C.O.R.E. Community Based Services for Veterans Louisa D Altilia & Tammy Weisenberger Lutheran Social Service of Minnesota COA National Conference August 5 7, 2011 1
Lutheran Social Service of Minnesota At Lutheran, our 2,300 staff serve nearly 100,000 people of all ages in each of Minnesota s 87 counties and in more than 300 communities. With an annual budget of $94 million funded from public, private and charitable sources, LSS is the state s largest, nonprofit social service organization: Our aim is to provide service that inspires hope, changes lives, and builds community. Our approach is non denominational, with services evidence based and informed practices. Our service outcome goals are organized around children, youth and families; people with disabilities; and older adults. They shape our planning and our action.
LSS Minnesota C.O.R.E Is a nation leading community based program bringing services directly to Veterans & their families through : Case Management & Counseling, Outreach, Referral, and Education Provides comprehensive, assistance through existing state wide network of offices and resources located strategically all through the state
C.O.R.E. SERVICES Individual, family, relationship and child counseling; Deployment and Reintegration related issues; Behavioral health (Depression, Anxiety, PTSD, Suicide, etc); Medication management; Addiction/Chemical dependency assessments; Financial counseling/budgeting and debt management strategies; Domestic Violence; Youth services for teens, kids and parents; Employment counseling, job search, workforce education & development.
Minnesota C.O.R.E. 2011 2012 Client Demographics Ages Served 0 19 12% 20 39 29% 40 49 19% 50 59 18% 60 69 17% 70 79 3% 80 89 2% Service distribution (clients use multiple services) Case Assessment/Planning 21% Case Follow Up 8% Case Management 48% Financial Counseling 3% Off site Counseling 9% In Office Counseling 35% Travel 17% Veteran Status Gulf War 8% Vietnam War 26% Korean War 3% WW I WWII 1% OEF/IOF 31% Peace Time 18% Active Duty 13% An estimated 67% of services are used by veterans/military service members, 22% by veteran s spouse or in conjunction with the veteran, 11% by veteran s children. Clients with no insurance: 39%
Why LSS C.O.R.E.? LSS is COA accredited and mission oriented organization Accessible Innovative approaches community and home based services provided Offers comprehensive Services : Clinical, Community, In office, in home, full circle Understanding and empowerment of the Veteran culture High practice standards & ongoing professional development for staff Support groups provided: spousal support, SMART Recovery (addiction recovery), amongst others Work with families : i.e. developing a camp program for children of Veterans
Advantages of using C.O.R.E. Community Based = going to where the Veteran is, in their community Rapid response practice Confidentiality High touch, personalized Work in collaboration with Veteran service providers Ability to provide services to the family unit Broker of services; either LSS provided or through statewide network One organization to provide services statewide
C.O.R.E. FY12 Client Satisfaction Strongly Agree Agree No Opinion Disagree Strongly Disagree Blank The services received were helpful and met my/our needs. 69 52 1 1 0 2 I was treated with respect by LSS staff. 90 33 0 0 0 2 The LSS staff members listened and addressed concerns. 76 46 0 1 0 2 The reason(s) for seeking services has improved 59 44 16 2 1 3 I received assistance in a timely manner 78 41 3 1 0 2 Community resources recommended were helpful/appropriate. 61 39 12 1 1 11 YTD Total 433 255 32 6 2 22 750 YTD Percentage 57.7% 34.0% 4.3% 0.8% 0.3% 2.9% Yes No No Opinion Blank I would use these services again. 117 5 0 3 125 Would you refer others for C.O.R.E. services? 119 4 0 2 125 YTD Total 236 9 0 5 250 YTD Percentage 94.4% 3.6% 0.0% 2.0%
Practice Challenges Outreach Coordination and Continuity of care Complexity of client cases Defined client population; who can and cannot be served Veteran services (per MNDVA definition) are not provided to domestic partners Possible territorial issues with other providers Increased service need with same dollar amount = decrease in number and types of services able to provide through contract
The Wider Lens: Administrative Realities The Praise: The program is known as CORE, for crisis management, outreach, referral and education. Started in 2008 to combat post deployment problems, it provides {free}, confidential counseling to Veterans.and their families. It served more than 1,400 clients in the 2009 10 fiscal year and more than 1,500 in its most recent fiscal year. Program officials claim it has prevented more than 14 suicides, helped mend more than 45 marriages and kept more than 40 people from becoming homeless. Its success..unlike other programs, CORE often acts as a first responder to veterans and active duty service members and their families in crisis, providing mental health and financial counseling services, either at a person's home, in local offices or over the phone. Mark Brunswick, Star Tribune, January 29, 2012
