/AOCAP 
training efforts designed to improve cross program knowledge and 
coordination regarding Vietnam Veterans families with children with special 
needs. Such training would involve not only Title V CSHCN Programs and 
AOCAP Projects, but would also include public and private providers of 
primary and specialty health care; and those who provide veteran's, mental 
health, child abuse, vocational, educational, social and other support services. 

• Additional resources targeted to support efforts to train Vietnam Veterans 
families about the availability of, and how to access primary and specialty 
health care; and veteran's, mental health, child abuse, vocational, educational, 
social and other support services. 

• The identification of Vietnam Veterans families with children with special 
needs as a population in need of special attention in various research, service, 
and training grant guidance and block grant guidance, as administered through 
the Maternal and Child Health Bureau, the Administration on Children and 
Families, the Department of Education, the Rehabilitative Services 
Administration, Department of Veterans Affairs, etc. This would help target 
existing service, research and training resources on this population. This 
would also help to document the number of Vietnam Veteran families with 
children with special needs, and to describe the extent to which their needs are 
not appropriately addressed. 

• Changes in the Department of Veterans Affairs service system's organization 
and philosophy, so that it is more in keeping with the principles of family- 
centered, community-based, collaborative, culturally competent, care- 
coordinated, comprehensive care. 



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145 



Statement of 

Frank McCarthy 

President 

Vietnam Veterans Agent Orange Victims, Inc. (VVAOVI) 

Founder 

Brandie Schieb Children's Fund 



Before the 

Subcommittee on Oversight and Investigations 
Committee on Veterans Affairs 
U.S. House of Representatives 



May 18, 1994 



146 



Good morning Chairman Evans and members of the Committee. I wish to 
thank you for inviting me to testify today on the subject of " Social Services for 
Vietnam Veterans and Their Families: Current Programs and Future 
Directions". 

My name is Frank McCarthy. I am a combat disabled Vietnam Veteran and 
have been President of Vietnam Veterans Agent Orange Victims, Inc. 
(VVAOVI) for more than 16 years. 

WAOVI has provided a multitude of direct services for Vietnam Veterans and 
Agent Orange Victims for more than 17 years and the Agent Orange class action 
litigation (MDL-381) was conceived and initiated by our organization's founder, 
Paul Reutershan, in 1978. 

I am a member of the Court appointed Board of Advisors to the Agent Orange 
Class Assistance Program (AOCAP) and the settlement fund of MDL -381 since 
1984. I hold various positions with seven other traditional and non-traditional 
Veteran's service organizations throughout the nation and have worked in 
Veteran's affairs for the last twenty-two years of my life. 

In order for me to give you an accurate understanding of current programs and 
future directions of social services for Vietnam Veterans and their families I 
must first give you a brief history, from my perspective, of where we have 
come. 

Prior to the May 7, 1984 out of court settlement of MDL-381 our organization 
(VVAOVI) had more than 68 chapters and information points throughout the 
nation. 

Our organization functioned and was created solely to address the needs of 
Agent Orange Victim Vietnam Veterans and their families. They came to us by 
the thousands with health care problems which encompassed the entire 
spectrum of chronic toxicity including a multitude of birth defects and disorders 
experienced by the Veteran's children. 

Each chapter was funded and operated totally by either a Vietnam Veteran or 
family member who was adversely affected by Agent Orange. Today we only 
have one chapter in Darien, Connecticut. 

One by one the chapters closed because those Veterans were dying of cancers, 
immunological and neurological illnesses most of which are now recognized 
and compensated by the Department of Veterans Affairs (VA) as Agent Orange 
related. 

Those chapters whose directors were not dying of such illnesses had to close 
their chapters as well because the financial burden of providing direct one-on- 
one services and programs was so devastating that they could not continue on. 
Estimates of monies spent by those individuals and chapters are in the millions. 

The dedication, selflessness and sacrifices of those Veterans and families will go 
down in history as one of the finest examples of courage and determination 
ever written. They epitomize the Agent Orange issue. They are the heart of 
America's Veteran community. 

They did what they had to do regardless of the toll, simply because there was no 
one else to do it. There was no AOCAP. There was no settlement fund. There 
was only the sick, dying and suffering coming to them for help. 



147 



And, of course, there was the horrible and constant obstacles created by the 
controversy surrounding the cause and effect relationship between exposure to 
Agent Orange and illness. 

The number one priority of those chapters and the main reason why Paul 
initiated the law suit was to "stop the suffering". The same suffering that has 
existed within the Vietnam Veteran community ever since the first day 
Vietnam Veterans returned from the battlefields of Vietnam. The same 
suffering which AOCAP faces today and the same suffering which will exist 
when AOCAP is gone. 

That suffering has many faces which transcend the Agent Orange issue. It is the 
ugly face of war. Post-traumatic Stress Disorder, cancers, neurological & 
immunological illnesses, social and economic devastation, illnesses endemic to 
Southeast Asia and a whole host of other ill health effects abound. 

As any Vietnam Veteran will tell you, by far, the worst suffering of them all is 
the developmental disabilities experienced by our children. The children are 
why we fought and died in the war itself. They are the future of America. 

They are the main priority of AOCAP and they must be seriously assisted by 
Health And Human Services and the Department of Veterans Affairs. 

WAOVI can no longer provide millions of dollars worth of help. No other 
Veteran's organization can do it alone and soon AOCAP will no longer exist. A 
huge void will exist in America. A hole, if you will, in the heart of the Veteran 
community that will tear at the very fabric of our nations humanity. 

I will not attempt to detail the intricacies of the AOCAP program. You have 
received much more detailed testimony by its director Dennis Rhoades and 
others providing services with AOCAP funding. 

What I do want you to realize, however, is that Judge Jack B. Weinstein, the 
AOCAP Administrators and Advisors dared to have the courage to stand up to 
the constant criticisms of squeaky Veteran wheels, legislative ineffectiveness, 
legal ignorance and precedence, medical and scientific inconclusion and 
traditional Veterans health care thought, and address our children's suffering 
head on. They did, in the words of Abraham Lincoln, "Determine that the 
thing can and shall be done, and then we shall find the way". 

AOCAP dared to seal the social and health care cracks through which our 
children had fallen and battled the seemingly endless suffering. For this I shall 
always love them all. For this the Veteran's community as well as the nation 
shall always owe them a debt of gratitude and for this, I pray, Congress takes 
example from! 

AOCAP, " found the way " by linking up the Veterans service delivery system 
with the family services and developmental disabilities delivery systems which 
created a triangle of positive energy directed towards the suffering Veterans and 
their children. 

The results, some examples of which you have heard about today, have 
exceeded my greatest expectations. Lives of our children have been, literally, 
saved. Veteran families by the tens of thousands have received help which did 
not exist prior to AOCAP and, " the suffering " is on the ropes. 

However, the crucial message I am here to deliver to you today is one of alarm. 
AOCAP, for all of its virtue is severely flawed, for it is mandated to cease 
operations soon. What this will mean to those of us who will be left to 
continue the fight against the suffering is shocking. 



148 



There will be no more funding of life giving programs and services. There will 
be nothing in place to combat the suffering and those small but effective 
Veteran's service organizations like VVAOVI will be cast back into the dark 
ages of inadequate funding, an overwhelming number of case loads and 
seemingly endless hopelessness. 

Mr. Chairman and members of the Committee you must not let this happen. 
You must not let the light of help and hope created by AOCAP go out for our 
children. 

You and you alone are the only source of power existing in America today who 
can help us to continue the fight against the suffering. You alone can make it 
possible for us to continue to stand when the AOCAP support structure is 
dismantled. You alone can make the difference between life and death. 

Congress must " determine that the thing can and shall be done " by forcing 
Health and Human Services as well as the VA to cast aside the controversy 
surrounding the Agent Orange issue and bridge the gap in services which will 
exist when AOCAP ceases to exist. 

Specifically, the VA must be directed to provide Vietnam Veterans and their 
families with family oriented programs and services, or, at the very least, third 
party contract with existing crucial AOCAP service providers. 

For the last 17 years the VA has adhered to a political position regarding 
Vietnam Veterans claiming Agent Orange related ill health effects which 
prioritizes the financial compensation factor. 

Until a recent court decision, and your successful legislation, Mr. Chairman, 
Veterans had to prove that Agent Orange caused their ill health problems, 
which essentially enabled the VA to solve its compensation fear, yet skirt its 
responsibility as advocate of the Vietnam Veteran. As a result the VA became 
our enemy. 

The jewel of the AOCAP program is that it takes no political position 
whatsoever regarding cause and effect. If you are a Vietnam Veteran or family 
member and the Veteran served in the U.S. armed forces in Southeast Asia 
during the war, the services and programs of the AOCAP network are available 
to you. 

Lawyers, adjudication and service officers and bean counters must no longer be 
a detriment to the vital help which the VA could and should provide to 
Vietnam Veterans and their families by mirroring AOCAP. 

Let " end the suffering " be the main priority of the VA in its future dealings 
with the Agent Orange issue and the VA will no longer be the enemy of Agent 
Orange Vietnam Veterans and their families. 

The future directions of social services for Vietnam Veterans and their families 
must include measures designed to prevent and /or minimalize the illnesses 
which advances in medicine and age insure that Veterans will experience. The 
VA, in particular must end its isolation and its refusal to engage in cooperative 
efforts to provide services and share information which may be helpful to 
veterans and their families. 

Sharing important information regarding the various illnesses which the 
Veterans themselves have commonly associated with exposure to Agent 
Orange, as well as many other chemicals in Vietnam and daily living will save 
lives and in fact, save the VA money by decreasing necessary care for the 
Veteran in the future. 



149 



Prior VA administrations have told us that they could not make such 
information available to us because, " that would be practicing preventive 
medicine and the VA does not do that ". I submit to you Mr. Chairman, that 
the little money the VA spends for paper now is an investment against the ever 
increasing medical care costs it will surely have to pay in the future. Soon the 
Vietnam-era-Veteran population will out number the World War II 
population. The Testicular Cancer Self-Examination Guide, which I have 
enclosed, is a prime example of the kind of information which has contributed 
greatly in decreasing the unnecessary deaths of Vietnam Veterans from 
Testicular Cancer. It is also, unfortunately, an example of the VA's steadfast 
insistence on remaining isolated in its own closed system. 

This guide is fast becoming unnecessary, because the average age of the 
Vietnam Veteran has passed the age of 40. Testicular cancer is rare after that 
age. However, our organization not only created this guide, but, during the last 
13 years has distributed more than one million of them throughout the nation. 

There is no greater example of the effectiveness of this guide as is demonstrated 
by the hundreds of Veterans who came to us after they had read the guide, 
checked themselves, detected the lump and quickly sought treatment which 
saved their lives. Their cancer was caught and treated before it spread and 
became terminal. 

I will be haunted for the rest of my life by the voices and faces of those Veterans 
who came to us after reading the guide and told us of how much they wished 
they would have received the guide before the cancer spread and became 
irreversible. 

When we first created this guide I brought it to the VA and asked them to 
distribute it. Instead of welcoming it the VA central office condemned it as 
inaccurate and called me an alarmist. What they don't know is that I sent a 
copy of this guide to every VA hospital in America. We sold tens of thousands 
of them to VA hospitals throughout the nation. They enthusiastically bought 
them up and reordered more when they ran out. Individual VA hospitals 
loved them because they had no credible nonpolitical medical Agent Orange 
information to give the Veterans and their families who were coming to them 
for help. 

VA doctors and nurses needed help and truth about possible Agent Orange 
related illnesses to give to the Vets. They had to face the Veterans every day. 
The VA bureaucracy gave them "Worried About Agent Orange?" pamphlets. 

We took the funds we received from the VA hospitals and had more copies of 
our guide made which we distributed to hundreds of Vietnam Veteran groups 
throughout the nation who could not afford to buy them. We distributed them 
to every VA Vet Center as well as individual Veterans for free. Similar anti- 
cancer information will save Vietnam Veteran lives. 

Logic demands that if the VA now recognizes and compensates Veterans for 
over 40 different Agent Orange cancers, many of which are treatable if detected 
early, many lives and much money will be saved if they put out information 
about those diseases. Desert Storm Veterans are currently at the high risk age 
for contracting Testicular cancer. Who will inform them and distribute self- 
examination guides? 

The future directions must not forget the class of Agent Orange victims and 
Vietnam Veteran families who are rarely, if at all, serviced by the VA or 
AOCAP. For the most part they are the poor, the homeless and the uninsured 
working class. 

Those Vietnam Veteran's identity is clouded by stereotypes; the downtrodden, 
the drug and alcohol addicted, the criminal, the useless and the psychotic. 



150 



However, the reality is that they are the minority. The overwhelming majority 
are decent, law abiding and upstanding American citizens who have all of the 
Agent Orange and Vietnam related ill health problems of their Veteran peers 
except they have lost their auto, steel, manufacturer and various other blue 
collar jobs to the economic ills of the past decade and are now homeless. 

They are the, " silent suffering ", unable to access the existing social services 
system due to the overwhelming task of just trying to survive. 

I see them every day in Florida, especially when the harsh climate of winter hits 
the northern cities. I see them in every major city in America. They live in 
their cars and live from moment to moment, day to day, city to city, state to 
state. They are trapped in a world of uncertainty, fear and hopelessness over 
and above their chronic ill health problems. They comprise practically every 
racial, social, political, philosophical and religious entities existing within the 
Vietnam Veteran community. Their children age from new born to late 
twenties. 

Vietnam Veterans and their families have been battling the injustices of being 
stereotyped, abandoned, bureaucratic disinterest and misunderstanding about 
their Agent Orange and Vietnam war related problems from the beginning of 
the war to date. 

They have sought remedial and compensative measures from our nations 
highest authorities including the legislative, judicial and social services systems 
of America. They have marched in parades, demonstrated ( including hunger 
strikes), testified before various city, county, state and most federal branches of 
the US government. In fact they helped create many laws in many states. They 
have sold their homes and businesses, spent millions of dollars paying lawyers 
and other supportive measures just to keep the class action law suit before the 
highest courts in America. 

They have opened their hearts, minds and homes to the cold, harsh eyes of the 
various medias and their horror stories of suffering, death and birth defects 
have touched the hearts of the American public. 

They have subjected themselves to a myriad of medical and scientific studies, 
and surveys which in many cases included extremely painful physical and 
psychological requirements such as, literally taking more than an ounce of flesh 
from individual Vietnam Veterans. 

In turn they have had their health insurance canceled or denied. Their 
children have been discriminated against ( because of their fathers exposure to 
Agent Orange) by the insurance and health industries. 

Their futures are clouded by uncertainty, chronic pain, suffering, social 
deprivation and out right death. 

AOCAP is doing about as much as it possibly can to fight the suffering. My 
praise is tainted by my fear of what life will be like when AOCAP is no more. 

In closing, Mr. Chairman, members of the Committee, I wish you to know that I 
appreciate your continued support of programs and services for Vietnam 
Veterans and their families. I will make myself available for any questions 
and /or supportive documentation for any statements I have made in this 
testimony and I do pray to God that it makes a difference. 

I will leave you with a thought best expressed recently by the First Lady, Hillary 
Rodham Clinton, " there isn't anything more important than taking care of 
our children ." 



151 



STATEMENT OF 

DAVID H LAW, M.D. 

ACTING ASSOCIATE DEPUTY CHIEF MEDICAL DIRECTOR FOR CLINICAL PROGRAMS 

BEFORE THE 

HOUSE VETERANS' AFFAIRS COMMITTEE 

SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS 

MAY 18, 1994 

f- MR CHAIRMAN AND MEMBERS OF THE COMMITTEE: 

I AM PLEASED TO REPRESENT THE VETERANS HEALTH ADMINISTRATION AND TO 
DISCUSS WHAT THE DEPARTMENT OF VETERANS AFFAIRS DOES TO ASSIST VETERANS AND 
THEIR FAMILIES USING SOCIAL SERVICES. 

WITH ME TODAY IS DR LAURIE HARKNESS, CHIEF OF PSYCHIATRIC REHABILITATION 
DR HARKNESS IS FROM OUR HOSPITAL IN WEST HAVEN, CONNECTICUT, SO SHE IS OUT THERE 
ON THE FRONT LINES WORKING WITH VIETNAM VETERANS, THEIR SPOUSES AND THEIR 
CHILDREN 

THE SIGNIFICANT IMPACT OF WAR AND MILITARY SERVICE ON FAMILIES HAS BEEN 
RECOGNIZED THROUGHOUT OUR NATION'S HISTORY. IT HAS BEEN EXPERIENCED DIRECTLY BY 
MILLIONS OF OUR CITIZENS AND HAS BEEN A VERY PERSONAL EXPERIENCE OF THOSE PRESENT 
AT THIS HEARING THIS MORNING. 

VA ONLY HAS AUTHORITY TO PROVIDE DIRECT TREATMENT TO A VETERAN'S FAMILY 
MEMBERS FOR COLLATERAL TREATMENT IN MENTAL HEALTH, REHABILITATION AND LONG 
TERM CARE PROGRAMS. VA DOES RESPOND TO THE OTHER NEEDS OF FAMILIES, THROUGH 
WELL-ESTABLISHED REFERRAL NETWORKS AND COMMUNITY PLANNING PARTNERSHIPS 

DISCHARGE PLANNING, INFORMATION AND REFERRAL, CASE MANAGEMENT SERVICES 

AND FAMILY CONSULTATION RANK HIGH AMONG THE MOST FREQUENTLY USED DIRECT 

SERVICES. IN THE PAST THREE MONTHS ALONE, FOR EXAMPLE, NEARLY A Q ; IARTER MILLION 

VETERANS RECEIVED THOSE SERVICES FROM VA SOCIAL WORKERS. VET CENTER 

READRISTMENT COUNSELORS ALSO PROVIDE COMMUNITY OUTREACH, PSYCHOLOGICAL 

COUNSELING AND REFERRALS TO OTHER COMMUNITY PROVIDERS THROUGH A NATIONWIDE 
t 

NETWORK OF 202 COMMUNITY- BASED VET CENTERS. SINCE 1979 VET CENTERS HAVE 

COUNSELED NEARLY ONE-AND-A-HALF MILLION VETERANS AND FAMILY MEMBERS AND OVER 

15 PERCENT OF THOSE SERVICES WERE FOR MARITAL AND FAMILY PROBLEMS. 



152 



CLINICAL STAFF ASSIGNED TO VA MEDICAL CENTERS, OUTPATIENT CLINICS, 
COMMUNITY BASED VET CENTERS AND VETERANS BENEFITS COUNSELORS IN VA's REGIONAL 
OFFICES PROVIDE PRIMARY LINKAGE AND REFERRAL SERVICES TO COMMUNITY SOCIAL 
SERVICE AGENCIES AND PROGRAMS. 

VIETNAM VETERANS' PROBLEMS STEMMING FROM POST TRAUMATIC STRESS ARE NOT 
JUST INDIVIDUAL, THEY IMPACT THE ENTIRE FAMILY. FOR INSTANCE, A VETERAN WHO 
WORKED IN THE PAST, MAY NOT BE ABLE TO CONTINUE TO WORK DUE TO THE SEVERITY OF 
SYMPTOMS. THIS FORCES THE PARTNER TO GO TO WORK WHILE ALSO MANAGING THE 
HOUSEHOLD. THIS COMMON SCENARIO INCREASES A FAMILYS STRESS LEVEL. IT CAUSES THE 
VETERAN TO FEEL RESENTFUL AND TO MISDIRECT ANGER TOWARD THE FAMILY. THE FALLOUT 
FREQUENTLY IS ON THE CHILDREN - CREATING A DYSFUNCTIONAL HOME ENVIRONMENT FOR 
ALL. LEFT UNTREATED, THE PATTERN CAN REPEAT ITSELF LEAVING BEHIND A LEGACY OF 
IMPAIRED INTERPERSONAL RELATIONSHIPS WITH CHILDREN AND SPOUSES. 

MR CHAIRMAN, WE IN VA APPLAUD THE EXCELLENT WORK WITH FAMILIES AND 
CHILDREN OF DISABLED VIETNAM VETERANS ACCOMPLISHED BY THE AGENT ORANGE CLASS 
ASSISTANCE PROGRAM, OR, AOCAP. IT HAS FILLED A CRITICAL GAP IN SERVICE DELIVERY TO A 

highly needful population of veterans' families. 

the unique stresses that occur in military life and in the subsequent 
transition to veteran status require therapeutic intervention from all 
available resources. the consequences of not recognizing these needs could 
result in veterans and families being isolated with the problem and alienated 
from the community. the long term consequences are additional social problems 
and dysfunction coupled with greater cost to the family and society to repair or 
rebuild Lives at a later time. 

an important va mission is to provide for the military service-related 
social service needs of veterans and their families. to meet those needs, va has 
implemented programs that deal with post traumatic stress disorder substance- 
abuse, and family violence. to supplement existing programs and resources, va 
staff call upon the full range of public, private, non-profit and self-help 
community organizations and resources to assist veterans and their families to 
obtain needed services. 



153 



IN LARGE METROPOLITAN AREAS, COMMUNITY SOCIAL SERVICE AGENCIES ABOUND 
AND VA SOCIAL WORKERS HAVE LITTLE DIFFICULTY MAKING REFERRALS OF VETERANS' 
FAMILY MEMBERS. IN SMALLER COMMUNITIES, FINDING APPROPRIATE AGENCIES WITH THE 
RIGHT SERVICES AVAILABLE FOR THE VETERANS' FAMILY MEMBERS BECOMES MORE OF A ' 
CHALLENGE. "MANAGING" A CASE ENCOMPASSES MUCH MORE THAN JUST PROVIDING HIGH 
QUALITY HEALTH CARE TO THE VETERAN. IT MEANS GETTING THE FAMILY THE SERVICES IT 
NEEDS SO THAT IT CAN SUPPORT THE VETERAN FOLLOWING A COURSE OF VA HOSPITALIZATION 
OR OUTPATIENT CARE. ALSO, WITHOUT EFFECTIVE COORDINATED CASE MANAGEMENT 
SERVICES, SOME FAMILIES AT HIGH SO< : \i. <uSK MAY NOT RECEIVE NEEDED SERVICES 

VA PROGRAMS THAT MEET THE SOCIAL SERVICE NEEDS OF VETERANS AND THEIR 
FAMILIES SHARE CERTAIN CHARACTERISTICS. THEY SYSTEMATICALLY ADDRESS THE 
BIOLOGICAL, PSYCHOLOGICAL, SOCIAL AND VOCATIONAL NEEDS OF THE VETERAN. BASED ON 
A FAMILY NEEDS ASSESSMENT, THEY INCORPORATE A HOLISTIC APPROACH AND SEEK 
SOLUTIONS TO THE SOCIAL NEEDS THROUGH USE OF THE FAMILY, VA PROGRAMS AND 
COMMUNITY RESOURCES. THE SUCCESSFUL PROGRAMS FOCUS ON HEALTHY FAMILY 
RELATIONSHIPS, ENCOURAGE INDEPENDENCE AND PERSONAL RESPONSIBILITY, USE 
VOLUNTEERS AND PROGRAM GRADUATES. AND PROVIDE CASE MANAGEMENT AND CARE 
COORDINATION SERVICES. SOME EXAMPLES OF A WIDE RANGE OF LOCALLY-DEVELOPED VA 
PROGRAMS INCLUDE: 

• VA PTSD PROGRAMS OFFERING INPATIENT AND OUTPATIENT COUNSELING, 

FAMILY COUNSELING, AND CHILDREN AND ADOLESCENT COUNSELING. BY 
INCLUDING FAMILIES AS PART OF THE VETERAN'S TREATMENT, THE FAMILY MAY 
GAIN AN UNDERSTANDING OF THE VETERANS PTSD SYMPTOMS AND BE MADE 
AWARE OF THE TREATMENT PROCESS AND PROGRESS FAMILY PROBLEMS RELATED 
TO THE VETERANS ILLNESS ARE ALSO ADDRESSED. 

VIETNAM VETERANS LIAISON UNITS AND POST TRAUMATIC STRESS DISORDER 
RESIDENTIAL REHABILITATION PROGRAMS. MEDICAL CENTERS WORK WITH A ' 
LARGE AND DIVERSE GROUP OF VIETNAM VETERANS AND THEIR FAMILIES AND 
OFFER A WIDE RANGE OF SOCIAL SERVICES. SERVICES INCLUDE FAMILY AND 
MARITAL COUNSELING, INCLUDING A COMMUNITY-BASED WEEKLY FAMILY AND 
SIGNIFICANT OTHERS GROUP, AGENT ORANGE INFORMATION AND REFERRAL AND 
CARE AND COORDINATION SERVICES WITH COMMUNITY SOCIAL SERVICES. 



154 



VA AND AOCAP WILDERNESS INQUIRY PROGRAM THIS PROGRAM AUGMENTS VA 
PTSD TREATMENT SERVICES AND TARGETS THE NEEDS OF THE VETERANS' 
CHILDREN. IT PROVIDES A POSITIVE WILDERNESS EXPERIENCE THAT ALLOWS 
PARTICIPANTS TO SEE THEIR OWN POTENTIAL, TO LEARN RECREATIONAL SKILLS, 
AND TO INCREASE SELF-RELIANCE AND SELF-ESTEEM. 

. " VA HOSPITAL AND VET CENTER OUTDOOR CHALLENGE GROUP. THIS IS A 

COUNSELING PROGRAM FOR VIETNAM AND POST- VIETNAM WAR ZONE VETERANS 
AND SPOUSES. THE PROGRAM COMBINES THE EXPERIENCES OF TEAM-BUILDING, 
OUTDOOR TRIPS AND CONFIDENCE-BUILDING. THE CHALLENGE GROUP HAS 
INCORPORATED CHILDREN INTO ITS PROGRAM. 

. COUPLES GROUP FOR VIETNAM VETS AND WIVES OR PARTNERS. 

VIETNAM VETERANS CHILDRENS GROUP. THE GOAL OF THIS PROGRAM IS TO 
ASSESS AND TREAT THE IMPACT OF THE VETERANS PTSD ON THE VETERANS' 
CHILDREN. 

MR. CHAIRMAN, THE DEVELOPMENT OF AOCAP AND OTHER VOLUNTARY SERVICE 
ORGANIZATION-SUPPORTED COMMUNITY BASED SOCIAL SERVICES HAS MADE A MAJOR 
CONTRIBUTION TO VETERANS' FAMILIES AND THE SOCIAL SERVICE NETWORK. IT HAS 
PROVIDED A FULL RANGE OF COMMUNITY SOCIAL SERVICES WHICH ARE ESSENTIAL FOR THE 
EFFECTIVE DELIVERY OF HEALTH CARE SERVICES TO VETERANS AND THE HEALTHY 
FUNCTIONING OF THEIR FAMILIES. OUR STAFFS APPRECIATE THE SERVICES PROVIDED BY 
THESE COMMUNITY SERVICE PROGRAMS. WE ALSO APPRECIATE THE NETWORKING WE HAVE 
BEEN ABLE TO ESTABLISH WITH THE COMMUNITY AGENCIES FUNDED BY AOCAP. THEY ARE 
SKILLED IN WORKING WITH DISABLED CHILDREN OF VIETNAM VETERANS WE HAVE 
COORDINATED WITH MANY OF THOSE AGENCIES TO MEET THE PSYCHOLOGICAL AND SOCIAL 
NEEDS OF VETERANS WHOSE CHILDREN WERE UNDERGOING CONCURRENT MEDICAL CARE IN 
THE COMMUNITY. 

MR. CHAIRMAN, THIS CONCLUDES MY TESTIMONY. MY COLLEAGUE AND I WILL BE 
PLEASED TO ANSWER ANY QUESTIONS YOU MAY HAVE. 



155 
WRITTEN COMMITTEE QUESTIONS AND THEIR RESPONSES 




THE SECRETARY OF VETERANS AFFAIRS 
WASHINGTON 



OCT 71994 



The Honorable Lane Evans 
Chairman, Subcommittee on Oversight 
and Investigations 
Committee on Veterans' Affairs 
House of Representatives 
Washington, DC 20515 

Dear Mr. Chairman: 

Enclosed is follow-up information to the May 18, 1994, post-hearing questions 
regarding Social Services for Vietnam Veterans and Their Families. 

In our answer to Question 4, we indicated that, "The requested data regarding Vet 
Center referrals is being collected in the field and will be transmitted as soon as it has 
been received, reviewed and collated." The data has been processed and is enclosed for 
your review. 

We regret the delay in getting this information to you and appreciate the 
opportunity to submit this information for the record. 

Sincerely yours. 



fy~<$ 



Enclosure 
JB/rlh 




Putting Veterans First 



156 



QUESTIONS SUBMITTED BY 

HONORABLE LANE EVANS, CHAIRMAN 

SUBCOMMITTEE ON OVERSIGHT & INVESTIGATIONS 

COMMITTEE ON VETERANS' AFFAIRS 

SOCIAL SERVICES FOR VIETNAM VETERANS AND THEIR FAMILIES: 
CURRENT PROGRAMS AND FUTURE DIRECTIONS 

MAY 18, 1994 

QUESTIONS FOR DR. DAVID H. LAW 

ACTING ASSOCIATE DEPUTY CHIEF MEDICAL DIRECTOR 

FOR CLINICAL PROGRAMS 

DEPARTMENT OF VETERANS AFFAIRS 



Question 1: 



Dr. Law as your testimony notes, "Vietnam veterans' problems stemming from 
post-traumatic stress are not just individual, they impact the entire family." 



What services are VA authorized to provide directly or indirectly to veterans for 
problems stemming from post-traumatic stress? 

What services are VA authorized to provide directly or indirectly to family 
members of veterans for problems stemming from post-traumatic stress? 

What services are VA authorized to provide directly or indirectly to veterans and 
their family members for problems stemming from post-traumatic stress? 

What important services are VA not authorized to provide directly or indirectly to 
veterans for problems stemming from post- traumatic stress? 

What important services are VA not authorized to provide directly or indirectly to 
the family members of veterans for problems stemming from post-traumatic stress? 

What important services are VA not authorized to provide directly or indirectly to 
veterans and their family members for problems stemming from post-traumatic 

stress? 

Identify the types of services or treatment not currently authorized to be provided 
directly or indirectly by VA to veterans for problems stemming from post- 
traumatic stress which would be expected to provide more effective treatment to 
these veterans if provided by VA. 

Identify the types of services or treatment not currently authorized to be provided 
directly or indirectly by VA to veterans' family members for problems stemming 
from post-traumatic stress which would be expected to provide more effective 
treatment to these family members if provided by VA. 

Identify the types of services or treatment not currently authorized to be provided 
direcdy or indirectly by VA to veterans and their family members for problems 
stemming from post-traumatic stress which would be expected to provide more 
effective treatment to these veterans and their family members if provided by VA. 



The Readjustment Counseling Service (RCS) administers a nationwide system of 
202 community-based Vet Centers located in 50 states. Puerto Rico, the District of 
Columbia, the Virgin Islands, and Guam. The Vet Center mission is to provide 
community outreach and counseling to assist Vietnam era veterans, and since April 
1991 veterans of Lebanon. Grenada, Panama, the Persian Gulf and Somalia. This 
includes assisting in resolving war-related psychological difficulties (including 
post-traumatic stress disorder) and helping these veterans attain a well-adjusted 



157 



post-war family and work life. As currently provided at Vet Centers, readjustment 
counseling is a highly specialized set of social, economic, and psychological 
services specifically designed for post-war readjustment 

Working in small teams of three to five. Vet Center counselors provide a mix of 
community outreach, psychological counseling and supportive social services 
within a non-medical rehabilitative setting. Specifically the mix of services include: 
psychological counseling and psychotherapy (individual, group and family), 
outreach, networking and referral for other needed services (VA and non-VA), 
employment counseling, education/career counseling, crisis counseling, community 
education, substance abuse aftercare and referral, consultation to professionals, 
and conjoint services at VA medical facilities and regional offices. All of these 
services are directly available to the veteran, and indirectly available to veterans' 
family members. Psychological counseling regarding the veterans' post-traumatic 
stress disorder (PTSD) is, however, directly available to family members, where 
family member means spouse, children or other socially defined significant 
person(s). This includes legal guardians as well. 

Since the inception of the Vet Centers in 1979, they have seen over 1.4 million 
veterans and family members. On an annual basis the Vet Centers, system-wide, 
provide services to approximately 140,000 veterans and 25, 000 family members. 
Family treatment can be an important adjunct to direct treatment of the veteran 
with PTSD to improve the clinical management of the effect of family relations on 
the course of the PTSD in the veteran and reciprocally of the impact of the 
veteran's PTSD on the quality of family relations with particular reference to the 
development of second generation symptomology in the veteran's children. Vet 
Centers have been authorized to provide family counseling (to the extent needed 
for the veteran's readjustment) as part of readjustment counseling from the onset 
which has contributed significantly to the general success of Vet Centers. The 
RCS in-service training program also features continuing education for service 
providers in family counseling and PTSD. Family therapy at Vet Centers is also 
provided in some cases to assist veterans and family members with emotional 
reactions to possible exposure to herbicides in Vietnam and to refer the family to 
medical facilities (VA and non-VA) for treatment of possible related medical 
problems. 

With particular reference to treatment for war-related PTSD. VA has developed a 
spectrum of integrated programs ranging from the community-based Vet Centers 
to the VA Medical Center-based programs such as the PTSD Clinical Teams 
(PCTs), the Special Inpatient PTSD Units (SIPUs) and the other various 
specialized inpatient and outpatient programs. The ability of clinicians operating in 
VA medical centers and outpatient clinics to provide clinical services to the 
families of veterans is constrained by law to the provision of "collateral" care: 
limited treatment in support of the care of the primary patient, the veteran. 
Contact with a patient's family is essential in the care of many who suffer from 
mental disorders, including Post-traumatic Stress Disorder (PTSD). Information 
on the patient's condition, and education of family members on how to best help 
the veteran are some of the advantages of such contacts. Many V AMC-based 
programs are currently providing ongoing group and/or family therapy for the 
spouses and children of veterans being treated for PTSD. Taken collectively, these 
programs address the full range of clinical needs presented by veterans with war- 
related PTSD, with particular reference to the residuals of primary war trauma in 
the veteran and the secondary trauma of post-war breakdown in relationship 
between the veteran and his or her family members. 



