[House Hearing, 112 Congress]
[From the U.S. Government Publishing Office]
IS IT WORKING: REVIEWING THE
U.S. DEPARTMENT OF VETERANS AFFAIRS' COMPENSATED WORK THERAPY PROGRAM
=======================================================================
HEARING
before the
SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS
of the
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED TWELFTH CONGRESS
FIRST SESSION
__________
DECEMBER 14, 2011
__________
Serial No. 112-37
__________
Printed for the use of the Committee on Veterans' Affairs
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COMMITTEE ON VETERANS' AFFAIRS
JEFF MILLER, Florida, Chairman
CLIFF STEARNS, Florida BOB FILNER, California, Ranking
DOUG LAMBORN, Colorado CORRINE BROWN, Florida
GUS M. BILIRAKIS, Florida SILVESTRE REYES, Texas
DAVID P. ROE, Tennessee MICHAEL H. MICHAUD, Maine
MARLIN A. STUTZMAN, Indiana LINDA T. SANCHEZ, California
BILL FLORES, Texas BRUCE L. BRALEY, Iowa
BILL JOHNSON, Ohio JERRY McNERNEY, California
JEFF DENHAM, California JOE DONNELLY, Indiana
JON RUNYAN, New Jersey TIMOTHY J. WALZ, Minnesota
DAN BENISHEK, Michigan JOHN BARROW, Georgia
ANN MARIE BUERKLE, New York RUSS CARNAHAN, Missouri
TIM HUELSKAMP, Kansas
MARK E. AMODEI, Nevada
ROBERT L. TURNER, New York
Helen W. Tolar, Staff Director and Chief Counsel
SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS
BILL JOHNSON, Ohio, Chairman
CLIFF STEARNS, Florida JOE DONNELLY, Indiana, Ranking
DOUG LAMBORN, Colorado JERRY McNERNEY, California
DAVID P. ROE, Tennessee JOHN BARROW, Georgia
DAN BENISHEK, Michigan BOB FILNER, California
BILL FLORES, Texas
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
hearing records of the Committee on Veterans' Affairs are also
published in electronic form. The printed hearing record remains the
official version. Because electronic submissions are used to prepare
both printed and electronic versions of the hearing record, the process
of converting between various electronic formats may introduce
unintentional errors or omissions. Such occurrences are inherent in the
current publication process and should diminish as the process is
further refined.
C O N T E N T S
__________
December 14, 2011
Page
Is It Working: Reviewing the U.S. Department of Veterans Affairs'
Compensated Work Therapy Program............................... 1
OPENING STATEMENTS
Chairman Bill Johnson............................................ 1
Prepared statement of Chairman Johnson....................... 21
Hon. Joe Donnelly, Ranking Democratic Member..................... 2
Prepared statement of Congressman Donnelly................... 21
WITNESSES
Anthony Campinell, Ph.D., Director, Therapeutic and Supported
Employment Programs, Veterans Health Administration, U.S.
Department of Veterans Affairs................................. 4
Prepared statement of Mr. Campinell.......................... 22
Accompanied by:
Anthony Kerrigan, Ph.D., ABPP, Coordinator, Vocational
Rehabilitation Services, Michael E. DeBakey Veterans
Affairs Medical Center, Houston, TX
Sean Kayse, Coordinator, Homeless Veteran Supported
Employment Program, Iowa City Veterans Affairs Medical
Center, Iowa City, IA (Former Compensated Work Therapy
Participant)
IS IT WORKING: REVIEWING THE
U.S. DEPARTMENT OF VETERANS' AFFAIRS
COMPENSATED WORK THERAPY PROGRAM
----------
WEDNESDAY, DECEMBER 14, 2011
U.S. House of Representatives,
Committee on Veterans' Affairs,
Subcommittee on Oversight and Investigations,
Washington, DC.
The Subcommittee met, pursuant to notice, at 10:07 a.m., in
Room 334, Cannon House Office Building, Hon. Bill Johnson
[chairman of the Subcommittee] presiding.
Present: Representatives Johnson, Roe, Donnelly, McNerney,
Barrow.
OPENING STATEMENT OF CHAIRMAN JOHNSON
Mr. Johnson. Good morning. This hearing will come to order.
I want to welcome everyone to today's hearing titled ``Is
It Working: Reviewing VA's Compensated Work Therapy Program.''
The Compensated Work Therapy Program or CWT is one of the
VA's vocational rehabilitation programs designed to assist our
war fighters back into the workforce.
The program is specifically geared toward veterans who have
suffered from mental illness, delivering a titled approach for
reemployment that provides support and guidance through the
process.
In a time of high unemployment, especially among veterans,
we all must make every effort to match qualified workers with
suitable jobs. The CWT Program does just that, matching
disabled veterans with employers.
When done correctly, the CWT Program is a win-win. We know
of several success stories including the program at Bedford,
Massachusetts that has partnered with over 15 community
businesses.
The businesses benefit from having qualified workers adding
to productivity. And the veterans benefit, obviously, from
being employed.
However, we also know of situations where little, if any,
emphasis is placed on the program. Few partnerships are made
with the community and in the end, it is the veteran who
suffers.
We share a common goal of assisting our veterans to reenter
the workforce. A discussion on what the VA can do to sustain
successful programs and rejuvenate struggling ones in addition
to what Congress and this committee can do to help will better
enable us to achieve that goal.
It is also my hope that today's hearing will provide the
Subcommittee with a clear picture of the structure of the CWT
Program from its national leader all the way down to the
individual veteran at a VA facility.
I also look forward to today's testimony and the chance to
discuss how we can ensure that the CWT Program is rolled out
consistently and effectively all across the country.
How can successful programs share their best practices with
struggling program? How can national oversight be improved?
What kind of metrics are needed to effectively gauge success?
It is not good enough merely to have well-intentioned
programs. We need effective ones that consistently deliver
results and improve the lives of our veterans.
Again, I thank everyone for being here this morning, and I
will now yield to Ranking Member Donnelly for his opening
statement.
[The statement of Bill Johnson appears on p. 21.]
OPENING STATEMENT OF HON. JOE DONNELLY,
RANKING DEMOCRATIC MEMBER
Mr. Donnelly. Thank you, Chairman Johnson, for the
opportunity to discuss the Department of Veterans Affairs'
Compensation Work Therapy Program and its role in the
vocational rehabilitation of those who have served our country.
Occupational specialties have been an important part of the
lives of our veterans. Their identities are linked to their
military occupation. Therefore, illnesses that limit a
veteran's ability to work once they have transitioned out of
the military can have a significant impact on their self-
esteem.
Being part of the Committee on Veterans' Affairs for the
past 5 years, I am aware of the unique needs veterans with
mental illnesses have. Homeless veterans, veterans with brain
injuries, post-traumatic stress disorder, and other mental
health problems require a prolonged individualized
rehabilitation plan.
Providing them a rehabilitation plan that will help them
lead an independent life is critical. Providing them the tools
they need to obtain meaningful employment is even more. And
that is why CWT is critical for our veterans.
The benefits of the CWT Program are many. It provides
veterans with skills training, job development, placement
services, and employment support.
But not a lot is known about this program and I fear that
not many veterans know about the program as well. Because a
veteran must be referred by a clinician, many veterans that
would benefit from CWT are not aware of it and may not know to
ask their doctor about it.
Recently I came across a blog discussion on CWT. And in it,
most of the individuals talk about their positive experience
and discuss their successful rehabilitation.
But there are a couple of individuals who said their local
VA clinic was short-staffed and did not provide the service and
treatment needed.
Programs like CWT need to be successful nationally. It is
unfair for veterans to get poor quality treatment in some VA
clinics while others get better treatment. These regional
disparities undermine the good work VA is capable of providing
and is providing in so many places.
I look forward to learning more about this program, the
services you provide to our veterans in need, and what you are
doing to provide consistent treatment to all veterans.
Thank you, Mr. Chairman, and I yield back.
[The statement of Joe Donnelly appears on p. 21.]
Mr. Johnson. I thank the gentleman for yielding back.
I would like to now see if any of our other colleagues, do
you have opening statements or would you like to--if you would
like to, you are certainly able to make one.
