Understanding the Warfighter
24 October 2013
Bobby Walden, LCSW
HUD-VASH Social Worker Dept. Veterans Affairs
Capt. USAFR, BSC
Disclaimer
 This presentation does not reflect the opinions or views of
the United States Air Force nor the Department of Veterans
Affairs.
Overview
 PRESENTATION
1. Eligibility for VA Healthcare.
a. Overview of services available
b. Service Connected condition
c. Eligible Reserve/National Guard
2. The Culture of the Military
a. Differences among the branches and their specific
cultures.
b. Core Values
Overview
3. Deployment.
a. Emotional reactions
b. Management strategies
4. Combat Stress Facility
a. Treatment concepts
5. Discharge
a. Returning Home
b. Identity Issues.
c. Common struggles.
Veterans Benefits
We will not be discussing claims benefits. For purposes of this presentation we will only be
discussing medical benefits
Basic Eligibility
 Active Duty
 Reserves/National Guard
 Most Veterans who enlisted after September 7, 1980, or
entered active duty after October 16, 1981, must have
served 24 continuous months or the full period for which
they were called to active duty in order to be eligible.
Means Tested
 Examination of somebody's income: an examination of
somebody's income and savings, carried out in order to
determine whether the criteria for a type of assistance or
financial aid are met.
Service Connected Disability
 Veterans who are disabled by an injury or illness that was
incurred or aggravated during active military service. These
disabilities are considered to be service-connected.
Priority Groups
 Priority Group 1
 Priority Group 2
 Priority Group 3
 Priority Group 4
 Priority Group 5
 Priority Group 6
 Priority Group 7
 Priority Group 8
Priority Group 1
 Veterans with VA Service-connected disabilities rated 50% or
more.
 Veterans assigned a total disability rating for compensation
based on unemployability.
Priority Group 2
 Veterans with VA Service-connected disabilities rated 30% or
40%.
Priority Group 3
 Veterans who are former POWs.
 Veterans awarded the Purple Heart Medal.
 Veterans awarded the Medal of Honor.
 Veterans whose discharge was for a disability incurred or
aggravated in the line of duty.
 Veterans with VA Service-connected disabilities rated 10% or
20%.
 Veterans awarded special eligibility classification under Title
38, U.S.C., § 1151, “benefits for individuals disabled by
treatment or vocational rehabilitation.”
Priority Group 4
 Veterans receiving increased compensation or pension based
on their need for regular Aid and Attendance or by reason of
being permanently Housebound.
 Veterans determined by VA to be catastrophically disabled.
Priority Group 5
 Nonservice-connected Veterans and noncompensable
Service-connected Veterans rated 0%, whose annual income
and/or net worth are not greater than the VA financial
thresholds.
 Veterans receiving VA Pension benefits.
 Veterans eligible for Medicaid benefits.
Priority Group 6
 Compensable 0% Service-connected Veterans.
 Veterans exposed to ionizing radiation during atmospheric testing
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or during the occupation of Hiroshima and Nagasaki.
Project 112/SHAD participants.
Veterans who served in the Republic of Vietnam between January
9, 1962 and May 7, 1975.
Veterans who served in the Southwest Asia theater of operations
from August 2, 1990, through November 11, 1998.
Veterans who served in a theater of combat operations after
November 11, 1998, as follows:
 Veterans discharged from active duty on or after January 28, 2003,
for five years post discharge
Priority Group 7
 Veterans with incomes below the geographic means test
(GMT) income thresholds and who agree to pay the
applicable copayment.
Priority Group 8
 Veterans with gross household incomes above the VA national
income threshold and the geographically-adjusted income
threshold for their resident location and who agrees to pay
copays.
The Culture of the Military
What counts is not necessarily the size of
the dog in the fight - it's the size of the
fight in the dog. - Dwight D. Eisenhower
Icebreaker
Slang
Meaning
Gedunk
Candy
A '96
4 days off
POG
Person other than Grunt
Boot
A term for Marines who are new to the
Marine Corps. Derived from the term
"boot camp", to insinuate that the
Marine is fresh out of boot camp.