Question 2: Your statement refers to the isolation and alienation of Vietnam veterans and their 
families. 

Which V A programs are meeting the needs of these veterans and how effective are 
these problems? 



0-95-6 



158 



Which V A programs are meeting the needs of the families of these veterans and 
how effective are these programs? 

How could the needs of these veterans be better met by VA? 

How could the needs of the families of these veterans be better met by VA? 

Answer: VA's Vet Centers are a highly utilized and successful service for helping veterans 

resolve war-related psychological trauma and achieve post-war readjustment to 
civilian life. As referenced above, the Vet Centers, systemwide, see approximately 
140,000 veterans and an additional 25.000 family members per year. The non- 
medical community-based service delivery system is highly popular with the 
veteran public and results in a steady flow of satisfied customers and positive 
media coverage nationwide. There has been no negative media coverage of these 
services anywhere nationwide for the past approximately eight years. Many 
referrals are from former veteran clients. Vet Centers have become an honored 
and valued community institution throughout the United States, earning a 
respected role among community service agencies. They have provided an 
effective bridge between an entire generation of war veterans and the Department 
of Veterans Affairs, and now furnish access to the VA system for younger war 
veterans. Also Vet Center services are highly economical, with a cost per veteran 
and cost per visit far below that of the most closely comparable services at medical 
facilities. In addition, due to effective quality management. Vet Center client 
suicide rate is one-fifth that of the general population of comparable age range. 

Another major source of effectiveness of Vet Centers is that a clear focus on the 
mission has been maintained for fourteen years. Since 1979 the mix of services 
and various program emphases have been refined by experiences within the 
initiating mission definition. So structured, the Vet Centers are a community- 
centered service whose ultimate service objective is the readjustment of the veteran 
to the civilian community. Family and work adjustment are seen as integral to 
successful post-war civilian readjustment, but the family group is itself seen as 
embedded in a social and cultural environment with which it must maintain an 
adaptive interchange if the veteran is to achieve a successful post-war 
homecoming. The character of readjustment counseling and its effectiveness, are 
also tied to the fact that 60 percent of the service providing staff are war- zone 
veterans, and another 25 percent war era veterans. 

Precise data on all the services provided to the families of Vietnam veterans 
through VA medical facilities would require a special survey, as this information is 
not routinely tracked. It would involve checking on those services provided by 
general mental health programs as well as our specialized PTSD units. The 
Northeast Program Evaluation Center notes that of veterans seen by our PTSD 
Clinical Teams (PCTs), about 10 percent received some family therapy, and for 5 
percent , this was a substantial part of their treatment. It must be noted that of the 
veterans who use PCTs, 32 percent are divorced, and 9 percent never married. 
Also, 25 percent are living alone (The Long Journey Home III: The Third Progress 
Report on the Specialized PTSD Programs, May 1, 1993). These conditions may 
reflect some of the ravages of PTSD on successful family life, but they also may 
prevent the use of family therapy for these particular veterans. 

Concerning the final two questions, VA believes that the needs of veterans and 
their families are being met to the fullest extent the law currently allows. 



Question 3: AOCAP has "filled a critical gap in service delivery to a highly needful population 
of veterans' families." according to your prepared statement. How should this 
critical gap be filled in the absence of AOCAP? What role could VA play in filling 
this critical gap? 



159 



While VA has and should continue to provide a wide range of benefits and services 
to veterans whose health may have been adversely affected by exposure to Agent 
Orange and other potential environmental hazards encountered during their service 
in Vietnam, there are some restrictions on our efforts. Although some veterans 
have alleged that their exposure to Agent Orange has resulted in birth defects 
among their children, this has not been demonstrated in scientific investigations. 
We realize that some AOCAP-funded organizations have provided valuable 
services to some Vietnam veterans with children suffering with birth defects and 
that some organizations may be negatively impacted by the termination of 
AOCAP. A number of public and private organizations, nevertheless, will 
continue to provide important services to these veterans and their families. VA 
officials will continue to provide advice and referral information regarding 
appropriate community resources. Given the limits of VA's authority in this area, 
VA is doing as much as it can in this regard consistent with the authority provided 
by Congress. 



Question 4: According to your written statement, VA often refers Vietnam veterans and their 
families to other agencies. Other witnesses, however, reported very few referrals 
made by VA. 

How many or what percent of the Vietnam veterans and their families referred to 
other agencies by VA (a) received or (b) did not receive services from the agencies 
to which they were referred by VA? Describe the method(s) used by VA to track 
the results of the referrals VA makes to other agencies? 

What factors reduce the number of Vietnam veterans and their families referred by 
VA to other agencies? 

Referrals, without active case management and service coordination, do not insure 
the receipt of needed services or effective treatment. How many Vietnam veterans 
and their families referred by VA to other agencies are receiving active case 
management and service coordination from VA? 

What prevents VA from providing active case management and service 
coordination to veterans and their family members for problems stemming from 
post-traumatic stress? 

Answer: RCS understands the importance of case management and follow-up coordination 

in relation to referral services for veterans and family members. The features of 
effective referral services on behalf of veterans include: ( 1 ) community outreach 
and networking to locate and evaluate other needed providers in the community 
for services not directly provided by Vet Centers, (2) education and consultation 
to prospective referral sources regarding the special needs of veteran clients, (3) 
case-management for tracking and integrating the efforts of variable service 
providers in a coordinated case treatment plan and (4) follow-up to ensure that 
anticipated outcomes have in fact been achieved. This is long standard practice for 
Vet Centers when involved in community interventions on behalf of veterans. 

The requested data regarding Vet Center referrals is being collected in the field and 
will be transmitted as soon as it has been received, reviewed and collated. 



As noted above, information about numbers of veterans' families referred for 
services are not available and would require a special survey of the field. Case 
management as an approach to ensuring continuity of care is becoming standard 
practice in VA mental health services. The Admissions and Aftercare 
Coordinators assigned to Specialized Inpatient PTSD Units with large waiting lists 
are one example of the application of case management concepts to PTSD care. 



160 



Questions Submitted by Honorable Lane Evans 

Follow-up Information to May 18, 1994 

Hearing on Social Services for Vietnam Veterans and Their Families: 

Current Programs and Future Directions 

Questions for Dr. David H. Law 



Question 4: 

During the first two quarters of fiscal year 1994, the Vet Centers system-wide referred a 
total of 3,937 Vietnam veterans and family members to other service providers (VA and 
non-VA) for family related problems. During the same period of time. 3.197 (or 81 
percent) of these referrals were judged effective by Vet Center staff, i.e., successful 
contact was made with the referral source and the anticipated service was provided. Case 
management and coordination were actively provided on an ongoing basis by Vet Center 
staff for 2,855 (or 73 percent) of the cases referred. 

The following activities were undertaken by Vet Center staff system-wide to track and 
follow-up on the course and outcome of case referrals of Vietnam Veterans and family 
members. 

• Telephonic follow-up and/or case staffings 

• Personal follow-up and/or case staffings 

• Direct contact with client & referral agency for case review 

• Letters to referral agency and/or veteran for follow-up 

• Written case reports from referral agency 

• Veterans and/or families continue in treatment at Vet Center for other 
issues and report progress of referral 

• Referral agency involved in Vet Center staffing sessions pertaining to 
veteran and family 

• Case management oversight by Vet Center staff 

• Hand carry and personal escort of client to referral agency 

The following activities were undertaken by Vet Center staff system-wide to provide case 
management for referrals of Vietnam Veterans and family members. 

• Case reviews and clinical supervision between Vet Center and referral 
agency 

• Telephone calls to and from referring agency for case related consultations 
and treatment summaries 

• Sharing of case treatment summaries and case reports through client 
release of information 

• Direct involvement at the referral agency by Vet Center staff through case 
staffing and supervision 

• Referral agency providing care invited to the Vet Center to consult with 
staff and participate in the referral process, treatment planning and case 
review 

• Collaborative plans developed between Vet Center and referral agency to 
ensure that positive outcomes of needed services are achieved 

• Interagency clinical staff meetings to develop conjoint treatment plans and 
strategies 

• Individual clinical supervision of Vet Center counselors regarding case 
follow-up for referrals 

• Clinical consultation between Vet Center and referral agency staff 

• Direct contact maintained with veteran by scheduled appointments at the 
Vet Center for referral feedback and case follow-up 

• Continuation of the veteran's counseling at the Vet Center for other or 
related problems 



161 



For those referrals that were not successful, the following variables were operative in 
impeding and disrupting the referral. 



Unavailability of suitable resources and trained staff 

Client resistive to treatment 

Relapses for chemical dependency 

Unforeseen family emergencies or catastrophes 

Divorce or separation during treatment 

Financial problems 

Veteran does not meet the criteria for treatment at VAMC under the means 

test 

Legal Issues 

Distance from available resource 

Lack of commitment to treatment by one or more family members 

Trust issues related to referral agency 

Family resistance to the referral 

Lack of confidence in the referral source 

Referral sources did not understand combat PTSD and how if affects 

family members 

Some community resources do not include war-related readjustment issues 

in the assessment and counseling process 

Veterans' denial of problems/issues 

Many veterans are unable to pay and/or do not have medical insurance for 

services available through private agencies 

Veterans discouraged about all the rituals of paperwork required from the 

referral agency 

Lack of adequate transportation 

Working clients' schedules conflicted with community service hours of 

referral agency 

Inaccessibility of VAMC for non-service connected Veterans to receive 

mental health outpatient care 

Delayed appointment schedules 



162 



Question 5A: Your written testimony describes several locally initiated programs which respond 
to the needs of Vietnam veterans and their families. Please identify the V A facility 
at which each locally initiated program described in your written statement is 
located and provide the cost for each of these locally initiated programs. 

Answer: VA PTSD Programs: Enclosed is the PTSD Directory dated April 1994. which 

includes the location of all VA PTSD Programs as well as the Coordinator/ 
Director, of the program, phone number, etc. Except where stated, the cost for 
the programs identified below are funded through allocations provided for our 
PTSD programs. 

Vietnam Veterans Liaison Unit (VVLU): The VVLU operates as the "Front- 
Door" for Vietnam veterans' services at the West Los Angeles VA Medical Center. 
VVLU promotes a comfortable, safe, humane, "Safety zone" where veterans and 
their families can learn about a variety of services designed to help them. Those 
services include: 

( 1 ) Basic VA infprmation 

(2) Crisis - counseling 

(3) Group and individual counseling 

(4) Family/Marital counseling-including a community-based weekly 
family/significant others group 

(5) Employment/vocational resources 

(6) Veteran educational workshops/family workshops 

(7) Referral to other VA programs 

(8) Working on future and unmet veterans needs 

(9) Agent orange information/referrals 

The VVLU has been providing these services for over 11 years. 

Again, these comprehensive services are provided in a caring and humane 
environment that utilizes staff, community, volunteers, and former clients to create 
a dynamic, problem-solving program that "keeps it simple" within a large, complex 
medical center. The VVLU provides services to "link" the veterans and their 
families to services outside the VVLU. In the case of needs that have been 
identified and are not being met, the VVLU has worked to establish and implement 
new programs. VVLU has served over four thousand veterans and their families 
every year since 1983 and the key is knowing the clients and their needs. 

Post Traumatic Stress Disorder Residential Rehabilitation Programs (PRRP): The 
Department of Veterans Affairs currently has ten PRRP's systemwide. the 
locations of which are included. The PRRP provides comprehensive social 
services to Vietnam veterans and their families, making the transition to the 
community. The PRRP is the "home-coming and debriefing" that many of the 
Vietnam veterans never received. The PRRP teaches communication and family 
skills and actively involves family and significant others in all aspects of inpatient 
and outpatient care. The PRRP encourages veterans and their families to view 
problems and solutions within the family system. PRRP also encourages full 
community participation. 

The VA/AOCAP Wilderness Inquiry Program: As reported in the April 1994, 
VFW Magazine, the program provided a father-son trip to the Canadian North and 
was comprised of clients in the PTSD clinic at the Hines VA Medical Center in 
Illinois. This program augmented VA PTSD treatment services to veterans by 
including the children in the AOCAP funded event. The non-profit Wilderness 
Inquiry is funded by corporate and individual donations, foundations, fund-raising 
and federal funds. Some 30 - 50 percent of revenues come from trip participants. 



163 



VA Medical Center/Vet Center Outdoor Challenge Group: The Outdoor 
Challenge Program is a collaborative effort of the Vet Centers in Evanston and 
Springfield, Illinois, and the North Chicago and Hines VA Medical Centers. It is 
comprised of a four session counseling program, during which participants will join 
in a variety of challenging outdoor experiences. Participants are selected from 
Vietnam and post Vietnam conflict zone veterans in counseling at one of the 
Chicago VA Medical Centers or Vet Center facilities. The program is funded by 
the North Chicago VA Medical Center and a variety of organizations which have 
donated funds for patient activities. 

Couples Groups for Vietnam Veterans and Wives or Partners: This is essentially 
one of the treatments of choice in all PTSD and Vet Center programs when there 
is a spouse or partner available for inclusion into the treatment program. Veterans 
and/or spouses/partners are also seen individually, as determined by the clinician to 
meet the comprehensive needs of the client situation. 

Vietnam Veterans Children's Group: The Topeka VA Medical Center developed 
this program to assess and treat the impact of the PTSD experience on veterans' 
children. This is accomplished through age - appropriate education, discussion, 
therapeutic play and caring. 

Question 5B: Does each VA facility have a program which responds to the needs of Vietnam 
veterans and their families? Please identify these programs. Please identify each 
VA facility which does not have a program which responds to the needs of 
Vietnam veterans and their families. 

Answer: The enclosed list shows that we have 141 specialized PTSD programs at 99 VA 

Medical Centers. In addition the 202 Vet Center programs respond to the 
specialized needs of the Vietnam veterans and their families. Also, enclosed is the 
Vet Center Program Directory for April 1994. Facilities that do not have 
designated PTSD programs often have staff that have received training which 
qualifies them to provide the intervention. Although all VA facilities should be 
capable of responding to the needs of Vietnam veterans and their families, services 
throughout VA are uneven. The isolated rural VA Medical Centers which treat 
smaller Vietnam veteran populations do not have the number of admissions to 
merit the more specialized PTSD programs. Some facilities offer extensive 
services while others are limited to the availability of trained personnel and 
resources. 

Question 5C: How does each of the locally initiated programs described in your written 
testimony as responding to the needs of Vietnam veterans and their families 
supplement other programs at those VA facilities which also respond to the needs 
of Vietnam veterans and their families? 

Answer: The locally initiated VA Medical Center programs described in the written 

testimony in most instances were developed as an outgrowth of an existing PTSD 
program. They were started to address an identified need or resource which the 
Vietnam veteran and family required for this comprehensive treatment. They are 
often viewed as an aspect of a "continuum of care" in providing a holistic approach 
in resolving the social needs of the family. It should also be noted that PTSD is a 
complex, many-faceted syndrome. With the establishment of PTSD treatment 
units, hospital staff in other programs became aware and knowledgeable that the 
underlying or primary cause of the problems their veteran clientele are 
experiencing may be related to traumatic stress. The specialized PTSD programs 
receive referrals from all existing VA Medical Center treatment programs, medical 
and psychiatric. Although there are a number of referrals from the medical and 
surgical programs the majority of requests reviewed are from the psychiatric, 
substance abuse and homeless programs. The referral process is two way and the 
quality of the overall treatment benefits to the veteran are enhanced. 



164 



Relationships with the local community programs described in the testimony have 
grown over a period of time and have enhanced and extended treatment and 
agency resources to Vietnam veteran and their families. An example is AOCAP. 
AOCAP, at several of their locations nationwide, are not only working closely with 
VA Medical Center and Vet Center staff but are working at VA facilities locations 
to serve their clientele. This arrangement strengthens both programs, provides 
more treatment options and most importantly benefits the veteran and his family. 

Question 5D: At how many additional VA facilities could a locally initiated program like those 
described in your written testimony as responding to the needs of Vietnam 
veterans and their families be beneficial to Vietnam veterans and their families? 

Answer: As mentioned above, most of the locally initiated programs are an outgrowth of 

existing PTSD programs. In the past when our Department has solicited the VA 
Medical Centers for Requests for Proposals (RFPs) for funding of specialized 
PTSD programs we have always received more requests for new or expanded 
programs than the funding would allow. An extensive review process was 
required to select the most deserving requests and rarely were any programs 
funded to meet the documented financial request of the program. 



Question 6: Please comment on "family-centered veteran services" and describe how they differ 
from traditional veteran services. Why are "family-centered veteran services" 
important and what are the advantages and disadvantages of this approach 
compared to traditional veteran services? 



Answer: Family-centered or systems approaches are distinguished from other more 

traditional individual psychological approaches by the following attributes: 
(1) since problems are defined in transactional or relational terms, the onus for 
change does not rest on the client alone, (2) the unit of client-therapist attention is 
expanded to include the life space or the social field of relevant interpersonal 
systems, (3) human beings are viewed as active, purposeful, goal-seeking 
organisms whose development and functioning are outcomes of transactions 
between themselves and their environment, (4) a reorienting of intervention 
procedures toward more adaptive transactions with an improved environment. 

As referenced above, family-centered therapy can be an important adjunct to direct 
treatment of the veteran with PTSD specifically to improve the clinical 
management of the effect of family relations on the course of the PTSD in the 
veteran and reciprocally of the impact of the veteran's PTSD on the quality of 
family relations. As a psychological condition, however, PTSD adheres in the 
individual personalities of those exposed to extreme environmental stress. The 
mechanism of influencing family members is via the behavior of the victim which, 
in its extreme expressions, can become an environmental stressor for other family 
members. Also, the behavior of other family members can trigger intrusive 
recollections of traumatic memories and/or defensive avoidance behaviors in the 
veteran. Family triggers and reactive behaviors on the part of the veteran would 
all be individualized on a case-by-case basis specific to the particulars of the 
veteran's traumatic experiences and recollections. Depending on the 
intrusive/avoidant cycling of PTSD symptomology, the veteran's influence on 
family members could range from abusive anger to neglectful distancing. Fear of 
loss and unresolved grief in the veteran could also result in over-controlling 
attitudes and behaviors in relation to older children who developmentally require 
increased latitudes for growing autonomy. 



Question 7: Compare the cost of traditional veteran services with the cost of "family-centered 
veteran services." Are "family-centered veteran services more costly or more cost- 
effective for providing effective treatment to veterans than traditional veterans 
services? 



165 



It is not possible to answer the question directly, because VA does not have a 
history of providing family-centered services for veteran's families. Therefore, 
there is no basis for comparing costs of services under the two models. The 
Persian Gulf Family Support Program is one of the few programs intentionally 
designed around the principles of family-centered services. However, two cases 
may be informative. First, among many public social service agencies, family 
preservation programs have shifted their attention from the child as the primary 
client to the child's family as the client. When this family-centered model is used, 
several benefits are derived: 

(a) There is a decreased need for expensive foster care. 

(b) The likelihood of childhood illness and injury is reduced. 

(c) Adjudication costs are reduced. 

(d) The need for alcohol and drug treatment is reduced. 

(e) Publicly-subsidized child care enables the adults in the family to more 
easily enter or re-enter the work force. 

(f) Caregivers of the frail or ill elderly have needs that are often 
overlooked. Satisfaction of the client and the caregiver are often 
enhanced under the family-centered model. 



Question 8: Is trauma treatment likely to be less successful if it is not family oriented? 
Please explain your answer. 

With regard to effectively addressing the problems experienced by veterans and 
their family members which are related to the veteran's military experience, discuss 
the importance of addressing the needs of the family as a unit. 

Answer: The use of family therapy in the treatment of PTSD in war veterans is a valuable 

tool depending on the clinical features of the case. For some cases, treatment of 
PTSD in the veteran will not be as effective if appropriate attention is not given to 
the family, with particular attention to family environments which function to 
maintain the veteran's PTSD symptoms by either protecting the veteran or by being 
victimized by the veteran. Again, it is helpful to be mindful of the fact that, 
psychologically, PTSD is a collection of symptoms which adhere in the survivor's 
individual personality, the therapeutic recovery from which is also personal and 
individualized according to the victim's particular personality, traumatic 
experiences and recovery environment. 

Psychotherapy for PTSD begins with the telling of the story of the events before, 
during and after the major traumatic event. In addition, the therapeutic working 
through for PTSD consists in the systematic linking of the current PTSD 
symptoms (behaviors, thoughts, feelings, dreams, defenses, etc.) with the actual 
war-related traumatic memories. Family therapy sessions may need to be worked 
into the therapeutic equation to address immediate family relationship problems 
and help prepare the veteran for more intensive revisiting of traumatic memories, 
or alternatively may be important in a later phase of therapy, after some of the 
individual trauma work has concluded, to help reconnect the veteran to his/her 
social environment. Additionally, in some cases, individual processing of traumatic 
material may be accomplished in conjoint marital sessions if the veteran's marriage 
provides a sufficiently supportive and trusting environment for the required 
intensity of this work. 



166 



Question 9: Your prepared statement refers to "well-established referral networks and 

community planning partnerships." Please provide several examples of these 
networks and partnerships. 

Answer: (1 ) Principle: In service networks, resources are known and accessed regularly. 

Example: The VA mental hygiene clinician is familiar with school-based 
counseling options for children. The clinician knows how to refer veterans' 
children to school and community mental health resources for children and 
adolescents. 

(2) Principle: Referral processes are two way-from VA and to VA. Example: A 
judge orders a veteran into a community program for domestic violence. The 
counselor recognizes that the veteran might also have a chemical dependency 
problem and refers him to the VA substance abuse program. Likewise, the VA 
clinician might recognize that a veteran in the PTSD program is subjecting his 
family members to violent behaviors and might refer the family to the domestic 
violence program in the community. 

(3) Principle: Services are coordinated for the time that multi-agency resources 
are needed to serve the veteran and his/her family. Example: An ill, homeless 
veteran with physical disabilities could live more or less independently in the 
community if accessible housing could be located. VA works with the local 
housing authority to locate suitable, accessible housing. VA provides medical care 
and physical therapy or rehabilitation and coordinates services with the housing 
authority as long as the veteran requires services. 

(4) Principle: Service quality is based on the effectiveness of the network of 
agencies, rather than just one agency. Example: VA develops a new program to 
assist formerly hospitalized veterans with chronic mental illness to live in the 
community. It works within the VA hospital to prepare clients for living in the 
community. It also works with community housing sources to develop suitable 
housing arrangements (some supervised, some independent) and with the county 
recreation department to develop leisure time activities for veterans and other 
members of the community. The quality of services in each agency and the quality 
of the community living program depends on the effectiveness of the network that 
VA has organized. 

(5) Principle: Service networks involve planning for non-duplicated services 
based on agreements on resource sharing. Example: VA's supported work 
program works with the community mental health center to develop support 
groups for community members who have recently entered the work force. 
Veterans are referred to the support groups. In addition, the community job 
service and VA work with local industry to create new jobs for veterans enrolled in 
the supported work program. The industry involves VA and community 
counselors in their in-service program to help their employees understand the 
needs of workers with chronic mental illness. Because of VA's initiative, these 
programs and resource sharing agreements benefit veterans and the entire 
community. 

Additional information regarding community referral networks for Vet Centers 
is being collected from the field and wili be transmitted as soon as it has been 
received and aggregated. 



Question 10: Discuss the transgenerational effects of combat related PTSD on a veteran's family 
and children. 



See response to Question 8 above. 



167 

ATTACHMENT TO QUESTION 5B 

DEPARTMENT OF VETERANS AFFAIRS 

READJUSTMENT COUNSELING SERVICE 

VET CENTER PROGRAM DIRECTORY 

APRIL 1994 
ALPHABETICAL BY STATE AND CITY 



ALABAMA, BIRMINGHAM 

TEAM#: 0302 SUPPORT FACILITY: BIRMINGHAM, AL 

DATE OPENED: 03/07/80 

TEAM LEADER: WAYNE ANDERSON, MS. W. 



ADDRESS 

VRC 

1425 S. 2 1ST STREET 
SUITE 108 
BIRMINGHAM, AL 35205 



-TELEPHONES- 



COMMERCIAL: 205/933-0500 

205/939-2050 

FTS: NONE 

FAX: 205/731-1820 



ALABAMA, MOBILE 

TEAM#: 0313 SUPPORT FACILITY: BILOXI, MS VAMC 

DATE OPENED: 02/17/82 

TEAM LEADER: JOHN HARMAND, M.S.W. 



-ADDRESS- 



VET CENTER 

MOBILE FESTIVAL CENTER 
3725 AIRPORT BLVD., SUITE 143 
MOBILE, AL 36608 



-TELEPHONES- 



COMMERCIAL: 205/304-0108 



FAX: 



FTS: NONE 
205/304-0652 



ALASKA, ANCHORAGE 

TEAM#: 0502 SUPPORT FACILITY: ANCHORAGE, AK VARO 

DATE OPENED: 10/28/80 

TEAM LEADER: BOB ERWIN, M.S.A. 



-ADDRESS- 



VRC 

4201 TUDOR CENTER DRIVE SUITE 1 15 

ANCHORAGE, AK 99508 



-TELEPHONES- 



COMMERCIAL: 907/563-6966 

907/271-3063 

FTS: NONE 

FAX: 907/562-3602 



168 



ALASKA, FAIRBANKS 

TEAM #: 0511 SUPPORT FACILITY: ANCHORAGE, AK VARO 

DATE OPENED: 07/12/81 

TEAM LEADER: KENNETH GREEN, PH.D. 



-ADDRESS- 



-TELEPHONES- 



VET CENTER 

529 5TH AVENUE, SUITE 104 

FAIRBANKS, AK 99701 



COMMERCIAL: 907/456-4238 



FTS: 
FAX: 



NONE 
907/456-0475 



ALASKA, KENAI 

TEAM*: 0513 SUPPORT FACE.ITY: ANCHORAGE, AK VARO 

DATE OPENED: 01/15/82 

SATELLITE COORDINATOR: BRENT ZOLMAN, MS. 



ADDRESS 

VET CENTER SATELLITE 
445 CORAL STREET 
KENALAK 99611 



-TELEPHONES- 



COMMERCIAL: 907/283-5205 



FTS: 
FAX: 



NONE 
907/283-5406 



ALASKA, WASILLA 

TEAM*: 0512 SUPPORT FACILITY: ANCHORAGE, AK VARO 

DATE OPENED: 10/20/81 

ACT. TEAM LEADER: BOB ERWIN, MS.A. 



ADDRESS 

VET CENTER 


TELEPHONES 

COMMERCIAL: 907/376-43 18 


851 E. WESTPOINT AVENUE 




SUITE 109 


FTS: NONE 


WASILLA, AK 99687 


FAX: 907/373-1883 



ARIZONA, PHOENIX 

TEAM#: 0517 SUPPORT FACILITY: PHOENDC, AZ VAMC 

DATE OPENED: 06/27/80 

TEAM LEADER: KEN BENCKWITZ, MS.W. 



-ADDRESS- 



-TELEPHONES- 



VET CENTER 
141 a PALM LANE 
SUITE 100 
PHOENDC, AZ 85004 



COMMERCIAL: 602/379^769 



FTS: 
FAX 



261-4769 
602/379^130 



169 



ARIZONA, PRESCOTTT 

TEAM #: 0518 SUPPORT FACILITY: PRESCOTT, AZ VAMC 

DATE OPENED: 02/15/86 

TEAM LEADER KENNETH HALL, MS. W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 602/778-3469 
637 HILLSIDE AVENUE 

SUITE A FTS: 768-6544 

PRESCOTT, AZ 86301 FAX: 602/776-6042 



ARIZONA, TUCSON 

TEAM #: 0521 SUPPORT FACILITY: TUSCON, AZ VAMC 

DATE OPENED: 06/19/81 

TEAM LEADER DEAN MCKEE, B.ED. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 602/882-0333 

3055 N. 1ST AVENUE 

TUSCON, AZ 85719 FTS: 762-6914 

FAX: 602/670-5862 



ARKANSAS, LITTLE ROCK 

TEAM#: 0713 SUPPORT FACILITY: LITTLE ROCK, AR VAMC 

DATE OPENED: 05/08/80 

ACT. TEAM LEADER RICHARD L. KING, B.A.. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 50 1/324-6395 

RTVERVIEW CENTER NORTH 

20 1 W. BROADWAY - SUITE A FTS: 

NORTH LITTLE ROCK, AR 721 14 FAX: 501/324-6928 



CALIFORNIA, ANAHEIM 

TEAM #: 0624 SUPPORT FACILITY: LONG BEACH, CA VAMC 

DATE OPENED: 10/31/80 

TEAM LEADER: RONALD R HART. PKD. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 714/776-0161 

859 SOUTH HARBOR BLVD. 213/596-3 101 

ANAHEIM, CA 92805 FTS: NONE 

FAX: 714/778-5592 



170 



CALIFORNIA, BURLINGAME 

TEAM it: 0647 SUPPORT FACILITY: SAN FRANCISCO. CA VAMC 

DATE OPENED: 07/21/86 

ACT. TEAM LEADER: JOHN GONZALES, MS. W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL:415/344-3126 

1234 HOWARD 

BURLINGAME, CA 94010 FTS: NONE 

FAX: 415/344-0368 



CALIFORNIA, CHICO 

TEAM#: 0649 SUPPORT FACILITY: SAN FRANCISCO 

DATE OPENED: 12/14/92 

TEAM LEADER: JOHN WHJTTEN, MS. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 916/899-8549 

C/O CALIFORNIA EDD OFFICE - CHICO 

109 PARMAC ROAD FTS: 

CHICO, CA 95926 FAX: 916/899-0581 



CALIFORNIA, CONCORD 

TEAM #: 0602 SUPPORT FACILITY: PLEASANT HEX, CA VANCSC 

DATE OPENED: 06/30/82 

TEAM LEADER: FARRELL L. UDELL, MS. W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 5 10/680^526 

1899 CLAYTON ROAD FTS/486-3 120 

SUrrE 140 FTS: 449-3201 

CONCORD, CA 94520 FAX: 510/680-0410 



CALIFORNIA, EAST LOS ANGELES 

TEAM#: 0623 SUPPORT FACILITY: LOS ANGELES, CA VAOPC 

DATE OPENED: 07/25/80 

ACT. TEAM LEADER: NATALIE MATSON, RN 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 213/728-9966 

5400 E. OLYMPIC BLVD., #140 

COMMERCE, CA 90022 FTS: 798-6109 

FAX: 213/887-1082 



171 



CALIFORNIA. EUREKA 

TEAM* 0644 SUPPORT FACILITY: WHITE CITY, OR VAMC 

DATE OPENED: 10/07/85 

TEAM LEADER: DEXTER BARGY, M.S.W. 



-ADDRES 



-TELEPHONES- 



VET CENTER 
305 -V" STREET 
EUREKA, CA 95501 



COMMERCIAL: 707/444-8271 



FTS: 
FAX: 



NONE 
707/444-8391 



CALIFORNIA, FRESNO 

TEAM*: 0628 SUPPORT FACILITY: FRESNO, CA VAMC 

DATE OPENED: 01/27/82 

TEAM LEADER: OBED FERNANDEZ, MS. W. 



-ADDDRESS- 



-TELEPHONES- 



VET CENTER 

1340 VAN NESS AVENUE 

FRESNO, CA 93721 



COMMERCIAL: 209/487-5660 



FTS: 
FAX: 



467-5660 
209/487-5399 



CALIFORNIA, LOS ANGELES (SO. CENTRAL L.A.) 

TEAM #: 0606 SUPPORT FACILITY: LOS ANGELES, CA VAOPC 

DATE OPENED: 03/29/80 

TEAM LEADER: JASON YOUNG, B.S. 



ADDRESS 

VRC 

251 WEST 85TH PLACE 

LOS ANGELES. CA 90003 



-TELEPHONES- 



COMMERCIAL: 3 10/215-2380 



FTS: 
FAX: 



983-2380 
310/215-2449 



CALIFORNIA, LOS ANGELES (WEST L.A.) 

TEAM #: 0607 SUPPORT FACILITY: WEST LOS ANGELES, CA VAMC 

DATE OPENED: 05/28-80 

TEAM LEADER: JERRY MELNYK, B.A. 



-ADDRESS 



VET CENTER 

2000 WESTWOOD BLVD. 

LOS ANGELES, CA 90025 



-TELEPHONES- 



COMMERCIAL: 3 10/475-9509 



FTS: 
FAX: 



NONE 
310/470-6689 



172 



CALIFORNIA, MARINA 

TEAM #: 0639 SUPPORT FACILITY: PALO ALTO, CA VAMC 

DATE OPENED: 09/06/86 

ACT. TEAM LEADER: CECIL JACKSON, A A 



-ADDRESS TELEPHONES 



VET CENTER COMMERCIAL: 408/384-1660 

455 RESERVATION ROAD 

SUTTEE FTS: 

MARINA, CA 93933 FAX: 408/384-0282 



CALIFORNIA, NORTH BAY 

TEAM#: 0646 SUPPORT FACILITY: SAN FRANCISCO, CA VAMC 

DATE OPENED: 01/16/85 

ACT. TEAM LEADER: DENVER MILLS, MA 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 707/586-3295 

6225 STATE FARM DRIVE, SUITE 10 1 707/586-3296 

ROHNERT PARK, CA 94928 FTS: NONE 

FAX: 707/586-9055 



CALIFORNIA, OAKLAND 

TEAM #: 0612 SUPPORT FACILITY: PLEASANT HILL, CA VANCSC 

DATE OPENED: 05/24/80 

TEAM LEADER: DEBORAH BAXTER, MF.C.C. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 5 10/763-3904 

287-17TH STREET 

OAKLAND, CA 94612 FTS: 536-7341 

FAX: 510/763-5631 



CALIFORNIA, RIVERSIDE 

TEAM*: 0611 SUPPORT FACILITY: LOMA UNDA, CA VAMC 

DATE OPENED: 03/12/82 

TEAM LEADER; LARRY HOMAN, MS. W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 714^59-8967 
4954 ARLINGTON AVENUE 

SUITE A FTS: 799-6342 

RTVERSIDE,CA 92571 FAX: 714/352-0301 



173 



CALIFORNIA, SACRAMENTO 

TEAM* 0638 SUPPORT FACILITY: PLEASANT HILL, CA VANCSC 

DATE OPENED: 04/011/86 

TEAM LEADER: L MICHAEL COHEN, ED.D. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 9 16/978-5477 
1111 HOWE AVENUE 

SUITE 390 FTS: 460-5477 

SACRAMENTO, CA 95825 FAX: 916/978-5550 



CALIFORNIA, SAN DIEGO 

TEAM#: 0618 SUPPORT FACILITY: SAN DIEGO, CA VAMC 

DATE OPENED: 02/26/80 

TEAM LEADER: RICHARD TALBOTT, MS. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 619/294-2040 

2900 6TH AVENUE 

SAN DIEGO, CA 92103 FTS: 895-7226 

FAX: 619/294-2535 



CALIFORNIA, SAN FRANCISCO 

TEAM #: 0620 SUPPORT FACILITY: SAN FRANCISCO, CA VAMC 

DATE OPENED: 06/16/80 

TEAM LEADER; DENVER MEXS, MA 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL:415/431-6021 

25 VAN NESS AVENUE 

SAN FRANCISCO, CA 94102 FTS: 470-3991 

FAX: 415/431-9826 



CALIFORNIA, SAN JOSE 

TEAM#: 0615 SUPPORT FACILITY: PALO ALTO, CA VAMC 

DATE OPENED: 0U17/8O 

TEAM LEADER: JOHN GONZALES, MS. W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 408/993-0829 

1022 WEST HEDDING 

SAN JOSE, CA 95126 FTS: 466-7750 

FAX: 408/249-3469 



-7- 



174 



CALIFORNIA, SANTA BARBARA 

TEAM* 0643 SUPPORT FACILITY: WEST LOS ANGELES, CA VAMC 

DATE OPENED: 03/15/86 

ACT. TEAM LEADER: JOSEPH NARKEVITZ, MFAVMA. 



