The Future of “Support our Troops” by a Civilian Workforce: A Plan for the Civilian Sector to Engage in Military Informed Practices for #MissionAct Success

“Thank you for your service” or donations to vet organizations are the extent of action for many civilians not personally or professionally engaged with military populations. Previously, the onus of responsibility for veteran care has been placed upon government agencies or veterans helping other veterans, formally or informally. Civilians may feel the government’s resources adequately provide for this population, but this is not the case.  Think about your workplace, courses you took in school, or visits with doctors or therapists. What focus of training, resources, or conversation has there been on cultural diversity, racial bias/harassment, or treatment differences by ethnicity? Now, think about how much training you received about military culture, mindset, and adaptations to those who led a military lifestyle, or the impact of war conflicts on behavior (to name a few).  The need for civilian cultural competence in the understanding and care of Service Members, Veterans and their Families (SMVF) may seem more evident upon our reflection of military specific education.  This post proposes a solution for SMVF populations inclusive of all Americans working towards the understanding and support of our Armed Forces, past, present and future.

The Trump administration wants to expand the Mission Act by expanding civilian options for care to Veterans. This expansion could provide both an opportunity and a crisis for veterans needing health services in a timely manner. The VA continues to face significant backlash from the consequences to veterans of long wait lists. Even with the increase in VA employees from 250,000 employees in 2009 to 370,000 in 2018, all veterans could not possibly obtain service. The VA is not meant to be the end all/be all in helping veterans and their families. On the surface, the expansion offering more private healthcare options seems appropriate. This expansion will only work if an effort exists to systematically develop an education program of military cultural differences.

The last report available from the National Center for Veterans Analysis and Statistics (2016) stated “48% of all Veterans used at least one VA benefit or service in FY 2016… with 44% using multiple benefits.” A benefit encompasses not only health care, but pension, loans, life insurance, education, memorial benefits and vocational rehabilitation. This leaves the potential for 56% of veterans not using a VA benefit or service much higher if only looking towards health care utilization.  If over half of veterans seek care in the civilian community how many of these civilians are culturally competent in understanding military experiences and the impact of serving our country?

Rand Corporation’s (2014) report identified a significant gap in cultural competency of civilian mental health providers. 24% of the providers under the Tricare network of referrals met the guidelines for military cultural competency and worse, only 8% of the private civilian mental health providers surveyed were culturally competent. Many of the 24%, while culturally competent, were not aware of appropriate evidence-based best practices with military populations. As recently as 2018, Rand Corporation surveyed health care professionals in New York and found only 2% qualified as able to provide quality care to veterans. If this type of unawareness occurs in health and mental health settings, what about businesses and education?

A Solution

The needed civilian awareness of SMVF culture and requirements is evident. Businesses, educational institutions, healthcare and mental health providers are awaking to the basics of providing culturally competent services fostering better outcomes for SMVF populations and society. In the United States, 40% of our population is ethnically diverse. Using military culture as a category, SMVF populations have a significantly high rate in the general population accounting for almost 11% of citizens, meaning potentially 1 out of 11 people are SMVF affiliated. Even with these significant numbers, no formal measure has been enacted to address Military Informed Practices in civilian mainstream populations.

The motivation for change in the SMVF system of care has been spearheaded by informal systems of either veterans or family members of veterans. Those individuals committed to helping SMVF populations are developing numerous non-government options including mental health care, employment and education.  The next step to this process is involving non-SMVF populations to support and integrate understanding of this nation’s military workforce.

The formal development of cultural competencies into practice needs structure and government support. Military Informed Practice standards can be addressed through modification of the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (the National CLAS Standards) along with national standards for mental health, business and education. After these modifications, a process of education and certification can be initiated to provide SMVF populations an awareness of which organizations commit themselves to SMVF culturally competent certification.

