1. From the Battlefield to the Workplace: Helping Veterans and Their Families Succeed

2. 2 SummitQuestions@valueoptions.com Speakers Dr. Harold Kudler, MD VA Mid-Atlantic Network Mental Illness Research, Education and Clinical Center and Duke University Dr. Stephen Scroggs, PhD EVP, Government Affairs and Development The Citizen Soldier Support Program at the Odum Institute, University of North Carolina at Chapel Hill contributed to the development of this presentation

3. 3 SummitQuestions@valueoptions.com Objectives Identify the unique concerns and strengths among veterans and their family members within your workforce Learn how to provide effective leadership for your human resource teams, managers, and employees through the process of deployment, homecoming and reintegration

4. 4 SummitQuestions@valueoptions.com Agenda Part 1: Introduction ValueOptions’ Role With Military Employers’ Role With Military Part 2: Military Culture Who Are Our Veterans? Professional Ethos Part 3: Post-Deployment Issues Mental Health Physical Health Battlemind

5. 5 SummitQuestions@valueoptions.com Agenda (continued) Part 4: Workplace Issues Things Employers Can Look For How Employers Can Lead How EAP Can Provide Assistance Part 5: Summary and Questions

6. 6 SummitQuestions@valueoptions.com ValueOptions’ Wealth of Experience Serving Military Families Nation’s largest independent behavioral health and wellness company Provide easily accessible mental health and substance use services to active duty members, retirees and their families for DoD Currently serve 2.9 million military beneficiaries across 10 states comprising the TRICARE South Region as the behavioral health partner for Humana Since 1988, under numerous contracts, ValueOptions has continuously served the behavioral health needs of the military community

7. 7 SummitQuestions@valueoptions.com Challenges Facing Returning Warriors & Families Employers Are Part of the Solution! Rates of soldier suicides increasing Increasing rates of domestic violence Higher rates of divorce Higher rates of drug and alcohol abuse Homelessness Combat stress reaction, PTSD and TBI Violence in communities, incarcerations

8. 8 SummitQuestions@valueoptions.com Why Employers Care About Military Families Employers respect and benefit from military work ethic and values Employers and Military face similar hurdles in hiring quality workers –mid-20s, drug free, physically fit, background check, certain aptitude–identified and paid for by DoD –medical, law enforcement, logistics, signal/fiber optics The future: New federal laws increasing financial partnerships between National Guard and Reserve and employers It’s the right thing to do—especially in this world where there is little shared sacrifice in the defense of our country

9. 9 SummitQuestions@valueoptions.com Veterans Are Us! Of 24.3 million veterans currently alive, nearly three- quarters served during war or an official period of conflict About a quarter of the nation's population, approximately 63 million people, are potentially eligible for VA benefits and services because they are veterans or family members http://www.va.gov/

10. 10 SummitQuestions@valueoptions.com Who Are Our New Veterans? An estimated 1.8 million service members have served in Iraq and Afghanistan –Half are members of the National Guard and Reserve –12% are women –These new combat veterans have families who, in a very real sense, also serve! Chances are that some of them work for you!

11. 11 SummitQuestions@valueoptions.com Military Culture Understanding the nature of the military culture, combat and the stresses of living and working in a war zone is critical in supporting your employees through the deployment cycle

12. 12 SummitQuestions@valueoptions.com Military Culture Army –Army National Guard Navy Marine Corps Air Force –Air National Guard Coast Guard

13. 13 SummitQuestions@valueoptions.com Basic Training – Military Culture High standard of discipline that helps organize and structure the armed forces Professional ethos of loyalty and self-sacrifice that maintains order during battle Distinct set of ceremony and etiquette that create shared rituals and common identities Emphasis on group cohesion & esprit de corps that connect service members to each other

14. 14 SummitQuestions@valueoptions.com Military Culture A word about lingo … some examples: OEF = Operation Enduring Freedom (generally refers to Afghanistan 2001-present) OIF = Operation Iraqi Freedom 2003 - present IED= Improvised Explosive Device VBIED = Vehicle Born IED (car or suicide bomb) Other examples are included in the Appendix

15. 15 SummitQuestions@valueoptions.com Post-Deployment Concerns Among Active and Reserve Component Soldiers Study followed 88,235 U.S. soldiers returning from Iraq who completed both a Post-Deployment Health Assessment (PDHA) and, 6 months later, a Post- Deployment Health Reassessment (PDHRA) Screening includes standard measures for: –Posttraumatic stress disorder (PTSD) –Major depression –Alcohol abuse –Traumatic brain injury –Other mental health problems Milliken, Auchterlonie & Hoge. (2007) Journal of the American Medical Association, 298:2141-2148.