-ADDRESS- 



-TELEPHONES- 



VET CENTER 

1300 SANTA BARBARA STREET 

SANTA BARBARA, CA 93101 



COMMERCIAL: 805/564-2345 



FTS: 
FAX: 



NONE 
805/963-7662 



CALIFORNIA, SEPULVEDA 

TEAM#: 0605 SUPPORT FACILITY: SEPULVEDA, CA VAMC 

DATE OPENED: 01/26/80 

TEAM LEADER: DAVIDALCARAS.MA. 



-ADDRESS- 



-TELEPHONES- 



VET CENTER 

16126 LASSEN STREET 

SEPULVEDA, CA 91343 



COMMERCIAL: 818/892-9227 

800/637-6524 

NONE 

818/892-0557 



CALIFORNIA, UPLAND 

TEAM#: 0637 SUPPORT FACILITY: LOMA LINDA, CA VAMC 

DATE OPENED: 03/12/86 

TEAM LEADER; HOUSTON A. LEWIS, JR., MS.W. 



-ADDRESS- 



-TELEPHONES- 



VET CENTER 

313 N. MOUNTAIN AVENUE 

UPLAND, CA 91786 



COMMERCIAL: 714/982-0416 



FTS: 
FAX: 



NONE 
714/931-0536 



CALIFORNIA, VISTA 

TEAM* 0642 SUPPORT FACILITY: 

DATE OPENED: 09/06/85 

TEAM LEADER: GARY MCKAY, MS.W. 



SAN DIEGO, CA VAMC 



-ADDRESS- 



-TELEPHONES- 



VET CENTER 
1830 WEST DRIVE 
SUITE 103/104 
VISTA, CA 92083 



COMMERCIAL: 619/945-894 1 



FTS: 
FAX; 



NONE 
619/945-7263 



175 



COLORADO, BOULDER 

TEAM* 0527 SUPPORT FACILITY: DENVER, CO VAMC 

DATE OPENED: 09/12/85 

TEAM LEADER: STEWART BROWN, PHD. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 303/440-7306 

2128 PEARL STREET 

BOULDER, CO 80302 FTS: NONE 

FAX: 303/449-3907 



COLORADO, COLORADO SPRINGS 

TEAM*: 0525 SUPPORT FACILITY: DENVER. CO VAMC 

DATE OPENED: 08/31/81 

TEAM LEADER: CLIFFORD BROWN, MS. W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 719/471-9992 

4 16 E. COLORADO AVENUE 

COLORADO SPRINGS, CO 80903 FTS: NONE 

FAX: 719/632-7571 



COLORADO, DENVER 

TEAM*: 0504 SUPPORT FACILITY: DENVER CO VAMC 

DATE OPENED: 02/20/80 

TEAM LEADER: EDWARD SALDIVAR, MS. W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 303/433-7123 

1815 FEDERAL BLVD. 

DENVER, CO 80204 FTS: 322-2595 

FAX: 303/458-8864 



CONNECTICUT, HARTFORD 

TEAM #: 01 17 SUPPORT FACILITY: NEWINGTON, CT VAMC 

DATE OPENED: 01/16/81 

TEAM LEADER: IRMA GIBSON, MS. W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 203/240-3543 

370 MARKET STREET 203/240-3544 

HARTFORD, CT 06120 FTS: 

FAX: 203/240-3415 



-9- 



176 



CONNECTICUT, NEW HAVEN 

TEAM* 0116 SUPPORT FACILITY: WEST HAVEN. CT VAMC 

DATE OPENED: 02/22/80 

TEAM LEADER: BERNARD JONES, M.S.W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 203/932-9899 

141 CAPTAIN THOMAS BLVD. 

WEST HAVEN, CT 06516 FTS: 203/933-1827 

FAX: 203/933-1827 



CONNECTICUT, NORWICH 

TEAM #: 0127 SUPPORT FACILITY: NEWINGTON, CT VAMC 

DATE OPENED: 01/21/86 

ACT. TEAM LEADER: JANE THOMSON, MS.W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 203/887-1755 

100 MAIN STREET 203/887-7934 

NORWICH, CT 06360 FTS: 240-3191 

FAX: 203/887-6343 



DELAWARE, WILMINGTON 

TEAM*: 0215 SUPPORT FACILITY: WILMINGTON, DC VAMC 

DATE OPENED: 06/25/80 

TEAM LEADER: MARK KAUFIO, ED.D. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 302/994-1660 
VAMROC BUILDING 2 

1601 KIRKWOOD HIGHWAY FTS: 487-5360 

WILMINGTON, DE 19805 FAX: 302/633-5250 



DISTRICT OF COLUMBIA, WASHINGTON 

TEAM #: 0214 SUPPORT FACILITY: WASHINGTON, DC VAMC 

DATE OPENED: 04/25/80 

TEAM-LEADER: WAYNE MILLER, MA. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 202/543-8821 
801 PENNSYLVANIA AVENUE, SE 

LOWER LEVEL FTS: 745-8400 

WASHINGTON, DC 20003 FAX: 202/543-2681 



-10- 



177 



FLORIDA, FORT LAUDERDALE 

TEAM* 0311 SUPPORT FACILITY: MIAMLFLVAMC 

DATE OPENED: 04/18/81 

TEAM LEADER: BOBBY WHITE, MS. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 305/356-7926 

315 N.E. 3RD AVENUE 

FT. LAUDERDALE, FL 33301 FTS: 356-7373 

FAX: 356-7609 



FLORIDA, JACKSONVILLE 

TEAM* 0305 SUPPORT FACILITY: GAINESVILLE, FL VAMC 

DATE OPENED: 03/31780 

TEAM LEADER: REGINALD LAWRENCE, B. A 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 904/232-3621 

1833 BOULEVARD STREET 

JACKSONVILLE, FL 32206 FTS: NONE 

FAX: 904/232-3167 



FLORIDA, MIAMI 

TEAM#: 0310 SUPPORT FACILITY: MIAMLFLVAMC 

DATE OPENED: 03/01/80 

TEAM LEADER: ED CALVO 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 305/859-8387 
2700 SW 3RD AVENUE 

SUITE 1A FTS: 350-6856 

MIAMLFL 33129 FAX: 350-7870 



FLORIDA, ORLANDO 

TEAM#: 0314 SUPPORT FACILITY: TAMPA FL VAMC 

DATE OPENED: 03/18/82- 

TEAM LEADER: LEONARD PORTER, MS. W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 407/648-615 1 

5001 S. ORANGE AVENUE, SUITE A 

ORLANDO, FL 32809 FTS: 820-6151 

FAX: 407/648-6104 



178 



FLORIDA, PALM BEACH 

TEAM* 0326 SUPPORT FACILITY: MIAMI FLVAMC 

DATE OPENED: 12/13/85 

TEAM LEADER: WILLIAM WEITZ, PHD. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 407/585-044 1 
SPECTRUM CENTRE 

2311 10TH AVENUE, N. #13 FTS: 350-6790 

LAKE WORTH, FL 33461 FAX: 407/585-1330 



FLORIDA, PENSACOLA 

TEAM* 0321 SUPPORT FACILITY: BILOXL MS VAMC 

DATE OPENED: 12/04/85 

ACT. TEAM LEADER: LARRY RAPPE 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 904/435-876 1 

202 W. JACKSON STREET 

PENSACOLA, FL 32501 FTS: 

FAX: 904/438-6625 



FLORIDA, SARASOTA 

TEAM#: 0320 SUPPORT FACILITY: BAY PINES, FL VAMC 

DATE OPENED: 11/01/85 

TEAM LEADER: FRED MCLAUGHLIN, B.A. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 813/952-9406 

1800 SIESTA DRIVE 

SARASOTA, FL 34239 FTS: NONE 

FAX: 813/366-2672 



FLORIDA, ST. PETERSBURG 

TEAM#: 0301 SUPPORT FACILITY: BAY PINES, FL VAMC 

DATE OPENED: 03/24/80 

TEAM LEADER: JOSEPH ADCOCK, MA. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 813/893-3791 

2837 1ST AVENUE, NORTH 

ST. PETERSBURG, FL 33713 FTS: 826-3791 

FAX: 813/893-3210 



-12- 



179 



FLORIDA, TALLAHASSEE 

TEAM#: 0323 SUPPORT FACILITY: LAKE CITY, FL VAMC 

DATE OPENED: 10/04/85 

TEAM LEADER: GREGG BROWN, B. A 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 904/942-8810 

249 E 6TH AVENUE 

TALLAHASSEE, FL 32303 FTS: 965-8810 

FAX: 904/942-8814 



FLORIDA, TAMPA 

TEAM #: 03 18 SUPPORT FACILITY: TAMPA FL VAMC 

DATE OPENED: 07/09/81 

TEAM LEADER: RON MOONEYHAN, M A 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 8 13/228-262 1 

1507 W. SLIGH AVENUE 

TAMPA, FL 33604 FTS: 826-2621 

FAX: 813/228-2868 



GEORGIA, ATLANTA 

TEAM #: 0304 SUPPORT FACILITY: ATLANTA (DECATUR), GA VAMC 

DATE OPENED: 01/23/80 

TEAM LEADER: LYNWOOD BRADLEY, MS. W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 404/347-7275 

77 PEACH STREET PLACE, N.W. 

ATLANTA, GA 30309 FTS: 257-7264 

FAX: 404/347-7269 



GEORGIA, SAVANNAH 

TEAM*: 0323 SUPPORT FACILITY: CHARLESTON, SC VAMC 

DATE OPENED: 12/05/85 

TEAM LEADER: JAMES MILLER 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 912/652-4097 

81 10 WHITE BLUFF ROAD 

SAVANNAH, GA 31406 FTS: 652-4097 

FAX: 912/652-4204 



-13- 



180 



GUAM, AGANA 

TEAM*: 0648 SUPPORT FACILITY: HONOLULU, HI VARO 

DATE OPENED: 08/22/88 

TEAM LEADER: SALVADOR UED A, MS. W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 01 1671471716 
U.S. NAVAL HOSPITAL 

PSC 490 BOX 76 1 3 FTS: 550-7252 

FPO-AP 96540-1600 FAX: 011671472716 



HAWAILHILO 

TEAM*: 0635 SUPPORT FACILITY: HONOLULU, HI VARO 

DATE OPENED: 08/22/88 

TEAM LEADER: ALBERT IGNACIO, MS.W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 808/969-3833 

120 KEAWE STREET, SUITE 20 1 

HILO, IH 96720 FTS: NONE 

FAX: 808/969-3835 



HAWAH, HONOLULU 

TEAM*: 0609 SUPPORT FACILITY: HONOLULU, HI VARO 

DATE OPENED: 05/29/80 

TEAM LEADER: STEPHEN T. MOLNAR, MA 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 808/541-1764 
1680 KAPIOLANI BLVD. 

SUITE F FTS: 551-1764 

HONOLULU, HI 96814 FAX: 808/541-3600 



HAWAII, KAUAI 

TEAM#: 0633 SUPPORT FACILITY: HONOLULU, HI VARO 

DATE OPENED: 08/22/88 

TEAM LEADER: ROMY CASTILLO, MS.W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 808/246-1 163 
3367 KUHIO HIGHWAY 

SUITE 101 FTS: NONE 

LIHUE,HI 96766 FAX: 80S/246-9349 



-14- 



181 



HAWAII, KONA 

TEAM* 0636 SUPPORT FACILITY: HONOLULU, HI VARO 

DATE OPENED: 08/22/88 

TEAM LEADER: RONALD BOXMEYER, MS. 

ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 808/329-0574 

POTTERY TERRACE, FERN BUILDING 808/329-0575 

75-5995 KUAKINIHWY, SUITE 415 FTS: NONE 

KAILUA-KONA, HI 96740 FAX: 808/329-0776 



HA WAD, MAUI 

TEAM#: 0634 SUPPORT FACILITY: HONOLULU, HI VARO 

DATE OPENED: 08/22/88 

ACT. TEAM LEADER: BOB MORTON 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 808/242-8557 
TING BUILDING 

35 LUNALILO, SUITE 101 FTS: NONE 

WAILUKU.HI 96793 FAX: 808/242-6846 



IDAHO, BOISE 

TEAM #: 0503 SUPPORT FACILITY: BOISE, ID VAMC 

DATE OPENED: 02/28/80 

TEAM LEADER: MIKE MIRACLE, MS. W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 208/342-3612 

11 15 W.BOISE AVENUE 

BOISE, ID 83706 FTS: 554-7568 

FAX: 208/342-0327 



IDAHO, POCATELLO 

TEAM#: 0531 SUPPORT FACILITY: SALT LAKE CITY, UT VAMC 

DATE OPENED: 07/10/85 

TEAM LEADER: DONALD ROTH, MJP.A. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 208/323-03 16 

1975 SOUTH 5TH STREET 

POCATELLO, ID 83201 FTS: NONE 

FAX: 208/232-6258 



-15- 



182 



ILLINOIS, CHICAGO 

TEAM* 0410 SUPPORT FACILITY: CHICAGO (WESTSIDE), IL VAMC 

DATE OPENED: 01714/80 

TEAM LEADER: GERALD HAYES, MA 



-ADDRESS- 



-TELEPHONES- 



VRC 

1514 E.63RD STREET 

CHICAGO. IL 60637 



COMMERCIAL: 3 12/684-5500 



FTS: 
FAX: 



886-5738 
312/684-8225 



ILLINOIS, CHICAGO 

TEAM#: 0420 SUPPORT FACILITY: 

DATE OPENED: 03/22/86 

TEAM LEADER: BETSY TOLSTEDT, PHD. 



NORTH CHICAGO, IL VAMC 



-ADDRESS- 



-TELEPHONES- 



VET CENTER 

565 HOWARD STREET 

EVANSTON, IL 60602 



COMMERCIAL: 708/332-1019 



FTS: 
FAX: 



NONE 
708/332-1024 



ILLINOIS, CHICAGO HEIGHTS 

TEAM#: 0407 SUPPORT FACILITY: CHICAGO (LAKESIDE\ IL VAMC 

DATE OPENED: 01/14/83 

TEAM LEADER: EARNEST WEBB, PHD. 



-ADDRESS 



-TELEPHONES- 



VET CENTER 

1600 HALSTED STREET 

CHICAGO HEIGHTS, IL 6041 1 



COMMERCIAL: 708/754-0340 



FTS: 
FAX: 



NONE 
708/754-0373 



ILLINOIS, EAST ST. LOUIS 

TEAM#: 0422 SUPPORT FACILITY: ST. LOUIS, MO VAMC 

DATE OPENED: 11/01/83 

TEAM LEADER: ROSE JOHNSON, MS. W. 



-ADDRESS- 



-TELEPHONES- 



VET CENTER 

1269 N. 89TH STREET SUITE 1 

EAST ST. LOUIS, IL 62203 



COMMERCIAL: 618/397-6602 



FTS: 
FAX 



618/482-9484 
618/397-6541 



-16- 



183 



ILLINOIS, MOLINE 

TEAM* 0430 SUPPORT FACILITY: IOWA CITY. IA VAMC 

DATE OPENED: 07/20/85 

TEAM LEADER: PATRICK WALSH, L.C.S.W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 309/762-6954 
1529 16TH AVENUE 

ROOM #6 FTS: NONE 

MOLINE, IL 61265 FAX: 309/762-8298 



ILLINOIS, OAK PARK 

TEAM #: 04 1 1 SUPPORT FACILITY: HINES. IL VAMC 

DATE OPENED: 03/03/80 

TEAM LEADER: JEANNE DOUGLAS, PHD. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 708/393-3225 

155 SOUTH OAK PARK AVENUE 

OAK PARK, IL 60302 FTS: 886-6480 

FAX: 708/383-3247 



ILLINOIS, PEORIA 

TEAM*: 0417 SUPPORT FACILITY: DANVILLE, IL VAMC 

DATE OPENED: 08/06/82 

ACT. TEAM LEADER; PATRICK WALSH, L.C.S.W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 309/67 1-7300 

3310 N. PROSPECT STREET 

PEORIA, IL 61603 FTS: 309/671-7300 

FAX 309/671-7311 



ILLINOIS, SPRINGFIELD 

TEAM #: 0421 SUPPORT FACILITY: ST. LOUIS, MO VAMC 

DATE OPENED: 03/21/86 

TEAM LEADER: DONNA BUECHLER, RN. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 2 17/492^955 

624 SOUTH 4TH STREET 

SPRINGFIELD, IL 62702 FTS: 217/373-4955 

FAX: 217/492-1963 



184 



INDIANA, EVANSVILLE 

TEAM* 0418 SUPPORT FACILITY: MARION, EL VAMC 

DATE OPENED: 09/09/81 

TEAM LEADER: JACKIE WEBER, MS. W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 812/473-5993 

3 1 1 N. WEENBACH AVENUE 812/473-6084 

EVANSVILLE, EN 47711 FTS: 812/465-6536 

FAX: 812/332-6558 



INDIANA FORT WAYNE 

TEAM #: 0406 SUPPORT FACILITY: FORT WAYNE, EN VAMC 

DATE OPENED: 05/13/80 

TEAM LEADER: EDWARD DAX, ACS. W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 219/460-1456 

528 WEST BERRY STREET 

FORT WAYNE, EN 46802 FTS: NONE 

FAX: 219/460-1390 



INDIANA GARY 

TEAM* 0412 SUPPORT FACILITY: CHICAGO (LAKESIDE), EL VAMC 

DATE OPENED: 06/20/86 

ACT. LEADER: PHILLIP MEYER, MS.W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 2 19/887-0048 

2236 WEST RIDGE ROAD 

GARY, EN 46408 FTS: NONE 

FAX: 219/887-2429 



INDIANA, INDIANAPOLIS 

TEAM#: 0413 SUPPORT FACILITY: INDIANAPOLIS, EN VAMC 

DATE OPENED: 07/17/80 

TEAM LEADER: STEVEN GROSS, MS. W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 3 17/927-6440 

3833 MERIDIAN 

INDIANAPOLIS, EN 46208 FTS: NONE 

FAX 317/927-6447 



•18- 



185 



IOWA, CEDAR RAPIDS 

TEAM*: 0431 SUPPORTS FACILITY: IOWA CITY, IA VAMC 

DATE OPENED: 02A)2/93 

SATELLITE COORDINATOR: PHILLIP ROSS, RN. 



-ADDRESS TELEPHONES- 



VET CENTER SATELLITE COMMERCIAL: 3 19/362-0409 

3349 SOUTH GATE COURT 

CEDAR RAPIDS, IA 52404 FTS: 

FAX: 319/362-4081 



IOWA, DES MOINES 

TEAM* 0405 SUPPORT FACILITY: DES MOINES, IA VAMC 

DATE OPENED: 01/12/80 

ACT. TEAM LEADER: CHARLES ZIMMERMAN, MA, MS. W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 5 15/284-4929 

2600 MARTIN LUTHER KING, JR PKWY 

DES MOINES, IA 50310 FTS: 5157284-4929 

FAX: 515/284-4931 

IOWA, SIOUX CITY 

TEAM #: 0428 SUPPORT FACILITY: SIOUX FALLS, SD VAMC 

DATE OPENED: 08/16/81 

TEAM LEADER JOHN SABATA, MS.W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 712/255-3808 

706 JACKSON 

SIOUX CITY, IA 51101 FTS: NONE 

FAX: 712/255-3725 



KANSAS, WICHITA 

TEAMS: 0426 SUPPORT FACILITY: WICHITA, KS VAMC 

DATE OPENED: 11/21/79 

TEAM LEADER: LEON HAVERKAMP, MS.W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 3 16/265-3260 

413 S. PATTIE 

WICHITA, KS 67211 FTS: NONE 

FAX: 316/265-3623 



186 



KENTUCKY, LEXINGTON 

TEAM*: 0203 SUPPORT FACILITY: LEXINGTON, KY VAMC 

DATE OPENED: 03/20/82 
TEAM LEADER: JOHN FOLEY, MS. W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 606/276-5269 

1 1 17 SOUTH LIMESTONE STREET 

LEXINGTON, KY 40503 FTS: 352-4899 

FAX: 700/3524880 



KENTUCKY. LOUISVILLE 

TEAM*: 0202 SUPPORT FACILITY: LOUISVILLE, KY VAMC 

DATE OPENED: 08/08/80 

TEAM LEADER: PHILGOUDEAU 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 502/894-6290 

1355 S. 3RD STREET 

LOUISVILLE, KY 40208 FTS: 548-6290 

FAX: 700/548-6294 



LOUISIANA, NEW ORLEANS 

TEAM#: 0717 SUPPORT FACILITY: NEW ORLEANS, LA VAMC 

DATE OPENED: 04/16/80 

TEAM LEADER: HARRY J. DOUGHTY, MS.W. 



-ADDRESS TELEPHONES- 



VRC COMMERCIAL: 504/943-8386 

1529 N. CLAIBORNE AVENUE 

NEW ORLEANS, LA 701 16 FTS: 

FAX: 504/589-5912 



LOUISIANA, SHREVEPORT VET CENTER 

TEAM#: 0704 SUPPORT FACILITY: SHREVEPORT, LA VAMC 

DATE OPENED: 09/05/85 

TEAM LEADER: LOTTIE TWPLbTlVHTrS, MS.W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 3 18/425-8387 

BLDa3,SUrrE260 

2620 CENTENARY BLVD. FTS: 

SHREVEPORT, LA 71104 FAX: 318/425-8386 



-20- 



187 



MAINE, BANGOR 

TEAM* 0121 SUPPORT FACILITY: TOGUS, ME VAMC 

DATE OPENED: 01/04/82 

TEAM LEADER: JOSEPH DEGRASSE, B.S. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 207/947-339 1 

352 HARLOW STREET 207/947-3392 

BANGOR, ME 04401 FTS: 833-7309 

FAX; 207/941-8195 



MAINE, CARIBOU 

TEAM#: 0119 SUPPORT FACILITY: TOGUS, ME VAMC 

DATE OPENED: 10/15/92 

SATELLITE COORDINATOR: FREEMAN COREY, MS.W. 



-ADDRESS TELEPHONES- 



VET CENTER SATELLITE COMMERCIAL: 207/496-3900 

228 SWEDEN STREET 207/493-6770 

CARIBOU, ME 04736 FTS: NONE 

FAX: 207/493-6773 



MAINE, LEWISTON 

TEAM*: 0129 SUPPORT FACULTY: TOGUS, ME VAMC 

DATE OPENED: 

ACT. TEAM LEADER: JOE DEGRASSE, B.S. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 207/783-0068 
PLEASANT STREET PLAZA 

475 PLEASANT STREET FTS: NONE 

LEWISTON, ME 04240 FAX: 207/783-3505 



MAINE, PORTLAND 

TEAM* 0115 SUPPORT FACILITY: TOGUS, ME VAMC 

DATE OPENED: 02/08/80- 

TEAM LEADER: PATRICIA RJXER; R.N.C.S., MS.W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 207/780-3584 

475 STEVENS AVENUE 207/780-3585 

PORTLAND, ME 04103 FTS: 

FAX: 207/780-3545 



-21- 



188 



MAINE, SANFORD 

TEAM* 0130 SUPPORT FACILITY: TOGUS, ME VAMC 

DATE OPENED: 

ACT. TEAM LEADER; JACK HANSEN, R.N. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 207/490-1513 

441 MAIN STREET 207/490-1520 

SANFORD, NE 04073 FTS: NONE 

FAX: 207/490-1609 



MARYLAND, BALTIMORE 

TEAM*: 0201 SUPPROT FACJLTY: BALTIMORE, MD VAMC 

DATE OPENED: 03/13/80 

TEAM LEADER; JAMES WORKMAN, MS. W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 4 10/539-55 1 1 

777 WASHINGTON, BLVD. 

BALTIMORE, MD 21230 FTS: 962-1815 

FAX: 410/539-0162 



MARYLAND, ELKTON 

TEAM*: 0209 SUPPORT FACILITY: PERRY POINT, MD VAMC 

DATE OPENED: 02/22/80 

TEAM LEADER; LON D. CAMPBELL 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 410/398-0171 

7 ELKTON COMMERCIAL PLAZA 410/398-0172 

SOUTH BRIDGE STREET FTS: 956-6189 

ELKTON, MD 21921 FAX: 410/398-0173 



MARYLAND, SILVER SPRING 

TEAM*: 0213 SUPPORT FACILITY: WASHINGTON, DC VAMC 

DATE OPENED: 04/25/80 

TEAM LEADER: JOE COX, MS. W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 30 1/589-1073 

1013 SPRING STREET 301/589-1236 

SUITE 101 FTS: 745-8397 

SILVER SPRING, MD 20910 FAX: 301/588-4882 



-22- 



189 



MASSACHUSETTS, BOSTON 

TEAM#: 0101 SUPPORT FACILITY: BOSTON, MA VAMC 

DATE OPENED: 02/12/80 

TEAM LEADER: TOM HANNON, RN.C.S. 



■ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 617/424-0665 

665 BEACON STREET 

BOSTON, MA 02215 FTS: 835-6195 

FAX: 617/424-0254 



MASSACHUSETTS, BROCKTON 

TEAM#: 0104 SUPPORT FACILITY: BROCKTON, MA VAMC 

DATE OPENED: 03/28/80 

TEAM LEADER: ANDRE BOURQUE, MED. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 508/580-2730 

104 1L PEARL STREET 508/580-273 1 

BROCKTON, MA 02401 FTS: 840-6674 

FAX: 508/586-8414 



MASSACHUSETTS, LOWELL 

TEAM#: 0125 SUPPORT FACILITY: BEDFORD, MA VAMC 

DATE OPENED: 09/20/85 

TEAM LEADER: JAMES LAWRENCE, MA. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 508/453-1 151 

73 EAST MERRIMACK STREET 508/452-9528 

LOWELL, MA 01852 FTS: 565-6642 

FAX 508/441-1271 



MASSACHUSETTS, NEW BEDFORD 

TEAM* 0128 SUPPORT FACILITY: PROVIDENCE, RI VAMC 

DATE OPENED: 09/19/85 

SATELLITE COORDINATOR: NEAL BUCHANAN, MED 



-ADDRESS TELEPHONES- 



VET CENTER SATELLITE COMMERCIAL: 508/999-6920 

468 NORTH STREET 508/999-1805 

NEW BEDFORD, MA 02740 FTS: 

FAX 508/997-3348 



-23- 



91-084 0-95 



190 



MASSACHUSETTS, SPRINGFIELD 

TEAM*: 0103 SUPPORT FACILITY: NORTHAMPTON, MA VAMC 

DATE OPENED: 05/26/82 

TEAM LEADER: SUZANNE LITTLE, MS. W. 



■ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 413/737-5167 
1 985 MAIN STREET 4 1 3/737-5 168 

NORTHGATE PLAZA FTS: 

SPRINGFIELD, MA 01103 FAX: 413/733-0537 



MASSACHUSETTS, WORCESTER 

TEAM#: 0126 SUPPORT FACILITY: BROCKTON, MA VAMC 

DATE OPENED: 01/13/85 

TEAM LEADER: JOHN WILDER, MA 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 508/752-3579 

108 GROVE STREET 508/752-3526 

WORCESTER, MA 01605 FTS: 840-6978 

FAX: 508/793-1512 



MICHIGAN, GRAND RAPIDS 

TEAM* 0403 SUPPORT FACILITY: BATTLE CREEK, MI VAMC 

DATE OPENED: 10/22/82 

TEAM LEADER: CLYDE POAG. MS. W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 616/243-0385 

1940 EASTERN AVENUE, S.E. 

GRAND RAPIDS, MI 49507 FTS: 616/456-2329 

FAX: 616/243-5390 



MICHIGAN, LINCOLN PARK (DETROIT) 

TEAM*: 0401 SUPPORT FACILITY: ALLEN PARK, MI VAMC 

DATE OPENED: 05/09/80 

TEAM LEADER: CHET MCLEOD, MA 



ADDRESS TELEPHONES 

VET CENTER COMMERCIAL: 3 13/381-1370 

1766 FORT STREET 

LINCOLN PARK, MI 48146 FTS: 378-3798 

FAX: 313/381-2450 



-24- 



191 



MICHIGAN, OAKPARK (DETROIT) 

TEAM*: 0402 SUPPORT FACILITY: ALLEN PARK, MI VAMC 

DATE OPENED: 05/09/80 

ACT. TEAM LEADER; CHET MCLEOD, MA. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 3 13/967-0040 

20820 GREENFIELD ROAD 3 13/967-004 1 

OAKPARK, MI 48237 FTS: 378-3791 

FAX: 313/967-3210 



MINNESOTA, DULUTH 

TEAM*: 0429 SUPPORT FACILITY: MINNEAPOLIS, MN VAMC 

DATE OPENED: 05/18//84 

TEAM LEADER: THOMAS MARTIN, MS. W. 



-ADDRESS TELEPHONES 



VET CENTER COMMERCIAL: 2 1 8/722-8654 

405 E. SUPERIOR STREET 

DULUTH, MN 55802 FTS: 218/720-5211 

FAX: 218/723-8212 



MINNESOTA, ST. PAUL 

TEAM*: 0416 SUPPORT FACILITY: MINNEAPOLIS, MN VAMC 

DATE OPENED: 03/18/80 

TEAM LEADER: MARK MULVMLL, B.A. 



-ADDRESS TELEPHONES- 



VRC COMMERCIAL: 6 12/644-4022 

2480 UNIVERSITY AVENUE 

ST. PAUL, MN 55 1 14 FTS: 780-462 1 

FAX: 612/725-2234 



MISSISSIPPI BILOXI 

TEAM#: 0322 SUPPORT FACILITY: BILOXLMSVAMC 

DATE OPENED: 08/15/83 

TEAM LEADER: HARRY BECNEL, PHD. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 60 1/388-9938 

2196 PASS ROAD 

BILOXLMS 39531 FTS: 

FAX: 601/388-9253 



-25- 



192 



MISSISSIPPI, JACKSON 

TEAM* 0709 SUPPORT FACILITY: JACKSON, MS VAMC 

DATE OPENED: 04/04/80 

TEAM LEADER; GLENN CURTIS, MS. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 60 1/965-5727 

4436 N. STATE STREET 

SUITE A3 FTS: 

JACKSON, MS 39206 FAX: 601/965^023 



MISSOURI, KANSAS CITY 

TEAM* 0408 SUPPORT FACILITY: KANSAS CITY, MO VAMC 

DATE OPENED: 11/25/79 

TEAM LEADER: ROBERT WAECHTER, MA, MP.A 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 816/753-1866 

393 1 MAIN STREET 816/753-1974 

KANSAS CITY, MO 641 1 1 FTS: 816/374-6778 

FAX: 816/753-2328 



MISSOURI, ST. LOUIS 

TEAM* 0414 SUPPORT FACILITY: ST. LOUIS, MO VAMC 

DATE OPENED: 06/30/80 

TEAM LEADER: GARY COLLINS, MS. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 3 14/23 1-1260 

2345 PINE STREET 

ST. LOUIS, MO 63103 FTS: 278-6424 

FAX: 314/289-6539 



MONTANA, BILLINGS 

TEAM* 0509 SUPPORT FACILITY: MILES CITY, MT VAMC 

DATE OPENED: 04/16/80 

TEAM LEADER: ROBERT PHILLIPS, MS. W. 



-ADDRESS — TELEPHONES- 



VET CENTER COMMERCIAL: 406/657-607 1 

1948 GRAND AVENUE 

BILLINGS, MT 59102 FTS: 585-6071 

FAX: 406/657-6603 



-26- 



193 



MONTANA, MISSOULA 

TEAM* 0528 SUPPORT FACILITY: FT. .HARRISON, MT VAMC 

DATE OPENED: 05/31/85 

TEAM LEADER: RICHARD JOHNSON. MS. 



ADDRESS 

VET CENTER 

500 N. HIGGINS AVENUE 

MISSOULA, MT 59802 



-TELEPHONES- 



COMMERCIAL: 406/72 1-49 18 

406/721-4919 

FTS: 585-3015 

FAX: 406/329-3006 



NEBRASKA, LINCOLN 

TEAM*: 0427 SUPPORT FACILITY: LINCOLN, NE VAMC 

DATE OPENED: 12/02/81 

TEAM LEADER; LAWRENCE OBRIST, A.C.S.W. 



