Welcome to Unit 05.02. In this unit we're gonna talk about how active duty service people reintegrate into civilian life once their service to our country has completed. So you have to remember that the trajectory of service members is that from civilian, to active duty, to veteran. And we forget that this is a developmental trajectory like anything that might happen in our lives. And so people who either enlist in the military go in as officers or ROCT training have various ways have lived a long time of their life as civilians. There's a process about moving from civilian to active duty service person and that is through boot camp, military job training, or ROTC and other things as we've talked about. And then there's this life trajectory in terms of being active duty and what that means to a person in terms of serving their country and serving their roles. And then they'll spend a long part of their trajectory again as a veteran. And as they reintegrate from going from active duty person to a veteran status. And again, they'll spend most of the rest of their life as a veteran, and we'll focus a little bit on reintegration during this segment. Here are some photos of really what it means, if you want to think about the previous trajectory of going from active duty service person to veteran. And we forget that there is lots of wealth and life experience that is actually happening between those two transitions that actually is actually quite interesting to talk about it as a way to develop rapport with your patients. So as we talk about reintegration the definition is really the process of transitioning from military life back to civilian life, and particularly, this becomes an issue even If they're transitioning from a deployment back to military life, say back at the United States. So there's really phases of post deployment, there's excitement in terms of homecoming, there's often a relief, there's a sense of safety. However, there's a sense of insecurity as well as to, my life was actually very clear as to what the processes were, what the expectations were when I was deployed. And now my hours are my own. I might have to report to a job but really try to understand how I can reintegrate into the life. So there's a homecoming, there's a honeymoon. Like with anything new, there's excitement and newness. But also with excitement and newness comes conflict, disappointment, trying to understand new roles, and overall joy. And then there's a shift that happens and this is various and sundry roles. I think one of the interesting things that happen. It's my understanding of what happened for veterans who were coming back from our recent conflicts during the economic downturn is that veterans were coming back. Especially here where we're based in the state of Michigan and really having difficulty finding employment. So that made a whole different set of circumstances when you're trying to reintegrate into life. And luckily the economy is improving and veterans are more able to seek jobs. There are actually very interesting initiatives, you hear them on the commercials about hiring veterans. We've talked about in previous segments and units. I think unit two, we talked about this issue about what veterans bring potentially to the employment community and why you might actually wanna actively seek to hire a veteran. And then there's this imperative new normal that really means that a veteran must incorporate all of their life experiences like we all must and really live their life as a veteran. So, this reintegration process Is really interesting piece to really understand and really try to understand where your patients are on this trajectory, when you're talking to them. And the issue here that we really wanna talk about is, how difficult or how easy is it to come home? And here, you can see a survey from the PEW Research Center asking veterans how easy was it for them to reenter civilian life and, as you can see, almost half say that there was somewhat of a difficult time. 70% found it somewhat or very easy, but then there's almost a whole nother third that really had difficulty transitioning. And some when you wanna think about what makes that transition difficult is you wanna think about, what's it mean to be a warrior? You have to consider other invisible wounds, such as PTSD, TBI, etc that make, that impact on whether integration is successful. And again when we ask veterans who receive care at the VA, 25 to 40% say that they had some degree of difficulty with reintegration process. Returning veterans all have individual experiences. So one can assume anything and so that's the great thing about asking patients did they have some difficulty with this, what kind of injuries did they suffer, etc. Really trying to one develop rapport, but two really try to understand what impact military service might have on the veteran that you're encountering. Either within the VA hospital and healthcare system or within civilian healthcare facilities when you encounter a veteran. So, again, it's just to re-iterate some of those reintegration difficulties, our issues around social relationships, lack of interest, and difficulty concentrating, emotional instability, nightmares. These are all things that could be attributed to some of the invisible wounds of war, are really around mental health, but they also could just be adjustment disorders. I think many of us can experience some of these things in terms of mood swings, difficulty sleeping, whenever we've had a large transition in our lives one way or the other. But we also wanna focus on what those determinants are for a successful integration in civilian life and we really wanna provide resources for those military folks who are coming home in order to give them the best trajectory they have and easy reintegration. And those are things like clear information about how to access the needed health care that they might need. And again we talked about that in unit 2 about what the process is that they might have to undergo in order to set up healthcare within the Veterans Health Administration. Readjustment into family life, so there's been really quite a few initiatives both with the Department of Defense, with various states, the VA Hospital and other local agencies really, not only preparing the veteran for their reintegration, but also preparing the family who's welcoming this veteran home. Again, job security and financial security mean a lot to all of us. And so you wanna make sure that those resources are available. I think a great example we just had, a veteran job fair that was co-sponsored by the VA hospital here in Ann Arbor along with other local businesses such as Walmart and other sort of large employers who really say there's opportunities here in order to hire returning veterans. And so the things that you want to assess for if you're seeing them in the healthcare environment, the pieces of your history and physical exam that you directly want to ask about are those things related to post-traumatic stress disorder. Issues related to traumatic brain injury, substance abuse, anger or managing stress issues, and other mental health disorders such as mood disorders, such as depression, sadness, distress. These are all screening things that you should do as part of your assessment. And again, you want to remember that trauma, be it sexual in nature or post-traumatic in terms of combat related and also reintegration issues effect all of our veterans who want to understand where they are at on that trajectory and it is those things that can affect everyone in their lives and everything. So asking about them and really understanding how those issues and how you might address them as a healthcare provider are really key to welcoming and providing veteran centered care.
