2. ACCOMMODATING RETURNING SERVICE MEMBERS AND VETERANS FROM IRAQ AND AFGHANISTAN1.7 million Americans served in Iraq and Afghanistan. Because of the Global Waron Terrorism many service members have been exposed to traumatic combatexperiences on a daily basis. The 2008 Rand Corporation study reports that 1 outof 5 or 300,000 Afghanistan and Iraq soldiers suffer from major depression, PostTraumatic Stress Disorder (PTSD) or anxiety. If you add problems relating to thesoldier’s family and marriage the toll reaches one million. Only ½ or 53% havesought treatment through the Department of Veteran’s Affairs and 60,000 of120,000 of those who served in the two wars suffer PTSD and/or depression whichare highest for woman and reservists.Documents from the federal case of Veterans for Common Sense vs. Peake in May2008 disclosed that the 18 veterans commit suicide each day. 1000 of thoseveterans who receive care from the Department of Veteran Affairs (VA) attemptsuicide every month. As of 3/15/2008 287,790 Iraq and Afghanistan war veteransfiled disability claims with the VA. 1,467 veterans died awaiting approval of thedisability claim by the government. Those who appeal the VA decision await 4 1/2years for an answer.2008 American Psychiatric Association study indicates that one out of fourmilitary on active duty did not know anything concerning mental health treatmentthat might arise from their service in war zones. Those who were surveyed choseno assistance because:(1.) Side effects of medication,(2.) Believed family and friends could help with the problem, and(3.) Care would damage their career.This stigma and the toughness emphasized by the military contribute to notaccepting assistance by the soldier or veteran.According to a pamphlet (American Legion (American Legion. Guide for Post Traumatic StressDisorder (5th ed.) [Brochure]. Washington, DC) PTSD symptoms in combat veterans caninclude:1. Upsetting thoughts occurring frequently about the traumatic event.2. Frequent dreams (in many cases, nightmares) about the event.3. Suddenly feeling as though the event is reoccurring (flashbacks).4. Environmental stimuli (olfactory, auditory, visual) can trigger flashbacks andother troubling symptoms.5. Detaching oneself physically and emotionally from other people/places,especially large crowds.6. A feeling of detachment from others.7. A feeling of foreshortened future.8. Guilt related to being a survivor - living after the trauma when many othercomrades did not. Guilt may also surface because of ones duties (having to takeanother human life).9. Sleep disturbances (usually insomnia).
3. 10. Mood swings and anger outbursts.11. Cognitive/memory difficulties.12. Excessive vigilance and survival-related behaviors.13. Hyperarousal - a person may seem "jumpy," especially in the presence ofunexpected noises.It is important to note that not all veterans that experience combat will developPTSD; employers and coworkers must not assume that someone who is returningfrom the Middle East is having these difficulties. Furthermore, those who dodevelop this condition may not experience all of the symptoms and behaviorslisted above. In some cases, it may take years for PTSD to develop. Employeeswho are veterans of previous military conflicts may benefit from this informationas well. ACCOMMODATION INFORMATIONBelow are some suggestions for accommodations. It is important to rememberthat not all veterans with PTSD will need these accommodations, if any. This isnot an all-inclusive list:Lack of Concentration: People with PTSD may have difficulty concentrating on jobtasks. Reduce distractions in the work environment Provide space enclosures or a private space Allow the employee to play soothing music using a headset Increase natural lighting or increase full spectrum lighting Divide large assignments into smaller goal oriented tasks or steps Plan for uninterrupted work timeCoping with Stress: People with PTSD may have difficulty handling stress. Allow longer or more frequent work breaks as needed Provide backup coverage for when the employee needs to take breaks Provide additional time to learn new responsibilities Restructure job to include only essential functions during times of stress Allow for time off for counseling Assign a supervisor, manager, or mentor to answer the employees questionsWorking Effectively with a Supervisor: Managers could supervise people withPTSD using alternative supervisory techniques. Giving assignments, instructions, or training in writing or via e-mail Provide detailed day-to-day guidance and feedback Provide positive reinforcement Provide clear expectations and the consequences of not meeting expectations Develop strategies to deal with problems before a crisis occursInteracting with Co-workers: People with PTSD may have difficulty working withothers.
