Title of Course: After the War Zone CE Credit: 6 Hours (0.6 CEUs) Learning Level: Introductory Authors: Laurie Slone, PhD, and Matthew J. Friedman, MD, PhD Course Abstract: This is a test only course (book not included). The book can be purchased through Amazon or another source. This course is based on the book After the War Zone: A Practical Guide for Returning Troops and Their Families (2008, 304 pages) written by Laurie Slone, PhD, and Matthew J. Friedman, MD, PhD of the VA National Center for PTSD and Dartmouth Medical School. The book describes the experience of deployment and return from a war zone, typical experiences of military personnel, and issues relevant to special populations (women, ethnic minorities, peacekeepers, private contractors, and parents and extended family of affected individuals). It provides valuable insight into the military culture, as well as containing many useful military terms and definitions that would be essential for a lay clinician to know when working with military clients. As a psychoeducational tool for military personnel returning from Iraq and Afghanistan, this book may be used by clinicians as a recommendation for reading when conducting individual, family, or couples therapy with military patients or veterans. Learning Outcomes: As a result of taking this course, participant will be able to: 1. Define essential terminology relevant to the military and military operations, including the acronym BATTLEMIND. 2. Identify some basic information and statistics regarding today s military and the conflicts in Afghanistan and Iraq. 3. List common practical issues for military personnel and their families before, during, and after deployment, and common solutions to those issues. 4. Identify common emotional experiences among military personnel and their families before, during, and after deployment. 5. Identify warning signs and symptoms of PTSD, TBI, alcohol and drug abuse, suicidal tendencies, and domestic violence among military personnel, and how these differ from common reactions to being in a war zone 6. Identify coping strategies that troops and their families can use to facilitate adjustment. 7. Identify special populations affected by the war in Iraq and Afghanistan and issues that are specific to those populations. 8. Identify federal laws and federal, private, and volunteer organizations that provide support to troops. 9. Apply information provided in this book to several case scenarios. Please Note: You will no longer be able to download this course pdf once you pass the online posttest. If you would like to save this document, please do so prior to taking your test online. 2010 Professional Development Resources www.pdresources.org 60 88 After the War Zone Course Posttest Page 1 of 11
Instructions for Completing this Course Study Strategies: Educational research has shown that learning and retention of new knowledge are increased when new information is processed actively by learners. The test questions for this CE activity are designed with that goal in mind. We suggest that you take notes on the course materials. These techniques are designed to facilitate your learning and thinking about the material in more depth, leading to a more thorough understanding and retention of important concepts. Instructions: 1. Print CE Test: The following posttest questions are presented in the same order as information is presented in the course book. We recommend printing the CE test so you can mark your answers as you study the course materials. 2. Study Course Materials: Mark your answers on the CE test as you read through the course book. 3. Submit Test for Grading: Submit your test answers online for instant results (80% or better to pass, 3 chances to take test, please note incorrect answers are ONLY shown upon grading). Here s how: a. Login to your account @ www.pdresources.org b. Click on My Courses from your account dashboard c. Click the link to attend this course d. Click the view/print/take test link to open online test e. Mark your answers & submit when finished 4. Complete Course Evaluation: After you pass the test you will be prompted to complete the program evaluation (required to earn a certificate of completion). Certificates are dated the day you complete the program evaluation, regardless of when you passed the online posttest. Please note our system time zone is Eastern Standard. 5. Print Certificate of Completion: Upon successful completion of the CE test and evaluation, you will have instant access to print your certificate from the My Certificates page of your account. Just click on the course name to view and print your certificate. Certificates are permanently stored in your account for future use. After the War Zone Posttest Questions 1. What is the technical definition of deployment? a. A tour of duty b. Any military personnel going to a war zone, for any amount of time c. A troop movement resulting from a Joint Chiefs of Staff/United Command Deployment Order for 30 continuous days or greater to a land based location outside the United States. d. A troop movement resulting from a Joint Chiefs of Staff/United Command Deployment Order for 60 continuous days or greater to a land based location outside the United States. e. A troop movement resulting from a Joint Chiefs of Staff/United Command Deployment Order to any location other than their base, for any amount of time. 2010 Professional Development Resources www.pdresources.org 60 88 After the War Zone Course Posttest Page 2 of 11