-ADDRESS- 



-TELEPHONES- 



VET CENTER 
920 L STREET 
LINCOLN, NE 68508 



COMMERCIAL: 402/476-9736 



FTS: 
FAX: 



402/437-5298 
402/476-2431 



NEBRASKA, OMAHA 

TEAM*: 0424 SUPPORT FACILITY: OMAHA, NE VAMC 

DATE OPENED: 11/19/79 

TEAM LEADER: NORM MCCORMACK, MS., MP.A 



-ADDRESS- 



-TELEPHONES- 



VET CENTER 

5123 LEAVENWORTH STREET 

OMAHA, NE 68106 



COMMERCIAL: 402/553-2068 



FTS: 
FAX: 



402/221-3148 
402/553-6966 



NEVADA, LAS VEGAS 

TEAM*: 0505 SUPPORT FACILITY: LAS VEGAS, NV VAOPC 

DATE OPENED: 05/28/80 

TEAM LEADER: MATT WATSON, MS. W. 



-ADDRESS 



-TELEPHONES- 



VET CENTER 

704 SOUTH 6TH STREET 

LAS VEGAS, NV 89101 



COMMERCIAL: 702/388-6369 



FTS: 
FAX: 



388-6369 
702/388-6664 



-27- 



194 



NEVADA, RENO 

TEAM*: 0506 SUPPORT FACILITY: RENO, NV VAMC 

DATE OPENED: 04/24/81 

TEAM LEADER: MIKE LOY, MS.W., MP.H. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 702/323- 1 294 
1 155 W.4TH STREET 

SUITE 101 FTS: 470-5855 

RENO, NV 89503 FAX: 702/322-8123 



NEW HAMPSHIRE, MANCHESTER 

TEAM*: 0108 SUPPORT FACILITY: MANCHESTER, NH VAMC 

DATE OPENED: 03/24/80 

TEAM LEADER: CARYL AHERN. MS.W. 

ADDRESS TELEPHONES 

VET CENTER COMMERCIAL: 603/668-7060 

103 LIBERTY STREET 603/668-7061 

MANCHESTER, NH 03104 FTS: 666-7412 

FAX: 666-7404 



NEW JERSEY, JERSEY CITY 

TEAM#: 0102 SUPPORT FACILITY: EAST ORANGE, NJ VAMC 

DATE OPENED: 06/23/80 

TEAM LEADER: LE ROY ADDISON, MS. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 201/645-2038 

1 15 CHRISTOPHER COLUMBUS DRIVE 

JERSEY CITY, NJ 07302 FTS: NONE 

FAX: 201/645-5969 



NEW JERSEY, LINWOOD (ATLANTIC CITY) 

TEAM*: 0230 SUPPORT FACILITY: WILMINGTON, DE VAMC 

DATE OPENED: 01/09/86 

TEAM LEADER; JOSEPH STEELE, MA. 



.ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 609/927-8387 
CENTRAL PARK EAST 

222 NEW ROAD, BLDG. 2, SUITES FTS: 927-8387 

LINWOOD, NY 08221 FAX: 609/653-1272 



-28- 



195 



NEW JERSEY, NEWARK 

TEAM*: 0112 SUPPORT FACILITY: EAST ORANGE, NJ VAMC 

DATE OPENED: 06/13/80 

TEAM LEADER: FELJX E. DE JESUS, MS. W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 201/645-5954 

77 HALSEY STREET 

NEWARK, NJ 07102 FTS: 341-3425 

FAX: 201/622-5905 



NEW JERSEY, TRENTON 

TEAM*: 0114 SUPPORT FACILITY: LYONS, NJ VAMC 

DATE OPENED: 06/23/82 

TEAM LEADER: BOB OSENENKO, ED.D. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 609/989-2260 
1 7 1 JERSEY STREET 609/989-226 1 

BUILDING 36 FTS: 

TRENTON, NJ 08611-2425 FAX: 609/989-2265 



NEW MEXICO, ALBUQUERQUE 

TEAM#: 0515 SUPPORT FACILITY: ALBUQUERQUE, NM VAMC 

DATE OPENED: 01/11/80 

TEAM LEADER: BLAS FALCON, MS. W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 505/766-5900 

1600 MOUNTAIN ROAD NW 

ALBUQUERQUE, NM 87104 FTS: 474-4501 

FAX: 505/766-5939 



NEW MEXICO, FARMINGTON 

TEAM*: 0516 SUPPORT FACILITY: ALBUQUERQUE, NM VAMC 

DATE OPENED: 01/19/81 

SATELLITE COORDINATOR: RICHARD WAMBOLDT, MS.W. 



-ADDRESS TELEPHONES- 



VET CENTER SATELLITE COMMERCIAL: 505/327-9684 

425 1 E. MAIN, SUITE B 505/327-9685 

FARMINGTON, NM 87402 FTS: NONE 

FAX: 505/327-9519 



-29- 



196 



NEW MEXICO, SANTA FE 

TEAM#: 0520 SUPPORT FACILITY: ALBUQUERQUE, NM VAMC 

DATE OPENED: 08/09/85 

TEAM LEADER: RAY ATENCIO, MS.W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 505/988-6562 
1996 WARNER STREET 

WARNER PLAZA, SUITE 5 FTS: 476-6562 

SANTA FE.NM 87505 FAX: 505/988-6564 



NEW YORK, ALBANY 

TEAM#: 0111 

DATE OPENED: 03/27/82 

TEAM LEADER: JAMES GARRETT, PH.D. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 5 18/438-2505 

875 CENTRAL AVENUE 

ALBANY, NY 12206 FTS: 641-2465 

FAX: 518/458-8613 



NEW YORK, BABYLON (LONG ISLAND) 

TEAM*: 0120 SUPPORT FACILITY: NORTHPORT, NY VAMC 

DATE OPENED: 01/29/83 

TEAM LEADER: GASPER FALZONE, MS.W7C.S.W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 516/661-3930 

1 16 WEST MAIN STREET 

BABYLON, NY 11702 FTS: 

FAX: 516/422-5677 



NEW YORK, BRONX 

TEAM*: 0110 SUPPORT FACILITY: BROXNYVAMC 

DATE OPENED: 11724/80 

TEAM LEADER: WALTER SAMPSON, MS.W. 



-ADDRESS TELEPHONES 



VET CENTER COMMERCIAL: 718/367-3500 
226 EAST FORDHAM ROAD 718/367-3501 

ROOM #220 FTS: 

BRONX, NY 10458 FAX: 718/364-6867 



-30- 



197 



NEW YORK, BROOKLYN 

TEAM#: 0105 SUPPORT FACILITY: BROOKLYN, NY VAMC 

DATE OPENED: 08/28/80 

ACT. TEAM LEADER: MIKE MANDA, PSY.D. 



-ADDRESS TELEPHONES- 



VRC COMMERCIAL: 718/330-2825 

165 CADMAN PLAZA, EAST 718/330-2826 

BROOKLYN, NY 11201 FTS: 

FAX: 718/330-7672 



NEW YORK, BUFFALO 

TEAM#: 0107 SUPPORT FACILITY: BUFFALO, NY VAMC 

DATE OPENED: 02/07/80 

TEAM LEADER: DAVID KOWALEWSKI, MS.W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 716/882-0505 

351 LINWOOD AVENUE 716/882-0508 

BUFFALO, NY 14209 FTS: 

FAX: 716/882-0525 



NEW YORK, HARLEM 

TEAM#: 0133 SUPPORT FACILITY: NEW YORK, NY VAMC 

DATE OPENED: 06/28/93 

TEAM LEADER: ERIC GLAUDE. MS.W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 212/961-8121 

55 WEST 125TH STREET 

NEW YORK, NY 10027 FTS: 

FAX: 212/369-2374 



NEW YORK, NEW YORK (MANHATTAN) 

REAM*: 0106 SUPPORT FACELTTY: NEW YORK, NY VAMC 

DATE OPENED: 10/10/80 

TEAM LEADER: ANN TALMAGE, MS.W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 2 12/944-293 1 

120 WEST 44TH STREET 212/944-2917 

NEW YORK, NY 10036 TS: 265-2917 

FAX: 212/944-2904 



198 



NEW YORK, ROCHESTER 

TEAM*: 0124 SUPPORT FACILITY: B ATA VIA, NEW YORK VAMC 

DATE OPENED: 06/02/86 

TEAM LEADER: JOHN SCKOROHOD, M.S.W. 

ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 716/263-5710 

134 SOUTH FITZHUGH STREET 

ROCHESTER, NY 14608 FTS: 963-5710 

FAX: 716/263-5756 



NEW YORK, STATEN ISLAND 

TEAM#: 0132 SUPPORT FACILITY: BROOKLYN, NY VAMC 

DATE OPENED: 01/10/85 

TEAM LEADER: MICHAEL MAND A, PSY.D. 



-ADDRESS TELEPHONES- 



VET CENTER OMMERCIAL: 718/816-4799 

1 50 RICHMOND TERRACE 718/81 6-4499 

STATEN ISLAND, NY 10301 FTS: 264-1780 

FAX: 718/816-6899 



NEW YORK, SYRACUSE 

TEAM#: 0131 SUPPORT FACILITY: SYRACUSE, NY VAMC 

DATE OPENED: 12/16/85 

TEAM LEADER: MARY FEAR, B.S.N. 

ADDRESS TELEPHONES 

VET CENTER COMMERCIAL: 3 15/423-5690 

210 NORTH TOWNSEND STREET 315/423-5691 

SYRACUSE, NY 13203 FTS: 950-5690 

FAX: 315/423-6581 



NEW YORK, WHITE PLAINS 

TEAM#: 0123 SUPPORT FACILITY: MONTROSE, NY VAMC 

DATE OPENED: 07/23/82 

TEAM LEADER: ROGER PAULMENO, B.S. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 9 14/682-6250 

200 HAMILTON AVENUE 9 14/682-625 1 

WHITE PLAINS MALL FTS: 887-6250 

WHITE PLAINS, NY 10601 FAX: 914/682-6263 



-32- 



199 



NEW YORK, WOODHAVEN (QUEENS) 

TEAM#: 0109 SUPPORT FACILITY: BROOKLYN, NY VAMC 

DATE OPENED: 09/10/80 

TEAM LEADERo PAULETTE PETERSON, PHD. 

ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 718/296-2871 

75-10B 91 AVENUE 718/296-2932 

WOODHAVEN, NY 11421 FTS: 

FAX: 718/296-4660 



NORTH CAROLINA, CHARLOTTE 

TEAM#: 0317 SUPPORT FACILITY: SALISBURY, NC VAMC 

DATE OPENED: 04/28/82 

TEAM LEADER: LORETTA TWICKLER, RN 



•ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 704/333-6 107 
223 S. BREVARD STREET 

SUITE 103 FTS: 672-6805 

CHARLOTTE, NC 28202 FAX: 704/344-6470 



NORTH CAROLINA, FAYETTEVILLE 

TEAM#: 0315 SUPPORT FACILITY: FAYETTEVILLE, NC VAMC 

DATE OPENED: 05/02/80 

TEAM LEADER: TOMI CACDONOUGH, PHD. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 919/323-4908 

4 MARKET SQUARE 

FAYETTEVILLE, NC 28301 FTS: 699-7424 

FAX 919/323-0251 



NORTH CAROLINA, GREENSBORO 

TEAM* 0327 SUPPORT FACILITY: SALISBURY, NC VAMC 

DATE OPENED: 12/03/85 

TEAM LEADER: MAURICE MURPHY, C.MS. W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 910/333-5366 

2009 ELM-EUGENE STREET 

GREENSBORO, NC 27406 FTS: 333-5366 

FAX: 910/333-5046 



-33- 



200 



NORTH CAROLINA, GREENVILLE 

TEAM#: 0319 SUPPORT FACILITY: DURHAM, NC VAMC 

DATE OPENED: 02/11/86 

TEAM LEADER: HAROLD MCMILLION, ED.D. 



-ADDRESS 



-TELEPHONES- 



VET CENTER 

150 ARLINGTON BOULEVARD 

SUITE B 

GREENVILLE, NC 27858 



COMMERCIAL: 9 1 9/3 55-7920 



FTS: 
FAX: 



NONE 
919/756-7045 



NORTH DAKOTA, FARGO 

TEAM#: 0406 SUPPORT FACILITY: FARGO, ND VAMC 

DATE OPENED: 03/26/80 

TEAM LEADER: CARL SORONEN, MS.W. 



-ADDRESS- 



-TELEPHONES- 



VET CENTER 

1322 GATEWAY DRIVE 

FARGO. ND 58103 



COMMERCIAL: 70 1/237-0942 



FTS: 
FAX: 



783-3638 
701/237-5399 



NORTH DAKOTA, MINOT 

TEAM#: 0404 SUPPORT FACILITY: FARGO, ND VAMC 

DATE OPENED: 04/13/82 

TEAM LEADER: JAMES SAUVAGEAU. MED. 



-ADDRESS- 



-TELEPHONES- 



VET CENTER 

2041 3RD STREET, N.W. 

MINOT, ND 58701 



COMMERCIAL: 70 1/852-0 177 



FTS: 
FAX: 



NONE 
701/852-5223 



OHIO, CINCINNATI 

TEAM*: 0204 SUPPORT FACILITY: CINCINNATI, OH VAMC 

DATE OPENED: 05/07/80 

TEAM LEADER: DENNIS CARROLL, MS. 



-ADDRESS 



-TELEPHONES- 



VET CENTER 

30 EAST HOLLISTER STREET 

CINCINNATI, OH 45219 



COMMERCIAL: 5 13/569-7 140 



FTS: 
FAX 



569-7140 
513/569-7143 



-34- 



201 



OHIO, CLEVELAND 

TEAM*: 0206 SUPPORT FACILITY: CLEVELAND, OH VAMC 

DATE OPENED: 05/23/80 

TEAM LEADER: LINDA HADDEN-ROBINSON, L.I.S.W. 

ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 216/671-8530 

11511 LORAIN AVENUE 

CLEVELAND, OH 44111 FTS: 290-4916 

FAX: 216/671-6578 



OHIO, CLEVELAND HEIGHTS 

TEAM*: 0205 SUPPORT FACULTY: CLEVELAND, OH VAMC 

DATE OPENED: 05/23/80 

TEAM LEADER: EUGENE HARRIS, MS. W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 2 16/932-847 1 

2134 LEE ROAD 

CLEVELAND HEIGHTS, OH 44118 FTS: 290-4915 

FAX: 216/932-1781 



OHIO, COLUMBUS 

TEAM*: 0221 SUPPORT FACILITY: COLUMBUS, OH VAOPC 

DATE OPENED: 06/20/80 

TEAM LEADER: LAWRENCE ENDICOTT, MS. W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 614/228-3853 

222 E. TOWN STREET 

COLUMBUS, OH 43215 FTS: 469-6753 

FAX: 614/228-3866 



OHIO, DAYTON 

TEAM*: 0225 SUPPORT FACILITY: DAYTON, OH VAMC 

DATE OPENED: 05/09/80 

TEAM LEADER: RAY BLANFORD, MS.W. 



-ADDRESS TELEPHOJ 



VET CENTER COMMERCIAL: 513/461-9150 

6 SO. PATTERSON BOULEVARD 513/461-9151 

DAYTON, OH 45402 FTS: 950-1139 

FAX: 513/461-9371 



-35- 



202 



OKLAHOMA, OKLAHOMA CITY 

TEAM* 0718 SUPPORT FACILITY: OKLAHOMA CITY, OK VAMC 

DATE OPENED: 04/02/80 

TEAM LEADER: PETER SHARP, M.S. W. 



-ADDREJ 



-TELEPHONES- 



VET CENTER 

3033 N. WALNUT 

SUITE 101W 

OKLAHOMA CITY, OK 73105 



COMMERCIAL: 405/270-5184 



FTS: 
FAX: 



405/270-5125 



OKLAHOMA TULSA 

TEAM*: 0723 SUPPORT FACILITY: 

DATE OPENED: 04/02782 

TEAM LEADER: STEPHEN CRAIG, MS. W. 



MUSKOGEE, OK VAMC 



ADDRESS 

VET CENTER 

1855 EAST 15TH STREET 

TULSA OK 74104 



-TELEPHONES- 



COMMERCIAL: 918/581-7105 



FTS: 
FAX: 



918/581-7107 



OREGON, EUGENE 

TEAM* 0626 SUPPORT FACILITY: ROSEBURG. OR VAMC 

DATE OPENED: 09/11/81 

ACT. TEAM LEADER: CLIFF KAYLOR 



-ADDRESS- 



-TELEPHONES- 



VET CENTER 

1966 GARDEN AVENUE 

EUGENE, OR 97403 



COMMERCIAL: 503/465-6918 



FTS: 
FAX 



425-6918 
503/465-6973 



OREGON, GRANTS PASS 

TEAM* 0645 SUPPORT FACILITY: 

DATE OPENED: 01/10/86 

TEAM LEADER: WAYNE PRICE, MS. W. 



WHITE CITY, OR VAD 



-ADDRESS- 



-TELEPHONES- 



VET CENTER SATELLITE 

615 NORTH WEST 5TH STREET 

GRANTS PASS, OR 95726 



COMMERCIAL: 503/479-6912 



FTS: 
FAX 



NONE 
503/474-4589 



-36- 



203 



OREGON, PORTLAND 

TEAM#: 0617 SUPPORT FACILITY: PORTLAND, OR VAMC 

DATE OPENED: 02/15/80 

TEAM LEADER: RAY T. MOORE, PH.D. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 503/273-5370 

8383 NE. SANDY BLVD., SUITE 1 10 

PORTLAND. OR 97220 FTS: 424-5370 

FAX: 503/273-5377 



OREGON, SALEM 

TEAM*: 0640 SUPPORT FACILITY: PORTLAND, OR VAMC 

DATE OPENED: 02/28/86 

TEAM LEADER: CARL WHALEY, MS. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 503/362-99 1 1 

3 18 CHURCH N.E. 

SALEM OR 97301 FTS: 422-5754 

FAX: 503/364-2534 



PENNSYLVANIA, ERIE 

TEAM*: 0222 SUPPORT FACILITY: ERIE, PA VAMC 

DATE OPENED: 08/07/85 

TEAM LEADER: JACK S. EHRHARDT, MS.W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 814/453-7955 
G. DANIEL BALDWIN BLDG., SUITE 1&2 

1000 STATE STREET (LOBBY) FTS: 453-7955 

ERIE, PA 16501 FAX: 814/456-5464 



PENNSYLVANIA, HARRISBURG 

TEAM*: 0218 SUPPORT FACILITY: LEBANON, PA VAMC 

DATE OPENED: 05/07/82 

ACT. TEAM LEADER: JAN YUPCAVAGE, MS. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 717/782-3954 

1007 NORTH FRONT STREET 

HARRISBURG, PA 17102 FTS: 782-3954 

FAX: 717/782-3791 



-37- 



204 



PENNSYLVANIA, MCKEESPORT 

TEAM*: 0220 SUPPORT FACILITY: PITTSBURGH (HD), PA VAMC 

DATE OPENED: 12/07/81 

TEAM LEADER: DUANE BROKENBEK, M.S.W. 

ADDRESS TELEPHONES 

COMMERCIAL: 412/678-7704 

500 WALNUT STREET 

MCKEESPORT, PA 15132 FTS: 365-4563 

FAX: 4112/678-7780 



PENNSYLVANIA, PHILADELPHIA 

TEAM*: 0210 SUPPORT FACILITY: PHILADELPHIA, PA VAMC 

DATE OPENED: 02/07/80 

TEAM LEADER: RONALD GREEN, MS. W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 215/627-0238 

1026 ARCH STREET 

PHILADELPHIA, PA 19107 FTS: 597-0544 

FAX: 215/597-6362 



PENNSYLVANIA, PHILADELPHIA 

TEAM*: 0219 SUPPORT FACILITY: PHILADELPHIA, PA VAMC 

DATE OPENED: 04/01/80 

TEAM LEADER: JUAN MALA VE. MS. W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 2 15/924-4670 
101 E.OLNEY AVENUE 

BOXC-7 FTS: 951-5438 

PHILADELPHIA, PA 19120 FAX: 215/951-5434 



PENNSYLVANIA, PITTSBURGH 

TEAM*: 0211 SUPPORT FACILITY: PITTSBURGH (HD), PA VAMC 

DATE OPENED: 04/01/80 

TEAM LEADER: DAVID MCPEAK, MA., MP.A. 



-ADDRESS TELEPHO> 



VET CENTER COMMERCIAL: 4 12/765-1 193 

954 PENN AVENUE 

PITTSBURGH, PA 15222 FTS: 365-4530 

FAX 412/365-4440 



-38- 



205 



PENNSYLVANIA, SCRANTON 

TEAM*: 0229 SUPPORT FACILITY: WTLKES-BARRE, PA VAMC 

DATE OPENED: 10/10/85 

TEAM LEADER: CAROL ARMJLLEL MS. W. 

ADDRESS TELEPHONES 



VET CENTER COMMERCIAL: 7 17/344-2676 

959 WYOMING AVENUE 

SCRANTON, PA 18509 FTS: 344-2676 

FAX: 717/344-6794 



PUERTO RICO, ARECBO 

TEAM#: 0309 SUPPORT FACILITY: SAN JUAN, PR VAMC 

DATE OPENED: 03/27/86 

TEAM LEADER: JUAN FREYTES, MS.W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 809/879-45 10 

52 GONZALO MARIN STREET 809/879-4581 

ARECIBO, PR 00612 FTS: NONE 

FAX: 806/879^944 



PUERTO RICO, PONCE 

TEAM#: 0312 SUPPORT FACILITY: SAN JUAN, PR VAMC 

DATE OPENED: 03/28/86 

TEAM LEADER: LUISARDO CARMONA-ORTIZ, MS.W. 



-ADDRESS TELEPHONES- 



VET CENTER • COMMERCIAL: 809/841-3260 

35 MAYOR STREET 

PONCE, PR 00731 FTS: NONE 

FAX: 809/841-3165 



PUERTO RICO, SAN JUAN 

TEAM*: 0307 SUPPORT FACILITY: SAN JUAN, PR VAMC 

DATE OPENED: 12/18/80 

TEAM LEADER; EDWINO RTVERA-AYALA, B.A. 



-ADDRESS TELEPHONES- 



VRC COMMERCIAL: 809/749-4487 

CONDOMINO MEDICAL CENTER PLAZA 809/749-4488 

SUITE LC8A&LC9, LA RIVIERA FTS: NONE 

RIO PffiDRAS, PR 00921 FAX: 809/749-4416 



-39- 



206 



RHODE ISLAND, CRANSTON (PROVIDENCE) 

TEAM*: 0113 SUPPORT FACILITY: PROVIDENCE, RI VAMC 

DATE OPENED: 05/16/80 

TEAM LEADER: BERNE GREENE, MS. W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 40 1/467-2046 

789 PARK AVENUE 40 1/467-2056 

CRANSTON, RI 02910 FTS: 838-5236 

FAX: 401/528-5253 



SOUTH CAROLINA, COLUMBIA 

TEAM*: 0324 SUPPORT FACILITY: COLUMBIA, SC VAMC 

DATE OPENED: 07/13/85 

TEAM LEADER: MIKE WOLFORD, PHD. 



-ADDRESS TELEPHONES- 



VET CENTER SATELLITE COMMERCIAL: 803/765-9944 

1513 PICKENS STREET 

COLUMBIA, SC 29201 FTS: NONE 

FAX: 803/799-6267 



SOUTH CAROLINA, GREENVILLE 

TEAM*: 0316 SUPPORT FACILITY: COLUMBIA, SC VAMC 

DATE OPENED: 03/06/82 

TEAM LEADER: DAVID HOLLINGSWORTH, MS.W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 803/27 1-27 1 1 

904 PENDELTON STREET 

GREENVILLE, SC 29601 FTS: NONE 

FAX: 803/370-3655 



SOUTH CAROLINA, NORTH CHARLESTON 

TEAM*: 0303 SUPPORT FACTLITY: CHARLESTON, SC VAMC 

DATE OPENED: 05/30/80 

TEAM LEADER: SCOTT FREDERICK, A.C.S.W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 803/747-8387 

5603A RIVERS AVENUE 

NO. CHARLESTON, SC 29418 FTS: 259-7377 

FAX: 803/566-0232 



-40- 



207 



SOUTH DAKOTA, RAPID CITY 

TEAM* 0423 SUPPORT FACILITY: FORT MEADE, SD VAMC 

DATE OPENED: 01/22/82 

TEAM LEADER: EUGENE SUMMERS, MS.W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 605/348-0077 

6 10 KANSAS CITY STREET 605/348-1752 

RAPID CITY, SD 57701 FTS: 605/782-7296 

FAX: 605/348-0878 



SOUTH DAKOTA, SIOUX FALLS 

TEAM#: 0425 SUPPORT FACILITY: SIOUX FALLS, SD VAMC 

DATE OPENED: 11/10/79 

TEAM LEADER: MICHAEL DAFOE, MA. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 605/332-0856 
601 S. CLIFF AVENUE 

SUITE C FTS: 782-4552 

SIOUX FALLS, SD 57104 FAX: 605/330-4554 



TENNESSEE, CHATTANOOGA 

TEAM#: 0722 SUPPORT FACILITY: MURFEESBORO, TN VAMC 

DATE OPENED: 03/14/86 

TEAM LEADER: JAMES CECIL, MS.W. 

ADDRESS TELEPHONES 

VET CENTER COMMERCIAL: 615/752-5234 

425 CUMBERLAND STREET 



SUITE 140 FTS: 

CHATTANOOGA, TN 37404 FAX 615/752-5239 



TENNESSEE, JOHNSON CITY 

TEAM#: 0701 SUPPORT FACILITY: MOUNTAIN HOME, TN VAMC 

DATE OPENED: 12/05/85 

TEAM LEADER: RICHARD SHAMBAUGH, MS.W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 6 15/928-8387 

1615 W. WALNUT STREET 

JOHNSON CTTY, TN 37604 FTS: NONE 

FAX 615/928-6320 



-41- 



208 



TENNESSEE, KNOXVILLE 

TEAM*: 0720 SUPPORT FACILITY: NASHVILLE, TN VAMC 

DATE OPENED: 01/09/82 

TEAM LEADER: RONALD COFFIN, MS.S.W. 

ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 6 1 5/545-4680 

2817 EAST MAGNOLIA AVENUE 

KNOXVILLE, TN 37914 FTS: 

FAX: 615/545-4198 



TENNESSEE, MEMPHIS 

TEAM#: 0719 SUPPORT FACILITY: MEMPHIS, TN VAMC 

DATE OPENED: 05/01/80 

TEAM LEADER: WILLIAM FARGO, MA. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 90 1/722-25 10 

1835 UNION, SUITE 100 

MEMPHIS, TN 38104 FTS: 

FAX: 901/722-2533 



TEXAS, AMARILLO 

TEAM*: 0702 SUPPORT FACILITY: AMARILLO, TX VAMC 

DATE OPENED: 06/14/86 

TEAM LEADER: PEDRO GARCIA, JR., MS. W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 806/354-9779 

3414 OLSEN BLVD. 

SUITE E FTS: 

AMARILLO, TX 79109 FAX; 806/354-9837 



TEXAS, AUSTIN 

TEAM* 0703 SUPPORT FACILITY: TEMPLE, TX VAMC 

DATE OPENED: 05/25/85 

TEAM LEADER: JOHN FERGUSON, MS., A.N.P. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 512/416-1314 

1 110 WEST WILLIAM CANNON DR. 

SUITE 301 FTS: 

AUSTIN, TX 78745 FAX: 512/416-7019 



-42- 



209 



TEXAS, CORPUS CHRISTI 

TEAM* 0705 SUPPORT FACILITY: SAN ANTONIO, TX VAMC 

DATE OPENED: 08A)3/85 

TEAM LEADER: STEPHEN SIMMONS, ED.D. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 5 1 2/854-996 1 

3 166 REID DRIVE, SUITE 1 

CORPUS CHRISTL TX 78404 FTS: 

FAX: 512/854-4730 



TEXAS, DALLAS 

TEAM*: 0706 SUPPORT FACILITY: DALLAS, TX VAMC 

DATE OPENED: 05/11/80 

TEAM LEADER: MATT J. MENGER, PH.D. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 214/361-5896 

5232 FOREST LANE 

SUITE 111 FTS: 

DALLAS, TX 75244 FAX: 214/655-7347 



TEXAS, EL PASO 

TEAM*: 0707 SUPPORT FACILITY: EL PASO, TX VAOPC 

DATE OPENED: 02/19/80 

TEAM LEADER: CARLOS RIVERA, MS. S.W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 9 1 5/772-00 1 3 

SKYPARKH 

6500 BOEING, SUITE L-l 12 FTS: 

EL PASO, TX 79925 FAX: 915/772-3983 



TEXAS, FORT WORTH 

TEAM#: 0708 SUPPORT FACILITY: DALLAS, TX VAMC 

DATE OPENED: 07/1 1/82 

TEAM LEADER: AARON STRICKLAND, M S.W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 817/921-9095 

1305 W. MAGNOLIA 

SUITE B FTS: 

FORT WORTH, TX 76104 FAX: 817/921-9438 



210 



TEXAS, HOUSTON 

TEAM*: 0710 SUPPORT FACILITY: HOUSTON, TX VAMC 

DATE OPENED: 02/12/80 

TEAM LEADER; VASTINE HIGHTOWER, MS.W. 

ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 713/653-3 121 

503 WESTHEIRMER 

HOUSTON, TX 77006 FTS: 

FAX 713/653-3138 



TEXAS, HOUSTON 

TEAM#: 0711 SUPPORT FACILrrY: HOUSTON, TX VAMC 

DATE OPENED: 11/02/85 

ACT. TEAM LEADER: VASTINE HIGHTOWER, MS.W. 



-ADDRESS TELEPHONES- 



VRC COMMERCIAL: 7 1 3/682-2288 

701 N. POST OAK ROAD 

HOUSTON. TX 77024 FTS: 

FAX 713/653-3110 



TEXAS, LAREDO 

TEAM#: 0712 SUPPORT FACILITY: SAN ANTONIO, TX VAMC 

DATE OPENED: 04/22/80 

ACT. TEAM LEADER: HILARIO MARTINEZ, MS.W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 2 10/723-4680 

6020 MCPHERSON ROAD 

SUITE 1A FTS: 

LAREDO, TX 78041 FAX 210/723-9144 



TEXAS, LUBBOCK 

TEAM*: 0714 SUPPORT FACILITY: AMARILLO, TX VAMC 

DATE OPENED: 04/26/86 

TEAM LEADER: RAYMOND J. GEYE, MS.S.W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 806/792-9782 

3208 34TH STREET 

LUBBOCK, TX 79410 FTS: 

FAX 806/792-9785 



211 



TEXAS. MCALLEN 

TEAM*: 0715 SUPPORT FACILITY: SAN ANTONIO, TX VAMC 

DATE OPENED: 02/01/83 

TEAM LEADER: EVARISTO FLORES, M.S.W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 2 1 0/63 1 -2 1 47 
801 NOLAN A LOOP 

SUITE 115 FTS: NONE 

MCALLEN, TX 78504 FAX; 210/631-2430 



TEXAS. MIDLAND 

TEAM#: 0716 SUPPORT FACILrrY: BIG SPRING, TX VAMC 

DATE OPENED: 04/04/86 

TEAM LEADER: ARTHUR MCKAY, MS. W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 9 15/697-8222 
3404 WEST ILLINOIS 

SUITE 1 FTS: NONE 

MIDLAND, TX 79703 FAX: 915/697-0561 



TEXAS, SAN ANTONIO 

TEAM#: 0721 SUPPORT FACILITY: SAN ANTONIO, TX VAMC 

DATE OPENED: 04/02/80 

TEAM LEADER: fflLARIO MARTINEZ, MS. W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 2 10/229-4025 

23 1 W. CYPRESS STREET 

SAN ANTONIO, TX 78212 FTS: 

FAX: 210/229-4032 



UTAH, PROVO 

TEAM*: 0532 SUPPORT FACILITY: SALT LAKE CITY, UT VAMC 

DATE OPENED: 11/08/85 

SATELLITE COORDINATOR: RAY ROSS, MS.W. 



-ADDRESS TELEPHONES- 



VET CENTER SATELLITE COMMERCIAL: 801/377-1 117 
750 NORTH 200 WEST 

SUITE 105 FTS: NONE 

PROVO, UT 84601 FAX: 801/377-0227 



-45- 



212 



UTAH, SALT LAKE CITY 

TEAM#: 0514 SUPPORT FACILITY: SALT LAKE CITY, UT VAMC 

DATE OPENED: 01/04/80 

TEAM LEADER: JAMES ANDERSON, MS. W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 801/584-1294 

1354 EAST 3300, SOUTH 

SALT LAKE CITY, UT 84106 FTS: 588-1294 

FAX: 801/487-6243 



VERMONT, SOUTH BURLINGTON 

TEAM#: 0118 SUPPORT FACILITY: WHITE RTVER JUNCTION, VT VAMC 

DATE OPENED: 01/02/80 

TEAM LEADER: FRED FOREHAND, MS. W. 

ADDRESS TELEPHONES 



VET CENTER COMMERCIAL: 802/862-1806 

359 DORSET STREET 

SOUTH BURLINGTON, VT 05403 FTS: 951-6765 

FAX: 802/865-3319 



VERMONT, WHITE RTVER JUNCTION 

TEAM#: 0122 SUPPORT FACILITY: WHITE RTVER JUNCTION, VT VAMC 

DATE OPENED: 09/04/81 

TEAM LEADER: TTMBEEBE,MA. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 802/295-2908 

GILMAN OFFICE CENTER, BLDG. #2 802/295-2943 

HOLIDAY INN DRIVE FTS: 832-3267 

WHITE RTVER JUNCTION, VT 05001 FAX 802/296-3653 



VIRGIN ISLANDS, ST. CROJX 

TEAM*: 0306 SUPPORT FACILITY: SAN JUAN, PR VAMC 

DATE OPENED: 01/08/84 

SATELLITE COORDINATOR: ROGER HODGE, MS.W. 



