The Government of Canada is pleased to respond to the Fifth Report of the Standing Committee on Veterans Affairs: Improving Services to Improve Quality of Life for Veterans and their Families.
The Government has carefully reviewed the recommendations in the Standing Committee's report and welcomes the opportunity to respond.
Listening and Reaching Out to Veterans and Their Families
Previous Governments used to consult with Veterans primarily through a small number of Veterans' organizations. That approach was not effective in engaging an increasing number of modern-day Veterans and their families. That is why, in March 2011, the Government developed a modern outreach, consultation, and engagement framework at Veterans Affairs Canada (VAC) to broaden the exchange of information with Veterans, Canadian Forces (CF) members, their families, Veterans' organizations, and other stakeholders. To deliver results on this priority, VAC has:
broadened the range of Veterans' organizations with which it engages to include both traditional and modern-day Veterans' organizations;
delivered 26 information sessions on the New Veterans Charter (NVC) at 20 military locations across the country;
developed an online VAC Outreach Information session that will be available in fall 2012 for viewing 24-7, at www.veterans.gc.ca;
expanded outreach to homeless Veterans and to more than 190 organizations striving to address homelessness;
continued improvements to increase the user-friendliness of VAC's website regarding policies, programs, and services. For example, in 2011, VAC introduced an internal online tool called the Benefits Browser that allows staff to quickly access information on the programs and services most relevant to the Veterans they are serving. VAC will soon provide a similar tool for Veterans and their families; and,
expanded the use of technology to engage and consult stakeholders on-line, regarding developments, issues, or activities related to services and benefits for Veterans and their families. These tools include VAC's Twitter account; a re-focused YouTube Channel to include service and benefits information; consultation software; and VAC's Consultation web section, supported by Consulting with Canadians web site. This increased use of technology broadens outreach and complements the existing in-person outreach and consultation processes.
These efforts will give both Veterans and the public a clear picture of the array of programs available. In this way, VAC is continuing its outreach efforts among serving CF members, the CF command structure, and Veterans and their families to increase awareness of enhancements to the full suite of benefits and services available through VAC and the Department of National Defence/ Canadian Forces (DND/CF). At the same time, our Government is hearing directly from Veterans and CF members about what is working well for them and what can work better.
While there are some differences in services and programs available to members and former members of the RCMP, the Government is equally committed to reaching out to them and their families, tailoring communication to reflect their unique circumstances. VAC engages in an ongoing dialogue with RCMP disability pensioners, personnel from the Staff Relations Representative Program, and the RCMP Veterans Association. This ensures an effective exchange of information about their needs and the services and programs the Government
provides to meet those needs. They noted that the disability forms were too numerous and complex and VAC has responded by streamlining and tailoring them. They noted that they wanted to be able to find the portions of policy and process relevant to their members in one location and VAC is working towards improving its web section for members and former members of the RCMP. Communication will continue with members and former members of the RCMP about benefits and services available, taking into account their unique situation in relation to VAC programs.
The pride in, and commitment to, Veterans is shared by many non-profit organizations. Our Government recognizes that, in some circumstances, organizations outside Government may be better positioned to reach out to, and support, Veterans and their families. That is why our Government will continue to work collaboratively with those organizations that are striving to support the health and well-being of Veterans and their families, such as the Royal Canadian Legion and Good Shepherd Ministries to combat homelessness. The Government shares the Committee's admiration for such organizations and programs, including those noted in the report, and expresses appreciation for the tremendous contribution of partners.
Our Government will continue to work with community partners to combat homelessness and better support mental health among Veterans. Government will also continue to enhance its services to Canadian Veterans who are homeless or at risk of homelessness. Government will continue to consult internationally with experts on homelessness, such as Dr. Hugh Milroy, Chief Executive of London-based Veterans Aid. Using Dr. Milroy's model of movement for the homeless from 'welfare to well-being', HRSDC and VAC recently formed a partnership to further the Government's efforts to combat Veteran homelessness. For example, a Transitional Housing and Support for Homeless Veterans Pilot Project has been established through partnerships with community organizations in four Canadian cities -- Toronto, London, Calgary, and Victoria. Transitional housing and support services are being offered as part of this pilot project providing Veterans in need with appropriate stable housing, medical, and/or mental health/addiction services and, where appropriate, vocational rehabilitation. Through this pilot project, accommodations for more than 55 homeless Veterans can be provided at any one time in four cities across Canada. The pilot project will be evaluated in 2014 and VAC will receive quarterly reports on the number of homeless Veterans this pilot project is helping to 'leave the streets behind'.
