Increasing Cultural Competence with Minority Service Members and Veterans

1. Increasing Cultural Competence with Minority Service Members and Veterans Lena Payne, LCSW & Rachel Bentley, LCSW

2. Objectives I. Increase knowledge of relevant military culture and stigma that influences engagement II. Identify barriers and benefits of the minority/military dual cultural values in treatment behaviors III. Provide strategies for engaging and retaining minority veterans

3. Introductions • Name, profession, population you work with and services you provide • How many of you work with Veterans or Active Duty Military? • This is a unique population with a myriad of unique needs

4. VideoSix Word Memoirs: Veterans on Coming Home

5. The Growing Active Duty and Veteran Population • African Americans, Latinos and women make –up an increasing number of the Active Duty and Veteran Population • Active duty and Veteran populations often seek treatment outside the military and/or VA hospitals, which makes it imperative for mental health professionals to strive for cultural competence with this group

6. Active Duty Force Demographics of active duty u.s. military. (2011, 08 02). Retrieved fromhttp://www.statisticbrain.com/demographics-of-active-duty-u-s-military/

7. Active Duty Gender Distribution Demographics of active duty u.s. military. (2011, 08 02). Retrieved fromhttp://www.statisticbrain.com/demographics-of-active-duty-u-s-military/

8. Ethnicity Profile of Active Duty Force Demographics of active duty u.s. military. (2011, 08 02). Retrieved fromhttp://www.statisticbrain.com/demographics-of-active-duty-u-s-military/

12. Military Culture • “Military culture is comprised of the values, beliefs, traditions, norms, perceptions and behaviors that govern how members of the armed forces think, communicate and interact with one another as well as civilians. “ • Values: Honor, courage, loyalty, integrity, and commitment (Exum, Coll & Weiss, 2011)

13. Branches of the Military • Army (Soldier) • Army Reserve • Army National Guard • Marine Corp (Marine) • Marine Reserve • Navy (Sailor or Navyman) • Navy Reserve • Air Force (Airman) • Air Force Reserve • Coast Guard (Guardsman) • Coast Guard Reserve

14. National Guard and Reservist • Reservist train part time near home until needed, and members deploy alongside the Army. • Army National Guard members deploy with the Army on a part-time basis, with a special focus on homeland security and relief programs. • The Air National Guard trains part time to assist in domestic disasters and international conflicts. www.todaysmilitary.com

15. Cultural Differences Exum, Coll, & Weiss (2011)

16. Why People Join the Military? • Family Tradition • Travel and Adventure • Money for College • Money in College • Poor Economy • Career/Job • Medical Coverage • Direction • Job Skills • Honor/Duty • Sounds Fun • Socialization/Friendship • Medical Coverage • Part-time Income

17. Minorities in the Military • Racism in the Military • Committed suicide last year while in Afghanistan. Prior to his death he told a fellow soldier he was thinking of killing himself over the harassment he was getting from his fellow soldiers. Private Danny Chen

18. Racism in the Military • Some hate groups encourage members to join the military, especially the Army or Marines to train to fight in the race wars (Trotta, 08). • The military has stepped up it’s efforts to remove and prevent racists from entering service. Wade Page & Timothy McVeigh

19. Gender in the Military • Women are the fastest growing segment in the veteran population. • Some issues women in the military may face are: sexism, sexual assault, disputes in how women should serve and requirements for serving, pressure to be just as tough as the men

20. What Brings Them to Treatment • Stress • Financial Problems • PTSD • Military Sexual Trauma • Readjustment • Marital/Family Problems

21. Readjustment • Military personnel form a distinct sub-set, or sub-culture of American society and as such, are governed by a separate set of laws, norms, traditions and values than the civilian population. Thus, individuals who leave the military after many years of active duty service experience the same type of culture shock as any other newcomer to the American culture. These individuals share the same sense of disorientation, change of status and loss of identity as immigrants adjusting to a host culture. In veterans, there is a search for a new identity and an effort to recreate meaning, and often they are met with unfavorable societal attitudes or conditions (Exum, Coll, & Weiss, 2011).

