NEW JERSEY VETERANS HELPLINE PROGRAM

1-866-VETSNJ4… YOU!1-866-838-7654

A Partnership of UMDNJ- UBHC & NJ DMAVA

NEW JERSEY VETERANS FOR YOU HELPLINE AT UBHC-

UMDNJ Is answered 24 /7 by Veteran/Peer clinical

staff & counselors with military expertise A “Vet to Vet” experience, it is confidential,

free, and available to meet your needs New Jersey soldiers and their families

receive telephone peer counseling, clinical and suicide assessments as needed, referrals to veteran mental health treatment and customized resources available through NJ Department of Military & Veterans Affairs

NJ VETERANS HELPLINE Services Include:

“Veteran to Veteran” Peer Support Telephone Counseling Veteran Clinical Assessments Triage -Veteran Service Offices Resources Referrals to providers with military

expertise Crisis Support/Field Activity Vietnam Veterans Support Group

Meetings Family Support & Liaison activity

New Jersey Veterans Helpline CALL HISTORY- 2005- 2008Total calls : 5,637/8,882 Service Requests Call backs by Veteran/peer counselors: 3,324Telephone counseling /treatment requests:

1,5642009 (3 MO’S)TOTAL CALLS/CONTACTS= 2,894FIELD/GROUP CONTACTS = 1,977CALLS & TELEPHONE COUNSELING= 91760-70% OEF/OIFGender – 80% male, 20% female

FIELD ACTIVITY SUMMARYRECONSTITUTIONS/DEPLOYMENTS

UBHC Veteran staff participated in 58 Reconstitutions - 2005 - 2008

As a result approximately 175 veterans in therapy

Increase in 1:1 and group field activity highlighted our team in 2008

2009 selected to be “Lead” in NJ DMAVA PTSD Task Force

“Lead” in Welcome Home 1:1 sessions for Reconstitution of approx. 3,000 soldiers

“Welcome Home” is a UBHC Military One to One

Intervention Goal: To Decrease Stigma And Increase Chance

Vet Will Disclose Any Concerns Primary team of Veteran peers & clinicians Handouts- see “FORMS” Crisis triage capacity w/clinicians Goal = Engage, Psycho-Education, Crisis

Response Provide Military Support & Suicide information Encourage utilization of support services

WHO ARE YOU SERVING?New Jersey National Guard –

OIF/OEF WARRIOR SPIRIT-Acknowledge it! An intensity of life filled with energy

and readiness to act when needed protecting one’s family, neighborhood, nation and world.

A total willingness to stand up for what is right with a sense of duty greater than one’s own need. Charles Lewis Arnold, MS, BCPC, CTM, CTSS

(ret. Master Sergeant, United States Marine Corps and New Jersey Army National Guard)

WHAT YOU ARE DOING…

VOLUNTEERING TO SUPPORT OUR TROOPS AS AMEMBER OF THE UBHC- UMDNJ TEAM LED BYTHE NEW JERSEY VETERANS HELPLINE STAFF

BY GENUINELY SHARING YOUR GRATITUDE FORTHEIR SERVICE

PROVIDING PSYCHOEDUCATIONAL INFORMATION,“CHECKING IN” WITH THEM ON THEIR EXPERIENCES

BEING DEPLOYED

ASK HOW THEY FEEL AS THEY ADJUST TO RETURNINGHOME……

STEPS OF THE “WELCOME HOME” 1:1Welcome Home 1:1 Psycho

educational Session- Thank them!Introductions/Sign In/ Program

SheetReview Packet/Forms Interview-(script)Psycho educational componentOffer resources/follow-up

12

WHAT IS YOUR GOAL? Welcome Home- Soldier’s need

support Share gratitude for service Explain Confidential resource in

NEW JERSEY VETERANS HELPLINE Offer support through the–

Welcome Home 1:1 Interview Review Materials- Psycho education Ensure service to those in need

13

WHAT YOU ARE NOT DOING

• A CLINICAL/PSYCHOSOCIAL ASSESSMENT

• A CRISIS /ACUTE SCREENING ASSESSMENT

• AN INFORMAL CONVERSATION • A RIGID OR SCRIPTED SERIES OF

QUESTIONS• MEDICAL ASSESSMENT OF ANY KIND• REFERRAL TO SPECIFIC PROVIDERS• AN INQUIRY TO EXPLORE MILITARY LIFE

BEFORE YOU GET THERE

Review materials to ensure you are prepared

Bring photo ID- preferably Driver’s license

Report by 8:30 a.m. to check points to arrive by 9:00 am SHARP for morning briefing

