WOUNDED WARRIORS IN NATIONAL SERVICE PROGRAMS: EFFECTS OF TBI & PTSD. Best practices and impact on returning veterans

Transcription

1 WOUNDED WARRIORS IN NATIONAL SERVICE PROGRAMS: EFFECTS OF TBI & PTSD Best practices and impact on returning veterans

2 Synopsis of Presentation Deepen knowledge and understanding of issues related to Wounded, Ill, and Injured Warrior Signature Injury - TBI Post Traumatic Stress Disorder PTSD How can National Service Programs make life changes for returning warriors? Effective practices in working with veterans with PTSD and TBI Considerations for today

3 Overview of wounded, ill, and injured warriors Visible and invisible wounds of war

4 The Silent Epidemic Traumatic brain injury (TBI) is a blow or jolt to the head or a penetrating head injury that disrupts brain function. TBI is a life long process, not an event The impression that a person can sustain a brain injury, learn a few compensatory strategies and live happily ever after does not often happen. Academy of Certified BI Specialist, The Essential Brain Injury Guide

5 Signature Injury - TBI Blast injuries are injuries that result from the complex pressure wave generated by an explosion (rocket-propelled grenades, improvised explosive devices, and land mines). Those closest to the explosion suffer from the greatest risk of injury. Ears, lungs, GI tract, brain and spine are especially susceptible to primary blast injury. Additional means of impact include: being thrown, debris, and burns. Injured soldiers require specialized care acutely and over time.

6 Post TBI Changes Wide range of functional short-term and/or long-term changes can occur 1. Physical (pain - headache, fatigue, sleeplessness, ophthalmological, and seizures) 2. Thinking (memory, learning, high level problem solving, mental processing speed, and reasoning executive functioning)

7 Post TBI Changes 3. Sensory-motor (touch, taste, sensory, perceptual, motor abilities, restlessness, and smell processing and integration) 4. Language (communication, expression, information processing, reading and writing deficits, and understanding) 5. Emotion/Behavior (depression, anxiety, personality changes, aggression, predicting the consequences of actions, frustration tolerance, psychiatric problems, and increased suicidal behaviors) 6. Social (social inappropriateness, shrinking social capital)

8 Cognition Demands Emotional Demands Cognition Demands Reserve Physical Demands Reserve Emotional Demands Physical Demands HEALTHY BRAIN POST TBI/PTSD Less Reserve = More Demand

9 Definition of An anxiety disorder resulting from exposure to an experience involving direct or indirect threat of serious harm or death; may be experienced alone (rape/assault) or in company of others (military combat)

10 DSM-IV Criteria Essential Clusters of PTSD: 1. Re-experiencing symptoms (nightmares, intrusive thoughts) 2. Avoidance of trauma cues and numbing/detachment from others 3. Hyperarousal (i.e. increased startle, hypervigilance)

11 Symptoms of PTSD Recurrent thoughts of the event Flashbacks/bad dreams Emotional numbness - reduced interest or involvement in activities Intense guilt or worry and/or anxiety Angry outbursts and irritability Feeling on edge, hyperarousal/ hyper-alertness Avoidance of thoughts/situations that remind person of the trauma APA, 1994

12 Crossover and Confusion TBI Fatigue Headaches Memory Change in personality Insomnia Depression Attentional-poblems Irritability Anxiety PTSD Nightmares Flashbacks Intense guilt Hyperalertness

13 Belongingness The universal human need to form stable, positive attachments has been identified as one of the strongest empirical predictors of health and well-being. (House, Landis & Umberson, 1988; Uchino, Uno & Holt Lunstad, 1999).

14 Reverse Culture Shock Reverse Culture Shock is typically used to describe the unanticipated adjustment difficulties that many military people experience when returning to civilian life. People attempting to move beyond their military experiences can find themselves feeling disoriented and confused, neglected or frustrated, often unemployed, or under employed and generally struggling in their career as well as personal relationships. -BC/Yukon Command The Royal Canadian Legion and the Survival Kit for Oversees Living; For Americans Planning to Live and Work Abroad

15 Each wounded warrior will have a unique set of needs, conditions and contributions and so will need unique techniques to succeed How can National Service help in the reintegration to civilian life for warriors? How can you personally impact the lives of returning veterans?

16 Effective practices in working with veterans 1. REMINDERS, , checklists 2. iphone, Smart phone, technology 3. Environmental prompts 4. Frequent breaks with backup coverage 5. Extra time slow down 6. Allow for time off for appointments 7. Natural lighting, glare guards, noiseless space 8. Effective supervision 9. Routine 10. Emotional cues 11. Motivational Interviewing 12. Real-play stress response 13. Limit distractions - visual, cyber, over-stimulation

17 Suicide Resources 18 veterans die from suicide per day (National Violent Death Reporting System) VA Crisis Line ( TALK) Online chat ( Text option (838255)

18 You hold a key We can support wounded warriors to success through National Service and today is an important step! National

19 Resources American Psychological Association, Diagnostic and Statistical Manual of Mental Disorders, (DSM IV-TR Ashley, M., Ninomiya, J., Berryman, A., & Goodwin, K. (2004). Vocational Rehabilitation. In M. Ashley (Ed.), Traumatic brain injury: Rehabilitative treatment and case management (2 nd Ed; pp ). Boca Raton: CRC Press. Brain Injury Association of America, Academy for Certified Brain Injury Specialist training, and The Essential Brain Injury Guide. Bridget E. Bulman, Psy.D., VISN 19 Mental Illness research Education and Clinical Center, Denver VA Medical Center, TACE 8 Webinar, August 28 th, PTSD and TBI, Crisis Intervention (24/7), U.S. Department of Veterans Affairs (VA), Suicide Prevention Hotline Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE)

20 Engaging Vets 2011 Comprehensive Report; and Ft. Carson article; Iraq War Clinician Guide, 2nd Edition; Homecoming: Dealing with Changes and Expectations. Johnstone, B., Price, T., Bounds, T., Schopp, L., Schootman, M., & Schumate, D. (2003). Rural/urban differences in vocational outcomes for state vocational rehabilitation clients with TBI. NeuroRehabilitation, 18, Journal of Vocational Rehabilitation, Volume 29, Nov. 3, 2008, Building Social Capital, Janet M. Williams. In Country: Soldiers' Stories from Iraq and Afghanistan, 2010 Jennifer Karady, NATIONAL CENTER FOR PTSD working with veterans, community provider tool kit National Intrepid Center of Excellence Rand Invisible Wounds of War Project The Military to Civilian Transition Guide, Edition, Savino and Krannich. TBI Net, Wayne A. Gordon, The Mount Sinai Medical Center, Vocational Rehabilitation, TBI & The Power of Networking, March Uomoto, J. (2000). Application of the neuropsychological evaluation in vocational planning after brain injury. In R. Fraser and D. Clemmons (Eds.), Traumatic brain injury rehabilitation: Practical, vocational, neuropsychological, and psychotherapy intervention (pp. 1-94). Boca Raton: CRC Press. Wehman, P., Bricout, J., & Targett, P. (2000). Supported employment for persons with traumatic brain injury: A guide for implementation. In R. Frazer & D. Clemmons (Eds.) Traumatic brain injury rehabilitation: Practical vocational, neuropsychological, and psychotherapy interventions (pp ). Boca Raton: CRC Press.

21 THANK YOU! Nancy Freeman, CBIST CTAT at Rocky Mountain Human Services Prevention is the cure be safe!