vocational rehabilitation for formerly incarcerated veterans james p. lepage, ph.d. va north texas...
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Vocational Rehabilitation for Formerly Incarcerated Veterans
James P. LePage, Ph.D.VA North Texas Health Care System (VANTHCS)
Dallas VA Research Corporation (DVARC)University of Texas Southwestern Medical Center
(UTSW)
GoalsO1 Overview difficulties encountered by
ex-offendersO2 Overview vocational group format
and social support used for veterans with felonies
O3 Describe major components of supported employment
O4 Describe barriers/difficulties using supported employment with an ex-offender population
Team Members
O Julie Parish, MSO April Crawford, MSO Avery Lewis, MSO Ed Washington, BAO Ann GlasgowO Elizabeth Garcia-Rea, Ph.D.O Daisha Cipher, Ph.D.O Ledjona Bradshaw, MPH
Overview
O Based on Department of Justice numbers O Approximately 150,000 Veterans are
incarcerated in United States jails and prisons O An additional 75,000 in jails
O The number returning to the community each year is high with estimates of approximately 60,000 Veterans leaving incarceration annually.
O Texas numbersO In 2011, 11665 Veterans were in Texas Prisons, 7.5%
of totalO Average sentence was 11.8 years. O 3204, 27%, were released by 2012. 78% are VA
eligible
Overview
OCompared to non-Veteran incarcerated populations, incarcerated Veterans are:O Older (median age 38 vs. 28)O Caucasian (52% vs 35%)O More educated (87% vs 49% with at least
a GED)O Higher rate of sex offences (22% vs 9%)
Overview
O61% meet criteria for a substance use disorder
OEstimates of almost 50% have a non-substance mental health issues
Difficulties upon Release
Three-year Cumulative Prevalence of Adverse Events Following Prison Release Among 175 Veterans
Released felon % / Non-felon %
Received Homeless Services
Entered or Re-entered
Prison Death
Inpatient Psychiatri
c Treatment
Inpatient Substanc
e Treatmen
t
Inpatient Medical Treatme
nt
Any Negative
Event
1 year 26% / 1% 5% / 0.04% 1% / 1% 7% / 1% 4% / 1% 5% / 3% 37% / 5%
2 year 34% / 2%11% / 0.09%
2.9% / 1.7%
10% / 1.7% 6% / 1%
10% / 6%
60% / 10%
3 year 37% / 3% 15% / 0.1%3.7% / 2.2%
11% / 2.2% 9% / 2%
14% / 9%
75% / 16%
Overview of Employment
O Unemployment rates are 15-25% higherO Based on a limited Urban League review, 50% of
released prisoners will be unemployed one year following discharge O 85% of those employed will be working in unskilled jobs.
O Those with felony histories worked between 10% and 23% less during a year
O Overall effect of former felons on national unemployment is between .7% and 1.7%O The impact is even higher in African-American males with
estimates of 2.3% to 5.3%.
O Five S Barriers O Stigma
O SkillsO StatutesO Social SkillsO Social Networks
BARRIERS
Funding Sources
O 2005 – 2006 Development of vocational rehabilitation materials for mentally ill and/or substance dependent homeless veterans. VISN 16 & 17 MIRECC Clinical Education Grant Program
O 2008 – 2011 Evaluating Vocational Materials for Incarcerated Veterans with MI or SA. VA RR&D Merit Review D6192-R
O 2011 – 2014 Improving Social Support for Veterans with Felony Histories, Meadows Foundation
O 2013 – 2015 Development of Web-Based Vocational Services for Veterans with Felonies, VHA RR&D Pilot Award, I01BX007080
O 2012 – 2015 Assessing Supported Employment with Veterans with Felony Convictions and MI or SA VHA RR&D D7635-R
Vocational Manual
Helping Veterans with Special Concerns Enter the Workforce
Developed by James P. LePage, Ph.D.Marva Bluitt, M.A.
Pamela Abrams, MSW
The "About Face Vocational Manual" was created with a
VISN 16 MIRECC Education Grant
LePage, J., Bluitt, M., House-Hatfield, T., McAdams, H., Burdick, M., Dudley, D., & ... Gaston, C.
