1. Is Employment Enough? How to Support Employment Success through Veteran Empowerment… a Holistic Approach Samantha Loving, MS, CRC, VHA-CM Health Science Specialist National Homeless Program Office & OMHO Therapeutic and Supported Employment Services (TSES) Office

2. Training Objectives O Understand how employment can be affected by other factors in a Veterans life (i.e., homelessness, dual diagnosis, justice- involved, deployment, addiction, PTSD, suicide risk, etc.); O Identify available VA and community and on-line employment support programs; O Recognize how GPD grantee programs can support the Veterans in their programs with their employment needs; O Understand the importance of partnering with VA providers and natural support system to provide recovery-oriented, holistic care for Veterans in the GPD programs; and O Identify how GPD programs can support employment and job search while maintaining program policies and procedures. 2

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4. Abbreviation Reference List O CEC:Community Employment Coordinator O CWT:Compensated Work Therapy O CWT/TR:Compensated Work Therapy/Transitional Residence O DCHV:Domiciliary Care for Homeless Veterans O DOL:Department of Labor O GPD:Grant & Per Diem O HCHV:Health Care for Homeless Veterans O HUD-VASH:Housing & Urban Development – VA Supportive Housing O HVCES:Homeless Veterans Community Employment Services O HVRP:Homeless Veterans Reintegration Program O State VR:State Vocational Rehabilitation O VBA:Veterans Benefits Administration O VETS:Veterans Employment & Training Service (part of DOL) O VHA:Veterans Health Administration O VR&E:Vocational Rehabilitation & Employment 4

5. A random sample of homeless people showed that 88% were unemployed. The median duration of homelessness for those [who were] employed was 126 days vs. 201 days for those who were unemployed. Data source: Caton, Dominguez et al., 2005. “Risk Factors for Long-Term Homelessness: Findings for a Longitudinal Study for First-Time Homeless Single Adults”. 5

6. Put Yourself in These Shoes… I’m a 60-year-old Vietnam-Era combat Veteran who’s been homeless off and on for over 30 years (since returning from Vietnam). I’m currently residing in a GPD Program in Detroit. I feel pretty useless and would really like to work, but can’t seem to keep a job. I’ve not held a job for more than 3 months each during this time due to the following challenges: O History of addiction O Bipolar Disorder O History of incarceration O PTSD O Untrusting of others O Support System:Burned all bridges with family, but I have a childhood friend I still lean on for support O Employment Goals:In the military, I was a mechanic… I really liked working on vehicles HOW WOULD YOU SUPPORT THIS VETERAN? 6

7. Veterans working in the civilian workforce may experience: O Loss of teamwork/unit cohesion felt during military service; O Feel that others don’t understand or appreciate your military experiences (isolating self); O Difficulty adjusting to new or lack of rules/structure; O Feel that civilian job is pointless or trivial; O Feel frustrated when co-workers/supervisors are perceived to be inefficient or ineffective. O Increased irritability, feeling on-edge, and/or easily distracted; O Conflicts with your boss or co-workers; O Trouble concentrating and completing assignments; O Passed over for promotions; O Feel frustrated or stuck in your current position; O Feel pressure from demands of job and its impact on personal/financial situation (i.e., mental health, housing, family, financial, addiction/recovery, etc.). 7 Unique Veteran Employment Experience

8. Side Effects of Unemployment in the General Population Increased substance abuse Increased physical problems Increased psychiatric disorders Reduced self-esteem Loss of social contacts Alienation and apathy Warr, P.B. (1987), Work,Unemployment and Mental Health, Clarendon Press, Oxford 8

9. Employment as an Important Component in Ending Homelessness O Veteran feels as though they are a contributing member of society, O Increased financial stability, O Improved emotional stability, O Improved housing stability, and O Increased clinical stability. 9

10. According to the U.S. Interagency Council on Homelessness website (www.ich.gov), unemployment is cited as the third leading cause of homelessness in the United States. The U.S. Department of Labor publication: Employment Assistance Guide for Service Providers Helping Homeless Veterans states: “Unemployment and underemployment are two of the most critical issues affecting homeless veterans… Studies show that gainful employment at a livable wage, with opportunities for advancement, is the foundation for maintaining economic stability and reducing the risk of becoming homeless.” 10

11. Veterans and Recovery According to the National Consensus on Mental Health Recovery, “Mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential.” 11

12. Recovery is a journey that involves developing hope, self- direction, empowerment, respect, and peer support. 12

13. What does a GPD Program have to do with Veteran Employment? 13

14. Current GPD Performance Metrics 65% of Veterans discharged to permanent housing 42% of Veterans are employed at discharge <30% Negative Discharges from GPD * Based on FY 2014 Homeless Performance Metrics 14

15. “It is nearly impossible to make your own future when you are not part of the economic fabric of the culture you live in.” -Patricia Deegan, June 2004 20 th World Congress Rehab International: Oslo, Norway 15

