Transcript www.hawaiiguardohana.org

April 14, 2012
Waikiki Marriott Hotel
Military OneSource
Health Coaching Brief
General Eligibility
 Active, Guard, and Reserve service members
 Immediate family members
Private and Confidential
Privacy protected
• Personal information is not:
― Provided to the military or chain of command
― Shared with family or friends
― Released to other agencies
Duty to Warn
• Family maltreatment (spouse, child, or elder abuse)
• Harm to self or others
• Illegal activity
Range of Support
Community Resources & Referrals
Financial
Deployment
Health Coaching
Life Transitions
Relationships
Moving
Children & Youth
Libraries
Special Needs
Career & Education
Counseling & Crisis
Health Coaching
What Coaching is and does?
•
•
•
•
Partnership with members
Thought-provoking and creative process
Facilitates lifestyle improvement
Inspires maximum personal and professional
potential
Coaching Partnership
 The coach and the member create an alliance
and unique partnership.
 Together, they create a tailored approach that
helps the member achieve lifestyle behavior
changes.
• Participant driven, directed, and paced
• Interactive
• Supportive
• Focus on self-reliance, empowerment, and confidence
Health Coaching Is NOT…
 Counseling
 Judgmental
 Confrontational
 Argumentative
 An advice hotline
Who Are the Health Coaches?
 Interdisciplinary team of health professionals
 Most have a master’s degree in a healthrelated field, and carry additional health and
wellness certifications
 Average 12 years experience
 Required to have clinical and behavior change
expertise
What Happens During Health
Coaching Sessions?
 Assess and explore
 Establish a vision and focus area
 MAP goals
Measurable, Attainable/Achievable, Passionate
 Assess progress
 Discuss barriers, triggers, and strategies
 Evaluate effectiveness of behavior-change
strategies (ongoing)
Why Do Participants Work with
Coaches?
To gain:
• Control - Coaching prompts personal responsibility
• Energy - Coaching sparks motivation
• A positive attitude - Coaches can help explore physical and
emotional health
• Support - Coaching helps navigate change
• Self-confidence - Coaching can increase confidence in one’s
ability to change
• Resilience - Coaches can teach strategies for bouncing back
What Is Included?
 Health risk assessment
 Online health coaching programs
 Individual coaching sessions
• Telephone-based
• Online
Health Risk Assessment
 Global evaluation of one’s health status
 Personalized health report and direction
 Linkage to a health coach available
 Secure, confidential and HIPAA compliant
Online Coaching Programs
• LivingEasy™, a
resiliency and stress
management tool
• LivingLean™, a
workshop to control
unhealthy eating habits
• LivingFit™, where
members learn to make
exercise a habit
• LivingFree™, a course
proven to help members
stop smoking
Online-only Coaching
Works best for individuals who:
 Have a high level of confidence and a
support network in place
 Are looking for additional health resources
 Prefer virtual guidance and support
 Have minimal health risks
How Online Coaching Works
Participants:
 Have Web access to health and wellness
resources
 Guide their own experience with the online
materials
 Can contact their coach through a scheduled
chat
Coaching Resources
 Educational articles, including recommended
reading based on member’s goals
 Links to health and wellness resources for
more information about relevant topics
 Private, scheduled chat with dedicated coach
 Access to online coaching programs
Contact Your Coach
Accessing the Program
Health Risk Assessment:
Begin Here
Access
Toll-Free telephone:
1-800-342-9647
www.MilitaryOneSource.mil
Email your questions to a
consultant
Interaction with trained
outreach professionals
You should expect:
• 24/7/365 worldwide access
• Master’s-level consultants to
answer your questions
• Objective, experienced, caring
people
• Up-to-date and useful information
• No cost
• A commitment to quality
Military OneSource
Questions
www.militaryonesource.mil
1-800-342-9647
TRICARE
®
Your Military Health Plan
Reintegration Brief
Hawaii National Guard
April 14, 2012
What Is TRICARE?
TRICARE Stateside Regions (50 United States & Washington, DC)
TRICARE is available worldwide and managed regionally
Health Net
Federal
Services, LLC
TriWest
Healthcare
Alliance Corp.
Humana
Military
Healthcare
Services, Inc.
25
Registering on www.triwest.com
26
TRICARE Eligibility
Updating DEERS
• Keep your contact information up to date:
– Online: www.dmdc.osd.mil/appj/address/
– By Phone: 1-800-538-9552
– By Fax: 1-831-655-8317
– Visit an ID card-issuing facility: www.dmdc.osd.mil/rsl/owa/home
• More information: www.tricare.mil/DEERS
• Remember to register/update DEERS whenever there is a change
in the family (marriage, birth, adoption, divorce, death, etc.) or when
you move
27
Coverage Life Cycle
Early Eligibility
Service Member – Direct Care
Family Members – Prime/Prime Remote
Standard/Extra
TRICARE
Reserve Select
Active Duty -
Prime/Prime Remote
Family – Prime/Prime Remote
Standard/Extra
Transitional Assistance Management Program (if eligible)
Continued Health Care
Benefit Program
28
Medical Coverage
Transitional Assistance Management Program (TAMP)
• Guard/Reserve active duty served more
than 30 consecutive days in support of a
contingency operation
• 180 days of transitional health care
benefits
• Begins the day after you separate from
active duty
• All beneficiaries covered as active duty
family members; including the service
member
• Reenrollment necessary for TRICARE
Prime (where locally available)
Photo courtesy of Flickr user Herald Post
Note: TAMP does not cover Line of
Duty (LOD) care.
29
Medical Coverage
TAMP: Program Options
• TRICARE Standard: Available
worldwide
• TRICARE Extra: Available in the U.S.
• TRICARE Prime: Available in
Prime Service Areas (PSAs)
• US Family Health Plan (USFHP):
Available in six designated areas in the
United States
• Overseas information:
www.tricare.mil/overseas
30
Medical Coverage
TRICARE Standard and TRICARE Extra: Getting Care
• No referrals necessary
– Certain services require prior authorization
– In the event of an emergency, call 911 or go to the nearest
hospital
• Locate a MTF for space-available care
– MTF locator: www.tricare.mil/mtf
• For TRICARE Extra, locate a TRICARE Network provider
– Contact the TRICARE regional contractor, check their website,
visit a TRICARE Service Center (TSC)
31
Medical Coverage
TRICARE Standard and Extra Costs
TRICARE Option
