This document provides a holistic perspective on ending veteran homelessness by addressing the various mental health, substance use, medical, legal, vocational, financial, and housing challenges many veterans face. It discusses common issues such as PTSD, TBI, depression, substance abuse disorders, chronic pain, and legal barriers. It also outlines different treatment interventions and programs that target these problems, emphasizing the need for coordinated, multi-faceted services to successfully reintegrate veterans. Resources are provided for additional information on specific treatment approaches and services for veterans.

1. Healing Our Heroes
A Holistic Perspective on Ending Veteran
Homelessness
Presented by:
Christopher Monceaux, MBS, MS, PLPC, CCTP
Shauna Russell, M.S., PLPC, CCTP, CIT

2. Outline
I. Introduction
II. Mental Health
III. Substance Use Disorders
IV. Medical Issues
V. Legal Barriers
VI. Vocational Rehabilitation
VII. Finances
VIII. Housing
IX. Conclusion
X. Resources

3. Introduction
• Basic Tenets of Military Culture:
• “Duty, Honor, Country”
• Subcultures within the military
• Branch, Unit, Platoon, MOS (Military Occupational
Specialty)
• The “Average” Soldier
• Unique Challenges faced by veterans
• Importance of assuming a holistic perspective on
treatment

4. Mental Health: Trauma
• Post Traumatic Stress
Disorder (PTSD)
• Combat Related
• Childhood Trauma
• Military Sexual Trauma
(MST)
• Occurs among male and
female military members
• Self-medicating Prevalent
• Treatment Options

5. Mental Health: Other Concerns
• Veterans diagnosed with depression account for slightly more
than 14 percent of the total
• Current Suicide Rate among veterans: About 22 per day
• PTSD, Depression, and TBI has higher prevalence in OEF/OIF
veterans
• Personality Disorders:
• Often go undiagnosed
• Present unique treatment challenges

6. Estimated Number of Veteran Suicides per day by Year
(according to a 2012 study by the Department of Veterans
Affairs)

7. Interventions
• For trauma and other mental health diagnoses:
• Cognitive Processing Therapy (CPT)
• Prolonged Exposure Therapy (PET)
• Virtual Reality Prolonged Exposure Therapy
• Acceptance and Commitment Therapy (ACT)
• Mood Gym
• Mental Health Applications
• PTSD Coach
• Mindfulness Coach

8. Interventions (Ctd)
• Eye Movement Desensitization & Reprocessing (EMDR)
• Adaptive Information Processing Model
• 8-phase standard protocol
• Adapted protocols for several mental health disorders
• Dialectical Behavior Therapy
• Dialectics & Validation
• Skills Training
• Interpersonal effectiveness, emotion regulation, mindfulness, &
distress tolerance
• Integrative Approach

9. Substance Use Disorders
• Between 2004 and 2006, 7.1% of U.S. veterans met the
criteria for a substance use disorder.
• Older generation vs. Younger Generation
• Increased abuse of prescription drugs
• Legality of marijuana; potential treatment implications?
• Research is conflicting
• May explain higher usage among younger vets

10. SUDs Interventions
• Counseling & Psychotherapy
• Cognitive Behavior Therapy, DeTUR, Motivational
Interviewing, Harm Reduction, Relapse Prevention
• Community Support
• AA/NA Meetings & Sponsor
• SMART Recovery
• Celebrate Recovery
• Rational Recovery
• Seeking Safety (Co-Occurring PTSD and Substance Use
Disorders)

11. Medical Issues: TBI
• Traumatic Brain Injury (TBI) defined as “an alteration in
brain function, or other evidence of brain pathology,
caused by an external force.”
• A TBI may be classified as focal or diffuse; open or
closed; and mild, moderate, or severe. (Penetrating is a
different classification)
• Traumatic brain injury has become known as a “signature
wound” of Operation Enduring Freedom (OEF) and
Operation Iraqi Freedom (OIF)
• TBI can significantly affect diagnosis and treatment

12. TBI and Treatment
• Diagnostic Difficulties
• Effects similar to the symptoms of many mental health
diagnoses
• Treatment implications
• Slower
• Difficulty remembering appointments and completing tasks

14. Medical Issues: Other Concerns
• Chronic Pain
• Prevalence & Impacts
• Relation to SUDs
• Traditional Pain Management
• Alternative Pain Management
Strategies
• Other Service Connected Injuries
• Tinnitus
• Agent Orange Exposure
• Camp Lejeune Water Exposure

15. Medical Issues: Other Concerns
• Diet & Exercise
• MOVE Program
• Yoga and other low-impact activity
• Sexually Transmitted Diseases
• HIV & Hepatitis C
• Other chronic health complications

16. Legal Barriers
• Felonies (stigma, employment barrier, housing barrier)
• Drug Charges (Drug Court, treatment as alternative to jail
time)
• Child Support (numerous financial implications)
• License restrictions (no transportation = employment
barrier; consequence of child support and other legal
issues)

17. Legal Barriers
• Diversion Programs:
Problem Solving Courts
(VOA Veterans Court,
Drug Court)
• Expungement
• Advocacy within the legal
system

18. Vocational Rehabilitation
• Reintegration into civilian workforce
• VBA Vocational Rehabilitation & Education Programs
(Chapters 31, 36, 18, & 35)
• VHA Compensated Work Therapy Programs
• Incentive Therapy (IT)
• Compensated Work Therapy (CWT)
• Supported Employment Program (SE)
• Community Partners
• Goodwill
• LRS
• Employer-agency connections

19. Other Income Sources
• VA Service-Connected Benefits
• VA Non-Service Connected Pension
• SSDI/SSI Benefits
• SOAR application
• Non-cash Benefits

20. Maslow’s Hierarchy of Needs

21. Housing
• VA is committed to ending
Veteran homelessness by
the end of 2015
• Housing First/ Rapid
Rehousing
• Prioritization using the
SPDAT

22. Housing
• Various Programs:
• Safe Haven- low impact, low barrier
• GPD- more structure, transitional
• SSVF- short-term assistance
• HUD VASH- long-term intensive case management
• Theory vs. Practice
• Non-availability to rural veterans
• Importance of supportive services throughout re-entry
into permanent housing

23. Practice Scenarios

24. Conclusion
• Implications for
treatment
• Coordination of services
for best outcome
• Importance of assuming
a holistic perspective

25. Additional Resources
• Links for additional information
• SAMHSA:
• http://www.samhsa.gov/veterans-military-families
• Military OneSource
• http://www.militaryonesource.mil/
• Seeking Safety
• http://www.treatment-innovations.org/seeking-safety.html
• Virtual Reality Exposure Therapy:
• http://ict.usc.edu/prototypes/pts/
• Department of Veterans Affairs:
• http://www.ptsd.va.gov/
• http://www.va.gov/opa/docs/suicide-data-report-2012-final.pdf
• http://www.va.gov/homeless/about_the_initiative.asp

26. Resources Continued
• Volunteers of America
• http://www.voanorthla.org/
• Legal Resources:
• http://grantome.com/grant/NIH/I01-RX000484-02
• http://usich.gov/population/veterans/veterans_homelessness
_in_focus/breaking_down_legal_barriers_to_housing/
• http://www.nationalhomeless.org/factsheets/veterans.html