Project Open Arms: How Mental Disorders and Unemployment affect Veterans

Running head: PROJECT OPEN ARMS

Project Open Arms: How Mental Disorders and Unemployment affect Veterans (Program Development Initiative) Christian O. Coleman The Chicago School of Professional Psychology

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PROJECT OPEN ARMS

2 Applied Research Project Signature Page

Applied Research Project Signature Page Project Title: __ Project Open Arms: How Mental Disorders and Unemployment affect Veterans

(Program Development Initiative) Student Name: Christian Coleman x By checking this box I confirm that the content of this project was authored by the student listed on this form and approved by the assigned advisor. I also confirm that the content was gathered and processed in an academically honest way, not plagiarized in any fashion, and will be used for the purposes outlined in this project. I understand that by checking this box I am electronically signing this document and initiating the review of its contents by The Chicago School of Professional Psychology as fulfillment of the Applied Research Project requirement.

Was Institutional Review Board approval required?

Yes

x No

Was Institutional Review Board approval obtained?

Yes

Advisor Name:

No

Crystal Isbell

N/A

PROJECT OPEN ARMS

3 TABLE OF CONTENTS

ABSTRACT……………………………………………………………………..

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INTRODUCTION/LITERATURE REVIEW…………………………………...

6-18

PROGRAM INTERVENTION…………………………………………………

18-26

Program Materials……………………………………………………… 19-20 Needs of the Community……………………………………………….

20-21

Budget Narrative………………………………………………………..

21-22

Evaluation Instruments…………………………………………………. 22-23 Community Support……………………………………………………. 23-24 Implementation Plan……………………………………………………

24-26

METHODOLOGY………………………………………………………………

Overview………………………………………………………………..

26-30

26-28

Participants/Population of Interest……………………………………… 28-29 Procedure……………………………………………………………….. 29-30 Data Collection for Experimental Research……………………………. 30

ETHICS………………………………………………………………………….

Conflicts of Interest…………………………………………………….. 31-32 Deception……………………………………………………………….. 32 Benefit vs. Risk…………………………………………………………

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30-36

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Participant Recruitment………………………………………………… 33-34 Minority Group Membership and Treatment Distribution……………... 34 Privacy and Confidentiality…………………………………………….. 35-36

RESULTS & DISCUSSION…………………………………………………….

36-41

Projected Outcomes…………………………………………………….. 37 Areas for Future Research……………………………………………… 37-38 Project Limitations……………………………………………………… 37-40 Recommendations and Discussions…………………………………….

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Communication of Progress……………………………………………. 40-41

REFERENCES…………………………………………………………………..

42-44

APPENDIX A (Informed Consent Form)…………………………………….....

45-47

APPENDIX B (Experimental Research Questionnaire)………………………...

48-54

APPENDIX C (Budget)…………………………………………………………

55

APPENDIX D (Event Chronology)……………………………………………..

56-57

APPENDIX E (Community Awareness Brochure)……………………………...

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PROJECT OPEN ARMS

5 ABSTRACT

The goal of the Project Open Arms program is to address two main problems in the veteran community: unemployment and poor and unaddressed mental health. Site facilitators and volunteers will address this problem through the administration of the program. The implementation of the program will make sure that each participant gets the help that they need and will guide them through the optional experimental research that accompanies membership in the program. The goal of this program is primarily to address the above mentioned goals for all clients that come to the program from the veteran community. With the resources (both human and non-human) at the disposal of the program’s administration, mental health and unemployment issues will be issues that will be less of a plague to the veteran community.

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Project Open Arms: How Mental Disorders and Unemployment affect Veterans (Program Development Initiative) The chosen ARP is a program development for reintegrating war veterans back into society called Project Open Arms. The program was designed to benefit former war veterans returning from combat trying to cope with the civilian world again. The author also designed this program to benefit National Guardsmen who have returned from combat and will be reentering the civilian world most likely without jobs. This program will render job assistance, counseling services, etc. to the chosen audience.

The author became interested in this program when seeing several instances when members of the chosen audience would either return home to the civilian world jobless and helpless and after researching and finding that a lot of post combat veterans suffer from posttraumatic stress disorder (PTSD) and go untreated. These particular people are likely to commit acts of criminal nature and this program will be designed to deter this behavior through counseling and multiple other types of intervention.

This program is being proposed because there are issues that exist concerning America’s troops with regard to them becoming civilians again or battling post-traumatic stress disorder.

The program will address several issues however the two main ones are PTSD and employment.

The first reason the author decided to propose this program is because of employment. Many of the returning combat veterans, more specifically National Guardsmen, return home from war and have no idea how they will support their families or where to begin looking for help getting to work. Many employers will not hire National Guardsmen because they may get called to duty any time and the position they are filling will end up vacant if this is the case. This program is in

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place to specifically help these veterans find work tailored to their needs and to advocate on the soldier’s behalf in finding these jobs.

Another reason this program was developed was to offer counseling to combat veterans (regardless of branch of service) as long as they have had been overseas within the last 8 years.

Research (outlined later in the report) dictates that soldiers that go untreated for PTSD are likely to commit acts of a criminal nature versus soldiers who are currently undergoing treatment for the disorder or one who has never been exposed to the disorder. This program will offer counseling on many different spectrums to treat soldiers who suffer from PTSD in order to deter them from not only criminal activity but from depression, suicide, and other situations that could surface as a result of untreated PTSD. As mentioned earlier, soldiers who suffer from PTSD often commit acts of criminal nature. According to Elbogen (2012), a research survey conducted by the U.S. Department of Veterans Affair’s Environmental Epidemiological Service revealed that “Factors associated with arrests in the final model included younger age, male gender, history of arrests, witnessing family violence, substance misuse, and PTSD with high anger/irritability; TBI with increased irritability approached, but did not achieve, statistical significance in this multivariate model. Combat exposure was significantly associated with arrest in bivariate analyses but failed to achieve significance in the multivariate protocol; post hoc analyses indicated the link between combat exposure and arrest was mediated by PTSD with high irritability.” (p. 1099).

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In other words, former combat veterans suffering from PTSD have a higher risk of committing acts of a criminal nature.

There are two problems this program aims to fix. The first problem is that these soldiers feel that they may be alone and there isn’t enough help available to them. A lot of the time, they do not know where to turn. Many soldiers to not even recognize they have a problem which is why PTSD often will go untreated. The program will specialize in counseling those who suffer from this disorder and work to provide awareness for the disorder to that more people get the help they need.

Another problem that exists that the program aims to address is the shortage of employment among National Guardsmen that are returning home from combat. This has been a problem for years even more so now that the economy isn’t as good as it used to be. As explained earlier, National Guardsmen who go overseas often come back with no job and little or no resources to turn to for help. This program aims to change that for these servicemen.

One of the initial approaches to the problems identified in this ARP is the use of traditional methods of treating mental disorders such as cognitive behavioral therapy, psychiatric drug, etc. Another approach is the use of more innovative treatments to treat mental disorders.

Providing veterans with employment advocacy is a third approach for the problems stated in the problem statement of this ARP. All three of these solutions will be collectively used as the selected solution for the problems stated in the ARP. There are some serious issues to address with post-war veterans. Two of these issues are the development of mental disorders from exposure to combat and the threat of possibly not having employment upon returning from active duty. One objective will be the treatment of

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mental disorders in post-war veterans. There is an issue with there not being enough treatment or reliable treatment available to veterans who experience post-traumatic stress disorder.

Another objective in the prevailing issue of post-war veterans with mental disorders is traumatic brain injury. There has been an increase in traumatic brain injuries in post-war veterans. According to Davis (2013), post-traumatic stress disorder and traumatic brain injuries are commonly encountered by clinicians treating veterans of war in both mental health and general health settings. Amongst the array of different types of mental disorders post-war veterans can suffer from, Schizophrenia is one of them. Schizophrenia can be the most serious of mental disorders to occur in post war veterans as it can sometimes be difficult to treat this disorder.

The second main issue with post war veterans is employment after active duty. Some veterans are all active duty military and therefore have nothing to worry about when they come from overseas; they go back to their post and resume their jobs as normal. Then there are the reservists and national guardsmen. When they are overseas they make active duty pay, however, when they come back, they don’t have posts to go to resume work. Some have jobs to go back to when they come back and some do not. Some reservists and national guardsmen can’t even find jobs, because some employers are afraid to hire such citizens because of the threat of them one day being called to go overseas. According to Dreisbach and Martin (2012), National Guard and Reserve components of the U.S. Armed Forces often face a unique challenge when it comes to finding employment because the model is predicated on their ability to move in and out of an employment situation as they're activated and deactivated.