4. Encourage the employee to walk away from frustrating situations andconfrontations Allow employee to work from home part-time Provide partitions or closed doors to allow for privacy Provide disability awareness training to coworkers and supervisorsDealing with Emotions: People with PTSD could have difficulty exhibitingappropriate emotions or controlling anger. Refer to employee assistance programs (EAP) and veterans centers Use stress management techniques to deal with frustration Use of a support animal Allow telephone calls during work hours to doctors and others for neededsupport Allow frequent breaksSleep Disturbance: People with PTSD may have disruption in sleep patterns thatcould affect workplace performance. Allow the employee to work one consistent schedule Allow for a flexible start time Combine regularly scheduled short breaks into one longer break Provide a place for the employee to sleep during breakAbsenteeism: People with PTSD could have absenteeism or tardiness issues orhave difficulty maintaining reliable attendance. Allow for a flexible start time or end time, or work from home Provide straight shift or permanent schedule Count one occurrence for all PTSD-related absences Allow the employee to make up the time missedPanic Attacks: People with PTSD could experience panic attacks at home or atwork which could affect workplace performance. Allow the employee to take a break and go to a place where s/he feelscomfortable to use relaxation techniques or contact a support person Identify and remove environmental triggers such as particular smells or noises Allow the presence of a support animalHelping to ease the transition back to the workplaceThe Disability Management Employer Coalition and several large insurers teamedup with military and veteran advisers to examine the challenges and opportunitiesfacing returning veterans and to identify employer-based resources and strategies
5. to help ease the transition. The group, calling themselves the Workplace WarriorThink Tank, has produced a useful guide for employers: The Corporate Responseto Deployment and Reintegration Highlighting Best Practices in Human Resourcesand Disability Management.The following are among the groups most important best practicerecommendations: Establish a Military Leave and Return Policy covering employees who are members of the Reserves or National Guard. A key component of that policy is to communicate the range of benefits and programs that apply, including provisions of the federal Uniformed Services Employment and Re-Employment Rights Act of 1994 (USERRA), which requires job protection for all employees who are deployed regardless of the size of the employer. Evaluate the effectiveness of the Employee Assistance Program (EAP) and behavioral health services to help returning employees (including members of the military and civilian employees assigned overseas) who have been diagnosed with or who are exhibiting symptoms of major depression, generalized anxiety or post traumatic stress disorder (PTSD). Use good general disability management practices that apply, including: - maintaining communication during absences; - celebrating employees’ return to work; - giving employees adequate information about benefits prior to deployment; - allowing time to reintegrate after an extended absence; - considering accommodations to assist the employee’s return to productivity; - recapping changes while employees were gone; - establishing red flags to help supervisors identify potential problems; and - obtaining commitment from senior management to ensure that programs are given strong support and a cultural presence. Offer sensitivity training to managers, supervisors and co-workers on issues and challenges faced by civilian soldiers during deployment and post-deployment. Provide mentoring programs to link returning civilian soldiers with veterans in the workforce. The commonality of military experience may forge bonds among colleagues to support the successful reintegration of returning workplace warriors.Employee Assistance Programs (EAP) identified as a vital resourceThe Workplace Warrior Think Tank stressed the importance of employers havingnot just an EAP, but one that is well equipped to address the full spectrum of
6. behavioral health issues that are common to re-acclimating veterans, particularlyPTSD and depression. According to a November 14, 2007 article in the Journal ofthe American Medical Association, U.S. Department of Defense cliniciansidentified that 20.3 percent of active and 42.4 percent of reserve componentsoldiers required mental health treatment. This incidence rate was identifiedthrough either an initial post-deployment health assessment or re-assessmentthat occurred approximately six months later. “Estimates indicate that three outof five veterans probably have PTSD to some degree. We need to educatecompanies about traumatic brain injury and PTSD so people can understand andbe aware of the issue.” Bill Dozier, Assistant Director, National Veterans Outreach Services, Veteran ofForeign Wars (VFW)In addition, the EAP must be poised to address the many family problems andstresses that can surface both during and after deployment. According tocongressional testimony by Todd Bowers, Director of Government Affairs for Iraqand Afghanistan Veterans of America, 27% of soldiers now admit they areexperiencing marital problems, and 20% of deployed soldiers say they arecurrently planning a divorce. And a CBS investigation points to a veteran suiciderate that is twice that of average Americans.Employers must train supervisors and HR staff to spot warning signs for problems early and must have resources in place for referrals to appropriate help and support services. For employers who will have returning citizen soldiers, the next EAP renewal might be a good time to kick the tires and ensure that it is up to providing the serious support and mental health services that will be needed. The transition will not be a once-and-done matter, but a long-term issue that Americas employers will be dealing with over the next few decades. (HR WEB CAFÉ, Employers best practice guide for helping veterans reacclimate to the workplace”, ESI Employee Assistance Group, Wellsville, NY, 2006)Compiled by: Vincent J. McNally, MPS, CEAP Trauma Reduction Inc. TRAUMAREDUCTION@AOL.COM