Reducing Veteran Suicide by Addressing Economic Risk Factors

Testimony of: Nicholas J. Armstrong, Ph.D., D’Aniello Institute for Veterans and Military Families (IVMF), Syracuse University

Prepared for: U.S. House Veterans Affairs Committee, Subcommittee on Economic Opportunity

June 15th, 2022

Read the full testimony below and watch it to the left.

Mr. Chairman, Ranking member, Members of the committee, I’d like to thank you for the opportunity to testify on the topic of reducing veteran suicide by addressing economic risk factors.

My name is Nick Armstrong. I served eight years in the U.S. Army, including nearly three years deployed to Iraq, Afghanistan, and Bosnia with the 10th Mountain Division. After transitioning out, I attended Syracuse University as the University’s first Post-9/11 GI Bill recipient. Today, over a decade later, I continue to serve as the Managing Director of Research and Data for the D’Aniello Institute for Veterans and Military Families (IVMF).

All this is to say, today’s topic is one that is both deeply personal to me and central to what we study, and what we do, at the IVMF. We understand how critical post-service economic and financial stability are—particularly in the first few months and years after a veteran leaves the service.

In fact, VA researchers now coin this initial period after separation as “the deadly gap” when transitioning veterans are more likely to die by suicide than later in life.1 This is why we, as a nation, must “get transition right” for our service members and their families. And this is why we at the D’Aniello Institute are laser focused on delivering impactful programs and services that support those in transition—on a national scale.

Though based in Syracuse, nearly one-third of the IVMF team of more than 100 professional staff are deployed across the United States in and around highly concentrated military and veteran communities. We serve more than 20,000 transitioning service members, veterans, and military spouses annually. These programs and initiatives squarely address the economic risk factors of those in transition in three forms:

  1. high-demand, industry-specific career training and credentialing,
  2. small business and entrepreneurship education, and
  3. technical assistance to community-based service provider networks, supporting veterans’ navigation to the services they need.

I want to emphasize that reducing economic barriers to this programming is core to our philosophy, and consequently, why all IVMF programs are offered at no charge to the veteran or spouse, and with no commitment of GI Bill or any other government benefits. This has been possible, in large part, due to the support of private philanthropy.

I will touch on a few of these initiatives, though my testimony is framed around three broad recommendations for how the federal government can better address the economic risk factors to veteran suicide. And all three involve investing in cross-sector partnerships with the private and social sectors.

1.   Expand Career Training and Credentialing Offerings Through Public-Private Partnerships

I’ll begin with how we prepare transitioning service members for their post-service careers.

For most veterans, successful transitions are more than simply finding a job. It’s about starting a second career. Finding meaningful careers after service is among the greatest stressors for transitioning service members and their spouses. Recent analyses by colleagues at Penn State,

who run a national longitudinal study of post-9/11 veterans called The Veteran Metrics Initiative, have identified that the frequency of suicidal thinking increases over time for those in transition who experience persistent work and financial problems, particularly for women veterans.2

Clearly, a successful career transition is a fundamental building block of post-service well-being for decades to come. A quality job provides purpose, identity, and the financial security to ensure all other aspects of the veteran families’ wellness can be effectively addressed.

For this reason, seven years ago the IVMF launched the Onward to Opportunity program, now the largest career skills program operating under the DoD SkillBridge Authority.3 Onward to Opportunity provides career exploration and employability skills training, and access to industry-recognized certifications to 11,000 transitioning service members, veterans, and spouses every year—again, at no cost. The program operates on 19 military communities, reaching over 70 installations across the country and provides virtual training to participants in all 50 states.

Today, demand for programs like Onward to Opportunity outpaces the capacity of nonprofits to supply them. Two major barriers exist preventing programs like Onward to Opportunity from providing full services to everyone that requires them. First, collaboration between DoD installations and nonprofits depends greatly on installation command leadership. This leads to serious inequities when servicemembers and their families cannot access programs like Onward to Opportunity. Transitioning service members separating from installations without these critical career skills program offerings miss out on a robust set of transition supports.

In fact, new research suggests lack of access to these training programs can impact the employment outcomes of transitioning service members. Service members who utilized credentialing and job training programs during transition were nearly twice as likely to find a job as those who did not.4

Credentials are the worker’s currency in the modern-day economy. Our efforts must be focused on helping transitioning service members and spouses gain credentials that, when matched with their military experience, make them competitive in the modern-day job market.

