Improving Transitions from Military Service to Civilian Life

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ALABAMA – Researchers, policy makers and federal agencies have been slow in coming to terms with the realities of being in long-term, worldwide conflicts in multiple countries and the impact that has on service members, veterans, their families, and their communities.

The 2nd annual Service Member to Civilian (S2C) Summit will be hosted by the University of Alabama’s School of Social Work September 21-23 2016; a special Pre-Summit Session on Moral Injury and Faith-Based Approaches to Supporting Veterans and Families will be held September 20, 2016. S2C is an international summit addressing the current and emerging needs of service members in their transition to civilian life (AKA Military to Civilian Transition; MCT. S2C will examine how service members from all branches of the military transition to civilian life and how we can improve that transition through translational science and service.

S2C will bring together service members, veterans, their families, and community stakeholders to meet with advocates, researchers, clinicians, educators, and policymakers from around the nation to better understand and explore ways that all stakeholders can improve the transition from service to civilian life.

The Objectives of the Summit:

Service members face a life of numerous changes in circumstance, experiencing frequent cycles of deployment followed by the challenges of reunion/reintegration with their families, children, communities, employers, and schools. The transition from military life to civilian life is difficult and can be exacerbated by mental and physical trauma. Thus, the S2C objectives are to:

  • Present current research and best practices for improving military to civilian transitions.
  • Build research and practice consortiums that bring service members, including National Guard and Reservists, veterans, and their families together with researchers, Department of Defense (DoD) and Veterans Affairs (VA) clinicians and decision makers, civilian employers, researchers, students, and higher education leaders.
  • Articulate short-term and long-term translational agendas for research and practice in four core theme areas.
  • Provide job acquisition training and access to employment opportunities.

For the pre-summit event on September 20th, there will be an examination of how local communities can best support veterans and their families via collaboration and coordination within and among faith-based organizations featuring a panel of national experts discussing moral injury. Panelists include:

  • Dr. Nancy Sherman
  • Dr. Rita Brock
  • Dr. Bill Nash
  • Dr. Irene Harris
  • Also featuring Col Sean Lee, who will present on the “Partners in Care” program and its potential in Alabama communities and beyond.
  • Invited responses will present examples in Alabama communities of unfolding initiatives engaging and mobilizing local faith communities to support veterans and their families.

On September 21st – 23rd, the Service Member to Civilian Summit will officially begin. As a collaborative research summit, we will be honoring our nation’s service members from all branches of the military and addressing current and emerging needs of service members transitioning to civilian life, encompassing:

  • Civilian employers
  • Community-based organizations
  • Family and children
  • Higher Education

The 2016 Summit will bring together service members, veterans, their families, and community stakeholders to meet with advocates, researchers, clinicians, educators, and policy makers from around the nation to better understand and explore ways that all stakeholders can improve the transition from service to civilian life. S2C is hosted by The University of Alabama School of Social Work and is partly supported by a grant from the National Institute of Child and Human Development and support from The University of Alabama and other sponsors.

VA employees must pre-register via the VA ACES system before registering here. To register in VA ACES, VA employees should go to the VA internal website link for EES ACES registration: 

For more information

Karl Hamner at khamner@ua.edu or
David Albright at dlalbright@ua.edu

Telemental Health: Improving Access to Veterans’ Mental Healthcare

By Brian Neese

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Photo Credit: Dublin VA

Military members comprise less than 1 percent of the U.S. population, yet veterans represent 20 percent of suicides nationally, according to the National Alliance on Mental Illness. Each day, about 22 veterans die from suicide.

An issue affecting mental healthcare for veterans is accessibility. In the spring of 2014, the U.S. Department of Veterans Affairs (VA) wait time scandal emerged when allegations surfaced of veterans dying while waiting for care at the Phoenix VA Health Care System, according to Military Times. Wait time issues and manipulated appointment scheduling highlighted a nationwide problem and resulted in several top officials resigning or retiring.

Months later, Congress passed a $15 billion bill allowing more veterans to seek care in the private sector through the VA Choice program. Meanwhile, the VA continued focusing efforts on telemental health, or the use of telecommunications technology to provide behavioral health services, to try to improve veterans’ access to mental health services, National Psychologist reports.

Accessibility

Nearly one in four active duty military members show signs of a mental health condition, based on a study in JAMA Psychiatry. With 44 percent of veterans returning home from Iraq and Afghanistan to rural zip codes, accessibility becomes an important topic for veterans’ mental healthcare. This is a natural strength of telemental health services, which can include clinical assessment, individual and group therapy, educational intervention, cognitive testing and general psychiatric treatment.

The first telemental health program funded by the VA’s Office of Rural Health is at the Portland VA Center in Oregon. Through telemental health sessions, veterans saved 826,290 miles driven and $161,126 worth of gasoline in 2013, program director Mark Ward said. Some veterans who live far from Portland and lack high-speed internet are given electronic tablets and notebooks for videoconferencing.

Telemental health can increase veterans’ access to services and eliminate travel. Another benefit is that telemental health can help veterans overcome the perceived stigma sometimes associated with seeking mental health treatment. Veterans who might feel embarrassed or ashamed to get help in person can receive care in their home.

The VA delivered a total of more than 650,000 telemental health sessions nationally from the program’s inception in 2004 through 2014. The VA anticipated delivering 300,000 telemental health visits for 115,000 veterans in 2014, an increase from more than 200,000 telemental health visits for 80,000 veterans the previous year. Additionally, the VA has created free smartphone apps that veterans can use to help with post-traumatic stress disorder (PTSD), such as the PTSD Coach application developed by the VA and the Department of Defense.

Telemental health has made progress in improving accessibility for veterans’ healthcare, and it will be needed to make further ground. The Government Accountability Office found that 18 months after the wait time scandal, the VA still struggled with wait times and patients’ schedules.

Effectiveness

The first large-scale assessment of telemental health services was published in Psychiatric Services. This study assessed clinical outcomes of 98,609 mental health patients before and after enrollment in telemental health services of the VA between 2006 and 2010. During this time, psychiatric admissions of telemental health patients decreased by an average of about 24 percent, and patients’ hospitalization lengths decreased by an average of nearly 27 percent.

