VA Support for Justice Involved Veterans: Veterans Health Administration (VHA)

Transcription

1 VA Support for Justice Involved Veterans: Veterans Health Administration (VHA) Jim McGuire, LCSW, PhD Jim McGuire, PhD National Director, Veterans Justice Programs Veterans Health Administration Sean Clark, JD National Coordinator, Veterans Justice Outreach National Association of Drug Court Professionals Conference Washington, DC July 18, 2011

2 VA who are we? U.S. VA: VBA, VHA, NCA FY 2008: ~$38B budget: ~$27B medical services; ~$3B MH/SA 2008: 5.8M veterans (~1/5); 263K OEF/OIF VHA Nationally: >150 hospitals; >1,100 CBOCs Residential treatment/transitional housing beds: MHRRTP: >8,000 beds, >180 programs ~10,000 Grant and Per Diem VA-funded community residential care beds FY 2008: 10,000 HUD permanent housing vouchers: FY ,000 more HUD vouchers

3 Business Week (2006): Best Medical Care in the U.S. VHA how good are we? Quality of care: Chronic disease care: VA 72% vs. private care 59% Preventive care: 64% vs. 44% Clinical practice guidelines adherence: 84% Access to care: goal 90% of primary care within 90 days Patient satisfaction: 2006 : Inpatient care: 10 pts. higher than private-sector Outpatient: 8 pts. higher than private-sector Harvard s Innovations in American Government Award (2006): VA s Computerized Record Systems (CPRS) *Asch etal Annals of Internal Medicine:141; 12:

4 Veteran use of the VA 34% of all U.S. Veterans reported using any VA services lifetime in 2001 (vs. 21% in 1987; SOV) Strongest correlates of any use: VA compensated, low income, lack of private insurance, poor health, age over 30, African American race, POW experience, mental health service use and related disability Of the 7% of Veterans reporting MH use, 41% use VA MH/SA Non-VA healthcare service use for VA users: Low (7-17%) Returning Veteran VA service use (2008): 42% of 945,423 former active duty, reserve and national guard

5 Justice-Involved Veterans: Estimates Estimated number of military Veterans, 2007: Probation supervision: 399,300 Parole or supervised release: 75,000 Local jail custody: 72,600 State prison custody: 136,800 Federal prison custody: 19,300 Total, correctional supervision: 703,000 Arrests: 1,159,500 Source: Bureau of Justice Statistics, 2007

6 Veterans in Jails: Clinical/ Social Characteristics Serious medical problem (ever): 61% Substance dependency: 65% Any one of 5 psychiatric diagnoses:29% PTSD: 9.9% Dual dx: 28% Homeless year before arrest: 18% Source: Bureau of Justice Statistics, 2002

7 Veterans in Jails: Trauma? Experienced physical abuse: 18% Experienced sexual abuse: 7% Either: 18% In combat?: 20% Combat or abuse: 36%

8 Criminal justice status: Average # prior arrests: 5 Veterans in Jails: Criminal Justice Characteristics & VA Eligibility 2 or more state prison incarcerations: 45% Age, first arrest: 24 Eligibility: 82% honorable or general with honorable ~Sources: Bureau of Justice Statistics, 2002

9 Services: U.S. VA Benefits: pensions, education and training, home loan guaranty, life insurance Health: Physical health: prevention, medical and specialty Mental health: medication, inpatient, outpatient, mental health/substance abuse services, homeless/housing services, evidence-based treatments; supported employment, consumer/peer supports Cemetery: burial and memorial benefits

10 Legal Services initiatives VJP VA Regional Counsel partnership VA legal referral process

11 External Partners/Stakeholders Veterans/families State government Professional organizations/ nonprofits Federal government DOJ: BJA, BJS DOL: VETs HHS: SAMHSA, OCSE HUD DoD USICH DVA DOC CSG County government Veteran Service Offices Courts/jails/law enforcement VSOs NADCP ABA NCHV GAINs PRA JLI CSH VERA PRI grantees IVTP grantees ACA/ASCA AJA NAMI NACO NLETC Medical and Mental Health Services Criminal justice boards

