Title Slide. ATR SERVICES AND THE MILITARY: PREPARING YOUR ATR STAFF AND SYSTEM. 2:00 p.m. – 4:00 p.m. EST February 17, 2011. WEBINAR. Technical Information.
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Title Slide ATR SERVICES AND THE MILITARY:PREPARING YOUR ATR STAFF AND SYSTEM 2:00 p.m. – 4:00 p.m. ESTFebruary 17, 2011 WEBINAR
Technical Information • You may ask a question at any time during the Webinar by typing it into the “Questions” field below the slide presentation, and then pressing “Enter.” Most questions will be addressed at the end of the presentation. • Today’s slides as well as additional resource materials are available in the “Downloads” area to the left of the slide presentation.
Presenter Introductions Master Sergeant Stephanie A. Weaver Major Angela M. Halvorson Pamela Woll MA, CADP
Modules for Today’s Webinar • SAMHSA Priorities and Other Approaches for Addressing the Behavioral Health Needs of Military Members and Veterans • Military Culture • Serving the Military Client • Military Health Programs
Module 1: SAMHSA Priorities and Other Approaches for Addressing the Behavioral Health Needs of Military Members and Veterans
Need for Treatment and Recovery Support Services FY2010 National Guard evaluations • 6% (59) Primary problem was alcohol or drugs • 7% (69) Secondary problem was alcohol or drugs Suicides in the Army National Guard • Increased 77% from FY2009 to FY2010 • More than 52% were soldiers that have never deployed
National Guard Substance Abuse 25% deployed 75% never deployed
Drugs of Choice • Alcohol Marijuana Cocaine • Meth Rx Drugs
SAMHSA’s Strategic Initiatives Behavioral health care for military personnel and their families is one of SAMHSA’s eight strategic initiativesSource: SAMHSA’s Strategic InitiativeDownload:Strengthening Our Military Families
Top 5 Key Considerations • Ensure staff has basic military culture training • Ensure intake staff know military rules • Limited Use Policy • Command-directed requirements • Limitations on type of treatment (e.g., no methadone) • Collaborate with National Guard, base/post, leadership and substance abuse and mental health staff • Partner with VA and TRICARE • Ask for help when necessary
Military 101 • Active and Reserve • All volunteer • U.S. Armed Forces • Five branches
Geographic Distribution 1.4 million now in 153 countries: Europe, the Former Soviet Union, East Asia/Pacific, North Africa, Near East, South Asia, Africa, and North, Central and South America 1.6 million deployed to Operation Iraqi Freedom (OIF)/Operation Enduring Freedom (OEF) since 2001
Who Enlists? • On average an enlisted • Individual is: • Educated • 92.1% active component (AC) officers have a bachelor’s or higher • <2% 2003-2005 recruits have no high school/GED • Middle-class • 17-29 years of age
Demographics Who Enlists? continued 3.8% Asian/ Pacific Islander 1.1% Native American 8.6% Hispanic African American 20.3% Caucasian 64.3%
Why? Patriotism Giving back Part of the solution Friends enlisted Education benefits A job Loyalty Finish the mission Home doesn’t work anymore
Military Ranks Leadership and Responsibility Officers Enlisted (84%) Officers (15%) Warrant Officers (1%)
Military Structure Clear, delineated unit structure Civilian-controlled Structured sub-units Unit terminology Chain of Command Drives Everything.
Military Culture Terminology Mindset Specific “way of doing business” Way of life
Military Mindset First trained to kill Mission first Ingrained Need to go back Follow orders Control Discipline
Military Values Army—Loyalty, Duty, Respect, Selfless Service, Honor, Integrity and Personal Courage Navy and Marine Corps—Honor, Courage and Commitment Air Force—Integrity First, Service Before Self, Excellence In All We Do Coast Guard—Honor, Respect and Devotion to Duty All—Leave No One Behind Above all, it is about honor and integrity for service, comrades and self.
“War is God’s way of teaching Americans geography.”—Ambrose Bierce
Uncertainty Uncertainty Confusion Disruption
Constant Tactical Awareness No “front” Insurgency war “Even when it’s safe, it’s not safe” Accelerator and brake
Grief Multiple Losses, Grief and Guilt
Instant Communication Cell phones, texting, emails Stress and distraction: -In country -At home Stress building on stress “A distracted soldier is a dead soldier.”
War-zone stress poll • Clinical and Recovery Support Concerns
Untreated PTSD About HALFof those who meet DSM criteria for PTSD or depression have sought help or been evaluated.(Source: Tanielian & Jaycox, 2008) See also: Combat Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care
Am I “crazy”? No!
Fast system Slow system Avoidance Balancing Memory: Gaps Invasion Re-experiencing Complexity of stress effects model Challenges in reintegration back home It’s not simple! Resilience/risk in genetic legacy Resilience/risk in early development & attachment Services that address: Nature, intensity, chronicity of war-zone stress effects: • All these complexities Resilience/risk in later life experiences • Individual goals/needs • Cultural compatibility Resilience/risk in deployment experiences
Maintaining humility All we can know about an individual cannot compare with the world of what we can never know. Humility (don’t show)
Not showing up Not trusting future providers Not improving Flooding Shutting down Compulsive, reckless behavior Harm to self or others Problems with medication Safety model Safety First! Progressive nature of many post-deployment effects Neurological cues for sense of danger Give them: Fear of shame, judgment and discrimination • Skills • Choice • Control • Respect • Strength orientation • Gradual look at memories • Individual and military-specific • Med monitoring Danger of: Real risks in treatment and recovery Alienation from behavioral health & recovery cultures
At 24 Years of Age… “…a soldier, on average, has moved from home, family and friends and has resided in two other states; has traveled the world (deployed); been promoted four times; bought a car and wrecked it; married and had children; has had relationship and financial problems; seen death; is responsible for dozens of Soldiers; maintains millions of dollars worth of equipment; and gets paid less than $40,000 a year.” Source: Army HP/RR/SP Report 2010
Understanding Military Responsibilities: Enlisted • Non-commissioned officers (NCOs) execute mission/plan • Often told what to do and when to do it • Provide officers with recommendations • Not often the decision maker • Sr. NCOs have more decision-making ability • Deployed enlisted leaders have more decision-making ability • NCOs teach and instruct and mentor others
Understanding Military Responsibilities: Officers • As young as 22 • Leader of troops • Planners/strategists • Responsible for troops and equipment • Responsible for ensuring mission execution and success • Ultimate authority in his or her unit • Plan, direct, control, coordinate • Lead from the front
Cultural Impact on Program Assessments and Data • SAMHSA does NOT require any data collection beyond GPRA requirements • Suggestions: • Ask about veteran status or military service • Ask about deployment history (how many times, to where, etc.) • Share trends in data with military leadership. For example: • See a lot of alcohol cases from the National Guard or marijuana use from people just returning from a deployment