Presenter: Michael Frain, Ph.D., Florida Atlantic University
Facilitator: Steffany Stevens
Good afternoon and good morning depending where you are in the southeast region. Welcome to 2009 TACE Region Four webinar series. My name is Steffany Stevens and I am a member of the Southeast TACE Region Four team. I want to welcome back many of you who have participated in many of our previous sessions and a big hearty welcome for those of you who are joining us for the first time.
As most of you already know, the mission of the southeast TACE Region IV along with our nine counterparts across the country is to work together, and work together to improve the quality and effectiveness of Vocational Rehabilitation service. The primary purpose is to enhance employment outcomes for individuals with disability. Our TACE works in the eight southern states, we have the largest region to serve and we are very proud of that. We are working with some great people. As you know, we serve Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina and Tennessee. Our TACE is a collaboration with the DBTAC, and the southeast ADA Center. Both the TACE and the southeast DBTAC are managed by the Burton Blatt Institute. We are hosting quite a few Webinars this year, as many of you know and if you have already signed up for those up for those topics that are of interest to you, great. If not, please visit our website and look at the TACE Webinar room. The URL is going to be posted in the chat room. All instructions about how to register are provided on the site and of course if you need any assistance, or staff is ready to assist you.
Just a quick note about the webinar system. We use a system that is fully accessible to everybody regardless of their disability and or the assistive technology that might be used with a computer. This system makes it possible to conduct workshops over the Internet from just about any computer with an internet connection and a web browser. Please note that sometimes long distance charges may apply. Unfortunately, there are many computer issues you have reported to us that are inherent in your system, and beyond our control. That is why it is important for you to check your system prior to the session. Staff is available upon request to work with you in advance of the session. I want to stress the word advance as we are unable to troubleshoot technical issues at this point right just before the Webinar is scheduled to begin.
As in the past, during today’s session typing your questions into the chat area, and our speaker will follow-up with these questions as they present themselves. So our chat area you can use for your questions. They will also voice questions for the benefit of participants, and the captioner and for the transcript. For those joining us on the telephone line, they will not be able to see what is in the chat room, all of that will be voiced so it can be captured. You might also turn off any automatic system checks that your computer does automatically to eliminate any further interface with the session. If you’re a connected to a network, do not forget to periodically tap the space bar every once in a while just to let the webinar system know you are still there.
At this point we are ready to begin. We are so privileged to be joined by our featured speaker Dr. Michael Frain. Dr. Frain is assistant professor in the department of counseling education at the Florida Atlantic University in Boca Raton. His professional affiliation includes the council for rehabilitation educators, the national rehabilitation association and the American counseling association. His research interests includes veteran issues, self-management and rehabilitation outcomes. Since 2005, Dr. Frain has been a coordinator of the rehabilitation counseling program at Florida Atlantic University. Since that time all students have passed their national certification exam on their first attempt.
Dr. Frain has over twenty published manuscripts in peer reviewed journals and book chapters. He recently was awarded the initial Council on Rehabilitation Counselor Certification research grant to study counselors who work with veterans with disabilities, and to study veteran’s employments changes after being injured during military service. He has presented as a keynote speaker and at national conferences on veteran issues, self-management issues and family issues in rehabilitation counseling.
Dr. Frain has received several prestigious awards in the fields of research, rehabilitation counseling including the New Career in Rehabilitation award by the National Council on Rehabilitation Education in 2008, the Florida Atlantic University College of Education Researcher of the Year and in 2009 he was recognized by American Rehabilitation Counseling Association.
Dr. Frain received his PhD. in Rehabilitation Psychology from the University of Wisconsin-Madison in 2003, after receiving his Masters of Counseling Psychology from the University of Missouri in 1994.
So, I am going to turn it over to Dr. Michael Frain for our Webinar today on the psychosocial aspects of disabilities of disabled veterans. Dr. Frain, you can take it from here.
Dr. Frain: Thanks for everyone for joining us today to discuss Rehabilitation Issues of Veterans with disabilities. I see we have bad language in our title “Disable Veterans”. Person first, I apologize for that one. I am Michael Frain coming to you from Boca Raton Florida. I am a former job coach, and rehabilitation counselor, and now as Steffany said I am an Associate Professor in Florida where everybody wants to do their rehabilitation, it appears. In the past few years, I have began exploring rehabilitation issues with veterans, reservists, as maybe many of you when we saw some of the things happening with Iraq, Afghanistan veterans, and we saw the need for rehabilitation to maybe take a stronger role. I have seen from the chat room that we have a couple veterans out there in this group. So, I of course welcome any kind of insights you would like to share with us as we go along. And during the course of this Webinar, I am very open to questions and comments from anyone out there as we go. There will be, of course, time for comments at the end as well.
So, we will get started here and see how it goes. I will announce the slides and the slide number as we go so everybody can kind of keep track and make sure everyone is on the same page. But if you get bored, feel free to flip ahead and see what interests you and then come back to us.
We are on to slide number 2, talking about wars in general. We can talk about the similarities of Vietnam and Iraq, or Iraq and Afghanistan, but in reality we know every war is different and also individual experiences in war are unique. Much like we talk about individuals with disability all have their own story, we understand every veteran with disability also has their own story. Some of the things we talk about today, won't apply to all veterans, of course, but can be used sort of as a starting place for your work when your working with veterans. Maybe to give you a template to know where to branch out from.
We know that employment needs change with time, and the needs are different at age 19 when some people go into the military than they might be at age 32, or 42 when military reservists might acquire a disability in combat. So when working with newly injured veterans we may see many similar issues to many other rehabilitation clients in general. One thing that we see is perhaps a road block to employment for many people with disabilities is lack of job experience. And we see this also with veterans of course. Veterans often, veterans with disability often have done many great things during their war experience, they might have led a platoon, they might have had many lives at risk where they have to organize battle situations, so they are used to maybe being in charge, supervisory roles, and those things can be exciting and very unique and perhaps rewarding, but oftentimes those sort of experiences don't translate well on to a resume. So they are recognized the same as maybe an MBA when applying for a job.
We know on average, people who have been in the military have much less education, and work experience, than their same-age peers. So what we see is that they have a lot of experiences, but were not quite always sure and they are not quite always sure how it translates into job experience in the so-called United States world perhaps. So what often happens is a veteran, any veteran with or without a disability might be offered more entry level work or manual labor type position which can lead to a lot of frustration when your just coming from the supervisory situation in war, where lives are at stake and every day is a unique and challenging experience.
Moving on to slide number 3. Still talking about wars in general. The veterans we see in the rehabilitation world are adjusting to their disability. But we also recognize with veterans there are also readjustment issues related to the war. Persons might have been away from their families and significant others for a significant amount of time before they acquire and disability and they come to see us. Often times, training may be six to nine months, and then a deployment of 9 months sometimes 12 months these days. So it could be a year or two years since they have been at home. That experience of war has also changed the person, besides the time. It has oftentimes changed the person and the family back home.
One way that we talk about how the experiences change the person and the adjustment to coming back to the United States, is that analogy to a heating coil. On those new-fangled stoves that some of us have and those of us that are still wood burning haven’t quite got onto. We know that after we turn the stove, that the heating coil stays hot for a little while. We’ve all burned our hands as we’ve thought our stove was off but the heating coil was still hot.
With Veterans we often think of maybe a similar situation. They may have come back to the United States, but inside they are still hot, they’re still sort of burning from the experience of war where they have to be hyper vigilant, where they have to be very concerned because of life and death situation on a daily basis. It may take them, much like the stove, a significant amount of time to cool down. To understand that when they come to a four-way stop, they maybe should waive someone through as opposed to attacking that Subaru at the corner.
Adjusting to a life in the United States where we respect kindness as opposed to hypervigilence can take some time.