A survey of veterans found high levels of satisfaction and perceived safety with home-based telemental health provided by the VA pilot program in Portland, according to the International Journal of Psychiatry in Medicine. Findings support the feasibility and safety of using technology in the home for the delivery of mental health services. Additionally, results suggest fewer no-show appointments in home-based telemental health compared to clinic-based telemental health.

Currently, telemental health is regarded as appropriate for general clinical use. Yet, the VA cautions that more needs to be known about using telemental health services for conditions such as PTSD, which Jama Psychiatry says is 15 times higher for those in the military than civilians. “While preliminary research has clearly established that a variety of telemental health modalities are feasible, reliable, and satisfactory for general clinical assessments and care, less is known about the clinical application and general effectiveness of telemental health modalities employed in the assessment or treatment of PTSD,” the VA says.

The Need for Behavioral Health Professionals

Approaches such as telemental health can support better access to behavioral healthcare and are expected to grow as a result. Yet, more professionals are needed for rising populations of veterans, children and others in need of services.

The online B.A. in Behavioral Health from Alvernia University enables students to meet this need. Some graduates enter fields such as addiction counseling, long-term care and child welfare, while others enter graduate studies. The program takes place in a convenient online format to accommodate students’ work and personal schedules.

Let’s Talk About Military Family Mental Health: Tweetchat 5/8/14 #MacroSW

Military service members, veterans, and their families are extremely resilient , but the stress of war, multiple deployments, and frequent moves can impact their emotional, physical, and overall well-being. During the month of May, #MacroSW is teaming up with USC School of Social Work to help raise awareness by inviting our community to participate in the Military Family Mental Health campaign. The goal behind this campaign is to build public recognition about the importance of mental health to overall health and wellness, particularly within the military community.

Join us for the next #MacroSW Chat this Thursday 5/8 6pm PT/ 9pm ET to discuss Military Family Mental Health Advocacy!

  • How are milfamily organizations taking the lead on Mental Health advocacy?
  • What can civilian organizations and advocacy groups learn from the military family groups?
  • What do social workers who work with the military community need to know to provide the best care?

Raise your voice to raise awareness through social media!

  • Stay tuned to the conversation around Military Family Mental Health using #MilfamMH!
  • Take 30 seconds to change your profile picture or cover photo to one of these images during the month of May to show your support for this important cause!

Change your Facebook profile picture:

MFMH.FBProfile

MFMH.MilSpouseFBProfile

MFMH.VetFBProfile

Change your Facebook Cover Photo:

MFMHCoverPhoto2

Share this message with your friends and family on your favorite social platform!:

Facebook/ Google+: This May, I am raising my voice to raise awareness around milfamily mental health. Find out how you can make a difference by participating in the #MilfamMH campaign too!

Twitter: I’m joining the #MacroSW chat hosted by @MSWatUSC to discuss #MilfamMH advocacy on 5/8 6pmPT/9pmET! More info:

Twitter: I’m raising #MentalHealthAwareness this month! Join me and @MSWatUSC for the #Milfam Mental Health Campaign: #MilfamMH

Do You have a blog or Newsletter? Copy and paste this message to show your support!:

“I’m raising awareness for Military Family Mental Health by blogging for the #MilfamMH Campaign sponsored by USC’s masters degree in social work program. Join me in blogging for an important cause!”

Archived Tweetchat:

Can be viewed on Storify at this link.

Serving Our Veterans: Will History Repeat Itself? (Part 4 of 4)

WWI veterans excercising their civil liberties and demanding their Bonus checks that were promised to them.
WWI veterans excercising their civil liberties and demanding their Bonus checks that were promised to them.

Throughout the series, I have taken you back to Washington D.C. during the Great Depression, alongside 25,000-45,000 WWI veterans protesting and lobbying for their Bonus checks that would help get them out of poverty. I analyzed two key tensions, Micro vs. Macro and Public vs. Private, in order to show you how they have had a dramatic impact on the way our country treats those who fight her wars. Now, I will tie everything together and demonstrate how these historical lessons can help us better serve our veterans today.

Similar to the Bonus Expeditionary Force (B.E.F.) veterans of 1932, modern U.S. military veterans are issuing grievances to the U.S. government, and anyone who will listen, over issues related to compensation. 82 years after the B.E.F., popularized as the Bonus Army, occupied our nation’s capital, 550,000 veterans who fought in Iraq and Afghanistan are waiting on average between 273- 327 days for their disability compensation claims to go through, often at the expense of their physical and mental health. While recognizing the U.S. government has made much progress since the time of the B.E.F., it is apparent that work still needs to be done.

Although society has widely accepted public assistance as a need for U.S. military veterans, there are hundreds of private agencies that still exist to serve the needs of the same veterans that the U.S. Department of Veterans Affairs (VA) serves, or aims to serve. This would suggest that the services provided by the public, federal government, are not adequately meeting the needs of U.S. military veterans. One must only consider the average wait on the VA’s disability claim back log mentioned previously to see the VA is not prepared to handle the rising needs of U.S. veterans.

While there is observable Public vs. Private tension among services provided to veterans, a question can also be asked in consideration of this tension: Does the U.S. government view the issues that military veterans face as being personal/private problems, or does it acknowledge that these are public issues brought upon individual veterans as a result of their time in military service? This question may be a topic for further investigation. While we can still observe Public vs. Private tension occurring among modern U.S. veterans and the U.S. government’s approach to serving them, we can see Micro vs. Macro tensions as well.

Through an analysis of all the services the VA provides U.S. military veterans, it is apparent that the VA takes a micro level approach, treating every veteran on a case by case basis, rather than having a focus on macro level systems to address environmental factors that might contribute to adequate care.  We’ll see why this matters to society in a minute, but why does this matter to the field social work? Social work has been an integral part of veteran services provided by the U.S. government since 1929 and the VA is now affiliated with over 180 Graduate Schools of Social Work, training about 900 students per year. VA Social Work demonstrates its micro level focus in its mission statement which reads “The mission of VA Social Work is to maximize health and well being, through the use of psychosocial interventions for Veterans, Families and Caregivers” (2013). Psychosocial interventions aren’t necessarily the wrong approach, but it is near the foundation of micro level practice.