Mr. McNerney. No thank you, Mr. Chairman.
Mr. Johnson. Okay. Well, thank you.
I now invite the first panel to the witness table. On this
panel today, we will hear from Dr. Anthony Campinell, the VA's
director of Therapeutic and Supported Employment Programs.
Dr. Campinell is accompanied by Dr. Anthony Kerrigan,
coordinator of Vocational Rehabilitation Services at the
Michael E.--do I have that right--DeBakey, DeBakey----
Mr. Kerrigan. Yes.
Mr. Johnson [continuing]. Veterans Affairs Medical Center
in Houston, Texas. Dr. Kerrigan should be able to answer
questions related to the CWT Program at the local level there.
They are both accompanied by Mr. Sean Kayse. Mr. Kayse
spent 4 years on active duty with the U.S. Army having
supported combat units as an ammunition specialist while on
deployment in Iraq.
After his discharge from the Army in 2005, Mr. Kayse was
diagnosed with PTSD. He then went on to participate in the Iowa
City, Iowa VAMC's CWT Supported Employment Program for
approximately 5 months.
Upon finishing the program, he was hired as a medical
support assistant at the VAMC and now serves as coordinator for
the Homeless Veteran Supported Employment Program for the Iowa
City VAMC.
Mr. Kayse is also a part-time student at Upper Iowa
University where he is using his GI Bill benefits to pursue a
bachelor's degree in public relations. He will be able to help
answer Members' questions about the CWT Program as experienced
at the individual level, and we are certainly glad to see a
success story come out of this program.
Thank you for being here with us today.
Dr. Campinell, your complete written statement will be made
a part of the hearing record, and you are now recognized for
five minutes.
STATEMENT OF ANTHONY CAMPINELL, THERAPEUTIC AND SUPPORTED
EMPLOYMENT PROGRAMS, VETERANS HEALTH ADMINISTRATION, U.S.
DEPARTMENT OF VETERANS AFFAIRS ACCOMPANIED BY ANTHONY KERRIGAN,
COORDINATOR, VOCATIONAL REHABILITATION SERVICES, MICHAEL E.
DEBAKEY VETERANS AFFAIRS MEDICAL CENTER, HOUSTON, TEXAS; SEAN
KAYSE, COORDINATOR, HOMELESS VETERAN SUPPORTED EMPLOYMENT
PROGRAM, IOWA CITY VETERANS AFFAIRS MEDICAL CENTER, IOWA CITY,
IOWA (FORMER COMPENSATED WORK THERAPY PARTICIPANT)
STATEMENT OF ANTHONY CAMPINELL
Mr. Campinell. Thank you.
Chairman Johnson, Ranking Member Donnelly----
Mr. Johnson. Sir, could you move the microphone up and then
press the button. Hopefully the light will come on.
Mr. Campinell. My apologies.
Mr. Johnson. There you go. Thank you.
Mr. Campinell. Chairman Johnson, Ranking Member Donnelly,
and Members of the Subcommittee, thank you for the opportunity
to discuss the Department of Veterans Affairs' Compensated Work
Therapy or CWT Program.
I am accompanied today by my colleague, Dr. Anthony
Kerrigan, CWT coordinator at the Houston VA Medical Center.
Also accompanying me today is Mr. Sean Kayse, a U.S. Army
veteran recently hired by VA, who will discuss his experience
in the CWT Program in Iowa.
CWT provides veterans whose lives have been disrupted by
mental illness or coexisting physical disabilities with a
supportive, stable, structured approach to help them achieve
their employment goals.
Currently there are almost 750,000 veterans under age 50
not in the labor force due to various disabilities or illnesses
including serious mental illness.
Employment is a vitally important personal goal. It
contributes to a positive self-image and sense of purpose. One
of the best ways to give someone an identity other than being
disabled or homeless or mentally ill is to give them a job.
In the 27 years since Congress formally established CWT,
the program has grown substantially doing that. In fiscal year
2011, over 41,000 veterans have received CWT services at 187
locations. And an additional 26,000 veterans received other
forms of vocational rehabilitation.
CWT programs provide vocational rehabilitation services by
medical prescription to veterans, many of whom have extensive
barriers to employment.
Again, we find that a majority of persons with a disability
want to work and the core philosophy of CWT is that all persons
with a disability can work when provided with the necessary
supports. And no one should be excluded from the opportunity to
participate in meaningful employment.
CWT programs serve eligible veterans including veterans
with service-connected disabilities, veterans who have been
involved in the justice system, and veterans with addictive
disorders. Many have serious mental illness including psychotic
disorders, serious physical disabilities with co-occurring
mental health diagnoses, and spinal cord injury and traumatic
brain injury.
In addition, CWT programs include homeless veterans and
veterans who have been out of the workforce for an extended
period of time, in some cases since discharge from the
military.
Collectively these efforts are making a difference. All
tolled, our programs provide paid work experience, competitive
employment, and vocational services to almost 70,000 veterans
each year, approximately 11 percent of whom are OEF, OIF, and
OND veterans.
In fiscal year 2011, out of 11,266 veterans who were
discharged from various CWT programs, 27 percent were placed in
community competitive employment at discharge, with an
additional 8 percent leaving CWT to pursue formal training,
higher education, or volunteer work.
Since March 2011, the Homeless Veteran Supported Employment
has served 2,564 veterans, 20 percent of whom have been placed
in competitive employment.
We know there is a growing demand for CWT services. When I
talk to veterans about what the program does, they almost
always want to know more about how they can sign up and what
possibilities it may hold for them.
To meet their needs, we are constantly looking for new ways
to prepare them for work and find them jobs, to help them own
an identity they can be proud of.
Thank you for the opportunity to share information about
VA's efforts to provide vocational rehabilitation services to
veterans. VA is dedicated to improving veterans' overall
quality of life through a vocational rehabilitation experience
in which veterans learn new job skills, strengthen successful
work habits, and regain a sense of self-esteem and self-worth.
My colleagues and I are prepared to answer any questions
you may have. Thank you.
[The statement of Anthony Campinell appears on p. 22.]
Mr. Johnson. Thank you, Dr. Campinell.
We will now begin with questions and I will yield myself
five minutes.
Dr. Campinell, the Bedford, Massachusetts CWT Program is
one we have found to be very successful.
Can you highlight the approximate number of positions
there?
Mr. Campinell. I can, sir. Bedford is a very specialized,
unique program. I had worked there. I started my career there
in 1972, and I am still using part of their facility as my
office as the national director. So it is good to be close to
the program.
The CWT Program at Bedford, which has three major
components, one is transitional work, which is noncompetitive,
the other is supported employment, which is competitive
employment in the community, and the third is VCT, which is
what they call the veterans construction team, their weekly
payroll to veterans, the amount of money paid to veterans each
week is between 50 and 60,000 dollars which makes it one of the
largest programs in the country.
Mr. Johnson. We are probably going to get into some of
those kinds of details. Specifically, though, I am looking for
the approximate number of positions of veterans that are
employed through the program there. Do you have that number?
Mr. Campinell. There are 180 veterans on the payroll each
week, sir.
Mr. Johnson. Okay. Can you give us an idea of some examples
of the types of jobs that are performed by these veterans?
Mr. Campinell. I can. There are veterans that are working
within the medical center providing services in the janitorial
department, housekeeping, grounds, various engineering
departments, dietetics. It is pretty widespread throughout the
medical center.
And the same thing is true in the community. There are a
number of entities in the community, both business and other
Federal agencies, that are engaged and partnering with the
Bedford program.
Mr. Johnson. Excellent. How many programs and agreements
have been developed in the Bedford area and the community and
can you share with us some of the names of some of those
business partners?
Mr. Campinell. I can, sir. There is a total of 17 as of
last August, 13 companies and four Department of Defense
entities.
And so the example at Fort Devens 99th Reserve Unit,
Hanscom Air Force Base, Otis National Guard Base, and some of
the private entities are Brooks Management which runs a
cafeteria system in a business community, Diversified
Technology, the Chelsea Soldiers Home, the Town of Burlington,
Middlesex Community College, the Caritas Hospital System, and a
number of others that are similar.
Mr. Johnson. The list goes on.
