June 19, 2019

Chairman Isakson, Ranking Member Tester, distinguished members of the Committee: Thank you for this opportunity to discuss the important topic on how communities leverage networks and systems to actively prevent veteran suicide.

After serving in the government and veteran nonprofit space for over 19 years, and now as the CEO of Combined Arms, I am excited to report that in Houston, community collaboration with the VA has never been stronger. It’s stronger because of the work of our local VHA and VBA leadership to understand the value that our 56 member agencies composed of other government agencies and nonprofit organizations can serve as agile and effective force multipliers for VA programming and customer service.

The Combined Arms Model
Combined Arms is a dynamic, ever-evolving collaborative impact organization that is using an innovative approach of technology and service delivery to disrupt the veteran transition landscape. By providing a holistic online assessment that efficiently connects veterans to member organizations, Combined Arms is accelerating veteran transition in order to deliver maximum impact in Houston. Combined Arms operates its collaborative system through four major pillars:

Combined Arms runs a co-working space for 56 government and nonprofit agencies that is centrally-located and creates intentional collaborative collisions for those professionals that serve military veteran families. The Combined Arms Center is also a single point of entry from transitioning service members, veterans, and their families.
Combined Arms created an integrated technology platform that ensures thousands of military veteran families have access to 399 customized resources provided by our 56 vetted member organizations. Combined Arms has flipped the accountability from the veteran to the service organizations through their unique data driven methodology.
Combined Arms has developed an innovative marketing campaign that reaches further upstream to attract more military veteran families still on active duty or looking for their next opportunity. Combined Arms is serving the community by attracting more military talent to Houston as a means of economic development for our region.
Combined Arms is recruiting, training, and deploying community leaders who have successfully made the difficult transition from military to civilian life to engage those veteran families still making the transition at the neighborhood level to ensure we are all #unitedaftertheuniform. This model not only positively activates successful veterans to volunteer and make a social impact on our community but also ensures more veterans in transition have direct access to the resources provided by our member organizations.

These four pillars have effectively connected over 5,000 unique veteran clients to the 399 resources provided by the 56 member organizations since 2016. It is self-driven by the veteran and custom-fit for their needs based on how they answer the assessment. Little effort is required on behalf of clients who may be in crisis mode, unable to access other services, or unaware of services that exist. If a client reports a score less than 13 from the World Health Organization wellbeing index or “WHO 5” on the profile, then an alert is sent to the intake team for additional follow up on mental health. Every time a client returns to our system 30 days apart, the system automatically asks for an update on the WHO 5 and tracks the data so we can see trends of their responses. Similarly, if clients report being homeless or living in a shelter, then an alert is sent to the Intake Team for additional follow up and assessment to ensure the client is properly referred to vetted housing programs. The Intake Team provides ongoing follow up with veterans reporting they are homeless until permanent housing has been confirmed. The Combined Arms Intake Team is trained on STRONG STAR’s Crisis Response Plan if they engage with clients demonstrating suicidal ideation.

The Combined Arms system actively prevents client re-traumatization, as pertinent information can be shared between the Combined Arms system and the member organization delivering services. Clients are not asked the same questions multiple times, thus reducing frustration and increasing speed and efficiency of service delivery. The standard procedure is that Combined Arms member organizations follow up with the referred client within 4 days per the contract agreed upon. All of the aforementioned components act as “prevention nudges” - minor yet impactful structural supports that keep clients engaged in care and community which are both preventative measures and facilitators of veteran health. Case progression is monitored by Combined Arms regularly to ensure that no clients are slipping through the cracks. Because of this experience, we firmly believe that suicide prevention lies in the ability to provide direct access to social services to the veteran as far upstream in their transition process as possible. If we can prevent unemployment and underemployment, substance abuse, family challenges, homelessness, and criminal behavior by accelerating veteran access to critically needed resources in a faster, more efficient way then we will prevent veteran suicides.

VA Collaboration
15 different VA programs and clinics at the Michael E. DeBakey VA Medical Center (MEDVAMC) have been assigned to work within the Combined Arms system ranging from the Post Deployment Clinic to Womens Clinic to the Mental Health and TBI and Benefits programs and other peer support or outreach programs. The objective is for the VA to utilize the Combined Arms system to refer veteran patients to vetted government and nonprofit agencies delivering social services not provided by MEDVAMC. Similarly, other agencies can refer veteran clients into the VBA and VHA programs. Additionally, on a monthly basis, Combined Arms, MEDVAMC, and Houston Regional Office (VBA) join forces on “Vet Connect Days” to make VBA and VHA programs and care more accessible to veteran clients seeking services through the Combined Arms system. These events increase client enrollment into VA programs. Finally, through the work of the Mayor’s Challenge, the Combined Arms Transition Center is a distribution site for gun locks from the VA.

MEDVAMC is also one of few VA hospitals in the nation that work with local organizations like Combined Arms and county Medical Examiner to track, analyze, and report veteran suicides in the region served. Based on the data available to these partners, the Combined Arms team and VA partners discovered that approximately 65 veterans died by suicide in Harris County - the fourth largest veteran population in the United States - last year. Their average age is 53 with the most vulnerable populations being the youngest and oldest generation of veterans, aged 25-33 and 65+ years. This data is important for Combined Arms partners to better understand what programs and services can be deployed to actively prevent future veteran suicides and ensure that the number of deaths by suicide each year continues to decline.

Combined Arms remains in constant communication with our member organizations and the community and are provided ongoing reports of incidents of veterans in crisis in need of outreach including via social media, suicides, and attempted suicides. The Intake Team will follow up, assess needs, and connect to appropriate partners including the VA who are notified in advance of the system referral regarding the severity of the situation to ensure immediate follow up by our partners. This innovative model can better prevent suicide if our member organizations are given the opportunity to provide direct access to social services to veterans as far upstream in their transition process as possible. If we can prevent unemployment and underemployment, substance abuse, family challenges, homelessness, and criminal behavior by accelerating veteran access to critically needed resources in a faster, more efficient way then we will prevent more veteran suicides in the communities veterans return to.

Thank you again for your consideration of this written testimony and for your continued service to our military veteran community.

Very Respectfully,

John Boerstler
CEO, Combined Arms

Special thanks to Katie McCormick, LMSW, and Monique Rodriguez, LMSW, and the Combined Arms member organizations for their expert contributions to this testimony.

CC: Houston Congressional Delegation: Senator John Cornyn, Senator Ted Cruz, Rep. Al Green, Rep. Kevin Brady, Rep. Sheila Jackson-Lee, Rep. Michael McCaul, Rep. Pete Olson, Rep. Randy Weber, Rep. Brian Babin, Rep. Lizzy Fletcher, Rep. Dan Crenshaw, Rep, Michael Cloud, and Rep. Sylvia Garcia.