U.S. veterans, veteran service organizations, and even social workers within the VA, might benefit from following the social work trend and adopting or including a macro level approach to address modern day issues. After all, this series has shown that macro level approaches are historically the most effective at creating positive change and building security and autonomy for a group of disadvantaged individuals. It is through this intersection that the most profound implications of this series can be drawn.

In order to adequately address the needs of U.S. veterans, more work needs to be done at the macro level. Whether this manifests through the VA adopting new practices like creating a program with the sole focus of macro systems, social workers advocating and lobbying for macro changes in public policy, or veterans themselves recreating a physical effort at the scale of the Bonus Army in 1932; a macro approach larger than anything currently present must occur for the veteran population’s needs to be adequately addressed.

If U.S. veterans from around the country arrived en mass at Washington D.C. demanding legislation to end the VA backlog, support alternative healthcare measures within the VA, and to protect veterans benefits from any future government shutdowns or policy changes (three primary, widespread issues noted by the author); then modern U.S. veterans would be able to carry on the legacy that the Bonus Expeditionary Force left behind. Such an effort would require something that we don’t see very often: the participation and collaboration of the Veterans of Foreign Wars, American Legion, Disabled American Veterans, Iraq and Afghanistan Veterans of America, and the dozens of other national agencies that work with and for U.S. veterans. After all, collaboration among large veteran organizations was what finally led to the passage of a Bonus Bill in 1936.

I will conclude by saying this is not just an issue for U.S. veterans, it is an issue for society as a whole and in particular, social workers. Especially social workers who work within the U.S. Department of Veterans Affairs. Every U.S. citizen has benefited from the passage of the Bonus Bill and the GI Bill that followed; evident in the rise of the middle class during the 1950’s from millions of veterans going to college and buying homes. When U.S. veterans are adequately cared for, everyone wins. If social workers are called to “draw on their knowledge, values, and skills to help people in need and to address social problems” (National Association of Social Workers Code of Ethics, 2013), then social workers should not only help carry on the B.E.F. legacy, they should be using their knowledge, values, skills, and privilege as professionals; to lead such an effort from the front.

References:

Dickson, P. & Allen T. B. (2004). The bonus army: an American epic. New York, NY: Walker.

Iraq and Afghanistan Veterans of America. (2013). The wait we carry.  Web.  Retrieved Nov 26 2013 from http://thewaitwecarry.org/.

Martinez, M. & Couwels, J. (2013). Obama says backlog reduced in veterans’ disability claims. CNN. Cable News Network, 10 Aug. 2013. Web.  Retrieved Nov 26, 2013 from .

National Association of Social Workers Code of Ethics. (2013). (n.d.)

United States Department of Veterans Affairs. (2013). Veterans services. n.d. Web. Retrieved Nov 26, 2013 from .

VA Social Work. (2013). United States Department of Veterans Affairs. 2012. Web. Retrieved Dec 9, 2013 from .

Serving Our Veterans: Micro vs Macro (Part 3 of 4)

Part one of this series analyzed the impact of the Bonus Army, and part two looked at the survival of the Private vs. Public argument when providing services to those who fight our nation’s wars. In this third installment, I will be analyzing micro vs macro an even greater tension that has persisted from the Depression to present day, and it still continues to influence our effectiveness at serving our veterans.

Bronfenbrenn-system-bigSocial work as a field is constantly living within the Micro vs. Macro tension, as were the Bonus Army veterans also known as the Bonus Expeditionary Force (B.E.F.). At the most basic micro level, social workers aim to assist individuals in need. At the macro level, social workers aim to change policy and environmental conditions that support social change and afford individuals some level of security and autonomy. All along the way, we can observe tension among individuals and agencies, who place a higher priority on one or the other.

In the Anacostia Flats during the summer of 1932, there were certainly veterans of the B.E.F. who were there for their own personal motives, operating from a micro perspective. There were also veterans among them, who were motivated by a macro perspective, hoping to effect change for the entire veteran population. Life in Anacostia for these WWI veterans during the Bonus March had its own Micro vs. Macro tensions as a result.

During the same time veterans of the B.E.F. were impacting macro level change; the field of social work was taking a similar approach. Throughout the 1920’s and 1930’s social workers advocated for changes at the macro level, often taking the form of community organizing. Even the field of social work itself was founded in macro level approaches. Through Jane Addams’ Hull House and the settlement house concept of the late 1800’s, social work gained its foot hold as a profession by working with groups and communities, advocating for policy change, and even Addams herself was a political leader.  After a few decades however, the field of social work began to shift more toward micro level perspectives.

As time progressed and our society continued to challenge the status quo at the macro level, social workers by and large became distracted at the micro level. This change was largely fueled by an increase in Freudian ideology, which brought social workers out of the community and into their offices as individual counselors and case workers. With social work changing its focus to the micro level practice of diagnosing and counseling individual clients, the field had much less workers on the macro scale advocating for public services and had very little stake in the changing political climate of the 1960’s and 1970’s as a result. Only within the past decade or two has social work begun to step back into the macro level as a viable agent. So we observe this Micro vs. Macro tension shifting among social work over time.

As Bertha Reynolds (1935) pointed out, “social case work rather finds its function in dealing with difficulties in the relationship between individuals or groups and their physical or social environment”. Her observation, which was made during the same period as the events of the Bonus Army, was true before these events and is still true to this day. The tension between Micro vs. Macro is likely to continue to persist.

What can we learn from this? If these tensions will persist indefinitely, what’s the point? I would argue that by acknowledging the existence of these tensions, we are more apt to finding better solutions that will help us be more effective at serving our veterans for the long haul. So what are the implications of these tensions in how the U.S. government addresses it’s military veterans now? What can we do better? Stay tuned for the final segment of this series to find out.

References:

Addams, J. (1893). The objective value of a social settlement. Philanthropy and social progress (pp. 27-40). New York: Thomas Y. Cromwell.

