52 | The road to entrepreneurship and not sacrificing your healthspan w/ Paul Reilly It'll buff

We mixed things up in this episode, we brought topic of health into play. Paul Reilly's journey from military service to where he is today is proof that this whole process is evergreen. Paul has continued to learn and grow throughout his whole journey of transitioning into civilian life. Exiting from the military was easy for him, but the rest wasn't. From the start Paul found himself in an industry that he felt wouldn't fulfill his dreams (medical sales), but he had a lot of fun and was very successful in medical sales. He left his career of 20 years there and embarked on his entrepreneurial journey. He committed a lot to the journey. Stood up franchises for active Rx in 2012. The business model feel apart, but instead of shutting down Paul listened to his clients. So when Active Rx shut down and his investment was crushed, he rebranded. Enter Midstrong! After working with many clients Paul listened to their needs and developed a process that would help his clients optimize their healthspan (the time in your life where you are physically able to be involved in life's activities) As Service members we focus on all the right things when getting out of the military, job, living standards, benefits, etc. We forget to take care of ourselves. Don't miss out on more years down the road with your family by forgetting to do the things that will maximize your healthspan. We covered so much in this episode, this was a great one of resilience, growth, and to keep chasing your dreams!

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Serving the Country in Multiple Ways: Veterans Reflecting on the Journey from Military Service to Public   Service

By Chris Díaz (he/him)

Ahead of Veterans Day, Chris Díaz, Deputy Chief of Staff and White House Liaison at the Department of Veterans Affairs and a U.S. Navy veteran himself, spoke with four appointees about their motivations to serve in the U.S. military, how their military service informs their public service, and what being a veteran means to them.

In honor of Veterans Day, I had the chance to speak with four appointees who served in the U.S. military before joining the Biden-Harris Administration:

Jimmy Anderson , Deputy White House Liaison at the Department of Veterans Affairs and U.S. Air Force reservist

Ben Cobley , Senior Director of Digital Strategy at the Department of Education and U.S. Army veteran

Maria Carolina González-Prats , Special Assistant to the Under Secretary for Benefits at the Department of Veterans Affairs and U.S. Army veteran

Claire Russo , Senior Advisor in the Bureau for Conflict Prevention and Stabilization at the U.S. Agency for International Development and U.S. Marine veteran

Our conversation, below, has been edited for clarity and length.

whole journey navy service

Chris: Veterans Day honors the sacrifices and service of our nation’s veterans and their families. As veterans yourselves, can you tell us what motivated you to serve in the military?

Carolina: After finishing college, I was working as a social worker at a high school and trying to figure out what to do next in my life. I knew I wanted to work with students, specifically elementary school students, so I joined the military to eventually continue my education and become a teacher. Since then, the military – and the desire for service it inspired in me – became my career.

Claire: I was motivated to serve by a sense of duty and service that my parents instilled in me. My father is an immigrant. Coming from a lower-class, he grew up an orphan without the opportunities provided by a democracy. His experiences remind me every day that I can’t take for granted anything this country has offered me.

From a really young age, I wanted to serve. I grew up in a family with four girls, and I was like my dad’s son. I wanted to join the toughest service out there, and I wanted to be treated the same as the men. It was at a very young age – I think I was ten – that I decided I wanted to become a Marine. My motivations to serve run deep for me.

Ben: I don’t think my answer is all that inspiring. I saw military service as a duty to my country – and I felt like I had to serve that duty. I also saw it as a challenge. I was never the toughest guy or the top athlete, but serving in the military – and specifically, serving in a combat role – was a challenge that would help me live up to a personal obligation of mine to earn freedom rather than simply inherit it.

Chris: You said you didn’t think your answer was inspiring, but I want to note that less than 1% of Americans are active-duty service members – you answered a personal obligation and duty that very few people do. And of that 1%, only 10% of people serve in direct combat arms. That is very worthy of mentioning, and that is part of what this holiday is about.

Now Jimmy, since you’re still serving in the military in a reserve capacity, I should ask: what motivates you to continue to serve?

