Valerie Wallace, right, calls the psychological health and traumatic brain injury team at the National Naval Medical Center in Bethesda, Md., a godsend in helping wounded warriors like her son, Army Sgt. John Barnes, left, deal with the unseen scars of war. Photo by Donna Miles

Valerie Wallace was at her wits’ end when she first heard about a novel traumatic brain injury treatment program under way here at the National Naval Medical Center.

Her 22-year-old son, Army Sgt. John Barnes, was wounded in southwestern Iraq in 2006 during a mortar attack while he was deployed with the 101st Airborne Division.

He had slipped into a coma for 12 days, remembering nothing of the attack when he regained consciousness with a severe traumatic brain injury. He recognized his family members’ faces, but had lost much of his verbal and motor skills as well as his short-term memory.

After two months at Walter Reed Army Medical Center in Washington, followed by treatment at the Department of Veteran Affairs’ Tampa Polytrauma Rehabilitation Center, in Tampa, Fla., Barnes seemed on the road to recovery, his mother recalled.

But a fluid buildup within his brain stopped that progress cold, requiring an emergency craniectomy to relieve swelling. From there, as Barnes began his rehabilitation almost from square one, he fluctuated between extremes. At one point, his recovery was so successful that he’d started living independently and enrolled in college, but at other times, his condition was so dire that his mother feared he was spiraling out of control.

“Then the [post-traumatic stress disorder] set in and he began self medicating with whatever he could get his hands on,” his mother recalled. “It was just a disaster.”

The problem, she said, was that no program within the military, the VA or the civilian community treated all three of Barnes’ afflictions — TBI, PTSD and substance abuse – simultaneously. “There was no place I could find capable of treating all three of these issues,” she said. “But I truly believed that they were all correlated and needed to be treated together.”

The one private program discovered online failed miserably, she said. After six weeks of treatment, Wallace’s son returned home “hostile, disrespectful and bitter,” she recalled, and lacking the supervision he now required, had blown through tens of thousands of dollars.

It was only by chance that Wallace learned through a friend about the National Naval Medical Center’s psychological health and traumatic brain injury team. The little-known team was stood up here about two years ago to address the complexities of brain and mental-health injuries.

Dr. David Williamson, the team leader, admitted Barnes for about a month of close observation in the six-bed TBI unit known as “7 East.”

“This is an environment where we can do very detailed evaluations of brain functions after a brain injury,” he explained.

“We have a whole portfolio of brain injury specialists, treating clinicians who look at all the basic aspects of brain function, like movement, balance and vision, up through the higher brain functions like memory and personality and emotional regulation,” Williamson said. “And the [patient's] time here allows us to put together a very sophisticated assessment of all these different areas of brain function, and to identify what the needs will be downstream.”

The team then provides families “a complete briefing on what to expect,” Williamson said, while releasing the patient for follow-up care, typically to a VA polytrauma rehabilitation center.

“We know certain types of brain injuries are more associated with mood swings or depression or communication problems or judgment impairment,” Williamson said. “And we will look at the brain scans and the behavior of the patient while at Bethesda, and form an assessment that put in place strategies now to prepare this family and begin to work with this ahead of time.”

Williamson calls this approach “proactive intervention.”

But as word gets out about the psychological health and traumatic brain injury team’s capabilities, Williamson finds he’s getting calls from family members like Wallace, some whose loved ones have struggled with traumatic brain injuries for five, even 10 years.

“We’ll bring those people back to Bethesda and do an intensive evaluation or reevaluation of their brain injury, and look at new strategies for treatment, or maybe add additional elements to the treatment plan,” he said.

For Wallace, the National Naval Medical Center’s psychological health and traumatic brain injury team restored hope she’d all but lost in finding help for her son.

She worked closely with the entire team, which she said treated Barnes’ problems holistically rather than piecemeal. “It brought a component of completion, dealing with all the complex issues of brain injury,” she said. “It’s everything: the behavioral problem, the cognitive problem, the physical problem.”

Wallace reserved her highest praise for Williamson, whom she said “understands traumatic brain injury inside out, backwards, forwards and sideways.”

Williamson “sees the big picture,” she continued. “It’s not one dimensional; it’s multidimensional. There is a lot of mental illness that can come up because of the brain injury, and he understands that.”

The treatment “has made all the difference in John,” his mother said, crediting the PHTBI team with saving his life.

“John would be dead by now if he hadn’t been able to get there last summer,” she said. “There’s no doubt about it.”

