Department of Veterans Affairs Office of Mental Health Services

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Department of Veterans AffairsOffice of Mental
Health Services

• Compensated Work Therapy
• Vocational Rehabilitation Services and OEF/OIF
  Veterans with Poly Trauma Related Disabilities

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Introductions

• Charles McGeough National Marketing Director
• VHA Office of Mental Health Services-VACO
• Samantha Loving -CWT Coordinator
• Richmond, VA
• Clifton Charles -VRC Poly Trauma
• Houston, TX

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Definitions

• OEF-Operation Enduring Freedom - Afghanistan
• OIF- Operation Iraqi Freedom - Iraq
• Polytrauma injury to more than one physical
  region or organ
• system, one of which may be life threatening, and
  which results in
• physical, cognitive, psychological, or
  psychosocial impairments
• and functional disability. Some examples of
  Polytrauma include
• Traumatic Brain Injury (TBI)
• Hearing Loss
• Amputations
• Fractures
• Burns
• Visual Impairment 
• Traumatic Brain Injury- Signature disability of
  OEF/OIF

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OEF/OIF Veteran Statistics

• 48 Active Duty
• 52 National Guard
• 88 Men
• 12 Women
• 65 Army (76 Inj.)
• 12 Air Force (3 Inj.)
• 12 Navy
• 12 Marine (20 Inj.)

• 34 Deployed
• multiple times
• 52 Age 20-29
• 69 Filers received SC
• Top Initial Diagnosis
• Primary----Chest
• Secondary-Knee/Leg
• Tertiary-----TBI

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VA Polytrauma System of Care
Palo Alto
Greater LA
21 VISN 4 Level-1 PT Centers 21 Level-2 PT
Centers Level-3 PT Program
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How Big A Problem isPost-TBI Failure to RTW?

• Data from the Colorado TBI registry found that
  about fifty(50)percent of those who were
  severely injured failed to RTW at one-year post
  injury.
• Twenty(20)percent of those with mild TBI
  injuries were unemployed at one-year post injury.
• Whiteneck, G., Mellick, D., Brooks, C.,
  Harrison-Felix, C., Noble, K., Sendroy Terrill,
  M. (2001). Colorado traumatic brain injury and
  follow up system data book. Englewood, CO Craig
  Hospital

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CWT/Supported Employment

• Evidence Based SE in 160 CWT Programs Nationally
• Title 38 USC section 1718 through Veterans
  Omnibus Health Care Act of 1976, P.L. 94-581,
  authorized Compensated Work Therapy (CWT).
• December 6, 2003, PL 108-170 section 104
  amended, enhanced and expanded the clinical
  authorities of CWT to provide therapeutic
  employment services.
• CWT/SE in Spinal Cord Injury-Vocational
  Integration Program
• CWT/SE in 13 of 21 Level-2 PT Centers
• CWT/SE in PTSD (research)

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SE Principles

• Zero Exclusion Individuals are not precluded
  because
• of the lack of prior work history or vocational
  goal.
• Rapid Engagement People with severe disabilities
• can obtain and succeed in competitive jobs
  without
• pre-employment training or extended evaluation.
• Integration Vocational rehabilitation should be
• considered an integral component early in
  treatment.
• Ongoing Assessment Vocational development is
  continuous
• and based on competitive work experiences, rather
  than in
• artificial or sheltered settings.
• Dr. Robert Drake Dr. Deborah Decker
• A Working Life-Individual Placement and Support
  (IPS) Program

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Contact Information

• Compensated Work Therapy 1-800-355-8262www.va.go
  v/vetind

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• Hunter Holmes McGuire VA Medical CenterRichmond,
  VA Samantha Loving, MS, CRCProgram Manager,
  CWT

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For prints/slides www.Whitehouse.gov www.C-Span
.org www.Newsday.com www.Marine.com www.Marine.g
ov www.Navy.gov
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• Hunter Holmes McGuire VA Medical Center offers
  the following services within the Polytrauma
  System of Care
• Level I Inpatient Polytrauma Rehabilitation
  Center one of 5 in the nation
• Polytrauma Transitional Rehabilitation Program
  strong focus on community reintegration and
  vocational re-entry
• Level II Outpatient Polytrauma Network Site
  one of 21 in nation

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Polytrauma System of Care Demographics

• Polytrauma Transitional Rehabilitation Program
  (PTRP)
• Active-Duty 93
• Veterans 7
• Inpatient Polytrauma Rehabilitation Center (PRC)
• Total since FY2003
• OEF/OIF 119
• Active-Duty 66
• Veteran 176
• Outpatient Polytrauma Network Site (PNS)
• Veteran 84 (including Natl Guard, Reserves)
• Active-Duty 16

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Interdisciplinary Team Approach

• Physician/Physiatrist/
• Medical Resident Vocational Rehabilitation
• Speech Therapy Kinesiotherapy
• Physical Therapy Recreation Therapy
• Nurse Clinical Nurse Case Manager
• Blind Rehabilitation (BROS) OEF/OIF Case Manager
• Social Worker Occupational Therapist
• Prosthetist/Orthotist Patient Advocate

