1. Home from the War: Where can I get the help I need? Home from the War: Where can I get the help I need? Beth Wick, Manager of 2-1-1 Texas I&R Network Mary Cooksey, Director of 2-1-1 West Central Texas

2. Goal To provide scope of the problem for the individual, families, and societal impacts of OIF/OEF. To provide information on how one I&R decided to be part of the solution.

3. OIF/OEF Operation Iraq Freedom Operation Enduring Freedom

4. No one comes home from war unchanged. Iraq and Afghanistan Veterans

5. Scope of Issue ~1.5 Million Soldiers have served 449,000 deployed > 1 tour 20% Female Soldiers As of January 23, 2006, DoD reports 505,366 OIF/OEF Veterans eligible for VA services » 43% separated Active Duty troops » 57% Reserve/National Guard members

6. What We Know About OIF/ OEF Veterans 19% OIF, and 11% OEF have mental health problems 17% of OIF Soldiers and Marines screened positive for PTSD, generalized anxiety, or depression 35% OIF veterans accessed MH services in first year Hoge, Journal of American Medical Association, 2006

7. What we know… Survey of 894 Army soldiers from Operation Iraqi Freedom: * 95% observed dead bodies or human remains * 93% were shot at or received small-arms fire * 89% were attacked or ambushed * 65% observed injured or dead Americans * 48% were responsible for the death of an enemy combatant Charles Hoge et al., 2004

8. What we know about the families Over half of service members are married –At least 1.8 million children have one or both parents in the military »1.2 million with Active Duty parents and 650,000 with parents in reserves Ages of children affected by deployment: 0-5: 40% 6-11: 33% 12-18: 25%

9. Military Families cont… – Dual military families (6.9%) – Single active duty parents (5.4%) – Families with special health care needs (7.3%)

10. Military Families cont… Over ½ said their child had trouble sleeping 1/3 of the children were categorized as high risk for psychosocial problems (which is 2.5x the national norm) Parenting stress levels were double that of normative data Parental stress was most significant predictor of childs mental health (Flake et al., 2008)

11. Military Families cont Nationally, rate of child maltreatment in families of enlisted soldiers was 42 percent higher when military spouses were off at war than when they were at home Female civilian parents were twice as likely to abuse a child physically and almost four times more likely to neglect a child when male soldiers were deployed than at other times. Gibbs (2007): Studied U.S. Army families worldwide 2001 - 2004 using Army human-resource data and Army Central Registry

12. Military Youth Unique Challenges Frequent moves Changing schools, friends, activities, etc. Parent working long hours and away for long periods of time Unprecedented combat deployments Many parents returning home with physical and/or emotional wounds

13. Military Youth cont… 53% worry about my military parent while he/she is deployed 38% worry about the person who takes care of me while my parent is deployed 57% of interviewed youth said that getting to know their parent again (upon homecoming) was difficult. Chandra et al 2008

14. Military Youth cont… ACADEMIC PROBLEMS: Parental deployments may be related to modest decreases in test scores across most subjects – effects may be long-term (Engel et al., 2006) PHYSIOLOGICAL DIFFERENCES : Teens whose parents had been deployed to Iraq had significantly higher levels of systolic blood pressure, heart rate, and perceived stress than a civilian comparison group (Barnes et al., 2007).

15. Scope of Problem 30-40% Iraq Veterans will face depression, anxiety, or PTSD Multiple tours and prolonged deployments increase combat stress by 50% National Guard and Reserve at increased risk for MH issues and Suicide

16. Scope of Problem MH symptoms reported to a health care provider – 56% of Active Duty – 60% of Reservists – 76% of Veterans – Dole-Shalala Commission

17. Scope of Problem 300,000 OIF/OEF Veterans with PTSD and/or Major Depression 320,000 OIF/OEF Veterans with TBI RAND Survey: 2008

18. Scope of Problem NOT Knowledgeable about MH warning signs – 49% Soldiers – 52% Military Spouses Treatment options for MH: Ignorance – 59% Soldiers – 66% Military Spouses 10% have sought treatment; STIGMA prevents MH Care APA Harris Interactive Survey: 2008

19. PTSD

20. Diagnosis of PTSD The individual experienced or witnessed an event that involved actual or threatened death or serious injury, and felt very afraid or helpless. Traumatic events can include a wide variety of different experiences: military troops involved in combat victims and rescue workers involved in natural disasters victims and rescue workers involved in man-made disasters sexual assault or other violent crimes domestic violence physical and/or sexual abuse immigrants fleeing violence in their homeland Torture MVAs

21. Impact of PTSD Individuals may AVOID certain triggers or reminders of the trauma and may experience EMOTIONAL NUMBING (and/or distance themselves from others). They may try to avoid: activities places thoughts people

22. Traumatic Brain Injury

23. What Is A Traumatic Brain Injury? External force applied to the head Disruption of brain function Alteration of consciousness » incomplete memory of the event » dazed or confused » loss of consciousness Adapted from ACRM Special Task Force on TBI

24. Blast Injury Incidence of TBI in med evac patients with blast injuries at Walter Reed ~ 60% 64% of all military-related TBI from blast OIF/OEF: 33% of all battle injuries TBI Past war-wounded: 14-20% TBI Modern warfare TBI risk 2X greater Warren Lux, MD, Presentation @ BIAT, August, 2005 Deputy Director, Defense of Veterans Brain Injury Center

25. Impact of TBI Attention/Concentration Speed of Mental Processing Learning/Information Retrieval Executive Functions (e. g., Planning, Problem Solving, Self Monitoring) May see judgment problems, apathy, inappropriate behaviors

26. Psychological/Psychiatric and Psychosocial Changes after TBI Personality: Increased/Decreased Activation Episodic Dyscontrol; Irritability Psychiatric: Mood Disturbance Psychosis Psychosocial: Work Status Relationships with others

27. Public Health Impact: OIF/OEF

28. Alcohol Abuse Narcotic addiction Major Depression Military Sexual Trauma Job loss Family dissolution Homelessness Violence towards others Incarceration Suicide Post Deployment Mental Health: Its not just PTSD and/or TBI

29. Effects on Relationships 1.Social anxiety 2. Angry outbursts 3.Emotional unavailability 4.Sleep disturbance 5.Difficulty managing family roles and responsibilities

30. Relationship Impact 20% of married Iraq troops are planning a divorce 2/3 of Married or Cohabitating Veterans report Family Adjustment Issues Iraq and Afghanistan Veterans of America

31. Impact on Families Domestic Violence Childhood Abuse Substance Abuse Parent with MH/TBI and associated socioeconomic/legal issues

32. What To Do, and How To Do It – Community Awareness » Military Forces members, Veterans, and their families » Employers » School » Faith Based Organizations » State & Non-Profit Agencies » Health Care Providers – Coordination of Available Services » 2-1-1 West Central Texas Experience