Substance Abuse and Employment of Homeless Veterans - PowerPoint PPT Presentation

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Substance Abuse and Employment of Homeless Veterans


Teleconference Session January 25-26 – PowerPoint PPT presentation

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Title: Substance Abuse and Employment of Homeless Veterans

Substance Abuse and Employment of Homeless
  • Teleconference Session
  • January 25-26

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
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
  • 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
  • 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)

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
Statistics Provide Typical Profile of a Homeless
  • 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//

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

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.

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

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

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

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
  • 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.

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
  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.

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.

Americas Heroes at Work
  • America's Heroes at Work http//www.americasheroes 
  • 10 top reasons link    
  • http//

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

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

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

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.

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
  • The vocational assessment is continuous and based
    in competitive work experiences

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

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

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

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

  • 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

Supervisory Steps to Implementation of Supported
  • The supervisor that is leading the implementation
    must have backing from key leaders and decision
  • 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

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

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
  • 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.

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.

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

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.
  • 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

Supported Employment Works Best in a Clinical
  • Supervisor should set aside a part of regular
    weekly/monthly staff meeting for employment
  • 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.

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.
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.

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.
  • SOURCES for this presentation
  • http// (Supported Employment
    Resource Tool Kit)
  • http// (Defense of Veterans
    Brain Injury Center)
  •  - 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.
  • - 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

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.
  • 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
  • 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.

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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