Handbook of Military Social Work E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Geisteswissenschaft
• Sprache: Englisch
• Veröffentlichungsjahr: 2012

Seitenzahl: 1309

Beschreibung

The need has never been more crucial for community health providers, programs, and organizations to have access to training in addressing the unique behavioral health challenges facing our veterans, active duty military, and their families. Handbook of Military Social Work is edited by renowned leaders in the field, with contributions from social work professionals drawing from their wealth of experience working with veterans, active duty military, and their families. Handbook of Military Social Work considers: * Military culture and diversity * Women in the military * Posttraumatic stress disorder in veterans * Traumatic brain injury in the military * Suicide in the military * Homelessness among veterans * Cycles of deployment and family well-being * Grief, loss, and bereavement in military families * Interventions for military children and youth Offering thoughtful advice covering the spectrum of issues encountered by mental health professionals working with individuals and families, Handbook of Military Social Work will contribute to the improvement of efforts to help our military personnel, veterans, and their families deal with the challenges they face.

Leseprobe

Contents

Foreword

Preface

Acknowledgments

Introduction: Understanding and Intervening With Military Personnel and Their Families: An Overview

About the Editors

About the Contributors

Part I: Foundations of Social Work With Service Members and Veterans

Chapter 1: A Brief History of Social Work With the Military and Veterans

World War I and Its Aftermath

World War II and Its Aftermath

The Korean War and the Start of the Vietnam War: 1950–1970

Conclusion

Chapter 2: Military Culture and Diversity

Introduction

Military Cultural Competence and Counseling

Military Culture: Values and Beliefs

Distinctive Characteristics of Military Culture

The Military as an Organization

Combat Readiness: Mission of the U.S. Military

Military Culture and Civilian Society

Conclusion

Chapter 3: Women in the Military

Introduction

Gender

Military-Related Sexual Harassment and Assault

Married Women in the Military

Menses and Pregnancy

Bisexual and Lesbian Service Members

Health in Women Veterans

Treatment Implications and Case Application

Conclusion

Chapter 4: Ethical Decision Making in Military Social Work

The Military Context as the Dominant Paradigm

Ethical Dilemma: Dual Loyalty Issues

Ethical Dilemma: Confidentiality and Privacy Issues

Ethical Dilemma: Hierarchy and Power Issues

Legal and Moral Contexts for Ethical Dilemmas

Models for Ethical Decision Making

Conclusion

Chapter 5: Secondary Trauma in Military Social Work

Defining Secondary Trauma and Related Terms

Assessing Secondary Trauma

Treating Secondary Trauma

Preventing Secondary Trauma: Policy, Organizational, and Personal Strategies

Conclusion

Part II: Interventions for the Behavioral Health Problems of Service Members and Veterans

Chapter 6: Posttraumatic Stress Disorder (PTSD) in Veterans

Introduction

Posttraumatic Stress: DSM Diagnostic Criteria

Psychosocial Models of Posttraumatic Stress

Conclusion

Chapter 7: The Neurobiology of PTSD and Cognitive Processing Therapy (CPT)

The Neurobiology of PTSD

PTSD as a Memory Disorder

The Amygdala and Prefrontal Cortex

Emotional Versus Episodic Memory

Memory Consolidation and Reconsolidation

PTSD-Related Psychotherapies

Cognitive Processing Therapy (CPT)