Jimmy: I tried college for a semester and then decided to serve. For me, it was more of a survival thing – I just wanted a paycheck and to be taught a trade. But, there’s a reason why people serve, and there’s a reason why people stay in. I stay in because I’m serving something higher than myself – there’s a real impact that people are feeling because of our military service. That same sense of service is interconnected with my work at the VA. I’m not doing this for myself anymore; I’m not doing this for a paycheck anymore but rather, for a higher calling and impact.

Chris: What I’m hearing from you is that you took this opportunity to serve in the military and made something out of it. You’ve all served your country in multiple ways, first as service members and now as political appointees. How does your military service inform your public service today?

Claire: I’ll just throw it out there that the hardest thing I’ve done in the military is be a spouse – I’m eighteen-and-a-half years in for my husband’s service. Being a veteran makes it a little harder as a spouse because I know what could be happening when I don’t get a call for a few weeks at a time or when I’m reading the news.

Serving in the Administration, there is not one word that hits the paper without me considering that policy is way more than words – on the other end of that policy, someone has to implement it. At USAID, a lot of our work happens overseas, very much in conflict spaces, spaces that often overlap with the places military service occurs.

People live in the countries we’re serving – and there are American citizens who are offering their lives to serve, giving up a great deal. As we’re writing policy, we’re always considering the lives of the people who are impacted on the ground and the impact on the lives of those who have to implement the policy.

Chris: For readers who may not know, every Marine is considered a rifleman, first and foremost – and now Claire, you’re at the front end of the peacemaking process. Your range of perspective is poignant.

Carolina, what about you – what lessons from your military service do you carry in your work now?

Carolina: One of the most important lessons I learned is being grounded. There can be a lot of noise in life – I learned from the military and mentors to quiet the noise around me and focus on what needs to be done. My work today focuses on helping veterans transition to civilian life, and I always think about the impact my work has on veterans’ daily lives. I try to go back to the basics of what the mission is.

There’s also a common humanity in the military – service members have different personalities and come from different walks of life, yet we all come together as one. Even in communities that have experienced war like those in Iraq and Afghanistan, there is a common humanity amidst all the chaos.

Chris: And as a service member that has transitioned to civilian life, your lived experience also directly impacts the work you’re doing today to help veterans make that same transition. It’s not just an abstract concept for you – it’s your life experience.

Ben, how does your military service inform your public service?

Ben: During my deployment, I saw women and children desperately looking for a chance to learn – that experience makes fighting for things like universal, high-quality education and investing in educators even more important here in America, having seen the other side of the coin.

When I was in the Southern Kandahar Province of Afghanistan, infrastructure was almost non-existent and almost always structurally deficient. Buildings were absolutely destroyed – seeing all of this makes building up our country’s infrastructure seem that much more vital.

There are of course many differences between those areas and the United States, but the motivation to better the lives of people fuels my fight every single day.

Jimmy: When you first enlist, you’re an E-1 at the bottom of the totem pole. Folks will tell you, “You can’t make any changes; you’re executing.” That experience of enlisting informs my public service because when you’re an appointee, you’re not solely in an execution role – you’re building partnerships, during a high impact time in a high impact space. You’re definitely doing high impact work in uniform, too, but it’s a different type of impact.

Chris: Equity and access is so important because we need to ensure the leaders that serve in these capacities look like America. Jimmy, in particular, I know that you’ve worked a great deal on making sure our workforce reflects the diversity of our nation – and now we have the most diverse and competent workforce of political appointees we’ve ever had at the VA.

To frame this, I want to note that veterans don’t work solely in the VA – Ben and Claire are examples of veterans working at agencies across the Administration. Being a veteran is a part of our identities, but it’s not the only part.

As veterans – with such a diverse range of experiences and the shared experience of serving in the military – what message would you like to share with our fellow appointees who aren’t veterans? What would you tell them about what your service means to you?

Jimmy: I would say as veterans, we aren’t looking for any special treatment; we aren’t looking for any handouts. Veterans have a certain lived experience, and we have a certain set of skills that aren’t necessarily aligned with any specific place or line of work. We have a broad set of skills that come from our service, such as engaging with others in a very collaborative way, or sitting back and listening before we act. I would hope that our colleagues can see the level of value-add that veterans bring to the Administration and other organizations.

