Substance Abuse and Employment of Homeless Veterans

1. Substance Abuse and Employment of Homeless Veterans Teleconference Session January 25-26

2. 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

3. 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. Q&A (10-15 min) 6. Closing Comments (2 min)

4. 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

5. 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/

6. 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 who’ve 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.

7. 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.

8. 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

9. 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

10. 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 VA’s 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.

11. 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.

12. Hire Vets First, 10 reasons • 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. • 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. • 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. • 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. • 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.

13. Next 5 reasons • 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. • 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. • 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. • 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. • 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

14. America’s Heroes at Work America's Heroes at Work http://www.americasheroesatwork.gov/ 10 top reasons link:     http://www.americasheroesatwork.gov/links/links2#hiring

15. 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

16. Barriers to Employment • Behavior issues • Untreated psychosocial disorders • Drug/Alcohol use/abuse • Lack of income • Homelessness • Legal issues • Untreated medical problems

17. 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.

18. Tools (con’t) • 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.

19. 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

20. Models (con’t) • 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 person’s preferences • Services are provided in the community • A multidisciplinary team approach is used rather than parallel services

21. 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

22. Preparing (con’t) • 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

23. Preparing (con’t) • 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

24. 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

25. 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

26. Three Phases of Implementation • Build momentum for change • Enact the Change • Maintain and extend the gains

27. 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 it’s proven effectiveness shown by scientific research. Actions to Gain Buy-In for Staff and Key Leaders • 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.

28. 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 staff’s arguments of why work may not be useful to this population.

29. 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?

30. Selecting the Employment Specialist

31. Celebrate Success Employment Specialist should network with other ES’s in the field to discuss job leads and build relationships. Supervisor should be doing the same. 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

32. 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.

33. How Program Leaders Can Support Success

34. 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.

35. Critical Resource – dvbic.orgDefense and Veterans Brain Injury Center

36. 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.

37. 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, Q&As 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.

38. 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 (VR&E) 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.

39. Questions This conference call may be recorded for the purpose of archiving the call online. The audio and transcript files will be available to the public. By speaking on the call you are authorizing Virginia Commonwealth University to use your name and/or voice on the archived call and the transcript. If you would like to ask a question without speaking on the call, please email it in advance to Cameron Carter, ccarter4@vcu.edu.