Transcript Slide 1

Paving The Way Home
Military Culture
overview the culture of military
families, issues and effective
treatments, and sources of support
Blaine Everson
[email protected]
706-369-7911
Alan Baroody
[email protected]
912-369-7777
Peter McCall
[email protected]
770-329-6156
1
Presentation Goals
There are 5 goals of this presentation:
1. Review ‘causes for concern’ and the
need for private and public sector to
work together to address these concerns
2. Review how CareForTheTroops is attempting to address these
concerns and provide access to information for clinicians
3. Review key military culture issues that can impact
the mental health of a military family
4. Review the recommended treatments for military trauma, what
triggers to look for, and commonly encountered issues
5. Motivate all in attendance to continue the work to provide
mental health support to all military family members
2
Agenda
Topic
Duration Comments
Presenters, Goals and Agenda
Oath of Enlistment
Intro and Opening
5
CareForTheTroops.org
10
Overview Mission / Role of Clinicians
Show Key Website Components for Clinicians
Review Enrollment and Marketing Assistance
Causes For Concern
En’visioning’ the Issues
25
Brothers at War Trailer
Audience Discussion
Fraser Center Perspective
Military Culture
15
Jargon and Organization
Deployment/Family Life Cycles
Stressors
Clinical Treatment Info
15
Demographics
PTSD-Signs and Treatments
Family Therapy Approaches
Case Study
Q&A and Closing
5
Handout – A0 …..an Example
On-Going Discussion
3
CareForTheTroops, Inc.
Who Are We – ‘Big Picture’
•CareForTheTroops is working to help the military and their
extended family members receive mental health services and
support from the civilian elements of our society in the State
of Georgia.
• CareForTheTroops is attempting to equip the civilian support
services of society e.g. clinicians, with the capacities to be
helpful.
• We are working toward “building a better net” to catch those
that need help before they fall too far and reach moments of
desperation.
4
CareForTheTroops Organization
501c3 status has already been approved by the IRS
Current Board of Directors:
President
Exec Director
Member
Member
Member
Member
Rev Robert Certain, Rector, Episcopal Church of St Peter and St Paul (USAF)
Peter McCall (USArmy)
Bill Harrison, Partner, Mozley, Finlayson & Loggins LLP (USAF)
William Matson, Exec Director, Pathways Community Network, Atlanta, GA
Alan Baroody, Exec Director, Fraser Counseling Center, Hinesville, GA
Joseph Krygiel, CEO of Catholic Charities, Archdiocese of Atlanta (US Navy)
Current Partners:
The Georgia Association for Marriage and Family Therapy (GAMFT)
The EMDR Network of Clinicians in Georgia
Pathways Community Network, Inc
Fraser Counseling Center, Hinesville, Georgia (nearby Fort Stewart)
Episcopal Diocese of Atlanta
Presbytery of Atlanta and the Presbyterian Women of Atlanta
Catholic Charities and the Archdiocese of Atlanta
5
CareForTheTroops Approach
Military
Member
Person in
need of
support
Spouse
Siblings
Children
Parents
Grandparents
6
How We Can Help Each Other
Help For You
• Use the web site as a resource www.CareForTheTroops.org
• Information and reference material
• Training
• Referrals
• Use your involvement with CFTT to help market your practice
Help for Us
• Enroll in the CFTT database
• Publicize CFTT to community and congregations
• Would you consider being a Trainer using material like you
see today?