TRICARE Standard
TRICARE Extra
Deductible**
Sponsor rank E1-E4:
Same
Amount due each fiscal
year before cost-sharing
begins.
Outpatient Cost-share
Inpatient Costs
Inpatient Behavioral
Health Care
Catastrophic Cap
$50/single or $100/family
Sponsor rank E5 & above:
$150/single or $300/family
20%*
$16.85/day ($25 minimum)
$20/day ($25 minimum)
15%
Same
Same
$1,000 per family per fiscal year
The federal fiscal year is Oct. 1- Sept. 30.
*Non-network providers may charge up to 15% above the TRICARE allowable cha
**Deductible is waived if activated was in support of a contingency operation.
Get extra cost-savings with
TRICARE Extra!
32
Medical Coverage
TRICARE Prime: Getting Care
• Affordable and comprehensive
health care coverage
• Primary care manager (PCM)
delivers most routine care
33
Guard & Reserve
Resource Center
www.triwest.com/ngr
34
Medical Coverage
TRICARE Reserve Select (TRS): Step 1 – Qualify
• Selected Reserve Member may qualify if:
– Not eligible for, or enrolled in, Federal Employees Health Benefits
(FEHB) program
– For more information, visit www.tricare.mil/trs
• Log onto the “Reserve Component Purchased TRICARE Application”
1. Follow the instructions to qualify
2. If qualified, print-out and sign the completed DD Form 2896-1,
Reserve Component Health Coverage Request form
If you have any questions regarding your TRICARE Reserve Select eligibility, please
contact your Reserve Representative at http://ra.defense.gov
35
Medical Coverage
TRICARE Reserve Select: Step 2 – Purchase
• Mail
1. Signed and completed request form (DD Form 2896-1)
2. To TRICARE contractor address on form
3. Make initial premium payment as indicated on form
Note: For continuous TRICARE
coverage, purchase TRS up to 60
days before TAMP ends, but no
later than 30 days after end
Photo courtesy of the National Guard
36
Medical Coverage
TRICARE Reserve Select: Getting Care
• No referrals necessary
– Certain services require prior authorization
– In the event of an emergency, call 911 or go to the nearest
hospital
• Locate a MTF for space-available care
– MTF locator: www.tricare.mil/mtf
• For TRICARE Extra, locate a TRICARE network provider
– Contact the TRICARE regional contractor, check their website,
visit a TRICARE Service Center (TSC)
37
Medical Coverage
TRICARE Reserve Select Costs
Monthly Premiums
TRS Member-only: $54.35
TRS Member and family:
(per fiscal year)
$192.89
Rank E-4 & below:
$50/individual or $100/family
Cost-Shares
Rank E-5 & above:
$150/individual or $300/family
Network Provider: 15%
(after annual
deductible is met)
Catastrophic Cap
Non-network Provider: 20%
$1000 per enrollment
(per fiscal year)
38
BR414001BET0405W
Annual Deductibles
Other Important Information
TRICARE Pharmacy Program
Pharmacy Option
MTF Pharmacy
Formulary
Non-Formulary
Generic
Brand Name
$0
$0
N/A
$0
$12
$25
$5
$12
$25
(up to a 90-day supply)
TRICARE Pharmacy
Home Delivery
(up to a 90-day supply)
Retail Network
Pharmacy
(up to a 30-day supply)
Non-Network Retail
Pharmacy
(up to a 30-day supply)
TRICARE Prime: 50% costshare after point-of-service
deductible is met
TRICARE Prime: 50% costshare after point-of-service
deductible is met
Other Programs: $9 or 20%
of total cost (whichever is
greater) after the annual
deductible is met
Other Programs: $22 or 20%
of total cost (whichever is
greater) after the annual
deductible is met
Express Scripts, Inc. website: www.express-scripts.com/TRICARE
39
Dental Options: National Guard or Reserve Family
Members
• TRICARE Dental Program (United Concordia)
• Premiums revert back to full premium rates
– From active duty family member rates to National Guard
and Reserve family member rates
• Automatically disenrolled if they enrolled within 30 days of
your activation for specific contingency operations
• If not previously enrolled, may enroll now
Contact United Concordia for information:
www.TRICAREdentalprogram.com or
1-800-866-8499
40
For Information and Assistance
Stateside Regional Contractors
Overseas Regional Contractor
TRICARE North Region
Health Net Federal Services
1-877-TRICARE (1-877-874-2273)
www.hnfs.com
International SOS Assistance, Inc.
Eurasia-Africa:
+44-20-8762-8384
Latin America & Canada:
+1-215-942-8393
Pacific:
Singapore: +65-6339-2676
Sydney: +61-2-9273-2710
www.tricare-overseas.com
TRICARE South Region
Humana Military Healthcare Services
1-800-444-5445
www.humana-military.com
TRICARE West Region
TriWest Healthcare Alliance
1-888-TRIWEST (1-888-874-9378)
www.triwest.com
Connect with TRICARE Online!
General Contact Information
www.tricare.mil/mediacenter
41
PP4111BEC05101W
TRICARE Website: www.tricare.mil
Contacts: www.tricare.mil/contacts
MMSO: www.tricare.mil/tma/mmso
Thank you
Mavis Okihara
TriWest Healthcare
Alliance
(808) 838-7220
[email protected]
42
HIARNG
Finance Mobilization Family Briefing
Mobilization Finance
Assistance/Support and
Information
United States Property and Fiscal Office-Hawaii
91-1179 Enterprise Ave Bldg #117
Kapolei, HI 96707
HIARNG
Finance Mobilization Family Briefing
When our Soldiers Leave the Combat
Zone
•Hazardous Duty Pay (HDP) - $100.00/mo
•Hostile Fire Pay (HFP) - $225.00/mo
•Combat Zone Tax Exclusion (CTZE)
Total $325.00/mo
HIARNG
Finance Mobilization Family Briefing
When Your Soldier Arrives Home
•Family Separation Allowances (FSA) $250.00/mo
Total: $575.00/mo
HIARNG
Finance Mobilization Family Briefing
Yellow Ribbon Events
Mandatory Attendance for Soldiers
HIARNG
Finance Mobilization Family Briefing
Travel Vouchers
Soldiers responsibility to complete
HIARNG
Finance Mobilization Family Briefing
Miscellaneous
•SDP– accrue interest 90 days after leaving theatre
•Withdrawals done thru MYPAY
•Tax filing – 180 days after leaving theatre
•Continued Pay Issues – check with unit representative
•Our team will audit 100% for paying/collecting with
Soldiers closeout
HIARNG
Finance Mobilization Family Briefing
Questions
Stretching My Money in
a Tight Economy
Ed Henrickson
Phone: 808-542-9892
Email: [email protected]
Lunch
Suicide Prevention
Kerry L. Knox, Ph.D., M.S.
Director
Heather A. Von Bergen, Ph.D.
Research Health Science Specialist
Developed by:
Education, Training, and Dissemination core of the VISN 2 Center of Excellence at
Canandaigua
Canandaigua VA Medical Center
Center of Excellence, Bldg. 3
400 Fort Hill Avenue
Canandaigua, NY 14424
Janet Kemp RN, Ph.D.
VA National Suicide Prevention
Coordinator
Associate Director Education and
Training
Deborah A. King, Ph.D.
Clinical Training Coordinator
52
Suicide Prevention
Introduction
About this training