We also understand tha with a lot of vetrans who are coming back form the war, that they have lost people that might have had a shared experience with them. In a war time situation individuals make a lot of friends in their area where they have common experiences. They might have been in battle together, they might have seen death together, they might have shot at someone as a unit. When they get discharged back to the United States, very few people around, even here in Florida where violence is common, have shot at people or been shot at. So it’s tough to go to a PTA meeting for a lot of these individuals and talk about some of their experiences, because there are few people around them that have a similar shared experience. So they find themselves maybe introverting some of those feelings and not discussing some issues that are pertinent to them because they don't get understanding when that comes out.
We also see that time has also changed the family that they left, and maybe the family roles as well. We often see that when a spouse goes off to war that the partner that has stayed behind has had to take on a much more prominent role, or much different role in the family. They might be paying the bills now, they might be making some of the family decisions; that in the past the spouse that went off to war took on or perhaps they were shared. Now that the veteran has come back home it can take a long time to perhaps renegotiate those roles again. The spouse that stayed home might have enjoyed some of those things obviously. Getting to pay the bill, well maybe not pay the bills but some of those decision-making skills and decisions might have become a role that they relish and now can be difficult to suddenly have another person in the family life who we have to share some of those decisions with and have to learn to renegotiate again.
So all those things, all those readjustment issues are going on obviously at the same time that an individual is adjusting to a disability, and adjusting to doctors and many appointments that they have to have, as well as the change that comes with disability, some of the anger, some of the renegotiating, some of the acceptance, all those things take time. We see there's a parallel time that going to be taken to readjustment to life in the United States as well.
Moving on to slide number 4 talking about the situation with the wars in Afghanistan and Iraq. One good thing about studying this field is that I’ve learned to spell out Afghanistan that was always a toughie for me. Skills are coming in many areas. One aspect about these wars, the study of engagement of wars is a little bit different. With these wars, there are no frontlines. People in the military talk about always being to be on guard . That they can be attacked at any time, anywhere. So very high stress that goes with this. There's no safe place. One report indicates about 80% of veterans report an exposure to trauma, which is a much higher percent than has been reported for past wars, Vietnam, World War II, etc. where there was a frontline, and there was times when people are exposed to trauma, but many people who never got to the frontline or they knew there would be a time they were away from battle. I think of the TV show, "Mash," where they talk about going to Seoul for some R and R sometimes on the weekends. It’s not quite the same with Iraq or Afghanistan, where our military ports are. Because the enemy is hard to distinguish and never quite sure what is a safe place or if there are safe places.
Another aspect that's different with these wars, there's much higher percentage of females that we now see in battle. Anywhere from 12 to 23% of armed forces now are females, and we understand females often bring a different set of concerns or skills to the war. Some of the concerns is that they leave their family at home, that there is more family issues, more likely to be a single mother, than a single father in the military. With the increase in females, some of the sexual trauma appears to be very frequent at wartime, both among individuals who are sort of the enemy, but also sexual trauma within, within the United States armed forces.
The third aspect that is a little bit different with these wars is the high percentage of citizen soldiers. Citizen soldiers, being any type of reservists who is being part of the military forces now. We see almost half, sometimes, of the active forces are in some way reservists. Reservists come much different than our typical Army, they are often much older, not of draft age, 50% report to have families. With families you can understand there are different issues they bring to a war. Might have mortgage payments, house payments, more likely to already have started a career, leaving a job, and there can be some issues of will that job exist when they get back. Especially now when we see layoffs happening, we can understand oftentimes when a reservist goes to war there’s that concern that they won't be as valued and their job can be lost due to lay offs, and laying off people who are perhaps more expendable.
Moving on to slide number 5. Still talking about the situations with the wars in Afghanistan and Iraq, and understanding there are many reasons that there is high stress in these wars, enemy difficult to distinguish, and also come new things with the media that have come about within the last 20 years. One thing that we see in many newspapers is the daily reports of the number of dead. So, for families back home where they understand their son, brother, sister, spouse, is in Afghanistan or Iraq, every day they can see that four people who might have been killed in action, oftentimes not sure if that is a are relative of theirs. Can cause high stress just with that, very salient factor in the paper every day.
It also can cause some difficulty for individuals in the war with the new type of media that is out there. I was talking to an individual who served on a ship in Iraq, during early stages of the war, they would shoot bombs off, he would report they would fire away, go back to the base. But what was interesting is that they could watch it on CNN later that night, the effects of what they were doing. So it makes it, the war much more salient to someone who wouldn't see the damage a bomb would do or killing that might happen from it. So he reported it was much different emotionally being able to go home and watch what his bomb did. It caused some conflict for him and some difficulties with understanding that people died from what he was doing.
We will talk a little bit more about the tour of duty, that seems similar to like a lot of other conflicts, where often times we think the reservist is good to go off for a nine month stint and it turns into 12 months, or it turns into a couple more stints than they are thinking.
The last bullet the support of veterans, perhaps similar to Vietnam, we know that individuals in the war, and that citizens in the United States often have moral or ethical conflicts with this war. What's different this time with the media perhaps is that there's easy access to the media for those in the war. So they might be much more aware of the conflicting emotions or what they perceive as lack of support from the United States that they feel like they are fighting for. So, this can cause some stress and can cause some uncertainty in their mission and understanding what they are supposed to be doing.
Moving on to slide number six; still talking about this situation especially in regards to disability. We understand that our military now has much better equipment and much better medical service than we have seen in past conflicts. The result of course is that less die, but we see a higher percent that are wounded. One aspect of medical service in Afghanistan, Iraq, since there's no frontline, we often see that medical service is very close to where someone gets injured. So in some ways, the no front line is difficult, but as far as helping wounded soldiers stay alive there is a positive effect on that one.
With this situation, with the better equipment, what we see is a higher incident of disability. But the disability rating or the severity of disability is lower than in past conflicts. So individuals are often injured, we see a lot of injuries coming back from Iraq and Afghanistan, but they have perhaps what we might consider more minor injuries, so that they are more likely to be able to work quickly with less surgeries, less downtime so to speak. Even with the high incidence of poly-trauma that comes from different type of weapons being used in this conflict, and the average of five surgeries per person who has a disability, you still see that those people, those veterans that get discharged with a disability, over 40% have disability ratings of 30% or lower. A large percentage of people, veterans are coming back with ratings that indicate they are able to go back to work quickly, with not a whole lot of rehabilitation services, or maybe some minor adjustments in their work site. Which in some ways is good for us as counselors, we are able to put people back to work quickly. But there is a whole lot of individuals coming back of course so, some difficulty there.
Just looking to see if we have questions out there. Everyone seems to be doing well. Feel free to break in.
We are moving on to slide number 7.Talking about the situation and a little about employers. We know that most employers, most current employers lack some experience with veterans who are returning from wars. Generally they have not been trained to recognize problems that may result from being in war. We know that alot of employers do a lot of in-house training programs that take on subjects such as substance abuse or sexual misconduct, but few employers have knowledge or skills to recognize or address mental health issues that are common for employers. Couple of reasons for that it seems. For one the number of veterans coming back from Iraq and Afghanistan, have not been seen in this country for generally for this generation. We haven't seen these kind numbers since maybe the late 60s or early 70s. Maybe you can go back to World War II, or Korea, for these kind of numbers.
So, what has happened is that war is really not a shared experience for many employers. The majority of people in supervisory or human resource roles are generally under the age of 53. If your 53 or younger, you have never been subject to a military draft and maybe never contemplated what it would be like to be in the armed services, much less likely to have served in the armed services, so maybe not understanding so much the lingering effects that can happen with war or some of the uncertainty with things that frustrate alot of veterans, such as never knowing when they will get called up, some of the difficulty with policies that go along with being in the war.
