The Government of Canada welcomes the opportunity to respond to the Third Report of the Standing Committee on Veterans Affairs, The New Veterans Charter: Moving Forward. We would like to thank both the Committee for its study and the 54 witnesses who appeared before the Committee from November 2013 until June 2014.
The Committee was asked to conduct a comprehensive review of the New Veterans Charter with special focus on the most seriously disabled, their families, the delivery of programs, and how we define and demonstrate the Government of Canada’s relationship with Veterans. The Government is pleased with the Committee’s findings that the New Veterans Charter has sound principles which should be upheld, and that the vast majority of Canada’s 697,000 Veterans and 95,000 Canadian Armed Forces personnel are served well by the New Veterans Charter programs.
The Committee’s review has assessed the overall effectiveness of the Government’s $27 billion in investments in Veterans benefits, programs and services since 2006. While allocations for benefits for Canadian injured Veterans has increased by $4.7 billion since 2006, the Government agrees that more can and must be done to enhance service delivery to ensure that injured Veterans and their families are supported.
The Veterans Ombudsman recently noted that the New Veterans Charter was designed to address the frustrations faced by Veterans over many decades under the previous Pension Act. The introduction of the New Veterans Charter, that was unanimously supported by all parties, focuses on wellness and seeks to facilitate the transition for Veterans and their families from military to civilian life.
Under the New Veterans Charter, seriously disabled Veterans have access to benefits for life. It has re-focused Government support on those who need it most by ensuring that rehabilitation and successful transition remains paramount in everything we do to support Canada’s injured Veterans.
As a living document, since 2006, the Government has worked with Veterans’ groups and undertaken numerous measures to enhance the New Veterans Charter. An outline of these improvements and others is provided in Appendix A to the Government Response.
Additionally, the Government of Canada will continue to ensure that financial benefits and services meet the needs of Canada’s Veterans.
Building on these enhancements to the New Veterans Charter, the Government is pleased to indicate that it agrees with the spirit and intent of the vast majority of the Committee’s
recommendations. Many of these recommendations involve potentially complex changes to some Veteran programming. The implications of any potential changes must, therefore, be carefully assessed.
Therefore, the Government plans to address the recommendations made in the Report using a phased approach.
The first stage is to address those recommendations that can be quickly achieved within existing authorities and budgets of Veterans Affairs Canada and the Department of National Defence and which will improve the continuum of service provided to Veterans and their families when they leave the Canadian Armed Forces.
The more complex recommendations require further inter-departmental work, budgetary analysis, and coordination with a wide range of federal departments, as well as with the Veterans Ombudsman and Veterans’ groups. These recommendations will be considered in a second phase.
Our Government also continues to cut red tape for Veterans and their families. To help identify areas of improvement, the National Defence/Canadian Armed Forces and Veterans Ombudsmen are jointly reviewing the transition process between the Department of National Defence and Veterans Affairs Canada, and the Government has recently launched a similar third-party analysis. The findings, along with the Committee’s recommendations, will inform any forthcoming improvements.
Committee Recommendation 1
That military members seriously disabled as a result of service not be medically released until the following conditions are met:
- The individual is in a stable medical condition.
- The individual’s medical records have been transferred to Veterans Affairs Canada in accordance with privacy legislation, an official copy of the medical files has been given to the veteran, and the initial application for services and financial benefits provided under Part 2 of the New Veterans Charter has been adjudicated by Veterans Affairs Canada.
- The individual’s file has been assigned to a Veterans Affairs Canada case manager who has already established contact with the individual.
- The healthcare and rehabilitation professionals who will be supporting the individual during transition have been identified in the area where the veteran is planning to live once medically released and their respective responsibilities have been defined.
- And that an internal committee be struck by Veterans Affairs Canada and the Canadian Forces to:
- develop a unified list of service conditions to be used interchangeably by Veterans Affairs Canada the Department of National Defence.
- ensure to the greatest extent possible that the service-related condition, identified by the Canadian Armed Forces and that led to a veteran’s release on medical grounds, be recognized by Veterans Affairs Canada for adjudication purposes.
- establish a follow-up protocol for all military members who have been released for medical reasons.
Government Response 1
The Government of Canada is pleased to confirm that it will, as per current practice, ensure that all military personnel who are medically released from the CAF will only do so after they are medically stabilized. Veterans Affairs will implement a new protocol to ensure that contact between department officials and military members who are medically releasing is made at the onset of this process. Rehabilitation professionals where the Veteran intends to elect final residence after medical release will be identified as early on in the transition process as possible.
Government has also launched a third party analysis of the transition process to identify areas that can be improved between National Defence and Veterans Affairs. Both Veterans Affairs and National Defence are also working closely with the National Defence/Canadian Armed Forces Ombudsman and the Veterans Ombudsman who are conducting a similar, joint review of transition.
Committee Recommendation 2
That the Veterans Bill of Rights be included in the New Veterans Charter and in the Pension Act, and that a modified version of section 2 of the Pension Act be incorporated into the New Veterans Charter, and read as follows: The provisions of this Act shall be liberally construed and interpreted to the end that the recognized solemn obligation of the people and Government of Canada to provide compensation to those members of the forces who have been disabled or have died as a result of military service, and to their dependants, may be fulfilled.
Government Response 2
The Government of Canada confirms it will introduce legislation to amend the New Veterans Charter with a construction clause in line with that of the Pension Act which has served Canadian Veterans since shortly after the First World War.
Committee Recommendation 7
That independent access to Veterans Affairs Canada’s psychosocial and vocational rehabilitation services be given to spouses or common-law partners of veterans with a service-related disability, that access to psychological counseling be also given to parents and children of veterans with a service-related permanent disability, and that financial support be provided to family members of seriously-disabled veterans acting as “primary caregivers” as defined under section 16. (3) of the Veterans Health Care Regulations.
