ALABAMA VETERANS CONFERENCE MAY 2012 DISABILITIES & CASE MANAGEMENT

Profile of Today’s Soldiers All Volunteer Average Age 27 – 28 Many Married With Families High Number of Guard and Reservists

More Women in Combat More Than One Deployment Technology Improvements On & Off The Field Profile of Today’s Soldiers

High Number of Survivors WWII 1 soldier killed WWII 1 soldier killed = 1.6 wounded = 1.6 wounded Viet Nam 1 soldier killed Viet Nam 1 soldier killed = 2.6 wounded = 2.6 wounded OIF/OEF 1 soldier killed OIF/OEF 1 soldier killed = 16 wounded = 16 wounded Better care on the field & better armor

High Number of Survivors Transport field to U.S. Hospitals Viet Nam 35 – 40 days OIF/OEF 35 – 40 hours

QUOTE "In the history of the Republic, never has so much been placed on the shoulders of so few for so long," said Brigadier General Loree K. Sutton, director of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, "We have no reference population to compare with the addiction and mental-health problems facing today's military personnel.”Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury

Frequent Types of Disabilities Amputations Hearing Loss Visual Impairments Mental or Emotional Disorders ~ Anxiety Disorders -including PTSD ~ Depression Traumatic Brain Injury Burns

Amputations High tech prosthetics Above the knee/elbow compared to Below the joint Most have multiple prostheticsIn demand by employers Never assume limitations without discussion

Hearing Loss Technology getting better Many hearing aides only amplify sound Communication adds to frustration May be more difficult to place on a job May interfere with retention

Visual Impairments Common problem with soldiers May be associated with other issues Many devices/agencies to help JAN would be a good resource for placement issues

Mental /Emotional Anxiety disorders, including PTSD Depression Could be in combination

Anxiety Unlike the relative mild, brief anxiety caused by such a stressful event such as business presentations or a first date, anxiety disorders are chronic, relentless and can grow progressively worse, if untreated. Included: Panic, obsessive-compulsive, PTSD, phobia’s, & generalized anxiety disorder.

Depression An illness that involves the body, mood and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. Without treatment, symptoms can last for weeks, months or years.

Depression Symptoms Loss of interest in activities Weight loss or gain Poor concentration/memory Social withdrawal Unusual fatigue Feelings of worthlessness, sad Flat affect

Post Traumatic Stress Disorder Exposure to an event that causes intense horror, terror, or fear of death. After the event, the person: persistently re-experiences the event, attempts to avoid memory or images of the event, and suffers distress or impairment.

PTSD Many do not seek help-they do not want to be seen as “weak” May feel great guilt, just for surviving Do not recognize own symptoms for a long time Often a major event will bring it to surface A Whole body-mind disorder

PTSD Symptoms Sleep Problems Restlessness Overly watchful or hyper vigilant Social withdrawal Headaches or unexplained personality changes Anger outbursts-out of character Risk taking behavior

PTSD Symptoms Distrust of authority Socially disconnected/emotionally numb Depressed/anxious Problems with memory, attention, follow through Poor frustration tolerances

Traumatic Brain Injury or Concussive Blast Injury Estimates of over 30% from OIF/OEF have TBI Most resolved in 90 days 60% of bomb blast victims have TBI 80% with TBI also have PTSD Many avoid screening and do not disclose

TBI Common Symptoms Symptoms depends on part of the brain injured FatigueHeadachesAlertness/concentrationLack of Self Awareness

TBI/PTSD Share many symptoms Sleep problems Depression Anger/irritability Concentration Memory Planning Attention Poor frustration tolerance

What to Do? Listen carefullyDon’t try and diagnoseBe consistent Ask what would help-memory aides are important Be Patient Make appropriate referral if they are undiagnosed and you suspect an issue

COPING Denial/Isolation Anger Depression Acceptance Hope

USING THE SERVICE DELIVERY STRATEGIES TO PLACE WITH WARRIORS CASE MANAGEMENT

JAssessment Red Flags Strategies

Elements of Case Management Assessment Case Notes Develop and Document a Plan Case Notes Referral to Support Services Case Notes Follow up and Modification Case Notes Facilitate Job Placement

Definition: Case Man-age-ment Case Management, as the framework for Intensive Services is the facilitation and coordination of services at the community level. The purpose of case management is to provide an individual with specific resources to take control of his / her life. It requires the case manager to focus on the long and short term goals an individual has and empower him / her to make educated decisions about his or her future.

