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Service Delivery Innovation Profile

Coordinated Treatment and Support Enhance Access to Care for Veterans With Post-Traumatic Stress Disorder and Traumatic Brain Injury and Their Families


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Snapshot

Summary

The Red Sox Foundation and Massachusetts General Hospital Home Base Program is the Nation's first partnership between academic medicine and a Major League Baseball team designed to address the invisible wounds of returning Iraq and Afghanistan veterans and their families. The program coordinates with VA New England Healthcare System and the Department of Defense. The Home Base Program provides clinical care and support, regardless of the ability to pay, to veterans who experience traumatic brain injury, combat stress, or posttraumatic stress disorder as a result of their deployment in the post-9/11 conflicts. Based at Massachusetts General Hospital, the program also provides counseling and support to the families of these veterans, educates and trains health care providers and the community about these conditions, and conducts research. The Home Base Program has enhanced access to care and generated high levels of satisfaction, with 81 percent of vets agreeing that the program has made a difference in their lives.

Evidence Rating (What is this?)

Suggestive: The evidence consists of post-implementation data on the number of veterans and family members served and the results of a 2013 patient-satisfaction survey.
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Developing Organizations

Massachusetts General Hospital; Red Sox Foundation
The program coordinates with VA New England Healthcare System, the National Guard, the Massachusetts National Guard, the Department of Defense, and local and regional veteran-serving organizations.end do

Use By Other Organizations

Emory University and the Atlanta Braves have created a program to offer veterans and their families treatment and support through their BraveHeart program. 

Date First Implemented

2009
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Patient Population

Vulnerable Populations > Military/dependents/veteransend pp

Problem Addressed

Many veterans who served in Iraq and Afghanistan experience combat and deployment stress including posttraumatic stress disorder (PTSD), major depression, and traumatic brain injury (TBI). These mental health problems often lead to stress and emotional difficulties for family members as well. The stigma associated with these conditions prevents many veterans from seeking help, and those with less-than-honorable discharge do not have access to the Department of Veterans Affairs (VA) services. Limited care options for these veterans, along with the families of many service members including parents and children, increase the need for additional quality care.
  • High rates of mental health problems: A study of more than 1,500 previously deployed individuals from 24 geographic areas found substantial rates of mental health problems, with 14 percent screening positive for PTSD and major depression and 19 percent reporting a probable TBI during deployment. Overall, an estimated 300,000 previously deployed individuals currently suffer from PTSD or major depression, while roughly 320,000 have likely experienced TBI. About one-third of those previously deployed have at least one of these three conditions, and about 5 percent report symptoms of all three.1
  • Problems for family members as well: Overall, 43 percent of active-duty, reservist, and National Guard members have children, and nearly 2 million of these children have a parent who has been deployed to Iraq or Afghanistan. More than 40,000 children, not including younger brothers and sisters of service members, have been affected by the injury, death, or illness of a service member as a result of combat and deployment.1
  • Limited care options, stigma seeking treatment: Many veterans struggle with the stigma associated with disorders caused by the emotional stress and trauma of their battlefield experiences. In the above-referenced study, 57 percent of those reporting a probable TBI had not been evaluated by a physician for brain injury. As with civilian populations, only about half (53 percent) of veterans meeting the criteria for PTSD or major depression sought help from a physician or mental health provider for a mental health problem in the past year.1
  • Lack of quality care: Only a little more than half of those who have sought care for a mental health problem receive minimally adequate treatment; the proportion who receive high-quality care is even lower.1

What They Did

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Description of the Innovative Activity