Government Response 7
The Government shares the view of the Committee that support for families is a key component to facilitate a successful transition to civilian life. In this context, we fully agree with its recommendation to extend psychological counseling for Veterans families and will introduce new measures in this regard in due course.
Our Government will also work with Veterans groups and key stakeholders in the development of a new training program for Veterans caregivers. Careful review of extending vocational rehabilitation to family members is being considered, however it must not be at the expense of the Veterans rehabilitation program. With this in mind, further analysis of this aspect of the recommendation is currently underway.
Committee Recommendation 8
That Veterans Affairs Canada undertake a comprehensive review of the amount of the disability award to more adequately reflect awards in civil liability cases for personal injuries, implement a transparent and clear process for determining its value, and improve support for financial counseling throughout the process.
Government Response 8
The Government agrees in principle with this proposal and will explore options for addressing the recommendation.
Committee Recommendation 9
That the Service Income Security Insurance Plan (SISIP) Long Term Disability program be provided only to veterans medically released for a disability not related to military service, that all veterans released for service-related medical reasons benefit from the programs offered under the New Veterans Charter, and that the Canadian Forces and Veterans Affairs Canada work together as quickly as possible to eliminate overlap between Service Income Security Insurance Plan (SISIP) programs and those provided by Veterans Affairs Canada.
Government Response 9
The Government agrees in principle with this proposal and will explore options for addressing the recommendation.
Committee Recommendation 10
That eligible vocational rehabilitation training programs be allowed greater flexibility, and be less strictly related to skills acquired during military service.
Government Response 10
The Government fully agrees on the need to ensure maximum flexibility for Veterans and their families with regards to vocational rehabilitation. In 2013, the Government made improvements to the program by expanding the list of eligible training expenses. Veterans are now also able to claim individual vocational rehabilitation expenses through an overall program funding envelope, to a maximum total value of up to $75,800 per person. This change gives Veterans more flexibility in their vocational rehabilitation plans, which are based on the individual needs of each Veteran and simplify training plan approval and claims processing.
Committee Recommendation 11
That Veterans Affairs Canada establish a more rigorous case manager training program, and review the standard under which one case manager is assigned to 40 veterans, to determine if the ratio is appropriate, and to provide necessary resources for its adjustment if required.
Government Response 11
The cornerstone of the New Veterans Charter is case management, and as such Veterans Affairs agrees to explore a new and improved process whereby the needs of the client rather than overall numbers will determine how many Veterans are assigned to one case manager. As a result of this recommendation, the intent is to rebalance the case work load of complex and lower intensity cases in order to help case managers give the appropriate amount of care to each Veteran.
Committee Recommendation 12
That Veterans Affairs Canada and the Department of National Defence build on their existing collaborative efforts by providing adequate resources for research and understanding of known and emerging manifestations of operational stress injuries.
Government Response 12
The recent studies in the use of animal therapy for Veterans or related to the role of psychiatric service dogs in treating post-traumatic stress disorder (PTSD) demonstrate the Government’s ongoing commitment to military and Veterans health research. The Government agrees that research in this field is valuable and necessary to develop new tools and treatments that can help Veterans and their families. In this context, the Government intends to continue research that will further inform programs and policies on Veterans’ wellness. For additional detail on research initiatives, see Appendix A, paragraphs 49-61.
Committee Recommendation 13
That Veterans Affairs Canada consider moving towards a payment system that results in one comprehensive monthly payment that clearly identifies the source of funding, while ensuring the net benefit to the veteran is not reduced.
Government Response 13
The Government welcomes this recommendation and will immediately undertake measures to combine payments and benefits, leading to less confusion and significantly less Red Tape.
Committee Recommendation 14
That Veterans Affairs Canada and the Department of National Defence, after they have tabled their official response to this report within the next 120 days, also table, by 30 January 2015, a report outlining the progress made on implementing the recommendations in this report, and that the New Veterans Charter, as a “living document”, be amended to include a mandatory review of its provisions to be undertaken by the appropriate parliamentary committees as required.
Government Response 14
The Government of Canada supports and welcomes the Standing Committee on Veterans Affairs initiative to study the New Veterans Charter. After careful review, no new legislative or parliamentary authorities are needed to enable or allow such future reviews by the Committee.
Committee Recommendation 3
That the most seriously disabled veterans receive financial benefits for life, of which an appropriate portion should be transferable to their spouse in the event of death, that Veterans Affairs Canada consider the use of a probable earnings approach in determining the amount of the benefits, and include better access to the three grades of the permanent impairment allowance, for which eligibility criteria must be clarified.
Government Response 3
The Government agrees with the spirit and intent of this recommendation. Under the current legislation, the most seriously injured Veterans receive monthly financial benefits for life that can
equate to thousands of dollars each month. For example, eligible seriously injured Veterans can receive a monthly Permanent Impairment Allowance (PIA) for life. Amounts payable range from $574.89 per month to $1,724.65 per month for the most seriously injured. In addition to this, a PIA supplement of $1,056 per month is payable to Veterans in receipt of PIA who are unable to be gainfully employed. Given the interdepartmental, fiscal and legal implications of this recommendation, further due diligence is required to address this proposal.
Committee Recommendation 4
That the earnings loss benefit be non-taxable and set at 85% of net income, up to a net income threshold of $70,000, that it be adjusted annually to the consumer price index, and that for veterans who participate in a rehabilitation program, the disability award be paid once the program is completed.
Government Response 4
Under current programming, the Earnings Loss (EL) is a taxable benefit designed to provide income replacement during participation in VAC’s Rehabilitation Program. It is currently paid at 75% of gross pre-release income which is equivalent to 90% of take home pay. Should the Committee’s recommendation be implemented, which would see EL at 85% of net pre-release income and non taxable, there is a potential for some Veterans to receive a lower benefit than is currently the case. Significant analysis and consultation would be required with the Canada Revenue Agency to establish an appropriate definition of ‘net income’ and further analysis would be needed to compare it to other similar support programs. As such, further due diligence is required to address this proposal.
