Developed by: Richard Ayala MSW, NCAC, CADC II, ACRPS, SAP. C.E.O./Founder Bound To Change Counseling & Consulting. Briefly Identify the progression and impacts of The Warrior Culture Briefly Identify the major symptoms of PTSD and MST Briefly Identify evidence based clinical strategies for trauma informed care Soldiers are not as other men.. They are those of a world apart a very ancient world which exists in parallel with the everyday world but does not belong to it.. The distance can never be closed for the Culture of The Warrior can never be that of civilization itself. A History of Warfare, John Keegan Email: richardayala494@hotmail.com Phone: (209) 489 1012 1
A system of shared beliefs, values, customs, behaviors, and artifacts that members of society use to cope with their worlds and one another. Culture is passed down from generation to generation through various forms of learning. Fratkin Bates, Cultural Anthropology, 2002. General military knowledge: it s branches of service, rules/regulations, language, acronyms and processes An understanding of: military culture and core values across all branches of service An understanding of: the VA system (it s processes, services, benefits, and eligibility requirements) Knowledge of: how the military culture impacts a veteran s world view Ongoing information gathering: regarding the experiences of military service members The Warrior Culture Email: richardayala494@hotmail.com Phone: (209) 489 1012 2
Email: richardayala494@hotmail.com Phone: (209) 489 1012 3
INDUCTION INDOCTRINATION WARRIOR S CONDITIONING WARRIOR S EDUCATION Email: richardayala494@hotmail.com Phone: (209) 489 1012 4
1. Loyalty 2. Duty 3. Respect 4. Selfless Service 5. Honor 6. Integrity 7. Personal Courage Motto: Called to Duty; Boots on Ground 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. Always respect and obey the chain of command Stoicism (emotional control in the face of the unnatural and overwhelming) Accomplish the mission! You don t have to like it, you just have to do it! Embrace the suck! Son, if the military wanted you to have a wife, we would have issued you one! COLLECTIVE COHESION (DEVELOPING A UNIT) THE CULMINATION Email: richardayala494@hotmail.com Phone: (209) 489 1012 5
According to U.S. Department of Veterans Affairs: Currently female veterans are officially serving in combat related roles The number of female veterans will grow from 1.8 million (8.2% of all veterans) in 2016 to 2.7 million (15.2%) by 2036 Email: richardayala494@hotmail.com Phone: (209) 489 1012 6
PRE PATROL BRIEFING IN THEATER PATROL TRAUMATIC AND STRESSFUL EVENTS INTENSE PHYSICAL AND PSYCHOLOGICAL STRESS REACTIONS Email: richardayala494@hotmail.com Phone: (209) 489 1012 7
REQUIRED VIGILANCE HYPERVIGILANCE GRIEF & LOSS GUILT & SHAME EMOTIONAL ANESTHESIA & PSYCHIC NUMBING War is about combat, combat is about fighting, fighting is about killing, and killing is a traumatic personal experience. A warrior must be able to psychologically and emotionally distance themselves from the environment, the killing, and the civilian world to survive and win. COL. Timothy ( BT ) Hanifen, USMC Email: richardayala494@hotmail.com Phone: (209) 489 1012 8
APPRAISAL ADJUSTMENT THESE ARE UN WARRIOR LIKE RESPONSES IN THE FACE OF UNUSUAL HUMAN EXPERIENCE Email: richardayala494@hotmail.com Phone: (209) 489 1012 9
IMMEDIATE FAMILY FAMILIES OF ORIGIN FAMILY LIFE WORK AND RECREATION Email: richardayala494@hotmail.com Phone: (209) 489 1012 10
21% of men and women in the military report prescription drug misuse (x2 civilian age group 18 64) Prescription drug abuse among active duty women was 13% (4x that of civilian women) 12% reported using illegal drugs. 26% of veterans met the criteria for a substance use disorder. Source: 2017 Department of Defense Survey of Health Related Behaviors Among Active Duty Military Personnel FAMILY DISCORD DRUG & ALCOHOL USE ARREST/ LEGAL IMPACTS OCCUPATIONAL IMPACTS Email: richardayala494@hotmail.com Phone: (209) 489 1012 11
