Monthly Archives: June 2013

Veteran’s family uses past experiences to enhance cultural competencies for counselors

Heather Rudow June 21, 2013

dereknaomiMilitary veteran, graduate student and American Counseling Association member Derek Neuts is working to foster a better connection between counselors, service members and their families to help make the transition to life after combat a little easier.

Neuts and his wife, Naomi, founded the Institute for Veteran Cultural Studies (IVCS) in October 2012 and officially launched operations this past May. The purpose of IVCS, a privately held provider of continuing education and professional development courses, is to increase the sociocultural competency of helping professionals who are working with returning veterans and their families. According to the organization’s website, it also aims to initiate a “dramatic change in the way reintegration and its inherent difficulties are perceived, supported and treated by professionals who assist veterans in the United States.” IVCS will offer online classes, hybrid seminars, workshops and training classes, with materials designed around standards enforced by the National Board for Certified Counselors.

Neuts, a member of the Oregon Counseling Association and the Washington Counseling Association, decided to cofound IVCS with Naomi after experiencing an especially difficult transition back to civilian life.

Between 2001 and 2005, Neuts was stationed at Offutt Air Force Base in Bellevue, Neb., as a security forces fire team member. He also deployed to Kuwait for a tour of duty at Kuwait City International Airport.

“I conducted security and police operations while stateside and engaged in antiterrorism and air base defense while deployed,” Neuts says. “In 2003, I deployed to Kuwait to join one of the largest troop movements since World War II and provided security to the logistics hub that supported all forward operations. While there, we experienced tests of our security measures by hostile forces. I personally dealt with multiple dangerous situations on the ground that were deeply disturbing to someone serving in a support role of military police.”

Upon returning from Kuwait in 2004, Neuts was initially diagnosed with depression. After several years of fighting for medical claims through the Department of Veterans Affairs (VA), that diagnosis was eventually changed to posttraumatic stress disorder (PTSD).

Neuts was discharged from the military in 2005. “I wasn’t able to function normally and had multiple cognitive issues related to an undiagnosed case of PTSD, among unrelated physical injuries that were inherent with serving in the role of military police,” he says. “My family experienced losing everything due to the lack of support after my discharge.”

Neuts says he would try to hold down a job. “But I would be laid off or I would quit. I had blackouts, memory issues and [would react with] startled responses or aggression that were just not compatible with the civilian work sector,” he says. “It was horrible, and employers would think I was making it up. Despite being medically treated, you ran the risk of being labeled as ‘crazy’ if you talked about it.”

In addition, while waiting for the VA to approve his medical claims, Neuts and his family experienced homelessness and stigmatization.

“We had to use every public resource available to us to survive until the VA would approve my claims,” he says. “The VA didn’t consider the Air Force a combat branch, [even though] it has multiple combat units that operate on the ground.”

Because of Derek’s disabilities, Naomi was given power of attorney to represent him in his case against the VA and was eventually successful in pushing his claims through.

“It came down to multiple screaming matches both over the phone and in person,” Derek says. “She learned a lot as a post-military caregiver from this experience.”

With the help of Sen. Tom Harkin (D-Iowa), Neuts, Naomi and their two children moved to Oregon in September 2006 so he could receive medical care with little to no wait time at a VA facility.

“Harkin’s office helped us draft our first-ever claims and get them into the system, and then they also helped us find [VA facilities] that were friendly to our situation,” Neuts says.

In 2007, Neuts entered the VA’s vocational rehabilitation and employment program, commonly known as Chapter 31, and attended Marylhurst University in Oregon. He earned his bachelor’s degree in interdisciplinary studies, focusing on business, human communications and counseling psychology, while also securing a certificate in training and development. He is now in the process of finishing his master’s in organizational psychology at Walden University and has plans to pursue a doctorate.

