CONTEMPORARY ISSUES IN THE HUMAN SERVICES

SERVING VETERANS AND THEIR FAMILIES

OVERVIEW: CHAPTER 1(pages 1-6)

STATISTICS THE COMBAT ZONES: IRAQ AFGHANISTAN

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

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 THE MILITARY 70% HAVE 1 OR MORE CHILDREN

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 AND 5730 HAVE BEEN WOUNDED IN AFGHANISTAN AS OF MAY 7, 2012, 4,387 SOLDIERS HAVE BEEN KILLED, AND 31,809 HAVE BEEN WOUNDED IN IRAQ 29% OF FEMALE VETERANS REPORT HAVING BEEN RAPED!

GLOBAL WAR ON TERROR (GWT)

IRAQ OIF: OPERATION IRAQI FREEDOM SADAAM HUSSEIN AND WEAPONS OF MASS DESTRUCTION AFGHANISTAN OEF: OPERATION ENDURING FREEDOM AL- QAEDA, THE TALIBAN, OSAMA BIN LADEN, ATTACKS ON 9/11

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

 New President was elected Military activities aimed to stabilize new order Use of active and reserve forces

Iraq
Largest wartime deployment for U.S. women! Baghdad fell in less than a month Sunni and Shite engaged in civil war to gain political power Guerilla type war Army and Marines bear the brunt Unpopular in comparison to Afghanistan

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

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

 Coast Guard falls under secretary of homeland security The combined all-volunteer armed services, national Guard, and reserve referred to as the total force.

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

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

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

Military Subculture
1. Strict discipline to maintain organizational structure 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 on group cohesion and espirit de corps Often use military speak (see glossary)

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)

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

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

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 air and space Controls strategic nuclear missiles 65,000 commissioned officers and 260,000enlisted, 20% are women Coast Guard: prevention and deterrence of terrorist attacks, free flow of commerce, 50,000 and 10,000 reservists

COMBAT STRESS INJURIES: Chapter 3 and 5 and pages 7-15

POST TRAUMATIC STRESS DISORDER SUBSTANCE ABUSE

MAJOR DEPRESSION
SUICIDE TRAUMATIC BRAIN INJURY

STAGES AND EFFECTS OF KILLING

1. Before the kill: CONCERN Will I do my job, will I survive, am I a coward 2. The Killing: Not much conscious thought. If unable to kill, may rationalize or be traumatized by failure 3. Exhilaration: intense satisfaction, combat high, can lead to combat addiction 4. Remorse 5. Rationalization and acceptance: search is lifelong and can lead to PTSD, depression and selfdestructive behaviors

SUBSTANCE ABUSE
Mitigate intense emotions that come with combat Each war has an underlying drug culture Currently, alcohol is banned from war zones, but they get and use it anyways High rates of re-deployment have lead to increased risk of heavy drinking Current wars have produced new wave of addiction: prescription drugs and opiates to keep them in the fight rather than refer to treatment for treatment

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

POST TRAUMATIC STRESS DISORDER

INCUBATION FOR THIS INJURY: 50% of army and marine corps ground combat units report being shot at, and seeing dead or seriously wounded Americans of injured civilian noncombatants. 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. a disorder

DSM Definition of PTSD

1. Anxiety 2. Reexperiencing of a traumatic event via thoughts, dreams, reliving the event and intense psychological and physiological distress when exposed to cues that resemble the event 3. Avoidance of thoughts of the trauma, inability to recall the trauma 4. Detachment of others, numbness alternating with hypervigilence and irritability and anger Delayed onset if symptoms present at least 6 months after the stressor.

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 interpersonal relationship with family and friends who can develop secondary PTSD

SEXUAL ASSAULT EPIDEMIC

Can lead to PTSD and depression 41% of female veterans say they were victims of sexual 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 and court martialed.

Military Sexual Trauma

Term used to describe any sexual harassment or 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?

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

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

MAJOR DEPRESSIVE EPISODE: DSM

2 week period nearly every day with at least 5 of the 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

Kanels research results of CSUF college enrolled veterans in 2007

31% reported having recurrent recollections of the event 41% reported feeling detached and estranged from others 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)

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

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 and depression 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 30,000150,000

SUICIDE
Veterans are committing suicide at a rate that far exceeds nonveteran population. 32,000 suicides a year, 650,000 attempts in general population. Difficult to get an exact amount because some appear to be accidents. In June 2010, 1 per day killed themselves!!! In 2007, 108 confirmed suicides in the Army, 166 in Iraq and Afghanistan. firearms used most often, often preceded by a failed intimate relationship 47% are older than 30, half are sergeants

CAUSES?
Stigma to seeking help for needed problems like PTSD 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

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.

