4 discussion posts (1 paragraph long with at least 4 complete sentences for each discussion post)

Module 1-Introduction to the Psychological Care of Veterans

Module 2-Military Culture vs. Civilian Culture

Module 3-Psychosocial Issues Faced by Veterans (not just PTSD!)

Module 4-Mental Health Treatments and Systems of Treatment (not just for mental health professionals)

AND

1 reflection post (4 paragraphs long with each paragraph having at least 3 complete sentences)

Psychological Care of Veterans (Seminar)

Brief Discussion Posts for each module (1, 2, 3, and 4)

Module 1 – Introduction to Psychological Care of Veterans (power point attached)

· In your opinion, what were the two (2) most interesting or engaging things from Module 1?

· Why were those things especially interesting or engaging to you?

Module 2 – Military Culture vs. Civilian Culture (power point attached)

· In your opinion, what were the two (2) most interesting or engaging things from Module 2?

· Why were those things especially interesting or engaging to you?

Module 3 – Psychosocial Issues Faced by Veterans (not just PTSD!) (power point attached)

· In your opinion, what were the two (2) most interesting or engaging things from Module 3?

· Why were those things especially interesting or engaging to you?

Module 4 – Mental Health Treatments and Systems of Treatment (not just for mental health professionals) (power point attached)

· In your opinion, what were the two (2) most interesting or engaging things from Module 4?

· Why were those things especially interesting or engaging to you?

Requirements:

Post your response in at least 1 paragraph long with at least 4 complete sentences as brief discussion post for each module (1, 2, 3, and 4)

Your writing must reflect proper spelling, grammar, and punctuation

All information that is obtained and discussed beyond the lecture and/or required or optional readings are appropriately cited and are only peer-reviewed scientific journal articles.

Optional Reading/Viewing Materials

References:

Video Links:

· Veterans Talk About the Military-Civilian Divide (2017):

· TED Talk: Sebastian Junger: Why veterans miss war:

· VA Family Caregivers:

· Primary Care-Mental Health Integration in the Department of Veteran Affairs By Dr. Pomerantz (SAMHSA):

https://www.youtube.com/watch?v=AGaaiHQHfmE

· Implementing Measurement Based Care in VA:

· Mental Health Checkup for Veterans and VA Providers: https://www.youtube.com/watch?v=z7fuskt-pNc

· Living by an Ethos | Nicholas Lavery | TEDx Chagrin Falls: https://www.youtube.com/watch?v=FE43AC4WmdY

· The Ranger Creed | Matthew De Graaf | TEDx Youth @ Hewitt: https://www.youtube.com/watch?v=10c2izd0xWE

· Everything I Know I Learned in Kindergarten (and SEAL Training) | Kevin Williams | TEDx Saint Thomas: 

· https://www.youtube.com/watch?v=TXh1r0vOX0I

· Coming home from Iraq:  A Local Marine’s Story: Chad Russell at TEDx Bend:  https://www.youtube.com/watch?v=dOUkYy380mo (Links to an external site.)

· PTSD and Returning to the Classroom | Thomas Burke Jr. | TEDx Yale: https://www.youtube.com/watch?v=XBGNJQWSYHY

· The moral injury of war: Eric Hodges at TEDx Virginia Tech: https://www.youtube.com/watch?v=f3B5m6OUXCA

· Overcoming Moral Injuries | Joshua Mantz | TEDx Santo Domingo: https://www.youtube.com/watch?v=ORBf73HiJns

· Operation PTSD: Veterans Healing Themselves Through Meditation | Erik Younger | TEDx Wilmington Women: https://www.youtube.com/watch?v=yA1O5gmP4eg

· TED: Wes Moore: How to talk to veterans about the war:

https://www.youtube.com/watch?v=5P04stEjJ9E (Links to an external site.)

Websites:

About VA: https://www.va.gov/about_va/

Common Challenges During Re-adjustment to Civilian Life (VA): 

https://www.va.gov/vetsinworkplace/docs/em_challengesreadjust.asp

)

Community Provider Toolkit-Understanding Military Culture (VA): 

https://www.mentalhealth.va.gov/communityproviders/military_culture.asp (Links to an external site.)

