Another Kind of Valor:
A Day of Learning How to Better
Serve Veterans
and Their Families
Introduction
“…and they shall beat their swords into
plowshares, and their spears into
pruning hooks: nation shall not lift up
sword against nation, neither shall they
learn war any more.” Is.2:4
Overview
• What am I going to learn?
– The effects of war on returning Veterans and
their families
– The effects of war and differences among
those who served in all military branches, and
in services available to Veterans and their
families
– How to engage, talk to, work with Veterans
and their families
– Resources for Veterans and their families
Today’s Returning Veterans
• Who are returning vets?
– Over 1.6 million soldiers have been deployed to
Iraq or Afghanistan.
– Over 1/3 of those soldiers have been deployed
multiple times.
– Global War on Terror (GWOT): 799,791 veterans
are currently separated from the military.
– As of January 2008, there were 299,585 GWOT
Veterans who have sought health care through
the VA.
– Over 100,00 veterans have returned to California.
Alphabet Soup: Veteran Key Terms
•
•
•
•
•
•
•
OEF: Operation Enduring Freedom
OIF: Operation Iraqi Freedom
GWOT: Global War on Terror
DOD: Department of Defense
VA: Veterans Administration
VBA: Veteran Benefits Administration
VHA: Veteran Health Administration
Major Issues for Combat Veterans
• Major Depression
• Post-Traumatic
Stress Disorder
(PTSD)
• Traumatic Brain
Injury (TBI)
• Military Sexual
Trauma (MST)
• Substance Abuse
•
•
•
•
•
Suicide
Job loss
Family dissolution
Homelessness
Violence towards
self and others
• Incarceration
Population: Regular Forces
• What are concerns for those who served in
active duty in the Army, Navy, Air Force,
Marines and Coast Guard as well as the
National Guard & Reserves?
• 46.6% of regular forces are under 25 years
old.
• Many entered as teenagers and left home for
the first time.
• They may return to an already unstable home
environment with added stress from combat.
Population: National Guard &
Reserves
• What are the concerns among National
Guard and Reservist Veterans?
– The average age of Guard and Reservists is
35.8 years old.
– Many Guard and Reservists are forced to
leave jobs at or near the peak of their career.
– These “volunteer” soldier veterans are half as
likely to file VA claims as their regular forces
counterparts, and half as likely to have their
claims approved.
Population: Women Military
in the Military
• What are concerns among soldiers and
Veterans who are women?
– More women are engaging in combat roles in Iraq.
– To date there are between 155,000- 180,000 women
who have served in OIF/OEF.
– Women are 2 to 4 times more likely than non-Veteran
women to be homeless.
– Preliminary research shows that women in war have
much higher exposure to traumatic experiences than
women in the community.
Population: Veteran Families
• What are some of the issues facing Veteran families?
– PTSD frequently has a debilitating effect on Veterans’ ability to
maintain employment and family relationships.
– 50-60% of spouses of brain injured Veterans reported having
depression.
– A drastic increase in the rate of child abuse and neglect in
military families has been reported since 2002.
– Resources for Spouses and children of Guard and Reservists
lose all benefits 90 days after their soldier returns from war
Meeting and Greeting
Veterans & Families
• Be quick to listen and slow to speak.
• When discussing combat experiences,
ALWAYS avoid making character judgments.
• Never say anything as stupid and insensitive
as:
–
–
–
–
So, did you kill anyone?
My mom told me not to date a vet.
Did your (son, daughter, spouse) come back crazy?
What do you think about the war?
Talking With Veterans & Families
• How should I talk to
Veterans or their
families about their
experience?
– With respect, compassion
and patience. Talking
about combat can be an
awkward conversation.
• Ask factual, logistical
questions like:
– How long have you been
home?
– What did you do in the
military?
– How are you transitioning?
• Be honest and direct in
order to earn their trust
and build rapport..
– Welcome home. How can I
help you? Thank you for
your service.
Getting Help:
Support and Resources
• Where can Veterans and their families
go to get help?
– Veterans Administration.
– Vet Centers.
– Community Organizations like:
• Coming Home Project
• Swords to Plowshares
– YOU.
– What are helpful resources that you would
recommend?
Resource: Veterans Affairs (VA)
•
The Department
of Veterans Affairs
Veteran’s Health
Administration
Vet Centers
Can’t all veterans go to the VA?
