Richard J. Kulich, LCSW
Veteran’s Justice Outreach Coordinator Marion VA Medical Center
Veteran’s Justice Outreach and
Veteran’s Treatment Courts
Veteran’s Justice Outreach Program
(VJO)
The Department of Veterans Affairs (VA) has committed to preventing incarceration and reducing recidivism among Veterans through the development of the Veterans Justice Outreach (VJO) Program.
VJO Initiative:
The purpose of the VJO initiative is to avoid unnecessary criminalization of mental illness and extended incarceration among Veterans by ensuring that eligible Veterans in contact with the criminal justice system have access to Veterans Health Administration (VHA) mental health and substance services.
Source: Department of Veterans Affairs, April 30, 2009. Under Secretary for Health’s Information Letter
Veteran’s Justice Outreach Program
(VJO)
Focus areas of the VJO Program:
Courts and AttorneysProvide information and education about Veterans’ issues to include PTSD and TBI and services available. Develop and implement Veterans’ Courts.
Law Enforcement
Provide training to local law enforcement on Veterans’ issues and strategies to help work with Veterans.
Jails
Develop communication with jails to identify Veterans who are incarcerated and engage Veterans in available services upon their release.
Veteran’s Justice Outreach Program
(VJO)
What VJO Can Do:
Serve Veterans of all eras,
Assess Veteran’s health care needs, identify appropriate VA and non-VA services,
Refer and link Veteran to comprehensive health care services,
With Veteran consent, communicate essentials (attendance, progress, treatment, testing, discharge plan) to courts and probation,
Veteran’s Justice Outreach Program
(VJO)
What VJO Can’t Do:
Perform forensic psychiatric/psychological evaluations for the court
Accept custody
Guarantee program acceptance
Write lengthy court reports, complete diversion paperwork
Advocate for legislation
Serve VHA ineligible Veterans
Decide criminal justice criteria for Veteran Court participation or decide who gains admission to specialty treatment court
Veteran’s Justice Outreach Program
(VJO)
Important Considerations:
VJO services are available to Veterans involved in the criminal justice
system. Veterans involved in civil disputes, bankruptcy, divorce, etc. are
not eligible for the VJO Program.
A Veteran’s legal status will not be a factor in determining eligibility for
VA services and/or programs.
The court cannot mandate the VA to provide care to justice-involved
Veterans. However, the VA will provide appropriate services based on
clinical need for eligible Veterans involved in the criminal justice system.
Most Recent BJS Statistics (2007
estimates)
Justice Involvement U.S. Residents Veterans Veteran % Probation Supervision 4,293,200 399,300 9.3%
Parole 824,400 75,000 9.1%
Local Jail Custody 780,600 72,600 9.3% State Prison Custody 1,315,300 136,800 10.4% Federal Prison Custody 197,300 19,300 9.8% Adults Arrested 12,078,000 1,159,500 9.6%
The First Veteran’s Treatment Court
The First VTC was created by Judge Russell in Buffalo, New York, in
2008. Judge Russell presided over a drug treatment and mental health
court, and had a participant who was also a Veteran, who appeared to be
struggling with the program. Judge Russell’s staff included two Veterans
whom the judge had speak with the offender. They discovered that that
Veteran preferred to be around other Vietnam Veterans, and he was
subsequently connected with a Veteran’s Group at the VA. After
witnessing the positive impact that this had with the Veteran participant,
Judge Russell created a separate treatment court for Veterans.
Veteran Treatment Courts throughout
the United States.
