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CSSP OpEd Running on Tom Rick's Blog 4 September 2012

September 04, 2012 

Posted By Thomas E. Ricks     Share

By Kenneth E. Blackman

Best Defense guest commenter

The Defense Department, the veterans administration, and the Obama administration are missing an enormous opportunity to help wounded warriors, indeed every serviceman and woman returning from battle overseas.  

There's a hugely successful program in North Carolina called the Citizen Soldier Support Program (CSSP) that maps data about the deployments of service members down to the local level, trains civilian health professionals to identify and treat those in their communities in need, and then connects the military, veterans, and their families with knowledgeable providers to deal with post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), and other behavioral problems that result from combat and repeated rotations overseas.

Here's the rub: Federal funding has run out and the program is about to go out of business, despite memos of support from former Joint Chiefs Chairman Admiral Mike Mullen, two letters from North Carolina Senator Kay Hagan, another from four influential Tar Heel Congressmen (David Price, Mike McIntyre, Walter Jones, and Larry Kissell), and applause from virtually all who have looked at this effort.

The Citizen Soldier Support Program began with $9.8 million dollars from Congress in 2005-2007. The University of North Carolina at Chapel Hill serves as host (who says academe doesn't care about the military?). The focus is on military members and their families, especially in the reserves and National Guard, and especially in rural, sparsely populated, and other under-served areas -- in other words, those areas where the military and the veterans' administration aren't reaching the people who need help.

Check it out at It's unique -- no other program like it in the country. It starts by mapping the service populations by home zip code. For example, there are currently reservists and National Guardsmen and women in all but 12 U.S. counties (out of 3141 nationally). There are reserve/Guard vets of the Iraq, Afghanistan, and other deployments in all but 27 counties. So the first contribution is locating all those eligible, and their dependents. Take alook.

Then the program trains behavioral (and other) health providers onsite and online -- to date, over 20,000 practicing in all 50 states. Then it tracks the distribution of those trained and matches them against the needs identified in the mapping of deployment data. CSSP offers nationally recognized courses on PTSD, TBI, issues relating to women in combat, issues of importance to military families, and the like. There's training focused on primary care physicians and optometrists to recognize these injuries during routine examinations. All courses are available for free and the cost of continuing education credits is covered.

Last, the program contains a web-based, searchable database of providers to connect them with service members and their families who are in need. This database is modeled on the one developed for North Carolina, where there are more than 1200 total providers in 96 of the 100 counties. The goal is three trained health providers within 30 minutes of every service and family member who needs it -- nationwide.

For over two years, CSSP has sought re-funding from the Defense Department, Veterans Administration, and other government agencies at the highest levels, including speaking directly with the Secretary of Defense, the current and former Joint Chiefs Chairmen, and the Staff of the First Lady. They have had ample opportunity to act but have not, despite White House efforts to marshal the involvement of the nation's leading professional medical associations. The issues facing our returned and returning military population, veterans, and their families are not a government problem; they are a national crisis that is only going to get worse.

The Citizen Soldier Support Program is led by Bob Goodale, a retired CEO of the Harris Teeter supermarket chain, and retired LTC Bill Abb, a veteran of 21 years on active duty in the army. They have been working cooperatively with all these agencies, including the White House Joining Forces effort, and countless others at the local, state and national levels -- not as competitors but to complement and to help.

What puzzles CSSP, and its distinguished advisory board led by a retired Chief of the Army Reserves and a retired Adjutant General of the North Carolina National Guard, is why with all this support, after all these efforts at the highest levels of government, this program will die. It needs immediate funding to continue and then long-term money to realize its national potential -- in total, some $18 or 20 million over five years.

From the start of his first presidential campaign in 2007, Barack Obama has reached out to the military, emphasizing the needs of our soldiers and our military families. His bureaucrats say "they have it covered." But they don't -- not like this, not at the community level, not training local health providers, not focusing on the Guard and reserves and their vets. Last Friday the president essentially admitted that by issuing an executive order full of plans for interagency cooperation, partnering with community mental health services, new plans for more planning, hiring more therapists, creating pilot programs, and more -- proof positive of the crying need to expand mental health services to the military.

Everybody knows that Active Duty Service Members have overwhelmed the military's mental health resources, forcing referrals to local civilian providers. Everybody knows that deployments affect far more than those who went overseas: parents, spouses, siblings, significant others, children, and more. Everyone knows that it takes weeks or months for far too many wounded warriors to get help and that many vets are hours away from the nearest VA facility -- and that help often requires months of waiting and involves terribly frustrating runarounds. Suicides among current and former military have skyrocketed -- July just saw the worst monthly total on record among those on active duty, and those suicides are only the tip of the iceberg.

In that same month of July, the Pentagon asked Congress to allow $708 million appropriated for TRICARE, the health insurance for service members and vets, to be reprogrammed for use elsewhere. Twenty-four members of the House Armed Services Committee asked that the money be focused on PTSD, TBI, and related problems. What better use of the money than to find and connect health providers to those wounded, and their families, who aren't getting help from the VA or the military health system?

The president and first lady will soon be in North Carolina for the Democratic convention. His Executive Order sets in motion all sorts of good efforts but they will take months and years to implement. The Citizen Soldier Support Program is up and running, succeeding, and using the private sector -- health providers in local communities all across the country -- to identify those who need help, and getting it to them through professionals practicing right next door. If the president wants to be consistent with everything he's doing to support our military, and his own Executive Order, he will order the Pentagon or the VA, or both, to continue the Citizen Soldier Support Program, and announce it loudly to the Convention and the country. If he won't act, then Congress should. Not a single soldier or family should be left to suffer if help can be provided.

Kenneth E. Blackman, PhD, served four years in the Air Force Security Service and has spent a career in the biomedical and substance abuse treatment field. He currently serves on the Board of Directors of the Alcohol Drug Council of North Carolina and as a volunteer veteran representative in the Jail Diversion and Trauma Recovery Program.