Other causes of suicide

Rules of engagement: frustrating to have to wait 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 overwhlemed or breaking point, simply cant take anymore stress and continue to function.

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.

Acquired Capability to Kill

Failing to prevent death or injury and killing associated 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 suicide attempts and ideation Combat may desensitize soldiers, decreases the power of ear and pain regarding killing others and self

Post Deployment Suicide

STIGMA Military health system is overloaded and officers in charge at highest levels often continue to say that there is no direct correlation between war and suicide. Often told nothing wrong with you, coward, and were discharged. Female veterans 3 times more likely than civilian to commit suicide.

TRAUMATIC BRAIN INJURY

The use of Improvised explosive devices (IEDS) Persons exposed to IED blasts may develop mild, moderate or severe brain injury which results in temporary or permanent cognitive impairment. Decreased levels of consciousness, amnesia, skull fracture and intracranial lesions and can lead to death IED have caused 75% of all casualties

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!!!!

INTERVENTIONS: Chapter 4, pages 7677

Governmental Responses: Created program to deliver health care directly to members and families 1. Military Treatment Facilities (MTFs)-employ uniformed medical personnel, supplemented as needed by contracted civilian health professionals 2. TRICARE: MTFs and civilian health care market (9 million patients)

Chaplains
Often first step in obtaining access to mental health care Confidential: can remove stigma Refer out to unit-embedded mental health providers However, mental health providers in an operational combat unit are required to release information if unit commander determines he needs it

Community Service Programs

Counseling is confidential Found at local military installations Not recorded in service members medical record

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

Military OneSource
Information and consultation service for all service members of active and reserve and their families. 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 Vet Center or TRICARE professional Educated at masters level and licensed

Challenges in meeting mental health demands

1. Outpatient care operates during standards workday hours, and service members must be absent from training to attend. Reluctant to ask for time away due to stigma 2. Not enough uniformed mental health professionals, not enough funding to hire more, need for more nonprofits 3. But military providers understand military culture and social context of services, can better determine fitness for duty, more trust if in uniform

PREVENTION OF COMBAT STRESS

Prevention is key to reduce need for intervention later. Leaders are responsible to take action to strengthen service members tolerance to combat stress and manage it in his unit. It is described as the mental, emotional or physical tension strain or distress resulting from exposure to combat and combat related conditions.

COMBAT STRESS CONTROL PROGRAMS

1. Predeployment: rigorous training for units next combat encounter. Familiarized with stressors they can expect 2. Deployment and combat: regular meetings and briefings, reduce uncertainty, provide feedback to unit members so they know that they performed well as a group, accomplished missions, ensured families and loved one are being taken care of while away Combat stress control teams prevent and manage those who show signs of unhealthy combat stress reactions, soldier to soldier without fear of stigmatization, ensure rest and replenishment

 3. Postcombat, Postdeployment: end of tour debriefings to process memories, rituals such as awards 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.

DEPARTMENT OF VETERANS AFFAIRS

Mission: promote the health, welfare and dignity of all veterans. Entitlements and benefits represent the tangible 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 of low level priority.

Iraq and Afghanistan Veterans

Eligible to receive free VA health care for 5 years from date of separation whether or not combat related Must enroll to receive VA health care Promotes early recognition of those who meet formal criteria for diagnosis as well as those with subthreshold symptoms Evidence-based treatments to prevent chronic symptoms and lasting impairment from PTSD

Depression
Second most prevalent illness, only 25% being treated in primary care environment require referral to a specialized mental health setting As the number of veterans has increased, the number of clinic visits per veteran has decreased. 4% of OEF and OIF veterans receiving non-PTSD diagnoses and less than 10% receiving PTSD diagnoses attended 9 or more VA mental health treatment session in 15 weeks or less in first year of diagnosis.

TWO POSITIVE TREANDS IN POSTDEPLOYMENT

Suicide among veterans in VA care has declined by 12% since 2001

Homeless veterans as declined

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, more than 1/3 are OEF and OIF veterans. Outreach services Each counselor trained in standardized, proven therapies, mostly cognitive-behavioral Also, provide bereavement services to surviving family members.

