Serving Veterans and their families

7/29/2019 Serving Veterans and their families

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CONTEMPORARY ISSUES IN THE

HUMAN SERVICES

SERVING VETERANS AND THEIR

FAMILIES


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OVERVIEW: CHAPTER 1(pages 1-6)

STATISTICS

THE COMBAT ZONES:

IRAQ

AFGHANISTAN


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BASIC STATISTICS

SINCE 2003: MORE THAN 1 MILLION TROOPS

HAVE BEEN DEPLOYED IN IRAQ AND

AFGHANISTAN

1/3 HAVE SERVED AT LEAST 2 TOURS IN

COMBAT ZONE

1.2 MILLION CHILDREN LIVE IN US MILITARY

FAMILIES

700,000 HAVE AT LEAST 1 PARENT DEPLOYED


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MORE STATISTICS!!!

WHO SERVICES IN THE MILITARY?

50% ARE UNDER 25 YEARS OLD

85% ARE MALE

LATINOS AND BLACKS ARE OVERREPRESENTED

70% HAVE SOME COLLEGE

10% ARE MARRIED TO MEMBER OF THEMILITARY

70% HAVE 1 OR MORE CHILDREN


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THE TOLL IT TAKES

300,000 RETURNING SOLDIERS HAVE PTSD

320,000 HAVE TRAUMATIC BRAIN INJURY

AS OF MAY 7, 2010, 1,046 HAVE DIED AND5730 HAVE BEEN WOUNDED IN AFGHANISTAN

AS OF MAY 7, 2012, 4,387 SOLDIERS HAVEBEEN KILLED, AND 31,809 HAVE BEEN

WOUNDED IN IRAQ 29% OF FEMALE VETERANS REPORT HAVING

BEEN RAPED!


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GLOBAL WAR ON TERROR (GWT)

IRAQ

OIF: OPERATION IRAQI FREEDOM

SADAAM HUSSEIN AND WEAPONS OF MASSDESTRUCTION

AFGHANISTAN

OEF: OPERATION ENDURING FREEDOM AL- QAEDA, THE TALIBAN, OSAMA BIN LADEN,

ATTACKS ON 9/11


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AFGHANISTAN

As of 5/7/2010, 78,000 remain

All volunteer force

Multiple deployments vs. staying til it is done Purpose: remove Taliban from political and

military dominance, destroy al-Qaeda, kill

Osama bin Laden and his staff Coalition forces: Great Britain, France,

Australia, Special Operations


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New President was elected

Military activities aimed to stabilize new order

Use of active and reserve forces


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Iraq

Largest wartime deployment for U.S. women!

Baghdad fell in less than a month

Sunni and Shite engaged in civil war to gainpolitical power

Guerilla type war

Army and Marines bear the brunt Unpopular in comparison to Afghanistan


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MILITARY CULTURE: CHAPTER 2 (pages

16-24)

Set standards for performance and ethics

Distinct: success or failure in performance may

determine survival of the nation

Accept an unlimited liability clause whereby

they may be placed in danger of losing lives

Swear to support and defend U.S. Constitution

not any one person such as the President

Civilian control of the military


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Department of Defense

Pentagon of DOD: Headquarter of U.S. armed

forces

Secretary of Defense: civilian appointee serves

at pleasure of the President

Army, Air Force, Marine Corps headed by

generals

Navy headed by Admiral

All are members of the Joint Chiefs of Staff


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Coast Guard falls under secretary of homeland

security

The combined all-volunteer armed services,

national Guard, and reserve referred to as the

total force.


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Demographics of total force

As of 2006-2007:

Mostly middle and upper middle class family

economic backgrounds

Low income families are underrepresented

49.3% from incomes of more than $51,000

29% from less than $42,000 Only 1.4% not complete high school compared

with 20.8% in overall population


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Demographics continued

Race:

65.5%-White

12.82% -Black

3.25%- Asian or Pacific Islander

1.96%-American Indian or Alaskan

3.42% biracial or declined to state

13.19% Hispanics (underrepresented compared

to overall population of 20.02%) 42.97% from the south, 12.81% from the

Northeast


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Officers

Typically come from affluent families and are

highly education

Lower ranks are not highly education because

they usually enlist before they go to college

and then go to college after


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Military Subculture

1. Strict discipline to maintain organizationalstructure

2. Relies on loyalty and self-sacrifice to

maintain order in battle 3. rituals and ceremonies to create common

identity

4. Connected to one another by emphasis ongroup cohesion and espirit de corps

Often use military speak (see glossary)