Committee Recommendation 5
That all veterans with service-related disabilities, and their families, be entitled to the same benefits and support as part of their rehabilitation program, whether they are former members of the Reserve Force or of the Regular Force.
Government Response 5
The Government agrees with the spirit and intent of recommendation 5. The Government agrees with this recommendation and has taken steps to address distinctions in benefits between Veterans of the Regular and Reserve Force. In 2011, Earnings Loss Benefits for Reservists were increased from $2,000 per month to $2,700 .The Government of Canada continues to address distinctions in benefits between Veterans of the Regular and Reserve force. As such, careful review of this recommendation will be undertaken.
Committee Recommendation 6
That the Canadian Forces work with Veterans Affairs Canada to make Military Family Resource Centres available to veterans and their families in order to support them in their transition to civilian life.
Government Response 6
The Military Family Resource Centres (MFRCs) currently provide support to CAF still serving members and their families. They are dedicated to enhancing the quality of life for CAF families
by providing unique services tailored to the CAF community. CAF families and family members can access the services as a family, individually, or in groups. DND and VAC will work together to determine how best to meet the needs of transitioning CAF members and their families without compromising support available to our serving military community.
From 2006 to 2010, Veterans Affairs Canada (VAC) received a total of 255 recommendations and observations related to the New Veterans Charter from seven separate advisory committee reports, including a report from the House of Commons Standing Committee on Veterans Affairs (ACVA). The Government is listening and responding to the healthy debate and the suggestions from many stakeholders to improve programs and services for Veterans and their families. Veterans Affairs Canada has taken action, with approximately 160 recommendations being fully or partially implemented through 108 policy, service delivery, and legislative improvements.
Following is the list of advisory committee reports:
New Veterans Charter Advisory Group (NVCAG)
- Honouring Our Commitment to Veterans and Families, The Living Charter in Action, October 2009
- Special Needs Advisory Group (SNAG)
- REPORT 1 – Initial Report on The Implementation of the New Veterans Charter, January 2006
- REPORT 2 – The Implementation of the New Veterans Charter, November 2006
- REPORT 3 – The Implementation of the New Veterans Charter, December 2007
- REPORT 4 – The New Veterans Charter: What Are the Gaps for Special Needs Veterans and Their Families?, January 2009
- REPORT 5 – Unforeseen Consequences of the New Veterans Charter: A Financial Step Backwards for Seriously Disabled Veterans and their Families, September 2010
- House of Commons Standing Committee on Veterans Affairs (ACVA)
- A Timely Tune-up for the Living New Veterans Charter, June 2010
Each advisory group prepared recommendations from its specific perspective, however, five key themes were consistently expressed throughout the various reports:
- Financial Security
- Disability Benefits
- Transition, Continuity of Care and Service Delivery
- Case Management
- Support to Families
The full list of recommendations which Veterans Affairs Canada is of the opinion it has fully or partially implemented is attached. In some cases, the Department met the objective of the recommendation through actions other than those specifically recommended by the advisory committee.
The following overview outlines key actions taken under each of the themes to address the former advisory committee recommendations, the date the improvement was implemented and the recommendation(s) it addressed.
FINANCIAL SECURITY: Recommendations in this area focussed on increased access to the Permanent Impairment Allowance (PIA); introduction of an exceptional supplement; increased Earnings Loss Benefit; and enhancements to the Supplementary Retirement Benefit.
Actions taken by VAC:
- Seriously injured Veterans have improved access to the Permanent Impairment Allowance (PIA). The eligibility criteria were changed to allow seriously injured Veterans in receipt of a disability pension to access the PIA as long as they are not in receipt of the Exceptional Incapacity Allowance under the Pension Act. Prior to this change, only seriously injured Veterans in receipt of a disability award were eligible for the PIA. More than 3,500 additional Veterans are expected to be eligible.
- Veterans who are receiving the Permanent Impairment Allowance (PIA) and who are unable to be suitably and gainfully employed, receive an additional $1,056.96 (2014 rate) per month as a supplement to the Permanent Impairment Allowance. As of January 2014, the PIA rates range from $574.89 to $1,724.65 per month.
- Regulatory amendments were made to ensure a minimum pre-tax income of $42,426 (April 2013 rate) for Veterans while participating in VAC’s Rehabilitation Program or to the age 65, if unable to be suitably and gainfully employed.
- Disability benefits are no longer deducted in the calculation of the Earnings Loss Benefit and Canadian Forces Income Support, resulting in a more fair and equitable support to Veterans and their families.
DISABILITY BENEFITS: Recommendations in this area focussed on increasing the Disability Award, offering payment choices, making the award comparable to civilian court awards, and improving compensation for those with catastrophic injuries.
Actions taken by VAC:
- VAC monitors non-economic awards both internationally and within Canada. As part of its ongoing policy review process, the Department periodically conducts an environmental scan of non-economic awards payable by courts, provincial/territorial workers compensation boards, long-term disability programs and Canada’s allied countries including the United States, Australia, New Zealand and the United Kingdom. The analysis shows that VAC’s disability award is reasonably comparable to civilian court awards and other non-economic awards above.
- The Table of Disabilities (TOD) is the legislated/statutory instrument used to assess the extent of a disability for the purposes of determining both disability pensions and disability awards. The original TOD in 1995 was replaced by an updated TOD in 2006. With the changes, the disability assessment takes into consideration the impact of medical impairment on the Veteran’s quality of life.
- The Enhanced New Veterans Charter Act introduced flexible payment options for the Disability Award, so that Veterans can receive periodic payments over any period of time, a lump sum and periodic payments or one lump sum payment. Assistance for financial advice remains available to Veterans each time a Disability Award of 5% or greater is awarded.
