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Military 101 Presenters: Dr. Kimberly A. Kick, LCSW, PhD Jolaina Falkenstein, MA, LAMFT Boots on Ground Consulting, Inc. BootsOnGroundConsulting.com Myth versus Reality MILITARY STRUCTURE ENLISTING IN THE MILITARY Must be 18, or 17 with parental consent Must be a high school graduate. Must complete basic training for chosen branch After completing basic training, must attend a technical school to learn Military Occupational Skill (MOS) WHO SERVES? Approximately 2,267,000 Americans between the ages of 17 and 59 Or, less than 1 percent of the total U.S. population!!! TOTAL FORCE STATISTICS **Active Duty vs. Guard/Reserve Guard/Reserve (n=1,965,368) 37.2% Active Duty (n=3,329,697) 62.8% **Includes Service Members and family members Active Duty Guard/Reserve BRANCH STATISTICS Air Force Active Duty (15%) Air Force Guard/Reserve (9%) Army Active Duty (27%) Army Guard/Reserve (24%) Marine Active Duty (8%) Marine Reserve (1%) Navy Active Duty (13%) Navy Reserve (3%) Coast Guard Reserve (.27%) **Numbers include Family Members and Service Members AIR FORCE “AIM HIGH…FLY, FIGHT, WIN” Missions: Air, Space, and Cyberspace Numbers: Active Duty: 300,000+ Reserve: 70,000+ National Guard: 88,988 Male to Female Ratio: 4.0:1 Age of Entry: 18 to 27 years “HOME is where the Air Force sends us” AIRMAN’S CREED I am an American airman. I am a warrior. I have answered my nation's call. I am an American airman. My mission is to fly, fight, and win. I am faithful to a proud heritage, a tradition of honor, and a legacy of valor. I am an American airman, guardian of freedom and justice, my nation's sword and shield, its sentry and avenger. I defend my country with my life. I am an American airman: wingman, leader, warrior. I will never leave an airman behind, I will never falter, and I will not fail. ARMY “THIS WE WILL DEFEND” Largely ground movement, some air support as well Largest and oldest branch of the military Numbers: Active Duty: 571,108 Reserve: 201,235 National Guard: 352,689 Male to Female Ratio: 5.4:1 Age of Entry: 17-35 years “I’m an Army wife. What’s your super power?” SOLDIER’S CREED I am an American Soldier. I am a Warrior and a member of a team. I serve the people of the United States, and live the Army Values. I will always place the mission first. I will never accept defeat. I will never quit. I will never leave a fallen comrade. I am disciplined, physically and mentally tough, trained and proficient in my warrior tasks and drills. I always maintain my arms, my equipment and myself. I am an expert and I am a professional. I stand ready to deploy, engage, and destroy, the enemies of the United States of America in close combat. I am a guardian of freedom and the American way of life. I am an American Soldier. COAST GUARD “SEMPER PARATUS” Mission: Safeguarding the nation’s maritime interests Assigned to DHS Numbers: Active Duty: 42,000+ Reserve: 7,800 Male to Female Ratio: 6:1 Age of Entry: 18 to 27 years (Reserve up to 39) “Have seabag…will travel” COAST GUARDMAN’S CREED I am proud to be a United States Coast Guardsman. I revere that long line of expert seamen who by their devotion to duty and sacrifice of self have made it possible for me to be a member of a service honored and respected, in peace and in war, throughout the world. I never, by word or deed, will bring reproach upon the fair name of my service, nor permit others to do so unchallenged. I will cheerfully and willingly obey all lawful orders. I will always be on time to relieve, and shall endeavor to do more, rather than less, than my share. I will always be at my station, alert and attending to my duties. I shall, so far as I am able, bring to my seniors solutions, not problems. I shall live joyously, but always with due regard for the rights and privileges of others. I shall endeavor to be a model citizen in the community in which I live. I shall sell life dearly to an enemy of my country, but give it freely to rescue those in peril. With God’s help, I shall endeavor to be one of His noblest Works... A UNITED STATES COAST GUARDSMAN. MARINES “SEMPER FI” First on ground- Quick reaction “Once a Marine, always a Marine.” Numbers: Active Duty: 300,000+ Reserve: 39,500+ Male to Female Ratio: 15.1:1 Age of Entry: 18-29 “The Marine Corps is a way of life and not a job. If you can’t accept it on those terms, then your marriage is doomed to fail.” ~Marine Corp spouse