Presentation on theme: "1st SERGEANT’S BRIEFING Airmen in Distress"— Presentation transcript:
11st SERGEANT’S BRIEFING Airmen in Distress Neysa EtienneClinical PsychologistMaxwell Air Force BaseMental Health Clinic 42nd MDG
2Learning objectives Describe Phenomenon of Suicide ModelMindManage your reactions to Airmen in distressTake a collaborative, non-adversarial stanceManage Suicide Risk in AirmenHelpful Language and ApproachReconcile conflicting goalsPlan for how to assistAwareness of helping agenciesIdentify and Manage Airman in CrisisManage your reactionsReconcile Conflicting Goals: You desire to keep them safe, VS their desire to engage in self injurious behavior.
3Why The 1st Sgt? Spends time w/ personnel almost every day Is most likely familiar w/ typical behaviorOne of the first to see problems developYou are the first line of defenseBeing proactive with wellness & safety benefits people as well as the AF’s missionRationale…WHAT ARE YOU DEFENDING AGAINST? Lets take a look. This came out just last week…Stats update…HOW BIG OF A PROBLEM IS THIS? AND WHY IS IT RELEVANT TO YOU?Every single one of those completed AD suicides had a 1st Sergeant, a dormmate, a Commander
4COMPARISON BETWEEN:Air Education & Training Command and AIR FORCEAIR FORCELETS SEE WHAT WE BELIEVE ABOUT THESE NUMBERS…
5SNAPSHOT: MILITARY FAMILIES : > 1,100 members of the Armed Forces took their own lives2010: ARMY suicide rate among active-duty soldiers decreased slightly2009: 1622010: 1562010: Number of suicides in the Guard and Reserve increased by 55%2009: 802010: 1452010: More than half of the National Guard members who died by suicide had not deployed.* Suicide among veterans accounts for as many as 1 in 5 suicides in U.S.* No greater risk for service members compared to general population…AVERAGE OF 1 SUICIDE EVERY 36 hours& 3 These numbers may reflect differences in deployment tempos and percentages between AD vs Guard vs Reserves4. Interesting Stat, and encouraging
6“Mostly, I have been impressed by how little value our society puts on saving the lives of those who are in such despair as to want to end them. It is a societal illusion that suicide is rare. It is not.”--Kay Redfield JamisonHOW RARE IS IT?
7SNAPSHOT: UNITED STATES - 11th leading cause of death in the US- 2nd leading cause of death among college students- 3rd leading cause of death for young people aged 15-24- 4th leading cause of death among people aged 25-44- For every suicide event, 6 survivors are left behind- More than 30,000 Americans Commit suicide every year- 1 Suicide in the US approximately every 17 minutes- 650,000 attempted suicides per year- 2:3 Ratio (HOMICIDE TO SUICIDE) in the U.S.Startling to think that over the course of these three + hours we will spend together, approximately 12 people would have taken their life somewhere in the US.
8MYTH OR FACT 1. Suicide Usually Happens with no warning 2. More than 70% of people who kill themselves have previously considered it seriously?3. There is most often a note left behind when someone commits suicide.4. People who are suicidal are intent on dying and feel there is no turning back?5. Someone who survives a suicide attempt is really not serious about it.Discussing suicide openly with someone who seems really depressed does more harm than good.People who attempt suicide once, are unlikely to try it again.MYTH: Fact is 8/10 people who kill themselves give some sort of warning or clue to others, even if it is subtle.FACT: Myth is Someone who talks about suicide a lot is just trying to gain attentionMYTH: Fact is, in most cases there is NO NOTE, or explanation.MYTH: Fact is… most people who are suicidal are of two minds about it. Part wants to die, but part of them does not. The main thing is they want is to stop their pain.MYTH: Fact is: Any suicide attempt should be treated as though the person intended to die, and not simply dismissed as an attention seeking device.MYTH: Fact is discussing it openly can actually help not hurt.MYTH: 80% of people who die from suicide have made at least one other attempt already.MYTH OR FACT: SHOUT OUT WHAT YOU THINK!Perhaps because suicide is rarely talked about openly,there are a lot of mis-conceptions surrounding the issue,including who is at risk,why and underwhat circumstances it occurs,and how to get help.Knowing the facts is criticalto taking action and essential in saving lives.recommendation to “maintain continuity of care acrosstransitions” for service members and veterans. TheDefense Centers of Excellence for Psychological Healthand Traumatic BrainInjury (DCoE) man-ages the programand its supportcoaches. Family members are also encouraged to callthe program to find out how their service member canget started with inTransition. Coaches are available24/7 via toll-free call.All inTransitioncoaches are skilled counselors whounderstand today’s military culture and issues. Theyunderstand and respect the importance of your privacy.They are with you every step of the way. When youcontact inTransition, you will be assigned your owncoach who will:Coachyou one-on-one as you go through your transitionConnectyou with your new providerEmpoweryou with tools to continue making healthy life choicesSimply call the toll-free numbers:Inside the United States(DSN) Outside the United States toll-free(collect) Outside the United StatesJoin our listserv!