–
No. Generally, veterans must have an
honorable discharge, have served 24
continuous months, demonstrate
financial need, and/or have a service
connected disability.
–
OIF/OEF Veterans who served in
combat are eligible for 5 years of free
health care and may be eligible for 90
days of dental care after separation.
–
Veterans must apply separately to the
VHA and the VBA.
–
Vet Centers are designed to serve
combat veterans, their surviving family
members and victims of military sexual
trauma (MST).
–
Provide marital and family counseling
with counselors who are a Veteran as a
conduit for care.
Veterans Benefits
Administration
Barriers to Assistance
• I sent a veteran to the VA for help, so they
should be okay, right?
– Hopefully. Veterans do not always receive immediate
assistance.
– The backlog in Veteran benefit claims has risen to
600,000.
– As of June 2007, there were 202,705 GWOT
Veterans filing claims for the first time.
– The AVERAGE WAIT TIME for an initial decision on a
claim 183 days!
– The time frame for a claim decision, including
appeals, can exceed 10 years
What can I do to Help Veterans and
Their Families?
• Learn
– About military culture, experiences of soldiers,
and the needs of military, Veterans and their families.
• Give
– Them some of your time and energy, your
appreciation, and your resources.
• Be an Advocate
– For military, Veterans, and their families
• Talk
– To them with respect and honor, listening with
compassion and patience.
Engagement Skills
•
•
•
•
•
Practicing empathy
Providing choice
Removing barriers
Providing feedback
Clarifying goals
PTSD: Combat Stressors
• Being in constant alert for an IED/‘Booby
trap’ or other life threatening dangers.
• Feeling responsible for the death of an
enemy and fellow human.
• Seeing or experiencing the death or injury of
a friend or fellow soldier.
• Being shot at or exposed to other dangers.
• Sexual trauma.
Symptom Response
•
•
•
•
Acute stress reaction – immediate
Acute stress disorder – up to 1 month
Acute PTSD – 1 to 3 months
Chronic PTSD – 3 months and beyond
PTSD: Diagnostic Criteria
• Re-experiencing: thoughts, nightmares,
flashbacks, emotional reactions,
physiological reactions.
• Avoidance: Avoid thoughts, reminders,
amnesia; detachment, numbing, anhedonia.
• Arousal, sleep disturbance, concentration
problems, anger, hypervigilance, hyper
startle response.
PTSD: Impact on Families
• Intimate relationships:
– Directly effect the relationship: Anger
responses, withdrawal of affection,
unpredictable responses
– Indirect affect on relationship skills e.g.
impaired communication skills, avoidance,
numbing, etc.
– Perception of the relationship: satisfaction
with relationship reduced
PTSD: Impact on Families
• Spouse/partner
• Direct impact of PTSD symptoms
• Indirect: added stress, lack of intimacy
• Domestic violence
• Secondary trauma: “Contagious” PTSD
• Compassion fatigue
• Caregiver burden
PTSD: Impact on Children
• Direct effects: developmental milestones
delayed, adjustment issues, frightened of
parent
• Indirect effects: parenting skills/role
changes, compromised e.g. hypervigilance,
avoidance/withdrawal, anger/aggression
• Child at risk: increased risk taking, neglect,
violence, substance abuse
Stages of Recovery and Treatment
Ohio
Spaniol, Gagne,
et al
Prochaska &
DiClemente
Dependent
unaware
Overwhelmed by
disability
Precontemplation
Dependent
aware
Struggling with
disability
Contemplation/pr
eparation
Independent
aware
Interdependent
aware
Living with
disability
Living beyond
disability
Action
Maintenance
Stage of
Treatment
Treatment Focus
Engagement
• outreach
• practical help
• crisis
intervention
• relationship
building
Persuasion
• psycho-education
• set goals
• build awareness
Active Treatment
• counseling
• skills training
• self-help groups
Relapse
Prevention
• prevention plan
• skills training
• expand recovery
Motivational Interviewing
• asking open-ended questions
• listening reflectively
• affirming change-related participant
statements
• encouraging self-motivational
statements
• handling resistance without direct
confrontation
What Helps
• Cognitive Behavioral Therapy (CBT)
• Eye Movement Desensitization and
Reprocessing (EMDR)
• Brainspotting
• Support Groups
• Assistance with daily living support as
needed.
• Spiritual and Social supports.
• What have you found to be helpful in serving
returning Veterans and their families?