It Takes a Village to Heal Warriors- and It Takes the Warrior to - PowerPoint PPT Presentation

It Takes a Village to Heal Warriors- and It Takes the Warrior to Teach the Village How Understanding, Engaging and Providing Services to Our OEF/OIF Veteran Population Sherrill Valdes, LCSW, BCD

Goals and Objectives • Increase awareness of the military culture and possible psychiatric, medical, emotional and psychosocial challenges of the returning combat service member. • Discuss key issues that the service member and their family may experience during the deployment cycle. • Raise awareness of the collateral outfall of deployment and war on the service member, family and community • Discuss methods of intervention and treatment modalities that support healing of the service member, family and community.

Military Culture “To care for him who shall have borne the battle…” -Abraham Lincoln

• Army Soldier • Navy Sailor • Air Force Airman • Marine Corps Marine • US Coast Guard Seaman • Reserves • National Guard

Service Member Family Demographics DoD Reserve and Guard Demographic Variable Active Duty (Selected Reserve) 1,878,092 1,110,803 NUMBER OF FAMILY MEMBERS NUMBER OF SPOUSES 689,344 391,383 % WITH CHILDREN 42.8% 43.2% AVERAGE AGE AT BIRTH OF 24.9% 26.6% FIRST CHILD 42.5% % OF CHILDREN AGE 0 TO 5 42.3% 10,776 1,848 NUMBER OF ADULT DEPENDENTS 5.0% % SINGLE PARENTS 9.3% Source: Department of Defense (DoD), Demographics 2013: Profile of the Military Community (2010); Deployment and the Use of Mental Health Services among U.S. Army Wives (2013); and Medical Surveillance Monthly Report , April 2013

Demographics Service M Member D DoD Reserve and Guard Demographic Variable Active Duty (Selected Reserve) TOTAL NUMBER 1,370,329 842,510 % WOMEN 16.4% 18.5% % MEN 85.1% 81.5% % MINORITIES 30.7% 25.1% % LOCATED IN US 87.2% 99.0% % 25 YEARS OLD OR YOUNGER 43.1% 34.2% % MARRIED 55.2% 45.9% % DUAL MILITARY MARRIAGES 6.4% 2.6% Source: Department of Defense (DoD), Demographics 2013: Profile of the Military Community (2013);

Florida Demographics • According to the US National Census (2012-2013): There were 1,569,406 veterans residing in Florida and 92,575 of those live in Broward County. • Florida (59,357) Active Duty members • Broward County reported the second largest veteran population in the state and Palm Beach County, the third one. Broward is home to more than 20,000 veterans between the ages of 21 and 44. • There are many National Guard units in Broward http:www.miltaryonesource.mil/1203//MOS/Reports/20 12-Demographic-Report.pdf

Military Culture Professional Armed Services is a career, not a job • Operation adheres to a code of ethics • • There is structure, order and ways to behave Leadership and team work are essential • Goal is to complete the mission • • Expect respect There is community, brotherhood , trust honesty and connection • Support system military • • Two families Help others • Don’t see themselves as a hero •

Service Mem Member S Str trengt ngths Although I feel lost, not understood and do not fit into society, my strengths include: – Responsibility – Dependability – Trustworthiness – Maturity & Wisdom – Deep Bonding – Warrior Capability – Appreciate Beauty – Core values of integrity, courage and pride. – Team Member – Value life, relationships and nature – Humor – Leadership

COMBAT

Quotes: • “I went to war as a young man and came home an old man.” Marine , Vietnam • “I was glad to be alive, I did not care about anything. If you kill me it is ok because I’m already dead.” Navy Seal, Vietnam • “My eyes have seen too much.” Marine Sergeant, Iraq

Glob obal War on on Terr rrori rism September 11, 2001

Global War on Terrorism Operation E Opera Enduri nduring F Freedo reedom (OE (OEF) ► Octob ctober 7, 7, 20 2001 01 ► Afg Afgha hani nist stan an Opera Operation I n Ira raqi qi Freedo reedom (OI (OIF) ► March ch 20, 20, 2 200 003 ► Iraq aq Opera Operation n New ew Da Dawn (ON n (OND) D) ► Sep eptem ember 1 r 1, 2010

