Support to Military Families in Transition: A Review - March 31, 2016

Table of Contents

• Message from the Ombudsman
• Introduction
• Role of Families during Transition
• Existing Support Available to Families during Transition
• Summary of Reports Reviewed
  • Communication and Awareness
  • Support and Services
  • Financial Benefits
• Reports, Recommendations, and Action Taken
• Conclusion
• Annex A: Existing Support Available to Families during Transition
  • Programs and Services Provided by the Canadian Armed Forces
  • Programs and Services Provided by Veterans Affairs Canada
• Annex B: Reports' Recommendations and Action Taken
  • Veterans Ombudsman – Improving the New Veterans Charter: The Report (June 2013)
  • DND/CF Ombudsman – On the Homefront: Assessing the Well-Being of Canada's Military Families in the New Millennium (November 2013)
  • House of Commons Standing Committee on Veterans Affairs – The New Veterans Charter: Moving Forward (June 2014)
  • House of Commons Standing Committee on National Defence – Caring for Canada's Ill and Injured Military Personnel (June 2014)
• Footnotes

Message from the Ombudsman

I am pleased to publish Support to Military Families in Transition: A Review which was prepared in consultation with the Department of National Defence/Canadian Forces (DND/CF) Ombudsman.

A successful transition from military to civilian life is essential to the long-term independence, financial security, health and social integration of the transitioning member and their family. This transition process affects the entire family. Their ability to cope with the complexities of the process as well as the availability of adequate support and services are often a determinant of a successful transition. This is particularly true when the transitioning member is ill or injured. Adequate, accessible support to families is important to their long-term success.

This review examines the role of families and the challenges they face during transition. It identifies existing sources of support and analyzes information gathered from recent reports, policies, and interviews with key Canadian Armed Forces (CAF) and Veterans Affairs Canada (VAC) stakeholders. Lastly, it reviews the challenges and recommendations presented in recent reports and provides an overview of the actions taken.

I hope that this review will serve as a useful source of information both for transitioning members and their families and for Government to understand the gaps and current challenges faced by families in transition.

Introduction

Approximately 1,000 Regular Force members of the CAF are medically released annually because they no longer meet Universality of Service.^{Footnote 1} However, most medically-released CAF members do not suffer from a debilitating illness or injury. In the four-year period from 2011 to 2014, of the approximately 4,000 Regular Force members who were medically released, only 15 percent were deemed to be complex cases and required an Integrated Transition Plan.^{Footnote 2 Footnote 3} Furthermore, the Joint VAC/DND 2013 Life After Service Survey found that 25 percent of respondents, who were Veterans with Regular Force Service, reported a very or moderately difficult transition to civilian life.^{Footnote 4}

On June 17, 2014, the DND/CF Ombudsman and the Veterans Ombudsman announced the launch of a joint project to focus on the transition from military to civilian life for medically-releasing CAF members. As part of that project, this review looks at how families are affected by that transition, particularly in cases where the transitioning member has an illness or injury.

The purpose of this review is threefold:

1. to review the role and the challenges faced by families in transition;
2. to identify existing supports available; and
3. to review recent reports addressing the issue of families in transition and the action taken related to the recommendations from those reports as of January 1, 2016.

The review included a scan of current CAF and VAC policies related to families of medically-releasing CAF members and interviews with key stakeholders.^{Footnote 5} It also included a review of the recommendations and government responses to the following reports, which identified challenges faced by families in transition from military to civilian life:

• Improving the New Veterans Charter: The Report, Office of the Veterans Ombudsman (OVO), June 2013.^{Footnote 6} 
• On the Homefront: Assessing the Well-being of Canada's Military Families in the New Millennium, DND/CF Ombudsman Special Report, November 2013.^{Footnote 7}
• Caring for Canada's Ill and Injured Military Personnel, House of Commons Standing Committee on National Defence, June 2014.^{Footnote 8}
• The New Veterans Charter: Moving Forward, House of Commons Standing Committee on Veterans Affairs (ACVA), June 2014.^{Footnote 9}

Role of Families during Transition

A successful transition from military service to civilian life is a key element in creating positive long-term outcomes for independence, financial security, health and social integration for military families.