Generally, what we find is that employers have shown a general negative behavior toward rehiring and reemploying veterans with disabilities. We don’t see that across the board of course, but in general we find employers are not welcoming back veterans like we might hope.
Moving to slide number eight, just a little about the number for this war, for these two wars. Lots of estimates on number of individuals with disabilities coming back, a rough estimate is over 100,000 wounded. One way to estimate the number of wounded is for every individual dead, we think about 17 people get injury, and about 10 will have a disability. When you see those numbers you can get a rough estimate of the number of people with disabilities.
There is a question, about a law that states you can get your job back. There is, for military reservists a reemployment law, we will get into that in a minute, in about 20 minutes, actually. But yes in general, if you are a military reservists, and you go off to war, that job should be waiting for you and you should get promoted as time goes on. But we find much often, much like other people with disabilities, is that employers talk about undue hardship, some reasons why they can't rehire. We will bring that up in a little bit.
Roughly about one in five veterans who get discharged have a disability. We think about 10 to 15% of all personal probably have a traumatic brain injury. About half of people have some kinds of injury, have TBI we think. Most injuries we see are coming from blast injuries, multiple injuries. So along with perhaps losing a limb, we see that a lot of brain injuries are happening from the explosions, and the effect of the blast.
One other -- we saw for a little while maybe the numbers of disability, veterans is going down, but many of you have read, July 2009, the most deaths to date in Afghanistan. We have seen maybe a shift in the war that there are more disabled veterans, veterans with disability coming from Afghanistan, and Iraq maybe has quieted down a little, not a whole lot. But July 2009, with 30 individuals killed, as of four or five days ago, likely over 300 individuals with disability this month alone in Afghanistan. So it's quite a problem, rehabilitation counselors have to be addressing on a continue basis, for a number of years.
Moving on to number nine, talking about this is an opportune time for rehabilitation. One reason we talk about that is that we know a lot of rehabilitation laws grow out of war. Vocational Rehabilitation had its beginning with the Soldiers Act of 1918, the World War I time. So it can be a time when legislators are very willing to fund rehabilitation programs and services. It's an ideal time, I think, for rehabilitation to ask for changes. What often happens we see with laws, that the laws start with veterans programs, shows how veterans with disabilities can be successful, then benefits are extended to all persons with disabilities.
This opportunity with veterans is a national stage for rehabilitation to display its skills, how successfully we work with people with disability. Over all, I don't think rehabilitation is always great at marketing. Now seems like a good time for good public stories. We see in general people wanting to help veterans. A couple months ago on that home makeover show, there's a real title for that show, but that home-make-over show focused on a couple of veterans with disabilities and gave them new houses. I think we see that overall people want to tell stories about how veterans are doing well, want to help veterans. If rehabilitation can be successful with military veterans with disabilities, that talk of how rehabilitation helps people succeed will get out there in many different branches through individuals of course and through the media. Extreme Home Make Over, thanks. On ABC. Stephanie helped me out.
Another reason why it's an opportune time for rehabilitation. Obviously, a lot of budgetary thoughts going on, probably in states with rehabilitation. In Florida we have an order of selection, as well as asking clients to bring tax forms, so that they can be helped. Financial need has become an aspect of rehabilitation. One thing, rehabilitation can show is how we are financially helping both individuals, but the nation, with health care costs. If you think about a veteran with a disability, generally it's a younger age group. If they are not employed and if they stay unemployed due to disability, this can be of course a very large strain on government finances. Just to throw out a rough number, like someone getting SSDI for S1300 a month for an individual just injured in the war, might get that 35 years, comes out to about $550,000. And that’s also you throw in an additional costs for insurance and other benefits they might be eligible for. So we are talking roughly a million dollars for an individual injured in Iraq and Afghanistan if they are not rehabilitated. Rehabilitation counseling seems to be the way, best way to get them back and forth through successfully rehabilitation counseling.
There is just a comment that I will share with everyone. We are all talking about the brain injury society and discussing blast injuries. One of the problems is this type of injury is not immediately recognized in the fields and often not until they return back to the United States where they find difficulty with work, social skills. I agree, I think one thing about rehabilitation counselors, we are going to be the first ones to perhaps first professionals to see individuals and recognize perhaps a disability has occurred. For various reasons a lot of disabilities, I and others, believe don't get diagnosed in the field. For one, it's a different kind of atmosphere, perhaps you are not looking for TBI type of things. Oftentimes not family or significant past relationships around, so some of the small changes we see when someone has a TBI aren't recognized as often, the individuals they are around don't know their normal actions.
Thirdly, I think a lot of individuals in the military service have seen that reporting a disability, especially any kind of mental health disability, generally, is not useful for a promotion, I might say. The military has taken steps to change that, but in the past they were fairly open about discharging individuals with disabilities. I believe in the past, a lot of veterans felt that not being diagnosed was a much better way to go. Where rehabilitation needs to recognize, that we need to have the skills to screen and recognize some of the common injuries that come from war. So we will talk about small screenings for things like TBI, PTSD (post-traumatic stress disorder). And I would of course encourage you have a case load with veterans to become more familiar with the signs and ways of uncovering disabilities or injuries that might have happened in the conflict that have are undiagnosed at this point.
I think that a lot of veterans are aware that something is wrong. But no one has asked them perhaps the right question or brought it up that it might be a problem. Thanks, for that, Laura.
Moving on to slide 10. Still talking about the laws that support veterans. One thing about veterans, they are generally seen as a deserving class. Legislature, citizens, we all support generally, laws that support veterans. One aspect that can be positive about this in the rehabilitation community is that when we see veterans with disabilities it may help lessen the stigma against other people with disabilities. If you think about the reasons why individuals think people have disabilities, we often go back to some kind of punishment from God. It’s that they are weak people, et cetera, et cetera. A lot of misinformation out there.
If we see a veteran with a disability, some of those aspects about disability, why it happened, can cause change for a lot of other individuals in this world. We recognize that perhaps they were a good person, didn't deserve this, but it happened to them. So we have responsibility for helping them be employed, for helping them be a successful citizen, they were trying to help us.
I just had some students take the CRC, so I need to throw out a few laws such as the War Risk Insurance Act of 1917. That was the first one that focused on individuals with disabilities. The next time you take the CRC, remember that one.
The war risk insurance act provided vocational rehabilitation for servicemen or veterans of World War I and became the Soldiers Act of 1918. Just some background information to make it sound like I know what I am talking about to my students.
Moving onto, slide number 11. We are talking about employment issues now for veterans. Some of these statistics concern reservists more than the armed services over all. We know that with reservists, for various reasons, even individuals who don't report a disability when they are discharged, only three out of four will return to various places of employment. For individuals who acquire disability during their tour, get closer to about half who won't report to their pre-employment – pre-deployment employment. We understand as rehabilitation counselors the high need for reemployment services among reservists and all veterans in general.
Some of this data is a couple years old, so of course the unemployment rate has gone much higher in the last couple weeks, last couple years as well. But we know in general trends, that veterans seem to always have higher rates of unemployment than the citizens at large, so to speak. This is especially true of younger veterans. An individual who right out of high school goes into the military, gets discharged, 20, 21, they are much more likely to be unemployed than their peers who sometimes have gone off to college, trade schools, have a longer employment history. This kind of indicates to us, if we try to read between the lines a little bit, is that military service is not recognized, perhaps, as strongly by employers as other types of employment things we might put on resume . So other employment, education, some of those things employers seem to think is much more important than military service.
Someone asked what GTA is. Sorry I threw out an acronym there. Its Gulf Theater Action is what sometimes I refer to the wars in Afghanistan and Iraq as. I thought I had taken those off. So Gulf Theatre Action is one term some people use for the wars in Afghanistan and Iraq, more of an international term perhaps. Thanks for asking. That’s our veteran there who asked.