Let me make sure I understood correctly. You started your
career at Bedford, right?
Mr. Campinell. Yes, sir.
Mr. Johnson. So is it safe to say that you had something to
do with putting this program in place there at Bedford?
Mr. Campinell. Well, Bedford had a program in operation in
one form or another long before I got there. In fact, post
World War II, they were using work as part of the treatment for
veterans.
And when I came there in 1972, it was just formalizing
itself into a program that used a more structured model for
work and employment. But I was there I think when it started to
engage most directly with private sector businesses who were
interested in partnering with the VA and serving veterans.
Mr. Johnson. Well, I think that is great that you have that
history and how you are now directing the national program and
how you are going to emulate that program across the country
because, as we said, as I said in my opening statement, we have
examples of tremendous successes like the one we have there and
then we have some others that, you know, they are about on
their two and a half strikes in terms of effectiveness. So I am
interested in that.
Can you break down how long it takes to get a veteran
employed in a successful program such as Bedford and give us an
idea? What is the time frame?
Mr. Campinell. If by employed, you mean engaged in the
program, CWT is a clinical program.
Mr. Johnson. From the time the veteran comes in until the
time they are assigned to a position or get a position.
Mr. Campinell. It is approximately 30 days around the
country.
Mr. Johnson. Okay. And I am sure you have looked at all the
programs across the country. What about some of the less
successful ones?
Mr. Campinell. The average, as we understand it, is
approximately 30 days.
Mr. Johnson. Let me go back and re-qualify my question.
Mr. Campinell. Yes, sir.
Mr. Johnson. What is the time frame at Bedford?
Mr. Campinell. Bedford is generally approximately the same
as far as I know.
Mr. Johnson. Okay. And so if the average is 30, then you
have obviously got, across the country, you have some that are
far worse.
Mr. Campinell. We have some less and some that are more.
The problems tend to lie I think in the smaller programs where
there are less resources.
The clinical approach is the same at every location,
transitional work and supported employment under medical
prescription.
When there is a program with, say, for example, two staff,
I think the process of getting into the program might tend to
take a little bit longer, not because there is resistance
obviously to having veterans participate, but because caseloads
tend to be full and the work opportunities that may be
available might be more limited due to the size of the medical
center or the size of the program itself.
Mr. Johnson. Okay. All right. My time has expired. We may
have multiple rounds of questions, but I yield now to the
Ranking Member, Representative Donnelly, for his questions.
Mr. Donnelly. Thank you, Mr. Chairman.
And, Dr. Kerrigan and Dr. Campinell, I want to thank you
for your service to our veterans.
And, Mr. Kayse, thank you for your service on behalf of our
country. We have our freedom because of the work of you and all
the other veterans who have served. And we are much in your
debt.
And I want to ask you, how did you hear about this program
and how did you become familiar with it and how did it work for
you?
Mr. Kayse. Actually, my wife, who also is an Army veteran,
was enrolled in therapy in the VA medical center in Iowa City.
She met with a vocational rehabilitation specialist and asked
me to join her. And that is where I first made contact with the
vocational rehabilitation.
So we met and I went to my primary care provider. And they
put in a consult for me to get into the program.
Mr. Donnelly. What processes did you go through in the
program? What did you learn? What kind of features did it have
for you?
Mr. Kayse. Mostly resume writing skills, job application
skills, job seeking skills, kind of like job development. Also
just having the confidence that you have somebody helping you
with the whole process, it was huge because you fight that and
feel like you are alone the whole time. So just having someone
that was following along support and helping me through the
process was a great asset.
Mr. Donnelly. Dr. Kerrigan, how do you make sure that the
veterans in your area know of the existence of this program?
Mr. Kerrigan. Congressman Donnelly, thank you.
The program in Houston at the Michael E. DeBakey VA Medical
Center has been around for several decades as well. We have a
program that has been growing over the last 20 years.
We provide mental health forums where we meet with all the
mental health, with the executive and the providers who are
mainly psychiatrists, psychologists, social workers, nurse case
managers. We present the program to them. Sometimes we have
successful candidates who have completed the program, gone back
to work. Some have been employed at the VA. They present as
well.
And we have a business advisory council that meets once or
twice a year with community partners. I think you all have a
list of those partners. These are people with the City of
Houston Veterans Affairs.
We work closely with the VA regional office, Vocational
Rehabilitation & Employment services, Advocacy, Inc., and the
State agencies, Workforce Solutions, Texas Veterans Commission,
Gulf Coast Community Services, and then there are other private
and some private nonprofits, Homeless Veterans Reintegration
Program through Good Will Industries, Houston Launch Pad,
Career and Recovery Resources.
These are agencies that are also working with veterans. We
partner with them. Sometimes, you know, they piggyback or we
piggyback on what they can provide, services.
The CWT Program itself, we do not have money to provide to
veterans for training or certification, but we can partner with
the State. We have these people come into our agency on a
weekly basis.
Mr. Donnelly. Let me ask you and Mr. Kayse. One of the
things we often hear in our Committee is all the veterans who,
despite the presence of The American Legion, the VFW, the
Paralyzed Veterans of America, DAV, there are so many veterans
who once they are out, just want to get on with their life and
want to try to kind of not have to think about that portion of
their life so much on a regular basis. To those veterans who
are struggling, do you have any recommendations as to how we
can let them know that, hey, there are other programs out there
to help you?
Mr. Kerrigan. On Wednesday night last, I went with a
colleague to the Salvation Army. We have a partnership there.
There were 70 veterans in the room. Some have, you know, post
Vietnam era veterans and veterans of the most recent wars. We
talk about the services of the VA.
These veterans are going to be there for 90 days on a grant
and per diem that the VA is funding. We talked about benefits.
We talked to people who are in the process of having their
disability adjudicated with the VA and also with Social
Security. So our goal was to tell people that, you know, we
have these programs. There is hope.
We know from experience--I have worked at the Houston VA
since 1993 and before that in Louisiana, New Orleans, and
Shreveport--that, you know, in three to five or six or 9 months
at the most, you will be on your feet. You will have a place to
live because of the HUD-VASH and Voucher Program. There is
treatment at the VA for addiction and other psychiatric
disabilities.
When you come and work with our program, you will have a
vocational counselor case manager who will be that same person
who will follow through for three, six, and 9 months. And we
have, you know, a track record of seeing, you know, maybe five,
six, seven hundred veterans a year. And so we can tell veterans
this is what it will take and that there is a solution.
And a veteran told me I have been 4 years homeless, I want
it to end, and we can assure the veterans that this is the end
of it.
There is comprehensive treatment in the VA for addiction
and other psychiatric disorders that no other health system,
not my home country in Ireland and I worked in the UK, Canada,
there is not that kind of comprehensive care in any other
system and it is there. We have well-qualified staff.
Mr. Johnson. Thank you, Mr. Kerrigan. We are going to have
to cut that question off at this point.
I yield now to my colleague from Tennessee, Dr. Roe.
Mr. Roe. I thank the Chairman for yielding.
And just to go ahead with what Mr. Donnelly, go ahead and
finish your comments, if you would. Dr. Kerrigan.
Mr. Kerrigan. Thank you, Congressman Roe.
I was going to say we have the resources. Certainly Houston
has a lot of resources. We have 20 employment specialists and
voc rehab people on the staff in Houston. We have in the last
decade doubled the number of the staff.
We have initiated what is called the individual placement
and support model where an employment specialist works with a
manageable number on his caseload, 25 on the average to 30
veterans, with the most severe psychiatric disabilities and
also veterans who are homeless.
And they are in the community every day. They have
government vehicles, cell phones, electronic equipment to stay
in touch with records.
And so, you know, for people living in the community who
are looking for real jobs in the community with benefits, we
have about 46 percent of people working at any time and there
are about 300 people in the Supported Employment Program in the
community.
Then in the hospital, we have support from leadership for
physicians in compensated work therapy transition work. This is
for people who may be living at Salvation Army or the Star of
Hope or Santa Maria or another residential treatment center.
We have positions where we can put veterans to work in the
hospitals, some in the community where while they are in
treatment and they need to be in treatment in partial hospital
programs or on treatment teams, they can work every day.