-ADDRESS TELEPPHONES- 



VET CENTER SATELLITE COMMERCIAL: 809/778-5553 
BOX 12, RJR 02 

VILLAGE MALL, #113 FTS: NONE 

ST. CROTX, VI 00850 FAX 809/778-9497 



-46- 



213 



VIRGIN ISLANDS, ST. THOMAS 

TEAM* 0308 SUPPORT FACILITY: SAN JUAN, PR VAMC 

DATE OPENED: 01/01/81 

SATELLITE COORDINATOR: MEL VANTERPOOL, AA 



-ADDRESS 



-TELEPHONES- 



VET CENTER SATELLITE 
HAVENSIGHT MALL 
ST. THOMAS, VI 



COMMERCIAL: 809/774-6674 



FTS: 
FAX: 



NONE 
809/774-5384 



VIRGINIA, NORFOLK 

TEAM #: 0207 SUPPORT FACILITY: HAMPTON, VA VAMC 

DATE OPENED: 05/16/80 

TEAM LEADER: DENNIS PATTERSON, MS. W. 



-ADDRES 



-TELEPHONES- 



VET CENTER 

2200 COLONIAL AVE.. SUITE 3 

NORFOLK, VA 23517 



COMMERCIAL: 804/623-7584 



FTS: 
FAX 



441-3501 
804/441-6621 



VIRGINIA, RICHMOND 

TEAM#: 0217 SUPPORT FACILITY: 

DATE OPENED: 05/27/82 

TEAM LEADER: DANIEL DOYLE. PH.D. 



RICHMOND, VA VAMC 



ADDRESS 

VET CENTER 

3022 W. CLAY STREET 

RICHMOND, VA 23230 



-TELEPHONES- 



COMMERCIAL: 804/353-8958 



FTS: 
FAX 



698-1192 
804/353-0837 



VIRGINIA, ROANOKE 

TEAM#: 0226 SUPPORT FACILITY: SALEM, VA VAMC 

DATE OPENED: 10/22/85 

TEAMLEADELR: MICHAEL SHEARER, MS. W. 



-ADDRESS- 



-TELEPHONES- 



VET CENTER 

320 MOUNTAIN AVENUE, S.W. 

ROANOKE, VA 24016 



COMMERCIAL: 703/342-9726 



FTS: 
FAX 



982-6429 
703/982-6405 



-47- 



91-084 0-95-8 



214 



VIRGINIA, SPRINGFIELD 

TEAM*: 0228 SUPPORT FACILITY: WASHINGTON, DC VAMC 

DATE OPENED: 06/26/86 

TEAM LEADER: ROBERT TECKLENBURG, MA., MP. 



-ADDRESS- 



-TELEPHONES- 



VET CENTER 

7024 SPRING GARDEN DRIVE 
BROOKFIELD PLAZA 
SPRINGFIELD, VA 22150 



COMMERCIAL: 703/866-0924 



FTS: 
FAX: 



921-6891 
703/866-1944 



WASHINGTON, SEATTLE 

TEAM#: 0507 SUPPORT FACILITY: SEATTLE, WA VAMC 

DATE OPENED: 03/07/80 

TEAM LEADER: DON JOHNSON, PHD. 



-ADDRESS- 



-TELEPHONES- 



VET CENTER 

2230 EIGHTH AVENUE 

SEATTLE, WA 98121 



COMMERCIAL: 206/553-2706 



FTS: 
FAX: 



399-2706 
206/553-0380 



WASHINGTON, SPOKANE 

TEAM*: 0510 SUPPORT FACILITY: SPOKANE, WA VAMC 

DATE OPENED: 10/26/81 

TEAM LEADER: LINDA PARKES, MS. W. 



-ADDRESS 



-TELEPHONES- 



VET CENTER 

WEST 1708 MISSION STREET 

SPOKANE, WA 99201 



COMMERCIAL: 509/327-0274 



FTS: 
FAX: 



442-0274 
509/325-7927 



WASHINGTON, TACOMA 

TEAM* 0508 SUPPORT FACILITY: TACOMA, WA VAMC 

DATE OPENED: 12/20/79 

TEAM LEADER: STEPHEN FITZGERALD, PHJ>. 



-ADDRESS- 



-TELEPHONES- 



VET CENTER 

4801 PACIFIC AVENUE 

TACOMA, WA 98409 



COMMERCIAL: 206/473-073 1 



FTS: 
FAX: 



396-6940 
206/589-4026 



-48- 



215 



WEST VIRGINIA, BECKLEY 

TEAM*: 0231 SUPPORT FACILITY: BECKLEY, WV VAMC 

DATE OPENED: 07/19/88 

TEAM LEADER: ERNEST NICHOLS, MS. W. 



•ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 304/252-8220 

101 ELLISON AVENUE 304/252-8229 

BECKLEY. WV 25801 FTS: 924-4500 

FAX: 700/924-4504 



WEST VIRGINIA, CHARLESTON 

TEAM*: 0223 SUPPORT FACILITY: HUNTINGTON, WV VAMC 

DATE OPENED: 09/14/85 

TEAM LEADER" FRED MURRAY, MS. W.MS. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 304/343-3825 

512 WASHINGTON STREET WEST 

CHARLESTON, WV 25302 FTS: 347-5128 

FAX: 304/347-5303 



WEST VIRGINIA, HUNTINGTON 

TEAM*: 0208 SUPPORT FACILITY: HUNTINGTON, WV VAMC 

DATE OPENED: 05/23/80 

SATELLITE COORDINATOR- FRED MURRAY, MS. W.S. 



■ADDRESS TELEPHONES- 



VET CENTER SATELLITE COMMERCIAL: 304/523-8387 

1005/1007 6TH AVENUE 

HUNTINGTON, WV 25701 FTS: 924-2985 

FAX: 304/529-5910 



WEST VIRGINIA, MARTINSBURG 

TEAM*: 0224- SUPPORT FACILITY: MARTINSBURG, WV VAMC 

DATE OPENED: 11/17/85 

TEAM LEADER: LAUREN GOODALE, MED. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 304/263-6776 

105 S. SPRING STREET 304/263-6777 

MARTINSBURG, WV 25401 FTS: 940-4680 

FAX: 700/940-4684 



216 



WEST VIRGINIA, MORGANTOWN 

TEAM* 0216 SUPPORT FACILITY: CLARKSBURG, WV VAMC 

DATE OPENED: 05/11/82 

TEAM LEADER: EDDIE PAINTER, MS. W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 304/29 1 -400 1 

1191 PINE VIEW DRIVE 304/291-4002 

MORGANTOWN, WV 26505 FTS: 291-4001 

FAX: 304/29M932 



WEST VIRGINIA, PRINCETON 

TEAM*: 0232 SUPPORT FACILITY: BECKLEY, WV VAMC 

DATE OPENED: 07/25/88 

TEAM LEADER: SAMMIE HEFLIN, MS.W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 304/425-5653 

905 MERCER STREET 304/425-566 1 

PRINCETON, WV 24740 FTS: 425-5653 

FAX: 304/425-2837 



WEST VIRGINIA, WHEELING 

TEAM*: 0233 SUPPORT FACILITY: PITTSBURGH (HD), PA VAMC 

DATE OPENED: 12/12/88 

TEAM LEADER JOHN LOONEY. MS.W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 304/232-0587 

1070 MARKET STREET 

WHEELING, WV 26003 FTS: 232-0587 

FAX: 304/232-1031 



WISCONSIN, MADISON 

TEAM* 0419 SUPPORT FACILITY: MADISON, WI VAMC 

DATE OPENED: 04/16/82 

TEAM LEADER: ROBERT COOK, MA., MJED., MS.W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 608/264-5342 

147 SOUTH BUTLER STREET 

MADISON, WI 53703 FTS: 608/264-5342 

FAX: 608/264-5344 



-50- 



217 



WISCONSIN, MILWAUKEE 

TEAM*: 0415 SUPPORT FACILITY: MILWAUKEE (ZABLOCKI), WI VAMC 

DATE OPENED: 02/16/80 

TEAM LEADER: HOWARD HARRIS, MS. W. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 414/344-5504 

3400 WISCONSIN 

MILWAUKEE, WI 53208 FTS: 362-3515 

FAX: 414/344-9189 



WYOMING, CASPER 

TEAM #: 0415 SUPPORT FACILITY: CHEYENNE, WY VAMC 

DATE OPENED: 11/30/81 

SATELLITE COORDINATOR: GEORGE STEPHENS, MS.W. 



-ADDRESS TELEPHONES- 



VET CENTER SATELLITE COMMERCIAL: 307/235-8010 

HIS. JEFFERSON 

CASPER. WY 82601 FTS: 328-5438 

FAX: 307/261-5439 



WYOMING, CHEYENNE 

TEAM* 0501 SUPPORT FACILITY: CHEYENNE, WY VAMC 

DATE OPENED: 01/30/80 

TEAM LEADER: ROGER RILEY, MS. 



-ADDRESS TELEPHONES- 



VET CENTER COMMERCIAL: 307/778-7370 

3 130 HENDERSON DRIVE 
CHEYENNE, WY 82001 



-51- 



218 



ATTACHMENT TO QUESTION 5A 



April 1994 
PTSD Directory 



Mental Health and Behavioral Sciences Service (Central Office) 

Laurent Lehmann, M.D. 

Associate Director, Psychiatry (111C) 

MH & BSS 

VACO PTSD Programs 

810 Vermont Avenue, N.w. 

Washington, D.C. 20420 

(202) 233-7790/7590 

FTS (202) 535-7790/7590 

Douglas Gottfredson, PhD 

PTSD Automation Coordinator 

VACO - Decentralized Location/116B 

VA Medical Center 

500 Foothill Boulevard 

Salt Lake City, UT 84148 

(801) 585-1565, X2282 

FTS 588-2282 



Northeast Program Evaluation Center (NEPEC) 

Robert Rosenheck, M.D. 
NEPEC Director (182) 
VAMC PTSD Programs 
950 Campbell Avenue 
West Haven, CT 06516 
FTS 428-3434 

Alan Fontana, Ph.D. /Helen Spencer, M.A. 

NEPEC/PTSD Evaluation (182) 

VAMC 

950 Campbell Avenue 

West Haven, CT 06516 

FTS 428-3708/428-3700 

FAX FTS 428-3433 



219 



National Center for PTSD 

Matthew Friedman, M.D., Ph.D. 
Executive Director, NC/PTSD (116A) 
VAM & ROC NC/PTSD Programs 
North Hartland Road 
White River Junction, VT 05001 
FTS 829-5549 

Dennis Charney, ' M.D. 

Biological Science Division Chief (116A) 

VAMC NC/PTSD Programs 

950 Campbell Avenue 

West Haven, CT 06516 

FTS 428-4454 

Fred Gusman, M.S.Wi 

Educ. & Clin. Lab. Division Chief 

PTSD Coordinator, SIPD & PSU 

VAMC NC/PTSD Programs 

3801 Miranda Avenue 

Palo Alto, CA 94304 

FTS 463-2093 

Terence Keane, Ph.D. 

Behavioral Science Division Chief (116B) 

VAMC NC/PTSD Programs 

150 South Huntington Avenue 

Boston, MA 02130 

FTS 839-4047 

Robert Rosenheck, M.D. 

Evaluation Division Chief, NEPEC (182) 

VAMC PTSD Programs 

950 Campbell Avenue 

West Haven, CT 06516 

FTS 428-3434 

Raymond Scurf ield, Ph.D. 
Pacific Center Division Chief 
Honolulu VA Outpatient Clinic 
1132 Bishop St., Suite 307 
Honolulu, Hawaii 96813 
FtS 551-1555 

Jessica Wolfe, Ph.D. 

Women's Health Sciences Division Chief 

VAMC NC/PTSD Programs 

150 So. Huntington Ave. 

Boston, MA 02130 

FTS 839-4129 



220 



i. 



SOPP (Specialized Outpatient PTSD Programs) Directory 
PCTs (PTSD Clinical Teams) 4/ 94 -Draft 



Jose Canive, MD 

Coordinator, PTSD Program/ 11 66 

VA Medical Center 

2100 Ridgecrest Drive SE 

Albuguertjue , NM 87108 

FTS 572-4937/4931/4935 

(505) 265-1711, X4937 

FAX FTS 572-2882 



Israel Liberzon, MD 
PCT Director/116A 
VAMC Ann Arbor 
2215 Fuller Road 
Ann Arbor, MI 48105 
FTS 374-5593 
(313) 769-7100, X5593 
FAX (313) 769-7410 



David Baltzell, MD 
Atlanta PCT Director/116A 
VA Medical Center 
1670 Clairmont Road 
Decatur, GA 30033 
(404) 321-6111 
FTS 248-6030 



Daniel T. Merlis, MSW 
PCT Director/116W 
VA Medical Center 
10 North Greene Street 
Baltimore, MD 21201 
FTS 580-7270 
(410) 605-7270 
FAX (410) 605-7918 



Dharm Bains, PhD 

PCT Coordinator/116B2 

VA Medical Center 

5500 Armstrong Road 

Battle Creek, MI 49016 

FTS 974-3595 

(616) 966-5600, X3595 

FAX (616) 966-5511 



Wayne Krepsky, PhD 

PCT Program Director/ 116A3-1 

Biloxi VAMC/Gulfport Division 

200 East Beach Boulevard 

Gulfport, MS 39507 

FTS 499-2813 

(601) 867-2813 

FAX FTS 499-2311 



Jim Dayton, ACSW 
Director, PCT/116C 
VA Medical Center 
500 West Fort Street 
Boise, ID 83702-4598 
FTS 554-7979 
(208) 389-7979 
FAX FTS 554-7940 



Jose Vasquez, MSW 
Acting PCT Director/116A 
VA Medical Center 
7 00 South 19th Street 
Birmingham, AL 35233 
(205) 939-2159 



Michael Dodd, PhD 

PCT Director/116B3 

VA Medical Center 

940 Belmont St. 

Brockton/W. Roxbury, MA 02401 

(508) 583-4500, X3955 

FTS 885-3955 

FAX (508) 586-6791 



221 



Lisa Fisher, PhD 
Director, PCT/116B-2 
VA Medical Center 
150 So. Huntington Ave 
Boston, MA 02130 
FTS 839-4127/4123 
(617) 232-9500, X4129 
FAX (617) 278-4501 



Robert Levengood, MD 
PCT Coordinator/ 116A 
VA Medical Center/Bronx 
130 W. Kingsbridge Rd. 
Bronx, NY 10468 
FTS 884-5881/5215 
(718) 584-9000, X5881 
FAX (718) 933-2121 



Herbert Stein, MD 
PCT Director/116A 
VA Medical Center 
800 Poly Place 
Brooklyn, NY 11209 
FTS 667-3713/6814 
(718) 630-3713/2829 
FAX (718) 630-2829 



Joseph Coppola, MD 

Buffalo PCT Coordinator/116A 

VA Medical Center 

Redfield Pkwy 

Batavia, NY 14020 

FTS 546-7505 

(716) 344-3321 

FAX FTS 546-9350 



Roger Lyman, PhD 
Coordinator, PCT/116B1 
VA Medical Center 
400 Fort Hill Avenue 
Canandaigua, NY 14424 
FTS 952-4078/3687 
(716) 396-3687 
FAX (716) 396-3611 



Keith Chobot, MSW 
PCT Coordinator/116A 
Ralph Johnson VAMC 
109 Bee Street 
Charleston, SC 29401-5799 
FTS 259-7676/7797 
(803) 577-5011 
FAX FTS 259-7231 



Keith Langley, LCSW 

PCT Director/116Bl 

VAM & ROC 

2360 East Pershing Blvd. 

Cheyenne, WY 82001 

FTS 328-7504 

(307) 778-7504 

FAX FTS 328-7336 



Brenda Doherty, RN, MS, CS 
PCT Coordinator/116A1 
Westside VAMC 
820 So. Damen Ave. 
Chicago, IL 60612 
FTS 388-3202/3136 
(312) 666-6500, X3202 
FAX (312) 633-2195 



Yoshizo Nakano, MD 
PCT Director/116A2 
VA Medical Center 
17273 State Route 104 
Chillicothe, OH 45601 
FTS 975-7899/7885 
(614) 773-1141, X7899 
FAX FTS 97 5-7 023 



Susan Watkins, MSW 

Acting PCT Coordinator/ 17 0B 

Louis A. Johnson VAMC 

Route 98 

Clarksburg, WV 26301 

FTS 923-3613/3711 

(304) 623-7613 

FAX (304) 623-7685 



222 



David Inman, PhD 

PCT Coordinator/ 116B 

VA Medical Center 

1400 Black Horse Hill Rd 

Coatesville, PA 19320 

FTS 489-7680/7500 

(215) 384-7711, X7680 



Patrick Litle, PhD 
Media Outpatient Clinic 
1489 Baltimore Pike 
Suite 107, Bids. 100 
Springfield, PA 19064 
FTS 596-4899 
(215) 543-1588 
FAX (215) 543-1738 



Reagan Andrews , Jr . , PhD 

Coordinator, PCT/116A7 

VA Medical Center 

4500 South Lancaster Road 

Dallas, TX 75216 

FTS 749-7928 

(214) 372-7928 



Charles Allen, PhD 
PCT Director/116P 
VA Medical Center 
1055 Clermont Street 
Denver, CO 80220 
FTS 322-4699/2184/2553 
(303) 393-4699 
FAX (303) 333-4935 



Tim Kohlbecker, MSW 
PCT Coordinator, 122 
VA Medical Center 
1900 E. Main 
Danville, IL 61832 
(217) 442-8000, X5101 



Michael Hertzberg, MD 
PCT Director/116C 
VA Medical Center 
508 Fultori Street 
Durham, NC 27705 
FTS 671-7977 
(919) 286-0411, X7977 
FAX (919) 286-6825 



Salim Akhtar, MD, PhD 
PCT Director/116A 
VA Outpatient Clinic 
5919 Brook Hollow Drive 
El Paso, TX 79925 
(915) 540-7918/7919 
FAX (915) 540-7879 



William Brewi, MSW 
PCT Director/116A 
VA Medical Center 
1100 North College Ave 
Fayetteville, AR 72701 
FTS 742-5134/5700 
(501) 444-5078 



Ralph Maurer, MD 
PCT Medical Dir/116A 
VA Medical Center 
1601 SW Archer Road 
Gainesville, FL 32608-1197 
FTS 947-6305/6127 
(904) 374-6127 
FAX (904) 374-6113 



Robert Keiter, MD 
PCT Director/116A 
VA Medical Center 
Emancipation Drive 
Hampton, VA 23667 
FTS 959-2009/2004 
(804) 722-9961, X2009 
FAX FTS 959-3174 



223 



Edward Klama, ACSW 

PCT Coordinator/ 11 6A5 

VA Medical Center 

5th Ave. & Roosevelt Rd. 

Hines, IL 60141 

FTS 381-2095 

(708) 343-7200, X4656 



Lori Daniels, MA 

Director, PCT/116A 

Honolulu VA Outpatient Clinic 

1132 Bishop St., Suite 303 

Honolulu, Hawaii 96813 

FTS 551-1555 

(808) 541-1555 

FAX (808) 541-3067 



Bruce Perry, MD, PhD 
PCT Director/116A4 
VA Medical Center 
2002 Holcombe Blvd. 
Houston, TX 77030 
FTS 528-3424/7062 
(713) 794-7062 
FAX (713) 794-7652 



Nils Varney, PhD 
PCT Director/116-B 
VA Medical Center 
Highway 6 West 
Iowa City, IA 52246 
FTS 863-6000 
(319) 338-0581, X6000 
FAX (319) 339-7068 



Judith Lyons, PhD 

Dir . , Trauma Recovery Prog . 

VAMC/116A2 

1500 E. Woodrow Wilson Drive 

Jackson, MS 39216 

FTS 542-1224 

(601) 364-1224 

FAX FTS 542-1245 



John C. VanBiber, MD 
Director/PCT/116A5 
VA Medical Center 
4801 Linwood Boulevard 
Kansas City, MO 64128-2295 
FTS 754-1789/1790 
(816) 861-4700, X1789 
FAX (816) 861-8736 



L. Jay Mclntyre, MD 
PCT Director/116A-l 
VA Medical Center 
600 South 7 0th Street 
Lincoln, KB 68510 
FTS 865-7823 
FAX FTS 865-7872 



Ebrahim Amanat, MD 
Director, PCT 
East LA OP Clinic 
5400 E. Olympic Blvd. 
Commerce, CA 90040 
FTS 984-5360/5331 
(213) 894-5360 
FAX (213) 894-5056 



#150 



Nancy Whitney, LCSW 
Coordinator, PCT/122 
J.L.Pettis Memorial VetMedCtr 
11201 Benton Street 
Loma Linda, CA 92357 
FTS 996-2005/2311 
(909) 828-7084 



Timothy Donovan, MSW 
Director, PCT/122 
VA Medical Center 
Marion, IN 46953-4589 
FTS 364-3779/3295/3780 
(317) 674-3321, X3779 
FAX (317) 677-3106 



Edith Sewell, PhD 
PCT Coordinator/116A6 
VA Medical Center 
1030 Jeferson Avenue 
Memphis, TN 38104 
FTS 222-5760 
(901) 577-7407, X5760 



224 



Elizabeth Jackson, MD 
PCT Director/116All 
VA Medical Center 
1201 N.W. 16th Street 
Miami, FL 33125 
FTS 351-3813/6395 
(305) 324-4455 
FAX FTS 351-3306 



Harry Russell, PhD 
Coordinator, PTSR Prog/116A6 
VA Medical Center 
One Veterans Drive 
Minneapolis, MN 55417 
FTS 780-2125/4474 
(612) 725-2125 



Charles Halter, PhD 
PCT Coordinator/ 116B3 
Mountain Home VA Medical Ctr. 
Johnson City, TK 37684 
FTS 854-7723/7293 
(615) 926-1171, X7293 
AST FAX (615) 461-7932 



Madeline Uddo, PhD 
PCT Coordinator/116B 
VA Medical Center 
1601 Perdido Street 
New Orleans, LA 70146 
FTS 682-5835/5235 
(504) 589-5235 
FAX (504) 589-5919 



Bettye Elwell 
Psychiatry Svc AO/116A 
PCT Contact Person 
VA Medical Center 
3400 Lebanon Road 
Murfreesboro, TN 37130 
(615) 893-1360 



Jeff Fine, MD 
PCT Director/116A 
VA Medical Center 
423 East 23rd Street 
New York, NY 10010 
FTS 662-7981 



Dan E. Jones, PhD 
PCT Director/183A 
VA Medical Center 
921 N.E. 13th Street 
Oklahoma City, OK 73104 
FTS 743-5367/5369 
(405) 270-0501, X5367 
MAC FAX (405) 270-1541 



Larry Smyth, PhD 
PCT Director/116A5 
VA Medical Center 
Perry Point, MD 21902 
FTS 956-5461/6822 
(410) 642-1083 
AST FAX (410) 642-1133 



Lorene Ruuska, PhD 
PCT Director/116B 
VA Medical Center 
4101 Woolworth Avenue 
Omaha, NE 68105 
(402) 346-8800, X4647 



Tracy Dekelboum-Smith, MSW 
San Jose PCT Contact 
National Center for PTSD 
Palo Alto VAMC - 323 MP 
3801 Miranda Ave. 
Palo Alto, CA 94304 
FTS 463-7837 



Neal Daniels, PhD 

Director/PCT/116B 

VA Medical Center 

39th & University Aves. 

Philadelphia, PA 19104 

(215) 823-4459/4447 

FAX (215) 823-6054 



Jose Amato, MD 
PCT Director/116A8 
Carl T. Hayden VAMC 
650 E. Indian School Rd. 
Phoenix, A2 85012 
FTS 761-7449/7423 
(602) 277-5551, X7449 
FAX (602) 222-6435 



225 



Edward Pontius, MD 
PCT Director/ 116A 
VA Medical Center 
Highland Drive 
Pittsburgh, PA 15206 
FTS 726-4785/4747 
(412) 365-4785 
FAX (412) 365-4765 



Larry Schwartz, MD 

PCT Director/116T (OPC) 

VA Medical Ctr/Portland Div. 

(3710 SW US Veterans Hosp Rd) 

PO Box 1036 

Portland, OR 97207 

FTS 420-2953/2121 

(503) 293-2953/4121 

FAX (503) 293-2837 



James P. Curran, PhD 
Coordinator/PTSD Program 
Bldg. 14/116B 
VA Medical Center 
Davis Park 
Providence, RI 02908 
FTS 838-3077/3076/2639 
(401) 457-3077/3076 
FAX (401) 457-3354 



Sam Kilgore, MD 

PCT Coordinator/116A-2 

VA Medical Center, Bldg 15 

1601 Brenner Ave. 

Salisbury, NC 28144 

FTS 699-3842/2969 

(704) 638-3842 

FAX FTS 699-2960 



Ladd Hemmer, PhD 
PCT Coordinator/ 116A3 
VA Medical Center 
4801 Eighth St. North 
St. Cloud, MN 56202 
FTS 783-8236 



Steven Allen 

PCT Director/116A 

VA Medical Center 

500 Foothill Boulevard 

Salt Lake City, UT 84148 

FTS 588-1565, X2390/1217/2319 

(801) 584-1217 



Anne Andorn, MD 

PCT Contact Person 

Chief, Psychiatry Svc/116A 

VAMC-J.B. Div. 

915 N. Grand Boulevard 

St. Louis, MO 63125 

(314) 



Ross Taylor, MD 
Director, PCT/116A 
VA Medical Center 
7400 Merton Minter Blvd. 
San Antonio, TX 78284 
FTS 779-5227 
(210) 617-5227 
FAX FTS 779-5236 



Jeffrey Matloff, PhD 
PCT Director/116B 
VA Medical Center 
3350 La Jolla Village Dr. 
San Diego, CA 92161 
FTS 897-3908/7218 
(619) 552-8585, X3908 
FAX (619) 552-7414 



226 



Charles R. Marmar, MD 
Director, PCT/116P 
VA Medical Center 
4150 Clement Street 
San Francisco, CA 94121 
(415) 750-6931/6961 
FAX (415) 750-6921 



Ivonne Vicente, MD 
PCT Director/116A 
VA Medical Center 
One Veterans Plaza 
San Juan, PR 00927-5800 
(809) 758-7575, X5829 
FTS 766-5297/5564 
FAX FTS 766-5535 



Mario Mercado 
PCT Director/116 
VA Medical Center 
2501 W. 22nd Street 
Sioux Falls, SD 57117 
(605) 333-6800 
FTS 789-6800 



Miles E. McFall, PhD 

Dir. PTSD Trtmnt. Team/116MHC 

VA Medical Center 

1660 South Columbian Way 

Seattle, WA 98108 

FTS 396-2131/2177 

(206) 764-2131/2063 

FAX (206) 764-2572 

AST FAX (206) 764-2872 



Linda G. Peterson, MD 
PCT Director/116B2 
Togus VAM & ROC 
Togus, ME 04330 
FTS 833-5324 
(207) 623-8411, X5324 
FAX FTS 833-5766 
FAX (207) 623-5786 



Charmaine Kowalski, MD 

PCT Director/116A 

James Haley VAMC 

13000 Bruce Downs Boulevard 

Tampa, FL 33612 

(813) 978-5866 

FTS 822-5866 



Tim P. Rot, Psy. D. 
PCT Director/ 116B 
Colmery-O'Neil VAMC 
2200 S.W. Gage Blvd 
Topeka, KS 66622 
FTS 277-2058/2095/2097 
(913) 272-3111, X2058 
FAX 277-2099 



P. Michael Schlosser, PhD 

PCT Director/116D 

Junction VAM & ROC 

Tuskegee, AL 36083 

FTS 534-3838/4050 

(205) 727-0550, X3838/4050 



Alice Arrington, CISW 
PCT Director/122 
VA Medical Center 
3601 So. Sixth Avenue 
Tucson, AZ 85012 
(602) 629-1827 



Rosemary Tegano, PhD 
PCT Contact Person 
Chief, Psychology Svc/116B 
VA Medical Center 
3701 Loop Road 
Tuscaloosa, AL 35404 



227 



Raul Cuervo-Rubio, MD 
PCT Director/116A 
VA Medical Center 
50 Irving St., NW 
Washington, D.C. 20422 
FTS 921-8159 



Barbara Fretwell, MSW 
Chief, Social Work Svc/122 
PCT Contact Person 
VA Medical Center 
5500 East Kellogg 
Wichita, KS 67218 
(316) 685-2221, X3692 



Fernando Garza, Bd.D. 
PCT Coordinator/ 116B 
VA Medical Center 
4800 Memorial Drive 
Waco, TX 76711 
FTS 734-7268 
(817) 752-6581, X7268 
FAX FTS 734-6102 



William Weeks, MD 

PCT Director/116E 

White River Junction VAM & ROC 

N. Hartland Rd. 

White River JCT, VT 05009-0001 

FTS 829-5697/5688 

(802) 295-9363, X5697/5688 

FAX MAC (802) 295-5157 



228 



II. SUPTs (Substance Use-PTSD Programs) 



4/94 Draft 



Dale Smith, PhD 

Director, SUPT/116AS 

American Lake VA Medical Ctr 

Veterans Drive 

Tacoma, WA 98493 

FTS 396-6470/6460 

(206) 582-8440, X6460/6470 

FAX FTS 396-6447 



James Conn, MD 

SUPT Coordinator/ 116A2 

VA Medical Center 

1000 Bay Pines Boulevard 

Bay Pines, FL 33504 

FTS 826-4486/4463 

(813) 398-6661, X4486 

FAX 826- 5519 



Kenneth Weiss, PhD 

Clement O'Brien, LICSW 

SUPT Co-Coordinators /116B1 

Brockton/W. Roxbury VA Med Ctr 

940 Belmont Street 

Brockton, MA 02401 

FTS 885-3955/3957 

FAX (508) 583-4500, X955 

FAX 840-6955 



Lorraine Cavallaro, PhD 
Worcester Outpatient Clinic 
605 Lincoln Street 
Worcester, MA 01605 
FTS 885-7000, X7039 
(508) 856-0104, X7039 
FAX FTS 885-7068 



Christopher Elia, PhD 
SUPT Director/116B 
VA Medical Center 
Fort Meade, SD 57741 
FTS 782-6028/6027 
(605) 347-2511 
FAX (605) 347-7159 
FAX FTS 782-6675 



William Miller, ACSW 

Supt Coordinator/ 11 6 A2 

VAMC Knoxville 

1515 West Pleasant Street 

Knoxville, IA 50138 

FTS 861-6268/5164 

(515) 828-5164 

FAX (515) 828-5066 



Kevin Brailey, PhD 
SUPT Director/116B 
VA Medical Center 
1601 Perdido Street 
New Orleans, LA 70146 
FTS 682-5923 
(504) 568-0811, X5923 
FAX (504) 589-5216 



Richard Lees, PhD 
SUPT Coordinator/ 11 6A8 
Highland Dr. VAMC 
Highland Drive 
Pittsburgh, PA 15206 
FTS 

(412) 365-5070 
FAX (412) 365-5071 



Westley Clark, MD,JD 
SUPT Director/116E 
VA Medical Center 
4150 Clement Street 
San Francisco, CA 94121 
FTS 470-3885/2350 
(415) 750-2127, X3885 
FAX (415) 750-6921 



Andrew Meisler, PhD 
SUPT Director/1161A 
VA Medical Center 
950 Campbell Ave. 
West Haven, CT 06516 
FTS 428-2583/2570 
(203) 932-5711, X2583 



229 



SIPP (Specialized Inpatient PTSD Program) DIRECTORY 4/94 Draft 
I. SIPDs (Specialized Inpatient PTSD Programs) 



Steven Tice, MA 

PTSD/SIPD Coordinator (116P) 

American Lake VAMC 

Veterans Drive 

Tacoma, WA 98493 

FTS 396-6968/6577/6938 

(206) 582-8440, X6968 

FAX (206) 589-4039 

Dharm Bains, PhD 
SIPD Director/116B2 
VA Medical Center 
5500 Armstrong Rd. 
Battle Creek, MI 49016 
(616) 966-5600, X3595 
FTS 974-3595 



Edwin Sperr, PhD 
PTSD/SIPD Coordinator\116Bu 
VA Medical Center 
One Freedom Way 
Augusta, GA 30904-6285 
FTS 251-7190, X6258 
(706) 733-0188 
FAX (706) 731-7190 



Anthony Taylor 

PTSD/SIPD Coordinator (116B) 

VA Medical Center 

1000 Bay Pines Blvd. 

Bay Pines, FL 33504 

FTS 826-4614/4249 

(813) 398-6661, X4249/4614 

FAX (813) 398-9567 



David S. Liebling, MD 
PTSD/SIPU Dir./116A 
Center for Stress Recovery 
VAMC Brecksville 
Brecksville, OH 44141 
FTS290-6030, X7530/7541 
(216) 838-6055 
FAX (216) 838-6085 



Khalil A. Murad, PhD 

Coordinator, PTSD Prog (10D) 

VA Medical Center 

3495 Bailey Avenue 

Buffalo, NY 14215 

FTS 432-2036/3011 

(716) 834-9200, X3011/2036/2037 

FAX FTS 862-3756 

FAX (716) 862-3756 

Steven Silver, PhD 
PTSD/SIPD Coordinator/116B 
VA Medical Center 
Black Horse Hill Road 
Coatesville, PA 19320 
FTS 489-7267/7643 
(215) 384-7711, X4649 
FAX FTS 489-7207 



Peter Montgomery. MD 
SIPD Director/116A 
VA Medical Center 
1055 Clermont St. 
Denver, CO 80220 
FTS 322-2501 



Joyce Cohen, RN 
SIPD/Bldg 57BS/116A 
VA Medical Center 
151 Knollcroft Rd. 
Lyons, NJ 07939-5000 
FTS 348-6931 
(908) 647-0180, X6931 
FAX (908) 604-5839 



10 



91-084 0-95-9 



230 



George Paz, MD 
PTSD/SIPU Coordinator/ 116A 
West LA VA Medical Center 
Wilshire & Sawtelle Blvds 
Los Angeles, CA 90073 
(310) 824-6693 



Lucero Leon, MSw 

SIPU Coordinator/ 116A12 

VA Medical Center 

1201 K.W. 16th Street 

Miami, FL 33125 

FTS 351-6058/3953 

(305) 324-4455, X6058/3953 

FAX (305) 324-3232 



Jay Buckiewicz, PhD 

PTSD Unit (116B) 

VA Medical Center 

Route 9A 

Montrose, NY 10548-0100 

FTS 887-2500/2253 

(914) 737-4400, X2500/2253 

FAX (914) 737-4400, X2774 



James K. Besyner, PhD/116B 
Stress Disorder Trt. Unit 
Bldg 135-2B VAMC 
3001 Green Bay Road 
No. Chicago, IL 60064 
FTS 384-4673/4675 
(708) 688-1900, X4675/4673 
FAX FTS 384-3820 



Gregory Gillette, MD 
PTSD Sectn Chief /116AP/NLR 
VA Medical Center 
2200 Fort Roots Drive 
No. Little Rock, AR 72114 
FTS 740-1917/1893/1161 
(501) 661-1202, X1917/1893 
FAX (501) 370-6629 



David Robinson, MD 
PTSD/SIPU Coordinator/116A 
VA Medical Center 
421 No. Main Street 
Northampton, MA 01060-1288 
FTS 839-3053/2677 
(413) 582-3053 
FAX (413) 582-3040 



Debra DeAngelo, ACSW 

Women's Trauma Recovery Program 

National Center for PTSD 

VA Medical Center 

3801 Miranda Ave. (323E12 MPD) 

Palo Alto, CA 94304 

FTS 463-7373 

(415) 493-5000, X7373 

FAX (415) 617-2769 



Fred Gusman, MSW 

Director, SIPU/116A 

VA Medical Center 

3801 Miranda Ave. (323E MP) 

Palo Alto, CA 94304 

FTS 463-7314/2093/7837 

(415) 493-5000, X7314 

FAX FTS 463-2769 



Dennis Grant, MD 

PTSD Coordinator/ 116A 

VAMC SIPU Programs 

7th St. & Indian School Rd. 