When an ill or injured CAF member is notified that he or she will be medically released, the individual begins preparing to transition to a new life in the civilian world. If their illness or injury is of such severity that they are no longer able to work, the transition challenge is even greater. The success of the transition in either case often depends on how well the family can cope with and support the transitioning member. The transition from military to civilian life is not done in isolation – the entire family unit is affected.

Families play a particularly important role when the transitioning member suffers from an operational stress injury (OSI).^{Footnote 10} Often, members of the immediate family are the first to notice personality changes and uncharacteristic behaviours in their loved ones.^{Footnote 11} Spouses, partners and parents can expend considerable effort supporting the transitioning member and maintaining family cohesion. As well, frequently it is a spouse, parent or other family member who assumes the role of caregiver^{Footnote 12} to an ill or injured transitioning member.

Living with a CAF member or Veteran who suffers from a debilitating OSI such as post-traumatic stress disorder (PTSD) can put significant stress on the family. Due to stigma, families often face this stress alone. In some cases, the CAF member or Veteran either isolates himself or herself from the family while trying to deal with his or her condition or the individual may be unwilling or unable to seek medical care. These situations can lead to a disruptive home environment and to a variety of problems such as relationship stress or break-up, spousal health problems, social isolation and child behavioural problems.^{Footnote 13}

Existing Support Available to Families during Transition

In a 2013 DND/CF Ombudsman Report^{Footnote 14}, it was noted that families of serving members receive substantially more support today than at any other point in history. Similarly, VAC provides more support to families of Veterans since the New Veterans Charter (NVC)^{Footnote 15} came into effect in 2006 than it did previously. A summary of the programs and services available from the CAF and VAC to families during transition can be found in Annex A.

The CAF provide a number of services to families. Some are general in nature, such as the Military Families Fund and Military Family Resource Centres (MFRCs), while others are specifically related to supporting families of ill and injured members. For example, Instruction 5100-07 Member Focused Family Care is a policy that offers families a number of medical services linked to the treatment and care of a CAF member who suffers from an OSI. Information and counselling services are also available through the Family Information Line and the Canadian Forces Member Assistance Program.

VAC provides similar programs to those offered by the CAF. The VAC Assistance Service is a voluntary and confidential short-term 24/7 counselling service to help all Veterans and their families as well as primary caregivers who have personal concerns that affect their well-being. The service is available free of charge. OSI Clinics provide assessments and counselling to family members, but only to the extent required for the Veteran to achieve the established treatment outcomes. VAC also has provisions to reimburse travel costs for family members, under certain circumstances, and for respite care for caregivers.

Both the CAF and VAC have programs to inform transitioning members and their families about the benefits and services available to them, namely Second Career Assistance Network seminars and VAC transition interviews. Family members are encouraged to attend these sessions.

Summary of Reports Reviewed

The four reports examined as part of this review identified the challenges experienced by families and made 17 recommendations^{Footnote 16} for improvement. The issues, recommendations and any departmental action taken are provided in Annex B.

The reports note that the transition of a medically-releasing member is a family affair. If the individual has difficulty making the transition, it affects the family; conversely, if the family faces challenges during the transition, it can affect the success of the transitioning member.

Despite the support services currently available, the reports note that families still face a number of challenges related to their transition from military to civilian life, including:

• Caregiver support provided to an ill or injured transitioning member is frequently assumed by a spouse, parent or other relative. Caregivers may be ill-prepared and ill-equipped to take on the care of a loved one who suffers from complex medical conditions.^{Footnote 17}
• Living with a transitioning member who suffers from an OSI can put significant stress on the family. Due to stigma, families often face these stressful situations alone.^{Footnote 18}
• A family that moves to a different location after the medical release of a CAF member, especially one who suffers from a severe illness or injury, can face challenges because of lack of community services, their unfamiliarity with the community services available to them, the loss of continuity of the family's primary and specialist medical care and the loss of spousal employment.^{Footnote 19}
• Families who live in CAF Residential Housing Units, and who must move out after the medical release of a CAF member, may find it particularly difficult to adapt to life in a new civilian community.^{Footnote 20}
• Spouses may be unaware of the various services and programs available to help their transition.^{Footnote 21}
• As a result of military service, military families may be challenged in achieving both short-term and long-term financial well-being.^{Footnote 22}
• The transition process for reservists is not as well-structured, coordinated and consistent as the process for Regular Force personnel. Providing information and assistance to reservists and their families is often difficult because of location, the part-time nature of the employment and decentralized personnel administration.^{Footnote 23}

A review of these reports indicates that there is a measure of consistency in the shortcomings regarding support to families. The 17 recommendations fall into three broad categories: Communication and Awareness; Support and Services; and Financial Benefits.

