The West Michigan Veterans Coalition met on Feb 4, 2014 and presented to a group of veterans, veterans service providers, local and state agencies, and veteran service organizations.
Topic in the presentation:
- VA Work Study Program
- Veteran Employment Barriers, Resources, and Next Steps
- Veteran Barriers and PTSD
- Veteran Treatment Courts
West Michigan Veterans Coalition Feb 2014 Quarterly Meeting
1. Tuesday, February 4, 2014
Education
Employment
Healthcare
Quality of Life
MISSION: The West Michigan Veterans Coalition is a collaboration between local military friendly
organizations that provide support, information, and resources to veterans and their
families, employers, and other organization throughout West Michigan. We meet quarterly to highlight
military friendly organizations and businesses, network with one another, and to help promote and
enhance services to our heroes.
2. I.
Welcome
II.
Pledge of Allegiance
III. Spotlight Session:
•
Education Subcommittee - VA Work Study Program
- Jonathan Highman, Representative, Military & Veteran Services, Davenport University
•
Employment Subcommittee - Employment Barriers, Resources, and Next Steps
- Brandi McBride, Goodwill Industries Workforce Development Manager
•
Healthcare Subcommittee - Brief History, Condition, and Therapies of PTSD
- Mark Kane, Ph.D.
•
Quality of Life - Veteran Treatment Courts
- Judge David Jordon, Retired, Ingham Veterans Treatment Court
- Jon Caterino, 1st Mentor Coordinator Ingham Veterans Treatment Court
IV. NOON – Lunch provided by Aquinas College
V.
1:00PM- End
6. Allows veterans to earn
additional pay by working on
behalf of the VA while at least a ¾
time student.
Limited to working only with
veterans’ programs.
Funded by the VA.
Not used to replace existing staff.
The veteran will be paid the
state’s minimum wage ($7.40/hr.
for Michigan).
7. Veterans can work no more than
25 hours for every week in their
current semester.
Once the veteran reaches 50
hours, the supervisor will submit
VA Form 22-8690 (time record).
Payment is direct deposited to the
same account as the veterans
other VA benefits.
8. Read and understand the
Work-study Supervisor’s Handbook.
Provide direct supervision to VA
work-study students.
Ensure the student is trained to do
the work as stated in the
Position/Job Description.
Ensure the work-study does not
begin before their assigned start date.
Ensure the work-study does not
work more than 8 hours per day.
Initial the Time Record as new
entries are recorded.
9. You are required to maintain the
work-study file for 3 years. You are
also required to maintain a current
class schedule in the work-study file
to ensure verification of availability.
Confirm cumulative totals for hours
worked.
Email the Time Record to the
work-study department:
WKSRTN.VBASTL@VA.GOV in 50hour increments.
Report any changes in the workstudy’s address to the work study
department ASAP.
Make all work-study inquiries on
behalf of the veteran.
10. Determined by the VA
Must be enrolled in classes at
least ¾ time
Must be receiving one of these
VA funds:
Chapter 30 (Montgomery GI Bill)
Chapter 31 (Vocational Rehabilitation)
Chapter 32 (VEAP)
Chapter 33 (Post-9/11 GI Bill)
Chapter 35 (Survivors and Dependents
Assistance)
Chapter 1606 or 1607 (Reserve
Education Assistance)
11. Locate a work site and determine if
an opening exists.
The Work-site Supervisor must agree
to hire the student.
Supervisor has the student complete
VA Form 22-8691 and Position/Job
Description form.
If a student does not know of a work
site, they may call the V.A. Regional
office at: (888) 442-4551 and ask to
be transferred to work-study desk
where they will help to locate a site
within a close proximity.
