Tier One Training

Tier One includes three modules which introduce participants to working with the Reserve and National Guard, military culture, and the impact of deployment on families and children. Tier One is a day-long training offered in-person and online, and is appropriate for both behavioral health providers and anyone who works with veterans, service members and their families. Participants must attend the entire day of training. Tier One training is required in order to attend Tier Two training. Below you will find an overview for each module.

This training module gives a better understanding about how the military works and who comprises the armed forces. It provides an overview of military culture to include basics about its history, organizational structure, core values, branches of the service, mission, and operations, as well as the differences between the active and reserve components. Participants acquire greater competency in working with Service members by learning military culture and terminology, and by discussing how aspects of the military culture impact behaviors and perspectives.

This training module provides an overview of the impact of the deployment cycle on the Service member and family units. It explores the unique experiences that Service members and their spouses and children face across the deployment cycle by examining research findings and psychosocial stressors associated with stages of the deployment cycle. Strategies for promoting family resilience during separation and reintegration are discussed.

Tier Two Training

Tier Two training is designed to assist behavioral health providers with effectively screening, assessing, and identifying appropriate treatment for service members, veterans and their families experiencing common disorders and psychosocial stressors associated with military service. Tier Two is a two-day training comprised of seven modules, including three hours of ethics training, and is offered in-person and online. Participants must attend both days in their entirety. As a reminder, to attend Tier Two training, you have to have completed Tier One training. Below you will find an overview for each module.

This module provides a general overview of alcohol and substance use disorders (SUDs) within the military population. It reviews prevalence rates of use/misuse of substances, clinical assessment, and best treatment practices for SUDs. Additionally, commonly used brief assessment instruments for substance use disorders are introduced and use described. Finally, prevalence rates and treatment are discussed within the context of consideration for mentally and physically co-occurring disorders. Information provided is based upon recommendations as informed by the 2015 VA/DoD Clinical Practice Guidelines for the Treatment of SUDs with Service members and Veterans and the current literature informing SUD treatment.

In this interactive module, participants will gain an understanding of common sleep disorders and sleep-related problems for military members. It focuses on providing strategies to enhance the ability of mental health providers to assess, identify these common sleep disorders, and know evidence-based treatments for them.

This module reviews methods of assessment and treatment of PTSD. It reviews the DSM-5 diagnostic criteria for posttraumatic stress disorder. Types of PTSD assessments are discussed, including appropriate assessment instruments for the intended purpose (e.g., screening, tracking, diagnosis), and commonly used PTSD assessment instruments are described. Additionally, unique variables that can impact the assessment process with this population are identified. Finally, best practices for diagnosing deployment-related PTSD are introduced, and evidence-based treatments for PTSD are reviewed so participants become familiar with effective interventions for military-related trauma.

This training module provides an overview of military family resilience. A summary of the basic demographics of military families is presented, in addition to the normative stressors associated with military family life. Additionally, factors that can promote or impede military family resilience is reviewed. The module concludes with an exploration of military family resilience models, with an emphasis on how clinicians can promote resilience in military families.

This module is designed to help civilian mental healthcare providers working with military service members and veterans to identify and understand common ethical challenges unique to serving this population. This module focuses on five common ethical dilemmas that may arise when working with military connected clients. The course begins with a description defining ethics and a discussion of its importance to the behavioral health profession. The course also distinguishes between an ethical dilemma and ethical conflicts. Participants are then introduced to the five common dilemmas: informed consent, boundaries of cultural and clinical competence, disposition-driven diagnoses, multiple relationships, and professional fitness. These 5 challenges are all discussed in breadth and depth in the context of civilian practitioners working with military-connected clients. Decision-making models are presented to address ethical dilemmas, with specific discussion of the role of dual relationships within a clinical framework. Extensive, complex vignettes representing each of the five challenges are discussed in workshop/group format to ensure comprehensive, nuanced discussion.

This module begins with a discussion of the rates of suicide in the civilian and military population. Next, stigma is discussed with an emphasis on the impact of stigma on help-seeking behaviors in the military. Participants are introduced to the Self-Directed Violence Classification System, a nomenclature for self-directed violence. The VA/DoD Clinical Practice Guidelines for Assessment and Management of Patients at Risk for Suicide are reviewed, highlighting best practices for assessment and treatment of suicide ideation and behavior. This is followed by a review of suicide risk assessment including discussion of risk factors, warning signs, and protective factors related to suicide, laying the foundation for discussion of the Fluid Vulnerability Theory of risk assessment. Initial management of suicidal patients is presented including in-depth discussion of safety planning for suicide. The presentation ends with an overview of evidence-based treatments and suggested resources for additional training.

This module defines and describes the different types of TBI. It examines the rates of TBI in the military population with a focus on blast related TBI. Additionally, assessment and management of TBI are covered. Finally, the module covers common comorbid conditions, treatment models, and resources for providers, families, and patients in the military with TBI.

Tier Three Training

Tier Three trainings offer behavioral health professionals specific clinical skills that focus on evidence-based treatment to address specific behavioral health issues facing service members. Tier Three trainings are two-day workshops offered in-person and online. Participants must attend both days in their entirety. To attend Tier Three trainings, you must be accepted into the registry and have completed Tier One and Tier Two. You may, however, register for the training after completing a Tier Two before being accepted into the registry in order to reserve your spot.