The parameters of a Veterans Treatment Court vary from
court to court. Generally, a Veterans Treatment Court is a
problem-solving court designed to serve Veterans who have
been charged with a criminal offense, who are at high risk
for re-offending, and who have significant mental health
and/or substance use issues. Most Veterans Treatment
Courts are essentially a hybrid drug and mental health
treatment court
.10 Key Components of a Veteran’s
Treatment Court
Key Component #1:
Veterans Treatment Court integrate alcohol, drug treatment, and mental health services with justice system case processing
Veterans Treatment Courts promotes sobriety, recovery and stability
through a coordinated response to veteran’s dependency on alcohol, drugs, and/or management of their mental illness. Realization of these goals
requires a team approach. This approach includes the cooperation and
collaboration of the traditional partners found in drug treatment courts and mental health treatment courts with the addition of the Veteran
Administration Health Care Network, veterans and veterans family support organizations, and veteran volunteer mentors.
10 Key Components of a Veteran’s
Treatment Court
Key Component #2:
Using a non-adversarial approach, prosecution and defense counsel promote public safety while protecting participants' due process rights
To facilitate the veterans’ progress in treatment, the prosecutor and defense counsel shed their traditional adversarial courtroom relationship and work together as a team. Once a veteran is accepted into the treatment court program, the team’s focus is on the veteran’s recovery and law-abiding behavior—not on the merits of the
10 Key Components of a Veteran’s
Treatment Court
Key Component #3:
Eligible participants are identified early and promptly placed in the Veterans Treatment Court program
Early identification of veterans entering the criminal justice system is an integral part of the process of placement in the Veterans Treatment Court program. Arrest can be a traumatic event in a person’s life. It creates an immediate crisis and can compel
recognition of inappropriate behavior into the open, making denial by the veteran for the need for treatment difficult.
10 Key Components of a Veteran’s
Treatment Court
Key Component #4:
Veterans Treatment Court provide access to a continuum of alcohol, drug, mental health and other related treatment and rehabilitation services
While primarily concerned with criminal activity, AOD use, and mental illness, the Veterans Treatment Court team also consider co-occurring problems such as primary medical problems, transmittable diseases, homelessness; basic educational deficits, unemployment and poor job preparation; spouse and family troubles—especially domestic violence—and the ongoing effects of war time trauma.
10 Key Components of a Veteran’s
Treatment Court
Key Component #5:
Abstinence is monitored by frequent alcohol and other drug testing
Frequent court-ordered AOD testing is essential. An accurate testing program is the most objective and efficient way to establish a framework for accountability and to gauge each participant’s progress.
10 Key Components of a Veteran’s
Treatment Court
Key Component #6:
A coordinated strategy governs Veterans Treatment Court responses to participants' compliance
A veteran’s progress through the treatment court experience is measured by his or her compliance with the treatment regimen. Veterans Treatment Court reward cooperation as well as respond to noncompliance. Veterans Treatment Court
establishes a coordinated strategy, including a continuum of graduated responses, to continuing drug use and other noncompliant behavior.
10 Key Components of a Veteran’s
Treatment Court
Key Component #7:
Ongoing judicial interaction with each Veteran is essential
The judge is the leader of the Veterans Treatment Court team. This active, supervising relationship, maintained throughout treatment, increases the
likelihood that a veteran will remain in treatment and improves the chances for sobriety and law-abiding behavior. Ongoing judicial supervision also
communicates to veterans that someone in authority cares about them and is closely watching what they do.
10 Key Components of a Veteran’s
Treatment Court
Key Component #8:
Monitoring and evaluation measure the achievement of program goals and gauge effectiveness
Management and monitoring systems provide timely and accurate information about program progress. Program monitoring provides oversight and periodic measurements of the program’s performance against its stated goals and
objectives. Information and conclusions developed from periodic monitoring reports, process evaluation activities, and longitudinal evaluation studies may be used to modify program
10 Key Components of a Veteran’s
Treatment Court
Key Component #9:
Continuing interdisciplinary education promotes effective Veterans Treatment Court planning, implementation, and operations
All Veterans Treatment Court staff should be involved in education and training. Interdisciplinary education exposes criminal justice officials to veteran
treatment issues, and Veteran Administration, veteran volunteer mentors, and treatment staff to criminal justice issues. It also develops shared understandings of the values, goals, and operating procedures of both the veteran
10 Key Components of a Veteran’s
Treatment Court
Key Component #10:
Forging partnerships among Veterans Treatment Court, Veterans Administration, public agencies, and community-based organizations generates local support and enhances Veteran Treatment Court effectiveness
Because of its unique position in the criminal justice system, Veterans Treatment Court is well suited to develop coalitions among private community-based organizations, public criminal justice agencies, the Veteran Administration, veterans and veterans families support
organizations, and AOD and mental health treatment delivery systems. Forming such coalitions expands the continuum of services available to Veterans Treatment Court participants and
informs the community about Veterans Treatment Court concepts. The Veterans Treatment Court fosters system wide involvement through its commitment to share responsibility and participation of program partners.