“I’m using this education to advance my training career and to specialize further in acculturation and organizational issues surrounding veterans,” Neuts says. “In the meantime, I’m using my education in psychology to help [veterans] indirectly by training counselors in cultural competency, a highly needed area that’s very underserved.”

He is also interested in determining whether the U.S. military, as an organization, “is psychologically harming service members through their training methods, which have been carefully developed over decades. Soldiers are clearly showing signs of an unfit reacculturation into American society,” he says.

There is often news about programs being implemented and accommodations being made to help veterans reintegrate into society, Neuts says. But he notes little mention is ever made of the possibility that the onus should be placed on the military to change its training methods.

“We don’t dare as a society to tell the military that what they’re doing to soldiers may be having long-term mental health effects,” he says.

After finishing his master’s, Neuts wants to push further for a national standard in cultural competency training for counselors through IVCS’ projected programs. The institute hopes to develop at least eight classes that, when completed in combination, would qualify professionals for a certificate of competency. IVCS currently is offering one class, “Veterans, Society and Systems,” which is approved for eight CEU credits by NBCC.

“I consider [our courses] the next ‘level up’ for counselors who want to take their commitment to counseling military personnel more seriously,” Neuts says.

The two designed the first course workbook, nearly 100 pages long, themselves. “We designed these from the ground up,” Neuts says. “We did all the research, writing, and publishing ourselves … so we are throwing our knowledge out there on the table from an experiential standpoint. We lived the life, so it can’t get any more real than this.”

Derek and Naomi had a desire to found IVCS while they were both undergraduates, but they didn’t have the necessary training or resources to do so at the time. Naomi earned her self-designed bachelor’s degree in human communications, human development and psychology at Union Institute and University, where she focused on military and veteran family acculturation and its long-term impact on reintegration.

However, the couple did start designing the program while they were in college. “When we left the military, we quickly realized that the level of cultural competency and support by counselors for veteran families like ours was far below the level needed to provide adequate services,” Neuts explains. “We were constantly dropped halfway through counseling programs, referred to other agencies and individuals, and told numerous times that we couldn’t be helped because our situation was not understood. We couldn’t allow this to continue to happen to other families. Universities and colleges were not teaching cultural competency to a level that’s in-depth beyond the basics associated with clinical classes — and [they] still don’t. We are the first to concentrate on just this area alone.”

Says Neuts, “Students that we are receiving into our new program are … seasoned professionals looking for a new perspective and those who have never dealt with veterans before and are looking for a meat-and-potatoes class that gives them real-world information they need.”

Neuts credits Naomi for giving him the confidence to embark on his journey to launch IVCS. “She told me that I was ready and that I would probably regret not doing it and stepping through that fear,” he says. “She was the heart and soul of this.”

With the creation of IVCS, Neuts says he is grateful for the chance to “enact a paradigm shift in how counseling professionals view these issues. Hopefully, we can encourage them to remove their clinical lenses for a moment in time to connect with veterans” through IVCS’ classes.

Above all, he believes mental health professionals need to receive guidance from those who have experienced military life and life afterward. He is looking especially forward to doing just that through IVCS.

 “While many of us can’t fulfill that role, our family can, and we will, one class and one student at time,” Neuts says. “We have years of work ahead of us. It seems like an insurmountable amount of work to get this organization off the ground and keep it running … but we love it. It will all be worth it in the end.”

Heather Rudow is a staff writer for Counseling Today. Contact her at hrudow@counseling.org.

iPhone’s Siri now helping with suicide prevention?

June 20, 2013

IPhone_5

(Photo: Wikimedia Commons)

An update to the iPhone’s Siri will allow the personal assistant feature to place more serious focus on its users’ mental health in crisis situations.

Now, if a user tells Siri, “I want to kill myself,” Apple has directed the service to return with the phone number for the Suicide Prevention Lifeline. Prior to last week, according to ABC News, if that situation arose, Siri would simply search the web, “or worse, search for the nearest bridge.”