(2005). Improving success in a veterans homeless domiciliary vocational
program: Model development and evaluation. Rehabilitation Psychology,
50(3), 297-304. doi:10.1037/0090-5550.50.3.297
About Face ManualO Incorporates effective job readiness
componentsO InterviewingO Identifying skillsO Describing examplesO Resumes and applications
O Incorporates specific information related to felony convictionsO Handling questions
Job Readiness Class component
O 1 week classO 20 hours of class timeO Pre and Post Mock Taped Interview
O Pre and Post interview reviewed on final day of class
O Classes run best with 4-8 participants
Summary of Job Readiness Class
Summary of Job Readiness Class
O 1 week classO 20 hours of class timeO Pre and Post Mock Taped Interview
O Pre and Post interview reviewed on final day of class
O Classes run best with 4-8 participants
JOB READINESSNumbers game
O You will not get hired for every job you apply
O The more you apply, the more chances you have been hired
O The better you are prepared the better your chances of being hired
O Getting Hired is a numbers gameO This course teaches you how to go
from 1 in 20 to being 1 out of top 5
JOB READINESS CLASS
O Skills and Examples of SkillsO Transferable skillsO Adaptive skillsO Job related skills
JOB READINESS CLASSO Opening/Closing Statement
O Focused on skillsO Limited on personal information
O Traditional versus Non-Traditional Strategy
TRADITIONAL
• Want Ads• Internet Job Sites
– Monster– Career builder
NON -TRADITIONAL
• Cold Calls/contacts• Networking• Jist Cards
Summary CardJohn Doe Mobile: 972-555-5555 4500 S. Lancaster Rd Home: 214-555-5555Dallas, TX 75216 [email protected]
Position Desired: Warehouse/Forklift
6 years experience in all aspects of warehouse work. Able to operate forklift that includes: sit-down, stand-ups, and pallet jacks. Pulled finished pallets for weight and shrink wrap and Load/Unload trucks. Prioritized and staged outgoing product inventory control for US Air Force.
Available for all shifts and weekends. Available for overtime and willing to travel. Hardworking, determined, responsible and a team player
JOB READINESS CLASS
O DO’S AND DON’TO Examples
O Be on timeO Don’t inquire about salary, vacation, benefits
O ANSWERS TO MOST COMMON INTERVIEW QUESTIONSO Examples
O Tell me about yourselfO Why should we hire you
JOB READINESS CLASSHow to Handle your felonyOApplication
O Be honest regarding felony convictionO Will discuss in interview
OResume O Never list felony convictions on
resume
O InterviewO Acknowledge past mistakesO Focus on positive aspects
Description of StudyO Conditions
O Basic servicesO Self-Help using the manualO Group based program based on the
manual
6-MONTH FOLLOW-UP
LePage, J., Lewis, A., Washington, E., Davis, B., Glasgow, A. (2013). The effects of structured vocational services in ex-offender veterans with mental illness: 6-month follow-up. Journal of rehabilitation research and development, (50), 183-192.
Month 1 Month 2 Month 3 Month 4 Month 5 Month 60.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
BasicSelf-StudyFull Program
Different letters indicate significant differences p < .05
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LePage, J., Lewis, A., Washington, E., Davis, B., Glasgow, A. (2013). The effects of structured vocational services in ex-offender veterans with mental illness: 6-month follow-up. Journal of rehabilitation research and development, (50), 183-192.
Percent Employed During Each Month
Secondary impacts of the Standardized Group Condition
• Confidence/Self-Efficacy• Perceived Barriers to Employment• Interview Skills
O Importance of Confidence/Self-EfficacyO Development of Employment Confidence
QuestionnaireO 10 items are rated on a 5-point scale, with 1 labeled “No
Confidence” and 5 labeled “Complete Confidence” O Target handling problem areas O Cronbach’s alpha = .91O Convergent validity assessed through comparison with another
employment confidence questionnaire developed by Saks (1999, 2002); > .5
O 50 homeless Veterans in a Domiciliary Vocational ProgramO Those who found employment had higher ECQ scores than those who did not find
employment (mean of 38 vs mean of 31; p < .003)
Employment Confidence Questionnaire (ECQ)
Employment Confidence Questionnaire (ECQ)
Pre Post32.0
33.0
34.0
35.0
36.0
37.0
38.0
34.0
37.6
Ecq Average
p<.001
Assessment of Perceived Barriers
• Barriers to Employment Success Inventory (Liptak, 2002)
• 50 items• Four point scale• Cronbach’s Alpha <.87 for all scales
Five Categories of Barriers
O Personal & Financial O Emotional & Physical BarriersO Career Decision-Making and Planning BarriersO Job-Seeking Knowledge BarriersO Training & Education Barriers
Barriers to Employment Success Inventory (BESI)James P. LePage, Ph.D.April Crawford, M.S. Julie Parish, M.S., LCDC (CI), CRCAvery Lewis, M.S.
