Military-Informed Care: What it Means for Veterans and Their Families

The care needs of military-connected families can look different from those of other patients. Higher emotional or mental stress, and longer rehabilitation, are just a few of the challenges that these families can face. In observation of Veterans Day, Steve Schwab, CEO of the Elizabeth Dole Foundation, and Kara Walker, M.D., executive vice president and chief population health officer at Nemours Children’s Health, discuss how hospitals and health systems can meet the special health care needs for families who sacrifice the most.


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00:00:00:14 - 00:00:20:16
Tom Haederle
The care needs of military-connected families can be different from those of many other patients who seek care from hospitals and health systems. Often, they're dealing with higher rates of emotional or mental stress. Rehabilitation and recovery efforts take longer on average, and it's not unusual for military families to be providing long-term in-home care to their veteran members.

00:00:20:19 - 00:00:36:18
Tom Haederle
Experts say these unique circumstances matter, and that many caregivers need to be more mindful that they exist.

00:00:36:20 - 00:01:02:07
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications. As we observe Veterans Day this week, today's podcast takes a look at how hospitals and health systems, not to mention society at large, can do a better job of meeting the special health care needs of military-connected families. Our host is Nancy Myers, vice president of leadership and system innovation with AHA’s Center for Health Innovation.

00:01:02:12 - 00:01:14:17
Tom Haederle
She is joined by Steve Schwab, CEO of the Elizabeth Dole Foundation, and Dr. Kara Walker, executive vice president and chief population health officer, Nemours Children's Health. Here's Nancy.

00:01:14:20 - 00:01:36:05
Nancy Myers
I'd like to welcome everyone to our discussion today, and I'm so honored to be here with both of you to talk about this really cool and important topic. So, Steve, I want to start with you. Big picture. Why should it be important to hospitals and health systems to increase their use of military-informed care? What is the need in this space?

00:01:36:08 - 00:02:19:01
Steve Schwab
Well, that's such a great question to start off. And it's so good to join you both and talk about a topic that's really important, to our country. If you step back and think about the fact that there is less than one half of 1% of our population serving to protect our freedom and security, and it's easy to take that for granted and to lose the fact that our neighbors and our friends and our church members and our colleagues might be somehow military- connected, because it seems like such a small amount of folks, but actually, when you add in the layers of veterans and military-connected families and kids and folks who work in a

00:02:19:01 - 00:02:44:02
Steve Schwab
civilian setting and military-connected care, it actually adds up to a lot of Americans. And so when we talk about military-informed care, we talk about the unique ways that health care systems and health care practitioners can make military-connected populations feel special from the minute they walk in the door. But care needs for military-connected communities is really different and unique.

00:02:44:04 - 00:03:18:26
Steve Schwab
Military-connected patients tend to have increasing rates of mental and emotional stress, PTSD. Many of our military-connected patients have traumatic brain injuries or behavioral health issues. That doesn't mean everybody, but it means that practitioners and systems need to be acutely aware of the kinds of distinct conditions, mental and emotional, that are unique to the military population. And so when health systems think about when those folks come into, like Nemours, for instance, who's ahead of the game on military-connected care.

00:03:18:28 - 00:03:46:06
Steve Schwab
Because when folks come in, we want to ask patients, are you military-connected? We want to ask if children are inside military families. We want to ask spouses if they're caregivers or military or veteran-connected caregivers, because all of those characteristics, all of those roles, all of those conditions come with unique needs. And what it can provide practitioners and systems are a set of protocols that they can use clinically.

00:03:46:08 - 00:04:11:06
Steve Schwab
They can use administratively to have a special touch, and to take those families or those patients through a continuum of care that doesn't just recognize that they're military-connected, but actually embraces it and builds it into the practice from the front desk to the doctor's room, through to the way that practitioners and clinicians follow up with family members.

00:04:11:13 - 00:04:38:08
Steve Schwab
The other thing that I'll say, that’s unique to military-informed care is that rehabilitation and recovery within military and veteran families usually does really include the entire family — so the spouse and the children, as is the case in our work with Nemours. Military children tend to be more aware of what's going on with mom and dad if they have military service-connected wounds, injuries, or illnesses.

00:04:38:11 - 00:04:43:10
Steve Schwab
There's millions of kids across this country who are serving as primary and secondary caregivers.

00:04:43:13 - 00:05:12:09
Nancy Myers
Thanks for that background and Kara,  I want to turn to you. You know, you're a physician. You're a leader at Nemours Children's, which is really in the business of supporting kids and their entire family. Can you talk about what are the examples of the impact on kids and families when providers aren't providing military-informed care? Or conversely, you know, what are the winds that can happen when they are aware of that background in a child's life?

00:05:12:11 - 00:05:40:11
Kara Walker, M.D.
Thank you so much, Nancy. It is truly an honor to serve so many kids across our geographies. And we know that children in military-connected families serve our country too. And so I'm a family physician. I know that the context of which a family is in, at home, at school, in our communities, matters so much to the health that they have personally, but also to the health of their entire family unit.

