Employment Support in VA Housing First...
Transcript of Employment Support in VA Housing First...
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EmploymentSupportInVAHousingFirstProgramsAnImportantStepinEndingVeteransHomelessnessGlenOsowski,USMC,RET,VocaEonalSpecialistShawnDowling,LISW-S,ACSW,HCHVCoordinator
DATE/MONTHMarch2017
VETERANSHEALTHADMINISTRATION
Homelessness Amongst Veterans
• Homelessnessistheendresultofproblemsthatanindividual/familycannotresolvewithoutassistance
• Everyonedealswithstressorsandchallengesdifferently
• ReallynowaytopredicthoworwhenaHomelessorVeteranwillrealizethathe/sheneedshelp
• ResearchindicatesthatthemajorityofVietnamVeteransdidnotrequesthelpunEl8-12yearsaWertheirdischarge
• VeteransareHomelessataHigherRateThanTheirNon-VeteranCounterparts
• VeteransareHomelessLongerThanTheirNon-VeteranCounterparts
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VETERANSHEALTHADMINISTRATION
3 Major Reasons for Homelessness Amongst Veterans
• EconomicHardship;usuallyinvolveemploymentissuesandmounEngdebt
• LackofAffordableHousing;Thecostofhousingmakesitunlikelyforasingle-wageearnertobeabletoaffordacomfortableandsaferentalunit
• HealthIssues;uptoonethirdofcombatveteransarelikelytoexperiencesomeclinicaldegreeofdepression,post-traumaEcstressdisorder(PTSD)orotheremoEonal/psychologicaldifficulEesdirectlyrelatedtotheirmilitaryexperience(VAIraqWarClinicianGuide,2004).
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VETERANSHEALTHADMINISTRATION
Impact of Military Service/Employment
• ProlongedseparaEonfromtradiEonalsupport• HighlystressfultrainingandoccupaEonaldemands
• Non-transferabilityofsomemilitaryoccupaEonalspecialEesintothecivilianworkforce
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VETERANSHEALTHADMINISTRATION
Obtain Steady Gainful Employment • ManymilitaryoccupaEonalspecialEesduringwarEme–weapons
specialists,muniEonshandlers,doorgunnersonhelicoptersandinfantrymen–arenottransferabletotheciviliansector
• TransferablemilitaryoccupaEonsofyoungerveterans–warehousemen,clericalandfoodserviceworkers,healthcareassistantsandlowerlevelworkerswithlimitedexperience–areonthelowendofthewagescale
• VeteransmaybecompeEngforrareemploymentopportuniEeswithcivilianswhohavemoresite-basedtrainingormorepersonalcontactwithpotenEalemployersandtheircrewsorstaff
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VETERANSHEALTHADMINISTRATION
Gainful Employment At A Living Wage
• GainfulemploymentatalivablewagewithopportuniEesforadvancementisthefoundaEonformaintainingeconomicstabilityandreducingtheriskofhomelessness
• Thosewhomustrelysolelyontheirownincomestosupportthemselvesandtheirfamilies,economicpressuresarecompoundedbythedifficultyofpayingforandaaendingeducaEonalprogramstoimprovetheirearningpotenEal
• Singleheadsofhousehold,theissueofpayingtuiEonandfeesisoWennotasprohibiEveaschildcareandothernecessaryexpensesassociatedwithgoingbacktoschool
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VETERANSHEALTHADMINISTRATION
Supportive Services/ Supported Employment
• TheVAAnnArborHUD-VASupportedHousingPrograminconjuncEonwithLucasMetropolitanHousingAuthority,LucasCountyVeteransServiceCommissionandVeteran’sMaaerhavehoused170VeteransHomelessVeteransinLucasCountyin2015-2016.