12. Telephone: (314) 552-9861
(10am-2pm central)
Fax: (314) 552-9533 (24 hours)
WS.VBASTL@VA.GOV (Inquiries)
WKSRTN.VBASTL@VA.GOV
(Timesheets, applications, contracts)
General VA Education Questions:
(888) 442-4551 or
http://gibill.va.gov
Veterans Services: (800) 827-1000
or http://www.va.gov
16. PARTNERS
•
•
•
•
•
•
•
•
•
U.S. Dept. of VA
Goodwill Industries
TALENT 2025
H2H
ESGR
WGVU
DoL
VetBiz Central
MRS
•
•
•
•
•
•
•
•
•
•
VOA
Michigan Works
MVAA
State of MI
Army One Source
GR Chamber
Hello West Michigan
Axios Staffing
Herman Miller
Meijer
18. Veterans with
Significant Barriers
Homeless
Disabilities
Substance Abuse/
Mental Illness
HCHV
In-between
Felonies
Goodwill
VA
211 (Coming)
VOA
Job-Ready
Veterans
Student
Veterans
Student Vets
of America
VOA
MRS
Community
Rebuilders
Transitional
Housing
Shelters
*
Disability
Advocates
Network 180
Disability Advocates
Veteran’s
Court
Veteran Services
Officers
Career Counselors
Ind. Living Centers
Felonyfriendly
employers
Job Seekers
MI Talent
H2H
Job Fairs
Consortium of
Military and
Veteran Educators
We need to educate employers
about these populations
19. WHAT IS THE SYSTEM…
for veterans to work through
service providers to get to
employers to eventually find
employment?
20. • Suits for Soldiers
• VOA
• Army One Source
• Buddy 2 Buddy
• Career Counselors • VA
• Disability Advocates
• VetBiz Central
THE SYSTEM
The
Service
Provider
• Michigan Works
• Veteran’s Services
• Goodwill Industries
Division
• MVAA Portal
• H2H
• TALENT 2025
• SHRM
• MI Talent
The
Employer
Resource
The
Veteran
• Disabled
• Retired
• Active Duty
• Separated
What• isPrisoners
the system?
• Homeless
The
JOB
• Entry Level
• General Labor
• Management
• Hello West Michigan
• Prisoner Re-entry Programs
• Higher Education
• Part-Time / Full-Time
• Job Fairs
• MVAA Portal
• Guard/Reserves
• WGVU
• Executive Level
• Chamber
• Entrepreneurial
21. CURRENT PRACTICES
TAP | Job Fairs | Job Boards | MI Talent
Hola, estoy buscando un
trabajo. ¿Tiene alguna
posición abierta?
The
Veteran
Ich habe eine
offene
Position, sind Sie
interessiert an der
Arbeit?
The
Employer
Interaction between both but
neither one understands the other
28. DELIVERABLES - 2014
• Streamline process of preparing vets for
employment
• Increase # of Veteran-Friendly Employers
• Educate employers on resources to support
veteran hiring/retention
• Link the resources of WMVC to employers
through TALENT 2025
• Align regional and statewide efforts
30. Carrie Roy & Elena Bridges,
Co-Chairs of Healthcare Subcommittee
Elena.bridges@altarum.org
carrie.roy@kentcountymi.gov
31. Health Care Subcommittee
Barriers
• Lack of Education/Information/Family Support
• Cumbersome System
• Transportation
• Mental Health- Stigmas, specifically PTSD
32. PTSD 101
A short history, symptoms, and treatments.
Mark S. Kane, Ph.D. Licensed Psychologist
Fellow of the Michigan Psychological Association
Riverview Psychological Services, P.C.
drmskane@gmail.com 616-464-0811
32
33. National Center for Post Traumatic
Stress Disorder Statistics
7.8 % of Americans experience PTSD (Keane et al., 2006)
Women=2X risk
• MVA-related PTSD 25-33% or higher-comorbidity 48% major
depression (NIH, 2008)
• 30% of combat veterans experience PTSD
(Duke and Vasterling, 2005)
- Approximately 50% of Vietnam veterans experience symptoms
- Approximately 8% of Gulf War veterans have demonstrated
symptoms
• www.ncptsd.va.gov
33
35. * DISCLAIMER
Information during this presentation is for educational purposes
only—it is not a substitute for informed medical advice or
training. You should not use this information to diagnose or
treat a mental health problem without consulting a qualified
professional/ provider.