Who is the trainer
What the training is/is not
Training housekeeping and rules
53
Suicide Prevention
Introduction
Objectives:
By participating in this training you will learn:






The scope and importance of suicide prevention
The negative impact of myths and misinformation
How to identify a person at risk-signs symptoms
How to effectively communicate with a suicidal
person
How to gain information to help the person
How to refer a person for evaluation and treatment
54
Suicide Prevention
Brief overview
Suicide in the U.S.




13.5 % of all Americans reported a history of suicidal
ideation or thinking
3.9 % actually made a suicide plan that included a definite
time, place and method
4.6 % reported actual suicide attempts
50 % of those who attempted suicide made a “serious”
attempt
55
Suicide Prevention
Brief overview
Suicide in the veteran population



Male veterans are twice as likely as civilians of either
gender to commit suicide
1000 suicides occur per year among veterans receiving VA
care
5000 suicides occur per year among all living veterans
56
Suicide Prevention
Brief overview
What do the statistics mean?



Veterans are at a higher risk for suicide.
We need to do more to reduce risk.
Suicides are preventable in most cases.
57
Suicide Prevention
Program approaches
VA National Initiatives





Research
Best practices in identification and treatment
Educating employees at every level
Partnering with community based organizations and the
armed forces
Veterans Suicide Hotline
LOCAL Initiatives?
58
Suicide Prevention
Myths and Misinformation


Myth: Asking about suicide will plant the idea in a person’s
head.
Reality: Asking a person about suicide does not create
suicidal thoughts any more than asking about chest pain
causes angina. The act of asking the question simply gives
the person permission to talk about his or her thoughts or
feelings.
59
Suicide Prevention
Myths and Misinformation


Myth: There are talkers and there are doers.
Reality: Most people who die by suicide have
communicated some intent. Someone who talks
about suicide gives the guide and/or clinician an
opportunity to intervene before suicidal behaviors
occur.
60
Suicide Prevention
Myths and Misinformation


Myth: If somebody really wants to die by suicide,
there is nothing you can do about it.
Reality: Most suicidal ideas are associated with
the presence of underlying treatable disorders.
Providing a safe environment for treatment of the
underlying cause can save a life. The acute risk for
suicide is often time-limited. If you can help the
person survive the immediate crisis and overcome
the strong intent to die by suicide, you have gone
a long way toward promoting a positive outcome.
61
Suicide Prevention
Myths and Misinformation


Myth: He/she really wouldn't commit suicide because…
–
he just made plans for a vacation
–
she has young children at home
–
he made a verbal or written promise
–
she knows how dearly her family loves her
Reality: The intent to die can override any rational
thinking. “No Harm” or “No Suicide” contracts have been
shown to be ineffective from a clinical and management
perspective. A person experiencing suicidal ideation or
intent must be taken seriously and referred to a clinical
provider who can further evaluate their condition and
provide treatment as appropriate.
62
Suicide Prevention
Operation S.A.V.E.
Center of Excellence
Operation S. A. V. E. will help you act with care and
compassion if you encounter a person who is suicidal.
The acronym “SAVE” summarizes the steps needed to
take an active and valuable role in suicide prevention.




Signs of suicidal thinking
Ask questions
Validate the person’s experience
Encourage treatment and Expedite getting help
63
Suicide Prevention
Operation S.A.V.E.
Center of Excellence
Importance of identification




Suicidal individuals are not always easy to identify.
There is no single profile to guide recognition.
There are a number of warning signs and symptoms.
–
Some of the signs of suicidality are obvious, but
others are not.
Signs and symptoms do not always mean the person
is suicidal but:
–
When you recognize signs, it is important to ask
the person how they are doing because they may
mean that they are in trouble.
64
Suicide Prevention
Signs of suicidal thinking
Signs and Symptoms:








Threatening to hurt or kill self
Looking for ways to kill self
Seeking access to pills, weapons or other means
Talking or writing about death, dying or suicide
Hopelessness
Rage, anger
Seeking revenge
Acting reckless or engaging in risky activities
65
Suicide Prevention
Signs of suicidal thinking









Feeling trapped
Increasing drug or alcohol abuse
Withdrawing from friends, family and society
Anxiety, agitation
Dramatic changes in mood
No reason for living, no sense of purpose in life
Difficulty sleeping or sleeping all the time
Giving away possessions
Increase or decrease in spirituality
66
Suicide Prevention
Ask questions
To effectively determine if a person is suicidal, one
needs to interact in a manner that communicates
concern and understanding. As well, one needs to
know how to manage personal discomfort(i.e.,
anxiety, fear, frustration, personal, cultural or religious
values) in order to directly address the issue.
Know how to ask the most important question
The most difficult S. A. V. E. step is asking the most
important question of all –
“Are you thinking of killing yourself.”
67
Suicide Prevention
Ask questions
How DO I ask the question?