Read more: http://www.oprah.com/oprahshow/homeless Female Veterans#ixzz1aamprAHY A Warriors Peril 8/14/2018 The June 2017 unemployment rate among returning veterans is 21% compared to the national rate of 4.3% The national unemployment rate for veterans is 21%, here in California the rate is 28% In 2017 91,000 veterans were homeless on any given night. 186,000 veterans spent at least one night in a shelter last year. Of female veterans, 10,910 are sleeping in cars, shelters, or on the streets every night. Source: 1 Federal Times, December 20, 2017 2 Iraq and Afghanistan Veterans of America (iava.org) and Bureau of Labor Statistics (bls.gov/news.release/empsit.nro.htm) 3 San Gabriel Valley Tribune, November 13, 2017 4 Women s Bureau, U.S. Department of Labor 35 THERAPY AND CASE MANAGEMENT GROUP PROCESS AND PSYCHO EDUCATION Email: richardayala494@hotmail.com Phone: (209) 489 1012 12
PTSD is a mental condition classified among the trauma and stressor related disorders. Characterized by physiological and behavioral symptoms following exposure to, or awareness of extreme traumatic or stressful events involving actual or threatened death, serious injury, or other threat to one s physical integrity. Diagnostic & Statistical Manual of Mental Disorders, 5th Edition PTSD has four clusters of symptoms: Intrusion (dissociative reactions, nightmares, upsetting thoughts and memories, etc.) Avoidance (trauma related thoughts and feelings, trauma related external reminders.) Negative alterations in cognition and mood (dissociative amnesia, negative beliefs about self/world, constricted affect, feeling alienated from others etc.) Alterations in arousal and reactivity (hypervigilance, sleep disturbance, exaggerated startle response, anger outbursts, aggression, etc.) Diagnostic & Statistical Manual of Mental Disorders, 5th Edition Physical assault of a sexual nature, battery of a sexual nature, or sexual harassment repeated, unsolicited verbal or physical contact of a sexual nature which is threatening in character occurring while the veteran was serving on active duty or active duty for training. (Title 38, US Code 1720D) Email: richardayala494@hotmail.com Phone: (209) 489 1012 13
Obsessive thinking about how it should have been (incident specific) Nightmares (threatening in nature) Self blame and/or elevated level of responsibility Fixation on controlling environment and symptoms Lack of trust in self and others Victim paradigm Trauma informed systems view trauma as: A defining and organizing experience that forms the core of an individual s identity. Source: Harris, M. and Fallot, R.D. (Eds), 2001 Housing & Transportation Child Care Financial Core Treatment Intake Assessment Treatment Plans Medical Prevention Based Group/Individual Counseling,Therapy Pharmacotherapy Self Help Groups (VA/AA/NA/DRA) Mental Health Urine Monitoring Case Management Continuing Care Vocational Educational Family AIDS / HIV Risks Legal Etheridge, Hubbard, Anderson, Craddock, & Flynn, 1997 (PAB) Email: richardayala494@hotmail.com Phone: (209) 489 1012 14
Cognitive Behavioral Therapy (CBT) Trauma Focused Cognitive Processing Therapy (TF CPT) Prolonged Exposure Therapy (PE) EMDR (Eye Movement Desensitization and Reprocessing) Pharmacological Therapies (SSRIs) Individual and Group Therapy Family Therapy Brief Psychodynamic Psychotherapy Source: National Center for PTSD, PTSD a guide for clinicians 1) Safety: physical and emotional safety 2) Trustworthiness: make tasks clear, and maintain appropriate boundaries 3) Choice: prioritize consumer choice and control 4) Collaboration: maximize collaboration and the sharing of power with consumers 5) Empowerment: prioritize empowerment through skill building and self efficacy Richard Ayala MSW, NCAC II, CADC II, ACRPS, SAP. C.E.O. / Founder Bound to Change Counseling & Consulting Email: richardayala494@hotmail.com Phone: 209 489 1012 Fax: 209 710 0252 Note: when contacting me through email, please reference this workshop in the subject box of your correspondence. Email: richardayala494@hotmail.com Phone: (209) 489 1012 15