TRANSITION, CONTINUITY OF CARE AND SERVICE DELIVERY: Recommendations in this area focussed on transition, early intervention and rehabilitation, access to health professionals, improving relationships with service providers, outreach, research, monitoring programs and services and service delivery.
Actions taken by VAC:
Transition
- In 2003, VAC began to provide a transition interview to all releasing Regular Canadian Armed Forces (CAF) personnel, as well as all medically releasing Reservists. The process is mandatory for Regular Force members. All releasing CAF personnel (including all Reservists) and their families are strongly encouraged to participate.
- Transition interviews were expanded to include voluntary releasing Reservists deployed to a Special Duty Area/Special Duty Operation.
- A dedicated unit with specialized training in applications involving serious injury was established called the Afghanistan and Seriously Injured Unit. The establishment of this unit allowed VAC to better respond to the casualties arising from Canada’s participation in Afghanistan. The work of this unit is now incorporated into the Disability Benefits Unit at VAC.
- Casualty protocols were put in place between VAC and the CAF to proactively initiate contact with casualties and their families in order to provide faster and more streamlined adjudication decisions and award interim assessments.
- Regional Issues Resolution Officers were put in place to streamline benefits processing for high needs Veterans.
- VAC and the Department of National Defence (DND) operate 24 Integrated Personnel Support Centres (IPSCs) on or near Canadian Armed Forces Bases/Wings. Each IPSC co-locates key VAC staff with DND/CAF staff. Together, they work to support the recovery, rehabilitation and reintegration of CAF personnel and their families back into the military or in their transition to civilian life.
- VAC’s CAF Information and Support Unit has a Project Officer on-site at the DND Director Casualty Support Management Unit in Ottawa. This Project Officer has immediate access to service and casualty information held by the CAF/DND in their human resources management, career management and military health records/systems. This ensures quick and easy access to casualty reports, summary investigations, etc. in support of Veterans’ disability benefits applications, as well as service information required for supporting applications for other
VAC benefits.
- VAC and DND established a joint network of 17 clinics that provide CAF personnel, Veterans and their families with comprehensive assessment and treatment for operational stress injuries. Veterans Affairs Canada currently funds 10 Operational Stress Injury (OSI) Clinics. Four of the 10 outpatient clinics were opened between 2008 and 2009 in Fredericton, New Brunswick (2008); Ottawa, Ontario (2009); Vancouver, British Columbia (2009); and Edmonton, Alberta (2009). In 2010, VAC opened the tenth OSI clinic at Ste-Anne-de-Bellevue, Québec, offering in-patient stabilization and residential rehabilitation programs.
The seven remaining clinics within the network are Operational and Trauma Stress Support Centres, funded and operated by DND.
- Through the Legacy of Care initiative, the Government recognized the exceptional challenges faced by seriously ill and injured CAF personnel and their families. DND implemented four initiatives: barrier-free transitional accommodations; support services such as wheelchair-accessible transportation, caregiver respite, childcare and delivery of medical supplies and groceries while in transitional barrier-free accommodations; the CAF Spousal Education Upgrade Program; and the Canadian Armed Forces Attendant Care Benefit.
Through the Legacy of Care initiative, VAC implemented the enhanced case management support for seriously ill and injured Veterans. Experience confirms that seriously injured modern-day Veterans have more intense case management needs, and their recovery tends to take longer. Research also shows that intervention, comprehensive case management and treatment and adequate financial support are crucial to a Veteran’s rehabilitation.
Given this, as part of its national enhanced case management strategy, VAC increased its network of Case Managers by 20 across Canada to improve service to seriously injured Veterans who served in Afghanistan and other areas of conflict.
Rehabilitation
- The practice of providing integrated rehabilitation services (physical, psychosocial and vocational) is in place. Policies and procedures have been updated to ensure needed services are
- offered concurrently when appropriate. These policies and procedures clarify that services do not need to be offered sequentially. For example, medical rehabilitation does not need to come before psychosocial rehabilitation. Veterans may receive rehabilitation services as needed to improve health and support their integration into their community.
- VAC’s Vocational Rehabilitation Program provides career counseling, assessments, job finding assistance and training to meet the vocational goals of the Veteran or eligible spouse/survivor. In 2013, the regulations were amended to diminish red tape and increase flexibility by introducing a global maximum amount for training of $75,800. This replaces the previous regulations which had prescribed maximums for specific training expenses.
- A Request for Proposals for vocational rehabilitation contracted services was posted in October 2013. The revised contract will include greater follow-up requirements, including a requirement for follow-up assessments with those employed (6 weeks, 6 months, 12 months) as well as streamlining of processes.
- The area of selection in VAC hiring processes includes full-time CAF personnel in all internal selection advertised selection processes and cites military experience as an asset in all its staffing posters.
- Led by the True Patriot Love Foundation, the Veterans Transition Advisory Council was created to support Veterans’ employment. The Council includes representatives from leading national companies who work to raise awareness of the skill sets Veterans have to offer to the private sector. The Council also provides strategic recommendations to the Minister of Veterans Affairs and to the broader private sector to improve Veterans’ transition from military to civilian life.
- VAC partners with the Helmets to Hardhats program to expand employment opportunities in the construction industry. Helmets to Hardhats helps connect Veterans and men and women in uniform of the Canadian Armed Forces (Regular and Reserve Force) to a range of careers within the construction industry, including apprenticeships in various building trades.
- VAC established the Hire A Veteran Secretariat to coordinate the development and promotion of VAC’s employment initiatives designed to assist Veterans in finding employment.