Generating Best Evidence Through Research
As Veterans and their families start to integrate within, and contribute to, their local communities after military service, their experience may be different than that of other Canadians. Scientific research is critical to identifying and addressing the wide range of existing and emerging health and well-being issues. The Government of Canada shares the Committee's appreciation of the value of the clinical research expertise at Ste. Anne's Hospital through its affiliation with McGill University. This component is being discussed with the Province of Quebec as part of ongoing negotiations for the potential transfer at Ste. Anne's Hospital to that Province..
To strengthen the scientific basis to support the health and well-being of Veterans and their families, our Government has aligned efforts of VAC, DND/CF, and Statistics Canada to complete three studies designed to better understand life after military service. A wide range of analyses is underway using this information on topics like mental health, mental illness, income, suicide, and whether VAC programs are reaching the people they were intended to reach. Further information on the reports of these studies can be found on the Veterans Affairs Canada website at http://www.veterans.gc.ca/eng/pro_research/publications/reports or by contacting the Research Directorate of the Department at Research-Recherche@vac-acc.gc.ca.
This research also identified that there is a significant number of Veterans with whom traditional outreach has not been successful. Their needs and challenges are similar to those receiving benefits and support services, yet they are not participating in VAC programs. This evidence confirms that our Government's effort to introduce a strengthened, multi-channel outreach, consultation, and engagement approach is a sound investment.
Perhaps of greatest significance, these studies also indicate that the Veteran population has a health burden significantly greater than the rest of the Canadian population. This research aligns with the Committee's concerns around the "triple threat" to Veterans' health: musculoskeletal disorders -- arthritis and back problems -- mental illness conditions, and chronic pain.
Since 2006, our Government, primarily through Canadian Institutes for Health Research (CIHR), has invested approximately $950 million to support peer-reviewed, scientific research that addresses the following issues:
pain, disability, rehabilitation, mobility, tissue injury, repair and replacement, and chronic musculoskeletal disease;
brain and spinal injury;
mental health, including Post-Traumatic Stress Disorder (PTSD);
addictions and treatment.
In Budget 2012, our Government further committed to invest $5M to support the development of a national network of patient-focused depression research targeted at suicide prevention, PTSD, and intervention centres. A further $200,000 was directed toward anti-stigma mental health training for health-care professionals. This investment is a giant leap forward for all Canadians, including Veterans, which will lead to better patient care and a deeper understanding of depression, suicide, and PTSD.
The Government is ensuring close collaboration among departments and with both the Canadian Institute for Military and Veteran Health Research and Canadian Institutes for Health Research to advance research related to the military experience. The Government of Canada will continue to support research focused on health issues experienced by Veterans and military personnel. Government will leverage the results from such research to continue to improve front-line health and well-being services for Veterans and their families.
Given the prevalence of multiple health conditions within the Veteran population, the diversity of Government's investments in the Canadian research community is on the right track. Research results in multiple areas will be translated into continued program and service improvements designed to support the health and well-being of Veterans and their families.
Improving Inter-departmental Coordination
As was noted by the Committee, the quality of the Veteran's experience during transition is underpinned by the relationship between VAC and DND/CF. The VAC-DND Steering Committee has been in place since 1999. The goal of this Committee is to strengthen the working relationship between the two departments as well as to provide strategic direction and decision-making on issues concerning CF members, Veterans, and their families. For example, the establishment of Integrated Personnel Support Centres (IPSCs) across the country has greatly enhanced the ability of VAC and DND/CF to work together to support transitioning Veterans and their families. These centres provide "one-stop service" while ill and injured members work toward returning to active duty or prepare to release. In partnership with DND/CF, VAC has more than 100 staff co-located with DND/CF staff in 24 IPSCs to provide care and support to ill and injured CF members and their families as they transition from military to civilian life. Through this partnership service arrangement, releasing CF members can access the full range of programs and services, to which they are entitled, in one location. VAC and DND/CF staff work together at the IPSCs to develop transition plans for medically releasing CF members, ensuring that the needs of the CF members and their families are addressed simultaneously by both departments throughout the transition process. In support of ACVA's recommendation, these centres provide staff with an opportunity to inform releasing members of their right to request a copy of their medical file. In summer, 2012, a pilot project was initiated to electronically transfer CF members' health records from DND/CF to VAC. This will facilitate quicker and more secure access to health information that VAC requires to provide benefits and services to eligible CF members and/or veterans.