Phoenix, AZ 85012 

FTS 761-7970/7724/6704 

(602) 277-5551, X7724 

FAX FTS 761-6435 



231 



Robert Cox, MA 
Coordinator, PTSD Prog (9-2) 
VA Medical Center 
1970 Roanoke Boulevard 
Salem, VA 24153 
FTS 937-1158/2550 
(703) 982-2463, X2550 
FAX FTS 937-1080 



Kevin Polk, PhD 

Chief, PTSD Programs/ 11 6B2 

VAM & ROC 

Togus, ME 04330 

FTS 833-5458/5139 

(207) 623-8411 

FAX (207) 623-5786 



PTSD/SIPU Coordinator/116AD 
VA Medical Center 
Veterans Road 
Tomah, WI 54660 
FTS 769-6011, X6437 
(608)372-3971, X6437 
FAX (608) 372-1691 



John Farrell-Higgins, PhD 
PTSD/SIPO Coordinator/ 116B 
Colmery-O'Neil VAMC 
2200 Gage Boulevard 
Topeka, KS 66622 
FTS 277-2110/2112/2140 
(913) 272-3111, X2110 
FAX FTS 277-4309 



Carol Prescott, MSW 
SIPU Director/116B 
VA Medical Center 
1601 Brenner Avenue 
Salisbury, NC 28144 
FTS 672-3450 



Randy Jordan, Psy.D. 
SIPU Director/116B 
VA Medical Center 
Hospital Road 
Tuskegee, AL 36083 
(205) 727-0550, X3839 
FTS 534- 



Wayne Gregory, PhD 
Chief, PTSD/116B 
VA Medical Center 
4800 Memorial Drive 
Waco, TX 76711 
FTS 734-7273/7256 
(817) 752-6581 
FAX (817) 752-3108 



David Johnson, PhD 

Nat'l Center for PTSDM16A 

VA Medical Center 

950 Campbell Ave. 

West Haven, CT 06516 

FTS 428-2490 

(203) 932-5711, X2491/2490 

FAX (203) 937-3886 



II. 



PSUs (PTSD-Substance Use Programs) 



Joyce Cohen, RN 
PSD Director/116A 
VA Medical Center 
151 Knollcroft Rd. 
Lyons, NJ 07939-5000 
FTS 348-6931 
(908) 647-0180, X6931 
FAX (908) 604-5839 



Victoria Zueck, PhD 
PSD Coordinator/116B 
VA Medical Center 
5000 W. National Ave. 
Milwaukee, WI 53295 
FTS 383-1011 
(414) 384-2000/2367 
FAX (414) 382-5319 



232 



Pamela Abrams, LCSW 
PSD Coordinator/116AP/NLR 
VA Medical Center 
2200 Fort Roots Drive 
No. Little Rock, AR 72114 
FTS 740-4344/1917/1893/1611 
(501) 661-1202, X4344/1917 
FAX (501) 370-6629 



Fred Gusman, MSW 

PSD Director/116A 

VA Medical Center 

3801 Miranda Ave (323E MP) 

Palo Alto, CA 94304 

FTS 463-7314/2093/7837 

(415) 493-5000, X7314 



233 



in. 



PRRPs (PTSD Residential Rehabilitation Programs) 



Barton Penny, Bob Eaton 
PRRP Coordinator/DOM 
VA Medical Center 
2295 DeBarr Road 
Anchorage, AK 99508 



Tamara Miller, Psy.D. 
PRRP Coordinator/ 11 6B1 
VA Medical Center 
4100 West Third Street 
Dayton, OH 45428 
FTS 950-1145 
(513) 268-6511, X1145 
FAX (513) 262-2170 



Steve Halverson, LSW 
PRRP Coordinator/ 181 
VA Med Center, Bldg 68CD 
1515 West Pleasant Street 
Knoxville, IA 50138 
FTS 861-6277/6477 
(515) 842-3101, X6277 
FAX FTS 861-5131 Attn: 68CD 



Eric Gerdiman, PhD 
Coordinator, PRRP/116B 
VA Medical Center 
Martinsburg, WV 25401 
FTS 940-4710/4718/4717 
(304) 263-0811 
FAX (304) 267-2481 



Julian Ford, PhD 
PRRP Coordinator/ 116T-V 
VAMC/Portland Division 
3710 SW US Vets.Hosp Rd 
PO Box 1035 
Portland, OR 97207 
FTS 422-3882/3883/3884 
(206) 696-4061, X3883 
FAX (206) 690-0864 



Miles McFall, PhD 
PRRP Director/116B 
VA Medici Center 
1660 So. Columbian Way 
Seattle, WA 98108 
(206) 764-2131 



Hollis Hackman, PhD 
PRRP Coordinator/116B 
VA Medical Center 
Fort Road 
Sheridan, WY 82801 
FTS 329-3638/3213 
(307) 672-1658 
FAX FTS 329-3652 



Nathan Denny, PhD 

PRRP Coordinator/116B12 

O.Teague Veterans' Center 

1901 South First Street 

Temple, TX 76504 

FTS 760-5545 

(817) 778-4811, X5545 

FAX FTS 760-5548 



Pat McDonaugh, MSW 
PRRP Coordinator/122 
VA Medical Center 
950 Campbell Avenue 
West Haven, CT 06516 
FTS 428-2486 
(203) 932-5711, X2486 



Jim Dwyer, LCSW 
PRRP Director/116A 
VA Medical Center 
Wilshire & Sawtelle Blvds 
West Los Angeles, CA 90073 
(310) 478-3711, X4411 



234 



IV. 



EBTPUs (Evaluation and Brief Treatment PTSD Units) 



Daniel T. Merlis, MSW 
EBTPU Director/116W 
VA Medical Center 
3900 Loch Raven Blvd 
Baltimore, MD 21218 
(410) 605-7270 
FTS 580-7270 



Mark Heilman 
EBTPU Acting Director 
VA Medical Center 
500 W. Fort Street 
Boise, ID 83702-4598 
FTS 554-7208 



Peter Powchik, MD 

EBTPU Director/116A 

VA Medical Center 

130 w. Kingsbridge Road 

Bronx, NY 10468 

FTS 884-5777 



Dewleen Baker, MD 
PTSD Coordinator (7E/PTSD) 
VAMC Medical Center 
3200 Vine Street 
Cincinnati, OH 45220 
FTS 773-6693/4721 
(513) 559-6693 
FAX (513) 559-5611 



Peter Montgomery, MD 
PTSD Coordinator/116A 
VA Medical Center 
1055 Clermont Street 
Denver, CO 80220 
FTS 322-2501/3733 
(303) 393-2832, Beep 381 
FAX (303) 393-4683 



Judy Poncavage, MSW 

EBTPU Coordinator/ 122 

VA Medical Center 

30th and Euclid 

Des Moines, IA 50310 

FTS 862-5807 

(515) 255-2173, X5807 

Hosp FTS 862-5173, X5807 



Patrick Smith, PhD 

Trauma Recovery Prog/116A2 

VA Medical Center 

1500 E. Woodrow Wilson Dr. 

Jackson, MS 39216 

(601) 364-1224 

FTS 542-1224 

FAX FTS 542-1245 



George Bowen, PhD 
EBTPU Coordinator/116B 
VA Medical Center 
800 Zorn Avenue 
Louisville, KY 40206 
FTS 548-5989/5919 
(502) 895-3401, X5989 
FAX FTS 548-6155 



Stephen Barton, MD, PhD 
EBTPU Med.Director/116A6 
VA Medical Center 
One Veterans Drive 
Minneapolis, MN 55417 
FTS 780-2125 
(612) 725-2125 



235 



Karin Thompson, PhD 
EBTPU Coordinator/116B 
VA Medical Center 
1601 Perdido Street 
New Orleans, LA 70146 
FTS 682-5235/5923 
(504)589-5923 
FAX FTS 682-5919 



Alan Kirkendall, PhD 

EBTPD Director/116B 

VA Medical Center 

913 NW Garden Valley Blvd 

Rosebura, OR 9747 



Paul Roller, MD 
EBTPD Director/ 116N 
VA Medical Center 
4150 Clement Street 
San Francisco, CA 94121 
FTS 470-3134 
(415) 750-3134 
FAX (415) 750-6921 



Miles McFall, PhD 
Director, PTSD Prosrs/116A 
VA Medical Center 
1660 South Columbian Way- 
Seattle WA 98108 
(206) 764-2177/2063 
FAX (206) 764-2573 



David Johnson, PhD 
EBTPD Director/116B 
VA Medical Center 
950 Campbell Avenue 
West Haven, CT 06516 
FTS 428-2490 



William Weeks, MD 
EBTPU Director/116A 
VA Medical Center 
North Hartland Road 
White River Jet, VT 05001 
(802) 295-9363, X5697 
FTS 829-5697 



16 













































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FACILITY 

BUTLER. PA 
CANANDAIGUA, NY 
CASTLE POINT. NY 
CHARLESTON, SC 
CHEYENNE. WY 
CHICAGO (LS). IL 
CHICAGO (WS), IL 
CHILLICOTHE. OH 
CINCINNATI. OH 
CLARKSBURG, WV 
CLEVELAND, OH 
COATESVILLE. PA 
COLUMBIA. MO 
COLUMBIA. SC 
COLUMBUS (OPC). OH 
DALLAS. TX 
DANVILLE. IL 
DAYTON. OH 
DENVER. CO 
DES MOINES, IA 
DUBLIN, GA 
DURHAM. NC 
EAST ORANGE. NJ 
EL PASO (OPC). TX 
ERIE, PA 
FARGO. ND 
FAYETTEV1U.E, AR 
FAYETTEVILLE, NC 
FORT HARRISON, MT 
FORT HOWARD. MD 
FORT LYON, CO 



238 



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FACILITY 

FORT MEADE, SD 
FORT WAYNE, IN 
FRESNO, CA 
GAINESVILLE. FL 
GRAND ISLAND, NE 
GRAND JUNCTION, CO 
HAMPTON, VA 
HINES. IL 

HONOLULU (OPC), HI 
HOT SPRINGS, SD 
HOUSTON, TX 
HUNTINGTON, WV 
INDIANAPOLIS, IN 
IOWA CITY, IA 
IRON MOUNTAIN, Ml 
JACKSON, MS 
KANSAS CITY. MO 
KERRVILLE. TX 
KNOXVILLE. IA 
LAKE CITY, FL 
LAS VEGAS (OPC), NV 
LEAVENWORTH, KS 
LEBANON, PA 
LEXINGTON, KY 
LINCOLN. NE 
UTTLE ROCK, AR 
UVERMORE. CA 
LOMA LINDA. CA 
LONG BEACH. CA 
LOS ANGELES (OPC). CA 
LOUISVILLE, KY 



239 



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604 
607 
606 
609 
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611 
612 
613 
614 
546 
617 
695 
618 
619 
620 
621 
622 
623 
626 
629 
630 
627 
631 
556 
632 
635 
636 
548 
640 
641 
642 


FACILITY 

LYONS, NJ 
MADISON, Wl 
MANCHESTER. NH 
MARION, IL 
MARION, IN 
MARUN, TX 
MARTINEZ, CA 
MARTINSBURQ, WV 
MEMPHIS, TN 
MIAMI. FL 
MILES CITY, MT 
MILWAUKEE, Wl 
MINNEAPOLIS, MN 
MONTGOMERY, AL 
MONTROSE. NY 
MOUNTAIN HOME. TN 
MURFREESBORO, TN 
MUSKOGEE, OK 
NASHVILLE. TN 
NEW ORLEANS, LA 
NEW YORK. NY 
NEWINGTON, CT 
NORTHAMPTON, MA 
NORTH CHICAGO. IL 
NORTHPORT, NY 
OKLAHOMA CITY. OK 
OMAHA. NE 

PALM BEACH COUNTY. FL 
PALO ALTO, CA 
PERRY POINT. MD 
PHILADELPHIA. PA 



240 





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FACILITY 

TOPEKA, KS 

TUCSON, AZ 

TUSCALOOSA, AL 

TUSKEQEE.AL 

WACO. TX 

WALLA WALLA, WA 

WASHINGTON, D.C. 

WEST HAVEN, CT 

WEST LOS ANGELES. CA 

WHITE CITY, OR 

WHITE RIVER JUNCTION, VT 

WICHITA, KS 

WILKES-BARRE, PA 

WILMINGTON. DL 

TOTALS 



242 



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REGION 1 

FACILITY 

ALBANY, NY 
ALTOONA, PA 
BALTIMORE, MD 
BATAVIA, NY 
BATH, NY 
BECKLEY. WV 
BEDFORD. MA 
BOSTON (OPC), MA 
BOSTON, MA 
BROCKTON, MA 
BRONX. NY 
BROOKLYN, NY 
BUFFALO, NY 
BUTLER. PA 
CANANDAIGUA, NY 
CASTLE POINT, NY 
CLARKSBURG, WV 
EAST ORANGE, NJ 
ERIE, PA 

FORT HOWARD, MD 
HAMPTON. VA 
HUNTINGTON. WV 
LEBANON, PA 
LYONS, NJ 
MANCHESTER, NH 
MARTINSBURQ, WV 
MONTROSE, NY 
NEW YORK. NY 
NEWINGTON. CT 
NORTHAMPTON, MA 
NORTHPORT, NY 



243 



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REGION 1 

FACILITY 

PERRY POINT. MP 
PHILAPELPHIA. PA 
PITTSBURGH (HP), PA 
PITTSBURGH (UP). PA 
PROVIDENCE, Rl 
RICHMOND, VA 
SALEM, VA 
SYRACUSE. NY 
TOGUS, ME 
WASHINGTON, DC 
WEST HAVEN, CT 
WHITE RIVER JUNCTION, VT 
WILKES-BARRE, PA 
WILMINGTON, PL 

TOTALS - REGION 1 



244 



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REGION 2 

FACILITY 

ALLEN PARK, Ml 


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REGION 2 

FACILITY 

MARION, IN 
MILWAUKEE. Wl 
MINNEAPOUS. MN 
NORTH CHICAGO, IL 
OMAHA, NE 
POPLAR BLUFF. MO 
SAGINAW. Ml 
SALISBURY, NC 
SIOUX FALLS, SD 
ST CLOUD. MN 
ST LOUIS, MO 
TOMAH. Wl 
TOPEKA. KS 
WICHITA. KS 

TOTALS - REGION 2 



246 



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REGIONS 

FACILITY 

ALEXANDRIA, LA 
AMARILLO. TX 
ASHEVILLE, NC 
ATLANTA, GA 
AUGUSTA, GA 
BAY PINES, FL 
BIG SPRING, TX 
BILOXI. MS 
BIRMINGHAM. AL 
BONHAM. TX 
BREVARD COUNTY, FL 
CHARLESTON, SC 
COLUMBIA. SC 
DALLAS, TX 
DUBLIN, GA 
DURHAM, NC 
EL PASO (OPC). TX 
FAYETTEVILLE, AR 
FAYETTEVILLE, NC 
GAINESVILLE, FL 
HOUSTON. TX 
JACKSON, MS 
KERRVILLE, TX 
LAKE CITY. FL 
UTTLE ROCK, AR 
MARLIN, TX 
MEMPHIS. TN 
MIAMI. FL 

MONTGOMERY, AL 
MOUNTAIN HOME, TN 
MURFREESBORO, TN 



247 





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REGION 3 

FACILITY 

MUSKOGEE, OK 
NASHVILLE, TN 
NEW ORLEANS, LA 
OKLAHOMA CITY, OK 
PALM BEACH COUNTY, FL 
SAN ANTONIO. TX 
SAN JUAN. PR 
SHREVEPORT, LA 
TAMPA, FL 
TEMPLE, TX 
TUSCALOOSA, AL 
TUSKEGEE, AL 
WACO, TX 

TOTALS - REGION 3 



248 



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REGION 4 

FACILrTY 

ALBUQUERQUE, NM 
AMERICAN LAKE, WA 
ANCHORAGE, AK 
BOISE. ID 
CHEYENNE, WY 
DENVER, CO 
FORT HARRISON, MT 
FORT LYON, CO 
FRESNO, CA 
GRAND JUNCTION, CO 
HONOLULU (OPC), HI 
LAS VEGAS (OPC), NV 
UVERMORE. CA 
LOMA UNDA, CA 
LONG BEACH. CA 
LOS ANGELES (OPC). CA 
MARTINEZ, CA 
MILES CITY, MT 
PALO ALTO, CA 
PHOENIX, AZ 
PORTLAND, OR 
PRESCOTT, AZ 
RENO. NV 
ROSEBURQ. OR 
SALT LAKE CITY, UT 
SAN DIEGO. CA 
SAN FRANCISCO, CA 
SEATTLE, WA 
SEPULVEDA, CA 
SHERIDAN. WY 
SPOKANE. WA 



249 



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REGION 4 

FACILrTY 

TUCSON, AZ 
WALLA WALLA, WA 
WEST LOS ANGELES. CA 
WHITE CITY, OR 

TOTAL REGION 4 



250 



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FACILITY 

REGION 1 

PERCENT OF TOTAL 

REGION 2 

PERCENT OF TOTAL 

REGIONS 

PERCENT OF TOTAL 

REGION 4 

PERCENT OF TOTAL 

TOTALS 

TOTAL PERCENTAGE 



251 



To: Honorable Lane Evans, Chairman 

Subcommittee on Oversight and Investigations 
Committee on Veterans' Affairs 

Social Services for Vietnam Veterans and Their Families 
Current Programs and Future Directions 

Response to Questions for Thomas D Schroeder 
Executive Director 

Rock Island County Council on Addictions (R1CCA) 
East Moline, Illinois 61244 

1 . Coordinating receipt of the social services needed by Vietnam Veterans and their 
families is one type of assistance provided by the Vietnam Veterans and Families 
Assistance Program Based on your experience with V.A., does V.A. effectively 
coordinate the social services needed by veterans and their families 9 How could V.A. 
better coordinate the services needed by veterans and their families 9 

Our experience through the Vietnam Veterans and Families Assistance Program has 
resulted in a perceived inconsistency in the delivery of service to the families of Vietnam 
era veterans by the V.A The systemic structure of the V.A. means that the veteran is 
often treated in isolation, and services to the family are delivered from a piecemill 
perspective, referred to one or many local social service providers, or not provided at all. 
Families consequently come to the Vietnam Veterans and Families Assistance Program 
with a feeling of disgust and distrust as a result of their experiences with the V.A. 

Families of Vietnam era veterans could be better serviced by the V.A. through the 
adoption of a family systems/wholistic approach that involves true case management of the 
numerous issues facing the Veteran and his or her family Families need and deserve 
comprehensive planning and advocacy for the multitude of 
employment/housing/health/education/communication issues they face 

2 Why are Vietnam veterans and their families who have been assisted by the Vietnam 
Veterans and Families Assistance Program more likely to identify and receive social 
services from community resources 9 

The Vietnam Veterans and Families Assistance Program successfully tears down many of 
the artificial barriers inherented in social services delivery to families. The program case 
workers travel to the homes of the veteran families when necessary to meet with the family 
on their terms and at their convenience. The difficult paperwork required by the VA, 
SSA, or other federal, state or local entities is tacked by the case worker and the family 
jointly. The family is dealt with as a wholistic unit, with careful attention paid to the effect 
of any service on all members of the family 



252 



At every step of service coordination or delivery, families are treated with respect and 
dignity It is important to note that the case workers of the Vietnam Veterans and 
Families Assistance Program are Vietnam Veterans who have been serviced or disserviced 
by bureaucracy laden programs, and are therefore extremely cognizant of the need to treat 
families with humane compassion and empathy. 

The treatment families receive from the Vietnam Veterans and Families Assistance 
Program results in families being more likely to seek and secure services from other 
community resources. 

3 How do the social service needs of the families served by the Vietnam Veterans and 
Families Assistance Program differ significantly from other families 9 How has the 
Vietnam Veterans and Families Assistance Program informed the community resource 
programs of the differences 9 

Families served by the Vietnam Veterans and Families Assistance Program differ 
significantly from other families in many ways Exposure of the Veteran to Agent Orange 
directly creates a seemingly endless list of physical / psychological / behavior problems for 
the Veteran and his/her children, and coping/adaptation problems for other family 
members To complicate the family situation further, the medical and social service 
community has traditionally been slow and resistant to recognize and identify health issues 
of Agent Orange exposure, and consequently families have endured mis-diagnosis, failed 
treatment and systemic ignorance Families served by the Vietnam Veterans and Families 
Assistance Program are therefore reluctant to trust the program, hesitant to open up to the 
caseworkers, frustrated by past experiences, and wary of placing hope in the services 
provided by the program 

The program has attempted to inform the community by conducting inservice workshops 
for many community resource programs, speaking to service organizations, veterans 
organizations and community groups; and by working directly with school system 
administrators, counselors, social workers and psychologists to assist the school systems 
in designing procedures to identify A.gent Orange history and exposure in children of 
Vietnam era veterans 



253 



Institute for Human Development University of Missouri-Kansas City 

Health Sciences Building, Third Floor 

2220 Holmes Street 

Kansas City, Missouri 64108-2676 



October 13, 1994 



W$ 



Honorable Lane Evans 
Committee on Veterans' Affairs 
335 Cannon House Office Building 
Washington, DC 20515 

Dear Lane, 

I am sorry it has taken me a while to respond to your questions following my 
testimony. The problem, as you posed it, is, "According to your prepared statement, 'Our 
problem is that we still do not have a capacity, a commitment, and a plan of action within 
these service systems to assume responsibility for sustaining the needed coordination and 
integration to provide the services AOCAP has found to be beneficial and effective for these 
vets and their families.' What needs to be done to solve this problem? Are you optimistic it 
will be solved?" In response to your last question, I am optimistic they can be solved. 
However, the organizational changes necessary within Veterans services and some social 
services are significant. I have tried to outline an initial plan, the required outcomes, and 
necessary actions and strategies that could be implemented. 

The issue of commitment comes first. This can be realized in terms of outcomes and 
specific values. In order to change the existing service system, a new way of thinking about 
services and the responsibility for their delivery must be embraced. The focus or outcome of 
such thinking must consider creating a lifestyle that can help veterans and their families 
contribute in local community life. It means that we need to create an alternative to traditional 
planning efforts that will enable people to think about their future, solve problems and work 
with natural supports that already exist in the community, as well as government support. 
This is the essence of what is working for existing AOCAP programs. We have been able, 
through planning tools like personal futures planning, to help change people, to re-imagine 
what is possible and to reevaluate our own roles and investments in making these ideals 
possible. 

In contrast, traditional services and planning emphasize the deficits and needs of 
people, overpower them with endless goals and tracking procedures, and assign responsibility 
for decision making to professionals with narrow perspectives. These professionals often 
maintain the status quo of the existing organizational structure by focusing on accomplishments 
that are only possible within existing programs and structure. The messages that are given 
undermine the service recipients' confidence and growth with the not so subtle message: "You 
are the problem. You need to be fixed. You must learn to adapt. We (the professionals) will 
keep you out of the community until you are ready." 



r Dfvelopmenial DvabilM 



254 



On the other hand, if service agencies and their staff listen to what veterans and their 
families are telling them, they find many activities, people, and experiences that offer clues as 
to what conditions in their settings need to change. If the outcome is the desire to be part of 
community life, it is then the professionals' job to negotiate needed organizational changes that 
may stand in the way. Central to this is the belief that "it is our job to work to negotiate 
needed organizational changes that will establish the link to community lifestyles." In this 
process families, caring supportive friendships, and other natural supports (i.e., churches) are 
essential to an individual's well being. 

In addition to the characteristics of AOCAP I outlined in my testimony, e.g. sensitivity 
and respect; need to be recognized as a family; need for social support in the community; the 
need for information and training; and the need for advocacy, (Calkins, May 1994) there are 5 
outcomes that must be sought by any reorganization of existing services. These are: 

1 . A Positive View of People 

The definitive outcome noted here seeks the capacities or strengths in 
individuals or families. The result is that debilitating effects of dealing with 
labels, diagnosis or associated disabilities is compensated by a capacity-seeking 
process that generates a view of the future and constructive energy that helps 
people change. 

2. Motivation by Inspiration and Success 

The outcome here is the future vision that comes from success through 
individual decision making which others support. When one feels in control, 
he can create, invent, or seek answers that may not be readily apparent in the 
existing service delivery system. 

3. Personal Empowerment 

Empowerment is an outcome that is revealed by joint problem solving with 
agencies, friends, and families. An individual takes responsibility for his or her 
own lifestyle. 

4. Community Involvement and Development 

The outcome that results by community involvement and development is a long 
term solution that will sustain over time. The characteristics of this outcome 
are available resources, relationships, and opportunities that renew one's 
lifestyle over time. It also results in less requirements on government support 
or other social services. 

5. Organizational Change 

The outcome that is sought here is continuous returning of system responses. 
With the preceding outcomes in mind, the system continuously seeks to make 
itself more responsive to individuals and families. There must be an allowance 



255 



to reinforce growth and change. In essence, new directions for development 
(e.g., community) are sought and new ways to respond to people are learned. 

Lane. I realize that the preceding comments seek an ideal, but that is what must be 
agreed on first. The next step is to create a structure that will assure the preceding outcomes. 
I would propose that you create a Bureau of Community and Family Services within the 
structure of Veterans Affairs. Their intent would be to invest in the existing AOCAP 
structure. Their mission would be to support the development of community and family 
supports for veterans within each state. As a Bureau, they would not provide any services 
directly, but contract with providers in each state. The Bureau could provide two types of 
funds. 

The first would be community development funds. These funds would be targeted at 
leveraging existing resources, e.g., benefits at national, state and local levels, grants, program 
development and networking with other agencies. As an example, one case coordinator in our 
AOCAP project in Missouri generated over $1,105,760 in national, state and local resources 
in two years serving ninety-eight veterans and their families. Likewise, using this same 
principle. University Affiliated Programs generate $28 for every federal dollar allotted in their 
core grant. These funds are directed at capacity building in the existing system. I would 
suggest that a minimum allotment of $200,000 be allocated to a state and channeled through a 
UAP program. 

Secondly, some purchase of service (POS) dollars are needed to directly support 
families. We know when we invest in families, the veterans get better also. POS could come 
from redirected resources within Veteran Affairs. There is also now National Family Support 
legislation as well as similar support in most states. The POS funds could amount to $500,000 
for each state and be directed to existing AOCAP programs. Family support dollars are cost 
effective because they decrease long term effects of disabilities and prevent expensive 
alternatives like institutionalization. 

With a community development structure and Family Support POS dollars in place, the 
outcomes associated with the current AOCAP programs could be maintained. A pilot program 
for 10 states would cost $7 million. This level of organizational change would require 
ongoing training of federal, state and local agencies. However, that training could be expected 
from the development funds. The structure that I have outlined would provide movement from 
a depending model to an empowerment model of services and supports. 

Lane, I realize this is just an outline, but I would be glad to work with you to fill in the 
details. A newly formed National Alliance of Veterans and Families Services would be very 
helpful as well. Gary May is the current President. This organization has just formed from 
the existing AOCAP programs. 



256 



I hope this is helpful. Please do not hesitate to contact me for further assistance. 
Sincerely, 



C*JL F&lIU 



Carl F. Calkins 
Director 



257 



Florida State 

UNIVERSITY 

Psychosocial Stress Research Program 
103 Sandels Building 
Tallahassee, Florida 32306^*097 
(904) 644-1588 FAX (904) 644-4804 



October 13, 1994 



The Honorable Lane Evans, Chairman 

Subcommittee on Oversight 

and Investigations via fax: 202-225-2629 

U S. House of Representatives 
Committee on Veterans' Affairs 
338 Cannon House Office building 
Washington, DC 20515 

Dear Congressman Evans: 

Thank you for your letter of May 25. Unfortunately, I only received a fax copy of this 
important letter today. I am responding immediately, since the subject you address is 
so vitally important. 

In your letter you posed six questions. I will restate each and attempt to answer them 
here as fully as possible and hope that you will ask me to clarify as you see the need 
I assure you that I will respond immediately after receiving your correspondence. 

1. What are "family-centered veteran services" and how do they differ from 
traditional veteran services? Why are "family-centered veteran services" 
important and what are the advantages and disadvantages of this approach 
compared to traditional veteran services? 

Family-centered (FC) veteran services are those that focus on the well-being of the 
veteran's family and family-like support system, as well as the veteran so that the 
family functions as an effective support system. Thus, FC veteran services considers 
the needs of everyone in the family in the assessment and service delivery plans. FC 
veteran services are important because of their advantages. More than any institution, 
agency, or group, the family knows the veteran better and, with sufficient resources, 
can provided the kind of individualized care most needed by the veteran all of the time 
and for the rest of the veteran' life. Considerable research has supported the tenet that 
patient compliance in following pre- and post-operative care, for example, is directly 
related to the quality of the marital relationship Traditional care, in contrast, include 
family members only as "next of kin" and are viewed only as a component to 
patient/client/recipient services. Often medical decisions are made, for example, with 
no regard for the best interests of the family and, in the case of the location of 
treatment, may literally remove the veteran from the care and attention of family 
members. FC veteran services would always conduct a family impact assessment to 



258 



determine if the services provided would enhance or diminish the quality of family 
relationships, especially marital relationships. 

2. Compare the cost of traditional veteran services with the cost of "family- 
centered veteran services." Are "family-centered veteran services" more costly 
or more cost-effective for providing effective treatment to veterans than 
traditional veteran services? Please provide evidence which supports your 
response. 

The costs of FC services are far less than the more traditional veteran services in that 
the latter services inadequately calculate the hidden value of family member attention 
to and provisions for the needs of the veteran. In the case of combat-related PTSD, 
for example, family members know better than anyone else how the veteran is 
functioning and how it is affecting everyone in the family, including the children. 
Treatment services that focus exclusive on the veteran must assess the veteran 
without this vital knowledge known only to family members. Moreover, information 
about the veteran's war experiences, the post-war adjustments, and other vital 
information and insights the veteran shares with therapists are critical in helping the 
family recover from the secondary traumatic stress they have experienced in living 
with the veteran. They too need sufficient attention to their own war at home. 

It is difficulty to provide evidence for the position of the cost-effectiveness of FC 
veteran services, since such services do not exist at this time. However, I will send a 
copy to my colleagues in the American Association for Marriage and Family Therapists 
and the Division on Family Psychology of the American Psychological Association for 
their comments and possible evidence to show the cost effectiveness of mental health 
services that are family-centered. I believe that there are similar groups that focus on 
medical, dental, and vocational services that could respond as well. 

3. What are your recommendations regarding the provision of "family-centered 
veteran services" by VA? 

Unfortunately I am unfamiliar with the current provisions to comment with any 
authority. From my limited knowledge, I know that there are very few family-centered 
or "systems informed" mental health professionals and even fewer that focus on 
benefits, vocational education, and medical and dental services. This is very 
unfortunate. The movement toward managed care in which family practitioners provide 
a primary role as a service "gatekeeper," illustrates the direction in which the VA 
Medical system must go: Attending to the health needs of all family members for the 
benefit of each one, including the veteran. 

4. Please comment on the social costs and consequences of "secondary traumatic 
stress." 

There is now ample evidence emerging from the scientific literature based on studies 
in the Israel, the Netherlands, Canada, as well as in the US that the social costs and 



consequences of secondary traumatic stress (STS) is enormous. The costs can be 
viewed from the point of view of both professional service providers and from the point 
of view of family members and other supporters of the traumatized, such as combat 
veterans with PTSD. My most recent book, Compassion Fatigue: Secondary 
Traumatic Stress from Treating the Traumatized (New York: Brunner/Mazel, 1995) 
documents the high turnover rate among those who work with traumatized people. 
This is especially true among child protection workers, nurses in critical care units, and 
911 dispatchers. But it is also true among those who work with combat veterans. Until 
recently the simple explanation of "burnout" satisfied most who were concerned. 
However, we now know that STS or compassion fatigue is the real reason. It is a 
special form of burnout associated with the nature of the clientele and the inability of 
the professional to both derive a sense of satisfaction for their efforts to relieve the 
suffering and their inability distance themselves from their clientele. 

The suffering of family members, especially the children, who serve as supporters to 
the traumatized, has gone unnoticed until the last decade. It was first documented in 
the spouses (especially the wives) of combat veterans and POWs (see "interpersonal 
adjustment among Vietnam veterans," in my 1978 book, Stress Disorders Among 
Vietnam Veterans: Theory, Research, and Treatment), then among the families of the 
Americans held hostages held by Iran in 1980, Holocaust survivor children, family 
violence and other abuse, and a wide variety of traumatizing situations. 