UNITED STATES MARINE CREED This is my rifle. There are many like it, but this one is mine. My rifle is my best friend. It is my life. I must master it as I must master my life. My rifle, without me, is useless. Without my rifle, I am useless. I must fire my rifle true. I must shoot straighter than my enemy who is trying to kill me. I must shoot him before he shoots me. I will... My rifle and myself know that what counts in this war is not the rounds we fire, the noise of our burst, nor the smoke we make. We know that it is the hits that count. We will hit... My rifle is human, even as I, because it is my life. Thus, I will learn it as a brother. I will learn its weaknesses, its strength, its parts, its accessories, its sights and its barrel. I will ever guard it against the ravages of weather and damage as I will ever guard my legs, my arms, my eyes and my heart against damage. I will keep my rifle clean and ready. We will become part of each other. We will... Before God, I swear this creed. My rifle and myself are the defenders of my country. We are the masters of our enemy. We are the saviors of my life. So be it, until there is no enemy, but peace! NAVY “NON SEBI SED PATRIAE” Defends the right to travel and trade freely on the world’s oceans and protects our national interests overseas Numbers: Active Duty: 328,648 Reserve: 49,501 Male to Female Ratio: 5.1.:1 Age of Entry: 17-34 “There is nothing more enticing, enchanting, and enslaving than life at the sea.” Joseph Conrad SAILOR’S CREED I am a United States Sailor. I will support and defend the Constitution of the United States of America and I will obey the orders of those appointed over me. I represent the fighting spirit of the Navy and those who have gone before me to defend freedom and democracy around the world. I proudly serve my country's Navy combat team with Honor, Courage and Commitment. I am committed to excellence and the fair treatment of all. Characteristics Regular Separations and Reunions Military Speak High Risk Jobs “Mission First” Characteristics Code of ethics adhered by ALL Authoritarian parenting style Parent focused Blended Families Positive Characteristics Highly Adaptable Honor Disciplined Duty Selfcontrolled Loyalty Positive Characteristics Committed Crosscultural exposure Sense of community Attention to detail Done right the 1st time Mental Health Effects of Serving in OEF/OIF Wars in Afghanistan and Iraq are longest combat operations since Vietnam Stressors include: Threat of death or injury Witnessing death or severe wounding of others On high alert 24/7 Being away from home for extended period of time (more so for National Guard and Reservists who did not expect this) Nearly 50% of those who have served in OEF/OIF have been Guard or Reservists Military Sexual Trauma (MST) Mental Health Effects of Serving in OEF/OIF Research asked Soldiers and Marines about war-zone experiences and their symptoms of distress (2003) Combat Stressors Seeing Dead Bodies Being Shot At Being Receiving Ambushed/ Rocket/ Attacked Mortar Fire Know Someone Killed/ Seriously Injured Iraq Army 95% 93% 89% 86% 86% Iraq Marines 94% 97% 95% 92% 87% 66% 58% 84% 43% Afghanistan Army 39% Mental Health Effects of Serving in OEF/OIF Soldiers and Marines with more combat stressors had higher rates of mental health problems. Those who served in Iraq had higher rates of PTSD than those who served in Afghanistan. Strong link between combat stress and PTSD. 10%-18% of OEF/OIF troops likely to exhibit symptoms of PTSD upon return from theatre. OEF/OIF veterans are at increased risk for other mental health problems. Rates of depression range from 3%-25% Source: National Center for PTSD (ptsd.va.gov) Combat Stress Term to describe normal behavioral, physiological, and psychosocial reactions experienced pre, during, or post combat. Normal reaction to an abnormal situation. Symptoms include: Difficulty concentrating Higher levels of anxiety or being fearful Feeling sad Regressing Stomach problems Source: Department of Defense Stress Awareness Combat Stress Physical symptoms can include: fatigue, chest pain, shortness of breath, muscle shaking, and headaches. Behavioral Reactions can include: rage, agitation, fear, panic, restlessness, bizarre behavior, inability to think clearly. Recommended treatment=rest Estimated 18.5% of returning service members from OEF/OIF have PTSD or depression, 19.5% have TBI. When assessing severity