Unemployment* Minnesota U.S.A Unemployment Rates June 2009 8.3% 9.5% June 2010 7.3% 9.4% June 2011 6.7% 9.1% June 2012 5.6% 8.2% Percent of Population Who Are Veterans 2011 9.9% 9.4% All Veterans' Unemployment Rate 2011 5.9% 8.3% Post 9/11 Veterans' Unemployment Rate 2011 11.7% 12.1% 2012 * Department of Veteran Affairs NCVAS
Homelessness* A 2009 Wilder Research survey found that nearly 700 individuals in Minnesota who previously served in the U.S. military were homeless on any given night Estimated that over 4000 are homeless or at risk of becoming homeless at some point in the year 1 in 4 homeless men are veterans Veterans represent approx. 13% of the total homeless population 32% of homeless veterans have served in a combat zone 60% reported a serious mental illness 52% had a chronic health condition * Wilder Research 2006 2009 Statewide Survey of Homeless Veterans in Minnesota
Suicide The Department of Veteran Affairs estimates that 18 Veterans die by suicide each day* Service members and veterans reflect the broader American public, which not only suffers from suicide, but also stigmatizes mental health care. Further, some service members enter military service with mental health challenges and we should not conclude that serving in the military caused these suicides. *Harrell and Berglass, Losing the Battle, CNAS 2011.
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Barriers to Services Provider Perspectives Regarding Low Participation in Support Services Unit Leaders don t request/seek/attend because: Press of operational duties Hard to give priority unless there is an identified problem (hard to give priority to prevention) Military Members don t request/seek/attend because: They perceive the content as old news They don t think they need it Individual augments feel isolated Military Spouses don t request/seek/attend because: Seasoned spouses perceive content as old news Junior spouses don t think they need it They perceive it as intrusive or an invasion of privacy Some members instruct or prevent spouses from seeking help (e.g., taking ID cards) Lack of child care, transportation or other resources Fear of Stigma Members reported: I m scared to go to mental health I didn t fill out the PDHA honestly because I didn t want anything in my record I sought help and got grounded because I was depressed. I feel punished. Providers reported: Members doubt confidentiality Members feel they are letting the country down if they ask for help Members believe they will experience repercussions Members don t want to appear needy or weak Members fear that people will think badly of them Members and spouses fear it will hurt member s career Senior service members feel they are expected to be able to handle things without help Members don t want people knowing their business MacDermid, Shelley. Multiple Transitions of Deployment and Reunion for Military Families. Purdue University. June 2006.
Community Services: Our role going forward Partnership and Collaboration with VA and other healthcare organizations Be the bridge/connector Become competent in Military and Warrior Culture Maintain competencies in evidence based approaches: Bring them to the client Integrate more Veterans into our professions and the mainstream Understand stigma, advocate Understand the diversity of Veterans Context, context context Offer programs, support, treatment and help that go beyond rhetoric and nostalgia Astute data collection: Assessment, reporting Competency in trauma work Honor Healing : PTSD is a wound, not a weakness
Inspirations Richard Mollica: By creating the conditions that allow the trauma story to be told, we can follow the trace left by suffering. Vincenzo Di Nicola: And those of us who put broken lives back together must first cure ourselves of the need to do emotional alchemy as a way of validating our work. Hannah Ardent: The best thing that can be achieved is to know precisely what it was, and to endure this knowledge, and then to wait and see what comes from knowing and enduring.
Contact us! Louisa D'Altilia, BA, MSW, LISW Senior Director of Counseling & Family Resources Lutheran Social Service of Minnesota 612 879 5212 louisa.d'altilia@lssmn.org Tammy Weisenberger, MA, LPC Operations Director; C.O.R.E State Coordinator Lutheran Social Services of Minnesota 507 625 7660, ext 227 Tammy. Weisenberger@lssmn.org text here
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