TO CONSERVE FIGHTING STRENGTH 1 THERE IS A COST TO CARE KEVIN R. STEVENSON, LMSW-C, BCD LTC, MS CHIEF, SOCIAL WORK SERVICE UNCLASSIFIED INTRODUCTION STRESS.

TO CONSERVE FIGHTING STRENGTH 1

THERE IS A COST TO CARE

KEVIN R. STEVENSON, LMSW-C, BCD

LTC, MS

CHIEF, SOCIAL WORK SERVICE

UNCLASSIFIED

INTRODUCTION

STRESS AND THE FORCETREATMENT CHALLENGES DOWN RANGE AND IN GARRISON UPON RETURN

BEST TREATMENT PRACTICESISSUES SOLDIERS AND THEIR FAMILIES FACE UPON RETURN

TO CONSERVE FIGHTING STRENGTH 2

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PURPOSE

To discuss the treatment challenges of Providers “Down Range” and in “Garrison”. Discuss best Treatment practices. Identify issues Soldiers and their families face during deployment and upon return.

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OUTLINE

• INTRODUCTION • PURPOSE• OUTLINE• TREATMENT CHALLENGES “DOWN RANGE” AND IN “GARRISION”• ISSUES SOLDIERS AND THEIR FAMILIES FACE UPON RETURN • PERSONAL CHALLENGES• SUMMARY• CONCLUSION

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TREATMENT CHALLENGES “DOWN RANGE”

• UNIT ACCEPTANCE (ARE YOU VIEWED AS A “FORCE MULITPLIER”)

• PROFESSIONAL ROLE CONFLICT AND JOINT SERVICE OPERATIONS

• TRAINING IN “BEST PRACTICE TECHNIQUES”

- BRIEF PSYCHODYNAMIC PSYCHOTHERAPY

- CBT

- EYE MOVEMENT DESENSITIZATION AND REPROCESSING (EMDR)

- PROLONGED EXPOSURE THERAPY

- COGNITIVE PROCESSING THERAPY (CPT)

- ANGER MANAGEMENT GROUP THERAPY

• DOD DIRECTIVE 6490.1, “MENTAL HEALTH EVALUATIONS OF MEMBERS OF THE ARMED FORCES,” SEPTEMBER 14, 1993

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TREATMENT CHALLENGES “DOWN RANGE”

• BALANCING THE NEEDS OF THE SOLDIER AND MILITARY MISSION

• RELATIONSHIP AND BOUNDARIES

• CONFIDENTIALITY AND PRIVACY

• CONFLICTS WITH COMMANDERS

• CLINICIAN BURN-OUT AND SELF-CARE

• TEAMWORK, POPULATION SERVED, AND PRIDE IN SERVING COUNTRY

• BALANCING FAMILY AND MILITARY OBLIGATION “MULITPLE DEPLOYMENTS”

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TREATMENT CHALLENGES “GARRISON”

UNDERSTANDING THE MILITARY CULTURE

UNIQUE TREATMENT CONCERNS OF IRAQ AND AFGHANISTAN SOLDIERS

PRIORITZING THE ASSESMENT

FOCUSING ON THE PRESENTING PROBLEM

• BEST THERAPEUTIC TREATMENT METHODS

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THERE IS A COST TO CARE

TREATMENT CHALLENGES “GARRISON”

FLEXIBLE HOURS (EVENING CLINIC)

SERVICES AND BENEFITS (CHILD AND ADOLESCENT TREATMENT)

RESOURCES (CHILD CARE)

NETWORK AND BUILD RELATIONSHIPS WITH…

- VETERAN SERVICE OFFICER

- VETERAN AFFAIRS MEDICAL CENTERS

- LOCAL HOSPITALS AND CLINICS

- VET CENTERS

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ISSUES SOLDIERS AND THEIR FAMILIES FACE UPON RETURN

• MEDICAL

• PSYCHOLOGICAL

• FAMILY AND MARITAL

• TRANSITIONAL

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MEDICAL

• TRAUMATIC BRAIN INJURY (TBI)• AMPUTEES• MUSCLE AND SKELETAL INJURIES• CHRONIC PAIN• MEDS VS NO MEDS• INABILITY TO EXERCISE AND FUNCTION• LOSS OF LIBIDO• MOOD SWINGS

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PSYCHOLOGICAL

• POST TRAUMATIC STRESS DISORDER (PTSD)• MAJOR DEPRESSIVE DISORDER• SUBSTANCE ABUSE• ANXIETY DISORDER• SEXUAL TRAUMA• COMORBID DIAGNOSES• OTHER ADDICTIONS

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SUICIDE DATA

• There have been 88 reported active-duty suicides in the Army during calendar year 2009. Of these, 54 have been confirmed, and 34 are pending determination of manner of death. For the same period in 2008, there were 67 confirmed suicides among active-duty soldiers.

• During June 2009, among reserve component soldiers not on active duty, there were no confirmed suicides and two potential suicides; to date, among that same group, there have been 16 confirmed suicides and 23 potential suicides currently under investigation to determine the manner of death. For the same period in 2008, there were 29 confirmed suicides among reserve soldiers not on active duty.

