Utah Ahead conference DiXIE State College, May 9, 2009

1. Wounded Warriors: Issues, Context, Accommodation Utah Ahead conference DiXIE State College, May 9, 2009 Edward A. Martinelli, Jr., Ph.D., Utah Valley University

2. Impacts and Prevalence Intake Issues Qualification Issues Accommodation Issues Local Issues Outline

3. Impacts and Prevalence

4. Since October 2001 • Approx. 1.64 million troops have deployed as part of Operation Enduring Freedom (OEF; Afghanistan) and Operation Iraqi Freedom (OIF; Iraq). • As compared to past deployments • Higher proportion deployed • Deployments have been longer • Breaks between deployments have been infrequent • Redeployment to combat has been more common Scope of those involved

5. Nevertheless--- • Operations have employed smaller forces • Casualty rates (killed or wounded) are lower • Technology has led to more surviving…. • But “invisible wounds” are beginning to emerge Scope of those involved

6. RAND Study focused on 3 major conditions: • Post-Traumatic Stress Disorder (PTSD) • Major Depressive Disorder and associated symptoms, and • Traumatic Brain Injury (TBI) • All three affect mood, thoughts, and behavior • 1,965 servicemembers were surveyed • 24 Geographic Areas Three Major Impacts

7. Mental Health Issue Rates in the Past 30 Days • 14% screened positive for PTSD • 14% screened positive for Depression • 19% reported a probable TBI • Depression is not considered a combat-related injury, but it is highly associated with combat exposure • Not possible to know the severity of TBI issues Key Findings

8. About 1/3 of those previously deployed have at least one of these three conditions About 5% report symptoms of all three Some groups (Reserve Components and those who’ve left the service) may be at higher risk Prevalence (cont)

9. Of those reporting a probable TBI • 57% had not been evaluated by a physician • Rates for TX of Depression or PTSD • Comparable to general population (53%) Treatment

10. Like most issues, we can expect these issues to emerge in three or four major ways • Intake • Eligibility Determination • Accommodation Provision • Specific Institutional Issues INTERsection With Disability SErvices

11. Intake Issues

12. Label stigma Self-Identity Knowledge of services and location Differences between VA and School services Self-Identification

13. Qualification Issues

14. Invisible disabilities more difficult for us to quantify • TBI issues may present much later • Dynamic nature of some diagnoses • May be situational • Course content related • Time of year related Substantially limited

15. Individual may not have much experience with academic setting • Their experience so far may be simply with non-academic tasks • Memorization, short/long term memory, etc. • Documentation may be atypical • Military looks at disability sometimes from a compensation not a limitation standpoint

16. In summary, functional impacts may be hard to identify • Relationship important to returning for additional help • Adjustments may be needed mid-term

17. Accommodation Issues

18. What are you doing with other psychiatric issues? Watch for anniversaries, holidays, etc. Depression

19. Anxiety Issues Issues around sights, smells, locations, context Testing issues Classroom environment Interactions with others More often than not the individual simply wants to remove themselves from the situation PTSD

20. Not surprising to see • Memory issues • Concentration issues • Comparison to past performance • Old versus new learning and skills • May be emotional issues • Impulse control • Mood swings TBI

21. Local Issues

22. What have been your experiences?