Great Lakes BLN Members Meeting December 5, 2012

1. Great Lakes BLN Members Meeting December 5, 2012

2. PTSD Presented by: Dell McCaslin LMSW December 5, 2012

3. DSM - IV • Posttraumatic Stress Disorder • Falls under the Anxiety Disorders

4. What is needed to diagnose PTSD? A. Exposure to actual or threatened a) death, b) serious injury, or c) sexual violation, in one or more of the following ways: 1. directly experiencing the traumatic event(s) 2. witnessing, in person, the traumatic event(s) as they occurred to others 3. learning that the traumatic event(s) occurred to a close family member or close friend; cases of actual or threatened death must have been violent or accidental 4. experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse); this does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work-related. Taken directly from - APA DSM-V Development: http://www.dsm5.org/ProposedRevision /Pages/proposedrevision.aspx?rid=165#

5. PTSD Symptoms B. Presence of one or more of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: 1. spontaneous or cued recurrent, involuntary, and intrusive distressing memories of the traumatic event(s) (Note:In children, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed.) 2. recurrent distressing dreams in which the content or affect of the dream is related to the event(s) (Note:In children, there may be frightening dreams without recognizable content. ) 3. dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) are recurring (such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings. (Note:In children, trauma-specific reenactment may occur in play.) 4. intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s) 5. marked physiological reactions to reminders of the traumatic event(s) Taken directly from - APA DSM-V Development: http://www.dsm5.org/ProposedRevision /Pages/proposedrevision.aspx?rid=165#

6. Additional Criteria C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by avoidance or efforts to avoid one or more of the following: D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred), as evidenced by two or more of the following: E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two or more of the following: F. Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month. G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. H. The disturbance is not attributed to the direct physiological effects of a substance (e.g., medication, drugs, or alcohol) or another medical condition (e.g. traumatic brain injury). Specify if: With Delayed Expression: if the diagnostic threshold is not exceeded until at least 6 months after the event (although the onset and expression of some symptoms may be immediate). Taken directly from - APA DSM-V Development: http://www.dsm5.org/ProposedRevision /Pages/proposedrevision.aspx?rid=165#

7. PTSD • When a relatively normal person is exposed to abnormal situations; Stress & Anxiety is a normal response or adaptation to the situation.

8. Making the Connection • YouTube clip: “Make the Connection” from the Department of Veterans Affairs • http://www.youtube.com/watch?feature=player_profilepage&v=SqjwV-lsVEs

9. What are some common thoughts about PTSD? • Myths: Create problems in the work place, unproductive, out of control, can not focus on tasks, aggressive, and unstable Disclaimer: I am not here to give you a pair of rose colored glasses and I will never say that these issues can not or will not happen.

10. PTSD video • YouTube clip: “PTSD and Dissociation” by HealthyPlaces. • http://www.youtube.com/watch?v=ubSso78RcyM&feature=player_detailpage

11. Common Treatments for PTSD • Outpatient Therapy • Inpatient Therapy • Vocational Counseling • Pharmacological Treatment • Combination

12. Accommodations for PTSD • Breaking down projects into tasks • Allowing breaks that are more frequent but less time. Such as, a normal break being 15 minutes during a 3 hour work period. Offer a 5 minute break during each hour. • Mentoring: Using a team member that has experience with PTSD or they have helped other family members.

13. Trial by Error • Many times it comes down to asking the individual what they need and trying it. • Maintaining open dialogue to continuously assess what works and what does not is often a good tool. Usually at prescribed times or as the individual needs. • What works for one usually does not work the same for another.

14. Where to go for help with PTSD • Veteran’s Medical Centers outbased CBOCs • Community Mental Health Facilities • On-Line help: • PTSD.va.gov • Vetcrisisline.net • Vetcenter.va.gov • www.maketheconnection.net • Vet Crisis Line – 800 273-8255 • EAP’s-Employee Assistance Programs

15. Where to go for Vocational assistance • MRS • WWW.Michigan.gov/mrs Department of Veterans Affairs (Vocational Rehabilitation and Employment) • WWW.VetSuccess.gov

16. Engagement • Where can Vocational Rehabilitation Counselors engage an individual? • The Counselor can engage an Individual at any stage: prior to employment, recently employed and even in the mid to latter stages of employment.

17. References • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author. • American Psyciatric Association. (2012) DSM-5 Development. Downloaded on October 15, 2012 from: http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=165.

18. Questions • If you have any questions about this topic, I can be reached by cell phone at 313-212-2511

19. Compensated Work TherapyInformation SessionRevised December 3, 2012Revised October 20, 2011Original Powerpoint -December 10, 2009www.cwt.va.gov

20. CWT Informational Session-Overview CWT – Compensated Work Therapy • SE-Supported Employment • TWE-Transitional Work Experience • HVSEP-Homeless Veteran Supported Employment • SE/TWE/HVSEP all fall under the CWT umbrella.

