By Stephen Spotswood
WASHINGTON — Work therapy has been a part of VA rehabilitative programs for decades, but only since 1984 has it been codified under a national clinical initiative. With the return of the latest generation of veterans, who are entering VA care when a more holistic approach to treatment and rehabilitation is taken, compensated work therapy (CWT) has begun to be embraced fervently by veterans and clinicians.
Transitional work therapy participants are screened by VA Vocational Rehabilitation staff, assessed and matched to a work assignment for a limited time as deemed appropriate. Photo from Cheyenne VA Medical Center webpage.
Despite anecdotal reports of VA-administered work therapy’s success, national data on its impact is lacking. In addition, some facilities remain understaffed and under-resourced, resulting in veterans waiting longer for job placement. Approximately 750,000 veterans under age 50 are not part of the labor force due to disabilities and illnesses. During the past 27 years, CWT has targeted these veterans, helping them find employment as part of a clinical-prescriptive plan.
The CWT program is geared specifically toward veterans who have suffered from mental illness, delivering a tailored approach for re-employment that provides support and guidance through the process. According to VA, the benefits of CWT include providing veterans with skills training, job development, placement services and employment support.
The program has grown significantly since its beginnings and, in FY 2011, provided 41,000 veterans with CWT services at 187 locations. About 11% of these were Operation Enduring Freedom (OEF) or Operation Iraqi Freedom (OIF) veterans.
A Prescription To Work
Many of these veterans have serious mental and physical illnesses, including psychotic disorders, spinal-cord injury and brain injury. Many also have been or currently are homeless and out of the work force for an extended period of time, in some cases since their military discharge.
“Collectively, our efforts are making a difference,” Anthony Campinell, PhD, VA’s director of therapeutic and supported employment, told legislators at a recent House VA Committee hearing.
“I know there’s a lot of interest in the program. Whenever I tell veterans what the program entails, they always ask where they can sign up and what possibilities it may hold for them,” Campinell said. “To meet their needs, we’re constantly looking for ways to prepare them for work and to find them jobs.”
To do this, VA partners with local businesses to match disabled veterans with jobs for which they are best suited. For example, the Bedford, MA, CWT program — one of the oldest in the country and where Campinell formerly was employed — partners with local Air Force and National Guard bases, a cafeteria system, a soldier’s home, the town government, a community college and a hospital.
Lack of Data, Resources
In FY 2011, out of 11,000 veterans discharged from CWT programs nationwide, 27% were placed in community employment at discharge, with an additional 8% leaving to receive training, pursue higher education or find volunteer work. Committee members asked CWT leaders why the percentages were so low and what happened to the remaining 65%.
Sean Kayse, coordinator of the Homeless Veteran Supported Employment Program at the Iowa City VA Medical Center and a former CWT participant, said the biggest hurdle veterans need to overcome is fear.
“When we discharge from the military, sometimes you are just shuffled out the door, and you have to face life by yourself,” Kayse said. “And when you start in a government agency again, they say, ‘The government didn’t help me then. How can they help me now?’”
Part of that mindset is due to what Kayse described as “years of horror stories about VA.”
“But VA is becoming a more positive place to be,” he added. “That [mindset] is starting to go away.”
While VA knows the numbers of veterans employed at discharge from CWT programs, they have few figures on the long-term success of the programs. There is no data on whether CWT participants have lower long-term unemployment than those who do not participate in the program, Campinell said.
One research model from the Tuscaloosa, AL, VA Medical Center looked at veterans with PTSD whose treatment included CWT. After a follow-up period of one year, veterans in the CWT model were employed three times more than veterans not in the model, Campinell said.
“But in terms of national numbers — something the Department of Labor has access to — I’m not aware of anything,” he said.
Legislators urged Campinell to find a way to get those figures, which could help Congress justify moving more resources to CWT.
More resources are necessary — at least at certain VA facilities. The average wait time for a veteran entering CWT before they are placed in a job is 30 days. That wait time rises at facilities with fewer resources.
“The problems tend to lie in the smaller programs with less resources,” Campinell said. “The clinical approach is the same at every location: transitional work and supported employment under medical prescription. But when there’s a program with, for example, two staff, getting people into the program tends to take a bit longer. Not because there’s resistance to having veterans participate but because caseloads tend to be full, and the work opportunities that are available may be more limited due to the size of the medical center or the size of the program itself.
A facility-specific survey found that 138 of 140 VA facilities reported shortages of medical officers, with psychiatry and primary care positions being the most frequently listed.
When Terrence O’Neil, MD, retired as chief of nephrology at the James H. Quillen VAMC in Johnson City in December 2016, he left in his wake decades of work treating kidney disease—nearly 35 years in the Air Force and DoD, plus 11 more at VA.