ALABAMA VETERANS CONFERENCE

MAY 2012

DISABILITIES & CASE MANAGEMENT

Profile of Today’s Soldiers

All VolunteerAverage Age 27 – 28Many Married With FamiliesHigh Number of Guard and Reservists

More Women in CombatMore Than One Deployment

Technology Improvements On & Off The Field

Profile of Today’s Soldiers

High Number of Survivors

WWII 1 soldier killed = 1.6 wounded

Viet Nam 1 soldier killed = 2.6 wounded

OIF/OEF 1 soldier killed = 16 wounded

Better care on the field & better armor

High Number of Survivors

Transport field to U.S. Hospitals

Viet Nam 35 – 40 days

OIF/OEF 35 – 40 hours

QUOTE

"In the history of the Republic, never has so much been placed on the shoulders of so few for so long," said Brigadier General Loree K. Sutton, director of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, "We have no reference population to compare with the addiction and mental-health problems facing today's military personnel.”

Frequent Types of Disabilities

AmputationsHearing LossVisual Impairments Mental or Emotional Disorders

~ Anxiety Disorders -including PTSD~ Depression

Traumatic Brain InjuryBurns

Amputations

High tech prosthetics

Above the knee/elbow compared to Below the joint

Most have multiple prosthetics

In demand by employers

Never assume limitations without discussion

Hearing Loss

Technology getting better

Many hearing aides only amplify sound

Communication adds to frustrationMay be more

difficult to place on a job

May interfere with retention

Visual Impairment

s

Common problem with soldiers

May be associated with other issues

Many devices/agencies

to help JAN would be a good

resource for placement issues

Mental /Emotional

• Anxiety disorders, including PTSD

• Depression

• Could be in combination

Anxiety

Unlike the relative mild, brief anxiety caused by

such a stressful event such as business presentations

or a first date, anxiety disorders are chronic,

relentless and can grow progressively worse, if

untreated. Included: Panic, obsessive-compulsive,

PTSD, phobia’s, & generalized anxiety

disorder.

Depression

An illness that involves the body, mood and

thoughts, that affects the way a person eats

and sleeps, the way one feels about oneself, and

the way one thinks about things. Without treatment, symptoms

can last for weeks, months or years.

Depression Symptoms

Loss of interest in activities Weight loss or gain

Poor concentration/memorySocial withdrawalUnusual fatigue

Feelings of worthlessness, sadFlat affect

Post Traumatic Stress Disorder

Exposure to an event that causes intense horror,

terror, or fear of death.

After the event, the person: persistently re-experiences the

event, attempts to avoid memory or images of the

event, and suffers distress or impairment.

PTSD Many do not seek help-they do not

want to be seen as “weak”

May feel great guilt, just for surviving

Do not recognize own symptoms for a long time

Often a major event will bring it to surface

A Whole body-mind disorder

PTSD Symptoms

Sleep ProblemsRestlessness

Overly watchful or hyper vigilant

Social withdrawalHeadaches or unexplained personality

changes

Anger outbursts-out of character

Risk taking behavior

PTSD Symptoms

Distrust of authoritySocially

disconnected/emotionally numbDepressed/anxious

Problems with memory, attention, follow through

Poor frustration tolerances

Traumatic Brain Injury or Concussive Blast Injury

Estimates of over 30% from OIF/OEF have TBI

Most resolved in 90 days

60% of bomb blast victims have TBI

80% with TBI also have PTSD

Many avoid screening and do not disclose

TBI Common Symptoms

Symptoms depends on part of the brain injured

Fatigue

Headaches

Alertness/concentration

Lack of Self Awareness

TBI/PTSD

Share many

symptoms

•Sleep problems•Depression•Anger/irritability•Concentration•Memory•Planning•Attention•Poor frustration tolerance

What to Do?Listen carefully

Don’t try and diagnoseBe consistent

Ask what would help-memory aides are important

Be PatientMake appropriate referral if they are

undiagnosed and you suspect an issue

COPING

Denial/IsolationAngerDepressionAcceptanceHope

USING THE SERVICE DELIVERY STRATEGIES TO PLACE WITH WARRIORS

CASE MANAGEMENT

JAssessmentRed FlagsStrategies

Elements of Case Management

AssessmentCase Notes Develop and Document a PlanCase NotesReferral to Support ServicesCase NotesFollow up and ModificationCase NotesFacilitate Job Placement

Definition:Case Man-age-ment

Case Management , as the framework for Intensive Services is the facilitation and coordination of services at the community level. The purpose of case management is to provide an individual with specific resources to take control of his / her life. It requires the case manager to focus on the long and short term goals an individual has and empower him / her to make educated decisions about his or her future.

