Title: REINTEGRATING AMERICA'S RETURNING WARRIORS
1 REINTEGRATING AMERICA'S RETURNING WARRIORS TO
THE WORKPLACE
2PRESENTERS/CONTRIBUTORS
Jeffrey Yarvis, PhD, LTC U.S. Army Assistant
Professor of Family Medicine and Director of
Social Work, University Services University of
the Health Sciences Jose E. Coll, PhD Chair,
Military Social Work and Veterans Service
Program USC School of Social Work Catherine M.
Harrell, MSW (08) University of Southern
California R. Paul Maiden, PhD, LCSW Vice Dean
and Professor USC School of Social Work
3OBJECTIVES
- Understanding the military as a sub-culture.
- Who are our returning veterans?
- Identify the health and mental health needs of
military veterans and citizen soldiers as they
return to the workplace. - Identify supportive measures that EA
professionals need to take to assist in the
successful reintegration of military veterans
into the civilian workforce. - Assess the co-morbidity of PTSD and mild and
traumatic brain injury (TBI) and implications for
disability accommodation in the workplace. - The utilization of technology as a tool for
transition.
4DEFINING THE MILITARY
Who are we? What constitutes the U.S. armed
forces? Who can serve in the military?
Why do most people join the military?
5WHO CAN SERVE IN THE MILITARY?
Between 18 and 35 High school diploma Without
a criminal record In relatively good health
6WHY DO MOST PEOPLE JOIN THE MILITARY?
- Opportunities for travel and adventure
- Means of saving money for college
- Career choice
- Family tradition
- Patriotism
- Adventure (adrenaline / civilian life)
7MILITARY WORKPLACE CULTURE
MILITARY CULTURE is a set of values, beliefs,
traditions, norms, perceptions and behaviors that
govern how members of the armed forces think,
communicate, and interact. The CULTURE
influences how veterans engage with each other
and with civilians as well as how they view their
function in life, their status, and the role of
the military in American Society.
8MILITARY VALUES (Desirable Characteristics)
Honor Integrity Courage Commitment Loyalty R
espect Devotion to Duty
9CULTURAL DIFFERENCES
- Military Culture
- Emphasis on unit cohesion
- Emphasis on the mission
- Devotion to duty
- Chain of command
- Civilian Culture
- Emphasis on individuality
- Individual achievement
- Personal freedom
- Fluid social relationships
10WHO ARE OUR WAR FIGHTERS?
- Currently there are approximately 200,000
women which make up - approximately 15 of service members
- Guardsmen and Reservists make up approximately
35 of the - deployed force in Iraq/Afghanistan (141,000)
- Currently there are approximately 26,400,000
veterans. - It is estimated that the ratio of PMF to
Military personnel OIF/OEF is - currently in 110 vs. 1100 during the Desert
Shield
11REASONS FOR AVOIDING MENTAL HEALTH SERVICES
- Fear of a poor performance rating
- Fear of losing security clearance
- No guarantee of confidentiality
- Fear of appearing weak
- Fear of letting the team down
12ACTIVE DUTY COUNSELING ISSUES
- Faith issues
- Stress and anxiety
- Redeployment or reunion issues
- Moral and ethical values conflicts
- Requests for emergency leaves
- Requests for hardship discharges
- Full spectrum of clinical problems
13COMBAT TRAUMA
- Trauma is highly subjective
- It is not possible to determine who will
experience a trauma - It is not possible to know the specific
characteristics of an event that will make it
traumatic for a particular individual
14SIGNS OF POOR READJUSTMENT
- Living in isolation
- Socially isolated externally
- Socially isolated internally
- Inability to reintegrate
15SIGNS OF POOR READJUSTMENT
- Use of abusive and hurtful language
- May indicate PTSD
- May indicate substance abuse
- Does indicate poor interpersonal communication
- and family distress
16INTERACTION IN NON-CLINICAL SETTINGS
- Context is important
- Questions about service experience are OK
- What branch of the service were you in?
- Where were you stationed?
- What was your occupational specialty?