Moving along, slide number 12. Were talking about why these wars are an issue for rehabilitation. We know veterans with disabilities are at a critical age, oftentimes at the beginning of their career. So it is either going to be a long time to be employed, talk about the success through rehabilitation counselor, or a long time where they will be receiving benefits and services, perhaps, from different agencies. So a big change can happen obviously right after disability happens. It is an probably the most important time to work with someone if we want them to be successfully employed.
Another aspect is no group has seemed to really embraced this role. No profession has been at the forefront of addressing veterans with disability concerns. We see a lot of different professions talking about it, doing something about it, not saying it's ignored. We have seen improvement in the medical field, lots of research in the medical field concerning blast injuries, and some of those things. But it seems that rehabilitation is the logical profession to take the role, as far as being at the forefront of addressing needs and what changes should happen with veterans who have disabilities.
We think there may be a strong need for rehabilitation counselors with skills and helping clients acquire empowerment, to take charge of their reemployment situation. With some of the stories that were coming out of the VAs a couple years ago it seemed a lot of military veterans, because of the way the military works, is sort of a top down, a lot of veterans with disabilities weren't good at asking for what they wanted, they didn't feel empowered to get services they deserved. One role of the rehabilitation counselors, that rehabilitation counselors seemed to be trained in more than other counselors, is empowerment of clients, helping veteran clients deal with informed choice. In the military they are often told what they can do. In with counseling we want individuals to understand they have choices, choices of where to get their medical benefits, choices of what kind of employment they want. As a group, especially with younger reservists it might be a group who is not accustomed to informed choice and being empowered to make those choices.
I was driving to work, we have a lot of traffic, took me 10-miles, and I finally got in the right lane. So much like that I realized I was going over my slide this morning that I had them in a little bit of the wrong order. I will be jumping ahead to slide nineteen real quick and then slide back in, making sure you have good mouse skills at this point.
Slide number 19 talks about recent studies from various fields out there. We know research is a slow process. So although these wars have been going on for maybe six years, we are still learning about working with veterans with disabilities. Rehabilitation to it’s credit has recognized the importance of these issues and recently the CRC C gave a grant to myself and Malachy Bishop to study the issue of veterans. One part of our research is asking veterans where they think rehabilitation could be most useful. Another study that we did, asked people who are already working with veterans; counselors, case managers, those type of people who work with veterans, what knowledge and skills are most helpful to work successfully with veterans with disabilities.
What they indicated here on slide 20, some of the knowledge needs of counselors, a couple of the high areas of needs, counselors in the fields noted many knowledge areas of high need, especially laws pertaining to veterans. This kind of made sense to me. I teach a class in foundations of rehabilitation, we talk about a lot of different law, for people for instance who are blind, et cetera. Randolph Shepherd Act, those things, but very little on veterans, other than that 1918 Soldier's Act. Counselors are telling us we need to know for instance, the Uniformed Services Employment and Reemployment Act guarantees reservists a similar job on their return. There is a law stating reservists should have their job when they come back, by law. We will go into a little bit more detail on that.
Counselors are also talking that there's common psychological problems of veterans and there’s a lot of mental health concerns that are coming from veterans of these wars. We know about 20% of veterans screen for a mental health disorders upon discharge, but very few will seek treatment. The number that are not screened, the number of veterans who don't screen for a mental health concern, but have perhaps issues with things like substance abuse, anxiety problems, depression, are reported to be very high. We don't exact figures on that because we a lot veterans are not disclosing that kind of information on exit interviews for various reasons that are beneficial to them, I would say.
A couple of the other knowledge areas that counselors that work with veterans are indicating are an area that we should be training our students that are rehabilitation counselors concern things like community supports, deployment laws, and the psychological concerns of families, vocational services that are out there and also uncertainty. Especially as it concerns deployment. We found it's no longer clear what a reservist's deployment schedule will be. Sometimes they are called back soon after returning home. Sometimes reservists report that they are being called back after they believe they had completed their tour of duty. As counselors, one thing we can do is help create order and certainty where possible for our military reservist clients, so they can plan for the unexpected a little bit more.
Now I am moving back to slide number 13. We will get to a little bit on employment laws. I was trying to set the stage on why these are important to all of us. So by talking to counselors, they agree these are the issues that seem to be important for rehabilitation. Looking at slide 13, the issues, if you break it down into categories, seem to fall on four areas. The laws pertaining to veterans, mental health concerns of veterans, what kind of community services are out there that we can refer veterans to, and the common injuries in war.
So, slide number 14. Let’s talk about the laws pertaining to veterans. One law concerning services is the National Defense Authorization Act of 2005 (NDAA 2005). This law mandated service to gulf war veterans, especially for VAs. What we saw, gulf war veterans (people form Afghanistan and Iraq) were to be served before others, generally talking about Veterans Administration, and that their eligibility requirements had to happen within 30 days. I used to be a VR counselor, 30 days is pretty good for eligibility requirements. The thought behind this act of course is that veterans weren't being served very quickly. We had to do something to make sure veterans were receiving services and rehabilitation counseling. The positive side with this, it wasn't an unfunded mandate. We saw VAs had many positions open up, and funding went to positions that were previously going unfilled so counselors could work on serving veterans from Afghanistan and Iraq.
Couple other laws, I know you are all thinking you didn't have to learn any laws once you passed the CRC, but just to keep you all updated. One concerns the deployment demands on employers. The Uniformed Services Employment and Reemployment Act of 1994, USERRA. Obviously being in 1994 it came a little bit before this current conflict. It is the first time it's affecting employers a lot. It concerns individuals who leave civilian employment to perform military responsibilities. It's very similar to the Family Medical Leave Act. What it states is that the employer must rehire within a certain amount of time, unless they can prove undue hardship. And that the employer must provide reasonable accommodations for the individual. It mainly pertains to reservists that is let’s say is working at Anheuser Busch for 5 years and is an accountant. They are reservists so they go off to Afghanistan for 12 months they come back. That job should be there and if they had lost their vision while in combat, Anheuser Busch should make reasonable accommodations using JAWS, or some other computer adaptive software to allow them to perform their job as they could before.
Some of the other kind of fun reemployment laws that go along with things like USERRA, is the Escalator Principle. This principle is unique to benefits that only seem to happen for veterans. We don’t see some of these kind of benefits for all people with disabilities. The Escalator Principle quickly states that an employer must hire back the reservist at a salary and position equal to what they would have been at if they had not gone off to war. So let’s say you went off to war for a year and all your colleagues got a 10% raise. When you get back, you should get that same 10% raise. And of course you should tell us where you are working, because if you are getting a 10% raise these days, thinking I need to apply there as well. It also applies similar to promotions as well. So if after 5 years, your colleagues not only get bumped up to an Associate Professor, that’s not a very good example. But after 5 years you become a senior accountant at lets say Anheuser Busch again. If you’ve gone off to war and you’ve only been working there 4 years plus that 1 year of military service, you should be treated as if you’ve been there 5 years as far as promotion goes. You too should be a senior accountant. So many individuals, many veterans like these laws. You can see where some of employers are not on board as much as those of us in the rehabilitation field.
Moving on to slide number 15. A quick primmer in disability rating. I know we talked about it before. That word should be ratings not datings. We won't get into dating and veteran affairs, but it all fits together.
This information comes from the Department of Veteran Affairs. I am no expert, but kind of makes sense. We see disability rating for a veteran; they are always going to be in increments of 10%. The rating is what helps determine whether and individual is eligible for vocational rehabilitation and program services, VR any services. So the disability rating percentage represents roughly what the disability impairment earnings capacity resulting from disease, injury, and residual condition affects, so to speak. So, let me give you a quick example, I am not sure I understood what I said there.
