Culturally Competent Practice

1. Culturally Competent Practice Get to know the VA, organizations involved in veterans work, and veterans as clients

2. Introductions and Goals • Panelists: • Seth Bridge, Department of Veterans Affairs • Melissa Tyner, Inner City Law Center • Goals: • Build an understanding of VA structure • Provide an overview and tips on interacting with veterans service organizations • Discuss cultural competency when working with veterans

3. VA: Mission and Vision Mission To fulfill President Lincoln's promise “To care for him who shall have borne the battle, and for his widow, and his orphan” by serving and honoring the men and women who are America’s veterans. Vision To provide veterans the world-class benefits and services they have earned - and to do so by adhering to the highest standards of compassion, commitment, excellence, professionalism, integrity, accountability, and stewardship.

4. The Department of Veterans Affairs (VA)Overview of VA Structure Veterans Benefits Administration (VBA):Administers programs that provide financial and other forms of assistance to Veterans, their dependents, and survivors. • Benefits include: Veterans’ compensation, Veterans’ pension, Survivors’ benefits, Vocational rehabilitation and employment assistance, Education assistance, Home loan guaranties, Life insurance. • Note: More detailed information about each of these programs, including their eligibility requirements, is available at: http://benefits.va.gov/benefits/ Veterans Health Administration (VHA): The largest fully integrated health care system in the United States, the services and treatment delivery systems include: • Components include outreach; health education; assessments and screenings; care planning; triage to and provision of care; aftercare • Treatments to address: Medical, Mental health (trauma-related and addictions), Neuropsychiatric (e.g., TBI), Specialty (e.g., spinal cord injury, blind rehabilitation) • Support/services for psychosocial issues: Homelessness, Financial instability/unemployment National Cemetery Administration (NCA): NCA honors Veterans with final resting places in national shrines and with lasting tributes that commemorate their service to our Nation. • Additional information: http://www.cem.va.gov/

5. VBA: Applying for Benefits • Online • https://www.ebenefits.va.gov • By Phone • 1-877-222-VETS (8387) • Completed form sent to Veteran for verification and signature • In Person • Nearest Regional Office • Nearest VA medical center or clinic • Working with an accredited Veterans Service Organization representative, attorney, or claims agent • VSO offices in VA medical centers and Regional Offices • VA Office of General Counsel’s list of accredited reps: http://www.va.gov/ogc/apps/accreditation/index.asp Questions? VBA National Call Center: 1-800-827-1000

6. VBA: Homeless/Incarcerated Veterans Outreach Coordinators (HVOC) • At least one HVOC at every VBA Regional Office • Outreach to homeless Veterans at homeless shelters, homeless Stand Downs, through state and local community partners and other areas where homeless Veterans may be located • Processing claims for homeless Veterans and those at risk of homelessness to ensure they are expedited • Outreach to justice-involved Veterans in Veterans treatment courts, prisons, and jails • Outreach includes providing information and assistance on VA benefits and services such as discussing eligibility criteria and filing a compensation and/or pension claim.

7. VHA Service Continuum: Treatment as Justice System Alternative • Medical • Homelessness • Mental Health • Addiction • Cognitive Risk • Specialty Care

8. Helping Homeless Veterans VA's major homeless programs constitute the largest integrated network of homeless assistance programs in the country, offering a wide array of services to help Veterans recover from homelessness and live as self-sufficiently and independently as possible. Prevention Services Housing and Supportive Services Treatment Employment, Income and Benefit Assistance Outreach and Education Community Partnerships

9. Supportive Services for Veteran Families Program VA Grants – to non profits or consumer cooperatives Criteria for Veteran families Low income Living in or transitioning to permanent housing Examples of possible assistance Daily living services, financial planning, transportation, legal services, child care, third party payment

10. Serving Justice-Involved Veterans Healthcare for Reentry Veterans (Veterans incarcerated in prison facilities) • Outreach and pre-release eligibility determination and assessment for treatment • Referral and linkages to medical, psychiatric, and social services, including employment services upon release • Short term case management assistance upon release • Veterans contacted through outreach = 49,607 Veterans Justice Outreach (Veterans interfacing with front end of justice system) • Jail outreach and associated eligibility determination, assessment, & treatment linkage • Education of and liaison with VA and community law enforcement • Liaison with court system and staffing of collaborative treatment courts • Short term case management as indicated • Linkage to ancillary support (e.g. child support services, legal assistance) • Veterans contacted = 48,056 • Veterans admitted to Veterans docket = 7,724 69% (of 3,341) with successful resolution

11. Scope and Demand – Direct VJO Duties • Liaison with law enforcement • Jail outreach • Linkage with and coverage of treatment courts (and other courts) • Catchment area POC – justice involved Veterans • Support of ancillary needs of justice involved Veterans (e.g. child support, legal, financial stability and benefits) • Documentation and clinical record keeping • Data tracking, monitoring, and reporting • Program planning/development, coordination, and promotion • Linkage development – internal VA, justice partners, community providers • Participation in local Veteran Treatment Courts (VTC)

