As we train civilian providers around the country through our Star Behavioral Health Providers (SBHP) program, one thing that is new to many people---is the fact that reintegration is frequently more stressful for military-connected families than the deployment itself. There are multiple reasons that this phase of the deployment cycle are stressful. Family dynamic changes, fear of subsequent deployments, a Service member’s desire to deploy again, and the return of interpersonal conflict that was on hold during the deployment, can all contribute to this stressful time as the Service member once again finds their place in the family.
Families are frequently caught off guard by this unexpected challenge. They anticipate pre-deployment as a challenging time. They expect deployment itself to be difficult. But oftentimes are surprised when the reintegration is even more challenging than the other two phases of deployment. In my private practice, reintegration was the most common time military-connected families would seek behavioral health services.
The majority of military-connected patients in my practice were Reserve Component families and for them reintegration was especially challenging. Without the supports that are more easily accessible to the active component, families struggled with navigating this transition. The Yellow Ribbon Reintegration Program (YRRP) events sponsored by the National Guard provides education about deployment to both Service members and their families, but not all families attend these events. For those who do, they are often so excited about the reunion, that the planning for homecoming overshadows the planning for reintegration. Once families leave these events, they return to their communities where they can struggle to identify people and resources that understand their experiences.
When searching for help, it is often difficult to navigate the complex behavioral health system. For many families, this was their first experience accessing behavioral health care. When searching for medical care, seeking treatment can be more straightforward. For children, you look for a pediatrician. If you have heart related issues, you seek out a cardiologist. However, looking for behavioral health can be confusing. We are typically “labeled” according to our degrees, not specialties. Psychologists, Mental Health Counselors, Social Workers, Marriage and Family Therapists, and Professional Counselors are all titles we as behavioral health professionals understand, but for prospective patients, it can be more difficult and frustrating to try to identify who might be the best fit. This coupled with an existing shortage of clinicians in rural areas, made finding a clinician especially challenging. My military-connected private practice grew as many patients referred colleagues, peers, and friends to me. By seeking services with someone who came recommended by a trusted source, accessing care was made less complex.
SBHP was born out of a need for culturally competent mental health clinicians in Indiana, where we have a largely hidden military population. The Indiana National Guard needed providers to address the behavioral health needs of its members in a state where there were no active duty installations and where a large percentage of its members live in rural, underserved areas. As some of the stigma around mental health counseling has diminished in the military, it became apparent that civilian clinicians were not prepared to address the needs of this unique population (Rand 2011).
Since 2011, SBHP has grown (and continues to grow) to train civilian behavioral health providers in military culture and evidenced-based psychotherapies. Through a variety of funders, we have implemented the program in 17 states. Most recently, the National Guard Bureau has funded a large expansion that has allowed us to bring on 10 new states in FY20. With continued support, the hope is that the program will extend nationwide over the next several years.
Once clinicians are trained through SBHP, they can apply to be listed on a registry used by prospective patients seeking behavioral health services. The registry aims to provide a way for military-connected individuals and families to find clinicians who understand their culture. This connection can increase the likelihood of treatment engagement and successful completion of treatment.
For states who have a large Reserve Component military population and are also geographically rural, SBHP can provide an invaluable resource for those seeking mental health care. The registry offers extensive information about each provider. It allows those looking for services to search by location, as well as by populations served, specialized training, and payment options. This free public registry is accessible to both families and professionals.
In Indiana, promoting the SBHP registry became part of the YRRP events, and Service members and families would learn about this resource as part of their post-deployment events. By providing military families with information during the time they are likely to need it, the hope was that Service members and their families were armed with information that helps them access care when needed. This goal has not changed today. As SBHP continues to grow and expand, use of the registry continues to be a top priority. The National Guard expansion of SBHP is putting more clinicians who are trained to work with the military population where our Reserve Component population lives…..in their communities.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Christy Collette, MA, LMHC, is a Program Associate for the Center for Deployment Psychology at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.