Substance Abuse and Employment of Homeless Veterans

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Substance Abuse and Employment of Homeless
Veterans

• Teleconference Session
• January 25-26

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Presenters
Mary Huber, PhD Director of Research SARDI
Program School of Medicine Wright State
University Melissa Jones, MRC, PCCS,
LICDC Clinical Director of CAM Program Wright
State University Debbie Joseph, M.Ed., LPCC,
LICDC Program Manager The Traumatic Brain
Injury Network (TBI Network) The Ohio State
University
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Call Agenda

• Mary Huber (15 min)
• 1. Welcome and Introduction of the Guest
  Speakers (2 min)
• 2. Overview of the Problem Background and
  statistics, unique
• injuries of veterans returning from Iraq and
  Afghanistan
• Deborah Joseph (15 min)
• 3. Employee/Employer Relations Employment and
  substance abuse
• case examples - Strategies to use in approaching
  employers to provide
• a context for hiring homeless veterans with
  disabilities
• Melissa Jones (15 min)
• 4. Supervising Strategies Supervising and
  motivating staff to work with dual-diagnosis
  populations. Review of training materials and
  resources for clinicians and administrators
• 5. QA (10-15 min)
• 6. Closing Comments (2 min)

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Prevalence of Homeless Veterans

• Overall Homeless Statistics
• Estimated homeless veterans 131,000
  (conservative estimate)
• Most from the Vietnam War
• Estimated homeless female veterans 13,100 or 10
• One in four homeless people are military veterans
• Recent Homeless and Employment Statistics
• VA has pinpointed 3,717 homeless veterans of Iraq
  and Afghanistan but estimated post-9/11 homeless
  veterans 7,400
• Estimated number of female post-9/11 veterans
  740 or 10
• Jobless rate for post-9/11 veterans 11.3
• 2 of homeless veterans younger than 34 are women

Sources Department of Veterans Affairs, Bureau
of Labor Statistics
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Statistics Provide Typical Profile of a Homeless
Veteran

• Typical homeless Veteran is male, single, most
  come from poor, disadvantaged communities,
  45 suffer from mental illness, and 50 have
  substance abuse problems. More than 67 served
  our country for at least three years.
• http//www1.va.gov/homeless/

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Unique injuries and mental health issues among
veterans returning from Iraq and Afghanistan

• TBI - increasing evidence that combat-related TBI
  are a frequent occurrence. One half of all
  injuries are TBI due to explosion (mostly mild).
  Most common physical injury.
• PTSD - the VA defined PTSD as a type of anxiety
  that affects people whove experienced a
  particular traumatic event that creates intense
  fear, helplessness or horror. 20 (one of five)
  of Iraq veterans (seeking help) have PTSD with
  women suffering more pronounced and debilitating
  forms of PTSD.
• SUD includes both abuse and dependence of
  alcohol and drugs. SUD can create or exacerbate
  problems for homeless veterans looking for work
  or starting new jobs. On the other hand,
  employment can provide a powerful motivator for
  people to re-examine their behaviors related to
  substances.

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Most Recent Report from the National Institute
on Drug Abuse (NIDA)

• High correlation between PTSD and SUD.
• Military experts concerned about the rise in drug
  abuse among military personnel.
• NIDA, VA, and Defense Department joined together
  to find solutions to this problem.

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President's Commission on Care for America's
Returning Wounded Warriors

• Six Recommendations Thursday, July 26, 2007
• Immediately Create Comprehensive Recovery Plans
• Completely Restructure the Disability and
  Compensation Systems
• Aggressively Prevent and Treat Post-Traumatic
  Stress Disorder and Traumatic Brain Injury
• Significantly Strengthen Support for Families
• Rapidly Transfer Patient Information Between DoD
  and VA
• Strongly Support Walter Reed by Recruiting and
  Retaining First-Rate Professionals Through 2011

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More Funding (example) is Fundamental

• VA Doubles Disability Aid for Iraq War Veteran
• Department Responds to Appeals of PTSD
• Veteran- after his PTSD worsened and he was
  unable to hold a job. Saturday, October 20, 2007
  VA spokeswoman, raising his monthly check from
  1,352 to 2,781