Generally used as a pejorative term
(even if in an affectionate manner) in the
Fleet and elsewhere, sometimes as a
way to explain that new Marines should
know their place. It can also be used as a
term for a Marine who is new to a rank
or billet. e.g. - "He's a boot Corporal".
Slang
Meaning
Blood Stripe
Red band on dress uniform trousers; symbolizes
blood shed by Marines in war; worn by officers and
NCOs. Also a form of hazing where NCOs inflict skindamage on new Corporals.
Knife Hand
A way of getting your point across with the use of
your hand
High and Tight
Very short haircut with just a little on the top
Hit the Head
Bathroom break
Zero Dark Thirty
Really early in the morning
Scuttlebutt
Started out the water fountain, became gossip
Hit the Sack
Go to bed, get some sleep
Police the area
Clean up
Pogie bait
Cookies, anything that can be used to distract or
bribe non infantry personnel. In general; a bribe or
an object used to distract someone
Slang
Meaning
PCS
Permanent change of station
TDY
Temporary Duty Assignment
CONUS
Continental United States/State Side
Down Range
Deployed
Gun Decking
Falsifying reports
Why is it important to be Culturally
Competent?
What is Military Culture?
Understanding military culture can:
• Result in improved abilities to understand,
communicate, and effectively interact with service
members/veterans and their families.
• Having basic knowledge regarding the values, structure,
policies, can promote a stronger client-provider alliance
and help develop skills to provide more effective clinical
care.
A 20 year old male self refers to you for feeling "on edge",
"pissed off," and having difficulty sleeping. He tells you that he is a
SPC in the Army National Guard who returned about 4 months
ago from a 15 month deployment to Afganastan. In your first
meeting he tells you he is a gunner attached to Bravo Company,
2nd Battalion, 7th Infantry Regiment, First Brigade Combat Team
3ID. He's coming to see you because his First Sergeant expressed
concern over his irritability during their last drill. He reports that
he is still angry with everyone from his Company Commander
down to his Platoon Leader for many decisions made down range.
He is married with 2 children under the age of 4, one of whom
was born during his deployment. He reports a strained
relationship with is spouse who he says "doesn't get" what he
went through during his deployment. He also indicates that he
plans to volunteer to deploy again as soon as possible.
Questions
 What does it mean that he is in the “Army National Guard?”
 What is a SPC? A gunner?
 What does it mean that he is from the First Brigade Combat
team 3ID?
 What does "down range" mean?
Military Rank Structure
 Enlisted
 Warrant Officer
 Commissioned Officer
Military Rank Structure
 See Handout
 Note the Navy and Coast Guard has a different Officer Rank
titles
Enlisted
 Majority of military personnel approx 84%
 As members progress in rank, leadership responsibilities
increase significantly specifically at the NCO level.
 Typically have specific job functions similar to employees at a
company
 NCO – Noncommissioned officer
 Enlisted members may also refer to their pay grade E-1
through E-6
Role of NCO’s
 NCO = Noncommissioned officer.
 Traditionally the 1st formal role in leadership.
It is said among Marines “No plan survives contact with the
enemy” so the Marine Corps places heavy value on small unit
leadership to its lowest level.
• Marine NCO at an E-4
• Other Branches typically E-5
Warrant Officers
 Experts at in their field.
 Primary task Technical expert
- Trainers
- Advisors
- Coaches
- Although above all enlisted ranks they are still below
Commissioned officer grades
- Make up approximately 2% of the military
There are no Warrant Officers in the Air force.
Commissioned Officers
 Commissioned ranks are the highest in the military
 Similar to managers and leaders in a company
 Commissions are by order of the President of the United
States
 Typically seen as generalist in nature, with the ultimate goal
to take command over more and more personnel.
 Minimum of a four year Bachelors Degree.
 Make up approximately 14 % of the military
Uniformed Services
 United States Army
 United States Navy
 United States Marine Corps
 United States Air Force
 United States Coast Guard.
