Mentors in Veteran Treatment Courts: How They Make a Difference

1. Mentors in Veteran Treatment Courts: How They Make a Difference State of Tennessee Mentor Training Guidelines

2. What is a Veterans’ Treatment Court? The team members include, but are not limited to: Judge, Attorneys, Probation, Treatment (VA and Other), Case Managers, Law Enforcement, Veteran’s Service Agencies, Veteran Justice Outreach Specialist, and Program coordination. The veteran mentor coordinator may also be a member of the team A Veterans’ Treatment Court (VTC) is operated by a team of professionals who are primarily responsible for overseeing the day-to-day operations of the program and administering the treatment and supervisory interventions.

3. What Sets Them Apart From Standard Recovery Courts? • I. Participation is limited to members (current and former) of the United States Military • II. Programs are structured as a hybrid of both the drug court and mental health court models • III. Court and treatment team awareness, experience with and capacity to respond to common veteran treatment needs for issues such as post-traumatic stress disorder, traumatic brain injury, military sexual trauma, depression and crisis response. • IV. Presence of a VA representative on the court team to coordinate treatment services and other benefits for the veteran participants. • V. Court team awareness of veteran and military culture, terminology, and benefits. • VI. Presence of veteran mentors who support VTC participants.

4. What is TDMHSAS’ Role? • Defining, developing, and gathering outcome measures for veterans treatment court programs, established by this chapter; • Collecting, reporting, and disseminating veterans court treatment program data; • Supporting a state veterans treatment mentor program; • Sponsoring and coordinating state veterans treatment court program training; • Awarding, administering, and evaluating state veterans treatment court program grants; • Developing standards of operation for veterans’ treatment court programs to ensure there is a significant population of veterans in the criminal justice system willing to volunteer to participate in veterans’ treatment court programs so that funds are allocated to meet the greatest need.

5. Why Veterans’ Treatment Courts? “Veterans Treatment Courts have been recognized as a creative and effective innovation in criminal justice. They emphasize accountability, while also providing treatment. They reduce recidivism, restore families, and provide a second chance for vets who have lost their way after serving their country. Veterans Treatment Courts demonstrate how various stakeholders come together with a common goal: to restore lives, save families, strengthen communities, and be efficient with taxpayer dollars.” -Kathy McCormick, Spokesperson for the National Institute of Corrections

6. Why Veterans’ Treatment Courts? 1. Veterans Treatment Courts are an effective intervention and an alternative to incarceration for justice-involved veterans. 2. There are unique issues which contribute to veterans’ involvement in the criminal justice system at the local, state and federal levels; 3. They play an important role in improving public safety, reducing recidivism, saving taxpayer dollars and, most importantly, restoring the lives of those who have served our country; 4. There is a vital role for U.S. Department of Veterans Affairs, State Departments of Veteran Affairs, County Courts and Veteran Peer Mentors”

7. Veteran Facts • Nine out of every 100 inmates are veterans of military service • Since 9/11 we have had approximately 2.5 million American military personnel serve in combat either in Iraq, Afghanistan, or both.   • Since 2001, nearly 1.3 million service members have been discharged from the military and many have utilized VA Health services for a myriad of complex emotional combat related issues, including: Post Traumatic Stress Disorder (PTSD), Traumatic Brain Injury (TBI), depression, and anxiety.  • Despite these complex combat related issues and that most combat veterans had no involvement in the criminal justice system before their engagement in military service, these veterans or active duty service members are often being treated as any other civilian offender would be treated.  This information is adapted from the website of The National Institute of Corrections article on Justice-Involved Veterans http://nicic.gov/veterans

8. Types of Interventions The hybrid structure of a Veteran Treatment Court combines substance abuse and mental health treatment to attend to the needs of its participants. The utilization of VA providers and other appropriate community based treatment providers ensures that best practices in the treatment of veterans are employed.

