Ask the Question: History of "Ask the Question" in New Hampshire

Transcript of video:

The State of NH and the Ask the Question campaign owes a huge debt of gratitude to the passion and tenacity of a woman named Lt Colonel Stephanie Riley. 
I met Lt Colonel Riley back in the early days of the NH Legislative Commission on PTDS and TBI. The Commission had been tasked with studying the effects of PTSD and TBI on NH’s returning veterans from the conflicts in Iraq and Afghanistan. 
The wars had been on for nearly 10 years and it had become apparent that men and women were coming home with needs that our state might not be prepared to address. 

Lt Colonel Riley was serving in the NH Air National Guard. 
We connected over being working moms with busy children and professions in health care. 
Lt Colonel Riley worked in the emergency room of a NH civilian hospital. 
By 2013 she had begun sharing with us on the commission that she was frequently witnessing individuals presenting with symptoms of headaches, dizziness and sometimes hearing loss. 

Many were irritable and depressed, struggling with their jobs and relationships.
Based on their presenting symptoms, these patients were often diagnosed with migraines, provided short term medications and sent on their way.  
Lt Colonel Riley began to notice, based on her own service experience, that many of these individuals might have served in the military, things like t-shirts, tattoos or combat boots, so she began to ask them. 

She discovered that many of the migraine patients were actually veterans, possibly suffering from mild traumatic brain injuries or TBIs. 
Later that same year, Lt Colonel Riley encountered a veteran struggling with chronic head pain and other life difficulties. 
He had been to three different health care facilities in NH and not one had asked him if he had ever served in the military. 
By the time this veteran encountered Lt Colonel Riley, it was too late. Despite her efforts to help him get an accurate diagnosis and relevant treatment, the veteran died by suicide. 

Devastated, Lt Colonel Riley expressed her concern to many NH military and civilian leaders. I remember the day she arrived at our monthly commission meeting, still deeply emotional over the loss of this young veteran and her frustration with the system’s failure to catch him.  
The seed for the Ask the Question campaign was planted in NH that day. 
Lt Colonel Riley recognized the critical role that community service providers play in providing services and care to veterans, service members and their families. 
The fact is, across the country, over two-thirds of veterans choose to receive care and services in their community rather than at their local VA. 
Tragically, Lt Colonel Riley was later diagnosed with cancer. She passed away in December of 2014. She continued to attend commission meetings throughout her treatments and expressed frustration that her providers seemed to lack interest in the fact that she had served, 
or that exposures during her deployments may have played a role in her illness. 
In April of 2014, the spring before she passed, Lt Colonel Riley took her story to the Commission’s facebook page:
Today I went to Dana Farber in Boston for my second opinion in my cancer diagnosis. Throughout this latest medical journey I have been on, no one in the medical community has asked me if I have ever served in the military, because to them I look like a civilian. 

I have served on this Commission for a couple of years, and we have tried promoting medical services, or any community service for that matter, to start asking the question "Have you ever served in the military?" when doing an intake form. Don't ask if the person is a veteran. Many folks don't identify with being a veteran despite serving in the military, so the question might not be answered correctly. If the response to military service is a yes, the person may be entitled to VA benefits and not know it, and NOT be an uninsured person.

The person may be having symptoms related to a recent deployment; such as migraines from an undiagnosed TBI from an IED explosion, so a correct diagnosis can be made during the medical visit. The person may not associate symptoms to a military injury and by asking the question may remind them. 

Just one simple question can open up so many opportunities to help the person.

I am passionate about this cause because a few years ago, I worked as the case manager for the NH Army National Guard. I worked with soldiers returning from deployments and tried to get them plugged Into the VA for their care. Many service members do not go to the VA. Instead they will go to their local community hospitals for care. One of my "kids” was going to different hospitals seeking help for his terrible migraines. He had been in IED explosions, had lost his roommate to one of the bombs, and was having a bad time adjusting back home. Because no one knew of his background he was not diagnosed properly. He was given pain meds for his migraines and sent home. When I became aware of this we got him into the VA but by this time he had been suffering too much and he chose to end his life. I have never been more devastated in my life and have tried to do something to change the system. Because it is SO hard to have questions added to intake or triage forms (why that is is BEYOND ME!) I have decided to do what I can. 

I wore my military uniform to Boston to give them a visual that I am in the military. At the end of my appointment with my doctor, I explained to him about the uniform and the question. He felt rather sheepish that he didn't ask. I told him that I had been deployed to Qatar in the past and maybe all the sand had done something to my lungs. I asked him to look into changing the forms at his facility. I’II follow up on that at my next visit. He's a great guy. Maybe he will do something.

Lt Colonel Riley mentioned in her post the importance of asking the question the right way. 
Some medical facilities and forms have included the question “Are you a Veteran?” for decades, mostly because it might play a role in billing. 
But that question is much too narrow and has not historically been followed up with important health related questions. 
How we ask the question is critical to engaging those who have served and their family members. Not everyone who might qualify as a Veteran identifies as a veteran. 

Some who served do not feel that the nature of their service is deserving of the title. 
They may have personal beliefs that such a title should be reserved only for those who were deployed, or experienced combat, or were wounded. 
Some, despite their time in service, do not actually qualify for the title because maybe their discharge status prohibits it, or maybe their service was in the national guard or reserves, and they were never activated. 

What about those still actively serving? They wouldn’t identify as veterans until they were out of the military. 
The word “ever” is important because we want anyone who has ever served their country to feel included, 
even if the person was dishonorably discharged or was released before completing basic training. 
The word also makes clear that service of any era, peace time or war, is of value and important to disclose. 
The word ever allows us to identify anyone who might be in some way impacted by the unique culture and possible exposures of military service.  
Across the country we are quickly learning that to best serve our veterans, service members and their families, we need to first identify them. 
We need to identify them within our hospitals, mental health centers, senior centers, social service agencies, employment offices, law enforcement agencies, courts, and schools. 
NH’s Community Mental Health Center military liaison initiative is a powerful example of how one health care system in NH operationalized the “Ask the Question” campaign. 

Through Ask the Question, we now know that 18% of clients served at the 10 NH mental health centers are military connected. 
This new data helped to create intentional strategies to serve military connected patients and clients by generating military culture trainings, coordinating client referrals to the VA when relevant, and providing greater supports for military families. 
NH’s Ask the Question campaign was highlighted at the national mental health summit organized by the department of defense, US department of veterans administration, and the US department of health and human services. 
As a result of this discussion, the Ask the Question campaign was approved to be included in the national suicide prevention planning documents.  
Many of those who have served do not ask for help easily; military culture dictates self-sufficiency and sacrifice. 
Many are resistant to accepting resources or supports because they believe that there is probably a veteran out there that needs it more than they do. 
I could not possibly count the number of times a veteran has apologized in my office for taking up my time because he is certain that someone else’s problems are much worse than his. 
The Ask the Question campaign puts the responsibility on the service provider, on all of us, to identify possible needs, thus removing these barriers for veterans, service members, and their families. 
Thank you, Lt Col Riley for your service to our state and your service to our country. Your message proves to us again and again that one person can make a difference.