 United States Public Health Service
United States Army
 Motto: This We’ll Defend.
 Army's Mission: “To fight and win our Nation’s wars by
providing prompt, sustained land dominance across the full
range of military operations and spectrum of conflict in
support of combatant commanders.”
United States Army
 The Army is the oldest and largest of the military services
and represents the main ground force for the United States.
The Continental Army was formed on June 14th 1775 to
meet the demands of the Revolutionary War and was
subsequently replaced by the United States Army which was
created by Congress on June 14, 1784. The Army is
comprised of an Active component and two Reserve
components, the Army National Guard and the Army
Reserves.
Army Core Values
These core values are intended to guide service members
throughout their careers and day to day life.
 1. Loyalty
 2. Duty
 3. Respect
 4. Selfless Service
 5. Honor
 6. Integrity
 7. Personal Courage
United States Navy (USN)
 Motto: "Non sibi sed patriae" (unofficial)
"Not for self but for country“
The Navy has not Motto because they don’t need one!
 Navy Mission: “To maintain, train and equip combat-ready
Naval forces capable of winning wars, deterring aggression
and maintaining freedom of the seas.”
United States Navy
 The Navy is the second largest branch of service.
The U.S. Navy was founded on 13 October 1775,
and the Department of the Navy was established
on 30 April 1798. The Navy is comprised of an
Active and Reserve component but does not have
a National Guard. In addition, the Navy also plays
an essential role in augmenting air power and
transporting Marines to areas of conflict.
Navy Core Values
 1. Honor
 2. Courage
 3. Commitment
United States Marine Corps
 Motto: Semper Fidelis, “Always Faithful”
Marine Corps Mission:
 The seizure or defense of advanced naval bases and other land
operations to support naval campaigns.
 The development of tactics, techniques, and equipment used
by amphibious landing forces.
 Such other duties as the President may direct. (National
Security Act of 1947)
United States Marine Corps
 Smallest of the armed forces. Is a Department of the Navy
but operationally is a separate branch. The USMC was
originally organized as the Continental Marines on Nov 10,
1775 and served as naval infantry. The Continental Marines
were disbanded by the end of the revolutionary war and then
reestablished as the United States Marine Corps by Congress
in 1798.
 Similar to the Navy, the Marine Corps is comprised of an
Active and Reserve component but does not have a National
Guard
Marine Corps Values
 1. Honor
 2. Courage
 3. Commitment
United States Air Force
 Motto: “Fly- Fight- Win”
 Air Force Mission: “To deliver sovereign options for the
defense of the United States of America and its global
interests to fly and fight in air, space and cyberspace.”
United States Air Force
 The Air Force is the youngest of all the military services and
represents the aerial warfare branch of the armed forces. The
USAF was formed as a separate branch of the military on 18
Sept 1947 and was known prior to that as the Army Air
Corps. The USAF is comprised of an active component and
two reserve components, the Air Force Reserve and the Air
National Guard. While the Army, Navy and Marines all have
and utilize aircraft, it remains the mission of the Air Force to
“deliver sovereign options for the defense of the United
States of America and its global interests, to fly and fight in
air, space and cyberspace.”
Air Force Core Values
 1. Integrity First
 2. Service Before Self
 3. Excellence In All We Do
United States Coast Guard
 Motto: Semper Paratus, "Always Ready"
 Coast Guard Mission: “To protect the public, the
environment, and the United States economic and security
interests in any maritime region in which those interests may
be at risk, including international waters and America's
coasts, ports, and inland waterways.”
United States Coast Guard
 The United States Coast Guard is an armed force but differs from
the rest as it is not a part of the Department of Defense but
instead falls within the Department of Homeland Security. Its
fundamental roles include maritime safety, maritime security,
maritime mobility, national defense, and protection of natural
resources. The USCG’s mission is to “protect the public, the
environment, and the United States economic and security
interests in any maritime region in which those interests may be at
risk, including international waters and America's coasts, ports,
and inland waterways.”
