Transcript Slide 1

Military Culture & Treatment - 101
An overview of the culture of the military
and its families, issues affecting treatment,
and sources of support
Peter McCall
Exec Dir, www.CareForTheTroops.org
[email protected]
770-329-6156
Dr. Amy Stevens, Ed.D., LPC
Arcadian Resources, Counseling and Consultant Services
[email protected]
770-509-1034 (o) 770-309-7877(c)
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Presentation Goals
There are 5 goals of this presentation:
• Understand the basics of the
military culture and veteran issues
• Review key issues that can impact
the mental health of a military family
• Review the recommended treatments for military trauma,
what triggers to look for, and commonly encountered issues
• Provide an understanding of resources available and how
CFTT, Amy Stevens, and others can help
• Ultimately, build more credibility for working
with military families
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Opening Videos
These three movie trailers provide a
good backdrop to the Veterans Issues
we are about to discuss.
Please take notes as a discussion will
be conducted after the next section.
The run time is approximately 8
minutes.
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Veteran Issues and Concerns
1. Multiple deployments
2. PTSD, TBI, or significant Mental Stress
3. Mental health, marriage, and family
problems
4. The impact on military children and teens
5. Where Did They Come From? Family
Income?
Active
NG/Reserve
Small Town
44%
40%
Large Town
27%
30%
Urban Area
29%
30%
6. Active 33%
50%
< $42K / year
$42K - $65K / year
7. NG/Reserve median income=$46K / yr
8. Suicide is rising 20-29 8.4% 50-59 21.2%
30-39 10.8% 60-69 31.8%
40-49 16.3% 70+
55.8%
9. Addiction, alcoholism, drug abuse, domestic
abuse, violent crimes
10. Military Sexual Trauma (MST) – includes
Assault, Coercion and Unwanted Attention
11. DoD and VA facilities are stretched
12. Unemployment rate among post 9/11
veterans as 15.2% in January 2011, well
above the 9.6 percent rate for non-veterans.
13. Homelessness
14. More Reservists & Guardsmen are serving
than previous wars
15. Rand Study (‘08) estimates that PTSD and
depression among service members will
cost the nation up to $6.2 billion in the two
years after deployment.
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Discussion
…Does a Therapist Have To Be a Vet?
• Without extended military combat experience, a
therapist cannot understand (that's OK)
• Let the soldier know that you know you cannot
understand
• Let the soldier know you have no expectations that they
will tell you about his experience unless they want to
• Let the soldier know you may need their help in
understanding terms sometimes
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Discussion
Must a Congregation have deployed military to motivate
getting involved and being knowledgeable?
Who are the children?
A 9 minute video from the TV Show “Sunday Morning” that aired in February 2014.
Click Here to view the video
How significant a role can Pastors/Rabbis play in
addressing the needs of veterans? (4.5 min)
http://www.dvidshub.net/video/151300/american-veteran#.UvGCBWJdWa8
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Military Culture
Branches of the Military
Georgia’s Military presence is dominated by Marine and Army units, though Air Force
and Navy are well represented too.
Georgia’s National Guard also has a large number of transportation units subject to IEDs
on roads and highways. It was ill-prepared when first deployed in 2003.
Georgia is 3rd largest National Guard State. With the current base closing plan, GA will
be one of the 5 largest military states along with TX, CA, NC, VA
NOTE: Coast Guard is now under Homeland Security
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Atlanta Metro Area Veteran
Population as of 9/30/2013
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Governor
Nathan Deal
President
Commander-in-Chief
Maj. Gen. Jim
Butterworth
National Guard
Bureau
Adjutant General
Georgia Department
of Defense
Army
National
Guard
11,000+ Soldiers
Air
National
Guard
2,800+ Airmen
State
Defense
Force
800+ Members
State
Operations
460+ State Employees
Military Culture
Regular/Active Duty vs Reserve/Guard Units
Regular / Active
• Based at major
installations.
• Full-time soldiers
• Variety of support on-post
& in communities for families.
• 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
soldier’s unit
Reserve / Guard
• Small & based in local
communities.