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Supportive Services for Low-Income Veterans

• Public Law 110-387 VA to develop a supportive
  services program for very low-income Veteran
  families. It is the VAs goal to identify
  Veterans in unstable living situations and then
  intervene to close the front door on their
  potential entry into homelessness.
• Veterans and the family members in their
  household. Sometime in 2010, the VA expects to
  announce a notification of funding availability
  (NOFA) that will offer non-profit organizations
  and consumer cooperatives the opportunity to
  apply for grants to assist these very low-income
  Veterans. As additional details about the NOFA
  become available on this website
  http//grants.gov.

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The Department of Housing and Urban Development
and VA's Supported Housing (HUD-VASH) Program

• The HUD-VASH VA Program, through a cooperative
  partnership, provides long-term case management,
  supportive services and permanent housing
  support. Eligible homeless Veterans receive VA
  provided case management and supportive services
  to support stability and recovery from physical
  and mental health, substance use, and functional
  concerns contributing to or resulting from of
  homelessness. 
• HUD provides 20,000 Housing Choice Section 8
  vouchers designated for HUD-VASH to participating
  Public Housing Authorities to assist with rent
  payment. This program was designed to address the
  needs of the most vulnerable homeless Veterans.
  To be eligible for this program, Veterans must be
  VA Health Care eligible, homeless and need and
  participate in case management services in order
  to obtain and sustain permanent independent
  community housing.

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Hire Vets First, 10 reasons

1. Accelerated learning curve.Veterans have the
   proven ability to learn new skills and concepts.
   In addition, they can enter your workforce with
   identifiable and transferable skills, proven in
   real-world situations. This background can
   enhance your organization's productivity.
2. Leadership.The military trains people to lead by
   example as well as through direction, delegation,
   motivation, and inspiration. Veterans understand
   the practical ways to manage behaviors for
   results, even in the most trying circumstances.
   They also know the dynamics of leadership as part
   of both hierarchical and peer structures.
3. Teamwork.Veterans understand how genuine
   teamwork grows out of a responsibility to one's
   colleagues. Military duties involve a blend of
   individual and group productivity. They also
   necessitate a perception of how groups of all
   sizes relate to each other and an overarching
   objective.
4. Diversity and inclusion in action.Veterans have
   learned to work side by side with individuals
   regardless of diverse race, gender, geographic
   origin, ethnic background, religion, and economic
   status as well as mental, physical, and
   attitudinal capabilities. They have the
   sensitivity to cooperate with many different
   types of individuals.
5. Efficient performance under pressure.Veterans
   understand the rigors of tight schedules and
   limited resources. They have developed the
   capacity to know how to accomplish priorities on
   time, in spite of tremendous stress. They know
   the critical importance of staying with a task
   until it is done right.

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Next 5 reasons

1. Respect for procedures.Veterans have gained a
   unique perspective on the value of
   accountability. They can grasp their place within
   an organizational framework, becoming responsible
   for subordinates' actions to higher supervisory
   levels. They know how policies and procedures
   enable an organization to exist.
2. Technology and globalization.Because of their
   experiences in the service, veterans are usually
   aware of international and technical trends
   pertinent to business and industry. They can
   bring the kind of global outlook and
   technological savvy that all enterprises of any
   size need to succeed.
3. Integrity.Veterans know what it means to do "an
   honest day's work." Prospective employers can
   take advantage of a track record of integrity,
   often including security clearances. This
   integrity translates into qualities of sincerity
   and trustworthiness.
4. Conscious of health and safety standards.Thanks
   to extensive training, veterans are aware of
   health and safety protocols both for themselves
   and the welfare of others. Individually, they
   represent a drug-free workforce that is cognizant
   of maintaining personal health and fitness. On a
   company level, their awareness and
   conscientiousness translate into protection of
   employees, property, and materials.
5. Triumph over adversity.In addition to dealing
   positively with the typical issues of personal
   maturity, veterans have frequently triumphed over
   great adversity. They likely have proven their
   mettle in mission critical situations demanding
   endurance, stamina, and flexibility. They may
   have overcome personal disabilities through
   strength and determination.