Andrews, J. & Reisch, M. (1997). Social work and anti- communism: A historical analysis of the McCarthy era. Journal of Progressive Human Services, 8, 29-49.

Fisher, R. & Karger, H.J. (1997). Macro practice: Putting social change and public life back into social work practice. In Social work and community in a private world: Getting out in public (pp. 117-147). New York: Longman.

Perlman, H.H.(1957). Freud’s contribution to social welfare. Social Service Review, 31, 2, 192-202

Reynolds, B.C. (1935). Whom do social workers serve? Social Work Today, 2, 6, 5-8.

Seigfried, C.H. (2009). The courage of one’s convictions or the convictions of one’s courage: Jane Addams’ principled compromises. In M. Fischer, D. Nackenoff, & W. Chmielewski (Eds.). Jane Addams and the practice of democracy. University of Illinois Press.

Waters, W.W. & White, W.C. (1933). B.E.F.: the whole story of the bonus army. Mass violence in America. (1969). New York, NY: Arno Press & The New York Times.

Serving Our Veterans: Public vs Private (Part 2 of 4)

Part one of this series analyzed the history of the Bonus Expeditionary Force (BEF) and their actions during the Great Depression, and how its influence dramatically affected how the US government treated its brave men and women that go to war. In this second installment, I will take a  look at a key tension that has persisted from the days of the BEF up until our modern era. It is important to consider the historical context of these tensions when attempting to understand how we serve our nations military veterans.

Public vs Private
Public vs Private

The Public vs Private tension continues to work its way into social welfare discourse in the 21st century, but during the 1930’s it was just as rampant. In regard to social work, public represents services administered by a public agency, while private represents services provided through private charities, individuals, and groups. Previous to the Great Depression, by and large the aid and relief services were provided by private charities and local governments. Once the Great Depression hit, these private agencies were stressed to serve the needs of the millions who were suffering and starving; many of the available services at the time could not even shelter the homeless or feed the hungry.

Before the 1930’s and the Great Depression, issues like poverty and unemployment were primarily viewed as problems with the individual, rather than problems with the environment that individual lived within. Through that perspective, the common approach of the time was to address individual problems through private charity. With millions beginning to suffer from the Great Depression, the perception of social welfare began to shift. More people started to see that issues surrounding poverty had to be elevated to a public issue rather than maintain the narrow scope of a private or individual issue.

During this paradigm shift, it became evident to social workers and policy makers that the rising needs brought on by the Great Depression could only be addressed by public agencies . “Voluntary charity simply could not cope with the situation; only public agencies could deal with the collapse of the economy, mass unemployment, and widespread destitution”(Trattner, 1999) . As a result of this change in perspective, we created the U.S. Social Security Act of 1935, among several other programs. Public assistance worked its way into social policy and between 1929-1940 the number of persons on assistance or work- relief programs rose from less than a million to 9 million.

This tension between Public vs Private assistance took time to play out, and it had a direct impact on the wait time that veterans in the 1930’s seeking their Bonus had to endure. This was due to the observable conflict among political powers during the Bonus March era. President Hoover was adamant that assistance to the needy had no place for the public sector for a variety of reasons: “[f]or him, relief was a moral, not merely an economic, matter; private charity (such as he had distributed in war-ravaged Europe) was fine, but public aid, especially from national government, was a ‘dole’” (Trattner, 1999). As a result of these conflicts, it created several barriers to passing legislation that supported public assistance.

Subsequently, although the Great Depression proved that public agencies were the only group capable of providing adequate aid to those in need, tension existed and continues to this day. Unfortunately, the veterans of the Bonus Expeditionary Force just happened to be caught in the middle of all of it. Present day, those who are in need of services, including veterans, get caught in tension between the power sources who advocate for Public vs Private assistance.

In the next two parts of this series, I will be analyzing Micro vs. Macro and the long term implications of these paradigm shifts. Please stay tuned.

References:

Fisher, J. (1980). Social Work: The thirties as a watershed. In J. Fisher, The response of social work to the Depression (pp. 233-241). Boston, MA: G.K. Hall & Co.

Gordon, L. (1992). Social insurance and public assistance: The influence of gender in welfare thought in the United States, 1890-1935. American Historical Review 97, 19-54.

Trattner, W.I. (1999). Depression and a New Deal. In W. I. Trattner, From poor law to welfare state: A history of social welfare in America (6th ed.) (pp. 273-303). New York: Free Press.

Serving Our Veterans: WWI vets set the stage (1 of 4 Part Series)

World War I Memorial
World War I Memorial

As humans evolve, there is the expectation that we will function on a higher plane with each cycle of evolution. Learning from past mistakes and failures, it is expected this new knowledge will assist future generations in better preparation. When the United States entered the first World War, we were not prepared to handle the needs of veterans upon their return. Since then, our country has continued to amass the greatest arsenal of weaponry on the planet, and no other country’s military rivals that of the United States.

But, what did we learn about the treatment of our veterans and their families once they returned home, and did we make equilateral adjustments in how our country treats those who go to war? Over the course of a four-part series, I will be discussing the treatment of veterans returning home from war, but I think its imperative for me to begin with the past. Have we made the same strides in making improvements or is history repeating itself?

When the Great Depression set in, millions of people found themselves without food, shelter, work, and little hope for a change in circumstances. This was particularly troubling for many of the four million veterans that recently returned home from the First World War. Many were frustrated that the men who stayed home during the war had gained better and more secure career opportunities, which they missed during the time they were gone, fighting in Europe.

Having lost out on these opportunities, hundreds of thousands of veterans were suffering from unemployment, homelessness, and sometimes even starvation. For most of these veterans, the potential of a Bonus check was their only chance of obtaining enough capital to pull themselves out of poverty and have a chance at a bright future.

The Adjusted Compensation Act of 1924 put into law that veterans would be compensated, but not until they died or until 1945, whichever came first. Due to this stipulation, it became known as the Tombstone Bonus. During the peak of the Depression, the U.S. had millions of veterans that held certificates they were unable to cash in. Attempts to pass legislation to award veterans an early compensation occurred multiple times over the course of a decade, with no results. Veterans around the country were rife with frustration and desperation, which culminated in the formation of the Bonus Army.