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RANK

Rank structure leads to deference of junior

rank to seniors

Officers are referred to as sir, madam, maam

or by their rank by non officers

Noncommissioned officers, eg. Sergeants are

referred to by rank, not as sir or madam

Junior enlisted personnel are addressed by

their rank and last name (Private Pile)


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ARMY

Largest and oldest

Purpose: dominate the war on the ground

Soldiers

Active: full time Reserve: part time (report to governor of the

state) Make up half of the Army, older

1 out of 7 soldiers if female, 54% are married,

46% have children 712,895 family members

Reserve: 49% married, 42% have 2 children


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Marine Corps

Infantry of the Navy

Created in 1775

Specialty; amphibious operations: assaulting,

capturing and controlling beachheads Currently fight in Iraq and landlocked Afghanistan

too.

No medical professionals in Marines 20,000 officers and 173,-- enlisted on active duty

Strong identity, tradition bound branch


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Navy and Air Force

Navy: Control the seas

Major component of nuclear deterrence effort

325,000 enlisted Sailors and 54,000 officers

AirForce: youngest of branches, military might in airand space

Controls strategic nuclear missiles

65,000 commissioned officers and 260,000enlisted,20% are women

Coast Guard: prevention and deterrence of terroristattacks, free flow of commerce, 50,000 and 10,000reservists


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COMBAT STRESS INJURIES: Chapter 3

and 5 and pages 7-15

POST TRAUMATIC STRESS DISORDER

SUBSTANCE ABUSE

MAJOR DEPRESSION

SUICIDE

TRAUMATIC BRAIN INJURY


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STAGES AND EFFECTS OF KILLING

1. Before the kill: CONCERN Will I do my job, willI survive, am I a coward

2. The Killing: Not much conscious thought. Ifunable to kill, may rationalize or be traumatizedby failure

3. Exhilaration: intense satisfaction, combathigh, can lead to combat addiction

4. Remorse

5. Rationalization and acceptance: search is life-long and can lead to PTSD, depression and self-destructive behaviors


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SUBSTANCE ABUSE

Mitigate intense emotions that come withcombat

Each war has an underlying drug culture

Currently, alcohol is banned from war zones, butthey get and use it anyways

High rates of re-deployment have lead toincreased risk of heavy drinking

Current wars have produced new wave ofaddiction: prescription drugs and opiates to keepthem in the fight rather than refer to treatmentfor treatment


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SOUL WOUNDS

In addition to addiction, various injuries occur

often due to inability to rationalize, accept

and reintegrate with society

Visible vs. invisible wounds: less deaths than

Vietnam but many so called invisible wounds

1. PTSD

2. Depression

3. Traumatic Brain Injury


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POST TRAUMATIC STRESS DISORDER

INCUBATION FOR THIS INJURY:

50% of army and marine corps ground combatunits report being shot at, and seeing dead or

seriously wounded Americans of injured civiliannoncombatants.

More than half reported killing an enemy in Iraq.

Multiple deployments lead to higher rates

More realistic to think of PTSD as an injury vs. adisorder


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DSM Definition of PTSD

1. Anxiety

2. Reexperiencing of a traumatic event viathoughts, dreams, reliving the event and intensepsychological and physiological distress whenexposed to cues that resemble the event

3. Avoidance of thoughts of the trauma, inabilityto recall the trauma

4. Detachment of others, numbness alternatingwith hypervigilence and irritability and anger

Delayed onset if symptoms present at least 6months after the stressor.


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Effects of PTSD on life

1. Emotionally: anger, fear, anxiety

2. Cognitively: altered worldview, hopeless,

etc.

3. biologically: psychosomatic illnesses

4. Behaviorally: isolation, substance abuse

5. Socially: negative effect on interpersonalrelationship with family and friends who can

develop secondary PTSD


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SEXUAL ASSAULT EPIDEMIC

Can lead to PTSD and depression

41% of female veterans say they were victims ofsexual assault

29% report having been raped More likely to be raped by fellow soldier than

killed by enemy

As of 2006, 2,947 sexual assaults reported

181 out of 2,212 assailants were investigated andcourt martialed.


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Military Sexual Trauma

Term used to describe any sexual harassmentor sexual assault that occurs in the military

14-42% have reported sexual assault/rape

55-63% reported sexual harassment By 2009, sexual assault reports were up 9%

( times more likely to exhibit PTSD symptoms

Half of sexual assaults go unreported Why?


