National Academy of Medicine

Third Annual DC Public Health Case Challenge: Supporting Mental Health in Older Veterans

By Amy Geller, Alina Baciu, Sophie Yang, Haneen Abudayyeh, Jumoom Ahmed, Kaltun Ali, Joshua Chou, Jason David, Alexa Edmier, Hana Hanfi, Morgan Harvey, Madison Hayes, Claire Hong, Brooke Hyman, Maryama Ismail, Alexander Ives, Daniela Kofman, Laura Kropp, Elisabeth Kutscher, Zeinab Safi, Caroline Sell, Hana Stenson, Edwin Szeto, Shreya Veera, Kristin Wertin, Julia Michelle White, and Lauren Whittaker
October 09, 2017 | Discussion Paper

In 2015 the National Academy of Medicine and the Roundtable on Population Health Improvement of the National Academies of Sciences, Engineering, and Medicine (the National Academies) held the third annual District of Columbia (DC) Public Health Case Challenge, which had its inaugural year in 2013 and was both inspired by and modeled on the Emory University Global Health Case Competition.

The DC Case Challenge aims to promote interdisciplinary, problem-based learning in public health and to foster engagement with local universities and the local community. The Case Challenge engages graduate and undergraduate students from multiple disciplines and universities to come together to promote awareness of and develop innovative solutions for 21st-century public health issues that are grounded in a challenge faced by the local DC community.

Each year the organizers and a student case-writing team develop a case based on a topic that is relevant to the DC area and has broader domestic and, in some cases, also global resonance. Content experts are then recruited as volunteer reviewers of the case. Universities located in the Washington, DC, area are invited to form teams of three to six students, who must be enrolled in undergraduate or graduate degree programs. In an effort to promote public health dialogue among a variety of disciplines, each team is required to include representation from at least three different schools, programs, or majors.

Two weeks before the Case Challenge event, the case is released, and teams are charged to employ critical analysis, thoughtful action, and interdisciplinary collaboration to develop a solution to the problem presented in the case. On the day of the Case Challenge, teams present their proposed solutions to a panel of judges composed of representatives from local DC organizations as well as other subject matter experts from disciplines relevant to the case.

2015 Case: Supporting Mental Health in Older Veterans

The 2015 case focused on how to enhance the quality of life of older veterans (aged ≥ 65 years) by improving their mental health and well-being. The case asked the student teams to develop a program with a grant of $1.2 million over five years that would fill a void in interventions intended to support veterans in transitioning back to civilian life, promote the well-being and mental health of veterans throughout the course of their lives, and provide long-term solutions and gains. Each proposed solution was expected to offer a rationale, a proposed intervention, an implementation plan, a budget, and an evaluation plan.

The case framed the issue through five scenarios portraying a range of issues faced by older veterans. Though the five illustrative scenarios were fictional, they drew from actual circumstances faced by veterans in DC. In the first scenario, a Vietnam War veteran who had handled difficult tasks, such as prepping fallen or seriously ill soldiers for transport to the United States, later experienced difficulty sleeping and connecting with family and friends. He felt that he had to deal with these issues on his own, and his symptoms worsened. He was later diagnosed with PTSD but struggled with continuing treatment due to feelings of shame. The second scenario described a primary care physician at the Washington DC VA (Veterans Affairs) Medical Center. In her practice, she regularly came across older veterans who were “down in the dumps” and withdrawn. She did not feel qualified to treat these symptoms, and her patients were resistant to seeking the help they needed due to the stigma associated with mental illness. The third scenario looked at a retired World War II veteran whose leg was partially amputated during his service. He became withdrawn, started abusing prescription drugs and alcohol, and was resistant to treatment. He and his family felt they did not have any resources to which to turn. The fourth scenario centered on Fayven Jackson, who experienced mental health challenges prior to enlisting in the army during the Korean War as an administrative secretary. Fayven grew up in foster care and had a very small social network. Due to depression, she served in the army only a short time. She felt she did not have many resources and did not try to access the VA system because she was not sure if she was eligible. The final scenario looked at John Kim, a second-generation American veteran who joined the US Marines during the Vietnam War directly after graduating from high school. He was an exemplary serviceman with a bright future. Unfortunately, Kim’s family had no way to survive financially without his contributions. This played a role in his heavy anxiety. He was unable to separate family and work, and left service. His health declined steadily, and after a series of low-wage jobs, he never had the opportunity to further his education and advance his career.

The teams were provided with background information that included national and DC demographics; population statistics on veterans as well as statistics specifically for DC veterans; government services available to veterans, including health services; and important considerations for health in older adults, including information on transportation, socioeconomic status, Social Security, homelessness and poverty, educational attainment, employment, technology and aging, mental health, and substance abuse. Read more >>

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Disclaimer: The views expressed in this paper are those of the authors and not necessarily of the authors’ organizations, the National Academy of Medicine (NAM), or the National Academies of Sciences, Engineering, and Medicine (the National Academies). The paper is intended to help inform and stimulate discussion. It is not a report of the NAM or the National Academies. Copyright by the National Academy of Sciences. All rights reserved.