Psycho-Social Aspects of Disabilities of Disabled Veterans

Michael Frain, PH.D., CRC.

Florida Atlantic University

July 30, 2009

Wars in General

Always unique situation
Employment needs change with time
- Needs different at 19 than 22 or 32
- Often acquire new skills
  - Leadership
  - Technical
  - But without degree to put on resume

War in General

Readjustment issues
Time issues: training, then deployment
Experience may have changed person
- Physically and/or psychologically
- Heating coil
- Lose people with shared experience with discharge
- Time has changed family; roles

Situation with Wars in Afghanistan and Iraq

Setting and engagement of war different
- No front line, always on guard (anywhere, anytime)
More females in battle (12-23%)
High percentage of “Citizen Soldiers”(30-50%)
“Citizen Soldiers” often not draft age
- Families (half married), careers, house payments

Situation with Wars in Afghanistan and Iraq (cont.)

Enemy difficult to distinguish
Daily reports of dead and wounded
Unknown tour of duty (similar to other conflicts)
Support of veterans; but different views of war

This Situation

Better equipment and medical service
- Less die, more wounded (90% survival)
Different type of weapon
- Blast injuries
- Poly trauma
- Average of five surgeries
Some Civilian contractors also eligible for services

This Situation: Employers

Most employers lack experience
- Not trained to recognize problems that may result from being in a war
Number of veterans not seen in this country for this generation
War not a shared experience for employers

Situation

Likely over 100,000 wounded
20% with mental health diagnosis
Disability and health care payments could reach 600 billion $
Re-employment for non-disable 73%

Opportune Time for Rehabilitation

Rehabilitation laws grow out of war
- Vocational rehabilitation beginnings
  - Soldiers Act of 1918
- Services
National stage to display rehabilitation worth
Budgetary thoughts

Laws Support Veterans

Generally seen as a deserving class

May help lessen stigma against people with disabilities (if they are fighting for their country why would God punish them?)

1st laws in US for war-injured in early 1800s

War Risk Insurance Act (1917) first for disabilities

Employment Issues for Veterans

40% of injured will not return to pre-deployment employment
73% return rate for non-disabled
About 1 in 5 report disability at discharge
Jobless rate for GTA vets 5.2% (vs 3.9%)

- (well by 2007 data, higher for all I suppose)

Vets 18-24 17% unemployment (vs 10%)

Why a Rehabilitation Issue?

Clients at critical age
No group has embraced this
National stage
High need for group
- Unemployment rates

Issues for Rehabilitation

Laws pertaining to veterans
Mental health concerns of veterans
Community services
Injuries common in war

Laws Pertaining to Veterans

Services
- e.g. NDAA 2005
Deployment demands on employers
- USERRA
Re-employment laws
- e.g. escalator principle

Quick Primer on Disability Datings

From Dept. of Veteran affairs
Increments of 10%
When entitled to VR&E services
Most common

Mental Health Concerns

Stigma of mental health client
- Real military effects
Secondary concerns
- Substance abuse
Adherence problems

Community Services

Veterans affair hospitals
Vet Centers
Transitional Assistance Program (TAP)
Options for health care service providers

Student Thoughts

VAs (aka Veterans Affairs) called upon to provide more/better services
- National Defense Authorization Act of 2005
CRCs (interns) being hired by VA

Recent Studies

From various fields
Counselors with veterans
Veterans
Rehabilitation Counselors

Knowledge Needs of Counselors

High need areas

Laws pertaining to veterans
Common Psychological Problems of Veterans
Mental Health concerns
Injuries common in war

Knowledge Areas

Somewhat high

Community supports
Deployment laws and psychological concerns
Vocational services
Uncertainty

Areas of reported low preparedness

Family issues
Laws concerning military
Employer rights and views of reservists
Psychological problems of war

Job Functions

Training and employment assistance
Monitoring medical and psychosocial
Connection to veteran service organizations

Reported Critical Issues -Counselors Working with Veterans

Burnout
Caseload size
Bureaucracy
Understanding presenting issues

Responsibilities of rehabilitation counselors

A Roadmap for Rehabilitation

5 pronged approach to addressing the needs of veterans with disabilities

1. Infuse veteran issues into rehabilitation training
2. Employment needs
3. Self-management
4. Family resiliency
5. Developing researchers

Infusing Veteran Issues

Current textbooks
Laws pertaining to veterans
Injuries common among veterans

Rights of Veterans in Employment

Re-employment
Escalator principal
College requirements
USERRA
Current reported troubles

Veterans with a Disability

2 years for re-employment
“Reasonable accommodations”
“Undue hardship”

Distinct Employment Needs

Number of returning veterans changing employment
Specialize employment laws for veterans
Thoughts on importance of this group

Employers Needs

Rehabilitation’s responsibility to employers
Insurance and re-employment laws
Status and training requirements
Ability to fire; obligation to pay

Employer Attitudes

Shifting tide
New view of reservists
Co-worker attitudes
Employers view of reservist laws

Employment Retention in Military

Demographics of lower rates
- Gender issues
Social reasons for leaving
Impact on rehabilitation

Self-Management

What is it?
Why an issue for veterans?
Why an issue for rehabilitation counselors?
What are the interventions?

Family Resiliency

Importance of family in veteran issues
Changes in service delivery for rehabilitation counselors
Issues of family amenable to change

Development of Research

Current situation
- War unique situation to examine disability
War always a friend to rehabilitation
Similarities between ADA: Reservists Act
What researchers could do for the field

News You Can Use

Rehabilitation counselor role in any setting

Proactive
Focus on wellness
Screenings
Investigation of effect
Liaison with employers
Acceptance of person (if not war)

Screenings Rehabilitation Professionals Can Use

TBI
- e.g. Reading problems when no vision problems
PTSD (PCL checklist, 17 item)
- e.g. Substance Abuse (CAGE)
Sexual Trauma
Family Screening

PTSD

Symptoms
- Re-experiencing event
- Emotional numbness
- Sleep disturbances
- Depression, anxiety
- Outbursts of anger
- Feelings of intense guilt
Diagnosed when symptoms last >1 month

TBI

Hearing loss
Tinnitus
Auditory processing problems
3 quick screen questions

Rehabilitation Counselor Opportunities with veterans

Veteran affairs programs
- Pay
- Work details
Counselor opportunities
State VR roles

Survey Information

For counselors

www.coe.fau.edu/faculty/frain/consentcounselors.htm

For Veterans

www.coe.fau.edu/faculty/frain/consentveteransconsent.htm

Questions & Comments

Contact Information

Michael Frain Ph.D., CRC.

Florida Atlantic University

Email:

Phone: (561) 287-3626

THANK YOU!

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Fax: (404) 541-9002

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TACE Center: Region IV ©2009 with funds from the U.S. Department of Education, Rehabilitation Services Administration (RSA) under the priority of Technical Assistance and Continuing Education Projects (TACE) – Grant #H264A080021. However, the contents of this presentation do not necessarily represent the policy of the RSA and you should not assume endorsement by the Federal Government [34 CFR 75.620 (b)].

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