Friday, January 25, 2008

Finding a way home

Vet helps street vets find a new way

Nine years ago, Tomas Casados’ life was in utter disarray. A Vietnam-era veteran who had stumbled into alcoholism and a life of crime, he was cooling his heels in the Twin Towers jail in downtown LA when he met a man named Greg Cain.

Cain was an outreach worker for the Veterans Administration (VA), and was making one of his regular visits to the county jail in search of former soldiers who wanted to turn their lives around.

Despite Casados’ years of alcohol abuse, negative attitude toward authority and the fact he had already been to prison three times, he was struck by what Cain said.

It took another year for Casados to show up at the VA’s sprawling 388-acre hospital complex in West Los Angeles, but once he took the first step of joining a 90-day detox and rehab program, he never looked back.

In the past seven years, Casados has kicked his habit, come out of homelessness and has become an outreach worker for homeless veterans. He considers it a full-circle turnaround and fair repayment to the programs that saved his life.

“I go to jails and we give vets up there hope. We say we’ve been in the same place you have and we have the resources to help,” says Casados with a mix of humility and pride. “By the grace of God I’m a government employee and worked my way up from being a volunteer to conducting outreach and now being a team leader for four other outreach workers helping vets across Southern California. I turned my addiction of getting loaded into an addiction to helping people.”

Trouble by numbers
Casados is just one of thousands of veterans who have been helped by the VA’s homeless programs in the Greater Los Angeles area since its specialized services were launched in the late 1980s. Before that, homeless vets were part of a one-size-fits-all approach that had severe limitations. One was homeless vets were using already scarce inpatient beds for shelter and had few housing options once their medically necessary stays were completed. Thus, many were subjected to a never-ending revolving door of help and despair.

The VA’s own reports show that in 2006 America had nearly 200,000 homeless veterans living on the streets. And approximately 11 percent of those — 21,424 to be exact — lived here in the Greater Los Angeles area. Crime is also a problem. The New York Times has reported that more than 121 veterans returning from Iraq and Afghanistan have committed murders since coming home.

According to the VA’s 2006 report, 97 percent of homeless vets are men, but the number of homeless veteran women and their families has been increasing. Nearly 32 percent of homeless vets have been on the streets for one year or longer, and

51 percent of them served in the US Armed Forces after the Vietnam era — showing vets’ struggles have continued beyond that moment in history.

The report goes on to show that mental health and substance abuse problems are at the forefront of veteran homelessness. Nearly half of homeless vets indicated having a substance abuse problem and 37 percent had serious psychiatric disorders, ranging from psychosis to the notorious post-traumatic stress disorder (PTSD); 21 percent had the misfortune of suffering from both problems. Beyond that, 46 percent reported at least one serious medical problem.

Other challenges for homeless veterans include the fact that only 10 percent are currently married, revealing a lack of core support networks, and another 21 percent don’t have a job due to having a disability or being retired. According to Bruce Daniels, director of the Comprehensive Homeless Center at the Westside VA facility, it’s that loss of a support system that causes veterans’ other problems to spiral out of control.

“Most people know they have family to help them in a crisis. That is, unless you get into drugs and alcohol and burned bridges so badly they won’t come back to you, and it’s those situations that we deal with,” says Daniels. “But the VA alone can’t meet all the needs, so we partner with all sorts of community agencies, including the Salvation Army, the US Veterans Institute, Weingart Center Association and in Pasadena with Union Station and Passageways.”

And yet, many veterans are apparently unaware of the resources available to them. According to a CBS News report last fall, in 2005 more than 6,000 US veterans of all wars committed suicide — a rate of more than 120 suicides each week, a figure that more than doubles the civilian suicide rate.

More than 100,000 vets are pursuing treatment for mental health, more than 52,000 of those for PTSD alone. Among these, Daniels and others note that the veterans of the wars in Iraq and Afghanistan are facing dark problems more rapidly than soldiers in prior conflicts. Yet Daniels is also quick to point out that the problems facing returning soldiers have occurred throughout much of American history.

“This is not a new problem, for even after the Civil War some veterans had nowhere to live. This very VA property started from that, because we started as the National Soldiers Home in the late 1800s,” explains Daniels. “There was a big boom in the number of homeless vets we assisted after World War II, and 5,000 lived right here on the grounds in the years after that conflict. Then drugs and alcohol entered the picture in the aftermath of the Korean and Vietnam wars, and that led to a breakdown on a bigger scale.

“But even with all these challenges, if a veteran walks in that door and works with us, their homelessness is over.”

