Healing Our HeroesA Holistic Perspective on Ending Veteran

Homelessness

Presented by:Christopher Monceaux, MBS, MS, PLPC, CCTP

Shauna Russell, M.S., PLPC, CCTP, CIT

OutlineI. IntroductionII. Mental HealthIII. Substance Use DisordersIV. Medical IssuesV. Legal BarriersVI. Vocational RehabilitationVII. FinancesVIII. HousingIX. Conclusion X. Resources

Introduction

• Basic Tenets of Military Culture:• “Duty, Honor, Country”

• Subcultures within the military• Branch, Unit, Platoon, MOS (Military Occupational

Specialty)• The “Average” Soldier • Unique Challenges faced by veterans• Importance of assuming a holistic perspective on

treatment

Mental Health: Trauma

• Post Traumatic Stress Disorder (PTSD)• Combat Related• Childhood Trauma

• Military Sexual Trauma (MST)• Occurs among male and

female military members• Self-medicating Prevalent• Treatment Options

Mental Health: Other Concerns

• Veterans diagnosed with depression account for slightly more than 14 percent of the total

• Current Suicide Rate among veterans: About 22 per day• PTSD, Depression, and TBI has higher prevalence in OEF/OIF

veterans • Personality Disorders: • Often go undiagnosed• Present unique treatment challenges

Estimated Number of Veteran Suicides per day by Year

(according to a 2012 study by the Department of Veterans Affairs)

Interventions

• For trauma and other mental health diagnoses:• Cognitive Processing Therapy (CPT)• Prolonged Exposure Therapy (PET)• Virtual Reality Prolonged Exposure Therapy

• Acceptance and Commitment Therapy (ACT)• Mood Gym

• Mental Health Applications• PTSD Coach• Mindfulness Coach

Interventions (Ctd)

• Eye Movement Desensitization & Reprocessing (EMDR)• Adaptive Information Processing Model• 8-phase standard protocol• Adapted protocols for several mental health disorders

• Dialectical Behavior Therapy• Dialectics & Validation• Skills Training• Interpersonal effectiveness, emotion regulation, mindfulness, &

distress tolerance• Integrative Approach

Substance Use Disorders

• Between 2004 and 2006, 7.1% of U.S. veterans met the criteria for a substance use disorder.

• Older generation vs. Younger Generation• Increased abuse of prescription drugs• Legality of marijuana; potential treatment implications?• Research is conflicting• May explain higher usage among younger vets

SUDs Interventions

• Counseling & Psychotherapy• Cognitive Behavior Therapy, DeTUR, Motivational

Interviewing, Harm Reduction, Relapse Prevention• Community Support• AA/NA Meetings & Sponsor• SMART Recovery• Celebrate Recovery• Rational Recovery

• Seeking Safety (Co-Occurring PTSD and Substance Use Disorders)

Medical Issues: TBI

• Traumatic Brain Injury (TBI) defined as “an alteration in brain function, or other evidence of brain pathology, caused by an external force.”

• A TBI may be classified as focal or diffuse; open or closed; and mild, moderate, or severe. (Penetrating is a different classification)

• Traumatic brain injury has become known as a “signature wound” of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF)

• TBI can significantly affect diagnosis and treatment

TBI and Treatment

• Diagnostic Difficulties• Effects similar to the symptoms of many mental health

diagnoses• Treatment implications• Slower• Difficulty remembering appointments and completing tasks

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRw&url=http://blogs.extension.org/militaryfamilies/tag/tbi/&ei=Qdw3VYbwAezfsAT7roGgCA&bvm=bv.91071109,d.eXY&psig=AFQjCNExEgaN4v5d09UwHpicv4hzJ8I1rQ&ust=1429810594008918

Medical Issues: Other Concerns

• Chronic Pain • Prevalence & Impacts• Relation to SUDs• Traditional Pain Management• Alternative Pain Management

Strategies• Other Service Connected Injuries• Tinnitus• Agent Orange Exposure• Camp Lejeune Water Exposure

Medical Issues: Other Concerns

• Diet & Exercise• MOVE Program• Yoga and other low-impact activity

• Sexually Transmitted Diseases• HIV & Hepatitis C

• Other chronic health complications

Legal Barriers

• Felonies (stigma, employment barrier, housing barrier)• Drug Charges (Drug Court, treatment as alternative to jail

time)• Child Support (numerous financial implications)• License restrictions (no transportation = employment

barrier; consequence of child support and other legal issues)

Legal Barriers

• Diversion Programs: Problem Solving Courts (VOA Veterans Court, Drug Court)

• Expungement• Advocacy within the legal

system

Vocational Rehabilitation

• Reintegration into civilian workforce• VBA Vocational Rehabilitation & Education Programs

(Chapters 31, 36, 18, & 35)• VHA Compensated Work Therapy Programs• Incentive Therapy (IT)• Compensated Work Therapy (CWT)• Supported Employment Program (SE)

• Community Partners• Goodwill• LRS• Employer-agency connections

Other Income Sources

• VA Service-Connected Benefits• VA Non-Service Connected Pension• SSDI/SSI Benefits• SOAR application

• Non-cash Benefits

Maslow’s Hierarchy of Needs

Housing

• VA is committed to ending Veteran homelessness by the end of 2015

• Housing First/ Rapid Rehousing

• Prioritization using the SPDAT

Housing

• Various Programs:• Safe Haven- low impact, low barrier• GPD- more structure, transitional• SSVF- short-term assistance• HUD VASH- long-term intensive case management

• Theory vs. Practice• Non-availability to rural veterans• Importance of supportive services throughout re-entry

into permanent housing

Practice Scenarios

Conclusion

• Implications for treatment

• Coordination of services for best outcome

• Importance of assuming a holistic perspective

Additional Resources

• Links for additional information• SAMHSA:• http://www.samhsa.gov/veterans-military-families• Military OneSource• http://www.militaryonesource.mil /

• Seeking Safety• http://www.treatment-innovations.org/seeking-safety.html

• Virtual Reality Exposure Therapy:• http://ict.usc.edu/prototypes/pts/

• Department of Veterans Affairs: • http://www.ptsd.va.gov/• http://www.va.gov/opa/docs/suicide-data-report-2012-final.pdf• http://www.va.gov/homeless/about_the_initiative.asp

Resources Continued

• Volunteers of America• http://www.voanorthla.org/

• Legal Resources:• http://grantome.com/grant/NIH/I01-RX000484-02• http://usich.gov/population/veterans/veterans_homelessness

_in_focus/breaking_down_legal_barriers_to_housing/

• http://www.nationalhomeless.org/factsheets/veterans.html