• TheVAAnnArborHealthcareforHomelessVeteransprograminconjuncEonwithNaEonalChurchResidence,LucasMetropolitanHousingAuthority,LucasCountyVeteransServiceCommissionandVeteransMaaerhavehoused75HomelessoratRiskofHomelessnessVeteransbetweenOctober2015throughDecember2015
• OftheVeteransintheseprogram,thoseVeteranswhoareabletowork,52%areworkingincompeEEveemployment(FYTD16)
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VETERANSHEALTHADMINISTRATION
Supportive Services/ Supported Employment
• VAAnnArborHealthcareforHomelessVeteransprogrampartnerswithNeighborhoodProperEesInc.fortheGriffinStreetProject,whereourHomelessVeteranswithseverementalillnessreceiveservicerichtransiEonalhousing;
• Weareproudtosharethat50%ofemploymenteligibleVeteranswereworkingincompeEEveemploymentatexitfromtheprogram(FYTD16).
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VETERANSHEALTHADMINISTRATION
Supportive Services/ Supported Employment
• ReachingFuncDonalZero;AnyHomelessVeteranwhopresentsinourcommunitywillhaveaclearpathtopermanenthousing
• CompeEEveemploymentiskeytoexiEngHomelessVeteransfromsheltertopermanenthousingandmaintainingthathousing
• WerecognizethatcreaEngemploymentopportuniEesforHomelessVeteranstakesacoordinatedapproachwhereintegraEonofevidencedbasedbestpracEcesareparamounttoourVeterans’success(bothforhousingandemployment)
• SupportedEmploymentisrecovery-orientated,consumerdriven,empowering-usingrealsocialsituaEonstolearnfromandlastly,itisindividualplacementandsupport(IPS)
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NotLehnghomelessnessgetintheway
FindingJobsforVeterans
VETERANSHEALTHADMINISTRATION
Vocational Path
School
Part-EmeorSeasonal
EntryLevel 2ndEntryLevel
Relocate/Transfer
Mid-LevelPromoEon Trainings
NextJob
DreamJob?
VETERANSHEALTHADMINISTRATION
Vocational Interventions
TradiDonalApproach• Lengthypre-assessment• Training,train-place
philosophy• Trialwork• Shelteredworkshops,
structure,andprotecEon
SupportedEmployment• Recovery-oriented• Consumerdriven• Empowering,realsocial
situaEonstolearnfrom• Place-train• IndividualPlacementand
Support(IPS)
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VETERANSHEALTHADMINISTRATION
IPS Effectiveness
ParEcipantsachievedameancompeEEveemploymentrateof60%,comparedto24%receivingtradiEonalvocaEonalservices(over12-18months)
(Bond,Drake,&Becker,2008)
VETERANSHEALTHADMINISTRATION
Outcomes • Overan8-yearperiod,thenumberofclientsservedinIPSonaquarterlybasishasgrownfrom792-9,359.
Becker,Drake,&Bond,BenchmarkOutcomesinSupportedEmployment,AmericanJournalofPsychiatricRehabilitaEon,2011.
• Thenumberofemployedquarterlyhasincreasedfrom299-3,875.
Meanemploymentrateover32
quarterswas47%,rangingfrom38%to
apeakof55%
VETERANSHEALTHADMINISTRATION
Practice Principles
1.)Zero-ExclusionPolicy2.)IntegratedEmployment&Treatment
3.)CompeEEveJobs4.)RapidJob-Search
5.)SystemaEcJobDevelopment
6.)Time-UnlimitedSupport7.)ConsumerPreferences8.)BenefitsPlanning
Becker,andDrake,2003
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VETERANSHEALTHADMINISTRATION
Zero Exclusion Criteria All clients who want to work are eligible
• Psychiatricdiagnosis• Symptoms• Treatmentchoices• Workhistory• Legalhistory
• Substanceabuse• CogniEveimpairment
• CogniEveproblems• Missedappointments
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VETERANSHEALTHADMINISTRATION
Integrated Employment & Treatment Open communication between providers is vital
• SEspecialistembeddedonmulE-disciplinarytreatmentteams• Shareddecisionmaking,withtheclientatthecenter• Gehngajobisapartoftreatment,andchangestoserviceplansmaybenecessary
