Healing the trauma of war action planmg november 2010 (1)
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  • 1. Healing the Trauma of War A Project Sponsored by Mental Health America of Hawaii August 2009 to November 2010Executive BoardJim Bibbee Coordinator, Military OneSourceCapt. Que Schae Blue-Clark Family Services Director, Army National GuardHon. Michael Broderick Family Court JudgeLeigh Ching Provider Contracting Supervisor, HMSACol. C.J. Diebold Chief of Psychiatry, Tripler Army Medical CenterChief Lee Donohue Former Honolulu Police ChiefWarren Evans President, Argosy University-HawaiiNoe Foster CEO, theStrategist, LLCMarya Grambs Executive Director, Mental Health America of HawaiiKen Hirsch, MD PTSD Director of the PacificCherise Imai School Military Liaison, Department of EducationCynthia J’Anthony University of Hawaii Graduate StudentWalt Kaneakua Military Liaison, U.S. Senator Daniel InouyeLee-Ann Kida McClean Former Military Liaison, U.S. Congressman Neil AbercrombieKarl Kiyokawa Vice President, Tri West HawaiiHon. Ed Kubo Circuit Court JudgeMaj. Gen. Robert Lee State of Hawaii Adjutant GeneralKim Lipsky U.S. Veteran Affairs Senate Committee StaffClay Park Military Liaison, Papa Ola LokahiAlan Shinn Executive Director, Coalition for a Drug Free HawaiiRep. K. Mark Takai House of Representative; Major Army National GuardJim Tollefson President/CEO, Chamber of CommerceAnn Yabusaki Director, Family Intervention and Training ServicesProject BackgroundMental Health America of Hawaii contracted with theStrategist, LLC to lead anExecutive Board of senior military, business, and community leaders to identify problemsfaced by National Guard and Reserve soldiers and their families after combat anddevelop an action plan of solutions to improve the quality of life for these soldiers andfamilies.Over the course of a year, Healing the Trauma of War Executive Board shaped an actionplan that proposes 10 solutions ideas that will positively impact reintegration for NationalGuard and Reserve soldiers and their families. Through interviews, focus groups,surveys, legislative testimony, workgroups, and other discussions, hundreds ofindividuals offered their invaluable input and perspective to inform the final action plan.Since 9/11 more than 1.8 million U.S. men and women have served in Iraq andAfghanistan. For the first time ever, National Guard and Reserve soldiers comprise 30percent of all combat forces.Project Focus
  • 2. Target OutcomeImprove life for U.S. National Guard and Reserve soldiers and their families once theyreturn home from combat in Afghanistan and Iraq. Problem StatementFinanceIn transitioning back into civilian life, National Guard and Reserve troops experiencefinancial challenges that add stress to and strain family relationships. The currenteconomic climate, with many Hawai`i companies going out of business, compounds thesituation. We estimate that 15-20 percent of National Guard and Reserve soldiers returnhome jobless. Some have received “Dear John/Dear Jane” letters while in Iraq orAfghanistan from employers who have closed up shop. Others deployed immediatelyafter graduation and are now in search of their first job outside of the military.Employment/UnemploymentFor some, their employers have closed for business leaving them jobless, which oftenentails loss of health insurance. Many find it difficult to translate their combat experienceon a resume into marketable skills employers want to hire. Others return to work butundergo difficult transitions and feel “out of place.” Some employers are hesitant to hireor retain National Guard and Reserve soldiers because absences resulting from multipledeployments place a financial burden upon the business and/or fear of PTSD and othermental health challenges they have read about.DebtFinding affordable housing, paying for housing, and managing credit debt are issuesfacing returning soldiers. Some financial and lending institutions are violating Federallaws already established to protect soldiers from foreclosures and repossessions, or areinappropriately enticing soldiers to incur debt beyond their capacity to pay with homeand car loan solicitations.HomelessnessIn the U.S. one in three homeless adults is a Veteran. Today the fastest growinghomeless segment is women Veterans.Post 9/11 GI BillThe Post 9/11 GI Bill restricts the benefit period retroactive only to August 2009. Thisbill should be amended so that soldiers who incurred qualifying educational expensesbetween September 2001and August 2009 receive the financial relief that this bill offers.CommunicationsCommunication outreach efforts have improved, yet much more needs to be done toreach and motivate National Guard and Reservists to use resources and benefits availableto them. Often when benefit information is presented right after the soldier has returned, 2