Ask questions/receive instructions- Team Leader

WHEN & WHEREWILL THIS TAKE

PLACE?Welcome Reconstitution sessions will take place between

June 1, 2009 and June 20, 2009 atFort Dix

3601 Saylors Pond RoadFort Dix, New Jersey 08640

IMPORTANT- Confirm event prior to reporting as the schedule may change and confirmation via email or phone should be received.

LESSONS LEARNED

NJ Veterans Helpline data reflects trends in service needs and caller reporting of symptoms

VA/NJDMAVA study reflects specific information regarding the troops pre-deployment

National PTSD resources and Military resources have offered solutions to meet soldiers behavioral healthcare needs

WHAT HAVE THEY TOLD US?New Jersey National Guard –

OIF/OEFVeteran helpline Callers Clinical Issues

Depression/Mood Disorder Anxiety/Phobias Medical/Somatic Complaints Marital/Couples Post Traumatic Stress Disorder Family/Parenting Issues Substance Abuse Aggression/Violence Recent Loss Suicidal Thoughts

WHO IS OUR “HIGH RISK” CALLER?

65% counseling requests- OIF/OEF Anxiety, depression present in most

cases Anger was present in majority of cases.

Anger varied depending on the unique situation with each soldier. Multiple deployments a theme

Sleep disturbances reported frequently Long hours /difficult schedules a cause,

others report anxiety related to fear of harm etc.

Flashbacks and reaction to loud noisescommon

Military Families & New Jersey Veterans

HelplinePrimary Diagnosis/Complaint with Parenting/Family IssuesDepression 93%Anxiety 91%Aggression 89%Marital/Family 68%Violence 27%

FAMILY STATISTICS

63% of all family calls are from OIF/OEF

56% of all callers w/family issues = National Guard

Primary problems as Anxiety, Depression, Marital Discord

Majority of calls include marital discord w/aggression & violence prevalent for soldiers returned home from the war

TOP TEN COUNTIES DEPLOYED SOLDIERS –WHERE THEY LIVE

RANK COUNTY # DEPLOYED1 Burlington 1962 Essex 1923 Hudson 1884 Passaic 1655 Middlesex 1616 Camden 1587 Ocean 1538 Bergen 1329 Union 129

10 Gloucester 126

Preliminary Findings from the Pre-Deployment Survey of the New Jersey National Guard 2007-

2008Department of Military and Veterans Affairs VA

New Jersey Health Care SystemBloustein Center for Survey Research, Rutgers

UniversityPURPOSE To collect baseline information on the

mental and physical health of National Guard members deploying to Iraq

To assess the health effects of previous deployments to Iraq and Afghanistan by comparing those with and without previous OEF/OIF deployments

To use information to plan for the health service needs of returning veterans

METHODS Anonymous, self-administered surveys

were distributed to Guard members during pre-deployment medical assessments between 11/2007 and 5/2008

Questions focused on: • mental and physical health • substance abuse • combat experiences (for those previously

deployed) and • access to treatment

A total of 2,543 useable surveys were collected from the 2,890 deployed

SUMMARY

Guard members with one or more tours were significantly more likely to suffer from depression and PTSD than those with no previous tours

Alcohol misuse was high among all Guard members and did not increase significantly with previous deployment

The presence and intensity of physical pain was high among those previously deployed and increased according to the number of previous deployments

SUMMARY (CONT’D) Pain prevalence translated into significant

disability in performing physical activities, with more than 20% of those with 2 or more deployments reporting

The experience of pain and physical disability was especially high among those with PTSD, with 22% believing they did not meet physical conditioning requirements for deployment

Respondents reported significant barriers to mental health symptom reporting post-deployment, including the lack of post-deployment screening for mental health problems, a reluctance to report symptoms in order to avoid being placed on “medical hold” and discomfort in acknowledging mental health problems

Only 41% of those with PTSD were treated in the previous 12 months

DISCUSSION These data raise important questions about the

military readiness of troops returning to the OIF/OEF conflicts after experiencing previous deployments

