# Presentation: 137001

## Combatting Information Fatigue: Health Information Resources for Veterans

- Terri Ottosen
- Consumer Health Outreach Coordinator
- National Network of Libraries of Medicine, Southeastern Atlantic Region
- University of Maryland, Baltimore

## Objectives:

- Understand the unique information needs of veterans and their families
- Utilize resources presented to locate reliable, authoritative health information specific to veterans
- Acquire skills and knowledge to effectively identify and assess resources not covered in the class

**Notes:**
Veterans and their families need reliable health information resources and training to locate health information that is sensitive and pertinent to their needs. This class will cover resources for finding information on general health conditions, mental health resources including those for PTSD, family issues, substance abuse, amputations, support groups, etc. This class will also prepare participants to find and assess other veterans’ health resources. We’ll also be covering some resources for current awareness including blogs and RSS feeds.

## Informational Needs

- 8 million Vietnam Veterans
- 6.7 million World War II Veterans
- 4.3 million Korean conflict Veterans
- 697,000 Gulf War Veterans
- 1.4 million Afghanistan/Iraq
- Greater rates of diabetes/overweight/obese
- 1/3 U.S. veterans suffer from arthritis

## Informational Needs

- Polytrauma
- Chronic Disease
- Traumatic Brain Injury
- Spinal Cord Injury
- Limb Loss
- Eye injuries
- PTSD and other mental health issues
- Health care benefits, insurance, financial issues

**Notes:**
When I put this class together, I consulted a select group of VA librarians from around the region and they provided helpful information and a review of the resources in the class. Doing the research led to this list of health conditions and informational needs. Military personnel in Iraq and Afghanistan are surviving wounds in numbers far greater than previous wars. Largely due to advances in body armor and combat medicine as well as the rapidity of evacuation, survivorship is close to 90% (NEJM 2004, 351(24). However, many wounded service members are surviving severe injuries which will require sophisticated, comprehensive, and often lifelong care. Blasts, especially those generated by IEDs (improvised explosive devices) are the cause of 65% of Operation Enduring Freedom and Operation Iraqi Freedom casualties. Explosive devices produce a characteristic pattern of injuries: traumatic brain injury, which is the signature injury of the Iraq war, blindness, spinal cord injuries, burns and damage to limbs resulting in amputation. Many military personnel are sustaining more than one of these wounds. The term polytrauma is being used to describe complex, serious injuries to more than one body system. PTSD is commonly experienced by veterans and others who have survived traumatic events. It is characterized by hypervigilance, avoidance, numbing and re-experiencing of the traumatic event. The unique nature of the OIF and OEF conflicts, which include multiple and lengthy deployments, urban warfare, terrorist attacks and the ever present threat from roadside bombs, place special burdens on military service members. Therefore it is not surprising that PTSD is being reported in substantial numbers in returning service members. TBI, the signature injury of the wars can cause attention, memory and language problems as well as headaches, sleep disturbances, and personality changes. Most TBIs result in what is called closed injuries (no penetration of the skull) which Kevlar helmets cannot protect against. Closed TBIs may not cause any outward physical signs or symptoms so if the case is mild, it may go unrecognized and untreated. Protective gear has prevented many fatal abdominal or chest wounds but has shifted the pattern of injury to limbs, which are largely unprotected. As of July 2007, 911 amputations had been sustained during OEF and OIF, with a significant portion due to IEDs. IEDs or car bombs are the primary cause of burn injuries . The hands and head, often unprotected areas, are the most common burn sites. Although burns to these areas are often small in size, they are difficult to treat and can lead to functional impairment. The severity, complexity and multi-site nature of the wounds being sustained by troops in OEF/OIF makes it imperative that healthcare professionals, wounded military personnel, veterans and their families know where to go to find reliable, trustworthy information.
(Issues in Science and Technology Librarianship, Fall 2007, Danielle Carlock, ASU, Mesa, AZ)

## Informational Needs

- Number of uninsured veterans ~2 million
- Rose 2x as fast as the uninsured general population
- In Jan. 2003, health care access cut off to future veterans earning more than $30-35,000 annually on average
- Only a minority of veterans (those disabled by military service) are automatically eligible for VA care