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VETERANSHEALTHADMINISTRATION
COMPETITIVE JOBS Integrated work settings
• NotprevocaEonal,sheltered,orsegregatedworkexperiences
• RegularjobsinthecommunityratherthanjobsthataresetasideforpeoplewithdisabiliEes
• Don'tincludearEficialEmelimits• Payatleastminimumwage• SamepayandbenefitsforeveryonewhoholdsthoseposiEons
• Part-Emeorfull-Eme
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VETERANSHEALTHADMINISTRATION
Rapid Job Search Contact with potential employers & job exploration is conducted within the first month of referral
• Nodelayfortrainingorassessmentprocedures• Clientshavestrengthsandskillstotaketothejob,alreadyready
• DemonstratesthatpracEEonersaretakingtheirclients’goalsseriously
• ExploringjobsinthecommunityisonewaytotakeadvantageofmoEvaEon:peoplegetexcitedastheyseethepossibiliEes
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VETERANSHEALTHADMINISTRATION
Systematic Job Development Job search is very specific
• DevelopingrelaEonshipswithpotenEalemployers
• Learningmoreabouttheneedsandpreferencesofacompanyto“jobcarve”
• ApplyingtojobposEngs,andfollowingupwithhiringmanagerinperson
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VETERANSHEALTHADMINISTRATION
Time-Unlimited Support Individualized support for as long as needed, or desired
• SupportmaybeemoEonalinnature,ortroubleshooEngworkplacedifficulEes• NosetEmeframelimiEngparEcipaEon• JobinterestsmayevolveoverEme,newopportuniEesmaybedesired
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VETERANSHEALTHADMINISTRATION
Client Preferences Strongly influence all aspects of the job search process
• Findingajobthatfitstheperson,NOTchangingthepersontofitthejob
• Jobsearchmustembraceaperson'svalues,interests,andownwayofdoingthings
• Disclosureofillness• Whattypeofassistancedotheywant?• VAP
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VETERANSHEALTHADMINISTRATION
Potential Barriers
• Fear/anxiety• Benefits
• TransportaEon• Legalissues• Workhistory
STRENGTHS,GAPSANDCHALLENGESFORHOMELESSVETERANSEMPLOYMENTINOURCOMMUNITY
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VETERANSHEALTHADMINISTRATION
VA MISSION Lincoln’sCharge,1865~
“Tocareforhimwhoshallhavebornethebaale,andforhiswidowandhisorphan.”
Today~
“Tocareforthosewhoshallhavebornethebaale,andfortheirfamiliesandtheirsurvivors.”
VETERANSHEALTHADMINISTRATION
FACTS • DepartmentofDefensefocusedontrainingtroopsforwar
anditfallsoncommuniEestohelpmilitarymenandwomenhelptransiEontocivilianemployment
• Only17%ofthosethatentertheservicestayunElreErement.• TheVeteranunemploymentrateforthosewhoservedaWer
9/11is6.5percentasopposedto4.9percentforallotherVeteranswhichissimilarrateforallAmericans.
• AsthemilitarydownsizesarenewedfocusonhelpingVeteransfindjobs.
• Two-thirdsofVeteransexperiencedadifficulttransiEonfrommilitarytocivilianlife
VETERANSHEALTHADMINISTRATION
FACTS • Veteransnamefindingajobasthegreatestchallengein
transiEoning• MilitaryVeteransarehighlydisciplinedandhighlytrained.• Veteranshavetroublefindingandkeepingjobsandcivilian
employersstruggletounderstandthem.• Studiesanddatasupportthatnon-Veteransaremoreviolent
offendersthanVeterans• SomeVeteransneedlongtermsupportbutthevastmajority
don’tneednorwantahandout,theyjustneedahandshake.
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VETERANSHEALTHADMINISTRATION
“RightnowtomeIammorescaredofsihnginaninterviewroomgehnginterviewedforajob,thenwhenIhadpeople
shootatme.”
