1. © Warriors at Ease 2011 Credentialing Yoga & Meditation Teachers for Military and Veteran Populations Robin Carnes, MBA, E-RYT 500 Karen Soltes, LCSW, E-RYT 200 SYTAR 2011 Robin Carnes, MBA, E-RYT 500 Karen Soltes, LCSW, E-RYT 200 SYTAR 2011

2. © Warriors at Ease 2011 The Scope of Need  4.5 million Gulf War vets (1990-present)  7.6 million Vietnam era vets  2.3 million WW II era vets  2.7 million Korean War era vets  5.6 million vets from eras with no military conflicts The veteran community includes veterans from previous wars as well as Iraq & Afghanistan  4.5 million Gulf War vets (1990-present)  7.6 million Vietnam era vets  2.3 million WW II era vets  2.7 million Korean War era vets  5.6 million vets from eras with no military conflicts The veteran community includes veterans from previous wars as well as Iraq & Afghanistan

3. © Warriors at Ease 2011 The Scope of Need  Since 9/11, 1.8 million troops deployed in Iraq & Afghanistan  Approx 45,000 non-mortal woundings  6,219 deaths  Since 9/11, 1.8 million troops deployed in Iraq & Afghanistan  Approx 45,000 non-mortal woundings  6,219 deaths

4. © Warriors at Ease 2011 The Scope of Need  Approximately 19% return with PTSD and/or TBI  Approximately 300,000 with major depression &/or PTSD  Approximately 320,000 with brain injuries  Approximately 19% return with PTSD and/or TBI  Approximately 300,000 with major depression &/or PTSD  Approximately 320,000 with brain injuries

5. © Warriors at Ease 2011 The Scope of Need  For each person deployed, approx. 8-10 family members are affected  800,000 of deployed are parents  Implications for impact on health care systems and health care workers  For each person deployed, approx. 8-10 family members are affected  800,000 of deployed are parents  Implications for impact on health care systems and health care workers

6. © Warriors at Ease 2011 A Sea Change is Underway in Military Healthcare Need for cost-effective, non- stigmatizing care grows exponentially Need for cost-effective, non- stigmatizing care grows exponentially Scientific evidence mounts Scientific evidence mounts As yoga goes mainstream, active duty & vets practice grows As yoga goes mainstream, active duty & vets practice grows Top-down policy mandates Top-down policy mandates Need for cost-effective, non- stigmatizing care grows exponentially Need for cost-effective, non- stigmatizing care grows exponentially Scientific evidence mounts Scientific evidence mounts As yoga goes mainstream, active duty & vets practice grows As yoga goes mainstream, active duty & vets practice grows Top-down policy mandates Top-down policy mandates

7. © Warriors at Ease 2011 The Military ’ s Interest in Yoga/Meditation  Total Force Fitness (new paradigm adopted 2011)  Defense Center of Excellence report Mind-Body Skills for Regulating the Autonomic Nervous System  Yoga as a First Tier intervention for Chronic Pain by Pain Management Task Force  Medical Home Model of Treatment  Integrative Medicine Programs Expand  VA Office of Patient-Centered Care & Cultural Transformation  More Mind-Body Therapies Research is Funded  Total Force Fitness (new paradigm adopted 2011)  Defense Center of Excellence report Mind-Body Skills for Regulating the Autonomic Nervous System  Yoga as a First Tier intervention for Chronic Pain by Pain Management Task Force  Medical Home Model of Treatment  Integrative Medicine Programs Expand  VA Office of Patient-Centered Care & Cultural Transformation  More Mind-Body Therapies Research is Funded

8. © Warriors at Ease 2011 Karen’s Experience  Since 2007, Washington DC VA-War Related Illness and Injury Study Center (WRIISC)/Integrative Health Program  3 iRest® yoga nidra classes/weekly at WRIISC -predominantly Vietnam Veterans with PTSD, insomnia, chronic pain, anxiety, depression -predominantly Vietnam Veterans with PTSD, insomnia, chronic pain, anxiety, depression  One weekly iRest® yoga nidra class in Substance Abuse Recovery Program of Washington DC VA  Ongoing 60-90 min classes; Vets attending for up to 3 years; CD distributed for self-practice  Since 2007, Washington DC VA-War Related Illness and Injury Study Center (WRIISC)/Integrative Health Program  3 iRest® yoga nidra classes/weekly at WRIISC -predominantly Vietnam Veterans with PTSD, insomnia, chronic pain, anxiety, depression -predominantly Vietnam Veterans with PTSD, insomnia, chronic pain, anxiety, depression  One weekly iRest® yoga nidra class in Substance Abuse Recovery Program of Washington DC VA  Ongoing 60-90 min classes; Vets attending for up to 3 years; CD distributed for self-practice