**Notes:**
USA Today, Wed. October 31, 2007 : 6A Author: Gregg Zoroya, contributing Julie Appleby
This article discusses a study conducted by researchers at Harvard Medical School. Their findings pointed to the increase in veterans lacking insurance coinciding with the Bush administration’s policies aimed at limiting the number of veterans eligible for coverage from the Dept. of Veterans Affairs, according to the study published in the American Journal of Public Health. In 2002, the adminis. Stopped marketing veterans health care and in Jan. 2003 cut off access to the vets earning more than the above amt. Both times, VA officials cited budgetary constraints and backlogs of untreated patients. The percentage of veterans who don’t have health insurance has increased from 2000-2004, from less than 10% to now almost 13%). Individuals that have served their country and are deserving are falling through the cracks of the health care system. It really epitomizes who the uninsured are and it’s mostly the working poor and middle-income people.

## Informational Needs

- 1/3 U.S. Military personnel war in Iraq access mental health services after returning home
- Prevalence rates of mental health concerns higher for Iraq veterans – 19.1% vs. 11.3% Afghanistan and 8.5% from other locations
- Veterans suffering depression are 7-8x more likely to commit suicide than general population: 90:100,000 vs. 13.5:100,000

**Notes:**
The last five major military conflicts have produced health care issues for veterans and their families; each affecting health information needs. For example, the Iraq War veterans are experiencing limb loss, chronic disease, and spinal cord injuries. In addition, an article in the March 2006 issue of the Journal of the American Medical Association reported nearly one third of U.S. military personnel from the war in Iraq access mental health services after their return home.  Gulf War veterans experienced exposure to toxic chemical agents and post-traumatic stress disorder. Vietnam veterans were potentially exposed to Agent Orange and some suffer from significant mental health disorders. The Korean War saw increased rates of psychiatric illness in former prisoners of war. World War II veterans were exposed to Mustard Gas and greater rates of hearing loss.  While the examples are generalized, the health issues and the recent media reports of veterans receiving poor health care or the state of veteran’s health care institutions, point to the need for reliable resources of health information. The resources we’ll cover will assist veterans themselves and their families, but also Librarians assisting veterans and their families will benefit from training that demonstrates these resources. 
Suicide rate American Journal of public health October 2007 VA Study.

## Informational Needs

- VA and aid groups bracing for new surge in homeless veterans in years ahead
- Contributing factors:
- High rates of PTSD
- Traumatic brain injury which can cause unstable behavior and substance abuse
- Long and repeated tours of duty which makes reintegration into families and work harder

**Notes:**
(NYT, Nov. 8, 2007)
More than 400 veterans of the Iraq and Afghanistan wars have turned up homeless and Dept. of VA are preparing for a new surge in the years ahead. Experts who work with vets say it often takes several years after leaving military service for the vets accumulating problems to push them into the streets. But some aid workers say the Iraq and Afghanistan vets appear to be turning up sooner than the Vietnam vets did. Seeing the first trickle, they anticipate that it’s going to be a tsunami. Poverty and high housing costs contribute. The National Alliance to End Homelessness in Washington released a report that among one million veterans who served after the Sept. 11th attacks, 72,000 are paying more than half their incomes for rent, which leaves them highly vulnerable. More than 11% of the newly homeless veterans are women.

## Informational Needs

- Veterans: 11% adult population yet 26% of the homeless on any given day
- In 2006, 196,000 veterans of all ages were homeless on any given night
- Chronic cases (homeless for > year)
- 44,000-64,000 veterans
- Health information needs greater than general population?

**Notes:**
Veterans have long accounted for a high share of the nation’s homeless. The statistics are pretty startling. The VA is making a large and growing effort to prevent homelessness including offering 2 years of free medical care and identifying psychological and substance abuse problems early. 

## General Health Resources

- Evaluating what’s out there on the Internet
- M+ : _[Evaluating Health Information](http://www.nlm.nih.gov/medlineplus/evaluatinghealthinformation.html)_
- M+ : _[Guide to Healthy Web Surfing](http://www.nlm.nih.gov/medlineplus/healthywebsurfing.html)_
- Key Points: Who runs/pays for the site? What is the purpose? Source of info? Reviewed? Current? How are links to other sites chosen? User info collected? Able to contact? Accurate?