Conclusion

Chapter 8: Treating Combat-Related PTSD With Virtual Reality Exposure Therapy

The Military Health Care Challenge

Introduction to Clinical Virtual Reality

Virtual Reality Exposure

Virtual Reality Exposure Therapy using Virtual Iraq/Afghanistan

Suggestions for the Use of Virtual Iraq/Afghanistan for VRE

Overview of VRE using Virtual Iraq/Afghanistan

Conclusion

Chapter 9: Psychopharmacology for PTSD and Co-Occurring Disorders

Introduction

Antidepressants

Benzodiazepines

Antipsychotics

Medication Adherence

Combining Psychotherapy and Medications

Managing Comorbid Medical and Psychiatric Issues

Gender Issues

Cases

Conclusion

Chapter 10: Traumatic Brain Injury (TBI) and the Military

Overview

Diagnostic Considerations and Severity

Moderate to Severe TBI in the Military

Treatment and Recovery Following Moderate to Severe TBI

Mild TBI in the Military

Additional MTBI Diagnostic Considerations

Treatment and Recovery Following MTBI

Co-Occurring Recovery Considerations

Conclusions and Future Considerations

Chapter 11: TBI and Social Work Practice

Contact

Problem Identification, Data Collection, and Assessment

Case Planning

Intervention

Evaluation

Termination

Conclusion

Chapter 12: Assessing, Preventing, and Treating Substance Use Disorders in Active Duty Military Settings

Prevention

Assessment

Armed Forces Treatment Programs

Two Empirically Supported Outpatient Treatment Approaches

An Ecosystem Perspective for Treating Veterans With Comorbid Substance Abuse Disorders and Other Disorders

The Role of the Chaplain

Conclusion

Chapter 13: Preventing and Intervening With Substance Use Disorders in Veterans

Co-Occurring Disorders

Prevention and Treatment Programs

Prevention for Active Duty Personnel

Transition to Veteran Status

Prevention Within the VA

Treatment at the VA and Other Programs

Continuing Care

Conclusion

Chapter 14: Suicide in the Military

Potential Military Suicide Risk Factors

Military Suicide Prevention Gaps

Building Resilience: Suicide Prevention in the Context of Total Force Fitness

Discussion

Conclusion

Part III: Veterans and Systems of Care

Chapter 15: Homelessness Among Veterans

Introduction

Causes and Prevalence of Veteran Homelessness

Housing and Urban Development VA-Supportive Housing (HUD-VASH) Program

Health Care for Homeless Veterans

Domiciliary Care for Homeless Veterans

Homeless Veterans Reintegration Program (HVRP)

Project Chaleng: The VA’s Community Network Intervention

New VA Programs Designed to Prevent Homelessness

Homeless Veterans Stand Down

Medication Compliance and Prognosis for Ending Homelessness

Outreach Considerations

Clinical Issues in Working With the Veteran Homeless Population: With an Emphasis on Social Worker Self-Care and Safety

Self-Care and Burnout Prevention

Cost Benefit of Psychosocial Support and Case Management

Conclusion

Chapter 16: Navigating Systems of Care

Introduction

Basic Eligibility and Enrollment

Priority Groups

Combat Veterans

Service-Connected Disabilities and Compensation

Operation Enduring Freedom/Iraqi Freedom/New Dawn Veterans

Vet Centers

Homeless Veterans Program

Military Sexual Trauma

Suicide Prevention

Transition Assistance

Women Veterans

Conclusion

Chapter 17: Transitioning Veterans into Civilian Life

Introduction

Transition

Disabled Transition Assistance

Wounded Service Members and Military Programs

Military to Civilian Transition

Factors Relating to Transition

Transitioning from Military to Higher Education

Educational Benefits

A Brief History of the GI Bill

Connecting to the Community

Transitioning into Civilian Employment

Female Veterans

Reintegration Skills Training

Conclusion

Part IV: Families Impacted by Military Service

Chapter 18: A Brief History of U.S. Military Families and the Role of Social Workers

The Revolutionary (1775–1783) and Civil War Eras (1861–1865)

World War I Era: (1914–1918)

Families and World War II Era: (1941–1945)

The Korean War Era: (1950–1953)

The Vietnam War: (1954–1975)

The Persian Gulf War: (August 1990–March 1991)

The Global War on Terror (2001–)

Conclusion

Chapter 19: Cycle of Deployment and Family Well-Being

Combat Stress

Deployment Stressors

Predeployment

Deployment/Sustainment

Redeployment/Postdeployment

Deployment impact on Military Families

Deployment impact on Spouses and Marital Relationships

Children impacted by Military Service

Child Abuse

Case Vignettes

Conclusion

Chapter 20: Supporting National Guard and Reserve Members and their Families

Portrait of Reservist Families

Interventions to Mitigate Deployment impact on Families

Conclusion

Chapter 21: The Exceptional Family Member Program: Helping Special Needs Children in Military Families

