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The Importance of Military Cultural Competence

  • Military Mental Health (CH Warner, Section Editor)
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Abstract

Military cultural competence has recently gained national attention. Experts have posited that limited outcomes in the treatment of posttraumatic stress disorder and depression in the military may be related to limited familiarity with the military. National surveys have indicated low military cultural competence among providers and limited educational efforts on military culture or pertinent military pathology in medical schools and residency training programs. Military families, with their own unique military cultural identity, have been identified as a population with increased risks associated with deployment. In response to these findings, several curricula regarding military culture have been established and widely distributed. Assessments of military cultural competence have also been developed. The clinical impact of enhanced cultural competence in general has thus far been limited. The military, however, with its highly prescribed cultural identity, may be a model culture for further study.

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Notes

  1. Unpublished data from author (WB)

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Heinemann W. Hippocrates. Volume II: On decorum and the physician. 1923.

    Google Scholar 

  2. Green JW. Cultural awareness in the human services. Englewood Cliffs: Prentice Hall; 1982.

  3. Hobbs K. Reflections on the culture of veterans. AAOHN J. 2008;56(8):337–41.

    Article  PubMed  Google Scholar 

  4. Reger MA, Etherage JR, Reger GM, Gahm GA. Civilian psychologists in an army culture: the ethical challenge of cultural competence. Mil Psychol. 2008;20(1):21.

    Article  Google Scholar 

  5. Hoge CW. Interventions for war-related posttraumatic stress disorder: meeting veterans where they are. JAMA. 2011;306(5):549–51.

    Article  CAS  PubMed  Google Scholar 

  6. Brown JL. A piece of my mind: the unasked question. JAMA. 2012;308(18):1869–70.

    Article  CAS  PubMed  Google Scholar 

  7. Association of American Medical Colleges. Serving those who serve America—Joining Forces: results of an AAMC questionnaire. 2012. [www.whitehouse.gov/joiningforces] Accessed May 2015. This important survey demonstrated how few medical schools, residency programs and fellowship programs were discussing culture, TBI or PTSD in the context of the military.

  8. Tanielian T, Farris C, Batka C, Farmer CM, Robinson E, Engel CC, et al. Ready to serve: community-based provider capacity to deliver culturally competent, quality mental health care to veterans and their families. Santa Monica: RAND Corporation; 2014. This extensive study demonstrated that improved experience in working with veterans might be a key factor in improving care for veterans. The results demonstrated that cultural competence declined with decreased exposure to military patients and recommended further assessment of cultural competence trainings, increased military exposure and further use of evidence-based treatments.

    Google Scholar 

  9. Pankow SH, Dill MJ, Navarro AM, Jones KC, Prescott JE. Health care provider awareness of the military status of patients: asking the question. AAMC Analysis in Brief, 13(5), Oct 2013. This study followed Dr Browns (ref 6) JAMA article and assessed how many providers were asking their patients if they served in the military. As anticipated by Dr Brown’s article, the study found that less than half of providers outside the military or VA were asking about military service.

  10. Pew Research Social and Demographic Trends. The military-civilian gap: few family connections. Nov 23, 2011. Parker, K. (2011). The Military-Civilian Gap: Fewer Family Connections.

  11. The health care system for veterans: an interim report. Congressional Budget Office. 2007 [http://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/88xx/doc8892/12-21-va_healthcare.pdf] Assessed Sep 2015.

  12. Veteran’s access to care through Choice, Accountability, and Transparency Act of 2014, S. 2450, 113th Cong. § 713(d)(1)

  13. U.S. Census Bureau. 2014. (http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=bkmk) Accessed Jan 2016.

  14. Hoge CW, Castro CA, Messer SC, McGurk D, Cotting DI, Koffman RL. Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New Engl J Med. 2004;351(1):13–22.

    Article  CAS  PubMed  Google Scholar 

  15. Hoge, C. Once a warrior—always a warrior: navigating the transition from combat to home—including combat stress, PTSD, and mTBI. Guilford: Globe Pequot Press; 2010.

  16. Cozza SJ, Goldenberg MN, Ursano RJ. Care of military service members, veterans, and their families. American Psychiatric Pub. 2014. This comprehensive text reviewed the fundamentals for treating service members, veterans and their families, with highlights on military related conditions/interventions and the special needs of military children.

    Google Scholar 

  17. Kim PY, Britt TW, Klocko RP, Riviere LA, Adler AB. Stigma, negative attitudes about treatment, and utilization of mental health care among soldiers. Mil Psychol. 2011;23(1):65.