And that counselor or employment specialist sits on the
veteran's treatment team. So this is not virtual. This is in
reality. They sit on the ACT team. That Assertive Community
Treatment. They sit with the psychiatrist, psychologist, nurse
manager, case worker. And often our employment specialists are
the people are seeing these veterans on a daily basis and can
give feedback back to the treatment team and the psychiatrist.
Mr. Roe. Let me go ahead and I can see that the south Texas
has not changed your accent.
To go back to personal experience of when I was in the
military, I was drafted when I was halfway through my training.
So I had two more years of training to complete. When I
separated from the military in 1974, nobody said how are you
doing, what are you going to do when you leave. It was just
``adios!''
But I had a place to go back to and I had a job to do
already set and waiting for me. Many veterans do not have that.
I think that probably is the single most important thing that a
veteran can have when they leave is their family to go home to,
someone waiting for them, and, secondly, a job to go to, a
profession.
And when you find yourself separated from the military and
then nothing to do when you get out, it creates these problems
that we are dealing with decades later.
I am so thankful that General Shinseki has really made
homeless veterans a priority because those veterans, both men
and women, have really literally lost everything, no place even
to live.
So you all are getting the hardest of the hard to employ.
Volunteer Services for the Blind has two agencies in our
area and I can see the benefit of that tremendously.
So if you take a veteran who is homeless and get him into
gainful employment, however many steps you have to go through
to do it, that is a huge. For that one veteran, that is a
success and changes their life.
And, Mr. Kayse, I want to ask you. I saw in the testimony,
it was a 20 percent placement, I think, for jobs for the
homeless veterans.
What do you think the impediment is there? What can we do
differently or are these just severely mentally disturbed
people that cannot work in the regular workforce? What do you
see are the things we need to do to improve that 20 percent?
That is good, but it needs to be much better.
Mr. Kayse. The biggest thing that I face in Iowa City is
when you encounter a veteran who has been homeless for more
than just a short time. They get to a routine, a way of life.
And to change that by sending them to work is one of the
hardest things they have to face.
But through treatment teams, psychology, psychiatry, we are
able to get the veteran back on his feet and then start even
looking for a job sometimes in some cases.
I think the support that I receive in Iowa City from my
treatment teams is very, very high and very, very well-taken.
Mr. Roe. Will we have a second round?
Mr. Johnson. We will.
Mr. Roe. Okay.
Mr. Johnson. You have time. Let him answer that.
Mr. Roe. What about the 80 percent? Obviously the 20
percent are the success. What about the other eight out of ten?
What happens to them? Do they choose not to be in the program
or are just not able to participate in getting gainful
employment? What are the impediments, I guess, is what I am
asking?
Mr. Kayse. I would think that the impediments of the other
80 percent in keeping them from getting employed is, one, fear.
When we discharge from the military, sometimes you are just
shuffled out the door and you have to face life by yourself.
And when you start in a government agency again, they have
a fear of saying, well, the government did not help me then,
why would they help me now.
The word of mouth in the shelters and on the streets is
growing that the VA is changing and that the VA is becoming a
more positive place to be. There are so many war stories and
horror stories for so many years that now it is starting to get
where those are starting to go away.
In my position, I do go on the streets and I am able to go
into shelters. And now I have veterans calling me out of the
blue looking for employment. The word of mouth is spreading.
This program is taking off and it is changing. So I expect to
see that 27 percent disappear very soon.
Mr. Roe. I thank the chairman. I yield back.
Mr. Johnson. I thank the gentleman for yielding back.
I would like to go now to our colleague from California,
Mr. McNerney.
Mr. McNerney. Thank you, Chairman Johnson, and thank you
for having this hearing.
The thing I am hearing this morning is that, and this
reaffirms what I believed, is that it takes person-to-person
interaction. It takes several people to deal individually with
a single veteran to help him through this transition. And that
is the challenge we have is providing the resources for the VA
department and for other agencies and other NGOs to provide
that person-to-person help.
Mr. Kayse, your story was about that. Until there was
somebody actually working personally with you, it was very
difficult and that is what helped you make that transition. So
that is our challenge.
And I know, as my colleague, Mr. Roe, said, the secretary
has indicated that homelessness is his highest or one of his
highest priorities and, yet, there are about a half a million
homeless veterans. Is that the right number?
Mr. Roe. Yeah.
Mr. McNerney. I am really glad to hear how effective this
program is. I just want to follow-up with the Ranking Member's
question about how accessible it is to veterans.
Do they feel that they can approach this kind of program
and find a place in it? Are very many of them turned away? Are
there a lack of resources that are preventing you from meeting
the needs that are put upon you in this regard? Dr. Campinell.
Mr. Campinell. We receive specialized funding specifically
to hire veterans who are homeless or formerly homeless using
the Schedule A9 competitive hiring authority who will provide
services, specifically supported employment services,
specifically and directly to homeless veterans. And they have
been allocated at every medical center and into the various
treatment programs for homeless veterans.
So when a homeless veteran enters through the outreach
system and proceeds through the residential rehab treatment
programs or to the grant and per diem or the HUD-VASH Program,
there is a supported employment VRS working in CWT along with
the homeless case managers who are specifically focused on
helping those individuals find competitive employment using the
principles of supported employment which basically as a
treatment program is the integration of vocational services
into treatment rather than post treatment.
And we believe that this effort of hiring homeless
veterans, individual veterans who are themselves or have been
homeless will be very successful in helping to increase access
to work for homeless veterans.
Mr. McNerney. Well, as a Member of Congress with a
constituency of veterans and so on, I want to make sure that
this program and other successful programs are available in my
district and my region.
Do I have the ability to contact or to tell my VSOs that
they can contact an organization locally to help their clients?
Mr. Campinell. Yes, sir. We have a web page, a public web
page, cwt.va.gov, that has the phone number and address for
every CWT program around the country.
In order to participate, veterans have to enter the health
care system. They have to enroll for health care. They have to
be assigned a primary care provider. They may enter into other
treatment programs for addiction disorders, for example, or
depression or whatever. But it opens the door to treatment.
Work is sometimes the approach that attracts individuals
into the health care system and gives VHA an opportunity to
provide, to address other services. Work is a huge issue for
many people and it is a huge draw and attraction is the chance
to go to work in spite of your disability.
And when they come into the system, it gives our clinical
teams across the spectrum an opportunity to work with that
veteran, give them a physical exam, blood test, check for
diabetes, provide addiction counseling. It is a tremendous, we
will say, opening step in the process of providing
comprehensive care to a veteran.
Mr. McNerney. Well, when I leave this hearing, I am going
to call the VSOs back home and make sure they know about this
program. And I hope that they say, yeah, we know about it, we
are participating in it, and it is helping our local folks. So
that is something I am looking forward to doing today.
Mr. Kayse, you indicated that your experience is that
people out there on the street are becoming more aware of not
only this program but the attitude about the VA being there to
help them as opposed to just some big bureaucracy.
Do you feel that that is local specific to Iowa and Iowa
City or do you think that is sort of a national trend?
Mr. Kayse. I truly believe that it is starting to spread
nationally. I have contacts within the military and still talk
to them on a weekly, monthly basis, or whatever, and they
mention the VA health care system.
And, of course, being an employee, I am able to advocate
for the VA, but, you know, they tell me that they are going to
start going to the VA and encouraging in their community. So I
think it is definitely getting national attention and it is
growing.
Mr. McNerney. Well, I think this is one of our big
challenges is to get the word out that the VA really is out
there to benefit these individuals and that we need to do
everything we can to make sure that they get that work.
Thank you, Mr. Chairman. I yield back.
Mr. Johnson. Thank you.
We will go into a second round now and, Dr. Campinell, I
would like to come back to the questioning that I ended with.
How long has the longest veteran been waiting for
employment through CWT? Do you have any idea on that?
Mr. Campinell. I can only estimate based on informal
communication that there may have been veterans that have
waited perhaps 3 months to get into the program, but I think it
is relatively isolated.
And, in fact, as part of the mental health audit of waiting
times, they will also be looking at CWT across the country. So
that will give us more specific information that will help us
understand where the wait list problems might be and how we can
then best address it.
