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Provision of Mental Health Counseling Services Under TRICARE (2010) / Chapter Skim
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Appendix F: Case Summary Illustrating the Complexity of Mental Health Issues in the Military Population
Pages 241-250

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From page 241...
... The content has been constructed as a composite clinical case; it is a fictitious account written for illustrative purposes only.
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From page 242...
... He suffered second-degree and third-degree burns and a broken pelvis as a result of an improvised explosive device (IED) blast that killed two of his fellow soldiers.
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From page 243...
... Delia, 5 years old, refuses to attend school and has started to wet her bed in recent weeks; Ana, 2 years old, alternates between playing joyfully and clinging anxiously to her mother's legs when her father enters the room. Developmental History Developmental milestones appear to have been met adequately with no indication of childhood neglect or abuse.
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From page 244...
... Arrozo moved with his parents and four siblings to the mainland in time for him to start elementary school. Although many Puerto Rican families lived in their community in the southeastern United States and provided strong social support, Sgt.
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From page 245...
... Because his job involves detection of potential hazards, he assumed major responsibility for the deaths of his friends. Compounding his profound grief and loss was the plaguing awareness that he had killed a young child during the melee that followed the same IED blast.
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From page 246...
... DSM-IV-TR DIAgNOSES Axis I Posttraumatic stress disorder Major depressive disorder Substance abuse -- alcohol Axis II Deferred Axis III Mild traumatic brain injury, skin grafts on neck and arms after second-degree and third-degree burns, healing from broken pelvis Axis IV Severe stressors: deaths of his two combat buddies, marital separations and anticipated divorce, joblessness, financial pres sures, distress for wife and children Axis V Poor level of functioning (GAF score: 40) evidenced by disrup tions in his physical and mental health, marriage, parenting, relationships with friends and family, job seeking
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From page 247...
... Arrozo to experience rapid relief from his combat-related psychological injuries, the clinician referred him to a colleague for prolonged exposure therapy. Goals of that therapy included reduction in nightmares, reduction in flashbacks, and increased capacity to drive and shop.
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From page 248...
... Collaborative consultative relationships and carefully selected referrals were initiated with a network of providers, including a general practitioner, a psychiatrist, a vocational counselor, a rehabilitation counselor, school counselors for the children, a couple/family therapist,
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From page 249...
... Treatment goals included demonstrating skills to reduce stress and anger, demonstrating skills in tolerating distress, applying stress reduction and relaxation techniques, communicating directly with his wife and children, recognizing feeling states that are associated with a traumatic stress response, recognizing the effects of alcohol on his daily functioning, developing a plan to work with a rehabilitation counselor in relation to his TBI. Within 4 months, progress toward all those goals was noted.
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From page 250...
... To promote similar favorable outcomes in practice with service members and their families, each clinician needs to be prepared with satisfactory education from an accredited academic institution, ample supervised clinical experience with a broad array of clients, and certification, licensure, and privileging within a scope of practice. Given the serious adverse consequences of failed treatment, we must be vigilant in our evaluations of potential mental health clinicians.
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Key Terms

  • ied blast
  • psychosocial issues
  • health clinician
  • arrozo meets
  • cultural responsiveness

  • demonstrating skills
  • iraqi child
  • stress disorder
  • extended family
  • social support

  • secondary trauma
  • attend school
  • traumatic brain
  • brain injury
  • included reduction

  • mild traumatic
  • profound grief
  • fellow soldiers
  • rehabilitation counselor
  • alcohol intake

  • ovarian cancer
  • posttraumatic stress
  • goals included
  • treatment goals
  • substance abuse

  • health treatment
  • licensed mental
  • nonmedical mental
  • potential mental
  • clinical experience


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