If an individual is making $50,000 a year, go off to war; because of blast injury have tinnitus. Tinnitus is considered a disability. Tinnitus is that ringing in your head kind of thing. Tinnitus is considered a 10% disability rating. Rating can go anywhere from 10 to 100% obviously. If an individual would go back, making $50,000 a year. They acquire tinnitus; have disability rating of 10%. What the VA is saying is that tinnitus is going to cost you about $5000 a year. So you could get a job at $45,000 instead of the $50,000. What the VA will do, is they will supplement your income; the money isn't taxed, the difference being about 2500 a year. The VA tries to supplement half of the income you lost, back. This is kind of a rough case of what a disability rating is. The most common disability ratings out there are for muscular- skeletal injuries type of things, like arthritis or knees that happen from trauma. You can fill in your own blanks there. In order to be entitled to VR services, your disability rating must be at least 10%. It must be within 12 years of that disability rating and you can not have had a dishonorable discharge. One thing about mental health diagnosis, sometimes it results in a dishonorable discharge. I don’t want to get too much into that. It depends on pre-existing condition and things like that. But you got the idea on disability ratings, I hope.
Moving on to slide number16, I will take a quick drink of water here. Slide number 16 concerns the mental health concerns. We talked a little about the stigma of mental health. Officially the armed services have recently given more attention to mental health problems that go along with the war. In the past we could see that a mental health condition could affect promotion and especially the way you seem to be viewed by others in the military. A lot of veterans have a lot of undiagnosed problems that likely the rehabilitation counselor will be the first professional person to recognize as an undiagnosed problem. What happens, of course, we in the rehabilitation field understand that when we have undiagnosed problems, oftentimes secondary concerns arise. So sometimes these issues often come up if you have a TBI, but don't know you have a TBI. You understand that socially things aren't going well, you might isolate yourself much more often, and when we start doing those things, often that way people handle those problems in through things like substance abuse, lashing out at others, et cetera.
Another aspect that contributes to mental health concerns with veterans is we know that veterans in general have difficulty, more difficulty than the general population with adhering to medical advice. So they are much less likely to stay on their prescription medication, things like that, for a variety of reasons. We know that can cause problems when individuals aren't taking their medications.
I had a question from Elizabeth, talking about how is a disease service related? Does a disability have to be service-related to be eligible. Good question. In general, in order to be eligible for VR services, the condition can't be preexisting. So let’s say you went into military services and you had Crohn's disease but you were feeling pretty healthy for the nine months in Afghanistan. Two years after you get done, your Crohn's disease kicks in a little bit and you need service. From my understanding, you would not be eligible for VR services. The disability would have to have been acquired while a member of the armed services.
Jumping to slide number 17, talking about community services. Actually, we were going to talk about community resources for veterans. When I got home yesterday, in my mailbox was this new issue of the Journal of Rehabilitation, 2009 volume 3. The first article, by Burke and Chuck Diginef, who was a classmate of mine, has a great appendix starting on page 12 with a list of veteran health family and education resources, almost all are available online. I know a lot of you get the Journal of Rehabilitation, those who don't, often available to libraries, if you want a copy of the appendix, two pages with community services, send me an e-mail, I will scan and send it to you.
Someone asked about the VR services, the question is do you need a 10% rating to receive services? Yes, 10% is the minimum disability rating you need to get services, but disability ratings go in increments of 10%. If you have any disability your minimum rating would be 10%. So yes, 10% rating is needed.
Thanks to a couple of you who answered questions about diseases that happen during military service. I guess things like cancer that can happen from Agent Orange is an example. So it appears that yes, you would be eligible for services as long as it was acquired during time in armed forces. You would have to be diagnosed within 12 years of being discharged or else in special, obviously special cases where the timeline might have been extended slightly.
As far as community services, great resource in your most current issue of Journal of Rehabilitation. Chuck Diginef and Ms. Burke are at San Diego State University. A fine military area. So if anyone is interested in that kind of information, go to the Journal of Rehab or contact me. I am going a little bit slower here. I see it's almost 2:00, lots of information on community service, it's important for rehabilitation counselors to be aware of those services that are out there.
A question about research for post-traumatic stress disorder for current military as opposed to veterans. Yes, in that journal article, Chuck deJanive is a TBI PTSD researcher. What the article gives is or the appendix, what it gives a lot of health services that are available to current military and veterans. So for example, there is a website called MyHealth.VA.gov., which will talk a lot about health and benefits information available to both current military and veterans. This is from my limited exposure to those websites.
Thanks for all the questions. I need to throw in a student; this is a good of time as any, especially since it is slide number18. Talking about student thoughts. We talked earlier about the NDAA law from 2005, the National Defense Authorization Act of 2005. One thing, one effect from that law we thinks is that this act helped create or at least open up unfilled job opportunities for rehabilitation counselors, especially in veteran affair offices. We’ve seen alot of students in Florida have gotten jobs with the VA. One aspect of working with the VA, the pay is much better than some of us receive as rehabilitation counselors. For interns in the federal job, interns are getting about $40,000 a year. It appears after two years, if you have a CRC, vocational counselors for the VA make a minimum of $52,000 a year. So, well-paying jobs it appears. Partially though this National Defense Authorization Act, and what are also seeing is a lot more individuals being hired. What my students are reporting, and the supervisors at the VA, is that it is much easier as a student of rehabilitation if you do internship with the VA to then get hired on with the VA. These are very competitive jobs for the rehabilitation counseling positions, but if you have been an intern there, seems to be a lot higher percentage of interns getting hired by the Vas. VAs seem to be hiring a lot at this point, as well as Vocational Rehabilitation agencies that, at least in down here in Florida are seeing a lot more veterans as clients. My quick commercial for students thinking about a career in rehabilitation.
We're going to skip to slide number 22. Some of the results from our research with the counselors who work with veterans with disabilities. One thing we asked besides “what kind of knowledge did they need to work with veterans?”, we asked generally in their educational career, meaning both their college lifetime and their in-service training programs they had, wherever they were working; “what areas did they still feel unprepared to work with veterans?”. So four main things came out. The first one is family issues, which we see as a common concern among a lot of rehabilitation counselors. Rehabilitation counselors generally report having very rarely meeting up with families as a part of the rehabilitation of their consumers. Oddly enough, what we find in research is that family is instrumental for success of clients, but for a variety of reasons we have counselors, both time reasons and what we think is sometimes training reasons, don't involve the family very often. Some rehabilitation counseling programs and core overall has recognized this might be a training need, we see some colleges now mandating classes in with family counseling or group counseling. I would encourage rehabilitation counselors to be comfortable with family and perhaps think about changing the way we deal with consumers to involve family as much as possible. It seems to have a dramatic effect on outcomes of individuals.
We talked a little bit about laws concerning veterans. Concerning employer rights and views of reservists, as a rehab counselor we are obviously always aware of the employer aspects of employment. We work for the individual with the disability, but are wise enough to understand the employers affect the outcomes a lot.
A popular theory in the media and other places out there, would lead us to believe that employers strongly support military reservists and veterans. But what we are finding from most studies and from personal accounts from veterans, suggests both employers and even coworkers generally have a negative view of the worker who is in the military, the reservist in the military. Generally it is for a couple of reasons. We find when a reservist goes off to war, the increased work load falls on the either coworker, or the supervisor has to figure out a way to hire someone else to do that. There's a lot of uncertainty in timeline. If you are an employer you don't know when the individual will go off to war often. So often, if you have to hire someone else to do that job, it can be a difficult transition time to know when the dates are going to happen. Much like we see in the disability field with any type of laws, there's lots of confusion with the laws that pertain to the military. We talk to employers about the escalator principle, generally get a blank look on their face. But generally, it can be difficult to understand everything involved with a reservist. Especially an employer that might only have to deal with these issues once every five or ten years. Whatever the case is.