16. 16 SummitQuestions@valueoptions.com Posttraumatic Stress Disorder (PTSD) Characterized by a constellation of symptoms that follow exposure to an extreme traumatic event that involves actual or threatened death or serious injury The response to the event must include intense fear, helplessness or horror and symptoms that persist more one month, including: –re-experiencing the traumatic event through intrusive recollections, dreams or nightmares –avoidance of trauma-associated stimuli, such as people, situations, or noises –persistent symptoms of increased arousal, which may include sleep disturbance, hypervigilance, irritability or an exaggerated startle response

17. 17 SummitQuestions@valueoptions.com PTSD diagnosis must also be accompanied by clinically significant distress or impairment in social, occupational or other important areas of function Posttraumatic Stress Disorder (PTSD)

18. 18 SummitQuestions@valueoptions.com Traumatic Brain Injury (TBI) Problems with memory, concentration, emotional instability or irritability may also suggest TBI Most TBI is mild and will improve within a few months but veterans, their families and their co-workers do better with education and support

19. 19 SummitQuestions@valueoptions.com Changes Among Active Duty (AD) and Reserve Component (RC) Soldiers at PDHRA Roughly half of those with PTSD symptoms on PDHA improved by PDHRA yet: There were twice as many new cases of PTSD at PDHRA Depression rate doubled in AD (10%) and tripled in RC (13%) at PDHRA Overall, 20.3% AD and 42.4% RC were identified as needing MH treatment post-deployment

20. 20 SummitQuestions@valueoptions.com Changes Among Active Duty (AD) and Reserve Component (RC) Soldiers at PDHRA 4-fold increase in concern about interpersonal conflict Alcohol abuse rate high (12%AD/15%RC) at PDHRA, yet few (0.2%) referred for treatment If this is the progression among Service Members over the first 6 months, what about their family members?

21. 21 SummitQuestions@valueoptions.com Battlemind Training (www.battlemind.org) Developed by Walter Reed Army Institute of Research Battlemind represents a Soldier’s successful adaptation to combat but Don’t try this at home!

22. 22 SummitQuestions@valueoptions.com Key Signs of Battlemind Buddies vs. Withdrawal Accountability vs. Control Targeted vs. Inappropriate Aggression Tactical Awareness vs. Hypervigilance Lethally Armed vs. Unarmed Emotional Control vs. Anger or Detachment Mission & OPSEC vs. Secretiveness Individual Responsibility vs. Guilt Non-Defensive (Combat) Driving vs. Aggressive Driving Discipline & Ordering vs. Conflict

23. 23 SummitQuestions@valueoptions.com VA Care Access Points 154 medical centers 875 ambulatory care and community-based outpatient clinics 209 veterans centers My HealtheVet: http://www.myhealth.va.gov/ 21 Veterans Integrated Service Networks (VISNs)

24. 24 SummitQuestions@valueoptions.com OIF/OEF Veterans and VA As of May 2, 2008: –868,717 OEF/OIF veterans eligible for VA services –40% (347,750) have already sought VA care Their three most common health issues: –Musculoskeletal –Mental health –Symptoms, signs and ill-defined conditions

25. 25 SummitQuestions@valueoptions.com Mental Health Among OEF/OEF Veterans Possible mental health problems reported among 42.5% (147,744) of the 347,750 eligible OEF/OIF veterans who have presented to VA Provisional MH diagnoses include: PTSD 75,719 – (22% of all who presented to VA) Nondependent Abuse of Drugs54,415 Depressive Disorder 50,732 Affective Psychoses28,734 Neurotic Disorders 40,157 Alcohol Dependence 12,780 Drug Dependence 5,764