MILITARY LINGO • GWOT - Global War On Terror • OEF - Operation Enduring Freedom • OIF- Operation Iraqi Freedom • SOP- Standard Operating Procedures • ROE- Rules of Engagement • MOS- Military Occupational Specialty • DD214- Discharge papers • IED- Improvised Explosive Device

Active/Guard /Reserve Guard/Reserve Active Duty • Suspension of career/business/ Benefit of the military education goals community Resources Employment problems during • Support on base or and after deployment community for families and Financial Issues • service members pre and Child Care Issues • post deployment

THE EMOTIONAL CYCLE OF DEPLOYMENT Source: http://www.military.com/spouse/content/military- deployment/dealing-with-deployment/emotional-cycle-of- deployment-military-family.html

On Ongoi going a and E Evol olving S Str tress essors s th that t Challen enge th ge the e Veter Veteran a and th thei eir Fami mily • Medical • Psychiatric • Relationships • Employment • Education • Financial • Spiritual • Legal/Judicial • Housing • Citizenship • Redeployment

Remember the Children Break the silence Our most valuable gift is the gift from the heart

Global War on Terrorism Signature Wounds  2,000,000 service members have deployed to Iraq or Afghanistan  Amputations: 19.6 per month in 2011 vs.16.3 per month in 2010  PTSD: Mental health evacuations outpacing medical evacuations for OIF/OND since 2007  Traumatic Brain Injury: 647.4 a month in 2011  Spinal Cord Injuries Source:Department of Defense (DoD), Demographics 2010: Profile of the Military Community (2010); and Medical Surveillance Monthly Report , November 2011 Vol. 18 No. 11, http://iava.org/; http:costofwar.org, ) http://www.newmobility.com/articleViewIE.cfm?id=11279 New generation of vets comes home by Allen Rucker)

Most Common Medical Problems • Musculoskeletal Ailments • Traumatic Brain Injury • Dermatology • Amputations • Digestive Disorders • Dental Injury • Audiology & Speech

Most Common Psychiatric Problems • Acute Stress Disorder • Generalized Anxiety Disorder • Panic Disorder • Major Depressive Disorder • Post Traumatic Stress Disorder • Substance Abuse/Dependence • Adjustment Disorder • Complicated Grief Source: Invisible Wounds of War, RAND 2008

Posttraumatic Stress Disorder (PTSD) PTSD is a psychiatric disorder that can develop after the direct, personal experiencing or witnessing of a traumatic event, often life threatening to self or others. Essential Cluster of Symptoms:  Persistent Re-experiencing- (e.g. flashbacks, nightmares)  Persistent Avoidance or Numbing  Hyper arousal Source: American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders dsm-iv-tr fourth edition

Center for Military Health Policy Research “Since October 2001, approximately 1.64 million U.S. troops have been deployed for Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) in Afghanistan and Iraq. Early evidence suggests that the psychological toll of these deployments—many involving prolonged exposure to combat- related stress over multiple rotations—may be disproportionately high compared with the physical injuries of combat. Unlike the physical wounds of war, these conditions are often invisible to the eye, remaining invisible to other service members, family members, and society in general.”

Most Common OEF/OIF Traumatic Event Received small arms fire 94% Knew someone injured or killed 86% Saw dead or seriously injured 68% Handled or uncovered remains 51% Shot or directed fire at enemy 77% Responsible for death for noncombat 48%

Healing the Wounds of the Heart, Mind, Body and Spirit • Who am I now ? • Where was God ? • What is my purpose? “The people that come home (from war) are dying inside day by day. The ones that died (in war) have freedom .” -US Marine, Iraq

DSM Conditions for Further Study Complex Bereavement Disorder • Profound loss • Reactive distress to the death • Social/identity disruption • Traumatic bereavement • Differential Diagnosis • Major depressive disorder • Major depressive disorder with mixed features • Bipolar 1 disorder • Cyclothymic disorder

What Kept Them Alive Then Keeps Them From Living Now • Denial • Anger/ Rage • Trust Issue • Isolation/Withdrawal • Control of Self, Situation and Weapons • Avoidance of triggers • Numbing/Detachment • Alcohol/Drugs

Hyper-arousal symptoms • Hyper-vigilance • Startled response • Decreased sleep • Perimeter checking • Persecutory feelings • Irritability • Explosive/Labile mood

Re-experiencing of the traumatic event in the form of: Intrusive thoughts Nightmares Flashbacks Hypnogogic Hallucinations Combat Images Paranoid Ideation or false perception of danger