12. Who VJOs are not…. (though you may wish they were) • Specialty Care Coordinators • Homeless or Mental Health Case Manager • Forensic Evaluator • Mentor Coordinator • Residential Programs Admissions Coordinator • Enrollment Clerk/Benefits Specialist • Hospital Director/Policy Maker

13. For Additional Information Veterans Justice Outreach Specialists http://www.va.gov/HOMELESS/VJO.asp Seth T. Bridge Policy Analyst, VHA Homeless Programs 202-461-1915 Seth.Bridge@va.gov

14. Veterans Service Organizations (VSO) • VSO is a collective term referring to membership organizations of veterans • Examples: Veterans of Foreign Wars (VFW), Disabled American Veterans (DAV), AmVets, State Offices • The mission of each VSO may vary by organization but most are focused on assisting veterans and promoting the interest of veterans • Locations: • Regional Offices • County or State offices • Stand Alone Centers - VFW

15. VSO’s in the VA benefits process • Most VSO’s help veterans file claims with the Regional Offices, some will even represent them up to the BVA • VSO’s file claims with a different philosophy than attorneys • Incentive for quantity of veterans served • File on all possible claims

16. Interacting with VSO’s • Be aware of your status as an attorney in this process • Stigma surrounding attorney status • History of opposition to attorney involvement in veterans claims • VSO issues • VSO training issue - increasingly complex body of law • Pre-judgment of claims • VSO community involvement • Post as a community center • Sponsor other community based activities

17. Culturally Competent Practices: • Working with Veterans • Best Resource: Representing Washington Veterans: Basic Legal and Cultural Concepts – Northwest Justice Project • Authored by Equal Justice Works AmeriCorps alumni Lauren Peach and law clerk Leo Flor • Consider how to encourage veterans to speak freely and how to then constructively react to hearing about killing, death, or other situations and attitudes that are uncommon or unacceptable in society. • Never ask, “Have you ever killed anyone?”

18. Culturally Competent Practices: • Working with veterans cont… • Consider experiences among veterans in light of the duration, nature, and time of their service. Understand how drafted veterans may or may not differ from volunteer veterans. • Age of veterans – be careful with assumptions about their service

19. Culturally Competent Practices: • Working with veterans cont… • Do not ask, “ARE YOU A VETERAN?”: Instead ask, “Have you ever served in the military?” • Be careful with “THANK YOU FOR YOUR SERVICE”: • For recently returned veterans, “Welcome home,” or “Glad to have you back,” may be more suitable. For any veteran (or person), “I’d like to learn about your experience if you feel comfortable discussing it,” may more effectively connect an advocate and client without expressing judgment. Most veterans would rather be heard than thanked.

20. Culturally Competent Practices: • Female Veterans • May not identify as veterans • Combat Involvement • Do not make assumptions • Military Occupational Specialty (MOS) • Military Sexual Trauma: • Defined: rape, sexual assault, or severe harassment • 1 and 3 female veterans report MST • 1 and 6 male veterans report MST

21. Working with Survivors of Sexual Trauma • Understand that each survivor experiences sexual assault differently there is no “normal” response • Any behavior after the assault (positive or negative) may be effect of the trauma • Interviewing Survivors • Questions • Open-ended questions • Specific or Cue Questions

22. Working with Survivors of Sexual Trauma • Interviewing survivors continued… • Open-ended questions – soliciting a narrative • “Tell me about what happened…” • “Tell me about how you felt…” • Cue or Specific Questions • Use to clarify questions from the narrative • “You mentioned you went to get medical attention. Can you tell me more about that?”

23. Working with Survivors of Sexual Trauma • Interviewing survivors cont… • Environment is important • Location: • Safe and comfortable for the survivor • Private and free from distraction • Maintain an equal physical position • Explain the purpose of the interview • Survivors may not have all the answers to questions • The survivor is in control of the process

24. Being Trauma Informed • When working with survivors of sexual assault or other forms of trauma be aware of all times of the surroundings and what reactions your questions may cause.

25. Being Trauma Informed • Excerpts from stressor statements of veterans: “As soon as I walk into anywhere, I know how many people are there, how many exits there are, where all other people around me are located. This hypervigilance also makes me extremely anxious.” “I have problems remembering things. I have difficulties remembering both long term and short term. I am not sure why I cannot remember portions of my life. I find it so frustrating”

26. People First Language • People first language is about respect and dignity and it puts the person – not the condition – first • Like gender and ethnicity disability is • No one wants to be defined by a single trait such as a medical condition or height • Say “people with disabilities” not “the handicapped” • Say “Bob has a mental health condition” not “Bob’s mentally ill”

27. Questions and Answers