Military Culture & Treatment - 101

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 petemccall1@gmail.com 770-329-6156 Dr. Amy Stevens, Ed.D., LPC Arcadian Resources, Counseling and Consultant Services amstevens@mindspring.com 770-509-1034 (o) 770-309-7877(c)

2. Presentation Goals • There are 5 goals of this presentation: • Understand the basics of themilitary 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

3. 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.

4. Veteran Issues and Concerns

5. 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

6. 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

7. Military CultureBranches 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

8. Atlanta Metro Area Veteran Population as of 9/30/2013

9. Organization GovernorNathan DealCommander-in-Chief President Maj. Gen. Jim Butterworth Adjutant General National Guard Bureau Georgia Department of Defense StateOperations StateDefenseForce AirNationalGuard Army NationalGuard 460+ State Employees 11,000+ Soldiers 2,800+ Airmen 800+ Members

11. Military CultureRegular/Active Duty vs Reserve/Guard Units Regular / Active Reserve / Guard • 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 • 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

12. Family readjusts - Consequences for behavior The Military Deployment Cycle … or The Military Family Life Cycle Pre-deployment Conflict & Previous Stressor pile-up Revitalize Relationships and “honeymoon” Pre-deployment Stress – anxiety and concern Reunion and homecoming – joy and anticipation Soldier Deployment Pre-reunion Stress – anxiety and worry about behavior away Separation Stress – Depression & Anxiety Family Adjustment w/o Soldier in Home – Out-of-Ordinary Behaviors

13. FamiliesReserve 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.

14. ChildrenDevelopmental 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

15. 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.

16. 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

17. Caregivers • Unique Challenges • Navigators and Advocates • Legal and Financial • 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 Caregiver Support Website www.caregiver.va.gov 855-260-3274

18. 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

19. 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” Trauma Continuum:ASR to COSR to PTSD

20. 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 Trauma Continuum Signs / Symptoms Of (Combat) PTSD Don’t Forget “Inter-Generational” PTSD

21. 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

22. 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

23. 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”

24. 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 This results in making the renewal of spirituality very difficult

25. 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

26. ResourcesWebinars 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

27. Resources – Star Behavioral Healthhttp://starproviders.org/states/georgia

28. 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

29. Resources – CareForTheTroops’ Approach Affected Systems Extended Family Members Person in need of support Congregations Children Employers Spouse Parents Military Member Siblings Grandparents Community

30. 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 acceptancewithin 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.

31. 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 understand a military family’s needs and how congregations can respond.

32. In ClosingWhat are some next steps to consider? • Get on the Tricare Panel • Enroll in the CFTT Database http://www.careforthetroops.org/clinician_cftt_enroll.php • Enroll in the STAR BEHAVIORAL HEALTH database after taking their training http://starproviders.org/states/georgia • Go to additional training from CFTT or another organization. Consider attending EMDR training • Ask your current congregation to join the VFC initiativehttp://www.careforthetroops.org/overview_congregation.php