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Reasons for low reporting rates by

women in the military Conflict of interest Victim and perpetrator share a living and working

environment

Victim continues to serve in a life threatening

environment with their perpetrator Lack of training for those who are supposed to assist

the victim

Process of reporting lacks anonymity

Fears of confidentiality breaches or retaliation

Shame, blame, humiliation

Being re-victimized


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DEPRESSION

Not traditionally considered an invisible

wound of war but with record numbers of

suicides associated with current war fighters

and veterans, must learn more about it.

Loss of friends and comrades may trigger

depressive episodes


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MAJOR DEPRESSIVE EPISODE: DSM

2 week period nearly every day with at least 5 ofthe following symptoms:

Depressed mood

Loss of interest or pleasure

Weight changes

Insomnia or hyper-somnia

Psychomotor agitation, fatigue, loss of energy

Feelings of worthlessness, guilt Diminished ability to think or concentrate

Recurrent thoughts of death


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Kanels research results of CSUF

college enrolled veterans in 2007 31% reported having recurrent recollections of the

event

41% reported feeling detached and estranged fromothers

36% reported restricted range of feelings 33% reported a sense of not having a normal future

46% reported irritability or outbursts of anger.

33% said they experienced some type of impairment in

functioning 21% qualified for a diagnosis of PTSD, 49% met criteria

for Acute Stress disorder (only lasted 1 month)


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Kanels findings about depression

50% reported depressed mood most of the

day

45% fatigue and loss of energy nearly every

day

50% insomnia or hypersominia

27% met criteria for Major Depression

according to DSM

Being single related to more symptoms


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Other Research results

PTSD is more prevalent than depression among deployed,affects 5-15%

Depression ranges from 2-10%

Prevalence of PTSD and depression increases as time since

returning home from deployment increases Combat exposure and being wounded more likely to

develop PTSD

Deployed troops more likely to develop PTSD anddepression than nondeployed, those deplyed to Iraq higher

than Afghanistan Estimated number of those returning home with PTSD will

range from 75,000 to 225,000, with depression 30,000-150,000


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SUICIDE

Veterans are committing suicide at a rate that far exceedsnonveteran population.

32,000 suicides a year, 650,000 attempts in generalpopulation.

Difficult to get an exact amount because some appear to beaccidents.

In June 2010, 1 per day killed themselves!!!

In 2007, 108 confirmed suicides in the Army, 166 in Iraqand Afghanistan.

firearms used most often, often preceded by a failedintimate relationship

47% are older than 30, half are sergeants


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CAUSES?

Stigma to seeking help for needed problems likePTSD and Depression

-considered weak

-would be treated differently

Would have less confidence in them

Difficult to get time off of work

Would hurt their career

Difficult to schedule an appointment Would be embarrassing

Didnt trust mental health professionals


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Public Health Problem

MUST CHANGE STIGMA

Mental health issues like PTSD and depression

are expected just as physical injuries are

Mental health injuries are an occupation

hazard and need treatment just like physical

wounds.


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Other causes of suicide

Rules of engagement: frustrating to have towait until they are fired on or attacked.

Helplessness, horror, intense fear to wait to be

fired on. Watching others get injured.

Transitional density: accumulation of stressful

and traumatic events creates an overwhlemedor breaking point, simply cant take anymorestress and continue to function.


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Connection with PTSD

Associated with time and intensity of combat

In 2008, suicide was highest among deployed

and after deployment.

In 2009, 245 died by suicide and as of May

2010, 163, this is more dying than from

combat!

The Chain: Multiple deployment, leads to

PTSD, no treatment, leads to suicide.


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Acquired Capability to Kill

Failing to prevent death or injury and killingassociated with suicide attempts

Being threatened with being killed or injured

associated with PTSD Feelings of guilt after combat, regarding death of

women and children strong predictors of suicideattempts and ideation

Combat may desensitize soldiers, decreases thepower of ear and pain regarding killing others andself


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Post Deployment Suicide

STIGMA

Military health system is overloaded andofficers in charge at highest levels often

continue to say that there is no directcorrelation between war and suicide.

Often told nothing wrong with you, coward,and were discharged.

Female veterans 3 times more likely thancivilian to commit suicide.


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TRAUMATIC BRAIN INJURY

The use of Improvised explosive devices (IEDS)

Persons exposed to IED blasts may developmild, moderate or severe brain injury which

results in temporary or permanent cognitiveimpairment.

Decreased levels of consciousness, amnesia,skull fracture and intracranial lesions and canlead to death

IED have caused 75% of all casualties


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Effects of higher education and work

Can cause slower thinking attention span and

concentration issues, perceptual problems

with hearing, vision, touch and balance

Impairment in motor skills, endurance,

headaches and pain sensitivity

We must teach educators and employees to

be sensitive and accommodate, PLEASE!!!!