I want to emphasize that government can and should do more to leverage the efforts of nonprofit leaders already delivering these programs. We applaud the VA’s expansion of its job training offerings in the past two years of the pandemic. But it doesn’t make sense for government to recreate the wheel and deliver these programs alone. A better solution is the creation and expansion of public-private partnerships with successful nonprofits offering veteran employment and career training.

Relatedly, the second major barrier facing many nonprofits providing these services is financial sustainability. Thus far, private philanthropy has funded many of the initiatives supporting the career transitions of service members. On the plus side, programs like Onward to Opportunity have had to develop robust program evaluation and measurement capabilities to meet the demands of these private philanthropic funders. This means that nonprofit programs can provide evidence of their success and are a worthy recipient of VA and DoD investment. Private philanthropy is a great incubator of innovation. But their models do not support programs indefinitely. Eventually the spigot is turned off.

I’d like to expand on my previous point about measurement and accountability. Despite the noteworthy progress that has been made to TAP over the last decade, and recent suicide prevention legislation, efforts aimed at supporting veteran employment have created a confusing marketplace. For example, the GAO recently documented 45 programs across the federal government delivered by 11 different agencies supporting the employment transitions of service members and veterans.5 Many of these lack robust monitoring and evaluation, and several had no defined goals or outcomes whatsoever. We should note that the GAO report only covered federal government programs. There are literally hundreds of nonprofit and private sector-led career preparation and training programs6 operating under the DoD SkillBridge authority and several operating at a national scale—with measurable outcomes.7

Before starting any new federal employment programs for transitioning service members, VA and DoD must conduct a coordinated assessment of existing programs and make honest determinations about where funds might be better spent in partnership with the private and social sectors as opposed to direct government service delivery.

We applaud the recent passage of the Commander John Scott Hannon Veterans Mental Health Care Improvement Act, which included the creation of the VA-led Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program. This will send dollars to community-based organizations supporting transition and is an excellent first step. We’ve been working with congressional champions and the committee’s staff in both the Senate and House to ensure the swift and effective implementation of these grants.

However, we contend that DoD must be financially and programmatically involved in these partnerships as well. Not only is it a moral imperative that DoD ensure their service members are equipped for post-service careers, but it is also good financial policy. The most recent available data suggests DoD spends more on unemployment insurance claims for unemployed transitioning service members (about $300 million)8 than it does on all its career transition programs. New legislation introduced last year like the Onward to Opportunity Act9 would double down on the commitment of the VA’s transition grants and bring DoD to the table as financially invested in this effort.

2.   Invest in Cross-Sector Pilot Efforts that Support Veteran Navigation to Resources and Care

In addition to improving how we prepare those in transition for post-service careers, the federal government must continue to drive greater coordination of resources and care—both across agencies and with the private and social sectors—to better address economic risk factors to suicide.

It is well documented in research and practice that health, economic, and social needs rarely emerge in isolation. A 2019 study by VA researchers found that the presence of an adverse social stressor such as unemployment, housing or financial instability was related to a 64% increase in the likelihood of suicidal ideation.10 With each additional issue, this likelihood only increased.

Consequently, meeting the challenge of addressing veterans social and economic needs requires far more than just the VA, DoD, Labor and other interagency partners.11 It calls for comprehensive, cross-sector coordination with the tens of thousands of veteran-serving community-based organizations across the country.

At the IVMF, we remain actively committed to our federal, state, and local agency, and community partners in knitting together the patchwork of support greatly needed to improve how veterans access and navigate care and resources.

Through our AmericaServes12 initiative, the IVMF works closely with nonprofit providers, local government agencies, and in several locations, even VA facilities and DoD installations. Out of this effort we’ve helped 18 communities combine more than 1,000 health and human services organizations into an integrated, multi-state system of care. In each of these locations, there is a no-wrong-door point of entry for veterans, transitioning service members, and their families’ seeking services, backed by a coordination center managing referrals between providers. Since 2015, these networks have served the health, economic, and social needs of more than 43,000 veterans and family members who requested more than 103,000 services—well over two services at a time, on average.

More recently, the IVMF has come alongside our federal agency partners in several promising pilot initiatives supporting veterans’ navigation of services. I’ll briefly highlight three.

ETS Sponsorship Program (VA, DoD, Labor). The first pilot is called the Expiration Term of Service, or “ETS,” Sponsorship Program.13 This pilot effort was initially established as a partnership between VA and DoD to mitigate transition stressors by pairing service members with trained sponsors in the communities to which they transition and where they call home. These sponsors then connect them with local VA and community resources. IVMF serves as both a research and data sharing partner to the VA’s evaluation team, as well as an operational partner to help recruit local sponsors and ensure they are connected within our larger AmericaServes communities. This work is currently underway in New York State and Texas.

