BCCO PCT #4 PowerPoint

1. TRAUMA AFFECTED VETERAN (24-hrs) TCOLE Course # 4067 AND DAY TWO George D. Little Deputy Chief, TRAINING PCT#4 Bexar County BCCO PCT #4 PowerPoint BCCO PCT #4 PowerPoint

2. Learning Objectives DAY TWO 2.0 Introduction 2.1 LEO/Veteran Encounters 2.1.1 The student will discuss common types of offenses that may be committed by trauma affected veterans. 2.2 Depression/Suicide 2.2.1 The student will compare the risk of suicide for a veteran vs. the general population. 2.2.2 Students will list questions used to assess a suicide risk  2.2.3 The student will identify what gives Texas peace officers the authority to detain someone for the purpose of mental health well-being. 2.3 De-Escalation 2.3.1 The student will identify steps to take to de-escalate an encounter with a trauma affected veteran. 2.4 Active Listening Skills 2.4.1 The student will name the acronym for Active Listening Skills through the discussion of active listening skill techniques.  2.5 Empathy 2.5.1 The student will define Empathy. Video: https://www.youtube.com/watch?v=cDDWvj_q-o8 2.5.2 The student will list triggers that may negatively affect a call. 2.6 Case Studies 2.6.1 The student will discuss a case study. (Refer to Handout #2 for case studies)

3. DAY TWO Recap of Day 1DAY ONEREVIEW

4. What is a trauma affected Veteran?Types of Traumatic Exposures?What are the challenges for people with TBI?What are the symptoms of PTSD?How are families affected by deployment?How are Veterans and Officers similar?

5. A Trauma Affected Veteran : • Is very well trained • Is intimately skilled in tactical movement beyond the scope of typical police operations • May be hyper-vigilant • Is strongly in tune with non-verbal communication

6. A Trauma Affected Veteran Cont’d : • May react aggressively to crowding (fear-based response to perceived threat) • Understands escalation of force procedures • Can be very easily de-escalated if the situation is handled properly

7. Types of Traumatic Exposures • Moral injuries • Acts that go against the way we were raised or against our belief systems (e.g. killing children) • Physical injury • Witnessing/experiencing combat situation, etc.

8. Types of Traumatic Exposures Cont’d • Military sexual trauma • ~40% personal trauma (e.g. rape) • ~85% incl. sexual harassment, witnessing or experiencing

9. Relationship of TBI and Law Enforcement • TBI symptoms often result in increased verbal and physical altercations • Veteran may have difficulty remaining focused • TBI symptoms may appear to be resistance to authority

10. Relationship of TBI and Law Enforcement – Cont’d • Inappropriate or impulsive behavior/aggression or abusive language is common • Veteran may not remember, or respond well to, instructions or questions

11. Relationship of TBI and Law Enforcement • Law enforcement personnel may mistake individuals with brain injury for individuals under the influence of alcohol or other substance, especially in conjunction with traffic stops.

12. Relationship of TBI and Law Enforcement – Cont’d • Symptoms of TBI may create a difficult environment to interview parties involved; which law enforcement may perceive as dishonest or confrontational.

13. Similarities between PTSD & TBI TBI PTSD Flashbacks Headache Suicide Nightmares Impulsive behavior Depression Unwanted thoughts May appear intoxicated Anger/Irritability Avoidance of triggers Impaired judgment Sleep problems Hypervigilance Ringing in ears Social isolation Easily startled Easily triggered by sights, sounds, smells Slurred speech Poor attention/ Concentration Dizziness Anxiety Hearing loss

14. How Do Moral Injuries Relate to a Diagnosis of PTSD?

15. Service Member Stress Affects Families The service member may have developed behavioral health issues or received traumatic brain injuries from their work. Because of the issues going on, they may have a substance abuse problem– their reintegration difficulties are now transferred to the family.

16. Different and Similar Combat Veteran Trained to ensure protection/safety of others. Trained to ensure safety of self with force when needed. Faces traumatic stress daily in the course of duty.

17. Different and Similar – Cont’d Combat Veteran • May experience symptoms of traumatic stress and hesitant to report to chain of command. • Trained in use of physical force to receive desired response. • Trained in the use of weapons to ensure safety of self/others.

18. Different and Similar – Cont’d Combat Veteran • Traumatic and life threatening encounters happen in foreign battlefields.

19. Different and Similar – Cont’d Law Enforcement Officer • Trained to ensure protection/safety of others. • Trained to ensure safety of self with force when needed. • Faces traumatic stress daily in the course of duty.

20. Different and Similar – Cont’d Law Enforcement Officer • May experience symptoms of traumatic stress and hesitant to report to chain of command. • Trained in use of physical force to receive desired response. • Trained in the use of weapons to ensure safety of self/others.