Military Informed Practice through certification is one method of enhancing the general populations involvement in best practices. One model to examine is PACT training and certification. PACT addresses areas of Policy, Advocacy, Culture and Treatment specific to the purpose of serving our SMVF populations. Organizations earning PACT certifications would benefit from fully harnessing the resiliency and military mindset each SMVF person brings to their education or work. Health and mental healthcare providers benefit their military populations through more accurate assessment, interventions, and treatment impacting outcomes. The benefits of PACT may be similar to the benefits of organizations embracing and understanding strengths people from diverse populations offer.

                       

Military Informed Practice - PACT Certification Areas

Policy – Organizations/companies will learn to develop Military Informed Practice policies. Education of governmental policy and procedures affecting SMVF populations within the context of each type of provider relationship will enhance policies. Policies can be micro or macro oriented and dependent upon the type of certification being pursued. Advocacy –A Military Informed Practice approach educates individuals working with SMVF populations on strengths-based advocacy options. Civilians can increase their ability to advocate for SMVF populations in accordance with their military mindset, DoD standards, taking into account political changes, or through the different channels /resources offered to these populations. Culture – Develop competency in knowledge of military culture, mindset, resiliency factors, and experiences with SMVF populations as it applies to the corresponding setting. This area builds the foundation for a Military Informed Practice. Treatment – The awareness of Military Informed Practice develops appropriate measures to assess, support, and intervene with SMVF populations.  Treatment may be formal, as with healthcare or mental health treatments, or informal with how SMVF populations resources are developed in education or the workplace.

Using the carrot and the stick approach, provisions of PACT certification can be created as incentives for adoption. Earning PACT certification could increase points in obtaining government contracts, earn higher reimbursement rates for Tricare, or be used as a reason for SMVF populations to choose a university, apply for a job, and pick their health providers. PACT Certification badges branding can be proudly displayed on websites, literature, letterhead, or on business fronts, allowing easy identification by SMVF populations and their supporters. Pact certification can be highlighted on a resume' or provided as continuing education credits. A convenient PACT app can direct users to providers or employers who support our SMVF populations through Military Informed Practice. Benefits can be created in any industry to incentivize certification.

Actions towards an educated public on military culture can impact our culture long term. Twenty-six countries mandate military service, maybe our alternative to a mandated military service is a population educated on Military Informed Practices. How would our country change with an added empathy to those willing to give up their lives for our freedom? Imagine a country dedicated to providing culturally competent interactions with SMVF populations. Would military related suicides go down? Could different populations previously not interested in military service be engaged? Would veterans who are homeless be offered different alternatives towards self-sufficiency? Indifference can give way to a new understanding and empowerment of SMVF populations.

SMVF populations fought for us, sacrificed for us, and continue to provide a freedom rarely experienced by most other countries. Military Informed Practice can benefit any organization. Utilizing the PACT framework for education on Military Informed Practices can allow civilians to take action, backing up the phrase “Thank you for your service.” A Military Informed Practice provides a reciprocation of, to place it in an Army values context, “loyalty, duty, respect, selfless service, honor, integrity, and personal courage” our SMVF populations so graciously give us.  

Office of Public and Intergovernmental Affairs (2018, April 18). Debunking the VA privatization myth Retrieved from https://www.va.gov/opa/pressrel/pressrelease.cfm?id=4034

Rand Corporation (2018, March 1). Few civilian health providers in New York ready to provide timely, quality care to veterans. Retrieved from https://www.rand.org/news/press/2018/03/01.html

Hepner, A., Roth C. P., Farris C., Sloss, E. M., Martsolf G. R., Pincus H. A., Watkins K. A., Batka C., Mandel D., Hosek S. D., and Farmer C. M. (2015) Measuring the quality of care for psychological health conditions in the military health system: Candidate quality measures for Posttraumatic Stress Disorder and Major Depressive Disorder, Santa Monica, Calif.: RAND Corporation, Retrieved from January 08, 2019: https://www.rand.org/pubs/research_reports/RR464.html