Communication and Awareness

The first shortcoming identified is insufficient outreach and inconsistent communication to families in transition. Families need to be made aware of available programs, of how to access help and of how to identify support for mental health issues. In the absence of good communication, important programs and services, such as respite care, may go unnoticed.

CAF members and Veterans have said they would appreciate having an open line of communication between the CAF, VAC and their families because it is important for families to know that their efforts are being tracked and that they are being kept informed of the community events and support services available. Regular communication and engagement help families know that they are not alone.^{Footnote 24} Complicated policies and documents make it difficult for families to understand what supports are available to them and how to use such supports.^{Footnote 25}

Several of the reports identified challenges and made recommendations related to communications and awareness. The general issues are related to the dissemination of information to CAF members and their families, the collection of information on the challenges facing families and whether their needs are being met. Some of these challenges are:

• Insufficient direct and proactive communication, outreach and follow-up with families from both CAF and VAC to explain available support programs, to determine if their needs are being met and to identify families in crisis who need intervention.^{Footnote 26}
• Insufficient outreach and communication from VAC about support available to families. For example, the availability of respite care through the Veterans Independence Program (VIP) is not well known by families.^{Footnote 27}
• In addition, VAC does not know how many disabled transitioning Veterans are supported by an informal caregiver, the extent of the care provided, the health of the caregiver and whether help is needed.^{Footnote 28}

Support and Services

The second shortcoming identified is related to the care and support available to families. The burden on family members of ill and injured transitioning members is high and they do not receive the same level of support as the Veterans themselves. In particular, reports have noted a lack of counselling for families in their own right, and a lack of continuity of healthcare services as members and their families transition to civilian life. This lack of support impedes both the Veteran and the family's transition to civilian life.

Some of the challenges outlined in the reports related to the current services and support provided to the families of transitioning members include:

• Insufficient counselling, education and support to help the family cope with and care for a transitioning member who suffers from a mental health problem(s).^{Footnote 29}
• Insufficient assistance to families to help them find a family doctor, specialist care, childcare and other community supports, especially for the families who will or have relocated to a new community following the medical release of the CAF member.^{Footnote 30}
• Inadequate follow-up with families of seriously ill or injured Veterans to confirm whether their needs are being met.^{Footnote 31}

Financial Benefits

The third shortcoming identified by the reports is the inadequacy of financial benefits provided to families of transitioning members. It can be difficult for non-serving CAF spouses to find, sustain and advance a career while their spouse is serving. This can potentially put additional financial strain on the family when there is a decrease in income post-release.

The specific challenges related to financial benefits provided for the families of transitioning members include:

• No compensation is provided to the caregiver of an ill or injured transitioning member, other than CAF programs for members who suffer a catastrophic impairment resulting specifically from operations in Afghanistan.^{Footnote 32}
• Veterans who are medically released with less than 10 years of service, and their families, do not have access to the Treasury Board Pensioner Dental Service Plan.^{Footnote 33}
• A spouse who accompanies a Veteran for rehabilitation-related medical/psycho-social treatment is reimbursed less for travel costs by VAC than the reimbursement provided to a spouse of a serving member by the CAF.^{Footnote 34}
• Financial benefits under the NVC do not provide adequate lifelong financial support to Veterans and their families.^{Footnote 35}

Reports, Recommendations, and Action Taken

Since the release of the reports previously mentioned, several initiatives have been undertaken to address the challenges and gaps identified for the families of transitioning members. Annex B provides an overview of the issues, recommendations and action taken.

