Healing Our Heroes- LCA Presentation
- 1. Healing Our Heroes A Holistic Perspective on Ending Veteran Homelessness Presented by: Christopher Monceaux, MBS, MS, PLPC, CCTP Shauna Russell, M.S., PLPC, CCTP, CIT
- 2. Outline I. Introduction II. Mental Health III. Substance Use Disorders IV. Medical Issues V. Legal Barriers VI. Vocational Rehabilitation VII. Finances VIII. Housing IX. Conclusion X. Resources
- 3. Introduction Basic Tenets of Military Culture: Duty, Honor, Country Subcultures within the military Branch, Unit, Platoon, MOS (Military Occupational Specialty) The Average Soldier Unique Challenges faced by veterans Importance of assuming a holistic perspective on treatment
- 4. Mental Health: Trauma Post Traumatic Stress Disorder (PTSD) Combat Related Childhood Trauma Military Sexual Trauma (MST) Occurs among male and female military members Self-medicating Prevalent Treatment Options
- 5. Mental Health: Other Concerns Veterans diagnosed with depression account for slightly more than 14 percent of the total Current Suicide Rate among veterans: About 22 per day PTSD, Depression, and TBI has higher prevalence in OEF/OIF veterans Personality Disorders: Often go undiagnosed Present unique treatment challenges
- 6. Estimated Number of Veteran Suicides per day by Year (according to a 2012 study by the Department of Veterans Affairs)
- 7. Interventions For trauma and other mental health diagnoses: Cognitive Processing Therapy (CPT) Prolonged Exposure Therapy (PET) Virtual Reality Prolonged Exposure Therapy Acceptance and Commitment Therapy (ACT) Mood Gym Mental Health Applications PTSD Coach Mindfulness Coach
- 8. Interventions (Ctd) Eye Movement Desensitization & Reprocessing (EMDR) Adaptive Information Processing Model 8-phase standard protocol Adapted protocols for several mental health disorders Dialectical Behavior Therapy Dialectics & Validation Skills Training Interpersonal effectiveness, emotion regulation, mindfulness, & distress tolerance Integrative Approach
- 9. Substance Use Disorders Between 2004 and 2006, 7.1% of U.S. veterans met the criteria for a substance use disorder. Older generation vs. Younger Generation Increased abuse of prescription drugs Legality of marijuana; potential treatment implications? Research is conflicting May explain higher usage among younger vets
- 10. SUDs Interventions Counseling & Psychotherapy Cognitive Behavior Therapy, DeTUR, Motivational Interviewing, Harm Reduction, Relapse Prevention Community Support AA/NA Meetings & Sponsor SMART Recovery Celebrate Recovery Rational Recovery Seeking Safety (Co-Occurring PTSD and Substance Use Disorders)
- 11. Medical Issues: TBI Traumatic Brain Injury (TBI) defined as an alteration in brain function, or other evidence of brain pathology, caused by an external force. A TBI may be classified as focal or diffuse; open or closed; and mild, moderate, or severe. (Penetrating is a different classification) Traumatic brain injury has become known as a signature wound of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) TBI can significantly affect diagnosis and treatment
- 12. TBI and Treatment Diagnostic Difficulties Effects similar to the symptoms of many mental health diagnoses Treatment implications Slower Difficulty remembering appointments and completing tasks
- 14. Medical Issues: Other Concerns Chronic Pain Prevalence & Impacts Relation to SUDs Traditional Pain Management Alternative Pain Management Strategies Other Service Connected Injuries Tinnitus Agent Orange Exposure Camp Lejeune Water Exposure
- 15. Medical Issues: Other Concerns Diet & Exercise MOVE Program Yoga and other low-impact activity Sexually Transmitted Diseases HIV & Hepatitis C Other chronic health complications
- 16. Legal Barriers Felonies (stigma, employment barrier, housing barrier) Drug Charges (Drug Court, treatment as alternative to jail time) Child Support (numerous financial implications) License restrictions (no transportation = employment barrier; consequence of child support and other legal issues)
- 17. Legal Barriers Diversion Programs: Problem Solving Courts (VOA Veterans Court, Drug Court) Expungement Advocacy within the legal system
- 18. Vocational Rehabilitation Reintegration into civilian workforce VBA Vocational Rehabilitation & Education Programs (Chapters 31, 36, 18, & 35) VHA Compensated Work Therapy Programs Incentive Therapy (IT) Compensated Work Therapy (CWT) Supported Employment Program (SE) Community Partners Goodwill LRS Employer-agency connections
- 19. Other Income Sources VA Service-Connected Benefits VA Non-Service Connected Pension SSDI/SSI Benefits SOAR application Non-cash Benefits
- 20. Maslows Hierarchy of Needs
- 21. Housing VA is committed to ending Veteran homelessness by the end of 2015 Housing First/ Rapid Rehousing Prioritization using the SPDAT
- 22. Housing Various Programs: Safe Haven- low impact, low barrier GPD- more structure, transitional SSVF- short-term assistance HUD VASH- long-term intensive case management Theory vs. Practice Non-availability to rural veterans Importance of supportive services throughout re-entry into permanent housing
- 24. Conclusion Implications for treatment Coordination of services for best outcome Importance of assuming a holistic perspective
- 25. Additional Resources Links for additional information SAMHSA: http://www.samhsa.gov/veterans-military-families Military OneSource http://www.militaryonesource.mil/ Seeking Safety http://www.treatment-innovations.org/seeking-safety.html Virtual Reality Exposure Therapy: http://ict.usc.edu/prototypes/pts/ Department of Veterans Affairs: http://www.ptsd.va.gov/ http://www.va.gov/opa/docs/suicide-data-report-2012-final.pdf http://www.va.gov/homeless/about_the_initiative.asp
- 26. Resources Continued Volunteers of America http://www.voanorthla.org/ Legal Resources: http://grantome.com/grant/NIH/I01-RX000484-02 http://usich.gov/population/veterans/veterans_homelessness _in_focus/breaking_down_legal_barriers_to_housing/ http://www.nationalhomeless.org/factsheets/veterans.html