A growing crisis
Iraq and Afghanistan vets are facing greater post-combat problems, even as their actual death tolls are extremely low in comparison to prior wars. More soldiers are surviving combat due to the greatly improved quality of their protective gear, meaning that instead of dying they are experiencing protracted problems with their physical and mental health.

According to James Maddox, president of Pasadena’s chapter of the Vietnam Veterans of America, such troubles are only likely to escalate in the years and decades to come.

“No one knows how many more veterans will be revealed to have PTSD and other mental health problems from Iraq and Afghanistan, because of the strength of the explosions from IEDs (Improvised Explosive Devices) there,” says Maddox, who works from a small crowded office on Raymond Avenue in Old Pasadena when he’s not assisting with veterans issues at conferences nationwide.

Then, pointing toward St. Andrew Catholic Church about three blocks away, he made a disturbing comparison to the level of suffering our troops are subjected to on the Iraqi and Afghan battlefields.

“If an IED went off at St. Andrew’s, it would be felt right here where we are so strongly that our brains would be affected as if they had undergone a sonogram,” says Maddox. “And these bombs go off all the time around these soldiers and literally shake their brains. There’s almost no way that they’re not being affected by it, but it may take years to really show up as mental impairment.”

In the face of all these challenges, the staff of the Greater Los Angeles VA’s homeless outreach programs believes that they are making a difference. Casados notes that the program employs 20 people in its veteran outreach teams — a significant increase from its start in 1987 as a three-person program. Among the current staff is a three-woman team reaching out to female veterans, while other parts of the team are dispersed in a strategic fashion.

“At the LA city jail we have three outreach workers plus a social worker, and every person who comes in is asked if they served in the US military,” says Casados. “Every single day, the sheriffs get a list of those who have, and they send us a list of those. We go in, meet them, work with the courts to find jail alternatives unless their cases are truly severe crimes, and help them find rehab. They also have a special veterans’ dorm at the jail.”

Other Greater Los Angeles Area VA teams travel to such far-flung locales as Pomona, San Bernardino, Ontario and San Luis Obispo in their quest to assist veterans on the streets, and some members are currently involved in LA’s Project 50 program by helping to identify and assist the 50 most chronic occupants of the city’s Skid Row.

Coming home, again
So what happens to the veterans who agree to come in from the cold and seek a fresh start?

Casados joined the homeless outreach project’s director, Michelle Wildy, in showing a reporter through the step-by-step process involved.

Wildy transferred to her VA post in 2005 after a long career with the Department of Defense in Washington, DC, where

she was a deputy director of

a National Security Agency clinic and spent 45 days assisting at the Pentagon after it was attacked on Sept. 11.

“First, anyone who wants to be considered for assistance must undergo an immediate eligibility check to make sure they were truly members in good standing with the armed forces,” says Wildy. “They’re not eligible unless they have a good conduct discharge, but we can find out their status with just a three-minute check.”

“And we’ve got special cell phones that put us immediately in touch with people who can check their status even by phone, in case we meet homeless people on the streets who don’t trust us enough initially to come into the office,” adds Casados.

The ability to check backgrounds quickly and thoroughly is vital for other reasons. Often a family will contact the office to see if they can find a loved one who has gone missing.

“We take the information and a suggestion of where the person was last at and then we hit the streets to track them down,” says Casados. “We’ve found several guys in that way.”

The ability to conduct such sweeping checks is key to winning the trust of veterans in need, as the Greater Los Angeles VA workers strive to bring in eligible participants in within 24 hours for their first shot at rehab as well as a chance to clean up and receive clean clothes.

Then the staff’s two nurses take medical histories and check for problems such as high blood pressure and sugar diabetes before suggesting rehab programs if needed or either back-to-work programs or creative work therapy. The choice of in-depth programs depends on whether they’re deemed in need of simple help, like receiving housing vouchers, or complex help where a lot more help is needed.

“In creative work therapy, guys learn how to go back to work through learning schedules and responsibility on projects at the hospital first,” says Wildy. “We then work with employers in the community to get veterans into a work setting, and then case managing them for the first few months on the job to make sure they can keep up with the work.”

The overall programs available to the veterans in homeless outreach can last up to two years, although participants are case managed up to five years to ensure that they’re maintaining positive progress in their lives. They are coached through the issues of daily life, such as how to manage a checking account.

“Ultimately, turning these lives around and helping them abandon lives on the street comes down to caring for four main areas: access to care and treatment, access to income from benefits and job training, stable housing that guarantees you have your own pillow in your own bed under the same roof each night, and building a support system for those who don’t have it,” says Daniels. “It’s a big challenge, but someone has to do it and we’re here making it happen.”

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