beyond basic military awareness: cultural competence in with military … · 2019-10-21 · naadac...

NAADAC Specialty Training Series: Addiction Treatment in Military and Veteran Culture Part 4 of 6

10/26/2019

Presented by Duane K.L. France, MA, MBA, LPC 1

BEYOND BASIC MILITARY AWARENESS: CULTURAL

COMPETENCE IN WORKING WITH MILITARY AFFILIATED

POPULATIONS

PRESENTED BY DUANE K. L. FRANCE, MA, MBA, LPC

SAMSON TEKLEMARIAM, MA, LPC, CPTM

• Director of Training and Professional Development

• NAADAC, the Association for Addiction Professionals

• www.naadac.org

• [email protected]

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PRODUCED BY

NAADAC, THE ASSOCIATION FOR ADDICTION PROFESSIONALS

WWW.NAADAC.ORG/WEBINARS

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WWW.NAADAC.ORG/WEBINARS

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WWW.NAADAC.ORG/MILITARY‐VET‐TRAINING‐WEBINAR‐SERIES

CE CERTIFICATE

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CE HOURS AVAILABLE:1.5 CE

REGISTRATION TO ATTEND:

$25

CE CERTIFICATE:INCLUDED

1. Watch and listen to this entire webinar.

2. Pass the online CE quiz, which is posted at: www.naadac.org/beyond‐basic‐military‐awareness‐webinar

3. Maintain records of your invoice/receipt of payment and any CE certificate received from this series.

4. Email [email protected] if you experience any difficulty with this process.

To obtain a CE Certificate for the time you spent on this training:

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Using GoToWebinar –(Live Participants Only)

Control Panel

Asking Questions

Audio (phone preferred)

Polling Questions

WEBINAR PRESENTER

• Duane K. L. France, MA, MBA, LPC

• www.veteranmentalhealth.com

• [email protected]

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Family Care Center, LLC

WEBINAR LEARNING OBJECTIVES

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Describe the cultural aspects of military service, and how cultural aspects impact the

worldview of the military affiliated

population

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Recognize and understand the

explicit and implicit characteristics of

military culture and how they impact service members, veterans, and their

families

Articulate how culture impacts

transition into and out of the military lifestyle and how this impacts

individuals in post‐military life

Disclaimer: Presence of Department of Defense photos in this presentation does not imply endorsement by the Department of Defense or any affiliated agency or branch

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COMPREHENSIVE VETERAN MENTAL HEALTH (REVIEW)

Purpose and

Meaning

EmotionDysregulation

Addiction TBI

PTSD

Relationships

Needs Fulfillment

Moral Injury

www.veteranmentalhealth.com/naadac4


CORE CLINICAL COMPETENCIES FOR TREATING SERVICE MEMBERS, VETERANS, AND THEIR FAMILIES (REVIEW)

Advocacy represents counselors’ ability to understand and influence individual, system, and public policy efforts to increase access to mental health resources for military-connected clients and promote the role of counseling professionals working with military populations.

Military Culture represents general information about the functioning and worldview of military service members and their families.

Ethics represents counselors’ self-awareness and motivation to serve military-connected clients, as well as ethical considerations working with military populations.

Systems Features represents general information about the nature and structure of the military lifecycle including, but not limited to, deployment, family, spouses and children, health and wellness, employment, and retirement.

Assessment of Presenting Concerns represents common areas of clinical concerns that service members frequently present to mental health services to address.

Identity Development represents the whole person concept of military life including one’s personal identity as a service member and connection to mission and core values of working in a high-risk occupation across the lifespan. Treatment represents general information about unique issues that may arise in the treatment of military-affiliated clients and approaches supported by research for military populations, including best practices of military care systems, as well as holistic, wellness-oriented services.

Next up: Polling Question 1

POLLING QUESTION #1

Assimilation into military culture and lifestyle can have a lasting impact on service members and their families

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A. Strongly AgreeB. AgreeC. Neither Agree or DisagreeD. DisagreeE. Strongly Disagree

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CULTURE DEFINED


Anything that defines the characteristics of a culture —ways of dressing, language, conceptualization of the world — applies to the military

• The integrated pattern of human knowledge, belief, and behavior that depends upon the capacity for learning and transmitting knowledge to succeeding generations

• The characteristic features of everyday existence shared by people in a place or time.

• The set of shared attitudes, values, goals, and practices that characterizes an institution or organization.

The U.S. Army Old Guard Fife & Drum Corps take part in a ceremony, Sept. 30, 2019. DoD Photo by Lisa Ferdinando

SPECTRUM OF CULTURAL COMPETENCE


Cultural competence needs to be seen as a continuum from basic cultural awareness to cultural competence; effort must be made to move beyond knowledge towards cultural sensitivity and competence (Adams, 1995).