    Article  Google Scholar 

  18. Korman M. National conference on levels and patterns of professional training in psychology: major themes. Am Psychol. 1974;29:301–13.

    Article  Google Scholar 

  19. Kleinman A. Rethinking psychiatry: from cultural category to personal experience. 1988.

    Google Scholar 

  20. Pedersen PB. A handbook for development multicultural awareness. Alexandria: American Association for Counseling and Development; 1988.

    Google Scholar 

  21. Sue DW, Sue D. Counseling the culturally different: theory and practice. 1990.

    Google Scholar 

  22. Cross T, Bazron B, Dennis K, Isaacs M. Towards a culturally competent system of care, volume I. Washington, DC: Georgetown University Child Development Center, CASSP Technical Assistance Center; 1989.

    Google Scholar 

  23. Santiago‐Irizarry V. Culture as cure. Cult Anthropol. 1996;11(1):3–24.

    Article  Google Scholar 

  24. Liaison Committee on Medical Education. Cultural competency standards. 2000. (https://www.aamc.org/download/54338/data/culturalcomped.pdf) Accessed Sep 2015.

    Google Scholar 

  25. Taylor J. The story catches you and you fall down: tragedy, ethnography, and “cultural competence”. Med Anthropol Q. 2003;17(2):159–81.

    Article  PubMed  Google Scholar 

  26. Roysircar G. Cultural self-awareness assessment: practice examples from psychology training. Prof Psychol Res Pract. 2004;35(6):658.

    Article  Google Scholar 

  27. Harper M, Hernandez M, Nesman T, Mowery D, Worthington J, Isaacs M, et al. Organizational cultural competence: a review of assessment protocols. 2006.

    Google Scholar 

  28. Wasley P, Wasley P. Accreditor of education schools drops controversial ‘social justice’ standard for teacher candidates. Washington, DC: Chron High Educ. 2006;52(41):A13.

    Google Scholar 

  29. Gallegos SA. The need for advancement in the conceptualization of cultural competence. Adv Soc Work. 2008;9(1):51.

    Google Scholar 

  30. Carpenter-Song EA, Megan Nordquest Schwallie MA, Longhofer J. Cultural competence reexamined: critique and directions for the future. Psychiatr Serv. 2007;58(10):1362–5.

    Article  PubMed  Google Scholar 

  31. Kumas-Tan Z, Beagan B, Loppie C, MacLeod A, Frank B. Measures of cultural competence: examining hidden assumptions. Acad Med. 2007;82(6):548–57.

    Article  PubMed  Google Scholar 

  32. Mills M, Keddie A. Cultural reductionism and the media: polarizing discourses around schools, violence and masculinity in an age of terror. Oxf Rev Educ. 2010;36(4):427–44.

    Article  Google Scholar 

  33. Betancourt JR, Green AR. Commentary: linking cultural competence training to improved health outcomes: perspectives from the field. Acad Med. 2010;85(4):583–5.

    Article  PubMed  Google Scholar 

  34. Horvat L, Horey D, Romios P, Kis-Rigo J. Cultural competence education for health professionals. Cochrane Database of Systematic Reviews, 10. 2014. This recent review of recent research efforts demonstrates tentative improvement in adherence with cultural competency training. No improvement with outcomes was noted. Recommendations for future research included greater consensus on the core components of cultural competence, participant identification and outcome assessment.

    Google Scholar 

  35. Betancourt JR. Cross‐cultural medical education: conceptual approaches and frameworks for evaluation. Acad Med. 2003;78(6):560–9.

    Article  PubMed  Google Scholar 

  36. Krueger GP. Military culture. Encycl Psychol. 2000;5:251–9.

    Google Scholar 

  37. Wertsch JV. A sociocultural approach to socially shared cognition. 1991.

    Book  Google Scholar 

  38. Nash WP. The Stressors of War. In: Figley CR, Nash WP, editors. Combat stress injury: theory, research and management. New York: Routledge: Taylor and Francis Group; 2007. p. 11–32.

    Google Scholar 

  39. Fenell DL. A distinct culture: applying multicultural counseling competencies to work with military personnel. Couns Today. 2008;50:8–9.

    Google Scholar 

  40. Foynes MM, Shipherd JC, Harrington EF. Race and gender discrimination in the Marines. Cult Divers Ethn Minor Psychol. 2013;19(1):111.