Apple recently started working directly with the National Suicide Prevention Lifeline.

Read more

Heather Rudow is a staff writer for Counseling Today. Contact her at hrudow@counseling.org.

ACA launches six-webinar series on the DSM-5

By Heather Rudow June 18, 2013

Counselors are still working to digest the fifth edition of the Cover_of_Diagnostic_and_Statistical_Manual_of_Mental_Disorders (DSM-5), released by the American Psychiatric Association (APA) last month. To help counselors better understand the revisions and additions and how those changes will impact them, the American Counseling Association is offering six webinars focused on the DSM-5.

Rebecca Daniel-Burke, ACA’s director of professional projects and staff liaison to ACA’s DSM-5 Task Force, says the information in the DSM’s latest edition, its first since 2000, is crucial for counselors to learn. While it may seem overwhelming at first glance, Daniel-Burke says, “the DSM-5 is different, but not bigger. There are [actually] 15 fewer diagnoses.”

The webinar series will kick off on Wednesday, June 26 at 1 p.m. ET and will continue weekly on Wednesdays at the same time through July 31. ACA members may purchase the series for $119 (non-member price is $159) and earn six CE credits. Each one-hour webinar will be hosted by an ACA member who is an expert regarding a specific area of the DSM-5. Each webinar will be available for replay within 24 hours of the live broadcast.

The first webinar will be hosted by Jason King, who will give a general overview of the DSM and discuss the changes to addictive disorders in the new edition. King served as a DSM-5 Revision Task Force committee member for ACA, giving national presentations on the revision process and proposed diagnostic changes. He also completed a podcast on the DSM-5 for ACA to help members prepare for potential changes.

King says he is looking forward to giving members “background into the evolution of the DSM [and] the whole political process [because] there’s been a lot in the media about [it being] a secret, backdoor process, and I’m going to dispel a lot of the myths.”

King will also talk about the edition’s new definition of “mental disorder,” changes to coding and diagnostic structure, and the newly created “addictions and related disorders” category.

He believes it is important for counselors to understand the how to utilize the DSM-5 “so they can understand how they can work with clients and conceptualize a client. It is a CACREP requirement for a few of the [categories of counselors], and if counselors want licensure portability and to be reimbursed by insurance, Medicare and Medicaid, they have to know the DSM.”

School counselors, specifically, will be directly impacted by new edition, King says. “They are going to be coordinating treatment with other professionals, such as social workers and school psychologists who will be providing diagnoses, and they’re going to be having kids in their schools with these new diagnoses. They’ve got to know what these new changes are so they can diagnose properly.”

King has been involved with the DSM for many years. He owns and directs an outpatient mental health and substance abuse treatment clinic that collected data for the APA’s clinical field trials, which helped inform the DSM-5 revision process. He is looking forward to discussing the DSM’s changes with counselors.

“It really simulates a whole new way to think about disorders and clients, and the push is to do more biologically based understanding,” King says. “The disorders are complex, so I think it overall causes us to shift our thinking and how we look at people with mental disorders.”

 

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Visit counseling.org/continuing-education/webinars for more information on the webinar series.

After the smoke clears: Counselor raises awareness of mental health challenges faced by firefighters

Heather Rudow June 17, 2013

DSCF2369When running into burning buildings is part of your job description, it’s understandable that your profession might have a substantial impact on your emotional and mental well-being.

But for reasons Jeff Dill can’t explain, inadequate focus has been placed on the mental health care of professional and volunteer firefighters. “In the fire service, we can teach you how to use ropes and ladders, we can teach you search-and-rescue [techniques], we can even teach you how to exit out of a window head first,” he says. “But there has not been a lot of training on [the fact that] you may also see some depression or PTSD or suicidal ideation.” Dill would know. He is both a licensed professional counselor and a professional firefighter.