- Through its Hire a Veteran initiative (formerly known as Jobs-Emplois), VAC partners with corporate, academic and other organizations to increase opportunities for Veterans to enter the civilian workforce. Job opportunities are shared with the CAF, VAC field staff and national vocational rehabilitation services contractor, all of whom work directly with CAF personnel and Veterans.
- Government has introduced new legislation to provide medically released Veterans who were injured in service to Canada the top level of priority consideration for job openings in the public service. On November 7, 2013, the Government tabled a Bill in the House of Commons to amend the Public Service Employment Act to:
- create statutory priority entitlement for CAF personnel who medically release for service-related reasons;
- establish that the statutory priority period for CAF personnel who medically release for service-related reasons will last for 5 years; and
- extend regulatory priority entitlement for CAF personnel who medically release for non-service related reasons to 5 years (versus 2 years previously).
- Through Career Transition Services, VAC reimburses eligible Veterans and survivors up to a lifetime maximum of $1,000 for services such as job finding assistance, resume writing and interview techniques. The grant is available to any Veteran who applies within two years of release from the CAF.
- The Program Arrangement between VAC, DND and Service Income Security Insurance Plan (SISIP) outlines roles and responsibilities of each organization and improves case coordination. The Program Arrangement was renewed in 2012 and the changes introduced included the addition of a formal issue resolution process clarifying the roles, responsibilities and information sharing process. This is a formal escalation process involving step-by-step instruction for VAC and SISIP staff to follow once a Veteran issue has been identified.
Health Professionals and Service Providers
- VAC educates and informs family physicians on operational stress injuries and other mental health issues pertinent to Veterans and their families. A partnership approach is often adopted to achieve this. For instance, educational sessions on military PTSD were provided to community family physicians, psychiatrists and other professionals in the medical field as part of the 2012 Canadian Psychiatric Association Continuing Professional Development Perspectives in Mental Health Care Series. Five sessions were offered in total in the following cities from May to June 2012: Halifax, Vancouver, Montreal, Toronto, and Ottawa.
- VAC has increased the number of registered mental health service providers resulting in greater access to services for Veterans and their families.
- Support has been provided to family physicians and other health professionals in their work with Veterans. For example, VAC created an information resource for physicians on dementia. This resource was endorsed by the World Health Organization (WHO) and is available on the WHO website.
- A six-part webinar series was offered to provincial mental health professionals in Newfoundland and Labrador in 2011 on the topic of operational stress injuries.
- The National Centre for Operational Stress Injuries (NCOSI) worked with national psychological and psychiatric bodies to produce training information regarding the needs of Veterans and families. These materials were presented at conferences such as: the joint VAC - International Society for Traumatic Stress Studies (ISTSS) symposium held in Montreal in 2010 on the subject of trauma; a half-day workshop offered by VAC psychologists at the Canadian Psychological Association Convention held in Montreal in 2009 on the topic of treatment of anger management in Veterans with operational stress injuries and other clinical populations; and a full-day workshop offered by VAC psychologists at the Canadian Psychological Association convention in Toronto in 2011 on the treatment of symptoms related to emotion regulation in Veterans with operational stress injuries and other clinical populations.
- A comprehensive benefit grid review of over 700 VAC supported health benefits and services was conducted between 2009 and 2012. The benefit grids are comprehensive lists of treatment services available from VAC, with dollar and frequency limits and approval requirements. This review brought VAC dollar limits in-line with the standard fees charged in respective geographic areas across Canada. In addition, VAC reviewed the frequency limits on health services accessed by Veterans and adjusted these limits to meet the health needs of the majority of Veterans.
- To ensure the benefit grid rates and frequencies remain current, the Department has engaged its contracted claims administrator to regularly research and update rates based on industry standards.
- A supplementary provider relations strategy was developed which dedicates resources from the Department’s contracted claims administrator to foster good relationships with providers. First steps have included conducting provider surveys with vision care providers, physiotherapists, massage therapists and psychologists to gain insight into changes that could be made to improve service to Veterans and relationships with providers.
- Communications with VAC service providers has been enhanced through bulletins and other communication tools to help ensure they remain informed and current on VAC programs and billing processes.
- VAC has increased its presence at national and provincial service provider association conferences to strengthen ties and working relationships, and to identify and resolve issues with VAC service providers earlier.
- The Department is working in various areas to streamline the payment process. For example, VAC has removed the requirement for subsequent pre-authorization on the renewal of 393 benefits which represents 77% of benefits that previously required a subsequent pre-authorization.
Outreach – Actively promote New Veterans Charter programs and services
- A New Veterans Charter Outreach Strategy was developed that included providing information sessions at CAF locations across the country. This strategy included 26 briefings at 20 Bases/Wings.
- VAC participates regularly at the CAF Second Career Assistance Network (SCAN) seminars to provide information on VAC programs and services. VAC improved its presentation to make it more engaging, relevant, and easier to understand. In 2013/14, VAC participated in 50 SCAN seminars in 26 locations.
- In cooperation with the CAF Casualty Support Management, a new integrated VAC Medical SCAN presentation was developed to be used at the CAF Medical Information Day. The presentation provides detailed information on VAC programs and services to the CAF who are medically releasing.
- To improve outreach to Reservists, VAC cooperates with DND/CAF to provide VAC information on pay statements to reservists. Approximately 31,000 pay statements are sent monthly to reservists. A VAC message will appear 2-3 times per year on the pay statements.
- A strengthened consultation and engagement model was put in place. The model included expanded relationships with Veterans’ organizations and other stakeholders to ensure input from a broad range of stakeholders and broad outreach using a variety of tools.
The Department maintains relationships with longstanding Veterans’ organizations including:
Royal Canadian Legion
National Council of Veteran Associations
Army, Navy and Air Force Veterans in Canada
Canadian Association of Veterans in United Nations Peacekeeping
Canadian Peacekeeping Veterans Association
The network was expanded in 2011 to include new and emerging Veterans’ organizations including:
NATO Veterans Organization of Canada
Veterans UN NATO Canada
VeteransofCanada.ca
Canadian Veterans Advocacy
VeteranVoice.info
VAC continues to forge new relationships with groups including:
True Patriot Love Foundation
Veterans Emergency Transition Services (V.E.T.S.)
