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Cir Policy Brief Ensuring Quality Workforce March 2011 Final


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Cir Policy Brief Ensuring Quality Workforce March 2011 Final

  1. 1. POLICY BRIEF | MARCH 2011 ENSURING BEHAVIORAL one-third of all servicemembers will experience significant problems with HEALTHCARE CAPACITY combat stress, substance abuse, AND QUALITY depression and/or suicide (DoD Task FOR SERVICEMEMBERS, Force on Mental Health, 2007; Tanielian VETERANS AND MILITARY et al., 2008). Beyond the impact on those individuals, there are effects on FAMILIES the family members who send their loved ones off to war – and to whom the JAN A. NISSLY AND KELLY L. TURNER servicemembers return home. Many such family members experience significant socio-emotional challenges, A great deal of attention has been paid even so-called “secondary PTSD”, and in the past few years to the impact of also require professional assistance war on behavioral health. Statistics now (Chandra et al., 2010; Figley, 1998; Hall, abound regarding the numbers of 2008). Further, certain aspects of servicemembers who have deployed to OEF/OIF, beyond the sheer number of OEF/OIF, the common visible and those who have served, magnify the invisible wounds, and the high need impact and exacerbate the stresses of (whether acknowledged by those in war. These conditions include the need or not) for behavioral health extensive use of Reserve Component services. There appears to be forces, repeated deployments of enlisted widespread agreement that the capacity men and women, the absence of a of our nation’s behavioral health combat “front,” constant exposure to workforce must increase, and rapidly. threat, rapid return with little time for Exactly how to go about increasing this mental or emotional calibration, and capacity – in terms of both quantity and lack of readiness in the civilian culture quality – is not as clear. This military to understand and absorb veterans behavioral health policy brief addresses (Burnam et al., 2009; Castaneda et al., the development of a high-capacity 2008; DoD Task Force on Mental Health, behavioral health workforce to care for 2007; Erbes, 2009; Flynn & Hassan, our nation’s servicemembers, veterans, 2010). For example, reservists deployed and military families. to Iraq or Afghanistan were later found to be twice as likely as active duty personnel to meet screening criteria for IMPACT OF WAR ON PTSD and depression, suggesting a BEHAVIORAL HEALTH marked need for mental health services among this subgroup (Castaneda et al., Our nation has been at war for over a 2008; Schell & Marshall, 2008). This is decade, with more than 2.6 million not surprising, given the structure of American servicemembers having been their service itself: Reserve Component deployed to Afghanistan or Iraq. members return from deployment to Frequently cited statistics estimate
  2. 2. civilian jobs and communities, where there focused on older-generation and moreare often few supports – formal or informal – severely disabled veterans (Schell &who understand their deployment experience Tanielian, 2011).and the major adjustment involved inreturning to civilian life. Regardless of the reason, civilian providers are increasingly called to meet the behavioral healthcare needs of our nation’s servicemembers, veterans and militarySTRAINED TRADITIONAL families. Civilian education and trainingSERVICE SYSTEMS AND THE programs have historically not been orientedCIVILIAN RESPONSE toward content crucial for work with military populations, and civilian providers often haveHistorically, living arrangements, schools, minimal understanding of “military culture”medical services, and other institutions (Hall, 2008; Tanielian et al., 2008). Withoutserving the military and veterans have been such background, civilians have difficulty inseparated and often isolated from civilian relating to the experience of veterans, andprograms and services. While these insular according to anecdotal evidence, are oftensystems of care may have been sufficient in less effective – at least at engaging newprevious generations, they are overloaded clients - than are uniformed providers. Manyand no longer capable of independently community mental health providers also fallmeeting the needs of our wounded warriors short of recommended standards forand their families (Stahl, 2009). For example, treatment and care (Burnam et al., 2009;a military installation in Hawaii was reported Castaneda et al., 2008; DoD Task Force onto have had one mental health officer for Mental Health, 2007; Erbes, 2009). Civilianevery 265 cases, whereas the official military behavioral healthcare providers may notstandard is 1:50 (Pittsburgh Tribune Review, realize