A veteran of World War I from Portland, Oregon, by the name of Walter Waters, managed to rally a few hundred veterans to march on D.C. and demand action. The veterans of this collective effort called themselves the Bonus Expeditionary Force (B.E.F.). As they traveled across the country via train, veterans all along the way joined them. News media from around the country were covering the B.E.F. and the U.S. government began making secret preparations to deal with a possible threat of civil unrest. As the B.E.F. arrived in the U.S. capital in the summer of 1932, they numbered in estimates between 25,000- 45,000 veterans and family members.

The B.E.F. quickly established camps to shelter the veterans and their families as well as organized many community mechanisms to keep it running smoothly such as lobbyists flooding the capitol buildings daily, camp enforcement to weed out Communist agents and covert U.S. military intelligence officers, libraries by the Salvation Army, entertainment, and other necessities. The main camp was at Anacostia Flats, which has been noted for pioneering integration and unification of multiple races in a time when racial segregation was still the norm.

Groups of veterans in these camps were not formed by race, but rather upon which states they traveled from, so it was common for groups to be multi-racial. As James O. Horton notes in the PBS Home Video, The March of The Bonus Army, “Military experience has the potential for transcending things like race… and for black veterans to be in company with white veterans was a revolutionary thing”.

Roy Wilkins, an African American writer associated with the NAACP, visited Anacostia Flats and observed, “Men and women can live, eat, play and work together be they black or white, just as the B.E.F. demonstrated. Countless thousands of people know it, but they go on pretending, building their paper fences and their cardboard arguments”. Ahead of their time, the B.E.F. was unwittingly empowering the civil rights movement. To this diverse group of veterans at the height of the Depression however, the main concern was their own livelihoods.

Within two weeks of occupying the capitol, the House managed to pass a Bonus Bill, which went on to be defeated in the Senate. Distraught Waters, Commander of the B.E.F., tried to encourage the veterans to stay in D.C. until democracy worked for them. As the days passed, the U.S. government became increasingly worried and agitated with the B.E.F. presence. President Hoover grew weary and considered having the federal government step in to evict the veterans from their encampments.

Soon, at the leadership of General Douglas MacArthur along with two other notable officers under his command, Major Dwight Eisenhower and George S. Patton, the U.S. military moved in to disperse the veterans. Armed with tanks, tear gas, cavalry, machine guns, and several companies of infantry, the U.S. military cleared the veterans out of their camps and set their shanty buildings on fire. At the end of the day, “two veterans had been shot to death, an eleven-week old baby had died, an eight year old boy was partially blinded by gas, two police had fractured skulls, and a thousand veterans were injured by gas”. The physical presence of the Bonus Expeditionary Force was removed from Washington, but their legacy would live on.

Three years later, on November 10th, 1935, officers of the Veterans of Foreign Wars and American Legion made a pact to continue fighting for an early Bonus and they quickly brought the Disabled American Veterans into the coalition. This was the first time since the war that all three groups would work together to effect legislature and by the end of January, 1936, after congress over-rode Roosevelt’s veto, a Bonus Bill was finally passed.

Between the eviction of the B.E.F. in 1932 and the passage of the Bonus Bill in 1936, a very sobering event occurred, which may have influenced congress changing their views toward veterans and the Bonus. Many Bonus March veterans were shipped to Federal Emergency Relief Administration camps in the Florida Keys to build a bridge that connected the Keys. They were caught in one of the worst hurricanes on record in 1935 that killed many of them. As the government tried to cover up the event, Ernest Hemmingway, a veteran himself, traveled to the Keys and wrote some scathing words that blamed the government for the deaths of these veterans, claiming they were sent to Florida to keep them out of Washington.

With this hurricane event on the minds of members of congress, the attitude toward awarding a Bonus early was finally accepted by the majority. The legacy of the B.E.F. continued on to 1944 as well, when Roosevelt signed into law the GI Bill of Rights, which paid college tuition for millions of veterans around the country and is believed by many to be a huge contributing factor to the economic boom of the second half of the 20th century. Not only did the GI Bill pay for tuition, it helped finance 11 million of the 13 million homes that were built in the 1950’s. What is now known as “the Greatest Generation” is a direct result of the efforts of the veterans of the B.E.F. and their legendary Bonus March.

As we can see, the Bonus Expeditionary Force moved mountains in creating policy that serves military veterans, the economic development of our country, and was even ahead of its time in relation to social rights issues and race tensions. In my next article, I will analyze the struggles and achievements of the B.E.F. in the context of key tensions and future implications in modern-day society.

References:

Daniels, R. (1971). The bonus march: an episode of the great depression. Westport, Connecticut: Greenwood.

Dickson, P. & Allen T. B. (2004). The bonus army: an American epic. New York, NY: Walker.

Public Broadcasting Service. (2006). PBS Home Video. The march of the bonus army. Washington D.C.: New Voyage.

Schram, M. (2008). Vets under siege: how America deceives and dishonors those who fight our battles. New York, NY: St. Martin’s Press.

Waters, W.W. & White, W.C. (1933). B.E.F.: the whole story of the bonus army. Mass violence in America. (1969). New York, NY: Arno Press & The New York Times.

Zinn, H. (1999). A people’s history of the United States. New York, NY: HarperCollins.

Congresswoman Tammy Duckworth (D-IL) Stands Up to Misguided IRS Contractor

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by Logan Keziah

Tammy Duckworth’s election in 2012 was a victory for all disabled veterans. Not only did they get a representative in congress who would fight for them to get the benefits they deserve, but one who actually understands where they are coming from. Today, I got an email from, Upworthy, with an amazing video of Congresswoman Duckworth this past Wednesday giving  IRS contractor, Braulio Castillo, a piece of her mind. Castillo never actually served in the military, but he had injured his ankle playing football in prep school and uses it to get preferred treatment in government contracts.

