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Helping Veterans Find and Keep a Home

A nurse talks with a senior man about medications

Sarah Scalia assists Veteran Arthur Carter with routine life skills. Photo by Jeff Bowen, VA Medical Media Photographer

by Hans Petersen, VA Staff Writer
Monday, April 14, 2014

April is Occupational Therapy Month

“I’ve been too busy lately to sit around and think about how depressed I am.” When Sarah Scalia heard that, she knew she had helped a Veteran change his life.

And realized he had defined her job, occupational therapist, “better than I ever could have dreamed.”

Occupational therapy is a discipline that aims to promote health by enabling people to perform meaningful and purposeful activities.

As the largest health care system in the nation, VA is the single largest employer of occupational therapists.

Scalia works within HUD-VASH, a partnership between the Department of Housing and Urban Development (HUD) and VA Supported Housing (VASH).

HUD supplies a number of Section 8 housing vouchers designated for Veterans and VASH supplies ongoing case management services to help the Veteran obtain and maintain affordable housing with the voucher.

“As the first occupational therapist hired into a VA homeless program, I have had the privilege of a blank canvas on which to paint our services for our Comprehensive Homeless Program here at the Central Arkansas Veterans Healthcare System.”

Scalia was asked to help a Veteran who had accumulated so much clutter in his apartment that he was at risk of eviction. He had a long history of depression and alcohol dependence and only had a two-foot wide path from his bed to his chair in the living room.

Her assessment confirmed that his living space was a direct reflection of his depression: decreased self-worth and motivation. He did not want to become homeless again but he felt overwhelmed. “I assured him his goal was attainable, rolled up my sleeves; put some gloves on and spent three days a week for a month and a half with him.”

Scalia’s assignment includes assessing Veterans going into housing to ensure they are functionally able to reach the goal of maintaining housing long term. So far, she has conducted evaluations on 105 Veterans.

She also assists on cases for Veterans who are already in housing, assessing functional knowledge and skills associated with many basic activities of daily living, but mainly budgeting and home management.

As she explains, “It’s the nature of the job when developing a new program that the format of services must change and shift according to the needs of the population being served.”

Occupational therapists use a holistic approach and address activities of daily living such as dressing, bathing and grooming, as well as more advanced activities such as cooking, shopping, driving, parenting, and returning to work. They are skilled at assessing performance, analyzing the components of tasks and helping to improve performance through adapting the way a person is performing the task, the use of equipment, or by adapting the environment.

VA occupational therapists work with individuals who suffer from a mentally, physically, developmentally or emotionally disabling condition by using treatments that develop, recover, or maintain clients’ activities of daily living. They work with thousands of Veterans of all ages.

Remembering the Veteran with the clutter, Scalia noted that, “Once we got his apartment cleaned out, I began teaching him how to maintain the cleanliness we had achieved. His HUD-VASH social worker reported that his depression symptoms significantly decreased.

Scalia explained, when he was able to sit on his couch for the first time in over a year he said, “Now I could have a friend over. And, I could cook them dinner now that I can use my stove and oven.”

“He continues to live in a safe, clutter-free apartment. He has re-gained employment and his Mental Health Clinic team says our occupational therapy assistance helped to make a great difference in the symptoms they had been struggling to address for this Veteran for a long time.”

“I facilitated his engagement in occupation, meaning that I helped him with his problem solving skills, therapeutically challenging his thought processes associated with throwing things away and teaching him to recognize how and why certain items triggered an increase in his depression symptoms.”

Scalia is also designing a series of group protocols to improve HUD-VASH Veterans’ skill set associated with maintaining recovery: a Wellness Recovery Action Plan (WRAP) enhanced with education and experiential activities provided to promote mindfulness of our senses and how sensory processing affects our responses to everyday life.

The other will be a community re-integration group to promote social interaction, independence, and a sense of community among Veterans who are obtaining permanent housing. She will be co-facilitating this group with a HUD-VASH social worker.

About her job? “Quite frankly, it’s a beautiful thing! Multiple clinical services working toward the same goals, the goals of the Veteran.”

Since Scalia’s initiation of this new service, two additional VA occupational therapists have joined her in the unique assignment, Ellen Radford in Boston and Geoffrey Sittler in Portland, Oregon. More about them in a future story.

April is Occupational Therapy Month, a perfect time to reflect on the work VA does to help Veterans live a full and productive life.

 While we focus on patient safety as an everyday responsibility, Patient Safety Awareness Week allows us time to highlight some of the exciting ways people all over the VA are working to achieve high quality and safe care for their patients. 
— Robin R. Hemphill, Chief Safety and Risk Awareness Officer, Director National Center for Patient Safety