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INTERVENTIONS: Chapter 4, pages 76-

77

Governmental Responses:

Created program to deliver health caredirectly to members and families

1. Military Treatment Facilities (MTFs)-employuniformed medical personnel, supplementedas needed by contracted civilian healthprofessionals

2. TRICARE: MTFs and civilian health caremarket (9 million patients)


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Chaplains

Often first step in obtaining access to mentalhealth care

Confidential: can remove stigma

Refer out to unit-embedded mental healthproviders

However, mental health providers in an

operational combat unit are required torelease information if unit commanderdetermines he needs it


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Community Service Programs

Counseling is confidential

Found at local military installations

Not recorded in service members medical

record


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MTF treatment teams

Due to shortages of mental health personnel,

active-duty members have treatment priority

Usually outpatient, some inpatient

Primary care professional, care manager,

mental health professional

Reduces stigma by having this team


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Military OneSource

Information and consultation service for allservice members of active and reserve and theirfamilies.

Retired or separated personnel may use for 6

months after separation Consultants triage the call and refer for up to 12

free counseling sessions

If severe, may refer to MTF, VA hospital or VetCenter or TRICARE professional

Educated at masters level and licensed

Ch ll i i


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Challenges in meeting

mental health demands

1. Outpatient care operates during standardsworkday hours, and service members must beabsent from training to attend. Reluctant to askfor time away due to stigma

2. Not enough uniformed mental healthprofessionals, not enough funding to hire more,need for more nonprofits

3. But military providers understand military

culture and social context of services, can betterdetermine fitness for duty, more trust if inuniform


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PREVENTION OF COMBAT STRESS

Prevention is key to reduce need forintervention later.

Leaders are responsible to take action to

strengthen service members tolerance tocombat stress and manage it in his unit.

It is described as the mental, emotional orphysical tension strain or distress resultingfrom exposure to combat and combat relatedconditions.

COMBAT STRESS CONTROL


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COMBAT STRESS CONTROL

PROGRAMS 1. Predeployment: rigorous training for units next

combat encounter. Familiarized with stressors they canexpect

2. Deployment and combat: regular meetings and

briefings, reduce uncertainty, provide feedback to unitmembers so they know that they performed well as agroup, accomplished missions, ensured families andloved one are being taken care of while away

Combat stress control teams prevent and manage

those who show signs of unhealthy combat stressreactions, soldier to soldier without fear ofstigmatization, ensure rest and replenishment


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3. Postcombat, Postdeployment: end of tourdebriefings to process memories, rituals such asawards and recognition,

Battlemind Training: Used throughout all phases

of deployment cycle for families and soldiers. Reduces stigma of seeking and participating in

mental health care

Has evolved into resiliency training and impart

rational emotive behavior therapy Sadly, budget priorities lay with equipment and

not with needs of veterans.


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DEPARTMENT OF VETERANS AFFAIRS

Mission: promote the health, welfare and dignity of allveterans. Entitlements and benefits represent thetangible appreciation of a grateful nation.

VHA: Veterans Health Administration is largest health

care system in the nation Priorities: service-connected disabilities, prisoners of

war, Purple Heart recipients for wounds in combat,veterans with catastrophic disabilities unrelated to

service, low income veterans, and then 3 categories oflow level priority.


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Iraq and Afghanistan Veterans

Eligible to receive free VA health care for 5years from date of separation whether or notcombat related

Must enroll to receive VA health care

Promotes early recognition of those who meetformal criteria for diagnosis as well as thosewith subthreshold symptoms

Evidence-based treatments to prevent chronicsymptoms and lasting impairment from PTSD


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Depression

Second most prevalent illness, only 25% beingtreated in primary care environment requirereferral to a specialized mental health setting

As the number of veterans has increased, thenumber of clinic visits per veteran has decreased.

4% of OEF and OIF veterans receiving non-PTSDdiagnoses and less than 10% receiving PTSD

diagnoses attended 9 or more VA mental healthtreatment session in 15 weeks or less in first yearof diagnosis.

TWO POSITIVE TREANDS IN


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TWO POSITIVE TREANDS IN

POSTDEPLOYMENT

Suicide among veterans in VA care has

declined by 12% since 2001

Homeless veterans as declined

READJUSTMENT COUNSELING SERVICE


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READJUSTMENT COUNSELING SERVICE

(RCS) Vet Centers located in communities Not noticeably affiliated with VHA hospitals alleviate

stigma

Staffed with a team of social workers, psychologists,

psychiatric nurses and some paraprofessionals, morethan 1/3 are OEF and OIF veterans.