Unfortunately, Wallace’s story doesn’t end with a storybook “happily ever after.”

Her marriage dissolved during her son’s treatment. And her son, she noted, still has limited coping skills and occasionally self-medicates with an over-the-counter medication he knows the VA rarely screens for.

About four months ago, Barnes was readmitted to Bethesda for follow-on treatment by the PHTBI team. Wallace said she is resigned to the fact that it probably won’t be for the last time.

“John’s brain injury is never going to go away, and I don’t think there will ever be a real end to this,” she said. “I think that what will happen is that the need for interventions will become further and further apart. Instead of every three months, maybe it will be once a year. Then a couple of years from now, maybe it will be once every other year.”

That said, Wallace expressed hope her son will continue making progress under the PHTBI team’s guidance.

“It’s going to take a lot of time and consistency and dedication,” she said. “But that’s exactly what I’ve finally found in Dr. Williamson and his staff.”

DVIDS
Story by Donna Miles

Navy Lt. Cdr. Jena McLellan, a clinical trials coordinator with the National Intrepid Center of Excellence, demonstrates the center's Computer-Assisted Rehabilitation Environment virtual reality system to assess wounded warriors with traumatic brain injury or post-traumatic stress, at the National Intrepid Center of Excellence in Bethesda, Md., June 23, 2010. NICoE photo by Linsey Pizzulo

When the National Intrepid Center of Excellence opened its doors here last week, the sense of hope in reversing the rising tide of brain injuries and psychological illness in service members was palpable.

From its warm design and family-friendly amenities to its best-in-the-world diagnostic and assessment equipment, the center boasts the convergence of art and science that officials hope will become the new normal in researching, diagnosing and treating traumatic brain injuries and post-traumatic stress disorder.

As Deputy Defense Secretary William J. Lynn III said at the center’s June 24 dedication ceremony, the need for such a center could not be more pressing. Hundreds of thousands of servicemembers are believed to have suffered TBIs and PTSD during their service in Afghanistan and Iraq, and many go undiagnosed, suffering the “invisible wounds” of war without explanation.

Gen. Peter Chiarelli, Army vice chief of staff, was asked during testimony before a U.S. Senate committee last week why the military cannot better diagnose brain injuries and PTSD. “I promise you it is not from lack of trying,” he said. “We are doing everything we can.”

That’s where the Intrepid Center comes in. Not a clinical care hospital, the center instead is designed to accept on referral those military members whom the services struggle to help, those whose injuries are so elusive to not be detected, or that are unresponsive to treatment developed at base hospitals, which are lacking in proper equipment, staffing and expertise, officials said during a June 23 media event.

The Intrepid Center holds the promise of proper diagnosis and treatment plans for those toughest cases. The $65 million center on the grounds of the National Naval Medical Center houses $10 million in equipment, much of it unique to the center and a handful of academic research institutes.

It includes brain imaging equipment that produces up to 6,000 images per brain scan, Dr. Gerard Riedy, the center’s chief of neurology, said. While standard magnetic resonance imaging equipment allows for about 750 images mostly showing the outside structure of the brain, Riedy said, the center’s three-dimensional imaging equipment shows everything from lesions of mild TBI on the brain’s surface to internal brain functions, seen in real time.

“It’s all non-invasive,” Riedy explained from the center’s “visualization” room, surrounded by a large, 3-dimensional screen and multiple smaller screens showing brain images. While a patient undergoes what seems like a standard MRI or positron emission tomography or computed tomography scans in another room, Riedy and his staff of six assess color-coded images of the brain’s magnetic fields, wiring, and the like. One screen displays the brain activity when the patient is asked to do certain tasks, allowing doctors to assess proper functioning, including psychological stress.

Riedy said his staff with be interoperable, meaning they will process scans from military facilities and share their discoveries and observations. “This stuff is not easy to do,” he noted, “and I have six people working for me.”

Down the hall from the brain imaging room, patients may enter virtual reality suites where they can be assessed on their reaction to being fully immersed -– smells of burning rubber or dead bodies included — in recreated scenes from Iraq or Afghanistan. Or researchers or clinicians may test their driving or shooting ability in simulators for their possible return to duty.

In another room, a patient may walk or run on a treadmill suspended on a moving platform surrounded by any number of scenes that staffers create, from a street scene in Baghdad to a fishing pond in Idaho. The patient’s reactions to given tasks allows staff to assess functions such as balance, coordination, multitasking, reaction times and visual acuity, said Johanna Bell, an operator of the Computer-Assisted Rehabilitation Environment, or CAREN, machine.