1. Comprehensive and client centered2. The service provider and the client are

partners3. There is mutual respect between

clients and service provider.4. A client has only one IDP

Nine Key Concepts

5. Relates the client’s actions to outcomes6. Involves creative problem-solving7. Relies on a network of services and

support8. The service provider and the system are

accountable9. Requires partnership at the systems

level

Nine Key Concepts(Continued)

INITIAL ASSESSMENT

Gather Relevant Information

Establish Rapport

Use Whole Person Concept

Analyze Information

Identify Barriers to Employment

One on One facilitation skills

Body LanguageReflectionOpen-Ended QuestionsClosed-Ended QuestionsActive listeningNon JudgementalPara-PhrasingTaking Effective Case Notes

SOCIAL &ECONOMICFACTORS

INTERESTS

POTENTIALSKILLS

LEISURE TIMEACTIVITIES

PHYSICALCAPACITIES

PERSONALTRAITS

TRANSFERABLESKILLS

EDUCATION& TRAINING

Case NotesS DATE anything you writeS QUOTE exactly as statedS Recognize PERTINENT informationS Write in SPECIFIC, OBSERVABLE and

MEASURABLE termsS If your OPINION, say so

Writing The Individual Plan

Determine Employment Barriers to Address

Set Goals

Establish Plan as a Team

Review

Implement

Monitor

Modify If Needed

Criteria For Goals

Specific Measurable

Attainable

RealisticTrackable

S-M-A-R-T

1. Change problem statements into goal statements

2. Brainstorm solutions and options

3. Balance options with reality; Choosing one or more options

4. Sequence and assign responsibility on the IDP

FACILITATING JOB PLACEMENT

Establishing Business Relationships

Through the Business Services TeamThrough the Local Veterans Employment RepresentativeOn Your Own

Critical when placing individuals who have been in Case Management

Critical when working with someone who has a disability needing accommodations

COMMENTS FROM BUSINESSES

Veterans may need more time after returning homeAwareness of the needed mental and physical skills

of a jobBe there after the hireNew challenges may arise for the veteranBe willing to educate my staff and/or supervisorsAre absent from work for on-going treatment, not

disclosed

*INSTITUTE ON REHABILITATIVE ISSUES

Concern

All

companies

Small

(5–14)

Medium

(15–249)

Large

(250 or more )

% Rank % Rank % Rank % Rank

It costs more to employ workers with disabilities 58.1 1 64.0 1 54.4 1 39.7 5

Workers with disabilities lack the skills and experience to do our jobs 49.4 2 52.1 2 47.6 2 41.5 4

People with disabilities may not be as safe and productive as other workers 45.7 3 49.9 3 42.7 4 35.0 6

Supervisors are not sure how to take disciplinary action 44.3 4 44.4 4 43.6 3 47.6 1

Supervisors are not sure how to evaluate 40.7 5 39.8 5 41.3 5 43.1 3

Table 12. Percent of companies citing hiring strategies that would be helpful in hiring people with disabilities, by company size

Strategy

All

companies

Small

(5–14)

Medium

(15–249)

Large

(250 or more)

% Rank % Rank % Rank % Rank

Employer tax credits and incentives 69.2 1 66.8 1 70.5 1 77.1 5

Disability awareness training 64.3 2 59.1 5 66.9 2 82.8 3

Visible top management commitment 64.2 3 59.4 4 65.8 3 84.9 1

Mentoring 63.4 4 60.7 2 62.3 4 84.3 2

Assistive technology 61.1 5 59.1 5 59.7 6 80.3 4

Using a specialized recruiting source 60.8 6 57.3 7 61.8 5 76.6 6

Flexible work schedule 60.0 7 59.7 3 58.1 7 71.8 12

Training existing staff 57.9 8 54.7 8 58.0 8 76.1 7

On-site consultation or technical assistance 57.1 9 54.5 9 57.0 9 73.1 9

Disability targeted internship program 55.4 10 53.0 10 54.4 11 74.3 8

Short-term on the job assistance with job coach 54.3 11 50.5 11 55.2 10 72.4 10

Alternative Job Development Techniques

MentorsSupported EmploymentOn the Job TrainingSpecialized ProgramsCreating Jobs

Mentors

Mentors are normally from inside the organization

Become the go to person for the veteran

Meetings are held regularly, maybe daily in the beginning

then less and less

Supported Employment

Using employment coaches

The coach learns the jobThe coach coordinates with the

supervisor

The coach teaches the veteran the jobThey work side by side as

neededA contract often defines the

roles

Possible Coaches

Retirees

Graduate Students in Counseling or Rehabilitation

Disability Navigators

Through VR&E or State Rehabilitation programs

On the Job Training

A contract is established with the employer, the veteran

and the placement specialistTime frames are established

along with expected knowledge to be gained

Normally pay increases at each step of the process

Specialized Community Organizations

Placement is in a controlled environment

Supervisors work for the agency

Work is carried on at the agency or in the field under agency supervision

Many communities have these organizations: Goodwill, Compensated

Work Therapy, etc.

Alternative Job Development Technique

Business PerspectiveConnecting with the Business CommunityBeing AwareCreating a JobDeveloping Proposals

The Business Proposal

Identify problem /

issue withina business

Explain howthis

could be addressed

Provide a description of

someoneyou know

who could fill the proposed

position

Enclosea list

of references

ContactInformation

POSSIBLE ACCOMMODATIONS

Several Apps for the PhoneReduce Distractions Provide Private SpaceLightingDivide Work into Smaller TasksWork from HomeAllow for Flex TimeDisability Awareness Training to Co-Workers

What is Your Role?

Recognize possible problems, if un-diagnosed and make referrals

Know the resources and options for employment in your area

Help research accommodations Understand the frustrations Be creative when thinking employment

QUESTIONS?

SUGGESTIONS?

IDEAS?

RESOURCES?