21. Different and Similar – Cont’d Law Enforcement Officer • Traumatic and life threatening encounters happen at home community.

22. QUESTIONS

23. LEO/Veteran Encounters

24. Common types of offenses related to combat trauma

25. LEO/VETERAN ENCOUNTERS Has anyone had any prior experiences with veterans? What are the offenses the LEOs have been called out to? What types of situations did they encounter? Did the offense they were called out to escalate into other offenses charges?

26. Ted Talk Veteran convicted

27. Possible Encounters: • Self __________ • Driving while ______________ • Public intoxication • ________ crimes • Homelessness • ________ charges • Criminal ________ • Domestic violence • _______________ • Self-harm • Traffic/_________ Driving

28. LEO/VETERAN ENCOUNTERS May be a result of PTSD, TBI, or MST. Does the audience agree with these factors? Do they see these factors routinely in their dealings with Veterans? Are there other factors that may not be addressed here?

29. Aggressive driving could include the following: • ______________, • sudden ________ changes, • failure to _________ over, • driving down the _______ of road, • avoidance of _________ on side of road, • swerving under bridges, driving over curbs, etc.

30. LEO/VETERAN ENCOUNTERS • In traffic jam, may panic or feel “________________” if stuck in traffic, causing erratic driving responses.

31. A look at Travis County Source: Veterans Intervention Project, July 2009

32. A look at Travis County • This data comes from a report from the Veterans Intervention Project which studied the types of charges filed against veterans booked into the Travis County Jail in Austin, TX. • Are these the same types of offenses encountered by other LEOs across the state?

33. A look at Travis County • Of note, and indirect relation to a familiarity to a culture of violence, it is no small fact that there is a strong representation of ‘violent’ acts on this report.

34. National Veteran Incarceration Mental Health Indicators Among Male Inmates, By Veteran And Combat Status (2011 – 2012) TOLD BY A MENTAL HEALTH PROFESSIONAL THEY HAD AMENTAL DISORDER No INDICATOR OF MENTAL HEALTH PROBLEM PAST 30-DAY SERIOUS PSYCHOLOGICAL DISTRESS POPULATION Prison Inmates Non-Veterans Veterans With Combat Experience 36.0% 59.5% Without Combat Experience Jail Inmates Non-Veterans Veterans 67.2% 27.1% With Combat Experience Without Combat Experience

35. National Veteran Incarceration • A very large number of combat veterans self-report having a history of veteran _____________. • Do you think these incarcerated veterans have received appropriate _______________? • Do you think they will receive that _______________ in prison/jail?

36. Depression/Suicide

37. Suicide • ___ Percent of US deaths from suicide are veterans • Veterans are ________ likely than the general population to use firearms as a means for suicide • ________________ suicide rates in veterans aged 18-29 who use VA healthcare services

38. Suicide – Cont’d • _____ percent of recent veteran suicides have a history of previous attempts • Everyday in the US, there are ____ suicides completed

39. *See Hand out

40. The rate of suicide was ______________ for veterans within 3 years after leaving service. The graph shows the breakdown for both deployed veterans and non-deployed. Suicide rate is __________ for veterans that did NOT deploy. Are you surprised by this?

41. Any reasons why you think this may be? Notice that between 6-9 years that the deployed veteran is at higher risk than the non-deployed veteran.

43. The Interpersonal Theory of Suicide • Repeated exposure to _________, pain, and death—and access to / familiarity with means is important • Studies of suicide by occupational group indicate that people in the following groups are more likely to choose these methods: Military / Protection: firearms Construction: hanging

44. How PTSD could relate to Joiner’s suicide theory Sleep Problems Irritability Relationship Distance Perceived Burdensomeness

45. How PTSD could relate to Joiner’s suicide theory – Cont’d Avoidance Symptoms Social Isolation Thwarted Belongingness

46. How PTSD could relate to Joiner’s suicide theory – Cont’d Repeated Exposure to Trauma, Death, Firearms Habituation to Injury, Death Reduced Fear of Death

47. Responding to a Situation Involving Potential Mental Health Concerns • TCOLE Mental Health Officer course is highly recommended. . • Responding __________ should at least have received Crisis Intervention Training and Advanced Crisis Intervention Training.

48. Responding to a Situation Involving Potential Mental Health Concerns – Cont’d • Nationally, officers are being expected to use ____ _______ and more de-escalation tactics on all calls • Treat the call like a ____________ concern or emotionally disturbed person (EDP) • Utilize de-escalation and active ______________ skills

49. Responding to a Situation Involving Potential Mental Health Concerns Know your department policies and SOPs; if you suspect that the subject has mental health concerns or the person is in crisis, call a MHO or CIT officer to the scene to assist immediately.

50. CLASS DISCUSSION Explain the process you follow when trying to identify if a person is displaying suicidal behavior.