Chapter 15: Veterans, Their Families, and Military Social WorkLecture NotesChapter 15: Veterans, Their Families, and Military Social WorkOutlineI. The Armed Services and Military CultureA. Basics1. Work with military requires understanding of military culture and norms2. Licensed social workers can join the military or work with military members and veterans through the Department of Veterans Affairs (VA)3. Current members of the military are volunteers, while in past they may have been conscripted4. Military work is regarded as a career people choose5. The military is taking more responsibility today for the mental and physical well-being of its members and veterans6. Uniform Code of Military Justice governs military behavior and morality7. Department of Defense (DoD): HQ of all five branches of the military8. Hierarchy and bureaucracy are the normB. What It Means to Be a Soldier1. Four distinct pillars of military culturea) Strict disciplineb) Loyalty and self-sacrificec) Ceremonies and rituals used to solidify common identitiesd) Emphasis on cohesion and esprit de corps2. Common reasons for joininga) Identification with warrior mentalityb) Family legacyc) Benefits of military lifed) Escape from difficult situations at home3. Veterans: Active duty, discharged, retired, or reserve military membersC. How War Affects Soldiers1. Both psychological and physical effects2. Operation Enduring Freedom and Operation Iraqi Freedom have been extended military operations/conflicts3. Three factors considered essential for success: secrecy, stoicism, denial4. Common effects of war are PTSD, shame, survivors’ guilt, helplessnessD. How the Military Takes Care of Its Own1. Veterans’ relationships, careers, education, and physical independence often suffer from their service2. VA hospitals and TRICARE military insurance were designed to meet these needs3. Military families also suffer considerable stress from both separation and reunification4. Military families are also increasingly diverse in formII. Social Work with the Military and VeteransA. A History of Military Social Work1. Since WWI, military has employed social workers2. 1943: Army designated psychiatric social work as a distinct job category3. Today: unformed social workers in Army (since 1945), Navy, Air Force (1947)4. Naval social work expanded considerably during Vietnam and in 19795. Most military social workers, however, work through the VA6. Help veterans cope with mental health effects of war and stigma7. Social workers have to balance professional ethics with military codes8. Must have knowledge of a variety of issues (criminal justice, homelessness, mental health, GI bills, women, LGBTQ+ service members) and how to manage secondary stress9. Social workers must understand the military power structure and its influence10. Also provide discharge planning and ongoing case management for veteransB. Behavioral Health Problems of Military Service Members and Veterans1. Traumatic Brain Injury (TBI)a) Ranges in severity from mild to severe; often from blast exposureb) Complicates adjustment to civilian life post-servicec) Symptoms can include headache, fatigue, sleep issues, vomiting, seizures, speaking problems, limb weakness, poor coordination, confusion, and so on2. Posttraumatic Stress Disorder (PTSD)a) One in five veterans qualify for PTSD diagnosisb) Combat PTSD is more chronic and complex than civilian PTSDc) Vietnam vets have a greater occurrence of panic disorder, earlier average onset of alcoholismd) May relive traumatic experiences through flashbacks, nightmares, trigger responsese) May avoid crowds, driving, war movies if they’re reminded of combat3. Substance Use Disordersa) Problems in combat settings and after dischargeb) Prevention efforts have stepped up, as with the Air Force’s community capacity model(1) Shared responsibility: one is concerned(2) Collective competence: one is motivated and will actc) Veterans active in process of healing may be less likely to abuse substances4. Suicidea) Highest suicide rate occurs among those who have gone to warb) Three biggest risk factors: relationship, legal, and financial troublesc) Successful prevention efforts have focused on mind-body framework(1) Medical, environmental, psychological, nutritional, behavior, social, physical, spiritual and family fitness(2) The goal is to enhance resilience through getting fit in these spheresC. Issues Affecting Wounded Military Veterans1. Most wounded warriors survive, resulting in long-term care and potential economic problems2. Social workers work with these vets to help them adjust to their new circumstancesD. Issues Affecting Military Families1. Deployment strains military families2. Spouses become lonely and stressed with additional responsibilities3. Especially vulnerable: younger families, families with young children, families with pregnancy, families where soldier is deployed to a new and unfamiliar place4. Reservists also have this uncertainty, as they may be called into active serviceat any time; income for families often decreases during deployment5. Post deployment role negotiation can be a challenge for reunited families6. Vets may resist needed mental health care due to stigma7. Spouses may also have mental health needs, and children may struggle with (repeated) relocation and separation from a parent8. Unemployment may be high and tempt people to reenlistE. Programs and Policies for Military Personnel, Veterans, and Their Families1. Disabled transition assistance2. TRICARE3. Social work servicesa) Social workers typically must have 2 years postgraduate experienceb) Internships are also available to help new MSWs earn licensureF. Social Work Assessment and Intervention Skills1. Basic knowledgea) Physical injuries including TBIb) Systems-ecological approachc) Case management, counseling, therapy options, advocacy, medical work, hospice cared) Neurobiology and PTSDe) Recognition of secondary traumaf) Conflicts between the NASW Code of Ethics and military expectations2. Common types of therapya) Cognitive processing therapy: treatment for PTSDb) Cognitive information processing emphasizes decision making and career problem solving to aid workforce reintegration3. Multidisciplinary team approacha) Medical personnelb) Military chaplainsIII. Diversity and Military Social WorkA. Age1. Most active service members are 17–24 years old; women leave earlier2. Maximum ages designated by each service branch as wellB. Class1.