00:05:40:11 - 00:06:15:16
Kara Walker, M.D.
And so we know that each encounter with a military-connected child or youth provides us an opportunity to recognize their service. And we know how important trust is and trust building and seeing the whole person is in creating health in our nation. This enhances the care that we provide as physicians, as caregivers, as health systems. And we also know that in conversations we have with military families, we get to hear the stories of what it looks like when it's done right.

00:06:15:18 - 00:06:42:12
Kara Walker, M.D.
We know that that means we acknowledge military connections. It means we're checking in with our patients and parents in a way that shows we understand how being part of a military-connected family impacts so much of what it means to thrive. It means it impacts their social supports, their health care needs, but also their mental health needs. So we also know what it feels like when it's done well.

00:06:42:14 - 00:07:12:13
Kara Walker, M.D.
Unfortunately, we also hear stories of frustration when it's not done well. We hear of families who have to be that bridge and have even more burden to act as educators and then orient the entire health system to what it means to have challenges and stressors that can be caused by deployments and relocations, or what it means to be a young person who's also caring for a parent with PTSD or other types of service-related injuries or illness.

00:07:12:16 - 00:07:43:27
Kara Walker, M.D.
So we know both sides of that coin. I think that's where being military-informed can help all of us do more for the patients we serve and our communities. There's a saying that when you know better, you do better. And through our Hidden Helpers Coalition and other work, the Elizabeth Dole Foundation does an incredible job of raising the collective awareness of needs of military-connected spouses and children, particularly for those who are caregivers for injured veterans or service members.

00:07:44:00 - 00:07:51:06
Kara Walker, M.D.
We are so fortunate to participate in this Coalition. It has been part of our journey to know better.

00:07:51:09 - 00:08:13:10
Nancy Myers
So I want to come back to you in a moment to talk to you about how Nemours got involved with the Hidden Helpers Coalition, but Steve, wanted to turn back to you to tell us a little bit about that Coalition. Why was it needed? What types of organizations are you working with and how you feel that hospitals and health care can really contribute to the work?

00:08:13:13 - 00:08:42:21
Steve Schwab
Yeah, well, I think you can tell by Kara's answer that Nemours gets it, and military families notice that. Military-connected patients notice when they walk into a clinical setting or a hospital or a doctor's office, if that physician, if that office has a culture of military-connected care because their experiences serving this country are so unique. And that's really what's been beautiful about the partnership between Nemours and the Elizabeth Dole Foundation.

00:08:42:24 - 00:09:19:15
Steve Schwab
Let me tell you about the work that we're doing around Hidden Helpers. In 2014, we did a groundbreaking study with RAND and really put the military and veteran caregiving issue on the map. We stood in the East Room of the White House with then President Obama, Mrs. Obama, and Dr. Biden. And we said this country has a crisis occurring in military and veteran families, 5.5 million families across the country who are providing long-term, in-home care for wounded, ill and injured veterans in a way our country had never seen before because so many veterans were coming home with injuries that they had sustained in war and that they were surviving in rates they hadn't in

00:09:19:15 - 00:09:45:17
Steve Schwab
prior war eras, because of advancements in battlefield medicine, which means the family model of care in this country for military and veteran families has totally changed. Families are now engaged in home health care in a way that they hadn't been. So multiple generations are being impacted, including kids. And so part of what that RAND study told us was there wasn't enough research on the implications of this new caregiving situation in America.

00:09:45:20 - 00:10:14:15
Steve Schwab
Nemours and others joined us as we unveiled an update to that 2014 study 10 years later, that tells us that that number has gone from 5.5 million to 14.3 million families. So in 10 years, we've seen an almost threefold increase in the amount of families across this country. And they're in all 50 states. They're inside military health institutions and VA facilities, but they're also going into places like Nemours and clinical health facilities all across this country.

00:10:14:18 - 00:10:51:19
Steve Schwab
And so we did a research blueprint, and that blueprint from RAND told us that we needed to understand more what was happening with kids and the implications of this caregiving situation on children. And so we did a study, went back to the White House. Dr. Biden helped us launch an initiative called Hidden Helpers three years ago, and we challenged American childcare organizations and health care organizations to come together with government in the private sector in a coalition approach to think about how we can bring special, tailored care and support to these kids.

00:10:51:20 - 00:11:25:18
Steve Schwab
Nemours was one of the first institutions to raise its hand. It has been remarkably leading the front as it relates to innovating care, both technology approaches and clinical approaches, training approaches that are becoming the model for the nation. And that's the whole idea behind this Coalition, bringing these partners together to create programs and innovation and educational interventions to change these kids’ lives and to help them in the school setting, in the health care setting, in their home and to create stronger, healthier families.

00:11:25:21 - 00:11:32:05
Nancy Myers
Thanks. So, Kara, talk a little bit about what are some of the initiatives to improve military-informed care?