I do not think it happens very often because I do not get
complaints or calls from my field staff to indicate that it is
a huge issue at a medical center.
Mr. Johnson. And I am glad you are not getting those kinds
of complaints, but I am not sure that that is indicative of the
success of the program nationwide.
I share my colleague from California's concerns that maybe
a lot of veterans do not know this program exists and we have
instances throughout the Nation clearly where the CWT Program
is not an emphasis. And so they may not even know.
For example, at the present time, the information that our
Subcommittee has received is that the Bedford VAMC has more
work assignments than veterans to fill them. So, I mean, you
guys are doing wonderfully in terms of reaching out to the
community and otherwise. It takes approximately a month to be
enrolled in the program and it matches with what you said
earlier, roughly 30 days to get in.
By comparison, however, our investigation noted roughly a
90 day wait in Houston while Dayton reported that they have no
waiting periods, but they require the veterans to go into a
training program called the Job Club for 30 days before they
are assigned to a position and wait for acceptance and that the
investigation revealed there that favoritism is reportedly a
problem. And there appears to be some validity to this.
Are you aware of that complaint there in Dayton?
Mr. Campinell. Only recently we came to understand that
there were issues at Dayton by virtue of preparation for this
hearing that there was perhaps encouragement of the veterans
who file a complaint about extending their time within the
program or something about their delay in getting into the
program.
As a clinical model, it provides services based on the
resources that the facility has made available to it and
sometimes those resources can be quite high in a large program
and at other times, it is quite low in a smaller----
Mr. Johnson. Let's talk about the resources. You are a
great straight man. You are playing the straight guy really
good because that is my next question.
In 2010, the VA's Vocational Rehabilitation and Employment
Service conducted a work measurement study for a number of
programs that included CWT to document the amount of time
vocational rehabilitation counselors, employment coordinators,
and vocational rehabilitation officers spend on various
activities. The study's final report was released in April 2011
and it made seven recommendations.
Are you familiar with that report and those seven
recommendations?
Mr. Campinell. No, sir, I am not. And we are not part of
VR&E, so I was not aware that there was any component of CWT
being analyzed by the benefits division of the organization.
Mr. Johnson. Well, it was. And I commend that report to
you. Recommendation number one was adopt a workload model as
the basis for determining staffing levels. In other words,
let's determine the right numbers of people to make these
programs successful.
And I hope you are sensing certainly the tone of my
questions. You have a successful program in Bedford. I am
particularly interested in how you are going to roll that out
across the country so that our veterans from shore to shore are
able to receive the same kind of support and getting into this
program that the ones in Bedford do.
Mr. Kayse, let me turn to you. What initially drew you to
the CWT Program in Iowa City?
Mr. Kayse. When we first moved to Iowa from Texas, I tried
to find work. I did find work at a hospital working in the
trash department and laundry facilities. And it was not
desirable. It was not what I wanted to do. So I started job
seeking on my own.
After numerous applications and resume writing and just
nothing, you know, taking on, when I found out that my wife was
meeting with an employment specialist, it really sparked the
interest that I want to see what the VA is offering first.
And then when I found out that they are going to assist me
with the problems that I am having, the problems I am facing,
it was like a win-win for everybody. And I was able to find new
job leads that I did not know about and update and create a
more permanent resume.
Mr. Johnson. Okay. Based on your experience, what parts of
the program there could be improved today? I mean, it is going
very well today. You got any ideas on what part of the program
could be improved?
Mr. Kayse. In the program today that I am able to
facilitate and coordinate, I think the biggest problem is
veterans and their access to technology, whether that be able
to do an electronic resume for the veterans that they can keep
with them and be able to take that anywhere, to a library and
be able to bring it up. I think that is the biggest barrier
that we face.
Also another barrier will be clothing, that they have a
shirt and tie to go to an interview, and finding funding for
that.
Mr. Johnson. Okay. Did other veterans who were in the
program experience the same type of success that you did?
Mr. Kayse. Yes. I do have a veteran currently that I have
been working with that is now employed by the VA medical
center. She did go from military life to homeless life now to a
VA job. I also have other veterans who have successful
employment and it is just rated on how they feel and how their
comfort level is.
Mr. Johnson. Okay. All right. Well, thank you.
We will go now to the Ranking Member for another round.
Mr. Donnelly. Thank you, Mr. Chairman.
This is for Dr. Campinell or Dr. Kerrigan. Some of the ways
you are getting a chance to talk to our veterans are really
creative, the places you are going to see them and talk to
them.
Do we have any program in particular in regard to this
where we have reached out to psychiatrists or psychologists or
federally qualified health centers or clinics or doctors
saying, you know, if you can contact your veteran without
violating any health protocols to let these veterans know that
this process is out there?
Mr. Campinell. Most definitely. It is a major part of the
effort that goes on within CWT. Since it is a clinical program
that requires a practitioner to provide orders to----
Mr. Donnelly. Right.
Mr. Campinell [continuing]. Participate in the program,
outreach to the providers, educating them as to what the
program can do, what it is for, which program seems most
appropriate for a particular individual based on diagnosis is a
constant effort.
So our staff, the field staff at every medical center
spends time meeting--they are either assigned to a treatment
program such as the Mental Health Intensive Case Management
Program or they meet individually with psychiatrists in the
outpatient clinic and talk to them and present the idea of
particular veterans with a serious disability participating in
work.
So, for example, in Supported Employment where we have the
evidence-based practice of Supported Employment particularly
focuses on veterans with psychosis, schizophrenia, bipolar
disorder, traumatic brain injury, and spinal cord injury, so
our staff become part of the treatment teams that work in those
various departments and advocate for referral and participation
by veterans with those particular disabilities.
Mr. Donnelly. For instance, and, Dr. Kerrigan, maybe you
can help with this, a veteran who does not use the VA and who
is struggling, maybe uses a federally qualified health center,
you know, like a south Houston, Texas health center or
something. Are you in contact with those health centers to let
them know, hey, if you have vets who have issues, who have
challenges, you know, talk to them or let them know we are here
in terms of employment help as well?
Mr. Kerrigan. We are. We are talking to people in the
community. First of all, a lot of people go to the employment
office when they are out of work. We work with and the
employment office often hires disabled outreach, disabled
veteran outreach people themselves. These are veterans who work
in the employment office who help with job search activity.
We meet with them on a regular basis. We have somebody who
comes into the hospital one day a week. The State voc rehab
will also see people who want to go back to school to get some
training with disabilities. They find out that this man or
woman is a veteran.
We have a network with the local Department of Assistive
and Rehab Services and somebody who is at the VA once a week so
that we can----
Mr. Donnelly. And, Dr. Campinell, I do not know if you
already do this and you may, but is there a way to find best
practices from all of VA. The health clinics, the centers
around the country, for instance, like Dr. Kerrigan going to
the Salvation Army, of saying here is a list of 52 places where
we need to be touching on a constant basis to see if they have
veterans in need?
Mr. Campinell. In an outreach model you are referring to?
Mr. Donnelly. Right, in reaching out to try to find where
our veterans are who may be in need of the service.
Mr. Campinell. That might be helpful, yes. And we do have
staff that spend considerable amount of time in the community
looking for potential employers. And in those efforts, it is
quite easy, I believe, for them to include an opportunity to
make presentations to the various organizations.
Many VA medical centers and CWT programs have joined the
Chamber of Commerce, have joined the Better Business Bureau,
and other types of community organizations and they tend to be
specifically those organizations that have some connections to
the business community, but they also have connections to--
those organizations have connections to other people who have
veterans in their family or no veterans who are seeking. So I
think it is a constant effort where that information is passed
forward.
And I wanted to comment in terms of information about the
availability of CWT. I think last year, not even the whole
fiscal--the fiscal year of fiscal year of 2011, we had about
300 veterans referred to CWT from the VR&E Program for whom
they felt the services that we provide would be better. So we
promote even within our own structure.
National Cemetery has two or three hundred veterans that
work in the cemeteries around the country seasonally providing
grounds keeping type of maintenance. And other Federal agencies
are also providing services. National Archive System has a
number of vets, a large number of vets working for them.