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SUICIDE DATAOEF/OIF SUICIDES

ACTIVE-DUTY MILITARY FORCESMarines, active-duty forces, deployed, 2003: 2Army, active-duty forces, deployed, 2003: 25 Marines, active-duty forces, deployed, 2004: 7 Army, active-duty forces, deployed, 2004: 11 Marines, active-duty forces, deployed, 2005: 4 Marines, active-duty forces, deployed, 2006: 4 Army, active-duty forces, deployed, 2005-2006: 120 Marines, active-duty forces, deployed, 2007: 6 Army, active-duty forces, deployed, 2007: 115 Army, active-duty forces, deployed, January-August 2008: 62 Army, active-duty forces, deployed, through August 2008 (suspected): 31 Army, active-duty forces, between deployments, 2002-2008: ???Army, active-duty forces, suicide attempts, 2002: 350 Army, active-duty forces, suicide attempts, 2007: 2.100 [5 per day]

VETERANSMarines, active-duty, prior deployed, 2003: 6 Marines, active-duty, prior deployed, 2004: 10 Marines, active-duty, prior deployed, 2005: 8 Marines, active-duty, prior deployed, 2006: 5 Marines, active-duty, prior deployed, 2007: 12 Veterans, separated from service, under VA care, 2002-2005: 141 Veterans, separated from service, under VA care, 2006: 113 Veterans, separated from service, not under VA care, 2002-2008: ??? [*at least 139]

OEF/OIF SUICIDE TOTALS: Active-duty military forces: 356 [+another 31 suspected]Veterans: 295 [+another 139 not officially counted by DoD or VA]

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FAMILY AND MARITAL

• COMMUNICATION • AVOIDANCE AND ISOLATION • ANGER AND RESENTMENT• UNREALISTIC EXPECTATIONS• RETURNING TO COMBAT ZONE• FEELINGS OF BEING … - MISUNDERSTOOD

- A FAILURE

- EXCLUDED

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MILITARY DIVORCE  RATES

: By Rod Powers, About.comFiled In: Family & Domestic & Divorce Separation Dec 15 2008

The military divorce rate continues to climb slightly over previous years, according to Department of Defense statistics. The overall

divorce rate for military personnel during fiscal year 2008 was 3.4 percent, compared to 3.3 percent in 2007 and 2006. Among the DOD services for FY 2008:

Army. Enlisted divorce rate was 3.9 percent. Officer divorce rate was 2.3 percent. Overall divorce rate was 3.5 percent.

Air Force. Enlisted divorce rate was 4.1 percent. Officer divorce rate was 1.6 percent. Overall divorce rate was 3.5 percent.

Navy. Enlisted divorce rate was 3 percent. Officer divorce rate was 1.5 percent. Overall divorce rate was 3 percent.

Marine Corps. Enlisted divorce rate was 4.1 percent. Officer divorce rate was 1.6 percent. Overall divorce rate was 3.5 percent.

The general population divorce rate in the United States, for the 12 months proceeding Feb 2008 was 3.6 percent, according to the most recent National Vital Statistics Report, prepared by the Center for Disease Control andPrevention.

Historically, female service members get divorced at a rate of more than double of military men:

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MILITARY DIVORCE RATE BY GENDER

Service 2006 Male Divorce Rate 2006 Female Divorce Rate

Army 2,5% 7.9%

Air Force 2.6% 6.2%

Navy 2.9% 6.9%

Marine Corps 2.9% 7.1%

Service 2007 Male Divorce Rate 2007 Female Divorce Rate

Army 2.6% 8.1%

Air Force 2.9% 6.5%

Navy 2.8% 6.5%

Marine Corps 3.0% 8.1%

Service 2008 Male Divorce Rate 2008 Female Divorce Rate

Army 3.0% 8.5%

Air Force 2.9% 6.5%

Navy 2.5% 6.3%

Marine Corps 3.2% 9.1%

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TRANSITION

• COPING WITH LIFE OUTSIDE THE ARMY• LOW SELF ESTEEM• UNEMPLOYMENT• FINANCES• FORECLOSURES• HOMELESSNESS• CHILD CARE• COLLEGE• NEW CAREER CHOICES

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PERSONAL CHALLENGES

• ACCEPTANCE

• AVOIDANCE AND ISOLATION

• DEPRESSION AND PTSD

• SUICIDAL THOUGHTS

• IRRITABLE AND ANGRY

• SHOULDER, BACK , AND KNEE PAIN

• TREATMENT

• MEDICATION

TO CONSERVE FIGHTING STRENGTH 18

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SUMMARY

• TREATMENT CHALLENGES “DOWN RANGE” AND IN “GARRISION”• ISSUES SOLDIERS AND THEIR FAMILIES FACE UPON RETURN • PERSONAL CHALLENGES

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QUESTIONS

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CONCLUSION

Our goal has to be a clear focus to provide the best care to our Soldiersand their family members. It is just as important to ensure we focus on provider resilience. There is still a real stigma related to seeking mentalhealth service. If the stigma is not reduce our Soldiers face a never ending battle for years to come. Lets make the difference and reshape the future of returning Soldiers and their families.