9EXPERIENTIAL EXERCISE FIND A PARTNERFACE OFFRELATEDEBRIEFWHY?Let’s pause here for a moment for a fun little interactive exercise…EVERYONE Get a Partner… Someone in close proximity. And I want you to face off, as best as you can. EYE to EYE. So be sure you are looking each other square in the face. Now one of you please volunteer to go first. Let me see? Who are my brave souls.Okay, now for the next 4 minutes, I want you to look at your partner and share your most AMAZING sexual experience… Spare no detail! Just jump right in and tell them the who what when where how… and why it was SOOOOO FANTASTIC!Hmmm… a bit quiet. Anyone feel a bit uncomfortable? Can someone tell me why?Okay, so here is the thing, that I hope you can take away from that experience.I was asking you to share a HIGHLIGHT EXPERIENCE, and it was not easy... For a number of reasons…People do not come in for tx to share their life highlights. Usually PTSD equates to the worst experience in their life.I hope you can remember that sense of discomfort you felt sharing a + experience, bc it is magnified 100 fold when your airman are coming to share something so – and painful, so we need to make it easier for them to share.
10MIND & MODEL Theoretical Framework BIOPSYCHOSOCIAL MODEL THE SUICIDE MODE (Rudd, 2009)Predispositions to SuicideTriggersInteraction between:Perceptions (thoughts)Emotions (feelings)BehaviorsPhysiology
11This diagram illustrates THE SUICIDE MODE (FRAME OF MIND) model of suicide. Attempts to provide a foundation to understand how an individual arrives at the point of wanting to end life by taking into account:Any contributing biological and genetic factors such as: Genetic Predisposition towards impulsive behavior, family history of suicidal behavior, family history of psychiatric disorders.Any contributing psychological factors: mood state, impaired problem solving, hopelessness, despair.Any contributing social factors: lack of adequate support network, lack of adequate access to helping resources.TAKEN ALL TOGETHER… the biological/psychological/ and social factors create a profile of PREDISPOSING FACTORS. OR A PERSON’S BASELINE RISK FOR SUICIDE…This model is known as the suicidal mode (Rudd, 2006) According to theory, in the combination of predisposing factors and an acute stressor (SUCH AS) can trigger or activate a suicidal episode. The suicidal mode consists of cognitive, affective, behavioral, physiological, and motivational systems that interact with each other and sustain the suicidal state.
12BASELINE RISK Predispositions Previous suicide attempts Impulsivity MaleSame sex orientationRecent discharge from inpatient unitFamily history of suicideHistory of physical, emotional, or sexual abusePrevious suicide attemptsImpulsivitySubjective or Objective
13ADDITIONAL RISK Additional Risk Factors Older Caucasian Isolated Medical issuesAlcohol useDepressionPanic attacksThe following basic risk factors have remained relatively consistent over the years…The theoretical models identified cognitions, emotional processing, and associated behavioral responses as critical to understanding motivation to die, associated distress (and symptoms) and ultimately changing the suicidal process. Patients found the models easy to understand, distilling them down to thoughts, feelings and behaviors that are associated with suicide risk and hopelessness. In short, these treatments made it easy to sit down with a patient and explain in understandable language why they have tried or are thinking about killing themselves. This was an important consistency across effective treatments.