9. Treatment In a VTC program, the judge and court director oversee and monitor a JIV’s progress and coordinate services determined by the VTC team members. The judge will promote cooperation between law enforcement, prosecution and defense. The court director is responsible for the case manager, counselor, and ensuring inter-agency services, including mentors, are being provided to meet the JIV’s needs. The VTC approach to integrated treatment includes the cooperation and collaboration of traditional partners with the addition of the Veterans Administration Health Care Network, veterans and veterans family support organizations, and volunteer veteran mentors.

10. Substance Abuse and Mental Health Substance abuse and mental health issues are two of the most common co-occurring disorders observed in JIV’s. Veterans often turn to alcohol or drugs in an effort to self-medicate from real or imagined physical and emotional conditions. Many veterans have voiced concern about the potential for negative stigma associated with seeking screening and treatment for mental health disorders including: being seen as week, being treated differently by unit leadership, being unable to get time off from work and concern about negative career impacts. While mentors need to stay informed and be aware of this relationship, it is not their position to make a diagnosis or recommend any certain plan. The mentor can and should refer the JIV to professional, licensed clinicians who can make a proper diagnosis, prescribe medications if necessary, and support the veteran in following a specific recovery plan and program.

11. Trauma Sensitive Trauma is an experience that can be physical or psychological. Examples of physical trauma could be the loss of an arm or leg, hearing, eyesight, or being shot or stabbed. Examples of psychological trauma could be witnessing an accident or tragedy, suffering a deep personal loss or observing or participating in combat. These experiences can leave a lasting, and sometimes, permanent damage to an individual’s psyche.

12. Trauma Sensitive This is particularly true in the case of our military, police and other first responders. The effects of psychological trauma are cumulative in nature, but may not be realized for weeks, months, or even years after the experience(s). Trauma-sensitive care is a practice that incorporates working respectively and collaboratively with an individual to realistically promote healing and recovery. JIV’s tend to be more open in conversing to mentors who are veterans and be more honest in sharing what traumas may be the triggering event for their behavior.

13. Trauma Facts Taking a trauma informed approach in responding to justice-involved veterans is essential given the background of many veterans returning to civilian life. In a study of individuals who participated in 12 trauma and veteran focused jail diversion programs across the country;   • 94% experienced non-military trauma • 73% experienced trauma before the age of 18 • 68% experienced physical violence by someone they knew • 19% experienced sexual molestation by someone they knew

14. Trauma Facts Of those included in the study who served in a combat zone: 82% saw someone get killed or injured 78% saw, smelled or handled a dead body 78% patrolled areas with landmines/IEDs 75% were shot at or received fire 69% were attacked or ambushed 35% were wounded or injured 31% felt responsible for the death of someone

15. Post-traumatic Stress Disorder Post-traumatic stress disorder (PTSD) is a mental health condition triggered by experiencing or witnessing some horrific traumatic event. It does NOT mean that someone is crazy… it is a normal reaction to an abnormal event. A short-term, immediate reaction may be treated as shock; a longer, chronic condition may be diagnosed as PTSD. While anyone can develop PTSD, it is more common for military men and women and first responders who experience traumas for an extended period of time or on a daily basis. PTSD symptoms may not start immediately after a traumatic event, and often take months and years to manifest themselves to be debilitating. The effects of PTSD cause problems in all areas of life: social, economic, and family relationships. In some cases, associated depression and anxiety can lead to suicide.

16. Mental health professionals believe PTSD symptoms can be categorized into four types: 2. Negative changes in thinking and mood ( survivors guilt, sense of hopelessness, emotional numbness, unable to maintain personal relationships) • Intrusive memories (nightmares, flashbacks, emotional and physical responses such as shaking and sweats) 4. Changes in emotional responses (hyper-alertness, irritability and anger, memory problems, interrupted sleep, perceived threats and paranoia, using alcohol and drugs to self-medicate in hopes of forgetting the trauma) 3. Avoidance (avoiding people, places and things that may bring back memories of a traumatic event)

17. Traumatic Brain Injury Traumatic brain injury (TBI) occurs when an outside force causes a sudden jarring to the brain. It could be physical, such as a bullet or shrapnel to the head or helmet, a head hitting the door or windshield of a vehicle, or a tackle in football. It could also be concussive, as experienced by being near any kind of explosion or blast. TBI conditions range from mild to moderate to severe. Mild physical symptoms could include momentary loss of consciousness, acting dazed or disoriented, nausea or vomiting, tiredness, dizziness or loss of balance. In many cases, an individual may not even be aware of or remember experiencing these symptoms.