7
Agenda
Topic
Duration Comments
Presenters, Goals and Agenda
Oath of Enlistment
Intro and Opening
5
CareForTheTroops.org
10
Overview Mission / Role of Clinicians
Show Key Website Components for Clinicians
Review Enrollment and Marketing Assistance
Causes For Concern
En’visioning’ the Issues
25
Brothers at War Trailer
Audience Discussion
Fraser Center Perspective
Military Culture
15
Jargon and Organization
Deployment/Family Life Cycles
Stressors
Clinical Treatment Info
15
Demographics
PTSD-Signs and Treatments
Family Therapy Approaches
Case Study
Q&A and Closing
5
Handout – A0 …..an Example
On-Going Discussion
8
Causes for Concern
1. Multiple deployments are common causing stress and family attachment issues
2. An April ‘08 Rand Study reported 37% have either PTSD, TBI, or significant Mental
Stress (5% all 3). Some estimate >50% return with some form of mental distress
3. Suicide, alcoholism, domestic abuse and violent crimes rates are rising. Suicide is 33%
higher in ‘07 over ’06, 50% higher in ‘08, and almost equal to ‘08 by May of ’09
4. Military Sexual Trauma (MST) is running at 16%-23%
5. In 2008, military children and teens sought outpatient mental health care 2 million
times, a 20% increase from ‘08 and double from the start of the Iraq war (‘03)
6. DoD and VA facilities are stretched … the Aug 2009 VA claims backlog is 900,000
7. Many more Reservists & Guard than previous wars (54% as of mid ‘08) and they and
families are more distant from DoD and VA support facilities
8. Other mental health, marriage, and family problems often occur with or leading up to
PTSD requiring attention so they don’t get worse
9. Rand Study estimates that PTSD and depression among service members will cost the
nation up to $6.2 billion in the two years after deployment. The study concludes that
investing in proper treatment would actually save $2 billion within two years
9
Brothers At War Film Clip
http://www.brothersatwarmovie.com/
10
Fraser Center Experience
Film Clip Comments
THERAPEUTIC ISSUES OBSERVED IN THE CLIPS FROM “BROTHERS AT WAR”:
1. The adrenaline high, or adrenaline addiction – “It’s like the best!”
2. Personality changes. No one returns the same from combat or lengthy deployments.
3. Generalized and undifferentiated anger: short fuse, loss of patience, (increase in
domestic violence and child abuse). “Now when he gets mad, he just screams.”
4. Grief over absence during important life transitions (also, resentment by spouse at
soldiers absence). “When I come home I just want to hug her, but she may not let me
because she won’t know who I am.”
5. Intense bonding during deployment competes with and sometimes trumps marital
and family bonds. “My friends here are closer than any I’ve had.” “These guys take
you on as a brother.”
6. Survivor guilt and loss: “It hurts a lot to lose fellow soldiers.”
7. Family of origin issues: “I want to make my Dad proud.”
8. Fantasy verses reality. (living on dreams and through TV series)
9. Emotional numbing: “He used to be sensitive. Now, he shows no emotion and wants
me to be the same way.”
10. The ramifications of “sacrificing for family” and the sacrifices made by families.
11
Chris Warner’s Sources of Stress
Number of Contacts
300
250
200
150
100
50
0
1
2
3
4
Combat Exposure
5
Peer/Unit
6
7
8
9
10
11
--->> Number of Months
Home Front Stressors
Warner CH, Breitbach JE, Appenzeller GN, et.al. “Division Mental Health: It’s Role in the New Brigade Combat Team Structure Part I:
Pre-Deployment and Deployment” Journal of Military Medicine 2007; 172: 907-11.
12
Agenda
Topic
Duration Comments
Presenters, Goals and Agenda
Oath of Enlistment
Intro and Opening
5
CareForTheTroops.org
10
Overview Mission / Role of Clinicians
Show Key Website Components for Clinicians
Review Enrollment and Marketing Assistance
Causes For Concern
En’visioning’ the Issues
25
Brothers at War Trailer
Audience Discussion
Fraser Center Perspective
Military Culture
15
Jargon and Organization
Deployment/Family Life Cycles
Stressors
Clinical Treatment Info
15
Demographics
PTSD-Signs and Treatments
Family Therapy Approaches
Case Study
Q&A and Closing
5
Handout – A0 …..an Example
On-Going Discussion
13
Military Culture
Sociologists define culture as …
• Language - nomenclature;
acronyms, abbr.
• Beliefs – defenders of Democracy
• Value Systems – leave no one behind
• Norms & Rules – formal & informal conduct
Culture is associated with a social system
and unique to a given system.
Handout – A2
14
Language Barriers for Civilians
Glossary of Military Terms and Acronyms
Military Cultural Competence
OEF
Operation Enduring Freedom – it is a multinational military operation aimed
at dismantling terrorist groups, mostly in Afghanistan. It officially commenced
on Oct. 7, 2001 in response to the September 11th terrorist attacks.
OIF
Operation Iraqi Freedom - also known as the Iraq War; began on 3/20/2003.