Culture (ASA): https://www.asanet.org/topics/culture)

Insomnia disorder common in post-9/11 Veterans (VA): https://www.research.va.gov/currents/1020-Insomnia-disorder-common-in-post-9-11-Veterans.cfm)

U.S. Department of Veterans Affairs: https://www.ruralhealth.va.gov/aboutus/structure.asp)

VA Research on Mental Health (VA): 

https://www.research.va.gov/topics/mental_health.cfm)

What is Allied Health? (ASAHP): 

https://www.asahp.org/what-is

Articles:

Resources and Capabilities of the Department of Veterans Affairs to Provide Timely and Accessible Care to veterans

https://www.rand.org/pubs/research_reports/RR1165z2.html

Providing Coordinated Care to Veterans of Iraq and Afghanistan Wars with Complex Psychological and Social Issues in a Department of Veterans Affairs Medical Center: Formation of Seamless Transition Committee

https://www.researchgate.net/publication/280257477_Providing_coordinated_care_to_veterans_of_Iraq_and_Afghanistan_wars_with_complex_psychological_and_social_issues_in_a_Department_of_Veterans_Affairs_Medical_Center_Formation_of_seamless_transition_com

Current and Projected Characteristics and Unique Health Care Needs of the Patient Population Served by the Department of Veterans Affairs

https://www.rand.org/pubs/research_reports/RR1165z1.html

The Behavioral Health of Minority Active Duty Service Members

https://www.rand.org/pubs/research_reports/RR4247.html

The Behavioral Health of Minority Active-Duty Service Members

https://www.apa.org/advocacy/military-veterans/mental-health-needs

EXPRESSION OF VALUES AND IDEALS BY SERVICE BRANCH

https://www.mentalhealth.va.gov/communityproviders/docs/values

Information Regarding Homelessness in Veteran Population:

Common Challenges During Re-adjustment to Civilian Life: https://www.va.gov/vetsinworkplace/docs/em_challengesreadjust.asp

Veterans Experiencing Homelessness:

https://www.va.gov/homeless/

FAQ ABOUT HOMELESS VETERANS:

http://nchv.org/index.php/news/media/background_and_statistics/

State of Homelessness: 2020 Edition:

https://endhomelessness.org/homelessness-in-america/homelessness-statistics/state-of-homelessness-2020/

Psychological Care of Veterans: Module 1

Introduction and Overview of Psychological Care of Veterans

1

Intended Audience & Purpose
Audience: students interested in learning about psychosocial issues faced by veterans and how those issues may be addressed by mental health professionals (or others, including friends, family members)
Purpose (STUWBATs)
Describe common psychosocial issues faced by veterans.
Explain why collaboration with professionals from other healthcare disciplines (e.g., physicians, nurses, etc.) can be crucial for successful mental healthcare of veterans.
Describe different psychosocial treatment approaches utilized to address mental health issues in veterans and evaluate the efficacy/effectiveness of those treatment approaches.
Describe future directions for increasing effective mental healthcare in veterans.

Disclaimers
This seminar is not intended to provide sufficient clinical training for students to deliver specific therapies (e.g., PE, CPT, CBT, etc.) in clinical settings and/or to individuals with the intention of treating a diagnosed mental disorder (this is consistent with the APA ethics code 2.01, in the area of “Competence”).
Students interested taking what they learned in this class and applying it to treat veterans/active duty military should obtain supervised clinical training under experienced clinicians who have (years of) experience working with veterans/active duty military.

3

Introductions: What about you?
Civilians
Do you have some assumptions (i.e., biases) about how individuals with a history of military service typically look like, act, etc.?
Do you know some people who have a history of military service?
Do you already have some idea about the kinds of mental health issues veterans may experience?
Do you already have some opinions about mental health treatments, such as CBT, ACT, DBT, etc.? What about trauma-related therapies, such as PE, CPT, EMDR?

Introductions: What about you?
Students with Military Experience
How would you describe the military culture (yes, this may be specific to the branch[es] you served under)?
How was the transition from military experience to civilian living?
How open have you been with others about having a military background?
What would you say are the biggest challenges involved in adjusting to civilian living?