16. Correlation between GPD Low Demand Principles & Recovery-Based Employment Supports O Recovery-Based Employment Supports: O No exclusionary… i.e., services continue even during setbacks. O Integration of services with Veteran’s treatment/support team in order to coordinate care and provide individualized support. O Empowerment of Veteran to self-direct their future through personal responsibility and self-direction. O Use of peer supports to further empower Veteran. O Low Demand Principles for GPD: O Lower barriers to services, more flexibility in working with Veterans who relapse, and worked toward the development of flexible service designs. O Provision of transitional housing, case management, and services to homeless Veterans. Services can include, but again each site is different, financial counseling, budgeting, mental health services and or substance abuse counseling. 16

17. GPD with a Vocational Lens O Introduce the concept of work and career development from day one of GPD residency O Include vocational goals within Veteran service plans O Assist Veterans in navigating employment services as well as available educational and training resources O Partner with Veteran’s VA and natural support system to ensure good communication on goals, preferences, and needs O Acquire knowledge and expertise regarding your local labor market and employer expectations 17

18. A New Perspective: Employment in the Context of Treatment O Assume Employability early in treatment… discussion of employment goals, preferences, and needs should occur on Day 1 of GPD admission O Ongoing assessment in the context of treatment; involvement of Veteran’s providers and natural support system O Employment outcomes are a function of rehabilitation and treatment… one component of Veteran’s life O Integration of GPD staff with Veteran’s clinical team 18

19. What is meant by the term Integration? O Coordination of employment and clinical care between Veteran and his/her providers/support staff (i.e., GPD program staff, Homeless Program Clinical Case Managers, Employment Program staff, Social Workers, etc.). O Team approach to supporting Veteran. O Strategies are developed to address the particular employment and clinical issues. These strategies are incorporated into the employment and clinical supports provided to the Veteran. 19

20. Advantages of Good Integration O Enhanced ability to engage and support Veterans. O More efficient and effective communication between different types of providers. O Enlistment of clinical staff in support of Veterans’ vocational goals and in attaining employment. O Incorporation of employment and clinical issues into the GPD housing process. 20

21. Why Does Integration Matter? O Job Search, employment, and job retention occur within the framework of ongoing Homeless program requirements and training. These activities need to be coordinated. O The Veteran may require joint meetings with GPD staff, Employment Program staff, Homeless Program staff, and clinicians to resolve issues and enhance treatment outcomes. O GPD Program staff, Homeless team, Employment Program staff, and clinicians need to be on the same page about Veteran’s desirable outcomes of treatment plan. 21

22. But how do I, the GPD Program, truly understand and support a Veteran in their employment journey? 22

23. Given a choice… by Robert E. Drake, M.D., Ph.D Given a choice… by Robert E. Drake, M.D., Ph.D. Given the choice between work and idleness, people will almost always choose work. Regardless of our station in life, the conditions of our bodies and minds, or the amount of money in our bank accounts, the need to work remains one of our strongest drives. Work is central to our lives, and as such, gives a large measure of structure to our days. Common sense tells us that we feel better about ourselves when we are working regularly. 23

24. Who Can Provide Support (building a support system)? O GPD staff O Homeless Program staff O Employment Program staff (CWT, Homeless, etc.) O Family O Co-workers O Friends, neighbors O Religious groups O Workplace support groups O Aftercare services O Treatment providers (VA and non-VA) 24

25. Integrate Housing & Employment Services O Develop employment support services targeting GPD residents: O Job Clubs O Computer Job Center O Employment Board O Partner with employment service providers O Conduct joint service planning with VA providers O Share joint service plans O Address critical barriers, eg., criminal justice backgrounds 25

26. See Jobs as Transitions All jobs are successes Employment experience is a way to learn about Veteran’s job likes and dislikes Loss of job does not mean program discharge Opportunity to update assessment with new information Rapid job search – less time to dwell on lost job Revisit disclosure Zero exclusion 26

27. Helpful Strategies to Support Veteran O Validate the stress and anxiety of job search and/or employment situation O Listen without judgment O Assist the Veteran with developing a job search plan to guide their search. Consider: O geographic preference, O transportation issues, O job preference, O legal issues that may be a factor, O resume/cover letter update, O work schedule and salary needs, O clothing needs, etc. 27

28. Helpful Strategies to Support Veteran O What approaches to job searching have been successful and what have not? O GPD is encouraged to review and understand community resources for employment. O What natural supports are available to the Veteran to enhance their job search activities? 28

29. Emphasize the Use of Coping Mechanisms on the Job O Take breaks when needed and go for a walk; O Take deep breaths; O Focus on tasks one at a time; O Think positively, look for ways you can solve the problem; O Share your thoughts calmly with a trusted supervisor, co- worker, GPD staff, or integrated team member; O Exercise regularly; O Center your mind once a day, such as through meditation; O Take care of body by getting enough sleep and eating healthy meals regularly 29

30. Supporting Veteran in Building Job Stability O Support after placement O Be proactive - don’t assume silence is good O Help to problem solve O Inquire about possible need for job accommodations. If job accommodations are needed, speak with Veteran’s team for support O Work with the Veteran’s team O Ask about any changes or problems that may explain the increase in work or housing-related difficulties O Increase supports, if necessary 30

