Working With Veterans and Their Families: A Community Program Overview

1. Working With Veterans and Their Families: A Community Program Overview Paula G. Panzer, MD Director Center for Trauma Program Innovation Jewish Board of Family and Children’s Services New York, NY October 21, 2010 JBFCS - October 2010

2. Acknowledgements • Home Again Project Coordinator: Adriana Rodriguez, LCSW • Project Team • CUNY Office of Veterans Affairs: Wilfred Cotto, Director • Project Assistant: Rebecca Wynn • Veteran Peer Advocates: Reneel Langdon; August Coleman; Danessa Duverce • New York State Psychiatric Institute/Columbia University Trauma and PTSD Program: Yuval Neria, PhD, Director; Maren Westphal, PhD, Research Project Manager • Jewish Board of Family and Children’s Services Center for Trauma Program Innovation is a National Child Traumatic Stress Network Member JBFCS - October 2010

3. Acknowledgements Funding Home Again: Veterans and Families Initiative – NYS Health Foundation; Charles & Mildred Schnurmacher Fund Home Again: Reaching Out – McCormick Foundation and Major League Baseball “Welcome Back Veterans” JBFCS Staff training to prepare for community practice: van Ameringen Foundation JBFCS - October 2010

4. Veterans’ Access to Care • Is the issue access to care or use of care? • Think about • Care settings • Linkages • Relevance • Reimbursement • Flexibility • What do you have in your community? JBFCS - October 2010

5. Veterans’ Families - Access to Care • Families are broadly defined yet their adjustment and mental health needs can be specifically related to military exposure and cultural context • Family members can be a point of entry for care of Veterans • Access to targeted care is limited • Their needs may be individual AND family based JBFCS - October 2010

6. Problem Statement, Part I • Home Again and other programs face the same problem: the challenge of engaging veterans and their families in mental health care. • Hypothesis: Primary obstacle is stigma and fear of being perceived as weak, unable to move forward with life if mental health help is sought (and used). JBFCS - October 2010

7. Problem Statement, Part II • Other issues: • Veterans are distrustful and fear repercussions if they ask for help. • Those still in the National Guard and Reserve or in civilian law enforcement fear jeopardizing promotion or their leaders’ confidence. • Long deployments, family obligations and financial needs make veterans want to reintegrate quickly, without psychological self-care or reflection, feeding the avoidance that is symptomatic of PTSD. • Families with currently deployed service members have difficulty engaging in treatment due to added responsibility and stress at home. JBFCS - October 2010

8. Problem Statement, Part III • Home Again and other Veterans programs urgently need new outreach messages, methods, and approaches. • Home Again: Reaching Out • New communications strategy using Veterans to reach Veterans • Training Peer Advocates to bridge the gap between school and mental health service for those in need JBFCS - October 2010

9. Intervention Model • Provide an ongoing peer advocate outreach program to encourage and assist veterans in engaging in services and moving toward successful outcomes • Develop new ways of identifying veterans and their psychological challenges despite social stigma • Provide Access to families for support and services without obligation for Veteran family member use of service • Develop a city-wide psycho-educational campaign using media which reaches Veterans and their families • Prepare MH Serving Community for sub-specialty service • Partner, Partner, Partner JBFCS - October 2010

10. Home Again: Reaching Out — Start Up • Veteran Serving Linkages • Mental Health Serving Linkages • Training Plan • Outreach Work • Time Line • Fundraising alongside Case Finding JBFCS - October 2010

11. Lessons Learned from Veterans • Sources of information • Advisory Board • Focus Groups • Semi-structured interviews • Feedback at tabling events JBFCS - October 2010

12. Lessons Learned from Veterans • Relevance • Timing • Connection to Peers • Risk • Connection to Work, Family • Stigma • Hope • Prior Assumptions • Housing • Substance Use • Cognition & Learning • Military Understanding JBFCS - October 2010

13. Lessons Learned from Veterans • Some examples from “What Therapists Should Know” handout: • Therapists should know what type of threats veterans face while deployed in a combat zone (for example: improvised explosive devices, vehicle-based explosive devices, suicide bombers, and rocket-propelled grenades). • Therapists should understand that being in a combat zone is different than being at a duty station. JBFCS - October 2010

14. Lessons Learned from Veterans • Some examples from “What Therapists Should Know” handout: • Therapists should understand that there is a lot of sexual harassment in the military for both men and women. • Therapists should understand that veterans are used to a structured environment. JBFCS - October 2010

15. Lessons Learned from Veteran Serving Systems • It is critical to have a veteran: • Provide encouragement to a veteran to access services • Vouch for the program’s quality of services. • Programs need to be established for several years before receiving a steady stream of referrals. • Linkages with VA are important AND competition and role remain issues. JBFCS - October 2010

16. Prepare MH Serving Community • Military Cultural Competence • Engagement • Targeted Treatments • Access to Linkages for cases which can’t be served • Address funding issues JBFCS - October 2010

17. Interventions Capacity to provide evidence informed interventions • Assessment (include suicidality and family violence risk evaluation) • Brief individual and family interventions • Targeted treatment for PTSD, traumatic depression, substance use, TBI, etc. • Cognitive Processing Therapy for PTSD in Veterans & Military Personnel JBFCS - October 2010

18. Useful Web Sites • National Center for PTSD • http://www.ptsd.va.gov • Military Cultural Competence • http://www.ptsd.va.gov/professional/ptsd101/flash-files/Military_Culture/player.html • http://deploymentpsych.org/ • Cognitive Processing Therapy (CPT) • http://cpt.musc.edu • http://www.essentiallearning.net/Student/content/sections/Lectora/CognitiveProcessingTherapyforPTSDinVeteransandMilitaryPersonnel/index.html • NCTSN Military Families Knowledge Bank • http://mfkb.nctsn.org • NYS Health Foundation: Returning Veterans & Families Resource Center • http://www.nyshealthfoundation.org/section/resources/veterans_resources JBFCS - October 2010

19. Contacts Paula G. Panzer, MD ppanzer@jbfcs.org Home Again: Veterans and Families Initiative (646) 957-0853 www.homeagainveterans.org http://homeagainveterans.blogspot.com/ JBFCS - October 2010