DO ask the question after you have enough
information to reasonably believe the person is
suicidal.
DO ask the question in such a way that is natural
and flows with the conversation.
DON’T ask the question as though you are looking for a
“no” answer. “You aren’t thinking of killing yourself
are you?”
68
Suicide Prevention
Ask questions
Things to consider when you talk with the
person:
Remain calm
Listen more than you speak
Maintain eye contact
Act with confidence
Do not argue
Use open body language
Limit questions to gathering information
casually
Use supportive and encouraging comments
Be as honest and “up front” as possible
69
Suicide Prevention
Validate the person’s experience
Validation means:






Show the person that you are following what they
are saying
Accept their situation for what it is
You are not passing judgment
Let them know that their situation is serious and
deserving of attention
Acknowledge their feelings
Let him or her know you are there to help
70
Suicide Prevention
Encourage treatment and Expedite getting help
For the cooperative person:
Tips for encouraging treatment:
1.
2.
3.
4.
5.
Explain that there are trained professionals available
to help them.
Explain that treatment works.
Explain that getting help for this kind of problem is no
different than seeing a specialist for other medical
problems.
Tell them that getting treatment is his or her
right.
If they tell you that they have had treatment
before and it has not worked, try asking: “What if
this is the time it does work?”
71
Suicide Prevention
Encourage treatment and Expedite getting help
Tips for expediting a referral:
1.
2.
3.
4.
5.
Know the referral process in your facility/organization
Know what roadblocks might exist and how
to deal with them.
Set the stage and tell the person exactly
what to expect with regard to the referral.
Answer any questions the person may have
about the referral process.
Be honest about things such as ED wait
times and limits of confidentiality.
72
Suicide Prevention
Encourage treatment and Expedite getting help
For uncooperative people or those in immediate crisis:
As you encourage the person to seek help, some
situations may involve people who are hostile and
aggressive.
Here are some useful safety guidelines for working
with seriously and acutely distressed people:
[These rules are both for the person’s safety and yours.]

If you are not in face-to-face contact but are speaking over
the phone with a person who expresses intent to harm self
or others - call 911 if you know that they are located
off the facility or call security if you know they are
located within the facility.
73
Suicide Prevention
Encourage treatment and Expedite getting help



Any time a person has a weapon or object that can be
used as a weapon – call security.
If a person tells you that they have overdosed on pills
or other drugs or there are signs of physical injury –
call security.
In addition to calling security, if you are confronted
with a hostile or armed person, leave the area and
attempt to isolate the person. If the person leaves
your area, attempt to observe his or her direction of
movement from a safe distance and report your
observations as soon as authorities arrive on scene.
74
Suicide Prevention
Encourage treatment and Expedite getting help
Never attempt to subdue or detain a
hostile or armed person!
Never try to negotiate with a hostile or
armed person!
Review your organization’s process for referring
both cooperative + uncooperative people. Have
emergency phone numbers (police +ambulance)
readily available.
75
CASE STUDY/ROLE PLAY



Marcus has recently returned from an 18 month tour in Iraq. He has completed four
years of military service and starts complaining about how long he has had to wait for
his medical appointment when you approach him. Marcus also keeps stating, I’m just so
damn tired”.
Marcus has had recurring dreams after witnessing the death of a soldier friend in a
suicide bombing. He also feels guilty that there was nothing he could do to save his
friend. He thinks it should have been him who died.
Since his return he and his spouse have not gotten along. “My wife claims I’m not the
same man she married”.
76
Suicide Prevention
Operation S. A.V. E.
SUMMARY
Operation S. A. V. E. can save lives by helping you
become aware of:
Signs of suicidal behavior and giving you the skills to:
Ask questions
Validate the person’s experience and to
Encourage treatment and Expedite getting help
77
Suicide Prevention
Operation S. A.V. E.
By participating in this training you have learned:








