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Exploring Ways of Providing Seamless Care for Veterans with Spinal Cord Injury

By Carolann Murphy, PA

In this episode of Kessler Foundation's podcast, learn about “Best of Both Worlds: Establishing Fruitful Partnerships between VA Spinal Cord Injury/Disorders Care and SCI Model System Centers." 

Listen to the podcast, and download this episode and others for free on Apple Podcasts, SoundCloud, Podbean, or where ever you get your podcasts.


On October 24, 2019, researchers and clinicians convened at the Kessler Conference Center for a Spinal Cord Injury Grand Rounds titled, “Best of Both Worlds: Establishing Fruitful Partnerships between VA Spinal Cord Injury/Disorders Care and SCI Model System Centers.” Attendees learned about practical ways to achieve the shared goal of both systems of care - to restore function for Veterans living with spinal cord injury and related disorders (SCI/D), reduce the risk for secondary medical complications, and increase quality of life. 

The Department of Veterans Affairs (VA) provides SCI care nationally through their Hub-and-Spoke network of 25 SCI specialty care centers (i.e., Hubs) and their other VA facilities in designated catchment areas (i.e., Spokes). For example, the VA New Jersey Health Care System (VANJHCS) serves as the Hub for SCI care to Veterans in New Jersey and eastern Pennsylvania, and provides some support to Veterans in northern Delaware. The SCI Model System (SCIM) provides care through a national network of 14 regional model system centers, including the federally funded Northern New Jersey Spinal Cord Injury System (NNJSCIS) based at Kessler in West Orange, NJ.

Denise Fyffe, PhD, (principal investigator), a senior research scientist in the Center for Spinal Cord Injury Research and an investigator for the NNJSCIS, was joined by co-investigators Dr. Carol Gibson-Gill and Joyce Williams, LCSW, from VANJHCS SCI/D Center to present preliminary findings from their collaborative study. This federally funded project was conducted at two New Jersey sites: the VANJHCS in East Orange, NJ, and the NNJSCIS in West Orange, NJ.

Study participants included service- and non-service-connected Veterans living with SCI of varying duration. Veteran participants described their primary sources of healthcare as: 1) VA system only (52%); 2) SCIMS only (21%); 3) a combination of VA and non-VA healthcare settings (26%) (i.e., dual healthcare system users). Toward ensuring that all Veterans receive optimal care, the research team investigated the reasons underlying the choices of care made by Veterans, and the perspectives of SCI clinicians at both study sites.  

Preliminary findings study identified misperceptions and lack of knowledge that hinder Veterans from receiving the seamless care they deserve. For example, some Veterans who receive care in the SCIMS (and their clinicians) did not realize that they were eligible to receive healthcare from the VA. Under this circumstance, the research team recommended identifying Veteran status from patients who are getting care from the SCIMS, so that they can be encouraged to revisit their VHA eligibility in order to access coverage for assistive technology, home modifications, long-term care, and other VA benefits. 

Most importantly, the study suggests the need for SCI providers to rethink the traditional either/or choices of VA and private-sector care for Veterans living with SCI, revealing a common ground for clinicians in both systems of care. “We need to re-evaluate the divide by working hard at coordinating our efforts to reach our common goal – that is, providing our Veterans with optimal healthcare and supporting their caregivers, so they can live fulfilling and healthy lives in their communities,” said Dr. Gibson-Gill. Based on the study findings, Joyce Williams, LCSW, recommended the following three steps to start the collaborative process: 1) identify patients who are Veterans; 2) confirm their Veteran status; and. 3) connect them with a VA SCI Coordinator or VA SCI Center.”

To reach the SCI/D Coordinator at the VA New Jersey Health Care System, call 973.676.1000, ext. 1729. 

This project was funded by the Office of the Assistant Secretary of Defense for Health Affairs through the Spinal Cord Injury Research Program under Award No. W81XWH-15-1-0278. The contents of this paper, including opinions, interpretations, conclusions, and recommendations are those of the author and are not necessarily endorsed by the Department of Defense.

This SCI Grand Rounds is part of a series hosted by Kessler Foundation and Kessler Institute for Rehabilitation and sponsored by the Northern New Jersey SCI System, part of the SCI Model System funded through the National Institute on Disability Independent Living and Rehabilitation Research.