NALHD's VetSET Nebraska program has been leading statewide efforts to prepare communities to be ‘set' (ready) to harness their strengths to support connection, resiliency, and wellbeing of Veterans and their families. Leading the program ats the SACCHO-level aligns with many Veteran services which are driven from the state and federal level. NALHD is positioned to collaborate with state-wide and national partners and provide content expertise, thereby enabling the member LHDs to partner and lead locally for the betterment and focus of their individual communities.
In 2013 and 2014, LHDs noted the relative absence of military and Veteran engagement in their Community Health Improvement Plans (CHIPs) process and were worried about the implications. The resulting VetSET program has since evolved to the current goals and objectives:
1. Build capacity within and collaboration between military-serving and civilian-serving partners in LHD jurisdictions and statewide.
a. Provide backbone support to the Nebraska Veteran and Family Task Force (NVFTF). NVFTF is a unique cross-sector, grassroots forum for a range of partners to learn together, coordinate efforts, and collaborate for strategic impact.
b. Provide outreach and tailored training and technical assistance to civilian partners across each VetSET LHD jurisdiction.
c. Support all LHD staff onboarding and ongoing skill building.
2. Support a range of local, LHD-specific activities that engage and serve Veterans and families in their local communities.
3. Build LHDs' suicide prevention ability, especially to reach Veterans and their families.
a. Provide Veteran-focused QPR (Question. Persuade. Refer.) Gatekeeper Suicide Awareness workshops in communities across the state and on a virtual platform.
4. Develop sustainable mechanisms for collecting, synthesizing, and sharing surveillance data on Veteran and families' health and wellbeing. These data provide direction for local policies and programs.
a. Institutionalize Veteran-connection screeners in all state-level surveillance surveys—including the BRFSS and the NRPFSS.
NALHD and LHDs assumed the role of convener and informer with stakeholders. A key feature of NALHD's VetSET program is the involvement with the Nebraska Veteran and Family Task Force (NVFTF), a statewide, cross-sector collective impact group working to highlight issues and advance solutions in the Veteran and Veteran family space. NALHD provides backbone support to the NVFTF, starting in 2017 when it facilitated a day-long strategic reset of the floundering group. Today a rejuvenated Task Force meets bi-monthly, convening over 60 different individuals representing civilian and military sectors. While the task force engages many state and federal-level partners, individual LHDs and local partners also actively participate, bringing the rural voice to discussion and decision making. Mirroring aspects of the Chief Health Strategist role at the state level, the SACCHO is a logical and appropriate facilitator of this group.
LHD Executive Directors demonstrate leadership commitment for their Veteran work by prioritizing VetSET and military cultural competence as a training block during their staff onboarding processes.
VetSET LHDs engage with their community partners in ways that increase partners' knowledge and awareness about Veteran-specific issues and concerns. They rely on their own skills and capacity as well as the support housed at the SACCHO-level. Engagement activities are often driven by local CHIPs and range from engineering social gatherings for Veterans and Veteran families that promote emotional connection and healthy activities; to identifying gaps in service for Veterans and their families; to collaborating with community partners on strategies to meet these needs. The LHDs engage with local service providers focused on the military and Veterans as well as community partners such as schools, law enforcement, employers, community organizations and many others. This cross-sector, community-wide approach helps to broaden the base of people in local communities who are working towards the same goal of awareness and service to Veterans and their families.
VetSET has improved the military cultural competence LHD staff and their partners in health care, education, law enforcement, community development, faith-based organizations, local and state government. To date, over 1,000 individuals have participated in No Wrong Door trainings across Nebraska. VetSET's No Wrong Door builds military cultural competence while also incorporating targeted networking between participants. These events have been the genesis of relationships—including local work groups and task forces—that advocate for Veterans and their families. No Wrong Door is relevant to a broader range of participants: health professionals, counselors, community members, clergy, law enforcement, employers–anyone who needs to be ready for Veterans and their families when they walk through the door. Evaluation of this Continuing Education Unit (CEU)-awarding curriculum shows that it significantly enhances participants' awareness and understanding of the particular needs of service members, Veterans and their families as they face the challenges on the home front. No Wrong Door introduces community providers to the invisible” wounds of war, services, and resources so all can support Veterans and their families in local communities. No Wrong Door provided a way for LHDs, their staff, and their key partners to build shared expertise on Veteran's issues in Nebraska that they can apply to their work, including with VetSET. No Wrong Door and the shorter Military 101 have remained a key piece of the VetSET program and serve as a mechanism for engaging partners across the state.
VetSET has developed suicide prevention skills to over 700 rural and suburban community members through Veteran-focused workshops that include QPR (Question. Persuade. Refer.) Gatekeeper training. Veteran-focused QPR Gatekeeper suicide prevention training, customized by NALHD, raises local awareness and contributes to Veteran-focused tactics in several CHIPs.
Even amidst a pandemic, NALHD and LHDs collaborated through monthly check-ins, mini-training opportunities, virtual meetings, and the use of virtual collaboration platforms which aided greatly in maintaining relevance and a consistent focus on Veterans and their families.
To develop sustainable mechanisms for collecting, synthesizing, and sharing surveillance data on Veteran and families' health and wellbeing, NALHD led and continues to lead efforts to add military connection screeners to the Nebraska Behavioral Risk Factor Surveillance System (BRFSS) survey and to the Nebraska Risk and Protective Factors Student Survey (NRPFSS). These screeners are providing ongoing insight into the health and wellbeing of military-connected families in Nebraska. Their data show that Veteran spouses and partners have more poor mental health days and are more likely to have been told that they have depression than the population as a whole. Also, Nebraska students with a military connection (through their parent or guardian) are significantly more likely to report that they considered attempting suicide, attempted suicide, and engaged in self-harm. They are also more likely to use alcohol, tobacco, and prescription drugs. NALHD is partnering with the University of Nebraska Medical Center's College of Public Health to develop the second brief based on these unique data sources. The first of the briefs is at Students_from_Military_Families_07_06_2020.pdf (unmc.edu). NALHD's VetSET team is also working on messages, side decks, and social media assets that feature these data findings and are designed to influence policy to support Veterans and families.
Time and resources demanded to implement a program like VetSET are significant and require dedicated funding for a Veteran-focused coordinator/manager. Ideally this type of program is led by someone with military experience and ties to the Veteran community. Without at least one position of statewide leadership to mentor, support, influence and inform LHDs and partners, the work would fall short.
Additional key expenses include travel and facilities costs for local training and funding for data collection. The actual cost to have the 2018 the Veteran Connection Screener added to the BRFSS was $11,000 – plus evaluation and analysis ($10,000). Other costs to support member LHD's specific activity varied widely depending on funding available. NALHD was able to attract larger grants based on statewide reach, sizable proportions of which went to member LHDs to support specific work.