5

Introduction-Who is the “Veteran?” (U.S.)
What do we mean by “veteran?”
Definition of a Veteran (Minnesota Department of Veterans Affairs): https://www.youtube.com/watch?v=HmR6N-ZB9_A
Great, but how would veterans describe themselves?
What Does Being a Veteran Mean to You? (PEO Soldier): https://www.youtube.com/watch?v=floZanYgCTk

Sounds Good…but I heard Veterans can face mental health issues?
Indeed, when we take a look at veteran mental health research, not all, but a significant number of veterans can be dealing with mental health issues (VA Office of Research & Development)
Mood disorders (depression and bipolar disorder)
Psychotic disorders (schizophrenia)
PTSD
Anxiety conditions
Substance use disorders
Co-occurring conditions (e.g., PTSD and substance use)
This does not mean that it is not possible that veterans may face other issues, like any mental health condition listed in the DSM-5.

I heard the “VA” is the place for Veterans to go to get their (mental health) care
Indeed, many, but not all, veterans received their mental health care at a VAMC (Eibner et al., 2016).
But, what is “the VA?”
“United States Department of Veterans Affairs”: Part of the Executive branch of our federal government.
Mission Statement: To fulfill President Lincoln’s promise “To care for him who shall have borne the battle, and for his widow, and his orphan” by serving and honoring the men and women who are America’s veterans.
Made up of several administrations: VBA (non-medical), VHA (medical/health), NCA (in-memoriam)
Given the topic of this seminar, we focus on the VHA, which includes providing mental healthcare.

What is it like to provide mental health service to veterans?
Let’s listen to one of my clinical supervisors-Dr. Ken Cogswell, located at the Mann-Grandstaff VAMC-talk about psychological care of veterans.

So, what approaches to mental healthcare are typically used?
Certainly, those designed and shown to work for addressing trauma-related (e.g., PTSD) conditions:
PE
CPT
EMDR
However, a host of other therapeutic approaches, as long as they are evidence-based (i.e., empirically supported), are used to treat the variety of other issues that may also present themselves in veterans: CBT, ACT, DBT, and others…

How might these mental health approaches be integrated into healthcare settings (VAMCs)
Behavioral health (i.e., psychological) services are typically offered via a specialty section/wing of a VAMC (i.e., “Behavioral Health”/”Mental Health”) or an integrated “PCMHI” service within its medical section.
Let’s take a look at a video showing the varied healthcare and supportive services offered in the same area (a VAMC) and what the setting may literally look like: Providence VA Medical Center: https://www.youtube.com/watch?v=NN-pd1FOJPA

Psychological Care of Veterans: Module 2

Military Culture vs. Civilian Culture

1

What do we mean by “culture?”
Emphasis on “shared” and “socialized/transmitted” values:
“Sociology understands culture as the languages, customs, beliefs, rules, arts, knowledge, and collective identities and memories developed by members of all social groups that make their social environments meaningful.” (ASA, 2021)
Consider: There can be a myriad of cultures and “sub-cultures,” including those embedded in any of the military service branches and across any group in the U.S. (or elsewhere, of course).

Beginning to understand “Military Culture,” from the top-down
There are five “branches” of our U.S. military
Army
Navy
Air Force
Marine Corps
Coast Guard
What about the National Guard?
Made up of reserves of Army and Air Force
To examine overarching socialization of its members, let’s examine the mission, motto, and core values of each branch.

Army
Mission: To fight and win our Nation’s wars by providing prompt, sustained land dominance across the full range of military operations and spectrum of conflict in support of combatant commanders.
Motto: This We’ll Defend 
Core Values
Loyalty
Duty
Respect
Selfless Service
Honor
Integrity
Personal Courage

Navy
Mission: To maintain, train and equip combat-ready Naval forces capable of winning wars, deterring aggression and maintaining freedom of the seas.
Motto: Semper Fortis, “Always Courageous” 
Core Values:
Honor
Courage
Commitment