Marion, IL VA Medical Center
Parent facility – 55 hospital beds (currently 39 due to renovation), 60 bed Community Living Center, Primary Care Annex, Behavioral Medicine Annex, Administrative Annex, AmVets Building (under construction), Residential Rehabilitation Treatment Program
Community Based Outpatient Clinics (CBOC’s) Illinois – Effingham, Mt. Vernon
Indiana – Evansville (largest CBOC), Vincennes
Kentucky – Paducah, Mayfield, Owensboro, Hanson
STAFF
30 Clinical Social Workers 16 Psychologists 15 Psychiatrists 15 Nurses 14 Administration 8 Interns 4 Nurse Practitioners 3 Addiction Therapists 3 Physicians Assistants 3 Clinical Nurse Specialists 2 LPNs
2 Psychology Technicians
2 Vocational Rehabilitation Specialists
SERVICES AVAILABLE
Substance Use Disorder Services (SUD)
Outpatient Specialty Mental Health
Post Traumatic Stress Disorder Clinic (PCT)
Mental Health Intensive Case Management (MHICM)
Compensated Work Therapy (CWT)
Military Sexual Trauma Treatment (MST)
Mental Health in Primary Care (MHPC)
Suicide Prevention Program
Healthcare for Homeless Veterans
Veterans Justice Outreach
Peer Support Services
Home Base Primary Care (HBPC)
Residential Rehabilitation Treatment Program (RRTP)
Psychosocial Rehabilitation and Recover Center (PRRC)
Family Services
SERVICE REFERRALS
Inpatient psychiatric treatment - Jefferson Barracks, St.
Louis, MO
Outpatient opioid substitution - Jefferson Barracks, St.
Louis, MO
Residential treatment for Post-Traumatic Stress Disorder -
Topeka VA, Topeka, KS
Residential treatment for dual-diagnoses at the Psychiatry
and Addiction Recovery Treatment (PART) Program -
Leavenworth VA, Leavenworth, KS
Fee Basis referrals are made to community resources when
appropriate
OVERALL
MENTAL HEALTH CARE
In FY2011, 1,338,482 Veterans received specialized mental health
treatment from VA for a mental health problem; this number has
risen each year. Example: 927,052 in FY2006.
Mental health staff levels have increased, from 13,802 in FY2006 to
more than 20,500 currently.
Expanded access is available, with longer clinic hours, telemental
heath capability to deliver services, and standards that mandate
rapid access to mental health services.
OVERALL
MENTAL HEALTH CARE
VA has worked with the Department of Defense (DoD) to develop
the VA/DoD Integrated Mental Health Strategy (IMHS);
implementation for all 28 actions of the IMHS is now underway.
The National Call Center for Homeless Veterans
(1-877-4AID VET) was fully implemented March 1, 2010. The Call
Center ensures that homeless Veterans or Veterans at-risk for
SUICIDE PREVENTION
August 6, 2011, marked four years since the establishment of VA’s Veterans
Crisis Line, which has expanded to include a Chat Service and texting option for contacting the Crisis Line. The program continues to save lives and link
Veterans with effective ongoing mental health services on a daily basis.
