culturally competent practice kara mahoney, inner city law center
TRANSCRIPT
CULTURALLY COMPETENT PRACTICE
Kara Mahoney, Inner City Law Center
Overview
Build an understanding of VA structure Provide an overview and tips on interacting
with veterans service organizations Discuss cultural competency when working
with veterans
Overview of VA Structure
Overview of VA Structure
Veterans Health Administration (VHA):
•Healthcare benefits• Primary care & specialists• Dental• Pharmacy
• Largest hospital network in the nation
Overview of VA Structure
Veterans Benefits Administration (VBA):
•Financial Benefits• Housing• Education• Employment• Disability
Overview of VA Structure
Interaction between VHA and VBA
• VHA is entirely separate from any benefits determinations made in the Compensation & Pension programs in the VBA
• VHA does commonly provide medical evaluations for VBA benefits eligibility
VSO: a collective term referring to membership organizations of veterans E.g.: Veterans of Foreign Wars (VFW),
Disabled American Veterans (DAV), AmVets, State Offices
Veterans Service Organizations
Mission of VSO may vary by organization but most are focused on assisting veterans and promoting the interest of veterans
VSOs can provide veterans with support to address “health, housing, legal, financial, and education & employment issues in the context of a community with similar experiences.”
Locations: Regional Offices County or State offices Stand Alone Centers - VFW
Veterans Service Organizations
Most VSOs help veterans file claims with the Regional Offices; some will represent them up to BVA
VSOs file claims with a different philosophy than attorneys Incentive for quantity of veterans served File on all possible claims
Veterans Service Organizations
Interacting with VSOs Be aware of your status as an attorney in this process
Stigma surrounding attorney status History of opposition to attorney involvement in veterans
claims
VSO issues VSO training issue - increasingly complex body of law Pre-judgment of claims
VSO community involvement Post as a community center Sponsor other community-based activities
Veterans Service Organizations
Working with Veterans Resource: Representing Washington
Veterans: Basic Legal and Cultural Concepts – Northwest Justice Project
Consider how to: Encourage veterans to speak freely; Constructively react to hearing about killing,
death, or other situations and attitudes that are uncommon or unacceptable in civilian society; and
Never ask, “Have you ever killed anyone?”
Culturally Competent Practice
Working with Veterans Challenges:
Homelessness Physical disabilities Mental disabilities Unemployment Social isolation/relationship difficulties Substance abuse
Culturally Competent Practice
Autonomy and military culture Encouragement to form group mentality Privilege the health of the group over
individuals Individuals taught to push aside any
psychological concerns in favor of a fully positive report to a superior officer
Hierarchical structure teaches servicemembers to obey whatever commands of their superiors
Culturally Competent Practice
Autonomy and military culture Encouragement to form group mentality Privilege the health of the group over
individuals Individuals taught to push aside any
psychological concerns Hierarchical structure teaches
servicemembers to obey whatever commands of their superiors
Culturally Competent Practice
Stigma of Mental Health Symptoms in Military Inherent nature of military Isolation & ridicule “hysteria” Career aspirations
Consequences of Stigma Underreporting or failing to report symptoms Ignoring reported symptoms Painting discharge-related misconduct as
unrelated to mental health symptoms
Culturally Competent Practice
Consider experiences among veterans in light of the duration, nature, and time of their service. Drafted veterans versus volunteer
veterans.
Age of veterans Be careful with assumptions about their
service.
Culturally Competent Practice
Understand where a veteran may be coming from in terms of behavior For example, military service may have involved:
Driving aggressively Taking cover Shouting/hitting Taking charge Taking orders Carrying a weapon Being in groups Abnormal physical contact/proximity
Culturally Competent Practice
Instead of: “ARE YOU A VETERAN?” ask,“Have you ever served in the military?”
Be careful with “THANK YOU FOR YOUR SERVICE”: For recently returned veterans, “Welcome home,”
or “Glad to have you back,” may be more suitable. For any veteran (or person), “I’d like to learn about
your experience if you feel comfortable discussing it,” may more effectively connect an advocate and client without expressing judgment.
Culturally Competent Practice
Differences in Terminology Army: Soldier Marine Corps: Marine Navy: Sailor Coast Guard: Coast Guardsman /
“coastie” Air Force: Airman
Culturally Competent Practice
Women Veterans May not identify as veterans Combat Involvement
Do not make assumptions More likely to have been raped by a fellow
servicemember than killed in combat Military Sexual Trauma:
Defined: rape, sexual assault, or severe harassment 1 in 3 female veterans report MST 1 in 6 male veterans report MST
Culturally Competent Practice
Working with Survivors of Trauma Everyone experiences trauma differently
No “normal” responseAny behavior after the trauma (positive
or negative) may be an effect of it
Culturally Competent Practice
Working with Survivors of Trauma Open-ended questions – soliciting a
narrative “Tell me about what happened…” “Tell me about how you felt…”
Cue or Specific Questions Use to clarify questions from the narrative
“You mentioned you went to get medical attention. Can you tell me more about that?”
Culturally Competent Practice
Working with Survivors of Trauma Environment is important
Safe and comfortable for the survivor Private and free from distraction Maintain an equal physical position
Explain the purpose of the interview Survivors may not have all the answers to
questions The survivor is in control of the
process
Culturally Competent Practice
When working with survivors of sexual assault or other forms of trauma be aware of all times of the surroundings and what reactions your questions may cause.
Culturally Competent Practice
Excerpt from stressor statement of Vietnam combat veteran:“I can snap at just about anything. When I was married, my wife and I would go out to dinner and I would order a steak. If it wasn’t cooked right, I would barge into the kitchen and shove it in the chef’s face. I would explode. If I thought people were screwing with me in any way, I would retaliate immediately. I still have a lot of anger and I am learning how to manage it, but it’s there.”
Being Trauma-Informed
Excerpt from stressor statement of survivor of rape in the military:
“At that time, I didn’t feel safe talking about the rape. Fellow soldiers were harassing and threatening me. Some of the threats were direct, some were indirect. They would tell me to keep quiet, or you never know who’s gonna get you. They would say that if I went to another duty station, they knew someone there and they could hurt me. Basically saying I would never be safe, and they could always get me no matter where I’m at. So I kept my mouth shut because I was terrified of being hurt even more.”
Being Trauma-Informed
People first language Respect & dignity Putting the person–not the condition–first
No one wants to be defined by a single trait (e.g. medical condition or height) Say “people with disabilities” not “the
handicapped.” Say “Bob has a mental health condition”
not “Bob is mentally ill” or “Bob is insane.”
People First Language