The absence, military reservist is absent it causes problems. Military reservist are an integral parts of the working world and when we loose one of those integral parts for nine, 12, 18 months, there can be issues that resolve from the absence. We all see that with the increased work load or only one person knows how to fix the copier, when they are gone we stop making copies.
Moving onto slide number 23. We are talking about job functions. What counselors are telling us they want to help understanding the availability of training and employment assistance programs that exist for veterans. And sort of how best to monitor the medical psychosocial issues for veterans when often times a veteran is dealing with another organization. There seems to be a need for connection between the service organizations that are working with veterans. We see this throughout the rehabilitation community of course, one thing we have done, and built the one-stop shops so there have been better communication. The same goes for veteran organizations. Some communities have done this well, and others places we see a lot of fragmentation. An often time there is a lack of trust between the organizations. Some are organizations might be government run and other are privately run, free-standing organizations. Maybe there is some conflict for some of those reasons. Alot of younger veterans don't feel the same connection with some organizations that have been traditional veteran organizations, such as the VFWs. What younger veterans are reporting is that they feel those organization sometimes cater to veterans from wars of Korea, Vietnam, not addressing their issues or their concerns maybe. Oftentimes is no connection to the military once a young veteran gets out of the service, at least in a social type way we might see from the VFW type of organization.
Slide 24 talks about critical issues for working with veterans. I think some of these are very similar to what we see with any type of rehabilitation counseling role. Especially with state agencies, or federal agencies that have high case loads. We will skip over that, commiserate together next time we are at a conference together.
As a field, rehabilitation, what we are trying to get is a starting place for what the rehabilitation field should do. Sort of a roadmap for rehabilitation. If we can make a focus together as a field, this is one idea for maybe how we should focus rehabilitation issues to best serve veterans with disabilities, a five-pronged approach and all of us can take different prongs in the way we address these issues.
The first prong, how do we infuse veteran issues in rehabilitation training. So when our young rehabilitation counselors come out, ready to deal with veteran issues. Second being employment for veterans. The third one is the self management issues for veterans with a disability. The fourth one is family resiliency issues. And the fifth one is developing researchers who are going to take this on as a topic, helping lead the rehabilitation field.
Slide 26 talks about infusing veteran issues. Veteran issues don't seem to be important when we interview current rehabilitation counselors, and their roles and functions, veteran issues rarely come up as an issue for people who aren't dealing with veterans. Part of that could be because if we look at current textbooks or current training, generally there's nothing about veteran laws or issues. Oftentimes what happens with students is they don't learn much about veterans until they get on the job, then it's a crash course, can be a difficult transition period. What I think we need to do, while we have classes and training that discuss specific laws of things like blindness, HIV, it would be easy to add into that discussion issues that concern vets, and wouldn't necessarily alter our training courses that significantly.
We know that veterans are often going to be seen by rehabilitation counselors as the first professional. Some of the injuries common among veterans, we as rehabilitation educators need to educate rehabilitation counselors on the signs to look for on things like PTSD, TBI and so on.
Moving to some of the rights of veterans in employment, this concerns some of the laws that rehabilitation counselors should be aware of to share with veterans. With veterans, one aspect of knowing laws is that some benefits to veterans are time-related. For instance, with re-employment, an individual after discharge must be rehired within 14 days of reapplication. If a veteran gets discharged, come back to Anheuser Busch August 1st and asks for their job back; Anheuser Busch has until the 15th to rehire them. Veterans also have laws pertaining to how soon they must apply for reinstatement for re-employment so to speak. If the individual was gone zero to 30 days, they have to apply right away when they get back. An individual gone three or four months have more time before they have to reapply for their job. It's important as counselors to educate the veteran with a disability about some of the aspects in order that they can allow these laws to work with them.
We talked about the escalator principle before. College requirements as far as re-employment or readmission, the college must readmit if it's within two years. Say an individual is in a PhD program, don't have to go through the interview again, the college should readmit to the next class coming in, so to speak.
USERRA, sometimes referred to as the Reservists Act; when we are talking about lingo out there. When we talk to veterans, they report although these laws are out there, there are troubles getting employers to follow the laws. One in six report troubles about the amount of time it took for the employer to restore the job or get benefits back. Others report they weren't given their job back at all. The most common report is that if an individual puts down on resume they are a reservist the employers have a negative attitude to hiring them in the first place. So sort of switching jobs can be a problem too.
One thing about reemployment, oftentimes for an individual who has gone off to war, they acquired new skills, they are often looking in their own mind, they think they are a much better employee and should be getting a job better than the one they left. It can be frustrating, went off, learned new things and come back and they find themselves in the same position. So it’s like you go off and get a college degree, go back home and you’re still working at the 7-11. So the expectations can also be a difficult thing to deal with when we are talking about reemployment of veterans.
Moving onto slide number 28, talking about veterans with a disability. Thins like reasonable accommodations are similar to other aspects of rehabilitation, that I think we understand. And if employers can prove undue hardship, so if a reservists comes back with a disability to a small company and the small company can show that rehiring is undue hardship for the company, of course they don't have to rehire. It's a little more difficult with veterans than other people with disabilities.
The other aspect of veterans returning to their place of employment, we know eight to 10% of reservists run their own business. If you are gone nine months, it can obviously have a detrimental effect on your business. A lot of individuals who go off to war, come back, find it's not so easy to start the business up again. There can be difficulty getting things going, obviously coming back as an individual with a disability.
Slide number 29 discusses the distinct employment needs of veterans. We know that the number of returning veterans that change jobs is significant. So about 25% are going to change jobs, for some of the reasons we just mentioned. That they learn new skills and they don't want to work where they were before, and that they now have supervisory experience etc.
We know since there are specialized laws for veterans it can be confusing for employers. We understand in the disability world when employers are confused they don't necessarily take the time to become unconfused, what they do is they just don't hire people with disabilities. Things from the ADA, and some of the other laws that are out there and put in place to help people with disabilities, the effect sometimes on employers is that it scares them off and they just choose not to hire someone rather than having to learn the intricacy of the law. So I think one role we have as a rehabilitation counselor is to slowly and kindly educate the employers, about the laws and that they are there for people’s benefits and that they are really not that difficult to understand.
Slide 30, talking a little bit about employer's needs. Because I think that often we can fixate on clients, think employers should do more, but the aspect that the employer needs to make money, they need to do things for their company. Walking in the steps, shoes of an employer can be a helpful thing for a rehabilitation counselor.
What employers need to do, is they need rehire within 14 days of reapplication. They need to know insurance and reemployment laws. They need to offer insurance within 30 days, it can be a cobra type thing, but insurance has to -- they can't have a 90-day waiting period if like they have with a new hire.
There are some status and training requirements. They must give status from the escalator principle, and they also must offer training if it's required to be successful on the job. If a computer programmer goes off to war for nine months, they come back. We know often time those computer skills are changing day-to-day. The employer must help that individual get the skills to become current at the acceptable level of that position.
There are laws that pertain to ability to fire and obligation to pay. In most states returning veterans in general cannot be fired within one year without a reason. If you have questions on that, I think employer-at-will states. I come from Florida so we are an employer-at-will state. There’s no obligation to pay salary when the individual is gone
Moving onto slide number 31, we see on that is where the employer attitude that has shifted. Back in the Persian Gulf War in the 1990’s. What we saw is that most employers were supportive of their reservists. A very high percentage paid salary and benefits for individuals going off to war. They came home. They were welcomed back. They got their jobs back. They had a party. But what we find now, the new bureau of reservists, employers are very unhappy with the uncertainty of deployment. Don't like the time away, comes up over and over again. As opposed to the Persian Gulf War, almost like a movie script, it happened one time. It happened for a very short time. The employee went away; they came back and were still successful. With Afghanistan and Iraq, it appears that employers are tired of the constant deployment activities.
