1. CARING FOR ALL WHO SERVE PTSD, TBI & SUICIDE IN THE MILITARY AND VETERAN POPULATION 16 MAY 2011 LON MORRIS COLLEGE JACKSONVILLE, TEXAS PLANNING PARTNERS Anderson-Cherokee Community Enrichment Services Andrews Center The Burke Center Community Healthcore Lon Morris College Lone Star Military Resource Group PLANNING PARTNERS Anderson-Cherokee Community Enrichment Services Andrews Center The Burke Center Community Healthcore Lon Morris College Lone Star Military Resource Group

2. M ILITARY C ULTURE I NVISIBLE W OUNDS OF W AR W AYMON S TEWART A NDREWS C ENTER CEO 31 Y EARS C AREER S ERVICE W ITH 1 OIF T OUR R ETIRED 1 ST S ERGEANT Slides reprinted with permission of Austin Travis County Integral Care and Western Interstate Commission for Higher Education

4. P EOPLE D ON ’ T U NDERSTAND Understanding the nature of the military culture, the stresses of working in a war zone, and the journey of adjusting from combat to the community can: » Reduce Stigma » Enhance Outreach » Increase Military And Provider Satisfaction

5. O PERATION I RAQI F REEDOM (OIF) O PERATION E NDURING F REEDOM (OEF) –Over 2 million soldiers have been deployed to GWOT –867,003 have been deployed more than once (39%) –Over 5900 deaths –Over 42,000 wounded in action –Over 54,000 evacuated due to injury or disease –Almost 300 casualties due to suicide Veterans for Common Sense, March 2011 *AS OF NOVEMBER 27, 2006, “THE WAR IN IRAQ HAS BEEN GOING ON LONGER THAN WORLD WAR II” DoD Task Force on Mental Health, June 2007

6. T HE OIF/OEF C OMBAT E XPERIENCE 78% received incoming rocket or mortar fire 33% handled or uncovered human remains 72% knew someone seriously injured or killed 60% saw dead bodies or human remains 56% had a member of their unit become a casualty MST - military sexual trauma - of 5,777,169 veterans screened, 61,126 (1.1%) male veterans and 59,690 (19.9%) female veterans experienced MST

7. W OMEN V ETERANS Over 235,000 women served in OIF/OEF Women currently comprise 15% of military There are an estimated 1.8 million living female veterans of all eras Women have had difficulty gaining recognition for their combat service “Combat to Community: Facts and Figures of Post-9/11 Veterans and Their Families” - Sword to Plowshares, January 2011

8. Colorado’s Military/Veteran Population Consider some of the unique aspects of military life...

9. MILITARY CULTURE  High standard of discipline helps organize and structure the armed forces  Professional ethos of loyalty and self ‐ sacrifice maintains order during battle  Distinct set of ceremony and etiquette creates shared rituals and common identities  Emphasis on group cohesion & esprit de corps connects service members to each other. From Painting a Moving Train

10. MILITARY CULTURE - ACRONYMS If you don’t know, it’s okay to ask (or to Google!)

11. MILITARY CULTURE – RANK STRUCTURE  Enlisted  Noncommissioned Officers (NCOs)  Warrant Officers  Commissioned Officers

12. MILITARY CULTURE – RANK STRUCTURE What you need to know:  Chain of Command is key to day‐to‐day operations.  Understand how rank structure influences decision making.

14. K EY I SSUES –Military related trauma and stress –Traumatic Brain Injury (TBI) –Substance Abuse –Suicide –Employment/Education –Family/relationships/parenting

15. MILITARY CULTURE - BRANCHES Army Navy Air Force Marines Airman Marin e Coast Guard Soldier Service Sailor Veteran Coas tie Member

16. Barriers to Accessing Help  Stigma  Concerns about impact on career  Need for civilian partners and providers trained in military/veteran culture & key issues  Complexity of systems of care

17. Military Culture – Connecting Points Maintain interactive neutrality Honor ideals Understand social structure Attune to communication differences Have awareness of accepted norms of behavior Keep up to date on new trends in military culture

18. Military Culture – DISconnecting Points Making assumptions (e.g. presupposing PTSD) Being focused on deployment/non‐deployment Lack of sensitivity regarding experiences Assumption that if they are non‐infantry, they did not see action Discussion of politics and war

19. MILITARY/VETERAN SYSTEMS OF CARE MILITARY ‐Military TX Facilities ‐ TRICARE GOVERNMENT ‐US Department of Veterans Affairs COMMUNITY ‐Private Providers ‐Community Mental Health Centers & Clinics

20. MILITARY/VETERAN SYSTEMS OF CARE MILITARY - Military TX Facilities (MTFs) - TRICARE Limited confidentiality for Active Duty Service Members Command and control over care, even outside of MTFs Treatment decisions can impact fitness for duty Eligible dependents are covered for care

21. MILITARY/VETERAN SYSTEMS OF CARE GOVERNMENT ‐US Department of Veterans Affairs Veterans Health Administration Hospitals Community Based Outpatient Clinics (CBOSs) Vet Centers Veterans Benefits Administration Disability Compensation Survivors’ Benefits Education Benefits Home Loans Vocational Rehabilitation Most services are only for the veteran (with some exceptions).

22. MILITARY/VETERAN SYSTEMS OF CARE COMMUNITY ‐Private Providers ‐Community Mental Health Centers & Clinics Individuals may access providers via their private insurance, TRICARE, Medicaid, private pay, etc. There is significant need for providers trained and equipped to work with service members, veterans & their families

23. IMPORTANT FACTORS & QUESTIONS A service member, veteran or family member will have different benefits, programs and resources available according to their branch, current status and past service. Has this individual ever served in the military? What is the person’s current military/veteran status? Active Duty Activated National Guard Activated Reserves Non‐activated National Guard Non‐activated Reserves Veteran (less than 20 years service) Medically Retired Veteran ‐ Retired (20+ years service )

24. IMPORTANT FACTORS & QUESTIONS Based on their status, what is their eligibility for benefits and care in the different systems? Are they already receiving care in any of these systems? Who do you need to be in contact with to coordinate care within or across the systems? If they are currently serving, what do you need to be aware of as you provide care?

25. Military Culture Reintegration - Military Culture Reintegration - Military Culture Reintegration - 5 critical tasks service members need to master: 1. Overcome alienation ‐ from family, friends, coworkers, community 2. Move from simplicity to complexity: – from self to others – from surviving to thriving – from others thinking for you to responsibility – from no choices to overwhelming choices

26. Military Culture Reintegration - Military Culture Reintegration - 3.Replace war with another form of high ‐ war is an adventure, nothing in civilian life matches the intensity 4.Move beyond war and find meaning in life 5.Come to peace with self/God/others

27. Documentaries & Films on the Military Experience  Restrepo – A documentary that chronicles a one‐year deployment of a platoon in Afghanistan.  Carrier – A 10‐part documentary that follows the crew of an aircraft carrier over six months.  Band of Brothers – A miniseries based on the true story of Easy Company during WWII.