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Garrett remains confident in Tony Romo
Despite hiccups, Cowboys' coach remains steadfast there's no trust issues with QB
IRVING, Texas -- After a fourth-quarter fumble and interception in the season opener at the New York Jets, Tony Romo had to hear about how he is always awful in the clutch and will never be a Super Bowl quarterback.
After three interceptions and 24-point implosion against the Detroit Lions on Oct. 2, Romo had to hear about how careless he is with the ball and will never be a Super Bowl quarterback.
This week, Romo has to hear about how Jason Garrett has put the training wheels back on the Dallas Cowboys' signal-caller after last week's loss at the New England Patriots ... and how he'll never be a Super Bowl quarterback.
It can all be so dizzying.
The recent claim that Garrett has trust issues with Romo began with the conservative nature of the game plan at New England, especially the final series with 3:36 to play that saw the Cowboys run the ball on three straight plays and punt.
"There is absolutely no issue with my trust level with Tony Romo. Anybody who follows our football team understands that kind of trust and belief I have in him and our football team has in him. ... He's certainly responded to that really, really well over the last four-and-a-half years, and there's no reason for us to think otherwise.
" -- Cowboys coach Jason Garrett
To the trust crowd, the play calling was a manifestation of Romo's five fourth-quarter turnovers in the first four games. To them, the picture that ran through Garrett's mind was Darrelle Revis' interception that set up the Jets' winning field goal or Stephen Tulloch's pick that led to the Lions' winning touchdown.
Garrett played it safe and then watched Tom Brady answer with an 80-yard drive while completing 8-of-9 passes to lead the Patriots to a 20-16 win on a touchdown pass with 22 seconds to play.
Earlier in the game, the Cowboys had three trips inside the red zone against the Patriots and scored one touchdown. They did not throw a pass to the end zone in any drive.
Was Garrett being conservative because he lost faith in Romo?
Was he being conservative because he felt that was the best way to beat a team that had not lost at home with Brady at quarterback since 2006? Was he being conservative because of an undersized offensive line against New England's beefy interior defensive line?
To Garrett, he was not managing Romo.
"I know that there are different circumstances that come up within a game that you have to manage," Garrett said. "That has a lot to do with many different factors - your opponent, where you are playing, how good is our offense, how good is their defense, how much time is on the clock."
Garrett has been Romo's playcaller for 56 games since 2007. Romo has thrown for 15,337 yards with 107 touchdowns and 55 interceptions during that time frame.
Would one poor half against Detroit wipe out years of trust? Would one game? Two? Seven? Ten?
"There is absolutely no issue with my trust level with Tony Romo," Garrett said. "Anybody who follows our football team understands that kind of trust and belief I have in him and our football team has in him.
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"Playing quarterback in the National Football League, there's a tremendous amount of responsibility that comes with that. Tony knows that and prepares for it. We know that as coaches, and we prepare that each week, and we give him a lot of responsibility on Sunday. And that's the way we like it. He's certainly responded to that really, really well over the last four-and-a-half years, and there's no reason for us to think otherwise."
Romo puts the "trust issue" talk more on being a storyline because the Cowboys lost. He said after the game he was fine with the playcalling and reiterated it again Thursday because of how well the defense had been playing.
"You go by what you're watching and playing with," Romo said, "and I didn't envision their offense going down to score a touchdown either at the time."
Romo threw 41 passes against the Patriots, the second most on the season. He had more than 300 yards in the air for the fourth time in five games. New England's defense did not allow him to throw it deep much, and the offensive line could not protect long enough.
Over the years, Garrett has talked about not wanting to take away what makes Romo ... well ... Romo.
If he has lost trust in Romo, then you'll need more than one game as evidence.
"We believe very strongly in him and I believe very strongly in him," Garrett said, "and we're just going to keep going forward."
Todd Archer covers the Cowboys for ESPNDallas.com.