We see an over all negative attitude towards reservists. With reservists, the law states they can leave for up to five years over a 20 year period. If you are an employer, one positive aspect of deployments during Afghanistan, Iraq, once the five years hits you can count on that employee being there for a long time to come. So bring up the positives with your employer that you are discussing these things with all the time.
Slide number 32 talks about employment retention in the military. One thing we have seen with the high rates of disability for the military is much more likely to keep individuals who have become disabled in combat as part of the armed forces. Usually more minor disabilities of course, but people with disabilities are being employed at a much higher rate in the military than they once were.
There are often some social reasons for leaving. We know that employer support has a strong correlation with reservist decision to stay or to leave reservists. Employers who are supportive of their workers being in the reserve are more likely to have individual who is stay with the reserves. As a country in general, if we think reservists are a good thing, then supporting employers who then who support their employees them seems like a positive aspect.
There's a question on the reservist law, how it relates vocational counselors. USERRA, the reservist law talks about reemployment for individuals who are in the service and it acts alot like the Family Medical Leave Act. We talked a little bit about it in slide 14, but I can talk to you a little bit more about it if you have questions.
We are talking here about self-management and what it is and how it relates to issues for veterans. What self-management is, it is learning and practicing skills to carry on ordinary life with a disability. Doing the things that keep you healthy. So it might be taking medication, exercising, diet. The reason it is such in issue for veterans is we know that veterans as a group have low adherence rates of taking medication, perhaps due to the cost, perhaps due to things like post-traumatic stress disorder, location, oftentimes veterans have a long way to go to get prescriptions. Due to the way VA hospitals work and we changing some of that. It becomes an issue for rehabilitation counselors, because we know that secondary conditions tare potentially the biggest barriers to long-term employment. We know that with a disability we can help someone rehabilitate whatever it is if they lose a limb, lose their vision. Those things are not easily accommodated perhaps, but if that is the only issue it seems like employment is, successful employment is an easy goal sometimes. However, those secondary disabilities come along with the primary disability, things like substance abuse, diabetes, obesity, pressure sores, a lot of those things come from the difficulty of adherence to medical advice or medications. I think we see as rehabilitation counselors, those secondary things are those things make it very difficult for an individual to stay employed. An individual with a TBI, we can work with them to become employed, having a TBI and a substance abuse problem. That substance abuse problem oftentimes that is their down fall. Not showing up for work, getting there late, things like that, employers have problems with.
Some ideas with interventions as a rehabilitation counselor you can do. There are some scales out there. Malachy Bishop has a good scale on self-management that helps you focus on how to help the individual become more adherent. But I think as rehabilitation counselors, just asking a couple questions can help us understand if our consumers are following the medical advice. If you have an individual in your office you can ask how many pills they are supposed to take for injuries and ask them how many they took yesterday. I think that just one of those quick and easy ways to understand the medical adherence difficulties people are having. Consumers often, when you ask them those type of questions, when they are supposed to take five pills, didn't take any yesterday. And understand they didn't take any because they can't afford medication, this and that were going on, helps uncover issues that the veteran might know is an issue, but doesn't know who they are suppose to talk to about it. It helps define what our role is as rehabilitation counselor.
On slide 34, talking about family resilience, as part of the importance with veterans, especially. individuals with disability are probably affected just as greatly when they have a disability. We see substance abuse rates, depression, anxiety, much higher than families without disabilities, at similar rates for individuals with disability.
We know that in general, even though there are VA hospitals, and there are very good VA hospitals out there, about 2/3 of the care for a veteran with a disability is going to come from the family. So we know the family is important. We are not sure how they are going to work with us in the rehabilitation of an individual, but it appears important to at least get them, on our side. One way, when I was a rehabilitation counselor, we tried to change in service. We would see some clients in their homes to see their family environment, see if the family would be supportive or not, may have to adjust to time to meet with clients later in the day, or weekends. Not pushing for those things, but if we want to involve family we have to think of ways to involve the family. Maybe emphasizing to the family and veteran with the disability that if they are going to get rehabilitated it has to be a whole community program to do it. They will need support from their family. They are going to need their family to do certain things. So maybe their families should come to meetings with the rehabilitation counselor. Maybe they should take some time off work to understand what the issues will be. Maybe eliminate some of that uncertainty as far as timeline goes. As far as who they are to meet with, et cetera.
Some things rehabilitation counselors can work on if they have the whole family there, are some of the issues concerning the family. Things like problem solving skills, ways to gather social support, so what kind of support systems that are out there for veterans. Helping them understand communication, especially with spouses with newly-acquired disabilities. Also, long-term goals. Often times what we see with a family that has a new individual with a new disability is that one member might quit work to take care of the individual. It's a fine thing, but oftentimes not a good long-term solution. Someone quits their job, what we see is down the road they may regret quitting their job and there may be financial concerns that they did not realize right away. So just bringing the family in and talking about long term goals can sometimes help people not make such rash decisions or help them think through decisions that are going to be beneficial, both long-term and short-term.
Moving onto slide 35. This talks about research and I think we need to promote research in our field, and at individual agencies, understand research on veterans and in order for us to keep advancing, and keep being seen as a leader.
Slide 36, a little about news you can use for a rehabilitation counselor in any setting. We talk about adjustment, family issues before they escalate to job loss or divorce. So we know as counselors, we want to be proactive. We want to focus on wellness. With this group we know veterans as a group generally were very active, in very good shape. When talking to veterans, we understand that maybe athletics and such are important in their life. So discussing programs such as the wounded Warrior program, who do a good job with things like sports and health can be important. Some people with a disability that sports, athletics have been a big part of their life.
Some other things we should learn. Some screenings for TBI and PTSD that we will get into in a second. Liaisons with employers. The last one, acceptance of the person. What veterans tell us is that they feel generally supported but that often feel that the war they were part of was not supported. Often a veteran will talk about that it makes it difficult to work with people if they are not sure of their views. They oftentimes feel like counselors maybe don't support what they had done in the past. There's some questions that make them a little defensive about some of the activities.
As a rehabilitation counselor, understanding your view of war, your view of politics, might be different than the view of the person sitting across form you. How do you want to relate that to your client in the best way possible.
I wanted to give you a few things that you could sort of take away as well, as some of this information. I might have missed the question concerning an ADA situation. Meanwhile on slide 37, we’re talking about screenings rehabilitation professionals can use. A couple of big areas we think rehabilitation counselors should be proficient at screening for are things like TBI. A couple different ways of looking for TBI. One thing is we know when individuals have reading problems, but no vision problems, that could be a processing issue, so that could be a sign of TBI. Oftentimes individuals will screen with normal vision but complain to you that they can't read the form they are going to sign. That might be an indication you should send them for more check ups concerning their brain injury. With PTSD, the PCL is a good check list you can give clients in your waiting room. 17 items they can do it while they are waiting.
Checking for substance abuse through simple four question types screening like the CAGE or other types of screening devices that I am sure a lot of you are familiar with.
With sexual trauma, we have reports that about 25% of females have had some kind of sexual trauma during their deployment, but seems to be an issue we have not focused on greatly at this point. I encourage rehab counselors to just bring up the issue and talk about sexual trauma with veterans. Half the cases are male cases, so we have that stereotype in mind of what sexual trauma is, but maybe with all veterans we need to talk a little bit about if they have experienced any type of sexual trauma.