## General Resources

- _[ClinicalTrials.gov](http://clinicaltrials.gov/)_
- _[Disability Information](http://www.disabilityinfo.gov/)_
- _[MedlinePlus: Veterans and Military Health](http://www.nlm.nih.gov/medlineplus/veteransandmilitaryhealth.html)_

**Notes:**
ClinicalTrials.gov is a registry of federally and privately supported clinical trials conducted in the United States and around the world. ClinicalTrials.gov gives you information about a trial's purpose, who may participate, locations, and phone numbers for more details.

This diability site is a collaborative effort among 22 Federal agencies and is intended as the Federal government’s one-stop website for people with disabilities, their families, employers, veterans and service members, workforce professionals and many others. It connects people with disabilities to the information and resources they need to actively participate in the workforce and in their communities. Information is available in 9 subject areas: employment, education, housing, transportation, health, benefits, technology, community life, and civil rights.
The site also has a section on veterans and the military. This section of the main disability information site provides news and information regarding new programs and resources as they become available. Users can also search for state and local resources on a wide variety of topics specific to veterans and members of the military community.

## General Military Health Resources

- _[MyHealthE Vet](http://www.myhealthyvet.va.gov/)_
- _[Deployment Health Clinical Center](http://www.pdhealth.mil/hcc/scc.asp)_
- _[VA Polytrauma System of Care](http://www.polytrauma.va.gov/index.asp)_
- _[Disabled American Veterans](http://www.dav.org/)_
- _[Deployment Health and Family Readiness Library](http://deploymenthealthlibrary.fhp.osd.mil/home.jsp)_
- _[Traumatic Brain Injury](http://www.ninds.nih.gov/disorders/tbi/tbi.htm)_
- _[Veterans and Military Health: Websites Serving NC](http://www.nchealthinfo.org/resources.cfm?info=0,164,0,0,0)_

## Mental Health Resources

- _[Dept. of Veterans Affairs Vet Center](http://www.vetcenter.va.gov/)_
- _[National Center for Posttraumatic Stress Disorder](http://www.ncptsd.va.gov/ncmain/index.jsp)_
- _[Mental Health Self-Assessment Program](https://www.militarymentalhealth.org/welcome.asp)_
- _[VA Mental Health ](http://www.mentalhealth.va.gov/)_

**Notes:**
Vet Center – 

The Department of Veterans Affairs Vet Center program operates a system of 207 community based counseling centers. The Vet Centers are staffed by small multi-disciplinary teams of dedicated providers, many of which are combat veterans themselves. Vet Centers provide readjustment counseling and outreach services to all veterans who served in any combat zone. Services are also available for their family members for military related issues. Veterans have earned these benefits through their service and all are provided at no cost to the veteran or family. The 207 community based Vet Centers are located in all fifty states, District of Columbia, Guam, Puerto Rico and the US Virgin Islands.

National Center for Posttraumatic Stress Disorder – 
The National Center for PTSD (NCPTSD) aims to advance the clinical care and social welfare of U.S. Veterans through research, education and training on PTSD and stress-related disorders. This site is an educational resource on PTSD and traumatic stress, for veterans and also for mental health care providers, researchers and the general public. The Center’s vision includes the facilitation and rapid translation of science into practice, assuring that the latest research findings inform clinical care; and translation of practice into science, assuring that questions raised by clinical challenges are addressed using rigorous experimental protocols. By drawing on the specific expertise vested at each separate division (e.g., behavioral, neuroscientific, etc.), the National Center provides a unique infrastructure within which to implement multidisciplinary initiatives regarding the etiology, pathophysiology, diagnosis and treatment of PTSD. The PTSD Information Center has Fact Sheets and Videos to answer questions on trauma, PTSD and related issues. A good place to start is the section entitled, “what is PTSD?” Another very helpful document is the “psychological first aid guide.”

Mental Health Self-Assessment Program – 
Available in Spanish and English, this site offers a self-assessment questionnaire for the user to determine whether or not current symptoms are consistent with a condition or concern that would benefit from further evaluation or treatment. It is not intended to provide a diagnosis, but can offer guidance as to where the user might also seek assistance. The self-assessments are voluntary and anonymous.

VA Mental Health – 
The mission of the Office of Mental Health Services is to maintain and improve the health and well-being of veterans through excellence in health care, social services, education, and research. Their site has many excellent resources including information regarding services, suicide prevention, PTSD, and counseling.