Ben: Serving is about more than just putting on a uniform – it’s a mindset of leadership. It’s an ethos that we live and breathe, that makes us stand out amongst others. That dedication to service is a trait that helps build up our agencies and teams – it’s something that I feel is an important trait to lean on as we keep working for the best version of our country.

Carolina: When it comes to transition periods, there are opportunities for members of the Administration to be partners and allies. I’ve benefitted a lot from non-veterans who took the time to reach out to me and try to understand my experience.

Veterans are neighbors, friends, and community members – we’re not meant to be pathologized or stereotyped as broken. Veterans are humans first.

Claire: Veterans have a distinct shared identity – there are things that are specific to the experiences of veterans and their families. The lifestyle can be very isolating if there aren’t people around you who understand what you’re going through.

My husband is stationed at Fort Belvoir – this is the first time we’re not living in a neighborhood where every other household is a military family. There are times when I’m at school picking up my kids, and the other moms introduce me, “This is Claire. She has three kids, and her husband is always gone. She moves all the time. It’s crazy – she’s Superwoman; we don’t know how she does it.” It’s painful to hear my life described that way and to be constantly reminded that the people around me don’t really understand who we are as a family. These moments can really demonstrate how the lifestyle of military families and veterans can seem so foreign, even to their own neighbors.

It’s important to foster partnerships between veterans and the rest of the community that go beyond, “Thank you for your service.” It takes a deliberate recognition of the value of having service members in conversations and as members of our community.

It’s also important to know that on the other end of policy, people are enacting that policy – whether it’s teachers at the Department of Education or caregivers at the VA. Veterans are people who have had experiences that are far beyond what we know here in Washington, D.C. – they have perspectives that are important to take on and understand.

Chris: This is just a small microcosm of what this community brings to the conversation around public service – whether men, women, Black, Brown, white, enlisted, commissioned, or across different branches, there’s a through line here of continued service. Despite taking off your uniforms, you’ve never stopped serving.

whole journey navy service

James “Jimmy” Anderson currently serves as Deputy White House Liaison at the Department of Veterans Affairs. Anderson previously served as a prior-enlisted Air Force intelligence officer at U.S. Air Forces Central Command. He founded the University of South Carolina’s Veterans Alumni Council, a 200-plus membership-based organization with an endowed scholarship for military members and their families. Anderson has held fellowships with the Center for a New American Security, Truman National Security Project, and Veterans in Global Leadership; he was also a Fulbright Scholar in Canada. He continues to serve in the U.S. Air Force Reserve. He completed master’s degrees at Queen’s University in Canada and American University’s School of International Service, and a bachelor’s degree from the University of South Carolina.

whole journey navy service

B en Cobley serves as Senior Director of Digital Strategy at the Department of Education after serving in numerous digital roles on the Biden-Harris Presidential Inaugural Committee and Presidential Campaign. Prior to that, Cobley developed and implemented digital and communications strategies for candidates and causes at nearly every level of state and federal service. Cobley holds a bachelor’s degree from the University of Iowa in International Relations, and served our country as a non-commissioned officer in the First Infantry Division of the U.S. Army and deployed to Afghanistan in support of Operation Enduring Freedom.

whole journey navy service

Chris Díaz is Deputy Chief of Staff and White House Liaison at the Department of Veterans Affairs, and a U.S. Navy veteran. During his service in the U.S. Navy from 2007 to 2012 as an Aviation Boatswain’s Mate and then as a Fleet Marine Corps Hospital Corpsman, he saw duty aboard the USS Harry S. Truman and, in support of Operation Enduring Freedom, deployed with the 6th Marines to Marjah in the Helmand Province of Afghanistan. After leaving the Navy, Díaz graduated from Drexel University in 2015 with a bachelor’s degree and master’s degree in Psychology. At Drexel, he joined other veterans to revitalize the school’s veterans’ group, gaining national recognition from Student Veterans of America (SVA). Additionally, Díaz was the recipient of the Pat Tillman Scholarship, awarded to veterans and veteran family members with a commitment to strengthening communities at home and around the world. He was the founder and former executive director of the veteran-led Action Tank – a Philadelphia-based nonprofit leveraging veterans’ experience, leadership, and relationships with service-minded citizens to tackle challenges like the opioid crisis, gun violence, and food insecurity. A native New Yorker, Díaz lives in Philadelphia with his wife, Jennifer; his son, Rain; and his dog, Upa.