21. What Is CWT? • A vocational rehabilitation program that endeavors to match and support work ready Veterans in competitive jobs, and to consult with business and industry regarding their specific employment needs.

22. CWT Is Also… CWT is an evidence-based recovery program. It encompasses different types of employment services to assist Veterans in their recovery process. Every VA is unique in the services that it provides for CWT opportunities. The Aleda E. Lutz VAMC offers: SE TWE HVSEP

23. Supported Employment- SE • The Compensated Work Therapy/Supported Employment (CWT/SE) program is an evidence-based practice which consists of competitive employment with therapeutic supports.

24. Principles of SE • Individualized plan • One on one support • Rapid employment • Competitive community employment • Liaison services between employer and Veteran • Individual job coaching as needed • Referral to other VA services

25. Principles of Supported Employment • Equal opportunity employment. Zero exclusion. • Competitive employment supports improved quality of life. • Supported Employment is integrated with treatment. • Competitive employment is the goal. Rapid job search. • Community-based employment. • Consumer preferences are important. • Follow-along supports are continuous.

26. Transitional Work Experience • The Transitional Work Experience(TWE) is a pre-employment vocational assessment program that operates in the VA medical center and local community businesses. • TWE participants are screened by vocational rehabilitation staff, assessed and matched to a work assignment for a limited time as deemed clinically appropriate.

27. Transitional Work Experience cont. • TWE work assignments are supervised by work site staff, and impose the same job expectations as are experienced by non-CWT workers in the organization or company. • The general assignment length is four to six months. • Assignments are placed in the VAMC.

28. Eligibility for TWE • Enrolled in local VA Medical Center • Medically cleared by their physician to engage in employment seeking activities • Currently not employed • Stated goal of competitive employment

29. HVSEP • Homeless Veteran Supported Employment program is an initiative to employ Veteran who may have experienced homelessness. • Rapid employment. • Time limited service. • Job development and job coaching. • Community networking. • 6 month follow-along support.

30. Contact Information • CWT Supervisor Mary Wegerski, LMSW Ext. 11912 • CWT/SE – Vocational Rehabilitation Specialist Jody Uhl, CTRSExt. 11797 • CWT/TWE – Vocational Rehabilitation Specialist Shelley Brotherton, LLPC Ext. 11793 • CWT/HVSEP – Vocational Rehabilitation Specialist Sarah Villa Ext. 11896 Calvin Jackson Ext. 11934

31. Supporting the Seven Seals www.esgr.mil

32. A DoD chartered volunteer organization with four primary functions: Advocate for employers to hire Guard/Reserve members. Educate employers and Guard/Reserve members on USERRA rights and responsibilities. Recognize employers for their support to their Guard and Reserve employees. Mediate conflicts related to military duty requirements. ESGR is the only DoD agency that performs these vital functions. What is ESGR www.esgr.mil

33. ESGR 101 • ESGR founded in 1972 by Executive Order • Chartered by the Department of Defense • Reports to the Assistant Secretary of Defense for • Reserve Affairs • National Committee for ESGR – National Chair • 54 Committees - one committee for each of the states, territories, & the District of Columbia www.esgr.mil

34. ESGR Organization • Volunteer Leadership • – State Chair CAPT Paul Ryan USNR (Ret) • Full-time Support Staff • – Executive Director – Gary Aten (Lansing) • – Employment Transition Coord – Mel Bauman (Walker) • – East Side of State – Michael Peplinski (SANGB) • – Admin Support Tech – Andrew Cosgrove (Lansing) • Six Area Chairs – Volunteers • –Employer Outreach Reps • – Military Outreach Reps • – Ombudsmen • Total of about 110 Volunteers www.esgr.mil

35. ESGR Programs • Employment Initiative • Partner with state & federal agencies to enhance employment opportunities for Guard/Reserve members • Encourage employers to hire veterans and Guard or Reserve members • Employer Outreach • Educate employers on the Reserve Components and USERRA. • Build partnerships with key employers of Guard/Reserve members • Military Outreach • Brief unit/personnel annually, and before and after Mobilizations • Provide resources • Encourage service members to nominate their employer for awards • Ombudsman Services • Informal resolution of conflicts • Authorized under Administrative Dispute Resolution Act www.esgr.mil

36. Employment Initiative • Coordinate Employment Initiatives • Veterans Job Fairs • Pre Employment Training • Hero to Hired – H2H.jobs • Referrals to MI DELEG LVER/DVOP’s • ESGR is not an employment agency www.esgr.mil