the harm they are doing, or could do –2011). Similar examples are evident within not only by perpetuating beliefs about thethe Department of Veterans Affairs, where inability of civilian providers to understand,recent research has borne out longstanding or to help - but to the individual, family,anecdotal scenarios of long delays in getting community, and society by having someoneinitial appointments, extended periods continue to suffer from the invisible woundsbetween appointments, and lengthy waiting of war long after the deployment has delays (National Council for BehavioralHealthcare, 2010; Schell &Tanielian, 2011).Clearly, not all servicemembers and veteransseeking care through the DoD or VA are CURRENT RESPONSES TOcurrently able to find it, at least in a timely INCREASING CAPACITYmanner. Further, some veterans choose notto seek care through the VA, sometimes the Huge demand, strained service systems, andresult of logistical barriers, such as the lack of providers relatively unfamiliar with theproximity to a healthcare facility or extended specific needs of those they seek to servehours to accommodate a full-time work point unequivocally to the need for expandedschedule, and other times due to perceptions behavioral healthcare capacity. Theof VA culture – that the VA is primarily Department of Defense Task Force on Mental POLICY BRIEF | MARCH 2011 | CIR.USC.EDU 2
  3. 3. Health (2007) and RAND (Tanielian et al., RECOMMENDATIONS2008) provided clear and compellingarguments and recommendations for an In light of previous literature that makes aexpansion of our nation’s behavioral clear case for expanding our nation’s military-healthcare workforce. Efforts appear to be trained behavioral healthcare workforce, andmobilizing, both across the U.S. and across the evidence of a mounting response, wedisciplines: at least four schools of social suggest the following ways to maximizework and psychology offer degree-based progress in this area:programs specializing in military behavioral  Behavioral healthcare provider traininghealth (please see reference list) ; other must include attention to the military as adegree-granting institutions offer focused culture, and integrate the latestelectives; academic scholarship funding is empirically-supported methods ofavailable for students planning to pursue intervention.practice careers with military-related  Providers of military behavioral healthpopulations; and several academic training would serve their students andinstitutions, governmental agencies and their profession well by evaluating thehuman services organizations offer impact of their training. Key outcomes forcontinuing education courses for behavioral inclusion might include context-specifichealthcare professionals on a variety of topics knowledge, trainee perceptions ofrelevant to providing behavioral healthcare influences on practice, and traineeto servicemembers, veterans and military characteristics, such as clinical selffamilies. Moving a step beyond training, efficacy, in the context of working with aleaders in military social work have military population.developed a set of guidelines for advancedpractice in military social work (CSWE, 2010),  Accrediting bodies might assessand a similar document is being developed to educational institutions offering degreeguide behavioral healthcare practice with programs in relation to newly-establishedfamilies impacted by military service (A. military behavioral healthcare guidelinesHassan, personal communication, January 5, such as the Council on Social Work2011). Education’s Advanced Practice Behaviors for Military Social Work Practice (CSWE,What we do not know at this point is how 2010) or the forthcoming set of guidelineseffective are the various programs at for practice with families impacted byincreasing provider capacity, both in volume military service (A. Hassan, personaland in culturally-relevant, empirically- communication, January 5, 2011).supported military behavioral health training. Additional guidelines, pertaining toWhile recent activity in academia and in the specific areas of military behavioralservice delivery sector suggests that the call healthcare practice, might need to befor increased capacity has been heard, further developed.attention needs to be directed towards  Governmental entities at the national andunderstanding the impact, as well as the state levels could ensure that relevantquality, of the response. POLICY BRIEF | MARCH 2011 | CIR.USC.EDU 3