The scope of the problem of suicides among the
veteran population
The importance of suicide prevention
The negative impact of myths and misinformation
How to identify a person who may be at risk
Some of the signs and symptoms of suicidal
thinking
How to effectively communicate with a suicidal
person
How to gain information to help the person
How to refer someone for evaluation and treatment
78
Suicide Prevention
Operation S. A.V. E.
There are plenty of resources available to
someone who is suicidal but we need you to
partner with us in identifying the suicidal person
and getting them into treatment.
79
8 Battlefield Skills That Make
Reintegration Challenging
Adapted from James Munroe, Ed.D, VA Boston Healthcare System
Dave Kaul,NCC,MHC. 1SG,USA(Ret.)
Director of Psychological Health
July 17, 2015
80
SAFETY
Military personnel in the war zone must be on
constant alert for danger. Everyday events at
home, like a traffic jam, can trigger a sense of
danger and vulnerability. The Service Member
may seek constant control and vigilance, or
attempt to avoid these situations altogether.
Those accustomed to living in a safe and
secure environment may find these attitudes
and behaviors difficult to understand.
July 17, 2015
82
TRUST AND IDENTIFYING THE ENEMY
To survive Military personnel must learn quickly
no to automatically trust in the war zone. It’s
better to assume that everyone is the enemy
until proven otherwise. AT home, mistrust and
suspiciousness can severely damage the most
important relationships, including marriage.
July 17, 2015
83
MISSION ORIENTATION
The primary task in the military is to complete
the mission ordered from above. All attention
and resources are directed to its completion.
In the civilian world, individuals are expected
to take initiative, seek out tasks, balance
completing priorities and decide for
themselves how to proceed.
July 17, 2015
84
DECISION MAKING
• In the war zone, following orders is critical to
personal safety, the well-being of comrades,
and the success of the mission. Military
personnel whose rank requires decision
making must give life-and-death orders, even
when all the information is not available. At
home, especially in families, decision making
tends to be cooperative. People take time to
consider questions and options and seek out
additional information
July 17, 2015
85
RESPONSE TACTICS
In the war zone, survival depends on automatic
response to danger. It is critical to act first – with
maximum firepower – and think later. Keeping all
supplies and equipment, including weapons, clean,
well-maintained, . and in their proper place is
critical to response. At home, messy rooms and
dirty dishes can feel dangerous, and the Service
Member’s response to these realities may appear as
an over-reaction and may intimidate or even
frighten families.
July 17, 2015
86
PREDICTABILITY & INTELLIGENCE CONTROL
In the war zone, troops are in serious danger if
the enemy can predict their movements,
routine, location or intentions. Military
personnel learn to vary their routine and
withhold information.
But at home in a civilian environment,
employers expect routines and children need
them.
July 17, 2015
87
EMOTIONAL CONTROL
Combat exposes military personnel to
overwhelming events that elicit fear, loss and
grief. Yet the job requires that they move on
quickly, staying alert and vigilant. The range
of acceptable emotions may narrow to anger
and numbness. Drugs and alcohol help sustain
emotional numbing, even after the Service
Member comes home. Emotions that are
dangerous in combat are critical for
relationships at home.
July 17, 2015
88
TALKING ABOUT THE WAR
It’s hard to talk about how the war changed the
individual. War may challenge the Service Member’s
core beliefs about humanity and justice in the world.
There are few opportunities to reflect on this in a
combat situation. At home, it is difficult to explain to
civilians – to people who live in safety – what
happened in combat, what decision were made, why
those decisions were necessary. Talking about the
war may overwhelm the Service Member with horror
and grief. Also, Service Members may be afraid that
their stories will upset people they care about or lead
to rejection.
July 17, 2015
89
THANK YOU FOR YOUR SERVICE
Discussion?
Questions?
Comments?
July 17, 2015
90
Contact Information
Dave Kaul, NCC, MHC. 1SG,USA(Retired)
91-1227 Enterprise Ave.
Building 46, Room 305
Kapolei, HI 96707
(808)295-7818
[email protected]
All National Guard members and their families are eligible for the
Psychological Health Program regardless of branch and status.
July 17, 2015
91
Janet Covington
• Military and Family Life Consultant
• Joint Family Support Assistance Program
• Topic: Communication
• Phone: 808-221-6470
• Fax: 808-672-1436
• Email: [email protected]
92
Communication
• The components of communication include verbal and non-verbal
communication, listening skills, and being assertive. Roadblocks to
good communication are blaming, lecturing, name-calling,
analyzing, and sarcasm.
• Verbal skills include the words you choose, voice quality, clarity of
words, and pace and rhythm of words.
• 90% of communication is non-verbal. When your body language
and facial expressions don't match the words you're saying,
miscommunication can occur.
93
Communication
• Tips to help with effective communication include
• 1) avoid generalizations like always, never,
• 2) take responsibility for yourfeelings and
actions,
• 3) stop blaming and being judgmental,
• 4) inform vs ordering,
• 5) don't assume people can read your mind or
know how you feel, and listen with your full
attention.
94
Communication
• Active and reflective listening are valuable communication tools.
Ask for clarification, ask open-ending questions vs questions that
require just "yes" and "no" responses, restate/repeat what you think
is being said to ensure understanding, minimize distractions, look at
the speaker, don't interrupt, and nod or give nonverbal signals that
you are paying attention.
• Aggressive and passive styles of communication are ineffective
since these styles result in avoidance, stored up resentment and
anger, and inevitably, an inability to resolve conflict. The assertive
style of communication allows one to stand up for his or her rights
without violating the rights of others.
UNCLASSIFIED
95
Communication
• Remember, good communicators acknowledge others
communicating with you using verbal and nonverbal cues, clarify
understanding by rephrasing what is being said, maintains a
positive, non-threatening attitude, and listens actively to those who
are speaking. Being a good communicator takes practice and
patience...but you'll be amazed at how effective you can be when
you practice these basic skills.
• Your MFLCs are here to assist you with the challenges of military
and home life. Our service is always free, flexible and confidential
(with the exception of harm to self to others). Please don't hesitate
to call if I can be of help to you or your family members. Janet
Covington, 808-221-6470, [email protected]. MAHALO!
UNCLASSIFIED
96
10 Minute Break
Nicole (Nikki) Dorsey, LCSW, CSAC
Child & Adolescent Telebehavioral Services (CATS)
Tripler Army Medical Center
Disclaimer
 The views expressed in this presentation are those of
the presenter and do not reflect the official policy or
position of the Department of the Army, Department
of Defense, Veterans Administration, or the U.S.
Government.
Objectives
 Participant will be able to list the responses of children
of differing ages.
 Participant will be able to identify 2 qualities of
resilience.
 Participant will be able to identify 2 indicators when
resilience is fading.
Neighbor Hawaiian Islands*
Kauai
Niihau
Oahu
Molokai
Maui
Lanai
Kahoolawe
Big Island
of Hawaii
Source: M2, FY11 Relational Detail, Jul 11 (as of 21 Jul 11).
*Oahu population = 155,341.
Impact of War on Guard and Reserve
Troops
 Guard/Reserve activations since 9/11 (as of 23 Aug 2011)
350,524 ARNG
200,941 USAR
88,782 ANG
179,488 Other Reserve
 Multiple, prolonged deployments of NG/Reserve: Up to 81%
HIARNG and 45% HIANG have seen action
 Known BH impact on Service Member, Family, and Community:
PTSD, TBI, and family/marital difficulties
 Suicide
 In HI, very limited BH resources outside of Oahu
Question-what are the effects on
families when a parent is away during
critical developmental periods?
Effects
 Desert Storm Conflict
 Children noted to have increased externalizing and
internalizing symptoms when parent deployed.
 Effects not long lasting.
 War described in terms of weeks, months.
Effects
 Previously discussed in terms of the deployment cycle
 Pre-deployment
 Deployment
 Sustainment
 Re-deployment
 Post-deployment
 However, currently studied in terms of how parents,
children, adolescents coping due to multiple, long
deployments.
 Currently think of war in terms of years, decade.
Effect on Parents
 Lester et al (2010) gathered data regarding parents.
 Parental stress increased
 Parental depression a specific problem linked to
stresses of deployment, for both military and nonmilitary spouse
 Parental depression linked to other problems in family
and child adjustment in military families
Effect on Soldier
 Lengthy, Repeated Deployments
 Posttraumatic Stress Disorder
 Traumatic Brain Injury
 Other Mental Health Concerns
 Alcohol/Drug Abuse
 Maladaptive Coping
Effect on Family
 Thus, with stresses of return (redeployment) Return to civilian job
 Economic changes
 Separation from family
 Family roles changed while deployed
Spouse more independent
Children have grown, changed
 Reintegration difficulties
 Behavioral health issues (PTSD, TBI)
 Marital difficulties-emotional distance
 Marital conflict can be linked to children's adjustment
problems
How do we “build that bridge”?
 Good communication among deployed and non