There does not seem to be enough good quality programs to assist these veterans. Aside from the economic reasons this is a point of concern, is the crime rating. According to Phillips

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(2012), aggregate unemployment often has a negative effect on crime and most common in capitalist societies but generally anyway geographically. The research that will be reviewed here will support a plan that will offer mitigations for the two above mentioned main issues.

The program and research is related to the field of forensic psychology in a number of different ways. One of the ways is to decrease the amount of unemployed post war veterans. As the upcoming research will allude to, crime rate goes up when unemployment percentages go up.

Another way this program could be of good to the forensic psychology community is that the program can offer involuntary counseling services as deemed necessary by law for the patient.

Every good research defense needs a hypothesis. The hypothesis for the defense of this program is stated as follows: Will veterans that receive the treatment they need for mental disorders they may be experiencing and the employment assistance (also if needed) commit less antisocial acts (such as crime, etc.)? As far as the research being gathered, there is research that has been gathered for this program thus far that dates back to 1998. In the beginning stages of research gathering for the defense of this program, there were foreseeable gaps in research. As of now, there are no known gaps in the research that has been gathered for the defense of this program.

Veterans have to experience a lot of things while at war. One of the things veterans have to go through or experience is the mind-gripping effect being away from their loved ones for an extended period of time. This can include family, friends, co-workers (if applies), etc. Veterans experience a lot of stress by not having familiar surroundings when they are abroad for long.

These veterans often experience the vision of having their fellow soldiers blown up right before their eyes. Others things veterans report experiencing is the sign of bloody corpses around

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the battlefield, hearing bombs go off with resounding noises that can remain with them in their minds long after they return from war. Veterans fighting in some countries are additionally exposed to chemical warfare, nuclear warfare, and other types of advanced weaponry and/or weapons of mass destruction. Last but certainly not least of the things veterans experience while overseas is that some of the veterans report that they have been held prisoners of war or POW. In addition to the veterans, families also feel the soreness of having a loved one overseas for a long period of time. The number one thing families of veterans have to worry about is what could possibly happen to their loved ones while they are overseas. Families and loved ones often worry about, more commonly, if their loved one will return home and are around for their family’s growth and development.

Some times when veterans come back from war will they have physical limitations? If so, these limitations can make it hard for the affected veteran to work and support his/her family upon returning home. There are limitations besides physical ones. A veteran, upon returning home, could fall victim to a mental or psychological limitation.

When it comes to reintegrating post-war veterans back into society, one must think about the things that could possibly make it difficult to reintegrate them. Placing post-war veterans back into civilian society from the battlefield can be tough. Some of the veterans are often diagnosed with mental disorders or have these disorders and do not get proper treatment upon returning from war. The fact that some veterans go untreated can lead to them performing acts of criminal activity that are often seen as socially abnormal.

Some veterans take in and harbor many elements of war. One of the elements of war, in relation to reintegrating war veterans, is watching a fellow soldier get injured or getting killed.

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This particular element of war can lead to psychiatric disorders. Another element associated with war and being overseas is that of possibly unemployment upon returning home. This is particular of national guardsmen and reserves; they often have issues with employment upon returning home from active duty. Criminal justice involvement is one of the most significant problems for war veterans, especially Iraq and Afghanistan war veterans. Many veterans have returned home diagnosed with post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) which have been linked to aggression or violence among the veteran population (Elbogen, 2012).

According to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision or DSM-IV-TR (2000), Post-Traumatic Stress Disorder or PTSD is an anxiety disorder in which the essential characteristic is the development of symptoms following exposure to an extreme traumatic stressor; these stressors can include sexual trauma, threatened death, death of a loved one, and even war or combat. Any citizen can get post-traumatic stress disorder any age and any time in life. According to the National Institute of Mental Health (2010), anyone can get post-traumatic stress disorder (PTSD) at any age. People who typically get PTSD include: war veterans, survivors of physical and sexual assault, accidents, disasters, and several other serious events.

Veterans living with PTSD are living with an anxiety disorder, which means that they generally will elect not to be around someone or something that reminds them of the trauma in which is responsible for their horrible condition. People with PTSD and other anxiety disorders often plan every aspect of their day differently from someone who wasn’t affected by these disorders. Veterans with PTSD also may have difficulties with their families and/or relationships.

According to the U.S. Department of Veterans Affairs (2014), the symptoms of PTSD can cause problems with closeness, trust, communication and problem solving skills. These problems could

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also have an effect on the way the affected person acts with other people. In turn, the way a loved one would respond the affected person can affect them. Often times, a circular pattern can develop that has the potential to harm relationships.

Veterans that may be living with PTSD, along with treatment can create and maintain good and prosperous relationships. One of the ways a veteran with PTSD can work on relationships with others is by building a personal support network to help cope with the disorder while working on family and friend relationships. Another way is by sharing feelings honestly and openly using respect and compassion. Finally, a veteran affected by PTSD can work on building skills in problem solving and connecting with others (U.S. Department of Veterans Affairs, 2014).

The research collected for the defense of this program will include traditional as well as innovative ways to treat PTSD. The main treatments for PTSD are psychotherapy and medications such as antidepressants. Better known as ‘talk therapy’, psychotherapy is one of the main ways to treat PTSD. Antidepressants are also another well-known way used to treat PTSD. Among the medications used are sertraline (Zoloft) and paroxetine (Paxil). Other methods of medicating for this disorder include the use of benzodiazepines and antipsychotics. Each person’s situation is different; therefore the same method will not always be used to treat all cases (National Institute of Mental Health, 2010).

There are also newer and more innovative ways to treat PTSD and other disorders like it.

The use of innovative treatments is growing simply because psychologists, as well as their patients, are always on the hunt for methods that will better and perhaps less expensive for some methods. One of the new and innovative treatments for PTSD is the use of virtual reality treatment or VRT. VRT, according to McLay (2013):

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“is similar to a video game, allowing the patient to feel as if they are in the traumatic scenario. Just as a pilot in a flight simulator might use virtual reality to learn how to safely land a plane without the risk of crashing, a patient with PTSD can learn how to confront painful reminders of trauma without facing any real danger.� (Introduction, para. 3).

The technology levels for VRT programs varies a lot. The quality of these programs can vary from the best built programs with high end special effects down to a simple, standard headset with animated images. According to Cardenas-Lopez (2011), due to this socially relevant problem, and based on the efficacy treatments, it is important to design treatments involving the use of virtual reality, because it can help overcome some of the limitations of traditional therapy using exposure.

Although not listed in the DSM-IV-TR as a mental disorder, Traumatic Brain Injury or TBI can leave lasting effects and mental disease on those who sustain it. The brain is a very fragile and vulnerable body organ that can be damaged in a number of ways. One of the ways one can sustain TBI is by having an object penetrate the brain and cause almost irreparable damage to certain areas of the brain. TBI can result from sports injuries, automobile accident, intentional or accidental blow to the head, and TBI can even be caused by injuries sustained on the battlefield. Regardless of how one sustains TBI, is a brain injury s sustained, one should seek medical attention right away. Very little can be done to reverse the effects of TBI, however; getting prompt and effective medical treatment, this can prevent the injuries from becoming lifethreatening.

There is a broad array of drugs and treatments that can be used to treat TBI. Among the available treatments, medications like diuretics and anti-seizure drugs may be used by a doctor to

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help treat TBI. Depending on the severity and while under the appropriate care, doctors may propose the use of coma-inducing drugs to treat severe cases of TBI where blood vessels have collapsed and cannot deliver the required amount of oxygen to the brain. Fractures of the skull, blood clots and immense pressure can result from TBI, thus surgery may be proposed in order to alleviate these somatic symptoms resulting from TBI. In many severe cases of TBI, rehabilitation may be required in effort to closely achieve the best brain functioning possibly. According to the Centers for Disease Control and Prevention (2013): “Every year, at least 1.7 million TBI related injuries occur and research also shows that TBI contributes to about 30.5% of all injury related deaths in the United States.

Clinicians play a key role in the identification, diagnosis and management of TBI. Early management, appropriate referral and rehabilitation can improve patient outcomes.� (Traumatic brain injury, para. 1).

