EXAMINING THE ACTIVE-DUTY TO Nathan Ainspan, PhD VETERAN - - PowerPoint PPT Presentation

EXAMINING THE ACTIVE-DUTY TO VETERAN TRANSITION FROM BOTH SIDES OF THE DD-214: CLINICAL CONSIDERATIONS AND RECOMMENDATIONS FROM VA AND DOD PERSPECTIVES

Nathan Ainspan, PhD Timothy Hoyt, PhD Adrienne Weede, LCSW Brian Kok, PhD

DISCLAIMER

• The views expressed in this presentation are those of the

authors and do not necessarily represent the official positions of the Department of Defense, Department of Veterans Affairs, or the U.S. Government.

BACKGROUND

• Over 200,000 service members separate from the

U.S. military each year

• One of the few ‘universal’ military experiences
• Often marked by major life changes, stressors, and

role-transitions

• At-risk period
• Siloed research and differing priorities has left the

transition period relatively understudied

• Notable exception: The Veteran Metric Initiative (Vogt et

al., 2018) longitudinal study of Veterans

• Many clinicians don’t have in-depth understanding of

DOD and VA programs-level collaboration

LEARNING OBJECTIVES

Describe the programs and services the DOD provides to service members as the separate from active-duty.

1

Describe the programs and services the VA provides to recently-discharged veterans.

2

Discuss normative and maladaptive issues during the transition process, as well as best-practices for addressing these concerns.

3

Mili ilitary ry-Civili ilian Tran ansition Office Overvie iew Brie rief

TR TRAN ANSITION TION AS ASSISTANC ANCE E PROGRA OGRAM M & YE YELL LLOW W RI RIBBO BBON N RE REIN INTEGRA TEGRATION TION PROGRAM OGRAM

De Department of

• f De

Defense

THE E TRAN RANSITION SITION AS ASSI SIST STANCE ANCE PR PROG OGRAM RAM

Every year, approximately 200,000 men and women leave U.S. military service and return to life as civilians, a process known as the military to civilian transition. The Transition Assistance Program (TAP) provides information, tools and training to ensure service members and their spouses are prepared for the next step in civilian life. Military to civilian transition occurs within a complex and dynamic network of relationships, programs, services, and benefits, which includes transition planning and assistance efforts by individual Service branches, the interagency TAP partnership, and community resources delivered through local government, private industry, and nonprofit organizations.

Under the Military-Civilian Transition Office (MCTO), The Yellow Ribbon Reintegration Program (YRRP) is a Department of Defense wide effort to promote the well-being of National Guard and Reserve members, their families and communities, by connecting them with resources throughout the deployment cycle. Through Yellow Ribbon events, Service members and loved ones connect with local resources before, during, and after deployments. Reintegration during post-deployment is a critical time for members

• f the National Guard and Reserve, as they often live far from

military installations and other members of their units. Commanders and leaders play a critical role in assuring that Reserve Service members and their families attend Yellow Ribbon events where they can access information on health care, education and training opportunities, financial, and legal benefits.

TAP AP IN INTERA ERAGENCY GENCY PAR ARTNERS NERSHIP HIP

In addition to the Military Departments, TAP is the result of an interagency partnership between the: Department of Defense, Department of Labor, Department of Education, Department

• f Veterans Affairs, Department of Homeland Security, in conjunction with the

Small Business Administration and the Office of Personnel Management.

MO MODERN DERN TRAN RANSITION SITION

▪ In response to the VOW Act, interagency partners redesigned TAP into a cohesive, modular, outcomes-based program that standardized transition opportunities, services, and training to better prepare the nation’s Service members to achieve their post military career goals. ▪ Since the VOW Act, the interagency partners, along with other federal agencies, continue to expand transition assistance support based on the ever changing needs of transitioning service members and their families. ▪ In 2018, President Donald Trump signed FY 2019 NDAA into law, which significantly altered TAP for the first time in many years and led to the current state of TAP.

