- From the ability to easily access timely medical care to experiencing certain medical conditions at disproportionate rates, veterans represent an extremely vulnerable patient population. That limited health equity is further exacerbated when veterans fall through the cracks of the social determinants of health.
At NC Serves, a North Carolina-based consortium of non-profits dedicated to addressing veteran social- and healthcare-related needs within individual communities, leaders are focused on connecting patients with the resources veterans need in the way they need them.
Veterans can be a particularly hard-to-reach patient population. For one, homelessness affects veterans at disproportionate rates. Per statistics from the National Coalition for Homeless Veterans, nearly 39,500 veterans are homeless.
Data shows that poor health is tied to homelessness. Veterans who are homeless may not have the chance to visit the doctor regularly and face climate elements that make it more likely that they will fall ill. If the patient does get sick, it is more difficult for her to get better when she is homeless.
According to Brandon Wilson, an assistant director for service coordination at NC Serves Western, veteran homelessness is a significant problem in his service area, Asheville. Asheville is home to excellent homeless shelters and community resources, Wilson told PatientEngagementHIT.com in an interview. As a result, more homeless veterans are drawn to the city to reap those benefits.
In an effort to coordinate care and services for veterans in need of social work, NC Serves has installed kiosks collecting data about the social determinants of health and social needs.
These kiosks, hosted by Unite Us, alert social workers and individuals at NC Serves of specific needs a veteran or a veteran’s family member may need. The worker then connects the veteran with those types of services once resources become available.
Kiosks – which include a table attached to a durable stand – are useful because they provide NC Serves with regional or individualized data in real time. Instead of waiting weeks to analyze the results of a community health needs assessment (CHNA), NC Serves can see that most veterans in the area are looking for housing, employment, and substance abuse and mental health assistance.
The tools also accomplish several of Wilson’s patient-centered goals with NC Serves. For one, the kiosks help reach patients who are otherwise unreachable. Currently, NC Serves has the kiosks set up in various locations throughout the community, including the public library.
Across the country, libraries serve as important resources for the homeless. Whether the library serves as a place to get warm or a place with free internet access for job and apartment applications, homeless individuals often find refuge in them.
“One of the things that drove us putting the kiosk there was because of that issue,” Wilson explained. “We knew that we had veterans that utilized that library downtown, which allowed us to be able to say, ‘hey, how about we put a kiosk here and then I’ll at least catch some of those veterans that say they need a job or housing or something else.’”
These kiosks will also ideally reach the medical community, Wilson shared. NC Serves is currently in the midst of reaching a deal with Asheville’s VA Medical Center to install the tools. This will help reach more veteran populations who otherwise would not report social determinant of health needs.
Underreporting of social needs is a common trend throughout the veteran community, regardless of whether the patient is homeless or not. Cultural norms often discourage veterans from seeking help.
“The military community has a specific military culture,” Wilson pointed out. “There’s a way that we are trained. There’s a way we live. There’s a way that we look through a lens that is different than a civilian population.”
“Veterans typically don’t like to ask for help,” he continued. “So how do we get someone who’s in need of substance use who’s afraid to ask for help or afraid to bring forth this issue that they’re having to life to get them on the right track?”
These kiosks are an empowering way for patients to disclose social or health needs that could otherwise remain undetected. Patients visiting the library, community locations, or – ideally – eventually VA Medical Centers, can seek help in a way that still preserves their sense of pride.
It is important for care coordination groups to reach out to veterans in a way that works for this unique population, Wilson added. Too often, veterans see their job assistance requests denied because traditional social work protocol want to address a veteran’s substance abuse disorder first.
Most theories suggest that the substance abuse disorder is a more pressing issue and must be overcome before a veteran can manage work. But listening to the patient’s voice is an important way to gain the veteran’s trust and eventually uncover other social determinant of health issues.
“With veterans oftentimes if we meet that individual where they’re at and help them get what’s right in front of them, all of a sudden that trust is there. They’re more willing to talk to you,” Wilson explained.
Uncovering the social determinants of health is a key population health management principle. The healthcare industry has established some strategies for collecting and understanding this data, but still, some populations fall through the cracks.
Establishing systems unique to veteran populations will help healthcare professionals and social workers better understand veteran social needs. Ultimately, this will require meeting veterans where they are in both data collection and addressing veteran needs.