TBI rehabilitation includes a psychiatrist (who oversees the rehabilitation), a speech therapy, occupational therapy, and recreational therapy.

As previously stated, another main mental disorder that can affect post-war veterans is Schizophrenia. In most people, this is a mental disorder that can have catastrophic side effects.

According to the DSM-IV-TR (2000), Schizophrenia is a mental disorder involving a range of cognitive and emotional abnormalities including abnormalities in perception, thought, communication, language, behavior, affect, etc.

According to the National Institute of Mental Health (2010), Schizophrenia affects men and women alike and some of the major symptoms of Schizophrenia (i.e. hallucinations and delusions) tend to develop between the ages of 16 and 30 but not after age 45. People can also

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develop Schizophrenia after traumatic events such as sexual abuse and after being exposed to combat. The research collected for the defense of this program will include traditional as well as innovative ways to treat symptoms. Some of the main treatments available to post-war veterans for the treatment of Schizophrenia are cognitive behavioral therapy (CBT), psychosocial treatment, and the use of antipsychotic medications such as Thorazine. In addition to conventional methods, there are some must more innovative ways being created in order to treat the disorder. According to Garrido (2013), cognitive remediation therapy is emerging as a psychological intervention that targets cognitive impairment, however; a newer, more innovative treatment is available to manage Schizophrenia, and it is known as computer-assisted cognitive remediation.

Cognitive remediation therapy or CRT is not a new therapy, however; it is a new way to treat Schizophrenia. The primary aim of CRT is to reduce cognitive defects in patients for which the treatment is used on. According to Favrod (2014): “When considering remediation tools that are currently in practice, one could compare it to brain training. However, in contrast to cognitive remediation, brain training is aimed at healthy subjects wishing to prevent aging-related cognitive deficits before they occur. Brain training programs (in addition to possible medical indications) employ evidence-based techniques to prevent cognitive aging.�

(Definition of cognitive remediation/cognitive rehabilitation, para. 1).

People with Schizophrenia can lead very difficult lives to say the very least. Their lives can be very socially isolated, upon development; occupational growth can be stunted, it can be hard for them to become productive members of society and most schizophrenics never get married or have meaningful relationships. People with this disorder can have a hard time but

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there are things that can be done (along with getting the necessary treatment) to make things easier for the ones who have to live with this disorder. According to McGrath (2012): “People suffering from schizophrenia struggle to set goals for themselves, therefore; other people can help guide them through it. By setting small, reachable goals, loved ones can help their affected family member slowly and steadily grow more independent. For friends and family of schizophrenia patients, responding to the delusions and hallucinations schizophrenics can have can prove to be difficult at times. For this situation, it is recommended to not try to dispute nor play along with the schizophrenic's false notions. Instead, be nice and tell them that people are entitled to their own opinions, but that you disagree.� (Living with schizophrenia, para. 2).

In addition to gathering research, facts and statistics to defend the medical standpoint of the program, research has been collected for the unemployment standpoint. According to research, the relationship between the state of the economy and crime has a long history in criminology research dating as far back as the mid-1930s to mid-1940s. There are two independent and counteracting effects from unemployment that affect crime: motivation and guardianship (Andersen, 2012). There are three types of crimes that are often associated with unemployed veterans: violent crime, property crime, and nuisance crime.

Generally when post-war veterans come home from the combat zone, especially if they are guardsmen or reservists, it is not uncommon for them to be a little confused about how they are going to support their families (as some of them may not have jobs when they return). With that being said, the reason this is the case is employers tend to not hire guardsmen or reservists

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because of high deployment rates. Also as part of post reintegration, some veterans find themselves having to battle mentally-debilitating disorders.

The research shows that some veterans involved in war often come away from war with a little more than just a story to tell. According to the research supplied here, veterans exposed to wartime combat can experience a multitude of mental disorders (i.e. general anxiety disorder, PTSD, TBI, and schizophrenia). The research also shows that wartime combat can affect not only the veterans themselves but the veterans’ families as well. Finally, the research within this report has shown that some veterans who return home from combat are often met with being unemployed or having employment issues (veterans in the Reserves or National Guard tend to experience employment issues more than other branches of the service). The research shows that a wide array of treatments can be best for treating veterans. These treatments include cognitive behavioral therapy (CBT), talk therapy, virtual reality treatment, and the use of drugs such as antipsychotics. Finally, the best way to assist veterans that are experiencing the issues listed in this report is to make sure they have the best advocates. Making sure these veterans have advocates for mental disorders, employment issues, and family affairs will ensure less domestic and possibly criminal issues associated with these issues if they were left untreated. This ARP program will provide methods and solutions to help veterans deal with mental disorders, employment issues, and the families.

INTERVENTION This is the intervention portion of the ARP/Thesis. This report will identify individuals who will be involved in the project, will assess the needs of those involved, include a budget narrative, evaluation and instruments layout, community support of the program, and an implementation plan will be discussed in this report.

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Program Materials The first thing to be discussed in the intervention report is the materials to be used in the program. Before the beginning of the program materials discussion is a brief discussion of the purpose of the program. The purpose of this program is to provide mental health services and employment advocacy services to qualifying veterans of the U.S. Armed Services. The need being addressed here is the lack mental health services for veterans (lack of speedy and localized mental health services for veterans) and the level of unemployment amongst veterans. These are the two primary needs being addressed by the program. Good mental health and dedicated employment advocacy go hand in hand because both ensure that crime rate and arrest amongst the veterans’ community stays low.

One of the expected effects of the program is, foremost, for veterans to get any mental health help they may need for post-traumatic stress disorder, schizophrenia, traumatic brain injury, and other types of mental illnesses. Another expected effect is to advocate for and help the veterans in need of this service to gain employment so that they may support their families post military (mainly Reserve and National Guard veterans after they return from active duty).

These are the two primary expected effects that are expected from the program. There are quite a few criteria that are necessary for the success of this program. One of the main criteria of the program that is needed for success is to secure methods of financing the program. This program will be primarily funded by private donations and any type of government funding that may be available to the administration of the program. If there are no financing options for the program, obviously the program can’t be implemented and put into place. Another one of the main criteria of success will be the number of volunteers that can be secured for working in the program.

Since the majority of money for the program’s success will come from private sources, the

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program can only afford to hire and actually pay a certain number of individuals. The program will not be able to hire enough individuals to run the multiple locations the project intends to have set up (locations are not being disclosed until implementation of the program). The other man power would have to come from volunteers employed by the program. Without steady financial contributions from private donors or the volunteers to work for the program, the success of the program would be severely compromised.

One main activity for the program is the research element. The participants have the option of participating in an optional experimental research. The research element consists of a questionnaire that contain questions about the participant’s vital information (name, height, weight, etc.), health questions (general and mental health), and questions about employment history. This questionnaire will be designed to take the participant 45 minutes to complete. Other than the services that are offered to the participants (mentioned earlier), the only major activity is the experimental research. There are several resources used for this program. The volunteers employed for the program, the brochures, web site, mailers and other forms of advertisement, the counselors, advocates, and the administrators are all part of the resource list for the program.||| Needs of the Veteran Community Veterans need a lot of things. Many of these things are no different from what the average human needs to get through on a regular basis. However, veterans often need help with mental health problems as a result of what they have experienced on the battle field. Another certain need amongst the veteran community, particularly those veterans that are reserves or National Guard, often times when they are overseas at war on active duty, they are getting the active duty pay from the Department of Defense. However, when they return, the Department of Defense takes back the active Duty pay and goes back to paying them a couple hundred dollars

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per month. The problem is, if these men and women come back and they either didn’t have a job before they went overseas or they have received a demotion or decrease in pay, this is an issue for the veterans and their families and thus a very real need that this program is designed to mitigate. Bureau of Labor Statistics (2013) states: “Among the 722,000 unemployed veterans in 2013, 60 percent were age 45 and over. Thirty-five percent were age 25 to 44, and 5 percent were age 18 to 24.

Veterans with a service-connected disability have an unemployment rate of 6.2 percent in August of 2013.” (Employment situation of veterans, para. 3).

The program will mitigate the two needs mentioned above by offering mental health services at no charge to veterans in need and advocate to the veterans in hopes of finding them gainful employment. There are no other ways (other than the main ways mentioned here) that this program has to mitigate the needs of the veteran community.