There is a great deal of word of mouth among veterans as
well. When they go back, even if they go into the readjustment
counseling center and they have been working, they pass that
information on.
I have colleagues that have gone to VA medical centers for
their own care who have been approached by a veteran who says
go ask them about CWT because they have jobs for you.
So the word of mouth among veterans is quite powerful.
Mr. Donnelly. Thank you very, very much.
Mr. Johnson. I will now go to Dr. Roe.
Mr. Roe. Thank you.
Just to dovetail on what Mr. Donnelly and Mr. McNerney were
talking about, I wonder if we could or would it be helpful for
us? You have less than 1 percent of the House of
Representatives sitting here and obviously we did not know what
was going on and we are on the Committee. I can assure you the
other 431 out there do not have a clue what you are doing or
mostly do not.
So would it be beneficial if we on the Veterans' Affairs
Committee at our local VAs or at our CBOCs hold a hearing or a
public awareness program, with the VA to say this is one
program that is available? I think one that has been incredibly
successful in our area has been the HUD-VASH Program. We have
gotten a lot of veterans off the street.
And the limiting factor there is the number of case
managers we have and then obviously finding the housing that
you can put them in. But that is very much a piece of what you
are talking about right here. The HUD-VASH Program is here.
Would that be helpful?
Mr. Campinell. The higher the level of public information
that is shared particularly by Congress in terms of your role
and representative services to your constituency, I think would
be invaluable.
Mr. Roe. That is something we should think about and our
staff should think about how we put together a program. The
other thing we could do is put this together in a little white
paper to make sure that all the offices know that this is
available.
And, Mr. Kayse, another thing, we had a huge tornado in my
district this year. Clothing will not be a problem. If you make
that available and known, I can assure you--and I remember now
it dawned on me locally, one of my good friends works at the VA
and she would always ask me, well, do you have a suit or you
have some ties, you know, that do not have mustard on them or
whatever that we can use, and the answer is yes.
And I think if you make that need known, that is solved. I
really believe that. That one, we saw we had actually too many
clothes after the tornado. So I think if you can let it be
known what is needed, it will happen. And I do not think that
will be an issue at all where a veteran can have a new suit.
And I can assure you in our area, that would happen literally
overnight.
And I think the other one is how do we get the word out. We
hear word of mouth, maybe a Web site. I think the media
publicizing it would be important to let people know because I
think this is an underused asset.
The other thing, back to the Chairman's point, how do you
replicate, how do you take the Bedford and replicate that model
across the country so that in rural America where I am, it can
work and in urban America where--Boston, I assume this is or
near Boston can work? How do you do that?
Mr. Campinell. Well, the Office of Mental Health has issued
policy that applies to all VA medical centers that they will
operate a CWT program that has both clinical models in it, both
transitional work and supported employment.
And in the approximately 4 years ago or 3 years ago when
the mental health enhancement funds were released, 50
facilities that had no programs at all were funded to establish
a basic program with one staff for each of two those clinical
models to operate within CWT.
So at this point in time, we have 187 locations including
some CBOCs. We have a program, two programs out on the
reservation that is 300 miles away from the major city.
So we have covered every facility both in terms of
financial resources and we have established a policy that
requires the provision of these services at some level within
the structure of that organization.
In addition, the resource planning model for VHA includes
projections based on some complicated algorithm, includes
projections that represent the increase in veterans potentially
participating in CWT out for the next 10 or 15 years and
becomes part of the calculations that go into VHA's budget for
the forthcoming fiscal year that is related to that.
So I think there are a lot of efforts going on to ensure
that programs--we ensure consistency in the clinical model. We
ensure resources so that they can establish a program and we
ensure that VHA is utilizing the projections of needs of
veterans that will participate into this program so that the
budget structure includes an acknowledgment and recognition of
them.
Mr. Roe. Just one last comment and I will yield back. As
congressmen, people will come up to you and thank you for
helping them get their disability claim. But I think the most
rewarding thing I have seen is a homeless veteran that is now
gainfully employed.
I really think that there was a complete failure when you
see this veteran out on the street and to see them come up with
a place to live and a job is one of the most rewarding things I
have seen since I have been in Congress.
And they will tell you stories that are just heart
wrenching. And I think this program is vital to it. I really
want to see it expanded and made more available and more
successful to people. It has got to be rewarding for you all to
see this happen too.
Mr. Chairman, I yield back.
Mr. Johnson. Thank you, Dr. Roe.
Mr. McNerney.
Mr. McNerney. Thank you.
I am just going to make a comment following up on Dr. Roe's
comment is we have a very successful program in Bedford and it
is expanding. And as it expands, there is always the fear of
the quality diminishing and the effectiveness diminishing.
And I hear what you are saying about your efforts to make
sure that does not happen. And I expect the chairman will be
keeping an eye on this program to make sure that that is the
case.
So thank you.
Do you have statistics or some idea of whether or not
veterans that take advantage of the CWT Program have a lower
unemployment rate than veterans in general and lower
unemployment rates than their non-veteran contemporaries, non-
veterans in the same demographic categories?
Mr. Campinell. I do not, sir. I only have measures of the
results at point of discharge, but not a comparison to other
veteran or non-veteran populations outside of the health care
system.
Mr. McNerney. Okay. So you do not have any sort of long-
term information on long-term success?
Mr. Campinell. I do not. In terms of follow-up of the
individuals that have participated, I do not, no.
Mr. McNerney. That might be something that would be useful
because it sounds like this is a program that we would like to
put more resources into and we would like to have sort of
evidence-based information as to whether that is a successful
program in the long run and, if not, how adjustments can be
made or follow-up can be made with individuals to make sure
that they stay on track.
Mr. Campinell. Well, I can speak to one specific instance
which is a research model, a successful research program out of
Tuscaloosa VAMC that provided supported employment specifically
for veterans with PTSD.
And their follow-up period, I think, was post 1 year and
there was a three-time greater level of employment among
veterans in that model at the 1-year period of follow-up than
other veterans receiving services as usual.
And I believe that Dr. Jack Drumming who is the chief of
mental health at Bedford has some internal research of his own
based on their programs that show similar results, that
participation in the program does have a long-term positive
outcome.
But in terms of national numbers such as, you know,
something the Department of Labor has access to or provides, I
am not aware of anything.
Mr. McNerney. Well, that would be a very powerful tool----
Mr. Campinell. Yes, sir.
Mr. McNerney [continuing]. In terms of getting support for
the program.
Mr. Campinell. Yes, sir.
Mr. McNerney. I am a little surprised of one of the facts
you mentioned, that only 11 percent of the participants are
OEF, OIF, OND veterans. That seems kind of low to me.
Is that just the proportion of those veterans to the
overall number of veterans? How come that number is so low?
Mr. Campinell. I can only say it might depend on the number
of veterans that are the receiving care at the VA medical
center and the type of care that they are receiving.
Many of the veterans coming in from OIF, OEF are also
service-connected. They have a service-connected disability and
they are going to be eligible or they are already eligible for
services from VR&E. So there may be more veterans going in that
direction.
There is also a great interest in the GI Bill, as you know,
the current GI Bill. And a lot of veterans are availing
themselves of that rather than the more traditional vocational
rehabilitation models, as I understand it.
Mr. McNerney. So maybe what you are saying is that the OEF,
OIF are not the hard cases yet and the older veterans are the
ones that really need this kind of help? I mean, obviously that
is a generalization, but that seems to be where we are at.
Mr. Campinell. Yes, sir.
Mr. McNerney. Thank you.
I yield back.
Mr. Johnson. Well, I want to thank the panel for being here
this morning. This wraps up our questioning and the panel is
now excused.
I hope that we can move forward from this hearing with a
renewed commitment to ensuring the VA's CWT Program is sound
throughout the whole country no matter whether a veteran lives
in an urban area or a rural area.
As I mentioned before, we should always be doing everything
we can to help veterans who can and want to work and reenter
the workforce, especially during this time of severely high
unemployment.
Just as they served and sacrificed for our country, so,
too, must we now serve and care for our veterans when they
return home.
With that, I ask unanimous consent that all Members have
five legislative days to revise and extend their remarks and
include extraneous materials. And without objection, so
ordered.