Aboriginal Veterans Autochtones
Aboriginal Veterans and Serving Members Association
Helmets to Hardhats
Wounded Warriors
- Information on the VAC website is now more Veteran-focussed and easy to understand.
- Social Media is used to enhance interaction with, and inform Veterans, Veterans’ associations, and other stakeholders – particularly modern-day Veterans and their families.
- The Veterans Benefits Browser allows Veterans and their families to quickly and easily find information on the benefits, services and programs offered by VAC. Veterans and their families can browse all of the benefits, or select information specific to their need and service.
- My VAC Book was designed to help Veterans and their families learn about the services and benefits available to them. To build a personal My VAC Book, Veterans answer a few questions and once finished, a book will be displayed on screen in a PDF format. Within a few days a hard copy is mailed to the Veteran.
- VAC presented information on VAC programs and services at four national health professional conferences (Canadian Association of Occupational Therapy, Vocational Rehabilitation Association of Canada, Canadian Physiotherapy Association and the National Case Management Conference).
Investing in research
- In partnership with DND/CAF and Statistics Canada, VAC is engaged in research to help fill the gap in Canadian and international research related to transition to civilian life. The Life After Service Studies (LASS) program of research is examining many aspects of health over the life course of military Veterans, including disability, income, access to the determinants of health, mortality (including suicide) and cancer. The first wave of the study was released in 2011.
- The LASS – Reserve Study (second wave of LASS) will include a Survey on Transition to Civilian Life and an Income Study. The study has been developed so that VAC will be able to assess transition and well-being for Canadian Reservists as well as Regular Force Veterans.
- Statistics Canada’s 2003 Canadian Community Health Survey of the general Canadian population included a series of questions to identify Veterans living in Canada. VAC, in collaboration with Statistics Canada, examined the data to compare the well-being of CAF Veterans with the general Canadian population.
- The Canadian Institute for Military and Veteran Health Research was established in 2010; the fourth annual forum is to be held November 25-27, 2013 in Edmonton, Alberta. As in previous years, the forum will cover a wide range of military and Veteran health topics. Themes include military and Veteran families, mental health, traumatic brain injury and presentations on international research.
- VAC partnered with McGill University to include a Veteran Identifier Question in the Canadian Longitudinal Study on Aging (CLSA). This will allow for comparisons between Veterans and the general population tracked in the study.
- A contract was developed between VAC, DND, the CAF and the Canadian Institute for Military and Veteran Health Research to promote independent research of importance to military and Veteran health. VAC sponsored five projects with three Canadian universities:
- University of Manitoba (two studies): a study examining the co-morbidity of anxiety and physical health conditions in CAF Veterans; and a study examining the relationship between income, mental disorders and suicide in CAF Veterans.
- Queen’s University (two studies): a study examining the health-related quality of life for CAF Veterans; and a study to understand the relationship between pain and well-being in CAF Veterans.
- University of Sherbrooke (one study): development of measurement tools for workplace reintegration of Veterans with mental health disorders.
- VAC provided support to Can Praxis for a study on Equine Assisted Learning. It includes the development of measurement tools to assess the effectiveness of equine-assisted learning for CAF Veterans with mental health conditions and their spouses.
- VAC provided support to St. John Ambulance for a study on animal assisted therapy for institutionalized Veterans. It includes developing tools to assess how the use of service dogs in institutions can affect social isolation.
- VAC is partnering with the Canadian Institute for Military and Veteran Health Research to review research related to the use of psychiatric service dogs for Veterans with PTSD.
- From the perspective of mental health, through a Canadian Institutes of Health Research grant, VAC brought together a team to conduct research on workplace reintegration for Veterans with mental health conditions.
- DND and the Canadian Institutes of Health Research are funding three research projects that will advance understanding of mild traumatic brain injuries, more commonly known as concussions, suffered by soldiers in military operations as the result of exposure to the blast force of explosive devices. The knowledge gained in this research will be shared with VAC and will assist the Department in helping Veterans with mild traumatic brain injuries.
- VAC, DND/CAF and Canadian Institutes for Health Research share information on research activities through participation on the Canadian Institute for Military and Veteran Health Research Technical Advisory Committee and through other bi-lateral and multi-lateral meetings.
- Research is a main theme of the Ministerial Summit and Senior International Forum meetings which include the countries of Australia, New Zealand, United States, United Kingdom and Canada. Researchers from the respective countries comprise the Senior International Forum Research Committee which presents findings on emerging Veterans’ health issues to Ministers and Deputies at the meetings. VAC uses this information to strengthen policy and program development.
Monitoring programs and services
- VAC conducts a survey of participants in the New Veterans Charter Rehabilitation Program at program entry and program completion. The results of the survey are compiled on an annual basis. Results indicate that Veterans completing the VAC Rehabilitation Program more often report that their health is excellent, very good or good, when compared to Veterans who are beginning the program (2009-10, 2010-11 and 2011-12).
- Each program under the New Veterans Charter has a Performance Measurement Strategy which assesses the results of a program relative to the program’s objectives. The Strategy assists program managers and deputy heads to:
- continuously monitor program performance;
- make informed decisions and take appropriate, timely action with respect to programs;
- provide effective and relevant departmental reporting on programs; and
- ensure that credible and reliable performance data are being collected to effectively support program evaluation.
- A Case Management Services Accountability Framework for Performance and Reporting was implemented to provide guidelines and tools for case planning, performance monitoring, and a learning strategy for case management. The Framework enhances the ability of managers and staff to provide effective case management services by ensuring that Veterans and their families receive timely, appropriate and consistent levels of service.