Budget Narrative Every program or business, whether it be for profit or not, needs a good and sound budget that the administrators can stick to. In this budget narrative, the program will first consider manpower. The program will employ a lead administrator, an assistant to the lead administrator and a group of site facilitators. The program will employ 10 site facilitators that are paid a set salary to travel to different states and set up different sites throughout the state that they are in.

The lead administrator’s salary will be $20,000 annually, the assistant administrator’s salary will be $15,000 annually, and the site facilitators will be paid an annual salary of $12,500. These salaries are paid monthly with no scheduled increases. All other assistance will be in the form of non-paid volunteer work. Another point of consideration in this budget narrative will be the use

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of advertisement and community awareness. The program will likely have to raise an additional $20,000 annually for advertisement and community awareness (this would include standard media such as mailers, newspaper ads, website publication, radio/television ads, etc.). Finally the third point of consideration in the narrative will be mental health referral. While the site facilitators will be trained individuals in counseling, there may be times where the participant will need to be referred out of the program to gain additional treatments and therapies (at no cost to the participant, of course). This will perhaps be the biggest expenditure as the program will raise $100,000 for this.

Other than the three main points of consideration listed here in this narrative (manpower, advertisement/community awareness, and mental health referral) the program administrator does not foresee having to spend money to do anything else. Considering all the numbers listed above, the program’s core budget must be set at $300,000 (with an extra $20,000 programmed into the core budget for additional annual expenses that may arise that may result in budget overflow such as office supplies and other materials). Outside of the core operating budget, the program will always proactively offer multiple fundraising opportunities to gain even more funds for nonprofit measures.

Evaluation Instruments Every two years (post-implementation) the lead administrator will evaluate all site facilitators and volunteers to ensure that they still have proper knowledge of what their role is in the program and still have the ability to fulfill said roles. The training evaluation will be a three day training combine with points centered on general health and mental health practices, privacy/confidentiality, ethics, how to deal with the veteran community, general appearances to the public, and other general non-profit organization practices. The training will take place over

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the course of three 8 hour days and will culminate in a final written comprehensive examination that is designed for each employee of the program to demonstrate their abilities to perform the duties that they have been assigned to perform. The reason for the training is so that the lead administrator and the assistant to the lead can maintain the purity and consistency of the program and to maintain a great and professional public image. Other than the three day training program and employment exam for the employees, there aren’t any other modes of evaluation that will be used within the program (with concern to the employees).

Community Support Since Project Open Arms is a non-profit community-based program that is staffed mostly by volunteers catering to an often vast community of veterans, securing and maintaining community support is priority. One of the most important things to the program is keeping up appearances to the community. While there may be several ways to secure community support, the lead administrator states that one of the ways to secure and maintain support amongst the veteran community is to show the community that you care. There is perhaps nothing that speaks good news about a non-profit organization than the care of the employees and volunteers to the community for which the organization serves. One of the ways the program intends to show it cares is for example, if the program cannot get a specific service for a participant, the program is more than willing to work with community resources to get the service that veteran needs (a list of commonly used community resources will be discussed later). Another way to gain community support is to let the community know of the program’s existence. The community cannot support something they do not know is there. Finally one last key way to establish community support is by integrating with the community via advertisements, speeches to the community, giving back to the community, etc.

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Another element in community support is by working with many of the community’s resources. Working with community resources gives the program options to work with when a participant of the program can’t be offered a particular service by the program itself. This program intends to work with several community resources including: local sheriff’s office, churches in the area, Red Cross, United Way, Veteran’s Affairs, Department of Social Services, etc. Again, when the participant cannot be offered a service through Project Open Arms, the program can use the above mentioned resource list (not limited to the ones listed) in order to get the participant the help or service they need.

Implementation Plan The implementation plan (if/when program is implemented) will begin with the lead administrator selecting an assistant who will then use program budget to post a program brochure detailing they the program is in search of ten (10) site facilitators and an in that same ad post that the program is in search of program volunteers (the site facilitator and the volunteer positions will be open until they are filled. When all of the manpower is in place to run the program the program administrator will then begin working with the states the program intends to serve. This will include obtaining a license to operate a non-profit organization in the state, other local usiness licenses, taxes and other petitions (if necessary) will be applied for at this point. After the lead administrator has completed the business set up of the program, the lead administrator and the assistant will be utilizing standard media (newspaper, radio, television, etc.) for advertisement letting the community know that the program is up and running and is ready to service the many needs of the veteran community. The list of states that the program will work with will be the states that have the highest concentration of veterans in need. This list will remain unknown until implementation because if revealing a list now, it may change

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considerable if/when the program is implemented. All that can be said about the primary community base at this point is that the program will cater to the majority of the 48 contiguous states. There is no information available on when the program will be implemented at this point, however; when the program is implemented, it will operate within the $300,000 budget mentioned in the budget narrative.

Again, there is no timeline for implementing the program at this moment, but there are some real and potentially difficult barriers that will have to be overcome before the program can be implemented. One of the barriers is manpower. As stated earlier, the program will likely cater to most of the 48 contiguous states and only employ 10 site facilitators (with one facilitator at each site) therefore, first of all, only 10 sites would be in operation at a time and well over 90% of the faculty working at each site will be unpaid volunteers. This particular hurdle can be easily overcome simply by operating fewer sites at a time and search for volunteers well enough in advance so that when the site does come to a particular state, the volunteers are already notified and are ready to work. The second big problem is funding. Since this is a non-profit organization, the majority of funds will come from what the program will be able to raise from government grants and charitable donations (also keeping in mind that the program has to have a core operating budget of $300,000 to operate above minimum efficiency). One solution for this problem would be for the program to allow more room in the budget for a certified public accountant or CPA that will be able to work on the budget well enough in advance to let the administrators of the program know how much money is left from the previous year and how much needs to be raised for the following year. These are the two main issues with implementation of the program and the two best ways to mitigate them also presented in this section is the most efficient way to implement Project Open Arms. Upon implementation of the

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program, the information of program implementation will be communicated via the online website projectopenarms.org and via informational workshops held in the states to be first served by the program.

METHODOLOGY Overview Research shows that approximately 30% of the veterans treated by Veterans Affairs have post-traumatic stress disorder (PTSD) (Reno, 2012). Ten percent of America’s unemployed veterans (roughly 246,000 citizens) are currently unemployed (Starr, 2013). The development of this program will help veterans with PTSD, veterans who are unemployed, and their families.

The intention of this program is to address the unemployment issues for veterans who may also have a diagnosis of PTSD which contributes greatly to their unemployment status. As for the ARP, the main problem in the ARP is that the services that veterans get for issues like mental illness and unemployment could always be better, more innovative and perhaps even closer to home. This ARP has been designed to address a potential gap in services for veterans that are not addressed through the VA. There are two interventions that are being considered for the mental illnesses that can plague soldiers and one intervention for the unemployment of veterans. The use of traditional methods of treating mental disorders such as cognitive-behavioral therapy, psychiatric drugs, etc. is one of the ways to intervene with the problem of this ARP (mental health problem). The use of more innovative treatments such as virtual reality treatment is another way to intervene in the ARP problem (mental health problem). Providing veterans with employment advocacy is a third way to intervene in the ARP problem (the unemployment problem).

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The first intervention to the problem of the ARP is to provide traditional care and treatment to veterans suffering from mental illnesses such as post-traumatic stress disorder (PTSD). Cognitive processing therapy is one of the traditional treatment methods commonly used to intervene with patients that exhibit mental illnesses such as post-traumatic stress disorder (PTSD) or traumatic brain injury (TBI). Cognitive processing therapy or CPT is adapted from cognitive behavioral therapy (CBT) and is commonly used by clinicians to explore recovery from PTSD, TBI, and other related mental disorders. According to Davis (2013): “Researchers and clinical collaborators within the Veterans Health Administration have developed guidelines for assessment and treatment of PTSD and TBI. With regard to psychotherapeutic intervention for PTSD, prolonged exposure (PE) and cognitive processing therapy (CPT) have been endorsed as best practice models.” (p. 37).

The second intervention in the problem of the ARP is an intervention which uses innovative or newer forms of therapy to treat veterans with PTSD and related disorders.

Innovative or non-traditional ways often allow for a wide range of intervention when it comes PTSD and related mental illnesses. According to Cardenas-Lopez (2010): “One in four of the people victim of violence develops PSTD symptoms. Due to this socially relevant problem and based on the efficacy treatments, it is important to design treatments involving the use of Virtual Reality (VR), because it can help overcome some of the limitations of traditional therapy using exposure.” (p. 109).