    Article  Google Scholar 

  41. Harris GLA. Reducing healthcare disparities in the military through cultural competence. J Health Hum Serv Adm. 2011;34(2):145.

    CAS  PubMed  Google Scholar 

  42. Lundquist JH. Ethnic and gender satisfaction in the military: the effect of a meritocratic institution. Am Sociol Rev. 2008;73(3):477–96.

    Article  Google Scholar 

  43. Brewin CR, Garnett R, Andrews B. Trauma, identity and mental health in UK military veterans. Psychol Med. 2011;41(08):1733–40.

    Article  CAS  PubMed  Google Scholar 

  44. Bell ME, Turchik JA, Karpenko JA. Impact of gender on reactions to military sexual assault and harassment. Health Soc Work. 2014;39(1):25–33.

    Article  PubMed  Google Scholar 

  45. Dahn VL. Silent service in the soldier’s shadow. Couns Today. 2008;51(4):55–7.

    Google Scholar 

  46. Lande RG. Stress in service members. Psychiatr Clin North Am. 2014;37(4):547–60.

    Article  PubMed  Google Scholar 

  47. Malmin M. Warrior culture, spirituality, and prayer. J Relig Health. 2013;52(3):740–58.

    Article  PubMed  Google Scholar 

  48. Vogt D. Mental health-related beliefs as a barrier to service use for military personnel and veterans: a review. Psychiatr Serv. 2011;62(2):135–42.

    Article  PubMed  Google Scholar 

  49. Greenberg N, Langston V, Gould M. Culture: what is its effect on stress in the military? Mil Med. 2007;172(9):931.

    Article  PubMed  Google Scholar 

  50. Dubey J. The military psychiatrist as social engineer. Am J Psychiatr. 1967;124(1):52–8.

    Article  CAS  PubMed  Google Scholar 

  51. Castro CAE, Adler AB. Re-conceptualizing combat-related posttraumatic stress disorder as an occupational hazard. Deployment Psychology, vol. 2011. Washington, DC: American Psychological Association; 2011. p. 217–42.

    Google Scholar 

  52. Lunasco TK, Goodwin EA, Ozanian AJ, Loflin EM. One shot-one kill: a culturally sensitive program for the warrior culture. Mil Med. 2010;175(7):509–13.

    Article  PubMed  Google Scholar 

  53. Jones E. The military and its psychiatric challenges. Int Rev Psychiatry. 2011;23(2):125–6.

    Article  PubMed  Google Scholar 

  54. Ames GM, Cunradi CB, Moore RS, Stern P. Military culture and drinking behavior among US Navy careerists. J Stud Alcohol Drugs. 2007;68(3):336–44.

    Article  PubMed  Google Scholar 

  55. Harrison D. The role of military culture in military organizations’ responses to woman abuse in military families. Sociol Rev. 2006;54(3):546–74.

    Article  Google Scholar 

  56. Cameron RP, Mona LR, Syme ML, Cordes CC, Fraley SS, Chen SS, et al. Sexuality among wounded veterans of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND): implications for rehabilitation psychologists. Rehabil Psychol. 2011;56(4):289.

    Article  PubMed  Google Scholar 

  57. Greene T, Buckman J, Dandeker C. The impact of culture clash on deployed troops. Mil Med. 2010;175(12):958–63.

    Article  PubMed  Google Scholar 

  58. Keats PA. Soldiers working internationally: impacts of masculinity, military culture, and operational stress on cross-cultural adaptation. Int J Adv Couns. 2010;32(4):290–303.

    Article  Google Scholar 

  59. Gooddale R, Abb WR, Moyer BA. Military culture 101: not one culture, but many cultures. 2012. [www.citizensoldiersupport.org] Retrieved Sep 2015.

    Google Scholar 

  60. Meyer E. Case report: military subcultural competency. Mil Med. 2013;178(7):e848–50.

    Article  PubMed  Google Scholar 

  61. Wood FR. At the cutting edge of institutional and occupational trends: the U.S. Air Force officer corps. In: Charles CM, Frank RW, editors. The military: more than just a job? Washington, DC: Pergamon-Brassey; 1988. p. 27–30.

    Google Scholar 

  62. Scannell-Desch E. The culture of war: a study of women military nurses in Vietnam. J Transcult Nurs. 2000;11(2):87–95.

    Article  CAS  PubMed  Google Scholar 

  63. Singh JA. American physicians and dual loyalty obligations in the “war on terror”. BMC Med Ethics. 2003;4(1):4.

    Article  PubMed Central  Google Scholar 

  64. Street AE, Vogt D, Dutra L. A new generation of women veterans: stressors faced by women deployed to Iraq and Afghanistan. Clin Psychol Rev. 2009;29(8):685–94.