The result of this is an impaired family system that is ineffective in function for its 
members and, in turn, becomes a burden on its community and country when these 
problems are left unattended. Children, for example, exposed to a family member with 
active PTSD most often develop the parallel symptoms of STSD, do poorly in school- 
socially and intellectually, and do not reach their potential. I would be happy to provide 
you with a full list of references that document these problems. 

5. Describe the possible generational consequences and costs of not providing 
family-centered veteran services. 

In addition to what is noted above, when left unattended, families do the best they 
can. Often this effort to cope runs counter to treatment plans emerging from traditional 
veteran services providers. In the case of children of a veteran who is heavily 
medicated, for example, they frequently lose respect for their parent veteran, assume 
that this is the natural and normal costs to military service, and a sense that your 
country has a limited commitment to those "who bore the battle." Moreover, any 
services for the children, most often delivered outside the context of veteran services, 
will not fully integrate the services delivered to the veteran. As a result the integrity of 
the family is compromised and the natural support and caring is undermined. Again, 
there are ample published works that address this issue and can be made available to 
the Committee. 

6. Is the trauma treatment likely to be less successful if it is not family oriented? 
Please explain your answer. 



260 



As noted above, trauma treatment focused exclusively on the individual traumatized 
person is flawed in at least two ways. As noted in my book, Treating Traumatized 
Families (San Francisco: Jossey-Bass, 1989), disclosures by the traumatized person 
that specifies what happened, why they believe it happened, why they acted and felt 
as they did during and following the event, and their concerns about similar events in 
the future are all critical information to the person's supporters. This information 
enables them to understand and often accept how and why the family member 
behaved as they did and do. Traditional treatment programs are also flawed because 
they do not address the full impact of the traumatic experiences for other family 
members. Memories of a father screaming in the middle of the night, for example, 
leave lasting negative impressions that must be addressed fully and candidly to 
eliminate the negative consequences for the children who experienced them. Finally, 
by focusing on the traumatized family, not just the veteran, there is greater likelihood 
that everyone one will recover at a similar rate and that the treatment will be lasting 
and enable the family to be even stronger and more prepared for other crises that 
confront them. 

Thank you again for your interest in my opinions regarding my testimony before your 
important Committee. Please let me know if I can be of further assistance. 




y — - - i a -A 

Srles R. Figley, Ph.D. (J 
Professor and Director 

cc: Michael Bowers, AAMFT Executive Director 

Ronald F. Levant, Division 43 (Family Psychology) of the APA 



261 

JUL ZZ 1994 



nonoracie Lane tvans 

Chairman 

Subcommittee on Oversight & Investigations 

Committee on Veterans' Affairs 

Social Services For Vietnam Veterans And Their Families: Current Programs 
And Future Directions 



1. In your opinion, what is the relationship, if any, between the 
trauma you experienced due to combat and the less than honorable 
discharge you received? 

The traumatic relationship between my combat experiences and the 
le3s than honorable discharge I received had and contines to have special 
problems many of them relating to psychological readjustment to civilian 
life Because of my bad discharge and combat experiences I became 
dependent on alcohol I couldn't keep a job. I had no skills or training 
that would get me a decent job I couldn't get help from the VA with the 
less than honorable discharge. Due to the unpopularity of the war, my 
combat experiences and less than honorable discharge, I returned home to a 
society that made me feel different and alone. As an African American 
Vietnam veteran, I felt even more alienated because I represent a small 
minority of society that have always been subject to racism and 
discrimination. In addition my Vietnam combat experiences and less than 
honorable discharge perhaps will always have a lasting and powerful effect 
on my life 

2 Are you currently eligible for all VA benefits? 
Yes, I am currently eligible for most VA benefits. 



~*> 



^5^f^T^^^ 



91-084 0-95-10 



262 



Agent: Orange Class Assistance Program 

P.O. Box 27413 

Washington, D.C. 2D03B-7413 

(202) 2B9-B173 



July 6, 1994 



Honorable Lane Evans, Chairman 
Subcommittee on Oversight and Investigations 
Committee on Veterans Affairs 
335 Cannon House Office Building 
Washington, D.C. 20515 

Dear Mr. Chairman, 

Attached are my responses to the questions you posed in your letter of May 25, 
1994, as a followup to the May 18th subcommittee hearing on social services for Vietnam 
veterans and their families. 

I appreciate the opportunity to furnish information on the experience of the Agent 
Orange Class Assistance Program in assisring Vietnam veterans and their families. 



STtoerely yours 



UUf) 




Dennis K. Rhoades 
Executive Director 



263 



According to your testimony, 72 AOCAP network programs provide 
broad based social services to Vietnam veterans and their families 
and have provided services to over 150,000 persons to date. 

A. How many additional individuals in this class would be expected 
to benefit from but have not yet received, broad based social services 
like those provided by AOCAP network programs? What is the basis 
of your estimate? 

Assessing the universe of need among AOCAP-eligible veterans and 
their families is difficult, because the class itself does not conform to 
the veteran population cohorts which the federal government tracks 
through the census. The court has defined a member of the class as 
any person who served in Vietnam between 1962 and the end of 1971, 
which is the time period during which Agent Orange was used. In 
addition, however, the class also includes the veteran's parents, 
spouse, and children. For operational purposes, we have estimated 
that the class includes 2.5 - 3 million veterans, as well as another 8-10 
million relatives. The class itself is therefore large. To estimate the 
number of persons in the class needing services, certain inferences 
can be made from available statistical data. First, according to the 
Research Triangle Institute, approximately 15% of veterans who 
served in Vietnam suffer from Post Traumatic Stress Disorder 
(PTSD) to one degree or another. As Dr. Charles Figley has pointed 
out in his testimony, PTSD is likely to have negative ramifications for 
the veterans' family. Second, national studies have shown that 
approximately two to two and one half percent of all children in the 
United States have developmental or other chronic disabilities. The 
children of Vietnam veterans, however, are unusual in this regard. 
Data collected by the National Information System at the University 
of South Carolina indicate that the families of Vietnam veterans 
differ from other families in that there is a higher rate of disability 
within the family (i.e., Vietnam veterans are likely to have more than 
one child with a disability) and that the children are more likely to 
have multiple disabilities. 

B. How much financial support does AOCAP provide annually to 
network programs and how many individuals receive services on an 
annual basis from AOCAP network programs? 

The Assistance Program currently provides $12.3 million per year to 
the 72 projects in the Vietnam Veterans Family Assistance Network. 
This support assists approximately 40,000 individuals annually. 

The provision of services to Vietnam veterans' children with 
developmental or other chronic disabilities and related services to 
families have been a high priority for AOCAP. What other services 
have been priorities for AOCAP? 

AOCAP also places a high priority on the family, both as a unit of 
care and as a resource for healing. In evaluating early grants, we 
began to recognize the high degree of dysfunction among many of the 
families served by the network. Grantees further reported that the 
incidence of dysfunction often appeared to be directly related to Post 
Traumatic Stress Disorder (PTSD). This evaluation paralleled the 
findings of the National Vietnam Veterans Readjustment Study 
which reported that "...707< (of all Vietnam veterans with PTSD) 
have been divorced ... and 49% have high levels of marital or 
relationship problems." Currently, the Veterans Administration 
(VA) -- through its Readjustment Counseling Program -- provides 
very little family counseling. Thus, through its network of grantees, 
the Assistance Program is filling a large gap in treating the effect of 
PTSD on families and in bringing a family centered approach to bear 
on the problems of Vietnam veterans. 



264 



Equally important, given limited resources and the large size of the 
class, we were determined to magnify the impact of settlement funds 
by using limited settlement dollars to leverage resources available 
through government and private agencies. Thus, one of the 
priorities of the AOCAP program has been the network's use of 
service coordination. Such coordination amplifies the impact of 
settlement funds, fosters development of class members' skills in 
using community programs and services, and represents a more 
holistic, integrated approach to serving people. 



Will the social service needs of Vietnam veterans and their families 
be met without AOCAP-like provided support in the future? 

AOCAP's current program emphasis was developed precisely 
because many of the social service needs of Vietnam veterans and 
their families were not being met either through the veterans 
services system or the broader human services system. Moreover, it 
is doubtful that any legislation, either pending or recently passed, yet 
addresses the broad spectrum of social service needs of Vietnam 
veterans and their families. In designing AOCAP's service network, 
we sought to fill gaps in the service system as evidenced by testimony 
from the court's Fairness Hearings, the large numbers of letters and 
phone calls we took from members of the class, and the original 
claims made against the settlement. During the five and half years 
of AOCAP's operation, there has been little movement on the part of 
the federal government to fill these gaps. In part, this is attributable 
to the fact that the Vietnam Veterans Family Assistance Network 
has itself taken the initiative to meet the social services needs of the 
class. Additionally, however, there has continued to be little 
recognition - especially in the relatively isolated world of veterans 
affairs - that these gaps exist at all. 

How can VA better meet the social service needs of Vietnam veterans 
and their families? 

First, the VA needs to become a family-oriented agency, adopting the 
family as the unit of care rather than the individual veteran. The 
concept of a "dependent" has a quaint, antiquated ring to it in our 
contemporary society. The family is the veteran's primary support 
system, and its dynamics are often vital to the readjustment and 
rehabilitation of the individual veteran. 

Second, the VA should take a more holistic approach to service 
provision, i.e., service coordination. How many VA service providers 
are currently conversant with SSI, or the peculiarities of Medicaid? 
For too many, I suspect, once the avenues of VA benefits and services 
are explored and exhausted, veterans and their families in need are 
turned away rather than assisted in examining alternatives. 

Third, the VA's services and programs are among a shrinking 
minority which are still operated directly by the federal government. 
As I indicated in my testimony, the trend toward decentralization of 
programs is now over a generation old. Large scale national 
categorical programs are becoming rarer as we approach the end of 
this century. This is not to suggest that the veterans services system 
should in some way be defederalized, and responsibility for services 
shuffled out to the states. That particular avenue is frought with 
dangers in and of itself, as the Department of Labor has so clearly 
demonstrated over the years. What it does suggest is that the VA, its 
medical centers, counseling functions and other programs, needs to 
become considerably more community-oriented and community 
intergrated. Effective coordination of services with state and local 
agencies can only be achieved if the VA becomes, either directly or 
through contracting out, an active, visible partner in the human 
services system at both the state and local levels. 



265 



A. What have traditional social service providers learned about the 
unique social service needs of Vietnam veterans and their families 
from AOCAP network programs? 

Perhaps the first lesson that social service providers learn (and need 
to learn) is that the Department of Veterans Affairs does not provide 
all of the services needed by a veteran and his or her family. Too 
often, the VA is perceived as providing such a broad constellation of 
assistance that other public agencies are somehow absolved of the 
responsibility for serving what they perceive as this "special 
population group." 

Within the social services system, it has become apparent that, in 
order to provide appropriate service coordination to veterans' 
families, a multitude of agencies often must be dealt with i.e. 
housing, developmental disabilities, veterans, mental health, 
alcoholism/substance abuse, employment, education. Many of these 
systems are interacting for the first time, and all have widely variant 
regulations/eligibility criteria etc. Maneuvering among these groups 
to put together any kind of service(s) package often requires 
innumerable hours of effort. 

Within the developmental disability community in particular, it has 
only been recently that the needs and issues facing the entire family - 
rather than the individual - have been considered when providing 
services. This is particularly relevant when dealing with a veteran's 
family because in addition to the disability factor, issues such as 
PTSD and secondary PTSD (as well as other problems specific to the 
veteran and his or her family) may be adding stressors to the family 
unit. 

There is a major need for training within and among service systems 
regarding the special needs of veterans and their families. This 
ultimately leads to both increased understanding and better 
coordination of services. 

B. How have traditional social service providers responded to what 
they have learned about the unique social service needs of Vietnam 
veterans and their families? 

When veterans' families are initially perceived as a "special 
population", there is often a reticence about the potential (and 
unknown) cost of serving a "new" group of people. The fact is that 
service rationing is very often a reality, particularly in states and 
communities which are financially strapped. Eventually, in many 
cases, the systems come to recognize that they are, in all likelihood, 
already serving the veterans' family in some capacity. Without the 
knowledge that a member of the family is a veteran, however, 
problems peculiar to the families of some veterans (e.g., secondary 
PTSD) may go unrecognized. Very often, these families will appear 
unresponsive to conventional counseling and service strategies to the 
bafflement of the service provider. 

Many social services providers have thus expressed a strong interest 
in receiving more information/training on the unique needs of 
Vietnam veterans' families. To date, no comprehensive and 
coordinated initiative has taken shape although we are currently in 
discussion with the Bureau of Maternal and Child Health (MCH) at 
the Department of Health and Human Services (HHS) on 
development of one such project. Providers have also indicated that 
the service coordination function developed by the AOCAP network 
has provided an important link between systems that have not 
previously dealt extensively with each other on a local, state or 
federal level (specifically veterans and HHS). 



266 



C. How can information about the unique social service needs of 
Vietnam veterans and dieir families be widely and effectively 
disseminated to traditional social service providers? 

As mentioned previously, we have begun discussions with MCH 
regarding development of a training video and accompanying 
manual on Vietnam veteran/family needs. AOCAP training projects 
could be disseminated as models to help demonstrate how to 
effectively meet and respond to family issues and to systematically 
develop service responses at the local level. As part of this concept, 
we are exploring usage of a regional telecommunication process to 
disseminate information as widely and cost effectively as possible. 
We would like to explore similar initiatives with the developmental 
disabilities and education fields. Additionally, we would like to work 
with the VA on training in areas such as incorporation of spouse and 
family issues when dealing with veterans. 

In your opinion, what actions should the federal government and 
particularly the Department of Health and Human Services take to 
respond to the unique needs of Vietnam veterans and their families 
when AOCAP financial assistance is no longer provided to 
community-based social service agencies for this purpose? 

Based on the experience of the AOCAP network the two major 
emerging areas of need appear to be appropriate service coordination 
and increased public awareness vis a vis on-going training and 
technical assistance efforts. We would like to further explore the 
following actions: 

—Development of a federal interagency task force consisting of the 
VA, HHS (MCH & ADD), Education, National Institute of Mental 
Health and Defense (we strongly feel that the issues facing all vets 
and currently active military personnel are similar enough on 
many levels to warrant broadening the AOCAP model 
accordingly) to send a signal to states and localities of both the 
importance of this issue and the intention of a collaborative 
approach in dealing with it. 

--Inclusion in various agency RFP's of Vietnam veterans as a 
targeted/special popluation, thereby allowing programs interested 
in providing services equal access to existing funding streams. 

—Development of special collaborative projects (i.e. through 
SPRANS grants) in demonstrated areas of need. One specific idea 
would be the support for emerging grass roots regional consortia 
to address Vietnam veterans issues. Another concept could be the 
previously mentioned training/technical assistance initiative. 



267 



QUESTIONS SUBMITTED BY 

HONORABLE LANE EVANS, CHAIRMAN 

SUBCOMMITTEE ON OVERSIGHT & INVESTIGATIONS 

COMMITTEE ON VETERANS' AFFAIRS 

SOCIAL SERVICES FOR VIETNAM VETERANS AND THEIR FAMILIES: 
CURRENT PROGRAMS AND FUTURE DIRECTIONS 

MAY 18, 1994 

QUESTIONS FOR MS. EILEEN PENCER 

VICE PRESIDENT, CHIEF PROGRAM OFFICER 

LOWER EASTSIDE SERVICE CENTER, INC. 

NEW YORK, NY 



Before receiving financial support from AOCAP, did the Lower Eastside 
Service Center provide Vietnam veterans and their families social services 
which they needed? 

Before receiving financial support from Agent Orange Class Assistance 
Program (AOCAP), the Lower Eastside Service Center (LESC) provided 
substance abuse services for Vietnam veterans in accordance with 
New York State Division of Substance Abuse Services' guidelines. 
Social services were provided only for substance abusing clients (in 
this case, veterans) - not their families. In the course of providing 
services to these veterans, we learned that they had special needs 
and that their needs (and those of their families) were not being 
adequately addressed. Thus, when AOCAP funding became available, 
LESC seized the opportunity to access this funding resource that 
promoted a family-centered approach and enabled LESC to provide 
Vietnam veterans and their families the social services they needed. 
LESC's broad range of social services, made possible by AOCAP 
funding, would no longer be available if AOCAP funding were 
discontinued. 

How have the social services provided to Vietnam veterans and their families 
by the Lower Eastside Service Center changed since the Lower Eastside 
Service Center has received financial support from AOCAP? 

As a result of financial support received from AOCAP, LESC currently 
provides through Vietnam Veterans Family Services Center (VVFSC) 
specialized services for Vietnam veterans and their families and 
through our outpatient and residential services, a broad continuum of 
treatment and service coordination for this treatment population. 
VVFSC's services include individual, couples and family therapy; 
group therapy for children, adolescents, adult children of Vietnam 
veterans and women; PTSD and secondary PTSD 
counseling/education as well as case management services. 

LESC's coordinated service delivery system has significantly enhanced 
the quality of social services provided to Vietnam veterans and their 
families. VVFSC staff provide training for other agency staff to view 
clients from a family-centered perspective, sensitize them to veterans' 
and veterans' families' distinct needs and familiarize them with the 
established network of veterans' community services. Through LESC 
program staffs' consolidated team effort, Vietnam veterans and their 
families receive the social services they need as LESC strives to 
provide consistency of care for veterans and their families 
agencywide. 



268 



What changes will occur in the services the Lower Eastside Service Center 
provides to Vietnam veterans and their families if the financial support 
provided by AOCAP is no longer provided? 

Once AOCAP financial support is no longer provided, specialized 
family services now available to Vietnam veterans and their families 
will be discontinued. The implications of this loss at LESC would be 
far-reaching in that there would be a dismantling of social services 
benefitting Vietnam veterans and their families agencywide and a 
resultant void in the field since these specialized services would be 
unavailable elsewhere. 

VA Vet Center clients and staff would also directly experience a loss 
on many levels, the most important being a significant reduction in 
specialized family services. However, the greatest loss would be 
suffered by whole categories of families, eligible under AOCAP 
guidelines, who would subsequently be denied these same services 
under VA eligibility guidelines. 



What is a "family-centered 'systems'" approach and why should it be used? 
How could VA use a "family-centered 'systems'" approach? 

To view families from a systems perspective is to 
recognize that "relationships formed among' family 
members are extremely powerful and account for a 
considerable amount of human behavior, emotion, values, 
and attitudes, fvloreover, like strands of a spiderweb, 
each family relationship, as well as each family member, 
influences all other family relationships and all other 
family members." (Figley, Helping Traumatized Families , 
1989, p. 4) 

LESC's selection of "family-centered 'systems' treatment" as a core 
value corresponds to an ever-growing trend in the field of social 
services. This treatment approach has gained widespread recognition 
by renowned mental health professionals in the human services field 
as a cost-effective and efficient mental health treatment intervention 
for a broad range of individual and family needs. For example, 
recognized authorities in family therapy such as Salvador Minuchin, 
Jay Haley and Charles Figley (the latter, a Vietnam veteran who has 
become a leading figure in this area) have educated legions of 
professionals in the social services field on the merits of the family- 
centered systems approach, pointing out that this type of intervention 
has been far more successful than individual and/or group treatment in 
the rehabilitation of families. 

In general, the family-centered systems approach addresses the needs 
of the entire family constellation, confronts problems enmeshed in the 
veteran's interpersonal network and includes veteran's family 
members as equal partners in the veteran's rehabilitation. This 
treatment approach is based on the premise that the family support 
system can, with direction and guidance, serve as a valuable vehicle 
for promoting recovery and healing and that family system 
intervention is essential and key to achieve permanent change. 

VA Medical Centers are not suited and could not apply a family- 
centered systems approach within the structure of their existing 
medical model. However, VA Vet Centers could more easily integrate 
a family systems approach through contract for service agreements 
with community based agencies (see below). 



3. Describe your partnership with VA. What are the advantages, 

disadvantages and results of this partnership? How could this partnership be 
modified and improved? 

LESC has established a unique partnership with VA through an 
integrated service delivery model with VA Vet Centers where we have 
established satellite clinics and our family therapists provide services. 
LESC family therapists function as an integral part of the VA Vet 
Center treatment team, participate in case conferences, receive and 
make referrals and collaborate in shared cases. 

The principal advantage of our complementary partnership with VA 
lies in bridging the gap in services to families who are ineligible for 
these services based upon VA eligibility requirements. As a result of 
this synergy, both the quality of services provided to Vietnam 
veterans by VA Vet Centers and the effectiveness of family treatment 
provided by LESC are immeasurably enhanced. Neither VA nor LESC 
can accomplish alone what we have been able to accomplish together. 

The principal disadvantage of our partnership with VA is that, while 
our relationship is collaborative, accommodations in treatment focus 
and clinical decisions are in keeping with the VA model and not 
LESC's family-centered systems model. That is, family treatment is 
provided as an auxiliary service to the veteran. Moreover, due to our 
informal partnership with VA, sensitivity must be exercised in reaching 
clinical decisions and a delicate political balance adhered to, in order 
to maintain our partnership. 

The paradigm for providing family-centered systems treatment is most 
effective when implemented in the context of a community based 
organization. Thus, VA Vet Centers, developed upon the community 
based model, are better suited to integrate the enriched family- 
centered systems approach. VA Vet Centers, positioned as they are 
within the community, could capitalize on the LESC precedent by 
integrating family services and expanding their service delivery model. 
For example, VA Vet Centers could formalize partnerships with 
community based agencies through "contracts for services" similar to 
Medicaid's contracts for case management services for veterans, 
families and/or children with complex needs. 



4. Have veterans and/or family members been referred to your agency by VA? 

Veterans' families have been referred to LESC by VA, primarily from VA Vet 
Centers. 

If referrals have been made to your agency by VA: 

(a) Do you know why VA made these referrals; 

These referrals were made to fill unmet needs and bridge the gap in 
services to families who were otherwise ineligible for these services 
from VA. VA recognizes that LESC family therapists provide 
specialized services such as PTSD, secondary PTSD counseling and 
education as well as war trauma counseling unavailable in community 
mental health agencies. 

VA Vet Centers have made referrals to LESC primarily because of our 
on-site physical presence, easy access and availability. The disparity 
between the number of referrals received from VA Vet Centers and 
VA Medical Centers points to the significance of these variables. 



270 



How many referrals have been made by VA; and 

Of 180 families, approximately 57 families have been referred by VA: 
approximately 80% from VA Vet Centers; approximately 20% from 
VA Medical Centers. 

Do you know why more referrals have not been made by VA? 

Overall, more referrals have not been made as VA considers the 
veteran to be the primary client, the family, an adjunct to the 
veteran's care. Until VA considers family participation essential to the 
veteran's rehabilitation and a formalized service partnership is 
established, family service referrals will remain at a minimum. 



If referrals have not been made to your agency by VA, do you know why VA 
has not referred veterans and/or family members to your agency? 

Not applicable. 



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QUESTIONS AMP ANSWERS 

SUBMITTED TO: 

HONORABLE LAME EVANS. CHAIRMAN 

S U BCD M M I TT E E N OV E RS I G HT A N D I NV EST I GAT ! NS 

CO M M I TT E E N V ET E RA NS ' A F F A I RS 

BY: Thomas M James. JD 
Managing Director 

Community Outreach to Vietnam Era Returnee.; 
Charlottesville . Vi rgi nia 

SOCIAL SERVICES FOR VIETNAM VETERANS AND THEIR FAMILIES 
C U R R E NT P ROG PA MS A N D FUTURE Dl R ECT 1 NS 

1 . How can YA be more successful in meeting the unique social service needs of veterans and their 
families? 

The YA should strengthen the existing Vet Center programs and Contract Programs under the 
Readjustment Counseling Program for veterans. These store front vet centers and community 
based contractors have direct access to the veterans and their families. Many have existed for 
many years and are veil entrenched in their respective communities. They have a working 
knowledge of community resource?, and how to access such resources for their clients. They are 
better able to case manage the needs of the clients by offering support and guidance through any of 
the needed programs. 

The YA. Medical Centers are not seen as part of the community by the veterans. Their formal 
and institutionalized process does not afford the veteran the flexibility necessary to reach needed 
resources. Ti me has shown many veterans fall through the cracks of such large centers. 

2. Have any veterans\and or family members been referred to your agency by the YA? 

It is worth noting that as a contractor to the VA under the Readjustment Counseling Program 
any client we service regardless of the source of their intake is considered to be technically a 
referral from the VA. The contract states that any client serviced by a contractor agency under the 
VA program is to be considered a direct referal from the vet center overseeing the contract. Most 
of our clients come to our office based on refemls by current or past clients of our agency. W't 
call the vet center to get approval for services for an initial three visits for evaluation followed by 
our providing a treatment plan and psych/social to the Vet Center. At that time the Yet Center will 
approve 1 5 visits under the program. The veteran in mo3t situations has never been to or seen the 
authorizi ng vet center. The Yet Center, however, is desgnated by the wordi ng of the contract as the 
refering source. This policy covers all veterans seen under the contract program as well as their 
spouses. 

The contractor must follow the same procedures for approval of services to a spouse. The 
spouse is then considered to be a referral by the VA to the contractor. We may see hundreds of 
veterans and their families during a year and all of them would be considered under the contract as 
being a YA referral. 

We have received approximately six referrals from VAMC's for services by our agency during 
the last fourteen years. These clients were either completing an in - patient substance abuse 
program at the VAMC and were in need of after care or they had gone through the Desert Storm "VA 
program at YAMC's. These programs include meeting with a social worker and discussing any 
problems they might have and then being given a list of possible resources. The veteran is 
responsible for making the contact. It is also worth noting the YAMC's in many cases will work to 
have the veterans serviced through the clinics within the "hospital. 

Our agency, in its fifteen years of direct service to veterans and their families, has never as 
of get received a referral of a spouse or child of a veteran from any VA Medical Center. Any 
spouse or child we have serviced has entered our program through word of mouth referral from 
other clients or from referrals from hospitals and organizations within our community. 



272 



Chairman Evans to Mr. Raymond Swope 



U.S. House of Representatives 
Committee on Veterans' Affairs 
335 Cannon House Office Building 
Washington, DC 20515 

1 . What changes and improvements in services provided to Vietnam Vetera 
their families have occurred as a direct result of the partnership 
AOCAP and Universal Family Connection? 

The changes and improvements we have created has resulted in the following: 

A central place where V.A. , State, and local agencies can refer Vietnam 
veterans with families. 

We provide coordinated case management to reduce waste fragmentation and 
duplication of services. 

2. According to your prepared statement, your agency has been "very 
successful' in meeting unique social service needs of veterans and their 
families. 

What are the unique needs of Vietnam veterans and their families and what 
explains the success of your agency? Please provide several examples of their 
success . 

For eighteen years Universal Family Connection has provided family counseling 
services. Vietnam veterans are unique because they bring their military 
experiences along with mental and emotional disorders to the family unit. 

The family has to cope with the Veterans symptoms of Post Traumatic Stress 
Disorder and their fear of being exposed to a chemical with unknown risk. 

The success of UFC is due in part to our linkage agreements with other social 
service providers. The success of our agency is due to our combine service 
approach. We help with Social Security, V.A. Disability, Public Aid, Food 
Stamps, Handicap Permits, ect. We are a One - Stop - Shop. 

We have a manageable caseload, therefore, the Veterans are seen in a timely 
fashion. Secondly, we are community-based, therefore, very accessible to 
families . 

Examples of Success: 

Every client who enters our office is a success story. These people can't be 
measured in dollars or statistics. When they come in they are confused, hurt, 
and tired from dealing with the system. We give them honest answers and they 
leave with hope. How can you measure thatl 

One of our clients came to us four years ago. He was receiving 50% for a 
service connected disability for PTSD. His four children are all disabled. His 
wife is manic depressive. He could not pay his mortgage and didn't have food. 
In the last four years we helped this family get on Social Security. We are 
assisting his grandchild, who is also disabled, to get S.S.I. At this time, 
we have helped this family to receive $11,000.00 in back benefits from S.S.A. 
Additionally this family has received $10,000.00 in additionally benefits for 
the children. This client also received a $500.00 check to help with his 
mortgage. UFC also provided assistance with food clothing and medical card. 

Why were we able to help him and his family when others failed? We know about 
the programs in the community. We built a trusting relationship with the 
veteran and his family. We listened and coordinated our services with other 
community-based organizations. 

seting the unique social service needs of 

How should VA be reconfigured, as recommended in your statement? 

Which services should VA obtain from community-based social service agencies 
and why should VA purchase these services instead of providing them directly? 

Often times the V.A. can't provide services for the veterans. There is a 25 
year old lack of trust. Veterans benefit from agencies like ours. 

The V.A. should conduct outreach through community based, non-profit, social 
service agencies. Families need a "One-Stop-Shop", not a huge impersonal 
monolith. 

What the V.A. should purchase is not a list of services. They should purchase 
systems which are designed to meet the needs of the individuals. One family 
may need a home, the next psychological counseling, the next a special 
wheelchair, the next Social Security, the next CHAMPVAS, the next may simply 
need information. They need to purchase services from agencies like ours 
which are multi-faceted. 



273 



Dear Mr. Evans, 

Here is my response to the recent set of questions 
you sent to go along with me testimony. 



Why are AOCAP supported organizations seemingly 
so successful in cuttinf through the bureacracy 
to help veterans and their families? 

Aocap supported organizations are family focused 
and community based. They ask the family what their 
needs are and work through community resourves to 
to help the family access the support necessary 
to meet those needs. AOCAP organizations work 
collaboratively with agencies, organizations , and 
individuals. They cross the boundaries of bureaucracies. 

Have veterans and/or family members been referred 
to your agency by the VA? 



If referrals have been made to your agency by VA: 

(a) Do you know why VA made these referrals; 

The family of a Vietnam vet had a child with a 
disability . 

(b) How many referrals have been made by Va; 

Nine out of the total 177 families who have been 
eligible for our services and who have elected to 
to work with us on an individualized family service 
plan were referrals from the VA medical Centers and 
Vet Centers in Arkansas. 

(c) Do you know why more referrals have not been 
made by VA? 

No, the director of our program and the veteran's 
liaison made a presentation at an inservice meeting 
to all of the social workers at the VAMC at the 
beginning of the grant period. The program director 
has met with and advised the Agent Orange Physical 
coordinator, physician, and Vet Center administrator. 
The service cordinator in the northwest corner of 
of the state has worked closely with theVAMC in her 
region of the state. The service cordinator in central 
Arkansas has made quarterly visits to the VA to 
leave materials and keep them advised as to the status 
of our program. 

How can the VA be more successful in meeting the socail 
service needs of veterans and their families? 

In addition to the suggestions made in my original 
testimaony, the VA must provide more local services 
and become a true member of the community in which 
veterans and their families live. They must become 
more aware of the needs of the families and veterans 
and local resources available. 



274 



Your testimaony refers to a public awreness program. 
Please desrcribe this program. 

Our public awareness program focuses on three areas, 
state, regional, and local. The statewide public awareness 
has been accomplished through meeting with the 
leaders of all of the human service and veterans 
organizations and providing information to them. 
We have participated in state meetings and inservice 
programs. Our press release has appeared in the 
state newspaper and in every local newspaper in the 
state. Local and state radio stations have recieved 
our public service announcements. Service coordinators 
have contacted the hauman service and veteran 
organizations in their regions. Perhaps the best 
method of public awareness has been on the local 
level. All our service coordinators are encouraged 
to participate on the resource committee in their 
community. When their community sees them as a valid 
and valuable resource, referrals are made and the word 
is spread. Most of our refferals come from the 
families themselves. They hear about us from others 
that we have been able to assist. 



Mr. Evans , thank you for this opportunity to 
answer these questions . I will gladly answer any 
further questions that you may have. 



Peggy St. Clair 



275 



REPLY 

HONORABLE LANE EVANS, CHAIRMAN 

SUBCOMMITTEE ON VETERANS' AFFAIRS 

SOCIAL SERVICES FOR VIETNAM VETERANS AND THEIR FAMILIES: 

CURRENT PROGRAMS AND FUTURE DIRECTIONS 

June 27, 1994 

by Bryan C. Smith, EdD 

Director of the National Information System 

Center for Developmental Disabilities 

University of South Carolina 

Columbia, SC 



Dear Chairman Evans and members of the Subcommittee: 

I am very pleased to have this opportunity to respond to the questions posed in your 
letter of May 25, 1994. The basis of this reply to the questions posed by the subcommittee 
have been taken primarily from two studies that the National Information System staff 
conducted recently and presented at the Agent Orange Class Assistance Program's 
National Symposium held in Washington, DC in May of 1994. 

Question la Can Vietnam veterans and their families be served effectively without service 
coordination services? 

Vietnam veterans and their families cannot be helped effectively without service 
coordination because of the complex web of agencies, confusing eligibility requirements 
and the array of professionals with vastly differing roles and missions that constitute the 
service delivery system. Even the most informed family members and experienced 
professionals can have difficulty determining which agency has the responsibility or 
expertise to respond to a particular need. In families where the parents are not well 
informed or able to be effective advocates of their family's needs, the challenges are even 
greater. 

The existing structure of services, including veteran, child, and disability-related 
services is a fragmented system of care and one that predictably allows children to fall 
through the cracks created by the restrictive eligibility criteria of the service systems 
intended to help them. The Class Assistance Program's success has demonstrated that the 
coordinated provision of family-centered services is a viable alternative for Vietnam 
veterans and their families. They have shown that service networks can effectively make 
the necessary linkages between the community-based services and the centralized, 
specialty services needed to provide comprehensive care to veterans and their children 
with disabilities or chronic illnesses. 

In contrast to the principles of family-centered care, public policy has historically 
addressed the needs of returning veterans as ones specific to the veteran. The traditional 
system of veterans benefits and services is veteran-directed, providing services and 
benefits to the veteran directly and with little regard to the veteran's family configuration, 
except in relation to certain income allowances and burial entitlements, with no services 
available to the veteran's family members from that system. Members of the veteran's 
family, characterized as "dependents," are generally recognized as having needs only if the 
veteran is disabled or deceased. Even the Vet Centers, which are designed to be more 
flexible and progressive in their service delivery approach, deal with family issues only in 
the context of their impediment to the veteran's "readjustment" counseling program. 

