Oh Captain, My Captain (pt II)

(The following is a continuation of yesterday’s post from guest blogger Bob Fraser, director of Neurological Vocational Services and Professor in the University of Washington Department of Rehabilitative Medicine, University of Washington. He is  the author/co-author of more than 100 research articles/chapters and editor/co-editor of five books, including the Traumatic Brain Injury Work Book: Living Fully Within the Community (Lash and Associates, on Press).  He writes on vocational rehabilitation services for veterans.)

Having talked to both medical school and VA colleagues, I’d like to offer the following recommendations – the emphasis being on transition and stabilizationwithin the community:

• Each veteran with disability should have a single point case manager from medical hospital care to community stabilization. Contact strategies should be flexible, e.g. teleconferencing, web-based, etc. Many rural vets, in particular, will not come to urban bastions of rehabilitation. Continuity is critical to success.
• The VA should not duplicate services and infrastructure when these services exist in various communities. It is both an imprudent use of limited monies and often does not meet the veteran’s service needs. Why not more mainstream?
• Peer support services need to be developed, particularly with assistance of diverse veterans’ organizations. Peer vets, with some standardized training, can both help with transitional services and often model integration.
• Supported education services are critical. Vets are taking advantage of educational benefits, but without sufficient supportive services (including successful peer modeling), they are likely to fail. This is a big missing piece!
• There needs to be a major concerted and coordinated effort in vocational rehabilitation. Compensated work and other hospital-based vocational rehabilitation programs need to be staffed by certified rehabilitation counseling staff with seamless coordination to community Vocational Rehabilitation and Counseling (VR & C) staff. Community VR & C can’t end with service “vocational preparation” activity, but needs to assist the veteran all the way to placement and stabilization (to include job coaching on site if necessary). Veterans with PTSD, brain injury, and other cognitive disabilities are in special need of these services. A vibrant VA vocational rehabilitation program, staffed by competent professionals will also attract vocational rehabilitation interns and draw competent fulltime personnel.