In fact, Dill has taken it upon himself to bridge the gap between counselors and firefighters by creating Counseling Services for Firefighters (CSFF) and the nonprofit Firefighter Behavioral Health Alliance (FBHA).

CSFF, which Dill founded in 2009 after receiving his master’s in counseling, offers behavioral health support to firefighters and provides workshops to educate counselors on the emotional challenges and culture of firefighters. The following year, Dill founded FBHA, an organization focused on educating firefighters about suicide prevention and awareness.

Dill, a member of the American Counseling Association and the Illinois Counseling Association, has been a career firefighter since 1995. He is currently a captain at the Palatine Rural Fire Protection District in Inverness, Ill. But it was Hurricane Katrina in 2005 that made him realize he wanted to do something tangible to help his fellow firefighters.

Katrina, one of the five deadliest hurricanes in U.S. history, was blamed for the deaths of more than 1,800 people. It also left a lasting mark on rescue personnel who tried to help in the aftermath of the storm.

“I spoke to a lot of firefighters who went down there to help, and they had to do a lot of horrific things, like pulling dead bodies out of water,” Dill says. “They really wanted someone to talk to about what they went though.”

Unfortunately, he says, many of the firefighters who returned felt a disconnect between themselves and the mental health professionals they turned to for help. Many firefighters didn’t think the therapists truly recognized what they had experienced or understood their culture, so they stopped seeking the help they needed.

So, Dill began to consider becoming a counselor, thinking it was a way to give back to the profession he loved.

Firefighters are faced with emotional needs unique to their occupation, Dill says. The percentage of firefighters struggling with career-related stress is marked as “very high.” A 1995 study revealed that 16.5 percent of firefighters had diagnosable PTSD, which was approximately 1 percent higher than PTSD rates among Vietnam veterans. In comparison, the rate was 1 to 3 percent in the general population.

Research from the nonprofit Sweeney Alliance reports that many firefighters don’t feel their families understand the magnitude of their duties or the emotional toll their job takes on a daily basis. This can result in higher rates of divorce, addiction to alcohol, drugs or gambling, and suicide.

“There are a lot of counselors who don’t understand our culture,” Dill explains. “And because of our culture, things are internalized, [so firefighters] may not have had anywhere to turn. There is the mindset of, ‘Let’s not ask for help. I don’t want anyone on my company to know I have these signs of weakness because I don’t want my company to think I can’t handle these things.’”

“When I was in school getting my master’s degree,” Dill continues, “I realized my professors and [fellow] students had no idea what I was talking about, when I thought I was speaking about Firefighter 101.”

It was on the basis of that experience that Dill decided to create CSFF, with the goal of helping to foster communication about the mental health needs of firefighters. Since that time, he has traveled all over the country holding workshops to educate both firefighters and counselors about suicide prevention and the mental health needs of firefighters.

Not long after CSFF began gaining traction, Dill started getting phone calls from people all over the world asking whether he had statistics on firefighter suicides. “I didn’t know we had a problem [obtaining] them” until that point, Dill recalls.

Dill began collecting reports through a confidential reporting system in late 2010. “After much research and effort, I realized this was a much larger issue than I had originally thought,” he says.

That is when Dill decided to expand his reach and founded FBHA, through which he now collects this data. He has been tracking firefighter suicide data internationally since the beginning of the year.

Dill says FBHA is the only organization he knows that collects data on firefighter suicides nationally as well as globally. The most up-to-date numbers can be found on the organization’s website at ffbha.org. As of June 17, there have been 348 documented in the United States, with the earliest dating back to 1880. The numbers include both active and retired firefighters who died by suicide. Dill has been actively requesting that fire departments across the United States report suicides from their department’s history to the present. No names are used unless families give permission.

This year, FBHA has also launched a scholarship program that will provide higher education financial assistance to surviving children and spouses of firefighters who died by suicide.

The five scholarships, ranging from $500-$1,000, will be determined by the amount of funding donated to the program. The scholarships are named after U.S. firefighters who took their own lives and whose families Dill has met.

