Ch. 21
Creating an effective hybrid or integrated identity requires incorporating both ...
"military and civilian cultural knowledge, values and practices"
Identify the second S in Schlossberg's transition theory and can be described in terms of resources, or personal assets necessary for successful transition, and deficits, or liability serving as roadblocks to transition
Self
What is the philosophy shared by peer support programs
Self-direction, choice, and empowerment
Behavioral manifestations of moral injury may include...
Self-harm, social withdrawal, substance abuse, and social instability
Grief can result from any event that produces a significant disruption in __________, _________, and/or _________
Self-image, self-worth, and/or worldview
The transition to civilian life is further compounded by the disconnect between who
Service members and the general public
What is the term used to define life events or nonevents that require change, changes in relationships, assumptions, roles, and/or routines
Transitions
What is the term used to describe "a traumatically induced structural injury and/or physiological disruption of brain function as a result of an external force" according to the VA
Traumatic brain injury
True or False Although initial military training is designed to facilitate the transition into military culture, there is no corresponding mechanism to assist Veterans in successfully reintegrating into civilian life
True
True or False Although many military service members adjust seamlessly into civilian life, others struggle to transition back into family life, work, and community
True
True or False Compared to civilian populations with similar injury types, patients who received amputations reported higher functional outcomes than those with limb salvage
True
True or False Higher military rank was positively correlated with a lower probability of depression and PTSD and with a higher probability of working/on active duty or in school and being engaged in vigorous activities
True
True or False If a veteran is not able to or does not want to seek paid employment, volunteer works is a health-promoting alternative
True
True or False More intense combat experiences were associated with worse functional scores and a higher likelihood of PTSD
True
True or False Mental health conditions often present with medical comorbities
True Pain Hypertension Diabetes
The following events are examples of what type of transitions Divorce, premature death of a spouse, death of a child, natural and technological disaster, being laid off or fired from a job, war, and terrorism
Unanticipated transistions
What types of transitions are non-normative, have a low probability of occurrence, and often involve crisis - Outside of one's control and offer little or not opportunity to prepare - May occur at the individual, family, community, or societal level
Unanticipated transitions
OT practitioners have the knowledge and skills to do what for veterans
- Foster Veteran's engagement i health-enhancing occupations, habits, roles, and routines - Promote mental health - Enable occupational participation - Encourage community reintegration - Facilitate the recovery process
To work effectively with veterans, it is important to ...
- Understand military culture, the context of their overseas military culture, the context of their overseas military deployment, the physical and mental health conditions with which they return home, and the psychosocial stressors they experience
According to a study in the text, what are 4 factors that were associated with a more difficult readjustment experience when reentering civilian life
1. Being seriously injured in the line of duty 2. Serving in the military while married 3. Knowing someone who was killed or seriously injured in military service 4. Experiencing a traumatic event during military service
In order to repair moral injury and experience spiritual renewal, what 3 aspects of intervention appear to be useful
1. Emotional and psychological processing of the morally injurious event and its impact 2. Exposure to and participation in positive moral experiences, such as giving and receiving love and engaging in altruistic behaviors 3. Fostering reparation and the practice of forgiveness of self and others
The top three top-ranked interventions endorsed by occupational therapists for Veterans with PTSD are
1. Engaging in goal-directed meaningful occupations and activities 2. Developing occupational roles, habits, and routines 3. Meditating or using other mindfulness techniques
What were the top 5 physical health symptoms reported by those having difficult coping with grief
1. Fatigue 2. Sleep problems 3. musculoskeletal pain 4. Back pain 5. Headaches
Eligibility and health-care benefits requirements vary by whether or not the Veteran's disability is related to .... What 4 things?
