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3rd Deployment Mental Health Symposium
Interactive Workshops on Treatment
Approaches for Warriors and Their Families
Thursday and Friday, May 6-7, 2010
EDUCATIONAL OBJECTIVES
Thursday, May 6, 2010 Workshop Session As more and more severely wounded return from the wars in Iraq and Afghanistan, the challenges of caring for them and their families has become increasingly complex and demanding on the existing health care systems within the Department of Defense (DoD), the Veterans Administration Health Care System and civilian practices. Since the beginning of these wars, over 1.8 million service men and women have been deployed, and over 35,000 have been severely wounded, suffering battlefield injuries that in previous wars and conflicts would have most likely been fatal. Injuries from IED's (Imbedded/Individual Explosive Devices) and roadside bombs are causing complex pain issues compounded by multiple mental health concerns. Derek McGinnis, a Navy Corpsman severely injured in Fallujah, Iraq in 2004 shares his journey of debilitating pain, despair, depression and ultimately hope and recovery, along with his personal success as a competitive Tri-athlete and Para-Olympic hopeful, as he navigated the DoD and VA health care systems, with the support of his family and community. Brenda Murdough MSN, RN-BC will add to the discussion with information, resources and tools to assist in the management of the very complex and chronic pain producing physical wounds of combat, and the often invisible or unseen accompanying mental health concerns that affect today's Veterans.
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Thursday, May 6, 2010 Workshop Session A Insomnia is defined as difficulties falling and /or staying asleep, early morning awakenings, and /or complaints of non-restorative sleep despite adequate opportunity for sleep. Insomnia is one of the most common reasons for referral to mental health services in active duty personnel, a frequent complaint among returning veterans. Several epidemiological and clinical studies have shown that insomnia is an important risk factor of poor mental and physical health outcomes such as depression, anxiety disorders, alcohol abuse, and increased somatic complaints and medical comorbidities. Behavioral techniques that are effective to treat insomnia can be implemented in non-specialized primary and community care settings. The goal of this workshop is to provide an in-depth introduction the evaluation and treatment of insomnia complaints using effective brief assessments and behavioral techniques aimed that can be implemented in all types of care settings where military personnel and veterans seek help. Learning Outcomes:
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Workshop Session B Behavioral couples therapy (BCT) is an evidence-based approach for treating people with substance abuse problems together with their spouses or domestic partners. BCT explicitly focuses on both substance use and relationship issues, and is readily compatible with 12-step approaches. In BCT a substance abusing patient and spouse work together each day to support abstinence and improve their relationship. BCT promotes abstinence with a "recovery contract" that involves both members of the couple in a daily trust discussion ritual to reward abstinence. BCT improves the relationship with techniques for increasing positive activities and improving communication. Using didactic material, video clips and case examples, this presentation will teach participants how to introduce BCT; implement a recovery contract to support abstinence; work with clients to increase positive activities, improve communication, and reduce relapse risks; and deal with special treatment challenges. This presentation is based on O’Farrell and Fals-Stewart’s (2006) book on Behavioral Couples Therapy for Alcoholism and Drug Abuse. Learning Outcomes:
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Workshop Session C The majority of deaths in the United States (U.S.) Armed Forces are sudden and traumatic in nature as well as involve the death of a young adult. When a military service member dies, the typical demographic profile of military surviving families often includes a young adult widow, young children, young adult siblings and adult parents (who may often be young adults themselves). Developmentally, family survivors of young adult loss have little, if any, life experience with death, especially traumatic death and limited repertories of coping. Survivors affected by the death of a young adult also have a limited age-related peer group who have had a common experience and can offer support in their grief. Learning Outcomes:
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Friday, May 7, 2010 Workshop Session A The focus will be on up-to-date conceptualizations of traumatic loss and the emerging literature on posttraumatic growth. Clinical examples will be given throughout. The workshop will cover old and new conceptions of traumatic loss and bereavement, especially in relation to combat experience; philosophical conceptual and empirical foundations of posttraumatic growth; a growth oriented clinical stance of Expert Companionship, an integrative therapy with cognitive, constructivist, and narrative elements. Learning Outcomes:
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Workshop Session B The deployment cycle can be stressful to military families and children are not exempt from these stressors. Each phase of the deployment cycle presents unique challenges for children of all ages. Their reactions are impacted by age and deployment phase. Understanding these will help professionals and families provide effective support and strategies to children, increasing their abilities to cope. Strategies for enhancing resilience in military children as they face the deployment cycle and other life challenges will also be discussed. Working with children as they cope with the deployment cycle can take a toll on professionals. Ideas for self-care will be provided. Learning Outcomes:
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Workshop Session C Since entering the wars in Afghanistan (2001) and Iraq (2003), the U.S. Department of Defense (D.O.D.) reported that suicides in the U.S. Army among soldiers in 2008 rose for the fourth year in a row, reaching the highest level in nearly three decades. The U.S. Marine Corps has also begun to bare the second largest proportional rise in suicide deaths over the past few years. As the wars in Iraq and Afghanistan continue, the general public is becoming increasingly interested in the health and well being of military families. The effects of war are not limited to physical injuries, war can leave both psychological and emotional wounds and some that never heal. Even as a peacetime nation, the military has experienced death of service members by suicide at a rate similar to that of the national average and falling into a similar high-risk demographic profile. When a loved one, friend, family member or co-worker dies as a result of a sudden, traumatic death, the immediate trauma and ensuing chaos may leave survivors vulnerable to a more prolonged and complicated grief process. There are many faces to suicide, but more commonly suicide is experienced as a sudden, traumatic death loss, co-victimizing survivors in it’s aftermath. For each person who loses their life to suicide, conservative estimates are that 6-10 persons close to the deceased are affected. As most in the community of suicide loss survivors know, suicide has an even greater, deeper and more devastating rippling effect on the individual, family, community and greater society at large. The bereavement process for suicide loss survivors presents with unique traumatic, psychological, grief and spiritual challenges leaving survivors at higher risk for a more complicated grief process, psychological distress and at higher risk for suicide. This session will address working with military suicide loss survivors, the growing need for employing conventional, complementary and alternative strategies specific to working with this population, the use of postvention work as survivors as prevention work, as well as resources for support. Learning Outcomes:
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Friday, May 7, 2010 Workshop Session A This program will discuss areas of controversy in the assessment and treatment of the returning military/veteran OIF/OEF population in terms of TBI and its common comorbidities (e.g., PTSD, depression, physical injuries, and pain). Controversial areas discussed will include: screening for TBI, diagnosis of TBI and/or postconcussion syndrome, baseline computerized neurocognitive assessment, concerns regarding valid self-report and test performances, patterns of overlapping symptoms across conditions and causative contributions, patient and system attributional biases, and treatment considerations. Learning Outcomes:
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Workshop Session B Both didactic and experiential in nature, this workshop is designed for clinicians working with returning service members and their families. The didactic section will cover topics such as:
The experiential portion of the workshop will feature: Guidelines for developing specific interventions to address reintegration concerns, while promoting resilience through increased coping skills, in the dyadic/couple realm. The following topics will be covered:
Participants will be divided into working groups and asked to develop an intervention for a specific clinical case (vignette). Each group will be assigned a type of intervention, such as couples therapy, group, individual, or workshop model that will need to be created. At the end of the allotted time, the groups will present their model of care to the larger group. Learning Outcomes:
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Workshop Session C This workshop will provide participants with an overview of the new proposed DSM-V diagnosis of Complicated Grief and some of the development research surrounding it. We will focus on the post-deployment needs of Iraq/Afghanistan veterans and the complicating factors surrounding issues of grief and loss, including trauma exposure/PTSD, physical injury/disability and guilt, and possible moral injury. We will attempt to review the latest research concerning treatments for grief and how these intersect with other empirically-supported treatments for PTSD and other comorbid issues. Finally, we will look at the issues of resilience and their intersection with grief issues among veterans. This will be a participatory workshop with large and small group discussions and activities. Learning Outcomes:
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