1. Issues Facing Combat Veterans

2. Agenda Virginia Wounded Warrior Program (VWWP) Population Description – Paradox of Coming Home – Traumatic Brain Injury – Post Traumatic Stress Disorder Suggestions for Working with Combat Veterans Resources

3. Virginia Wounded Warrior Program The Virginia Wounded Warrior Program (VWWP), in cooperation with the Department of Behavioral Health and Developmental Services and the Department for Aging and Rehabilitative Services, monitors and coordinates behavioral health and rehabilitative services and support through an integrated, comprehensive and responsive system of public and private partnerships. VWWP facilitates these services for Virginia veterans, members of the Virginia National Guard and Armed Forces Reserves (not in active federal service), and their families affected by stress related conditions or traumatic brain injuries resulting from military service.

4. Our Military Population Approx. 1.5 million Active Duty Service Members More than half of these are 25 yrs. old or younger More than half are married and/or have children 100,000 are single parents 888,000 National Guard and Reserve Members One third are 25 yrs. old or younger 60% are married and/or have children 28% are single parents 30,000 are dual military couples

5. Our Veteran Population 21.9 million veterans in the US 1.5 million are females 9 million are 65 years or older 28% of all Americans who die each year are veterans (each month 73,000 WWII, Korea and Vietnam Veterans die) 823,348 veterans reside in Virginia

6. Current Conflicts 30,852 U.S. service members wounded in hostile action since the beginning of U.S. military operations in OIF and over 6,300 service members have been killed in Iraq and Afghanistan Approximately 2.3 million service members have deployed in OIF/OEF/OND since 9/11/2001 Approximately 600,000 National Guard and Reservists have deployed since the beginning of U.S. military operations in Iraq

7. Everyone is changed by war

8. The Paradox of Coming Home Combat Zone Responses helped the soldier remain alert, safe and ready Challenge is to modify these responses for the transition back to civilian life

9. The process of moving from this….

10. To This:

11. Common Transition/Adjustment Responses Feeling irritable or jumpy Becoming easily annoyed or frustrated Feeling numb Feeling disconnected from friends and family Experiencing sadness or guilt

12. Common and Normal Transition Responses Sleeping too much or too little Being uncomfortable with physical or emotional intimacy Having intrusive thoughts, flashbacks, or nightmares Having trouble concentrating or remembering

13. Traumatic Brain Injuries 28% of all OIF/OEF Troops have been exposed to blasts Signature wound of these conflicts Most common- Closed- caused by changes in pressure that cause concussions and contusions. May not exhibit physical wound and therefore go unrecognized Many overlapping symptoms between TBI and PTSD: FATIGUE IRRITABILITY INSOMNIA COGNITIVE DEFICITS MEMORY PROBLEMS ANGER FRUSTRATION DEPRESSION

14. PTSD Symptoms Criteria Stressor Criterion Re-experiencing: flashbacks, night-mares, distressing recollections Avoidance: anything reminding one of the past, detachment, loss of interest Arousal: hyper-vigilance, startle response, concentration problems, sleep problems, anger

15. Common Coping Strategies for Veterans with Combat Stress, TBI, and PTSD Alcohol abuse Weapons as security Isolation Yelling, anger, outbursts Motorcycles/Cars—speed Overspending Suicide – approx 6,500 Veterans / year

16. Throwing the Lifeline: Strategies for Helping Link veteran with other combat veterans *support and networking groups *VWWP, WWP, VFW, AL Help veteran think about setting new career goals (perhaps based on MOS) Help veteran connect to appropriate resources

17. Suggestions for Working with Combat Veterans If needed reassure the veteran/service member that they are home (particularly helpful in crisis settings) Show respect and appreciation for their military service Do not share your personal views on war or politics Connect the veteran/service member with other veterans-help them develop a peer support network

18. Suggestions (cont) Avoid use of labeling (“you must have PTSD”) Do not say you understand what they have experienced unless you have experienced combat yourself Involve the veterans primary support system Long term- recognize importance in discussing grief and survivors guilt and the impact of experiences on the veteran’s spirituality and belief system Refer to other professionals as appropriate

19. Resources Virginia Wounded Warrior Program: www.wearevirginiaveterans.orgwww.wearevirginiaveterans.org Center for Deployment Psychology : www.deploymentpsych.orgwww.deploymentpsych.org National Center for PTSD : www.ptsd.va.govwww.ptsd.va.gov Defense and Veterans Brain Injury Center: www.DVBIC.orgwww.DVBIC.org National Resource Directory for Wounded Warriors, Veterans and Service Members : www.nationalresourcedirectory.orgwww.nationalresourcedirectory.org