Such equipment may provide the missing link in proper diagnosis and treatment.

“We’ve got no other objective measures of TBI right now,” Riedy said. Service members take written tests when returning from deployment, but those aren’t conclusive in the ways of brain scans and virtual reality equipment.

Still, expensive equipment alone won’t solve the problem of TBI and psychological illness in servicemembers. The center’s staff also offers hope of improved care, not only with their understanding of the science and equipment, but also in the art of working with and understanding patients.

“A lot of these patients just need an understanding that they are not crazy,” said Army Lt. Col. Matthew St. Laurent, assistant chief of occupational therapy at Walter Reed Army Medical Center in Washington, D.C. “There’s something wrong in their brain tissue.”

St. Laurent said he is honored to be associated with the center, which he called “a place for us to come and learn” about the nascent science of combat-related TBI.

In a second-floor open area surrounded by windows and flooded with natural light, St. Laurent and others can assess patients on various types of exercise equipment to measure their ability to push, pull, carry, lift and perform other basic functions.

A few steps away, patients can open a door into the center’s “Central Park,” a circular refuge of tranquility with skylights, green plants and park benches. Displaying the center’s openness for alternative therapies – in this case, ambient therapy — the room’s floor is a labyrinth of two-toned, polished wood, inviting its guests to relax or confront their troubles on its winding paths.

From the best diagnostic and imaging equipment to the desire to make military families comfortable and engaged, staff members are clear about their goals.

“Our ultimate goal is to get our military men and women back to duty,” St. Laurent said.

DVIDS
Story by Lisa Daniel

National Intrepid Center of Excellence (NICoE) Facebook Page

Symptoms of combat stress and post-traumatic stress disorder for wounded warriors include continual nightmares, avoidance behaviors, denial, grief, anger and fear.

Some servicemembers battling these and other symptoms, can be treated successfully as an outpatient while assuming their normal duties, but for others; however, returning to work and becoming their old selves again were challenges recognized by several mental health professionals across the European theater.

“We were looking at how we can best meet the needs of our clientele, and we were identifying that a lot of the Soldiers needed more than once a week outpatient, individual therapy and probably needed more than once or twice a week group therapy,” said Joseph Pehm, the chief of Medical Social Work at Landstuhl Regional Medical Center.

NEW PROGRAM
The solution came in the creation of an intensive eight-week therapeutic Post-Traumatic Stress Disorder Day Treatment Program called “evolution” that began in March 2009 at LRMC. During the eight-hour days, patients enrolled in the program participate in multiple disciplines and interests, including art therapy, yoga and meditation classes, substance abuse groups, anger and grief management, tobacco cessation, pain management and multiple PTSD evidence-based practice protocols.

“I am a great believer in the kitchen sink, meaning I throw everything, including the kitchen sink, and something will stick,” said Dr. Daphne Brown, chief of the Division of Behavioral Health at LRMC. “And so we’ve come with all the evidence-based treatment for PTSD that we know about. We’ve taken everything that we can think of that will be of use in redirecting symptoms for these folks and put it into an eight-week program.”

Doctor Brown, Mr. Pehm and Sharon Stewart, a Red Cross volunteer who holds a Ph.D. in psychology, said the program is designed from research into the effects of traumatic experience and mirrors successful PTSD programs at Walter Reed Army Medical Center and the Department of Veterans Affairs, as well as programs run by psychologists in the U.S.

“We are building on the groundbreaking work that some of our peers and colleagues have done and just expanding it out,” Doctor Brown said.

TREATMENT METHODS
During treatment, patients begin the day with a community meeting where they discuss how well they feel and any additional issues or concerns since their last meeting. The remainder of the day depends on the curriculum scheduled for that week.

The first few weeks focus on learning basic coping skills such as how to reduce anxiety and fight fear, as well as yoga and meditation for relaxation. Eye Movement Desensitization and Reprocessing, an evidence-based practice for treating PTSD, is also conducted during the early phases of the treatment program.

“The concept behind EMDR is that, essentially, memories become fixed in one part of our brain and they maintain their power and control over our emotions as long as they are fixed there,” Doctor Brown said. “And if we can activate a different part of the brain while we’re experiencing that memory, we can help to remove some of that emotional valence from it. So we use physiological maneuvers to activate both sides of the brain.”

The goal at the beginning of the PTSD program is to provide patients with a number of tools they can use to help them calm down when feeling overwhelmed, especially before more intense therapy begins in the latter weeks. Cognitive processing therapy is used throughout the program. EMDR and prolonged exposure therapy are also available on an individual basis at the Soldier’s request. All three techniques are research-based treatments.