1. Military service (service connection) 2. Period of service 4. Employment status 5. Income
Of the types of chronic pain, what 2 types have the highest prevalence in VA primary care settings
1. Musculoskeletal 2. Back pain
A survey indicated that the most significant challenges of the transition from military to civilian life are HINT: 4 things
1. Navigating VA programs 2. Benefits and services 3. Adjusting to civilian culture 4. Addressing financial challenges 5. Applying military -learning skills to civilian life
What are the 4 types of nonevent transitions
1. Personal 2. Ripple 3. Resultant 4. Delayed
It was determined that 2 elements directly influenced CR, what are they
1. Personal factors 2. Social support
In addition to the type of transition, additional factors determine the influence a transition has on a person's life. What are these 3 factors
1. Perspective 2. Context 3. Impact
What are the 4 terms used the describe the transition process under Schlossberg's transitions theory or "4S system"
1. Situation 2. Self 3. support 3. Strategies
Veteran identity is affected by what 3 things
1. Sociocultural factors 2. combat exposure 3. Time period (war era) in which the service occurred
A person's perception of and response to pain are influenced by the dynamic and reciprocal interactions of what 3 variables
1. biological 2. psychological 3. sociological
What are the 4 most common mental health diagnoses across all services
1. depressive disorders 2. anxiety 3. Insomnia 4. PTSD
What types of transitions are expected or hoped for events that did not occur - Alter a person's life and require change and adaptation
Nonevent transitions
Transitions can be
Normative, anticipated, and expected or unpredictable, unanticipated, and unexpected
According to the VA, ____ Veterans die each day by suicide
20
About half of active duty service members are _____ years of age or younger
25 years of age
On average, deployed personnel are under _____ years of age, more than _____ are married, and about ______ have children at the time of deployment
30 years old more than half about half
Meeting the needs of Veterans and their families begins with what
A comprehensive evaluation process Duhhhh
What is the first step in the process of the peer recovery support services
A conversation about the peer's values, interests, goals, and abilities
After sustaining a fracture from a blast injury, what happens next
Casualties are evacuated from the theater of operations, medically stabilized, and returned to a definitive care facility, where management may include amputation or limb salvage
What did the Uniformed Services University develop to address the need for culturally competent care for Veterans
Center for Deployment Psychology (CDP)
The primary underlying theme regarding reintegration transitions for families was the need for
Changes in family members' occupational performance patterns upon the service member's return
Veterans experience a disparity in health-care coverage on _______ and __________ ________
Age and employment status
The following events are examples of what type of transitions Graduation, marriage, starting a job, birth of a child, retirement
Anticipated transitions
What types of transitions are typically normative, meaning they predictably occur during the life course and the vast majority of people experience them - They are often self initiated and planned - There is usually time to prepare
Anticipated transitions
Social supports acted as _______ of CR HINT: Facilitators or barriers
Both
Identify the only occupation-based assessment that is demonstrated through research to be useful with Veterans who are in the provess of reintegrating into civilian life
COPM
What assessment was used in an interdisciplinary residential treatment program for Veterans with PTSD and TBI and was found to be effective in identifying each individual's unique set of goals and as an outcomes measure of the efficacy of treatment
COPM
According to the text, in a Delphi study that was conducted, what was the most highly supported FOR to be used for interventions with Veterans with PTSD What were 2 other theories identified as a result from this study
Canadian Model of Occupational Performance and Engagement (CMOP-E) MOHO and the recovery model
What is the term used to describe pain without biological value that has persisted past the expected time for tissue healing
Chronic pain
Veterans who reported a relatively easy transition back into civilian life were more likely to be
Commissioned officers, have a college degrees, and attend religious services at least once a week
Identify an assessment that consists of 15 questions designed to ascertain whether the person performs a certain activity alone or with another person - The higher the score, the greater the integration into the community
Community Integration Questionnaire (CIQ)
Identify the instrument specifically designed for Veterans, developed based on the International Classification of Functioning, Disability, and Health (ICF) and measures both objective and subjective aspects of participation - Consist of 3 scales: extent of participation, perceived limitations in participation, and participation satisfaction
Community Reintegration for Service Members assessment (CRIS)
Evaluation of community _________ is an important component of overall well-being and quality of life
Community integration
What term is used to define "returning to participation in home, social, and community living after deployment and in many cases, after injury as it relates to veterans