35
36. A Short History of PTSD From
Homer to “Irritable Heart” Civil War
• In the “Odyssey” in the 8th Century B.C. Homer
described Odysseus as a veteran of the Trojan Wars who
was afflicted with flashbacks and survivor’s guilt. In 490
B.C. Herodotus documented an incident where a soldier
became blind due to witnessing the death of his
comrade.
36
37. In 1597, William Shakespeare's Henry IV had
Lady Percy describe her husbands PTSD
symptoms
•
LADY PERCY: O my good lord, why are you thus
•
Of palisadoes, frontiers, parapets,
alone?
•
Of basilisks, of cannon, culverin,
•
For what offense have I this fortnight been
•
Of prisoners' ransom, and of soldiers slain,
•
A banished woman from my Harry's bed?
•
And all the currents of a heady fight.
•
Tell me, sweet lord, what is't that takes from thee
•
Thy spirit within thee hath been so at war,
•
Thy stomach, pleasure, and thy golden sleep?
•
And thus hath so bestirred thee in thy sleep,
•
Why dost thou bend thine eyes upon the earth,
•
That beads of sweat have stood upon thy brow
•
And start so often when thou sit'st alone?
•
Like bubbles in a late-disturbèd stream,
•
Why hast thou lost the fresh blood in thy cheeks
•
And in thy face strange motions have appeared,
•
And given my treasures and my rights of thee
•
Such as we see when men restrain their breath
•
To thick-eyed musing and cursed melancholy?
•
On some great sudden hest. O, what portents are
•
In thy faint slumbers I by thee have watched,
•
And heard thee murmur tales of iron wars,
•
Some heavy business hath my lord in hand,
•
Speak terms of manage to thy bounding steed,
•
And I must know it, else he loves me not
•
Cry 'Courage! to the field!' And thou hast talked
•
Of sallies and retires, of trenches, tents,
these?
37
39. PTSD first used in 1980 in DSM-III
Current Definition of PTSD used in DSM V
• A Trauma related disorder in which exposure to a
traumatic or stressful event resulting from exposure to
an experience involving direct or indirect threat of
serious harm or death; may be experienced alone
(rape/assault) or in company of others (military combat).
39
40. PTSD Stressors
• Violent human assault
• Natural catastrophes
• Accidents
• Deliberate “man”-made disasters
40
U.S. Department of Defense Images: http://www.defense.gov/DODCMSShare/NewsStoryPhoto/200109/hrs_200109205g_hr.jpg
41. Combat Fatigue
Immediate psychological and functional impairment that
occurs in war or during other severe stressors during combat
Caused by stress hormones
- Features of the stress reaction include:
• +Restlessness
• +psychomotor deficiencies
• +withdrawal
• +Stuttering
• +Confusion
• +Nausea
• +Vomiting
• +Severe suspiciousness and distrust
APA, 1994
41
42. Symptoms of PTSD
• Recurrent, involuntary, and intrusive thoughts of event
• Traumatic nightmares, flash backs
(visual, sound, smell, taste, pressure etc…/bad dreams)
• Emotional numbness (“it don’t matter”); reduced interest
on a continuum from brief episodes to complete loss of
consciousness
• Intense guilty or worry/anxiety including survivor guilt
• Angry Outbursts and irritability
• Feeling “on edge,” hyper-arousal/hyper-alertness
• Avoidance of thoughts/situations that remind person of
the trauma
42
43. DSM – V Criteria
• A: stressor
• B: intrusion symptoms
• C. voidance
• D. negative alterations in cognitions and mood
• E. alterations in arousal and reactivity
• F. duration B,C,D,E, for 30 days
• G. functional significance/work, social
• H. Exclusion/not meds, illness, substance abuse
• Diagnosis 6 months or more post trauma
43
44. Duration of PTSD
Full diagnosis is not met until at least six months after the
trauma(s). Although onset may occur immediately.