All returning OIF/OEF troops receive a series of DoD post-deployment assessments and, prior to returning to combat, a pre-deployment medical assessment by both the National Guard and DoD. Troops in the present study had passed their National Guard pre-deployment assessment but had not yet been assessed pre-deployment by DoD

DISCUSSION While it is possible that many symptomatic

troops would be screened out by DoD, DoD reports that between 3/2007 and 2/2008, only 5.5% of all troops receiving pre-deployment assessments were referred for a medical visit, including only 1% referred for mental health reasons (DOD, 2008)

These data suggest that many symptomatic troops continue to be deployed to combat because of a reluctance to report symptoms and seek treatment

POLICY IMPLICATIONS The number of Veterans returning from Iraq

needing treatment for mental health and substance abuse problems is likely to be very high - 33% of the approximately 2,800 deployed troops, or over 900 veterans

Stigma is a serious barrier to veterans reporting and seeking treatment for mental health and substance abuse problems (see poster)

Alcohol problems are rarely treated and may require intensive outreach to impaired veterans

Mental Health Problems by Number of Previous Tours

2.3

6.6 6.69

4.2

14 14.1

25.4

0

5

10

15

20

25

30

Depression AlcoholDependence

PTSD Depression,Alcohol or

PTSD

No previous tours One or more previous tours

All values significant at p=.000

Mental Health Problems by Length of Time Since Previous OIF/OEF Tour

11.1

6.4

13.3

8.2

26.7

14.7

33.3

25.3

0

5

10

15

20

25

30

35

Depression Alcoholdependence

PTSD Depression,alcohol or

PTSD

12 months or less More than 12 months

MILITARY POPULATION TREATMENT RESISTANCE

Efforts to minimize distress may be based in desire to hasten discharge, quicken return to family, avoid compromising military career or retirement and in response to realistic fears about impact on career prospects.

Lessen risk through prevention of:• family breakdown• social withdrawal and isolation • employment problems• substance abuse

MILITARY SUICIDE RISK“The highest relative suicide risk is in

veterans who were wounded multiple times or hospitalized for a wound [suggesting] that the intensity of the combat trauma, and the number of times it occurred, may influence suicide risk in veterans with PTSD.” (National Center for PTSD)

MILITARY SUICIDE INFORMATION

Statistics 2007 (Violanti)

89 confirmed suicides in 2007 with an additional 32 deaths being investigated

2,100 suicide attempts in 2007 350 suicide attempts in 2002, the year

before the war in Iraq began 5 attempts per day Multiple deployments a risk

FORMSNew Jersey Veterans For You

Helpline FlyerRefer to Flyer in offering and

explaining serviceHighlight that flyer has

questions re; reactions the soldier may have that can be reviewed (PTSD checklist)

FORMSQPR

Explain to soldier QPR can help them and their families to help each other

Refer to FlyerQuestion, Persuade, Refer Suicide

Prevention Know the signs/symptoms

Be your “Brother’s/Sister’s Keeper” not just during times of crisis, but always…..

Question, Persuade, Refer

NEW JERSEY VETERANS HELPLINE PROGRAM1-866-VETS-NJ-4 - - - 1-866-838-7654

Free Confidential Helpline for New Jersey Veterans and their families

Question, Persuade, ReferQPR IS A SUICIDE AWARENESS TOOL

Be your “Brother’s Keeper” not just during times of crisis but alwaysRemember:

How you ask the question is less important than that you ask it!Similar to how CPR helps someone stay alive until you can get medical help;

QPR helps someone stay alive until they can get psychological help!Q – Question the Person about Suicide. Don’t be afraid to ask if they have thoughts of killing themselves?

Do they have a Plan?Tips for Asking the Suicide Question

• If in doubt, don’t wait, ask the question, be persistent!• Talk to the person alone in a private setting, allow them to talk freely• Give yourself plenty of time• Have resources handy; phone numbers, counselor’s name and any other information

that might help

P – Persuade the Person to get help. Listen carefully. Then say, “Let me help.” “Come with me to find help.” or “Have you thought about calling the New Jersey Veterans Helpline Program for someone to talk to? 1-866-838-7654”Don’t try to be their counselor; be their friend and support them in seeking help

R – Refer for help. Utilize the New Jersey Veterans Helpline Program 1-866-838-7654, local Emergency Room or Chaplain. Whoever will help!