  • 3. the soldier is disengaged and does not feel an immediate sense of urgency to access thesebenefits until he or she is in a crisis situation. The commands’ restrictive interpretation ofprivacy laws has also hampered outreach efforts. There are many support programs thatare underutilized because National Guard and Reservists don’t know they exist or find ittoo labor intensive to apply for these benefits.Mental HealthSoldiers are returning home with psychological war wounds that include: post traumaticstress disorder (PTSD) various degrees of traumatic brain injury (TBI), military sexualtrauma (MST), substance abuse, depression, and other mental health conditions, whichmay lead to attempts at self-harm (including suicide) and/or violence against others.Soldiers who are struggling with mental health and substance abuseconditions are at greater risk for involvement in domestic violence, high-risk behavior(fighting and high speed driving), and other involvement in the justice system.To complicate matters, most National Guard and Reserve troops see non-militaryphysicians and health care providers, who may not be familiar with combat-relatedissues. Additionally, because DOD and VA medical record systems are not compatiblesoldiers medical records are often incomplete. Although there are many programs tooffer support, these services are fragmented and often difficult to navigate and, in somecases, may not be culturally sensitive. In addition, stigma and denial are powerful factorsthat prevent early intervention or ongoing treatment.FamilyDeployment tests the foundation of the family.Impact on ChildrenChildren are impacted when a parent deploys and when he or she returns.Reactions are highly individual with each child and with each deployment, but it is safeto say that it is traumatic to lose a parent to a war zone and face a returning parent whomay be suffering from problems. Child abuse rates are at an all time high, with one studyreporting that the at-home parent was three times more likely to abuse a child while theother parent is deployed when compared with non-deployed parents. Research confirmsthat children with one or both parents deployed to war experience mental healthconditions more often than other children. The rate increases when the parent’sdeployment is extended and when it has occurred multiple times.Impact on the SpouseFamily roles change. The at-home spouse often carries an enormous burden. Marriagesexperience pressures that generate high rates of strife, infidelity, break-ups and divorce,which negatively affect the children. Domestic violence rates are on the rise, fueled bysubstance abuse and untreated mental health issues. Wives of deployed soldiers are athigher risk for mental health conditions. The rate increases when the deployment islonger than a year. There is a false perception that National Guard and Reserve soldiersare advantaged because they have on-island extended family support. However, thesefamily members often lack a full understanding of the dynamics and challenges of 3
  • 4. military life and are often ill prepared to offer support.Delivery of CareFew private, non-military physicians and mental health providers are sufficientlyprepared to treat the unique needs of National Guard and Reserve soldiers. Also, most areunaware of the military resources available and how best to connect their patients withthese services.Insurance CoverageNational Guard soldiers lose health insurance coverage after 180 days after he or shereturns home from a deployment and transitions off of active duty status.Over-arching Factors that Influence All IssuesAvailability and Access to ServicesTo exacerbate the problems, there is a shortage of psychiatrists, psychologists, marriageand family therapists, and mental health and substance abuse providers. Of theseproviders, few are sufficiently prepared to treat the unique needs of National Guard andReserve soldiers. Provider shortages are even more critical on the Neighbor Islands, withvery few psychiatrists and psychologists available. Telemedicine programs to expandcoverage to Neighbor Island families are not yet operational and planning initiatives arestill in the infancy stage. Of great concern is the fact that there are no established healthassessment protocols for private, non-military primary care physicians, pediatricians,Ob/Gyns, mental health providers, and others that direct them to ask, “Have you or afamily member been deployed to combat?” Finally, National Guard and Reserve soldiersare vulnerable to eligibility restrictions and do not have full access to family supportprograms, as do active duty military members.Stigma and DenialStigma and denial are huge barriers that prevent soldiers from seeking mental health andsubstance abuse help, impeding treatment for the family as well. Concern over “fit forduty,” loss of rank, shame, or individual or family denial can often interfere with asoldier’s decision to seek help. In addition, National Guard and Reserve soldiers areanxious to return to a non-military lifestyle when they arrive home after a deployment,and sometimes avoid unit events like Yellow Ribbon reintegration sessions.Lack of DataChildren of National Guard and Reserve soldiers have not been not consistently identifiedin the school system. As a result, National Guard and Reserve children fail to get thesame level of school-based outreach and support as active duty children. No data iscurrently collected or tracked regarding the primary care physician and health insurancefor National Guard and Reserve soldiers and their families. Although data is collected atvarious stages of deployment, the data is not aggregated, analyzed, or publicly reported. 4