31. Incentivize Job Placement & Job Retention Activities O Recognize Veterans who to work and continue working O Provide transportation and/or meal subsidies for working Veterans O Acknowledge Veterans who remain employed for 3, 6, & 9 months with gift cards or other awards O Hold staff and programs accountable for employment outcomes and reward achievement of goals 31

32. Keys to Effective Job Searching O Based on Veteran’s employment preferences O Incorporates a number of job search strategies O networking, O utilizing community and VA resources, O following-up on job leads either in person or online O in-person and on-line job searching and application completion O Focuses on community competitive employment O Partners with an array of resources to support the Veteran’s job search effort O Update resume and cover letter O Remind Veteran to be honest on application in relation to criminal history… can write ‘will explain at interview’ instead of going into detail on application O Encourage participation in job clubs, which are groups specifically focusing on job search and employment maintenance as well as receiving support from their peers. 32

33. VA Health Care Partners O Homeless Program: O Homeless Community Employment Coordinators (CEC) O HCHV/HUD-VASH Vocational Development Specialists O Compensated Work Therapy (CWT) O Transitional Work (CWT/TW) O Evidence-Based Supported Employment (SE) O Vocational Assistance 33

34. Role of VA Homeless Program Community Employment Coordinator (CEC) O Central figure (i.e., liaison, advocate, technical advisor) within the local Homeless Program Continuum O Facilitation of ongoing orientation and training on Homeless Services Continuum for providing direct assistance in connecting Veterans VA and/or community-based employment service leading to competitive employment with appropriate supports. O Collaboration with local CWT Managers or designee in orchestrating clinical and administrative staff, within the VA and without, into a cohesive platform with which homeless Veterans can establish meaningful employment. O Local Liaison to community partners of employment placement and support services. O To identify (1) what’s currently available in terms of employment programs and services, (2) are there any gaps, and (3) how can resources be pulled together to fill gaps in services. 34

35. Community Partners O Department of Labor (DOL) Employment and Training Programs: O Veterans Employment & Training Service (VETS) O offers employment and training services to eligible veterans through a non-competitive Jobs for Veterans State Grants Program. O Under this grant program, funds are allocated to State Workforce Agencies in direct proportion to the number of veterans seeking employment within their state. The grants support two principal staff positions: O Disabled Veterans' Outreach/Local Veterans' Employment Representative Programs (DVOP/LVER) O Homeless Veterans' Reintegration Project (HVRP) O Designed to provide services to assist in reintegrating homeless veterans into meaningful employment within the labor force and to stimulate the development of effective service delivery systems that will address the complex problems facing homeless veterans. 35

36. Community Providers O State Vocational Rehabilitation O Coordinates and provides counseling, evaluation, and job placement services for people with disabilities. O VBA – Vocational Rehabilitation & Employment (VR&E) O For Service-Connected Veterans O provides services to help with job training, employment accommodations, resume development, and job seeking skills coaching. Other services may be provided to assist Veterans in starting their own businesses or independent living services for those who are severely disabled and unable to work in traditional employment. VA's Education and Career Counseling program provided personalized counseling and support to help guide their career paths, ensure the most effective use of their VA benefits, and achieve their goals. O Veterans Employment Services Office (VESO) O strategic program management office that provides employment and career management resources designed to attract, retain, and support Veteran employees at VA and across the federal government, including those serving in the National Guard and Reserve. 36

37. Available Vocational/Employment Services O Community-Based Employment Support Services: O Local American Job Centers (formerly Career One Stops) – www.servicelocator.org O Goodwill Employment Centers O Operation: GoodJobs Program for Veterans (not offered in all states) O Local Goodwill employment services – http://www.goodwill.org/find-jobs-and-services/ O Local libraries (computer lab) 37

38. Web-Based Job Seeker Services O Department of Labor O Career One Stop – www.careeronestop.org O Military transition to civilian employment – www.careeronestop.org/militarytransition O Resumes & interview assistance – www.careeronestop.org/ResumesInterviews/ResumeInterviews.aspx O American Job Center – www.jobcenter.usa.gov O USA Jobs – www.USAJobs.gov O Veterans Job Banks – www.jobbankinfo.org 38

39. So… How Can a GPD Program Support Veterans in Their Employment Goals? So… How Can a GPD Program Support Veterans in Their Employment Goals? Listen Don’t Judge Encourage & Support Partner Don’t Give Up Be Accountable for Outcomes 39

40. References O Department of Labor VETS Program - http://www.dol.gov/vets/programs/empserv/employment_services_f s.htm O Homeless Veterans Reintegration Program (HVRP) - http://www.dol.gov/vets/programs/hvrp/main.htm O VBA Vocational Rehabilitation & Employment (VR&E) - http://www.benefits.va.gov/vocrehab/ O Veterans Employment Service Office (VESO) - http://vaforvets.va.gov/veso/Pages/default.aspx O State Vocational Rehabilitation Agency - http://wdcrobcolp01.ed.gov/Programs/EROD/org_list.cfm?category_ cd=SVR#V (website lists available VR agencies by state) 40