- What was your component? (active or reserve)
- Communicating to your civilian counterparts
17PTSD HISTORY
18W W I
19W W II
20HOLOCAUST
- April, 1945 Jewish prisoners at Auschwitz,
liberated by Russian soldiers (AP)
21PTSD AND TRANSMISSION
PTSD AND TRANSMISSION
- Clinical descriptions have characterized
parenting by veterans with PTSD as - Overprotective (or potentially avoidant) (Haley,
1984) - Controlling, overprotective, demanding (Harkness,
1993) - Enmeshed (Jurich, 1983 Rosenheck, 1986)
- Highly emotional (Rosenheck, 1986)
- Children of PTSD veterans describe families as
- More conflicted (Westerink Giarratano, 1999)
- Less Cohesive (Westerink Giarratano, 1999)
- Veterans with PTSD are more likely than those
without PTSD to endorse severe parenting problems - 54.7 vs. 17.3 (Jordan et al., 1992)
22VIETNAM
23 TREATMENT OF OEF/OIF VETERANS WITH
POSTTRAUMATIC STRESS TODAY
24REASONS
- Psychological (mind) AND physical (brain and
body) injury is a common - result of war and deployment. The current
wars in Iraq and Afghanistan - are returning thousands of war-fighters with
psychological, brain and - bodily injuries, many with long-term
symptomatic and functional - consequences.
- War is a fertile breeding ground for PTSD and
provides a renewed - emphasis on clinical practice AND research.
25IS PTSD CLEAR TO YOU?
- A common anxiety disorder that develops after
- exposure to a terrifying event or ordeal in
which - grave physical harm occurred or was
threatened. - Confounds two distinct constructs stress and
- mental traumatization.
- Is a retrospective construct.
- How cohesive is PTSD across different groups?
- BLUF How is PTSD related to health?
26THE CHALLENGE
- PTSD is difficult to treat.
- Current research is focused on treatment and
- debunking ineffective prevention measures.
- PTSD is observed to have considerable
variability in - outcome.
- PTSD is associated with considerable
co-morbidity - most frequently depression and substance
abuse. - Sub-threshold PTSD is not well studied.
27PTSD DSM DIAGNOSTIC CRITERIA
- Typically develops following an exposure to
- an event that is perceived to be threatening
to the well- - being of oneself or another.
- Person must be exposed to event or actual
perceived - threat.
- Symptom clusters
- Re-experiencing (1 of 5)
- Avoidance and emotional numbing (3 of 7)
- Hyper-arousal (2 of 5)
- Significant distress or impaired functioning
28TAXONOMIC ISSUES
- Kraeplins classification system based on
- medical model affecting predictive validity.
- Appears to be diagnostic yardstick with a
- sliding scale.
- No one-size-fits-all category has persisted
- over time.
- Debate over what constitutes normal and
- pathological responses continues
- PTSD has been a labile polymorphic disorder-
- Solomon.
- DSM versus ICD.
29PTSD RATES
- 1990-1999 (OOTW at height)
- there were 1,380 hospitalizations and
18,597 ambulatory visits for - treatment of active duty U.S.
- soldiers for PTSD (Hoge, et al.,
- 2002).
- Sub-threshold PTSD accounts for
- another 20 to 40 of impaired
- soldiers (Yarvis, Bordnick et al.,
- 2005).
- MHAT 10-20
30CONSTRUCTS OF TRAUMA
- Types I, II, III trauma (Terr, 1999)
- Cultural and racial trauma (Allen, 1998
Pinderhughes, 1988) - Civilian trauma vs. combat trauma
31SAME OR DIFFERENT TODAY? EX. VIDEOS
32 THE STIGMA
33 LEADERSHIP MITIGATES STIGMATIZING EFFECTS
34SAME AND DIFFERENT TODAY
- The multi-component and overlapping nature of
injuries - in returning war fighters are appropriately
considered as - war-related, trauma-induced spectrum disorders
(wrTSD) - and may be of a different character than
civilian TSD. - gt15 of soldiers returning from the wars in
Iraq and - Afghanistan suffer from diagnosable
post-traumatic - stress disorder (PTSD).