2. Before deployment, which of the following is the best way that military personnel can prepare in order to help their family manage while they are away? a. Creating a household management plan d. Signing a health care proxy b. Meeting with family and friends e. Making child care plans c. Doing their taxes 3. Which of the following should be considered when planning for deployment? a. Planning day to day household maintenance and routine tasks; making contingency plans for seasonal issues and possible household problems. b. Planning for children s educational needs, daily routines, and discipline; making plans for pet care. c. Making emergency plans. d. Planning for legal issues, such as designating powers of attorney or signing a health care proxy. 4. Which of the following is the most accurate description of how military personnel typically deal with the stress of deployment? a. Troops will be excited to be deployed, and they only focus on practical elements of deployment. b. Troops will have a mixture of excitement and sadness, and they often prepare by drinking. c. Troops will have a mixture of feelings, including excitement and sadness, and they often ignore those feelings and focus instead on practical matters. d. Troops do not experience stress, so this is not a relevant question. 5. What is the Military Reserve? a. Armed forces not on military duty which can be called in an emergency, including the National Guard and the Reserves. b. Specifically, the Army National Guard, the Army Reserve, and the Air National Guard c. The active component of the reserves in the military. 6. The Reserve Components of the Armed Forces of the United States includes which of the following? a. Army National Guard, Army Reserve, Naval Reserve, Marine Corps Reserve, Air National Guard, and the Air Force Reserve b. Army National Guard, Army Reserve, Naval Reserve, Marine Corps Reserve, Air National Guard, Air Force Reserve, and the Coast Guard Reserve c. The National Guard, which consists of military reserves recruited and under the control of the states, and which is subject to be called by either the state or federal government in an emergency or time of war d. Both A and C e. Both B and C 7. What are two prominent differences between the National Guard and the Reserves? a. The National Guard is more specialized, and the Reserves are more generalized. b. The Reserves are under federal control, while the National Guard is under state and Federal control; the National Guard is more specialized than the Reserves. c. The Reserves are under federal control, while the National Guard is under state and Federal control; the Reserves are more specialized than the National Guard. d. The Reserves are under federal control, while the National Guard is under state control; the Reserves are more specialized than the National Guard. 2010 Professional Development Resources www.pdresources.org 60 88 After the War Zone Course Posttest Page 3 of 11
8. What is a typical family dynamic that troops experience? a. Before they leave, their family expresses much love and support. b. Before they leave, members of their family often feel sad, but they express support. c. Before they leave, members of their family often feel sad, but they express anger and avoidance. d. Before they leave, members of their family often feel lonely, so they buy a pet. 9. What is the term for a situation where partners of military personnel emotionally prepare for the possibility that their loved one will not return alive? a. Anticipatory grief d. Exposure b. Grief and loss c. Death, dying, and bereavement 10. What is an improvised explosive device (IED)? a. A suicide bomber b. A bomb c. A rudimentary device such as a pipe bomb made out of fertilizer d. A missile or SPUD 11. What is a common, yet often unexpected issue with multiple deployments? a. While it s always great to be back, every deployment presents different challenges b. Every deployment is different; homecoming can also be different, depending on the circumstances (e.g., what happened during deployment and what happened in the family during that time) c. Deployments are usually the same; however, homecomings can vary dramatically d. Reactions to earlier deployments do not affect later deployments 12. What is one risk of frequent deployments? a. If there is not enough time between deployments, soldiers and families can experience burnout b. If there is not enough time between deployments, divorce rates tend to increase dramatically c. If there is not enough time between deployments, troops have a greater risk of being killed during the next deployment d. Both A and C 13. What are some issues involved with return or homecoming? a. Both the military personnel and his or her family probably changed during the absence b. Homecoming is a time of readjustment and renegotiation c. Often troops and their families experience a honeymoon period, but then the reality of everything that has changed sets in 14. What are some special issues for reservists? a. They may be assigned or inserted into units in which they know no other personnel b. Deployment may result in losing their civilian job and loss of income c. They usually don t expect to be deployed d. They don t live on military bases, so their families might not have as much support while they are away 2010 Professional Development Resources www.pdresources.org 60 88 After the War Zone Course Posttest Page 4 of 11