Ask A Question, Save A Fellow SoldierQPR is not intended to be a form of counseling or treatment.

QPR is intended to offer hope through positive action.QPR is a tool to identify suicidal intentions in your fellow soldier

Be your brother’s keeper – Ask the Question!

Question, Persuade, ReferAsk a Question and be more than a friend!

Persuade someone to live instead of attempt suicide.Don’t hesitate to get involved or take the lead. Refer them to help.

Give your fellow soldier back up during a time when they need it most! 1-866-VETS-NJ-4 - - 1-866-838-7654

The More Clues and Signs Observed, the Greater the Risk. Take All Signs Seriously.

SOLDIER SUICIDEKNOW THE FACTS / BE AWARE OF WARNING SIGNS

Facts:• Asking won’t put the thought in someone’s head; it will give them an opportunity for help. • The suicide rate for veterans was found to be between 22.9 and 31.9 per 100,000. The suicide

rate for non-veterans is 8.3 per 100,000,• Most suicidal individuals express some intent the week prior to their attempt. • Suicide is the most preventable kind of death, and almost any positive action may save a life.

Signs/Cues to look for:• Warning Signs - despair, hopelessness, depression

• Suicide threats and previous suicide attempts• Alcohol and drug abuse (including prescription drugs and pain medications) • Statements revealing a desire to die or thoughts about killing oneself• Sudden changes in behavior • Prolonged depression• Making final arrangements• Giving away prized possession

• Direct verbal Cues - I wish I were dead. If x doesn’t happen, I’m going to kill myself.• Indirect verbal Cues - My family would be better off without me. Soon you won’t have to worry about

me anymore. Here take this - I won’t be needing it.IMPORTANT!

If you are dealing with a soldier that is not open to a referral of any sort and you believe significant risk for suicide, it is very important that you initiate the proper psychiatric emergency protocols to ensure the soldier’s safety as well as the safety of others is secured. REMEMBER New Jersey Veterans Helpline is always there; don’t wait until it’s too late!

1-866-VETS-NJ-4 -- 1-866-838-7654

MILITARY DEFINITIONS

RECONSTITUTION: To return the soldiers to their home base taking them off active duty status and putting them on reserve status.

DEFINITIONSREINTEGRATION: The time when

the service member eases his/her way back into a routine and returns to the day-to-day civilian life. To avoid upsetting the balance established during the service member’s absence, the veteran must slowly work his/her way back into the family. 30, 60 & 90 day events will support soldier and his/her family as a follow-up

DEFINITIONSMOS- Military Occupational SpecialtyOIF- Operation Iraqi FreedomOEF- Operation Enduring FreedomLOD- Line of DutyNJDMAVA-New Jersey Department of

Military & Veterans AffairsFAC- Family Assistance CentersVSO- Veteran Service Organization

WELCOME HOME INTERVIEW SAMPLE

Hello, my name is ____________

Welcome home and thank you for your service.

I am here from the New Jersey Veterans program to find out how you’re doing (Explain program)

What is your name?

What is your Armory?

What is your MOS (Military Occupational Specialty) and rank?

Did you work in your MOS during deployment?

Was this your first, second or third deployment?

What was it like being in Iraq?

Were you inside or outside the wire?

Were you involved in any combat situations?

Did you fire your weapon?

Did you experience any injuries or medical issues?

•If yes, was an LOD (Line of Duty) Completed?

Now that you are back home, what are your concerns?

From the contact you have had with your family while you were deployed, how are things at home?

Does your family have any needs or concerns that they have told you about?

Is your post deployment employment secure?

If the soldier shows signs of trauma or has ask specifically:

what are you thinking/feeling?

Are you having suicidal thoughts?

Is there anything else you would like to discuss?

PSYCHOEDUCATIONAL COMPONENT

Give them the forms and review • New Jersey Veterans Helpline Flyer• QPR Form• New Jersey Veterans Helpline cards

Tell the Veteran that staff from the New Jersey Veterans Helpline program will be attending the 30-60-90 day reintegrations and will be available for counseling if neededAlso advise they can call the “New Jersey Veterans Helpline” program anytime day or night

1-866-VETSNJ4…..You1-866-838-7654

WRAP UP PHASE

If no assistance is required at this time, remind the Veteran that he/she can call the helpline at any time. Ask them if they would like a follow-up call from a New Jersey Veterans Helpline staff member in a few days. If the Veteran says yes, provide New Jersey Veterans Helpline callback form and complete it.