## Support Groups and Organizations

- _[Citizen Soldier Support Program](http://www.ribbonstoreality.org/)_
- _[Wounded Warrior Project](http://www.woundedwarriorproject.org/)_
- _[Military Homefront](http://www.militaryhomefront.dod.mil/)_
- _[Military Onesource](http://www.militaryonesource.com/skins/MOS/home.aspx)_
- _[Amputee Coalition of America](http://www.amputee-coalition.org/)_
- _[National Amputation Foundation](http://www.nationalamputation.org/)_

**Notes:**
Citizen Soldier Support Program – 
Spearheaded by the Odum Institute at the University of North Carolina at Chapel Hill, the Citizen-Soldier Support Program (CSSP) focuses specifically on the needs of National Guard and other reserve component members and families.

Wounded Warrior Project – 
The mission of this non-profit organization is to raise the awareness and enlist public aid for the needs of severely injured service men and women, to help severely injured service members aid and assist each other, and to provide unique, direct programs and services to meet needs. 

Military Homefront – 
This site is the official Department of Defense web site for reliable quality of life information designed to help troops and their families, leaders and service providers. A wide variety of advocacy information is available.

Military Onesource – 
This 24/7/365 service is available by phone, online and face-to-face through private counseling sessions in the local community by highly qualified, master’s prepared consultants. Personalized consultations on specific issues such as education, special needs, and finances are provided. Customized research detailing community resources and appropriate military referrals are also offered. The site includes locators for education, child care, and elder care, online articles, referrals to military and community resources, financial calculators, live online workshops called Webinars, and “E-mail a consultant.” Additional resources include brief videos of consultants addressing common issues such as communicating as a couple, budgeting and managing anger.

Amputee Coalition of America –
The Amputee Coalition of America (ACA) is a national, non-profit amputee consumer educational organization representing people who have experienced amputation or are born with limb differences. The membership is comprised of individual amputees, amputee education and support groups for amputees, professionals, family members and friends of amputees, amputation or limb loss related agencies and organizations. The majority of the governing Board of Directors are amputees. According to the site, the organization operates on the principle that education enables individuals who have lost a limb to participate knowledgeably in decisions about their own care, services, and outcomes. To achieve their highest potential, people with limb loss must play the central role in decisions affecting their lives; only then can they fully embrace life and its limitless opportunities for self-fulfillment. The ACA exists to provide this education.

National Amputation Foundation – 
The National Amputation Foundation (NAF) has for over 50 years been offering valuable assistance to veterans of World War I, II, Korea, the Vietnam Conflict, Desert Storm and Iraqi Freedom. The organization was founded in 1919 by a group of amputee veterans who suffered the loss of limb or limbs in the service during World War I. From its inception, the foundation was aware of the needs unique to amputees, and therefore dedicated its efforts to helping all veteran amputees. The foundation has since expanded its facilities to include civilian amputees. The foundation sponsors an Amp-to Amp program, which provides visits whenever feasible, by an amputee member of their organization, who has returned to a normal life. The organization believes this has proven to be a real morale builder. They have a list of support groups for every state and offer booklets and pamphlets of special interest to the amputee. Donations of medical equipment are also accepted and distributed to those in need.

## Demographic Group Resources

- _[Women Veterans Health Strategic Healthcare Group](http://www1.va.gov/wvhp)_
- _[Center for Minority Veterans](http://www1.va.gov/centerforminorityveterans/)_
- _[National Native American Veterans Association](http://www.nnava.org/)_
- _[BlackMilitaryWorld](http://www.blackmilitaryworld.com/)_

**Notes:**
Women Veterans Health Strategic Healthcare Group – 
While supporting the overall mission of Department of Veterans Affairs and in collaboration with VA's Center for Women Veterans established in 1994, the Women Veterans Health Strategic Healthcare Group specifically addresses the health care needs of eligible women veterans, providing appropriate, timely, and compassionate health care. A full continuum of comprehensive medical services is provided,  including health promotion and disease prevention, primary care, women’s gender-specific health care (e.g., hormone replacement therapy, breast and gynecological care, maternity and limited infertility), acute medical/surgical treatment, telephone, emergency and substance abuse treatment, mental health, domiciliary, rehabilitation and long term care.  VA researchers at many VA facilities also conduct medical research on women’s health.