The third intervention and the design of this ARP is to combine mental health intervention with employment services so that a more comprehensive strategy is used for their

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long term success. Helping people like unemployed veterans get and maintain gainful employment and being employed overall helps keep the level of crime levels down. In some areas, crime levels can reach peak levels especially when individuals do not have jobs.

According to Phillips (2012), “an increase in the unemployment rate shifts the density distribution of the population along a continuum of low to high motivation to commit crime.�

What this means is that the higher the unemployment rate amongst a population of people, the higher the crime rate will be in that same population. All of these solutions will be collectively combined and used as the selected solution/intervention for the problem of the presented ARP. The majority of the research collected in will utilize qualitative research. Qualitative research methodology has been chosen because using people to gain statistics (what a qualitative methodology does) would be best in gathering information about unemployment and mental health research.

Participants/Population of Interest One of the groups of participants in this program will be post war veterans with posttraumatic stress disorder or other similar disorders such as anxiety and depression. Another group of participants will be the same post war veterans with unemployment issues. The participants could have one or both of these issues. The participants will be engaged through use of advertisements, brochures, and the use of a website (these methods of engagement will also be outlined later in this report). Any information obtained from the participant relating to the program, the experimental research, or both will remain secure and confidential at all times and only released to the participant or third party requestors upon the participant’s request. The administrators of this program will maintain at all times a duty to warn policy which requires program administrators to report potential issues for client safety. As such if anything is

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disclosed during the experimental research or any mental health session that would suggest that the participant is a threat to themselves, a threat to others, and the welfare of a youth or of an elder, the administrators of this program have a legal responsibility to notify the appropriate authorities.

Procedure The project will split into three phases once an applicant has expressed his or her interest for joining: initial or interview phase, acceptance or decline phase and the render phase. In the interview phase, the applicant submits his/her application online or in person with a project manager at a project location. Applicants can submit applications online at any time and at physical Project locations whenever there is a workshop being held in the applicant’s area. After the applicant has submitted an application, there will be a 3 day waiting period for normal priority and no more than 24-hour waiting period for urgent priority and court-ordered priority.

After the application has been reviewed, the applicant will be notified of eligibility either by written, vocal or electronic means. If the application is approved and eligibility has been validated, the applicant then enters the acceptance/decline phase. During this phase, the applicant will be interviewed and notified of the Project’s decision to approve or decline the application.

Upon the result of the interview phase will the applicant move on to the render phase or have the application ultimately declined. The interview in the acceptance/decline phase is required because the Project requests further proof that the applicant is serious about getting help for themselves or their families and to gain an understanding of the applicant’s character. After the application reaches the render phase, the applicant will receive the requested assistance (mental health, employment, family assistance, etc.).

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This program will be implemented by volunteers, certified mental health counselors and employment advocates. One of the requirements is that the participant be active duty military or has been active duty military within a program required time frame (this can vary based on the participant’s branch of military). There are no age, race, ethnicity, or gender requirements other than the participant must be at least 18 years of age and be registered to vote in their local area.

A veteran’s family can get assistance under the program as well as long as they meet certain requirements such as gross income requirements.

Data Collection for Experimental Research The participants in this program will have the option of participating in an optional experimental research to be conducted after the participant has had their initial evaluation (if applicable). This experimental research will involve qualitative research efforts to determine if post war veterans that are exposed to post-traumatic stress disorder (PTSD) or similar mental disabilities are prone to committing acts of a criminal nature. This research will also be geared towards determining if post war veterans that are unemployed or under employed are also prone to committing criminal acts. To collect data to be used in the experimental research, participants will be given a research packet that includes a questionnaire with questions about the participant’s vital information (name, height, weight, etc.), health questions (including general and mental health), and questions about employment history. The questionnaire is designed to take the participant no longer than 45 minutes to complete.

ETHICS In any research effort or professional career, there is a set of ethics that must be followed to ensure fruitful practice, freedom from ethical sanctions, loss of job, loss of practice or

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licensure, and even legal trouble. This report addresses the ethical issues of the thesis intended to assist veterans with employment and problems that result from mental health issues. Items to be covered include: conflicts of interest, how deception will be used in the thesis, informed consent form (and its importance to human research participants), benefit vs. risk in the thesis, participant recruitment, minority group membership and treatment distribution, and privacy and confidentiality.

Conflicts of Interest This ARP, as well as many other forms of research, often contain conflicts of interests or commitments. According to the American Psychological Association (2014): “Conflicts of interest occur when a researcher has to contend with two or more competing concerns, such as honestly reporting research results versus making a profit, achieving publication or retaining outside funding. A conflict of commitments may occur when a researcher engages in competing obligations, such as collaboration on another project, preparing a new grant application, teaching or peer review.� (Conflicts of interests and commitments, para. 1).

While most of the conflicts aren’t related to this thesis, there are a few that will be addressed here. Also listed in this report will be how the researcher intends to mitigate these conflicts of interest. The stakeholders in this thesis/ARP are the post war veterans that are suffering from post-traumatic disorder, schizophrenia or other related mental illnesses. Post war veterans that deal with unemployment issues will be considered stakeholders in this thesis/ARP. Lastly, the families of post war veterans could also be considered stakeholders in this research.

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One conflict in this study is the relationship that the researcher has with a family member who is also currently serving in the US military. This researcher is from a military family with a sibling that is active duty military therefore, the design of this thesis/ARP is toward helping military personnel gain necessary services they may need in order to lead better and more comfortable lives after combat. Emotional attachment could cause the researcher to make mistakes in the research such as compromising certain facts that would have otherwise been present in the research had there not been this conflict. The second area identified is conflict that was discovered in the research is a conflict of commitment. This conflict of commitment is a time constraint between the researcher’s other school work (classes and work in addition to the completion of the thesis/ARP) and the actual research of the thesis/ARP. The researcher will develop and maintain a schedule of what needs to be done and prioritize the list based on what is most important at the time tasks are being done. This mitigation is believed to make both the research and the other related school tasks flow more smoothly with little to no conflicts in time.

Deception Many works of research involve deception (for example, the Milgram Experiment).

However, this research does not require the use of deception. The reason deception will not be needed in this research is because the thesis is based on collecting information from willing participants and studying this information to draw several conclusions. It is also stated on the informed consent form that participation in the study (supplying information to be analyzed and studied) will be 100% voluntary thus the researcher sees no reason to use deception in this research.

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Contents of the Informed Consent Form -See APPENDIX A Benefit vs. Risk This study has very positive implications to the field of psychology. In the experimental research portion of the thesis/ARP, for instance, it will be determined whether or not new age treatments for post-traumatic stress disorder (PTSD) or related disorders and commonly used treatments will help heal post war veterans thus leading to less crime amongst these individuals.

This type of intervention in the lives of affected port war veterans is believed to have positive implications in the field of forensic psychology, therefore contributing to the overall benefit factor of the research effort.

Although this study is set up to cause no harm to participants, the administrators of the program will take every effort possible to ensure that minimal to no harm is caused to participants including but not limited to: advising participants in the event administrators foresee any harm to come to the participant, offering alternative questioning when applicable, if harm that causes mental upset outside of what the participant is already being counseled for alternative counseling may be provided in those instances. Also, as discussed earlier in the report, another way to ensure minimal risk is that there is no use of deception in this research. Participants are told everything they could expect and will not encounter during the research.

Participant Recruitment Recruiting participants for use in research can be a tedious effort to say the least. Since this research program will be funded almost entirely of funds from government grants, privately raised funds, or by other non-profit means, there could potentially be an issue with regard to a

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lack of funds or resources for advertisement. The process for recruiting participants for this research effort will include holding workshops that will inform the audience that there is a research opportunity available and advertising in newspapers and other available media (such as flyers, brochures, etc.) . These media will also describe the benefits of the research and program, who to contact for more information (including pertinent website, phone numbers, email addresses, etc.).

There is no foreseeable problem with the lack of access to a population of interest. The administrators of the program and research will ensure that the research sample obtained will be of the population of interest by conducting an application process on all individuals that wish to take part in the research and participate in the program. Included in this application process will be an inquiry into the Department of Defense to make sure that the person or persons applying to the program is/are qualified to participate. The administrators of the research and program will offer each participant an equal opportunity to participate in the program or research (so long as they meet program requirements) without bias to sex, race, religion, sexual orientation, or any other factor that would be seen by a reasonable person to be a major discriminatory factor.