12 Sequential Intercept Model Intercept 1 Law enforcement/ Emergency Services Community Local Law Enforcement Intercept 2 Initial detention/ Initial court hearings Arrest Initial Detention First Appearance Court LAW ENFORCEMENT- COURTS-JAILS: VA Veterans Justice Outreach (VJO) Intercept 3 Jails/Courts Specialty Court Jail - Pretrial Dispositional Court Intercept 4 Reentry Jail - Sentenced Prison PRISONS: Health Care for Reentry Veterans (HCRV) Intercept 5 Community corrections/ Community support Probation Community Parole

13 HCRV and the Prisons: The Model Access to the prison Veteran identification Group Presentation - Information About VA and VA Services Eligibility Determination Individual Reentry Planning (6 months pre-release) Linkage to VA and Community Services/Resources Time-Limited Case Management Hand-Off to VA Service Providers Continuing Monitoring and Consultation

14 VJO: The Model Identification of Veterans Outreach, assessment, case management for justice-involved Veterans in local courts and jails Liaison with local justice system partners Provide/coordinate training for law enforcement personnel Assist in eligibility determination and enrollment Time-limited case management Hand-off to VA and community service providers Continuing monitoring and consultation Outstanding warrant resolution

15 VHA Justice-Involved Veterans the Veterans Justice Program's universe Healthcare for Reentry Veterans (HCRV) Begun FY ,000-56,000 est. number of Veterans released from state/federal prison each year; 80% likely eligible 34,303 since Aug. 2007; 12,410 served FY 2010 in 1,006 of 1,319 US prisons (78%) FY funding: 44 full-time HCRV and 4 hybrid VJO staff a. Law Enforcement Education: 1,159,500 Veterans annual arrests VA and community police focus: 3,200 VA police; 777,885 (sworn officers, BJS, 2004) Crisis Intervention Teams (CIT) added to VA Law Enforcement Training Center Veteran piece to community CIT Veterans Justice Outreach (VJO) Begun Fiscal Year (FY) 2009 FY 2009 staff appointed at every medical center (.25 FTEE) FY 2010 funding: 39 full-time VJO and 4 hybrid HCRV staff FY 2011 funding: 79 additional full-time (120 total) 13,832 Veterans served since Oct. 2009; FY 2011: 9,499 (thru May) FY 2012 target: 25,000 Veterans served c. Court outreach and liaison: b. Jail Outreach: 72,600 Veterans in local jail custody (point in time) 3,365 local jail facilities Common pleas/criminal courts Treatment Courts: 2,700 Drug & MH Treatment Courts, 75 Veterans Treatment Courts

16 IVTP (DOL + VA): 35% vs. 50% (N=926) Logistic regression models for re-arrest within one year of release. Any re-arrest one year after release (with employment and health services) Factors Coefficient SE p OR (95% CI) Constant Age: (0.93, 0.99) Criminal justice: Age at first arrest (0.95, 1.02) Number of prior arrests (1.00, 1.06) Index offence type (ref = public order) parole violations (1.31, 7.73) property (0.75, 3.49) drug (1.16, 4.91) violence (0.52, 2.99) sex (0.15, 2.74) Index offense months incarcerated (0.99, 1.00) Correctional institution (ref: state prison) County jail (1.08, 3.25) Federal prison (0.01, 0.74) Enrolled in IVTP: (0.68, 3.51) Employment upon release: (0.29, 0.80) VA outpatient services: (0.96, 0.99)

17 Veterans & Drug Treatment Courts: DRAFT/Preliminary CSAT 6-month GPRA Performance Data* Veterans 7% of the drug treatment court population: 6 month outcome impressions: Veterans more improved on absence of arrests (96% vs. 58%) Veterans more improved on no substance use (33% vs. 19%) Veterans less improved on being housed (12% vs. 18%) Veterans less improved on being employed (23% vs. 36%) Ns: 65 Drug courts; 315 Veterans. *Provided by CSAT. 17

18 Goals: VJO DRAFT Strategic Plan 1. Identify/Promote Engagement with Veterans 2. Develop VJO Workforce 3. Match Veterans with Appropriate Treatment 4. Remove Attitudinal Barriers 5. Evaluate the program/operationalize the Research Agenda