whole journey navy service

Dr. Maria Carolina González-Prats currently serves as Special Assistant to the Under Secretary for Benefits at the Department of Veterans Affairs. She is a proud Operation Enduring Freedom/Iraqi Freedom (OEF/OIF) War veteran, educator, and Latino youth and family advocate. Dr. González-Prats served as both an enlisted soldier in the Army Reserves and as an active-duty officer in the U.S. Army. As a member of the Third Infantry Division, she deployed to Iraq, leading thirty soldiers who led 24-hour warehouse operations in three concurrent locations in Kuwait and Iraq, supporting over 10,000 soldiers with mission-critical supplies for combat operations during Operation Enduring Freedom and Operation Iraqi Freedom. She then led a company of 155 American and Korean soldiers in the Republic of Korea. Dr. González -Prats recently completed her doctorate in Social Work and Social Research at Portland State University.

whole journey navy service

Claire Russo serves as Senior Advisor with the Biden-Harris Administration at the U.S. Agency for International Development in the Bureau for Conflict Prevention and Stabilization. Russo started her career in the Marine Corps as an intelligence officer. During her time in the Marines, she served with the First Marine Expeditionary Force, First Marine Air Wing, and First Intelligence Battalion. In Fallujah, Russo led a team of Marines in targeting critical nodes of insurgent networks across Anbar Province. Following her deployment, Russo worked with the Joint Task Force for Sexual Assault Prevention and Response, assisting in the writing of the first-ever Department of Defense-wide assault prevention and response policy. After leaving the Marines, Russo took a position with the Department of the Army as a civilian advisor to infantry brigades operating in Afghanistan. Russo spent over a year in Afghanistan building the Female Engagement Team program and increasing women’s participation in the counterinsurgency campaign. After a year in Eastern Afghanistan, Russo moved to Kabul to serve as a special advisor to General David Petraeus. Upon her return from Afghanistan, Russo served at the Council on Foreign Relations as an International Affairs Fellow. Russo served as Chief of Staff for Veterans for Biden. Russo’s husband Josh currently serves in the U.S. Army, and they live in the D.C. metro area with their three children.

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Issue Cover

Article Contents

Introduction, brief history of whole health, whole health in va today, ongoing research and evaluation, supplement sponsorship, conflict of interest statement, data availability, clinical trial registration, institutional review board (human subjects), institutional animal care and use committee (iacuc), individual author contribution statement, institutional clearance.

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Veterans Affairs’ Whole Health System of Care for Transitioning Service Members and Veterans

The views expressed are solely those of the authors and do not reflect the official policy or position of the Department of Veterans Affairs, U.S. Army, U.S. Navy, U.S. Air Force, the Department of Defense, or the U.S. Government.

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Cynthia J Gantt, Nancy Donovan, Maureen Khung, Veterans Affairs’ Whole Health System of Care for Transitioning Service Members and Veterans, Military Medicine , Volume 188, Issue Supplement_5, September/October 2023, Pages 28–32, https://doi.org/10.1093/milmed/usad047

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The Department of Veterans Affairs (VA) has launched an organization-wide transformation to a Whole Health System of Care that will ideally begin at the time of transition from active duty through the end of a Veteran’s life. A brief history and overview of the Whole Health approach are provided along with selected evaluation results and planned initial actions as a result of the Total Force Fitness–Whole Health Summit held in March 2022. More work is required to strengthen the natural linkages between the Department of Defense’s Total Force Fitness and Veterans Affairs’ Whole Health approach to care. The Total Force Fitness–Whole Health collaboration is a model of whole-person care for the nation.