- Covered NFL since 1997, Cowboys since 2003
- Previously covered Bengals and Dolphins
- Lives in Dallas area with his wife and two children
Check out ESPN Dallas' home for complete Dallas Cowboys coverage before and after each week's game, including analysis, commentary, videos, predictions, report cards, leaders, photos and more. Cowboys Center »MORE COWBOYS COVERAGE
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Many of the family pictures were in the Sam Shaw Estate and were donated to the committee by
Charlie and Marion Walton, publishers of the Moundsville Echo.
* - In the plot with Hiram and Elizabeth are the gravestones of Lovie Irene Cockayne and a child named Ida Loughary. There are other Cockayne and Loughary children buried in the plot, but these are the only markers that remain. - Ida Loughary was the daughter of William and Harriet Buxton Loughary. Harriet Buxton was from WV although William was not. Harriet and William met and married in Iowa and were neighbors of Hiram and Elizabeth. I have tried to determine if Harriet had a familial relationship with Hiram or Elizabeth, but I have come up empty. It is an intriguing question though as the Loughary children were buried with the Cockayne children, and the markers are alike suggesting their relationship was more than casual. William and Harriet Loughary eventually moved on to Oregon, and Harriet wrote a book about her experience on the overland trail. The book is a well-known piece of pioneer literature. This is just an interesting aside and goes to show how the family story just keeps morphing. - Jane Weaver, September 21, 2010.
Edmund Grose took photos of Cockayne Graves in Mt. Rose and First Street Cemeteries, Marshall County, W. Va.
Marshall County Cemeteries |

subset: commoncrawl


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27 year old woman | Miami, FL, USA | Seeking men 26-38 within 50 miles
I am a single mom with two small children. I am a law enforcement officer of 6 years.I am just looking for that right person to be with.
I am looking for someone who will be Excepting of my children treat them like there own or treat them like he would want his children to be treated if he had any. And someone who is'nt so judgmental of me I have been trough a lot and so have my children. Understanding to the fact I am a single mom and I work a crazy schedule but just know that if your with you are with me and I will spend just as much time with you. I multi task very well. Someone who is serious about a relationship, finacially responsible and has things figured out. I love a man that is well groomed smells nice and looks nice. I just may go with you I like to be pamperd . I want someone who is funny,sexy,honest,caring and who will bring the best out in me and I will do the same for you.I want you to want me and need me ask me to go with you to the gym or football game ( the best ever) and know that I will . I want to not only be a partner but a friend. But most of all I want a partner who will except me and my children we are a packaged deal.
Fishing/Hunting , Movies/Videos , Museums and art , Nightclubs/Dancing , Travel/Sightseeing , Video games , Watching sports
Basketball, Football, VolleyBall, Weights / Machines
I exercise 5 or more times per week.
I like Dogs, Horses
Key west, The groove,
Central Florida Community College, Ocala, FL
I like to watch t.v when i can find the time. I pay attention to what I eat I am not picky. I listen to all types of music.
Play with my children and execise , fishing , going to the beach,
i read all types of magazines
Her | What she is looking for | |
Appearance | ||
Height: | 5'9" (175cms) | 5'11" (180cms) to 6'11" (210cms) |
Body type: | Athletic and toned | About average, Athletic and toned, Stocky |
Eyes: | Blue | No preference |
Hair: | Dark brown | No preference |
Lifestyle | ||
Smoke: | No Way | Occasionally |
Drink: | Moderately | No preference |
Occupation: | Law enforcement / Security / Military | No preference |
Income: | I'll tell you later | No preference |
Relationship: | Never Married | Never Married, Widow / Widower, Divorced |
Have kids: | Yes, and they live at home (2) | Yes, and they live at home |
Wants kids: | Someday | Someday |
Background | ||
Ethnicity: | White / Caucasian | Latino / Hispanic, White / Caucasian |
Faith: | Christian / Catholic | No preference |
Languages: | English | English |
Education: | Associates degree | No preference |


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Pokemon Black Question and Answers :
TheMugenSpec tator |
I Need A Code For A Level 5 Gigalith & A Level 5 EmboarI borrowed my friend's pokemon black and him and i wanted some pokemon. |