Developing sensitivity and understanding of

another ethnic group…Cultural

awareness must be supplemented with cultural knowledge

Familiarization with selected cultural characteristics, history, values,

belief systems, and behaviors of the members of

another ethnic group

Has the ability to be appropriately

responsive to the attitudes, feelings,

circumstances of groups of people that share a common and distinct

racial, national, religious, linguistic, or

cultural heritage

Can Function effectively and

appropriately in diverse cultural interaction and

settings

Cultural Awareness

Cultural Knowledge

Cultural Sensitivity

Cultural Competence

CULTURE DIFFERENCES


Recognizes the unique within group cultural differences of Service members including gender, race, ethnicity, age, education, sexual orientation, socio‐economic status, ability‐status, and religious/spiritual orientation (Department of Defense, 2017).

• Among enlisted recruits, 43 percent of men and 56 percent of women are Hispanic or a racial minority.

• Women represent 16 percent of the enlisted forces across branches and 18 percent of the officer corps

• Enlisted recruits across the military join the military from neighborhoods where the median income is between $40k and $84k a year

• Age distribution varies between branches: enlistees below the age of 20 made up 84% of USMC, 65% of USAF and USA, and 67% of USN Deployed female service members reflect, look to future of women in uniform

[Image 2 of 3] (U.S. Army photo by Cpl. Mariah Best)

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RESOURCES BY COMPONENT


Understands the potential for variance in the resources and support systems available to different components of the military (Active Duty vs. Reserve Component)

• Active Duty service members serve in specific locations around the U.S. and overseas and have the military as their full time occupation

• All branches of the military have a Reserve component, as well as each state has a National Guard and Air National Guard component

• As of 2014, over 800,000 National Guard and Reserve service members deployed in support of the Global War on Terror

• Non‐activated guard and reserve service members, from non‐combat eras, not eligible for VA services (Polusny et al., 2016)


POLLING QUESTION #2

Explicit characteristics of the military lifestyle can create a separate experience for those who served from those who

haven’t

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EXPLICIT CULTURAL DIFFERENCES


Explicit characteristics of military culture are those observable characteristics that make military life unique. Manner of dress, branch and era of service, era of service, and rank structure are all examples of explicit characteristics of the SMVF population

• Able to recognize different branches of service and differences in the characteristics of each

• Differences between current and former service members, as well as former service members from different eras

• Knowledge about different military operations, current and former, as well as differences between combat theaters within conflicts (i.e., Iraq vs. Afghanistan, Pacific vs. European theaters of operation)

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Can identify the Active Duty service branches of the U.S. armed forces, and understands that each branch adheres to specialized structures, roles, ranks, and terms and is aware that differences in military culture exist between each branch of service

• U.S. Army: the main ground force of the U.S., largest and oldest of all of the branches

• U.S. Air Force: the air and space branch of the military, began as Army Air Corps

• U.S. Navy: the naval force of the U.S., delivers combat forces while maintaining security at sea

• U.S. Marine Corps: An amphibious and ground expeditionary force

• U.S. Coast Guard: a maritime component; law enforcement branch and military branch



Is aware that differences in experiences may exist between Veterans who previously served and Service members/Veterans who currently serve, as well as Veterans who served in different eras (DeBruyne & Leland, 2015)

• The military changes significantly over a short period of time; serving in 1995 was different than in 2005, which was different in 2015, etc.

• Military is an inherently dangerous occupation, with possible trauma and stress occurring even in times of “peace”

• According to a 2015 Congressional Research Service Report, the total number of U.S. Active Duty Military deaths in 1980 was 2,392, as opposed to 1,485 in 2010.

World War II Era 1939 ‐ 1945Post WWII Era 1945‐1950Korean War Era –1950 to 1954Post‐Korean War Era 1954 ‐ 1961Vietnam War Era ‐ 1961 to 1975Cold War Era –1975 –1990Persian Gulf Era –1990 to 1992Post Persian Gulf Era ‐ 1992 – 2001Post 9/11 – 2001‐Present



Seeks education on the training methods and objectives of military operations, including potential differences among combat zones.

• A service member’s experience in Iraq in 2010 is completely different than another service member’s experience in the Persian Gulf War in 1991

• Technology, resources, method of combat differ from era to era and theater to theater

• A single service member, especially career military members, likely served in multiple conflicts; WWII and Korea, Korea and Vietnam, Vietnam and Persian Gulf War, Gulf War, Balkans, and GWOT

Potential Combat Conflicts:

World War IIKorean WarVietnam WarLebanonGrenadaDesert Storm/ Desert ShieldBosnia

KosovoOperations in the former Yugoslavia areaGlobal War on TerrorismOperation Enduring FreedomOperation Freedom's SentinelOperation Iraqi FreedomOperation New Dawn

Mid-Webinar Q&A

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Q&A

www.veteranmentalhealth.com/naadac4Next up: Polling Question 3

POLLING QUESTION #3

Implicit characteristics of the military lifestyle, such as internalized values, are not as important as explicit characteristics

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IMPLICIT CULTURAL DIFFERENCES


Implicit characteristics of military culture are the underlying values and unwritten norms of behavior that are associated with military service. Just as important as explicit characteristics, these tend to remain in the veteran population after a service member is no longer in the military.