15. Which of the following have been learned from prior and current wars? a. Difficult working environments and danger 24/7 do not add to stress b. Preparing for the psychological impact of war is essential c. Community support for military families does not significantly help them d. Both A and C e. Both B and C 16. Does everyone returning from a war zone have posttraumatic stress disorder (PTSD)? a. Yes, they all have PTSD b. No, PTSD is a fictional disorder c. No; while almost everyone will have some symptoms that families might find disruptive, like nightmares, hyper alertness, or overprotective behaviors, the presence of difficulties does not in itself constitute PTSD. Most veterans have some difficulties, but never develop PTSD. d. No; PTSD is a rare and debilitating disease requiring full disability 17. Which of the following accurately describes today s armed forces? a. 50% are married and 43% have children; 40% are single with no children b. 14% are women c. Average ages of enlisted personnel are 27 in active duty and 31 in the reserves; for officers, the averages are 35 and 41, respectively d. Of those in Iraq and Afghanistan, 50% are active duty and 50% are reserves 18. Which of the following acronyms is NOT correct? a. MOS Military Occupation Specialty, or job category in the military b. VBIED Vehicle Born Improvised Explosive Device c. FOB Forward Operating Base d. EAP Easy Access Platoon e. LSA Logistical Supply Area 19. Which of the following statistics are correct descriptions of Operation Enduring Freedom/Operation Iraqi Freedom? a. Over 1.5 million US troops had been deployed as of January 2008 b. As of October 2007, 3,856 US troops had died, over 28,400 had been wounded, and many times this number Iraqis had died c. Multiple deployments are common, with 1/3 of the troops having been deployed more than once and returning within 9 months or less d. The survival rate of those wounded has increased from 75 to 90%, but those who survive are at greater risk for psychological problems 20. Which of the following is a correct description of conditions in Afghanistan and Iraq? a. Bases are safe places where troops can relax b. All personnel have been properly trained on the relevant cultural differences to expect, so there are no surprises or stresses due to a new environment. c. High temperatures are not a problem in the desert because it is dry, so even when troops wear protective gear, it feels very cool d. All of the above 2010 Professional Development Resources www.pdresources.org 60 88 After the War Zone Course Posttest Page 5 of 11
21. Which of the following statements is true about communication among family members of deployed military personnel? a. The military only communicates with one identified individual, usually the spouse; this can be difficult for family members, who all want to know what is happening. One solution is to have a family communication plan. b. Letters are not a good idea, because service personnel can keep them and read them in between contacts. c. It is now easier than ever for deployed personnel to communicate with loved ones at home; however, it is not clear whether this is always good because it might interfere with their work performance. Thus, it is best to keep communications upbeat and wait until problems are solved to share information about what has been happening. d. Both A and C 22. Which of the following are common reactions of children to the deployment of a parent? a. Emotional withdrawal or separation anxiety b. Negative reactions towards communications from the absent parent c. Problems at school d. Both A and C 23. What is an essential way for military personnel and their families to cope with stress? a. Obtaining social support b. Parents dealing with their own issues so they don t hand the additional stress on to their children c. Drinking alcohol and smoking cigarettes 24. Which of the following may be encountered by troops returning from military operations? a. Medical Holding Company (MHC) b. Post Deployment Health Assessment (PDHA) c. Post Deployment Health Re Assessment (PDHRA) 25. What are common problems encountered by families upon reuniting? a. The strong one might be injured, which causes a problem for family dynamics b. It takes time to reconnect with family members c. Anger is a common reaction, and it is best to find ways to cope with anger like those explained in this book, or to talk to a chaplain or counselor to keep it from getting out of hand d. After returning from a war zone, troops often feel disconnected from their families at first 26. How is BATTLEMIND adaptive for troops? a. It is a teaching tool used in the military to help troops prepare mentally for war b. It is a teaching tool used to help troops understand that while some skills are necessary in war, they can be problematic at home c. It is a teaching tool for meditation 2010 Professional Development Resources www.pdresources.org 60 88 After the War Zone Course Posttest Page 6 of 11