Introduction

Military and Disability Culture—Two Worlds

The Exceptional Family Member Program (EFMP)

Personnel Assignment

Civilian Services for EFMP Families

Family Support Services for EFMP Families—Military and Civilian

Conclusion

Chapter 22: Grief, Loss, and Bereavement in Military Families

Suicide Bereavement

Issues That Influence Suicide Bereavement

Survivors of a Military Suicide Loss and the Associated Complexities

Circumstances of the Death and Condition of Bodily Remains

Geography of the Death/Geography of the Survivor

Age of Decedents/Age of Survivors

Commitment to Service

Death Notification

The Immediate impact to Survivors

Secondary and Multiple Losses

Additional Challenges Facing Military Suicide Loss Survivors

Chapter 23: The Stress Process Model for Supporting Long-Term Family Caregiving

Introduction

Scope of the Issues

Who are the Caregivers of Military Service Members and Veterans Today?

What is the Stress Process Model?

Using the Stress Process Model to Guide Assessments of Caregivers of Wounded Warriors

Background and Context of Stress

Stressors

Mediators of Stress

Outcomes or Manifestations of Stress

Applying the Stress Process Model to Guide Assessments of Caregivers

Conclusion

Chapter 24: Family-Centered Programs and Interventions for Military Children and Youth

Background and Overview

Composition of Families in the Military

The impact of Military Culture on Families

Parental Separation and Deployment

The Family-Centered Approach

Programs, Interventions, and Resources

Conclusion

Chapter 25: Couple Therapy for Redeployed Military and Veteran Couples

Introduction

Rationale

Key Principles of Clinical Social Work Practice

Synthesis of Theory Models

Role of Gender

Phase-Oriented Couple Therapy With Military and Veteran Couples

Conclusion

Chapter 26: Theory and Practice With Military Couples and Families

Stressors

Theoretical Models

An Introduction to Veteran Injury and impact on the Family

Rationale for Family-Based Interventions

Assessment

Empirically Informed Therapies

Conclusion

Appendix: Veteran Organizations and Military Family Resources

Glossary of Military Terms

Author Index

Subject Index

Praise forHandbook of Military Social Work

“This is an important book for anyone interested in providing care for our recent veterans and their loved ones. It provides a sophisticated, thoughtful orientation for nonmilitary clinicians. The discussion of military culture and diversity is especially comprehensive and brings together concepts that clinicians need to understand if they are to provide the best possible treatment for our military and their families. I highly recommend it!”

—Judith Broder, MD, Founder/Director, The Soldiers Project

“This handbook is a vital work for social work students as well as practitioners who are or plan to be engaged with veterans and their families. The chapters’ authors represent a who’s who of leading researchers and practitioners as they delve into the wide range of challenges, strengths, and interventions that social workers need to learn about. The text is also built around the Council on Social Work Education (CSWE)’s 2008 Educational Policy and Accreditation Standards while reflecting an evidence-based approach to practice. All social workers should become familiar with this important work. Rubin, Weiss, and Coll call us to stand firmly by our professional and civic responsibilities to these warriors and their families. To do otherwise would be the social work profession’s shame.”

—Ira C. Colby, DSW, LCSW, Dean and Professor of Social Work, University of Houston

“Wow, this is an extremely comprehensive and easy-to-read handbook regarding all aspects of military social work. The authors and editors have done a fantastic job of covering military life from the perspective of the serving members, veterans, and their families. This handbook will be of use to students and to experienced practitioners.”

—Nicola T. Fear, PhD, Reader in Epidemiology, King’s Centre for Military Health Research, King’s College, London

“The editors of this handbook have literally written to meet Educational Policy and Accreditation Standards (EPAS) Core Competencies of the field of social work. The 26 chapters provide a comprehensive guide to understanding and helping within the military culture. This book fills a void in military social work and will become one of the most referenced handbooks of its kind.”