deployed spouse
Resolving caregiver stress: counseling, support group,
FRG, stress-reduction techniques, self-care
Maintaining a regular routine
Limited exposure to media coverage
Discuss the cultures of countries to which the person
has deployed
Talking about deployments reasonably and in an ageappropriate way
It’s definitely not all bad…
 Many children are resilient
 Many military families are strong and experience
continued family cohesion, even during deployment
 Increased financial stability
 Increased sense of purpose and pride in service
 What else?
The experience of children in the
military
 …young children are likely to
 Report on the Impact of
Deployment of Members
of the Armed Forces on
Their Dependant Children
(DoD, 2010)
exhibit externalizing behaviors
such as anger and attention
difficulties…
 …school-aged children
demonstrate more internalizing
behaviors such as increased levels
of anxiety and fear, sensitivity to
media coverage, and reduced
school performance…
 …adolescent children likely to
experience declining academic
performance, depressive
symptoms, and behavioral
problems in response to
emotional stress…
 The Psychosocial Effects of
Deployment on Military
Children (Flake, et al, J Dev
Behav Pediatr, 2009).
 Over 1/3 of children experiencing
deployment were seen as “high risk” for
psychosocial issues…more emotional issues
than national samples.
 …school may provide an established
structure and routine that minimizes
child stress…
 Although not all families require the
same degree of support, all who
experience wartime deployments should
be offered resources.
 Available resources are more accessible
for families living on a military
installation than those rural families of
the National Guard or Reserve
components.
Impact on Academics
 …school staff interviewed had little
 Effect of Soldiers’ Deployment
on Children’s Academic
Performance and Behavioral
Health (Richardson, et al, Rand
Organization, 2011)
consistent information on which
students are military, when students
may be experiencing deployment...
 …some parents appear to be
struggling more than their children
with deployments, which appear to
underlie many of the challenges that
these children faced during these
extended and multiple
deployments…
 …ensuring that families have timely
access to psychological and
behavioral health services for
children can be challenging…
Studies-Adolescents
 1. Chandra et al (2009) interviewed school staff
 2. Deployments affect functioning of adolescents
 Worry about parent who was away as well as parent at home
 Uncertainty had a negative effect
 3. Adolescents losing resiliency
 4.Schools are becoming safe haven, sanctuary

Sports, leisure, activities important as respite
Now looking at what makes people
resilient
 Definition of resilience
The ability to bounce back from negative, even
traumatic life experiences
Flexible adaptation
Resiliency- traits
 Optimistic
 Hope about the future
 Self efficacy
 Feel they have the skills necessary to accomplish the task
 Mastery
 Break down problems into smaller, more manageable
tasks
Resiliency-traits
 Hardy
 Accept change as part of life, view it as a challenge
 Sense of coherence
 Events will make sense
 For both of the above, important that they feel that the
effort of the families is supported
Important factors in achieving,
maintaining resilience in children
 High quality parenting
 Measured along two dimensions
 Warmth and responsiveness
 Control and demandingness
 Authoritative parents-love and support with clear
standards
 Children have good relationships
 They are cheerful, self reliant
Parenting factors
 Authoritarian: demanding but not responsive
 Children and adolescents less independent
 4 year olds boys show hostile attitude towards adults
 Adolescents, obedient but have low self esteem
 Permissive: warm but not clear standards
 Preschoolers show poorer psychological adjustment
 Adolescents show positive self esteem but then get into
drugs and show misconduct at school
Building resilience
 Support communication skills
 Adults-allow for true listening, particularly feelings
 Allow for children to communicate, support each other
 Support family communication