USAR
USANG
Title 10 – Title 32
United States Army Reserve
United States Army National Guard
10=Federal Orders; 32=State Orders; these impact benefits available
E1-E9; O1-O10
SPC
First SGT
NCO
Enlisted Ranks; Officer Ranks
Specialist, rank of E4, often referred to a “Spec 4”
First Sergeant, rank of E7, lead enlisted person in a company. It and SSG,
Staff Sergeant are key leadership ranks with lots of job pressures
Non-Commissioned Officer, ranks E6 through E9
IEDs
FOB
Sandbox
Down Range
Outside the Wire
Taking the Pack Off
Top Cover
Improvised Explosive Devices
Forward Operating Base
Iraq and Afghanistan
Deployed to anyplace where there is shooting.
Leave the safety of the “enclosed” military base (FOB)
Leaving mentally and physically from combat
Making sure the boss looks good
Handout – A3_1, A3_2, A3_3, A3_4
www.rivervet.com/oif_glossary.htm
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The next few charts cover organizational
background to help understand the client,
where he/she was positioned, and to
better interpret the information and stories
they might tell during their therapy
16
Branches of the Military
Georgia’s Military is dominated by Marine and Army units,
though Air Force and Navy are represented as well.
Georgia’s National Guard also has a large number of
transportation units subject to IEDs on roads and highways.
NOTE: Coast Guard is now under Homeland Security
Handout – A4
17
Military Branch Structures
Example: U.S. Army
Core Values
84%%
2%
14%
84%
2%
14%
Handout – B1, B2, B3
18
Military Culture
Belief and Value Systems; Norms and Rules
•
Beliefs:
Defenders of Democracy
Trust in the leadership
Role clarity
Distrust of civilians
•
Value Systems:
Leave no one behind
“The Group” practically becomes a ‘family system’
Top Cover - defend and support the boss
Violence - many have a history of violence which often plays a role
•
Norms & Rules:
Formal and informal conduct
Stigma of mental health and PTSD
Cover of the boss (Top Cover)
Back-logging trauma
19
Reserve and National Guard Units
vs Regular Army
Reserve / Guard
• Units are small & based in local
communities.
• Part-time soldiers, often working with
local police, fire, and EMS.
• Families may be left in a town with
little or no support services.
• Mostly support units in Georgia
(transport, MP, etc)
• Likely to work within
local communities
• Can’t relocate easily
when activated
• Lack of military related health services
- PCP not Tricare approved
• Make use of family or local supports
(congregation, etc.)
Handout – C1
Regular
• Units are based at
major military
installations.
• Full-time soldiers who
expect to be deployed .
• Families are left at their post where a
variety of support is in place both onpost & in communities.
• Are part of a larger fighting force
including 1/5 combat units.
• Live on-post or nearby; other family
support
• Less need to relocate when deployed
• Access to a variety of health, welfare,
& educational services
• Support groups in-place through
20
soldier’s unit
The next few charts provide some
background of this war that might help you
better understand your client and their
presenting story and issues
21
Why is this war different?
•
•
•
•
•
•
•
•
•
Volunteer vs. draft
Multiple deployments
Type of suicide bombings
Never any safety, no real recovery time
Use of civilians as shields and decoys by the enemy
Deliberately targeting our moral code
COMMUNICATION! Internet, cell phones, etc.
IEDs, RPGs (TBI, hearing loss, neuro-chemical effects)
Advancement in medical treatments
22
OIF/OEF - Statistics
As of 12/1/2008
• 1.7M troops deployed
• 4207 US Military killed in Iraq
(excludes civilians)
• 627 US Military killed in Afghanistan
(excludes civilians)
• 65,000+ US Military wounded
• 54% deployed are Reserve / Guard (4/08)
• Deployed as of 09/2009:
~ 130K troops in Iraq
~ 160K civilian contractors in Iraq
~ 65K troops in Afghanistan (more are being sought as of Oct 2009)
23
OIF/OEF - More Statistics
•
15 wounded for every 1 fatality
(Vietnam was 3 for 1)
•
VA predicts that it will treat 263,000 OIF/OEF
vets in 2008 and 330,000 in 2009
•
Current backlog of veterans is 400,000 (as of 2008)
•
Claims backlog is over 900,000 (as of Aug 2009)
•
Heaviest of that backlog is mental health (Ex: Virginia VA community
mental health services has a waiting list of 5,700 as of early 2008)
•
550,000 school age children of active duty Service Members
(Reg/Res/NG)
•
84% of Regular Military Service Members’ children
attend public school, not DoD base schools
•
Georgia has over 750K veterans
Handout – C3
24
OIF/OEF – and some more Statistics
According to a new American Journal of Public Health study on
veterans' mental health diagnoses
– Of the 289,328 veterans who entered VA care in 2008, nearly
37% had mental health problems, including post traumatic stress
disorder (about 22%) and depression (roughly 17%).