—Professor Charles R. Figley, PhD, Paul Henry Kurzweg Distinguished Chair in Disaster Mental Health at Tulane University and School of Social Work Professor and Associate Dean for Research

“This handbook is a comprehensive and invaluable resource. It has relevance for all health professionals helping service members and families impacted by recent military operations.”

—Colonel Rakesh Jetly, OMM, CO, MD, FRCPC, Psychiatrist and Mental Health Advisor to Surgeon General of Canada, Ottawa

“An excellent text that offers a lot of valuable information to social work students or professionals (especially nonveterans) who want to serve this population. Service members are a unique population because of their experience in war and the dramatic impact that can have on them and their families. An understanding of this culture is essential in order to provide them the services they need to reintegrate successfully.”

—Stephen Peck, MSW, USMC, Vietnam Veteran, President/CEO, United States Veterans Initiative

“This book is a superb collection that will inform, educate, and inspire both social work students and practitioners in their commitment to provide the very best services to service members and their families. The challenges facing military personnel and their families are daunting. This volume meets a critical need in the preparation of practitioners who will meet those needs in the target population. I endorse it most highly.”

—Julia M. Watkins, PhD, Executive Director Emerita, Council on Social Work Education, Alexandria, Virginia

Cover Design: Andrew Liefer

Cover Images; Backgound image: © Sava Alexandru/iStockphoto, Inset wheelchair image: © Mehmet Yunus Yesil/iStockphoto, Inset soldier image: © Daniel Bendjy/iStockphoto, Inset family counseling image: © Miodrag Gajic/iStockphoto, Inset father/daughter image: © Jason Swarr/iStockphoto, Inset family silhouette image: © kfotos/iStockphoto, Inset family image: © Blend Images/Alamy

Copyright © 2013 by John Wiley & Sons, Inc. All rights reserved.

Published by John Wiley & Sons, Inc., Hoboken, New Jersey.

Published simultaneously in Canada.

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Library of Congress Cataloging-in-Publication Data:

Handbook of military social work/edited by Allen Rubin, Eugenia L. Weiss, Jose E. Coll.

p. cm.

Includes bibliographical references and index.

ISBN 978-1-118-06783-3 (cloth)

ISBN 978-1-118-33094-4 (e-bk)

ISBN 978-1-118-33022-7 (e-bk)

ISBN 978-1-118-33305-1 (e-bk)

1. Military social work—United States—Handbooks, manuals, etc. 2. United States. Armed Forces—Mental health services—Handbooks, manuals, etc. I. Rubin, Allen. II. Weiss, Eugenia L. III. Coll, Jose E.

UH755.H36 2013

362.8—dc23

2012020185

This book is dedicated to our brave men and women service members, veterans, and their families, who have unselfishly sacrificed so much for us to enjoy the freedoms provided by this great nation, and to social work faculty members, practitioners, and students dedicated to supporting the heroes of our past, present, and future generations.

Foreword

It’s about time! Finally, a book has been written to inform community social workers and other behavioral health providers about military culture, challenges, and clinical practices for military personnel, veterans, and their families. This type of book has been missing from our classrooms and professional bookshelves and is long overdue.

The wars in Iraq and Afghanistan are now the longest-running wars in U.S. history. Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) are being fought with a small, all-volunteer military made up of less than 1% of the U.S. population. What motivates individuals to enlist? Many of the men and women who have been fighting these wars joined the military because they were inspired by a sense of patriotism or were continuing a family tradition of military service. Whatever the reason for joining, these individuals enter the ranks prepared to give their lives for their country. Nevertheless, they and their families have grown weary after a decade of war.

It is now apparent that the psychological and personal stress for service members, veterans, and their families is more prevalent and powerful than previously understood. The persistently high operational tempo, along with the development of invisible wounds and the challenges associated with reintegration, have clearly taken a toll. Evidence indicates that the key mental health issues affecting the approximately 2.4 million American troops deployed to Iraq and Afghanistan since 2001 are traumatic brain injury, posttraumatic stress disorder, substance abuse, depression, anxiety, marital discord, and suicide—and often these disorders overlap (Schell & Tanielian, 2011). As troops return from the war zones and contend with transitioning back into their communities, we expect to see an increase in these issues. This is a lesson we have learned all too well from the plight of Vietnam-era veterans. Health care workers and family members can be deceived by what seems to be a relatively smooth homecoming from deployment, and perceive that all is well among these service members. However, as the initial flush of homecoming fades and time stretches on, more and more people will come forward with their struggles. The influx of OEF/OIF/OND veterans into the U.S. mental health system has yet to peak, but it is clearly underway.