VAC and DND/CF are working together very closely to harmonize and align policies and programs to ensure continuity of support on release. VAC is also designing a four-year policy review cycle during which policies will be reviewed. As part of this framework, VAC will continue to consult with DND/CF to ensure that, to the extent possible, policies are harmonized. Similarly, VAC and DND/CF are working together to establish common VAC-DND/CF qualifications for mental health providers (psychologists and social workers) to ensure continuity of care after release. Furthermore, with advances in medical technology, medications and treatments are continually being developed. VAC and DND/CF will continue to collaborate to ensure that these advancements in treatment are considered and utilized as appropriate. For example, VAC and DND/CF have recently implemented a process to support drug coverage benefits for transitioning members. This combined effort between VAC and DND/CF illustrates the commitment to strengthen their partnership and ensure a seamless transition for CF members.
Ensuring Early and Seamless Transition Support
VAC and DND/CF understand that early support is essential to a successful transition to civilian life and have developed programs to maximize support at the earliest opportunity. For example, the mental health program at DND/CF provides dedicated and responsive care to ill and injured CF members and emphasizes the elimination of barriers to early intervention. DND/CF currently employs 51 civilian clinical psychologists that work as part of an interdisciplinary team of civilian and military psychiatrists, psychologists, social workers, mental health nurses, addictions counsellors, chaplains, and support staff at the DND/CF Operational Trauma Stress Support Centres. Initiatives are in place to give civilian providers an understanding of the military culture and work environment, and CF members highly value the specialized expertise of these health care professionals. Our Government constantly evaluates the level of care it provides to CF members and DND/CF will continue to consider hiring additional civilian clinical psychologists and to assess the feasibility of adding military clinical psychologists. Government will engage in consultations with the Canadian Psychological Association to explore areas of mutual interest and share expertise in order to better serve military populations.
Once released from the CF, Veterans with mental illness conditions can continue to access the DND/CF-VAC network of 17 mental health clinics. Within VAC, there are nine specialized outpatient clinics for operational stress injuries (OSI) across the country and one residential treatment clinic at Ste. Anne's Hospital. These clinics are operated in collaboration with the provinces. Each clinic also has the capacity to offer tele-health services which are important to Veterans and their families who are having difficulty travelling to the clinics. VAC's network of out-patient OSI clinics is located in major cities across the country. Given the prevalence of co-existing mental illness and physical health conditions, the specialized programs offered through these facilities provide tailored diagnosis, assessment, and treatment services to meet the often complex needs of these Veterans and their families.
In addition, the Operational Stress Injury Social Support (OSISS) Program provides confidential peer support and social support to CF members, Veterans, and their families, affected by an operational stress injury such as anxiety, depression, or PTSD resulting from military service. The OSISS Program also provides peer support to families who have lost a loved one due to military service.
Our Government recognizes the importance of collaborating and engaging with other countries, including the United States, Australia, and the United Kingdom, concerning new research and evidence-informed best practices in the area of mental health care. For example, VAC has consulted with American and Australian colleagues on treatment and specialized care programs for Veterans with operational stress injuries, including resources available for families. Knowing what programs and initiatives other countries offer, and their success in meeting treatment needs, helps Government to plan suitable program development. VAC is consulting with the United States Veterans Affairs National Centre for PTSD, for example, on mobile self-help and educational tools to assist individuals with PTSD and for those interested in learning more about PTSD.