The Department of Veterans Affairs (VA) has successfully launched an organization-wide transformation to a Whole Health System of Care that is designed to begin at the time of transition from active duty through the end of a Veteran’s life. A brief history and overview of Whole Health are provided along with selected evaluation results and planned actions. Whole Health is defined as “an approach to health care that empowers and equips people to take charge of their health and well-being so that they can live their life to the fullest.” 1 , 2 The central focus of Whole Health is asking the transitioning service member (TSM) and Veteran, “What matters to you?” versus the reductionist question: “What’s the matter with you?” embodied in medical problem lists and chief complaints. Discovering one’s mission, aspirations, and purpose and developing a dynamic Personal Health Plan are key to focusing on “what matters” for the TSM during the unique and sometimes vulnerable journey out of military service for approximately 200,000 persons annually. 3 Congress, along with the Department of Defense (DoD) and VA, recognizes the need for a seamless transition experience. The 2018 Executive Order 13822, “Supporting our Veterans during their Transition from Uniformed Service to Civilian Life,” 4 included Whole Health as an avenue for empowering TSMs to focus on health and well-being along with mental health care and other VA services. In response to this, 2-hour “Introduction to Whole Health” sessions were established at Veteran Affairs Medical Centers (VAMC). Similarly, Whole Health is integral to VA’s response to the Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019. Whole Health was a key strategy included in Section 101 that required a strategic plan on the expansion of health care for TSMs. Section 202 mandated an updated analysis of complementary and integrative health (CIH) services (e.g., yoga, meditation, and acupuncture) in the VA. 5

Most recently, VA’s ongoing commitment to Whole Health is demonstrated in the 2022–2028 VA Strategic Plan, Objective 2.2: Tailored Delivery of Benefits, Care and Services Ensure Equity and Access: VA and partners will tailor the delivery of benefits and customize Whole Health care and services for the recipient at each phase of their life journey; and Strategy 2.2.2: “(Whole Health) VA empowers employees to deliver high-quality Whole Health care that equips Veterans and supports their health and well-being by addressing what matters to them most.” 6

VA’s Office of Patient Centered Care and Cultural Transformation (OPCC&CT) began the development of VA’s Whole Health model in 2011. In 2013, VA formally recognized Whole Health as VA’s approach to personalized, proactive, patient-driven care. VAMCs were identified and evaluated as design sites and/or centers of innovation from 2011 to 2016. In 2014, OPCC&CT launched VA’s Integrative Health Coordinating Center to identify and address barriers to providing CIH services across VA and serve as a resource for clinical practices, education, and research related to CIH. 7 In 2016, the Comprehensive Addiction Recovery Act (CARA) to address the opioid epidemic became law. 8 Per Section 933 of CARA, OPCC&CT launched a 3-year research-based implementation pilot of the Whole Health System for Veterans with chronic pain at 18 Whole Health Flagship sites in partnership with every Veteran Integrated Service Network. Veteran Integrated Service Network leaders identified medical facilities that had demonstrated personalized, proactive, Veteran-driven approaches to care provided to Veterans and designated these facilities as Flagship sites to implement the Whole Health model of care and participate in a formal evaluation study on the impact of Whole Health on opioid use, Veteran experience, and utilization of Whole Health services. These Flagship sites received designated 3-year funding for key implementation staff and activities. Based on this work, the Whole Health System was formalized by OPCC&CT in 2017, and VA Directive 1137: “Provision of CIH” was also published. The directive established mechanisms for vetting CIH approaches that must be made available to all Veterans, either in VAMCs or in the community. 7 Currently, acupuncture, meditation, yoga, Tai Chi/Qi Gong, biofeedback, clinical hypnosis, guided imagery, and massage are the covered approaches. In response to the Mission Act of 2018, VA embarked on its Modernization efforts and Whole Health as a key transformational health care delivery effort to engage Veterans in lifelong health and resiliency. 9

In response to the coronavirus pandemic in early 2020, Whole Health strategies for Veterans, caregivers, and employees were quickly developed and continue to grow. TeleWholeHealth encounters increased 33% between fiscal year 2021 and third-quarter fiscal year 2022. Additionally, on-demand Whole Health self-care resources were developed to address isolation associated with the pandemic and were made publicly available. 10 Concurrently, comprehensive Employee Whole Health resources have also been developed. 11

In 2021, a 3-year collaborative effort began to integrate Whole Health into the daily workflows of Primary Care and Mental Health teams. Teams receive training to bring a Whole Health approach to clinical encounters, with a focus on what matters most to the Veteran. Two simple questions, (1) “What is most important to you in your life right now?” and (2) “What is one change you could make today to help move closer to what is most important?”, ensure that self-care is front and center in all Veteran interactions in and outside of traditional medical encounters. This large-scale integration will further reinforce that Whole Health is a cultural transformation rather than a stand-alone program. 12