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Polytrauma Rehabilitation Center Vocational
Pathway

• Compensated Work Therapy/Polytrauma Supported
  Employment (CWT/Polytrauma SE Program)
• Provision of vocational rehabilitation services
  as part of the CWT Program to the following
  programs
• Level I inpatient Polytrauma Rehabilitation
  Center (PRC)
• Polytrauma Transitional Rehabilitation Program
  (PTRP)
• Level II Outpatient Polytrauma Network Site
  (PNS)
• CWT/Polytrauma SE consults received through all
  components of the Polytrauma System of Care as
  part of an interdisciplinary team approach.
• At times, patients will transition
• from the Richmond PRC, to the PTRP, then to the
  PNS
• from the Richmond PRC to the PNS
• From the Richmond PTRP to the PNS
• And any variation of the above listed

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Polytrauma Rehabilitation Center Vocational
Pathway

• Active-duty service members and Veterans seen
  through the Richmond Polytrauma System of Care
• Participants of the CWT/Polytrauma SE Program can
  remain enrolled in the program for as long as
  they feel vocational services are needed
• While enrolled in CWT/Polytrauma SE, VA-based
  Service-Connected benefits and VA NSC Pension are
  not jeopardized
• IDT Team Decision/Neuropysch evaluation/ medical
  clearance (light duty vs. regular, etc) used to
  assist with degree of vocational services
  provided
• CWT/Polytrauma SE staff take a very proactive
  role with those enrolled in the program i.e.,
  as the individual progress or decline, vocational
  rehab. services are adjusted accordingly
• Collaboration w/ military to address voc. needs
  for AD service members
• Use community voc. agencies for additional voc.
  support services

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CWT/Polytrauma Supported Employment Demographics

• All AD service members and Veterans admitted to
  the PRC (except EC patients) are referred for
  CWT/Polytrauma SE evaluation possible
  enrollment
• All AD service members and Veterans admitted to
  the PTRP are referred for CWT/Polytrauma SE
  evaluation possible enrollment
• Tuesdays weekly, all AD service members and
  Veterans seen through the PNS evaluation day are
  seen by CWT/Polytrauma SE staff for evaluation
  possible enrollment in addition, those seen
  through Thursday mini-screens may also be
  referred for voc. eval. possible enrollment

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Collaborate w/ military for voc. needs of AD
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Vocational Services Richmond CWT/Polytrauma SE
Provides

• Motivational interviewing and comprehensive
  evaluations formal, informal, and through
  situational assessments
• job placement assistance,
• job exploration, job development, and, when
  appropriate, job sculpting,
• assistance with basic work skills and attitudes,
• follow-along vocational services,
• resume writing, application completion
  assistance, interviewing skills,
• assistance with getting necessary documentation,
• benefits counseling,
• Job coaching/on-the-job support,
• Partnership with employers to assist in obtaining
  and maintaining employment,
• Evaluation and assistance with assistive
  technology needs
• Provide a supportive, structured environment to
  address vocational issues
• Goal of CWT is a return to competitive employment
  or military unit
• Utilize volunteer, transitional, and supported
  employment opportunities to assist individuals
  achieve their vocational goals as well as
  collaborate with community supports for address
  additional vocational needs

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Success Story

• Background at Initial Meeting
• 39-year-old, active-duty service member
• U.S. Army, 21 years of service in the military
• combat engineer
• Injured by an IED blast while serving in Iraq
• Medical Care
• Previously received medical care through an Army
  Medical Center
• Underwent Cranioplasty to repair a missing
  frontal portion of skull.
• Admitted to the Richmond PRC for treatment and
  rehabilitation
• Moderate to severe TBI with secondary injuries

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Success Story (cont.)

• Vocational Rehabilitation Services
• Initial voc. evaluation completed through PNS
  following receipt of CWT consult
• Interest in VBA VRE - Chapter 31 Return to Work
  Program for assistance with utilizing his GI
  Bill previously been unable to receive appt.
  for evaluation
• Goal to return to school to become a
  kineseotherapist
• Situational assessment completed thru volunteer
  placement where he was assisting with weekly
  Nursing Home Coffee Socials and Game Days
• Current Progress/Vocational Updates
• Has now been medically discharged from military
• New vocational goal complete college to become a
  counselor
• Currently enrolled in second semester of college
• Recently purchased a house with his wife using
  his VA Home Loan
• CWT VRS staff worked with VBAs VRE staff to
  expedite enrollment, evaluation, and schooling
  assistance
• CWT VRS to continue providing voc. support as
  needed

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Richmond CWT Program Staff

• Samantha Loving, MS, CRC
• Program Manager, CWT Program
• Antonio Bedford, MS
• CWT/Polytrauma SE VRS
• Sherri Ballenger, MS, CRC
• CWT/Polytrauma SE VRS
• Dr. Jennifer Menzel, Psy.D.
• CWT/Polytrauma SE Neuropsychologist
• Betinna Fields, MS, CRC
• CWT/SE SMI VRS

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Michael E. DeBakey VA Medical Center (Houston,
TX)
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Veteran Success Story

• Vocational Rehabilitation Section
• Substance Dependence Vocational Rehabilitation
  Services
• Polytrauma Team
• Rehabilitation Care Line
• Michael E. DeBakey VA Medical Center

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Presentation Highlights

• Polytrauma Unit
• Program Relevance
• Veteran Success Story

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Polytrauma Unit
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Interdisciplinary Team Approach

• The Polytrauma CWT-Supported Employment Staff
  is part of the larger Interdisciplinary
  Polytrauma Team that provides comprehensive
  rehabilitative services for veterans. This
  collaboration helps veterans prepare physically
  and mentally to obtain and maintain desired
  vocational goals.