27. What are some components of BATTLEMIND? a. Buddies, Accountability, Targeted Aggression, Tactical Awareness, Lethally Armed, Emotional Control b. Mission Operational Security, Individual Responsibility, Non Defensive Driving, Discipline c. Spouse/Partner BATTLEMIND 28. What are common reactions to spending time in a war zone? a. Feeling relaxed and at ease in any situation, no matter how stressful b. Problems with one s body, emotions, behavior, and relationships c. Posttraumatic Stress Disorder (PTSD) 29. What are common emotional reactions to being in a war zone? a. Grief, sadness and guilt b. Feeling abandoned c. Anger and aggression d. Numbness 30. What are some reactions to being in a war zone that can affect relationships? a. Mistrust and communication problems b. Being overcontrolling c. Being overly clingy and dependent 31. What are some motivating forces behind anger for military personnel? a. Sometimes it is easier to feel anger than to have other emotions b. Anger can be the result of others not doing what they are supposed to, trust issues, feeling betrayed, or being victimized c. Anger can be the result of fear or losing of control d. Anger can be the result of physical tenseness 32. What is survivor guilt? a. It is feeling guilty over having survived, while others perished b. It is feeling too much responsibility for bad things that happened c. It is feeling guilty over what they did or did not do 33. What is the only form of individual counseling that is completely confidential and never needs to be reported to military medical staff? a. Receiving psychotherapy through military providers b. Talking to the military chaplain c. Receiving counseling through the VA d. Receiving counseling from an outpatient provider not affiliated with the military ; no counseling is completely confidential 34. Which of the following describes the level of confidentiality of a serviceperson s medical information? a. All treatment provided at the VA is confidential; it is never provided to the military b. Troops must report all changes in health status and mental health status to the military, so many of them are afraid to receive mental health treatment 2010 Professional Development Resources www.pdresources.org 60 88 After the War Zone Course Posttest Page 7 of 11
c. Once someone is no longer on active duty, their health information is confidential and need not be transmitted to the military 35. What are common symptoms of PTSD? a. Symptoms occurring 1 month or more after an incident in which there was an actual threat to the integrity and/or life of self, or in which someone close was witnessed experiencing that threat b. Experiencing the event caused fear, helplessness, or horror c. Symptoms include re experiencing the event, avoidance and numbing, and hyper vigilance or increased arousal 36. What factors affect the development of PTSD? a. Severity of the trauma b. Extent of loss of control, and intensity of reaction to trauma c. Extent of help and support following the event 37. What some warning signs for suicide? a. Talking or writing about death, dying, or suicide; making plans to commit suicide b. Being overly cautious; avoiding drinking and drug use c. Feeling hopeful about the future and listing reasons to live d. Keeping in touch with ones family and friends 38. What are some warning signs of drug use? a. Changes in behavior (changes in sleep, going out every night, disappearances, missing from school/work; changes in friends; lost interest in previously enjoyed activities, neglected appearance or poor hygiene, frequent sickness) b. Sudden mood swings, impulsive behavior, aggressive outbursts, depression, hyperactivity c. Secretive behavior, lying, lack of boundaries, avoiding eye contact, missing money or valuables d. Slurred speech, weight loss/gain, bloodshot eyes, bruises 39. What are some warning signs of domestic violence? a. Controlling behaviors and verbal abuse such as humiliating, manipulating, blaming, and confusing the victim b. Excessive jealousy and radical mood changes c. Alcoholism 40. What is phantom limb pain? a. Factitious complaints of injured soldiers who are trying to obtain benefits b. Sensations of pain or other unpleasant feelings in the place of a missing limb c. A phenomenon caused by pain medication e. Both A and C 2010 Professional Development Resources www.pdresources.org 60 88 After the War Zone Course Posttest Page 8 of 11
41. What is a vocational rehabilitation therapist? a. A therapist who helps disabled, ill, or injured workers find and retain appropriate work b. A consultant who helps rehabilitate jobs so that they are more worker friendly c. A consultant who works with the military to improve military occupations specialties for injured soldiers d. A consultant who works with the military to improve military occupation specialties 42. What is a Fisher House? a. A structure used for ice fishing b. A home away from home for families of wounded military patients c. A facility operated by Ronald McDonald House 43. In the army, what is considered at disease and non battle injury (DNBI)? a. Any illness that predates service b. Any injury that did not occur in battle c. Any injury that may have occurred in battle, but was not discovered until years later d. Any injury that included both disease and a non battle injury 44. Symptoms of a mild traumatic brain injury (TBI) may include which of the following? a. Headaches, dizziness, low tolerance for noise b. Emotional problems (impatience, impulsiveness, depression, anxiety, moodiness, apathy, anger, agitation, irritability) c. Sleep problems d. Cognitive problems (attention, concentration, decision making) 45. Symptoms of moderate to severe TBI include: a. Persistent headache, repeated vomiting or nausea, inability to wake up from sleep, stupor, coma b. Convulsions or seizures c. Vegetative state and persistent vegetative state d. Symptoms of PTSD e. Both A, B, and C 46. What is a problem in diagnosing mild traumatic brain injury (TBI)? a. Memories of trauma overwhelm memories of head injuries b. Injuries from blasts often erase memories of what happened, or there may be no documentation of a head injury resulting from a blast c. mild TBI might be confused with other problems, such as PTSD 47. Which law requires civilian employers to accept returning members of the uniformed services to jobs at the same status and pay level at which they would have been if they had continued working at that job instead of deployment? a. The Uniformed Services Employment and Reemployment Rights Act (USERRA) b. The Employer Support of the Guard and Reserves (ESGR) c. US Army MWR d. The GI Bill 2010 Professional Development Resources www.pdresources.org 60 88 After the War Zone Course Posttest Page 9 of 11