Many people are concerned that the mental health care system is not prepared to handle this inevitable wave of veterans. Recent reports indicate that there is a shortage of mental health professionals competent to meet the demands of those returning from war (Cameron, 2011). This is not from a lack of empathy or interest from the health care community. Although many civilian organizations and professionals are eager to work with service members and their families, the reality is that a cultural divide exists between military-impacted populations and their civilian counterparts—particularly regarding the warrior psyche and the experience of combat trauma. Civilian clinicians lack the means to fully comprehend these paradigms and the effect they have on the lives of service members and their families. As a result, military-impacted individuals, already reticent to seek services or mental health treatment, encounter well-meaning clinicians who are ill-prepared to accommodate them and their families with appropriate mental health and medical care, employment readjustment, training support, educational and financial guidance, and other critical services and transition supports.

The military, and the biopsychosocial challenges that arise from military involvement, have been a part of this country’s history since its inception. So how did this cultural divide persist within the health fields between military and civilian populations? One factor has been that services for military personnel and veterans have historically been strictly segregated from their civilian counterparts. Compounded with the specialized and selective nature of professional military training in the United States, these factors have produced a distinctive “military culture” that is poorly understood by civilians. Drawing from my own experiences as an enlisted member and officer of both the Army and Air Force for 25 years, and having experienced deployment, I believe that to be truly effective, behavioral health professionals working with the military and veteran population need to be able to connect in a manner that says, “I understand you.” If you do not connect with the military or veteran client during the first session, then he or she is not coming back.

Unfortunately, there has been little done within behavioral health education to increase the workforce supply in the area of military cultural competence and evidence-based treatment for this population. However, some steps have been taken in this direction with the Council of Social Work Education (CSWE) Task Force setting up educational and practice guidelines for a specialization in military social work. This task force was comprised of an array of military and veteran mental health experts who developed advance practice skills, behaviors and ethical conduct guidelines that define military social work today based on a set of core competencies that prepare professionals working with this population. (The Preface of this book links the CSWE approved core competencies for military social work to the chapters to which each competency pertains.) Additionally, the School of Social Work at the University of Southern California is one of the first to develop a military social work subconcentration (under the Master of Social Work), and includes curricula derived from the competencies and provides field training opportunities as well as a research center that is dedicated to studying military and veteran issues (and I am pleased to report that more and more of such educational, research, and training programs are coming to fruition around the country).

However, to fully address the behavioral health of military-impacted populations, the quality of care available, and the lack of qualified providers, there must be a concerted, coordinated effort between local, state, and federal agencies (as well as collaboration between educational institutions). We need to bring together a diverse set of resources, and ensure that access to these resources is not fragmented. We need to identify new opportunities in both the public and the private sectors that will support the range of services that this population needs. And we need to make sure that we lay a foundation that will last for many years to come—well beyond the wars in Iraq and Afghanistan.

The need for community behavioral health providers, programs and organizations to address the current and future behavioral health challenges facing our veterans and their families has never been more crucial. We need to increase our capacity to competently serve those who have so valiantly served us so that we can more effectively assist in the resolution of these hardships and in the restoration of human potential for veterans and their families. Our ability to meet these challenges will be enhanced by drawing from the valuable lessons in this timely and comprehensive handbook.