Outreach services

Each counselor trained in standardized, proventherapies, mostly cognitive-behavioral

Also, provide bereavement services to surviving familymembers.

Joshua Omvig Veterans Suicide


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Joshua Omvig Veterans Suicide

Prevention Act of 2007

Shot himself in front of his mother His parents testified before Senate Committee on

Veterans Affairs in 2007

Congress passed the Act into law on 11/6/2007.

Requires VA to develop suicide preventionprograms

Veterans affairs staff must receive mental healthtraining, VA medical centers have a suicidecounselors, all veterans receiving care at VAfacility will have a mental health screening, andhave an available VA suicide hotline


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SAND TRAY THERAPY

MAY REFER TO IT AS A PROJECT

NONVERBAL REINACTMENT

MIXED IN WITH SOME COGNITIVE WORK


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EMDR

EYE MOVEMENT DESENSITIZATION AND

REPROCESSING

USING NEURAL PATHWAYS TO INTEGRATE THE

EMOTIONAL AND COGNITIVE COMPONENTSOF TRAUMA


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COGNITIVE BEHAVIORAL THERAPY

Rebt: Albert Ellis

Focus on irrational, illogical, unrealistic beliefsabout events that happen to us or that we

participate in. Identify the irrational component and then

offer a more tolerable, rational thought.

Use of persuasion, psychoeducation, teaching Learn to tolerate our imperfections and that

the world isnt fair.


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Cognitive Therapy: Beck

Focus on cognitive distortions

Exaggeration

Personalization

Polarizations Arbitrary inferences

Minimizations

Selective abstractions Depresssion: sees self as negative, the world as

negative, the future as negative


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KANELS RESEARCH RESULTS

31% had seen a counselor and having someonejust listen was helpful.

Other helpful things:

-Expressing how helpless they felt -Being in a relationship

-being able to talk honestly and face the truth

-reassurance -allowing myself to explain what I am thinking

and going through


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NOT HELPFUL

-watching President talk about the troops

-reliving the experience

-group counseling and having to explain

themselves

-5% admitted taking psychiatric medication

like anti-depressants


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59% had not seen a counselor

26% said at least one of the following helped themovercome negative experiences:

-dealing with it,

-driving on

-family -just live life without much thought of it

-getting involved with a veterans group

-planning family life in a forward moving direction

-having a buddy or mate

-ignore negative feelings

-wife

-reading the Bible


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SPECIAL POPULATIONS

HOMELESS VETERANS

INCARCERATED VETERANS

WOMEN VETERANS

VETERANS IN HIGHER EDUCATION

FAMILIES OF VETERANS


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What is a homeless Veteran?

1. A person who served in the active military andwas not dishonorably discharged

2. Lack a fixed and adequate nighttime residenceor who has a nighttime residence that is

supervised publicly or privately operated shelterdesigned to provide temporary accommodations,or who lives in an institution that providestemporary residence for people intended to be

institutionalized, or who lives in a public orprivate place not designed for a regular sleepingaccommodation for human beings.


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Homeless Veterans

to 1/5 of all homeless persons is a veteran!!! 40% of all homeless men are veterans, veterans only

account for 34% of the general male population.

Women veterans account for 4% of the homeless

veteran population. Males tend to be older and more educated than

homeless nonveterans

More physical and mental health problems

Abuse of alcohol and drugs Women veterans are 2-4 times more likely than

nonveteran women to be homeless


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Homeless Veterans

National coalition for Homeless Veterans hasworked for the past 20 years to end

homelessness of veterans.

2009: President Obama added in the budget newhelp so no veteran ever sleeps on the streets

Plan includes: outreach, treatment, employment

and benefits, community partnerships,prevention and housing support services for low

income veterans.

14 programs and initiative offered by


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14 programs and initiative offered by

the VA in 2010

- National Call Center for Homeless Veteransfor at risk

-grant and Per Diem Program: financial

resources to community based agencies -Department of Housing and Urban

Development and VA Supported Housing:permanent housing and ongoing casemanagement and treatment, section 8vouchers


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Healthcare for Homeless Veterans: outreachto identify eligible homeless veterans

-Stand Downs:1-3 days of safety and security,

food, shelter, clothing health care

-Compensated Work Therapy: temporary

housing in group homes for working veterans,

VA contracts with private and public industryto jobs, job skills, sense of self esteem


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Community Homelessness Assessment, LocalEducation and Networking Groups (CHALENG):Assess needs, develop action plans

-Domiciliary Care provides residential treatmentto 5,000 homeless veterans with healthproblems.