jeremy5521 |
srrySrry i dont know the code for those 2, but i can tell u victini's code. Press select in |
TheMugenSpec tator |
OkThanks, i never had a victini before, so this sounds like fun! :) but i'll still try and |
Unregistered |
??Die code voor victini als ik op select druk krijg ik niks ... |
TheMugenSpec tator |
Dude...I have no idea what you're talking about but all I'm thinking is something something code |
Sorry, to fulfil this action you have to be CheatsGuru User
Your answer:


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£69,500 Fixed PriceFixed Price £69,500
1 bedroom ground floor flat for sale 48A East Main Street, Armadale
Set within a detached, two storey building, this lovely ground floor flat is one of only three flats and the communal hall provides access to them all. The entrance hall has a ... More details › -
£57,500 Offers Over
Offers Over £57,500
1 bedroom flat for sale Ochilview Square, Armadale, West Lothian, EH48
We are delighted to present to the market this newly refurbished flat located within the heart of Armadale, West Lothian. Within walking distance to Armadales local amenities including a good range of shops and local supermarket . (contd...) More details ›Reduced on 15/01/2014 by Aberdein Considine, Bathgate. Call: 01506 335063 Local call rate


text:
Pronunciation: verwirken
Added on: 2010-12-18
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Pronunciation in German [de]
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verwirken = forfeit
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Pronunciation: /ˈmilər/
Definition of Miller, Arthur in English:
( 1915–2005), US playwright. He achieved success with Death of a Salesman (1949). The Crucible (1953) used the Salem witch trials of 1692 as an allegory for McCarthyism. He was married to Marilyn Monroe 1955–1961. Other notable works: All My Sons (1947), After the Fall (1964), and The Ryan Interview (1995).
Definition of Miller, Arthur in:
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What does AFT mean in Software?
This page is about the meanings of the acronym/abbreviation/shorthand AFT in the Computing field in general and in the Software terminology in particular.
Find a translation for AFT in other languages:
Select another language:
What does AFT mean?
- aft(a)(adverb)
- (nautical, aeronautical) situated at or toward the stern or tail
Discuss this AFT abbreviation with the community:
Use the citation below to add this abbreviation to your bibliography:
"AFT." Abbreviations.com. STANDS4 LLC, 2015. Web. 6 Mar. 2015. <http://www.abbreviations.com/term/194383>.
AFT also stands for:
- Abbreviated Functional Test
- About Fucking Time
- Accelerated Failure Time
- Accelerated Failure Timeamp
- Accounting Financing And Tax
... and 32 more »
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China reports another bird flu death, total now 8
BEIJING (Reuters) - Another person died in China from a new strain of bird flu on Tuesday, state media said, raising to eight the number of deaths from the H7N9 virus since it was confirmed in humans for the first time last month.
The 83-year-old victim, from the eastern province of Jiangsu, was admitted to hospital with a fever on March 20 and confirmed as having H7N9 on April 2, Xinhua news agency said.
The H7N9 strain has now infected 28 people, all of them in eastern China, of whom eight have died. The cases include another four people confirmed to be infected with the virus, two in Shanghai and two in Zhejiang province, one of whom was dangerously ill, according to Xinhua.
The World Health Organization (WHO) said on Tuesday that it was looking into two suspected "family clusters" of people in China who may be infected with the H7N9 virus, potentially the first evidence of human-to-human spread.
The new virus is severe in most humans, leading to fears that if it becomes easily transmissible, it could cause a deadly influenza pandemic.
"At this point there is no evidence of sustained human-to- human transmission. There are some suspected but not yet confirmed cases of perhaps very limited transmission between close family members. Those are still being investigated," WHO spokesman Gregory Hartl told a news briefing in Geneva.
"In general, no matter what their exposure, this virus so far has produced overwhelmingly severe cases," he said.
Hartl said that the two suspected "clusters" are in Jiangsu and Shanghai, two of the four affected provinces. In each suspected cluster, a family member has been confirmed as being infected, the so-called "index case", he said.