-USArmyVeteran
VETERANSHEALTHADMINISTRATION
Toledo Veteran Challenges to Employment
• Food,Clothing,PersonalHygiene• RemovinglegalissuestoincludefelonyconvicEons,criminalcharges,taxissues,familyandchildsupport,lossofdrivingprivilegesandconsumerdebt
• GeographicalOpportuniEesandTransportaEon
• PhysicalandMentalhealthchallenges• TransferringmilitaryskillsandtrainingtocivilianworkforceorcerEficaEons
VETERANSHEALTHADMINISTRATION
Toledo Veteran Challenges to Employment
• SupportortrainingfortransiEonalchallenges• Culturalbarriers–Militarymodelofsupport,Veteranbeliefsaboutemployers
• CompeEngwithcandidatesandeducaEon• Veterandriven• Telephone,Computerhardware,computercompetencyandinternetaccess
• CurrenteconomicsituaEon
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“CommunitycollaboraEonhasbeenidenEfiedasthesinglemosteffecEvemeansofenhancingthequalityofandulEmatesuccessofemploymentandvocaEonal
trainingprogramsandservices.”-DepartmentofLaborNaDonalCoaliDonforHomeless
Veterans
VETERANSHEALTHADMINISTRATION
GAPS AND OPPORTUNITIES NearlyhalfofallVeteranjobseekers
reportneeding“ALot”ofhelp• Networking• Skillsin“closing”ajobinterviewandInterviewskills• TargeEngemployersandresearchingcompanies• EffecEveresumewriEngandwriEngacoverleaer• Preparingforajobinterview• Followingupwithinterviews• ImprovingtransiEoningsupportearlier
VETERANSHEALTHADMINISTRATION
GAPS AND OPPORTUNITIES
• Training–Post9-11notchoosingperceivedcivilianvocaEons• Smallgrouptraining• VeteransexpressstronginterestinpotenEalcustomized
programs• VeteranshavehighexpectaEonsforemployer-provided
supportprograms–thisisNOTenEtlement• EducaEonandVocaEonalTraining• Employernetworkwithroundtablequarterlyfeedback
meeEng
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VETERANSHEALTHADMINISTRATION
WecanpreventnotjusttreathomelessnessamongVeterans.
VETERANSHEALTHADMINISTRATION
A Community-Wide Action To End Veterans Homelessness
• CoordinatedefforttoconnectHomelessVeteranswithimmediate,“rightfit”employmentwithsupportedservices
• CoordinatedefforttoplaceHomelessVeteransinjobtrainingprogramsthatenhanceskillsandleaddirectlytocompeEEveemployment
• UElizaEonofFederal,State,CountyandCityresourcesincoordinaEon;avoidingduplicaEonofservicetoprovideaNoWrongDoorapproachtovocaEonalandemploymentservices
• ConveneaworkgroupofkeystakeholderstocreateclearaccesstocompeEEveemploymentthatassureseachHomelessVeterancanaffordtoliveautonomously
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VETERANSHEALTHADMINISTRATION
Bibliography
• Ainspan,N.D.(2011).FromDeploymenttoEmployment.U.S.NavalInsEtuteProceedings,137(2),44–50.
• Black,D.,&Lane,J.(2007).ReportonTask1:TheLaborMarketTrajectoriesof20–24yearoldVeterans.RetrievedfromNORCwebsite:hap://www.dol.gov/vets/research/trajectories_rev.pdf
• CohenS.I.,Suri,P.,Amick,M.M.,&Yan,K.(2013).ClinicalanddemographicfactorsassociatedwithemploymentstatusinU.S.militaryVeteransreturningfromIraqandAfghanistan.Work,44(2),213–219.
• DavisL.L.,Leon,A.C.,Toscano,R.,Drebing,C.E.,Ward,L.C.,Parke,P.E.,Kushner,T.M.,&Drake,R.E.(2012).ArandomizedcontrolledtrialofsupportedemploymentamongVeteranswithposaraumaEcstressdisorder.PsychiatricServices,63(5),464–470.doi:10.1176/appi.ps.201100340.
• Drebing,C.E.,Mueller,L.,VanOrmer,E.A.,Duffy,P.,LePage,J.,Rosenheck,R.,Drake,R.,Rose,G.S.,King,K.,&Penk,W.(2012).PathwaystovocaEonalservices:FactorsaffecEngentrybyVeteransenrolledinVeteransHealthAdministraEonmentalhealthservices.PsychologicalServices,9(1),49–63.