9. © Warriors at Ease 2011 Karen’s Experience  Instructor for research study on iRest ® Yoga Nidra ’ s impact on Chronic Pain in Veterans with TBI beginning Fall 2011

10. © Warriors at Ease 2011 Robin’s Experience lnstructor for first yoga research done in US military Yoga as an Adjunctive Therapy for Post Traumatic Stress Disorder, 2006 Yoga as an Adjunctive Therapy for Post Traumatic Stress Disorder, 2006 COL Charles C. Engel, Jr., MD, MPH (WRAMC DHCC) Christine Goertz Choate, DC, PhD (Samueli Institute) Samueli Institute Research Team Damara C. Cockfield, MPA (Study Coordinator) Joan A.G. Walter, JD, PA-C (Collaborating Personnel) Matthew Fritts, MPH (Collaborating Personnel) WRAMC DHCC Research Team David W. Armstrong, PhD, FACSM (Associate Investigator) Kristie Gore, PhD (Associate Investigator) Michael Freed, PhD (Interviewer) Dr. Thomas Roesel (Medical Monitor) Consultants Rachel Greene (Yoga Nidra Instructor) Robin Carnes, MBA, RYT (Yoga Nidra Instructor) Richard Miller, PhD (Yoga Nidra Consultant) lnstructor for first yoga research done in US military Yoga as an Adjunctive Therapy for Post Traumatic Stress Disorder, 2006 Yoga as an Adjunctive Therapy for Post Traumatic Stress Disorder, 2006 COL Charles C. Engel, Jr., MD, MPH (WRAMC DHCC) Christine Goertz Choate, DC, PhD (Samueli Institute) Samueli Institute Research Team Damara C. Cockfield, MPA (Study Coordinator) Joan A.G. Walter, JD, PA-C (Collaborating Personnel) Matthew Fritts, MPH (Collaborating Personnel) WRAMC DHCC Research Team David W. Armstrong, PhD, FACSM (Associate Investigator) Kristie Gore, PhD (Associate Investigator) Michael Freed, PhD (Interviewer) Dr. Thomas Roesel (Medical Monitor) Consultants Rachel Greene (Yoga Nidra Instructor) Robin Carnes, MBA, RYT (Yoga Nidra Instructor) Richard Miller, PhD (Yoga Nidra Consultant)

11. © Warriors at Ease 2011 Robin’s Experience  2006-present, Yoga & iRest ® yoga nidra meditation instructor for acute PTSD treatment program and Medically Unexplained Physical Symptoms (MUPS)  Integrative Medicine Program serving all services at Walter Reed Army Medical Center  8 outpatients, 3 weeks, daily meditation, 2x weekly yoga (asana & pranayama)  +Week-long education/self-care programs for family members and spouses of those with PTSD  2006-present, Yoga & iRest ® yoga nidra meditation instructor for acute PTSD treatment program and Medically Unexplained Physical Symptoms (MUPS)  Integrative Medicine Program serving all services at Walter Reed Army Medical Center  8 outpatients, 3 weeks, daily meditation, 2x weekly yoga (asana & pranayama)  +Week-long education/self-care programs for family members and spouses of those with PTSD

12. © Warriors at Ease 2011 Unique Challenges/Issues Teaching in Military Settings  Socio-Cultural Barriers  Need for Trauma-Sensitive Approach to Yoga and Meditation Instruction  "Trigger-rich" environment for Instructor requires boundaries & support  How to Integrate Yoga/Meditation into Existing Treatment/Programs  Socio-Cultural Barriers  Need for Trauma-Sensitive Approach to Yoga and Meditation Instruction  "Trigger-rich" environment for Instructor requires boundaries & support  How to Integrate Yoga/Meditation into Existing Treatment/Programs