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 prevention programs Veterans affairs staff must receive mental health training, VA medical centers have a suicide counselors, all veterans receiving care at VA facility will have a mental health screening, and have an available VA suicide hotline

SAND TRAY THERAPY

MAY REFER TO IT AS A PROJECT NONVERBAL REINACTMENT MIXED IN WITH SOME COGNITIVE WORK

EMDR
EYE MOVEMENT DESENSITIZATION AND REPROCESSING USING NEURAL PATHWAYS TO INTEGRATE THE EMOTIONAL AND COGNITIVE COMPONENTS OF TRAUMA

COGNITIVE BEHAVIORAL THERAPY

Rebt: Albert Ellis Focus on irrational, illogical, unrealistic beliefs about 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.

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

KANELS RESEARCH RESULTS

31% had seen a counselor and having someone just 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

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

59% had not seen a counselor

26% said at least one of the following helped them overcome 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

SPECIAL POPULATIONS
HOMELESS VETERANS INCARCERATED VETERANS WOMEN VETERANS VETERANS IN HIGHER EDUCATION FAMILIES OF VETERANS

What is a homeless Veteran?

1. A person who served in the active military and was not dishonorably discharged 2. Lack a fixed and adequate nighttime residence or who has a nighttime residence that is supervised publicly or privately operated shelter designed to provide temporary accommodations, or who lives in an institution that provides temporary residence for people intended to be institutionalized, or who lives in a public or private place not designed for a regular sleeping accommodation for human beings.

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

Homeless Veterans
National coalition for Homeless Veterans has worked for the past 20 years to end homelessness of veterans. 2009: President Obama added in the budget new help 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 the VA in 2010

- National Call Center for Homeless Veterans for 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 case management and treatment, section 8 vouchers

 Healthcare for Homeless Veterans: outreach to 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 industry to jobs, job skills, sense of self esteem

 Community Homelessness Assessment, Local Education and Networking Groups (CHALENG): Assess needs, develop action plans -Domiciliary Care provides residential treatment to 5,000 homeless veterans with health problems. -Supported Housing: ongoing case management to help find permanent housing -Drop-in Centers: daytime place to wash clothes, clean up and other activities

 VHA Special Outreach and Benefits Assistance: funding for counselor to work in VHA facilities in identifying and applying for benefits -Acquired Property Sales: makes all the properties VA obtains through foreclosures available for sale at a discount -Excess Property for Homeless Veterans: distributes excess federal property -Program Monitoring and Evaluation: provide information about the veterans served and therapeutic value and cost effectiveness.

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

 140,000 veterans incarcerated in state and federal prisons in 2004. -46% in federal prisons for drug law violations -15% in state prisons for drug law violations, 5.6 simple possession

WOMEN VETERANS
Tens of thousands have lived, worked and fought in Iraq and Afghanistan 3 factors influence their role in military today: 1. ) Insufficient number of male volunteers, and they 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

Demographics
Female veterans who are married are more likely to be in dual-service marriages 61% vs. 8% Earn on average $28,962 annually compared to males who earn $36,285

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

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

Sexual Harassment and Assault

Military may allow for this practice with less than effective 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 in military(probably underreported) Only 8% of sexual offenders are prosecuted compared to 40% in civilian cases

Mothers in Combat Boots

30,000 single mothers have served in both wars 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

Women Veterans Health Care

Medical centers were not prepared for privacy women 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

College Experience
Women veterans are seeking higher education at a greater rate than male counterparts Largely unprepared to offer support services to them Historically under-represented and underserved Employed at a lower percentage rate than male counterparts Unemployment for female veterans of OIF and OEF is 13.5% compared to the 8.4% for nonveteran women

A model to work with women veterans

1. Transition: movement, passage or change from one position, state, stage, subject, concept to 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 into conformity with external requirements how might a woman veteran struggle while moving from military identity to a personal identity and how does this differ from a male?

 Reintegration: Restoration to a condition of integration 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

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 being able to carry out missions Pentagon is initiating a program to prepare all services for integration of gay and lesbian service members into open military service

Veterans in higher education

Vet Success on Campus program launched in 2011 by the VA. Partners with colleges and universities student services to create collaborative services to make campus more friendly and welcoming to veteran students

Preventing Social disadvantage

Must learn from problems experienced by Vietnam Veterans Focus was on increased military pension and disability benefits, thereby increasing dependence and decreasing mainstreaming into society post service. This led to low incomes, depression, social alienation, failure to secure employment, homelessness, and untreated PTSD.