In response to the Mental Health Services for Veterans chapter of the Office of the Auditor General's Fall 2014 Audit, the following measures related to family support were announced in VAC's Mental Health Services for Veterans Action Plan ^{Footnote 36}:

• Mental Health First Aid Program: A Veteran-specific program offering mental health literacy training where Veterans and their families receive information on mental health conditions, learn the signs and symptoms of common mental health disorders, practice crisis first aid for mental health conditions, learn where and how to get help, and learn how and what type of help has shown to be effective.
• Military Family Resource Centres (MFRC) Pilot: A four-year pilot to study the benefits of continued military community support for medically-released Veterans and their families for a period of two years after release. The pilots are taking place in Victoria, Edmonton, Shilo, North Bay, Trenton, Valcartier and Halifax.
• New OSI Clinic/Satellite Clinics: A new clinic in Halifax, additional satellite clinics in Victoria, Kelowna, Pembroke, Brockville, Montreal, Chicoutimi and St. John's and expanding the facility in the Greater Toronto Area to improve mental health care services for Veterans and their families.
• Additional Operational Stress Injury Social Support (OSISS) Peer Support Coordinators: An additional 15 Peer Support Coordinators to ensure Veterans and their families have the care and support required when needed.

The following new benefits were announced in the spring of 2015 by the Minister of Veterans Affairs:

• Retirement Income Security Benefit (RISB): A monthly taxable benefit that provides life-long financial stability to eligible Veterans beginning at age 65. The RISB tops up an eligible Veteran's total annual income to at least 70 percent of what he or she received in financial benefits from VAC before age 65, recognizing that Veterans who are totally and permanently incapacitated may have a reduced capacity to plan sufficiently for a post-age 65 income and may have become reliant on monthly financial benefits. The RISB is also available to Veterans eligible for Service Income Security Insurance Plan – Long Term Disability (SISIP-LTD) benefits, who are totally disabled and have entitlement for a Disability Award or Disability Pension. Survivors may also be eligible for the RISB in certain cases.^{Footnote 37}
• Family Caregiver Relief Benefit (FCRB): An annual tax-free grant of $7,238 which could be used by the caregiver for relief options, such as covering the cost of having a professional caregiver come into the home or covering the cost of another family member or friend travelling to the Veteran's home.^{Footnote 38}

Conclusion

While progress has been made in the last few years to support military families, challenges remain for the families of medically-releasing CAF members and Veterans transitioning to civilian life. Specifically:

• There is a lack of direct and proactive communication with families to explain available programs and services.
• There is a lack of outreach and follow-up with families to determine if their needs are being met and to identify those in crisis who may be in need of intervention.
• Beyond the increase in the number of VAC assistance services sessions, current initiatives do not provide treatment benefits specifically for family members in their own right.
• There is no wage compensation for caregivers who give up their employment to care for their spouse.
• There is no access for Veterans and their families to the Treasury Board Pensioner Dental Service Plan for those who do not otherwise have access as part of their terms of service.

In July 2015, the CAF and VAC launched the Veterans 20/20 Project to close the seam between the two departments and to reduce the barriers to a successful transition. Veterans 20/20 has three key objectives: seamless transition, Veteran-centric focus and service excellence.

I will continue to closely monitor ongoing progress in order to ensure that the recently announced initiatives are meeting their intent and that challenges facing families are being addressed. A successful transition from military to civilian life is essential to the long-term independence, financial security, health, and social integration of transitioning members and their families.

Annex A: Existing Support Available to Families during Transition.^{Footnote 39}

Programs and Services Provided by the Canadian Armed Forces

Veteran Family Journal.^{Footnote 40} provides a summary of available support for transitioning ill and injured CAF members and their families.

Personnel Support Programs (PSP)^{Footnote 41} are integrated within the military community, and comprise flexible, diversified, cost-effective and responsive programs and services for CAF members, Veterans, and their families. These include messes, CAF newspapers, golf courses, yacht clubs, curling clubs, cottages and campgrounds, and recreation programs and clubs. Transitioning CAF members can visit http://www.cfcommunitygateway.com to learn about PSP programs and services in their local communities.

Service Income Security Insurance Plan Long Term Disability (SISIP LTD) and Vocational Rehabilitation transition interview and support are accessible to all CAF members. Applicants are provided with professional case-management support, an initial telephone transition interview, and then a face-to-face meeting with their assigned vocational rehabilitation counsellor. Members are encouraged to bring their spouses so they have the opportunity to understand the future financial impact of the transition on the family. Focus is placed on developing a plan that will provide the member with the tools to support the family, engage in the community and successfully transition from the CAF with the opportunity for a long-term career.