A partnership between academic medicine and a Major League Baseball team, the Home Base Program provides clinical care to New England veterans who experience TBI, combat-related stress, or PTSD as a result of their service in Iraq and Afghanistan, regardless of their insurance or ability to pay. The program offers diagnostic, treatment, and referral services at a Massachusetts General Hospital outpatient clinic. A multidisciplinary staff of psychiatrists, psychologists, physical medicine and rehabilitation specialists, nurses, social workers, and other clinicians provide treatment in the Home Base clinic. Six Iraq and Afghanistan veterans, including two female veterans, are part of the clinical team and are the first point of contact for all veterans entering the program. The program also provides clinical counseling and resilience support to the families of these veterans, educates health care providers and others about these conditions, and conducts research. Key program elements are described below:
  • Marketing and outreach: Full-time Iraq and Afghanistan veteran outreach staff promote the program through personal contact with veterans and family members, collaboration with other provider groups and veteran-service organizations, and formal and informal community presentations to reduce the stigma associated with deployment and combat-related stress. The program uses traditional and social media to publicize its services, including a quarterly newsletter, Facebook, and Twitter. It also hosts fundraising and community-education events, holds special events at Fenway Park for veterans and their families, and works closely with media outlets to promote program-related services, activities, and research.
  • Appointment scheduling through intake team: Veterans and family members call a designated telephone number at Massachusetts General that is answered by a trained administrative assistant, who directs calls to either the veteran's intake team or family team. One of these teams schedules appointments and, as appropriate, makes referrals. Except in cases of an emergency, veterans receive an appointment for an assessment and evaluation in approximately 2 weeks. In some instances, where the scope of the problem is beyond the mission of the program, family members might speak to a social worker who will refer them to another program or service. People receive care regardless of their ability to pay, discharge status, or other circumstances that might make them ineligible to receive VA services. However, for those with coverage, the program is required by law to bill the insurance company.
  • Clinical care for veterans: The program offers diagnostic, treatment, and referral services at Massachusetts General and Spaulding Rehabilitation Hospital. A multidisciplinary staff of psychiatrists, psychologists, nurses, social workers, and other clinicians coordinate care with other providers of care for the veteran or family, such as the VA Boston and New England Healthcare Systems. The availability of a multidisciplinary team of adult-, child-, and couples-focused clinicians who specialize in PTSD and TBI fills a treatment gap for providers serving veterans and their families.
  • Counseling and support for families: The program offers psychosocial education, counseling, and referrals to all family members of veterans, including spouses, parents, children, siblings, and significant others. Services include a parent-support group that addresses postdeployment adjustment and reintegration issues; individual counseling for spouses and children; family counseling; and a Web-based guidance tool for military parents and school professionals called Staying Strong (www.stayingstrong.org). Family services draw on the skills and knowledge of the PACT Program (Parenting at a Challenging Time), which was developed at Massachusetts General to address the issues families face when a parent is living with cancer. The program also conducts a variety of community activities for veterans and their families, including family baseball at Fenway Park, sailing with local boating associations, and skiing trips.
  • Community education and training: For their clinical educational offerings, the program uses the combined resources of the Massachusetts General Hospital Psychiatry Academy and the VA National Center for PTSD to help disseminate information regarding readjustment issues for veterans and family members associated with deployment-related stress, PTSD, and TBI. In addition to print and video materials, the program provides live and Web-based training to health care providers, with a focus on increasing their understanding of military culture and its impact on their ability to provide direct care.
    • Web-based training: Information provided in January 2014 indicates that in 2012 and 2013, Home Base and the VA's National Center for PTSD collaborated to present a free, 23-part live, interactive Web series called From the War Zone to the Home Front: Supporting the Mental Health of Veterans and Families. More than 8,700 clinicians nationwide have participated in the series, and received continuing education credits. 
    • Community education: Information provided in January 2014 indicates that in 2013 alone, program staff conducted community education sessions for more than 3,700 nonclinical audience members, including student, veteran, and college faculty; elementary and high school guidance counselors and teachers; members of the military; and non-profit organizations. Educational products, which are available on the program Web site, include Webcasts, lectures, slide presentations, and downloadable tool kits and print materials.
  • Veteran and family activities: The program also conducts a variety of community activities for veterans and their families, including minor-league baseball games in the New England area, sailing on the Charles River, visits to the Basketball Hall of Fame, and skiing trips.
  • Research: The Home Base Program, working with Massachusetts General Hospital and Spaulding Rehabilitation Hospital, supports research on deployment- and combat-related stress and TBI. As part of this work, the program identifies veterans who might benefit from participating in clinical trials of new treatments and technologies. Examples include a Department of Defense study that investigates the effectiveness of combining the medication Sertraline with evidence-based psychotherapy to reduce symptoms of PTSD.