Minority Group Membership & Treatment Distribution There are no potential concerns as to the distribution of treatment to any of the participants who decide to participate in the program and research. The administrators as well as all volunteers and paid workers of the program will receive extensive training in providing services to minorities. The administrators will take all necessary steps to ensure that at all times an equal opportunity to provide policy remains in effect and enforced at all times. These are two major ways that the program will ensure that treatment is distributed equally and fairly to groups of all ethnicities.

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Privacy and Confidentiality As stated previously in the informed consent section of this report, all necessary steps will be taken to ensure privacy and confidentiality. Any and all information obtained by the program (including but not limited to: names, personal and vital information, medical information, mental health information, etc.) will be kept 100% confidential by the administrators, volunteers, and paid workers for the program and will be released to no one except for the participant or any third parties upon the named participant’s request. The administrators of the program will give extensive training in privacy and confidentiality to its volunteers and paid workers prior to employment. This along with innovative supervisory efforts (such as developmental training, checking behind each worker making sure each case is worked correctly, etc.) is a major way to ensure that the privacy and confidentiality of all participants is kept and not compromised.

The administrators of this program will also maintain a duty to warn policy. If anything is disclosed during the experimental research or during any mental health session that would suggest that the participant is a threat to themselves, a threat to others, the life or well-being of a youth or an elder is in danger; the administrators of this program reserve the right to warn appropriate authorities of the situation.

In a professional’s career, ethics will almost always play a role in some fashion or another. It is important that professionals keep their profession-related ethics in mind during their practice. Failure to adhere to ethical guidelines can result in an array of different consequences including but not limited to loss of reputation, ethical sanctions, loss of job or practice, suspension or loss of license, and even legal trouble. It is for these reasons and more that ethics

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are very important to research as well; this certainly includes the Project Open Arms research effort and program.

RESULTS/DISCUSSION This ARP is a program development for reintegrating war veterans back into society called Project Open Arms. This program was designed to benefit former war veterans returning from combat trying to cope with the civilian world again. The author also designed this program to benefit National Guardsmen who have returned from combat and will be reentering the civilian world without jobs. This program will render job assistance, counseling services, etc. to the chosen audience. One main reason the program was created is to help post war veterans get the treatment they need for post-traumatic stress disorder or PTSD and other mental illnesses they may experience as a result of being on the battle field. Elbogen (2012) states: “Factors associated with arrests in the final model included younger age, male gender, history of arrests, witnessing family violence, substance misuse, and PTSD with high anger/irritability; TBI with increased irritability approached, but did not achieve, statistical significance in this multivariate model. Combat exposure was significantly associated with arrest in bivariate analyses but failed to achieve significance in the multivariate protocol; post hoc analyses indicated the link between combat exposure and arrest was mediated by PTSD with high irritability.� (p. 1099).

Put simply, former combat veterans suffering from PTSD have a higher risk of committing criminal acts as a result of no treatment or the lack thereof.

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Another existing problem that the ARP was designed to take care of is the lack of employment that can exist among returning veterans from overseas or returning from active duty.

The number of unemployed veterans in the United States is overwhelmingly large. Bureau of Labor Statistics (2013) states: “Among the 722,000 unemployed veterans in 2013, 60 percent were age 45 and over. Thirty-five percent were age 25 to 44, and 5 percent were age 18 to 24.

Veterans with a service-connected disability have an unemployment rate of 6.2 percent in August of 2013.� (Employment situation of veterans, para. 3).

Nearly a million U.S. veterans are unemployed, many perhaps with families to feed. This program will help resolve this problem as well.

Projected Outcomes One of the overall projected outcomes of the ARP is to have less of the veteran community experiencing untreated post-traumatic stress disorder or PTSD, traumatic brain injury or TBI, schizophrenia and other mental disorders that can contribute to criminal activity amongst the veteran community. Another outcome of the program is for the program to begin successfully aiding the hundreds of thousands of veterans that are unemployed in the United States. Treating mental disorders and aiding unemployed veterans are the two things that the ARP seeks to accomplish.

Areas for Future Research If there are any areas of study that should be explored in continuance of or as a follow up to this program or study, it should be a program on assisting veterans who do happen to have to get in trouble with the justice system. After prison or parole, this suggested program would pick

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up (voluntarily) and offer intervention on how the veteran can reconstruct their life and stay away from doing what got them in trouble in the beginning. This program would also offer Cognitive behavioral therapy to be provided by a state board certified psychiatrist or counselor/therapist. The reason being is because it is believed that intervention and cognitive behavioral therapy or CBT can be used in effort to prevent future criminal activity. Clark (2009) states the following: “Cognitive behavioral therapy reduces recidivism in both juveniles and adults. The therapy assumes that most people can become conscious of their own thoughts and behaviors and then make positive changes to them. A person's thoughts are often the result of experience, and behavior is often influenced and prompted by these thoughts. In addition, thoughts may sometimes become distorted and fail to reflect reality accurately.� (One form of psychotherapy stands out in the criminal justice system, para. 1).

As far as any gaps in this particular research, there are no gaps. This field of properly assisting the veteran in need is lacking in multiple aspects. One aspect in which this field is lacking is listed above: there aren’t enough programs that offer services to veterans that have been incarcerated and in need of post-prison intervention. Another aspect is that there is a shortage of specially trained professionals to treat post-traumatic stress disorder or PTSD. As stated throughout this report, post-traumatic stress disorder or PTSD can really change the life of a veteran and his or her family, therefore the clinicians that treat PTSD should either be veterans themselves or should have to be required to have a good education specifically in treating war veterans. It can be said that this specialized field could be less lacking if the aforementioned items were properly addressed in the near future.

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Project Limitations Writing and planning of this ARP project yielded no limitations except that of research that is used in this report to back up the study and program. The reason this was a limitation is because the field is so specialized and is not a generalized study. In designing the study on the other hand, there was one main hindrance in the design and that is (and will be if the program is implemented) gathering funding. As stated previously in the report, the majority of the funding for this program will come from what the administrators of the program can raise through charity, government grants, and other non-profit fundraising efforts. The reason this is seen as a hindrance is because the federal government has Veterans’ Affairs in place to handle a lot of the issues veterans often encounter throughout their time in the service and some of the services are available to them even when their service is complete. A large amount of tax money is spent to keep up the Department of Veterans’ Affairs. An example, Smith (2012) states the following: “The U.S. Department of Veterans Affairs expects to spend $57 billion on disability benefits next year. That’s up 25% from $46 billion this year, and nearly quadruple the $15 billion spent in 2000, before the wars in Iraq and Afghanistan began.”

(Introduction, para 2).

The talk of budget cuts across all areas of federal government have been one of the main subjects of the media for years. With that being said, being that the federal government is limited on budget, it may be hard (not impossible) to procure funds needed run the program. Getting veterans to participate in the program could pose a slight challenge, but not a very big one. The reason this would not pose a big challenge is because the services being offered are free of charge to all participants and the services are for the sole benefit of the veteran and his/her

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family. Other than the financial limitations that plague nearly every non-profit operation, there are no other design limitations to speak of.

Recommendations and Discussions Subjectively speaking, I have a few recommendations regarding this specialized field.

One of the recommendations is that there be more research written on treating veterans with PTSD and making this information readily available to anyone conducting this type of research or if in the future I have to use more research to expand upon the program. More recommended advice is that the clinicians providing this treatment be of military background and/or be required to have specialized education in treating veterans with PTSD and other mental illnesses that veterans may get while in the line of duty. Other than the aforementioned recommendations and advice to the field, there are no other recommendations or advice to speak of.

Communication of Progress Once commencement of the project has begun (if implemented), progress of the project will be tracked and computed by entry into a word processor (such as Microsoft Word) as a journal to be reviewed regularly by the program’s lead administrator (the lead administrator will be Chris Coleman who for the duration of this section of the report will be referred to as the lead administrator). The lead administrator and the assistant administrators will be the necessary parties. Each journal entry will be entered as a separate word document to be saved into a folder that is separate from all other files that may be present on the computing device that will house the electronic version of the journal. Every time a journal entry is made on the progress of the program, the entry must be saved to the electronic folder on a computing device that the lead administrator will have access to and the entry must be printed and stored in a physical folder

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that the lead administrator will be in charge of in case the electronic version were to become impaired in any way.

