CULTURALLY COMPETENT PRACTICEGet to know the VA, organizations involved in veterans work, and veterans as clients

Introductions and Goals

Panelists: Seth Bridge, Department of Veterans Affairs Melissa Tyner, Inner City Law Center

Goals: Build an understanding of VA structure Provide an overview and tips on interacting

with veterans service organizations Discuss cultural competency when working

with veterans

VA: Mission and Vision

Mission

To fulfill President Lincoln's promise “To care for him who shall have borne the battle, and for his widow, and his orphan” by serving and honoring the men and women who are America’s veterans.

Vision

To provide veterans the world-class benefits and services they have earned - and to do so by adhering to the highest standards of compassion, commitment, excellence, professionalism, integrity, accountability, and stewardship.

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The Department of Veterans Affairs (VA)Overview of VA Structure

Veterans Benefits Administration (VBA): Administers programs that provide financial and other forms of assistance to Veterans, their dependents, and survivors. Benefits include: Veterans’ compensation, Veterans’ pension, Survivors’ benefits,

Vocational rehabilitation and employment assistance, Education assistance, Home loan guaranties, Life insurance.

Note: More detailed information about each of these programs, including their eligibility requirements, is available at: http://benefits.va.gov/benefits/

Veterans Health Administration (VHA): The largest fully integrated health care system in the United States, the services and treatment delivery systems include: Components include outreach; health education; assessments and screenings; care planning;

triage to and provision of care; aftercare Treatments to address: Medical, Mental health (trauma-related and addictions), Neuropsychiatric

(e.g., TBI), Specialty (e.g., spinal cord injury, blind rehabilitation) Support/services for psychosocial issues: Homelessness, Financial instability/unemployment

National Cemetery Administration (NCA): NCA honors Veterans with final resting places in national shrines and with lasting tributes that commemorate their service to our Nation. Additional information: http://www.cem.va.gov/

VBA: Applying for Benefits

Online https://www.ebenefits.va.gov

By Phone 1-877-222-VETS (8387) Completed form sent to Veteran for verification and signature

In Person Nearest Regional Office Nearest VA medical center or clinic

Working with an accredited Veterans Service Organization representative, attorney, or claims agent VSO offices in VA medical centers and Regional Offices VA Office of General Counsel’s list of accredited reps:

http://www.va.gov/ogc/apps/accreditation/index.asp

Questions? VBA National Call Center: 1-800-827-1000

VBA: Homeless/Incarcerated Veterans Outreach Coordinators (HVOC)

At least one HVOC at every VBA Regional Office

Outreach to homeless Veterans at homeless shelters, homeless Stand Downs, through state and local community partners and other areas where homeless Veterans may be located

Processing claims for homeless Veterans and those at risk of homelessness to ensure they are expedited

Outreach to justice-involved Veterans in Veterans treatment courts, prisons, and jails

Outreach includes providing information and assistance on VA benefits and services such as discussing eligibility criteria and filing a compensation and/or pension claim.

VHA Service Continuum: Treatment as Justice System Alternative

Medical Homelessness Mental Health Addiction Cognitive Risk Specialty Care

Helping Homeless Veterans

VA's major homeless programs constitute the largest integrated network of homeless assistance programs

in the country, offering a wide array of services to help Veterans recover from homelessness and live as

self-sufficiently and independently as possible. Prevention Services Housing and Supportive

Services Treatment Employment, Income and

Benefit Assistance Outreach and Education Community Partnerships

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Supportive Services for Veteran Families Program

VA Grants – to non profits or consumer cooperatives

Criteria for Veteran familiesLow incomeLiving in or transitioning to permanent housing

Examples of possible assistanceDaily living services, financial planning, transportation,legal services, child care, third party payment

Serving Justice-Involved Veterans

Healthcare for Reentry Veterans (Veterans incarcerated in prison facilities) Outreach and pre-release eligibility determination and assessment for

treatment Referral and linkages to medical, psychiatric, and social services, including

employment services upon release Short term case management assistance upon release Veterans contacted through outreach = 49,607

Veterans Justice Outreach (Veterans interfacing with front end of justice system) Jail outreach and associated eligibility determination, assessment, &

treatment linkage Education of and liaison with VA and community law enforcement Liaison with court system and staffing of collaborative treatment courts Short term case management as indicated Linkage to ancillary support (e.g. child support services, legal assistance) Veterans contacted = 48,056 Veterans admitted to Veterans docket = 7,724

69% (of 3,341) with successful resolution

Scope and Demand – Direct VJO Duties

Liaison with law enforcement Jail outreach Linkage with and coverage of treatment courts (and other courts) Catchment area POC – justice involved Veterans