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Polytrauma Team

• Physical Therapy
• Occupational Therapy
• Recreational Therapy
• Vocational Rehabilitation
• Psychology (CWT)
• Neuropsychology
• Speech and Language Pathology
• Nurse Practioner

• Social Work Case Management
• Nurse Case Management
• Rehabilitation Medicine Doctor
• Blind Outpatient Rehabilitation Services
• Chaplain Services
• Prosthetics

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Polytrauma CWT-Supported Employment Program
Mission

• The Vocational Rehabilitation Section is
  committed to assisting Operation Enduring Freedom
  (OEF) and Operation Iraqi Freedom (OIF) veterans
  from the wars in Afghanistan and Iraq with
  traumatic brain injury and physical disabilities
  to attain and maintain community employment.

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SE Program Goals

• Provide vocational support and job accommodation
• Long term follow-up and family support
• Reduce physical and psychiatric symptoms
• Assistance with accessing medical and community
  services
• Improve self-esteem and enhance quality of life
• Return veterans to competitive community
  employment

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Program Relevance
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What is traumatic brain injury?

• Definition
• 1. Traumatic brain injury is an insult to the
  braincaused by an external physical force, that
  may produce a diminished or altered state of
  consciousness, which results in an impairment of
  cognitive abilities or physical functioning.
• 2. It can also result in the disturbance of
  behavioral or emotional functioning.
• 3. These impairments may be either temporary or
  permanent and cause partial or total functional
  disability or psychosocial maladjustment.
• Brain Injury Association
• February 22, 1986
• http//www.biausa.org

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Symptoms of Traumatic Brain Injury

• Mental symptoms
• Poor concentration, forgetfulness, word finding
  problems
• Physical symptoms
• Sensitivity to light or sound, weakness, numbness
  or tingling, sleep problems, loss of balance,
  dizziness, headaches
• Emotional symptoms
• Short temper, poor motivation, depression,
  agitation

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Program Relevance (Houston)

• Houston was designated as a Polytrauma
  Rehabilitation Site Level II on 08/08/05
• There have been 587 Brain Injury Consults
  submitted to date (from 04/24/07 thru 03/06/08)
• The Houston VA Medical Center leads the country
  in Brain Injury Consults

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Veteran Success Story
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Work History Before SE program Participation

• Noted unemployment and difficulty keeping jobs (8
  jobs since military discharge in 2004)
• Did not get along with co-workers
• Difficulty trusting others in personal life and
  on worksite
• Frequently quits jobs due to lack of satisfaction
  with work

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Patient Demographics

• Personal
• 30 year old Divorced Caucasian Male with one
  child living in another state, currently lives
  with mother and father in the Houston area
• Diagnosis
• Physical Brain Injury, Chronic Lower Back and
  Neck Pain, Myocitis of the Cervical and Lumbar
  and Knee, Arthralgia
• Mental - Post Traumatic Stress Disorder, Major
  Depressive Disorder and Attention-Defit
  Hyperactive Disorder
• Education
• H.S. Diploma plus some college Completed 42
  Hours Majoring in Criminal Justice (University of
  Houston and Junior College)

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Military Information

• Military History
• Service Connected for PTSD and sequelae of
  TBI (e.g., tinnitus headaches) United States
  Army 1995-2004 (Airborne Infantryman)
• The veteran is an OIF\OEF participant
  (Operation Iraqi Freedom and Operation Enduring
  Freedom)
• Combat Injuries Notables
• Multiple blast exposures with no lost of
  consciousness, suffered brain injury from fall
  with loss of consciousness followed by brief
  hospitalization
• Worst War Experience
• Three close friends were hit by IED which
  blew up underneath the humvee killing 3 of the 4
  soldiers. Veteran had to help put bodies back
  together to make sure they got all of them

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Success Since SE Program Participation

• The veteran is now satisfied with working in the
  community (job retention)
• Active in treatment at the VA Medical Center
• Veteran's mood is less aggressive
• Improved communication and socialization skills
  through positive interaction with worksite staff
  and customers
• Establishing career while utilizing transferable
  skills attained through military experience

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Veterans Quote

• Respect my sacrifice, respect me as a
  veteran

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Recovering Hope

• ASSUME SUCCESS

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Looking for a Bright Future
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Department of Veterans AffairsCWT Poly Trauma
Programs