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BASIC STATISTICS
SINCE 2003: MORE THAN 1 MILLION TROOPS HAVE BEEN DEPLOYED IN IRAQ AND AFGHANISTAN 1/3 HAVE SERVED AT LEAST 2 TOURS IN COMBAT ZONE 1.2 MILLION CHILDREN LIVE IN US MILITARY FAMILIES 700,000 HAVE AT LEAST 1 PARENT DEPLOYED
MORE STATISTICS!!!
WHO SERVICES IN THE MILITARY? 50% ARE UNDER 25 YEARS OLD 85% ARE MALE LATINOS AND BLACKS ARE OVERREPRESENTED 70% HAVE SOME COLLEGE 10% ARE MARRIED TO MEMBER OF THE MILITARY 70% HAVE 1 OR MORE CHILDREN
AFGHANISTAN
As of 5/7/2010, 78,000 remain All volunteer force Multiple deployments vs. staying til it is done Purpose: remove Taliban from political and military dominance, destroy al-Qaeda, kill Osama bin Laden and his staff Coalition forces: Great Britain, France, Australia, Special Operations
New President was elected Military activities aimed to stabilize new order Use of active and reserve forces
Iraq
Largest wartime deployment for U.S. women! Baghdad fell in less than a month Sunni and Shite engaged in civil war to gain political power Guerilla type war Army and Marines bear the brunt Unpopular in comparison to Afghanistan
Department of Defense
Pentagon of DOD: Headquarter of U.S. armed forces Secretary of Defense: civilian appointee serves at pleasure of the President Army, Air Force, Marine Corps headed by generals Navy headed by Admiral All are members of the Joint Chiefs of Staff
Coast Guard falls under secretary of homeland security The combined all-volunteer armed services, national Guard, and reserve referred to as the total force.
Demographics continued
Race: 65.5%-White 12.82% -Black 3.25%- Asian or Pacific Islander 1.96%-American Indian or Alaskan 3.42% biracial or declined to state 13.19% Hispanics (underrepresented compared to overall population of 20.02%) 42.97% from the south, 12.81% from the Northeast
Officers
Typically come from affluent families and are highly education Lower ranks are not highly education because they usually enlist before they go to college and then go to college after
Military Subculture
1. Strict discipline to maintain organizational structure 2. Relies on loyalty and self-sacrifice to maintain order in battle 3. rituals and ceremonies to create common identity 4. Connected to one another by emphasis on group cohesion and espirit de corps Often use military speak (see glossary)
RANK
Rank structure leads to deference of junior rank to seniors Officers are referred to as sir, madam, maam or by their rank by non officers Noncommissioned officers, eg. Sergeants are referred to by rank, not as sir or madam Junior enlisted personnel are addressed by their rank and last name (Private Pile)
ARMY
Largest and oldest Purpose: dominate the war on the ground Soldiers Active: full time Reserve: part time (report to governor of the state) Make up half of the Army, older 1 out of 7 soldiers if female, 54% are married, 46% have children 712,895 family members Reserve: 49% married, 42% have 2 children
Marine Corps
Infantry of the Navy Created in 1775 Specialty; amphibious operations: assaulting, capturing and controlling beachheads Currently fight in Iraq and landlocked Afghanistan too. No medical professionals in Marines 20,000 officers and 173,-- enlisted on active duty Strong identity, tradition bound branch
MAJOR DEPRESSION
SUICIDE TRAUMATIC BRAIN INJURY
SUBSTANCE ABUSE
Mitigate intense emotions that come with combat Each war has an underlying drug culture Currently, alcohol is banned from war zones, but they get and use it anyways High rates of re-deployment have lead to increased risk of heavy drinking Current wars have produced new wave of addiction: prescription drugs and opiates to keep them in the fight rather than refer to treatment for treatment
SOUL WOUNDS
In addition to addiction, various injuries occur often due to inability to rationalize, accept and reintegrate with society Visible vs. invisible wounds: less deaths than Vietnam but many so called invisible wounds 1. PTSD 2. Depression 3. Traumatic Brain Injury
DEPRESSION
Not traditionally considered an invisible wound of war but with record numbers of suicides associated with current war fighters and veterans, must learn more about it. Loss of friends and comrades may trigger depressive episodes
SUICIDE
Veterans are committing suicide at a rate that far exceeds nonveteran population. 32,000 suicides a year, 650,000 attempts in general population. Difficult to get an exact amount because some appear to be accidents. In June 2010, 1 per day killed themselves!!! In 2007, 108 confirmed suicides in the Army, 166 in Iraq and Afghanistan. firearms used most often, often preceded by a failed intimate relationship 47% are older than 30, half are sergeants
CAUSES?