Center for Minority Veterans – 
The Center for Minority Veterans is part of the Office of the Secretary. The Center assists eligible veterans in their efforts to receive benefits and services from the Veterans Administration. The Center acts only as a mediator and facilitator; it does not process claims, handle equal employment complaints, or deal with employee relation problems. The Center is dedicated to ensuring that all veterans are aware of benefits, services, and programs offered by VA. The Center's main goal is to provide and promote the use of VA programs, benefits, and services use by minority veterans, to make benefits and services more accessible to minority veterans, and to evaluate current programs and make recommendations on how the VA can better serve minority veterans.

National Native American Veterans Association – 
The mission of the National Native American Veterans Association is to educate and assist Native American Veterans without regard to Tribal Affiliation, degree of Indian Blood, branch of the Armed Forces, or Combat Status with regard to Veteran Rights, Entitlements, and Benefits. The National Native American Veterans Association will also assist Tribal Entities in the development of Veteran Groups within each Tribe if desired, and provide a resource center for the Tribal Entities for information on Veteran Rights, Entitlements, and Benefits which can be used to augment current Tribal Programs.

BlackMilitaryWorld – 
Blackmilitaryworld.com provides a daily source of news, information, history, and a variety of other information to interested viewers, both employed by the Department of Defense and non-military. The organization’s mission is to celebrate and recognize the contribution and struggles of Black Americans in military service. This website does not necessarily serve the interest or the goals of the Department of Defense or the U.S. Government, but still shows its appreciation for the valuable role that Black Americans have played throughout American military history. 

## Spinal Cord Injuries and Disease Resources

- _[National Spinal Cord Injury Association](http://www.spinalcord.org/)_
- _[SPINALCORD: Spinal Cord Injury Information Network](http://www.spinalcord.uab.edu/)_
- _[M+ Interactive Tutorial: Spinal Cord Injuries](http://www.nlm.nih.gov/medlineplus/spinalcordinjuries.html)_

**Notes:**
National Spinal Cord Injury Association – 
The NSCIA is the oldest and largest civilian organization dedicated to improving quality of life for hundreds of thousands of Americans and their families living with the results of spinal cord injury and disease (SCI/D) and their families. The organization’s mission is to educate and empower survivors of spinal cord injury and disease to achieve and maintain the highest levels of independence, health and personal fulfillment. They provide an innovative Peer Support Network and raise awareness through education. Educational programs are developed to address issues important to their constituency, policy makers, the general public and the media, and include injury prevention, improvements in medical, rehabilitative and supportive services, research and public policy formulation. They provide information and referral to individuals with new and existing SCI/D, their families and their service providers. Their National Peer Support Network provides peer support referrals to programs across the country, linking people with SCI/D to each other. 

SPINALCORD: Spinal Cord Injury Information Network – 
This is a Federally-funded website devoted to providing the most complete resource for SCI and disability-related information, the Spinal Cord Injury Information Network site, produced by the University of Alabama at Birmingham, offers educational and research information relevant to persons with SCI, their families, and others of interest. There is original information managed by the UAB Model SCI System along with links to web sites around the world that contain SCI educational and research information.

MedlinePlus: Interactive Tutorial – Spinal Cord Injuries – 
This interactive tutorial explains the anatomy involved in spinal cord injuries, causes, symptoms, treatment and prevention. The tutorial uses animated graphics and explains the condition in easy-to-read language so that the user can read or listen to the tutorial.

## Chronic Disease Resources

- _[(WHO) World Health Organization: Chronic Diseases](http://www.who.int/topics/chronic_diseases/en)_
- _[(CDC) Centers for Disease Control: Chronic Disease Prevention](http://www.cdc.gov/nccdphp/index.htm)_

**Notes:**
Two resources for chronic disease are the WHO site and the CDC site. Chronic disease is defined as diseases of long duration and generally slow progression. Chronic diseases, such as heart disease, stroke, cancer, chronic respiratory diseases and diabetes, are by far the leading cause of mortality in the world, representing 60% of all deaths. Out of the 35 million people who died from chronic disease in 2005, half were under 70 and half were women. The site from the WHO has fact sheets, Q and As, and a wide variety of statistics and publications. The CDC site focuses on prevention  and contains state profiles. Both of these focus on the big picture. For specific chronic disease information, I would recommend M+.

