1. Vocational Rehabilitation for Formerly Incarcerated Veterans James P. LePage, Ph.D. VA North Texas Health Care System (VANTHCS) Dallas VA Research Corporation (DVARC) University of Texas Southwestern Medical Center (UTSW)

2. Goals O 1 Overview difficulties encountered by ex- offenders O 2 Overview vocational group format and social support used for veterans with felonies O 3 Describe major components of supported employment O 4 Describe barriers/difficulties using supported employment with an ex-offender population

3. Team Members O Julie Parish, MS O April Crawford, MS O Avery Lewis, MS O Ed Washington, BA O Ann Glasgow O Elizabeth Garcia-Rea, Ph.D. O Daisha Cipher, Ph.D. O Ledjona Bradshaw, MPH

4. Overview O Based on Department of Justice numbers O Approximately 150,000 Veterans are incarcerated in United States jails and prisons O An additional 75,000 in jails O The number returning to the community each year is high with estimates of approximately 60,000 Veterans leaving incarceration annually. O Texas numbers O In 2011, 11665 Veterans were in Texas Prisons, 7.5% of total O Average sentence was 11.8 years. O 3204, 27%, were released by 2012. 78% are VA eligible

5. Overview O Compared to non-Veteran incarcerated populations, incarcerated Veterans are: O Older (median age 38 vs. 28) O Caucasian (52% vs 35%) O More educated (87% vs 49% with at least a GED) O Higher rate of sex offences (22% vs 9%)

6. Overview O 61% meet criteria for a substance use disorder O Estimates of almost 50% have a non- substance mental health issues

7. Difficulties upon Release Three-year Cumulative Prevalence of Adverse Events Following Prison Release Among 175 Veterans Released felon % / Non-felon % Received Homeless Services Entered or Re- entered PrisonDeath Inpatient Psychiatric Treatment Inpatient Substance Treatment Inpatient Medical Treatment Any Negative Event 1 year26% / 1%5% / 0.04%1% / 1%7% / 1%4% / 1%5% / 3%37% / 5% 2 year34% / 2%11% / 0.09%2.9% / 1.7%10% / 1.7%6% / 1%10% / 6%60% / 10% 3 year37% / 3%15% / 0.1%3.7% / 2.2%11% / 2.2%9% / 2%14% / 9%75% / 16%

8. Overview of Employment O Unemployment rates are 15-25% higher O Based on a limited Urban League review, 50% of released prisoners will be unemployed one year following discharge O 85% of those employed will be working in unskilled jobs. O Those with felony histories worked between 10% and 23% less during a year O Overall effect of former felons on national unemployment is between.7% and 1.7% O The impact is even higher in African-American males with estimates of 2.3% to 5.3%.

9. O Five S Barriers O Stigma O Skills O Statutes O Social Skills O Social Networks BARRIERS

10. Funding Sources O 2005 – 2006Development of vocational rehabilitation materials for mentally ill and/or substance dependent homeless veterans. VISN 16 & 17 MIRECC Clinical Education Grant Program O 2008 – 2011Evaluating Vocational Materials for Incarcerated Veterans with MI or SA. VA RR&D Merit Review D6192-R O 2011 – 2014Improving Social Support for Veterans with Felony Histories, Meadows Foundation O 2013 – 2015 Development of Web-Based Vocational Services for Veterans with Felonies, VHA RR&D Pilot Award, I01BX007080 O 2012 – 2015 Assessing Supported Employment with Veterans with Felony Convictions and MI or SA VHA RR&D D7635-R

11. The "About Face Vocational Manual" was created with a VISN 16 MIRECC Education Grant LePage, J., Bluitt, M., House-Hatfield, T., McAdams, H., Burdick, M., Dudley, D., &... Gaston, C. (2005). Improving success in a veterans homeless domiciliary vocational program: Model development and evaluation. Rehabilitation Psychology, 50(3), 297-304. doi:10.1037/0090-5550.50.3.297

12. About Face Manual O Incorporates effective job readiness components O Interviewing O Identifying skills O Describing examples O Resumes and applications O Incorporates specific information related to felony convictions O Handling questions

13. Job Readiness Class component

14. O 1 week class O 20 hours of class time O Pre and Post Mock Taped Interview O Pre and Post interview reviewed on final day of class O Classes run best with 4-8 participants Summary of Job Readiness Class

15. O 1 week class O 20 hours of class time O Pre and Post Mock Taped Interview O Pre and Post interview reviewed on final day of class O Classes run best with 4-8 participants

16. JOB READINESS Numbers game O You will not get hired for every job you apply O The more you apply, the more chances you have been hired O The better you are prepared the better your chances of being hired O Getting Hired is a numbers game O This course teaches you how to go from 1 in 20 to being 1 out of top 5

17. JOB READINESS CLASS O Skills and Examples of Skills O Transferable skills O Adaptive skills O Job related skills

18. JOB READINESS CLASS O Opening/Closing Statement O Focused on skills O Limited on personal information O Traditional versus Non-Traditional Strategy TRADITIONAL Want Ads Internet Job Sites – Monster – Career builder NON -TRADITIONAL Cold Calls/contacts Networking Jist Cards

