COMING HOME FROM WAR: A COMMUNITY’S RESPONSE TO OUR VETERANS

1. HOMECOMING COMING HOME FROM WAR: A COMMUNITY’S RESPONSE TO OUR VETERANS “To care for him who shall have borne the battle, and for his widow, and his orphan” A. Lincoln 88th Regional Readiness Command Combat Operational Stress Control Team MAJ. Cynthia Rasmussen

2. The Products 88th RRC Deployment Cycle Support Program • Education • Resource Materials and Briefings - to help leaders, Service members and families manage deployment stress • Networking and Marketing Presentations - to increase public awareness and support of military families • 1:1 Counseling, Brief Intervention, Referrals, Command Consultation, Grief education and support • Suicide education/Intervention, First Responder Training • Sexual Assault Prevention and Response Program

3. OEF/OIF Veterans’ Statistics(from VA National WEB site & Womens vet. Center) • 48% are Active Duty, 52% are Reserve/National Guard • 88% are men, 12% are women (14% AC/RC) • 65% Army; 12% Air Force; 12% Navy; 12% Marine • 34% were deployed multiple times • 52%, largest age group, is 20-29 years old

4. total number of soldiers who have been deployed during OIF/OEF 1.6 million

5. total number of soldiers who have been deployed to a war zone twice or more 700,000+

6. 86% Know someone who was seriously injured or killed.

7. 77% Have shot at or directed fire at the enemy.

8. 68% Have seen dead or seriously injured Americans.

9. WHY A BRIEFING ON REINTEGRATION? History has taught REUNIONS are more stressful than separations: • People grow and change • Expectations are Different • Experiences were different • Understanding & having the right words to dialogue about changes and expectations has made significant strides in improving the reintegration process…

10. “Never before have we asked so few citizen soldiers to do so much in war time, while knowing they and their families have great psychosocial needs.” Dr. Charles R. Figley

11. Lack of/too much communication Lack of freedom of movement Environmental / climate changes Isolation & boredom Poor sleep patterns Home-front worries Repetitious & routine duties Separation from loved ones Unclear / misunderstood mission Uncertain redeployment date Operations Tempo Cultural Differences Lack of personal time Threat of attack Observation of atrocities Taking of life, watching others die Recovering the dead Breaking of personal moral code Experiencing abuse or harassment POOR LEADERSHIP Mission Stressors Then

12. War Zone Skills are not the same skills we need at home. “Normal” behavior for a service member is often not understood by family, friends, co-workers, or our communities.

13. Service members need 2 sets of skills:WAR/Survival Coping SkillsHOME Skills

14. Mission Oriented • WAR • Once a mission is assigned other, unrelated tasks are unimportant • Decisions need to be quick, clear, accurate • No time for discussion “one person talks-everyone listens” • HOME/JOB/SCHOOL • Multiple competing tasks cause confusion • Get angry with those who get in the way of mission • Difficulty participating in cooperative decision making • Frustration with others “lead, follow, or get out of the way” “I must be on time for everything” “CHAOS” “everyone talks- everyone listens”

15. Safety & Trust • WAR • Vigilance pays off • Never Relax/ Never let guard down • Assume everyone is the enemy “suspicious of others you have known & trusted” • HOME/JOB/SCHOOL • Avoid getting involved • Suspicious of everyone • Test people to earn trust • Always on guard • Isolative “being suspicious isolates you” “I have never been able to go to the mall again” “Holiday Weekend, My family took a nap and I cleaned my weapon” (female OIF Vet)

16. Emotions/Anger “NOT talking about your emotions in war (strength) only leads to CAN”T talk about emotions at home (weak)” • WAR • Control emotions • Numbing • Anger useful, protective, IS a survival skill • HOME/JOB/SCHOOL • Insensitivity to others “look hot headed, hard headed” • Decreased ability to read others emotions “you look / act emotionless” • Decreased emotional enjoyment • Increased irritability and defensiveness • Increased aggression “fed by constant frustration” “They think I have PTSD cause I don’t cry” Increased alcohol/drug use to avoid feeling emotions

18. Authority WAR • Little room for choice “do what you are told when you are told” • May have had much authority • May not have faith in authority “bad decisions by authority = deadly consequences” HOME/JOB/SCHOOL • May Resent authority “who are you to tell me what to do” • May be Reluctant to let others have authority “may cause grades to fall at school” ”loss of jobs” “etc” • May take on too much authority/ or want none at all • May lead to Increased confrontations