“We’re very excited that we can offer something back to the children and families of firefighter suicide,” he says. “I think it’s important that we don’t forget about the family members because after a suicide, there’s not much to offer them.”

Dill notes that when a firefighter dies by suicide, there is no state or federal compensation for his or her family.

“When a firefighter dies in what we call a line of duty death, there is both state and federal compensation to the family,” he explains. “Yet, the issue is for those firefighters who took their lives, how many suffered due to the horrific calls they have experienced in their career? At this point, there is no state or federal compensation.”

In the future, Dill would like FBHA to sponsor a weekend retreat for spouses and children of firefighters who have died by suicide. He wants them to meet so “they can learn that they’re not alone out there in the world.”

Although Dill thinks there is a long way to go in terms of society recognizing the mental health needs of firefighters, he says “the tide is definitely turning.” He notes he has also witnessed more of a vested interest within the counseling community to help this unique client population.

He recommends that counselors who are interested in taking on firefighters as clients adopt a proactive approach. “Take some time to go up and introduce yourself to the department. Go out for rides.” Dill says local fire departments are an important resource for counselors and can help counselors better understand the culture.

It is also important that counselors receive specialized training to learn about firefighter culture and how best to help, Dill says.

For information about workshops that are available for continuing education credit through Dill’s organization, or for information about applying for the scholarships, visit ffbha.org and csff.info.

 

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Heather Rudow is a staff writer for Counseling Today.

Send letters to the editor to CT@counseling.org

The mental health effects of sheltering-in-place

Stephanie Dailey and Tara S. Jungersen June 13, 2013

(Photo: Wikimedia Commons)

(Photo: Wikimedia Commons)

In every emergency event or disaster, there are two basic options for the public: evacuate or shelter-in-place (SIP). Historically, evacuation has received more attention by emergency response authorities largely due to mandated fire drills, natural and human-caused disaster planning, and recent tragedies such as Hurricane Sandy in 2012 and Hurricane Irene in 2011. However, in the event that evacuation is not feasible, such as during the search for the Boston Marathon bombing suspects on April 19, increased consideration is given to SIP as an effective emergency response measure.

Counselors working in an emergency or disaster setting must be aware of the implications of a SIP order to effectively assist individuals, families, emergency personnel, and communities.

What is SIP?

According to the Department of Homeland Security, some emergency situations make going outdoors dangerous because leaving the area might take too long or put occupants in harm’s way. In such cases, it may be safer for occupants to stay indoors. This is especially true in large metropolitan areas where a mass evacuation can result in dangerous gridlock rather than serving as a protective action strategy. SIP can occur in a variety of emergency situations, ranging from the detonation of radiological dispersal devices (dirty bombs), toxic explosions and chemical spills to much more common emergencies such as electrical blackouts and snowstorms.

During an SIP emergency, individuals must remain indoors, whether they are at home, work, school, shopping, in a place of worship, at a friend’s house or elsewhere. A SIP response can last from a few hours to several days and may require individuals to be separated from family members.

Depending on the type of emergency that precipitates the SIP, individuals may have varying access to supplies, materials and information. For example, if a dirty bomb is detonated in an area, groups of individuals may have to retreat to a single room and tape the windows, doors and air vents shut to prevent exposure to radiation. During a storm, individuals may be without electricity and heat. In both scenarios, individuals without battery-powered radios may be effectively cut off from status updates and public messages about the disaster event. This can result in fear, confusion and anger.

 SIP during the Boston Marathon bombing manhunt

On April 19 at 5:13 a.m., Massachusetts Gov. Deval Patrick and Boston Police Commissioner Edward Davis suggested a SIP order for residents in the communities of Watertown, Cambridge, Waltham, Newton, Belmont and Boston, while police and emergency personnel searched for suspects in the Boston Marathon bombings. For 12 and a half hours, residents were instructed to remain indoors while authorities conducted an areawide manhunt for the individuals believed to be responsible for detonating two bombs near the marathon finish line four days earlier.