18. Traumatic Brain Injury Moderate to severe TBI physical symptoms generally occur within a few hours or days after the injury or incident. These symptoms demand more immediate testing and care and include: loss of consciousness lasting from several minutes to hours, dilation of one or both pupils of the eyes, multiple episodes of vomiting, convulsions or seizures, loss of coordination and others. Two other areas affected by TBI are sensory and cognitive. Sensory problems could exhibit blurred vision, ringing in the ears, changes in the ability to taste and smell and sensitivity to sound or light. Cognitive or mental symptoms include memory or concentration problems, mood changes, depression or anxiety, confusion, slurred speech, combativeness, and even coma.

19. Sexual Trauma Military Sexual Trauma (MST) is the term used by the Veterans Administration to refer to sexual assault or repeated, threatening sexual harassment that occurred while a veteran was in the military. Examples of MST include rape or other sexual activities, unwanted sexual touching or grabbing, threatening, offensive remarks about a person’s body or appearance, or unwelcome sexual advances. Both men and women can experience MST during their time in service, and it can be from the same or opposite sex.

20. Sexual Trauma The rates of trauma exposure reported by female veterans are higher than the trauma exposure rate of the civilian population. Female veterans are more likely to experience sexual assault when compared to their male counterparts. Among female veterans: 81% - 93% have experienced any type of trauma 38% - 64% have experienced lifetime sexual assault 27% - 49% have experienced child sexual abuse 24% - 49% have experienced adult sexual assault 30% - 45% have experienced military sexual trauma 4% - 31% have experienced combat exposure

21. Depression/Suicide Awareness Studies on suicide have shown a strong link between suicide and depression. In a posting by SAVE (Suicide Awareness Voices of Education), they report research shows 90% of the people who die by suicide have an existing mental illness or substance abuse problem at the time of their death. Current information from the VA indicates 22 veterans a day commit suicide. “Substance use often precedes suicidal behavior in the military, as indicated by the 30% of Army suicides and over 45% of suicide attempts since 2003 that involved alcohol or drug use (U.S. Army Center for Health Promotion and Preventive Medicine, 2010). Further, the Army Suicide Prevention Task Force (2010) reported that approximately 20% of 188 high-risk behavior deaths from 2006 to 2009 that were not combat-related were due to a drug or alcohol overdose.” LARSON MJ, WOOTEN NR, ADAMS RS, MERRICK EL. Military Combat Deployments and Substance Use: Review and Future Directions. Journal of social work practice in the addictions. 2012;12(1):6-27. doi:10.1080/1533256X.2012.647586.

22. SIGNS TO WATCH FOR: ✓ Talking about wanting to die or kill oneself ✓ Looking for a way to kill oneself, such as searching online or buying a gun ✓ Talking about feeling helpless or having no reason to live ✓ Talking about feeling trapped or in unbearable pain ✓ Talking about being a burden to others ✓ Increasing the use of alcohol or drugs ✓ Acting anxious or agitated; behaving recklessly ✓ Sleeping too little or too much ✓ Withdrawn or feeling isolated ✓ Showing rage or talking about seeking revenge ✓ Displaying extreme mood swings ✓ Preoccupation with death ✓ Suddenly happier, calmer ✓ Loss of interest in things one cares about ✓ Visiting or calling people to say goodbye ✓ Making arrangements; setting one’s affairs in order ✓ Giving things away, such as prized possessions