I want to thank all Members and witnesses for their
participation in today's hearing. And this hearing is now
adjourned. Thank you very much.
[Whereupon, at 11:07 a.m., the Subcommittee was adjourned.]
A P P E N D I X
----------
Prepared Statement of Hon. Bill Johnson, Chairman,
Subcommittee on Oversight and Investigations
Good morning. This hearing will come to order.
I want to welcome everyone to today's hearing titled ``Is it
Working: Reviewing VA's Compensated Work Therapy program.''
The Compensated Work Therapy, or CWT, program is one of the VA's
vocational rehabilitation programs designed to assist our warfighters
back into the workforce. The program is specifically geared toward
veterans who have suffered from mental illness, delivering a tailored
approach for re-employment that provides support and guidance through
the process.
In a time of high unemployment, especially among veterans, we all
must make every effort to match qualified workers with suitable jobs.
The CWT program does just that, matching disabled veterans with
employers.
When done correctly, the CWT program is a ``win-win.'' We know of
several success stories, including the program in Bedford,
Massachusetts, that has partnered with over 15 community businesses.
The businesses benefit from having qualified workers adding to
productivity, and the veterans benefit from being employed. However, we
also know of situations where little, if any, emphasis is placed on the
program. Few partnerships are made with the community, and in the end
it is the veteran who suffers.
We share a common goal of assisting our veterans to reenter the
workforce. A discussion on what the VA can do to sustain successful
programs and rejuvenate struggling ones, in addition to what Congress
and this Committee can do to help, will better enable us to achieve
that goal.
It is also my hope that today's hearing will provide the
Subcommittee with a clear picture of the structure of the CWT program,
from its national leader all the way down to the individual veteran at
a VA facility.
I also look forward to today's testimony and the chance to discuss
how we can ensure that the CWT program is rolled out consistently and
effectively all across the country. How can successful programs share
their best practices with struggling programs? How can national
oversight be improved? What kind of metrics are needed to effectively
gauge success?
It's not good enough merely to have well-intentioned programs. We
need effective ones that consistently deliver results and improve the
lives of our veterans.
I now yield to Ranking Member Donnelly for an opening statement.
Prepared Statement of Hon. Joe Donnelly, Ranking Democratic Member,
Subcommittee on Oversight and Investigations
Occupational specialties have been an important part of the lives
of our veterans, their identities are linked to their military
occupation, therefore, illnesses that limit a veteran's ability to work
once they have transitioned out of the military can have a significant
impact on their self-esteem.
Being part of the Committee on Veterans' Affairs for the past 5
years, I am aware of the unique needs veterans with mental illnesses
have. Homeless veterans, veterans with brain injuries, post-traumatic
stress disorder and other mental health problems require a prolonged
individualized rehabilitation plan. Providing them a rehabilitation
plan that will help them lead an independent life is important,
providing them the tools they need to obtain meaningful employment, is
even more and that's why CWT is critical for these veterans.
The benefits of the CWT program are many, it provides veterans with
skills training, job development, placement services, and employment
support. But not a lot is known about this program and I fear that not
many veterans know about this program as well. Because a veteran must
be referred by a clinician many veterans that would benefit from CWT
are not aware of it and may not know to ask their doctor about it.
Recently, I came across a blog discussion on CWT, in it, most of
the individuals talk about their positive experience and discussed
their successful rehabilitation. But there were a couple of individuals
who said their local VA clinic was short staffed and didn't provide the
service and treatment they needed. Programs like CWT need to be
successful nationally, it is unfair for veterans to get poor quality
treatment in some VA clinics while others get better treatment. These
regional disparities undermine the work VA is capable of providing.
I look forward to learning more about this program, the services
you provide to our veterans in need, and what you are doing to provide
consistent treatment to all veterans.
Prepared Statement of Anthony Campinell, Ph.D., Director,
Therapeutic and Supported Employment Programs,
Veterans Health Administration, U.S. Department of Veterans Affairs
Chairman Johnson, Ranking Member Donnelly, and Members of the
Subcommittee: thank you for the opportunity to discuss the Department
of Veterans Affairs' (VA) Compensated Work Therapy (CWT) program. I am
accompanied today by my colleague Anthony Kerrigan, Ph.D., CWT
Coordinator at the Houston VA Medical Center. Also accompanying me
today is Mr. Sean Kayse, a U.S. Army Veteran recently hired by VA, who
will discuss his experience in the CWT program in Iowa.
CWT provides Veterans whose lives have been disrupted by mental
illness or coexisting physical disabilities with a supportive, stable,
structured approach to help them achieve their employment goals.
Currently, almost 750,000 Veterans under age 50 are not in the labor
force due to various disabilities or illnesses, including serious
mental illness. Employment is an important personal goal and
contributes to a positive self image and a sense of purpose, and is a
critical element for people recovering from mental health issues.
Congress formally established CWT for VA in 1984. The program has grown
substantially over these 27 years, with over 41,000 Veterans receiving
CWT services at 187 locations in Fiscal Year (FY) 2011, and an
additional 26,000 Veterans receiving other forms of vocational
rehabilitation. In addition to its clinical benefits, CWT serves as a
complement to other employment services available from the Veterans
Benefits Administration, the Department of Labor, or state employment
agencies.
My testimony today will begin by providing an overview of the CWT
program, including its purpose and functions. It will then describe the
leadership and organization of the program, and conclude with a review
of some of the program's major successes, as well as its challenges.
Overview of CWT Program
CWT programs provide vocational rehabilitation services by medical
prescription to Veterans, many of whom have extensive barriers to
employment. A majority of persons with a disability want to work. The
core philosophy of CWT is that all persons with a disability can work
when provided with the necessary supports, and thus no one should be
excluded from the opportunity to participate in meaningful employment.
CWT programs serve eligible Veterans, including those with service-
connected disabilities, Veterans who have been involved in the justice
system, and Veterans with active addictions. Many have serious mental
illness, including psychotic disorders; serious physical disabilities
co-occurring with mental health diagnoses; and Spinal Cord Injury and
Traumatic Brain Injury. In addition, CWT programs include homeless
Veterans and Veterans who have been out of the workforce for an
extended period of time, in some cases, since discharge from the
military. VA benefits, including service-connected compensation and VA
pension, cannot be reduced, denied, or discontinued based on
participation in either CWT or Incentive Therapy (IT).
CWT programs are available in both urban and rural areas, as well
as in remote and difficult to access locations. For example, CWT
services are provided through the Black Hills Health Care System and
Rapid City VA Medical Center in South Dakota. These facilities extend
access to Native American Veterans on the Standing Rock Lakota Sioux
Indian Reservations in McLaughlin, SD, Eagle Butte, SD, and Pine Ridge,
SD, on the Pine Ridge Indian Reservation. The CWT program and services
in these remote and isolated locations offer economic stability and a
recovery-based culture for the participating Veteran and his or her
family alike.
CWT provides a number of options for Veterans who are looking to
get back into the workforce. These options include the following:
Incentive Therapy (IT): This is a pre-vocational work restoration
program that authorizes the assignment of patients to various hospital
work situations. IT provides a diversified work experience at those VA
medical centers that choose to incorporate it for Veterans who exhibit
severe mental illness or physical impairments. IT services may consist
of full or part-time work with remuneration limited to the maximum of
one half of the Federal minimum wage and paid on an hourly basis. IT
participants provide services in various ``jobs'' or roles: escorting
Veterans to and from appointments; delivering messages and
communications; and providing a range of assistance to program areas,
including light cleaning, picking up lunches, and folding items. Hours
of work may be adjusted from as little as 1 hour per day to 8 hours per
day, based on the Veteran's work stamina and treatment goals. IT also
provides an opportunity for VA to assess Veterans in a more independent
but clinically supportive environment.
Sheltered workshops: These activities are operated at approximately
35 VA medical centers nationally. CWT sheltered workshop is a pre-
employment vocational activity that provides an opportunity for
assessment and the development of work skills in a simulated work
environment. Veterans participate in a wide variety of work, from
advanced printing, including business cards and engraving, to furniture
upholstery, with participating Veterans paid on a piece rate basis
commensurate with the type of work performed.
