Serving Veterans and their families
Transcript of 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