• Part-time soldiers
• Few support services for families.
• 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
• Need to make use of family or
local supports (church, etc.)
though FRG’s are very helpful 11
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
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Families
Reserve and National Guard Family Concerns
• Families are not as experienced with deployment and
extended absences
• Family members are less familiar with military
support agencies
• Live in local communities with less
access to military support systems
• Face integration back into civilian job
or may need job assistance.
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Children
Developmental Issues
• Toddlers (3-5) - Separation Anxiety,
Self-Comforting Behavior, Regression,
Refusal to Eating and Sleep
• Elementary (5-10) - Anxiety, Withdrawal,
Regression, Fear, Uncontrolled Acting
Out, Behavioral Contagion
• Middle School (10-13) + Fighting, Isolation Behavior,
Emotional Contagion, Difficulties with Concentration
• Teenagers (13-18) + Rule Testing, Substance Use,
Assaults, Use of External Systems for Support
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Facts about Military Women
• According to (VA) estimates, the number of female veterans will grow
from 1.8 million (8.2% of all veterans) in 2010 to 2.1 million (15.2%) in
2036. The number of male veterans is expected to decline.
• Prior to the recent recession, female veterans ages 18-24 had an
unemployment rate of 16% – double that of their non-veteran
counterparts. The overall unemployment rate for post-9/11 female
vets surged to 19.9 percent in September 2012 compared to 14.7
percent a year earlier and 12.1 percent in August.
• Women veterans are up to four times more likely to:
– 1) be younger than their male counterparts, with a median age of
47 for female veterans versus 61 for male veterans;
– 2) identify themselves as a racial minority;
– 3) have lower incomes than male veterans; and
– 4) be unemployed.
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• Women’s Health Education
– Female Hygiene Issues for about 50%
• Uniform and Protective Gear Fit
– Chafing and Limited Mobility
• Psychological Effects of Deployment
– Pre and Post Education about deployment
– Lack of Contact with Other Women
– Challenges of Being a Mother
• Post Partum Issues and Length of Dwell Time
• Effects of Deployment on Children and Families
• Sexual Harassment/Assault
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Caregivers
• Unique Challenges
Caregiver Support Website
– Navigators and Advocates
www.caregiver.va.gov
– Legal and Financial
855-260-3274
– Childcare and Jobs
• Self-sacrifice
– Physical Strain and Emotional Distress
– Lack of Self Care
– Disportionate Mental Health Problems
• Available Resources
– Limited Help & Lack of Access
– New Programs Post 9-11 and Varying Eligibility
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The Trauma Continuum
“The past is never dead.
It is not even past.”
…William Faulkner
“Not everyone has PTSD.
It is not the only diagnosis.”
…me
ASR
COSR
PTSD
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Trauma Continuum:
ASR to COSR to PTSD
• ASR (acute stress reaction)
produces biological, psychological, and behavioral
changes. ASD means it has become
disruptive and destructive.
• COSR(combat and operational stress)
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”
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Trauma Continuum
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
Don’t Forget “Inter-Generational” PTSD
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Trauma Continuum
VA Opinion of PTSD Interventions
• Cognitive Therapy (CT)
• Exposure Therapy (ET)
• Stress Inoculation Training
(SIT)
• Eye Movement
Desensitization &
Reprocessing (EMDR)
• Generally individually
oriented and systemically
focused – “One size does
not fit all”
From VA website, 2010
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The Spiritual Wounds of War
“The soldier’s heart, the soldier’s spirit, and the
soldier’s soul are everything. Unless the
soldier’s soul sustains him, he cannot be relied
on and will fail himself, his commander, and his
country in the end.
. . . General George C. Marshall
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The Spiritual Wounds of War
Veteran Quotes of Spiritual Injuries
•
•
•
•
•
•
•
•
•
•
•
“I was totally alone”
“I was not myself”
“I saw myself dead”
“I lost my innocence, sanity and faith”
“Time stopped”
“Did I die there?”