http//hirevetsfirst.dol.gov/10reasons.asp
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Americas Heroes at Work

• America's Heroes at Work http//www.americasheroes
  atwork.gov/ 
• 10 top reasons link    
• http//www.americasheroesatwork.gov/links/links2
  hiring

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Traumatic Brain Injury

• TBI is a growing concern among veterans
• 68 of more than 33,000 wounded soldiers have
  experienced blast related injuries
• TBI effects of these injuries are far reaching
  emotional, vision, hearing, speech, dizziness,
  sleep disorders, and memory loss
• Effects are cumulative for those involved in
  multiple blasts

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Barriers to Employment

• Behavior issues
• Untreated psychosocial disorders
• Drug/Alcohol use/abuse
• Lack of income
• Homelessness
• Legal issues
• Untreated medical problems

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Tools to Overcome Barriers to Unemployment

• Studies show that using a supported employment
  model like the Individual Placement and Support
  Model designed by Dr. Robert Drake and Deborah
  Becker works well in helping persons with
  drug/alcohol and mental health problems return to
  work.

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Tools (cont)

• A study of homeless veterans with psychiatric
  disorders, addiction disorders or both,
  Implementation of Supported Employment for
  Homeless Veterans with Psychiatric or Addiction
  Disorders Two-Year Outcomes, Rosenheck, M. C.
  and Mares, PH.D. show improved rate for days of
  competitive employment when compared to a
  comparison cohort.

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Eight Empirically Derived Principle of IPS Model

• Employment is considered an integral component of
  treatment rather than a separate service
• Competitive employment is the goal
• Persons can be successful without pre-employment
  training
• The vocational assessment is continuous and based
  in competitive work experiences

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Models (cont)

• Follow along supports continue for a time that
  fits the individual, rather than terminating at a
  set point after starting a job
• Job finding, disclosure and supports are based on
  the persons preferences
• Services are provided in the community
• A multidisciplinary team approach is used rather
  than parallel services

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Preparing for the Job Search

• Have a good understanding of how involved the
  applicant wants you to be in the process
• Create a support network/treatment team around
  the applicant
• Maintain regular contact with applicant and team
  scheduling regular meetings so that all members
  keep each other updated
• Get a benefits analysis for anyone receiving
  Social Security benefits

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Preparing (cont)

• Make contact with potential employers prior to
  their filling out application
• Explain your program to potential employer (we
  can make or break the deal)
• Try to schedule a face to face with the applicant
  and the hiring person as a way to eliminate being
  screened out prior to reaching that level
• Practice interviewing skills and be supportive

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Preparing (cont)

• Join the applicant in the face to face
  meeting/interview if appropriate
• Allow the applicant processing time after the
  interview
• Maintain follow-up contact with potential
  employers
• Remember, a lost job is not a failure, but an
  opportunity to learn

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Robert

• Traumatic brain injury
• Recent and sporadic crack and alcohol use
• 5 Felony thefts with multiple incarcerations
• Impulsive and disinhibited behavior
• Difficulty with authority figures
• Anger management issues

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Supervisory Steps to Implementation of Supported
Employment

• The supervisor that is leading the implementation
  must have backing from key leaders and decision
  makers.
• Focus on consumer centered goals.
• Progress should be measured by consumer outcomes,
  those in competitive employment, as oppose to
  hours in treatment.
• Must advocate for funding, keep the momentum
  going with all clinical staff. Ex. Provide
  updates in staff meetings, show outcomes

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Three Phases of Implementation

• Build momentum for change
• Enact the Change
• Maintain and extend the gains

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Actions to Gain Buy-In for Staff and Key Leaders

• Work with NAMI (National Alliance on Mental
  Illness) to identify consumer and family that can
  talk to your team, about the importance of work
  for their loved one.
• Educate your staff about supported employment and
  its proven effectiveness shown by scientific
  research.

• Establish planning meetings with other agencies,
  such as Division of Vocational Rehabilitation
• Bring in outside speakers to inspire staff.
  Particularly a presenter that is a practitioner.
  Ex. A specialist on TBI from the VA.

