Building Competency to Serve Active Duty & Reserve Members, Veterans and Dependents. Re-Integration and Recovery.

HCHV COORDINATOR

VAAAHS

Shawn Dowling

LCDCIII, LISW-S, ACSW

PEER SUPPORT SPECIALIST

VA SUPPORTED HOUSING PROGRAM

VAAAHCS

Vincent Warren Management Specialist, U.S Navy

Understanding Military Culture

In order to effectively meet the needs of military members and their families we must understand the culture within the US Military.

Culture is defined as: The set of shared attitudes, values, goals, and practices that characterizes an institution, organization or group

What is Different for Military Members compared to Being a Civilian

Service is Generational

Lack Control Over: Location, body, clothes, etc.. Becomes a piece of Government Property

Dependents Are Not Encouraged to Ask for Help or Admit they Need it.

Constant changes in regulations, expectations, and position security

Freedom of speech limited

Cannot Advocate for a Sober Work Culture

Cannot Transfer or Quit

Violence is a Fact of Every Day Life

Can’t call in sick or take a mental health day

Confidentiality is non existent

Constant reintegration

1% of population

Common Military Behaviors

Being constantly on guard (hyper vigilant) Common practice for weapons to be present Stoic/Flat affect Recalling events repeatedly Emotional numbing/detachment Heightened response to loud noises Lack of assertiveness/speaking up Situational awareness THESE BEHAVIORS MAXIMIZED SURVIVAL

DURING ENLISTMENT, BUT CAN BE CONSIDERED DISRUPTIVE IN CIVILIAN ENVIRONMENTS

OLD WAYS OF THINKING BY THE MEMBER AND SOCIETY

Seeking help is a sign of weakness

Impacts career-deployability, promotions

Combat Veterans are all “messed up”

Service members are victims of government agenda

WWII, Korean, Vietnam veterans didn’t need help-they didn’t have problems.

If a member deploys they have PTSD, or have experienced some form of trauma

When a crime has been committed by a service member- military service is disclosed

The Current Epidemic of Suicide

20.2 per 100,000 soldiers have completed suicide-higher than current civilian rate.

32 suicides in the month of June 2011. 22 had been deployed, of those 10 had deployed 2-4x.

Males 18-24 at higher risk.

Security Forces, Maintainers and Recruiting at higher risk.

155 suicides in the first 154 days of the year-2012

Undocumented attempts

Inability to cope is interpreted as a loss of respect, dignity, lacks resiliency and purpose.

Drugs Impact Military Discipline

The abuse of alcohol, prescription drugs or the use of illicit drugs are inconsistent with the Armed Forces Values, the Warrior Ethos and the standards necessary to accomplish the mission:

• Performance

• Discipline

• Safety

• Readiness

Substance Use Disorders

Pain Medication while in the field-not prescribed when they return home.

Return home, substances are used as a tool during the reintegration period

Coping mechanism to assist with anxiety, depression, trauma, adjustment

Sleep meds prescribed due to drastic changes in sleep patterns

Times are Changing

Lt. Col. Wayne Talcott, Air Force Psychologist stated; “You maintain a jet engine so it doesn’t fall out of the sky,” he said. “We need to begin to look at where there are risks to the human weapon system and how we can build a system that protects our people.”

Mitigation Strategies

Significant Protective Factors can be Mobilized BEFORE hand that are PROVEN to work

Prevention Education

Team/Social Support

Coworker Peer Referral

Supervisor Responsiveness

Stigma Reduction

Advertising of Resources

Team Moderation in Alcohol Use

Wellness Lifestyle

Positive Policy Attitude

Significant Stress for Members Before, During, After Deployment

Accelerated Deployment Impacts Operational Readiness (Individual & Unit) Impacts: • Retention • Accidents • Mental Health & Stress Disorders • Substance Abuse • PTSD • Co morbidity of PTSD/Substance Abuse • Family Problems / Generational Impact / Community

Risk Factors Mitigation

Current Pilot Programming for Military

Needs assessment/Data collection and integration

Data visualization and data dashboard projects (DE, IA, MD, NH)

Tracking Veteran status on driver’s licenses (GA, MD, UT, WA)

Workforce development/Military culture-informed services

Hosted Operation Immersion (AZ, TN, RI)

Military cultural competency training (AZ, IA, ME, NC, OH)

Training with law enforcement and first responders (CT, ME, NC, OH)

ESGR-Employment Support for Guard and Reserve

Criminal Justice Implementation of Veterans Treatment Courts (FL, NH, ME, UT, OH)

Intimate partner violence strategic action plan (CT)

Veteran Dormitory Program in prisons and jails (FL)

Navy Capt. Robert Murphy, a medical corps officer stated that

“We’re certainly not opposed to alcohol use, but we are trying to

reduce the prevalence of alcohol abuse.”

Then VS. Now

Old Approach New Approach

Goal: Eliminate the problem Cultural change

Focus: Deterrence Prevention

Target: Service member Circle of Influence

Primary Responsibility: Service member Service member

Substance Abuse:

Abuse vs. Addiction

Individual Issues Community Issues

Approach: Punitive

Intervene to prevent substance

abuse and foster rehabilitation

Key Message:

Don’ t Get Caught

Every Service member has a duty

to intervene to prevent substance

abuse and access to rehabilitative

services with command support

Policy Academy Objectives

17

Strengthen behavioral health systems for Service Members, Veterans, & their Families

Involve Service Members, Veterans, and Families

Increase access

Close the gaps

Build capacity

Increase interagency communication/collaboration

Incorporate best practices

Plan for sustainability

Mental Health

Adjustment disorder vs. SPMI diagnosis Allowed medications Understanding needed documentation Evaluation Diagnosis/prognosis Meds prescribed Treatment Plan Regular Summaries

Acknowledge the concern they may feel that seeking treatment will impact their career.

Understanding the Process

Member seeks help

Placed on Profile: ALC-C code given: Good for 1 year

Unfit

Disqualifying diagnosis-MEB required. Retire or discharge

Unsuitable

Not a medical issue -command determines to

retain or discharge

Unfitting Diagnoses’

Psychosis, unless brief and from a reversible cause

Persistent impairment (> 1 year)

Continuing psychiatric support (> 1 year)

Recurrent impairment (>1 in 1 year)

Conditions requiring use of lithium, anticonvulsants, or antipsychotics for mood stabilization

Unsuitable Diagnosis’

Personality disorders

Learning disorders

BUT ALSO:

ADHD; if medication required, WWD and waiver request from NGB/SG required

Adjustment disorders

Sexual perversions

Flying phobia

Substance use disorders

Must be seen by Military MH

Recurrent depression or anxiety disorders

Psychiatric medication for > 1 year

Hospitalized for any psychiatric condition

RECOVERY/RESTABILIZATION

It is a PROCESS not an EVENT.

Provider competency a must, without it the individual will dis-engage.

Know the SYSTEM and the INDIVIDUAL

Assist with Serving the “Whole Person” including the Dependents in a non-threatening setting that is family focused. Remember they are trained as a team work with them as such.

HELPFUL HINTS

Learn the Language: www.militaryfactory.com

Understand Rate and Rank, Medals and Awards.

Learn About the Base closest to your practice/agency

Deployment Structure-for active duty, reserve, guard.

Understand and Respect the Traditions and Expectations of the Military Culture-customs and courtesies and military bearings.

References

http://usmilitary.about.com/library/milinfo/milarticles/blalcohol.htm

http://www.ptsd.va.gov/

http://www.afterdeployment.org/

http://www/samsha.org/

http://www.vetsprevail.com