00:11:32:07 - 00:12:00:10
Kara Walker, M.D.
Well, I'm so thrilled that when we raised our hand, Steve said, “Yes, let's go and let's run.” Before I summarize our current work, I want to say that the Coalition's focus is on children who have a parent with service-related injuries. The work we're doing at Nemours Children's takes a “yes and” approach. It's really focused that our efforts are designed to benefit caregiving children, plus any and all military-connected children.

00:12:00:12 - 00:12:22:11
Kara Walker, M.D.
So one of the commitments when we joined the Hidden Helpers Coalition was to create this introductory professional development course for providers and others who are in the health care sector. Now, I know as a doc, sometimes we have to sign up for these courses to make sure we're current and we have the best evidence and the best tools.

00:12:22:14 - 00:12:52:12
Kara Walker, M.D.
This education opportunity was developed in partnership with the Elizabeth Dole Foundation. It merged our expertise on, you know, the technical health care medical side, but then we combined it with extensive knowledge of military culture. It created a course that's publicly available on our Nemours continuing education platform at no cost. But I will say that there are very few educational courses that I personally have taken where I teared up.

00:12:52:15 - 00:13:23:17
Kara Walker, M.D.
I got emotional and I walked away with true skills. This course is compelling. It features young adults who are part of military caregiving homes, spouses of injured veterans, as well as physicians, nurses, behavioral health care providers from Nemours Children's. It really is a robust opportunity, and if you want some more resources who want to learn more, dive deep into the course, such as learning more about trauma-informed care, what secondary PTSD is, and many others,

00:13:23:17 - 00:13:52:16
Kara Walker, M.D.
check it out. It really is an incredible course. I'll also say we're very proud of the work that's happening around creating new tools in our electronic medical record. So this summer we added an identifier to our EMR that allows us to document if a child is part of a military-connected home. So, you know, the doc pulls up the electronic screen, you check into your visit and it says maybe your address, your age, maybe what meds you're on.

00:13:52:18 - 00:14:24:18
Kara Walker, M.D.
Now, you can see as a snapshot whether a child is also military-connected. That just gives you a quick prompt to make sure we know the information is flowing. The identifier is there. This is truly unique. Once we have a few months of the data, our team is going to create some sense out of this. We're going to meet to review the data, understand what procedures and trainings need to be in place so that the entire care team knows what to do when they're connecting and interacting with a military-connected patient.

00:14:24:20 - 00:14:31:23
Kara Walker, M.D.
It'll make sure that we adapt, how we interact, how we ask questions, how we ask the right questions at the right moment.

00:14:31:25 - 00:14:50:04
Nancy Myers
I always like to end with, what are a couple of things you can do today as you go back to your own organization, for our listeners. So for AHA members and other health care organizations that want to expand and increase their use of military-informed care, what are the concrete actions you recommend? Where should they start?

00:14:50:06 - 00:15:15:27
Kara Walker, M.D.
Easy. There are two things I would underscore. One, I want to encourage providers, care team members, health professionals who are listening to take this professional development course. It is an incredible opportunity to learn from both our experience at Nemours and the Elizabeth Dole Foundation's expertise, to understand the ability to respond to the unique strengths and stressors of military-connected children and families.

00:15:16:02 - 00:15:48:21
Kara Walker, M.D.
We'll share the course link in the show notes. Check it out. It is no cost, CME, all the good things and lots of incredible patient stories and kids who are doing tremendous work. Second, I want to encourage others who are listening across AHA’s membership to join Nemours Children's Health and being part of the national Hidden Helpers Coalition. There are already a hundred members from a broad range of sectors, but like CHA, I know there are health system leaders who want to be part of this Coalition membership.

00:15:48:24 - 00:16:06:10
Kara Walker, M.D.
It brings you an invaluable opportunity to learn and bring those lessons back to your organization. More than anything, Hidden Helpers Coalition is action focused, so this is a real chance to collaborate on joint initiatives that go beyond the scope of what one organization alone can do.

00:16:06:12 - 00:16:08:19
Nancy Myers
Steve, anything that you'd like to add?

00:16:08:21 - 00:16:30:15
Steve Schwab
Can't beat what Kara just said. We take a more than the merrier approach in this Coalition. If you work with kids, if you work with families, if you work in the health care sector, in the education sector, there's room for you at this table. I think you'll find a really innovative group of folks who are mission oriented, and want to make a difference in the lives of military families.

00:16:30:15 - 00:16:40:02
Steve Schwab
So we really appreciate this opportunity to spread the word and how important it is for all of us to be military-informed, especially as it relates to what we're doing in the health care setting.

00:16:40:05 - 00:17:03:09
Nancy Myers
Well, I would like to thank you both for this important conversation and for reminding us that as we honor the service of our active military members and our veterans, we also recognize the support that we can provide to their families in our hospitals and health systems. And make sure to check out the resources available through Nemours Children's and the Elizabeth Dole Foundation.

00:17:03:11 - 00:17:11:22
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.