  4. 4. training is accessible to current  Federal entities might also consider behavioral healthcare professionals by working with state licensing boards to working with the key professional mandate military culture continuing associations, such as the American education courses for all behavioral Psychological Association (APA), the healthcare providers. Such efforts are not National Association of Social Workers uncommon when the relevant issues and (NASW) and the Association for the populations are important and far- Advancement of Marriage & Family reaching; for example, the state of CA Therapy (AAMFT), as well as with large mandates that all Licensed Clinical Social provider groups (e.g., Give an Hour, Workers have one time and/or recurrent Soldiers Project). Provision of funding continuing education in domestic support for workforce training, violence, law & ethics, and aging. particularly among volunteer providers, could serve to enhance training availability and accessibility. AUTHOR BACKGROUND SUGGESTED CITATIONJan A. Nissly, PhD is a Research Assistant Nissly, J.A., & Turner, K.L. (2010). EnsuringProfessor at the USC Center for Innovation Behavioral Healthcare Capacity and Qualityand Research on Veterans and Military for Servicemembers, Veterans and MilitaryFamilies (CIR). A former military social work Families. Los Angeles: USC Center forclinician, her current research examines the Innovation and Research on Veterans andeffectiveness of a specialized curriculum for Military Families (CIR).training military behavioral health providers. REFERENCESKelly L. Turner, PhD is a Senior ResearchAssociate at the USC Center for Innovation Adler School of Professional Psychology,and Research on Veterans and Military Doctor of Psychology in ClinicalFamilies. Psychology, Military Psychology Track: views expressed in this brief are those of hicago/doctor-of-psychology-in-clinical-the author and do not necessarily represent psychology-military-psychology-the views of the USC Center for Innovation track/overviewand Research on Veterans and Military Burnam, A., Meredith, L.S., Tanielian, T., &Families (CIR) or collaborating agencies and Jaycox, L.H. (2009). Mental health care forfunders. Iraq and Afghanistan war veterans. Health Affairs, 28(3), 771-782. FOR MORE INFORMATION Castaneda, L.W., Harrell, M. C., Varda, D. M., Phone: (213) 743-2050 Hall, K. C., Beckett, M. K., & Stern, S. Fax: (213) 743-2051 (2008). Deployment experiences of guard Email: and reserve families. Santa Monica, CA; Website: RAND Corporation. POLICY BRIEF | MARCH 2011 | CIR.USC.EDU 34
  5. 5. Chandra, A., Lara-Cinisomo, S., Jaycox, L. H., Veterans mental health act still not Tanielian, T., & burns, R. M. (2010). implemented. Children on the homefront: The Pittsburgh Tribune Review (2011, February experience of children from military 6). Program for departing service members families. Pediatrics, 125(1), 13- 22. plagued by inconsistencies, indifference.Council on Social Work Education. (2010). Schell, T. L., & Marshall, G. N. (2008). Survey Advance Practice Behaviors for Military of individuals previously deployed for Social Work Practice. Alexandria, VA: OEF/OIF. In Tanielian, T. & Jaycox, L.H., Author. eds. (2008). Invisible wounds of war:Department of Defense Task Force on Mental psychological and cognitive injuries, their Health (2007). An Achievable Vision: consequences, and services to assist Report of the Department of Defense Task recovery, 87-115. Force on Mental Health. Falls Church, VA: Schell, T. L., & Tanielian, T. (Eds.). (2011). A Author. Needs Assessment of New York StateErbes, C. R., Curry, K. T., & Leskela, J. (2009). Veterans: Final Report to the New York Treatment presentation and adherence of State Health Foundation. Santa Monica, Iraq/Afghanistan era veterans in CA: RAND Corporation. outpatient care for posttraumatic stress Stahl, S. M. (2009). Crisis in Army disorder. Psychological Services, 6(3), 175- Psychopharmacology and Mental Health 183. Care at Fort Hood. CNS Spectrum, 14(12),Fayetteville State University, Department of 677-684. Social Work. (2011). Army Fayetteville Tanielian, T. & Jaycox, L.H. (Eds.). (2008). MSW Program: Invisible wounds of war: psychological and cognitive injuries, their consequences, and sam.htm services to assist recovery. Santa Monica,Figley, C.R. (1998). Burnout in families: the CA: RAND Corporation. systematic cost of caring. Boca Raton, FL: Uniformed Services University of the Health Taylor and Francis. Sciences, Clinical Psychology Program,Flynn, M., & Hassan, A. (2010). Unique Military Psychology Track: challenges of war in Iraq and Afghanistan. Journal of Social Work Education, 46(2), ml 169-173. University of Southern California (USC)Hall, L. K. (2008). Counseling military families. School of Social Work, Military Social New York, NY; Taylor and Francis. Work and Veterans Services Subconcentration:Hassan, A. (2011, January 5). Personal communication. oncentrations.htmlNational Council for Community Behavioral Healthcare (2010, November 10). POLICY BRIEF | MARCH 2011 | CIR.USC.EDU 35