Summation

The semester and my project are coming to a close. I wanted to take time to review what I've learned.

1. What learning objectives have I met?

While developing my project, I wanted to include a population that was most pertinent to my future career. Being that I was a veteran, and I wanted most to work in psychiatric nursing, homeless veterans were a perfect fit for me.

While working at the shelter, I gained exposure to the various mental illness and substance abuse disorders that plague the homeless population. Also, I was able to experience the many secondary effects of these disorders; an experience that is lacking in the traditional nursing career.

I feel that to see where many of my future patients come from, and where they will go after their hospital stay, will help me to include appropriate nursing interventions and to provide patient teaching that will be more effective for the homeless individual.

2. What surprised me the most about my project?

I was surprised mostly by the people I met at the shelter. My perception of homelessness was not accurate before I began. Many of them hold regular jobs, and have families. Some may dress in  manner that would not identify them as homeless. I wonder how many homeless people I meet in a week and don't even know it.

Mental illness is of coarse prevalent, but many homeless people are not mentally ill. Some, who have lived paycheck to paycheck like many Americans do, found themselves in a shelter soon after loosing their job. Some of these people, independent of any mental, or substance abuse disorders, are victims of the economy.

3. Words of wisdom to future honors students.

PERSEVERANCE. While developing a program to streamline entrance into a complicated VA system, I became a victim of it myself. Right at the time when my project really should have taken off, it fell apart due to someone else's lack of accountability.

I learned that when working with an organization, or a government agency in general, it's best to do the ground work yourself. Don't rely on anyone to relay information, or to process paperwork. It's best to do it all manually. If you are trying to reach someone, don't leave a message. E-mail only if you must.

Most importantly, Show your face! Even after you think you've got the ball rolling with your partner organization, be sure to remain visible. ASSUME THAT THEY WILL FORGET ABOUT YOU. It's important to stay fresh in their memories.

Advocating

This week I had two appointments scheduled; one with the veteran with the one month wait (Ill call him Steve), and the other a new case.

I sat down with Steve and his case manager on Monday to discuss some options as far as how to address his referral issue. We decided to have his case manager call to "schedule an appointment", to emphasize the fact that she was making the needed referral. I was not present for the call, and I'm still awaiting the results of it.

I was scheduled to meed a new veteran who was planning on transferring from the main shelter to transitional housing. From what I know of him, he would have qualified for VA services. Unfortunately, the veteran was not adjusting well to his new life in Birmingham, and decided to move in with his brother in Mobile. So, there was no meeting.

I've still got Steve. Hopefully he and I will make some progress next week.

Jason Watkins

Making Progress

Progress indeed!

After assessing 5 veterans, I finally found one that qualifies (at least on paper). We contacted mental health services to schedule an appointment. We got an appointment... with his primary care physician 1 month from now.

This is the problem. The vet and I were told that we must have a referral from his physician before mental health services will see him.

Not true.

Program guidelines state specifically:

12. REFERRAL

As HUD-VASH is one available program in the homeless continuum of care, close collaboration with HCHV outreach and other VA homeless programs is essential. A primary source of HUD-VASH Program referrals are Veterans that have been identified through HCHV outreach, or those currently receiving services. Veterans may be referred to HUD- VASH through:

a. The HCHV Program;

b. The Domiciliary or RRTP;

c. The Health Care for Re-Entry Veterans (HCRV) Program;

d. The GPD Program;

e. The VA medical facility inpatient and outpatient programs;

f. The VA emergency services;

g. The Community-based Outpatient Clinic (CBOC); or

h. A community source, such as an agency that provides services to individuals who are homeless.

So, rather than have a more speedy entry into the program, this gentleman must wait another month just to see his promary care docor, and hope for a referral. Luckily, he has a warm place to say. Many don't. 

I don't want to risk effecting the vets chances for entry, so I've decided that it's best that I not push the issue. But, as you can see from the section above pulled right from the program manual, this man should be in mental health services now. Not a month from now.

Jason Watkins

Great Start

It feels good to finally start. The word is out around the shelter, and I've done intakes on 4 guys so far. Unfortunately, none of them have qualified. No problem, there are more to come.

Day 1

Today's meeting with the shelter kicks off phase one of the project. I'll be posting fliers to help draw out the veterans residing in transitional housing. Hopefully, I'll have a group to work with on Wednesday and Friday.

I'll start with identifying who's already attempted to enter the program, and why they weren't admitted. Hopefully, that will provide a starting point for intervention.

For the guys who haven't made an attempt, I'll give an overview of the program and start them on gathering supporting documentation.

Hoping for a good turnout!

Jason Watkins 

Blog Kick off!!

I'm still learning many of the intricacies of "blogging", but hey, that's why I'm here. Today I asked myself, "Is there an ideal vet for HUD-VASH? If so, what are their characteristics?"

Conveniently, the HUD-VASH manual spells it out under a section entitled "Target Population". The manual describes the vet as follows:

1. chronically homeless ("chronically" meaning homeless for 1 year or more, or 4 episodes of homelessness within the last 3 years)
2. suffers from either a metal or substance abuse disorder
3. is disabled
4. has dependents
5. is a veteran of Operation Iraqi Freedom or Enduring Freedom (or both!)
6. is female (for obvious reasons, being homeless and female carries a very different set of issues)

None of these factors are requirements. In fact, the only requirements are that a) you're a veteran b) you're homeless and c) you make your appointments. However, these factors guide the case managers in selection of vets based on the greatest need.

Most homeless vets will satisfy more than one of these factors. The key however, is documentation. The vet who walks into a mental health facility with documented proof that he is chronically homeless, receives precedent over the vet "claiming" to be chronically homeless.

This is where I come in. Discouragement is one of the major reasons vets do not fulfill the necessary requirements when entering the program. With knowledge of what the VA is looking for, my goal is to prepare the vets with the right documentation and ultimately the right attitude before they even make the first trip to the facility.

That's the plan anyway... (pessimism)

Monday, I'll post fliers in the transitional housing facility to try and identify how many vets I have to work with. I'll schedule meetings with them on Wednesday and Friday. I know there are a couple, maybe a few, but mostly, this is the big unknown...

Jason Watkins