When life-changing events occur, Doctor Brown said perceptions about the world may change. For example, before Soldiers experience combat trauma they may think the world is safe. Following combat, a Soldier’s perceptions may change; a majority of the world may now seem unsafe. Cognitive processing therapy attempts to readdress experiences and reshift a Soldier’s perceptions.

Prolonged exposure therapy is behaviorally based and addresses a Soldier’s fears, which are seen as reflex reactions to a stimulus. To decondition the reactions, a patient is continually exposed to the stimulus by retelling the story repeatedly, minus the negative outcome. Doctor Brown compared it to riding a roller coaster over and over again to overcome a fear of roller coasters.

“So they’re getting EMDR, they’re getting cognitive processing therapy, they’re getting individual therapy, they’re getting group therapy, they’re getting education, anger management, self-esteem, relationship issues, grief and loss, yoga, meditation exercise, skill building — a little bit of everything across the board,” Doctor Brown said. “Not everything’s going to resonate with everyone who comes through, but something’s going to resonate for everyone who comes through.”

ADDITIONAL PROGRAMMING
In addition to the overall core curriculum, Doctor Brown and her staff have programs such as pain management, relationship enrichment and tobacco cessation to help individualize treatment.

“The core of the group and individual education is consistent for everyone,” Doctor Brown said. “But we recognize that every patient is different, and we have to tailor make it to give an individualized treatment plan. We don’t keep people in pain management if they’re not in pain. We don’t give them tobacco cessation if they’re not smoking. So we do try and tailor as much of it as we can.”

Spirituality, relationship enrichment and gender-specific issues are also areas of focus.

“The program is holistic,” Mr. Pehm said. “It looks at people from different spheres, not just the medical model because everything is impacted when someone has combat stress or PTSD; not just the individual Soldier, but everybody who comes in contact with them.”

The intensity, length and “kitchen sink” qualities are not the only aspects that make this program unique, Doctor Brown said. It is a joint military and civilian effort accomplished entirely by volunteers. The staff is as diverse as the therapy options, and includes chaplains, social workers, Red Cross volunteers, psychiatrists, a nurse practitioner, enlisted psychiatric technicians, and graduate students. Brown said having a sundry of personnel keeps the program fresh and the staff excited.

“The patients get perspectives from people from a number of different backgrounds,” Doctor Brown said.

STAFFING
Thus far, the staff outnumbers the program’s participants.

“By design we started out small, and we were able to establish a really good working relationship with the local Warrior Transition Unit people … It’s been a wonderful working relationship with them,” Mr. Pehm said.

Evolution is currently on it second eight-week course, with five patients enrolled. The first class had four. The goal is to keep the class size small in order to benefit from the program’s intensity. Thinking small also helps keep the impact large by successfully returning Soldiers to their units, while also expanding access outside the WTUs. However, Mr. Pehm said they would like to expand the program to include patients from throughout the European Command.

“Ideally, we’d like to max it at about 10 because it is so intensive,” Doctor Brown said. “These are folks we hope to remediate and return to the Army to be functional members again. Also, if they go back to their communities and their providers or spouses see the changes that have come about, that will increase the willingness or desire of more people to be here.”

SIGNS OF SUCCESS
Though few have completed this young program, signs of success have already started to surface.

“With the last group, the shift from ‘I have to be here’ to ‘I’m so glad I came’ was really phenomenal,” Mr. Pehm said.

“One of them said that he didn’t think he was getting anything out of the program,” Doctor Brown said. “It was about week six until he saw himself react differently to a situation that came up, and watched himself do it differently using skills that he didn’t know he learned. He went, ‘Wow, maybe I am getting something out of this.’”

It is too early, and the numbers are too small, to generalize the early trends, but self-completed PTSD checklists showed a significant decrease in reported symptoms for three of the four patients in the first cohort. Additionally, anxiety and depression symptom measures decreased.

“The whole idea is that we know all the changes aren’t going to take place here,” Doctor Brown said. “But we hope we give them enough learning to send them in a different direction. My hope is that we can build a program to provide valid, effective treatment to folks who have put themselves in harm’s way at the request of their country, and help them live happier and better lives.”