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Fight the Stigma

• Address the bias that may exist that the mentally
  ill population cannot work.
• Have staff reflect on the role work plays in
  their own life.
• Work is part of getting on with life despite
  mental illness and injury.
• Challenge staffs arguments of why work may not
  be useful to this population.

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Consideration

• Generally it takes one year for staff to feel
  confident in providing Supported Employment
  Services.
• Will Supported Employment impact other revenue?
  Ex. Will you see a reduction in attendance
  because of employment?

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Selecting the Employment Specialist
Selection should focus on positive, hopeful people who believe in the model and have a passion for the work. Training is a MUST how to elicit employment history, seek jobs, talk to employers, job saves, self disclosure issues.
Position should be full time with employment work being job focus. Caseload should not exceed 25 consumers. Employment Specialist should be open to working with internal or external clinical team on behalf of the consumer.
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Supervision

• The supervisor MUST be actively involved
• Weekly structured meetings should occur
• Identify road blocks
• Continue discussion about mental illness and TBI
  impact on job placement
• Should be in the field with ES to support and
  guide efforts

• Celebrate Success
• Employment Specialist should network with other
  ESs in the field to discuss job leads and build
  relationships. Supervisor should be doing the
  same.

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Supported Employment Works Best in a Clinical
Environment

• Supervisor should set aside a part of regular
  weekly/monthly staff meeting for employment
  discussion.
• Employment Specialist needs to be an active
  participant in this meeting, whether the meeting
  is internal/external.
• These direct, personal, clinical contacts provide
  a wealth of information to the ES.

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How Program Leaders Can Support Success
Keep Paperwork to a minimum EX. Voc. Profile Employment plan Monthly note This may be impacted depending on funding stream, and requirements of governing bodies Display Outcomes stats, graphs, that are employed This helps the team stay focused and committed to the model
Track Outcomes Know job gains and losses Review Policies and Procedures Make certain your policies identify your commitment to Supported Employment.
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Continuing the Success

• Complete the Supported Employment Fidelity Scale
  at least one time per year.
• Conduct regular meetings with management staff to
  review program implementation.
• Recognize staff who have had success with the
  model, and find out what they did correct.
• Devote time to good news in meetings.
• Make a BIG deal out of achievements, bring in the
  consumers who are showing gains, provide a
  platform to share their success story.
• Pass on your knowledge and experience to others.

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Critical Resource dvbic.orgDefense and
Veterans Brain Injury Center
Access for any veteran in the US who has suffered TBI/secondary MI issues Johnstown, PA nearest access for Ohioians Focused on rehabilitation for veterans with emphasis on return to work. Utilization of individualized, evidence based practice model. Website provides a host of information on the impact of cumulative concussions, blast injuries, sport vs. military concussion, includes a 30 minute video on TBI.
Provides a family TBI curriculum developed by a 15 member panel, with multiple educational modules. Including how to navigate service benefits. DV Brain Injury Center services are provided to veterans with TBI who are insured through Tricare or Veteran Affair Benefits. They accept self referrals, PCP referrals, or other healthcare provider referrals. Call the regional office nearest you for more information, or contact the Washington D.C. headquarters at 1-800-870-9244 to be directed to services.
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• SOURCES for this presentation
• http//www.samhsa.gov/ (Supported Employment
  Resource Tool Kit)
• http//www.dvbic.org/ (Defense of Veterans
  Brain Injury Center)
• iava.org  - Iraq and Afghanistan Veterans of
  America - a site that addresses critical issues
  facing new veterans and their families, including
  mental health injuries, a stretched VA system,
  inadequate health care for female veterans, and
  GI Bill educational benefits.
• mirecc.va.gov - The Mental Illness Research,
  Education and Clinical Centers (MIRECC) were
  established by Congress with the goal of
  researching the causes and treatments of mental
  disorders and using education to put new
  knowledge into routine clinical practice in the
  VA.