22. Emotional Cycle of Deployment http://blog.whileyouwereaway.org/2010/10/21/tip-120-more-tips-for-military-families/

23. Stigmas and Myths • A stigma exists related to Veterans and Active Duty Military seeking mental health treatment. • Veterans and Active Duty Military may believe the myth that seeing a “shrink” means their “crazy.” • The stigma and these myths impact their decision to seek mental health treatment or discuss mental health issues. • Discussion: What stigmas or myths related to Veterans and Active Duty Military seeking mental health treatment have you heard/experienced?

24. Barriers to Seeking Treatment • Military culture itself can discourage seeking treatment as a sign of “weakness”, needing “help” or being “crazy.” • Veterans/Active Duty Military may be concerned that seeking treatment may impact a reenlistment, service in the reserves or benefits. • There are also concerns about “privacy” or “confidentiality.” • Believing that irritability, isolation and somatic complaints are just “normal” for your culture or gender (case example).

25. Military Values vs. Traditional African American Values…Barrier or Catalyst? • Family vs. Unit • Family hierarchy/family dynamics vs. military chain of command • Traditional Gender Roles • Spirituality

26. Military Values vs. Traditional Latino Values…Barrier or Catalyst? • Family vs. Unit • Family hierarchy/family dynamics vs. military chain of command • Traditional Gender Roles • Spirituality • Machismo • Language

27. VideoMarine Corps Recognizes Contributions of Hispanic Marines • 2:02

28. Military Values vs. Female…Barrier vs. Catalyst Traditional Female Roles vs. Roles of Women in the Military

29. Gender Barriers or Catalysts to Seeking Treatment • Female Service Members may avoid mental health treatment for fear it will impact their eligibility for service. • Female Service Members may have experienced Military Sexual Trauma (MST) , which went unreported and fear reprisal for reporting or seeking treatment for MST. • Female Service Members sometimes report feeling that they are treated as “less than” their male counterparts when seeking help. • Just as their male counterparts, female service members may believe seeking help makes them “weak.” • Female Service Members sometimes feel that female specific clinics or services are not available.

30. Why would a Veteran/Active Duty Military Service Member choose private treatment over VA/DOD • Some Service Members do not want any treatment from an agency connected to the government/military. • Some Service Members have private insurance. • Africans Americans, Latinos and Women may have experienced prejudice during military service and want to distance themselves from this experience or fear this may reoccur through VA services.

31. VideoWar on Many Fronts: African American Veterans w/ PTSD (Part 3) • 0:00 to 04:42 up to religion • 04:42 to 10:11 females

32. Now that you are improving your cultural understanding of African American, Latino and Female Service Members, how would you modify an assessment for this population? • Include questions in your assessment that take military service into account • Do not make assumptions about their service • Ask what their service experience was like • Ask how they were treated during service • Assess for Military Sexual Trauma • Incorporate Spirituality into your assessment

33. Questions to get more information… • During Assessment you might ask… • Describe your experience in the military? • What was your branch, rank, unit, where did you serve and what was occupational specialty? • How has your military experience impacted your parenting? • What was it like being a female in the military? Were there any challenges?

34. Practical Tips for Assessment • Use correct terminology or ask if you do not know • Focus on the shared human experience…don’t be afraid or nervous that you will not be able to connect, because you are not a Veteran…building rapport and the therapeutic relationship is significant to the outcome of treatment. • Remember-they are the expert…let them tell their story • Even if you were in the military, your patient’s experience could be very different from your own • Be authentic about your own experience (i.e., “You are right, I don’t know what it’s like being in combat” etc.)

35. Treatment • Being aware, informed and culturally competent • Basic cultural competence & military cultural competence • Transculturally Competent

36. References • Demographics of active duty u.s. military. (2011, 08 02). Retrieved from http://www.statisticbrain.com/demographics-of-active-duty-u-s-military • Department of Veterans Affairs, Office of the Actuary, Veteran Population Projections Model (VetPop) • Exum, H., Coll, J., & Weiss, E. (2011). A civilian counselors primer for counseling veterans. (2nd ed.). Deer Park, NY: Linus Publications. • Trotta, D. (08, 2012 21). U.S. army fights racists within its own ranks. Retrieved from http://news.yahoo.com/u-army-battling-racists-within-own-ranks-050115179.html

37. Q and A