Air Force
by Capt. Bryan Lewis
Landstuhl Regional Medical Center Public Affairs

Maj. Larissa G. Coon developed several stress coping programs as the occupational therapist officer at the Patriot Clinic on Joint Base Balad, Iraq. Photo by Spc. Brian Barbour

In order to be successful in their missions, Soldiers deployed throughout Iraq deal with combat stress daily whether they perform their duties inside or outside the wire.

The 1835th Medical Detachment (Combat Stress Control) helps Soldiers find positive ways to cope with that combat stress and reduce incidence of suicide through their work at the Patriot Clinic here.

Maj. Larissa G. Coon, Patriot Clinic occupational therapist officer describes combat stress as “dealing with one of the top life stressors while in a combat or deployed environment.”

“This combat stress can be identified through dramatic changes in habits or routines,” Coon said.

Coon, a resident of Goodland, Kan., designed and implemented many of the stress coping programs available here.

She said some of the top stressors that people deal with in their lives are: a job change, a divorce or marriage, the birth or adoption of a child, the death of a family member or close friend, or major purchases like a house or a car.

Coon said these stressors are challenging for anyone to cope with, but when the stressor is combined with a deployment, the stressor for a Soldier is magnified many times over.

When these triggers occur, the affects on a Soldier can be seen in several areas. Soldiers may become angry at everything, have a change in sleeping habits or become withdrawn from contact with family, friends, or coworkers, Coon said.

The combat-stressed Soldier may have a change in eating habits, or may no longer be interested in activities that once brought them pleasure, she said.

Coon said battle buddies and unit leaders need to watch for any dramatic and significant changes in a Soldier’s behavior; it could indicate the need for a “buddy check.”

“Change is the main clue – the key,” she said.

Coon explained that combat stress should not be mischaracterized as Post-Traumatic Stress Disorder. PTSD is a long-term mental health diagnosis where dramatic changes in a person’s habits or routines continue for six months or longer.

A 2003 Army Medical Command report on mental health indicated that forward deployed behavioral health units experienced more than a 95% rate of return to duty status for Soldiers who sought combat stress treatment. The report indicated that almost half of the Soldiers surveyed reported not knowing how to obtain their mental health unit’s services.

The presence of combat stress control units here in Iraq now reflects the efforts the Army has taken to make these services readily available to service members.

There are currently five clinics that offer stress coping programs to service members needing them. These clinics in Iraq are located at Joint Base Balad, Contingency Operating Base Speicher, Camp Liberty, Camp Taji and Forward Operating Base Diamondback.

There are behavioral health assets dispersed across Iraq in more than 25 locations.

Coon said an overwhelming majority of the service members visiting the clinic come voluntarily with only 1 percent of Soldiers being command referred.

When a battle buddy accompanies a fellow Soldier to the Patriot Clinic for assistance, the clinic has no obligation to report the visit to the Soldiers command. The only time this happens is when there is a fear for the immediate safety of the Soldier.

Coon said that Soldiers exhibiting combat stress do not all need to be treated as being a risk of suicide.

“Sometimes they just need someone, like their battle buddy, to offer some help,” she said. Coon said the help a Soldier needs might not be anything more than hearing a buddy’s offer of advice or guidance to some of the resources to help them handle an issue.

The Soldier talking about the stressors they are experiencing can do a lot to relieve some of the pressure they are dealing with alone, Coon said.

If a Soldier needs additional help, Coon listed some other resources besides the clinic where Soldiers can turn to. Such resources are the Judge

Advocate General’s office for legal issues; the finance office for pay issues; the chaplain for spiritual guidance; the Army Emergency Relief fund for unexpected financial shortfalls; the Veterans of Foreign Wars or American Legion for support to loved ones back home; and Military OneSource as a gateway to numerous other agencies and organizations who provide military support, counseling, and assistance in the states.

Coon said: “I have the best job in the Army as I get to supply the activities to make people forget about their stress!”

The 1835th Med. Det. is an Army Reserve unit from Aurora, Colo. The fifty Soldiers of this unit will return to the Fitzsimmons Reserve Center in the spring of 2009 at the end of their deployment.

DVIDS
Story by Maj. Christopher Emmons

When the military looks for innovation, it typically turns to its special operators – those elite forces on the cutting edge of new equipment, tactics and techniques.

So if a new program here proves as successful as expected in helping Navy SEALs and their families cope with multiple deployments, officials hope to expand it, not just throughout the special operations community, but military-wide.

Several hundred SEALs and their support forces just back from deployments, as well as their family members, will take off next weekend for four days at a popular resort.

The retreat is part of a unique new Naval Special Warfare Group 1 program to build resiliency within the force, explained Wally Graves III, the group’s family support coordinator.