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• SEC. 1142
• SEC. 1144

PRE-SEPARATION COUNSELING

TRANSITION ACTIVITIES CAN OCCUR AS EARLY AS 24 MONTHS FOR THOSE RETIRING, AND NO LATER THAN 365 DAYS FOR THOSE SEPARATING/TRANSITIONING

NLT 365 days prior to separation or retirement

INDIVIDUALIZED INITIAL COUNSELING (IC)

NLT 365 days prior to separation or retirement

DoD TRANSITION DAY VA BENEFITS AND SERVICES DOL ONE-DAY CAPSTONE

DoD Transition Day includes: ▪ Managing Your Transition ▪ MOC Crosswalk ▪ Financial Planning for Transition ▪ Explores VA benefits earned by the service member and how to apply them. ▪ How to leverage earned benefits for the best possible

• utcome.

▪ Overview of employment topics and best practices. ▪ Culminating event in which Commanders verify achievement of Career Readiness Standards (CRS) and viable ITP prior to transition. ▪ Must occur no later than 90 days before separation. ▪ If not, referred to appropriate agency for further assistance via a Warm Handover. ▪ Statement of benefits to be received no later than 30 days prior to transition.

1 DAY 1 DAY

▪ Transitioning service members must select one of the two-days of instruction: ▪ DOL Employment Workshop ▪ DoD Education Workshop ▪ SBA Entrepreneurship Workshop ▪ DOL Vocational Workshop 2-DAY SERVICE MEMBER ELECTED TRACKS

The Transition Assistance Program

Title 10, Chapter 58

1 DAY 2 DAYS

TRACKS

▪ Personal Self-Assessment/ Individual Transition Plan (ITP)

TAP AP CORE ORE COM OMPONENT PONENTS

➢ INITIAL COUNSELING ➢ PRE-SEPARATION COUNSELING ➢ DOD TRANSITION DAY

• Managing Your Transition
• Military Occupational Codes Crosswalk
• Financial Planning for Transition

➢ VA BENEFITS AND SERVICES ➢ DOL ONE DAY ➢ 2-DAY SERVICE MEMBER SELECTED TRACKS ➢ CAPSTONE

2-DAY Y AD ADDI DITI TIONAL ONAL TR TRACKS

Identifying Skills Job Searching Networking Resume Building Federal Hiring Social Media Branding Applications Interviews Job Offers Vocational Training Career Clusters Career Assessments Opportunities Credentials Educational Goals

EMPLOYMENT VOCATIONAL

2-DAY Y AD ADDI DITI TIONAL ONAL TR TRACKS

Education Terms Attitudes Perceptions Fields of Study Degree Options Choice of Institution Admissions Funding Options Fundamentals Opportunities Market Research SmallBiz Economics Legal Financing

HIGHER EDUCATION ENTREPRENUERSHIP

CARE CAREER ER RE READ ADINESS INESS STAN ANDAR ARDS DS

▪ Complete a personal self-assessment/Individual Transition Plan ▪ Register on eBenefits ▪ Complete a Continuum of Military Service Opportunity counseling (Active-component only) ▪ Prepare a criterion-based, post-separation financial plan ▪ Complete a MOC Gap Analysis or provide verification of employment ▪ CRS for DoD Education and DOL Vocational Tracks: Complete a comparison of higher education or technical training ▪ CRS for DOL Employment Track: Complete a completed resume or provide verification of employment institution options

THE HE WAR ARM M HAN HANDO DOVER VER PR PROCES OCESS

The Warm Handover is a Capstone process between respective Military Departments and appropriate interagency partners (e.g., Department of Labor, Veteran Administration, etc.) that results in the person-to-person connection of service members to services and follow-up resources, as needed. The warm handover provides a confirmed introduction and assurance that the appropriate interagency partner acknowledges that an eligible service member requires post-military assistance and the interagency partner is willing to follow-through on providing support to meet the needs of the service member, to include assisting the service member in attaining the Career Readiness Standards (CRS) promoting a successful transition.

WHAT IS A WARM HANDOVER?