• Assimilation into the military culture inculcates values, beliefs, and traditions that impact an individual’s world view

• Military is a mission‐focused, process and results oriented organization

• Service members internalize military values such as sacrifice, honor, humility, collective effort, and a desire to limit risk or harm to others

DoD photo by Maria L. Taylor

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A mental health professional needs to acknowledge that values, beliefs, traditions, and functions of the military can influence the client’s worldview. A particular worldview is a distinct philosophy of life or experiences within social, cultural, environmental, and psychological domains (Weiss & Coll, 2011).

• Military servicemembers and their families have more of a global perspective than those who have never served, due to multiple duty assignments

• All branches have a commitment to the value of service and sacrifice

• Exposure to trauma or stressful situations outside the common experience of those who didn’t serve can negatively impact values (moral injury)



Is aware of the mission‐first, process‐ and results‐oriented value system of the military. A unified effort towards a common goal (macro or micro) is a significant part of establishing a cohesive collective culture. This is even translated to military spouses and children who operate in “everything else comes first” conditions

• Service members and their families experience a unique set of stressors, such as isolation from family of origin, frequent moves, and unpredictable changes, undertaken for the needs of the military and mission

• Putting mission before self can lead to a loss of personal identity and identity focused on military role

• A personal stake in the accomplishment of goals can lead to accepting an inordinate amount of responsibility for perceived failures

A recruit looks through a compass during land navigation training, June 11, 2019. Marine Corps Photo by Lance Cpl. Christopher McMurry



Acknowledges sacrifice, honor, and humility as values for Service members. Recognizes the importance of collectivism within the military culture, including a desire to limit risk or harm to others. This can impact their ability and willingness to seek mental health support for perceived weaknesses and a desire to protect others (Meyer & Wynn, 2018)

• Assimilation into military culture, either brief, short or long term, can lead to an indelible culturalization that is most significant in a veteran’s life

• Seeking care for mental health concerns can be seen as mission compromising and an admission that they are unreliable

• Often, service members and veterans will be reticent to disclose details, not to avoid reliving the trauma, but to “protect” the therapist from feeling what the veteran is feeling

Air Force Master Sgt. Tiffany Robinson kneels in front of a battlefield cross, May 26, 2014. . Navy photo by Petty Officer 1st Class Eric Dietrich


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POLLING QUESTION #4

The reasons for transitioning into and out of the military lifestyle are many and

varied, and require a flexible approach to individual clients

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CULTURAL IMPACTS ON TRANSITION


Acculturation into the military lifestyle impacts service members and their spouses, as well as to children and other family members. Understanding the challenges related to cultural dissonance is important for providers. The in‐group / out‐group nature of military service forms a psychological divide between those who served and those who haven’t

• Not all cultural assimilation is the same for service members, so providers need to explore the individual client’s response to military culture

• Clinicians must understand the different reasons why individuals join or leave the military, and their feelings towards these decisions

• There is a need to acknowledge and address the differing worldviews of those who served and those who haven’t. A Recruiter speaks to two U.S. Marines at the Warrior and

Family Transition Fair on Marine Corps Base Quantico, Va., June 18, 2015. DoD Photo.



Providers must explore the introjection of military culture in the client’s personal and professional functioning. Although the veteran no longer exhibits the explicit characteristics of the military, their implicit characteristics are maintained and sometimes strengthened, such as the value of collectivism in the military versus the value of individual achievement.

• Military culture emphasizes working as a team, while non‐military employment culture is often focused on individual achievement and skills

• Inability to adapt to a different point of view can cause resentment and the feeling that military skills are not valued in post‐military life

• The need to make a cultural shift is not as emphasized during transition programs as is the development of skills and processes (Trussa & Castro, 2019) Personnel Specialist 2nd Class Kendra Velasquez from Syracuse, N.Y.,

Speaks with representatives from Commander Navy Region Northwest during a job fair. (U.S. Navy/Christopher R. Jahnke)

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Respects the individual motivations of service members to enlist or commission in the military, as well as their individual experiences during their time in service and decision to leave or retire from the military. Service members show diversity in their reasons for why they join and leave the military, which branch they join, and how these impact how they view their service.