Service Income Security Insurance Plan (SISIP) Life Insurance for Released Members (IRM) allows all releasing CAF members and their spouses to transfer existing SISIP optional life insurance coverage to IRM without medical underwriting. Coverage can continue until age 75. Premiums can be deducted from pension benefits.

SISIP Life Insurance Coverage for Dependants provides insured current and former CAF members and their spouses automatic $10,000 no-cost dependent life insurance coverage for dependent children up to age 25.

SISIP Financial provides tailored advice and financial products (insurance and investments) that enhance the financial health and security of serving members, Veterans and their families. A division of the Canadian Forces Morale & Welfare Services (CFMWS), SISIP Financial has 20 offices across Canada that provide financial services exclusively to current and former CAF members and their families. 

Support Our Troops Program^{Footnote 42} is an official program that provides financial support and assistance to the CAF community. This includes the Military Families Fund. It is funded through individual and corporate donations, proceeds from third-party events and "Yellow Ribbon" merchandise, and contributions by external organizations. Collectively, these funds are used to deliver individual and program support in the form of grants and loans to serving members, Veterans and their families.

Military Family Resource Centres (MFRCs)^{Footnote 43} are the backbone of the CAF's support to military families. The 32 centres provide families with information, services, counselling or referrals to local community services and programs. MFRCs deliver nationally-mandated services in accordance with the Military Family Services Program (MFSP), including introductory orientation; employment and education assistance; second language services; emergency, casual, respite, and casualty support childcare; deployment support; parent education and support; separation education and support; well-being assessment and referral; and, short-term intervention and crisis support. MFRCs also deliver community-specific services. VAC is currently funding a 4-year pilot project at 7 MFRC locations (Victoria, Edmonton, Shilo, North Bay, Trenton, Valcartier and Halifax) to study the benefits of MFRC support to medically-released Veterans and their families for a period of two years after their release. The study is focused on community integration in support of transition.

Defence Fitness (DFit.ca)^{Footnote 44} provides online fitness training plans and guidance to serving members. A new module of DFIT.ca, specifically for families, is an online resource featuring general fitness and a more total lifestyle approach to active living. Using their CFOne card number, Veterans and their families can access this new module, available at no cost until January 2017.

Instruction 5100-07 Member Focused Family Care^{Footnote 45} enables the military healthcare system to offer families a number of limited medical services linked to the treatment and care of CAF members who suffer from an OSI. These include psycho-education, marital counselling and family counselling. This medical support is dependent upon military members first seeking care for themselves.

Family Liaison Officers (FLOs)^{Footnote 46} are social workers who belong to the MFRCs but operate within, and are responsive to, the Integrated Personnel Support Centres (IPSCs). The 32 FLOs at 28 locations across Canada provide families with responsive crisis counselling, community outreach and education, as well as consultation and coaching throughout the CAF member's transition process. They connect family members to a wide range of external community programs and resources.

Family Information Line (FIL)^{Footnote 47} provides confidential 24/7 information, referral and short-term counselling services by certified counsellors (social workers and psychologists). Counsellors also assist families to find support services in their community. Even though this is a CAF program, from April to September 2014, almost 10% of calls to the FIL were from families of Veterans.

Operational Stress Injury Social Support (OSISS)^{Footnote 48} program – a non-clinical peer support network for CAF members, Veterans and their families. It provides personal and group support, and conducts outreach, referral and advocacy activities on behalf of their peers. This is a joint program with VAC.

Canadian Forces Member Assistance Program (CFMAP)^{Footnote 49} is a voluntary, confidential and free 24/7 counselling service that provides short-term counselling services for those in need of assistance on a wide range of individual or family issues (maximum of eight sessions).

Family Road to Mental Readiness (R2MR)^{Footnote 50} program provides families with guidance and skills to mitigate the stress of a deployment experience on the family. The goal of the R2MR program is to improve well-being and short-term performance, while mitigating any negative long-term mental health problems for the families. Training is delivered via three-hour briefings for both pre-deployment and post-deployment, and is conducted at the local MFRC or online.