 The Coast Guard can operate under the DoD as a service in the
Dept of the Navy if Congress declares war or at the request of the
President.
Coast Guard Core Values
 1. Honor
 2. Respect
 3. Devotion to Duty
Inter Branch Rivalry – A
misunderstanding of the mission
 Navy & Air Force
- Traditionally process driven – highly repetitive, exercise and
mission remains the same differ little.
- Process failures – Cause loss of life or millions or dollars in
equipment due to loss of aircraft shipboard disasters.
• Marine Corps & Army
• Operate in environments by their very nature are
unpredictable and are not controllable
- Again see the importance of small unit leadership
Inter Branch Rivalry
The flexible side views the process driven side as irrelevant the
disparity of values is created which leads to cynicism
It is important for you to see this distinction so that you
understand your bravado veterans are not judgmental rather
a product of the environment they served in.
Case Study Review
 What does it mean that he is in the “Army National Guard?”
 What is a SPC? A gunner?
 What does it mean that he is from the First Brigade Combat
team 3ID?
 What does "down range" mean?
Summary Culture
 Understanding military language
 Rank Structure
Leadership levels
 Reviewed the individual branches
a. Core values
b. Mission
a.
Questions
 We will next be covering the differences between active duty
and the reserve component.
Active Component/Active Duty
 Works full-time for the military
 Full time hours, full time benefits
 On-call 24 hrs/day, 365 days a year
 Permanent force of the military
AC Benefits include:
1.
2.
3.
4.
5.
Competitive salary and bonuses
Healthcare
Annual leave
Base privileges
Retirement
Challenges/Stressors
 Permanent Change of Station (PCS) every 2-4 years
 Temporary Duty (TDY)
 Deployment
Reserve Component/Reserves
 Part-time duties
 One weekend a month (39 days/yr), 2 weeks a year
 Can be activated to augment AC
 7 components (1.Army Reserve 2. Army National Guard 3.
Air Force Reserve 4. Air National Guard 5. Navy Reserve 6.
Marine Corps Reserve 7. Coast Guard Reserve)
National Guard vs. Reserves
 The National Guard continues its historic dual mission,
providing to the states units trained and equipped to protect
life and property, while providing to the nation units trained,
equipped and ready to defend the United States and its
interests, all over the globe.
 The National Guard may also be activated into Federal
military service during times of need like the present wars in
Iraq and Afghanistan. In this sense, the National guard
essentially has a dual mission to serve its state as well as the
federal government.
RC Benefits include:
1.
2.
3.
4.
5.
Pay for drill and annual training
Bonuses
Healthcare
Base Privileges
Retirement
*Challenges/Stressors RC
 Deployment/Mobilization
 Lack of military installations close to home
 Interruptions in civilian life (jobs, school running business)
 Returning home access to military facility, healthcare other
services
 Isolation from a strong military community.
Challenges/Stressors RC
 Traditionally active duty plan and train to deploy. That is the
MISSION.
 Work ups for deployment begin approximately 1 year out
from the actual deployment. They are in the field families
have time to prepare to be alone.
 AC ,members and their family are psychologically more
prepared as this is talked about frequently and on a weekly
basis. RC personnel are at the installations assigned at a
minimal basis and often live most of their lives in a civilian
capacity.
Questions
 Next topic Deployment
Deployment
Eat & Drink Today Fore, We May Die Tomorrow
Objectives:
 Discuss typical emotional reactions during the stages of
deployment and management strategies.
 Discuss management strategies for each of the stages of
deployment.
8 Stages Deployment Model
1.
2.
3.
4.
5.
6.
7.
8.
