Vet program offers jobs with therapy

Homeless veterans with mental health challenges re-enter the work force.

By Jamie Chamberlin
Monitor staff

Thomas Horvath, MD, watched as construction workers in yellow hard hats ran up and down ladders, hammered and nailed, spray painted and carefully pulled electrical wires out of walls. Two men in hardhats directed the workers?a trained electrician and a clinical psychologist.

Horvath was so impressed with the workers? skill and energy, he had to remind himself of who they were.

'These were all hard core Boston homeless, dually diagnosed, mentally ill and substance addicted veterans,' he says. 'People that you would regard as severely mentally ill, and they were working hard, building a mail-out pharmacy for the Department of Veterans Affairs.'

'I said to them all right then, ?I have seen the future of psychology, and it works,?' he says.

Horvath, chief consultant for mental health for the U.S. Department of Veterans Affairs (VA) and a professor of psychiatry at the State University of New York?Stony Brook, was witnessing the labors of the Veterans Construction Team at the Edith Nourse Rogers Memorial Veterans Hospital in Bedford, Mass.

The team is part of the hospital?s highly successful Compensated Work Therapy (CWT) program run by the hospital?s psychology service. The program provides construction, administrative and assembly jobs in tandem with psychological services to veterans with psychiatric illness, substance abuse or homelessness. It seeks to help veterans re-establish their sense of identity and make a transition to the civilian work force.

'I see three legs to the stool of recovery,' says Horvath. 'We need appropriate biological treatment and psychotherapy, but these only get veterans ready for rehabilitation. The third leg of treatment is real life work experience,' he says.

There are 105 other CWT programs in the nation, but Bedford is the largest, employing 350 veterans each week. Bedford?s program provides a continuum of vocational rehabilitation services that vary in levels of structure and challenge. One program provides assembly jobs for veterans that have psychiatric disabilities that prevent them from doing more competitive work, another offers entry-level jobs in federal agencies and private businesses on a day-to-day basis. And the construction team, which is a full-scale, nonprofit business, provides veterans who are ready to commit to full-time employment with jobs in painting, electrical work, carpentry and accounting.

Bedford?s work therapy program has contracts with the U.S. Department of Defense, the VA and more than 60 corporations in Massachusetts, including 3M and Polaroid. In 1997, Bedford?s 'sales' reached almost $6 million dollars.

The program also benefits Massachusetts businesses?they receive high-quality services that cost 10 percent to 20 percent below market rates. And the VA saves money through the program?s services as well. 'The VA spends money on mental health care because that?s our mission, and it spends money on renovation and construction in the medical buildings,' says Anthony Campinell, deputy director of psychological rehabilitation at the Veterans Health Administration Headquarters. 'This model combines the two costs.'

But veterans are the program?s greatest benefactors, says Campinell. Many veterans in these programs are not only constructing buildings or equipment for 3M, they are reconstructing their lives.

Real work, real pay

The construction team program?the most challenging of Bedford?s work therapy programs?is the brainchild of Bernard Cournoyer, a vocational rehabilitation specialist with the VA. In 1993 a staff member at Hanscom Air Force Base in Hanscom, Mass., asked Cournoyer if the veterans at Bedford could tackle a small painting project. Cournoyer, who had experience with work rehabilitation, saw the offer as an opportunity to launch a new program. Hospital administrators agreed and Bedford assembled a team of six veterans to complete the $2,500 project.

Fifty veterans are now involved in the construction program, says Cournoyer. 'Veterans are beating down our door to get into this program,' says Cournoyer, who markets the program and acquires many of its contracts. The team now competes for contracts worth nearly $500,000.

Selections for the team are based on referrals throughout the hospital. Before joining the construction team, veterans are evaluated by staff psychologists and attend a safety education program.

The team?s accomplishments in the last three years include renovating an inpatient care unit at the VA Center in Manchester, N.H., building a Consolidated Mail-Out Pharmacy that serves 11 VA medical centers in New England, and renovating one of the buildings in the Phillips Laboratory at Hanscom Air Force Base.

Bedford?s program pays more than any work therapy program in the nation, says psychologist Christopher Boyd, PhD, the program director of compensated work therapy at Bedford. The veterans earn wages that are comparable to civilian wages and get a 50-cent-per-hour raise for every 90 days they succeed in the program.

Nontraditional therapy

The program?s psychologists deliver vocational rehabilitation services to the veterans at the work site, focusing on the veterans? work experiences instead of their illness or disability.

'Rather than opening people up to bring out problems, we focus on problem-solving at work,' says Boyd. 'We try to help the veterans in the program build a real sense of identity, and consolidate that identity as a worker and a solid person.'

Psychologists also address the factors that may be prohibiting a veteran from achieving his or her work goals, such as previous problems with anger management or depression.

'Work is a very powerful tool to help people deal with difficult things,' says Walter Penk, PhD, chief of psychology services at Bedford. 'The work situation, particularly the issue of supervision, really brings a lot of core problems to the fore almost immediately,' says Penk.

A psychologist meets with groups of five to 15 veterans, depending on how many veterans work at a particular site. How often the psychologist visits depends on the veterans? level of functioning and stage of recovery. Work-site supervisors, who are hired for their construction skills and their ability to learn to work with veterans, are trained to recognize problems or signs of relapse.

'You can immediately intervene in a model like this,' says Campinell. 'It?s much easier to catch that person and engage him in treatment, you don?t have to wait until after he has relapsed.'

Rising to the challenge

Veterans in the program attest to its healing power. Robert Mabie, a former U.S. Navy pilot, says he might never have gone back to work without CWT. After leaving his job to care for his ailing parents in Massachusetts, he became depressed and sought treatment at Bedford. He then joined the construction team as an administrative clerk. He says the experience gave him the confidence he needed to help pay off some of his parents? bills, save his family?s home and take on a second job. He is now pursuing a civilian consulting job.

'Veterans use this program as a launching point,' says Mabie. 'You are always encouraged to find something better.'

Veteran Fred Brein?s problems with alcohol dependency and depression brought him to the program. 'It has given me my life back,' says Brein, who has strengthened his relationship with his college-age children since he started with the program three years ago.

The construction team jobs are challenging, and the stress can cause some veterans to suffer setbacks or turn to substance abuse. Veterans who relapse are removed from the program until they are able to return. Boyd views such setbacks as part of the rehabilitative process. 'Rehabilitation is not like a straight line, it is more like a spiral moving through time,' he says. 'We don?t see people as falling off, but falling back. We get them back in the stream as quickly as possible, and they find that if they can come back from something like this, they?re stronger.'

Outcomes research

Armed with a VA research grant, the Bedford program is gathering data to study the outcomes of its program. So far, data have shown that the programs reduce the VA?s mental health-services costs because veterans return to work and use outpatient services less, Horvath says. Veterans are also reporting better medication compliance and are securing civilian jobs, he says.

In the meantime, other VA programs around the country are trying to learn from Bedford?s example. Bedford helped the Washington, D.C., VA medical center set up a construction team, and in July the D.C. and Bedford teams completed an opthamology center at the Washington, D.C., VA hospital. The Bedford staff is also working with VA hospitals in Richmond, Va., and Charleston, S.C., which are interested in transplanting Bedford?s model. And several of the companies that Bedford has built strong relationships with, such as Polaroid, are forming contracts with other Veterans Industries programs around the nation.

The Bedford staff attribute the program?s success to teamwork, says Penk. The program has strong support from the VA, the Bedford business community, nearby VA hospitals and Bedford?s hospital director William Conte, he says.