Community reintegration
What is the term used to define the desire to ameliorate the suffering of another
Compassion
The experience of positive emotions, particularly __________, ________, and ______ may assist in moral injury repair, increase cognitive flexibility, and promote social cohesion
Compassion, elevation, and pride
What is the term used to describe a "persistent and impairing condition, often in response to a traumatic death, that is characterized by intense emotional pain and sorrow, avoidance of reminders of the deceased, role and identify confusion, and a wish not to live without the deceased
Complicated grief (CG)
What is the primary contribution of the MOHO to the program at Veterans Recovery Resources
Concept of performance patterns and habituation
According to the Department of Veterans Affairs, the total Veteran population is predicted to ______ from 2017 to 2037 HINT: Increase or decrease
Decrease
What type of non-event transitions are those events that do not happen at the expected or desired time but are still hoped for and aspired to
Delayed nonevents
Military culture has been described as more ______ than most cultures, having an overt set of values and normative behaviors and a code of ethics supported by its own judicial system
Delineated
What is the term used to define "the movement of military personnel and equipment into places where they can be used when needed"
Deployment
Mental health assessments for Veterans should screen for what
Depression, anxiety, PTSD, and substance abuse
The majority of service members entered the military during what period of emerging adulthood
Developmental period
True or False Research has found that male Veterans reported poorer overall health, health-related functional limitations, and lifetime health conditions less frequently than civilian men
FALSE Research has found that male Veterans reported poorer overall health, health-related functional limitations, and lifetime health conditions MORE frequently than civilian men
What are some cognitive symptoms a veteran with a mTBI may experience
Difficulties with attention, concentration, and visuospatial abilities
What are some of the values the military culture emphasizes
Duty honor loyalty Discipline Readiness Accountability Dedication Commitment to comrades Unit cohesiveness
From an OT perspective, community reintegration is a ______ _________ process that facilitates participation in culturally appropriate and personally meaningful roles and full engagement in community life
Dynamice adaptation
What designated the beginning of Operation Enduring Freedom (OEF) or the "War in Afghanistan"
Military operations in Afghanistan beginning on October 7th, 2001
What is the term used to define the feeling of warmth one gets from witnessing human goodness or moral beauty
Elevation
Successful community reintegration is not simply a matter of individual function but also the readiness of a community to
Embrace Veterans and their needs
True or False Peer support specialists do not receive training or have to pass an exam to become certified
FALSE
True or False Healthcare for Veterans is guaranteed by military service alone
FALSE Healthcare for Veterans is NOT guaranteed by military service alone
True or False Peer support services are a substitute for professional care
FALSE Peer support services are a complement to professional care but NOT a substitute for it
Identify the tool under development that measures self-perceived difficulties with reintegration into civilian life
Military to Civilian Questionnaire
True or False Service members returning home without any physical injuries or diagnosable mental health disorders are not likely to be coping with a variety of psychosocial stressors that produce confusing, frustration, and distress
FALSE Service members returning home without any physical injuries or diagnosable mental health disorders ARE likely to be coping with a variety of psychosocial stressors that produce confusing, frustration, and distress
True or False Strength of social support was not a strong and consistent correlate of both physical and psychosocial functioning
FALSE Strength of social support WAS a strong and consistent correlate of both physical and psychosocial functioning
True or False Unremitting chronic pain decreases the risk of substance abuse, depression, and suicide among veterans
FALSE Unremitting chronic pain INCREASES the risk of substance abuse, depression, and suicide among veterans
Personal factors acted as _______ of CR HINT: Facilitators or barriers
Facilitators
What type of intervention practices helps to focus attention, increase body awareness, and enhance emotion egulation
Mindfullness
What type of intervention practices include sitting and walking meditations and yoga
Mindfulness
A study stated in the text, postulates that experiences of moral injury may disrupt the coherence and stability of a Veteran's sense of _______ ______
Global meaning
______ ______ era (1990-present) veterans now comprise the largest demographics of the veteran population
Gulf War-era
The prevalence of mental health conditions among Veterans is much ______ (higher/lower) than in active-duty military service members and civilian populations
Higher
Veterans often hold themselves to ______ (higher/lower) standards than the typical civilian
Higher
Challenging transitions for Veterans during reintegration include...