of symptoms ask to what extent the symptoms interfere with the veterans ability to work, play, and love. Trauma Trauma Disorders in the DSM-5 include: Reactive Attachment Disorder (children) Disinhibited Social Engagement Disorder (children) Posttraumatic Stress Disorder Acute Stress Disorder Adjustment Disorders Individuals who experience short-term, or singleincident trauma may only experience symptoms for a few weeks. Most service members deployed to combat zones experience multiple traumas. Posttraumatic Stress Disorder (309.81) Criteria include: Exposure to actual or threatened death, serious injury, or sexual violence. Can be through direct experience, witnessing traumatic event occur to others, learning that the traumatic event happened to a loved one, or experiencing repeated or extreme exposure to aversive details of the traumatic event (first responders, police officers witnessing child abuse). Posttraumatic Stress Disorder (309.81) Symptoms Recurrent, involuntary, and intrusive distressing memories of traumatic event. Recurrent distressing dreams. Dissociative reactions (flashbacks) where individual feels as though traumatic event is occurring. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or represent traumatic event. Physiological reactions to internal or external cues that symbolize or represent traumatic event. Posttraumatic Stress Disorder (309.81) Symptoms Persistent avoidance of stimuli associated with traumatic event. Negative alterations in cognitions and mood associated with the traumatic event. Marked alterations in arousal and reactivity associated with traumatic event. Disturbance causes clinically significant distress or impairment in social, occupational, or other areas of functioning. Disturbance not attributable to a substance. Rates of PTSD for OEF/OIF Service Members OEF/OIF service members more likely to develop PTSD. Factors affecting this: Longer deployments Increased severe combat exposure (deployment to “forward” areas close to enemy, witnessing others killed or severely injured) Increased severity of physical trauma TBI Lower rank Lower level of schooling Low morale and poor social support within unit Rates of PTSD for OEF/OIF Service Members OEF/OIF service members more likely to develop PTSD. Factors affecting this: Being single Family problems Member of Guard or Reserves Prior exposure to trauma Female Hispanic ethnic group Source: U.S. Department of Veteran Affairs, http://www.ptsd.va.gov/public/PTSDoverview/reintegration/overview-mental-health-effects.asp PTSD https://www.youtube.com/watch?v=NkWwZ9ZtPEI What symptoms of PTSD does this soldier exhibit? What are some issues regarding his reintegration back into civilian life? How would you as a helping professional intervene? Acute Stress Disorder (308.3)DSM-5 Symptoms last between 3 days to 1 month postexposure to a traumatic event. Traumatic events may include: Combat in war Threatened or actual violent personal assault Natural or human-made disasters Severe accidents Acute Stress Disorder (308.3) Symptoms Recurrent involuntary, intrusive distressing memories. Recurrent distressing dreams related to the event. Dissociative reactions where individual feels event is recurring. Intense or prolonged psychological distress. Marked physiological reactions in response to internal or external cues symbolic of event. Persistent inability to experience positive mood. Acute Stress Disorder (308.3) Symptoms Altered sense of reality on one’s surroundings or self. Inability to remember an important aspect of traumatic event. Attempts to avoid traumatic memory. Attempts to avoid external reminders that arouse distressing memories, thoughts, feelings. Disturbance of sleep. Hypervigilance. Problems concentrating. Exaggerated startle response. Screening & Assessment Sequence for clinical intervention: check for suicide/homicide, family problems, medical issues Screening Formal Assessment Formulation/treatment planning Prioritization of goals for intervention. Gather information about experiences during deployment Screening & Assessment Look for co-existing conditions-depression, anxiety, alcohol/substance abuse. Post-traumatic Stress Disorder Checklist-Military Version (PCL-M)-17 item self-report checklist. Access at http://www.ncptsd.org/publications/assessment/adult_ self_report.html Traumatic Life Events Questionnaire (TLEQ) & PTSD Screening and Diagnostic Scale (PSDS) http://portal.wpspublish.com/ Screening & Assessment National Center for PTSD recommends evaluation & education on following domains: Work functioning Interpersonal functioning Recreation & self-care Physical functioning Psychological Symptoms Past distress & coping Previous traumatic events Deployment-related experiences http://www.ptsd.va.gov/professional/pages/vets-iraq-warguidelines.asp Adjustment Disorders (309.