VAC participates in international projects that aim to advance Veteran care, particularly in areas related to mental health. VAC has collaborated with the Australian, United States, and United Kingdom governments on a project related to the development of guidelines on peer support. This collaboration has resulted in a recent article, "Guidelines for Peer Support in High-Risk Organizations: An International Consensus Study Using the Delphi Method", being published in the April 2012 issue of the Journal of Traumatic Stress.
VAC also closely engages with the International Society for Traumatic Stress Studies (ISTSS), an international, multidisciplinary organization that promotes the advancement and exchange of knowledge about severe stress and trauma. The ISTSS holds an annual conference and the agenda includes an exchange of the latest developments in trauma research, treatment strategies, policy approaches, and theory. In 2010, VAC participated in the ISTSS annual meeting held in
Montreal. This was a very successful partnership venture and, as a result, a working relationship was established that continues to facilitate affiliation for other projects. VAC will continue to collaborate with international partners and seek opportunities to share valuable insights, research, and best practices on Veteran health care.
In September, 2012, Minister Blaney will be attending the Tri-National Military Mental Health Symposium at the Canadian Embassy in Washington, hosted by the True Patriot Love (TPL) Foundation. In addition to Minister Blaney, the Symposium will feature extensive collaboration among Canadian officials, the White House, British officials, business executives and non-governmental organizations (NGOs) from Canada, the United States, and Great Britain to examine issues surrounding Veteran mental health and its effective treatment and de-stigmatization. The National Centre for Operational Stress Injuries (NCOSI) and Research Directorate of VAC, have been asked by TPL to play an active role in planning the event by providing research content and by identifying speakers and participants in Canada and internationally. This event will allow Veterans Affairs Canada to share, with its international partners, what it is doing to assist Veterans and their families with mental illness issues, as well as learn from the experience of partner nations.
Government has also established an extensive network of approximately 4,000 registered providers in the private sector to deliver professional mental health services across the country. This includes specialized in-patient mental health treatment programs. In addition, the VAC Assistance service provides free, 24-7, counseling support to Veterans and their families wherever and whenever needed. VAC provides access to some 200 clinical care managers who provide day-to-day support to those Veterans and their families with the most intensive and complex needs. This support helps them to become reconnected to their communities and to access the support systems, programs, and services that are essential to their mental health.
VAC's case management services are available to support Veterans who are experiencing difficulties, including those who face challenges with transition to civilian life. Case Management service is a goal-oriented, collaborative, organized, and dynamic process that focuses on a holistic, needs-based approach supported by inter-disciplinary consultation. Government has introduced new tools to support VAC case management and increase consistency in service for Veterans. The tools enable case managers to better identify complex needs, assess risks in transition, and determine the appropriate levels of support required. This set of tools for front line case managers serves as an effective monitoring mechanism in a manner that respects the Veteran's privacy and autonomy while ensuring that contact is maintained so that their emerging needs can be addressed. The new work tools also provide the basis for a more equitable distribution of caseloads based on average complexity and risk scores. As such, they are key to VAC's improved client-to-case manager ratio which is now 30:1, on average. This is well within the established range of 30-40 cases per case manager.
VAC is working with academic institutions and national associations to leverage the best existing knowledge, expertise, and successful practices. These actions will strengthen standards of practice and increase the consistency of Veterans' experience with these services across the nation. These efforts that happen behind the scenes do not make headlines -- they make a difference. The Government's efforts to strengthen case management for Veterans have a huge impact on how they are supported through transition, especially those who are the most vulnerable.
Our Government has also taken concrete steps in recent years to enhance coordination between VAC and DND/CF on vocational rehabilitation programs to improve client outcomes and to avoid overlap of benefits for ill or injured CF members transitioning to civilian life. While SISIP and VAC rehabilitation programs are not concurrent, DND/CF and VAC work together to coordinate them. In June, 2012, Government finalized improvements to the program arrangement that governs the delivery of vocational rehabilitation programs between VAC and DND/CF. These amendments formalize the improved collaboration between VAC and DND/CF on vocational rehabilitation programs that has been taking place over recent years and also strengthen open lines of communication between the programs. To increase alignment further, our Government has also announced that it will discontinue the offset of disability pension benefits under both VAC and DND/CF programs. Government will continue to increase consistency, promote early intervention, and strengthen alignment of DND/CF-VAC programs for CF members and their families who are transitioning to civilian life.