(ref:
http://www.ajph.org/cgi/content/abstract/AJPH.2008.150284v1 )
– "Weekend warriors" over 30 years old in the national guard and
reserves who left stable family, work and community
environments for combat zones were especially susceptible to
mental health problems.
A recent (July, 2009) US government accountability office report found
that nearly 20% of women veterans suffer from PTSD
(ref: http://www.gao.gov/new.items/d09899t.pdf )
25
The next several charts will cover life
within the military family and clinical
treatment considerations
26
The Military Deployment Cycle
… or The Military Family Life Cycle
Pre-deployment
Conflict & Previous
Stressor pile-up
Family readjusts Consequences
for behavior
Revitalize
Relationships and
“honeymoon”
Pre-deployment
Stress – anxiety
and concern
Reunion and
homecoming –
joy and
anticipation
Soldier
Deployment
Separation
Stress –
Depression &
Anxiety
Family Adjustment w/o
Soldier in Home – Out-ofOrdinary Behaviors
Pre-reunion Stress
– anxiety and worry
about behavior
away
27
Military Family At-Risk Factors
1. Frequent Relocation
3.3 years average
2. Previous Deployments
87%
3. Longer Separations
7.3 month average
4. Larger Families
42% ≥ 3 children
5. Younger Mothers
26.5 median age
6. Blended Families
31% step-parents
7. Education
21% w/o HS diploma
8. Working Outside Home
44%
9. Median Income
< $30,000 (34%)
Quality of Life Among U.S. Army Spouses During OIF, Dissertation, 2005, Dr. Blaine Everson
28
Deployment Related Stressors for Spouses
STRESSOR
POSITIVE RESPONSE
Feeling Lonely
90.0% (271)
Having Problems Communicating with my Spouse
61.2% (184)
Experiencing the Death of a Close Friend or Relative
33.2% (100)
Managing and Maintaining Family/Personal Finances
47.2% (142)
Personal/Family Health Issues
43.2% (130)
Being Pregnant during the Deployment
26.9% (81)
Raising a Young Child while my Spouse is not Present
63.2% (190)
Childcare
39.9% (120)
Managing and Maintaining the Upkeep of my Home
49.1% (148)
Having Reliable Transportation
19.9% (60)
Caring/Raising/Disciplining Children with my Spouse Absent
56.5% (170)
Balancing between Work and Family
Obligations/Responsibilities
53.4% (159)
The Safety of my Deployed Spouse
96.4% (290)
Warner CH, Appenzeller GN, Warner CM, Grieger T. “Psychological Effects of
Deployments on Military Families” Psychiatric Annals 2009; 14: 56-62.
29
Summary of Stressors
For Active Component Families
• Permanent Change of Station (PCS)
• Temporary Duty (TDY)
• Deployment
• Foreign Residence
• Risk of Injury or Death
• Behavioral Expectations
Additional for Reserve/Guard
Component Families
• “Citizen Soldier”
• Mobilization and Deployment
• Separation from School, Jobs, etc
• Demobilization
30
…a closing thought
on the Military Culture
“The capacity of Soldiers for absorbing
punishment and enduring privations is
almost inexhaustible so long as they believe
they are getting a square deal, that their
commanders are looking out for them, and
that their own accomplishments are
understood and appreciated.”
GENERAL Dwight Eisenhower, 1944
31
Agenda
Topic
Duration Comments
Presenters, Goals and Agenda
Oath of Enlistment
Intro and Opening
5
CareForTheTroops.org
10
Overview Mission / Role of Clinicians
Show Key Website Components for Clinicians
Review Enrollment and Marketing Assistance
Causes For Concern
En’visioning’ the Issues
25
Brothers at War Trailer
Audience Discussion
Fraser Center Perspective
Military Culture
15
Jargon and Organization
Deployment/Family Life Cycles
Stressors
Clinical Treatment Info
15
Demographics
PTSD-Signs and Treatments
Family Therapy Approaches
Case Study
Q&A and Closing
5
Handout – A0 …..an Example
On-Going Discussion
32
Demographics - Young Adults in the Military
• 46.6% of all service members are <= 25 yrs old
• 53% of enlisted members are <= 25 yrs old
• 24.8% reported binge drinking >1x per week in the
past 30 days vs 17.4% for same-age civilians
• Higher smoking rates (40% vs. 35.4%) than same-age
civilians
• Illicit drug use in the military was 5% in 2005, but
nonmedical use of painkillers is the most common
form of drug abuse.