During this time, individuals were instructed to lock their doors and to open them only for a properly credentialed police authority. Additionally, several media outlets reported the possibility that the perpetrators had planted additional bombs throughout the city and that a safety clearance was needed to protect the public. As a result, a metropolitan area of 4.5 million people, the 10th largest in the United States, came to a halt as public services, transportation and businesses all shut down for the day.

 Why do counselors need to know about SIP?

Emergency managers and disaster response personnel express concern about the challenge of compliance with an SIP order. In a study of the public’s knowledge of SIP, Lasker, Hunter and Francis (2007) found that only 59 percent of the U.S. population would shelter inside a building other than their own home during an emergency. Furthermore, the emotional effects of this voluntary confinement strategy have not been widely explored. Analogue research as well as qualitative inquiries about SIP behavior have discovered that individuals worry about experiencing emotional distress, knowing what to do if others becoming unruly or violent, and about how much to trust authorities (Dailey & Kaplan, under review; Lasker et al., 2007).

Several factors can determine whether people comply with a SIP order. Practical issues such as loss of income, lack of supplies or lack of adequate shelter may affect an individual’s decision to shelter-in-place. Some may have caretaking obligations of family members or children. Others may struggle with the emotional effects of virtual confinement, separation from family members and the group dynamics that evolve when sheltering with coworkers, extended family members or strangers. Another issue relates to the event that set the SIP order in motion in the first place. Individuals evaluate the credibility of the source of the SIP order, the perception of actual danger and the degree of perceived personal relevance of the event. Previous disaster or trauma experience can also affect this perception.

What practical strategies can counselors use?

Counselors may be involved in various roles before, during and after a SIP order. Before a SIP, counselors can encourage their clients, organizations and/or schools to have appropriate prevention and preparation measures in place. Counselors can also ensure that persons have a resource list, such as the American Red Cross “Coping with Shelter-in-Place Emergencies” fact sheet. Counselors can also make sure that coworkers, friends and family members discuss the SIP plan ahead of time. Additionally, counselors can suggest that persons and organizations have a supplies kit stocked in case of a SIP emergency. Examples of needed supplies include bottled water, medications, first aid supplies, quiet games, books, playing cards, disposable wipes and nonperishable foods. Similar kits are used for emergency preparedness for hurricanes and other natural disasters.

During a SIP emergency, counselors may find themselves sheltering with several individuals. In this situation, a counselor’s knowledge of group dynamics and disaster responses can come in handy. Depending on the makeup of the group involved, some stages of forming, storming, norming, performing and adjourning may occur as groups develop various levels of cohesion. Some group members may unintentionally antagonize the group during the stressful situation by panicking. This situation would require individual attention or redirection away from talking about the emergency at hand. Other persons could be engaged in facilitative roles to assist other persons who may be struggling with sadness, fear or worry. Counselors may also utilize disaster interventions to help ground people in the here and now during a chaotic event. Finally, counselors should work to quell rumors, which can escalate an already tense situation. Counselors should encourage persons to deal only with confirmed facts and realize that information obtained during a disaster is fluid and requires substantiation.

After the “all clear” at the conclusion of the SIP, counselors must focus on the resilience and posttraumatic growth that can occur after a disaster or emergency. The outcome of the crisis event and the length of the SIP may affect individuals’ abilities to integrate back into their normal routines. However, studies show that most people do not have any long-term negative effects from the SIP experience itself. Counselors may be called upon by emergency management personnel to implement post-disaster interventions, such as Psychological First Aid, to further assist in the postvention.

For more information, see the following resources:

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Stephanie Dailey (Argosy University/Washington, D.C.) and Tara S. Jungersen (Nova Southeastern University) are members of the ACA Trauma Interest Network.