Anthony Hassan

REFERENCES

Cameron, P. (2011, July 20). Vets face shortage of therapists. Chicago Tribune. Retrieved from http://www.chicagotribune.com/health/ct-x-0720-vets-mental-health-20110720,0,66678.story

Schell T., & Tanielian, T. (Ed.). (2011). A needs assessment of New York State veterans. A final report to the New York State health foundation. Retrieved from http://www.rand.org/pubs/technical_reports/TR920.html

Preface

Allen Rubin

This book has been developed for use in the education and training of social work students and practitioners who are either currently or will in the future be working with our brave military personnel and their families. Social workers are uniquely poised to assist this population in dealing with the unprecedented and daunting challenges they face as active duty members, National Guard members, and reservists, or as veterans of today’s ongoing Global War on Terrorism.

The book is directed not only to those who will work as uniformed military social workers, but also to those who will work with this target population as civilian social workers. Indeed, the vast numbers of service members returning from the wars in Iraq and Afghanistan likely will exceed the capacity of the Department of Veteran Affairs and affiliated programs such as the Vet Centers to serve them all adequately. These clients will be seeking services within the civilian sector, such as in community mental health agencies, HMOs, and private practices. It no longer will suffice for civilian social workers to just refer veterans to the VA on the grounds that they (the civilian social workers) lack sufficient expertise with such cases. Thus, one objective of this book is to help civilian social workers gain the knowledge they need to better serve this population. This book also helps students gain such expertise, including those students aspiring to become uniformed military social workers as well as those who—as civilian social workers—will be better prepared to work with active duty service members, National Guard and Reserve personnel, and veterans and their families.

ORGANIZATION

The chapters in this book address the wide range of challenges, strengths, and interventions that social workers need to learn about in working with this population. The chapters in Part I impart foundational knowledge about social work with service members and veterans, including the history of social work and the military; unique aspects of the military culture that practitioners must know to understand and be credible to military personnel, veterans, and their families; common ethical dilemmas confronting uniformed and civilian military social workers; the triumphs and challenges experienced by women in the military; and the secondary trauma practitioners often experience when working with veterans who have been physically or emotionally injured from traumatic combat experiences or from other types of trauma.

The chapters in Part II of the book cover behavioral health problems and related interventions with service members and veterans, including posttraumatic stress disorder (PTSD) and co-occurring disorders and their treatment; traumatic brain injury; substance use disorders; and preventing suicide. The chapters in Part III address the challenges social workers face in helping veterans transition to civilian life, including preventing homelessness and rehabilitating those who are homeless; helping veterans and their families navigate through complex systems of care; helping veterans secure employment, adequate housing, and veteran benefits related to education and health care; and helping transitioning service members offset the loss of camaraderie and cohesion by becoming involved in community activities and thus finding a new “mission.”

The final section of this book, Part IV, contains chapters on families impacted by military service. These chapters discuss the impact of military service on families and its implications for the role of social workers, including content on family stress and resilience, such as the impact of multiple cycles of deployment on family well-being; domestic violence and its prevention and treatment; the unique circumstances of the families of National Guard and Reserve members and ways to support them; military families with children who have disabilities; grief, loss, and bereavement in military families—with a special focus on suicide loss; long-term family caregiving: the challenges faced by children and youth impacted by their parents’ military service; empirically supported therapies for military couples and families; and a conceptual and historical overview of the impact of military service on families.

Most chapters provide case vignettes to illustrate the practice applications of the chapter topic, case vignette discussion questions, and/or end-of-chapter discussion questions for reflection on the chapter’s main concepts—questions that might be particularly useful for instructors to employ in their teaching about those concepts. The book ends with a glossary that can help readers become familiar with military-related terms and an appendix that lists numerous resources relevant to helping service members, veterans, and their families.

EPAS CORE COMPETENCIES1

The contents of every chapter in this book pertain to core military social work competencies delineated in the Educational Policy and Accreditation Standards (EPAS) of the Council on Social Work Education (Council on Social Work Education [CSWE], 2010). For example EP 2.1.1 regarding proper professional conduct pertains to Chapter 2 on military culture and the need for cultural sensitivity in serving this population as well as the ethical decision-making content in Chapter 4. Chapter 4 also addresses the ethical demands placed on social workers assisting military (active duty) versus veteran cultures and provides extensive content on ethics that also pertains to EP 2.1.2, which refers to ethical principles for guiding professional practice.