14PROTECTIVE FACTORS Optimism about the future Strong social support life has purpose and meaningFeeling a sense of belongingWillingness to seek helpWillingness to talk about problemsEffective coping and problem solving skillsCultural norms that encourageOptimistic… This will passSocial support: from family, friends, and co-workersBelief that your life… One individual told: Message of childhood…Mom and Dad never believed you would amount to much. You were not wanted, you were an accident…The In Group and the Out Group (even in the AF)Cultural Norms ENCOURAGE PEOPLE TO SEEK HELP… It is part of your job to create that cultural norm. Is that a norm you are familiar and comfortable with? If not… it will be hard for you to create… Need to work through your own reasons and examine your own beliefs…
15KNOW YOURSELF Questions to ask self: Self-Awareness of personal reactionsHow to Manage Your ReactionsUnhelpful AttitudesRecognize Difference in GoalsConflict of interest in accomplishmentReconcile differencesCollaborative approach
16Questions to ask self Why do people die by suicide? What are your beliefs about suicide?What have you learned about suicide during your life?What type of person kills themselves?Who do you know that has died by suicide?(Rudd, 2006)What is your core belief?How do you feel about the act? spiritual and/or moralWhat is your personal experience, and how might past experiences you have had taint, inform and influence how you view this topic…
17BE MINDFUL OF REACTIONS FearHelplessness: “I can’t do anything to help”Hopelessness: “Nothing I do matters”AnxietyOver-protectiveness: Reduce autonomyUnder-protectiveness: Casual avoidanceAngerLack of compassion: Inability to careCriticism: Blaming
18YOUR REACTIONAccept that we will have emotional reactions to the problems our Airmen bring to usTake some time to explore our beliefs about the issues we will commonly faceKeep in mind that it is not our problem or perspective that matters, but the Airman’sRecognize that you do not have to agree with an Airman’s beliefs, perspectives, or behavior in order to help them
19ATTITUDES & BELIEFS Avoiding or denying that the Airman has a problem Doing the bare minimum to help the AirmanOver-reliance on one’s own opinions and experiencesDefensivenessBelieving the Airman is being manipulativeUndervaluing or overvaluing helping agenciesManaging your reactions to Airmen in distressWhat are your ATTITUDES and BELIEFSHere are some A & B that are unhelpfu, or might get in the way?l
20GOAL CONFLICT 1st Sergeant Goals: 1. Keep Airman safe 2. Keep others safe3. Mission effectiveness4. Protect unit morale5. Stay out of troubleAirman’s goals:1. Reduce distress2. Reduce pain3. Alleviate suffering4. Be understood5. Stay out of trouble
21APPROACH CONFLICT 1st Sergeant: Talk with others Increase healthy behaviorsAccess professional helpDistressed Airman:Alleviate the painDrinkingDrugsReckless behaviorsViolence / aggressionSuicidal ideationApproach to accomplishing the goal…Important to recognize, so you are prepared for the struggle. Not caught off guard.
22Reconciling Differences Understand that the Airman engages in harmful behaviors because they “make sense” and they workRecognize the functional purpose of the behaviorsView the Airman as individual with unique set of issues and circumstancesListen to the Airman’s “story”Part of the work of Reconciling these differences has to do with maintaining a COLLABORATIVE/NON-ADVERSARIAL STANCE(reserch to support this). Based off of the work of David A Jobes (authored Managing Suicide Risk)Emphasizes a CAMS approach which stands for: Collaborative Assessment and Management of Suicidality
23"I got very angry when they kept asking me if I would do it again "I got very angry when they kept asking me if I would do it again. They were not interested in my feelings. Life is not such a matter-of-fact thing and, if I was honest, I could not say if I would do it again or not. What was clear to me was that I could not trust any of these doctors enough to really talk openly about myself."
