West Michigan Veterans Coalition Feb 2014 Quarterly Meeting

Tuesday, February 4, 2014

West Michigan Veterans Coalition

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.

Education Employment Healthcare Quality of Life

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

Agenda

Jonathan Highman, Chairman of Education [email protected]

Education Subcommittee


mailto:[email protected]

Work-study DepartmentVA Regional OfficeSt. Louis, Missouri

Telephone: (314) 552-9861Fax: (314) 552-9533

VA Work Study Program

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).

Brief Overview

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.

Brief Overview (cont.)

Read and understand theWork-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.

Responsibilities of a Site Supervisor

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 thework-study department: [email protected] in 50-hour increments.

Report any changes in the work-study’s address to the work study department ASAP.

Make all work-study inquiries on behalf of the veteran.

Responsibilities of a Supervisor

(cont.)


Determined by the VAMust be enrolled in classes at

least ¾ timeMust 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)

Veteran Eligibility

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.

How a student-veteran applies

http://www.vba.va.gov/pubs/forms/vba-22-8691-are.pdf

Telephone: (314) 552-9861(10am-2pm central)

Fax: (314) 552-9533 (24 hours) [email protected] (Inquiries) [email protected]

(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

Where to get help



http://gibill.va.gov/

http://www.va.gov/

VA Work StudySupervisor’s Handbook

Application for Work-studyallowance (VA Form 22-8691)

Useful Documents

Brandi McBride & Michael Poyma, Co-Chairs of Employment [email protected]@va.gov

Employment Subcommittee




Employment Focus

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

KEY INSIGHT

Two unique veteran populations facing different challenges

Veterans with Significant Barriers

HCHV

VOA

Community Rebuilders

Transitional Housing

Shelters

VA

MRS

Disability Advocates

211 (Coming)

Network 180

Disability Advocates

Ind. Living Centers

Goodwill

VOA

Veteran’s Court

Felony-friendly

employers

Homeless DisabilitiesSubstance Abuse/

Mental Illness Felonies Student Veterans

Job Seekers

Student Vets of America

Veteran Services Officers

Career Counselors

Consortium of Military and

Veteran Educators

MI Talent

H2H

Job Fairs

In-between

Job-Ready Veterans

We need to educate employers about these populations*

for veterans to work through service providers to get to

employers to eventually find employment?

WHAT IS THE SYSTEM…

• VOA

• Buddy 2 Buddy

• VA

• Michigan Works

• Goodwill Industries

• Suits for Soldiers

• Army One Source

• Career Counselors

• Disability Advocates

• VetBiz Central

• Veteran’s Services Division

• MVAA Portal

• TALENT 2025

• MI Talent

• Hello West Michigan

• MVAA Portal

• Prisoner Re-entry Programs

The Service

Provider

The Employer Resource

• WGVU

• Chamber

What is the system?

• H2H

• SHRM • Job Fairs

TheJOB

The Veteran

• Disabled

• Retired

• Separated

• Prisoners

• Guard/Reserves

• Higher Education

• Entry Level

• General Labor

• Management

• Executive Level

• Entrepreneurial

• Part-Time / Full-Time

THE SYSTEM

• Active Duty

• Homeless

CURRENT PRACTICESTAP | Job Fairs | Job Boards | MI Talent

The Veteran

The Employer

Interaction between both but neither one understands the other

Hola, estoy buscando un trabajo. ¿Tiene alguna posición abierta?

Ich habe eine offene Position,

sind Sie interessiert an der Arbeit?

*

HOW DO WE CHANGE IT???

GOAL #1

Networking/educational workshops for employers

TALENT 2025

ESGR

MVAA

TRAINING WORKSHOPS

SERVICE PROVIDERS

Employers will be able to …

Understand populations | Translate skills Communicate at Job Fairs | Post Jobs on H2H

*

GOAL #2

Small networking events to connect smaller employers to

veterans

EMPLOYER

VETERANSERVICE PROVIDER

MONTCALMJUNE

OTTAWAAUGUST

NEWAYGOOCTOBER KENT

DECEMBER

KENTAPRIL

SERVICE PROVIDER

EMPLOYERVETERAN

Sponsored by GR Chamber and Hello West Michigan*

THE WAY FORWARD

Employment programming in a collaborative

environment

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

QUESTIONS?

Employment Focus

Carrie Roy & Elena Bridges, Co-Chairs of Healthcare [email protected] [email protected]

Healthcare Subcommittee




Health Care Subcommittee

Barriers• Lack of Education/Information/Family Support• Cumbersome System• Transportation•Mental Health- Stigmas, specifically PTSD

PTSD 101A short history, symptoms, and treatments.