13. © Warriors at Ease 2011 Core Competencies for Teachers Working with Military Familiarity with Military Culture and Values Familiarity with Military Culture and Values Cultural Sensitivity Skills Cultural Sensitivity Skills

14. © Warriors at Ease 2011 Core Competencies for Teachers Working with Military Basic understanding of the psycho- neurobiological mechanisms and symptoms of common combat stress conditions and secondary trauma Basic understanding of the psycho- neurobiological mechanisms and symptoms of common combat stress conditions and secondary trauma

15. © Warriors at Ease 2011 Core Competencies for Teachers Working with Military Basic understanding of most common war-related physical conditions and injuries Basic understanding of most common war-related physical conditions and injuries

16. © Warriors at Ease 2011 Core Competencies for Teachers Working with Military Skilled responses to emotional abreactions Skilled responses to emotional abreactions

17. © Warriors at Ease 2011 Core Competencies for Teachers Working with Military Ability to assess student's psychological and physical condition in order to offer appropriate asana, pranayama and meditation practices. Ability to assess student's psychological and physical condition in order to offer appropriate asana, pranayama and meditation practices.

18. © Warriors at Ease 2011 Core Competencies for Teachers Working with Military Ability to create and maintain a safe learning environment Ability to create and maintain a safe learning environment

19. © Warriors at Ease 2011 Core Competencies for Teachers Working with Military Ability to set up and maintain healthy boundaries Ability to set up and maintain healthy boundaries

20. © Warriors at Ease 2011 Core Competencies for Teachers Working with Military Know and work within the scope of your practice Know and work within the scope of your practice

21. © Warriors at Ease 2011 Core Competencies for Teachers Working with Military (cont.) Ability to set up and use a professional support network Ability to set up and use a professional support network

22. © Warriors at Ease 2011 Yoga/Meditation Teachers: Pioneering Healthcare Professionals: Positives  Field is wide open – not yet defined  Lots of autonomy  Rich with opportunity to make a difference  Room for creativity, diversity, innovation and new collaboration

23. © Warriors at Ease 2011 Yoga/Meditation Teachers: Pioneering Healthcare Professionals: Negatives  Yoga is under great scrutiny, even skepticism  One significant incident would thwart overall progress  Competition could hinder overall progress  Lack of regulation makes job definitions, hiring criteria and compensation problematic and inconsistent

24. © Warriors at Ease 2011 Current Status of Credentialing Efforts  Wide open field  VA Hospitals are currently decentralized; VACO gathering information to implement system-wide policy  Beginnings of centralized efforts in DOD ex. Pain Task Force planning to hire yoga teachers; developing position descriptions ex. Pain Task Force planning to hire yoga teachers; developing position descriptions

25. © Warriors at Ease 2011 Yoga Community Needs to Be Proactive  Agreed upon standards of practice  Agreed upon core competencies for working with this population  Training School accreditation  Formalized oversight and supervision  Advocate and work for quality research

26. © Warriors at Ease 2011 Training Resources Warriors at Ease (online & residential training & certification) www.warriorsatease.com www.warriorsatease.comwww.warriorsatease.com Robin Carnes rcarnes@warriorsatease.com Karen Soltes ksoltes@warriorsatease.com

27. © Warriors at Ease 2011 Training Resources  Veterans Yoga Project www.veteransyogaproject.org www.veteransyogaproject.org  Yoga Warriors www.yogawarriors.com www.yogawarriors.com

28. © Warriors at Ease 2011 Yoga for the Military Organizations  There and Back Again www.thereandback-again.org www.thereandback-again.orgwww.thereandback-again.org  Exalted Warrior Foundation www.exaltedwarriorfoundation.org www.exaltedwarriorfoundation.orgwww.exaltedwarriorfoundation.org  Yoga for Vets www.yogaforvets.org www.yogaforvets.orgwww.yogaforvets.org

29. © Warriors at Ease 2011 Resources  Defense Centers of Excellence www.dcoe.gov www.dcoe.govwww.dcoe.gov Mind-Body Skills for Regulating the Autonomic Nervous System Mind-Body Skills for Regulating the Autonomic Nervous System  JAMA-Interventions for War-Related Posttraumatic Stress Disorder (August 2011) Posttraumatic Stress Disorder (August 2011)  VA Office of Patient-Centered Care and Cultural Transformation