CWT/Transitional Work (CWT/TW): This is a pre-employment vocational
assessment program that operates in VA medical centers and local
community businesses. CWT/TW is provided at many National Archives and
Record Administration (NARA) Federal Record Centers and National
Cemeteries. Participants are matched to real-life work assignments for
a time-limited basis. Services may relate to work in janitorial/
housekeeping, food service, warehouse, prosthetics assistant, and
grounds maintenance. Veterans are supervised by personnel of the
sponsoring site, under the same job expectations experienced by non-CWT
workers. CWT/TW participants are not considered employees and receive
no traditional employee benefits. Participants receive no less than the
greater of Federal or state minimum wage, depending upon the type of
work performed. The CWT/TW program offers real training to Veterans and
provides an avenue to competitive jobs in these Federal agencies.
CWT/Supported Employment (CWT/SE): This is an evidence-based
practice which has been demonstrated to assist Veterans with the most
severe psychiatric disabilities to achieve competitive employment and
community integration with extensive clinical supports. CWT/SE was
implemented nationally in 2005 as part of VA's recovery transformation
efforts, and has since been highlighted in a RAND report as a gold
standard mental health program. CWT/SE services are individualized and
intensive, and are integrated as part of the Veteran's mental health
treatment. When the Veteran is able to maintain employment
independently, CWT/SE services are phased out and support is provided
by the clinical team and natural supports in the Veteran's community.
CWT/SE is routinely provided to Veterans with psychotic disorders.
Additionally, VHA's Therapeutic and Support Employment Services (TSES)
works in partnership with VA researchers to expand SE services to a
broader audience. CWT/SE services have been provided to Veterans living
with spinal cord injury and traumatic brain injury as part of VA-
sponsored research. A recently concluded 2011 study of SE for Veterans
with post-traumatic stress disorder (PTSD) funded by the VA Office of
Research and Development was so successful in improving rates of
employment among Veterans receiving SE that a new, larger study is in
the planning stages with the VA Cooperative Studies Program.
Homeless Veterans Supported Employment Program (HVSEP): This
program provides vocational assistance, job development and placement,
and employment support designed to improve employment outcomes among
homeless Veterans. In FY 2011, VA medical centers started to receive
funding for HVSEP. The program is coordinated between the CWT and
Homeless Veteran Programs. VA has provided funding to hire 407
Vocational Rehabilitation Specialist positions to support this
initiative. These employees have been trained and integrated into the
range of VA Homeless services, including the Health Care for Homeless
Veterans (HCHV), Grant and Per Diem (GPD), Department of Housing and
Urban Development-Department of Veterans Affairs Supportive Housing
(HUD-VASH), Domiciliary Care for Homeless Veterans (DCHV), Health care
for Re-Entry Veterans (HCRV), and the Veterans Justice Outreach
Initiative (VJO) programs for the purpose of providing community-based
vocational and employment services. All the HVSEP Vocational
Rehabilitation Specialists hired are themselves Veterans who are
homeless, formerly homeless, or at risk of homelessness.
Vocational Assistance: This CWT support provides a set of
assistance, guidance, counseling, or other services that may be offered
to individual Veterans or groups. These services enable Veterans to
identify skills, resources, attitudes, and expectations needed when
searching for employment.
CWT Leadership and Organization
The CWT program is an element of the VHA's Therapeutic and
Supported Employment Services section (TSES) in the Office of Mental
Health Operations. TSES is responsible for overseeing CWT and IT
programs. These two programs are authorized by 38 United States Code,
Section 1718, to integrate remunerative work restoration services and
vocational rehabilitation and employment support into treatment
planning for Veterans receiving care in VA's health care system.
VHA Central Office TSES staff consists of a Director and four
Program Planning Specialists, who function as liaisons and support
staff for assigned Veterans Integrated Service Networks (VISN); two
Supported Employment Specialists; one Program Analyst; and one staff
member who works closely with both TSES and Homeless Services to
support the Homeless Veterans Supported Employment initiative. TSES
provides guidance for implementing CWT programs and interpreting policy
in collaboration with networks and facilities.
A major effort of the TSES program is conducting fidelity reviews
of the CWT/SE program. These reviews follow a standardized procedure to
assess SE program implementation barriers and successes. TSES uses the
results of these reviews to assist programs in their ongoing quality
improvement efforts through recommendations and technical assistance to
the CWT Program Management as well as facility and service line
leadership. In FY 2011, 68 fidelity site visits were conducted, and the
results of these reviews showing strengthened levels of employment
implementation were disseminated nationally through the VA Northeast
Program Evaluation Center's reporting system.
In addition, TSES organizes national conferences to train CWT
staff, participates in monthly conference calls to address local and
national issues, and conducts onsite training visits upon request. VHA
provided five training visits to approximately 175 staff in FY 2011 in
response to requests from facilities for consultation.
In accordance with VHA Handbook 1163.02, Therapeutic & Supported
Employment Services Program, each facility is responsible for
appointing a TSES Vocational Program Manager. The facility program
manager is responsible for implementing the policy and procedures for
establishing and operating a TSES program in accord with the VHA
Handbook guidance. CWT program implementation occurs at the local level
to include CWT hiring decisions, staffing levels, and program manager
duties. In addition, each individual facility makes decisions regarding
the use of Transitional Workers.
CWT's Successes and Challenges
Collectively, these efforts are making a difference. All told, TSES
programs provide paid work experience, competitive employment, and
vocational assistance services to almost 70,000 Veterans each year,
approximately 11 percent of whom are Operation Enduring Freedom/
Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) Veterans. In
FY 2011, the IT component of TSES served over 7,000 Veterans; the CWT/
TW component served over 29,000 Veterans; and the CWT/SE component
served over 14,000 Veterans, a 12 percent increase over FY 2010. An
additional 29,300 Veterans received vocational assistance services.
Veterans in TSES programs earned in excess of $60 million as a result
of their work. Earnings generated through IT, CWT/Workshops, and CWT/TW
are also tax exempt and excludable as income for Social Security
Supplemental Security Income (SSI) program purposes. This exemption
enables Veterans who receive disability income to take advantage of the
skills learned at TSES programs and develop these work skills without
fear of losing their benefits.
In FY 2011, TSES provided CWT services at 187 program locations and
90 IT program locations. Of 11,267 Veterans who were discharged from
CWT/TW and CWT/SE Programs who were entered into the VA Northeast
Program Evaluation Center program evaluation database, 27 percent were
placed in community-competitive employment at discharge, with an
additional 8 percent leaving CWT to pursue formal training, higher
education, or volunteer work. Forty-six percent remained unemployed,
13.8 percent retired, and information is unavailable on the remainder.
Since May 2011, the Homeless Veterans Supported Employment Program has
served 2,564 Veterans, 27 percent of whom have been placed in community
employment.
The Commission on Accreditation of Rehabilitation Facilities (CARF)
has accredited VA outpatient mental health services for over 15 years.
All CWT programs with 4.0 Full-time Employee Equivalents or more (86
total) have received a 3-year CARF/Employment and Community Services
accreditation, the highest level score for quality rehabilitation
services. CARF accreditation recognizes that CWT programs are providing
efficient, effective services that result in high levels of stakeholder
satisfaction. Smaller programs are not required to be CARF accredited
at this time.
Notwithstanding these successes, the CWT program faces several
challenges. TSES staff has received reports about staff and funding
variations across local programs that sometimes result in delays in
patient enrollment. We also understand from CWT program staff that
there is growing demand for CWT services. Funding for CWT programs
comes from both national sources (for TSES staff) and from VA facility
budgets (for local programs). Funding is also received at the local
level from employers who contract with CWT programs to hire Veterans
enrolled in CWT. We are exploring new opportunities to standardize and
simplify the funding stream, which will also provide VA greater
oversight of how revenues are used across the system.
Conclusion
Thank you again for the opportunity to share information about VA's
efforts to provide vocational rehabilitation services to Veterans. VA
is dedicated to improving Veterans' overall quality of life through a
vocational rehabilitation experience in which Veterans learn new job
skills, strengthen successful work habits, and regain a sense of self-
esteem and self-worth. My colleagues and I are prepared to answer any
questions you may have.