Source: Military Family Research Institute at Purdue University.(2005). 2005 demographics report. Arlington, VA: Office of the
Deputy Under Secretary of Defense, Military Community and Family Policy. Retrieved January 7, 2009, from
www.cfs.purdue.edu/mfri/pages/military/2005_Demographics_Report.pdf
Handout – D2
33
Demographics – GENDER AND RANK
Women represent
approximately 15%
of the military force.
Representation of
women is slightly
lower for Senior
Enlisted and
General Officers.
34
Demographics – MARITAL STATUS
Marital Status
Divorce Trends
AC=Active Duty
RC=Reserves/Guard
RED
= Civilian
BLUE = Total DOD
35
Demographics – Suicide
Two dominant
factors:
1. Financial Stress
2. Concerns with
Intimate Partners
The 2008 overall
Army rate was
24/100K, a 33%
increase
70% increase
reported from
2005 to 2008
Handout – E1
36
Psychological Injury Continuum:
ASR to COSR to PTSD
• ASR (acute stress reaction)
produces biological, psychological, and behavioral
changes. ASD (acute stress disorder) means it has
become disruptive and destructive.
• COSR(combat and operational stress reaction)
is expected, common, and occurs throughout deployment to some
degree. Pretty much everyone comes home with some version of
combat and operational stress.
• PTSD(post traumatic stress disorder)
becomes classified if COSR symptoms are daily, interfere, and “last
longer than 1 month”
37
SIGNS / SYMPTOMS OF
(COMBAT) PTSD
• HYPER-AROUSAL:
Fight/Flight/Freeze, Angry, poor sleep, argumentative, impatient, on
alert, tense (hyper-vigilant), intense startle response, speeding
tickets (once home) and other risky behavior.
• NUMBING/AVOIDANCE:
Withdrawn, secretive, detached, controlling, removes all reminders,
avoids similar situations, ends relationships with people associated
with trauma, etc.
• RE-EXPERIENCING:
Nightmares, flashbacks, intrusive thoughts
38
PTSD: Cues or Triggers
•
Think “full body”: memories are laid down in all sensory spheres (smell,
sound, vibrations, colors, etc)
•
Terrain: desert, urban
•
Weather: heat wind, humidity
•
Songs
•
Smells
•
Driving: signature trigger for OIF/OEF vets (assess driving safety !)
•
Nature of war in Iraq and Afghanistan
•
Need for high speeds, evasive maneuvers
•
Importance of a driving assessment
•
People: automatic response to persons who appear Middle Eastern,
children
•
Situational: mimic loss of control powerlessness (e.g. dentist chair,
anesthesia, OB-GYN exam, endoscopy, etc)
39
PTSD: non-DSM
What does PTSD feel like – What do you “hear” in therapy
1. Sense of immediacy (“happening right now”)
2. Re-experiencing of original memories and sensory impressions
3. Involuntary
4. Guilt
• Rational or irrational
• Understanding atrocities
• “Survivor Guilt”, also guilt for leaving, being intact
5. Grief
• Multiple losses without time to grieve
• Affective numbing, anger/revenge
• Impact of pre-war losses, post-war losses
• Deaths of loved ones during deployment
6. Other Feelings
• Anger at Government
• Mistrust of Authority
• Desire to return to the war zone
• Damage to spirituality
Handout – F1, F2
40
TBI: Traumatic Brain Injury
•
Signature Injury of OIF/OEF
•
Prevalence hard to estimate
•
Approximately 2100 Afghanistan troops
diagnosed since 2001 as of 08/2007
•
VA reports 61,285 OIF/OEF vets had
preliminary screen, 11,804 were positive (20%)
•
Prevalence has probably been underestimated so far
•
Explosions account for 3 of 4 combat-related injuries
•
Improvements in war zone medical treatment decreases fatalities but may
impact rise in TBI
•
Soldier return home with “poly-trauma”
•
Symptoms: headaches, tinnitus, dizziness, balance problems, sleep
problems, persistent fatigue, speech, hearing and vision impairment,
sensitivity to light and sounds, heightened or lessened senses,
impairments in attention and concentration, memory problems more like
dementia than amnesia, poor impulse and anger control
41
MST: Military Sexual Trauma
1. 2008 Rand Study reported 16% - 23% experienced MST
2. Reported MST were 1,700 in 2004 and 2,947 in 2006
3. VA indicates that 1 in 4 female veterans using the VA
