You are a Vocational Rehabilitation Counselor at a Polytrauma Transitional Rehabilitation program. What is the role of a Vocational Rehabilitation Counselor in such a center?
As a Vocational Rehabilitation Counselor (VRC) at the Polytrauma Transitional Center (PTC) Service Member Transitional Advanced Rehabilitation (STAR) program, each day is an opportunity to lead, to collaborate and to create on a programmatic level, and to serve the Active Duty Service Members and Veterans (patients) of the STAR Program by providing comprehensive rehabilitation counseling services.
From a programmatic perspective, the STAR program VRCs are involved in the development and implementation of program priorities, marketing, researching, and creating and implementing outcome data. The most important and very rewarding role of the VRCs is providing daily, one-on-one comprehensive vocational services to each patient/Service Member/Veteran in the program.
Could you describe a bit about what a veteran with TBI experiences during their stay at a polytrauma transitional rehabilitation program from the day of admittance to exit? How are return to different areas of life addressed, including employment?
The Polytrauma Transitional Center is a single-story, 20-bed transitional rehabilitation facility. The patients live in single-occupancy rooms, equivalent to a hotel room with a full-size bed, accessible bathroom, and typical hotel room furniture. The patients share the kitchen area, laundry room, and common areas. To qualify for our programs, the Service Member/Veteran needs to be moderately independent with Activities of Daily Living (ADLs), capable of participating in a rigorous 6-8 hour therapy day, and demonstrate motivation to engage in vocational and community-based therapies. The program ranges in duration from 45 – 90 days, based on the patient’s goals.
Within the first week, each patient is evaluated by the therapeutic team and is provided with the level of support needed to progress while in the program. A patient’s schedule is typically filled with one-hour therapy blocks, in addition to larger blocks of time allotted for Therapeutic Community Events (TCEs). The emphasis of our program is on community reintegration, therefore, we “treat” within the community as often as possible. For example, Occupational Therapy, Physical Therapy, Recreational Therapy, and Vocational Rehabilitation provide one-on-one and group sessions in-clinic and in the community to address the patient’s leisure, social, physical, daily living, mental health, and vocational goals.
An advantage to being a “residential” program is that our patients rarely miss a scheduled therapy session or neglect their homework assignments. As one patient jokingly put it, “I live here, what else am I going to do?” The residential setting also provides a patient milieu that tends to be a supportive aspect of the patient’s recovery. The patients often “hang out” together during meals and after therapies.
Regarding employment, our patient population is comprised of 80% active duty Service Members and 20% Veterans, therefore, from a vocational rehabilitation perspective, most of our patients are “employed” (still on active duty) upon entry and exit from the STAR program. For this reason, our vocational services are directed toward planning and preparation for transition from military to civilian employment and education, and toward assistance with identifying and connecting to community, business, and educational resources in line with the Service Member’s goals.
In your experience, what role does return to work play in a veteran’s physical and mental recovery following a polytrauma TBI injury?
Work plays a HUGE role in a Veteran’s overall physical and mental recovery after TBI. Our patients state that returning to work gives them “purpose to recover” and “gives hope.”
We administer various assessments including pre and post VR service surveys. In the “Work Perception Assessment” the patient rates 10 statements as either Strongly Agree, Agree, Disagree, or Strongly Disagree. The first statement, “Work is important to my well-being” is consistently rated as “Strongly Agree” as are other questions such as “Work gives me a sense of accomplishment and value” and “Work gives me purpose.” Many of the patients comment verbally and in writing on post-service surveys that if the work component were not integrated into the therapy program, their motivation to participate would be significantly diminished.
