Increasing Cultural Competence with Minority Service Members and Veterans

Lena Payne, LCSW&

Rachel Bentley, LCSW

Objectives

I. Increase knowledge of relevant military culture and stigma that influences engagement

II. Identify barriers and benefits of the minority/military dual cultural values in treatment behaviors

III. Provide strategies for engaging and retaining minority veterans

Introductions

Name, profession, population you work with and services you provide

How many of you work with Veterans or Active Duty Military?

This is a unique population with a myriad of unique needs

VideoSix Word Memoirs: Veterans on

Coming Home

The Growing Active Duty and Veteran Population

African Americans, Latinos and women make –up an increasing number of the Active Duty and Veteran Population

Active duty and Veteran populations often seek treatment outside the military and/or VA hospitals, which makes it imperative for mental health professionals to strive for cultural competence with this group

Active Duty Force

Service Enlisted Officers Total Percentage

Army 452,064 87,610 539,675 37.8%

Navy 275,296 51,388 326,684 22.9%

Marine Corps 178,213 20,202 198,415 13.9%

Air Force 258,095 64,805 322,900 22.6%

Coast Guard 33,228 8,134 41,362 2.9%

Total 1,196,897 232,139 1,429,036 100%

Demographics of active duty u.s. military. (2011, 08 02). Retrieved fromhttp://www.statisticbrain.com/demographics-of-active-duty-u-s-military/

Active Duty Gender Distribution

Service Enlisted Percent Female Officer Percent Female

Army 13.2 % 15.5 %

Navy 15 % 15.1 %

Marine Corps 6.2 % 5.8 %

Air Force 19.9 % 18.3

Coast Guard 11.6 % 14.9 %

Total 14 % 15.3 %

Demographics of active duty u.s. military. (2011, 08 02). Retrieved fromhttp://www.statisticbrain.com/demographics-of-active-duty-u-s-military/

Ethnicity Profile of Active Duty Force

Service % White % Minorities % Black % Other

Army 73.9 % 26.1 % 21.5 % 4.6 %

Navy 66.2 % 33.8 % 19.3 % 14.4 %

Marine Corps 83.7 % 16.3 % 11.1 % 5.2 %

Air Force 78.1 % 21.9 % 15.6 % 6.3 %

Coast Guard 82 % 18 % 6.1 % 11.9 %

Total 74.6 % 25.4 % 17.8 % 7.6 %

Demographics of active duty u.s. military. (2011, 08 02). Retrieved fromhttp://www.statisticbrain.com/demographics-of-active-duty-u-s-military/

Military Culture

“Military culture is comprised of the values, beliefs, traditions, norms, perceptions and behaviors that govern how members of the armed forces think, communicate and interact with one another as well as civilians. “

Values: Honor, courage, loyalty, integrity, and commitment

(Exum, Coll & Weiss, 2011)

Branches of the Military

Army (Soldier) Army Reserve Army National Guard

Marine Corp (Marine) Marine Reserve

Navy (Sailor or Navyman) Navy Reserve

Air Force (Airman) Air Force Reserve

Coast Guard (Guardsman) Coast Guard Reserve

National Guard and Reservist

Reservist train part time near home until needed, and members deploy alongside the Army.

Army National Guard members deploy with the Army on a part-time basis, with a special focus on homeland security and relief programs.

The Air National Guard trains part time to assist in domestic disasters and international conflicts.

www.todaysmilitary.com

Cultural DifferencesCULTURAL DIFFERENCES

CIVILIAN CULTURE MILITARY CULTURE

EMPHASIS ON INDIVIDUALITY EMPHASIS ON UNIT COHESION

INDIVIDUAL ACHIVEMENT EMPHASIS ON THE MISSION

PERSONAL FREEDOM DEVOTION TO DUTY

FLUID SOCIAL RELATIONSHIPS CHAIN OF COMMAND

Exum, Coll, & Weiss (2011)

Why People Join the Military?

Family Tradition Travel and Adventure Money for College Money in College Poor Economy Career/Job Medical Coverage

Direction Job Skills Honor/Duty Sounds Fun Socialization/

Friendship Medical Coverage Part-time Income

Minorities in the Military

Racism in the Military

Committed suicide last year while in Afghanistan. Prior to his death he told a fellow soldier he was thinking of killing himself over the harassment he was getting from his fellow soldiers.

Private Danny Chen

Racism in the Military

Some hate groups encourage members to join the military, especially the Army or Marines to train to fight in the race wars (Trotta, 08).

The military has stepped up it’s efforts to remove and prevent racists from entering service.

Wade Page & Timothy McVeigh

Gender in the Military

Women are the fastest growing segment in the veteran population.