Children's health depends on a complex array of factors with medical care as only one 
element of the matrix. Family, home and community environments, adequate nutrition, 
and healthy lifestyles may be as important to children's health as timely access to 
appropriate medical care. Parental behavior has an important impact not only on the 
physical health and development of children, but on their mental and emotional health as 
well. The health and development of many veterans' children have been adversely affected 
by years of exposure to substance abuse, angry outbursts, and sometimes, domestic 
violence. The effects of this are being manifested today in the children of Vietnam 
veterans as what has been labeled as "secondary PTSD." This condition truly marks a 
second generation of individuals affected by a disorder that requires a level of awareness to 
diagnose and a commitment of time and resources to treat. 

The services supported by the Class Assistance Program, unlike many large publicly 



276 



funded programs, are based an the premise that flexibility and creative solutions are best 
suited to the diverse needs of veterans and their family members. Conventional responses 
and uniformity were never conditions for funding service providers. Instead, insistence on 
and monitoring of program quality and responsiveness were the standards. As a result, the 
Class Assistance Program network (from this point referred to as, the network) emphasized 
personal empowerment through assertive service coordination by community-based 
grantees. A defining characteristic has been the recognition that families are the primary 
decision makers for themselves and their children, making the family the unit of service 
for this newly formed network. 

Service coordination is rooted in a family-centered empowerment model in which 
services are oriented toward the family, rather than toward any individual, such as a 
veteran or a child with a disability. A central premise underlying the emphasis on service 
coordination is that for this population, it is probably only marginally effective, at best, to 
offer single-faceted services such as counseling or rehabilitation to just the veteran, spouse 
or child. Too many problems of the veteran impact the family, and too many problems of 
the family impact the veteran, for them to be separated and to expect them to manage 
without professional guidance in obtaining the services they need. These families often 
need help because of their children with disabilities and a frequent incidence of family 
dysfunction, psychological problems, and alienation. Because the problems faced by 
Vietnam veteran families are generally chronic, multi-faceted and complicated, service 
coordination became an essential component of the network. The process begins with 
outreach to Vietnam veteran families and ends with the satisfactory resolution of their 
presenting problems. The dominant service goals are access to appropriate services, 
continuity of care, and means to achieve the families' well being. Persistent underservice 
and access barriers are the pervasive problems that service coordinators frequently address 
in serving veteran families. Within this framework, the service coordinator continually 
moves in the direction of acting in a consultative capacity and with each contact, the 
families' need for involvement with service coordination diminishes as they become more 
proficient at independently navigating the service delivery maze. Ideally, this builds a 
residual of family empowerment and increased future capacity for self- advocacy. 

Since persons with disabilities generally have their conditions, or effects of the 
conditions, throughout their lives, their need for services continues; and as they get older, 
their service needs change. This dynamic state places considerable responsibility on 
family members to assume an important and active role in obtaining services that may be 
offered through a variety of resources. In one of the National Information System (NIS) 
studies, it was clearly shown that when a grantee was a central service coordination 
resource, it made a critical difference in families getting the services they needed. This 
critical component of the network facilitated the necessary linkages between community- 
based services and centralized specialty services and improved the delivery of 
comprehensive care to veteran's children. 

Question lb Compare the needs of Vietnam veterans and their families for service 
coordination with others who need social services. 

The Vietnam veteran family's need for service coordination is different from others 
because the nature and magnitude of their problems are different. A consistent finding by 
grantees who provide counseling is that, especially for Vietnam veterans, counseling 
strategies are only minimally effective if they do not involve the family. This holds true 
even when the veteran's PTSD is the central focus. 

In providing a national information and referral service to Vietnam veterans and their 
families, the NIS has been able to help over 16,000 persons. Of these, over half (52%) 
received referrals for some sort of assistance in accessing services. This level of requests 
clearly points to the broad need for service coordination. While it may be considered 
desirable for veterans and other family members, it is absolutely essential to Vietnam 
veteran families having children with disabilities. 

Before serving Vietnam veteran families, the NIS had operated four other national 
information and referral programs. The one most comparable to the current program was 
the National Information System for Health Related Services (HRS) that served families 
with children, ages 0-21, with disabilities and special health care needs. For both the NIS 
and HRS, caller data was collected on the same forms and the staff used the same 
interview techniques. While there were some similarities between the families and 
children in these two groups, there were differences and unique characteristics that were 
readily apparent. 

The magnitude of these differences is significant. In each characteristic cited, the 



277 



other population (HRS users) had a very small number or rate. For example, almost all 
(non-veteran) families, contacting the HRS to seek services, had only one child with one 
disability. In contrast, 29.4% of the Vietnam veteran families contacting the NIS to obtain 
services had more than one child with a disability, and 54.7% of the children with 
disabilities had multiple disabilities with an average of 2.9 conditions per child. It was not 
uncommon for a veteran to have as many as six or seven children, all having disabling 
conditions. Perhaps the critical difference, as it relates to the need for service 
coordination, was that most of the Vietnam veteran parents of a child with disabilities also 
had disabilities themselves, usually service-connected. 

The NIS data were collected from over 16,000 client callers who were either veterans 
or family members seeking services for themselves or for their children with disabilities. 
Consequently, any conclusions from the NIS data can only be implied to the group being 
helped by the NIS, not to all Vietnam veterans or their family members. Therefore, the 
statistics described here are descriptive, presenting what has been observed over the five 
years of this project. Over 930 different diagnosed conditions have been reported by 
callers. The most common categorically grouped children's conditions were: birth defects 
(18.1% of the children who needed help from the NIS had conditions in this category); 
learning disabilities (17.6%), skin abnormalities (12.3%), immune deficiencies (12.0%), 
and asthma (7.8%). 

Overall, the health status of the members of Vietnam veterans' families who used the 
NIS appear to be below an acceptable standard. Identified problems included a pattern of 
disability and chronic illness as well as social problems and poverty that seem unparalleled 
in comparison to other families, including those of other era veterans. The incidence oi 
many serious conditions within this population, particularly in children, appeared to be 
well above those who used other information and referral services similar to the NIS. In 
addition, the veterans' own disabling conditions have placed strains on family structures 
that are decidedly unique. Many veteran families face additional disadvantages as 
isolation, low socioeconomic status, and the lack of access to adequate services, including 
transportation. 

Question 2a Is service coordination more costly or a more cost-effective means of 
providing effective treatment to veterans ? Question 2b What evidence 
supports your response? 

The efficacy of service coordination was verified in both NIS studies and 
demonstrated by the fact that many private sector organizations, including health insurance 
companies, have adopted this approach as an efficiency or cost containment move. An 
example of validating service coordination for veteran families was shown by the finding 
that veterans' families were more likely to follow -through with recommended referrals 
when service coordination was provided than when the families were left on their own to 
pursue help. The studies revealed that there was a reluctance of some families to follow- 
through with referrals to organizations that potentially could address some of their unmet 
needs. Self-advocating behaviors were absent even in situations where there appeared to 
be a desperate need of services and the usual obstacles, such as cost or availability of 
services were not issues. Quite simply, for a variety of reasons, the Vietnam veteran 
family itself can be its own barrier to accessing needed services and service coordination is 
a means by which this barrier can be overcome. 

By maintaining the family-focused approach to services and taking necessary actions 
to reduce a lack of follow-through in seeking needed services, all family members benefit. 
But it is particularly critical when the person needing services is a child dependent upon 
other family members taking action to obtain those services. Veterans' families, like most 
families facing similar problems, need assistance from a variety of service providers. They 
need a service system that provides advocacy, specialized educational services, general 
health services, specialized nursing services, social services, and financial planning. 
Further, many need specialized therapies, such as nutrition, respiratory, hearing and 
speech, occupational and physical therapy. Given the variety of services many of these 
families need, they quite often need an advocate and the assistance provided by some form 
of service coordination. 

One of the studies conducted last year by the NIS was an impact analysis intended to 
determine if the network cost-effectively leveraged other resources to help Vietnam 
veterans and their families. Leveraging, which was used as a measure of cost- 
effectiveness, refers to the fiscally quantifiable outcomes of a grantee obtaining services or 
funds from another resource through advocacy, a service coordination function. This type 
of study is a systematic approach to evaluating the relative outcomes of an activity and it 
examines the costs, benefits, and uncertainties to determine if the initiative was a 



278 



beneficial means of meeting its objective. An impact analysis is an estimate and as such, 
the conclusions drawn are subject to the level of accuracy of the data used. One of the 
statistically significant study findings was that a benefit cost ratio showed that for every 
Class Assistance Program dollar spent on services and equipment for this study group, 
there was a $27.58 return in outcomes, leveraged through either financial assistance or 
services received. Further investigation in the study showed that non-respondents 
probably introduced bias that underestimated, not overestimated, the acquisition of 
benefits, and the $27.58 is a realistic, and probably conservative, finding. 

Grantees were not charged with the task of leveraging financial support by the Class 
Assistance Program. However, helping a family obtain entitlements and services from 
other providers was a critical part of grantee's service coordination function. The fact that 
grantees had considerable success in leveraging public and private sector resources may 
have been due to their unique skills in advocating and interpreting how various agencies 
and processes work and their knowledge of how to navigate through various bureaucracies 
to access resources and services to which family members are entitled. It may also be an 
indicator of the underserved nature of this population, implied by the apparent failure of 
the traditional system to champion the issues to obtain entitlements for veterans or their 
family members. 

Question 2b What evidence supports your response? 

The following references, the last four of which will be published in the proceedings 
of the AOCAP National Symposium, support my response to Question 2a: 

Falik, M., Lipson, D., Lewis-Idema, D., Ulmer, C, Kaplan, K., Robinson, G., Hickey, 
E., & Veiga, R. Case Management for Special populations: Moving Beyond 
Categorical Distincions. Journal of Case Management . 2:2 Summer, 1993 pp. 39- 
46. 

Smith, B., Mayfield-Smith, K., & Sudduth, D. Impact Analysis of the AOCAP 

Network. National Symposium: Catalysts for Change . May, 1994. 29 pp. (The 
impact of a service delivery system's ability to leverage resources on behalf of 
Vietnam veteran families) 

Smith, B., Mayfield-Smith, K., & Sudduth, D. Barriers to Services for the Vietnam 
Veteran Family. National Symposium: Catalysts for Change . May, 1994. 26 pp. 
(Barriers to services for Vietnam veteran families having children with disabilities, 
including the family itself, geographical, legal and institutional obstacles) 

Smith, B., Mayfield-Smith, K., & Sudduth, D. Some Lingering Consequences of The 
Vietnam War on Veterans and their Families. National Symposium: Catalysts for 
Change . May, 1994 26 pp. (A descriptive paper reporting the observations made 
on veterans' and veterans' children with disabilities) 

May, G. & Smith, B. The Potential for Systematic Change in Delivery of Services to 
Vietnam Veteran Families. National Symposium: Catalysts for Change . May, 
1994. 29 pp. (A comparison of three service delivery systems and their abilities 
to help Vietnam veterans and their families having children with disabilities) 



279 



Response of John Reiss, Ph.D. 



Associate Director 
Institute for Child Health Policy 



Assistant Professor of Pediatrics 
University of Florida 



Facilitator 
AOCAP/Title V Working Group 



To Questions Submitted by 

Honorable Lane Evans, Chairman 

Subcommittee on Oversight and Investigations 

of the House Veterans Affairs Committee 

Social Services for Vietnam Veterans and their Families: 
Current Programs and Future Directions 

July 6th, 1994 



Chairman Evans, thank you for this opportunity to response to follow-up 
questions to the testimony I presented to the Subcommittee on Oversight and 
Investigations on May 18, 1994 regarding "Social Services for Vietnam Veterans 
and Their Families: Current Programs and Future Directions". My response to 
your two questions are as follows. 



1. I am not aware of any empirical studies regarding 1) factors which effected 
the degree to which the social service needs of Vietnam veterans and their 
families were met prior to AOCAP or 2) the costs of providing needed 
services and the costs of the consequences of not providing needed services. 

However, based on my work with the AOCAP/Title V Work Group and my 
extensive experience with programs for children with special health care 
needs and their families, I would like to offer the following observations 
and recommendations. 

First, health and social services systems focus primarily on addressing the 
needs of those families that actively seek services. Because, in general, the 
demand for services exceeds available resources, limited time, effort, and 
resources are devoted to outreach. In addition, most service programs have 
an individual rather than a family orientation. Thus program eligibility 
criteria and services focus on a individual family member rather than the 
family as a whole. 

Based on information provided by AOCAP grantees, it is evident that many 
Vietnam veterans and their families have had negative experiences with the 
health and social services system; and do not have confidence in the 
capability of the "system" to address the full range of their family needs. 
Because programs tend to be categorical, and address a specific presenting 
problem of one individual, families with multiple needs must seek out 
assistance from a multiplicity of programs, each with its own eligibility 
criteria, application forms, waiting periods, a staff. The lack of a single 
point of contact and good interagency coordination thus poses a significant 
time and psychological barrier for those who do not expect that their efforts 
to access the system will, in fact, result in needed assistance. 



280 



The reported shortcoming of Veteran's Administration services system 
include: the focus of the VA on the individual Vietnam Veteran rather than 
on the Veteran within the context of the family as a whole; the VA's 
"institutional" approach, which focuses on the services provided through 
the VA and fails to access or coordinate with services provided in the 
community; and the VA's "medical model" which focuses on identifying 
and providing a short-term cure for problems rather on enhancing the 
ability of the Veteran and the family to participate in long-term growth and 
development. 

Based on information provided by state Title V Children with Special 
Health Care Needs (CSHCN) Programs, Vietnam veterans and their families 
have not been seen as a population group that is in need of targeted 
outreach and special assistance. While CSHCN Programs do have a family 
focus and consider the needs of the parents as well as the child, information 
about parent's military service status is not typically gathered as part of the 
program's standard intake process. Thus Vietnam veteran families have not 
been readily identified. In addition, Title V staff tend not to have special 
training regarding the needs of Vietnam Veteran's families or strategies for 
treating Post Traumatic Stress Disorder (PTSD). While, state Title V 
CSHCN Programs have not been optimally responsive to these families, it is 
my belief that these programs have been of assistance in addressing some of 
the needs of veterans and their families. Because Title V Programs are 
legislatively mandated to facilitate the development of family-centered, 
community-based, culturally competent, coordinated system of care for 
CSHCN and their families, these Programs are making available the types 
of services Vietnam Veteran families need. The philosophical basis of these 
state programs is to focus and build on the strengths of families, and to 
involve families not only in decision making about the care of their child but 
also in policy and program development for the service system as a whole. 

AOCAP funded projects were specifically designed to reach out to and 
work with Vietnam veterans families. Because many of the staff are, 
themselves, Vietnam Veterans, AOCAP Projects have special expertise and 
experience in recognizing and understanding the specific, unique problems 
of Vietnam veterans and their families. The projects are also successful 
because they are designed to maximize and leverage resources, and to build 
networks not only for a specific client, but for all Vietnam Veterans. The 
care coordination and advocacy services that these project provide can serve 
as the glue that brings the pieces of the fragmented service system together 
in a coordinated fashion. In addition, AOCAP is founded on the 
philosophy that the family, rather than an individual family member 
should be the unit of care. 

From the perspective of state Title V CSHCN Program leadership and the 
USPHS Maternal and Child Health Bureau, AOCAP Projects have provided 
much needed assistance to Vietnam Veteran families with children with 
special health needs. They have also developed special knowledge and 
skills, which could be of great value to state Title V CSHCN Programs. 

One of the goals of the AOCAP/MCHB Work Group is to help to 
institutionalize the knowledge and skills that have been developed through 
the AOCAP Projects. Within the constraints of existing personnel and fiscal 
resources, selected AOCAP Projects and state Title V CSHCN Programs will 
work together, in order to improve the capability of Title V Programs to 
address the needs of Vietnam Veteran families with CSHCN. However, the 
children of Vietnam Veterans are one of many "special populations" for 
which Title V has a responsibility. Thus additional resources should be 
made available to both support the ongoing activities of projects specifically 
targeted for Vietnam veteran families and to fund additional state agency 
(i.e. Title V) staff who have special expertise in working with Vietnam 
veteran families. 



281 



As noted above, I am not aware of any empirical studies which quantify and 
compare the costs of providing needed services to Vietnam veteran families 
with children with special needs to the costs of the consequences of not 
providing these services. However, the professional community that 
provides services to children with special needs and their families agree that 
prevention and early intervention is, in the long run, less costly than not 
providing needed services. This family-centered, coordinated, early 
intervention approach to addressing the needs of families is at the heart of 
both the Individuals with Disabilities Education Act (IDEA), Part H and the 
Maternal and Child Health Bureau's State Systems Development Initiative 
(SSDI). 

Currently, there is a general lack of data regarding the costs and outcomes 
of services for CSHCN and their families. It should be noted that the Office 
of the Assistant Secretary for Planning and Evaluation (OASPE) of the 
Department of Health and Human Services is currently soliciting 
applications to conduct children's disability policy research. As is noted in 
this announcement, "Policy issues revolve around a comprehensive set of 
services, including health care, education and income supports. Little 
information on children with disabilities exists at the national level and 
even less is known about the use, cost, and impact of services for these 
children...A patchwork of public programs have been enacted to provide 
families (with children with special needs) with a range of 
supports.. ..Growing program rolls and increasing costs give rise to a 
number of policy issues. The lack of data on disability among children, as 
well as on their service use and costs complicates analysis of policy options." 
[Federal Register, Vol 59, No. 96 pp. 26234-26235 (May 19, 1994)]. 

This request for applications outlines a comprehensive set of questions 
related to children with disabilities and their families, including definitions 
and measurement; demographic and socio-economic characteristics; service 
use, expenditures and effectiveness; private costs of care; financing of 
services and supports; and system organization. The results of this research 
initiative will be generally informative to your subcommittee regarding the 
costs of care and the consequences of unmet needs. A number of 
demographic characteristics are identified in the grants announcement as 
being of interest, including type of disability, severity of disability, family 
income, age, gender, race, SSI/non-SSI participation and coverage by 
Medicaid. However, "military service status" is not specifically identified, 
therefore, information specifically about Vietnam veteran families might not 
be developed through this research initiative. Because, through our work 
with the AOCAP/Title V Work Group, we are aware of the need for 
Vietnam veteran family-specific data, the research proposal we plan to 
submit in response to OASPE's solicitation will include Vietnam veteran 
families as a population of special interest. 

2. In regard to examples of services for children with disabilities that are 
family centered, comprehensive, coordinated, promote increased 
independence, productive and empowerment for the child and families, I 
am pleased to provide you with the names of the following organizations. 
This list is not all inclusive, but is reflective of my familiarity and long-term 
working relationship with these programs, agencies, and organizations. 
Since you are familiar with AOCAP funded projects, I have not included 
these on the list. I would suggest that your staff contact programs directly 
to gather additional information. 



282 



Deborah Allen, Director 

Division of Children with Special health Need 

Bureau of Family and Community health 

Massachusetts Department of Public Health 

150 Tremont Street, 4th Floor 

Boston, MA 02111 

Phone: 617-727-6941; FAX 617-727-6496 

Cathy Chapman, Program Manager 

Children with Special Health Needs 

Division of Parent health Services 

Department of Health 

PO Box 47880 

Olympia, WA 98504-7880 

Phone: 206-753-0908; FAX 206-586-3890 

J. Michael Cupoli, Director 

Children's Medical Services Program 

DHRS 

Building 5, Room 129 

1317 Winewood Blvd. 

Tallahassee, FL 32399-0700 

Phone: 904-487-2690; FAX 904-488-3813 

Nancy Hoyme, Health Services Administrator 
Children Special Health Services Programs 
South Dakota Department of Health 
118 W. Capitol Pierre, SD 57501 
Phone: 605-773-3737; FAX 605-773-3683 

Cassie Lauver, Director 

Services for Children with Special Health Care Needs 

Kansas Dept. of Health and Environment 

900 SW Jackson, 10th Floor Topeka, KS 66612-1290 

Phone: 913-296-1313; FAX 913-296-6231 

John Nackashi, Medical Director 
Pediatric Care Coordination Program 
Associate Professor of Pediatrics 
University of Florida College of Medicine 
(Member, American Academy of Pediatrics 
Committee on Children with Special Needs) 
Gainesville, FL 32610 
Phone 904-395-0552; FAX 904-338-9830 

Richard Nelson, Director 

Iowa Child Health Specialty Clinic 

University of Iowa 

Iowa City, IA 52242 

Phone: 319-356-1118; FAX 319-356-3715 

Ronald Uken, Chief 

Children's Special health Care Services 

Child and Family Services 

Michigan Department of Public health] 

PO Box 30195 

Lansing, MI 48909 

Phone: 517-335-8961; FAX 517-335-8560 

Jerry Wiley, Medical Consultant 

Children and Youth Section 

North Carolina Dept. of Environment, Health, and Natural Resources 

PO Box 27687 Raleigh, NC 27611-7687 

Phone: 919-733-7437; FAX 919-733-0488 



283 



Other organizations with special expertise in family-centered systems of 
care for children with disabilities and their families are: 

Betsy Anderson 

Federation for Children with Special Needs 

95 Berkeley Street, Suite 104 

Boston, MA 02116 

Phone: 617-482-2915 

Beverly Johnson 

Institute for Family Centered Care 
5715 Bent Branch Road 
Bethesda,MD 20816 

William Sciarillo 

Association for the Care of Children's Health 

7910 Woodmont Avenue, Suite 300 

Bethesda, MD 20814 

Phone: 301-654-6549 

Finally, as I noted in my written testimony to the subcommittee, the USPHS 
Maternal and Child Health Bureau's Division of Services for Children with 
Special Health Needs has provided significant leadership in supporting the 
development of family-centered systems of care for children with 
disabilities and their families. This has involved both the support of 
systems development by state Title V CSHCN Programs and the support of 
demonstration projects through the Bureau's Special Projects of Regional 
and National Significance (SPRANS) funding initiatives. Additional 
information about these MCHB initiated activities is available from the 
Bureau's representative to the AOCAP/Title V Work Group: 

John Shwab, Chief 
Habilitative Services Branch 
HRS A / MCHB / DSCSHN 
Parklawn Building, Room 18A27 
5600 Fishers Lane 
Rockville,MD 20857 
Phone: 301-443-1080 

In my written and oral testimony I made the recommendation that state and 
local efforts to improve services to Vietnam Veterans and their families 
could be enhanced by a federal initiative to identify: 

...Vietnam Veterans families with children with special needs as 
a population in need of special attention in various research, 
service, and training grants, as administered through the 
Maternal and Child Health Bureau, the Administration on 
Children and Families, the Department of Education, the 
Rehabilitative Services Administration, Department of Veterans 
Affairs, etc. This would help target existing service, research 
and training resources on this population. This would also help 
to document the number of Vietnam Veteran families with 
children with special needs, and to describe the extent to which 
their needs are not appropriately addressed. 

As you are aware, the National AOCAP Symposium was held during the 
week of your hearing. During the Symposium I had the opportunity to 
meet and learn from many AOCAP grantees, and to discuss in detail 
barriers and strategies for facilitating interorganizational collaboration on 
behalf of Vietnam Veterans and their families. 



284 



Based on these discussions, I would like to suggest, for your consideration, 
a strategy for helping to target existing federal service, research and training 
resources on Vietnam Veterans families with children with special needs. 
This strategy would involve the implementation of a federal interagency 
work group, comprised of representatives of those federal 
agencies/organizations that have a direct responsibility for these families. 
A preliminary list of these agencies is included in my testimony, as cited 
above. I would also recommend that the Maternal and Child Health Bureau 
be identified by Congress as the lead in this effort, because of their 
legislated responsibility for and extensive experience in systems 
development for children with special health care needs and their families. 
I would also suggest that Congress clearly charge other identified agencies 
with addressing the needs of Vietnam Veteran families through active 
participation in the Work Group, the develop of a federal plan of action on 
behalf of these families, and the allocation of existing resources for these 
families. 

Thank you, again, for this opportunity to respond to follow-up questions 
regarding social services for Vietnam veteran families with children with special 
needs. 



285 



Social Services for Vietnam Veterans and Their Families: 
Current Programs and Future Directions 

June 13, 1994 

Questions Submitted to 

Honorable Lane Evans, Chairman 

Subcommittee on Oversight and Investigations 

Committee on Veterans' Affairs 

Questions from Peter La Count 

Project Coordinator 

Vietnam Veterans Family Support Project (VVFSP 

Kennedy Krieger Institute 

2911 E. Biddle Street 

Baltimore, MD 21213 



1 . If the Vietnam Veterans Family Support Project did not exist, who 
would provide family-centered support services to Baltimore-area 
Vietnam veterans and their families? 

Under the direction of the Department for Individual and Family Resources of 
the Kennedy Krieger Institute, the Vietnam Veterans Family Support Project (VVFSP) 
has been operating since July, 1990 to provide support services for families of 
Baltimore-area Vietnam veterans who have children with disabilities. The project 
currently provides services to 46 families of Vietnam veterans. The services provided 
include: 

* coordination of services to help families find and coordinate community 
resources and assist families in advocating for their special needs; 

* home-based professional services provided by a special educator, 
occupational therapist, physical therapist, social worker and speech-language 
pathologist, who work with the children and families in their homes; 

* financial assistance to help families purchase needed services or equipment; 
this may include assistance to obtain respite care, see a medical specialist, or 
buy special equipment for the child with disabilities; 

* educational workshops and support groups for parents to help families make 
contact with other families and provide information on a variety of topics 
including self-advocacy, planning for the child's future and understanding 
educational placements. 

Services are targeted to Vietnam veterans and their families who have children 
between the ages of birth and 21 with disabilities. Disability is defined very broadly 
and includes developmental and physical disabilities, and chronic health problems. 
To be eligible for services the veteran must have served in or near Vietnam between 



286 



1961 and 1972 and the family must reside in the Baltimore metropolitan area. 
Families from other parts of the state are referred to appropriate services in their areas. 
Families are eligible for services even if the veteran does not live with them. 

If VVFSP did not exist, I do not believe that there would be any programs that 
would or could provide family-centered support services to Baltimore-area Vietnam 
veterans and their families. The U.S. Department for Veterans Affairs is not sanctioned 
to work with the veteran's families. There may be some well-meaning therapists and 
professionals who will work with the families only if the veteran is willing to seek out 
help first. However, these instances are few and far between. In the majority of the 
cases, the veteran is the only person in the family receiving services. If the veteran 
refuses services, has an aversion to "institutional" help, or is in denial of the need for 
services, then the family will not get the assistance that they need. Many families will 
fall through the cracks of both the veterans' assistance and developmental disabilities 
systems without programs like VVFSP. 

Families may fall through the cracks of the veterans assistance and 
developmental disabilities systems for one or more of the following reasons: 

1) most veterans assistance and developmental disabilities systems require 
that the veteran and his or her family seek them out for assistance; VVFSP and 
other Agent Orange Class Assistance Program (AOCAP) funded agencies have 
conducted systematic outreach measures to locate the veteran and their 
families i.e. to bring the program to the families; 

2) many veterans who have undiagnosed cases of Post Traumatic Stress 
Disorder may be in denial of family problems or be fearful of letting potential 
helpers inside the home; 

3) unlike the Department for Veterans Affairs (VA) our program can provide 
services to families if an adult in the family (adult child, spouse, uncle, aunt, etc.) 
requests assistance from VVFSP; the veteran need not be living in the home or 
be alive for the family of the Vietnam veterans to receive services; 

4) many Vietnam veterans are mistrustful of all "institutions" due to past 
unpleasant experiences in military hospitals, the Department for Veterans 
Affairs (VA) etc.; therefore, these veterans may be more likely to isolate 
themselves and their families from outsiders whom they may view as 
threatening; these veterans are less likely to seek help from educational, 
medical, and/or mental health "institutions" that may be of benefit to the veteran 
and their families; 

5) many families of Vietnam veterans fall through the cracks of the veterans and 
developmental disabilities systems because the veterans systems do not know 
how or are not equipped to work with families; the developmental disabilities 
programs do not have experience working with veteran's issues; the two 
systems do not communicate with one another. 

I believe that the success of the Vietnam Veterans Family Support Project comes from 
our ability to recognize the specific needs of the veteran and his/her family; a 



287 



knowledge of, and an ability to access both the veterans assistance and 
developmental disabilities systems so that veterans and their families can benefit from 
both systems; and, from "word of mouth" veterans and veterans organizations in the 
Baltimore metropolitan area have come to know our program as one that works 
effectively with veterans and their families. 



2. Has the Vietnam Veterans Family Support Project been successful 
in educating other social service agencies and providers in the 
community about the uniqueness of veterans and their families? 

VVFSP has had some success with educating social service providers in the 
community concerning the uniqueness of veterans and their families. Program staff 
have in their day-to-day contact with numerous local, state, and national social service 
organizations communicated the needs of the veteran and his or her family. VVFSP 
staff have collaborated with groups as diverse as the Department of Social Services, 
local public and private schools, local Kiwanis Clubs, VA Veterans Centers, along with 
hundreds of other programs and services in the Baltimore metropolitan area. 

VVFSP has had the most success in educating social service agencies and 
providers in the community by simply letting them know that VVFSP exists. By 
conducting outreach activities staff are making local agencies aware of our goals and 
objectives. Given this information, agencies are able to refer families of Vietnam 
veterans who have children with disabilities to our program. In this manner, families 
referred to VVFSP are receiving family centered and veteran oriented support 
services. VVFSP is then able to assist with support services in connecting families to 
the various service and support agencies in the areas in which the families live. 

Rather than having a great deal of insight into the unique needs of veterans and 
their families, I believe that most agencies refer families to VVFSP because of our 
organizations history of successful family-centered, home-based support services. 
Because of the paucity of literature and educational opportunities for professionals to 
learn about the unique needs of veterans and their families, most agencies do not 
often interpret the veteran family who has a child with a disability as needing veteran- 
centered services. Most professionals do not associate the veteran's problems such 
as psychiatric disorders, alcohol and drug abuse, heightened feelings of anxiety, 
uncontrolable rages, flashbacks, emotional isolation, physical and emotional abuse of 
spouse and/or children, etc. as relating to latent Post Traumatic Stress Disorder 
(PTSD). Professionals who are not versed in the needs of veterans and their families 
may interpret each barrier manifested by the veteran as separate and unrelated. On 
the contrary, often these issues are related to war induced trauma that has gone 
untreated for decades. 

As one agency, our ability to educate social service providers in the community 
concerning the unique needs of veterans and their families is limited. Greater 
emphasis needs to be placed in research to identify the needs of the veteran and his 
or her family. University programs, when educating future social service providers, 
need to offer courses and create opportunities for individuals to become more aware 
of the unique needs of the veteran and his or her family. 



288 



3. Why do social service agencies and providers in the community fail 
to recognize the uniqueness of veterans and their families? 

VVFSP has met with some barriers in communicating the unique needs of 
veterans and their families. Some of these barriers include: 

A paucity of training and research on the effects of war on the 
family- Unless a social service worker has experience working with a veteran 
and his/her family this worker may not recognize the needs of the veteran 
family. University and other training programs do not offer many (if any) 
courses describing the treatment methods of choice when working with families 
of veterans. When these individuals begin working in the "field" they have 
learned few skills to recognize the needs of the veteran and his/her family. 
Furthermore, since university programs do not teach treatment models for 
veterans and their families there is little opportunity for research in this area 
while in school. Therefore, when social service providers enter the work force 
there is virtually no literature that supports the notion that veterans and their ' 
families have unique needs. 

Through divorce or separation the veteran often does not live with 
the children. One of the latent effects of war and Post Traumatic Stress 
Disorder (PTSD) on families is the high rate of divorce and/or separation in 
families of veterans. When the veteran does not live with the family he or she is 
not able to tell the "story" behind the involvement in war. The secondary trauma 
that may be exhibited by spouses and children caused by the veterans PTSD 
associated flashbacks and violence, substance abuse, or feelings of 
alienation may not be readily identified by the family or social service worker as 
war related and, thus, unique to the veteran and his/her family. If this war 
related secondary trauma is not addressed therapeutically, then the roots of the 
family's trauma may never be uncovered. Family and/or individual therapy with 
the veteran and or the veteran's family may not ensue. Such therapy could 
help to heal wounds with the veteran, the spouse, and children while helping 
the family to understand the war related reasons behind the family's trauma. 

Newly traumatized persons manifest different symptoms than those 
living with trauma that occurred years or decades ago. Many social 
service providers are unaware or untrained in working with those living with 
long-term trauma. Veterans living today who experienced trauma resulting in 
PTSD twenty or more years ago often exhibit a wide array of symptoms. Left 
untreated, PTSD can result in numerous cognitive, physical, behavioral, and 
social problems that may be misinterpreted by service providers and family 
members as being unrelated to trauma occurring during war. Other difficulties 
that the veteran can experience over time include: anxiety, dissociative 
disorders, impulsive or depressive symptoms, employment difficulties, and legal 
problems. A social service provider who identifies the veteran's primary 
dysfunction as substance abuse or depression (for example) may treat that 
individual within the existing treatment facilities that include all other substance 
abusers or persons with depression. Misidentification of the root cause of the 
trauma may result in inappropriate and ineffective treatment for the veteran. In 



289 



fact, treating an isolated symptom may only agitate other symptoms manifested 
by the veteran. For instance, the veteran having left a emotional family therapy 
session may only self-medicate through alcohol and exacerbate his or her 
alcoholism. Therefore, it is essential that service providers gain a greater 
understanding of the trauma associated with war and its lasting legacy. 

Unless AOCAP programs such as the Vietnam Veterans Family Support Project 
continue to exist to educate social service programs on the unique needs of the 
veteran and his or her family, these family's needs will not not be met. Programs such 
as VVFSP help to bridge the gap between the developmental disabilities and veterans 
assistance systems. Without such programs, combined with the dearth of literature 
available to social service providers on the unique needs of the veteran and his or her 
family, I do not believe that the needs of the veterans' family will be met. 

Thank you for allowing me to provide this additional testimony on behalf of the families 
of Vietnam veterans with whom we work and others. I hope that you find it useful. 



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