    Article  PubMed  Google Scholar 

  65. Levander XA, Overland MK. Care of women veterans. Med Clin North Am. 2015;99(3):651–62.

    Article  PubMed  Google Scholar 

  66. Smith J. Air Force culture and cohesion: building an air and space force for the twenty-first century. Airpower J. 1998;12(3):40–53.

    Google Scholar 

  67. Groysberg B, Hill A, Johnson T. Which of these people is your future CEO? Harv Bus Rev. 2010;88(11):80–5.

    PubMed  Google Scholar 

  68. Griffith J. Decades of transition for the US reserves: changing demands on reserve identity and mental well-being. Int Rev Psychiatry. 2011;23(2):181–91. doi:10.3109/09540261.2010.541904.

    Article  PubMed  Google Scholar 

  69. Ray SL, HEASLIP K. Canadian military transitioning to civilian life: a discussion paper. J Psychiatr Ment Health Nurs. 2011;18(3):198–204. doi:10.1111/j.1365-2850.2010.01652.x.

    Article  CAS  PubMed  Google Scholar 

  70. Holmes AK, Rauch PK, Cozza SJ. When a parent is injured or killed in combat. Future Child. 2013;23(2):143–62. doi:10.1353/foc.2013.0017.

    Article  PubMed  Google Scholar 

  71. Blue Star Families, Department of Research and Policy. Military family lifestyle survey: findings and analysis. Washington, D.C. 2014.

    Google Scholar 

  72. Erbes CR, Polusny MA, Macdermid S, Compton JS. Couple therapy with combat veterans and partners. J Clin Psychol. 2008;64:972–83.

    Article  PubMed  Google Scholar 

  73. Trautmann J, Alhusen J, Gross D. Impact of deployment on military families with young children: a systematic review, Nursing outlook. 2015.

    Google Scholar 

  74. de Burgh HT, White CJ, Fear NT, Iversen AC. The impact of deployment to Iraq or Afghanistan on partners and wives of military personnel. Int Rev Psychiatry. 2011;23(2):192–200.

    Article  PubMed  Google Scholar 

  75. Deahl MP, Klein S, Alexander DA. The costs of conflict: meeting the mental health needs of serving personnel and service veterans. Int Rev Psychiatry. 2011;23:201–9.

    Article  PubMed  Google Scholar 

  76. Rosen LN, Teitelbaum JM, Westhuis DJ. Children’s reactions to the desert storm deployment: initial findings from a survey of Army families. Mil Med. 1993;158(7):465.

    CAS  PubMed  Google Scholar 

  77. Lester P, Flake LCE. How wartime military service affects children and families. Future Child. 2013;23(2):121–41.

    Article  PubMed  Google Scholar 

  78. Danish SJ, Antonides BJ. The challenges of reintegration for service members and their families. Am J Orthopsychiatry. 2013;83(4):550–8.

    Article  PubMed  Google Scholar 

  79. Soldier suicides could trump war tolls: US health official, American Family Physician, May 5, 2008

  80. Gorman LA, Blow AJ, Ames BD, Reed PL. National guard families after combat: mental health, use of mental health services, and perceived treatment barriers. Psychiatr Serv. 2011;62(1): 28–34.

  81. Kilpatrick DG, Best CL, Smith DW, Kudler H, Cornelison-Grant V. Serving those who have served: educational needs of health care providers working with military members, veterans, and their families. Charleston: Medical University of South Carolina Department of Psychiatry, National Crime Victims Research & Treatment Center; 2011.

  82. William Abb, M. S. A, Goodale R. Is your practice prepared to identify or treat post deployment problems? [www.citizensolidersupport.org] Accessed Sep2015.

  83. Hall L. The importance of understanding military culture. Soc Work Health Care. 2011;50(1):4–18.

    Article  PubMed  Google Scholar 

  84. Management of Post-Traumatic Stress Working Group. VA/DoD clinical practice guideline for management of post-traumatic stress. Washington (DC): Veterans Health Administration, Department of Defense; 2010.

    Google Scholar 

  85. Institute of Medicine. Treatment for posttraumatic stress disorder in military and veteran Populations: Final assessment. Washington, DC: The National Academies Press; 2014. This comprehensive review demonstrates the strengths and weaknesses in the nations current efforts to detect, diagnose and treat PTSD. Several recommendations are made, most notably tracking outcomes. Within the recommendations it is noted that improved outcomes may require improved understanding of military culture.