19 Contact/websites: Jim McGuire, PhD Director (310) ext Sean Clark, JD VJO National Coordinator (202) Jessica Blue-Howells, MSW HCRV National Coordinator (310) ext Websites: HCRV: VJO:

20 Federal Agency Support to Justice-Involved Veterans Benefits Assistance Service Veterans Benefits Administration NADCP 17 th Annual Drug Court Training Conference

21 Agenda VA Benefits and Assistance Homeless and Incarcerated Veterans Outreach Program VA Benefits and Incarceration VA Benefits and their Support for Justice-Involved Veterans

22 VBA Regional Offices Seattle Anchorage Portland Reno Oakland Los Angeles San Diego Boise Salt Lake City Phoenix Ft. Harrison Cheyenne Denver Albuquerque Fargo Sioux Falls Lincoln Wichita St. Paul Muskogee Des Moines St. Louis Little Rock Milwaukee Chicago Detroit Indianapolis Louisville Nashville White River Jct. Cleveland Atlanta Montgomery Manchester Buffalo Pittsburgh Huntington Columbia DC Roanoke Togus Boston Providence Hartford Newark Philadelphia Wilmington Baltimore Winston Salem New York Houston WACO New Orleans Jackson St. Petersburg Eastern Area Southern Area Central Area Western Area Honolulu San Juan

23 VA Benefits and Assistance Disability Assistance Benefits Assistance Compensation Pension and Fiduciary Insurance Economic Development Education Vocational Rehabilitation & Employment (VRE) Home Loan Guaranty

24 Homeless and Incarcerated Veterans Outreach Program VBA has 60 Homeless Veterans Outreach Coordinators (HVOC) nationwide represented at our VA Regional Offices and Pension Management Centers. HVOCs perform outreach to homeless Veterans on a regular basis at homeless shelters, homeless stand downs, through state and local community partners and other areas where homeless Veterans may be located. They also focus on prevention efforts and conduct outreach to justiceinvolved Veterans in prisons and jails and in Veterans treatment courts. Outreach activities include, but not limited to, providing information and assistance on VA benefits and services such as discussing eligibility criteria and filing a compensation and/or pension claim.

25 VA Benefits and Incarceration Official Notification of a Veteran s Incarceration Periodic computer matches are run between VA, the Bureau Of Prisons (BOP), and the Social Security Administration, to compare VA claimants' identifying data with BOP and SSA records. A completed VA Form from a representative of a correctional facility, with sufficient information to verify the individual and his or her incarceration status. Official statements by prison or law enforcement authorities, prosecutors, and parole officers. Due Process A claimant is entitled to due process before benefits are reduced or discontinued. Information is included about the dependent s rights to an apportionment.

26 VA Benefits and Incarceration con t Reducing Compensation Effective the 61 st day of incarceration following a felony conviction or reincarceration for a felony due to parole or probation violation. Reduced to the 10 percent rate for any Veteran with an evaluation of 20 percent or greater. Reduce payment to one half of the 10 percent rate for a Veteran with a disability evaluation of less than 20 percent Discontinuing Pension Effective the 61 st day of incarceration following the initial conviction or reincarceration for parole or probation violation. conviction of a felony or misdemeanor, and imprisonment in a Federal, State, local or other penal institution or correctional facility exceeding 60 days. The claims folder is reviewed to determine if the Veteran is entitled to compensation at a reduced rate while incarcerated.

27 VA Benefits and their Support for Justice-Involved Veterans Resumption of compensation or pension benefits or assistance with submitting a new application for compensation and/or pension benefits. If the evidence is dated no more than 30 days before the anticipated release from incarceration, VA may resume benefits prospectively from the anticipated date of release based on evidence received from a parole board or other official prison source showing a Veteran s scheduled release date. If Veterans are at least 10% service-connected, they can receive VRE services to assist them with finding and maintaining suitable employment. Education benefits can support Veterans who have been incarcerated get back on track through earning a degree or receive training to aid in career and job plans. Home Loan Guaranty Service can provide support to Veterans after being released from incarceration with purchasing a home.

28 Questions