Anticipation -Pre Deployment
Detachment & Loss Pre Deployment
During Deployment
Still Deployed Recovery and Stabilization
Anticipation of Homecoming
Post Deployment
Post Deployment Acceptance of new roles
Redeployment
Stage #1 Pre-Deployment: Anticipation of
Loss (1-6 weeks prior to deployment)
 Assessment for Pre-Deployment: Anticipation of Loss (1-6
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weeks prior to deployment)
Excitement, Denial, & Fear
Tension: Attempting to accomplish too many projects
Unexpressed anger: bickering usually increases;
This could be a useful tool to expose unspoken feelings and
fears: Restlessness, Depression
Irritability and/or Resentment
Management Strategies for Stage 1:
 Expression of a full range of emotional responses
 Encourage all family members to share their feelings
 Help the member to reassure partner of love and commitment
 Involve the whole family in preparing for the separation
 Create opportunities for warm loving memories
 Try to see the deployment as a challenging opportunity for growth
 Go through the Family Readiness Checklist together as a family (as
least spouses)
 Identify key contact telephone numbers, include military contact
numbers
Preparing children for separation:
 Talk to children before they are deployed; be open and honest.
 Build an emotional bond. Do not be afraid to hug your child.
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Displays of affection are powerful.
Visit your children’s teachers
Allow children to see the parent’s workplace
Plan time for communication
Help children to plan for the departure (timeline)
Outline children’s responsibilities
Tune into your child’s specific worries
Stage #2: Pre-Deployment: Detachment &
Withdrawal (1 week prior to deployment)
 Despair and hopelessness
 Decision making becomes more difficult
 Projects are never ending
 Fatigue increases
 Sexual relations may become ambivalent
 May stop sharing thoughts and feelings
 Departure delays increase tension
Management Strategies for Stage 2
 Remember that the deployment is not forever
 Go through checklists with your partner
 Set realistic goals for yourself for the deployment period
 Communicate as openly and honestly as possible
 Be patient with yourself, your partner, & your children
 Recognize stress
Stage #3: During Deployment
 Emotional Disorganization (First 6 weeks of deployment)
 Operational stress accounts for up to 1/3 of deployment
casualties
 Stress contributes to the loss of effectiveness and negatively
impacts military readiness
 Exposure to devastation & death can cause physical,
cognitive, emotional, behavioral, and spiritual reactions that
greatly diminish fighting effectiveness
 Stressors: Climate extremes; sensory overload;
loud/persistent noises; sleep deprivation
 Still in shock - Initial sense of relief overcome by guilt
 Depression, withdrawal from peers, emotional withdraw
from spouse
 Sense of abandonment, poor concentration
On the Home Front Young children may regress (toilet training & thumb sucking
 Complaints of stomach aches or headaches
 Older children may become clingy and demanding
Problem Prone Areas:
 Anyone with significant problems prior to deployment
 Substances abuse or who are in early recovery (Detox)
 Most common Stressors:
Financial, Relationships, Children, No Power of Attorney,
Unpaid Bills
Warning Signs:
 Feeling hopeless or helpless
 Acting out or seeking relief inappropriately
 Extreme mood swings
 Sleeplessness or too much sleeping
 Major appetite changes +/- 10%
 Loss of interests
 Inability to concentrate or poor memory
 Thoughts of hurting yourself or someone else
Management Strategies for Stage 3 for
the Military member
 Hook-up with the “Old hands” - experience is more helpful than
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rank
Military members who use high active coping report better health
The shorter the deployment, the less likely bonding will occur
Utilize MWR & recreation resource (non-alcoholic events)
Use Mental Health assets
Maintain healthy self-care practices established before departure
Participate in support groups (formal and informal)
Try to end phone calls on a positive note
Stage #4: Still Deployed. Recovery and
Stabilization (Variable duration)
 Both military member and spouse may become mildly
depressed, anxious, or vulnerable (risk for extra marital
relationships?)