reported at least one MST
4. The VA Day Hospital Program estimates 3-5 female
referrals have MST
5. Treatment Considerations
• May be compounded by combat trauma
• Frequently unreported
 Trauma occurs in context of where the solder lives and works
(comparable to incest)
 Military Culture emphasizes cohesion
• Males victims as well as female
• Female perpetrators as well as male
• Largely male population in the VA where female veterans go for help
Handout – C2
42
PTSD Treatments
•
•
•
•
Cognitive Therapy (CT)
Exposure Therapy (ET)
Stress Inoculation Training (SIT)
Eye Movement Desensitization
& Reprocessing (EMDR)
VA Opinion of PTSD Interventions
Generally individually oriented
and systemically focused – “One
size does not fit all”
Handout – G1, H1
43
… A Extra Word About The Children
•
Currently, there are about 230,000 American children and teenagers with an
active duty mother or father at war. [Another 320,000 from Reserve/Guard
families. 550K total] Nearly half of all troops deployed in support of the
recent wars are parents — most of whom are on their second or subsequent
deployments. (Aug ‘09)
•
In 2008, military children and teens sought outpatient mental health care 2
million times, which was double the number at the start of the Iraq war
(2003), according to an internal Pentagon document obtained by The
Associated Press.
•
An article published by the Associated Press (August 9, 2009) notes a
Pentagon report indicating a 20 percent increase in the number of active
duty dependent children hospitalized for mental health needs between 2007
and 2008.
•
The document revealed there was also a spike in the number of service
members' children hospitalized for mental health reasons.
•
http://www.msnbc.msn.com/id/32585278/ns/health-kids_and_parenting/
http://cbs3.com/wireapnewspa/Camp.for.military.2.1147685.html
44
Realizing the bridge is down…
“Home—the place many think is the safe haven to
find relief from the stress of war—may initially be a
letdown. When a loved one asks, ‘What was it like?’
and you look into eyes that have not seen what yours
have, you suddenly realize that home is farther away
than you ever imagined.”
Down Range: From Iraq and Back, by Cantrell & Dean, 2005
Handout – H2
45
Agenda
Topic
Duration Comments
Presenters, Goals and Agenda
Oath of Enlistment
Intro and Opening
5
CareForTheTroops.org
10
Overview Mission / Role of Clinicians
Show Key Website Components for Clinicians
Review Enrollment and Marketing Assistance
Causes For Concern
En’visioning’ the Issues
25
Brothers at War Trailer
Audience Discussion
Fraser Center Perspective
Military Culture
15
Jargon and Organization
Deployment/Family Life Cycles
Stressors
Clinical Treatment Info
15
Demographics
PTSD-Signs and Treatments
Family Therapy Approaches
Case Study
Q&A and Closing
5
Handout – A0 …..an Example
On-Going Discussion
46
What This Presentation WAS About
There were 5 goals of this presentation:
1. Review ‘causes for concern’ and the need for private and public sector
to work together to address these concerns
2. Review how CareForTheTroops is attempting to address
these concerns and provide access to information for
clinicians
3. Review key military culture issues that can impact
the mental health of a military family
4. Review the recommended treatments for military trauma, what
triggers to look for, and commonly encountered issues
5. Motivate all in attendance to continue the work to
provide mental health support to all military family members
47
In Closing…Consider These Next Steps
• Look for more training opportunity to learn about treating the military.
Visit www.CareForTheTroops.org
• Consider training in a trauma treatment technique
• If you are willing to work with military families, enroll in the
CareForTheTroops database, complete a Tricare application, and enroll
with Military OneSource
• Consider being a trainer to outreach to community organizations,
congregations, and other counselors
• to participate in the CFTT initiative
• to market your practice
Handout – L1, M1
48