OPERATIONSA mini “Welcome Home briefing” will be held each day for all volunteers before the reconstitutions start at 9:00 am SHARP

All information can be emailed to any individual wishing to participate in the reconstitutions. Please email/ call Jill Caravello at 732-235-3960 (caravejl@umdnj.edu) to be emailed PowerPoint and/or forms

OPERATIONSCrisis Response If the soldier seems to be having

a difficult time, there will be a triage room set up with licensed counselors available for follow up

Escort Soldier to the Triage Unit after notifying Team Leader

NEW JERSEY VETERANS HELPLINE

IMPORTANT STAFF NUMBERS HELPLINE: 1-866-VETS-NJ4/1-866-838-

7654

Jill Caravello: 732-235-3960

Chuck Arnold (cell) : 215-858-0879

Heather Altman (cell) : 856-366-0642

Cherie Castellano (cell) : 732-713-8037

SECURITY MEASURES WHEN ENTERING FORT

DIX If possible, please try to come in groups Please be sure to bring a photo ID (driver’s license

or passport) If you don’t have drivers license or passport, you will

need two forms of ID (one must be a photo and the other needs to be acceptable to the guard)

As your vehicle approaches the gate, please have your Drivers License, Vehicle Registration and Vehicle Insurance Card in hand and ready for police officers to identify you and all adult occupants. All adult passengers in the vehicle will be required to produce a photo ID. This will expedite entry

Plan to be at the gate by 8:30 AM

DIRECTIONS TO FORT DIX:To save time traveling to the installation, please contact the

individual where you are going for exact directions to their respective location. From New York and Northern New Jersey N.J. Turnpike South to Exit 7 (Fort Dix) Route 206 South (go to second traffic light -- about 1/2 mile) to Route 68 (left fork from Route 206). Route 68 will provide entrance to the installation where the SSG Terry Hemingway Reception Center is located

From Delaware and Southern New Jersey N.J. Turnpike North to Exit 7 (Fort Dix) Route 206 South (go to second traffic light -- about 1/2 mile) to Route 68 (left fork from Route 206). Route 68 will provide entrance to installation where the SSG Terry Hemingway Reception Center is located

From Philadelphia Take Walt Whitman Bridge to I-295 North, travel to Exit 40 (Route 38 East, toward Mt. Holly). Follow 38 through Mt. Holly and across Route 206 to Pemberton. Make a left in Pemberton (sign says To Military Bases) on Route 616 to where the SSG Terry Hemingway Reception Center is located

From Northern Pennsylvania Take Pennsylvania Turnpike to New Jersey Turnpike Take New Jersey Turnpike North to Exit 7 (Fort Dix) Route 206 South (go to second traffic light -- about 1/2 mile) to Route 68. Route 68 will provide entrance to the installation here the SSG Terry Hemingway Reception Center is located

DIRECTIONS TO THE T3 BATTLE LABBUILDING 3601SAYLORS POND ROADFORT DIX NEW JERSEY 08640

Route 68 South to Main Gate Pass through main gate and enter circle Take 2nd right turn from circle Travel 4/10 mile and make a left on-to Rancocas Road Travel 4/10 mile and make a right on-to Florida Avenue Travel 3/10 mile and make a left on-to Administrative Street NOTE: There will be a sign: NATIONAL GUARD BUREAU JOINT TRAINING AND

TRAINING DEVELOPMENT CENTER Travel 2/10 miles and turn right into parking area. The

building with the blue roof is where you want to go

Thank You for

Supporting our Troops!

PLEASE CONTACT JILL CARAVELLO re: YOUR AVAILABILITY

AND WITH YOUR INFORMATION FOR SECURITY

CLEARANCE FOR FORT DIX 732-235-3960 OR EMAIL caravejl@umdnj.edu

BY MAY 20TH

YOU ANSWER THE CALL OF DUTY,

WE ANSWER THE CALL FOR YOU 1-866-VETSNJ4…YOU

(1 866-838-7654)Thank you for supporting our

troops…