Civilian Clinicians Counseling Military Veterans

2. To be introduced to: 1. Who’s Responsible for our Veterans 2. A Call to Serve those who have Served us 3. Understanding Military Culture 4. Common Treatment Issues 5. Connecting with the VA 2

3. Department of Defense ➢ Defense Intelligence Agency ➢ National Security Agency ➢ NORAD ➢ National Geospatial Intelligence Agency ➢ Missile Defense Agency ➢ National War College ➢ And more… 3

4. Department of Defense 4

5. A Cabinet-level executive branch department of the federal government charged with integrating life-long healthcare services to eligible military veterans at >1700 VA medical centers and outpatient clinics located throughout the country. 5

6. Also provides non-healthcare benefits to military veterans which include disability compensation, vocational rehabilitation, education assistance, home loans, and life insurance; and provides burial and memorial benefits to eligible veterans and family members at 135 national cemeteries. 6

7. The VA Battles America’s Veteran Mental Health Crisis with Telehealth February 13, 2019 ➢ "One in every four active-duty members of the United States military exhibit symptoms of mental illness, which are mostly the manifestation of posttraumatic stress disorder (PTSD), depression, traumatic brain injury (TBI), and/or transition stress.” The VA Battles America's Veteran Mental Health Crisis With Telehealth - NeuroFlow 7

8. The VA Battles America’s Veteran Mental Health Crisis with Telehealth February 13, 2019 ➢ "The lifetime prevalence of depression and PTSD are five and fifteen times higher respectively when comparing veterans to civilians.” The VA Battles America's Veteran Mental Health Crisis With Telehealth - NeuroFlow 8

9. The VA Battles America’s Veteran Mental Health Crisis with Telehealth February 13, 2019 ➢ “It is an inescapable fact: serving in the armed forces and returning to civilian life afterwards is difficult. Transition stress encompasses all of the pressures that veterans face when transitioning back into civilian life, which can also trigger mental health consequences.” The VA Battles America's Veteran Mental Health Crisis With Telehealth - NeuroFlow 9

10. The VA Battles America’s Veteran Mental Health Crisis with Telehealth February 13, 2019 ➢ “The extreme physical and mental duress that the men and women serving in the U.S. Military experience, both while serving and while transitioning back to civilian life, can trigger and exacerbate mental health issues. The risk for suicide was 22% higher amongst veterans than it was non-veteran civilians.” The VA Battles America's Veteran Mental Health Crisis With Telehealth - NeuroFlow 10

11. The VA Battles America’s Veteran Mental Health Crisis with Telehealth February 13, 2019 ➢ “The U.S. Department of Veterans Affairs’ (VA) mental health report from June 2018 provides evidence that the suicide rate amongst veterans has grown by 25.9% from 2005 to 2015.” ➢ “In fact, veterans are one and a half times more likely to take their own life than nonveterans.” The VA Battles America's Veteran Mental Health Crisis With Telehealth - NeuroFlow 11

12. Gen. Martin E. Debussy, Chm. of the Joint Chiefs of Staff 2011-2015 “We face a deficit that is that’s larger than our budget, and that is a deficit of understanding between those of us who serve in uniform and our fellow citizens.” Retrieved from http://www.wbur.org/npr/263333207/chairman-ofjoint-chiefs- warns-of-disconnect-with-military 12

13. VA MISSION ACT OF 2018 and Telehealth Law and Policy: A Closer Look at Governing the Practice of Telehealth for Veterans' Mental Health (americanbar.org) 13

14. The VA Maintaining Internal Systems & Strengthening Integrated Outside Networks Act • Authorizes access to walk-in community clinics for enrolled veterans who have previously used VA healthcare services in the last two years. • Authorizes local provider agreements to remove bureaucratic red tape and to meet veteran’s needs in the community. • Creates standards of timely payment to community care providers. 14

15. Despite the shrinking population of veterans, the number of veterans who use VA for healthcare will increase until 2019. Balancing Demand and Supply for Veterans' Health Care | RAND 15

16. The US is amid the largest military demobilization in its history. Projections suggest that 300,000 are returning with symptoms of PTSD or major depression; 320,000 have been exposed to probable TBIs; and hundreds of thousands are dealing with psychological effects of physical injuries. The Pew Research Center reports that 44% of veterans from current wars are describing their adjustment to civilian life as “difficult,” and many of them are, and will be, returning to civilian mental health and primary care clinicians for assistance. 16

17. View From the Administrator (2009-2015) Pamela S. Hyde, JD “Because we know that private-sector providers can be more effective in treating military consumers if they understand the military culture, combat experience, and challenges of deployment, SAMHSA encourages civilian mental health practitioners to become certified TRICARE providers.” Credentialing information and details on participating in the TRICARE network are available through the SAMHSA Technical Assistance Packet for Becoming a TRICARE Provider. SAMHSA - Substance Abuse and Mental Health Services Administration 17

18. View From the Administrator 18

19. 1. Branches the US Military ➢Army ➢ Coast Guard ➢Navy ➢ Air Force ➢Marines ➢ Space Force 19

20. 2. Rank ➢ Enlisted ➢ Noncommissioned Officers ➢ Warrant Officers ➢ Officers Link for Understanding the Military Rank Structure: https://slideplayer.com/slide/12270372/#.YFIrjlfIL4w.gmail 20

21. 3. Hierarchy Link for Military Rank Chart: file:///Y:/000%20ITTI/001%20COURSES/MILITARY/RESEARCH/KH% 20-Military%20Research/Military%20Rank%20Charts_0.pdf 21

