The challenges that the veteran is experienced during his transition from military to civilian life
An initial statement is what a social worker says immediately after the patient finishes detailing their experiences and outlining their problems. The purpose of this statement is to immediately provide the patient with emotional support and encouragement while establishing initial rapport at the same time. Without rapport and a vote of confidence for the social worker, it is unlikely for the intervention to achieve success. Therefore, everything said and done during the first 5 minutes of your conversation should pursue these goals. My script for the initial statement towards Terry will be as follows (Kelly, Barksdale, & Gitelson, 2011):
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First and foremost, I will thank the veteran for his service and sacrifice to our country. Many veterans do not get the respect they deserve, which exacerbates their depression and makes them feel unneeded. Saying these words at the start would help earn the patient’s trust and ensure him that I am on his side.
It is important to assure the patient that their problems, while serious, are treatable. I will say that with a tone of confidence, but without sounding dismissive, as that would offend the patient.
Explanations and comparisons
Explaining to the patient what issues he has is a good strategy. As a soldier, Terry would prefer knowing his enemy rather than remain in the dark. I will explain the details of his diagnosis to him. In addition, I will tell the patient about other people (without naming them), whose cases were similar to that of Terry, and were successfully resolved.
The use of Motivational Interviewing counseling approach to engage with the veteran
Motivational Interviewing (MI) is a tool frequently used in social work and psychology as a means of helping people facing significant psychological and social challenges, such as social ineptitude, homelessness, depression, and others. MI is structured using OARS, which stands for (Wilson, Friedman, & Lindy, 2012):
- Open-ended questions (O).
- Affirmations (A).
- Reflective listening (R).
- Summary (S).
This framework enables the patients to come to their own conclusions about how to change their lives while constantly verifying the validity of their words throughout the entire interview. The interview with Terry will have many questions regarding his personal life, his feelings and beliefs, his diagnosis, and his relationship with friends and family. Each question will have to address one of these issues. Some of the questions asked will be as follows:
- What do you think are the main differences between military life and civilian life?
- How do you think your family feels about your attempt to go to jail?
- I appreciate and value the sacrifices you made for our country.
- Your family and friends love you very much.
These affirmations should reinforce the sense of value placed in the patient as well as call upon his routes and connections that keep him centered. The sense of duty and comradeship is very strong in military veterans and should be used as a focus point.
The programs that the veteran is likely eligible for
There are plenty of programs available for homeless veterans. However, many of them are geared towards particular cases or are restricted to certain states and locations. Since Terry is a homeless veteran suffering from a severe case of PTSD, therefore the primary three programs available to him are as follows (Rubin, Wiess, & Coll, 2012):
- Domiciliary Residential Rehabilitation and Treatment Program.
- Homeless Grant and Per Diem Program.
- Post-Traumatic Stress Disorder (PTSD) Residential Rehabilitation and Treatment Program.
All three of these programs are available through the local Department of Veteran Affairs (VA). My script will be built as follows:
- Inform the customer about the three programs available to him.
- Describe what does every specific program entails and what kind of help he would receive.
- Inform him of the location of the nearest VA office and suggest ways of getting there.
- Provide assistance with documents, if needed.
The conversation will be held in a respective and informative manner, in order to ensure that the patient does not feel like a burden for anyone. The customer has shown a desire to rid his family of additional needs to care for him. Therefore, he would be appreciative to use these programs to his advantage.
The PTSD symptoms that the veteran is experiencing and how to manage them
PTSD, also known as post-traumatic stress disorder, is a psychological illness frequently found in patients who have experienced a traumatic event associated with danger, pain, and loss of life. As a military man who fought in Iraq during the most intensive stages of the conflict, Terry has been diagnosed with PTSD for a long while. It was left untreated, which ruined the man’s life. According to the case study, Terry did not know about having PTSD. The script for the conversation regarding PTSD will be as follows (Wilson et al., 2012):
- Asking the patient what do they know about PTSD.
- Correcting any misconceptions they had and adding to their knowledge by describing the causes, symptoms, and possible effects of the disease on one’s psychological and emotional states.
- Assure the patient that the disease is treatable and that there were many other veterans who were successfully cured of PTSD.
- Provide a set of measures for managing PTSD, utilizing the Conservation of Resources theory (COR) as well as Orem’s self-care theory in order to enable the patient to take care of themselves while using minimal outside help.
As Terry will not be under medical supervision most of the time, it is the optimal strategy against PTSD.
This script may be altered depending on the patient’s responses, but all of these steps would need to be covered in order to create a wholesome program of recovery for the patient.
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Assessment for suicide risk
Suicide is always a risk in homeless veterans, who are exposed to a variety of psychological, physical, and socio-economical stressors. In the case with Terry, his risk for committing suicide is relatively low, as he seems to have clear goals for the future, such as pressing charges the army for hiding his condition from him. The only potential motive for suicide is to stop being a burden for the family. There are several protective factors that may keep the patient from performing suicide, which includes contacts with friends and old comrades, family support, military values, and honor. The initial safety plan would comprise out of several steps, which include (Wilson et al., 2012):
- Finding the veteran a temporary place to live in, preferably under family supervision.
- Contact the family and tell them about PTSD, its causes, and measures they could take to manage and prevent it.
- Contact the patient’s friends, and enable them to meet the patient and provide support.
- Locate all available community sources available to the patient, and inform them of Terry’s condition.
This plan is built utilized a very limited amount of information given in the case study. Based on further interviews, it could be refined to fit the patient’s particular psychological and socio-economic conditions better.
Overall clinical goals and detailed clinical objectives for this veteran
Establishing clinical goals and objectives for the patient is a good way to ensure progress in the short-term and long-term perspectives. Three clinical goals for Terry are as follows (Scott, Whitworth, & Herzog, 2016):
- Solve the problem of homelessness by finding a shelter either with the family or in special housings provided for veterans.
- Enable the patient to be able to manage his PTSD and its symptoms without requiring supervision and hospitalization.
- Facilitate recovery and growth, in order to gradually return the patient to normal life.
These goals will enable Terry to become an independent person and leave a healthy and fulfilling life without feeling like a burden to the family. In order to achieve these goals, there are several intermediate clinical objectives to achieve.
The first objective is to stabilize the patient’s psychological condition. This could be done through cognitive-behavioral therapy as well as medication treatment. The second objective is to teach the patient practical ways of treating his PTSD condition. These will include prevention and coping strategies to minimize the impact of a PTSD incident. Lastly, the patient will need to be treated from all diseases they have contracted during their period of wandering and homelessness. The morbidity of these diseases could potentially undo the psychological progress of the proposed intervention by increasing the patient’s overall morbidity.
Kelly, D., Barksdale, S., & Gitelson, D. (Eds). (2011). Treating young veterans: Promoting resilience through practice and advocacy. New York, NY: Springer.
Rubin, A., Weiss, E. L., & Coll, J. E. (Eds). (2012). Handbook of military social work. New York, NY: Springer.
Scott, D. L., Whitworth, J. D., & Herzog, J. R. (2016). Social work with military populations (advancing core competencies). New York, NY: Pearson.
Wilson, J. P., Friedman, M. J., & Lindy, J. D. (Eds). (2012). Treating psychological trauma and PTSD.