Air Force
Mission: Fly, fight and win … in air, space, and cyberspace.
Motto: Aim High…Fly-Fight-Win 
Core Values
Integrity First
Service Before Self
Excellence in All We Do

Marine Corps
Mission
The seizure or defense of advanced naval bases and other land operations to support naval campaigns. 
The development of tactics, techniques, and equipment used by amphibious landing forces. 
Such other duties as the President may direct.
Motto: Semper Fidelis, “Always Faithful”
Core Values
Honor
Courage
Commitment

Coast Guard
Mission: To protect important interests of the United States – the personal safety and security of our population; the marine transportation system and critical infrastructure; our natural and economic resources; and the territorial integrity of our nation – from both internal and external threats, natural and man-made. To protect these interests in U.S. ports and inland waterways, along the coasts, on international waters, and in any other maritime region where they may be at risk. The Coast Guard has three broad roles: maritime safety, maritime security, and maritime stewardship. 
Motto: Semper Paratus, “Always Ready”
Core Values
Honor
Respect
Devotion to Duty

So, if we were to pull some common themes…(VA, Community Provider Toolkit)
The overarching values of military culture set aside personal needs in favor of: teamwork, selflessness, shared goals, and perhaps most central, being of service to others – measuring one’s worth by how well one serves others selflessly. Each Servicemember takes an oath promising to remain faithful to and defend the social order of the United States of America, as embodied in the constitution.
Even after separation from the military service, military ideals and values often continue to be deeply held by Veterans.
Deeply-rooted practices and values, including hierarchical authority structures and being “mission-oriented” (e.g., backward planning, teamwork and shared goals), may be challenged by civilian/local community values and practices that go against these (e.g., serving self before serving the “team,” lacking structure, etc.).

What might Veterans/Active Duty Military Service Members say?
TRIGGER WARNING: video(s) may contain descriptions and images of combat, including, but not limited to, IEDs, gun fire, bodily injuries of self (presenter) or fellow service members
Living by an Ethos | Nicholas Lavery | TEDxChagrinFalls: https://www.youtube.com/watch?v=FE43AC4WmdY
Everything I Know I Learned in Kindergarten (and SEAL Training) | Kevin Williams | TEDxSaintThomas: https://www.youtube.com/watch?v=TXh1r0vOX0I
The Ranger Creed | Matthew DeGraaf | TEDxYouth@Hewitt: https://www.youtube.com/watch?v=10c2izd0xWE

Sounds like Military Service Members are set up to do quite well, actually?
Yes and no…
The difficulty posed with “re-entry” into civilian living may be explained by comparing the scenario to individuals who must acculturate from a culture of origin into a new “host culture.”
The pros: Learning certain valuable skills, structure, teamwork, and commitment in high stress circumstances.
The cons: Attempting to translate gained knowledge or acting from a value system that are not valued or shared by organizations, individuals, or other entities.

What might Veterans/Active Duty Military Service Members say?
TRIGGER WARNING: video(s) may contain descriptions and images of combat, including, but not limited to, IEDs, gun fire, bodily injuries of self (presenter) or fellow service members
Veterans Talk About the Military-Civilian Divide (2017): https://www.youtube.com/watch?v=nJUKxmsqpz8
TED Talk: Sebastian Junger: Why veterans miss war: https://www.youtube.com/watch?v=TGZMSmcuiXM
VA Family Caregivers: https://www.youtube.com/watch?v=XRmAwZHYRFE

Interested in learning about military culture and how to talk with veterans?
There are so many resources…
TED: Wes Moore: How to talk to veterans about the war: https://www.youtube.com/watch?v=5P04stEjJ9E
Community Provider Toolkit (VA): https://www.mentalhealth.va.gov/communityproviders/military_culture.asp
Military Culture Training
Speaking the Language
Military Ethos: Guiding Ideals and Core Values
Ret. Lt. Col. Dave Grossman: Book On Combat: The Psychology and Physiology of Deadly Conflict in War and in Peace and “Bulletproof Mind” presentation: https://www.youtube.com/watch?v=8RDCtMEHFLM
Researching via a good search engine…

Psychological Care of Veterans: Module 3

Psychosocial Issues Faced by Veterans

1

First, let’s be (somewhat) clear on some terms…
Psychological, behavioral, psychosocial, social, etc.
Psychological (broadest definition): refers more specifically to individual, internal psychological processes (e.g., thoughts and physiological feeling states) that may impact individual behavior.
In other words, how individuals think, feel, and behave.
Behavioral: interventions or conditions focused on the behavioral results of psychological conditions (NOTE: This does not ignore the fact that cognitions and emotions and social environment have parts to play! It is an emphasis that makes sense when we see the huge support and focus of building empirically-supported evidence.)