Specify if :With dissociative symptoms. In addition to
meeting criteria for diagnosis:
1. Depersonalization: Detached from oneself/outside
observer
2. Derealization: experience of unreality, distance, or
distortion (e.g. “Things are not real”)
• Often, the disorder is more Severe and lasts longer when the stress
is of human design(i.e., war-related trauma)
44
45. Comorbid/Coexisting Problems
• *Depression, Anxiety and Pain
• *Substance abuse/dependence
• *Other addictions, i.e., gambling, sex, work
• *Spectrum of severe mental illnesses
• *Aggressive behavior problems
• *Sleep problems like nightmares, insomnia, irregular sleep
schedules, Sleep Apnea, Restless Leg Syndrome
• *Acquired Brain Injury/Traumatic Brain Injury (TBI)
• *Conversion/Somatization Disorders
• *Hormone/ Hypothalamic,pitutary,adrenal (HPA) axis
It can be difficult for healthcare providers to prioritize target
treatment areas given the range of symptoms and difficulties
seen.
45
46. TBI Comorbidity
TBI is trauma to the brain triggered by externally
acting forces (i.e., direct penetration, sustained
forces, etc.)
• A significant portion of falls, car
accidents, physical abuse, gun shot wounds and
soldiers from OEF/OIF have sustained a brain
injury.
• Blast injuries are the leading cause of injury in
the current conflict.
46
47. Blast Injuries
Blast injuries are injuries that result from the
complex pressure wave generated by an explosion
• Ears, lungs, and GI tract, brain and spine are
especially susceptible to primary blast injury.
• Those closest to the explosion suffer from the
greatest risk of injury
• Additional means of impact:
• Being thrown, debris, burns, vehicle accidents.
47
48. Why Blast Injures are of Interest
Now?
Armed forces are sustaining attacks by rocket-propelled
grenades, improvised explosive devices, and land mines almost
daily in combat.
• Injured soldiers require specialized care acutely and over time.
Not all combat vets are treated by the VA. Many of them are
in the Reserve, National Guard, have TRICARE or private
insurances. They can and do show up in the ER’s and civilian
employer jobs.
48
49. PTSD and TBI symptoms
Overlap:
Emotional Liability• Difficulty with attention and concentration
• Amnesia for the event
• Irritability and anger
• Difficulty with over-stimulation
• Social isolation/difficulty in social situations
49
50. Identifying PTSD Consultants and
Trauma Specialists
• Expert therapists Psychiatrists (MD/DO)
• Clinical Psychologists (Ph.D./Psy.D.) Social worker
(LCSW/MSW) Psychiatric Nurse
• VA Medical Centers/VA PTSD programs/VA Vets
Centers/Community Bases Outpatient Clinics (CBOCs)
• Hospital/Medical Clinic Affiliations
50
51. Therapeutic Approaches &
Techniques
Prolonged Exposure Therapy (PE) – Prolonged Exposure
Therapy (PE) – Imaginal exposure: Repeated and prolonged
recounting of the traumatic experience
• In vivo exposure: Systematic confrontation of trauma-related
situations that are feared and avoided, despite being safe
• Goal: Increase emotional processing of the traumatic
event, so that memories or situations no longer result in:
• Anxious arousal to trauma
• Escape and avoidance behaviors
51
52. Therapeutic Approaches &
Techniques
Cognitive Processing Therapy (CPT) - Modify the
relationships between thoughts and feelings
• Identify and challenge inaccurate or extreme automatic
negative thoughts
• Develop alternative, more logical or helpful thoughts
• Goals:
• Help the individual recognize and adjust traumarelated thoughts and beliefs
• Help the individual modify his/her appraisals of self
and the world
52
53. Therapeutic Approaches &
Techniques
Eye Movement Desensitization and Reprocessing (EMDR)
• Information processing therapy and uses an eight phase
approach to address the experiential contributors for a
wide range of pathologies with a strong body of research
to support its effectiveness with PTSD. It attends to the
past experiences that have set the groundwork for
pathology, the current situations that trigger
dysfunctional emotions, beliefs and sensations, and the
positive experience needed to enhance future adaptive
behaviors and mental health.