VANTHCS, UTSW, DVARC, UNT
Change in perceived barriers
Personal/Financial Emotional/Phyisica Career Decision Making Job Seeking Knowledge Training/Education0
5
10
15
20
25
30
35
Perceived Barriers - Pre and Post Group
PrePost
Changes to Interviews
O Interview rating formO Rater observed videos of mock interviewsO Rated interviews on 22 criteria
O Criteria were the focus of the job readiness class (e.g. mention a skill, give example, discuss being a Veteran)
O Rater was blinded to conditionO Raters Trained to .90 agreement with
investigator
Interview Scores Pre and Post Group
Pre Post20
21
22
23
24
25
26
27
22.6
26
Inteview Score
Standardized Group Vocational Programs can improve
O Employment OutcomesO ConfidenceO Perception of BarriersO Interview Abilities
SUMMARY
O Becoming used in a wide variety of Veterans with less traditional target populationsO Serious mental illnessO Spinal cord injuriesO HomelessnessO Formerly incarcerated VeteransO PTSD
VA’s movement in the area of Individual Placement and SupportJames P. LePage, Ph.D.April Crawford, M.S. Julie Parish, M.S., LCDC (CI), CRCAvery Lewis, M.S.
VANTHCS, UTSW, DVARC, UNT
SUPPORTED EMPLOYMENT Traditional Vocational Rehabilitation
O Rapid employment seeking
O Counselor spends most time in community
O Assessment on the jobO Focused on finding person a
careerO Work with employer to create one
specific job for one consumerO Continues to follow individual
until individuals decides follow-up is no longer desired
O Wait until individual is ‘ready’ to look for work
O Counselor spends most time in office
O Assessment prior to job searchO Focused on finding person a
job
O Work with employer to open up any job for a consumer
O Follow-up for a finite time
Modifications for work with Veterans with felony histories
• The supported employment here could be viewed as “Supported Employment Lite” when compared to traditional populations served by SE
• Case loads can be larger• Follow-up is less intense• Needs for on-site work is lower• Natural Supports often receive lower focus• Focus on more limited job areas
Most Preferred Components ofTreatment Planning
Vocational Preferences Identified in Treatment Planning
Percent Desiring Component
Contacting potential employers for you to generate leads
98%
Discussing your unique skills and situations with employers to get the employer to give you a chance or create an opening (i.e job carving)
96%
Drive you around looking for potential employers and areas to work
87%
Work with an employer for part time work 78%
Least Preferred Components of Treatment Planning
Treatment plan preferences Percent Desiring
ComponentMeeting with you at your work after you are employed to review possible problems that may occur or help solve problems that have come up
73%
Meeting with your employer after you are employed to help you keep employment if there are difficulties
67%
Follow-up with your employer to find out how you are doing
62%
Going to interview site with you to coach you 52%
Meet with your mental health treatment team to discuss your plans
46%
About Face Demographics
Male 96.40%
Married 7.10%
Age 52.31
Education 12.65
Unique times in prison
1.63
Months Incarcerated lifetime
85.26
Months Incarcerated in last 10 years
33.25
Age of first arrest25.50
PTSD 9.50%
Depression 44%
SUD 89.30%
Psychotic/Bipolar 3.60%
38 Received Group based standardized Vocational Rehabilitation
46 Received Group based standardized Vocational Rehabilitation plus IPS
Types of offenses
Felony rape
Felony homicide/manslaughter
Felony weapons charge
Felony shoplifting
Felony sexual misconduct with child
Felony DUI/DWI
Other Felony
Felony assault
Felony robbery
Felony forgery
Felony burglary
Felony postitution
Felony drug charges
Parole violation
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
• Re-incarceration• Lack of focus on employment• Relapse
Complications to Supported Employment
SUPPORTED EMPLOYMENT Results
Group Based Control Supported Employment0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
40.00%
45.00%
50.00%
21.10%
45.70%
Percent Employed After Six Months
p < .05
SUPPORTED EMPLOYMENT Results
Online StudyO Currently developing an online
version of the About-Face programO Embedded videoO Live chat with vocational staffO Ability for vocational staff to make
direct comments about responses