24Collaborative approach Managing risk vs “telling” the Airmen what is best for him/her.Airmen is the “expert” on his or her behaviorAirmen feels safe discussing sensitive issues.Increase the Airmen’s openness for discussionIncrease the patient’s help-seeking behaviors in the futureImprove the effectiveness of the risk assessment1st Sgt is the “coach”1st Sgt can reinforce any help-seeking behaviors and/or any already existing coping resourcesWilling to do whatever it takes, however long, at whatever timeDecreases the 1st Sgt’s emotions (i.e. lessen the unrealistic sense of responsibility) Can’t work harder than they are willingHow you communicate matters…(Jobes, 2006)Create environment where Airman feels SAFE discussing…
25HELPFUL APPROACHES LISTEN first before giving advice Ask directly about thoughts of suicideTake reports of suicidal ideation seriouslyDon’t be judgmentalDon’t promise anythingExpress genuine caring and hopeDon’t promise secrecy or what will or will not happen…Regarding Military career, impact, hospitalization, secrecy… ETC…
26HELPFUL LANGUAGE I've noticed you're feeling upset. What's going on in your life?Are you thinking about suicide?What do you think might help?Where would you like to go for help?Why don't we make the call together?I'm not going to feel comfortable without being sure you're going to get some help.Accurate, Direct, & Precise:Enhances Communication w/ ProvidersEnhances Communication w/ AirmenCharacteristics:Intent to dieEvidence of self-inflictionOutcome
27Direct Communication HARD communication H Good Ex: “you look down” Bad Ex: avoidanceAGood Ex: “Sometimes people are down”Bad Ex: “Airmen don’t kill themselves”RGood Ex: “Would it be ok if we talk”Bad Ex: “get in my office”DGood Ex: “Are you thinking about killing yourself”Bad Ex: “ambiguity”
28REDUCING ANXIETY Be direct Notice hesitancy and body language “Are you thinking about suicide?”“Do you know how you might do it?”Notice hesitancy and body language“It looks like this is difficult to talk about.”Do not accept the first “no”Ask in slightly different waysRemain relaxed and unhurried“I know this can be tough, so take your time.”
29Raising the issue… Make behavioral observations Express concern “I’ve noticed…” techniqueExpress concernAvoid judgmental languageStick to the facts
30NORMALIZE DISTRESSNormalize the Airman’s feelings through gradual sequencing of questions“When people are extremely upset, they often feel like things will never get any better. Do you feel that way?”“When people feel things will never get any better, they often think about death. Have you been thinking about death or not being around?”“When people think about death, then sometimes think about killing themselves. Have you had any thoughts about suicide?”
31ATTENUATE SHAMEPhrase questions so that positive response do not feel self-incriminating or accusatory“With all this going on, have you been drinking more often?”“You said you were opposed to suicide, but I’m wondering, with all this stress you’ve been experiencing, did you have some thoughts about suicide, even if only a little bit?”