- Workload intensity tools were developed to assess the levels of risk, need, complexity and intensity of Veterans who are case managed. The tools allow for more effective caseload management for Case Managers and Veterans and are being used as part of day-to-day field operations.
- Four new and/or updated service standards relating to the delivery of the Rehabilitation Program and case management services were implemented. This includes:
- Needs will be assessed within 30 days of the Veteran’s eligible Rehabilitation Program decision;
- A Case Manager will work with the Veteran and develop a plan to best meet his/her needs within 45 days of an eligible Rehabilitation Program decision;
- A Case Manager will contact the Veteran at least every 90 days to discuss progress towards achieving rehabilitation goals; and
- Veterans participating in the Rehabilitation Program will have progress documented by VAC (i.e. the creation of a progress note) within their plan on a monthly basis.
- The New Veterans Charter (NVC) was evaluated in three phases, with the intent to improve the design and delivery of the NVC programs. These evaluations determined that, while there were some issues identified with the design of certain components of the NVC programs, as a whole, these programs provide the services and benefits needed to support successful re-establishment to civilian life. The evaluations contained recommendations that the Department is implementing respective to measurement of outcomes for departmental outreach and for Veterans and families regarding recognition, health, community integration, employment and income. There were 21 recommendations from these evaluations which can be found in the VAC Evaluation Reports on the external website.
- The Department fully cooperated in the Standing Committee on Veterans Affairs’ 2010 review of the New Veterans Charter. The Minister announced on September 26, 2013 that a comprehensive review of the New Veterans Charter would be undertaken. The Committee presented their report in June 2014.
Service Delivery
VAC has introduced a number of measures through the Cutting Red Tape for Veterans initiative to deliver better and faster service in more modern ways for Veterans and releasing military personnel.
- The Department has switched to up-front payments for grounds maintenance and housekeeping services under the Veterans Independence Program. Veterans and other recipients no longer need to submit receipts.
- Veterans may receive payment for benefits by direct deposit. This is already being used by more than 48,000 Veterans
- The Intelligent Call Exchange (ICE) telephone system improves the quality of service to Veterans as it promotes national consistency in response to inquiries. The new system is about connecting Veterans with those who have the delegated authority to render a decision on an inquiry.
- Reauthorization of medical treatment benefits is no longer required for 70% of the transactions.
- My VAC Account is a fundamental piece of the Department’s plan to improve online services for Veterans. Veterans now have the convenience and flexibility of doing business securely online with the Department, 24 hours a day, 7 days a week, 365 days a year.
- The time it takes to process applications for disability benefits has been greatly reduced by eliminating unnecessary steps, layers of bureaucracy and introducing new technologies in the processing of applications. The Department expects to reduce this turnaround time.
- The implementation of the electronic transfer of health records between VAC and
DND/CAF will further reduce the processing time for disability benefits when the project is fully completed by the end of fiscal year 2014-2015.
- Through a partnership with Service Canada, Veterans now have more than 600 points of service available to them across the country – a significant increase from the 60 points of service previously available.
- VAC has developed an area office standards manual. The goal is to provide a barrier-free, accessible environment which balances furnishings and decor with security needs. This change will also create a warm and inviting environment for Veterans and create a common look and feel in VAC offices throughout the country. Work to finalize these changes is ongoing, with the goal of completing all the offices in 2014.
- Under the policy renewal project, all program policies were simplified, clarified and consolidated where possible. VAC reduced the number of its policies from 450 to approximately 200.
- Policies will be reviewed on a four-year cycle. This four-year cycle will ensure polices are kept up-to-date and that VAC decisions on Veterans’ benefits applications are based on the most current evidence and best practices available.
- Veterans no longer need to submit receipts or appointment verifications from health care providers to receive reimbursements for health related travel expenses. This change eliminates paperwork for Veterans and ensures that their claims are processed faster.
- Decision letters on disability benefits and brochures on benefits and services have been updated to meet the accepted standards of plain language. Plain language improvements have been made to 62 disability letters. This includes the most commonly used decision letters. Cover letters and condolence letters have also been improved.
- The Veterans Bill of Rights was established reinforcing the Government’s commitment to Veterans and their families.
- The Veterans Ombudsman office was created as an independent voice to ensure the fair treatment of Veterans and their families in accordance with the Veterans Bill of Rights.
CASE MANAGEMENT: Recommendations in this area focussed on the need to improve case management services, particularly for Veterans and families with special needs; establishing case management standards; ensuring Case Managers have the authority to make decisions, and are well trained.
Actions taken by VAC:
- A ten-point Transformation Action Plan to enhance case management services was developed to provide better integration with rehabilitation and mental health. It included development and implementation of core competencies for Case Managers, strengthened reporting and performance measurement, and re-engineered tools and processes.
- Case planning guidelines were revised and implemented to help support the interdisciplinary teams and subject-matter experts in the decision-making process.
- A National Addictions Strategy was developed and implemented for Veterans and their families struggling with addiction. The Department provided addictions training to approximately 400 field staff. Training is ongoing and additional learning opportunities are planned over the next two years.
- VAC developed and implemented a National Suicide Prevention Strategy. VAC’s Suicide Awareness and Intervention Protocol was revised to provide staff with essential information on suicide risk as well as intervention techniques to help Veterans who are suicidal.
The protocol provides VAC frontline staff with the process to screen for risk of suicide, the immediate actions to take, and the follow up required. VAC staff received Applied Suicide Intervention Skills training, and a webinar is being developed to promote the use of the Protocol.
- A national training and learning strategy for VAC’s Case Management was implemented. This long term strategy focuses on development of skills and abilities of front line staff to ensure workloads and skill sets are appropriately aligned to best serve Veterans and their families.