As of February, 2012:
Over 500,000 calls and over 46,000 chat connections Over 20,000 rescues of those in immediate suicidal crisis Over 15,000 callers directly linked to immediate care
Over 85,000 callers provided referral to a VA Suicide Prevention
PTSD TREATMENT
In FY 2011, 476,515 Veterans received specialized mental health treatment for PTSD; this number has risen each year, for example from 271,976 in FY2006.
State-of-the-art treatments are available for Veterans with PTSD:
As of March 2012, over 4,200 VA mental health professionals have been trained to provide the most effective known therapies for PTSD,
Prolonged Exposure and Cognitive Processing Therapy
Medication treatments are offered and may be helpful for specific symptoms of PTSD
The National Center for PTSD guides a national PTSD
Mentoring program, which works with every specialty PTSD program across the country to improve care.
SUBSTANCE USE DISORDER
TREATMENT
In FY 2011, 160,223 Veterans received specialized treatment for substance
use disorders; 43% increase from 112,217 in FY 2006.
Developed and received approval for VHA’s five year plan to support the
2011 National Strategy of the Office of National Drug Control Policy; received evaluation of Substance Use Disorder programs by General Accounting Office with no recommendations offered for improvement.
Developed and disseminated clinical guidance to newly hired SUD-PTSD
specialists at 139 facilities who are promoting integrated care for these co-occurring conditions.
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General Eligibility for
Care in VHA
31
Served in the Active military and discharged or released under
conditions other than dishonorable
Former Reservists may be eligible if they served full-time and for
operational or support (excludes training) purposes
Former National Guard members may be eligible if they were
mobilized by a Federal order
WHO IS ELIGIBLE FOR VA
HEALTH CARE BENEFITS?
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Persons enlisting in the Armed Forces after 9/7/80 or who entered on
active duty after 10/16/81 are
not
eligible for VHA benefits unless they
completed:
24 months continuous active service,
or
the full period for which they were called or ordered to active
duty
MINIMUM DUTY
REQUIREMENTS
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Minimum active duty requirements do
not
apply to persons discharged or
released from active duty for:
Early out
Hardship
Disability that was incurred or aggravated in line of duty or Veterans
with compensable service-connected disability
EXCLUDED FROM THE
MINIMUM DUTY
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Eligibility for VHA Care as a
Combat Veteran
35
Title 38, U.S.C., Section 1710(e)(1)(D) gave authority to provide hospital, medical and
nursing home care to Combat Veterans despite insufficient medical evidence to conclude that such condition is attributable to such service.
Veterans who served on active duty in a theater of combat operations during a period of
war after the Persian Gulf War or in combat against a hostile force during a period of hostilities after November 11, 1998.
The National Defense Authorization Act of 2008 extended the period in which a
combat-theater Veteran may enroll for VA health care and services to five years post discharge/release date. (Please note that this includes Reserve and National Guard Personnel mobilized for Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF) and Operation New Dawn (OND).)
COMBAT VETERAN (CV)
AUTHORITY
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Must first meet the definition of a “Veteran” for VA health care
benefits.
Combat-theater Veterans who are ineligible to enroll for VA care are
referred to a Vet Center for readjustment counseling services,
if
appropriate, or to a community provider to obtain services at the
Veteran's expense.
If a health care emergency exists for an ineligible Veteran, treatment
is provided under VA’s humanitarian treatment authority.