    Google Scholar 

  86. Gleeson TD, Hemmer PA. Providing care to military personnel and their families: how we can all contribute. Acad Med. 2014;89(9):1201–3. This paper reviews pertinent needs of the military and highlights the Uniformed Services University as a model for other schools to utilize in bolstering their efforts to care for military members.

    Article  PubMed  Google Scholar 

  87. Lee J, Sanders KM, Cox M. Honoring those who have served: how can health professionals provide optimal care for members of the military, veterans, and their families. Acad Med. 2014;89(9):1198–200.

    Article  PubMed  Google Scholar 

  88. Meyer EG. The importance of understanding military culture. Acad Psychiatry. 2015;39(4):416–8.

    Article  PubMed  Google Scholar 

  89. Strom TQ, Gavian ME, Possis E, Loughlin J, Bui T, Linardatos E, et al. Cultural and ethical considerations when working with military personnel and veterans: a primer for VA training programs. Train Educ Prof Psychol. 2012;6(2):67–75.

    Google Scholar 

  90. Luby CD. Promoting military cultural awareness in an off-post community of behavioral health and social support service providers. Adv Soc Work. 2012;13(1):67–82.

    Google Scholar 

  91. Cole RF. Understanding military culture: a guide for professional school counselors. Prof Counsel. 2014;4:497–504.

    Article  Google Scholar 

  92. Goldenberg M, Hamaoka D, Santiago P, McCarroll J. (2012). Basic training: a primer on military life and culture for health care providers and trainees. MedEdPORTAL Publications. [http://www.mededportal.org/publication/9270] Accessed Apr 2015

  93. Center for Deployment Psychology. Military Cultural Competence. [www.deploymentpsych.org]. Accessed Sep 2015. This course was developed over a 4-year period with input from active duty and veteran Servicemembers along with a wide array of providers working within the DoD, VA and civilian health care systems. The course provides a throughout overview of military culture. CME available.

  94. Office of the National Coordinator for Health Information Technology. Voluntary 2015 Edition Electronic Health Record (EHR) Certification Criteria. 79 Fed. Reg. 10880. Feb 26, 2014.

  95. Department of Veterans Affairs. PTSD 101: Military Culture. [www.ptsd.va.gov/professional/ptsd101/course-modules/military_culture.asp] Accessed Sep 2015.

  96. Benedek DM, Ursano RJ, Holloway HC. Ch 28.9 Military and Disaster Psychiatry in Kaplan and Sadocks’s Comprehensive Textbook of Psychiatry 8th Ed. Lippincott: Williams and Wilkins; 2005.

    Google Scholar 

  97. Meyer EG, Hall-Clark BN, Hamaoka D, Peterson AL. Assessment of military cultural competence: a pilot study. Acad Psychiatry. 2015;39(4):382–8. This small study demonstrates the potential effectiveness of a military cultural competence tool. The tool is divided into skills, attitudes and knowledge. Notably, the skills and attitudes results are normed to the respondents’ baseline towards culture in general—providing a novel approach to assessment.

    Article  PubMed  Google Scholar 

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Acknowledgments

Special thanks to Harry Holloway MD, Dale Smith PhD, and Gary Wynn MD for their thoughtful feedback. Additional thanks the editors for their accommodations while the author (EM) was sent on a remote tour, demonstrating that even academia can be impacted by military life. Final thanks to our families, who taught us firsthand the impact military service has on us all.

Disclaimer

The opinions expressed in this document are solely those of the author and do not represent an endorsement by or the views of the US Air Force, the Department of Defense, or the US Government.

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Authors and Affiliations

  1. Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA

    Eric G. Meyer

  2. Department of Psychiatry, Audie Murphy VA Hospital, 7400 Merton Minter Blvd, MC 116 A, San Antonio, TX, 78229, USA

    Brian W. Writer

  3. Department of Psychiatry, University of Texas Health Science Center in San Antonio, 7703 Floyd Curl Drive, Mail Code 7792, San Antonio, TX, 78229, USA

    Brian W. Writer

  4. Center for Deployment Psychology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA

    William Brim

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Correspondence to Eric G. Meyer.

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Meyer, E.G., Writer, B.W. & Brim, W. The Importance of Military Cultural Competence. Curr Psychiatry Rep 18, 26 (2016). https://doi.org/10.1007/s11920-016-0662-9

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