- National access was established to Case Management Consultants who have backgrounds in mental health, rehabilitation and disability management. These consultants work with VAC Case Managers and staff in a professional practice and support role, providing coaching, mentoring and skills building. The goal of Case Management Consultants is to enhance the practice and overall delivery of case management services.
- Mobile technology is being used to support Case Management services.
- Roles and responsibilities were confirmed for the Client Service Team. This includes: Client Service Team Managers; Case Managers; Client Service Agents and the Administrative Support Group. For example, VAC transferred responsibility for administrative tasks from Case Managers to administrative staff, so that Case Managers can focus on providing service to Veterans.
- The Delegated Authority on Decision Making to Case Managers provides additional authorities to Case Managers resulting in improved turn-around times for decisions for Veterans.
- VAC works with more than 200 Clinical Care Managers who provide daily contact with Veterans with complex mental and physical health needs and their families. Clinical Care Managers are registered service providers paid for under VAC’s Treatment Benefits Program. Clinical Care Managers receive referrals from VAC Case Managers for the provision of one-on-one support for intensive services to those who have complex health needs and may require additional support. The Clinical Care Manager works directly with the Veteran in support of the case plan created between the VAC Case Manager and the Veteran. The VAC Case Manager continues in his/her primary role to coordinate services and interventions on behalf of Veterans.
- With the national implementation of three new workload intensity tools, a Case Manager’s caseload is based not only on the number of active cases, but also on the level of risk, complexity and intensity associated with each case. Generally, the range is 40 Case-Managed Veterans per Case Manager. The tools allow for the appropriate case mix, with the end result being well-balanced and manageable caseloads for Case Managers across the country.
SUPPORT TO FAMILIES AND CAREGIVERS: Recommendations in this area focussed on the need to provide more support to families including recommendations calling for the development of programs including counselling and rehabilitation services designed for families in their own right, and the provision of economic compensation to family caregivers.
Actions taken by VAC:
- The New Veterans Charter offers more supports to families than ever before. Services for families include:
- Case Management – ongoing support and evaluation of family needs; families are encouraged to participate in the Transition Interview and participate during the development of the Veteran’s case plan.
- Rehabilitation – vocational assistance can be transferred to spouses and common-law partners if the Veteran is unable to take part.
- Death Benefit – recognizes the non-economic impact of the CAF member’s death on the survivor and dependent children and provides a tax-free lump sum payment.
- Group Health Insurance – CAF families can qualify for the Public Service Health Care Plan for drug benefits, vision care, etc.
- Educational assistance – funding support to help children pay for post-secondary education.
- Families have access to the VAC Assistance Service, a toll-free 24-hour help line that provides Veterans and their families with short-term professional counselling and referral services. In 2012, VAC extended this service to include any family member who is the primary support or caregiver of a Veteran.
- Jointly funded by VAC and the CAF, the Operational Stress Injury Social Support program is a peer support program for Veterans, CAF personnel and families. Eight additional Family Peer Support Coordinator positions were created to enhance support to families.
- The bereavement support program, Helping Our Peers by Providing Empathy (HOPE), was run through Operational Stress Injury Social Support (OSSIS) Program, a VAC/DND partnership. HOPE is now part of DND’s program on major CAF bases/wings.
- Pastoral Outreach services are available for situations where Veterans and their families are dealing with end-of-life issues, including bereavement. The Pastoral Outreach Program was offered jointly by VAC and DND until 2010, after which time the program was solely offered by VAC.
- Policies have been clarified so that family members may receive and be involved in counselling and/or psycho-education sessions, in support of a Veteran’s treatment plan, case plan or rehabilitation plan.
- The Operational Stress Injury (OSI) Clinic network has standardized family screening, assessment and treatment for families of Veterans receiving treatment at an OSI clinic. This means that family members are considered important partners in the treatment of their loved one. Family members will receive the evidence-informed screening, assessment, treatment and referral services they need to support the rehabilitation of their loved one.
- A Departmental outreach strategy was developed with a focus on reaching CAF personnel, Veterans, families and Veterans’ organizations by ensuring that accurate and current information is available during VAC briefings using professional and standardized presentations delivered by well- trained staff. Briefings may include participation at CAF professional development days, the Integrated Personnel Support Centres and other CAF outreach opportunities, such as leadership courses and Medical Officer Conferences.
- VAC partnered with DND and communities on the first Veteran and Family Community Covenant that was launched in Newfoundland and Labrador. VAC provided the framework for the covenant which offers an opportunity to increase recognition and commemoration of the sacrifices of Veterans and their families, increase community awareness of the needs of Veterans and their families when transitioning and re-establishing into civilian life, as well as to increase understanding of VAC programs and services.
- The Mental Health Service Capacity Project was initiated, led by VAC and piloted in Newfoundland and Labrador in collaboration with provincial, non-governmental, community and federal organizations, private mental health services and the community. The intent of the pilot was to: improve access to, and awareness of, mental health services; recruit and strengthen service provider capacity; improve supports to staff; and build strong working partnerships with the province, non-government organizations and key communities in support of Veterans and their families. The project also included a jointly organized conference “Serving Those Who Have Served” and the development of a six-module webinar series developed and delivered to 60 clinicians in Newfoundland and Labrador.
- Revised case planning guidelines were approved and now include the family in the interview process and development of the case plan.
OTHER
- Opportunities were provided for the Special Needs Advisory Group (SNAG) to have input from Veterans with special needs and their advocates.
- Many of the actions taken by the Department to partially or fully respond to the former advisory committee recommendations demonstrate that the New Veterans Charter continues to be a living document.
Note – some SNAG recommendations related to the work of the committee or were part of ongoing and existing business practices of the Department.
This includes SNAG recommendations 41, 56, 57, 59, 60, 61, 62, 93, 105, 107, 111, 113, 115, 123, 124, 125, 133