Family rituals that encourage sharing
Building resilience
 Help develop problem solving
 Break down complex tasks into manageable components
 Set appropriate goals
 Develop ways of evaluating the process and outcomes
Building resiliency
 Help develop insights into feelings
 View from different perspectives
 Parent may have similar or different feelings
Understand that feelings are very complex
often contradictory
Understand that the feeling expressed may not be the
underlying emotion
When resiliency fading
 Risk factors
 Previous trauma
 Serious family conflict
 Socioeconomic status
 Isolation
When resilience fading
 Persistent poor performance in school
 Persistent somatic complaints
 Headache, stomach ache
 Isolation
 From other family members
 From peers
 Decrease in participation in activities
QUESTIONS
For more information, or to
discuss services:
Nikki Dorsey, LCSW
Child & Adolescent Telebehavioral Services (CATS)
Kahului, Maui
Ph: 808-469-1690
[email protected]
Education, Incentive, and
Employment Office
MAJ Erin Dvonch, Education Services Officer
CPT Todd Yukutake, Education Services Officer
MSG Jack Thompson, Incentive Manager
SGT Joy Quiva, Education Service Manager
PH. (808) 672-1019
Fax (808) 844-6451
[email protected]
Us.armymil
Agenda
• Federal Tuition Assistance
• GI Bill
• Misc.
129
Federal Tuition Assistance (FTA)
•A benefit funded by the Federal Government
for ARNG Soldiers to attend any U.S.
Department of Education approved school
for a high school diploma, college degree, or
certification/licensing courses.
Eligibility Requirements
- Active
drilling status
- No active adverse flagging
- Less than 9 AWOLS within 12 months
- ROTC scholarship recipients who elect room and board
Scholarship option.
- Commissioned Officer: agree to a 2 year Active Duty service or
a 4 year Reserve Duty Service Obligation
- Enlisted must have enough remaining obligation for the length
of the course
FTA Benefit Rates
Pays for 100% of tuition up to:
$250 per semester hour
$167 per quarter hour
$16.66 per clock hour
Authorized Fees:
Fees must be refundable
Fee must be linked to enrollment in a specific course.
Fee charged by the institution as a condition of enrollment
in a specific course/term or fees that all students must
pay.
Note: Max benefit is up to $4,500 per fiscal
year (Oct – Sept) based on funds availability.
Authorized Uses
No more than one credential from each of the following levels:
- High School Diploma or its equivalency
only)
- Certificates & Licensure
- Associate
- Baccalaureate (undergraduate)
- Master’s or First Professional
(tuition
Unauthorized Uses
- Degree at a lower level or lateral degrees
- NO degree plan
- Without grade point average of 2.0 or higher after completing
15 semester hours
- ARNG ROTC scholarship recipients who elect Tuition and
Fees scholarship option.
- Course previously funded by FedTA
- Course at the Doctorate level
Combining Education Benefits
and Entitlement
FTA may be used simultaneously with the following
funding sources:
- Montgomery GI Bill (Kicker, 1606, 1607, 30, 33)
- Financial aid
- Scholarships
- Pell Grant
How to Apply for FTA
• Contact the Education Office for tuition assistance eligibility
• Register for classes
• Apply for an account and FTA online at
www.GoArmyEd.com
Note: Application must be submitted up to 60 days before and
14 days after the start date of the course.
How to Apply for FTA-continued
www.GoArmyEd.com
GI Bill
Chapter 1607 (REAP)
Reserve Education Assistance Program
Chapter 33 - Post 9/11
The GI Bill Benefit
• Receive up to 36 months of paid benefits
for each GI Bill you are eligible for.
• Cannot receive more than 48 months in
total GI Bill benefits combined
(Ch1606/1607/30/33)
• Receive benefits for only 1 GI Bill at a time
• You will not be charged months you are
not paid. Example: if you do not attend
school in the summer.
GI Bill 1607 – Reserve Educational
Assistance Program (REAP)
For Selected Reserve Soldiers:
• Service in support of a contingency
operation on or after 11 September 2001
• Active Duty Title 10 Service
• Active Duty Title 32 Service if served
between 11SEP01-31MAY02 for
“Operation Noble Eagle”
• Expires 10 years after discharge from
the Selected Reserves or expires on
entry to the IRR/ING
GI Bill Chapter 1607 – (REAP)
• Complete VONAPP online application Form 221990 at www.gibill.va.gov and print the signature
page at the end
• If already receiving GI Bill, must complete VA form
22-1995 to change program from Ch 1606 to Ch
1607.
• Attach a copy of your GI Bill Kicker contract (if
applicable)
• Submit forms to your school’s VA Certifying Official
for certification of enrollment
CH1607 Benefit Rates
Monthly College Benefit Rates
Training Time
Service of 90
days but less
than one year
Service of 1 year
or more
Service of 2
years or more or
36 cumulative
months
Full time
$570.40
$855.60
$1140.80
3/4 time
$427.80
$641.70
$855.60
1/2 time
$285.20
$427.80
$570.40
$427.80**
$570.40**
$213.90**
$285.20**
Less than 1/2 $285.20**
time More than
1/4 time
1/4 time or
$142.60**
less
**Tuition and Fees ONLY. Payment cannot exceed the listed
Post 9/11 Chapter 33
Eligibility
Qualifying Title 10 Active Duty on/after 09/11/01
Served 30 continuous days and was discharged due to a service
connected disability
Eligibility Period
While on Active duty or 15 years from date of last discharge or
Release from Active Duty service of at least 90 consecutive days
Ineligibility
Qualifying Active Duty does NOT currently include the following:
ROTC Active Duty Contract
Service Academy Contract
What active duty counts?
Basic
Training/AI
T
Regular
Army
ARNG
Drills/AT
Title 32
OIF/OEF
Deploymen
t
Active Duty Title 10
Since September 11, 2001
Initial Active Duty Training counted if you have at least
24 months of other Title 10 time
Post 9/11 Payment Tiers
•
•
•
•
•
•
•
•
At least 36 cumulative months
At least 30 continuous days on active duty
and discharge due to service-connected disability
At least 30 cumulative months
At least 24 cumulative months
At least 18 cumulative months
At least 12 cumulative months
At least 6 cumulative months
At least 90 total days
100%
100%
90%
80%
70%
60%
50%
40%
Payment tier applies to tuition & fee; books & supplies Stipend and to the
housing stipend
9/11 GI Bill– Chapter 33
Pays a percentage based on time served.
Tuition at the highest public institution
rate:
• UH at $350 per semester hour
• Monthly benefit at the BAH E-5 with
dependents rate
• $1,000 for books and supplies yearly
Monthly Housing Allowance
• Stipend equivalent to BAH for an
E-5 with dependents
• Amount is determined by
enrollment Zip code and is
prorated
• $1899
• $1701
• $1665
• $1401
Oahu
Maui
Kauai
Big Island
Monthly Housing Allowance
Eligibility
•
•
•
•
Attending more than half time
Distance Learning – $673.50
Payments paid directly to YOU
Active Duty – NOT Eligible
9/11 GI Bill Example
UH Manoa Spring 2012 Benefits 100% Rate
GI Bill Tuition Payment = $4,200
Housing = $1899x4 months = $7,596
Book Stipend = $500
Total benefits