Congresswoman Tammy Duckworth is the representative for Illinois’s 8th congressional district. She is the first Asian-American woman elected to Congress in Illinois, the first disabled woman to be elected to the U.S. House of Representatives, and she is the first member of Congress born in Thailand. She lost both of her legs in combat and severely injured one of her arms.

My father is a retired US Navy sailor on disability, and on behalf of him, and every other individual who sacrificed and continues to sacrifice for the safety and security of all Americans, thank you Representative Duckworth for standing up for disabled veterans, in this instance, and in all others.

[youtube]http://www.youtube.com/watch?v=Jr1kwC0je1Y[/youtube]

Addressing Sexual Assault in the Military

Sad young military soldier saying goodbye to sad wife at home indoors

The U.S. military finds itself in the crosshairs of angry congressional members and a dismayed public amid media reports that a female soldier in combat zones is more likely to be raped by a fellow soldier than killed by enemy fire. Unwelcome headlines report on one high-level sexual assault allegation after another in the armed forces. Perhaps most embarrassing is the recent arrest of the leader of the Air Force’s Sexual Assault Prevention and Response unit on a sexual battery charge in Arlington, VA.

A perfect storm of high profile accusations has coincided with the release of a Pentagon report showing a six percent increase in reported assaults from 2011 to 2012 and the revelation that the number of reports of “unwanted sexual contact” jumped from 19,300 in 2010 to 26,000 in 2012.

All of this unwanted publicity was preceded by the release of the Academy-Award nominated documentary, The Invisible War. The movie is a searing indictment of the systemic cover-up of military sex crimes, substantiated by interviews with rape survivors themselves.

Victims of sexual assault in the civilian world can turn to the police force and the judicial system for help and justice; rape victims in the military must turn to their commanders, who are often a friend of the rapist or the rapist himself. In addition, military leaders are allowed to overturn convictions without explanation. Little wonder that so few victims actually come forward to risk their careers or that only eight percent of military sexual assault cases are ever prosecuted.

Senate Majority Leader Harry Reid was “terribly disappointed” as the rise in sexual assaults came to light and indicated that Congress needs to move forward with legislative proposals to curb the trend and push to change how military commanders handle accusations of abuse.

Sexual Assault Every 2 MinutesUltimately, stamping out sexual abuse cannot be addressed by handling each incident in isolation; it must be part of how military leaders choose to treat women — the most common victims of sexual assault, though one percent of men in the military (20,000 in 2009) were sexually assaulted. Martin Dempsey, chair of the Joint Chiefs of Staff, suggests that “when you have one part of the population that’s designated as warriors and another part of the population that’s designated as something else, this disparity begins to establish a psychology” that contributes to the problem. In other words, keeping women out of formal combat roles has, perhaps, contributed to a culture in which sexual assault is permissible, minimized, or covered up. Dempsey suggests that “the more we treat people equally, the more likely they are to treat each other equally.”

Meanwhile, thousands of victims are trying to go on with their lives, whether they have reported their assault or not. Depending on the nature of the assault, survivors may be vulnerable to post-traumatic stress disorder (PTSD). Social workers, whether working on military installations or in the community, can be a key source of emotional support and recovery for victims whose personal reality may be overshadowed by the charged political atmosphere that such news creates.

Sexual assault victims can benefit most from extensive emotional support to process what has happened to them. Cognitive therapy is one modality that helps survivors’ intense feelings of anger, betrayal, disgust, shame, guilt, humiliation, anxiety, and confusion. The social worker/therapist can help the client identify and modify “stuck points” by unraveling and challenging faulty thinking patterns. They can help a client learn to cope with distressing emotions, similar to the use of cognitive therapy to treat depression.

In response to previous allegations, the Department of Defense (DoD) some time ago established a Sexual Assault Prevention and Response Program (SAPRO) to help provide victims with accurate information, prompt medical care, counseling, and assistance with the military justice system. Recent bad publicity may have shaken the confidence of soldiers that they will receive meaningful support and justice.

Nevertheless, DoD’s Safe Helpline provides worldwide live, confidential support 24/7 online and at 877-955-5247. DoD has also launched an Active Bystander program, modeled after the University of New Hampshire’s “Bringing in the Bystander” program. It encourages fellow soldiers to take the initiative to help someone targeted for sexual assault and to restrain friends who may be talking about assaulting someone, particularly if they’re had too much to drink.

In Remembrance of Those Who Lost Their Lives: Honoring Memorial Day

By Deona Hooper, MSW

cbs-memorial-day-dlMemorial Day Weekend has morphed into many meanings over the years. For some, it’s the time of year when you have the biggest sales to start summer. For others, it’s booking the first family vacation to celebrate the warm weather. For those who have lost husbands, wives, sons, and daughters while serving our country in times of war, it’s a day of remembrance and mourning for their loved ones. We say Happy Memorial Day, but is it suppose to be a happy day if it is being celebrated as it was originally intended?

It is estimated that over 190,000 soldiers lost their lives during the past ten years of the Iraq War. Some families will never know what happened to their loved one other than he/she went to go serve their country to protect our freedoms, and they never came back home. I also believe that it is important to spend time with our friends and family on this Memorial Day, but I also believe that we should have a moment of silence for those who protect us and our freedoms.

Memorial Day Prayer:

Eternal God,
Creator of years, of centuries,
Lord of whatever is beyond time,
Maker of all species and master of all history —
How shall we speak to you
from our smallness and inconsequence?
Except that you have called us to worship you
in spirit and in truth;
You have dignified us with loves and loyalties;
You have lifted us up with your loving kindnesses.
Therefore we are bold to come before you without groveling
[though we sometimes feel that low]
and without fear
[though we are often anxious].
We sing with spirit and pray with courage
because you have dignified us;
You have redeemed us from the aimlessness
of things’ going meaninglessly well.
God, lift the hearts of those
for whom this holiday is not just diversion,
but painful memory and continued deprivation.
Bless those whose dear ones have died
needlessly, wastefully [as it seems]
in accident or misadventure.
We remember with compassion those who have died
serving their countries
in the futility of combat.
There is none of us but must come to bereavement and separation,
when all the answers we are offered
fail the question death asks of each of us.
We believe that you will provide for us
as others have been provided with the fulfillment of
“Blessed are those who mourn, for they shall be comforted.”  ~ US Memorial Day Prayer by Rev. Dick  Kozelka

Photo Credit: lasvegas.cbslocal.com

Interview with Dr. Allen Frances on the DSM 5

Approximately a week ago, I wrote an article asking Will Clinical Social Workers Embrace the New DSM 5 in light of the National Institute of Mental Health withdrawing its support for the publication. Then, Dr. Allen Francis wrote an article making a case for social workers not to embrace the DSM 5.