- Nearly 40 report stress-related symptoms and
- dysfunction that significantly prevent
re-integration into - a full, productive life.
- 96 survive wounds.
35STRESSORS OF ASYMMETRIC COMBAT
- Immense firepower
- Improved night vision
- Obscuration
- Advanced new weaponry
- Fear of destruction and WMD
- NBC
- Locus of Control
- ROE
- OPTEMPO
- No respite
- Reintegration AND Leaving Again
36 THE SOUNDS OF COMBAT STRESS
37 THE SOUNDS OF COMBAT STRESS
38WEATHER
39BEARING WITNESS I.E., POVERTY AND DEPRIVATION
40PASSIVE POSTURE
41FIRST EXPOSURE AND WMD
42CULTURAL DIFFERENCES
43HOME-FRONT, THE MEDIA AND UNIT CASUALTIES
Next slide VERY GRAPHIC
44DEATH OF CHILDREN
45MILITARY-INDUCED FAMILY SEPARATION
46MILITARY CULTURAL COMPETENCE
-
- Unconscious incompetence
- Conscious incompetence
- Conscious competence
- Unconscious competence
- Facts for Non-Military Social Workers (Kadis
- Walls)
- Iraq War Clinician Guide 2nd ed. (National
Center for PTSD, 2004) - Human Behavior in Military Contexts
(Blascovich Hartel, - 2008)
- (www.nap.edu/catalog/12023/html).
- www.americasheroesatwork.gov/index.html
-
47ROLE OF EMPLOYEE ASSISTANCE PROGRAM IN
REINTEGRATION
- Facilitating between service member,
co-workers and - civilian employer (Continuum)
- Evaluate complexities of service status
- Active duty, regular forces
- Active reserve or national guard
- Inactive reserve
- Individual augmentee vs. unit deployed
48ROLE OF EMPLOYEE ASSISTANCE PROGRAM IN
REINTEGRATION
- Establishing contact prior to re-entry
- Contact spouse, email veteran, expectations of
their - return
- Triaging their needs
- Planning a welcome back to work event
- Sensitivity to the returning employee
- Sensitizing the organization to their return
49NORMALIZATION FOR THE RETURNING VETERAN
- Passive observation Expect the worst, Hope
for the - best! But, dont over-react
- Expect a honeymoon period
- What was the employee like before deployment?
- Demeanor, work ethic, social and emotional
maturity
50WHAT TO EXPECT?
- Displaced anger
- Hyper arousal
- May sound aggressive at times without intent
- Dark sense of humor that may be perceived as
- harassment or prone to violence
- Adverse to ambiguity which creates
vulnerability - Most of all observe the subtleties
51PROBLEM ASSESSMENT
- Pre-occupation with themes of war
- Survivor guilt
- Perceived mission failure
- Suicidal ideation
- Precursors to adjustment
- disorder
- Early indicators
- Low productivity
- Presenteeism
- Agitation
- Insubordination
52HOW TO RESPOND
- Organizational Perspective
- The EAP Perspective
- Re-establishing normalcy What is their
- new normal?
- Re-connecting family, community, and work
- Maintain contact with local Vet Center
- Case management
53RESPONDING TO FAMILY NEEDS
- Common family reactions
- Unique features of military family dynamics
- Involving non-family caregivers and schools
- Multiple systems affected
54REINTEGRATION PITFALLS FROM A SPOUSES PERSPECTIVE
- Education
- Communication
- Combining two different chains of command
- Self-awareness
55PROGRAMS OFFERED TO MILITARY COUPLES
- The 5 Languages of Love
- Redeployment/Reintegration Briefings
- Post- Deployment Battlemind Training
- Counseling Services
- Marriage Retreats
56(No Transcript)
57THE RETURN IS THE BEGINNING
58THIS IS JUST THE BEGINNING!
- IN HONOR OF ALL OUR MEN AND WOMEN IN UNIFORM
- OUR WAR FIGHTERS ANDWOUNDED WARRIORS
- THANK YOU!JOSE, CATHERINE, PAUL AND JEFF