-Supported Housing: ongoing case management

to help find permanent housing -Drop-in Centers: daytime place to wash clothes,

clean up and other activities


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VHA Special Outreach and Benefits Assistance:funding for counselor to work in VHA facilities inidentifying and applying for benefits

-Acquired Property Sales: makes all the

properties VA obtains through foreclosuresavailable for sale at a discount

-Excess Property for Homeless Veterans:distributes excess federal property

-Program Monitoring and Evaluation: provideinformation about the veterans served andtherapeutic value and cost effectiveness.


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Incarcerated Veterans

-Thousands of veterans are in prison.

Substance Abuse, mental illness are linked

-30% of OIF and OEF veterans report

symptoms of PTSD, TBI depression

-19% have been diagnosed with substance

abuse or dependence

Veterans do not quality for substance abuse

disability benefits unless they also have PTSD


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140,000 veterans incarcerated in state andfederal prisons in 2004.

-46% in federal prisons for drug law violations

-15% in state prisons for drug law violations,

5.6 simple possession


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WOMEN VETERANS

Tens of thousands have lived, worked and fought inIraq and Afghanistan

3 factors influence their role in military today:

1. ) Insufficient number of male volunteers, andthey have proven they can do the job in a variety

of roles

2. Muslim countries forbid males from touching

muslim women.

3. 2 wars at a time, equal opportunity war


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Demographics

Female veterans who are married are morelikely to be in dual-service marriages 61% vs.

8%

Earn on average $28,962 annually comparedto males who earn $36,285

h l


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Why women enlist

-educational opportunities

-Social mobility for disadvantaged minorities

-steady employment

-family influence

-presence of a military institution in the

community

-patriotism

-dignity, challenge, adventure, fidelity, benefits


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ISSUES FOR WOMEN VETERANS

1. Bias from men who dont believe they

should be in armed forces, especially combat.

2. waste elimination and feminine hygiene

3. often labeled bitch, slut, dyke, harassment

in addition to challenging living conditions.

4. Sexual harassment and Assault

S l d l


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Sexual Harassment and Assault

Military may allow for this practice with less thaneffective restraint

Need a zero tolerance policy.

20% of women and 1% of men reported military

sexual trauma Most cases not prosecuted.

29,000 women reported sexual assault while inmilitary(probably underreported)

Only 8% of sexual offenders are prosecutedcompared to 40% in civilian cases

M h i C b B


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Mothers in Combat Boots

30,000 single mothers have served in bothwars

Pregnancy not automatic discharge, but get

maternity leave

May lose custody because of deployment

But DOD is working to prevent them from

losing custody just because of deployment

W V H l h C


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Women Veterans Health Care

Medical centers were not prepared for privacywomen need for exams

Restrooms didnt provide for female hygiene

supplies

Lack of qualified counselors to treat sexual

trauma and PTSD

Need for female case managers

Need for child care to access services

C ll E i


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College Experience

Women veterans are seeking higher education ata greater rate than male counterparts

Largely unprepared to offer support services tothem

Historically under-represented and underserved Employed at a lower percentage rate than male

counterparts

Unemployment for female veterans of OIF andOEF is 13.5% compared to the 8.4% for non-veteran women

A d l k i h


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A model to work with women veterans

1. Transition: movement, passage or changefrom one position, state, stage, subject, conceptto another.

How is a woman veterans experience returning

to civilian life differ from that of a male? 2. Adjustment: Adaptation to a particular

condition, the act of bringing something intoconformity with external requirements

how might a woman veteran struggle whilemoving from military identity to a personalidentity and how does this differ from a male?


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Reintegration: Restoration to a condition ofintegration or unity, to make or be made into

a whole again, to reintegrate inner divisions.

What dos it mean to be whole?

GAYS IN THE MILITARY


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GAYS IN THE MILITARY

President Obama passed the repeal of Dont

ask, Dont tell in 2010

Most service members dont believe this

would have an adverse impact on troops beingable to carry out missions

Pentagon is initiating a program to prepare all

services for integration of gay and lesbianservice members into open military service

V t i hi h d ti


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Veterans in higher education

Vet Success on Campus program launched in2011 by the VA.

Partners with colleges and universities

student services to create collaborativeservices to make campus more friendly and

welcoming to veteran students

P ti S i l di d t


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Preventing Social disadvantage

Must learn from problems experienced byVietnam Veterans

Focus was on increased military pension and

disability benefits, thereby increasingdependence and decreasing mainstreaminginto society post service.