The critical thinking component of EP 2.1.3 pertains to content in most of the chapters in Parts II, III, and IV of this book—particularly regarding (1) analyzing relationships among clients, families, the military, and veterans’ organizations; and (2) considering various assessment, prevention, and intervention models being implemented in military social work.

The diversity component highlighted in EP 2.1.4 pertains to most of the content in Chapter 2 on military culture and diverse groups, Chapter 3 on women in the military, Chapter 20 on families with children who have special needs, and the parts of Chapter 24 that discuss cultural responsiveness in connection to therapy with couples. Moreover, many of the case vignettes found in various other chapters involve culturally diverse cases.

The social and economic justice component in EP 2.1.5 pertains to content found in all of the chapters in Parts I, II, and III of this book. Chapter 2, for example, discusses the stigma perceived by service members associated with seeking help for their psychosocial problems, and Chapters 12 and 13 discuss stigma in connection to seeking help for substance use disorders. Chapter 15 discusses poverty and financial hardship in connection to homelessness. Chapter 16 provides a “road map” for helping economically disadvantaged veterans access resources and benefits. Likewise, Chapter 17 discusses how social workers can help transitioning service members find employment, adequate housing, and veteran benefits. Chapter 21 discusses resources available to families of children with special needs. In addition, the Appendix provides an extensive list of resources that can enhance the lives of veterans and military families.

Virtually every chapter in this book that discusses interventions mentions the empirical support for those interventions, many of which are evidence-based. Thus, those chapters pertain to EP 2.1.6 (engage in research-informed practice . . .). This is most evident in the chapters in Parts III and IV. For example, Chapter 3 applies the evidence-based intervention, cognitive behavioral therapy, to the case of a female veteran who was sexually harassed and who has PTSD. Chapter 6 discusses the evidentiary support for various theories of and interventions for PTSD. Chapter 8 describes exposure therapy, which is widely recognized as the most evidence-based treatment for PTSD. Chapters 12 and 13 describe motivational interviewing and seeking safety, two empirically supported interventions for substance abuse. Chapter 23 discusses the FOCUS model, which is empirically based. Chapter 25 describes empirically informed therapies being implemented with couples and families impacted by military service.

Virtually every chapter in this book contains extensive content pertaining to EP 2.1.7 regarding human behavior and the social environment. The policy emphasis regarding advancing social and economic well-being in EP 2.1.8 pertains to most of the chapters in this book, especially the chapters in Part III that contain content on preventing homelessness; helping veterans and their families navigate through complex systems of care; and helping veterans secure employment, adequate housing, and various veteran benefits.

EP 2.1.9 (respond to contexts that shape practice) is reflected in many of this book’s chapters, especially the historical content in Chapter 1 and the cultural content in Chapter 2, which correspond to the CSWE recommendation that social work practitioners working with military clients should know about the history and current trends in service delivery to “service members, veterans, their families, and their communities” (p. 13). Additional content pertinent to EP 2.1.9 can be found in the chapters in Part III, particularly Chapter 16, on helping veteran clients navigate through systems of care.

EP 2.1.10(a)-(d) refers to content regarding engaging, assessing, and intervening with clients at various levels of practice. This broad range of content pertains to almost every chapter in this book. To get a glimpse of the many ways our book reflects the extensive CSWE list of practice behaviors illustrating the 2.1.10 core competency, one need look no further than the Contents section that began on page ix. Providing examples of all of those ways would go beyond the scope of this preface, so I mention just a few. To begin, EP 2.1.10 overlaps with EP 2.1.6 regarding engaging in research-informed practice; thus, the examples provided above for that competency apply here, as well. Some other examples are as follows. Regarding engaging clients, Chapter 2 addresses how building a therapeutic alliance with military personnel, veterans, and their families requires knowledge of military culture. Chapter 5 identifies strategies for assessing, preventing, and treating secondary trauma among service providers working with combat veterans. Chapter 7 provides an overview of the cognitive processing therapy protocol, an empirically supported treatment for PTSD. Chapters 10 and 11 discuss the assessment and treatment of traumatic brain injury (TBI). Chapters 15 and 17 give considerable attention to organizational and community efforts to help veterans transition to civilian life. Chapters 18 and 19 discuss group and support system approaches for helping families cope with the cycle of deployment and other stressors.