19. Summary Card John Doe Mobile: 972-555- 5555 4500 S. Lancaster Rd Home: 214-555- 5555 Dallas, TX 75216 johndoe@yahoo.comjohndoe@yahoo.com Position Desired: Warehouse/Forklift 6 years experience in all aspects of warehouse work. Able to operate forklift that includes: sit-down, stand-ups, and pallet jacks. Pulled finished pallets for weight and shrink wrap and Load/Unload trucks. Prioritized and staged outgoing product inventory control for US Air Force. Available for all shifts and weekends. Available for overtime and willing to travel. Hardworking, determined, responsible and a team player

20. JOB READINESS CLASS O DO’S AND DON’T O Examples O Be on time O Don’t inquire about salary, vacation, benefits O ANSWERS TO MOST COMMON INTERVIEW QUESTIONS O Examples O Tell me about yourself O Why should we hire you

21. JOB READINESS CLASS How to Handle your felony O Application O Be honest regarding felony conviction O Will discuss in interview O Resume O Never list felony convictions on resume O Interview O Acknowledge past mistakes O Focus on positive aspects

22. Description of Study O Conditions O Basic services O Self-Help using the manual O Group based program based on the manual

23. 6-MONTH FOLLOW-UP LePage, J., Lewis, A., Washington, E., Davis, B., Glasgow, A. (2013). The effects of structured vocational services in ex-offender veterans with mental illness: 6-month follow-up. Journal of rehabilitation research and development, (50), 183-192.

24. Percent Employed During Each Month

25. Secondary impacts of the Standardized Group Condition Confidence/Self-Efficacy Perceived Barriers to Employment Interview Skills

26. Employment Confidence Questionnaire (ECQ)

27. Employment Confidence Questionnaire (ECQ) p<.001

28. Assessment of Perceived Barriers Barriers to Employment Success Inventory (Liptak, 2002) 50 items Four point scale Cronbach’s Alpha <.87 for all scales

29. Five Categories of Barriers O Personal & Financial O Emotional & Physical Barriers O Career Decision-Making and Planning Barriers O Job-Seeking Knowledge Barriers O Training & Education Barriers Barriers to Employment Success Inventory (BESI) James P. LePage, Ph.D. April Crawford, M.S. Julie Parish, M.S., LCDC (CI), CRC Avery Lewis, M.S. VANTHCS, UTSW, DVARC, UNT

30. Change in perceived barriers

31. Changes to Interviews O Interview rating form O Rater observed videos of mock interviews O Rated interviews on 22 criteria O Criteria were the focus of the job readiness class (e.g. mention a skill, give example, discuss being a Veteran) O Rater was blinded to condition O Raters Trained to.90 agreement with investigator

32. Interview Scores Pre and Post Group

33. Standardized Group Vocational Programs can improve O Employment Outcomes O Confidence O Perception of Barriers O Interview Abilities SUMMARY

34. O Becoming used in a wide variety of Veterans with less traditional target populations O Serious mental illness O Spinal cord injuries O Homelessness O Formerly incarcerated Veterans O PTSD VA’s movement in the area of Individual Placement and Support James P. LePage, Ph.D. April Crawford, M.S. Julie Parish, M.S., LCDC (CI), CRC Avery Lewis, M.S. VANTHCS, UTSW, DVARC, UNT

35. SUPPORTED EMPLOYMENT Traditional Vocational Rehabilitation O Rapid employment seeking O Counselor spends most time in community O Assessment on the job O Focused on finding person a career O Work with employer to create one specific job for one consumer O Continues to follow individual until individuals decides follow-up is no longer desired O Wait until individual is ‘ready’ to look for work O Counselor spends most time in office O Assessment prior to job search O Focused on finding person a job O Work with employer to open up any job for a consumer O Follow-up for a finite time

36. Modifications for work with Veterans with felony histories The supported employment here could be viewed as “Supported Employment Lite” when compared to traditional populations served by SE Case loads can be larger Follow-up is less intense Needs for on-site work is lower Natural Supports often receive lower focus Focus on more limited job areas

37. Most Preferred Components of Treatment Planning Vocational Preferences Identified in Treatment Planning Percent Desiring Component Contacting potential employers for you to generate leads98% Discussing your unique skills and situations with employers to get the employer to give you a chance or create an opening (i.e job carving) 96% Drive you around looking for potential employers and areas to work 87% Work with an employer for part time work78%

38. Least Preferred Components of Treatment Planning Treatment plan preferences Percent Desiring Component Meeting with you at your work after you are employed to review possible problems that may occur or help solve problems that have come up 73% Meeting with your employer after you are employed to help you keep employment if there are difficulties 67% Follow-up with your employer to find out how you are doing62% Going to interview site with you to coach you52% Meet with your mental health treatment team to discuss your plans46%

39. About Face Demographics Male96.40% Married7.10% Age52.31 Education12.65 Unique times in prison1.63 Months Incarcerated lifetime85.26 Months Incarcerated in last 10 years 33.25 Age of first arrest 25.50 PTSD9.50% Depression44% SUD89.30% Psychotic/Bipolar3.60% 38 Received Group based standardized Vocational Rehabilitation 46 Received Group based standardized Vocational Rehabilitation plus IPS

40. Types of offenses

41. Re-incarceration Lack of focus on employment Relapse Complications to Supported Employment

42. SUPPORTED EMPLOYMENT Results

44. Online Study O Currently developing an online version of the About-Face program O Embedded video O Live chat with vocational staff O Ability for vocational staff to make direct comments about responses

45. James P. LePage, Ph.D.James.LePage@va.gov QUESTIONS?