Stigma to seeking help for needed problems like PTSD and Depression -considered weak -would be treated differently Would have less confidence in them Difficult to get time off of work Would hurt their career Difficult to schedule an appointment Would be embarrassing Didnt trust mental health professionals
Chaplains
Often first step in obtaining access to mental health care Confidential: can remove stigma Refer out to unit-embedded mental health providers However, mental health providers in an operational combat unit are required to release information if unit commander determines he needs it
Military OneSource
Information and consultation service for all service members of active and reserve and their families. Retired or separated personnel may use for 6 months after separation Consultants triage the call and refer for up to 12 free counseling sessions If severe, may refer to MTF, VA hospital or Vet Center or TRICARE professional Educated at masters level and licensed
3. Postcombat, Postdeployment: end of tour debriefings to process memories, rituals such as awards and recognition, Battlemind Training: Used throughout all phases of deployment cycle for families and soldiers. Reduces stigma of seeking and participating in mental health care Has evolved into resiliency training and impart rational emotive behavior therapy Sadly, budget priorities lay with equipment and not with needs of veterans.
Depression
Second most prevalent illness, only 25% being treated in primary care environment require referral to a specialized mental health setting As the number of veterans has increased, the number of clinic visits per veteran has decreased. 4% of OEF and OIF veterans receiving non-PTSD diagnoses and less than 10% receiving PTSD diagnoses attended 9 or more VA mental health treatment session in 15 weeks or less in first year of diagnosis.
EMDR
EYE MOVEMENT DESENSITIZATION AND REPROCESSING USING NEURAL PATHWAYS TO INTEGRATE THE EMOTIONAL AND COGNITIVE COMPONENTS OF TRAUMA
NOT HELPFUL
-watching President talk about the troops -reliving the experience -group counseling and having to explain themselves -5% admitted taking psychiatric medication like anti-depressants
SPECIAL POPULATIONS
HOMELESS VETERANS INCARCERATED VETERANS WOMEN VETERANS VETERANS IN HIGHER EDUCATION FAMILIES OF VETERANS
Homeless Veterans
to 1/5 of all homeless persons is a veteran!!! 40% of all homeless men are veterans, veterans only account for 34% of the general male population. Women veterans account for 4% of the homeless veteran population. Males tend to be older and more educated than homeless nonveterans More physical and mental health problems Abuse of alcohol and drugs Women veterans are 2-4 times more likely than nonveteran women to be homeless
Homeless Veterans
National coalition for Homeless Veterans has worked for the past 20 years to end homelessness of veterans. 2009: President Obama added in the budget new help so no veteran ever sleeps on the streets Plan includes: outreach, treatment, employment and benefits, community partnerships, prevention and housing support services for low income veterans.
Healthcare for Homeless Veterans: outreach to identify eligible homeless veterans -Stand Downs:1-3 days of safety and security, food, shelter, clothing health care -Compensated Work Therapy: temporary housing in group homes for working veterans, VA contracts with private and public industry to jobs, job skills, sense of self esteem
Community Homelessness Assessment, Local Education and Networking Groups (CHALENG): Assess needs, develop action plans -Domiciliary Care provides residential treatment to 5,000 homeless veterans with health problems. -Supported Housing: ongoing case management to help find permanent housing -Drop-in Centers: daytime place to wash clothes, clean up and other activities
VHA Special Outreach and Benefits Assistance: funding for counselor to work in VHA facilities in identifying and applying for benefits -Acquired Property Sales: makes all the properties VA obtains through foreclosures available for sale at a discount -Excess Property for Homeless Veterans: distributes excess federal property -Program Monitoring and Evaluation: provide information about the veterans served and therapeutic value and cost effectiveness.
Incarcerated Veterans
-Thousands of veterans are in prison. Substance Abuse, mental illness are linked -30% of OIF and OEF veterans report symptoms of PTSD, TBI depression -19% have been diagnosed with substance abuse or dependence Veterans do not quality for substance abuse disability benefits unless they also have PTSD
140,000 veterans incarcerated in state and federal prisons in 2004. -46% in federal prisons for drug law violations -15% in state prisons for drug law violations, 5.6 simple possession
WOMEN VETERANS
Tens of thousands have lived, worked and fought in Iraq and Afghanistan 3 factors influence their role in military today: 1. ) Insufficient number of male volunteers, and they have proven they can do the job in a variety of roles 2. Muslim countries forbid males from touching muslim women. 3. 2 wars at a time, equal opportunity war
Demographics
Female veterans who are married are more likely to be in dual-service marriages 61% vs. 8% Earn on average $28,962 annually compared to males who earn $36,285
College Experience
Women veterans are seeking higher education at a greater rate than male counterparts Largely unprepared to offer support services to them Historically under-represented and underserved Employed at a lower percentage rate than male counterparts Unemployment for female veterans of OIF and OEF is 13.5% compared to the 8.4% for nonveteran women
Reintegration: Restoration to a condition of integration or unity, to make or be made into a whole again, to reintegrate inner divisions. What dos it mean to be whole?
