1. Wounded Warriors: Issues, Context, Accommodation Edward A. Martinelli, Jr., Ph.D., Utah Valley University

2.  Impacts and Prevalence  Intake Issues  Qualification Issues  Accommodation Issues  Local Issues

4.  Since October 2001  Approx. 1.64 million troops have deployed as part of Operation Enduring Freedom (OEF; Afghanistan) and Operation Iraqi Freedom (OIF; Iraq).  As compared to past deployments  Higher proportion deployed  Deployments have been longer  Breaks between deployments have been infrequent  Redeployment to combat has been more common

5.  Nevertheless---  Operations have employed smaller forces  Casualty rates (killed or wounded) are lower  Technology has led to more surviving….  But “invisible wounds” are beginning to emerge

6.  RAND Study focused on 3 major conditions:  Post-Traumatic Stress Disorder (PTSD)  Major Depressive Disorder and associated symptoms, and  Traumatic Brain Injury (TBI)  All three affect mood, thoughts, and behavior  1,965 servicemembers were surveyed  24 Geographic Areas

7.  Mental Health Issue Rates in the Past 30 Days  14% screened positive for PTSD  14% screened positive for Depression  19% reported a probable TBI  Depression is not considered a combat-related injury, but it is highly associated with combat exposure  Not possible to know the severity of TBI issues

8.  About 1/3 of those previously deployed have at least one of these three conditions  About 5% report symptoms of all three  Some groups (Reserve Components and those who’ve left the service) may be at higher risk

9.  Of those reporting a probable TBI  57% had not been evaluated by a physician  Rates for TX of Depression or PTSD  Comparable to general population (53%)

10.  Like most issues, we can expect these issues to emerge in three or four major ways  Intake  Eligibility Determination  Accommodation Provision  Specific Institutional Issues

12.  Label stigma  Self-Identity  Knowledge of services and location  Differences between VA and School services

14.  Invisible disabilities more difficult for us to quantify  TBI issues may present much later  Dynamic nature of some diagnoses  May be situational  Course content related  Time of year related

15.  Individual may not have much experience with academic setting  Their experience so far may be simply with non- academic tasks  Memorization, short/long term memory, etc.  Documentation may be atypical  Military looks at disability sometimes from a compensation not a limitation standpoint

16.  In summary, functional impacts may be hard to identify  Relationship important to returning for additional help  Adjustments may be needed mid-term

18.  What are you doing with other psychiatric issues?  Watch for anniversaries, holidays, etc.

19.  Anxiety Issues  Issues around sights, smells, locations, context  Testing issues  Classroom environment  Interactions with others  More often than not the individual simply wants to remove themselves from the situation

20.  Not surprising to see  Memory issues  Concentration issues  Comparison to past performance  Old versus new learning and skills  May be emotional issues  Impulse control  Mood swings