Culturally Competent Practice Power Point

Report
CULTURALLY COMPETENT
PRACTICE
Get 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.
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.
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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:
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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.
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Additional information: http://www.cem.va.gov/
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VBA: Applying for Benefits

Online
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By Phone
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1-877-222-VETS (8387)
Completed form sent to Veteran for verification and signature
In Person
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https://www.ebenefits.va.gov
Questions?
VBA National Call Center:
1-800-827-1000
Nearest Regional Office
Nearest VA medical center or clinic
Working with an accredited Veterans Service Organization
representative, attorney, or claims agent
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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
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 selfsufficiently and independently as possible.
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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 families
Low income
Living in or transitioning to permanent housing
Examples of possible assistance
Daily 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)
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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)
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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
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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
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Homeless or Mental Health Case Manager
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Forensic Evaluator
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Mentor Coordinator
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Residential Programs Admissions Coordinator
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Enrollment Clerk/Benefits Specialist
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Hospital Director/Policy Maker
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For Additional Information
Veterans Justice Outreach Specialists
http://www.va.gov/HOMELESS/VJO.asp
Seth T. Bridge
Policy Analyst, VHA Homeless Programs
202-461-1915
[email protected]
Veterans Service Organizations (VSO)

VSO is a collective term referring to membership
organizations of veterans
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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
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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
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VSO issues
VSO training issue - increasingly complex body of law
 Pre-judgment of claims
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VSO community involvement
Post as a community center
 Sponsor other community based activities
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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

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not make assumptions
Military Occupational Specialty (MOS)
Military Sexual Trauma:
 Defined:
1
rape, sexual assault, or severe harassment
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:
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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

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