23. What to Do • A suicidal person urgently needs to see a doctor or mental health professional! • If there is an immediate threat of suicide i.e. (lethal means are present and an individual wishes to kill themselves, contact (911) • If the threat of suicide is not immediate, call the National Suicide Prevention Lifeline: 1-800-273-TALK (8255) • This is also the same number for the Veterans Crisis Line: 1-800-273-TALK (8255)

24. Access to Mentor Support “The first day a veteran appears in a Veterans Treatment Court,” explains Patrick Welch, who has been recognized for his role in shepherding the Buffalo Veterans Court into being, “The judge points out the volunteer mentors and explains what their role is and tells them that one of the mentors will go out into the hall with each of them after each court session.”

25. Access to Mentor Support The mentoring component of the Veteran Treatment Court Model is the final and perhaps the most important service which distinguishes VTCs from other types of recovery court programs. Veteran mentors bring their own valuable experience and willingness to serve their comrades in a time of need. Justice involved veterans benefit greatly from the support offered by volunteer mentors as they often require assistance with stabilizing their personal life; housing, employment, education, transportation, as well as someone to help navigate the complex veterans benefit system which fellow veterans are well positioned to do.

26. Mentor Support Mentors are not counselors. They are not employed by the judicial system; they do not report to the judge what they say and hear from one of their charges [unless one of their charges threatens to harm himself or others, or commit a crime]. Rather, they function as a buddy.” Veteran peer mentors are all-important buttresses to the Veterans Treatment Court team. Ongoing interaction by mentors with program participants is imperative. Their active, supportive relationship, maintained throughout treatment, increases the likelihood that a veteran will remain in treatment and improves the odds for sobriety and law-abiding behavior.

27. Role of Mentors An essential component of the Veterans Treatment Court program is the mentor program where veteran mentors act as peer support to veteran participants. Veterans are better served by having a support system that includes veterans who understand combat experience and the different aspects of military service. Mentors participate in a supportive relationship with participants to increase the likelihood that they will remain in treatment, attain and manage sobriety, maintain law-abiding behavior and successfully readjust to civilian life. The mentor program consists of mentor coordinators and veteran mentors. Mentor traits, roles, responsibilities, requirements and qualifications are discussed in the following sections.

28. Desirable Mentor Traits • A listener who builds trust by keeping confidences of others. • One who supports veterans, especially when things aren’t going well, understanding the importance and necessity of accessing substance abuse/mental health treatment and recovery support services determined by clinical professionals to provide that support. • A volunteer who has the time, flexibility and availability to help when needed, willing to be trained in doing things that result in long-term success for the veteran being served. • One who guides, and is a role model and becomes a resource, willing to share experiences that lead to success and/or failure. • A collaborator with others on the recovery team, both volunteer and professional, who willingly follows directions from Court, State and Federal authorities while advocating the best outcomes for the veteran.

29. EXAMPLES OF EVERYDAY MENTORING: Each time you get together, ask your mentee to tell you three good things that have happened since he/she saw you last. Share your own answers. Throughout your time with your mentee, keep attuned to new interests and skills that may be developing in your mentee. Help and encourage him/her to explore and develop these interests.

30. Being a Mentor Veteran mentors are veteran volunteers responsible for serving as a supporter, guide and confidant for veteran participants. Mentors should provide support as participants’ progress through the Veterans Treatment Court and should feel comfortable working collaboratively to assist participants in successfully completing the directives of the court.