Leaving behind a built in support system, a steady income, and accessible resources
What are some factors associated with chronic pain in both Veteran and civilian populations
Lower levels of education, smoking, and emotional distress
What group of the population has the highest rate of suicide
Male veterans ages 18-34
What is one goal of occupational therapy interventions within this population is
Maximized the person-environment fit to enhance quality of life
What is the term used to describe "having attention paid to you, having a sense of importance, being appreciated, having people who depend on your, and having pride in what you do"
Meaning
According to the Defense Health Agency, the prevalence of active duty service members diagnosed with any mental health condition varies by ______ _____ and has ______ (increased/decreased) from 2005-2012 with a reported _______ (incline/decline) from 2013-2016
Military force Increased from 2005-20012 with a reported decline from 2013-2016
What is the term used to define the sense of the self as being good, competent, and virtuous
Pride
What term refers to the consequence of "perpetrating, failing to prevent, bearing witness to acts that transgress deeply held moral beliefs and expectations"
Moral injury
_______ ______ is a "broad clinical concept that exists in the intersection of multiple emotional, cognitive, and social pathways"
Moral injury
What is the term used to define a state in which a person or group of people are unable to do what is necessary and meaningful in their lives due to external restrictions
Occupational deprivation
What is the term used to define when a person's normal pattern of occupational engagement is disrupted due to significant life events - Typically temporary ad can occur due to a variety of situations
Occupational disruption
What is the term used to define when a person is unoccupied, underoccupied, or overoccupied
Occupational imbalance
In mid-2002, Congress signed into law authorization for the use of military force against the Saddam Hussein regime in Iraq, resulting in __________ _______ ______, also know as the "War in Iraq"
Operation Iraqi Freedom (OIF)
What are 2 of the major risk factors for suicide among Veterans that are identified in the text
PTSD and depression
PTSD and moral injury have common characteristics; however, what is the difference in how they are emotionally characterized
PTSD is emotionally characterized by fear Moral injury is emotionally characterized by shame
What term is used to describe a person who uses his or her lived experience of recovery from mental illness and/or addiction, plus skills in behavioral health settings to promote mind-body recovery and resiliency
Peer support specialists
What type of non-event transitions are those individual aspirations that are not realized Ex. never marrying or having a baby or not being promoted
Personal nonevents
What term is used to describe "two or more injuries to physical regions or organ systems one of which may be life threatening, resulting in physical, cognitive, psychological, or psychosocial impairments and functional disability"
Polytrauma
What was the signature injury of the wars in Iraq and Afghanistan
Polytrauma
The _______ _______ of mild traumatic brain injury (mTBI), chronic pain, and PTSD have proven to be a difficult diagnostic and therapeutic challenge for the current medical system
Polytrauma triad
What did the VA administer to financially assist Veterans transitioning to student status and provides significant financial educational benefits, including full tuition and fees, a monthly housing allowance, and up to $1,000 a year to use for books and supplies
Post-9/11 GI Bill
What type of non-event transitions are the result of some event that occurs that causes an aspiration of expectation to remain unfulfilled - Has a begining and an end, but the nonevent lasts a lifetime Ex. not graduating from college because of an acquired brain injury due to an automobile crash
Resultant nonevents
What type of non-event transitions are personal nonevents of people close to us that require us to change or adapt Ex. a spouse not receiving a promotion at work
Ripple Nonevents
Identify the first S in Schlossberg's transition theory, that consist of 7 variables: trigger, timing, control, role change, duration, previous experience, and concurrent stress
Situation
What kind of disturbances are highly correlated with suicide among veterans, making it a priority for interventions
Sleep disturbances