## Benefits Resources

- _[IRIS: Inquiry Routing and Information System (Veterans Affairs)](http://iris.va.gov/)_
- _[GovBenefits.gov](http://www.govbenefits.gov/)_

**Notes:**
IRIS – Inquiry Routing and Information System – 
IRIS is the Veterans Affairs system to obtain information about military benefits. There are 321 FAQs (Frequently Asked Questions) and an Ask a Question option. Answers can be found here for such things as education benefits, how to file a Board of Veterans Appeal, toll-free numbers for contacting the VA about benefits and a listing to help locate VA facilities. 

GovBenefits.gov – 
The site provides online guidance to a variety of federal government benefit programs. Benefits information may be located by state, federal agency, and category. Users answering a lengthy questionnaire on the site can retrieve a list of links to benefits programs for which they may be eligible. One of the goals in their mission statement is to continue to add programs and become the single source for Federal, state and local government benefit programs. A search for “veterans” produces a list of 49 potential programs.

## Health Insurance and Consumer Assistance

- _[Navigating the Health Care System: A Resource Guide for Consumers](http://library.uchc.edu/departm/hnet/hcbib.html)_
- _[Questions and Answers about Health Insurance Guide (AHRQ)](http://www.ahrq.gov/consumer/insuranceqa/)_
- _[Healthcare411](http://healthcare411.ahrq.gov/)_

**Notes:**
Navigating the Health Care System: A Resource Guide for Consumers – 
This guide was put together by Healthnet: Connecticut Consumer Health Information Network, Lyman Maynard Stowe Library, University of Connecticut Health Center in Farmington, CT. It includes information on evaluating physicians and hospitals, communicating with doctors, managed care plans, Medicare, obtaining health insurance, organizations that can provide assistance, long-term care, end of life decisions, and privacy rights.

Questions and Answers about Health Insurance Guide – 
From the Agency for Healthcare Research and Quality (AHRQ), this guide is designed to help consumers make important health insurance decisions. The guide explains different types of health insurance, including network-based plans, non-network based coverage, and consumer-directed health plans. It also provides a glossary of health insurance terms as well as additional resources to obtain more information. Print copies are available by sending an email to ahrqpubs@ahrq.hhs.gov 

Healthcare 411 – 
Healthcare 411 is a news series produced by the Agency for Healthcare Research and Quality (AHRQ), part of the U.S. Department of Health and Human Services. AHRQ’s mission is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. AHRQ is the lead Federal agency in the effort to improve patient safety and reduce medical errors. Using the latest podcasting technology, weekly audio and video programs feature news and information on current health care topics with synopses of AHRQ’s latest research findings. This innovative tool provides consumers with information they can use to improve the quality of their health care. In addition, the series gives AHRQ researchers and grantees an opportunity to share their findings and to be heard beyond the research community. Download the programs to your mobile media player or computer by subscribing on the site. The AHRQ subscription is free. Healthcare 411 features and programs range from 2 to 10 minutes in length. All new and archived items remain available on the Healthcare 411 site.

## Current Awareness and Other Resources

- _[House Committee on Veterans Affairs Activities](http://veterans.house.gov/)_
- _[Veterans History Project](http://www.loc.gov/vets)_
- _[Institute of Medicine: Health of Veterans and Deployed Forces](http://veterans.iom.edu/)_
- Blogs: Readers: _[Bloglines](http://www.bloglines.com/)_ or Google Reader
- Military Blogs (Milblogs)

## VALNET: Referral

- VALNET: VA Library Network

**Notes:**
VALNET: VA Library Network – 
A Health Sciences Library Network, under the OneVA concept, VALNET member libraries support the Department of Veteran Affairs (VA) Health Care System, the Veterans Benefits Administration, and the National Cemetery Administration. VALNET libraries and librarians provide knowledge-based information for clinical and management decision-making, research, and education to enhance the quality of care for more than 5 million veterans enrolled in the VA Health Care System. VALNET serves a diverse group of users, including VA staff and employees, students and trainees in affiliated teaching programs, and veteran inpatients and outpatients, their families, and caregivers.

## Thank You!

- Questions or Comments: National Network of Libraries of Medicine
- 800-338-7657
- or email: tottosen@hshsl.umaryland.edu