31. Veteran Mentors Should • When meeting with participants to assist in resolving their issues • Each meeting should build on the participants’ previous conversation • Meetings should be conducted in person (when possible) • Refer participants to appropriate services • Facilitate an understanding of courtroom procedures • Maintain appropriate boundaries with participants • Be respectful and always speak with a positive tone

32. Veteran Mentors Should • Mentors should work collaboratively with the other mentors and the mentor coordinator • Motivate participants utilizing a strengths-based approach by providing encouragement to participants by highlighting their strengths including, talents, skills and knowledge • Focusing on what has been successful • Believing that participants have the potential to learn, grow and change • Maintain federal and state confidentiality standards

33. Veteran Mentors Should Attend clinical and legal training programs supported or provided by the Veterans Treatment Court. Mentors should attend an initial training session where topics may include: Veterans Treatment Court’s policies and procedures, mentoring dos and don’ts, substance abuse, mental illness, Post-Traumatic Stress Disorder and Traumatic Brain Injury Communicate with their mentor coordinator to resolve any issues regarding time commitments, resistant participants or unmanageable challenges. If a mentor fears for the safety of a participant’s life call 911 and then report to the mentor coordinator immediately

34. Veteran Mentors Should NOT Make clinical recommendations Give legal advice Provide psychotherapy Utilize a stern approach Inappropriately extend the boundaries of their relationship Offer or give monetary gifts Post bond for mentee

35. Requirements and Qualifications • Complete a mentor application form • Provide a valid DD214 or DD215 • Submit to a background check • Be respectful of individual differences and maintain appropriate boundaries with participants • Not be an active employee of law enforcement or a member of any other organization that may present a conflict of interest with the mentor program • Commit to a time period of (individual courts determine the amount of time as some require 18 to 24 months commitment)

36. Communication • Communication with Justice Involved Veterans, Mentee, is often key to their success in the VTC Program. • Veteran Mentors will meet with their individual Mentee during Mentee’s required presence in VTC either before or after their meeting with the VTC Judge. • Veteran Mentors are encouraged to communicate with their Mentee via Phone Call, Email or Text in between court appearances. • If the Venter Mentor does not hear from their Mentee at least every other week they should call their individual veteran to see how they are doing with their own personal goals and the goals set out by the VTC’s Case Worker. • VTC Mentor will communicate any and all concerns of a Mentee being personal risk or a risk to others life or limb to the Mentor Coordinator or VTC Staff ASAP. If the Mentor is physically present with their At-Risk-Mentee they will, not leave the Mentee and call 911 to report their concerns and inform the Mentor Coordinator or VTC Staff when time permits. If on the phone with the At-Risk-Mentee they will call 911 to get assistance to the Veteran, inform the Mentor Coordinator or VTC Staff when time permits.

37. Mentor Ethics and Boundaries • 1. The primary responsibility of the Mentor is to help veterans achieve their own needs, wants and goals. • 2. Mentors will maintain high standards of personal and professional conduct. • 3. Mentors will conduct themselves in a manner that does not jeopardize their own well-being. • 4. Mentors will openly share with other mentors, veterans and non-veterans their own recovery stories from mental illness, substance abuse, or co-occurring disorders as appropriate for the situation in order to promote recovery and resiliency. • 5. Mentors will, at all times, respect the rights, dignity, and privacy of those they serve. • 6. Mentors will never intimidate, threaten, harass, use undue influence, use physical force, use verbal abuse, or make unwarranted promises of benefits to the individuals they serve. • 7. Mentors will not practice, condone, facilitate, or collaborate in any form of discrimination or harassment based on ethnicity, race, color, pregnancy, veteran’s status, sex, sexual orientation, age, religion, national origin, marital status, political belief, mental or physical disability, or any other category protected by state and/or federal civil rights/laws.

38. Mentor Ethics and Boundaries 8. Mentors will promote self-direction and decision making for those they serve. 9. Mentors will respect the privacy and confidentiality of those they serve. 10. Mentors will promote and support services that foster full integration of individuals into the communities of their choice. 11. Mentors will be directed by the knowledge that all individuals have the right to live and function in the least restrictive and least intrusive environment. 12. Mentors will not enter into dual relationships or commitments that conflict with the interest of those they serve. This includes but not limited contracts for work, lodging or financial commitment between the Mentor and Mentee or eithers family members’. 13. Mentors will never engage in sexual or other inappropriate activities with those they serve. 14. Mentors will not use illegal substances, misuse alcohol, or other drugs (including prescription medications).

