Working With Veterans and Their Families:
A Community Program Overview
Paula G. Panzer, MD
Director
Center for Trauma Program Innovation
Jewish Board of Family and Children’s Services
New York, NY
October 21, 2010
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Acknowledgements
• Home Again Project Coordinator: Adriana Rodriguez, LCSW
• Project Team
– CUNY Office of Veterans Affairs: Wilfred Cotto, Director
– Project Assistant: Rebecca Wynn
– Veteran Peer Advocates: Reneel Langdon; August Coleman;
Danessa Duverce
– New York State Psychiatric Institute/Columbia University Trauma
and PTSD Program: Yuval Neria, PhD, Director; Maren Westphal,
PhD, Research Project Manager
– Jewish Board of Family and Children’s Services Center for
Trauma Program Innovation is a National Child Traumatic Stress
Network Member
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Acknowledgements
Funding
Home Again: Veterans and Families Initiative – NYS Health Foundation; Charles &
Mildred Schnurmacher Fund
Home Again: Reaching Out – McCormick Foundation and Major League Baseball
“Welcome Back Veterans”
JBFCS Staff training to prepare for community practice: van Ameringen Foundation
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Veterans’ Access to Care
• Is the issue access to care or use of care?
– Think about
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Care settings
Linkages
Relevance
Reimbursement
Flexibility
• What do you have in your community?
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Veterans’ Families - Access to Care
• Families are broadly defined yet their adjustment
and mental health needs can be specifically related
to military exposure and cultural context
• Family members can be a point of entry for care of
Veterans
• Access to targeted care is limited
• Their needs may be individual AND family based
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Problem Statement, Part I
• Home Again and other programs face the same
problem: the challenge of engaging veterans and
their families in mental health care.
• Hypothesis: Primary obstacle is stigma and fear of
being perceived as weak, unable to move forward
with life if mental health help is sought (and used).
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Problem Statement, Part II
• Other issues:
– Veterans are distrustful and fear repercussions if they ask for help.
– Those still in the National Guard and Reserve or in civilian law
enforcement fear jeopardizing promotion or their leaders’ confidence.
– Long deployments, family obligations and financial needs make
veterans want to reintegrate quickly, without psychological self-care or
reflection, feeding the avoidance that is symptomatic of PTSD.
– Families with currently deployed service members have difficulty
engaging in treatment due to added responsibility and stress at home.
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Problem Statement, Part III
• Home Again and other Veterans programs urgently
need new outreach messages, methods, and
approaches.
• Home Again: Reaching Out
– New communications strategy using Veterans to reach
Veterans
– Training Peer Advocates to bridge the gap between
school and mental health service for those in need
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Intervention Model
• Provide an ongoing peer advocate outreach program to encourage
and assist veterans in engaging in services and moving toward
successful outcomes
• Develop new ways of identifying veterans and their psychological
challenges despite social stigma
• Provide Access to families for support and services without obligation
for Veteran family member use of service
• Develop a city-wide psycho-educational campaign using media which
reaches Veterans and their families
• Prepare MH Serving Community for sub-specialty service
• Partner, Partner, Partner
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Home Again: Reaching Out — Start Up
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Veteran Serving Linkages
Mental Health Serving Linkages
Training Plan
Outreach Work
Time Line
Fundraising alongside Case Finding
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Lessons Learned from Veterans
• Sources of information
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Advisory Board
Focus Groups
Semi-structured interviews
Feedback at tabling events
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Lessons Learned from Veterans
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Relevance
Timing
Connection to Peers
Risk
Connection to Work, Family
Stigma
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Hope
Prior Assumptions
Housing
Substance Use
Cognition & Learning
Military Understanding
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Lessons Learned from Veterans
• Some examples from “What Therapists Should
Know” handout:
– Therapists should know what type of threats veterans
face while deployed in a combat zone (for example:
improvised explosive devices, vehicle-based explosive
devices, suicide bombers, and rocket-propelled
grenades).
– Therapists should understand that being in a combat
zone is different than being at a duty station.
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Lessons Learned from Veterans
• Some examples from “What Therapists Should
Know” handout:
– Therapists should understand that there is a lot of
sexual harassment in the military for both men and
women.
– Therapists should understand that veterans are used to
a structured environment.
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Lessons Learned from Veteran Serving Systems
• It is critical to have a veteran:
– Provide encouragement to a veteran to access services
– Vouch for the program’s quality of services.
• Programs need to be established for several years
before receiving a steady stream of referrals.
• Linkages with VA are important AND competition
and role remain issues.
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Prepare MH Serving Community
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Military Cultural Competence
Engagement
Targeted Treatments
Access to Linkages for cases which can’t be served
Address funding issues
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Interventions
Capacity to provide evidence informed interventions
• Assessment (include suicidality and family violence
risk evaluation)
• Brief individual and family interventions
• Targeted treatment for PTSD, traumatic depression,
substance use, TBI, etc.
• Cognitive Processing Therapy for PTSD in Veterans
& Military Personnel
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Useful Web Sites
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National Center for PTSD
– http://www.ptsd.va.gov
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Military Cultural Competence
– http://www.ptsd.va.gov/professional/ptsd101/flash-files/Military_Culture/player.html
– http://deploymentpsych.org/
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Cognitive Processing Therapy (CPT)
– http://cpt.musc.edu
– http://www.essentiallearning.net/Student/content/sections/Lectora/CognitiveProcessingTherapyforP
TSDinVeteransandMilitaryPersonnel/index.html
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NCTSN Military Families Knowledge Bank
– http://mfkb.nctsn.org
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NYS Health Foundation: Returning Veterans & Families Resource Center
– http://www.nyshealthfoundation.org/section/resources/veterans_resources
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Contacts
Paula G. Panzer, MD
[email protected]
Home Again: Veterans and Families Initiative
(646) 957-0853
www.homeagainveterans.org
http://homeagainveterans.blogspot.com/
JBFCS - October 2010
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Working with Veterans - Jewish Board of Family and Children`s