by Ellen Belluomini, LCSW
Technology in systems is only as good as the planning behind it. An example of needing a systems plan integrating technology is the current crisis in Veterans’ mental health and health care. The U.S. Department of Veterans Affairs (2011) estimated there were almost 23 million veterans in the United States. Yet only 7.8 million veterans use their health care benefits. The VA’s current access audit uncovered the need for 90,000 veterans to be contacted because of their long wait times. Over the past 10 years 64,869 veterans never saw a clinician after being enrolled. The United States surpasses the world in technology, yet large government systems such as the VA and the Affordable Care Act remain rife with technology problems. Social workers can advocate for systems changes with technology solutions.
The Department of Veterans Affairs (VA) and Department of Defense (DOD) excel in implementing programs for micro systems. The VA is innovative in development of health and mental health phone applications. The DOD provides free training and information for mental health and health providers. The U.S. Department of Health and Human Services Health Resources and Services Administration (HRSA), the Center for Deployment Psychology, the National Council for Behavioral Health, and the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury offer an introduction of education toward effective care for military populations. The only issue with these services is how the information is disseminated. Unless providers are willing to surf the Internet for education and training, they may inappropriately treat military clientele.
I worked as a Family Advocacy Prevention Specialist on the Great Lakes Naval Base and as the director of an emergency shelter program on a VA campus. These experiences trained me to provide services to military members and their families. The manner of my practice with these military populations differs significantly from that with civilian populations. Common issues addressed include military values, power issues, trauma reactions, conflict resolution practices, and reintegration problems. These differences create a culture friction between military families and civilian lifestyles.
Here are some troubling statistics from the U.S. Department of Veterans Affairs:
- Veterans with Post Traumatic Stress Disorder
- Almost 31% of Vietnam veterans
- As many as 10% of Gulf War (Desert Storm) veterans
- 11% of veterans of the war in Afghanistan
- 20% of Iraqi war veterans
- 22 veterans commit suicide each day, the highest percent between the ages of 50 and 59.
- 57,849 veterans are homeless on any given night, and 1.4 million veterans are at risk of being homeless.
- The rate of depression is five times higher in soldiers than civilians.
- 55% of women and 38% of men report being victims of sexual harassment in the military.
- 20% of Iraq and Afghanistan veterans have substance abuse addictions after returning home.
- Of reported domestic violence situations in the U.S., 21% of these include combat veterans.
Military values and practices are not the same as in the civilian sector, but how are social workers addressing these variations? I informally asked several colleagues in the community who regularly work with military families. Not one of the 10 professionals I surveyed had ever taken any type of online or in-person training in the cultural literacy of military populations. Only one professional had taken a course on a treatment (EMDR) that specifically addressed military members as a subpopulation. Although all of the professionals “knew a veteran” from their extended family or friends list, they had never had a conversation with them about their military experience. Education is a gap within treatment of this population.
Higher education is responding to the need for specialization in working with military populations by providing training for social workers. The University of Southern California (USC) is breaking ground with research and education on military populations. USC developed a technology simulation to help social work students. The Motivational Interviewing Learning Environment and Simulation (MILES) allows students to practice therapy with a military member simulation. MILES is groundbreaking in its approach to supporting military studies. Some social work schools are offering concentrations and certificates in military social work. The Council on Social Work Education provides a full list of universities with a military focused social work degree or certificate program. (See http://www.cswe.org/default.aspx?id=17491.)
How well the government creates solutions through technology on a micro level does not mirror solutions on a mezzo and macro level. Mezzo practice with the military community does not include use of technology to enhance communication between the DOD, VA, veterans support programs, and community services. Each agency has separate electronic medical records and its own approach to mental health services. One community is not aware of the interventions of the other unless by self-report. The government is responding on a macro level with an increase in VA medical services, but it is not including mental health alternatives in this package. Societal solutions need to include the entire continuum of care.
Technology provides a bridge to services and communication. The Department of Housing and Urban Development financially supports each community’s Continuums of Care planning body for people experiencing homelessness to develop a single point of access to its system. This coordinated entry system moves people more quickly through services, provides communication of care between agencies, minimizes duplication of services, and increases the data collection accuracy on client needs for future services. This is a government system easily replicated for military communities. The system is effective for urban, suburban, and rural areas.
Social workers do not have to recreate the wheel in addressing needs of the military community. Awareness of this population’s cultural differences coupled with a collaborated voice of advocacy can make a difference. Military members and their families have made sacrifices for the stability of our nation. We need to work toward stabilization of their family systems.
Ellen M. Belluomini, LCSW, received her MSW from the University of Illinois, Jane Addams School of Social Work and is currently a doctoral student at Walden University. She is a lecturer at Dominican University. She has developed online and blended curricula with an emphasis on integrating technology into human services practice. She writes a blog, Bridging the Digital Divide in Social Work Practice, to increase awareness about technology’s uses. She presents and consults on various issues related to social services. Her clinical work has been in private practice, management of nonprofit agencies, and programming for vulnerable populations.