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Resources- Information on Hiring Wounded
Injured Veterans

• AbilityOneProvides employment opportunities for
  people who are blind or have other severe
  disabilities in the manufacture and delivery of
  products and services to the federal government.
• American Corporate PartnersA nationwide
  mentoring program dedicated to helping veterans
  transition from the armed services to civilian
  employment through career counseling and
  networking with corporations.
• DirectEmployersProvides employment opportunities
  through a non-profit consortium of leading U.S.
  corporations.
• DoDVetsProvides information for disabled
  veterans. Includes federal employment
  information, QAs for disabled veterans and
  managers, internships, scholarships and
  fellowships, grants, education and training and
  transition centers.
• Employer Assistance Recruiting Network
  (EARN)Offers a one-stop source for disability
  employment information. Includes information on
  recruiting services, resume writing tips, fact
  sheets, employer success stories and more.
• Employer Support of the Guard and
  ReservePromotes cooperation and understanding
  between Reserve component members and their
  civilian employers and assists in the resolution
  of conflicts arising from an employee's military
  commitment.
• Entrepreneurship Bootcamp for Veterans with
  Disabilities (EBV)Offers experiential training
  in entrepreneurship and small business management
  to soldiers, sailors, airmen and marines disabled
  as a result of their service supporting
  Operations Enduring Freedom and Iraqi Freedom.
• Hire Vets FirstComprehensive career Web site for
  hiring veterans of America's military. Search the
  directory for the One-Stop Career Center near you
  or call 1-877-US2-JOBS for direct assistance.
• Hire Heroes USAProvides links to career
  opportunities nationwide for returning service
  men and women, specifically those who have been
  wounded or with any level of disability.
• Operation Warfighter (OWF) Sponsored by the DoD
  Military Severely Injured Center, OWF is a
  temporary assignment or internship program for
  service members who are undergoing therapy at
  military treatment facilities within the US.

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Resources- Information on Hiring Wounded
Injured Veterans

• Resources for Hiring Veterans and Returning
  Service MembersOne-stop information to help
  employers find out why, where and how to recruit
  and hire veterans.
• Resources for Recruiting and Hiring People with
  DisabilitiesVast collection of resources on
  hiring people with disabilities sponsored by the
  Virginia Commonwealth University Rehabilitation
  Research and Training Center on Workplace
  Supports and Job Retention.
• Understanding Employer Rights and
  Responsibilities under USERRAProvides
  information on the basic provisions and
  requirements under the Uniformed Services
  Employment and Reemployment Rights Act (USERRA).
• VetCentralProvides online career resources for
  vets. Includes resume, spouse career center,
  transition assistance and more.
• Veterans Community InitiativesBased in Western
  Pennsylvania, provides employment assistance to
  veterans and family.
• Veterans Employment Coordination Service
  (VECS)Established to advance efforts to attract,
  recruit and hire veterans into the VA,
  particularly severely injured veterans returning
  from Operation Enduring Freedom and Operation
  Iraqi Freedom.
• Veterans Employment Specialist LocatorOffers the
  ability to quickly locate Disabled Veterans
  Outreach Program Specialists (DVOPs) and Local
  Veterans Employment Representatives
  (LVERs) in your area.  These specialists assist
  vets who are seeking employment. 
• Veterans Green JobsOffers training, education
  and career development programs through the
  Veterans Green Jobs Academy to help veterans
  expand on their military experience in order to
  serve the country in a new way by helping to
  rebuild the economy, restore the environment and
  renew our communities.  
• VetFranHelps veterans transition to civilian
  life by offering financial incentives to become
  franchise owners.
• VetSuccessInformation about the services that
  the Vocational Rehabilitation and Employment
  (VRE) program provides to veterans with
  service-connected disabilities.
• Vocational Rehabilitation Employment Program
  Services for EmployersInformation for employers
  from the VA regarding Vocational Rehabilitation
  Employment Program, which helps veterans with
  service-connected disabilities find and keep
  suitable jobs.
• Warriors To Work Program Helps individuals
  recovering from severe injuries received in the
  line of duty connect with the support and
  resources they need to build a career in the
  civilian workforce. Provides assistance with
  writing resumes, interviewing, career resources
  and more.

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Questions
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