You're Not Alone – Guide to Connecting Military Families to Mental Health and Social Wellness Programs^{Footnote 51} provides information to help families manage the stresses inherent to the military family lifestyle.

FRIENDS, Rainbow, E=MC³, the Mind's the Matter, Youth with Parents who have Experienced Trauma (YPET) and Individual Success Through Empowering Peers (iSTEP)^{Footnote 52} are programs designed specifically to help children cope with a parent who suffers from a mental health problem and to build resilience and self-esteem.

Operational Trauma and Stress Support Centres (OTSSCs)^{Footnote 53} provide psycho-education sessions for family members to the extent that they are required to support the CAF member.

Travel costs^{Footnote 54} (travel, accommodations and meals) are reimbursed for the primary next of kin to visit CAF members who are hospitalized or receiving treatment.

CF Spousal Education Upgrade Benefit^{Footnote 55} reimburses an ill or injured member up to $20,000 in expenses to improve employability of their spouse or common-law partner. Eligibility is restricted to CAF members who sustained a permanent catastrophic impairment on operations in Afghanistan and cannot benefit from participation in any federal tuition or vocational assistance program.

Attendant Care Benefit^{Footnote 56} reimburses an ill or injured member for payments up to $100/day, for a maximum of 365 cumulative days, made to an attendant to look after the member on a full-time basis. The member must suffer from a permanent catastrophic impairment or temporary catastrophic or non-catastrophic impairment and be assessed as reasonably and necessarily needing attendant care. The impairment must have been sustained on operations in Afghanistan.

Caregiver Assistance Benefit^{Footnote 57} reimburses an ill or injured member (sustained in operations in Afghanistan) for payments made for childcare or other caregiver expenses. The member must suffer from a permanent catastrophic impairment or a temporary catastrophic or non-catastrophic impairment which is assessed as preventing the member from engaging in the caregiving activities which he or she engaged in prior to suffering the impairment. The benefit is payable for reasonable and necessary expenses for the care of a dependent child to a maximum of $75/day.

Military Families Fund^{Footnote 58} assists military families who are faced with unforeseen and often immediate needs that have resulted due to conditions of service. Funds are received from individual donations, contributions from businesses, foundations and charitable organizations and through fundraising events.

Programs and Services Provided by Veterans Affairs Canada

VAC Transition Interview^{Footnote 59} is a meeting between a releasing CAF member and a VAC Client Service Agent to gain a greater understanding of the member and family's potential transition needs, provide information on VAC programs, benefits and services, and determine the support or intervention required from VAC and other community support systems. Families and/or other support persons are encouraged to participate in the releasing CAF member's transition interview.

Vocational assistance^{Footnote 60} may be provided to a spouse or partner if a Veteran is totally and permanently incapacitated and cannot benefit from vocational rehabilitation. Vocational assistance includes employability assessments, career counselling, training, and job-search and job-finding assistance with the goal of helping a spouse find appropriate employment in order to restore earnings capacity to a reasonable extent given education, skills and experience. In certain situations, spouses may be eligible for medical, psycho-social and vocational rehabilitation services if their needs present barriers to the success of a vocational assistance plan.

Travel costs^{Footnote 61} - When the Veteran client is critically ill and his or her attending physician is of the opinion that a visit by the spouse or common-law partner, another family member or another person designated by the client would be beneficial to the health of the client, the spouse or common-law partner, other family member or other person is eligible to be reimbursed the cost of transportation within Canada incurred to visit the client.

Reimbursement of travel expenses can be provided for site visits by the spouse or common-law partner, to permit joint participation in the Veteran's appointments at an OSI Outpatient Treatment Clinic in support of the Veteran's care plan.

Retirement Income Security Benefit (RISB)^{Footnote 62} is a monthly taxable benefit that provides life-long financial stability to eligible Veterans beginning at age 65. The RISB tops up an eligible Veteran's total annual income to at least 70% of what he or she received in financial benefits from VAC before age 65, recognizing that Veterans who are totally and permanently incapacitated may have a reduced capacity to plan sufficiently for a post-age 65 income and may have become reliant on monthly financial benefits. The RISB is also available to Veterans eligible for SISIP LTD benefits, who are totally disabled and have entitlement for a Disability Award or Disability Pension. Survivors may also be eligible for the RISB in certain cases.