College as the Key

May help returning Veterans to join mainstream society. Lessen feelings of social alienation Must create programs that help veterans complete education, become employed and transition 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 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 enrolled Veterans

Less than 30% have used services Why? -still live with military mentality that seeking help or asking for support is a sign of weakness -they are independent, they are trained to overcome challenges and obstacles, problems motivate them to work harder rather than seek help

 -Many are already married, they work and have 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 been terrible and do not want to associate themselves with any military related organizations

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 fellow veterans while getting paid -continually seek student veterans suggestions and feedback on how to improve services for them. -create a welcoming web page for veterans

Educational Characteristics
G.I. Bill covers most of the expenses, Yellow ribbon program supplements Often more mature than fresh out of high school students Bring practiced discipline to their studies Goal oriented attitude Accustomed to a chain of command and are clear about taking orders from leaders Have leadership skills Have shouldered major responsibilities

Strengths
Dependable Responsible Dedicated Respectful Punctual Know pressure and expect to be challenged Excel beyond expectations

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 military students May need to use assistance of disability services due to TBI, PTSD, etc.

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 children live 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 or injury, frequent locations, foreign residence

The whole family serves

Military culture says that when one person joins, the whole family services. Positive family functioning boosts service members morale and retention. Unique issues for Reserve service members and families: fewer available formal social support systems, closer ties with communities in which they live, did not attend predeployment briefings, lack knowledge about benefits, lack knowledge of how to transition from military health care to civilian systems

Positive aspects for families

Half of army spouses are satisfied with life in the military, officers spouses most satisfied Children may become more resilient due to having to move and connect with others on a regular basis Children tend to perform better in academic pursuits

STAGES OF DEPLOYMENT
1. PREDEPLOYMENT 2. DEPLOYMENT

3. POSTDEPLOYMENT

PREDEPLOYMENT
Military member is preparing to leave and getting 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, families with pregnant spouse, and those with special needs.

 Higher rates of domestic violence Increased child abuse Wives report greater parenting stress, numbness, shock, irritation, tension, disbelief, emotional distance, anger, loneliness, dysphoria, anticipatory fear or grief and somatic complaints. Smaller children show an increase in depression anxiety, cosleeping with parents and academic and discipline problems.`

 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 finances and 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
Service member off to combat or to an installation away from family. Lengthy deployments are most challenging, families must take on greater responsibilities. Military children receiving outpatient mental health care doubled and inpatient services increased by 50%. Deterioration in physical health, academic performance, behavior problems, depression and anxiety and psychosocial difficulties have all been observed.

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 more playful and fun. Must get reacquainted with parent and often leads to change in after school programs.

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 a need for role readjustment

COMMUNITY PROGRAMS AND ONGOING NEEDS

VA Caregiver support: family caregivers of post 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 Survivors

Peer based emotional support for survivors who have lost someone serving in the military Grief and trauma resources and information to educate family and friends as well as benefits information Casework assistance to work with families to help through their grieving 24/7 crisis intervention, to help prevent suicide Grief camps for children

COUNTY OF ORANGE VETERANS SERVICE OFFICE: OC COMMUNITY SERVICES

Mission: Pursue the rights of veterans, dependents, survivors to receive Department of Veterans Affairs benefits

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
Park and recreation programs have outreach efforts which include identifying specific needs and working to address them. Help families cope by encouraging them to interact through recreational pursuits, memory making activities helpful before deployments, kids nite out gives couples time alone Postdeployment: honeymoon period followed by reintegration and physical activities and social interaction among families helps with communication

 Military Child Education Coalition: Strengths based focus offers training for school counselors and teachers FOCUS: families overcoming stress is a family centered evidence informed resilience training program at UCLA and Harvard which deals with pre-deployment and re-deployment issues

NEEDED RESEARCH
Need research on the mental health of military families and the psychological and social effects of Global War on Terror Need research on what really works to help: evidence based practices Need research on the impact maternal mental health has on the childrens functioning

Need research on resilience factors such as managing small challenges to prepare for bigger stressors. Research on the siblings of service members

NEEDED INTERVENTIONS
Enhanced support services Identify at-risk children and families Provide education and pre-deployment preparedness Identify families with preexisting conditions Develop programs to educate families about injuries Activate mental health specialists with specific training and expertise in treating children and families

 Preparedness interventions such as stress management, 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

 Create programs that address strengths as well as problems 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

 Parks and recreation programs increasing role in providing practical support such as transportation, lowered fees and high levels of informal social support Children need interventions that focus on maintaining 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

Curriculum should build in how to work with veterans 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 work education programs