Responses by social workers on different social media outlets varied, but one unifying question remained….Why now? Historically, social workers have not been included in the developmental process of the DSM by the American Psychiatric Association (M.D.’s) despite being the largest provider of mental health services. I decided to email Dr. Frances and asked if he was available to answer some follow-up questions about his article on social workers.

He responded, “Sure…Let’s have a telephone call today. The week is very busy”.  Dr. Frances spoke with me for almost a hour in order to help me relay the likely long term implications of the DSM V and why social workers being the largest stakeholders should be concerned too. This article is packed with resources because I independently verified every statement made by Dr. Frances in order for you to make your own assessment.

Before I dive into the interview with Dr. Frances, I would like to bring you up to speed with some background information on this not so new controversy.

What makes Dr. Allen Frances an authority on the DSM?

Dr. Allen Frances was chair for the DSM IV task force and the Department of Psychiatry at the Duke University School of Medicine, and he is currently a professor emeritus at Duke University. In late 2010, Dr. Frances did an in depth interview with Wired Magazine who had unlimited access to him as he reflected on almost two decades in the past when he authored the DSM IV. Here is an excerpt from Wired Magazine:

In its first official response to Frances, the APA diagnosed him with “pride of authorship” and pointed out that his royalty payments would end once the new edition was published—a fact that “should be considered when evaluating his critique and its timing.”

Frances, who claims he doesn’t care about the royalties (which amount, he says, to just 10 grand a year), also claims not to mind if the APA cites his faults. He just wishes they’d go after the right ones—the serious errors in the DSM-IV. “We made mistakes that had terrible consequences,” he says. Diagnoses of autism, attention-deficit hyperactivity disorder, and bipolar disorder skyrocketed, and Frances thinks his manual inadvertently facilitated these epidemics—and, in the bargain, fostered an increasing tendency to chalk up life’s difficulties to mental illness and then treat them with psychiatric drugs.  Read Full Article

The article in Wired Magazine was indeed an eye opener. It discusses how an influential advocate for diagnosing children with bipolar disorder failed to disclose money received from the makers of the bipolar drug Resperdal. When viewed with a wider lens, it not really all that surprising considering the recent revelations on Attention Deficit Disorder as discussed in the New York Times.

History of Social Work Involvement with DSM

Back to the interview with Dr. Allen Frances, the first order of business was to gain some insight on the sudden outreach to the social work profession, and I didn’t anticipate learning something new. However, this was not the case.

Dr. Frances went on to tell me about Social Worker Janet B. Williams who was the text editor on the DSM III. Additionally, he also notes that she has been the only social worker ever to be included in the DSM development process. Currently, Janet Williams is the Vice President of Global Science at MedAvante. As stated in a 2011 PRNewswire Press Release, “MedAvante solutions help sponsors achieve enhanced assay sensitivity for increased drug effect and reduced trial failure rates, enabling them to bring better drugs to market faster.”

Dr. Frances acknowledged that social workers have not been represented in the development process despite being the largest provider of mental health services. However, he did state, “Social Workers have a huge stake in improving care for the really sick and should not be distracted by the expansions of the DSM V.”

DSM 5 Impact on Consumers 

Dr. Frances expressed concerns for military service men and women being overly diagnosed with PTSD in lieu of allowing time for transitional services. Dr. Frances gives another example of how unemployment causes depression which is the result of environmental factors and not a mental illness.

Once someone regains employment and the situational stressors have abated, should this individual retain the label of a psychiatric disorder for seeking counseling as a coping mechanism? Do practitioners really want to label someone as a major depressive because they are unemployed or have been diagnosed with Cancer? Here is a video where Dr. Frances goes more in depth on the potential problems this will cause:

[youtube]http://www.youtube.com/watch?v=-AMvrcBvYWk[/youtube]

Unintended Consequences of DSM V

Dr. Frances stated one of the major issues with the DSM series is that its primary authors are research academics who are making suggestions and recommendations based on controlled research studies conducted in University clinics which are not helpful in everyday practice. By expanding the DSM 5 to cover challenges of everyday living, it will mislabel medical illness as a psychiatric disorder.

Dr. Frances also stated it will continue to foster an environment that diverts attention and resources away from the severely mentally ill and uninsured. As an example, Dr. Frances referenced the 1 million inmates in prison as a result of an undiagnosed and untreated mental health disorders due to poor resources and health care. Apparently, the Bureau of Justice Statistics agrees with him, and you can view their report here.

Dr. Frances quotes President Obama when he stated, “It’s easier to get a gun than an outpatient appointment.” Although gun control was not apart of our discussion, it should be noted that the National Rifle Association (NRA) is using its powerful lobbying efforts to change mental health thresholds and reporting laws in all 50 states.

Couple this type of legislation with over diagnosis by mental health professionals, the outcomes for children and families could be devastating. The New York Times does a great job of summarizing the presenting issues with current NRA proposals in an article entitled, The Focus on Mental Health Laws to Curb Violence is Unfair, Some Say. You can also view this video of Dr. Allen Frances speaking on the over diagnosis of mental illness:

[youtube]http://www.youtube.com/watch?v=yuCwVnzSjWA[/youtube]

Common Misconceptions About the DSM V

The interview with Dr. Allen Frances gave me an opportunity to ask him for clarification on some of the concerns expressed by social workers and their reasons for embracing the anticipated DSM 5. I made of a list of the main key points that he wanted Social Workers to know:

  • The DSM is a copyrighted manual by the APA with no official authority with public or private health insurers.
  • The ICD Codes are the only required codes necessary for billing mental health services. He states these codes are free of charge from the government with accompany resources and guides available. Here is the link found on CMS.Gov.
  • The APA is motivated by earnings for publishing a new manual to cover budgetary shortfalls.
  • Unless your institution demands use of the DSM V, Don’t buy it, don’t use it, and don’t teach it.

