1. CULTURALLY COMPETENT PRACTICE Kara Mahoney, Inner City Law Center

2. Overview  Build an understanding of VA structure  Provide an overview and tips on interacting with veterans service organizations  Discuss cultural competency when working with veterans

3. Overview of VA Structure

4. Veterans Health Administration (VHA): Healthcare benefits Primary care & specialists Dental Pharmacy Largest hospital network in the nation

5. Overview of VA Structure Veterans Benefits Administration (VBA): Financial Benefits Housing Education Employment Disability

6. Overview of VA Structure Interaction between VHA and VBA VHA is entirely separate from any benefits determinations made in the Compensation & Pension programs in the VBA VHA does commonly provide medical evaluations for VBA benefits eligibility

7.  VSO: a collective term referring to membership organizations of veterans  E.g.: Veterans of Foreign Wars (VFW), Disabled American Veterans (DAV), AmVets, State Offices Veterans Service Organizations

8.  Mission of VSO may vary by organization but most are focused on assisting veterans and promoting the interest of veterans  VSOs can provide veterans with support to address “health, housing, legal, financial, and education & employment issues in the context of a community with similar experiences.”  Locations:  Regional Offices  County or State offices  Stand Alone Centers - VFW Veterans Service Organizations

9.  Most VSOs help veterans file claims with the Regional Offices; some will represent them up to BVA  VSOs file claims with a different philosophy than attorneys  Incentive for quantity of veterans served  File on all possible claims Veterans Service Organizations

10. Interacting with VSOs  Be aware of your status as an attorney in this process  Stigma surrounding attorney status  History of opposition to attorney involvement in veterans claims  VSO issues  VSO training issue - increasingly complex body of law  Pre-judgment of claims  VSO community involvement  Post as a community center  Sponsor other community-based activities Veterans Service Organizations

11.  Working with Veterans  Resource: Representing Washington Veterans: Basic Legal and Cultural Concepts – Northwest Justice Project  Consider how to: Encourage veterans to speak freely; Constructively react to hearing about killing, death, or other situations and attitudes that are uncommon or unacceptable in civilian society; and Never ask, “Have you ever killed anyone?” Culturally Competent Practice

12.  Working with Veterans  Challenges: Homelessness Physical disabilities Mental disabilities Unemployment Social isolation/relationship difficulties Substance abuse Culturally Competent Practice

13.  Autonomy and military culture  Encouragement to form group mentality  Privilege the health of the group over individuals  Individuals taught to push aside any psychological concerns in favor of a fully positive report to a superior officer  Hierarchical structure teaches servicemembers to obey whatever commands of their superiors Culturally Competent Practice

14.  Autonomy and military culture  Encouragement to form group mentality  Privilege the health of the group over individuals  Individuals taught to push aside any psychological concerns  Hierarchical structure teaches servicemembers to obey whatever commands of their superiors Culturally Competent Practice

15.  Stigma of Mental Health Symptoms in Military  Inherent nature of military  Isolation & ridicule  “hysteria”  Career aspirations  Consequences of Stigma  Underreporting or failing to report symptoms  Ignoring reported symptoms  Painting discharge-related misconduct as unrelated to mental health symptoms Culturally Competent Practice

16.  Consider experiences among veterans in light of the duration, nature, and time of their service.  Drafted veterans versus volunteer veterans.  Age of veterans  Be careful with assumptions about their service. Culturally Competent Practice

17.  Understand where a veteran may be coming from in terms of behavior For example, military service may have involved: Driving aggressively Taking cover Shouting/hitting Taking charge Taking orders Carrying a weapon Being in groups Abnormal physical contact/proximity Culturally Competent Practice

18.  Instead of: “ARE YOU A VETERAN?”  ask, “Have you ever served in the military?”  Be careful with “THANK YOU FOR YOUR SERVICE”:  For recently returned veterans, “Welcome home,” or “Glad to have you back,” may be more suitable.  For any veteran (or person), “I’d like to learn about your experience if you feel comfortable discussing it,” may more effectively connect an advocate and client without expressing judgment. Culturally Competent Practice

19.  Differences in Terminology  Army: Soldier  Marine Corps: Marine  Navy: Sailor  Coast Guard: Coast Guardsman / “coastie”  Air Force: Airman Culturally Competent Practice

20.  Women Veterans  May not identify as veterans  Combat Involvement Do not make assumptions  More likely to have been raped by a fellow servicemember than killed in combat  Military Sexual Trauma:  Defined: rape, sexual assault, or severe harassment 1 in 3 female veterans report MST 1 in 6 male veterans report MST Culturally Competent Practice

21.  Working with Survivors of Trauma  Everyone experiences trauma differently No “normal” response Any behavior after the trauma (positive or negative) may be an effect of it Culturally Competent Practice

22.  Working with Survivors of Trauma  Open-ended questions – soliciting a narrative “Tell me about what happened…” “Tell me about how you felt…”  Cue or Specific Questions Use to clarify questions from the narrative “You mentioned you went to get medical attention. Can you tell me more about that?” Culturally Competent Practice

23.  Working with Survivors of Trauma  Environment is important Safe and comfortable for the survivor Private and free from distraction Maintain an equal physical position  Explain the purpose of the interview  Survivors may not have all the answers to questions  The survivor is in control of the process Culturally Competent Practice

24.  When working with survivors of sexual assault or other forms of trauma be aware of all times of the surroundings and what reactions your questions may cause. Culturally Competent Practice

25.  Excerpt from stressor statement of Vietnam combat veteran: “I can snap at just about anything. When I was married, my wife and I would go out to dinner and I would order a steak. If it wasn’t cooked right, I would barge into the kitchen and shove it in the chef’s face. I would explode. If I thought people were screwing with me in any way, I would retaliate immediately. I still have a lot of anger and I am learning how to manage it, but it’s there.” Being Trauma-Informed

26.  Excerpt from stressor statement of survivor of rape in the military: “At that time, I didn’t feel safe talking about the rape. Fellow soldiers were harassing and threatening me. Some of the threats were direct, some were indirect. They would tell me to keep quiet, or you never know who’s gonna get you. They would say that if I went to another duty station, they knew someone there and they could hurt me. Basically saying I would never be safe, and they could always get me no matter where I’m at. So I kept my mouth shut because I was terrified of being hurt even more.” Being Trauma-Informed

27.  People first language  Respect & dignity  Putting the person–not the condition–first  No one wants to be defined by a single trait (e.g. medical condition or height)  Say “people with disabilities” not “the handicapped.”  Say “Bob has a mental health condition” not “Bob is mentally ill” or “Bob is insane.” People First Language

28.  Contact Information: Kara Mahoney kmahoney@innercitylaw.org Questions?