CLINICAL CONSIDERATIONS FROM THE ACTIVE DUTY/DOD PERSPECTIVE

Speaking: Timothy Hoyt, PhD

SEE PDF FOR ADRIENNE’S SLIDES

CLINICAL CONSIDERATIONS FOR TRANSITIONAL VETERANS IN THE VHA

“WHAT ARE THE KEY CHALLENGES IN YOUR TRANSITION?” (ZOLI ET AL., 2015)

Top Five:

• 60% - Difficulty navigating the

VA system of care

• 55% - Getting a job
• 41% - Getting socialized to civilian culture
• 40% Financial challenges
• 39% Skills translation

NORMATIVE CHALLENGES

• Culture shock at civilian life
• Loss of structure
• Difficulty sharing experiences

with others

• Isolation/ loss of community
• Navigating spousal/family

dynamics

• Finances and paying bills
• Entering school/ workforce

CLINICAL ISSUES IN TRANSITIONAL VETS (VOGT ET AL., 2020)

40% 31% 23% 20% 14% 14% 12% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% Chronic Pain Sleep Issues Anxiety Depression Arthritis Hearing Loss PTSD % Endorsing

• Vet. Metric Initiative
• n = 9556 veterans
• 3 mo. post-discharge

VA MENTAL HEALTH SERVICES

• Medical Centers & Community Based Outpatient Clinics (CBOCs)
• Referral sources: primary care, social worker (TCM or other), self-referral
• Once enrolled, a Mental Health Treatment Coordinator (MHTC) tracks

progress and updates goals

• VA mental health clinics: Mental Health Clinic, PTSD Clinical Teams, Primary

Care Mental Health Integration, Behavioral Medicine, Psychosocial Rehabilitation and Recovery Center (PRRC), Neuropsychology, Substance Abuse and Relapse Prevention, residential/domiciliary programs

• Emphasis on whole-health care (Patient Aligned Care Teams [PACT])

• May be reluctant to engage in mental health care, or slow to

trust

• Provide psychoeducation on therapy; Spend time building

rapport

• Validate and normalize readjustment challenges
• Manage expectations and encourage opportunities for

growth

• Utilize technology
• Review EMR/JLV, suggest apps, telehealth options
• Work with other providers to ensure whole-health care
• Assess risk early and often
• Use evidenced-based psychotherapies when applicable
• VA/DOD Clinical Practice Guidelines, APA Div. 12 Clinical

CLINICAL CONSIDERATIONS FOR TRANSITIONAL VETS

Treatments with Strong Evidence of Effectiveness Chronic Pain (APA Div. 12) Sleep problems (APA Div. 12) Anxiety (GAD, social anxiety; APA Div. 12) Depression (VA/DOD CPG, 2016) PTSD (VA/DOD CPG, 2017)

• Acceptance and

commitment therapy (ACT) for chronic pain

• Cognitive

behavioral therapy (CBT) for chronic pain

• CBT for insomnia

(CBT

• I)
• Mindfulness and

relaxation*

• CBT for GAD
• CBT for social

anxiety

• Acceptance and

commitment therapy (ACT)

• Behavioral therapy/

behavioral activation (BT/BA)

• CBT for

Depression

• Interpersonal

therapy (IPT)

• Mindfulness-based

cognitive therapy (MBCT)

• Problem-solving

therapy (PST)

• Prolonged

Exposure (PE)

• Cognitive

Processing Therapy (CPT)

• Eye Movement

Desensitization and Reprocessing (EMDR)

• CBT for PTSD
• Brief Eclectic

Psychotherapy (BEP)

• Narrative

Exposure Therapy (NET)

CARE FROM A PSYCHOSOCIAL LENS

Policy/Structural Community Organizational Interpersonal Individual

REFERENCES

• Bevc, C. A., H. Retrum, J., & M.

Varda, D. (2015). New perspectives on the “silo effect”: initial comparisons of network structures across public health

• collaboratives. American journal of public health, 105(S2), S230-S235.
• Vogt, D., Perkins, D. F., Copeland, L. A., Finley, E. P

., Jamieson, C. S., Booth, B., ... & Gilman, C. L. (2018). The Veterans Metrics Initiative study of US veterans’ experiences during their transition from military service. BMJ open, 8(6), e020734.

• Vogt, D. S., Tyrell, F. A., Bramande, E. A., Nillni,
• Y. I., Taverna, E. C., Finley, E. P

., ... & Copeland, L. A. (2020). US Military Veterans’ Health and Well-Being in the First Year After Service. American journal of preventive medicine, 58(3), 352-360.

• Zoli, Maury, & Fay,. (2015). Missing Perspectives: Servicemembers’ Transition from

Service to Civilian Life — Data-Driven Research to Enact the Promise of the Post- 9/11 GI Bill. Institute for Veterans & Military Families. Syracuse University, NY.

QUESTIONS