48. What is an organization that provides help for employers who deal with Guard and Reserves members returning to work? a. The Uniformed Services Employment and Reemployment Rights Act (USERRA) b. The Employer Support of the Guard and Reserves (ESGR) c. US Army MWR d. Fleet and Family Support Division 49. What is a common problem encountered by children of military personnel? a. Their teachers might not know how to deal with their issues, especially if there are not many children of military service personnel in their school b. So many children across the nation are affected by parents being deployed in Afghanistan or Iraq, teachers are overwhelmed c. Teachers have so many resources for helping children of military service personnel, they are overwhelmed and don t know what to do 50. What can parents do to help their children at school? a. Participate in the Readiness and Reintegration briefings that the military offers b. Tell teachers, administrators, and staff at school that the child s parent is in the military and give them resources c. Find Children and Youth programs or other resources for their child d. Enroll in the VA even if there are no immediate concerns 51. What is a common reaction of service members to support offered by well meaning civilians? a. Gratitude and thankfulness b. Denial that they need assistance c. Feeling like civilians just don t understand their situation d. Not wanting help because they receive all the assistance they need from the military or the VA e. Service members rarely interact with civilians, so this is not a relevant issue 52. Which of the following is most true? a. If community members watch war documentaries and news about the war, it can help them become aware of the conflict and know what the troops are going through b. Family and friends of military personnel are not encouraged to watch war documentaries or news about the war because it might increase their fears about their loved ones c. It is a good idea for everyone to watch news about the war and war documentaries 53. Why does the book use the term war zone exposure rather than combat exposure? a. The conflicts in Afghanistan and Iraq do not obey conventional war format, in which combat is in the front and support troops are in the rear b. Many troops, regardless of combat or support roles, are exposed to combat in Afghanistan and Iraq c. In Afghanistan and Iraq, there is little combat, because American troops mostly conduct peacekeeping activities within the war zone 2010 Professional Development Resources www.pdresources.org 60 88 After the War Zone Course Posttest Page 10 of 11
54. Which of the following statements about the United States military is most correct? a. Women are not allowed combat roles; however, in Iraq and Afghanistan, due to the nature of the conflict, they often encounter gunfire while performing support duties such as driving vehicles b. Women both in the military and in civilian life are more likely to seek psychological help than men c. Women make up 50% of the military e. Both B and C 55. Which of the following statements is most correct? a. Gender and ethnicity are not important when considering reactions to war b. Research suggests that women cope with wartime stressors as well as men c. Ethnic and cultural factors affect how PTSD is expressed e. Both A and B 56. What specific problems do private contractors in Afghanistan and Iraq face? a. Unlike military personnel, they are often ill prepared to deal with a war zone or the psychological effects of such a stressful environment b. Unlike military personnel, they are not offered the support services and resources they need to cope with wartime stressors c. They are often vulnerable to attack and to crossfire 57. Why is e mail not a good method of communication among extended family members of military service personnel? a. E mail is not a problem, and it is quick b. E mail messages can lack important information and leave nagging doubt c. E mail messages do not contain information like tone of voice or nonverbal messages, and therefore can be misunderstood d. E mail is not as good as Facebook or Twitter e. Both B and C 58. Where can family members of military service personnel find support? a. At the local National Guard Family Assistance Center (FAC) b. At the National Guard Family Assistance Center closest to the base where the military service personnel member was deployed. c. At the local DoD Family Assistance Center d. At the military base from which the military service personnel member was deployed e. From the local recruiter 2010 Professional Development Resources www.pdresources.org 60 88 After the War Zone Course Posttest Page 11 of 11