Community Navigator Pilot Program (SBA). The second pilot is the freshly launched Community Navigator Pilot Program with the U.S. Small Business Administration.14 This innovative program is part of the American Rescue Plan Act of 2021 and takes a “hub and spoke” network approach to help deploy trusted community advocates and resources to support small businesses hit hard by the pandemic. Of the eight national Community Navigator hubs funded, IVMF operates the only hub responsible for coordinating community-based, economic recovery for veteran-owned small businesses. Our own research reveals that veterans face an array of barriers in attempting to launch businesses, including a fragmented ecosystem, capital readiness, difficulty navigating resources, certification process hurdles, and lack of assistance from medical and disability service providers.15 This new pilot program with the SBA offers a unique and promising navigation solution for military-connected small business owners to receive efficient, timely, and comprehensive access to the services and resources they need, where they are, and when they need them on their entrepreneurial journey.

Employment Navigator and Partnership Pilot (Labor). The third pilot is the DOL’s Veteran Employment Training Services (DOL-VETS) Employment Navigator and Partnership Pilot program.16 IVMF’s Onward to Opportunity program, mentioned earlier, was recently onboarded in the second wave of national partners to join DOL-VETS’s new employment navigator pilot. This initiative is aimed to provide one-on-one career assistance to interested transitioning service members and their spouses at 18 select military installations worldwide. Offered outside of the formal DOL Transition Assistance Program classroom instruction, DOL navigators assist transitioning service members and spouses in securing meaningful and lasting post-separation careers. With the addition of IVMF’s Onward to Opportunity program, DOL navigators are now able to directly refer those seeking industry relevant career skills training and credentialing on multiple overlapping installations including: Fort Drum, Hawaii Pacific (Fort Shafter, Joint Base Pearl Harbor-Hickam, Schofield Barracks), Camp Pendleton and Miramar, Camp Lejeune (Wounded Warrior BN-East), Marine Corps Air Station Cherry Point, and Hampton Roads (Naval Station Norfolk and Joint Expeditionary Base-Little Creek).

Without a doubt, cross-sector pilot initiatives like these—those that pull together and integrate federal, state, and local community partners—are the future of transition support. More importantly, they hold the most promise to address economic risk factors to veteran suicide.

Congress should continue to encourage and monitor such innovations, and make smart investments to invest in and scale up those with emerging evidence of impact and performance.

3.   Empower Interagency and Cross-Sector Data Sharing to Build Evidence and Improve Coordination of Care

Finally, Congress should continue to support, and where necessary, eliminate barriers to interagency and cross-sector data sharing.

The federal government possesses enormous amounts of administrative data. If harnessed more effectively and securely, this data gives us the power to know whether policies and programs are having the desired improvement on our citizens’ lives. Yet, much of this data lives in bureaucratic silos, hampering the research and evaluation efforts of government and its partners to inform evidence-based policymaking and support Congressional oversight.

According to the U.S. Commission on Evidence-Based Policymaking, the vast majority of federal agencies experience trouble accessing other agencies’ data for purposes like evaluation.17 Knowing whether the Transition Assistance Program or Forever GI Bill are actually improving veteran economic well-being and reducing suicide risk are just two obvious examples of the imperative to integrate data housed across multiple agencies.

New legislation introduced like the Secure Research Data Network Act would be a big leap toward breaking down the data silos in the federal government. Among other requirements, this legislation would authorize a three-year pilot to develop a secure research data network under the auspices of the National Science Foundation, to approved researchers and evaluators with secure access to government-held data – all without risking Americans’ privacy and security.

In addition to reducing barriers within government, Congress should also incentivize more cross-sector data sharing between government, private, and social sector organizations to address complex issues such as suicide prevention and addressing social determinants of health. These are perfect use cases for data sharing between healthcare entities, community providers, and research and evaluation partners. In order to understand the social determinants of veteran health, the VA will need to expand its sources of data and evidence.

Additionally, the VA should expand strategic partnerships with universities and local nonprofits that have valuable data on the wellbeing of veterans that is not captured through the VA’s healthcare system. One example of this work is an initiative between the IVMF and VA’s Center for Health Equity Research and Promotion (CHERP), based in Pittsburgh. Sharing data between the VA and the IVMF’s AmericaServes program is allowing VA researchers to better understand how veterans are utilizing both VA health care and other local human service to meet their social and economic needs. Knowing this is impossible without the ability to share data with VA.