-Many are already married, they work and have no time to do student activities -war veterans in general feel isolated and not connected with other students -some of the veterans have admitted that their experience with the military has been terrible and do not want to associate themselves with any military related organizations
Educational Characteristics
G.I. Bill covers most of the expenses, Yellow ribbon program supplements Often more mature than fresh out of high school students Bring practiced discipline to their studies Goal oriented attitude Accustomed to a chain of command and are clear about taking orders from leaders Have leadership skills Have shouldered major responsibilities
Strengths
Dependable Responsible Dedicated Respectful Punctual Know pressure and expect to be challenged Excel beyond expectations
STAGES OF DEPLOYMENT
1. PREDEPLOYMENT 2. DEPLOYMENT
3. POSTDEPLOYMENT
PREDEPLOYMENT
Military member is preparing to leave and getting into military mentality. May create a sense of estrangement from family. Stress is high for all, no fixed departure dates or return dates. Very stressful for younger families, families with pregnant spouse, and those with special needs.
Higher rates of domestic violence Increased child abuse Wives report greater parenting stress, numbness, shock, irritation, tension, disbelief, emotional distance, anger, loneliness, dysphoria, anticipatory fear or grief and somatic complaints. Smaller children show an increase in depression anxiety, cosleeping with parents and academic and discipline problems.`
Couple issues include emotional distance, arguments and a rush to get married. Teens may get depressed depending on the level of concurrent family stressors such as finances and maternal psychopathology. May suffer from difficulty expressing emotions, behavior problems, anticipating future events, taking on others perspectives and feelings and being bullied by other teens who oppose the war.
DEPLOYMENT
Service member off to combat or to an installation away from family. Lengthy deployments are most challenging, families must take on greater responsibilities. Military children receiving outpatient mental health care doubled and inpatient services increased by 50%. Deterioration in physical health, academic performance, behavior problems, depression and anxiety and psychosocial difficulties have all been observed.
POSTDEPLOYMENT
When the service member returns home Reunification requires that the family accommodates to combat related injuries. May lead to secondary traumatic stress Role adjustments must be made, often the mother took on the father role of being more playful and fun. Must get reacquainted with parent and often leads to change in after school programs.
Mission: Pursue the rights of veterans, dependents, survivors to receive Department of Veterans Affairs benefits
Other programs
Park and recreation programs have outreach efforts which include identifying specific needs and working to address them. Help families cope by encouraging them to interact through recreational pursuits, memory making activities helpful before deployments, kids nite out gives couples time alone Postdeployment: honeymoon period followed by reintegration and physical activities and social interaction among families helps with communication
Military Child Education Coalition: Strengths based focus offers training for school counselors and teachers FOCUS: families overcoming stress is a family centered evidence informed resilience training program at UCLA and Harvard which deals with pre-deployment and re-deployment issues
NEEDED RESEARCH
Need research on the mental health of military families and the psychological and social effects of Global War on Terror Need research on what really works to help: evidence based practices Need research on the impact maternal mental health has on the childrens functioning
Need research on resilience factors such as managing small challenges to prepare for bigger stressors. Research on the siblings of service members
NEEDED INTERVENTIONS
Enhanced support services Identify at-risk children and families Provide education and pre-deployment preparedness Identify families with preexisting conditions Develop programs to educate families about injuries Activate mental health specialists with specific training and expertise in treating children and families
Preparedness interventions such as stress management, inoculation, use of optimism and positive psychology models and primary prevention Focus on mothers having more positive outlook and attitude and maintaining normalcy of schedule Prepare school personnel better
Create programs that address strengths as well as problems Expand existing programs Increase assistance, support and engagement of the broader community Student to student interaction programs to help students relocate Focus on re-deployment and post deployment phases Need to evaluate current programs for effectiveness
Parks and recreation programs increasing role in providing practical support such as transportation, lowered fees and high levels of informal social support Children need interventions that focus on maintaining normal routines, discussing feelings Parents need their own therapy which leads to positive outcomes for children Discuss family roles and changes when a parent returns