Three assistant administrators (to be named by the lead administrator upon implementation of the program) that will work on the program will be responsible for communicating the tracked, stored and computed progress of the program to the lead administrator on a prior designated schedule (established by the lead administrator) and also upon the random request of the lead administrator or any community official (community official could be any member of the media, local and/or state legislator, mayor or governor, etc.). Any private stakeholder that may be interested in contributing to the program has the same access level to progress communication as the lead administrator. This means that at any point, without permission, private stakeholders may inquire into the progress of the program. Finally, community officials may request access to program progress so long as permission is granted by the program administrator.

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American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.) Washington, DC: American Psychiatric Association.

American Psychological Association. (2014). Conflicts of interests and commitments. Retrieved from: http://www.apa.org/research/responsible/conflicts/index.aspx Andersen, M.A. (2012). Unemployment and crime: A neighborhood level panel data approach.

Social Science Research, 41(6), 1615-1628. doi: 10.1016/j.ssresearch.2012.07.003 Bureau of Labor Statistics. (2013). Employment situation of veterans. Retrieved from: http://www.bls.gov/news.release/vet.nr0.htm Cardenas-Lopez, G. & De la Rosa-Gomez, A. (2011). Post-traumatic stress disorder treatment with virtual exposure for criminal violence: A case study in assault with violence.

International Journal on Disability and Human Development, 10(4), 379-383. doi: 10.1515/IJDHD.2011.061 Centers for Disease Control & Prevention. (2013). Injury prevention & control: Traumatic brain injury. Retrieved from: http://www.cdc.gov/traumaticbraininjury/ Clark, P. (2009). Preventing future crime with cognitive behavioral therapy. National Institute of Justice. Retrieved from: http://www.nij.gov/journals/265/Pages/therapy.aspx Davis, J. J. (2013). Treatment adherence in cognitive processing therapy for combat-related

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PTSD with history of mild TBI. Rehabilitation Psychology, 56(1), 36-42. doi: 10.1037/a0031525 Dreisbach, T. & Martin, R. (2012). National guard members’ next battle: The job hunt. National Public Radio. Retrieved from: http://www.npr.org/2012/04/29/151619099/nationalguard-members-next-battle-the-job-hunt Elbogen, E. B. (2012). Criminal justice involvement, trauma, and negative affect in Iraq and Afghanistan war era veterans. Journal of Counseling and Clinical Psychology, 80(6), 1097-1102. doi: 10.1037/a0029967 Favrod, J. (2014). Cognitive remediation and rehabilitation. Retrieved from: http://www.cognitive-remediation.com/ Garrido, G. (2013). Computer-assisted cognitive remediation therapy: Cognition, self-esteem and quality of life in schizophrenia. Schizophrenia Research. doi: 10.1016/j.schres.2013.08.025 McGrath, J. (2012). How schizophrenia works. How Stuff Works. Retrieved from: http://science.howstuffworks.com/life/inside-the-mind/human-brain/schizophrenia2.htm McLay, R. N. (2013). How does virtual-reality therapy for PTSD work? Scientific American.

Retrieved from: http://www.scientificamerican.com/article/how-does-virtual-realitytherapy-fo/

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National Institute of Mental Health. (2010). Schizophrenia. [Brochure]. Bethesda, MD: National Institute of Mental Health.

National Institute of Mental Health. (2010). Post-traumatic stress disorder (PTSD). [Brochure].

Bethesda, MD: National Institute of Mental Health.

Phillips, J. (2012). The link between unemployment and crime rate fluctuations: An analysis at the county, state, and national levels. Social Science Research, 41(3), 681-694. doi: 10.1016/j.ssresearch.2012.01.001 Reno, J. (2012). Nearly 30% of vets treated by v.a. have ptsd. The Hero Project. Retrieved from: http://www.thedailybeast.com/articles/2012/10/21/nearly-30-of-vets-treated-by-v-a-haveptsd.html Smith, A. (2012). A cost of war: Soaring disability benefits for veterans. CNN Money. Retrieved from: http://money.cnn.com/2012/04/27/news/economy/veterans-disability/ Starr, P. (2013). 10% unemployment for post-9/11 era vets; 246,000 looking for work. CNS News. Retrieved from: http://cnsnews.com/news/article/penny-starr/10-unemploymentpost-911-era-vets-246000-looking-work U.S. Department of Veterans Affairs. (2014). Relationships and PTSD. National Center for PTSD. Retrieved from: http://www.ptsd.va.gov/public/family/ptsd-and-relationships.asp

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Informed Consent Form This study involves an experiment that is put together to help determine if servicemen suffer from PTSD and if they do, are they more likely than ones who don’t to commit crimes.

This study will also include an experiment on the correlation between unemployment and crime amongst former servicemen. The purpose of the research is to better understand what happens to servicemen who suffer from PTSD and are unemployed and use these statistics to render help to these servicemen in need. After the participant applies to the program, the overall participation in the program is left up to the participant. However, before help is rendered, information related to the participant (i.e. name, date of birth, other vitals, mental health questions, background questions, etc.) will be collected from the participant. The information gathering and questionnaires will take the participants approximately 45 minutes to complete and are not required to participate in the actual experimental research.

Upon discovery of the program, the participants can apply to the program either online at www.openarms.org or they can apply in person at a program location (which will be disclosed on the website). After applying, the applicant will be notified (either by mail, phone or electronic means) of acceptance into the program. After notification of acceptance, the program will provide the applicant the experimental questionnaires (including questions about medical health, mental health, and information on vitals such as name, date of birth, etc.). The completion of the experimental packet is the only experimental procedure the applicant will be asked to complete.

Due to the nature of the experiment (the completion of the experimental packet) there will be no foreseeable risks or discomforts to the participant. The participant will receive no

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additional benefit for participating in the experiment other than the benefits they will receive from the program (i.e. help with mental health, employment advocacy, help rendered to family, etc.). There will be no alternative treatments or procedures rendered to any of the participants other than the treatments he/she may receive standard contingent upon the type of service the participant requests. Any and all information obtained by Project Open Arms (including but not limited to: names, personal information, medical information, mental health information, etc.) will be kept 100% confidential and released to no one except for the participant upon request.

Please note: The program has a legal duty to warn. If anything is disclosed during the experimental or during any mental health session that would suggest that the participant is a threat to themselves, a threat to others, the life of a youth or an elder is in danger; the program has a legal duty to warn the appropriate authorities.

As previously stated, the risk of participating in the program’s experimental research is less than minimal. With that being said, there will be no compensation or medical treatments available. There is no risk or injury involved in this research. In the event there is an injury related to this research, the participant may contact local emergency services for assistance. If the participant has any questions regarding the research experiment, your rights in the experiment or in the event of a research-related injury the participant may contact one of our program advocates at (555) 241-7789 or they may log on to the program website www.openarms.org and leave an email. Messages submitted via the website are generally answered within one business day.

Participants may participate in the program and receive benefits (if they qualify) and not participate in the experimental research. Participation in the experimental research is completely voluntary and will in no way affect any benefit the participant may be receiving from the

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program or any benefit the participant tends to request from the program. Refusal to participate in the experimental research will involve no penalty or loss of present or future benefits. After receiving the experimental research packet, the participant may at any time return the packet unfinished and not have his or her information considered for research thus discontinuing participation in the research experiment without loss of present or future benefit.

â–Ą I _________________________ am at least 18 years of age or older, understand the statements above, understand the terms of the study and therefore AGREE to freely consent to participate in this study. â–Ą I _________________________ DO NOT agree to the terms of the study and therefore DECLINE participation in this study.

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48 APPENDIX B

______________________________________________________________________________ OPTIONAL EXPERIMENTAL RESEARCH QUESTIONNAIRE This program will also offer an experimental research that is optional to all participants of the program. The participant need not participate in the research questionnaire to participate in the Project Open Arms Program. This questionnaire will feature questions about the participant’s general medical history, mental health history and employment history. The participant will be given the questionnaire initially upon entrance into the program (reminder: it is optional) and again one year after being a part of the program. In order to gain good results from the research, it is strongly encouraged that members who participate in the first questionnaire participate in the second issuance of the questionnaire. The questionnaire should take 45 minutes or less to complete.

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GENERAL HEALTH QUESTIONS Date: __________ Name: _________________________________ What would you like to be called by the doctor? _________________ Marital Status: ______ Please list how you would like to be contacted, for test results: ____________________ In case of emergency, contact: _______________________________________________ Phone: _________________________ Relationship: _______________________ Please list your current medical problems: (list the conditions you are currently being treated for): Please list other doctors who are also currently treating you: Past medical history: Please list all hospitalizations, major illnesses and surgeries: Who lives with you in your home? (spouse, children, in-laws, significant others, etc.)