“I became mean and cold”
“I was afraid”
“I never talked about it”
“I reject religion”
“Nothing prepared me”
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The Spiritual Wounds of War
The Insidious Nature of Trauma
Spirituality requires a balanced connection between mental,
physical, emotional, and relational wellbeing
Trauma’s emotional and cognitive distortions cause numbing
and impairs relationships with families and God/Higher Power
Pre-Trauma Spiritual Approach
Post-Trauma Inhibiters
Experiential – Feeling God’s presence
Numbing of emotions and relationship
disrupts one’s experience
Cognitive – Well thought out belief in
God/Higher Power
Disrupts ability to process logically and
grasp belief (esp. if TBI exists)
This results in making the renewal of spirituality very difficult
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The Spiritual Wounds of War
Repairing Spiritual Injuries and Interventions
• The need for forgiveness of self and others
• Atonement for what one has done during combat
• Commitment to reparations regarding behavior, especially
violent behavior during combat
Interventions:
“Things to do vs Talk”
Introduction of rituals which enable a soldier and family transition from the
combat ready culture to the former culture of family, home, or social group
• Spiritual
• Body Movement
• Communal
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Resources
Webinars and On-Line Training
Beginning in 2011, large, well funded, well supported organizations began making
Webinars available that are of high quality. Appropriate topics and expert speakers
are being made available to all of us interested in the issue of helping veterans and
military personnel and their families. I have listed here two organizations that I
suggest you consider “enrolling” with so that you can get reminders sent directly to
you.
http://www.dcoe.health.mil/Training/Monthly_Webinars.aspx - past sessions
available back as far as 2011
http://www.aosresourcecenter.com/ - recordings available upon request
Additionally, the CareForTheTroops website keeps a calendar of these and other
events and also brings together on-line training modules from Alliant University, the
VA, Army OneSource, and the Pam Woll Series.
http://www.careforthetroops.org/search_events.php - The Calendar
http://www.careforthetroops.org/training_online.php - Training Modules
http://www.careforthetroops.org/crisis_intervention.php – Resource List
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Resources – Star Behavioral Health
http://starproviders.org/states/georgia
www.CareForTheTroops.org
Enabling communities to better
support veterans, civilian contractors,
and their extended families
This presentation is intended to provide an overview of the
Veteran Friendly Congregation (VFC) initiative which Faith
Communities can consider adopting and implementing
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Resources – CareForTheTroops’ Approach
Military
Member
Person in
need of
support
Spouse
Siblings
Children
Parents
Grandparents
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Military Ministry
Purpose
The ministry approach is intended to address all
the extended family members associated with
the person that is or has been in the military. The
ministry has the following goals:
• Help the congregation members maintain an awareness of the existence and needs
of those sacrificing their time and effort to support our country
• Create an environment of acceptance within the congregation for any extended
family member who worships or visits the congregation; acceptance of their needs
(physical, material, and spiritual), and a willingness to join in their struggles,
whatever they might be
A Military Ministry is a commitment by the congregation to the military
families and to themselves to provide support. It is not a commitment to
the CareForTheTroops organization.
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What is a Veteran Friendly Congregation (VFC)?
www.CareForTheTroops.org/about_programs.php
A VFC is making a commitment to have a Military Ministry
that provides support to the veterans and their families
A VFC means making the following 3 commitments:
• Agree to adopt or implement one or more Military Ministry Programs.
• Agree to communicate the existence of the Military Ministry Program(s)
at least twice a month
• Annually, renew your commitment with the two provisions above
A VFC will receive a certificate, suitable for framing and display in a
prominent location so that it can be seen by all. Also, 1 copy of the book
“Welcome Them Home, Help Them Heal” is provided that helps one
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understand a military family’s needs and how congregations can respond.
In Closing
What are some next steps to consider?
1. Get on the Tricare Panel
2. Enroll in the CFTT Database
http://www.careforthetroops.org/clinician_cftt_enroll.php
3. Enroll in the STAR BEHAVIORAL HEALTH database after taking
their training http://starproviders.org/states/georgia
4. Go to additional training from CFTT or another organization.
Consider attending EMDR training
5. Ask your current congregation to join the VFC initiative
http://www.careforthetroops.org/overview_congregation.php
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