$12,296
Transfer of Entitlement
•
•
•
•
Must have 6 years of service complete
May require up to 4 year service obligation
Dependent must be in DEERS
May transfer up to 36 months of benefits to
spouse, child or children
• May add, revoke, modify transferability
benefits while serving in the Armed Forces
• Retirees or separated service members
cannot transfer benefits
Note: Once transfer is approved, dependent
remains eligible until 26th birthday or when
months of benefits are exhausted.
Service Requirement Exceptions
Eligible to retire or 20 years of service on 01 Aug 2009
None
Eligible to retire or 20 years of service after 01 Aug 2009
and before 1 Aug 2010
1 year
Eligible to retire or 20 years of service on or after 01 Aug
2010 and before 1 Aug 2011
2 years
Eligible to retire or 20 years of service on or after 01 Aug
2011 and before 1 Aug 2012
3 years
All others
4 years
August 1, 2013
161
Benefit Transfer Process
• Step 1 – Apply to transfer benefits on-line
(TEB) application at:
• https://www.dmdc.osd.mil/TEB/
• Step 2 – Complete the Post 9/11
Educational Benefits Transferability
Commitment and Statement of
Understanding (SOU) form
• Step 3 – Complete an enlistment
extension with your unit if required.
Spouses
• May start to use the benefit immediately.
• May use the benefit while the member
remains in the Armed Forces or after
separation from active duty.
• Are not eligible for the monthly stipend or
books and supplies stipend while the
member is serving on active duty.
• Can use the benefit for up to 15 years
after the service member’s last separation
from active duty.
Dependents
• May start to use the benefit only after the individual
making the transfer has completed at least 10 years
of service in the Armed Forces.
• May use the benefit while the eligible individual
remains in the Armed Forces or after separation from
active duty.
• May not use the benefit until he/she has attained a
secondary school diploma (or equivalency certificate),
or reached 18 years of age.
• Is entitled to the monthly stipend and books and
supplies stipend even if the Service Member is on
active duty.
• Is not subject to the 15-year delimiting date, but may
not use the benefit after reaching 26 years of age.
Changes to Post 9-11
Effective August 1, 2009, but not
payable until October 1, 2011
• Expands the Post-9/11 GI Bill to include Active
Service performed by National Guard members
under title 32 U.S.C. for the purpose of
organizing, administering, recruiting, instructing,
or training the National Guard; or under section
502(f) for the purpose of responding to a national
emergency.
Changes to Post 9-11 (cont.)
Effective August 1, 2011
• For Veterans and their transferees - simplifies the
tuition and fee rates for those attending a public
school and creates a national maximum for those
enrolled in a private or foreign school
• Pays all public school in-state tuition and fees;
• Private and foreign school costs are capped at
$17,500 annually;
• The Yellow Ribbon Program still exists for outof-state fees and costs above the cap.
Changes to Post 9-11 (cont.)
Effective August 1, 2011
• Allows VA to pay MGIB (chapter 30) and MGIB-SR
(chapter 1606) ‘kickers’, or college fund
payments, on a monthly basis instead of a lump
sum at the beginning of the term
• Prorates housing allowance by the student’s rate
of pursuit (rounded to the nearest tenth)
• A student training at a rate of pursuit of 75% would
receive 80% of the BAH rate
Changes to Post 9-11 (cont.)
Effective August 1, 2011
• Break or interval pay is no longer payable under any VA
education benefit program unless under an Executive
Order of the President or due to an emergency, such as
a natural disaster or strike.
• This means that when your semester ends (e.g.
December 15th), your housing allowance is paid for
the first 15 days of December only and begins again
when your next semester begins (e.g. January 10th)
and is paid for the remaining days of January.
• Students using other VA education programs are
included in this change. Monthly benefits will be prorated in the same manner.
Changes to Post 9-11 (cont.)
Effective August 1, 2011
• Allows reimbursement for more than one “license or
certification” test (previously only one test was allowed).
• Allows reimbursement of fees paid to take national
exams used for admission to an institution of higher
learning (e.g., SAT, ACT, GMAT, LSAT)
• Allows those who are eligible for both Vocational
Rehabilitation and Employment (chapter 31) benefits and
Post-9/11 GI Bill (chapter 33) benefits to choose the
Post-9/11 GI Bill’s monthly housing allowance instead of
the chapter 31 subsistence allowance.
• NOAA and PHS personnel are now eligible to transfer
their entitlement to eligible dependents
Changes to Post 9-11 (cont.)
Effective October 1, 2011
• Allows students to use the Post-9/11 GI Bill for • Non-college degree (NCD) programs: Pays actual net cost for inState tuition and fees at public NCD institutions. At private and
foreign institutions, pays the actual net costs for in-state tuition
and fees or $17,500, whichever is less. Also pays up to $83 per
month for books and supplies.
• On-the-job and apprenticeship training: Pays a monthly benefit
amount prorated based on time in program and up to $83 per
month for books and supplies.
• Flight programs: Per academic year, pays the actual net costs for
in-state tuition and fees assessed by the school or $10,000,
whichever is less.
• Correspondence training: Per academic year, pays the actual net
costs for in-state tuition and fees assessed by the school or
$8,500, whichever is less.
Changes to Post 9-11 (cont.)
Effective October 1, 2011
• Housing allowance is now payable to
students (other than those on active duty)
enrolled solely in distance learning. The
housing allowance payable is equal to ½
the national average BAH for an E-5 with
dependents.
• The full-time rate for an individual
eligible at the 100% eligibility tier would
be $673.50 for 2011.
Test study guides
Free test study guides and practice tests
available for
• SAT, ACT, GRE, GMAT
• CLEP and DANTES exams
• ASVAB
• AFAST
• LSAT
• NCLEX
• EMT
www.petersons.com/dod
Finding a School
Use the Education Support
Center
• Receive help in locating the best school for you.
• Offer recommendations on colleges to attend
based on your needs, military training (AARTS),
job experience, and prior college experience.
• Over 700 Degree programs offered.
• Priority to Officers without a bachelors degree.
Call the ESC at 1-866-628-5999
https://education.ng.mil
Employer Partnership
• Free job placement
assistance
• Hundreds of local job
opportunities
• Military friendly employers
• Service members, retirees,
and dependents eligible.
https://www.employerpartnership.org/
Questions?
MAJ Erin Dvonch, Education Services Officer
CPT Todd Yukutake, Education Services Officer
MSG Jack Thompson, Incentive Manager
SGT Joy Quiva, Education Service Manager
PH. (808) 672-1019
Fax (808) 844-6451
[email protected]
Mahalo
UNCLASSIFIED
184