39. Mentor Ethics and Boundaries 15. Mentors will keep current with Court and Recovery Team policies and practices and ensure changes are reported to the Mentor Coordinator and shared with other mentors. 16. Mentors will not accept gifts of significant value from those they serve. 17. Mentors will not provide services beyond their qualifications. This includes diagnosing a condition or illness, recommending medications, or acting as a clinician. 18. A review of this Code will be conducted annually. 19. Violations of the Code will result in a review by the VTC Director and Mentor Coordinator and may result in mentor status and/or disciplinary action.

40. Mentor Ethics and Boundaries Challenging situations will inevitably arise for mentors working with justice involved veterans. Mentors should be aware that veterans may be uncomfortable asking for, or accepting assistance: “Military values and the warrior ethos become part of a collective identity that involves loyalty, duty, respect, selfless service, honor, integrity, and personal courage. The warrior ethos, grounded in these values, refers to a code of professional conduct that involves putting mission first, never accepting defeat, never quitting, and never leaving a fallen comrade.” (U.S. Department of the Army, 2006). Assuming a “sick role” is contrary to this idealized self-image, and may predispose individuals to avoid seeking help for a substance use or psychological problem. (DOD Task Force on Mental Health, 2007; Tanielian & Jaycox, 2008

41. Collaborating with Veteran Agencies and Organizations Why do we work with Veteran Agencies and Organizations? The work of Veterans’ Treatment Court relies on cooperation and positive proactive relationships with many partners to get the job done. We simply must work together, or we can’t help justice-involved veterans. This is the same teamwork approach used in the military. Veterans’ Treatment Courts collaborate with veteran agencies, organizations and even individuals, like private-practice therapists who understand the problems veterans face.

42. Collaboration The work of Veterans’ Treatment Court relies on cooperation and positive proactive relationships with many partners to get the job done. We simply must work together, or we can’t help justice-involved veterans. This is the same teamwork approach used in the military. Veterans’ Treatment Courts collaborate with veteran agencies, organizations and even individuals, like private-practice therapists who understand the problems veterans face.

43. Collaboration The size of the population is too great to go it alone. Literally millions of veterans have served, and thousands of these millions will need special services and may become justice involved, often as a direct result of that service. As a result: Every veteran agency and organization has a sense of being overwhelmed. Working together is the only sane way to address the issue.

44. Collaboration Synergyis the goal “The sum of the whole is greater than the sum of the parts” becomes true when we collaborate instead of just tolerate others who have a similar agenda. Every veteran agency, organization, or individual has an agenda to help veterans. When we choose to work together with cooperation, positive energy and proactive leadership a new equation results. One plus one becomes more than two, every time. Your energy plus someone else’s energy directed positively can create synergy.

45. Building Community Relationships Trust: The Key to Working Together • a. Trust is a choice. The whole thing starts with believing in one another, and it will end if and when we stop believing in one another. We know this work is going to take a lot of people working together, and that means we will need to extend trust to others. • b. “The good news is trust begins with you: Your attitudes, your intentions, and your behaviors within your relationships. This is good news because you’re in control of these things…” • c. Trust is either being built or destroyed in each action you choose to take in a relationship. • d. You must earn the trust of the Veteran Agencies, Organizations and individuals you work with.

46. Building Community Relationships Understanding • 2. “Seek first to understand, then seek to be understood” said noted relationship coach Stephen Covey • a. As you select Veteran Agencies and Organizations to work with, do your homework • i. Find out what matters to them and what they most want to get done. • ii. Align what you ask them for with what they want. Example: “It would help us help you if…” • 3.Earn trust by saying what you can do (avoid over-promising and under-delivering) and then be sure to do it. • 4.“No surprises”: Keep your partners in this work informed. If there is a problem, let them know before they find out, and work on a solution that builds trust.

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