32Mark S. Kane, Ph.D. Licensed PsychologistFellow of the Michigan Psychological AssociationRiverview Psychological Services, [email protected] 616-464-0811


National Center for Post Traumatic Stress Disorder Statistics7.8 % 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

http://www.ncptsd.va.gov/

“Best Practice Treatment” of Shell Shock after WWI

34

* 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

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.

36Part of: Selected Civil War photographs, 1861-1865 (Library of Congress)

http://www.loc.gov/pictures/item/cwp2003000865/PP/

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 alone?

• For what offense have I this fortnight been

• A banished woman from my Harry's bed?

• Tell me, sweet lord, what is't that takes from thee

• Thy stomach, pleasure, and thy golden sleep?

• Why dost thou bend thine eyes upon the earth,

• And start so often when thou sit'st alone?

• Why hast thou lost the fresh blood in thy cheeks

• And given my treasures and my rights of thee

• To thick-eyed musing and cursed melancholy?

• In thy faint slumbers I by thee have watched,

• And heard thee murmur tales of iron wars,

• Speak terms of manage to thy bounding steed,

• Cry 'Courage! to the field!' And thou hast talked

• Of sallies and retires, of trenches, tents,

• Of palisadoes, frontiers, parapets,

• Of basilisks, of cannon, culverin,

• Of prisoners' ransom, and of soldiers slain,

• And all the currents of a heady fight.

• Thy spirit within thee hath been so at war,

• And thus hath so bestirred thee in thy sleep,

• That beads of sweat have stood upon thy brow

• Like bubbles in a late-disturbèd stream,

• And in thy face strange motions have appeared,

• Such as we see when men restrain their breath

• On some great sudden hest. O, what portents are

these?

• Some heavy business hath my lord in hand,

• And I must know it, else he loves me not

37

History of PTSD: “Shell Shock” World War I

38

PTSD first used in 1980 in DSM-IIICurrent 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

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/2001-09/hrs_200109205g_hr.jpg

Combat FatigueImmediate 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

Symptoms of PTSD

42

• 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

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

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

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

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

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

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

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

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

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

Therapeutic Approaches & TechniquesCognitive 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 trauma-

related thoughts and beliefs• Help the individual modify his/her appraisals of self

and the world52

Therapeutic Approaches & TechniquesEye 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

Therapeutic Approaches & TechniquesMedications: SSRI’s

• http://www.ptsd.va.gov/professional/pages/clinicians-guide-to-medications-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

http://www.ptsd.va.gov/professional/pages/clinicians-guide-to-medications-for-ptsd.asp



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

“Courage is learning to ask for help”

56

Thank you!Mark S. Kane, Ph.D. Licensed PsychologistFellow of the Michigan Psychological AssociationRiverview Psychological Services, P.C.

[email protected] 616-464-0811 57


Elena Bridges & Debra Unseld Co-Chairs of Quality of Life [email protected] [email protected]

Quality of Life Subcommittee




Developing and Implementing a

Veterans’ Treatment Court

Judge David Jordon, Retired, Ingham County VTC

Jon Caterino, 1st Mentor Coordinator Ingham County VTC

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 Homecoming (Scribner, 2002), p. __.

MSU ALUMNI CHAPEL

JOHNNY’S HIGH SCHOOL YEARBOOK

A LEADER IN HIGH SCHOOL

Reflections on Another Soldier KilledRick 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.

Losses Beyond the VeteransPatricia 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.

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.

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.”

Mission and Vision

Assessing the NeedA 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.

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

How it Works

COMMUNITY RESOURCES

• The scope of the undertaking and your community will dictate the people and groups to engage.

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

Veteran Bond – Why it Matters

JudgeProsecuting Official(s), Defense Counsel

ProbationVA representative(s)- Health/treatment- Benefits (pension, grants, etc)- County Veterans’ Counselors

Other treatment providers Court Staff

Treatment Team

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.

Review by treatment teamSentencing 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.

Sentencing

Ideally a veteran of- same service and conflict- same gender (Buffalo, NY

Experience)- approximately same age

Assign at first court appearance if possible

Veteran Mentor - Assignment

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

Veteran Mentor - Role

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.

“…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.…

Results

…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.”

- VTC Participant

Cont.

“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

Another Result

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

In the End – The Goals

“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.

In the End – The Challenge

Material used by generous permission of Mr. Trudeau

Note the “thousand yard stare” of Ray and B.D.

THE CHALLENGEIf we can help, we should help.

Developing and Implementing a

Veterans’ Treatment Court

Judge David Jordon, Retired, Ingham County VTC

Jon Caterino, 1st Mentor Coordinator, Ingham County VTC

Thank you

To register please go tohttp://www.healingthewoundedwarriormi.com/