On the Home Front
 Living without member contributes to sense of selfconfidence
 New family patterns, eating habits and meal times change
 Social support may change
 Increased sense of freedom and responsibility
 More sickness due to stress
Management Strategies for Stage 4
 Confide in trusted peers, family, and professionals
 Celebrate signs of positive growth in self, partner,
children (new skills, freedom, and independence)
 Reassure your partner that you still long for the
separation to end
 Be aware of emotions that lead to vulnerability and
may result in impulsive behaviors
 READS (Relaxation, Exercise, Assertiveness, Diet, Sleep)
Stage #5: Anticipation of Homecoming
(6 weeks prior to redeployment)
 Sense of being “not ready,” mission not complete
 Anticipation and apprehension of reunion, unrealistic
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expectations
Decisions become harder to make; decisions are postponed
until after the homecoming
Heightening sense of loss – Freedom, independence
Restlessness and confusion
Family roles may have to be re-evaluated or adjusted
Management Strategies for Stage 5
 Reassure your partner of your love and commitment
 Plan to have some family time with the children before the
“honeymoon”
 Include children in the homecoming celebration
 Acknowledge only officially confirmed return information
(date, time, location)
 Ignore rumors; don’t raise false expectations, frustrations)
Stage #6: Post-Deployment
 Honeymoon for about a day, or until first argument
 Together physically but maybe not emotionally
 Primary task is to stop being “single”
 Disorganized feelings; things are not in your control
 Assumptions and expectations governing the marriage must
usually be adjusted
 Increased friction?
Management strategies for Stage 6
 Renegotiation of relationships (First 6 weeks after returning)
 Accept feelings as normal and not a threat to the relationship
 Be patient with yourself and your partner
 Renegotiate roles and responsibilities- the workload can
again be shared, but perhaps in a new way
 Celebrate personal growth together; each person has grown
during the separation
Stage #7: Post-Deployment
Acceptance of New Roles (6-12 weeks after returning)
 Try to use “our” instead of “mine”
 Establishing a new routine (new roles)
 Increasing sense of security and improved communication
How to Cope:
 Continue to participate in support group/networks
 Seek professional counseling (chaplain, social worker, doctor,
psychologist) for continuing signs of deployment stress, and
other concerns
8th Phase: Redeployment
 Here we go again!
 See previous Effects and Stages of Deployment
Questions
 Next Services in a deployed setting/down range.
Combat Stress Facility
What’s a normal reaction when in a combat zone?
TREAT WHEN YOU MUST
Combat Stress Facility Mission
 Promote combat readiness
 Enhance adaptive stress responses
 Prevent maladaptive stress reactions
 Normalize reactions to stressful environment
 Opportunity for rest and recuperation
 Expectation of RTD
 Potential 24-hour operations
CSF Goals
 Maintain military identity with expectation of return to
duty
 Normalize combat and operational stress reactions
 Not medical or psychiatric illnesses
 Provide rest and recuperation
 Skill acquisition
 Consultation with unit leadership
CSF Personnel Makeup
 CSF building blocks may include
 – Clinical Psychologist and 7 Level Tech
 – Clinical Social Worker and 7 Level Tech
 – Psychiatrist and 5 level Tech
 – 2 Mental Health Nurses
 – 2 5 level Techs
Expand and contract as the mission dictates (by
patient census)
Overall Duties
 24 Hour Operations
 24 hours a day, 7 days a week
 At least one staff member must be present at all times
 CSF will have 20 bed capacity
 Normal patient stay appears to be 3-6 days
Referral
 Anyone can refer to the CSF
 Only BH staff assigned to the CSF can accept personnel for
entrance to the CSF
Criteria for Acceptance
 Any cognitive, behavioral, emotional, or occupational
impairment related to combat or operational stressors of
such a nature to be responsive to 72 hours or less of rest and
milieu therapy. Possible examples include:
 Significant sleep deprivation functional impairment
 Sudden reduction in performance or marked change in
demeanor/behavior
 Recent combat exposure assessed with etiology related to a
disturbance in mood, cognition, and/or behavior causing significant