This led to low incomes, depression, social

alienation, failure to secure employment,homelessness, and untreated PTSD.

C ll th K


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College as the Key

May help returning Veterans to join mainstreamsociety.

Lessen feelings of social alienation

Must create programs that help veteranscomplete education, become employed andtransition from military to civilian life.

College administrators, counselors and faculty all

serve a vital role., must be trained Create a course on PTSD and military culture

CSUF V t C t


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CSUF Veterans Center

Includes:

Veterans Orientation and Welcome

Support Counseling and Guidance

Resources and Referrals

Workshops

Veterans Helping Veterans (Peer mentoring) Veterans Career Connection/Internship

Continuing problems for college


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g p g

enrolled Veterans

Less than 30% have used services Why?

-still live with military mentality that seeking

help or asking for support is a sign ofweakness

-they are independent, they are trained toovercome challenges and obstacles, problemsmotivate them to work harder rather thanseek help


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-Many are already married, they work andhave no time to do student activities

-war veterans in general feel isolated and not

connected with other students -some of the veterans have admitted that

their experience with the military has beenterrible and do not want to associate

themselves with any military relatedorganizations

New ideas to strengthen program


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New ideas to strengthen program

-outreach to incoming veterans -create credit earning voluntary opportunities

-begin a Veterans Affairs Work Study program,

where veterans can reach out and help fellowveterans while getting paid

-continually seek student veteranssuggestions and feedback on how to improveservices for them.

-create a welcoming web page for veterans

Educational Characteristics


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Educational Characteristics

G.I. Bill covers most of the expenses, Yellowribbon program supplements

Often more mature than fresh out of high schoolstudents

Bring practiced discipline to their studies Goal oriented attitude

Accustomed to a chain of command and are clearabout taking orders from leaders

Have leadership skills

Have shouldered major responsibilities

Strengths


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Strengths

Dependable

Responsible

Dedicated

Respectful

Punctual

Know pressure and expect to be challenged Excel beyond expectations

Why do only 40% go to college?


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Why do only 40% go to college?

Readjusting is challenging New situation: from hyperalert to safe

May lead to interpersonal difficulties with others

in an academic setting Limited patience for anyone wasting their time

May have a hard time relating to non militarystudents

May need to use assistance of disability servicesdue to TBI, PTSD, etc.

FAMILIES ( Chapters 7 and 8)


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FAMILIES ( Chapters 7 and 8)

As of 2009, 3,093,709 family members 2,258,757 military members

Most children under 5 years old, 1.2 million childrenlive in military family, 700,000 have had at least 1

parent deployed 14% of female service members are single parents

54% of all active-duty soldiers are married

Common demands: separation, intense training, war,long and unpredictable work hours, risk of death orinjury, frequent locations, foreign residence

The whole family serves


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The whole family serves

Military culture says that when one person joins,the whole family services.

Positive family functioning boosts servicemembers morale and retention.

Unique issues for Reserve service members andfamilies: fewer available formal social supportsystems, closer ties with communities in whichthey live, did not attend predeployment briefings,

lack knowledge about benefits, lack knowledge ofhow to transition from military health care tocivilian systems

Positive aspects for families


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Positive aspects for families

Half of army spouses are satisfied with life inthe military, officers spouses most satisfied

Children may become more resilient due to

having to move and connect with others on aregular basis

Children tend to perform better in academic

pursuits

STAGES OF DEPLOYMENT


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STAGES OF DEPLOYMENT

1. PREDEPLOYMENT

2. DEPLOYMENT

3. POSTDEPLOYMENT

PREDEPLOYMENT


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PREDEPLOYMENT

Military member is preparing to leave andgetting into military mentality.

May create a sense of estrangement from

family. Stress is high for all, no fixed departure dates

or return dates.

Very stressful for younger families, familieswith pregnant spouse, and those with specialneeds.


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Higher rates of domestic violence

Increased child abuse

Wives report greater parenting stress, numbness,

shock, irritation, tension, disbelief, emotionaldistance, anger, loneliness, dysphoria,

anticipatory fear or grief and somatic complaints.

Smaller children show an increase in depressionanxiety, cosleeping with parents and academic

and discipline problems.`


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Couple issues include emotional distance,arguments and a rush to get married.

Teens may get depressed depending on the level

of concurrent family stressors such as financesand maternal psychopathology. May suffer from

difficulty expressing emotions, behavior

problems, anticipating future events, taking on

others perspectives and feelings and being

bullied by other teens who oppose the war.