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Bibliography
• Drebing,C.E.,VanOrmer,A.,Mueller,L.,Hebert,M.,Penk,W.E.,Petry,N.M.,Rosenheck,R.,&Rounsaville,B.(2007).AddingconEngencymanagementintervenEontovocaEonalrehabilitaEon:OutcomesforduallydiagnosedVeterans.JournalofRehabilitaEonResearch&Development,44(6),851–866.
• Drebing,C.E.,VanOrmer,E.A.,Schua,R.,Krebs,C.,Losardo,M.,Boyd,C.,Penk,W.,&Rosenheck,R.(2004).ClientgoalsforparEcipaEnginVHAvocaEonalrehabilitaEon:DistribuEonandrelaEonshiptooutcome.RehabilitaEonCounselingBulleEn,47(3),162–172.
• Debring,C.E.,Rosenheck,R.,Schua,R.,Kasprow,W.J.,&Penk,W.(2003).PaaernsinreferralandadmissiontovocaEonalrehabilitaEonassociatedwithcoexisEngpsychiatricandsubstance-usedisorders.RehabilitaEonCounselingBulleEn,47(1),15–23.
• Ellison,M.L.,Mueller,L.,Henze,K.,Corrigan,P.,Larson,J.,Kieval,N.E.,Sawh.L.,&Smelson,D.(2012).TheVeteranSupportedEducaEonTreatmentManual(VetSEd).Bedford,MA:ENRMVeteransHospital,CenterforHealthQuality,Outcomes,andEconomicResearch.Retrievedfromwww.va.gov/HOMELESS/docs/Center/VetSEd_Manual_Version_FINAL.pdf
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VETERANSHEALTHADMINISTRATION
Bibliography
• Frain,M.P.,Bethel,M.,&Bishop,M.(2010).AroadmapforrehabilitaEoncounselingtoservemilitaryVeteranswithdisabiliEes.JournalofRehabilitaEon,76(1),13–21.
• Frueh,B.C.,Henning,K.R.,Pellegrin,K.L.,&Chobot,K.(1997).RelaEonshipbetweenscoresonangermeasuresandPTSDsymptomatology,employment,andcompensaEon-seekingstatusincombatVeterans.JournalofClinicalPsychology,53(8),871–878.
• Goldberg,R.W.,&Resnick,S.G.(2010).U.S.DepartmentofVeteransAffairs(VA)effortstopromotepsychosocialrehabilitaEonandrecovery.PsychiatricRehabilitaEonJournal,33(4),255–258.
• Harrell,M.C.,&Berglass,N.(2012).EmployingAmerica’sVeterans,PerspecEvesfromBusinesses.RetrievedfromMilitary,Veterans,andSocietyProgramattheCenterforaNewAmericanSecuritywebsite:hap://www.cnas.org/files/documents/publicaEons/CNAS_EmployingAmericasVeterans_HarrellBerglass.pdf
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Bibliography
• Humphreys,H.&Rosenheck,R.(1998).TreatmentinvolvementandoutcomesforfoursubtypesofhomelessVeterans.AmericanJournalofOrthopsychiatry,68(2),285–294.
• HumenskyJ.L.,Jordan,N.,Stroupe,K.T.,&Hynes,D.(2013).EmploymentstatusofVeteransreceivingsubstanceabusetreatmentfromtheU.S.DepartmentofVeteransAffairs.PsychiatricServices,64(2),177–180.
• LePageJ.P.,Lewis,A.A.,Washington,E.L.,Davis,B.,&Glasgow,A.(2013)EffectsofstructuredvocaEonalservicesinex-offenderVeteranswithmentalillness:6-monthfollow-up.JRehabilResDev,50(2),183–92.
• Mares,A.S.andRosenheck,R.A.(2006).AhtudestowardsemploymentandemploymentoutcomesamonghomelessVeteranswithsubstanceabuseand/orpsychiatricproblems.AmericanJournalofPsychiatricRehabilitaEon,9(3),145–166.
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