If we bring in families, families can help us screen for things like PTSD as well. We know with adjustment issues if veterans are isolated more often. If families are talking about this individual who used to be very social, now isolated themselves in many situations, can be a warning sign for PTSD and a sign that maybe we need to have them checked out further.
A little bit more on PTSD. Some of the symptoms we all learned about in different types of counseling classes. Things like re-experiencing the emotional numbness, sleep disturbances, depression, some outbursts of anger, feelings of intense guilt. A couple other individuals in the military have suggested that maybe counselors should have four quick screening questions ready so any individual who comes to them, who is a veteran, we can screen for it as part of our initial interview. The four quick questions that seem to fit would be: 1) Have you ever seen anyone wounded, dead or killed during this deployment experience? 2) Have you engaged in direct combat where you discharged a weapon? 3) During this deployment did you ever feel you were in great danger of being killed? 4) The fourth one that kind of just added on, would be something along the line of, have you been exposed to any kind of sexual trauma? These quick screening devices for PTSD can help rehab counselors see people who obviously need fuller check up for PTSD.
Slide number 39 talks about TBI and a couple warning signs. If you client is experiencing hearing loss, ringing in the year from tinnitus can be a sign of TBI. Auditory processing problems, especially for older individuals, problems they never experienced before but after being in Afghanistan they are having a problem.
So three quick screening questions that seem to fit for our veteran population concerning TBI are: 1) Have you ever been in a blast explosion or close proximity, vehicle crash or fall? 2) Have you ever been rendered unconscious? 3) Have you had any head trauma? What we find is that a lot of individuals who might have been near blast injury, but didn’t have any physical effects, They might not have lost a limb or anything, but they might have been knocked over or knocked out from a blast 30 or 40-yards away. It might not have occurred to them that anything is wrong because there is nothing physical. But obviously some of that trauma that can happen to the head can cause lots of problems with rehabilitation that they are unaware of.
We have talked about the opportunities there. I am trying to save time for questions at the end. We have surveys out there, if you want more information, feel free to contact me, and I will give you more information.
Someone is asking, question two, for TBI. Let me go over the screening questions for both of them. TBI there's three. 1) Have you ever been in a blast explosion or close proximity, vehicle crash or fall? 2) Have you ever been rendered unconscious? 3) Have you had any head trauma?
For PPTSD, the four quick questions, someone asking if I can type them. I shoould incorporate them into the slide. I will type as a speak, not very coordinated. For PTSD the four questions are: 1) Have you ever seen anyone wounded, killed or dead during this deployment experience? 2) Have you engaged in direct combat where you discharged a weapon? And a lot of these questions go for police and emergency room workers, too. 3) During this deployment did you ever feel you were in great danger of being killed? Driving down here on highway 95, I often feel a great danger, but not the same you would feel in Afghanistan or Iraq 4) Have you ever been exposed to any kind of sexual trauma? Those are the four quick questions to screen for PTSD.
The quick screens for TBI are 1) Have you ever been in a blast explosion or close proximity, vehicle crash or fall? 2) Have you ever been rendered unconscious? 3) Have you had any head trauma?
Now I realize, as I sped up through those last slides, we have more time than I thought for questions. Before I get to questions, let me throw out quickly, some of this information is being published in the Journal of Rehabilitation, 2009, volume 4, should come out in about September.
In addition, Malachy Bishop and I are editors for the special edition of Vocational Evaluation and Work Adjustment Journal that is coming out in the fall. There will be five articles on veterans, not from me but people you will find much more interesting. I encourage you if it's an interest area, look in both of those publications as well.
I am open for questions and comments. What I would really, I know in these situations it's sometimes hard to get a lot of dialogue going. I would really encourage if anyone has suggestions, comments, my e-mail is Mfrain@fau.edu. I would encourage you to contact me.
My phone number is 561-297-3626. I put this up so I don't get calls from my mother. That is correct e-mail, phone number.
There was a question concerning State Vocational Rehabilitation counselors and their work with vets. What I am hearing and its more self-reports talking to state directors is that a lot of veterans are going to the state VR offices. Part of what came out from some of the laws is that veterans should be getting services, so arguably they should be getting services from the VA, but some states have interpreted that as that they should be giving more services to veterans with disabilities. In talking to some counselors, I obviously see more in Florida, seeing that a lot more state VR workers are seeing veterans, especially the younger veterans seem to use the VR services more so than some of the older veterans who are more used to the VA. And generally, speaking from my limited knowledge, there are both rehabilitation counselors and mental health counselors in a VA service office. So often times an individual with a disability will see both. Sometimes the VR counselor in the office will work more on employment issues than perhaps in a state VR office where they might work on adjustment issues more.
Someone had a question about which group would monitor and enforce is a vet was not treated fairly when returning to a job post-war. That's an interesting question. I would have to guess that it would have to be the same for anyone with a disability. The same process as far as filing suit and such. I will check. You would think military might have other steps in place to help reservists who are not getting a fair shake from the past employer. It's interesting, never come up when I talk to reservists, the difficulties of going through the military to reconcile the problem. I am guessing ADA. Kind of an ADA issue. I guess you could say.
Someone asked me to repeat my phone number. It's correct in the public chat room now. It's area 561-527-3626. EOE is the correct organization to contact.
I have a question concerning someone who has a master's degree in learning disabilities, their own tutoring business, “The Reading Edge”. How can I help veterans’ audio processing problems here in Denver? I would start with, if you are seeing someone with an auditory processing problem, to make them aware, help them understand whether that auditory processing problem is coming from a TBI. Obviously the audio processing problem it might be a symptom of TBI, but the TBI might affect the individual many ways as well. If they are not aware of that, what we see with some individuals who are not aware of their TBI, is that they start having social difficulties, relationship problems because of that unawareness of the TBI and affects. So we want to be first of all diagnosed properly. Once they are diagnosed we can deal with the issues that TBI present.
A question from Mark, if it's legal for a company to offer comparable employment in another city or state, to a returning reservist as it would require relocation. I talked to a few people off the record on this. My understanding is, and if anyone has better information, chime in. From my understanding, that is legal, to do that. Not very nice, I don't think, there are problems there, but legally a company could offer comparable employment in another city for that individual.
Someone is asking about ADA, whether it would cover that, the escalator principle. ADA, the Americans with Disability Act. The escalator principle, from my understanding is a military, actually reservist-only, aspect of the law. It just came out of the 94 reservist law that USERRA, Uniformed Services and Employment and Re-employment Act of 94. Generally if someone has a disability, it acts more like the Family Medical Leave Act. The job has to be there when you come back healthy. But they don't have to promote you and they don’t have to give you the same rank as before. Unlike with military reservists, where the escalator principle states you should be receiving benefits comparable to what you would have received if you didn't have to go off to war or go off to military service. It also affects if you go into training. Oftentimes reservists have a six-month training program before they go off to war in some situations. So yes. ADA doesn't address the escalator principle. From my understanding.
I don't see other questions coming up. Again, I would encourage anyone if you have questions, feel free to ask me directly. I welcome comments. This is a new field for me. I know a lot of you work with people with disabilities and veterans with disabilities or maybe have your own veteran experiences. I think as a field, rehabilitation, we are still trying to define how we should work with people with disabilities who are veterans, so input in these type of discussions are the best way of going about that.
Someone brings up the point that looking into the Department of Health and Human Services in regard to veterans being treated unfairly is another great avenue to take to make sure laws are being followed and veterans are being treated fairly. That's a good recommendation.
I appreciate everyone's attentiveness. I appreciated all the questions and everything. I think it's a great issue, and I enjoy working with veterans with disability, and enjoy talking to others who are doing the same. I appreciate your time this afternoon; look forward to talking to many of you again shortly. At this point I want to let Steffany take over and she will fill you in on a few things. Thanks.
[Event concluded July 30]