DEPLOYMENT


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DEPLOYMENT

Service member off to combat or to aninstallation away from family.

Lengthy deployments are most challenging,families must take on greater responsibilities.

Military children receiving outpatient mentalhealth care doubled and inpatient servicesincreased by 50%. Deterioration in physical

health, academic performance, behaviorproblems, depression and anxiety andpsychosocial difficulties have all been observed.

POSTDEPLOYMENT


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POSTDEPLOYMENT

When the service member returns home Reunification requires that the family

accommodates to combat related injuries.

May lead to secondary traumatic stress Role adjustments must be made, often the

mother took on the father role of being moreplayful and fun.

Must get reacquainted with parent and oftenleads to change in after school programs.

POST MILITARY ADJUSTMENT


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POST MILITARY ADJUSTMENT

A period of ambivalent responding Anxiety and anger

Fear of rejection in spouses and returning

soldiers Soldiers often feel excluded and unneeded

Spouses experience depression, irritation,

anger, distress, emotional detachment,impaired communication and intimacy and aneed for role readjustment

COMMUNITY PROGRAMS AND


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ONGOING NEEDS

VA Caregiver support: family caregivers ofpost 9/11 veterans with serious injuries.

Caregiving takes a toll on caregiver.

Includes a monthly stipend, travel expenses,access to health insurance, mental health

services caregiver training and respite care

Tragedy Assistance Program for


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Survivors

Peer based emotional support for survivors whohave lost someone serving in the military

Grief and trauma resources and information toeducate family and friends as well as benefitsinformation

Casework assistance to work with families to helpthrough their grieving

24/7 crisis intervention, to help prevent suicide

Grief camps for children

COUNTY OF ORANGE VETERANS SERVICE


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OFFICE: OC COMMUNITY SERVICES

Mission:

Pursue the rights of veterans,

dependents, survivors to receiveDepartment of Veterans Affairs

benefits

ORANGE COUNTY VET CENTERS


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ORANGE COUNTY VET CENTERS

Service to Veterans by Veterans Readjustment counseling services

Counseling, outreach, referral services

Veterans from all wars are eligible

Individual, couple, group, family counseling

Crisis intervention

Women veteran issues

Alcohol referrals

Employment assistance

Other programs


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Other programs

Park and recreation programs have outreachefforts which include identifying specific needsand working to address them. Help families copeby encouraging them to interact through

recreational pursuits, memory making activitieshelpful before deployments, kids nite out givescouples time alone Postdeployment: honeymoonperiod followed by reintegration and physical

activities and social interaction among familieshelps with communication


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Military Child Education Coalition: Strengthsbased focus offers training for school

counselors and teachers

FOCUS: families overcoming stress is a familycentered evidence informed resilience training

program at UCLA and Harvard which deals

with pre-deployment and re-deploymentissues

NEEDED RESEARCH


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NEEDED RESEARCH

Need research on the mental health of military families andthe psychological and social effects of Global War on Terror

Need research on what really works to help: evidencebased practices

Need research on the impact maternal mental health hason the childrens functioning

Need research on resilience factors such as managing smallchallenges to prepare for bigger stressors.

Research on the siblings of service members

NEEDED INTERVENTIONS


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NEEDED INTERVENTIONS

Enhanced support services Identify at-risk children and families

Provide education and pre-deploymentpreparedness

Identify families with preexisting conditions Develop programs to educate families about

injuries

Activate mental health specialists with specifictraining and expertise in treating children andfamilies


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Preparedness interventions such as stressmanagement, inoculation, use of optimism

and positive psychology models and primary

prevention Focus on mothers having more positive

outlook and attitude and maintaining

normalcy of schedule Prepare school personnel better


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Create programs that address strengths as well asproblems

Expand existing programs

Increase assistance, support and engagement of the

broader community Student to student interaction programs to help

students relocate

Focus on re-deployment and post deployment phases

Need to evaluate current programs for effectiveness


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Parks and recreation programs increasing role inproviding practical support such astransportation, lowered fees and high levels ofinformal social support

Children need interventions that focus onmaintaining normal routines, discussing feelings

Parents need their own therapy which leads to

positive outcomes for children Discuss family roles and changes when a parent

returns

CHANGES IN SOCIAL WORK AND

COUNSELOR EDUCATION


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COUNSELOR EDUCATION

Curriculum should build in how to work withveterans

Social policy regarding veterans

Raise awareness of the many needs of veterans

and families Assessment protocols within agencies

Advocate for legislative initiatives

Biopsychosocial issues

Facilitate the entry of veterans in social workeducation programs

Documents

Serving Veterans and their families