1. Comprehensive and client centered 2. The service provider and the client are partners 3. There is mutual respect between clients and service provider. 4. A client has only one IDP Nine Key Concepts

5. Relates the client’s actions to outcomes 6. Involves creative problem-solving 7. Relies on a network of services and support 8. The service provider and the system are accountable 9. Requires partnership at the systems level Nine Key Concepts (Continued)

INITIAL ASSESSMENT Gather Relevant Information Establish Rapport Use Whole Person Concept Analyze Information Identify Barriers to Employment

One on One facilitation skills Body Language Reflection Open-Ended Questions Closed-Ended Questions Active listening Non Judgemental Para-Phrasing Taking Effective Case Notes

SOCIAL & ECONOMIC FACTORS INTERESTS POTENTIAL SKILLS LEISURE TIME ACTIVITIES PHYSICAL CAPACITIES PERSONAL TRAITS TRANSFERABLE SKILLS EDUCATION & TRAINING

Case Notes  DATE anything you write  QUOTE exactly as stated  Recognize PERTINENT information  Write in SPECIFIC, OBSERVABLE and MEASURABLE terms  If your OPINION, say so

Writing The Individual Plan Determine Employment Barriers to Address Set Goals Establish Plan as a Team Review Implement Monitor Modify If Needed

Criteria For Goals S pecific M easurable A ttainable R ealistic T rackable S-M-A-R-T

1. Change problem statements into goal statements 2. Brainstorm solutions and options 3. Balance options with reality; Choosing one or more options 4. Sequence and assign responsibility on the IDP

FACILITATING JOB PLACEMENT Establishing Business Relationships Through the Business Services Team Through the Local Veterans Employment Representative On Your Own Critical when placing individuals who have been in Case Management Critical when working with someone who has a disability needing accommodations

COMMENTS FROM BUSINESSES  Veterans may need more time after returning home  Awareness of the needed mental and physical skills of a job  Be there after the hire  New challenges may arise for the veteran  Be willing to educate my staff and/or supervisors  Are absent from work for on-going treatment, not disclosed  *INSTITUTE ON REHABILITATIVE ISSUES

Concern All companies Small (5–14) Medium (15–249) Large (250 or more ) %Rank% % % It costs more to employ workers with disabilities Workers with disabilities lack the skills and experience to do our jobs People with disabilities may not be as safe and productive as other workers Supervisors are not sure how to take disciplinary action Supervisors are not sure how to evaluate

Table 12. Percent of companies citing hiring strategies that would be helpful in hiring people with disabilities, by company size Strategy All companies Small (5–14) Medium (15–249) Large (250 or more) %Rank% % % Employer tax credits and incentives Disability awareness training Visible top management commitment Mentoring Assistive technology Using a specialized recruiting source Flexible work schedule Training existing staff On-site consultation or technical assistance Disability targeted internship program Short-term on the job assistance with job coach

Alternative Job Development Techniques Mentors Supported Employment On the Job Training Specialized Programs Creating Jobs

Mentors Mentors are normally from inside the organization Become the go to person for the veteran Meetings are held regularly, maybe daily in the beginning then less and less

Supported Employment Using employment coachesThe coach learns the job The coach coordinates with the supervisor The coach teaches the veteran the job They work side by side as needed A contract often defines the roles

Possible Coaches Retirees Graduate Students in Counseling or Rehabilitation Disability Navigators Through VR&E or State Rehabilitation programs

On the Job Training A contract is established with the employer, the veteran and the placement specialist Time frames are established along with expected knowledge to be gained Normally pay increases at each step of the process

Specialized Community Organizations Placement is in a controlled environment Supervisors work for the agency Work is carried on at the agency or in the field under agency supervision Many communities have these organizations: Goodwill, Compensated Work Therapy, etc.

Alternative Job Development Technique Business Perspective Connecting with the Business Community Being Aware Creating a Job Developing Proposals

The Business Proposal Identify problem / issue within a business Explainhowthis could be addressed Provide a description of someone you know who could fill the proposed position Provide a description of someone you know who could fill the proposed position Enclose a list of references referencesContactInformation

POSSIBLE ACCOMMODATIONS Several Apps for the Phone Reduce Distractions Provide Private Space Lighting Divide Work into Smaller Tasks Work from Home Allow for Flex Time Disability Awareness Training to Co-Workers

What is Your Role? Recognize possible problems, if un-diagnosed and make referrals Know the resources and options for employment in your area Help research accommodations Understand the frustrations Be creative when thinking employment

QUESTIONS? SUGGESTIONS? IDEAS? RESOURCES?