Context of the Innovation

The Red Sox Foundation and Massachusetts General Hospital Home Base Program is the Nation's first partnership between academic medicine and a Major League Baseball team designed to address the invisible wounds of returning Iraq and Afghanistan veterans and their families. The program coordinates with the VA New England Healthcare System and the Department of Defense. The impetus for the program came from owners, players, and managers of the Boston Red Sox, who decided they wanted to help veterans with TBI and PTSD and their families after two visits to Walter Reed Hospital that followed White House celebrations of the team's World Series victories in 2004 and 2007. Deeply moved by their conversations with injured soldiers, team representatives investigated what they could do to help. Based on their findings, the owners of the Red Sox contacted the President of Massachusetts General Hospital, and together they agreed to form a partnership to develop the Home Base Program to provide high-quality care to veterans and families regardless of their ability to pay.

Did It Work?

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Results

The program has enhanced access to care and support services for veterans and their family members and has generated high levels of satisfaction among patients.
  • Enhanced access: Information provided in January 2014 indicates that, to date, more than 700 veterans and family members have received treatment at Home Base. In a biannual 2013 patient survey, 74 percent of patients said Home Base helped them overcome barriers to seek the care they needed. These individuals may not have sought or received such care and support without this program.
  • High satisfaction: Information provided in January 2014 indicates that, in the above-referenced biannual patient survey, 86 percent of patients expressed satisfaction with the care received and 81 percent said the help they received at Home Base has made a difference in their lives.

Evidence Rating (What is this?)

Suggestive: The evidence consists of post-implementation data on the number of veterans and family members served and the results of a 2013 patient-satisfaction survey.

How They Did It

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Planning and Development Process

Key steps included the following:
  • Designing preliminary program: Key management and clinical staff held numerous meetings to develop a preliminary program design, which included a decision to house the program at Massachusetts General, building on the hospital's existing psychiatry, behavioral health, physical medicine, and rehabilitation services.
  • Securing support from key stakeholders: Representatives from both of the main partner organizations held meetings with key management and clinical staff to obtain buy-in for the program. They also met with national and local staff from the Department of Defense and VA representatives, along with local stakeholder organizations serving veterans, to present the proposed program, learn more about resources available to veterans and their families, determine how best to support these resources, and obtain backing for the endeavor.
  • Establishing partnership and funding: With administrative and legal approval from their respective organizations, the owners of the Red Sox and the President of Massachusetts General Hospital established the program with a $3 million contribution from each organization. In addition, both the Red Sox Foundation and Massachusetts General Hospital agreed to provide in-kind fundraising support for the program.
  • Finalizing design, creating oversight board: Two members of hospital leadership, the President of Massachusetts General and the Chairman of Partners HealthCare, along with two members of Red Sox ownership, the Chair and a Vice Chair, were appointed to an overseers board to govern the program. The board then appointed program leaders at Massachusetts General who could represent the administrative, management, clinical, fundraising, and communications aspects of the program, asking them to become responsible for finalizing program design and overseeing implementation.
  • Hiring program staff: Although most clinical and behavioral health staff were in place at Massachusetts General, the program hired an executive director and other management and program staff, including those responsible for education, outreach, communications and marketing, and technology.
  • Establishing relations with referral sources: Program staff contacted representatives at veteran-service organizations, educational systems, and other groups that could serve as referral sources.
  • Creating identity and marketing plan: As the program developed, marketing and communications staff created a program identity and a strategic marketing and communications plan for launching the initiative and maintaining communications and outreach activities.

Resources Used and Skills Needed

  • Staffing: The program has 54 full- or part-time staff, half of whom work on the clinical program, along with other programs at the Massachusetts General Hospital, and half who are focused on outreach, education, communications, technology, and fundraising. The Executive Director is a retired Brigadier General who commanded troops in both Iraq and Afghanistan. The Chief Medical Officer also directs the MGH Center for Anxiety and Traumatic Stress Disorders. Behavioral health staff include seven clinicians who work with veterans, five who work with veterans with TBI, and six who work with families. Most clinical staff also devote time to other activities, including research and public education. Outreach and education staff include two family-outreach workers, six veteran-outreach coordinators, a director of technology responsible for the program database and telemedicine, one individual responsible for communications and marketing, one individual responsible for social media and community events, and two individuals who coordinate community and clinical education. Other staff include a front-desk receptionist, a senior administrative practice manager, four full-time, in-kind fundraising staff at Massachusetts General, and a team of at least five part-time people at the Red Sox Foundation.
  • Costs: In fiscal year 2012, the annual program-operating budget totaled $5.2 million.
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Funding Sources

Massachusetts General Hospital; Red Sox Foundation; Major League Baseball; McCormick Foundation
As noted, the Red Sox Foundation and Massachusetts General Hospital each contributed $3 million to launch the program. Through its fundraising arm, the hospital also pays the salaries of four people dedicated to raising operating funds for the program.end fs

Tools and Other Resources

To learn more about the Home Base Program, go to www.homebaseprogram.org.