37. Employment Initiative • Veterans Job Fairs • 24 Jan 13 – Grand Valley Armory - Wyoming • 15 Feb 13– Benton Harbor – Lake MI College • 4 Apr 13 – Dearborn – Community Center • 11 Apr 13 – Battle Creek- Ft Custer Armory • 25 Apr 13 – Traverse City - Coast Guard Station • 3 May 13 – Saginaw – Dow Center www.esgr.mil

38. H2H.JOBS • DoD Employment Portal • Power job search engine • Free job search and resumes • Mobile Applications • Live and virtual hiring events • Career Assessments • Over 800,000 jobs listed www.esgr.mil

39. Employer Outreach • Statements of Support Program • Briefing with the Boss • Bosslifts (Local and Out-of-State) • Open Houses • Presentations at Conferences • Awards Program www.esgr.mil

40. Statements of Support • Public recognition of an employer’s support. • Opportunity to show support with • favorable personnel practices/policies. • Employers pledge that they will: • - Neither deny or reduce job and career opportunities because of service in the Reserve components. • - Grant leaves of absence for military training, consistent with existing laws without using vacation time. www.esgr.mil

41. Bosslifts • Opportunity for employers to observe service members in a training environment. • Conducted both in-state and out-of state. • In-state opportunities • Tour Day - Camp Grayling • Ice Breaker Cruise – St Ignace • Coast Guard Cruise – Grand Haven • Out-of-state opportunities • Limited to 35 participants • Utilize ANG KC-135 aircraft • Active Duty installation www.esgr.mil

42. Awards Program • Recognize supportive employers • Strengthens Reserve/Employer Relations • Available Awards • Patriot Award • Above and Beyond Award • Pro Patria Award • Freedom Award Ford Motor Company Kalamazoo Dept of Public Safety Uniform Color Company www.esgr.mil

43. Military Outreach • Inform Reservists about ESGR programs and activities. • Encourage use of ESGR awards program. • Explain importance of establishing close working • relationship with employers. • Identify major employers of unit members. • Ask if any unit members are having conflicts with their employer over their military affiliation. • Conduct pre- and post-mobilization briefings. www.esgr.mil

44. Ombudsman Services • Established in 1974. • Provides information, informal mediation, and • referral service to resolve employer conflicts. • ESGR is not an enforcement agency and does • not offer legal counsel or advice. • More than 95 percent of all such requests for • assistance are resolved in this informal process. • Cases not resolved are referred to DOL-VETS www.esgr.mil

45. USERRA Two Levels of Statutory Protection • Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA) - 38 USC 43. • Provides protection from unlawful discrimination by an • employer due to military affiliation. • Provides protection and rights of reinstatement to • employees who participate in the National Guard and • Reserve. • MI Public Act 133 of 1955 • Provides additional coverage for members of the • Reserve Components and during “state call-ups”. www.esgr.mil

46. USERRA • Provides protection and rights of reinstatement to employees who participate in the Reserve. • Takes precedence over any law, policy, or practice that would diminish rights establish by USERRA. • Does not supercede federal or state law, company policy, or union contract that provide additional rights. • Enforced by the US Department of Labor, US Department of Justice and Federal Court System. www.esgr.mil

47. USERRA • Covers active duty personnel, reserve component personnel, and members of the Coast Guard and Public Health Service. • Applies to nearly all employers* in the US, public and private, regardless of the size of their business. • Provides protection from unlawful discrimination by an employer due to military affiliation. • Covers all periods of military service, voluntary and involuntary, including Funeral Honors, enlistment processing, and medical treatment. www.esgr.mil

48. USERRA Reservist Requirements • Provide advance notice - written or oral • Less than five years cumulative absence • No dishonorable, misconduct, or other than • honorable Discharge. • Timely return to civilian job - 30 days or less: safe travel plus 8 hours - 31 to 180 days: two weeks - over 180 days: 90 days www.esgr.mil

49. USERRA Employer Requirements • Grant Leave of Absence • Timely reinstatement of member • Grant status/seniority/benefits • Donotdiscriminate in: • employment • reemployment • promotion www.esgr.mil

50. Vow To Hire Heroes Act • Signed into law on 21 November 2011 • Addresses high unemployment rate amongst veterans • Tax Credits • Up to $2,400 to hiring veterans out of work > 4 wks < 6 mo • Up to $5,600 for hiring veterans out of work for > 6 mo • Up to $9,600 for disabled veterans out of work for > 6 mo • Mandatory Transition Assistance Program participation • Disabled Veterans 1 yr of Vocational Rehabilitation • Additional Montgomery GI Bill benefits www.esgr.mil