Staff Perspective: What Does it Take to Work with Veterans and Military Families?

Staff Perspective: What Does it Take to Work with Veterans and Military Families?

Review of Leppma et al (2016) article on assessment of professional competencies working with veterans and military families.

What does it take to work with Veterans and military families?
Leppma et al. (2016) conducted a study to examine professional competencies deemed most relevant for mental health providers working with Veterans and their families.  The study makes an important contribution to military psychology by taking the initial steps to define critical professional competencies utilizing evidence-based practices.  The authors’ used a mixed Delpi method, surveying a panel of subject matter experts (SMEs) on working with military veterans and their families from various sources (i.e., APA Divisions 17, 18, and 19, Veteran Affairs Medical Centers, and those professionals who train mental health providers to work with this population).  A total of 21 experts were selected to participate, and averaged 11-12 years working with Veterans and their families respectively.  To start, the authors combined information from the American Counseling Association (ACA) and the American Psychological Association’s (APA) multicultural guidelines for the participants to rate on a 6-point Likert scale (1 - not at all important, 6 - extremely important).  The researchers surveyed the panel of experts three times.  The first survey also provided participants with an opportunity to add potentially relevant competencies (mixed methods allowing for qualitative data).  Each successive survey provided the mean and standard deviation of each competency to assist the expert reviewer in rating the items.  The goal was for the authors to obtain a general consensus about military professional competencies amongst the experts by looking at the reduction of standard deviations for items.

Training in Military Professional Competencies & Half-Life of Knowledge
The authors presented some interesting data pertaining to training in military professional competencies and the half-life of this knowledge base.  About half of the respondents (48%) indicated that their graduate training program did not prepare them or minimally prepared them for working with Veterans and their families.  On the job training (86%), personal research and reading (67%), and training from continuing education (57%) were rated as the top methods for training in professional competency in working with Veterans and their families.  The authors did not provide any comparison data to evaluate how this finding may differ or be normative with other health service content areas.

In addition to providing information about training, the researchers asked the panel of experts to estimate the current “half-life” of knowledge for health service professionals working with Veterans and their families.  The term half-life, refers to the time it would take for a professional to be about half as knowledgeable about the field.  The participants indicated that the average half-life of knowledge working with military veterans and their families is 5.35 years (SD = 3.10).  This finding stands in contrast to research that suggests the average half-life knowledge in professional psychology overall is 10.59 years (SD = 5.80) (Leppma et al., 2016).  As a result, the authors highlight the importance of continuing education and training to work effectively and ethically with military veterans and their families given the shorter durability of professional knowledge.

Key Findings: Cultural Awareness, Appropriate Interventions, & Self-Awareness
After three rounds of assessment, the panel of experts surveyed by the researchers came to a consensus pertaining to 25 professional competencies in working with Veterans and their families.  The authors found that these competencies comprised of three categories: cultural awareness, culturally appropriate interventions, and counselor self-awareness.  The competencies can be thought of as either general multicultural competencies or specific competencies deemed important in working with this specific population.  This review will only focus on those competencies specifically related to working with Veterans and their families.

Cultural awareness was the highest rated domain by the subject matter experts.  The term cultural awareness refers to knowledge of different cultures, awareness of his/her own cultural beliefs, expectations, and biases.  Of the eight professional competencies related to cultural awareness, only four dealt specifically with working with Veterans and their families.   The top rated military cultural awareness competency was recognition of reintegration issues facing Veterans and their families when transitioning out of the military.  Other cultural awareness competencies included: knowledge of the psychological and physical effects of military training on Feterans and their families; specific knowledge about the population they are working with including cultural implications of psychological jargon with Veterans and their families, and; how military culture may affect personality formation, vocational choices, psychological disorders, help-seeking behavior, and perceptions of mental health services.

 Leppma et al. (2016) found three out of 11 competencies for culturally appropriate interventions focused explicitly on working with Veterans and their families.  The top rated military culturally appropriate intervention competency was possessing knowledge and clinical skills in crisis and suicide prevention for veterans.  The authors also found that being able to talk with Veterans and family members appropriately (in an authentic manner) using language and military terminology, and awareness of discrimination that may affect the psychological functioning of Veterans and their families were important competencies.  Finally, in the category of counselor self-awareness, only two of the five competencies identified were specific to working with Veterans and their families.  The authors found that appreciation for military lifestyle and awareness about secondary trauma and compassion fatigue were important professional competencies.

CDP Resources to Help Obtain Professional Competencies
The research by Leppma et al (2016) highlights the importance of continuing education based on the half-life knowledge related to working with Veterans and their families and limited training opportunities in graduate training.

Listed below are links to different training resources offered by CDP to help health service providers gain and maintain competency while working with Service members, Veterans, and their families.  I highly recommend reading this article and watching for future research by this group of authors that want to use their research to start identifying benchmarks and assessment tools for relevant professional competencies for working with Service members, Veterans and their families.

CDP Links:


Leppma, M., Taylor, J. M., Spero, R. A., Leonard, J. M., Foster, M. N., & Daniels, J. A.(2016). Working with veterans and military families: An assessment of professional competencies. Professional Psychology: Research and Practice, 47(1), 84-92. doi:10.1037/pro0000059

Timothy Rogers, Ph.D.  is a Deployment Behavioral Health Psychologist for the Center for Deployment Psychology (CDP) at Joint Base San Antonio-Lackland Texas.