For example, a Navy officer recently came to our program from a large military medical center. From his perspective, that facility provided “good medical care,” but, the care only emphasized that he was “broken.” In his first VR session he asked, “How am I going to take care of my wife and four children if I am not able to return to duty?” When he first arrived at our program, he acknowledged that he felt discouraged, hopeless, and was not actively engaging in the therapies. As a result of creating a viable vocational plan and introducing him to Veteran employment opportunities in his local community, he said, “Now, I feel like I have hope” and, “I like that I can try to see what I can accomplish as I recover.” He actively engaged in the therapies and made gains in his recovery to the point that when his wife visited, she said, “I honestly did not recognize him at first” (and she commented on how confident he was carrying himself). In his STAR program discharge paperwork he wrote, “Honestly, I feel wonderful about myself and my future again. Thank you. Thank you for your help.”
Over the course of your career, what advancements in technology or evidenced-based practices have you seen that have been most influential in helping veteran’s with polytrauma TBI injury return to work?
Advancements in technology are likely influencing Veteran’s return to work, however, it is important to acknowledge the employment climate we are currently in and how this assists Veterans with return to work issues. In her article, “Vet unemployment hit an all-time low in 2018. Mission accomplished?” Natalie Gross stated, “leaders across federal and state governments, some of America’s most well-known companies and veterans services organizations sprang into action” about eight years ago when unemployment rates for Veterans were at an all-time high. In fact, it was a little over eight years ago (January 2012) that our program, the STAR program, opened its doors in response to a need for more vocational rehabilitation and transition services within the active duty military rehabilitation process. It was in 2011 when the U.S. Chamber of Commerce Foundation launched the Hiring our Heroes (HOH) initiative. The Department of Defense (DoD) has the Operation Warfighter program, and around 2014, created the “Job Training, Employment Skills Training, Apprenticeships, and Internships (JTEST-AI) for Eligible Service Members DODI 1322.29” (also known as the “SkillBridge” program). These programs assist transitioning Service Members with internships and training opportunities that can lead to permanent employment. Beyond DoD initiatives, many companies have volunteered to create Veteran hiring initiatives. In Virginia, the “Virginia Values Veterans, V3 Program” has over 1100 certified companies that have completed trainings, and over 60,000 Veterans who have been hired by V3 certified companies.
In our program, we have the most success when we connect to Veteran groups within a company. For instance, we interact on a regular basis with representatives from Capital One’s Military Business Resource Group (BRG) and Northrop Grumman’s Operation IMPACT program. We have also found that even small companies often have an informal or formal military/Veteran group willing to assist transitioning Service Members and Veterans with career support.
The landscape of work is changing. More individuals are working remotely, working non-traditional hours, and changing careers later in life. As you look to the future, are there any changes you expect to see in how your field assists veterans with polytrauma TBI to prepare for these differences when returning to work.
Changes in the employment landscape demand employment services stay connected to trends, technology, and remain flexible. Our program has an advantage with our emphasis on connecting to the community and individualizing the program to each person’s goals. For this reason, we are constantly meeting with employers and community resources and learning about new trends.
Previously, the ability to work remotely varied among companies and job titles. For instance, one of our patients, a retired Army Master Sergeant, went to work at the Defense Logistics Agency after retiring from the Army. DLA’s policy at that time required employees to work a year before being granted remote work access. Once he “earned” the ability to work from home, he shared that he works “more productively” when he is at home because he is able to eliminate distractions. I imagine that in the wake of the COVID-19 crisis where so many were required to work from home, remote work will be an option even in jobs where it was not previously an option.
Since the COVID-19 shut-down, our program was given permission to use videoconference platforms that were previously not approved for patient care. This opened up opportunities for videoconference informational interviews with employers and remote face-to-face networking meetings. I think that platforms like this will make more opportunities available to all, including individuals with TBI.
Interviewee: Cynthia Young, MS, CRC
Cynthia Young is a Vocational Rehabilitation Counselor at the Central Virginia VA Health Care System in Richmond, Virginia and a team member of the Service member Transitional Advanced Rehabilitation (STAR) Program.
Interviewer: Lauren Avellone, PhD, BCBA
Lauren Avellone is an assistant professor at Virginia Commonwealth University (VCU) and staff member at the Rehabilitation Research and Training Center and VCU.