In 2018, a TSM team was established in OPCC&CT. Results of the team’s efforts include Whole Health information in the Transition Assistance Program and Whole Health services for women leaving military service. A formal collaboration began in 2016 with OPCC&CT and DoD’s Uniformed Services University of the Health Sciences, Joint Consortium for Health and Military Performance. The Total Force Fitness (TFF) framework to optimize the performance of individual service members and their units was developed that aligns with the VA’s Whole Health Circle of Health. 13 , 14 In 2021, a small DoD/VA team focused on codifying the linkages between TFF and Whole Health to support TSMs. In March 2022, the TFF–Whole Health Summit was co-sponsored by Consortium for Health and Military Performance and OPCC&CT, resulting in a strengths, weaknesses, opportunities, and threats analysis and suggested actions as reported in this volume by Triscari et al.

The Whole Health approach is summarized by the Circle of Health ( Fig. 1 ). The four key elements of the Circle of Health are outlined in the Whole Health equation ( Fig. 2 ).

Circle of Health.

Circle of Health.

Whole Health equation.

Whole Health equation.

The Circle of Health ( Fig. 1 ) supports the identification of an individual’s mission, aspiration, and purpose, which is central to empowering and equipping a Veteran to live their life to the fullest.

First, “Me” is in the center of the circle surrounded by “Mindful Awareness” that places a focus on what matters most to a person. Next, as a Veteran develops their Personal Health Plan, they identify the role of eight self-care components in support of their health and well-being. Importantly, areas outside of traditional medical care (e.g., Personal Development and Surroundings) are included in the Circle of Health. 14 The third element, “Professional Care” incorporates the role of evidence-based conventional and CIH approaches in the prevention and treatment of diseases provided by the health care team and others. “Community” is the fourth element in the Whole Health equation that recognizes the potential contributions of non-VA entities (e.g., housing and education resources, Veteran Service Organizations, churches, and community centers).

In 2022, OPCC&CT developed the “Whole Health for All” model ( Fig. 3 ) to complement the original Circle of Health ( Fig. 1 ) to recognize the social, structural, and root causes that may be significant determinants of health and well-being. The Centers for Disease Control and Prevention define the social determinants of health as “conditions in the places where people live, learn, work, and play that affect a wide range of health and quality-of life-risks and outcomes.” 15 Moreover, the role of the structural determinants such as policies and institutional power can promote or hinder health and well-being. Likewise, the bottom circle recognizes the impact of systems of power such as racism, classism, sexism, homophobia, and ableism in the overall picture of someone’s Whole Health.

Whole Health for all.

Whole Health for all.

The Whole Health System ( Fig. 4 ) is specifically designed to support the Veteran in the realization of their mission, aspiration, and purpose and complement the Circle of Health. The model consists of three major components: (1) The Pathway empowers individuals to explore what really matters to them in the development of actionable goals in support of their personal mission, aspirations, and purpose through mindful self-exploration to optimize their health and well-being. Trained Veteran peers and Whole Health coaches are available to assist Veterans in this ongoing reflective process; (2) Well-being Programs focus on self-care and involve skill building (e.g., mindfulness and healthy eating classes) and evidence-based CIH approaches; and (3) Whole Health Clinical Care provides conventional care and CIH informed by an understanding of what matters most to the Veteran and designed to address personal health goals and foster self-care. 12

Whole Health System.

Whole Health System.