32WHAT ARE SOME SIGNS? Preoccupation with Death and Dying Drastic changes in behavior or personalityRecent severe loss or threat of lossUnexpected preparations for deathGiving away prized possessionsPrevious attemptsUncharacteristic impulsivenessLoss of interest in personal appearanceIncreased use or abuse of alcoholSense of hopelessness about the futureMorbid fascinations… (Music Choices, How room is decorated, clothing choices)Person just seems off, “Not themselves”Major Losses (reputation, loved one, relationship)Making out a will, giving stuff awayHistory of self-injurious behavior, hx of attempts, statementsrecklessness, risk taking (Drunk and playing with a tomahawk…) Reckless driving, flagrant violation of rules (uncharacteristic)Poor hygiene, lack of military bearingComments about bleak future…
33SEEK HELP WHEN… Persistent stress interfering w/ daily life Difficulty copingDifficulty functioningAccumulating signs of distressMultiple risk factorsThoughts about suicideEncourage people to seek help if you notice…
34ACCESS TO LETHAL MEANSSuicidal crises are short-term peaks in distressAmong survivors of life-threatening attempts:24% decided within 5 minutes preceding attempt70% decided within 60 minutes preceding attemptSuicide rates by firearm:57x higher in week following purchase30x higher in month following purchase7x higher in year following purchaseRoutinely ask about methods and access to means multiple times(Simon et al, 2001):IN VIEW OF RESEARCH ON ATTEMPT SURVIVORS: The crisis response plan is very strategic in that it is designed to cover a 60 minute period of time, because if we can move a person through the first 60 minutes of a strong suicidal mindset, we are ACTUALLY addressing close to 94% of the people who would have actually made an ATTEMPT!(Wintemute et al, 1999):
35IMPORTANT TERMS Suicide Suicide Attempt with injury Suicide Attempt without injuryInstrumental suicide-related behaviorSuicide threatSuicidal ideationMorbid ideationInstrumental suicide-related behavior… RISKY BEHAVIORSMORBID IDEATIONS- MORE PASSIVE
36Consult Your suspicions are substantiated Contact The Mental Health ClinicWhen to Contact ThemDOCUMENT Your InteractionYou feel as if you have adequate evidence to support your concern.Confirmed by Airman verbally, collateral informationYour observationWarm hand off to Mental Health… AVAILABLE AT ANY POINT IN YOUR PROCESS OF MANAGING INITIAL CRISIS, but Clinical Risk Assessment of individual is officially conducted by a mental health provider…Documentation of your interactions, observations, concerns, is very important… (NEXT SLIDE)
37Document Improve Continued Risk Assessment Improve Management InterventionsHelp Develop Long Term Treatment PlansExpedite the Transferring of CareVery Important Function in the Case of Morbidity/mortality ReviewsImportant in the case of CDEImportant in the case of Admin Separation
38MH RISK ASSESSMENT Suicide Status Informed Consent Commitment to TreatmentCrisis Response PlanSuicide TrackingStabilizationConsent to treatment…CDE and exceptions to consentEMERGENT CDE G-Series Commander
39Suicide Status Form: Filled out sitting next to the PT Suicide Status Form: Filled out sitting next to the PT. Coming along side them…Break Down of our risk assessment…
40Item 1: Psychological Pain “Psych-ache”: unbearable suffering unique to the individualSuicide risk reduction occurs through 2 processes:Increasing tolerance for psychological painRemoving / ameliorating root of psychological pain
41Item 2: StressLargely external (sometimes internal) pressures or demands that psychologically affect the individualRelationship conflictsJob lossCommand hallucinationsRuminationsIntimately linked to overwhelming feelings
42Item 3: AgitationState of being emotionally upset, disturbed, and disquietedCognitive constrictionPredisposition for self-harmImpulsive desire to do something to change or alter his or her unbearable statePsychological energy / driving force behind suicidal behaviors
43Item 4: HopelessnessOne’s expectation that a negative situation will not get better no matter what one doesIntimately linked to future thinkingBased largely on work of Aaron Beck
44Item 5: Self-hateSuicide as escape from unacceptable perceptions of selfSuicidal individuals are fundamentally preoccupied with their unhappiness2 essential components of suicidal struggle (Baumeister, 1990):Need for escapeCore importance of self
45Item 6: Self-assessment Behavioral self-report of riskWe have the tendency to overestimate suicide risk when compared to patient self-report(Joiner, Rudd, & Rajab, 1999)
46CONFIDENTIALITY Harm to Self Harm to Others Abuse Child Spousal Elder UCMJLPSP (Limited Privilege Suicide Prevention)1st Sgt & CommanderProfileLine of DutyDuty Impact/RestrictionsMobility RestrictionsInformed Consent outlines expectations regarding the relatinship between the individual and the clinic, their protected health information, and what goes on in treatment.EXCEPTIONS TO Confidentiality…RELEASE OF INFORMATION: Normal procedureContinued interactionTreatment updatesSetbacksProgress
47Commitment to Treatment I, ________________, agree to make a commitment to the treatment process. I understand that this means that I have agreed to be actively involved in all aspects of treatment including:(1) attending sessions (or letting my therapist know when I can’t make it)(2) setting treatment goals with my therapist(3) voicing my opinions, thoughts, and feelings honestly and openly with my therapist (whether they are negative or positive, but most importantly my negative feelings)(4) being actively involved during sessions(5) completing homework assignments in between sessions(6) taking my medications as prescribed(7) trying new behaviors and new ways of doings things(8) implementing my crisis response plan when neededI also understand and acknowledge that, to a large degree, a successful treatment outcome depends on the amount of energy and effort I make. If I feel like treatment is not working, I agree to discuss it with my therapist and attempt to come to a shared understanding as to what the problems are, and to identify potential solutions together. In short, I agree to make a commitment to treatment, and to living. This agreement will apply for the next ____ months, at which time it will be reviewed with my therapist and modified as needed.