Some issues women in the military may face are: sexism, sexual assault, disputes in how women should serve and requirements for serving, pressure to be just as tough as the men

What Brings Them to Treatment

Stress Financial Problems PTSD Military Sexual Trauma Readjustment Marital/Family Problems

Readjustment Military personnel form a distinct sub-set, or sub-

culture of American society and as such, are governed by a separate set of laws, norms, traditions and values than the civilian population. Thus, individuals who leave the military after many years of active duty service experience the same type of culture shock as any other newcomer to the American culture. These individuals share the same sense of disorientation, change of status and loss of identity as immigrants adjusting to a host culture. In veterans, there is a search for a new identity and an effort to recreate meaning, and often they are met with unfavorable societal attitudes or conditions

(Exum, Coll, & Weiss, 2011).

Emotional Cycle of Deploymenthttp://blog.whileyouwereaway.org/2010/10/21/tip-120-more-tips-for-military-families/

Stigmas and Myths

A stigma exists related to Veterans and Active Duty Military seeking mental health treatment.

Veterans and Active Duty Military may believe the myth that seeing a “shrink” means their “crazy.”

The stigma and these myths impact their decision to seek mental health treatment or discuss mental health issues.

Discussion: What stigmas or myths related to Veterans and Active Duty Military seeking mental health treatment have you heard/experienced?

Barriers to Seeking Treatment

Military culture itself can discourage seeking treatment as a sign of “weakness”, needing “help” or being “crazy.”

Veterans/Active Duty Military may be concerned that seeking treatment may impact a reenlistment, service in the reserves or benefits.

There are also concerns about “privacy” or “confidentiality.”

Believing that irritability, isolation and somatic complaints are just “normal” for your culture or gender (case example).

Military Values vs. Traditional African American Values…

Barrier or Catalyst?

Family vs. Unit Family hierarchy/family dynamics vs.

military chain of command Traditional Gender Roles Spirituality

Military Values vs. Traditional Latino Values…Barrier or Catalyst?

Family vs. Unit Family hierarchy/family dynamics vs.

military chain of command Traditional Gender Roles Spirituality Machismo Language

VideoMarine Corps Recognizes Contributions

of Hispanic Marines

2:02

Military Values vs. Female…Barrier vs. Catalyst

Traditional Female Roles vs.

Roles of Women in the Military

Gender Barriers or Catalysts to Seeking Treatment

Female Service Members may avoid mental health treatment for fear it will impact their eligibility for service.

Female Service Members may have experienced Military Sexual Trauma (MST) , which went unreported and fear reprisal for reporting or seeking treatment for MST.

Female Service Members sometimes report feeling that they are treated as “less than” their male counterparts when seeking help.

Just as their male counterparts, female service members may believe seeking help makes them “weak.”

Female Service Members sometimes feel that female specific clinics or services are not available.

Why would a Veteran/Active Duty Military Service Member choose private treatment

over VA/DOD

Some Service Members do not want any treatment from an agency connected to the government/military.

Some Service Members have private insurance.

Africans Americans, Latinos and Women may have experienced prejudice during military service and want to distance themselves from this experience or fear this may reoccur through VA services.

VideoWar on Many Fronts: African American

Veterans w/ PTSD (Part 3)

0:00 to 04:42 up to religion 04:42 to 10:11 females

Now that you are improving your cultural understanding of African American, Latino and

Female Service Members, how would you modify an assessment for this population?

Include questions in your assessment that take military service into account

Do not make assumptions about their service

Ask what their service experience was like Ask how they were treated during service Assess for Military Sexual Trauma Incorporate Spirituality into your

assessment

Questions to get more information…

During Assessment you might ask…1) Describe your experience in the military?2) What was your branch, rank, unit, where

did you serve and what was occupational specialty?

3) How has your military experience impacted your parenting?

4) What was it like being a female in the military? Were there any challenges?

Practical Tips for Assessment

1) Use correct terminology or ask if you do not know2) Focus on the shared human experience…don’t be

afraid or nervous that you will not be able to connect, because you are not a Veteran…building rapport and the therapeutic relationship is significant to the outcome of treatment.

3) Remember-they are the expert…let them tell their story

4) Even if you were in the military, your patient’s experience could be very different from your own

5) Be authentic about your own experience (i.e., “You are right, I don’t know what it’s like being in combat” etc.)

Treatment

Being aware, informed and culturally competent

Basic cultural competence & military cultural competence

Transculturally Competent

References

Demographics of active duty u.s. military. (2011, 08 02). Retrieved from http://www.statisticbrain.com/demographics-of-active-duty-u-s-military

Department of Veterans Affairs, Office of the Actuary, Veteran Population Projections Model (VetPop)

Exum, H., Coll, J., & Weiss, E. (2011). A civilian counselors primer for counseling veterans. (2nd ed.). Deer Park, NY: Linus Publications.

Trotta, D. (08, 2012 21). U.S. army fights racists within its own ranks. Retrieved from http://news.yahoo.com/u-army-battling-racists-within-own-ranks-050115179.html

Q and A