The CARA legislation outlined earlier has been leveraged by VA for the full-scale deployment and formal evaluation of the Whole Health System, beginning with 18 Flagship sites. 8 VA’s Health Services Research and Development Service collects quantitative and qualitative data on implementation approaches and service utilization, as well as patient-reported and clinical outcomes. Veteran-reported outcomes, known as the “Voice of the Veteran,” are considered exceptionally important in all Whole Health evaluations. An initial evaluation report of the Whole Health System of Care was published and reported to Congress in 2020. 1 , 16 A total of 3,266 Veterans completed baseline and 6-month surveys across the 18 Flagship medical centers at the time of the interim analysis for the Congressionally mandated report, with a 50% response rate for the baseline survey and 74% of these respondents completing the 6-month follow-up survey. Among the important clinical outcomes was the finding that Veterans diagnosed with chronic pain who fully engaged in Whole Health services decreased opioid use by 38% compared with 11% in Veterans engaged in conventional care. Similarly, Veterans engaged in Whole Health care demonstrated greater improvements in engagement in health care and self-care, perception of life meaning, and purpose and reported less perceived stress compared with Veterans engaged in conventional care. These findings supported the expansion of Whole Health across all health care facilities. Expanded longitudinal outcome evaluations of Veterans and employees participating in Whole Health services at the Flagship sites continue. Recent preliminary analyses of this cohort showed an increased likelihood of engagement with mental health services and decreased utilization of invasive spine procedures for Veterans with back pain who are engaged in Whole Health services. One study used a longitudinal cohort design using a difference-in-difference approach that examined how downstream utilization of spine procedures differs between users of CIH and other components of the Whole Health System ( Fig. 4 ). Overall results for the 3,914 Veterans identified with moderate-to-severe back pain showed that those who received CIH therapies had a −38.2% (−46.1, −29.1) lower rate than expected in the utilization of spine procedures at 3 months, whereas those who received other Whole Health services (e.g., coaching) had a −45.6% (−59.5, −31.3) lower rate. By 18 months, these reductions remained significant at 19.5% (−26.8, −14.0) and −24.6% (−37.1, −12.5), respectively. 17

Significantly, research has also linked employee participation in Whole Health practices to greater resilience, improved stress management skills, and better management of workplace burnout. VA recognizes the importance of the Whole Health System of Care to empower personal engagement and activation among employees in areas of self-care, health, and well-being. Participation also increases the likelihood of employees staying in VA and encouraging Veterans to engage in Whole Health services. 16 , 18

The VA–DoD Joint Executive Council provides oversight to transition-related issues, including legislative mandates such as the current efforts underway to meet the requirements for TSMs in the Hannon Act and the President’s Management Agenda. 19 VA recently chartered a Transition Sub-Council that includes VA, Veterans Health Administration, and Veterans Benefits Administration members to proactively and collaboratively address transition-related experiences 365 days pre-separation through 365 days post-separation. These efforts require deliberate coordination and collaboration to ensure warm handoffs for all TSMs, especially for those who might not have been deemed at higher risk for physical and psychosocial challenges. This will result in TSMs being better prepared and connected to medical and non-medical resources in a proactive manner so that they are living their lives to the fullest post-transition.

VA’s commitment to the Whole Health transformation is noteworthy because it is the nation’s largest integrated health and benefits system with 9.26 million enrollees, 1,297 care sites, including 145 that provide acute inpatient care, and over 427,000 full-time employees. 20 More work is required to strengthen the natural linkages between DoD’s TFF and VA’s Whole Health approach to care. Ensuring that every TSM is provided an optimal transition experience, including proactive referrals to the broadest internal and community-based resources based on what matters most to the TSM will improve their health and well-being so that they can live their life to the fullest. The TFF–Whole Health collaboration is a potential model of whole-person lifelong care for the nation.

This article appears as part of the supplement “DoD’s Total Force Fitness and VA’s Whole Health: A Lifelong Model for the Nation,” sponsored by Veterans Affairs and USUHS.

None declared.

The data that support the findings of this study are available on request from the corresponding author. All data cited are freely accessible at https://www.va.gov/WHOLEHEALTH/professional-resources/clinician-tools/Evidence-Based-Research.asp.

Not applicable.

C.J.G., N.D., and M.K. collected and collated historical information for the original manuscript. All authors read and approved the final manuscript.

Bokhour   BG , Hyde   J , Kligler   B , et al. : From patient outcomes to system change: evaluating the impact of VHA’s implementation of the Whole Health System of Care . Health Serv Res   2022 ; 57 Suppl 1 ( Suppl 1 ): 53 – 65 .doi: 10.1111/1475-6773.13938 .

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Department of Veterans Affairs : Personal health plan , 2022 . Available at https://www.va.gov/WHOLEHEALTH/docs/PHP-WalletCard-May22-fillable-508.pdf ; accessed August 26, 2022.