Tanielian, T., Farris C., Batka C., Farmer C.M., Robinson E., Engel C. C., Robbins M., and Jaycox L. H. (2014) Ready to serve: Community-based provider capacity to deliver culturally competent, quality mental health care to veterans and their families, Santa Monica, Calif.: RAND Corporation, As of January 27, 2019: https://www.rand.org/pubs/research_reports/RR806.html

United States Census Bureau (2017, July 1). Quick facts: United States. Retrieved from https://www.census.gov/quickfacts/fact/table/US/PST045217

United States Department of Veteran Affairs: National Center for Veterans Analysis and Statistics (2017, November). VA utilization profile FY 2016. Retrieved from https://www.va.gov/vetdata/docs/QuickFacts/VA_Utilization_Profile.PDF

Future Series: The Increase of Suicide Rates during Climate Crisis Underlines the Need for Social Work Action

Climate change consequences hit our nation full force this year. Inhospitable heat waves and flash flooding display the foreboding of climate intolerance to humans as weather changes increase in intensity. Temperatures extremes are costly to life, health, and the economy. This week, an article from the journal Nature Climate Change, reported a link between climate change and mental health, specifically, a direct increase in suicide rates. Researchers (Burke et al. 2018) reported:

 “Suicide rates rise 0.7% in US counties and 2.1% in Mexican municipalities for a 1 °C increase in monthly average temperature. This effect is similar in hotter versus cooler regions and has not diminished over time, indicating limited historical adaptation… > 600 million social media updates further suggests that mental well-being deteriorates during warmer periods.” (para 1)

An increase in suicide is only one substantial area influenced by increasing temperatures. Climate events prompt a broad spectrum of harmful behaviors from individuals. As social workers, our response to climate induced behaviors needs a systems overview, plan, and response to intervene, and in some cases prevent, negative consequences.(More information about  the social work's response to environmental change and how you can be involved is available from this link
American Academy of Social Work and Social Welfare Strengthening the Social Response to the Human Impacts of Environmental Change)

The impact of climate change is a problem for every intersection of diversity. Crisis interventionists can work easiest with those who have the most resources economically, personally, and regionally. Climate change consequences pose the most threat to marginalized and vulnerable populations. Social work can bridge the gap between long and short-term solutions between these populations. Collaborations across disciplines to identify and develop strategies for communities to decrease anxiety, depression, stress on relationships, health issues, violence, and aggressive behaviors need to be developed. 

The Impact of Climate Change on Humans 

https://health2016.globalchange.gov/

Considering the significant increases in temperature averages and weather extremes in the United States the response from social workers needs to be immediate and significant. People experiencing weather crisis require a coordination of resources. Heat waves, droughts, cold bomb cyclones, flooding, hurricanes, or when weather extremes increase past our ability to access resources, will challenge our national reserves to not only keep people safe from harm, but allow time for rebuilding or relocation. The effort to build support systems for climate change impact will involve all systems in order to be successful. Social workers can lead the shift in support systems through advocacy and education.

At the extreme, social workers will develop relocation plans for whole areas impacted negatively by continued hostile temperatures and weather. How will California residents respond to an increase of wild fire severity or drought conditions in agricultural areas? What if disrupting weather systems hit Puerto Rico each year making it significantly challenging to live there? Would the population of Puerto Rico become a third world where people have little access to electricity, food, or housing? Or will Puerto Rican’s be invited into our communities in America to continue their lives and culture without fear of losing their homes each year? How will Southern Florida residents respond to storms increasing in severity and damage along their coasts? What will happen to cities and businesses continually disenfranchised by flash flooding throughout the year similar to what is happening in Ellicott City, MD? These examples underly the need for future planning in the present, not as a band aid strategy as each crisis occurs.

At the least, social workers involve themselves with individuals impacted by climate extremes. Residents in warmer climates are now experiencing highs above 104 for the first time. Body temperatures reaching 104 degrees or higher develop heat stroke leading to organ damage or death. When the heat reaches 120 degrees Fahrenheit in California how do those without a way to cool their internal temperatures survive? What education and resources can seniors and children access to minimize the impact of new and existing heat waves? These questions require answers.