These are just a few examples. Integrating health and social care is the future of healthcare, and the future of providing veterans timely and accurate care and support. It is central to suicide prevention. But it can’t be done well without data sharing. Cross-sector data sharing is an area in need of greater attention and investment if we’re truly serious about reducing suicide and improving the post-service lives of veterans and their families.

Conclusion

To conclude, preventing veteran suicide is whole-of-the-nation responsibility. Solutions, therefore, must include non-governmental partners—especially when it comes to addressing social and economic risk factors. Expanding access to in-demand skills training with the private sector, investment in cross-sector efforts that streamline resource navigation, and empowering greater data sharing are just three ways government can further mitigate these risks. And as I’ve highlighted in this testimony, the U.S. government has an active, willing, and able partner in the IVMF.

Thank you for the opportunity to share this with you today, and I look forward to your questions.

1 Sokol, Y., Gromatsky, M., Edwards, E. R., Greene, A. L., Geraci, J. C., Harris, R. E., & Goodman, M. (2021). The deadly gap: Understanding suicide among veterans transitioning out of the military. Psychiatry research, 300, 113875. Available at: https://www.sciencedirect.com/science/article/abs/pii/S0165178121001724?via%3Dihub

2 Davenport, K., Perkins, D.F., & Morgan, N.R., (2022, March). Veterans who Discharged with Problematic Financial Status: Components and Changes in Outcomes. VETERANetwork Webinar Series: Data from the Veteran Metrics Initiative. Slide 14

3 See https://ivmf.syracuse.edu/programs/career-training/about-o2o/.

4 Perkins, D. F., Davenport, K. E., Morgan, N. R., Aronson, K. R., Bleser, J. A., McCarthy, K. J., … & Gilman, C. L. (2022). The influence of employment program components upon job attainment during a time of identity and career transition. International Journal for Educational and Vocational Guidance, 1-23. Available at: https://link.springer.com/article/10.1007/s10775-022-09527-1

5 U.S. Government Accountability Office. (July, 2020). “Military and Veteran Support: Performance Goals Could Strengthen Programs that Help Servicemembers Obtain Civilian Employment.” GAO-20-416, Washington, DC. Available at: https://www.gao.gov/products/gao-20-416

6 See https://skillbridge.osd.mil/locations.htm.

7 See https://ivmf.syracuse.edu/programs/career-training/.

8 See Congressional Budget Office report: https://www.cbo.gov/publication/52503

9 See H.R.4769, https://www.congress.gov/bill/117th-congress/house-bill/4769?s=1&r=6

10 Blosnich, J. R., Montgomery, A. E., Dichter, M. E., Gordon, A. J., Kavalieratos, D., Taylor, L., … & Bossarte, R. M. (2020). Social determinants and military veterans’ suicide ideation and attempt: a cross-sectional analysis of electronic health record data. Journal of general internal medicine, 35(6), 1759-1767. Available at https://link.springer.com/article/10.1007/s11606-019-05447-z

11 Armstrong, N., McDonough, J., & Savage, D. (2015). “Driving Community Impact: The Case for Local, Evidence- Based Coordination in Veteran and Military Family Services and the AmericaServes Initiative.” Institute for Veterans and Military Families, Syracuse University, Syracuse, NY. Available at: https://ivmf.syracuse.edu/wp- content/uploads/2016/06/DrivingCommunityImpactTheCaseforLocalEvidenceBasedCoordinationACC_03.08.18.pdf 12 See https://americaserves.org/.

13 See https://etssponsorship.com/.

14 See https://www.sba.gov/article/2021/nov/02/what-they-are-saying-sba-administrator-guzman-announces- community-navigator-pilot-program-awardees?utm_medium=email&utm_source=govdelivery.

15 Maury, R., Tihic, M., Pritchard, A., McKelvie, A., Euto, L. (2022, Jan). 2021 National Survey of Military- Affiliated Entrepreneurs. Syracuse, NY: Institute for Veterans and Military Families, Syracuse University. Available at: https://ivmf.syracuse.edu/nsmae?q=/nsmae-series/&

16  See  https://www.dol.gov/agencies/vets/programs/tap/employment-navigator-partnership.

17  See https://bipartisanpolicy.org/commission-evidence-based-policymaking/.