53
54. Therapeutic Approaches &
Techniques
Medications: SSRI’s
• http://www.ptsd.va.gov/professional/pages/clinicians-guide-tomedications-for-ptsd.asp
• http://www.ptsd.va.gov/public/PTSD-overview/basics/index.asp
• Connecting and Networking
• PTSD/ Stress Disorder Treatment Units inpatient within the VA;
Battle Creek VA, Saginaw VA, Ann Arbor VA and their related
CBOCs, ie Grand Rapids VA Outpatient, Private Hospitals with
insurance.
• Captain Lovell Federal Health Care Center. An integration of the VA
and DOD systems Approach for the 21st Century. CARF and JCAHO
accredited. All Medical and PTSD.
54
55. Take Home Points
Essential Features of PTSD
• Re-experiencing symptoms (nightmares, intrusive
thoughts) Avoidance of Trauma cues
• Numbing/detachment from others
• Hyperarousal (i.e. increased startle, hypervigilance)
*A variety of factors including personal, cultural, and social
characteristics, coping abilities, experiences in war, and the
post- deployment/civilian environment all contribute to the
level, severity and duration of stress reactions.
55
57. Thank you!
Mark S. Kane, Ph.D. Licensed Psychologist
Fellow of the Michigan Psychological Association
Riverview Psychological Services, P.C.
drmskane@gmail.com 616-464-0811
57
58. Elena Bridges & Debra Unseld
Co-Chairs of Quality of Life
Subcommittee
Elena.bridges@altarum.org
debra.l.unseld.ctr@us.army.mil
59. Judge David Jordon, Retired, Ingham County VTC
Jon Caterino, 1st Mentor Coordinator Ingham County VTC
60. Worthiness of Veterans
“Those who sacrifice in military service
rightly enjoy profound honor. They
sacrifice their lives and
parts, sometimes their sanity, and
according to my analysis, they
sacrifice their freedom when plunged
into war. In a peace-ensuring
system, of trustworthy collective
security, those who offer to do the
soldier‟s work, to risk all that, and
sacrifice all that for peace, truly
deserve our honor.”
Dr. Jonathan Shay, Odysseus in
America, Combat trauma and the Trials of
67. Reflections on Another Soldier Killed
Rick Atkinson wrote of another soldier killed
in the Normandy invasion:
- Corporal William Preston wrote of one dead
soldier in particular who caught his eye: “I
wonder about him … [w]hat were his plans never
to be fulfilled, what fate brought him to that spot
at that moment? Who was waiting for him at
home?” Rick Atkinson, The Guns at Last Light
(Holt, 2013), p 87.
68. Losses Beyond the Veterans
Patricia O‟Malley visited the grave of her
father. She … was a year old when her
father, Major Richard James O‟Malley, a
battalion commander in the 12th
infantry, was killed by a sniper in Normandy
….[She] wrote of seeing his headstone for
the first time in the cemetery at
Colleville, above Omaha Beach.
- „I cried for the joy of being there and the sadness
of my father‟s death. I cried for all the times I
needed a father and never had one. I cried for
all the words I had wanted to say and wanted to
hear but had not. I cried and cried.‟” Ibid. p 638.
69. Why a Veterans’ Treatment
Court?
“My goal is a flourishing, good human
life for veterans, their families, and
their communities.”
-Dr. Jonathan Shay, Odysseus in
America, Combat Trauma and the Trials
of Homecoming (Scribner, 2002), p. 59.
70. Mission
- To support the veteran through
readjusting to civilian life, to assist the
veteran in navigating the Court
system, the treatment system, and the
VA system. More importantly, to act as a
friend and ally through this difficult
period.
Vision
- That “no veteran is left behind.”