Social work educators and leaders are poised to assist legislators in designing appropriate mechanisms and funding streams for crisis intervention and support system infrastructure. Government planning will include micro and macro responses to climate change. Areas across the spectrum requiring intervention include; significant loss of life and illness, destruction of homes and businesses, the impact of economic costs in transportation, agriculture, production, energy and infrastructure, and the resources needed to address each crisis.

The chart below identifies key social work positions needed to stabilize our communities during times of climate change disasters and emergencies. This is not an inclusive chart. Each position is not intended to be the only resource. A multidisciplinary team of specialists supplement the strategies, resources, and labor force of climate change need. 

Climate Change Social Work Specific Position Needing to be Created

Position	Responsibilities	Collaboration	Housed
Community Relocation Transition Coordinator	·  Identification of welcoming communities for relocating individuals and families ·  Development of identified Welcoming Community to educate and prevent NIMBY ·  Develop strategies for moving small and large populations ·  Systems coordination between moving points	Government programs, Community stakeholders, Neighborhoods, Businesses, School systems, Health Care, Police and Fire, Military, National Guard	Local, State, Federal government, Insurance Companies,
Climate Relocation Specialists	·  Assessment of family needs for location ·  Financial and Career planning ·  Crisis Intervention ·  Community advocate and liaison for integration between old and new residents	Housing, Businesses, Communities, school systems, real estate companies, local governments, social service agencies	Local, State, Federal government, Insurance Companies
Weather Extreme Coordinators	·  Identification of weather impact potential ·  Storm Consequence Mapping of Human needs ·  Coordinate community response efforts ·  Educational coordination of suicide prevention/evaluation resource materials to therapists and community ·  Develop and communicate area safe zones	Weather Services, local, state and federal governments, National Guard FEMA, health care settings, supply companies, businesses, Police and Fire, Military, National Guard	Weather Centers, local Governments, Regional governments, Military bases, National Guard posts
Weather Extreme Case Managers	·  Crisis Intervention ·  Suicidal ideation evaluator due to weather temperature increases ·   Resource management ·  Health care management ·  Shelter stability	Hospitals, Pharmacies, Temporary housing, Social service agencies, Psychiatric facilities, Jails	Townships, Hospitals, Police or Fire Departments, Social Service agencies with emergency services
Weather Extreme Financial Managers	·  Crisis Intervention ·  Financial collaboration and translator for aid from Internet fundraising, insurance reimbursement, government aid ·  Works closely with Weather Extreme case managers	Federal Government agencies, Local government, Insurance Companies, Internet Fundraising groups	Insurance Companies, Internet Fundraising sites, Federal Government Aid, Townships, Social Service agencies with emergency services
Weather Extreme City Specialists	·  Community educator on self-care, relationship care, and health challenges during weather extremes ·  Coordinator of community actions to reduce crime and violence ·  Coordinate hotline and/or drop in centers for mental health issues related to extreme weather issues. ·  Collaborator with law enforcement officers and systems for methods in decreasing violence	Federal Government agencies, Local and city government, Social Service Agencies, Police and Fire, Jail and Prisons, Hospitals, National Guard	Local Government, City Agencies, Townships, Social Service Agencies, Law enforcement Agencies

Social work education can provide a pathway for training future advocates challenged by the impact of climate change on a micro and macro level. Answers will come from the collaboration of all disciplines. Please share your thoughts and solutions about addressing the impact of climate change either through education, research or practice. Please participate in @CSocialWorkEd 's #twitterchat on August 1, at 12pm EST or August 2, 1pm EST for a chat on #SWFutures. You can submit questions to CSWE.org by 7/27.

Reference

Burke, M., Gonzalez, F., Baylis P., Heft-Neal, S., Baysan, C., Basu, S., & Hsiang, S. (2018). Higher temperatures increase suicide rates in the United States and Mexico. Nature Climate Change. Retrieved from https://doi.org/10.1038/s41558-018-0