__) Emotional or behavioral symptoms in response to identifiable stressor within 3 months of onset of stressor. Distress that is out of proportion to severity or intensity of the stressor. Significant impairment in occupational, social, or other important areas of functioning. Symptoms do not represent normal bereavement. Once stressor has ended, symptoms do not persist for more than an additional 6 months. Types of Adjustment Disorders 309.0 Adjustment Disorder with Depressed Mood 309.24 Adjustment Disorder with Anxiety 309.28 Adjustment Disorder with Mixed Anxiety and Depressed Mood 309.3 Adjustment Disorder with Disturbance of Conduct 309.4 Adjustment Disorder with Mixed Disturbance of Emotions and Conduct 309.9 Adjustment Disorder Unspecified TBI DSM-5 Diagnostic Criteria Defined as brain trauma with specific characteristics that include at least one of the following: Loss of consciousness Posttraumatic amnesia Disorientation and confusion Presentation may vary and can include: Difficulties concentrating, Problems with complex attention executive ability, learning, memory, slow processing of information, social cognition disturbances. TBI According to the CDC, Traumatic Brain Injury (TBI) “..is an injury to the head that results in a decreased level of consciousness, loss of memory, skull fracture, intracranial lesion, or neurological or neuropsychological abnormality.” Primary injury is the blow or jolt to hear, secondary injury is swelling, bleeding, and metabolic changes. Can range from mild to severe Around 90% of mTBI sufferers recover with no residual problems. TBI can result in functional changes including: Thinking, sensations, movement, language, emotions Symptoms may not occur immediately after the head trauma, but can appear weeks or months later TBI Studies estimate 20%-22% of those having served in OEF/OIF screen positive for TBI, usually from a blast (Carlson et al., 2010) Consuming alcohol after suffering from a TBI increases risk of engaging in dangerous behavior TBI has been called the signature wound of OEF/OIF. Behavioral manifestation can include irritability, impulse control, changes in mood. TBI can range from mild to moderate or severe Individuals suffering from moderate to severe TBIs can present with: unprovoked seizures, depression, cognitive impairment, unemployment, aggression, isolation Treatment of TBI In OEF/OIF blast injuries are a major cause of TBI The DoD and VA has established clinical guidelines for non-deployed and deployed settings Treatment can include Cognitive Rehabilitation Therapy (CRT) CRT is a constellation of techniques to improve: memory, attention, perception, learning, planning and judgment Examples of CRT are using computer-assisted programs to complete writing tasks and interaction TBI https://www.youtube.com/watch?v=qbxVINWh88o Similarities between PTSD and TBI include: Depression Anxiety Insomnia Irritability and anger Trouble concentrating Fatigue Hyperarousal Avoidance Source: Brady et al., (2009); Bryant, (2008); Stein & McAllister, (2009). Depression Estimated that more than 17-21 million people suffer from depression in U.S. every year Cuts across SES, race, gender, age, although women are twice as likely to be dx with depression as are AA, and the poor Seeing more depression in SMVF as draw downs continue Symptoms: feelings of worthlessness, hopelessness, sleeplessness, changes in appetite, excessive crying, remaining in bed for longer than normal, anger/irritability, self-loathing, reckless behavior Depression Stigma associated with depression in the military: Reinforced by the system, fear of negative retribution Feel and express anger, frustration, rage as it is more acceptable than feeling depressed For those who get help, may return to the unit and be described as weak Estimated over 1/5 of those returning from deployment return with PTSD, trauma disorder, depression. Less than ½ of these service members seek treatment Laura’s Story Boots on Ground Consulting, Inc. Serving those who serve us Thank You