  • 5. 10 SolutionsLocal Solutions 1. Provide intensive job-ready support for soldiers. Work with Veterans Affairs, Department of Labor, Hawaii Workforce Development Council and other agencies to target a specific industry with job growth potential and provide training and employment placement for soldiers and their spouses. Leverage existing programs that offer opportunities for soldiers and their spouses to upgrade their skills or start a new business. Focus new efforts on target demographics, like women soldiers, whose needs are not yet met with existing programs. 2. Establish a Veterans Court or hybrid track within the judiciary system that initiates a problem-solving approach that involves Veteran Affairs intervention, mandated mental and behavioral health treatment, peer mentors and rehabilitation instead of incarceration. Introduce a protocol that is tailored to meet the unique needs of National Guard and Reserve soldiers in addition to active duty personnel. 3. Expand access to medical, mental health and behavioral health care on the Neighbor Islands by employing wireless and 3G technology platforms that link service providers in urban areas to soldiers who live in isolated and rural communities. Engage private, non-military physicians, psychiatrists, psychologists and behavioral health providers. 4. Train non-military physicians, mental health providers, school counselors and others through on-demand, web video clips, at conferences and through community forums. On a grass roots level, engage communities in brainstorming sessions that look at cultural, ethnic and geographic differences that impact a soldier’s decision to seek help. Develop better ways to identify combat-related conditions early. 5. Launch a multi-media communication campaign that informs National Guard and Reserve soldiers of the full scope of benefits available to them and how to access these benefits. 6. Identify children of National Guard and Reserve soldiers at the school-level through the DOE and expand outreach programs already in place for active duty military children. Add information to benefit military youth on Hawai`i’s Teen Help Line. 7. Ensure periodic health screenings are conducted for all returning soldiers according to Department of Defense policies. Track, trend and report aggregate data.National Solutions 8. Retroactive benefit effective date for Post 9/11 GI bill to September 2001. 9. Extend health insurance coverage to unemployed National Guard and Reserve soldiers and their families. Auto-enroll National Guard and Reservists into VA health and administrative benefit programs. 10. Remove 5-year time limit policy for PTSD diagnosis. 5
  • 6. Results• The U.S. Department of Labor Veterans’ Employment Training Services awarded a $300,000 federal grant to Mental Health America of Hawaii for an employment project to benefit homeless and unemployed women Veterans and Veterans with families in Hawaii. The project is called POWER Up! The initial project period is July 1, 2010 to June 30, 2011 with two additional years of funding possible.• Chief Justice Ronald Moon appointed an advisory committee comprised of judges to investigate and evaluate the feasibility and viability of establishing a Veterans Court or a hybrid Veterans track within the justice system. The 2010 Hawaii legislature passed HR200 directing the Judiciary to report its findings and recommendations relating to the establishment of a Veterans court to the 2011 legislature.• Mental Health America added a suicide prevention initiative to benefit youth of military families.• Increased media and public awareness. Through local and national news coverage of this project, more individuals have become sensitive to the unique re- integration challenges National Guard and Reserve soldiers face when returning home from combat in Afghanistan and Iraq.• New collaborations and synergies have been built with the Judiciary, Department of Education, legislature, Tri West, Chamber of Commerce, Argosy University, University of Hawaii and the Pacific Task Force for Psychological Health.• The Department of Education is now identifying and tracking children of National Guard and Reserve soldiers.• The Chamber of Commerce included in its 2010 Health Care Policy Statement the need to expand access to care for National Guard and Reserve soldiers who live in rural communities.• Healing the Trauma of War project was awarded the 2010 Innovation During Challenging Economic Times award by national Mental Health America. theStrategist Noe Foster t: (808) 753-7223 e: NFoster@theStrategist.tv w: theStrategist.tv 1164 Bishop Street, Suite 1503 Honolulu, Hawaii 96813 6