22. 4. Language• PMS: Prof. of Military Science • MANPADS: MAN-Portable Air-Defense System • MANCOC: Maneuver Advanced NCO Course • DICC: Defense Intelligence Collection Cell • DISCO: Defense Industrial Security Clearance Office • MAGIC CARPET: Maritime Augmented Guidance and Integrated Controls for Carrier Approach and Recovery Precision Enabling Technologies • DRBOB: Defense Resale Business Optimization Board • FARP: Forward Area Refueling Point 22

23. 4. Language • BLT: Battalion Landing Team • AOC: Army Operating Concept https://images04.military.com/sites/default/files/styles/full/public/ 2019-04/2z7fsl.jpg?itok=SxvtMm2d Link for military acronyms and terminology: Military Acronyms and Terms - Military Parent Technical Assistance Center (branchta.org) 23

24. 5. General Observations ➢ Nonhomogeneous: each branch and each service member is unique. ➢ Families: soldiers are recruited, but families are enlisted. (Moore, 2012, p. 7) ➢ Hierarchy: significance of leadership ➢ Mission: priority over everything else ➢ Values: each branch has its own core values 24

25. 5. General Observations ➢ Shared Oath Allegiance “I, [name], do solemnly swear (or affirm) that I will support and defend the Constitution of the United States against all enemies, foreign and domestic; that I will bear true faith and allegiance to the same; that I take this obligation freely, without any mental reservation or purpose of evasion; and that I will well and faithfully discharge the duties of the office on which I am about to enter. 25

26. 5. General Observations ➢ Uniform code of military Justice (UCMJ) 26

27. Uniformed Services University Link for USU: Learn About Military Culture | Center for Deployment Psychology 27

28. • Traumatic Brain Injury • PTSD & ASD • Major Depressive Disorder • Suicide • Substance Abuse • Family Issues 28

29. Traumatic Brain Injury Primary Blast Injury Secondary Blast Injury Tertiary Blast Injury 29

30. ASD & PTSD ➢ What is ASD? What is PTSD? ➢ What is the difference? ➢ How would you explain these disorders to a family? ➢ How would you help a family cope with a vet suffering with ASD or PTSD? A Family’s Guide to PTSD A Family's Guide to Posttraumatic Stress Disorder (pdhealth.mil) 30

31. Depressive Disorders VA/DOD Essentials For Depression Screening & Assessment in Primary Care ➢ Suicide Assessment ➢ Major Depressive Disorder screening ➢ Patient Health Questionnaire Follow this link: Patient check-in form.pdf (va.gov) 31

32. Suicidality DOD Report on Suicide 26 SEP 19 In 2018, 541 active and reserve service members died by suicide. Within the active component, the suicide rate was 24.8 per 100,000 personnel. In the service reserves, the suicide rate for 2018 was 22.9 suicides per 100,000, and in the National Guard, the 2018 suicide rate was 30.6 per 100,000. DOD Releases Report on Suicide Among Troops, Military Family Members > U.S. DEPARTMENT OF DEFENSE > Defense Department News 32

33. https://www.militarytimes.com/news/pentagon-congress/2020/11/12/suicide-rate-among-veterans-up-again-https://www.militarytimes.com/news/pentagon-congress/2020/11/12/suicide-rate-among-veterans-up-again- slightly-despite-focus-on-prevention-efforts/ 33

34. Substance Abuse veterans with substance abuse problems - Bing images 34

35. Family Issues hqdefault.jpg (480×360) (ytimg.com) 35

36. 1. Eligibility 2. Appointments 3. Getting Care 4. Billing Community Care - Community Care (va.gov) 36

37. Community Care Network - Community Care (va.gov) 37

38. Provider Reference Library Program Fact Sheets Forms & Guides Education & Training Contract & Locator Links Provider Reference Library - Community Care (va.gov) 38

39. Uniformed Services University Link for USU: Learn About Military Culture | Center for Deployment Psychology 39

40. This presentation is a very brief overview. It does not qualify as training and does not entitle you to counsel military veterans. For training go to International Trauma Training Institute (traumaonline.net) 40

41. Ainspan, Nathan D., Bryan, Craig J., Penk, Walter E. (eds.) (2016). Handbook of Psychological Interventions for Veterans and Service Members: A Guide for the Non-Military Mental Health Clinician. New York, NY: Oxford University Press. Bush, Shane S. (ed.) (2014) Psychological Assessments of Veterans. New York, NY: Oxford University Press. Everson, R. Blaine. & Figley, Charles R. (Eds.) (2014). Families Under Fire: Systemic Therapy With Military Families. New York, NY: Routledge. Hicks, Robert (1993) Trauma: The Pain That Stays. Grand Rapids, MI: Fleming H. Revell. Moore, Brett A. (Ed.) (2012). Handbook of Counseling Military Couples. New York, NY: Routledge. Psychological Health Center of Excellence (2017) A Family’s Guide to Posttrraumatic Stress Disorder. Washington, D.C.: VA & DoD. Veterans Administration & Department of Defense (2016) Clinical Practice Guideline For The Management of Major Depressive Disorder (ver. 3.0). Washington, D.C.: VA & DoD. Veterans Administration & Department of Defense (2017) Clinical Practice Guideline For The Management of Posttraumatic Stress Disorder And Acute Stress Disorder (ver. 3.0). Washington, D.C.: VA & DoD. Williams, Tom (Ed.) (1980). Posttraumatic Stress Disorders of the Vietnam Veteran: Observations and Recommendations for the Psychological Treatment of the Veteran and His Family. Cincinnati, OH: Disabled American Veterans. 41

42. Florida State University Course NGR 6639: “Foundations for Working with Military/ Veteran and Their Families in a Healthcare Setting” Email: help@campus.fsu.edu Liberty University Masters & Doctoral degrees offered https://www.liberty.edu/military/counseling Regent University Masters degree offered https://explore.regent.edu/psychology 42