Existing research indicates that successful recovery occurs when facilitated by _____ _____ within the context of the community
Social support
Identify the fourth S in Schlossberg's transition theory, that are the coping resources available to the person as he or she moves through the transition The coping strategies can be health enhancing or detrimental
Strategies
Rather than focusing on correcting deficits, disabilities, or problems, peer recovery support services incorporate what kind of approach to build resiliency and capacity
Strengths-based approach
Identify the third S in Schlossberg's transition theory, that refers to the encouragement, assistance, and options that are available in the environment
Support
What is the name of the national non-profit organization that deploys Veteran volunteers on specific projects for up to 6 months. - Designed to promote career and educational development
The Mission Continues
What was established to provide an integrated network of specialized rehabilitation programs dedicated to serving Veterans and service members with both combat- and civilian-related TBI and polytrauma
The VHA Polytrauma System of Care
What is the mission of the CDP
To lead the development of a community of culturally mindful and clinically competent providers through the delivery of high-quality training and education, the convening of experts, and the dissemination of research-based treatment and the latest topics in military behavioral health
What is the term used to define a "Veteran's self-concept that derives from his or her military experience within a sociohistorical context"
Veteran Identity
Understanding the differences of Veteran ________ should better inform community health promotion programming, resulting in improved health outcomes
Veteran culture
What is the model created to address the policy-institutional-, departmental,- and individual-level actions necessary to create an environment supportive of student Veterans that will lead to degree completion
Veteran-Friendly Environment Model
50% of Veterans live within 10 states, with the largest concentration residing in the _______ and _______ HINT: North, east, west, or south
West and south
Military cultural competence is essential to carrying for the __________ needs of military and Veteran populations
biopsychosocial
The majority of combat casualties are the result of a ______ injury
blast injury
Identify the term used to describe "ongoing or recurrent pain, lasting beyond the usual course of acute illness or injury or more than 3-6 months, and which adversely affects the the individual's wellbeing
chronic pain
The process of training for the armed services strips away a person's ________ ________
civilian identity
Chronic pain is considered a complex ___________ condition and therefore must be addressed hollistically
complex biopsychosoial
Because the military has its own culture, with a distinct set of values and norms significantly different from mainstream society, the community reintegration (CR) could be considered a _______ -_____ transition, making it ___________ and highly complex
cross-cultural transition making it multidimensional
Exposure to the death of an FSM was associated with _____ the rate of complicated grief when compared to other losses
double
Toblin et al. indicated that it was the _________ _______ of ________, rather than the actual experience of loss, that was associated with diminished physical health
emotional reaction of grief
69% of all Veterans suicide deaths are by _____
firearms
What are some physical symptoms a veteran with a mTBI may experience
headaches, pain, vestibular problems, and hearing and vision impairments
Other than the cognitive and physical symptoms, what other problems may a veteran with a mTBI experience
higher unemployment than counterparts without TBI and moderate to severe sleep disturbances
What kind of injury is characterized by loss of consciousness for 0 to 30 minutes, altered mental state of a moment up to 24 hours, post-traumatic amnesia of 0 to 1 days, and a Glasgow Coma Scale score of 13 to 15 in the first 24 hours
mTBI
Veterans often reflect on their military service as a time that fostered
personal maturation, teamwork and collaboration, and self-confidence
One strategy for assessing the community is through the use of ...
the PRECEDE-PROCEDE planning model
One of the most commonly reported organizational barriers to CR was the difficulty encountered when
when trying to access federal programs and services