 

Below you will find an overview of each of the courses for Tier Three. Please note that, while these topics are offered under Tier Three training, these courses are independent and conducted separately. To be listed as a Tier Three trained provider, you need only take one training; however, you may find it beneficial to attend several as it will offer you additional tools and resources.

This intensive 2-day workshop provides training in Prolonged Exposure (PE) Therapy, an evidence-based treatment for PTSD described in the manual, Prolonged Exposure Therapy for PTSD, Emotional Processing of Traumatic Experiences–Therapist Guide, 2nd edition, by Foa et al., 2019. It covers the empirical and theoretical support for PE and reviews the main clinical techniques used in this structured protocol. Step-by-step instructions for conducting PE therapy sessions, including in vivo and imaginal exposure, along with strategies for working with over- and under-engaged patients and other difficult cases, are shared. Videotaped examples of PE cases are used to demonstrate therapist skills, and participants are expected to do role-plays in class to practice PE techniques. Additionally, participants are responsible for acquiring a copy of the PE therapist guide prior to the start of the workshop, and attendance both days is required as the course material is cumulative.

This intensive 2-day workshop provides training in Cognitive Processing Therapy (CPT), an evidence-based treatment for PTSD described in the manual, Cognitive Processing Therapy for PTSD: A Comprehensive Manual, 1st edition, by Resick et al., 2016. It presents theory underlying CPT, a brief overview of CPT’s empirical support, and step-by-step instructions in CPT protocol techniques. Throughout the workshop strategies for conceptualizing and dealing with co-morbidity, managing avoidance, and keeping patients optimally engaged are provided. Video clips of expert therapists demonstrate CPT skills, and participants are expected to do role-plays and other assignments to learn concepts and practice skills. Additionally, participants are responsible for acquiring a copy of the CPT manual prior to the start of the workshop, and attendance both days is required as the course material is cumulative.

This intensive 2-day workshop provides training in the assessment of military-related sleep disturbance and treatment of insomnia via Cognitive Behavioral Therapy for Insomnia (CBT-I), an evidence-based approach to treating sleep problems. The workshop begins with a broad foundation of normal sleep, including sleep mechanisms and theories, which builds to instruction on sleep-focused differential assessment with a focus on functional analysis. From this perspective, we explore the etiology of insomnia and introduce clinical interventions within a step-by-step CBT-I protocol. Experiential and interactive elements develop practical skills for using Stimulus Control, Sleep Restriction, and cognitive therapy. Military case examples are incorporated to illustrate key concepts and techniques. Participants are expected to engage in case discussion and role-plays in class to practice CBT-I techniques. Attendance both days is required as the course material is cumulative.

This intensive 2-day workshop provides training in the assessment and treatment of suicidal ideation and behavior, and is designed for behavioral health providers working with Service members and Veterans. The workshop begins with a detailed review of the epidemiology of suicide both in the civilian population and within the military/Veteran community. Participants will be introduced to the Self-Directed Violence Classification System (SDVCS), a nomenclature supported by the DoD/VA for self-directed violence and suicidal behavior. Major theories of suicide are reviewed as a foundation for understanding this behavior. The course provides training in suicide risk assessment, identifying risk and protective factors for suicidal behavior and utilizing risk assessment to develop appropriate treatment plans. Risk assessment is followed by in-depth training in cognitive-behavioral therapy for suicide prevention. Participants will have the opportunity to practice assessment and intervention strategies throughout the training. Video demonstrations are provided, and participants are expected to do role-plays to practice key assessment and treatment techniques. Attendance both days is required as the course material is cumulative.

This intensive 2-day workshop provides a strong foundation in Acceptance and Commitment Therapy (ACT) theory and practice, and is highly experiential with a focus on helping participants practice and build skills that they can readily integrate into their work with military clients. The workshop is ideal for beginning practitioners new to the model as well as those already practicing ACT at an intermediate level who want to broaden their repertoire. Participants will learn to assess psychological problems using the Psychological Flexibility model, learn and practice skills relevant to each of the 6 core psychological flexibility processes, use the ACT skills to help clients differentiate between ineffective and meaningful actions, and to identify and address key indicators of psychological inflexibility. Additionally, the training will explore the ways in which language and metaphor influence behavior and can be used in therapy to help change behavior. Experiential exercises, small group work and dyad work will be used to encourage participants to practice and enhance new skills. Attendance both days is required as the course material is cumulative.

This intensive 2-day workshop provides training in the fundamentals of Cognitive Behavioral Therapy for Depression (CBT-D) for behavioral health providers working with Service members. The workshop begins with a discussion of depression in the military, followed by a summary of the theory underlying cognitive behavioral therapy. Participants will then learn how to conceptualize depressed patients according to this model, plan treatment, and utilize both cognitive and behavioral strategies. Videotaped examples of CBT-D cases are used to demonstrate therapist skills, and participants are expected to do role-plays to practice intervention strategies. Attendance both days is required as the course material is cumulative.

Tier Sustainment Training

Sustainment courses provide training opportunities for providers to continue to be engaged in SBHP in those states where Tier One, Two and Three workshops have already been offered.  The aim is to advance providers’ understanding of issues faced by military-connected clients and thereby help sustain their practice with service members, veterans and their families as well as their involvement in SBHP.

These sustainment trainings cover specialized topics related to the military population not addressed or only cursorily reviewed in Tier One or Two workshops. They typically provide a clinical overview or background knowledge on a particular subject in a relatively short presentation (2 hours to 1 day).  

Most Tier Sustainment courses require attendance in Tier One and Tier Two trainings and participation on the registry.

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