Support of ancillary needs of justice involved Veterans(e.g. child support, legal, financial stability and benefits)

Documentation and clinical record keeping Data tracking, monitoring, and reporting

Program planning/development, coordination, and promotion Linkage development – internal VA, justice partners, community

providers Participation in local Veteran Treatment Courts (VTC)

Who VJOs are not…. (though you may wish they were)

Specialty Care Coordinators Homeless or Mental Health Case Manager

Forensic Evaluator

Mentor Coordinator

Residential Programs Admissions Coordinator

Enrollment Clerk/Benefits Specialist

Hospital Director/Policy Maker 12

For Additional Information

Veterans Justice Outreach Specialistshttp://www.va.gov/HOMELESS/VJO.asp

Seth T. BridgePolicy Analyst, VHA Homeless Programs202-461-1915Seth.Bridge@va.gov

Veterans Service Organizations (VSO)

VSO is a collective term referring to membership organizations of veterans Examples: Veterans of Foreign Wars (VFW), Disabled

American Veterans (DAV), AmVets, State Offices The mission of each VSO may vary by

organization but most are focused on assisting veterans and promoting the interest of veterans

Locations: Regional Offices County or State offices Stand Alone Centers - VFW

VSO’s in the VA benefits process Most VSO’s help veterans file claims with

the Regional Offices, some will even represent them up to the BVA

VSO’s file claims with a different philosophy than attorneys Incentive for quantity of veterans served File on all possible claims

Interacting with VSO’s

Be aware of your status as an attorney in this process Stigma surrounding attorney status History of opposition to attorney involvement in

veterans claims VSO issues

VSO training issue - increasingly complex body of law Pre-judgment of claims

VSO community involvement Post as a community center Sponsor other community based activities

Culturally Competent Practices: Working with Veterans

Best Resource: Representing Washington Veterans: Basic Legal and Cultural Concepts – Northwest Justice Project Authored by Equal Justice Works AmeriCorps alumni

Lauren Peach and law clerk Leo Flor Consider how to encourage veterans to speak

freely and how to then constructively react to hearing about killing, death, or other situations and attitudes that are uncommon or unacceptable in society. Never ask, “Have you ever killed anyone?”

Culturally Competent Practices: Working with veterans cont…

Consider experiences among veterans in light of the duration, nature, and time of their service. Understand how drafted veterans may or may not differ from volunteer veterans.

Age of veterans – be careful with assumptions about their service

Culturally Competent Practices: Working with veterans cont…

Do not ask, “ARE YOU A VETERAN?”: Instead ask, “Have you ever served in the military?”

Be careful with “THANK YOU FOR YOUR SERVICE”: For recently returned veterans, “Welcome home,”

or “Glad to have you back,” may be more suitable. For any veteran (or person), “I’d like to learn about your experience if you feel comfortable discussing it,” may more effectively connect an advocate and client without expressing judgment. Most veterans would rather be heard than thanked.

Culturally Competent Practices: Female Veterans

May not identify as veterans Combat Involvement

Do not make assumptions Military Occupational Specialty (MOS)

Military Sexual Trauma: Defined: rape, sexual assault, or severe

harassment 1 and 3 female veterans report MST 1 and 6 male veterans report MST

Working with Survivors of Sexual Trauma

Understand that each survivor experiences sexual assault differently there is no “normal” response Any behavior after the assault (positive or

negative) may be effect of the trauma Interviewing Survivors

Questions Open-ended questions Specific or Cue Questions

Working with Survivors of Sexual Trauma

Interviewing survivors continued… Open-ended questions – soliciting a

narrative “Tell me about what happened…” “Tell me about how you felt…”

Cue or Specific Questions Use to clarify questions from the narrative

“You mentioned you went to get medical attention. Can you tell me more about that?”

Working with Survivors of Sexual Trauma

Interviewing survivors cont… Environment is important

Location: Safe and comfortable for the survivor Private and free from distraction Maintain an equal physical position

Explain the purpose of the interview Survivors may not have all the answers to

questions The survivor is in control of the

process

Being Trauma Informed

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

Being Trauma Informed

Excerpts from stressor statements of veterans:

“As soon as I walk into anywhere, I know how many people are there, how many exits there are, where all other people around me are located. This hypervigilance also makes me extremely anxious.”

“I have problems remembering things. I have difficulties remembering both long term and short term. I am not sure why I cannot remember portions of my life. I find it so frustrating”

People First Language

People first language is about respect and dignity and it puts the person – not the condition – first Like gender and ethnicity disability is

No one wants to be defined by a single trait such as a medical condition or height Say “people with disabilities” not “the

handicapped” Say “Bob has a mental health condition” not

“Bob’s mentally ill”

Questions and Answers