First, let’s be clear on some terms…
Psychological, behavioral, psychosocial, social, etc.
Social: of or pertaining to interpersonal interactions, groups, or cultures (that may impact thoughts, feelings, and behaviors of individuals).
Psychosocial: of or pertaining to interpersonal interactions, groups, or cultures and how they might impact thoughts, feelings, and behaviors of individuals (and vice versa).
May also be used to describe a collection of constructs that pertain to the “psychological” definition and the “social” definition, just combined.

What has the research found?
As you may have guessed, veterans, like any other human, could be diagnosed with any mental health condition. However, mental health conditions (yes, including PTSD) may occur more frequently in this population.

What has the research found?
Over and above what is found in the general population in the U.S., the following have been identified more frequently in those with a history of serving in the U.S. military:
Mental health conditions (general)
PTSD
Cancer
Diabetes
COPD
GERD
Hearing loss

Other mental health conditions commonly reported by veterans
Sleep (i.e., insomnia in more than half of post-9/11 veterans)
Personality disorders (with co-occurring PTSD, 45% – 79%, depending on outpatient/inpatient setting)
And those we covered earlier…
Mood disorders (depression and bipolar disorder)
Psychotic disorders (schizophrenia)
Anxiety conditions
Substance use disorders
Co-occurring conditions (e.g., PTSD and substance use)

What about underrepresented/minority populations? (Wong et al., 2021)
ethnoracial minority compared to white
Non-Hispanic black: less SI, problem drinking, cigarette/smokeless tobacco use (similar trends also found for Hispanic and non-Hispanic-Asian groups)
However, for non-Hispanic black and non-Hispanic Asian groups: more suicide attempts
female compared to male
Female: greater suicide behaviors (unclear if ethnoracial/sexual orientation differences accounted for this) and probable depression
Male: greater substance use (e.g., alcohol and tobacco products)
lesbian/gay/bisexual (most burden of disparities) compared to heterosexual
Gay/lesbian: greater SI, substance use (alcohol/tobacco products)
Bisexual: greater probable GAD, depression, PTSD, substance use issues
Sociocultural/environmental stressors may have accounted for many of these

How might veterans describe the mental health issues they experience?
TRIGGER WARNING: video(s) may contain descriptions and images of combat, including, but not limited to, IEDs, gun fire, bodily injuries of self (presenter) or fellow service members.
Overcoming Moral Injuries | Joshua Mantz | TEDxSantoDomingo: https://www.youtube.com/watch?v=ORBf73HiJns
Operation PTSD: Veterans Healing Themselves Through Meditation | Erik Younger | TEDxWilmingtonWomen: https://www.youtube.com/watch?v=yA1O5gmP4eg
PTSD and Returning to the Classroom | Thomas Burke Jr. | TEDxYale: https://www.youtube.com/watch?v=XBGNJQWSYHY

Psychological Care of Veterans: Module 4

Mental Health Treatment Approaches and Systems to provide psychological care to veterans

1

Unsurprisingly, with a myriad of co-occurring health issues…
…Approaches that promote better health in veterans will often involve coordinated efforts from multiple professionals.
Medical professionals (physicians, nurses, etc.)
Mental health professionals (e.g., psychologists)
Allied health professionals (occupational therapists, physical therapists, etc.)
The over-arching theme: taking a “biopsychosocial” approach to promoting health and wellbeing

consider the Biopsychosocial Model…
In short, it is a model that is well-utilized and is a simple way to think about how biological (“bio”), psychological (“psycho”), and social (“social”) factors can impact health and behavior.