Few military units are as heavily stressed as special operators. These elite forces have endured repeated deployments since Sept. 11, 2001, and typically operate in the most difficult and dangerous circumstances. Many members of the West Coast SEAL teams, for example, have deployed forward seven or more times.

Intensive training and discipline builds a breed of warfighters who pride themselves in physical, mental and emotional toughness that’s critical to their missions, Graves said.

A retired SEAL himself, Graves said he believes combat stress isn’t all bad for warfighters. “Ten pounds of [post-traumatic stress disorder] is good in war. It’s hyperactivity, it’s anger, it’s all the good stuff that keeps you alive on the battlefield,” he said. “But 400 pounds of PTSD after you get home is not good.”

The new resiliency program is designed to identify and treat symptoms of combat stress early to prevent them from becoming bigger problems, Graves said.

“We need to get out front and be proactive,” he said. “You nip it in the bud. You educate everyone, provide training for the high-risk category and then intervene when you have to prevent this from becoming a life-lasting problem or stigma.”

And in the process, Graves said, the effort builds force readiness by ensuring the SEALs are ready to turn around for the next deployment.

There’s new recognition within the SEAL community that “under the exoskeleton of a warrior is still a human being,” he said. When that human being is in distress – whether suffering from post-traumatic stress or experiencing family turmoil brought on by repeated deployments – the warrior can’t operate at his peak.

As NSWG-1 strives to build resiliency within its force, it’s extending that effort to families. “The culture has changed, from the leadership on down,” Graves said. “There’s a recognition that family readiness is a big component of force readiness.”

SEAL families are a special breed, Graves is quick to note. “Our wives are fantastic. They’re not complainers,” he said. “But our goal is to give them tools that will empower them so they can survive and thrive.”

The Family Resiliency Enterprise seeks to accomplish that through three steps: assessing individual sailors’ and family members’ needs; providing educational programs and services tailored to those needs; and helping newly reunited families reintegrate after deployments.

Screening is conducted using scientifically-proven computer software programs, neuro-cognitive measuring equipment and questionnaires. NSWG-1 has started screening its members and soon will offer these assessments on a voluntary basis to their spouses and children ages 8 to 18.

The assessments provide important insights into individual and family psychological, financial and psychosocial well-being, Graves said.

For the sailors, these screenings represent a baseline that, when compared to future post-deployment assessments, will provide objective measure for traumatic brain injuries and combat stress symptoms.

The findings also help the command tailor the training, education programs and other activities it offers to meet the community’s needs. These efforts run the gamut, from interpersonal communication workshops to parenting and financial planning classes to command-sponsored activities for spouses and children.

“Each SEAL is responsible for his own family readiness,” Graves said. “We are just providing him the tools that he can use, either as a mirror image, or in developing his own.”

As part of this effort, NSWG-1 has piggybacked on the Marine Corps’ Project FOCUS – Families Overcoming Under Stress – program. The Marine Corps launched FOCUS at Camp Pendleton, Calif., and has expanded it to several other locations to help families cope with multiple combat deployments. NSWG-1 announced its new FOCUS program during a town hall meeting this summer and encouraged families to take advantage of its offerings.

The third phase of the resiliency program is designed to help redeploying SEALs leave the stresses of combat behind and ease back into family life.

Next week’s retreat is expected to be a highlight of the program, giving the sailors and their families a chance to kick back and enjoy each other as they tap into educational programs and other services to help them through the reintegration process.

“There will be a delicatessen of psychological education tolls there,” Graves said.

Graves emphasized that the retreat isn’t a Morale, Welfare and Recreation outing or field trip, and that it has specific objectives for the participants.

“What we are doing is transferring them from a combat mindset, giving them the opportunity to process what they went through, then helping them reenergize,” he said.

Graves called the NSWG-1′s resiliency program a “great litmus test” for the rest of the military in how to help servicemembers and their families through the challenges of military life and combat deployments.

SEALs, he said, are the perfect community to test out the concept.

“We’re small, we’re innovators, we’re not constrained, and we’ll use out-of-the-box thinking to get the job done,” he said. “That’s the way we’re trained to operate, and it brings a lot of perspective to process improvement.”

Graves said he’s optimistic the resiliency program will strengthen families so they have the confidence and resources to stand up to tough times, while enhancing the readiness of the SEAL community.

“What we’re doing is taking a good warrior and making him a great warrior,” he said.

DVIDS
By Donna Miles
American Forces Press Service