CRITERIA FOR COMBAT
VETERAN ELIGIBILITY
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Recovery Orientation
Evidence-Based Practices and Treatments
Continuum of Care
Integration of Mental Health Services with Each Other and with
Physical Health Care Services
Role of Principal Mental Health Care Provider
Maximal Access to Care
Continuing Care
Measurement-Based Outcome Indicators
Automated Treatment Adjuncts (e.g. MyHealth
eV
et)
KEY ASPECTS OF VHA
MENTAL HEALTH CARE
SERVICES
38
At-risk drinking (annual)
Post-traumatic stress disorder (every year for first five
years and once every five years thereafter)
Depression (annual)
Suicide risk (if depression screen is positive)
Military sexual trauma (once)
Traumatic brain injury (once)
FREQUENCY OF VHA
MENTAL HEALTH
Operation Enduring Freedom (OEF)
Operation Iraqi Freedom (OIF)
Operation New Dawn (OND)
Experiences
Understanding the Experience
of OEF/OIF/OND
STATISTICS
Approximately 2.2 million have deployed since 2002
1,250,663 OEF/OIF/OND Veterans have separated from
service and are eligible for care
50% (625,385) of these have obtained VA health care since
FY 2002 (cumulative total)
Active Duty vs. Reserve/National Guard
53% (638,774) Former Active Duty Troops
47% (568,654) Reserve & National Guard
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“There’s nothing normal about war. There’s nothing normal
about seeing people losing their limbs, seeing your best friend
die. There’s nothing normal about that, and that will never
become normal…”
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TRAUMATIC EVENTS IN
OEF/OIF/OND
SERVICE MEMBERS
Multi-casualty incidents (suicide bombers, IEDs
(improvised explosive devices), ambushes)
Seeing the aftermath of battle
Handling human remains
Friendly fire
Witnessed or were involved in situations of excessive
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Witnessing death/injury of close friend/favored leader
Death/injury of women and children
Feeling helpless to defend or counter-attack
Being unable to protect/save another service member or
leader
Killing at close range
Killing civilians and avoidable casualties or deaths
TRAUMATIC EVENTS IN
OEF/OIF/OND
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OEF/OIF/OND
VETERANS AND VA
As of the Fourth Quarter, FY 2010:
1,250,663
OEF/OIF/OND Veterans eligible for VA services
50% (625,384)
have already sought VA care
Their three most common health issues:
Musculoskeletal
Mental Health
“The most complex and dangerous conflicts, the
most harrowing operations, and the most deadly
wars, occur in the head.”
(Anthony Swafford,
Jarhead
from
PBS video
Operation Homecoming
)
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MENTAL HEALTH PROBLEMS
IN OEF/OIF/OND VETERANS
38% of Soldiers and 31% of Marines report psychological symptoms.
Among the National Guard, the figure rises to 49%.
Further, psychological concerns are significantly higher among those with
repeated deployments
, a rapidly growing cohort.
Psychological concerns among
family members
of deployed and
returning OEF/OIF/OND Veterans are also an area of concern. Hundreds
of thousands of children have experienced deployment of a parent.
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MENTAL HEALTH ISSUES AMONG
OEF/OIF/OND VETERANS
Approximately half of OEF/OIF/OND Veterans have
provisional mental health diagnoses. The most common
of these are PTSD, affective disorders, neurotic disorders,
and nondependent abuse of drugs or alcohol, and alcohol
dependence.
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BEYOND MENTAL HEALTH
DIAGNOSIS
Many problems faced by returning combat Veterans and their
families are not so much clinical as they are functional:
Work Stress/Unemployment
Educational/Training Needs
Housing Needs
Financial and/or Legal Problems)
Family Issues
Lack of Social Support
Estrangement
Family Breakup
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COMMON THEMES &
PRESENTING PROBLEMS IN
OEF/OIF/OND VETERANS
Marriage, relationship problems
Financial hardships
Endless questions from family and friends
Guilt, shame, anger
Feelings of isolation
Nightmares, sleeplessness
Lack of motivation
Forgetfulness
Anger
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Resources
National Veteran’s Crisis Hotline:
800-273-8255
National Call Center for Homeless Veterans:
877-424-3838
Marion VA Medical Center’s VJO Coordinator:
618-997-5311 ext. 72360
Marion VA Medical Center’s OEF/OIF/OND Program:
618-997-5311 ext. 54642
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