• Reasons for joining the military can be identified by themes (Redmond et al., 2015):

• Institutional: desire to serve, patriotism, desire for adventure/challenge

• Future‐oriented: desire for a military career and money for college

• Occupational: desire to support family, best available option

• Pecuniary: repayment of college loans and bonuses Army Chief of Staff Gen. Ray Odierno administers the oath‐of‐enlistment to future soldiers during a ceremony celebrating the U.S. Army’s 237th birthday at Times Square in New York, June 14, 2012.



Is aware of the potential for differing worldviews between Service members and civilians. In 2011, nearly 75% of those who served and those who haven’t served in the military agreed that the American public does not understand the military experience, the characteristics of military personnel, and military culture

• A comparatively small number of Americans serve in the military; the current and former service members only account for 6% of the national population

• This gap in understanding can increase difficulties for service members and their families leaving military culture

• Addressing the civilian‐military divide is seen to have political ramifications as well as a national security concern (Smith, 2018)

Next up: Quote and Q&A

“ONE VETERAN I SPOKE WITH HAD INTERVIEWED FOR SEVERAL JOBS IN THE SAME INDUSTRY WITHOUT SUCCESS. HE ATTRIBUTED THIS TO HUMAN RESOURCES PEOPLE BEING BIASED AGAINST VETERANS. WHEN I POINTED OUT HIS NEGATIVE ATTITUDE TOWARD CIVILIANS AND ASKED IF HE THOUGHT HE HAD HIDDEN IT FROM THE

INTERVIEWERS, HE ACKNOWLEDGED THEY PROBABLY HAD PICKED UP ON IT. ‘WOULD YOU HIRE SOMEONE YOU FELT HAD A BAD ATTITUDE TOWARD YOU?’ I ASKED. HE SAID HE

WOULD NOT, YET HE PERSISTED IN BLAMING CIVILIANS RATHER THAN HOLDING HIMSELF ACCOUNTABLE FOR HIS ATTITUDE.”

‐ NAVY CHAPLAIN

LCDR KEVIN S. BEMEL

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REFERENCESAdams, D. L. (1995). Health issues for women of color: A cultural diversity perspective.

DeBruyne, N. F., & Leland, A. (2015). American war and military operations casualties: Lists and statistics. Congressional Research Service Washington United States.

Meyer, E. G., & Wynn, G. H. (2018). The importance of US military cultural competence. InMilitary and Veteran Mental Health (pp. 15‐33). Springer, New York, NY.

Polusny, M. A., Martyr, M. A., Erbes, C. R., Arbisi, P. A., Kramer, M., Gibson, E., & Oleson, H. (2016). Prevalence and risk factors for post‐traumatic stress disorder symptoms among National Guard/Reserve Component Service members deployed to Iraq and Afghanistan. Comprehensive Guide to Post‐Traumatic Stress Disorders, 455‐487.

Prosek, E., Burgin, E., Atkins, K., Wehrman, J., Fenell, D., Carter, C., & Green, L. (2018). Competencies for Counseling Military Populations. Journal of Military and Government Counseling, 87‐99.

Redmond, S. A., Wilcox, S. L., Campbell, S., Kim, A., Finney, K., Barr, K., & Hassan, A. M. (2015). A brief introduction to the military workplace culture.Work, 50(1), 9‐20.

Smith, A. (2018). “My Understanding… Has Literally Changed”: Addressing the Military‐Civilian Gap with an Academic‐Community Engagement Project. Journal of Veterans Studies, 3(1), 1‐17.

Truusa, T. T., & Castro, C. A. (2019). Definition of a veteran: the military viewed as a culture. InMilitary Veteran Reintegration (pp. 5‐19). Academic Press.

US Department of Defense. (2017). Population representation in the military services.

Weiss, E., & Coll, J. E. (2011). The influence of military culture and veteran worldviews on mental health treatment: Practice implications for combat veteran help‐seeking and wellness. International Journal of Health, Wellness & Society, 1(2), 75‐86.

Q&A

[email protected]

WWW.VETERANMENTALHEALTH.COM

THANK YOU!

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www.naadac.org/military-vet-online-training-series

CE CERTIFICATE

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CE HOURS AVAILABLE:1.5 CE

REGISTRATION TO ATTEND:

$25

CE CERTIFICATE:INCLUDED

To obtain a CE Certificate for the time you on this training:

1. Watch and listen to this entire webinar.

2. Pass the online CE quiz, which is posted at: www.naadac.org/beyond‐basic‐military‐awareness‐webinar

3. Maintain records of your invoice/receipt of payment and any CE certificate received from this series.

4. Email [email protected] if you experience any difficulty with this process.

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beyond basic military awareness: cultural competence in with military … · 2019-10-21 · naadac...

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