Your Occupation: _________________ What are your hobbies? ________________________________________ Birthplace: __________________________ Education:_________________________________ Have you recently traveled outside the U.S.? (If so, where?): Do you get regular exercise: (describe): Smoking history: Check which one applies: _____Never smoked _____Previous smoker Started (age) _____ Stopped (age) _______ On average, how many packs per day? ____________ ______Current smoker: Started (age) _____ On average, how many packs per day?

Do you drink wine, beer, or other alcoholic beverages? __________ If yes, how many times in the last year have you drank 4 or more drinks on one occasion?____________ Have you ever had a drinking problem? _____

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How many cups of coffee or caffeinated drinks do you drink daily? ______ Do you use marijuana, cocaine, any street drugs or prescription drugs not prescribed for you?

Family History Age (if living)

Age at Death

Health Problems or cause of death?

Mother Father Brothers/Sisters

Children

Medications Being Taken Name of

Prescribed

Medication

by:

Dosage:

When is the Medication Taken?

Purpose?

Refills needed

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MENTAL HEALTH QUESTIONS (Mental Health Screening Form III) (Carroll, J. F. (2000).

Mental Health Screening Form III. Project Return Foundation, Inc. Retrieved from: https://www.idph.state.ia.us/bh/common/pdf/substance_abuse/integrated_services/jackson_ment alhealth_screeningtool.pdf) 1) Have you ever talked to a psychiatrist, psychologist, therapist, social worker, or counselor about an emotional problem?

YES NO 2) Have you ever felt you needed help with your emotional problems, or have you had people tell you that you should get help for your emotional problems?

YES NO 3) Have you ever been advised to take medication for anxiety, depression, hearing voices, or for any other emotional problem?

YES NO 4) Have you ever been seen in a psychiatric emergency room or been hospitalized for psychiatric reasons?

YES NO 5) Have you ever heard voices no one else could hear or seen objects or things which others could not see?

YES NO 6) a) Have you ever been depressed for weeks at a time, lost interest or pleasure in most activities, had trouble concentrating and making decisions, or thought about killing yourself? YES NO b) Did you ever attempt to kill yourself?

YES NO 7) Have you ever had nightmares or flashbacks as a result of being involved in some traumatic/terrible event? For example, warfare, gang fights, fire, domestic violence, rape, incest, car accident, being shot or stabbed?

YES NO 8) Have you ever experienced any strong fears? For example, of heights, insects, animals, dirt, attending social events, being in a crowd, being alone, being in places where it may be hard to escape or get help?

YES NO 9) Have you ever given in to an aggressive urge or impulse, on more than one occasion, that resulted in serious harm to others or led to the destruction of property? YES NO 10) Have you ever felt that people had something against you, without them necessarily saying so, or that someone or some group may be trying to influence your thoughts or behavior? YES NO 11) Have you ever experienced any emotional problems associated with your sexual interests, your sexual activities, or your choice of sexual partner? YES NO 12) Was there ever a period in your life when you spent a lot of time thinking and worrying about gaining weight, becoming fat, or controlling your eating? For example, by repeatedly dieting or fasting, engaging in much exercise to compensate for binge eating, taking enemas, or forcing yourself to throw up? YES NO

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13) Have you ever had a period of time when you were so full of energy and your ideas came very rapidly, when you talked nearly non-stop, when you moved quickly from one activity to another, when you needed little sleep, and believed you could do almost anything?

YES NO 14) Have you ever had spells or attacks when you suddenly felt anxious, frightened, uneasy to the extent that you began sweating, your heart began to beat rapidly, you were shaking or trembling, your stomach was upset, you felt dizzy or unsteady, as if you would faint?

YES NO 15) Have you ever had a persistent, lasting thought or impulse to do something over and over that caused you considerable distress and interfered with normal routines, work, or your social relations?

Examples would include repeatedly counting things, checking and rechecking on things you had done, washing and rewashing your hands, praying, or maintaining a very rigid schedule of daily activities from which you could not deviate. YES NO 16) 1.Have you ever lost considerable sums of money through gambling or had problems at work, in school, with your family and friends as a result of your gambling?

YES NO 17) Have you ever been told by teachers, guidance counselors, or others that you have a special learning problem?

YES NO

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EMPLOYMENT QUESTIONS

1. HOW LONG HAVE YOU BEEN EMPLOYED BY THE U.S. DEPARTMENT OF DEFENSE? 2. HAVE YOU EVER BEEN ACTIVE DUTY? IF SO, HOW MANY ACTIVE DUTY TOURS HAVE YOU HAD? WHAT WAS THE LONGEST ACTIVE DUTY TOUR? 3. HAVE YOU BEEN EMPLOYED BY SOMEONE OTHER THAN THE U.S. DEPARTMENT OF DEFENSE? 4. LIST YOUR EMPLOYMENT HISTORY BELOW. (JUST THE EMPLOYER AND THE TIME EMPLOYED WILL BE FINE). ______________________________________

____________________

______________________________________

____________________

______________________________________

____________________

______________________________________

____________________

______________________________________

____________________

5. WERE THERE ANY GAPS IN YOUR EMPLOYMENT HISTORY? IF SO, CAN YOU EXPLAIN THOSE GAPS HERE AND THE REASON FOR THE GAPS? ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 6. WHAT WAS THE LOWEST SALARY YOU HAVE EVER MADE? THE HIGHEST? 7. AFTER ACTIVE DUTY, WILL YOU HAVE AN EMPLOYMENT OPPORTUNITY?

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8. IF YOU DO, WILL IT BE FROM A JOB THAT YOU HAD BEFORE OR AFTER ACTIVE DUTY? 9. IF YOU DON’T, DO YOU HAVE ANY HELP WITH EMPLOYMENT ADVOCACY? 10. HAVE YOU BEEN SUCCESSFULLY HELPED TO FIND EMPLOYMENT DURING THIS PROGRAM? (QUESTION NOT ANSWERED UNTIL AFTER 1 YEAR OF RECEIVING ASSISTANCE FROM THE PROGRAM). ______________________________________________________________________________

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55 APPENDIX C

Project Open Arms Budget

Budget

Salary

Ad/Community Awareness

Mental Health Referral

Salary of Paid Program Workers

$160,000

Advertisement/Community Awareness

$20,000

Mental Health Referral

$100,000

Budget Overflow

$20,000

Total

$300,000

Overflow

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56 APPENDIX D

Event Chronology Date or Date Range Introduction of Project Plan

Spring 2016

Initial Securing of Federal Grant and/or other forms of governmental funding

Summer 2016-Summer 2017

Advertise for employment

Spring 2017-Until filled

Community Awareness Update

Fall 2017

Community Awareness Update

Dec.-Jan. 2018

First training wave for employees

Beginning April 2018

Event Description The initial unveiling of the project plan to the community (at this point, there is not much money secured for the program, just information and what the project plans to do initially).

Although Fundraising will have to be an ongoing effort in order to maintain budget for the program, the initial petitioning and filing for government assistance will be an effort that could take some time that why this area of the timeline will be designated to this effort.

As stated in the budget narrative, Project Open Arms will employ a Lead Administrator (the person that primarily oversees the actions of the program), an assistant lead, and 10 site facilitators.

Advertisement for the filling of these positions will remain in force until the needed positions are filled.

This is another update primarily projected toward the community to let them know where the program is at in terms of finally being completed and ready to serve the veteran community.

This update will be to let the members of the community know how the administrators of the program plan to train all involved workers and volunteers to deal with veterans’ affairs This will be the first training session for the first wave of

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Community Awareness Update

Fall 2018

Final hiring and training efforts

Fall 2018

Project Open Arms will Officially Open to the Veteran Community

Jan. 2019

workers. This training will be primarily for the site facilitators This community update is designed to let the community know about the money that has been raised at this point by the administrators of the project and how the money has been used thus far.

The project will begin finishing initial hiring process and train the volunteers of the program.

After last efforts by the lead and assistance administrators to make sure everything from budget, to program employees, training, resources, etc. are in order, Project Open Arms will go live initially in: S. Carolina, N. Carolina, Florida, Virginia, Georgia, Washington (state), Oregon, California, Arizona, and New Mexico.

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58 APPENDIX E

Community Awareness Brochure