3

Health/Behaviors

Biological factors
(e.g., genes)

Social factors
(e.g., social support)

Psychological factors
(e.g., benefit-finding)

Several systems have been guided by the implications of this model…
Generally-speaking, we are talking about “integrative care” settings (APA).
Several models exist and have been empirically supported and widely utilized (e.g., VA and its “PCMHI”/Behavioral Health wing hybrid model)
Collaborative Care Model
PCBH
PCMH
The bottom line: with some differences in how mental health is utilized across a clinic/hospital setting, mental health professionals are somehow integrated into delivering overall healthcare.

Let’s take a look at how integrated care systems might work
“Team Structure” (Used with permission from the University of Washington AIMS Center, 1/22/2021)
Primary Care-Mental Health Integration in the Department of Veteran Affairs By Dr. Pomerantz (SAMHSA): https://www.youtube.com/watch?v=AGaaiHQHfmE
Implementing Measurement Based Care in VA: https://www.youtube.com/watch?v=UTwIYZo-Ows

What about the therapies?
Indeed, while use of therapies used outside the VHA (i.e., from providers outside the VHA) may be more varied and not as well-documented, evidence-based/empirically-supported therapies, such as those listed below, tend to be used to treat veterans’ mental health needs:
Trauma-focused therapies: PE, CPT, EMDR (this varies, given the uncertainty for how EMDR seems to work for some and does not seem to work for others)
The “family” of CBTs: BT, CT, CBT, ACT, DBT
And certainly more, as some clinicians may be more well-versed in some empirically-supported treatments (e.g., IPT, PST, SST) AND empirical evidence is always accumulating…

General Concepts about the theory underlying these therapies: Trauma-focused
Classical and Operant Conditioning -> the “danger” of the reinforcement of avoidance

General Concepts about the theory underlying these therapies: CBTs
Thoughts, Feelings, Behaviors (and all the theories underlying each of these three…)

However, being too focused on the therapeutic technique is a pitfall
A ”common factor” across therapies that forms the foundation for any therapy to work…the therapeutic alliance, which has also been called…
working alliance
shared/felt bond
(mutual) trust
Without a therapeutic alliance in place, therapies are less likely to work.
Given the differences in “Culture” that we covered earlier, hopefully you can see how this may take several sessions just to establish a shared bond (quick anecdote when talking with a sniper).

Interested in learning about military culture and how to talk with veterans?
There are so many resources…
TED: Wes Moore: How to talk to veterans about the war: https://www.youtube.com/watch?v=5P04stEjJ9E
Community Provider Toolkit (VA): https://www.mentalhealth.va.gov/communityproviders/military_culture.asp
Military Culture Training
Speaking the Language
Military Ethos: Guiding Ideals and Core Values
Ret. Lt. Col. Dave Grossman: Book On Combat: The Psychology and Physiology of Deadly Conflict in War and in Peace and “Bulletproof Mind” presentation: https://www.youtube.com/watch?v=8RDCtMEHFLM
Researching via a good search engine…

Psychological Care of Veterans (Seminar)

Reflection

Post your response in at least 4 paragraphs with at least 3 sentences in each paragraph.

Requirements:

Post your response in at least 4 paragraphs long with each paragraph having at least 3 complete sentences

Your writing must reflect proper spelling, grammar, and punctuation

All information that is obtained and discussed beyond the lecture and/or required or optional readings are appropriately cited and are only peer-reviewed scientific journal articles.

Prompt: Reflection on Your Experience during the Psychological Care of Veterans Seminar

Please address each of the following bullet points in your 4 paragraphs (please follow the requirements “For full credit” above when completing this prompt):

· If you were talking with a friend, how would you describe the psychological issues that veterans may face? Please use what was discussed in the seminar.

· What was the most difficult part of this seminar? This may include the exercises or discussions you found most challenging to engage in. In addition, please indicate why was it the most difficult part? Despite this difficulty, would you still consider the difficult information to be valuable?

· What was the most engaging/interesting part of this seminar? In addition, please comment on why was it the most engaging/interesting part?

· In your opinion, what are at least three of the most important points that were made during this seminar?