The unique nature of the Global War on Terrorism has confronted military service members, veterans, and their families with unprecedented biopsychosocial issues. These include the widespread problems of traumatic brain injury (TBI) and PTSD, an increase in the number of suicide attempts and completed suicides, the devastating impact that multiple and lengthy deployments can have on service members and their families, difficulties in transitioning back into civilian life between deployments and after retiring from military service, as well as various other problems. Therefore, more than ever before social workers are needed to address the multifaceted issues faced by this population and assist in supporting our nation’s warriors and their families. We hope this book spurs readers to have the desire to serve military personnel, veterans, and their families, and that it improves their effectiveness and confidence in working with this target population.

REFERENCE

Council on Social Work Education (CSWE). (2010). Advanced social work practice in military social work. Retrieved from www.cswe.org/File.aspx?id=42466

1The military social work EPAS can be found online at www.cswe.org/File.aspx?id=42466.

Acknowledgments

Special thanks go to four Wiley staff members who helped make this volume possible. Peggy Alexander, vice president and publisher, supported this project from the beginning. Rachel Livsey, senior editor, provided early inspiration for the book, and has been a solid source of support throughout the process. Amanda Orenstein, editorial assistant, has worked hard on this project from the start; we can’t thank her enough for her valuable help. Thanks also go to this book’s production editor, Kim Nir. We also thank our terrific chapter authors for their fine work and timely submissions. In addition, we would like to acknowledge the military and veteran clients and their families who have shared their stories of hardship and joy and taught us about sacrifice and honor. Finally, we want to acknowledge the veteran social work students who aspire to serve by giving back to the military community through their meaningful work. Their passion and commitment is an inspiration for the social work profession.

Allen Rubin

Eugenia L. Weiss

Jose E. Coll

Introduction

Understanding and Intervening With Military Personnel and Their Families: An Overview

Allen Rubin

Social workers have worked with military personnel, veterans, and their families throughout the history of the social work profession. In so doing, they have performed the full range of professional social work activities. With each new war, the value of military social workers became increasingly appreciated, and they have been increasingly employed by all of the branches of the armed forces. Today, the increased utilization of military social workers is seen not only among those in uniform, but also among those who work contractually on base, at the Veterans Administration (VA) and its centers, other departments of the federal government (such as the Department of Homeland Security), and in community agencies or private practice.

With each new war, the roles of military social workers expanded. Today, military social workers (including those in and not in uniform) perform work at all levels of social work practice, ranging from direct practice to administrative and policy-level roles. Some prominent examples of their varied services include case management; various modalities of psychotherapy; counseling; family psychoeducation and advocacy; medical social work and hospice care; and the development of community-level programs, policies, and procedures. Prominent examples of the types of problems that they deal with include posttraumatic stress disorder (PTSD), domestic violence and child maltreatment, traumatic brain injury (TBI), substance abuse, suicide prevention, family bereavement, combat stress, veteran homelessness, and readjustment to civilian life.

The expansion of social work roles in helping military personnel, veterans, and their families has escalated in the current Global War on Terrorism. Today’s U.S. military service members, veterans, and their families have had to deal with unprecedented biopsychosocial problems. Biologically, there is the widespread problem of TBI from roadside bombs that imperil even noncombat service members in this war without a defined frontline. Psychologically, the constant danger posed by the lack of a defined frontline has contributed to a growing prevalence of PTSD among the service members. Military personnel are constantly vigilant, as the enemy is not another country, but rather segments of the populace that they are trying to help. Realizing that anybody could be an enemy amid a civilian population, service members know that attacks can come at any time or place, from indigenous enemies dressed in civilian clothes who often exploit women and children as a means of attack. This contributes to a state of hyperarousal that is an undesirable PTSD symptom after returning home, but is actually adaptive during deployment. It also means that the need to sometimes kill without being sure who the good guys and bad guys are can exacerbate feelings of guilt and self-blame on returning from war.