Federal Register : Executive order 13822: supporting our veterans during their transition from uniformed service to civilian life . 2018 . Available at https://www.federalregister.gov/documents/2018/01/12/2018-00630/supporting-our-veterans-during-their-transition-from-uniformed-service-to-civilian-life ; accessed August 25, 2022.

Congressional Record : Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019 (Public Law 116-171) . Available at https://www.congress.gov/116/plaws/publ171/PLAW-116publ171.pdf ; accessed July 31, 2022.

Department of Veterans Affairs : Fiscal years 2022-28 strategic plan . 2022 . Available at https://www.va.gov/oei/docs/va-strategic-plan-2022-2028.pdf ; accessed July 31, 2022 .

Department of Veterans Affairs : Integrative health coordinating center . 2022 . Available at https://www.va.gov/WHOLEHEALTH/professional-resources/IHCC.asp ; accessed July 31, 2022 .

Congressional Record : Comprehensive Addiction Recovery Act of 2016 (Public Law 114-198) . Available at https://www.congress.gov/bill/114th-congress/senate-bill/524/text ; accessed July 31, 2022.

Congressional Record : Mission Act of 2018 (Public Law 115-182) . Available at https://www.congress.gov/115/plaws/publ182/PLAW-115publ182.pdf ; accessed July 31, 2022.

Department of Veterans Affairs : #live whole health online self-care resources online series . 2022 . Available at https://news.va.gov/category/health/livewholehealth/ ; accessed August 25, 2022 .

Department of Veterans Affairs : Employee whole health resources . 2022 . Available at https://www.va.gov/WHOLEHEALTH/professional-resources/EWH-Resources.asp ; accessed July 31, 2022 .

Kligler   B , Hyde   J , Gantt   C , Bokhour   B : The Whole Health transformation at the Veterans Health Administration: moving from “what’s the matter with you?” to “what matters to you?” . Med Care   2022 ; 60 ( 5 ): 387 – 91 .doi: 10.1097/MLR.0000000000001706 .

Uniformed Services University of the Health Sciences, joint Consortium for Health and Military Performance (CHAMP) that promotes Total Force Fitness . 2022 . Available at https://champ.usuhs.edu/home ; accessed July 31, 2022 .

Department of Veterans Affairs : Circle of health . 2021 . Available at https://www.va.gov/WHOLEHEALTH/circle-of-health/index.asp ; accessed July 31, 2022 .

Centers for Disease Control and Prevention (CDC) . Social determinants of health: know what affects health . 2022 . Available at https://www.cdc.gov/socialdeterminants/index.htm ; accessed July 31, 2022 .

Bokhour   B , Hyde   J , Zeliadt   S , Mohr   D : Whole health system of care evaluation: a progress report on outcomes of the WHS pilot at 18 flagship sites . 2020 . Veterans Health Administration, Center for Evaluating Patient-Centered Care in VA (EPCC-VA) . Available at https://www.va.gov/WHOLEHEALTH/professional-resources/clinician-tools/Evidence-Based-Research.asp ; accessed July 31, 2022.

Zeliadt   S , DeFaccio   R , Suri   P , et al. : Reduced downstream utilization of spine injections and surgeries following non-pharmacological strategies for pain management . Available at https://academyhealth.confex.com/academyhealth/2022arm/meetingapp.cgi/Paper/53414 ; accessed January 23, 2023.

Mohr   D , Bokhour   B : Whole health for employee morale: addressing workforce needs: VA Forum 2022: 4-5 . Available at https://www.hsrd.research.va.gov/publications/forum/spring22/ ; accessed August 26, 2022.

Office of Management and Budget . President’s management agenda. 2021 . Available at https://www.whitehouse.gov/omb/management/pma/ ; accessed July 31, 2022 .

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Whole Journey Services

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Are you looking to feel more connected, release stress, and join like-minded individuals committed to working through chronic health conditions? The group is aimed at providing additional support to those who are often focused on caring for the needs of others more than themselves. We aim to create a safe space for you to receive compassion, understanding, and support. This group may be beneficial to you if: It’s difficult to discuss the impact of your chronic health condition to others. You feel as though no one truly understands what you’re going through. Your experiences feel dismissed, minimized, and misunderstood.

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  1. Getting Started: Prepare for Your Journey

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