Improving Employment Opportunities
As was noted by the Committee, employment after service is a key factor to health, well-being, and quality of life after service. According to findings from the 2010 Survey on Transition to Civilian Life: Report on Regular Force Veterans, 89 percent of recent Canadian Veterans become employed in their life after service. VAC has developed an action plan to increase employment opportunities for Veterans within the public service and the private sector which includes the following:
VAC has expanded the Area of Selection Policy to include CF members in all internally advertised processes. As a result, CF members are now eligible to apply on all VAC internally advertised processes. Furthermore, VAC now includes CF experience as an asset qualification in all advertised processes.
Within the Public Service more broadly, our Government has been promoting the DND Transition Assistance Program which encourages prospective employers, in both the public and private sectors, to consider providing employment to highly-skilled, fully trained, qualified, and job-ready CF members who have been, or will be, medically released. Where immediate employment is not possible, due to injury or illness, VAC's rehabilitation program can provide support and training, if required. Further, VAC is working to familiarize CF members on the Public Service hiring process.
Working through the Public Service Commission, the Government is broadening awareness within the Public Service of additional challenges that CF members may face and of the priority accorded to medically releasing CF Veterans. The Government's legislation provides for eligible medically releasing Veterans to be placed as priority employees into positions where they meet the essential qualifications and are able to return to work, within 5 years of their release.
Working with partners outside the Public Service, our Government has been developing innovative partnerships with the private sector to increase employment opportunities for Veterans. An example is the "Helmets to Hardhats" initiative that is helping to connect Veterans and CF members to a range of careers within the construction industry.
The Government of Canada will continue its efforts to work with community organizations, private sector partners, and within the Public Service to support Veterans and their families in pursuit of suitable employment following release from military service, as well as to increase the number of Veterans who become employed at VAC.
Our Government has plans for a new employment initiative "Jobs – Emplois" to partner with corporate Canada to help releasing CF members and Veterans find civilian jobs. To support this initiative, VAC has created an email address to receive and distribute private sector job opportunities for releasing CF members and Veterans.
Improving and Simplifying Program Delivery
The Government is pleased that the Committee recognizes the significant efforts that have been made to improve programs, and notes that, for the most part, these programs are well received by Veterans. In 2011, the Government enhanced the New Veterans Charter (NVC) suite of programs. This included changes to the disability award to permit it to be payable either annually, in a lump sum, or a combination of the two. The Government also introduced a new monthly supplement to the Permanent Impairment Allowance for those permanently incapacitated and unable to return to work. A minimum income level has been established for Veterans engaged in the Rehabilitation Program. These are program improvements which are making a difference in the everyday lives of Veterans. Our Government is committed to continue to make improvements based upon ongoing dialogue with Veterans and the best evidence and practices available. The Government takes this opportunity to reconfirm its commitment to ensuring that eligible Veterans continue to have priority access to Ste. Anne's Hospital and to care and services in both official languages.
Our Government is also streamlining programs and services by cutting red tape. These efforts are paying dividends. For example, this summer, a bothersome paper process for Veterans seeking reimbursement for health-related travel has been simplified. Further, VAC will soon simplify much of the paper work for Veterans receiving VIP, as announced in Budget 2012. As red tape is reduced, resources are redirected to ensure that programs and services for Veterans are not impacted negatively. To the contrary, our Government is continually improving both its health and wellness programs and services, as well as how it delivers them to Veterans and their families, in order to maximize the positive impact on their quality of life.
Having listened carefully and consulted broadly with Veterans, Government has simplified programs and services and continues with improvements that make a difference in the quality of life of Veterans and their families.
Our Government is, therefore, pleased to provide assurance to the Committee, to Veterans, serving CF members, members and former members of the RCMP, and their families, as well as to all other Canadians, that it will continue to strengthen programs and their delivery and to reduce red tape to improve the health, well-being, and quality of life for Canadian Veterans and their families.
The Government of Canada thanks the Committee and the many witnesses who provided evidence. A great deal of effort and thoughtful consideration underpins the report. Its recommendations serve as a useful guide to the Government moving forward.
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The Canadian Veterans Advocacy Team.