Building Competency to Serve Active Duty & Reserve Members, Veterans and Dependents. Re-Integration and Recovery.
HCHV COORDINATOR VAAAHS
Shawn Dowling
P E E R S U P P O R T S P E C I A L I S T
V A S U P P O R T E D H O U S I N G P R O G R A M V A A A H C S
Vincent Warren
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
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,
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
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
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
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)
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
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
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
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
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
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,
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
Must be seen by Military MH
Recurrent depression or anxiety
disorders
Psychiatric medication for > 1 year
Hospitalized for any psychiatric
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.