“The ICD is the global standard in diagnostic classification for health reporting and clinical applications for all medical diagnoses, including mental health and behavioral disorders. The United States will be one of the last industrialized countries to adopt the ICD-10, even though it was published in 1990.

Every member state of the World Health Assembly is expected to report morbidity and mortality statistics to the World Health Organization (WHO) using the ICD codes, but countries are allowed to modify the ICD for use within their own country.” ~Practice Central

Dr. Frances provided his twitter feed where he disseminates information on his current projects. He also stated to tweet your questions, comments, and concerns to @AllenFrancesMD as seen above.

Recommendations

Dr. Frances states that he believes there should be a government arm similar to the FDA to help regulate, provide guidance for mental health providers, and make recommendations for public policy. He believes it should be comprised of an interdisciplinary team of psychiatry, social workers, and public health in order to create a holistic approach to treatment and diagnoses. Dr. Frances stated the APA should no longer have a monopoly on mental health especially with increasing influence from drug companies manifesting in their policies.

Also View:
Dr. Francis Op-ED in the New York Post
Don’t Buy it, Don’t Use it~Mother Jones
Find Him on Huffington Post

PTSD In Veterans and the Use of MDMA (Ecstasy) for Treatment

by Deona Hooper, MSW

Join us on 12/17/2012 at 8PM EST using the hashtag #SWUnited to discuss PTSD in Veterans, barriers to receiving services, and the use of MDMA (Ecstasy) for the treatment of PTSD. We will be joined by Laura Reed Goodson who has MA in Counseling and a MA in English from the University of North Carolina at Charlotte. Laura grew up Navy, and she has led writing workshops for veterans for the past 24 years. She has worked as an unpaid civilian advocate for combat veterans since 2006. Laura has also worked as a grief counselor for children during her counseling internship in 2011 and is currently working towards setting up a private practice. Laura will be bringing her expertise on PTSD, MST, grief/loss issues, and brain injury as they affect vets and their family members. Her twitter handle: @reedtome.

In the mid 1980’s, MDMA was banned in the United States despite being widely used as a therapeutic aid. Phil Donahue was the first to bring MDMA to the public for a national debate. This debate has been renewed in the wake of our active military and veterans returning home after being apart of America’s 10 year war in the Middle East. Marsha Rosebaum & Rick Doblin have also been doing research in this area to provide a different perspective and argument for the decriminalization of MDMA.

[youtube]http://www.youtube.com/watch?v=cnmRj43ikUk[/youtube]

Here is an excerpt of their research:

The most recent “recreational” drug to be made illegal is MDMA, or “ecstasy.”[1] Its criminalization never should have happened. MDMA had a beneficial therapeutic use prior to scheduling. Hundreds of therapists and psychiatrists used MDMAassisted psychotherapy with thousands of patients suffering from terminal illness, trauma, marital difficulties, drug addiction, phobias, and other disorders. MDMA was also used outside of therapeutic circles. With many anecdotal claims of benefits, users showed little evidence of problematic physiological or psychological reactions or addiction.

Scheduling and the attendant media attention on the controversial public hearings created an expanded market. But the scheduling process was fraught with problems, with the Drug Enforcement Administration’s emergency scheduling itself declared illegal by the courts and its scheduling criteria overturned. Ultimately, criminalization had little deterrent effect on the recreational user population while substantially reducing its therapeutic use. Perhaps the most profound effect of MDMA’s illegality has been the curtailment of scientific research and experimentation with a drug that held therapeutic potential.

The information to be presented here is taken from a recently completed NIDA-funded study of MDMA conducted by the lead author.[2] Using a qualitative methodology, this was an exploratory study in which 100 MDMA users were interviewed in depth between 1987 and 1989.[3] The second author was involved in the scheduling process and had done physiological research on MDMA.

This chapter begins with a short history of MDMA’s use and the scheduling process. Ultimately, it presents an argument critical of criminalization. Read More

***Update***

Here are a few interesting tweets from our guest expert Laura Reed Goodson.

View the full archived discussion at http://storify.com/SWUnited/ptsd-in-veterans-and-barriers-to-access-services-l

***End Update***

Resources:
Vets Get Ecstasy to Treat Their PTSD
Multidisciplinary Association of Psychedelic Studies
Veterans Mental Health Resources

Photo Credit: iraqsolidaritycampaign.blogspot.com

Serving Our Active Military and Veterans

Join us on November 12, 2012 at 8PM EST featuring guest panelist Tess Banko, BSW. Tess is a Social Worker, Marine Corps veteran and active-duty spouse currently living in Stafford, Virginia. She has worked actively with student veteran groups in San Diego, and within the larger veterans community in areas such as veterans transition, homelessness, and military sexual trauma.

Tess served as the First Vice Chair of the United Veterans Council from 2010-2011 and was named a 2012 Friend of San Diego Pride for her advocacy work surrounding the repeal of ‘Don’t Ask Don’t Tell’. She is currently completing her master’s degree thesis, “Social Work Students, Self-Care, Compassion Fatigue, and Burnout” at San Diego State University. Tess is interested in PTS/COS, its prevention and treatment; and recently completed Level 1 of Trauma Resiliency training with the Trauma Resource Institute. Tess will be using the twitter handle @tessitheterribl.

After two wars, our military men and women are returning home. Recently, Dr. Jill Biden spoke at the National Association of Social Workers National Hope Conference on aiding our active military personnel and veterans.  Dr. Biden and First Lady, Michelle Obama, has worked on the Wounded Warrior Project to assist our men and women returning home to transition into peace time.  View her speech here:

Dr Jill Biden speaks at NASW's 2012 National Hope Conference

Our chat turned up some interesting discoveries. Here are a few of the tweets:

View full archive of chat at

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