19. Closeness • WAR • Intense relationships • Strong bonds, depending on each other for survival • If losses, learn to avoid getting close • HOME/JOB/SCHOOL • Long term intimacy more complicated “lonely” “not open with emotions” • May expect same level of intensity of intimacy at home “not on the same page” • May push loved ones away “looking for replacements”

20. WAR Restrict any information that may be used against you Can change world view and of self (may be unable to articulate changes) “I didn’t feel safe anymore” HOME/JOB/SCHOOL Give little information “feel like I need to shred it all” Keep to self /More comfortable talking with Battle Buddies Avoid talking “phone vigilance/verification” Social chatter a waste“very direct communication (cold, not friendly)” “changing routes when commuting” Intelligence/ Talking

21. WAR Act first think later Maximum application of force and or resources “everytime” HOME/JOB/SCHOOL Unable to think first act later “too much going on” “you look reckless & uncaring /inconsiderate /selfish” He/She may insist things not be out of place“you appear to be extreme” May find self training the family to survive in a war zone “appear to be aggressive” “I am not one of your troops!” Response Tactics

22. Hypervigilence “Adrenaline RUSH” HOME/JOB/SCHOOL • Inability to relax • Sleep changes “too little/ too much” • Dreams • Monitoring environment/ perimeter Attempts to relive “RUSH” WAR • A year or more of daily Hypervigilence

23. War may be hell… but home ain’t exactly heaven, either. When a Service Member comes home from war, He/She finds it hard…

24. …to listen to his son whine about being bored.

25. …to keep a straight face when people complain about potholes

26. …to be tolerant of people who complain about the hassle of getting ready for work

27. …to be understanding when a co-worker complains about a bad night’s sleep

28. …to control his panic when his wife tells him he needs to drive slower

29. …to be grateful that he fights for the freedom of speech.

30. …to be compassionate when a businessman expresses a fear of flying.

31. …to be silent when people pray to God for a new car.

32. …to not ridicule someone who complains about hot weather.

33. …to just walk away when someone says they only get two weeks of vacation a year.

34. …to control his rage when a colleague gripes about his coffee being cold.

35. …to remain calm when his daughter complains about having to walk the dog.

36. …to be civil to people who complain about their jobs.

37. …to be happy for a friend’s new hot tub

38. …to be forgiving when someone says how hard it is to have a new baby in the house.

39. …to not punch a wall when someone says we should pull out immediately.

40. The only thing harder than being a Service Member… ……………

41. IS LOVING ONE…….

42. A gentle reminder to keep your life in perspective. And when you meet one of our Returning SERVICE MEMBERS/VETS/FAMILIES, please remember what they’ve been through and show them Compassion , Tolerance, Respect, and the Best Care. Thank you. CPT ( Ret.) Alison L. Crane, RN, MS

43. WAR ZONE/ MILITARY SKILLS DO NOT AUTOMATICALLY CHANGE WHEN YOU/THEY COME HOME.

44. What is Operational Stress?? • Combinations of physical and mental challenges (stressors) that can produce symptoms which temporarily interfere with performance. • Can happen to even the bravest warriors as well as those who have not been in combat • Operational stress can also produce positive behaviors. Negative effects diminish or resolve given time and positive support.

45. Two Types of Stress There are Two Kinds of Stress • ACUTE – “Fight or Flight” • CHRONIC -

46. Acute Stress • Body readies for “fight or flight”  Electrical changes in heart and sympathetic nervous system  Increased production of hormones & sugars  Immune system changes; blood pressure increases • Experience:  Thrill  Exhilaration  Adrenaline rush  • Results in:  Focused attention  Heightened strength  Feeling of competence  If stress is unmanaged, can result in ‘burnout’ Effects last at least 90minutes

47. Chronic Stress Injury – Adaptation vs Injury • The Stealth Bomber of Stress • Long term results of daily living. • PHYSIOLOGICAL EFFECTS • Mediates Hormones and NeurotransmittersSerotonin, Dopamine, Noradrenaline, GABA, CRF, Steroids • Exhaustion stage •  Available resources exhausted •  Performance becomes progressively worse •  Performance may stop

48. The Thing is… • The Goal of Military Training is to “HARDEN” (adapt) troops so they can operate under conditions where ACUTE STRESS is actually a CHRONIC condition.

49.  Adaptation - The path of change can be traced over time - Individual feels like he/she is still himself A more gradual process A focus of training and leadership What’s the Difference Between a Stress Adaptation and a Stress Injury? Two ways of looking at Battlefield stress:  Injury • May be more abrupt • A derailment, a change in self • Individual feels like he/she is not in control

50. Combat/ Operational Stress Reaction (COSR)