To learn more about PTSD, go to the VA National Center for PTSD at http://www.ptsd.va.gov/.

To learn more about the effects that deployment has on children, view A Toolkit for the Well Child Screening of Military Children at http://www.homebaseprogram.org/community-education/tool-kits.aspx.

Adoption Considerations

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Getting Started with This Innovation

  • Learn about military culture: Would-be adopters need to recognize and learn about the unique culture of military families and the specific culture of veterans who served in Iraq and Afghanistan. This knowledge is critical to establishing credibility and providing effective care.
  • Find right clinical team: The treatment of individuals who struggle with PTSD and TBI requires special training and expertise. Clinicians without such training are unlikely to be effective in working with veterans.
  • Invest in a family program: Families are underserved and underinsured, but represent one of the most important components of a veteran's ability to recover. Families need the tools and resources to heal themselves and their loved ones from the turbulent effects of war.
  • Hire veterans for outreach team: The stigma associated with PTSD and TBI presents a huge obstacle to treatment. Veterans who experience these conditions are more likely to first discuss their need for help with other veterans who served in Iraq and Afghanistan.
  • Develop fundraising plan: The program requires significant funds over a period of time, even if services are limited only to treatment and support for veterans and their families.

Sustaining This Innovation

  • Document and report outcomes: To facilitate research and fundraising, document and share information on the qualitative and quantitative impact of the program on outcomes for veterans, family members, and loved ones.
  • Consider use of alternative techniques for reaching veterans: With funding from the McCormick Foundation and Major League Baseball, program staff are pilot testing the use of videoconferencing technology to allow patients to work with their clinicians from home. Would-be adopters should consider this approach and other communications technologies that can aid in connecting with hard-to-reach individuals.
  • Work with insurers to identify resources: Would-be adopters may be in a good position to educate insurers about PTSD and TBI in veterans, deployment-related stress in families, and the need for additional resources to cover treatment.

Use By Other Organizations

Emory University and the Atlanta Braves have created a program to offer veterans and their families treatment and support through their BraveHeart program. 

More Information

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Contact the Innovator

Lee A. Chelminiak
Director of Communications and Marketing
Red Sox Foundation and Massachusetts General Hospital Home Base Program
165 Cambridge Street, Suite 702
Boston, MA 02114
Phone: (617) 643-9231
Fax: (617) 643-3840
E-mail: lchelminiak@partners.org

Innovator Disclosures

Ms. Chelminiak reported having no financial interests or business or professional affiliations relevant to the work described in this profile other than the funders listed in the Funding Sources section.

Footnotes

1 Tanielian T, Jaycox LH, editors. Invisible wounds of war: psychological and cognitive injuries, their consequences, and services to assist recovery. Center for Military Health Policy Research, RAND Corporation, 2008. Available at:
http://www.rand.org/pubs/monographs/MG720.html.
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Disclaimer: The inclusion of an innovation in the Innovations Exchange does not constitute or imply an endorsement by the U.S. Department of Health and Human Services, the Agency for Healthcare Research and Quality, or Westat of the innovation or of the submitter or developer of the innovation. Read more.

Original publication: December 07, 2011.
Original publication indicates the date the profile was first posted to the Innovations Exchange.

Last updated: January 29, 2014.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.

Date verified by innovator: January 13, 2014.
Date verified by innovator indicates the most recent date the innovator provided feedback during the annual review process. The innovator is invited to review, update, and verify the profile annually.

Back Story
As a Marine fighting in Afghanistan, Mr. and Mrs. C's son experienced fire fights, rescue-and-recovery operations of wounded and dead soldiers, and exposure to improvised-explosive-device blasts that left him with a traumatic brain injury (TBI). Shortly after he returned home, he began to experience symptoms of severe posttraumatic stress syndrome...

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