26. 26 SummitQuestions@valueoptions.com Beyond the DoD/VA Continuum Ideally such problems will be picked up somewhere within the DoD/VA continuum of care but: –If only 40% of All OEF/OIF Veterans eligible for VA care have come to VA where are the other 60%? There is a “silent majority” of OEF/OIF veterans not coming to VA

27. 27 SummitQuestions@valueoptions.com Thinking About The Silent Majority Who among them do we want to reach? What intervention(s) would be most appropriate? How would we reach these veterans? At what point do we reach them? What about their families? –Family support predicts resilience –Families have needs of their own

28. 28 SummitQuestions@valueoptions.com Public Health Model Most war fighters/veterans will not develop a mental illness but all war fighters/veterans and their families face important readjustment issues This population-based approach centers on helping individuals and families retain a healthy balance despite the stress of deployment Incorporates the Recovery Model and other principles of the President’s New Freedom Commission on Mental Health –There is a difference between having a problem and being disabled

29. 29 SummitQuestions@valueoptions.com Public Health Model The public health approach requires a progressively engaging, phase-appropriate integration of services This program must: –be driven by the needs of the Service Member/ veteran and his/her family –meet prospective users where they live and work –increase access and reduce stigma Stigma is the No. 1 obstacle to getting help!

30. 30 SummitQuestions@valueoptions.com Work Site Your workplace could be a vital link connecting new veterans and their family members with help … but ONLY if you are ready to help! –Issues may first surface at work

31. 31 SummitQuestions@valueoptions.com If You Don ’ t Take the Temperature, You Can ’ t Find the Fever Know something about our nation’s military and about our present military conflicts Know something about VA Know if your employee is a service member/veteran or a family member/significant other of a service member or veteran Know something about the deployments in your community

32. 32 SummitQuestions@valueoptions.com What to Look For Think about the effects of common deployment- related problems, including PTSD, major depression, substance abuse and/or traumatic brain injury when working with veterans and/or their family members Identify significant functional problems (such as job stress, family stress, and/or homelessness) whether or NOT a specific diagnosis applies

33. 33 SummitQuestions@valueoptions.com Other Ways Problems May Surface Deployment-related problems may: Surface indirectly as an exacerbation of chronic physical ailments (shortness of breath in an asthmatic) Be expressed in new physical problems (headaches, abdominal pain) Present as new or exacerbated substance abuse Lie veiled behind vague complaints of poor energy or poor sleep

34. 34 SummitQuestions@valueoptions.com Helping with Deployment-Related Problems The key is to develop a supportive alliance with the veteran and/or with his/her significant others Effective next steps/options include: –Early recognition of PTSD and other post- deployment MH problems –PTSD-related education –Pharmacotherapy –Psychotherapy/supportive counseling –Identifying resources (see the Appendix!) –Regular follow-up and monitoring of at-work issues

35. 35 SummitQuestions@valueoptions.com Goals Reduce stigma Promote healthy outcomes/resilience/recovery –Strengthen families –Decrease military attrition –Decrease disability –Improve productivity

36. 36 SummitQuestions@valueoptions.com The Bottom Line There should be No Wrong Door to which OIF/OEF veterans or their families can come for help

37. 37 SummitQuestions@valueoptions.com How Employers Can Lead Talk with employees about how and when they would like to inform co-workers of an impending deployment. Provide employees with information about benefits prior to deployment. Maintain communication during absences (possibly with a family member). Meet with Reservists' managers to discuss reintegrating reservists back into the workplace. Educate managers about what they might expect of returning Reservists.

38. 38 SummitQuestions@valueoptions.com How Employers Can Lead Educate managers and employees to be sensitive to Reservists' needs. Encourage returning Reservists to use the ValueOptions employee assistance program, and remind them that their families are covered as well. Counseling for spouses can be especially beneficial. Work-life services can ease the transition with help on financial and legal questions. Obtain senior management commitment to ensure that programs are given strong support and a cultural presence.

39. 39 SummitQuestions@valueoptions.com How Employers Can Lead Recap any company changes that occurred while employees were gone. Allow time to reintegrate after an extended absence. Consider accommodations to assist employees’ return to productivity. Assist with team re-acclimation. Roll out the welcome mat!

40. 40 SummitQuestions@valueoptions.com QUESTIONS?