48Crisis Response PlanWhen thinking about suicide, I agree to do the following;Use relaxation skillsGo for a walk or play a video gameCall a friend; (Earl; XXX-XXX-XXXX)REPEAT ALL OF THE ABOVECall provider at Clinic X (Dr.; XXX-XXX-XXXX)If unavailable, call Clinic (XXX-XXX-XXXX)Call crisis hotline; TALKGo to the emergency departmentCall 911PERCENTAGES: LIMIT ACCESS TO LETHAL WEAPONS…
49TRACKING Levels: Stabilization Back to baseline Self-management Mastered and uses skillsUtilization1st Sgt’s RoleWhat we are working towards. Monitored at varying levels of intensity until we see the following…
50ROLE OF LEADERSHIP · Good leadership promotes suicide prevention · Build a supportive work environment· Know Your Airman· Know the warning signs· Know the helping resources· Ask the tough questions· Encourage help seeking behaviors· Stay involved until problem is resolved· Recognize when help is needed and get it· Apply Suicide Intervention SkillsTHE TOUGH QUESTIONS…(i.e., about life problems, distress, suicidal ideation, alcohol use, etc.)
51ASK CARE ESCORT A - Ask your wingman Have the courage to ask the question, but stay calmAsk the question directly: "Are you thinking of killing yourself?"C - Care for your wingmanCalmly control the situation, do not use force, be safeActively listen to show understanding and produce reliefRemove any means that could be used for self-injuryE - Escort your wingmanNever leave aloneEscort to chain of command, behavioral health professional, Chaplain, or primary care providerCall the National Suicide Prevention Lifeline: (TALK)I am sure you are all familiar with this… I throw it in to reinforce what you already know, for the other AIRMAN, who are additional sets of eyes and ears… Empower them and lead by example.
52URGENT HELP Escort the person to the ER or the Mental Health Clinic Mental Health Clinic is on call 24/7Notify your supervisor or call 911 for helpDon’t leave the person aloneRemove means of self harmSuicide Prevention Hotlines:TALK or SUICIDETALK can connect you to a counselor who understands military issuesBy law, only commanders can order Airmen to receive a mental health evaluation, and only when following appropriate proceduresEMERGENT CDECommander who can give G-Series ORDERS
53Research Direction Current Research in the Maxwell Clinic Guilt & Shame w/ Suicide RiskAim of this Research studyThe proposed basic research attempt to advance our knowledge of the relationships between two specific cognitive/emotional processes, guilt and shame, with suicide risk.guilt and shame often considered to be important psychological contributors to suicide risk, very little research…AND Because guilt and shame are often associated with trauma, they could be particularly relevant among military populations, especially those with combat-related trauma.Shame involves negative attributions about one’s worth and goodness, while guilt involves feelings of sadness, and remorse over specific actions.In general, shame demonstrates a stronger relationship with depression than guilt (Kim et al., 2011), consistent with shame’s association with core identity. Because shame involves a sense of loss of one’s identity as a person of goodness, integrity, and virtue (Wilson, 2005), individuals experiencing shame may fear humiliation and reproach by others, and may feel unable to restore their value, integrity, and self-esteem. It has been suggested that this may lead to fantasizing about, or resorting to, suicide as a means of self-obliteration.