71. Assessing the Need
A survey that evaluates the number of
justice-involved veterans in your
jurisdiction should be done. Nothing
fancy is necessary. We had all the
probation officers in our three district
courts ask.
You could start capturing the data at
intake, the jail population, or
otherwise.
72. Identify
eligible veteran-defendants
- through evidence based screening and
assessments.
Divert
those defendants
- with substance dependency and/or mental
illness
- charged with typically felony or
misdemeanor criminal offenses
- to a specialized criminal court docket
73. COMMUNITY RESOURCES
• The scope of the undertaking and
your community will dictate the
people and groups to engage.
74.
A bond occurs between veterans regarding
shared values and sacrifices made
When veterans have difficulties and need
support it is the responsibility of the
veteran community to advocate for and
support those veterans coming in contact
with Criminal Justice
76. Plea
Typically veterans enter by a plea
bargain.
This is between the parties.
People could enter post-sentencing
from a probation not going well.
The goal is to be creative and
inclusive.
77. Review by treatment team
Sentencing
Typical term is eighteen months
- Conditions
- Pledge for Veteran Defendant
Ingham County Veterans Treatment Court
Participant Pledge:
I recognize that my sobriety and mental health must be my first
priority, every day.
I will be honest with myself and others.
I will be accountable for my actions.
I will respect the Ingham County Veterans‟ Treatment Court
I will succeed.
78. Ideally
a veteran of
- same service and conflict
- same gender (Buffalo, NY Experience)
- approximately same age
Assign
at first court appearance if
possible
79. Role
of mentor
- Generally
Coach, Facilitator, Advisor, Sponsor, Motivator
- In court
Discuss at review how veteran is doing
- Outside court
Meet regularly with veteran
Be available when veteran needs assistance
Help veteran through benefit and court
systems
Convey new programs/opportunities to veteran
80. FEATURES OF PROBATIONARY
TERM
Again, the planning process of each
community will dictate the details of
probationary oversight. Frequent substance
testing is important. Judicial reviews should
be regular and carefully done. Research has
shown at least three minutes of time spent
with treatment court defendants materially
reduces recidivism. (Thus a mandate for
judges to talk longer.) But defendants having
positive interactions in Court with the Judge
is a big deal.
81. “…Well, I gotta say, you know and it’s
hard to say it, but maybe drunk driving
was probably one of the best things that’s
happened to me in a long time.
Me, going through this program and
some of the people I’ve come in contact
with, through this program, and just the
change of my whole heart. You know, I’m
back in church. Going to
meetings, different things, you know, that
I wouldn’t have done otherwise.…
82. …It’s actually given me back—I care to live
now. Before I couldn’t have cared less. I
mean I wasn’t suicidal or anything of that
nature. I didn’t care from day to next what
happened. And now I look forward to
today and I look forward to tomorrow.
The Court: Great.
And if you’d asked me that seven months
ago, I’d say, whatever. I’ve come a long
ways in a short period of time and, you
know, I’ve got to give credit to God for that.
And I just look forward to keep moving in
that direction.”
83. “I wanted to take the time to let you know
how happy and thankful my family and I
are with the amount you have helped
[defendant] and our family! He’s been
sober for seven months now and truly is a
changed man! He’s so happy and fun to
be around! His true personality shines
through once again, and we can’t thank
you enough for your help and support!”
- VTC Participant Family Member
84. 1.
HELP VETERANS NAVIGATE THE
COURT,VA AND TREATMENT
SYSTEMS
2.
ASSESS “OTHER” NEEDS AND
HELP HIM OR HER ADJUST TO
CIVILIAN LIFE
3.
HELP VETERANS RECEIVE THE
SERVICES THEY NEED TO BE
PRODUCTIVE MEMBERS OF
SOCIETY
85. “It is my hope that this program will
serve our veterans as well as they
have served us.”
Chief Justice Marilyn J. Kelley
addressing the Ingham County
Veterans‟ Treatment Court on
May 3, 2010.
86. Material used by generous permission of Mr. Trudeau
Note the “thousand yard stare” of Ray
and B.D.