Respite care^{Footnote 63} may be provided to give a temporary period of rest or relief to the informal primary caregiver. VAC supplements provincial respite care programs through a combination of health care benefits, VIP services and long-term care.

Veterans Independence Program (VIP)^{Footnote 64} - When the need exists, services such as housekeeping, grounds maintenance, personal care, nutrition, ambulatory health care, transportation, and home adaptations may be provided. Additionally, if the Veteran client was in receipt of housekeeping and/or grounds maintenance services upon admission to a health care facility, these services may then be available to the informal primary caregiver.

VAC Assistance Service^{Footnote 65} - This confidential, short-term counselling service is offered by mental health professionals for all Veterans and their families as well as primary caregivers who have personal concerns such as: problems at work or at home; personal or emotional difficulties; family or marital problems; or anything that affects one's well-being. The service is available 24 hours a day, 365 days a year by calling 1-800-268-7708, and is offered free of charge. Since December 1, 2014, the number of counselling sessions has been increased from 8 to a maximum of 20 sessions, per issue, when needed. Bereavement services have also been added through the VAC Assistance Service. The bereavement services include assessment, counselling (short, medium and long-term) and case management, and assist families, Veterans of the CAF and the RCMP, and caregivers who are affected by a service-related death. Bereavement services can be accessed on request through the VAC Assistance Service toll-free line.

Operational Stress Injury Social Support (OSISS)^{Footnote 66} program – a non-clinical peer support network for CAF members, Veterans and their families, provides personal and group support, and conducts outreach, referral and advocacy activities on behalf of their peers. Joint program with the CAF.

Operational Stress Injury (OSI) Clinic^{Footnote 67} support includes couple and family assessments, counselling for partners, and family therapy. Mental health services may be provided to family members to the extent that they are required to achieve the treatment outcomes that have been established for the Veteran client. The need to include family members in a Veteran's treatment plan must be established by the Veteran's treating health professional, or be identified in the VAC Rehabilitation Plan. In addition, in order to successfully address the Veteran's case goals, the Case Manager may, with the Veteran's consent, coordinate marital counselling, individual mental health services for the spouse or common-law partner or child, or family counselling.

Public Service Health Care Plan (PSHCP)^{Footnote 68} provides access to group health insurance for eligible Veterans and certain survivors. Participation is voluntary and would be complementary to other medical coverage sources such as private insurance or VAC treatment benefit coverage. A monthly contribution is required depending on the chosen type and level of coverage selected.

Case Management Services^{Footnote 69} enable Veterans with complex needs, and their families, to achieve mutually agreed upon goals through a collaborative and organized process, coordinated by the VAC Case Manager.

Military Family Resource Centres (MFRCs) provide medically-releasing families access at 7 locations as part of a pilot project. The pilot projects are taking place in Victoria, Edmonton, Shilo, North Bay, Trenton, Valcartier and Halifax. The support provided focuses on community integration in support of transition.

Family Caregiver Relief Benefit (FCRB)^{Footnote 70} provides Veterans with an annual tax-free grant of $7,238, which could be used by the caregiver for relief options, such as covering the cost of having a professional caregiver come into the home or covering the cost for another family member or friend travelling to the Veteran's home.

Pastoral Outreach^{Footnote 71} program provides Veterans and their families with spiritual support.

Annex B: Reports’ Recommendations and Action Taken^{Footnote 72}

Veterans Ombudsman – Improving the New Veterans Charter: The Report (June 2013)^{Footnote 73}

The report contains 20 recommendations, five of which relate specifically to the support of military families during transition to civilian life.

DND/CF Ombudsman – On the Homefront: Assessing the Well-Being of Canada’s Military Families in the New Millennium (November 2013)^{Footnote 74}

The report contains 18 recommendations, four of which relate specifically to the support of military families during transition to civilian life.

House of Commons Standing Committee on Veterans Affairs – The New Veterans Charter: Moving Forward (June 2014) ^{Footnote 79}

The report contains 14 recommendations, five of which relate specifically to the support of military families during transition to civilian life.