54Tips for managing crises Understand your own triggers or hot buttonsBe consistent in how you help AirmenAvoid coercionEncourage and model openness and honestyRecognize positive change might be slowPay attention to positive changes(not just negative changes)
55Tips for after the crisis Protect privacyNormalize stress reactions“Who wouldn’t feel this way?”Foster a culture of help-seeking“Who wouldn’t get help in this situation?”Maintain Airman’s level of responsibilityAvoid stigmatizationProvide support on group levelDon’t single out Airmen in distress
57Be prepared Keep a list of helping agencies nearby Familiarize yourself with AF policyDiscuss with leadership how problems and issues will be handled in the unitBe Wingmen – don’t let your Airmen go alone
58QuestionIf someone came to you with a problem, would you know the agencies and resources available to help them?All of us, and especially those of us who are supervisors, have a sacred responsibility to know how to match people’s needs with community resources.IDS and Community Sources of SupportEach installation has an Integrated Delivery System (IDS) consisting of all the helping agencies on a base. As individual agencies and as a collaborative agency the IDS exists to assess and respond to community needs.Types of HelpList those services (classes, support groups, workshops) available at your base: Financial counseling, employment assistance, couples classes/support groups (PREP Fighting for your Marriage), parenting classes/support groups (Boys Town Commonsense Parenting), respite care, Infant and Toddler University play groups, conflict resolution workshops, dealing with difficult people workshops, life skills workshops, depression management classes/support groups, anxiety management classes/support groups, etc.IDS HandoutAsk your IDS to put together a handout that lists each of the services above, the POC, and their telephone number.
59Helping Agencies Airman & Family Readiness Center: 953-2353 Transition Assistance, Employment Assistance, Volunteer Resources, Information & Referral, Financial Readiness, Relocation Assistance, Air Force Aid, Personal & Work Life, Family Readiness, Family Ser-vicesFamily Advocacy:Family Maltreatment assessment & intervention, Outreach & Prevention Programs, New Parent Support Program, Family Resource LibrarySexual Assault Response Coordinator:24 hr assault report hotlineEducation, Awareness & Protection, Confidential Consultation, Victim Advocacy & Support
60Helping Agencies Family Member Support Flight: 953-3524 Full time child care, School Age Program, Hourly Care, Part Time Enrichment, Give Parents A BreakChaplain Service:Counseling services for: Premarital/Marriage, Family/ Parenting, Religious Issues, Work Related Issues, and GriefCatholic/Protestant Worship & Religious EducationMental Health Clinic:Group Therapy, Individual Therapy, Marriage Counseling, Personal Problem Assistance, Command Consultation, Evaluations, Psychological Testing, Relaxation Program, Healthy Thinking, Substance Abuse Evaluation & Treatment, Special Needs Coordination (SNIAC)Health & Wellness Center (HAWC):Nutrition Assessment & Counseling, Weight, Cholesterol, Hypertension & Diabetes Management, Exercise Assessment, Body Composition Assessment, Tobacco Cessation, Relaxation Room, Wellness Library
61Helping AgenciesEducational & Developmental Intervention Services (EDIS):Early intervention services for children under three years of age who have developmental delays of certain medical conditionsBehavioral Health Consultant:Behavioral Health appointments in primary care settingMilitary Family Life Consultant:Free confidential counseling, up to 4 appointmentsMilitary One Source:Free confidential counseling, up to 12 appointments
62Final thoughts"Suicide, I have learned, is not a bizarre and incomprehensible act of self destruction. Rather, suicidal people use a particular logic, style of thinking that brings them to the conclusion that death is the only solution to their problems. This style can be readily seen, and there are steps we can take to stop suicide, if we know where to look".-- Edwin Shneidman