impairment in functioning
 Having endured strenuous duty assessed that interrupted an
individual’s personal hygiene and dietary needs. Such neglect is
considered likely to cause significant impairment in functioning in
most individuals
Disqualifying Criteria for Acceptance or
Continued CSF Care
 Imminent risk to themselves or others
 Intentional self-injury or harm to others
 Serious medical problems preventing a person from
functioning at a more independent level
 BH issue more appropriately handled at a different level of
care or through administrative action
 SMs more appropriately handled by legal or administrative
authorities
 Chronically behaviorally disordered persons
Criteria for Release
 Improvement to such an extent they can return to light/full
duties
 Individuals who do not improve to the extent they can return
to light/full duties
 Should be re-evaluated
 Considered for a different level of care or administrative
disposition
Triage Categories
 HELP IN PLACE/UNIT (Unit)
 Active outreach, go to the unit
 REST (Unit)
 Close observation not required
 HOLD (Restoration Center)
 Medical/BH observation required “CSF”
 REFER (Reconditioning Center or other)
 Too disruptive for current level of care
Interventions
 Conduct assessments to identify
 Intervene consistent with protocols
 Triage as appropriate
 Treat consistent with BICEPS
 Provide R&R to RTD (“3 hots & a cot”)
 Implement/maintain CSF functions
 Consultation function
 Admissions function
 Therapeutic activities
 Command consultation
Restoration Principles
 BICEPS
 Brevity
 Immediacy
 Contact
 Expectancy
 Proximity
 Simplicity
Brevity
• Brief treatment, no longer than three
days
• Usually at second echelon facility
Immediacy
 Identify the need for care early – don't
wait
 Provide care as soon as possible
Centrality
 Treat in separate location (not in hospital)
 Not physically sick, they just need rest
Expectancy
 Member must understand verbally and non-
verbally they are returning to duty
 Patient is not ill
 Symptoms are passing reactions
 Recovery is rapid
 Wear of uniform while performing details
allows member to maintain self-image/military
bearing
Proximity
 Treat as close to home unit as possible
 Allow unit and friends to visit and offer
support
Simplicity
 Keep treatment directed to patient’s
return to duty
 No medications unless necessary and only
under doctor’s supervision
5 R’s
 Reassurance
 Rest
 Restore
 Replenishment
 Return to duty
Phase I – Reconstruction
Basic needs/rest
 Hygiene
 Food

Phase II – Reorientation
 Stress management
 Anger control
 Assertiveness training
 Relaxation techniques
 Goal setting
Phase III – Reintegration
 Preparation for return to duty
 Work assignments in applicable areas
 Individual’s role
 1 Don't be a loner
 2 Help others
 3 Know your limits
 4 Get at least four hour uninterrupted sleep. Nap when
you can
 5 Eat enough food
 6 Drink water/stay hydrated
 7 Good personal hygiene
 8 Stay active
What Are We Restoring?
 Replenish physiological status
- Rest
 Support military identity
 Structured military environment
 Military formations
 Unit update
 Restore confidence
 Normality of response
 Stress management
 Coping skills
Medication
 No meds on CSF equipment list
 Prescription medications should be used as sparingly as
possible
 Emphasis should be placed on the fact that personnel
admitted to the CSF are not considered patients
Outreach
 Formal outreach examples
 Commanders call
 First Sergeants Counsel
 Anger management
 Stress management
 Sleep hygiene
 Relaxation techniques
 Informal outreach
 Walk abouts
 “Stealth Mental Health”
Going to the FOB’s (Forward Operating
Bases)
 Usually the Tech will be the person who conducts outreach to
these remote locations.
 Typically it may be a 1x per week
- How are they perceived?
- Will members talk to them?
Cultural Differences
 Differences among the branches
- How they treat mental health
- Respect between members and rank
Questions
 Next section Discharge
Discharge
1st Civ Div, 1st Force Recline. John Rambo reporting for civilian
Duty.
Discharge/PCS/Going Home
 By choice?
 Forced?
 What have they lost?
 What have they gained?
 What went untreated or not talked about?
 Did they simply drop their pack?
 Do they feel like an outsider?
 Are they thinking about suicide?
Conclusion
1. Eligibility for VA Healthcare.
2. The Culture of the Military
3. Deployment.
4. Mental Health Services Down Range
5. Discharge