"They are small family clusters. One is two people, and the other is three people. We just are trying to get good samples in one of the cases of the family cluster in order to be able to test those samples, and we are waiting test results from the other cluster."
The exact source of infection remained unknown, although samples had tested positive in some birds in poultry markets that remain the focus of investigations by China and the U.N.'s Food and Agriculture Organisation (FAO).
"If it is confirmed, it means that it has passed between two people under the same roof. And if it passes between two people under the same roof, it's either human-to-human transmission between two people who have constant and close contact or it could be virus from the same environmental source, so we don't know yet," Hartl said.
The WHO has praised China for mobilising resources nationwide to combat the strain by culling thousands of birds and monitoring hundreds of people close to those infected.
Chinese authorities have said there is no evidence of the H7N9 strain being transmitted between humans.
The bird flu outbreak has caused global concern and some Chinese internet users and newspapers have questioned why it took so long for the government to announce the new cases, especially as two of the victims fell ill in February.
Airline shares have fallen in Europe and in Hong Kong over fears that the virus could be lead to an epidemic like Severe Acute Respiratory Syndrome (SARS), which emerged in China in 2002 and killed about 10 percent of the 8,000 people infected worldwide.
Chinese authorities initially tried to cover up the SARS outbreak.
"The Chinese ministry of health and family planning is working extremely openly and closely with us on this issue (H7N9). We are getting all the information that we need or ask for," Hartl said on Tuesday.
Referring to work being done in WHO laboratories worldwide to identify the best vaccine virus, he said: "In terms of vaccine development, we are still in the phase where a suitable vaccine virus is being developed. It is a matter of weeks not months."
(Reporting by Ben Blanchard in Beijing and Stephanie Nebehay in Geneva; Editing by Mark Heinrich)
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Knife attack wounds 9 at Chinese train station, suspect shot dead
Knife-wielding attackers slashed and stabbed people at a railway station in the southern Chinese city of Guangzhou, wounding at least nine before police shot dead one of the suspected assailants and arrested another. Full Article
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P.G. Chambers School Special Events
Throughout the year, P.G. Chambers School executes several highly successful events ranging from celebrity luncheons, an evening casino party, a summer golf outing, and a family outdoor celebration. We are delighted to share our event calendar below and showcase our commitment to raising awareness, celebrating, and supporting students with disabilities.
20th Annual Menus for the Mind Lecture Luncheon Series
11-13-2014 to 04-30-2015
Celebrating the 20 year anniversary of Menus and the 60 year anniversary of the school, we have an opportunity to have a significant impact. The annual Menus for the Mind Lecture Luncheon series bring people together for friendship, education to learn about our school, and to be inspired by our students. Generously sponsored by The MCJ Amelior Foundation.
2015 P.G. Chambers School Walk.Run.Fun 5K
02-22-2015 to 06-05-2015
P.G. Chambers School Walk.Run.Fun 5K event will be a great day for everyone of every ability level to run, walk, jog, move, and most importantly, have fun. Whether you have been running competitively for years or this is your first 5K, this is the event for you. All proceeds will support innovations in special education and therapies at P.G. Chambers…
Casino Royale 2015
March 7, 2015
P.G. Chambers School CASINO ROYALE
Thank you to our event sponsors: D&B, Tony Esposito Jr. Foundation, Pavel and Tiffany Srnensky, Dr. Unjeria C. Jackson and Larry Thompson, Strazza & Roughneen, PGCS Board of Trustees, The Tarpey Group, Haverford Trust Co., D&L Paving Contractors, Maurice J. Spagnoletti Foundation (in…
Red Carpet Market Rummage Sale
05-29-2015 to 05-30-2015
P.G. Chambers School 1st Rummage Sale "Red Carpet Market"
Fabulous finds... home goods, furniture, specialty items, and more!
Sale Dates:
Friday, May 29th (10:00 am - 2:00 pm)
Saturday, May 30th (9:00 am -1:00 pm)
Accepting items for the sale May 26th & May 27th. More details to come.
Interested in volunteering?…


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Jim Cramer's Best Blogs
Given that stocks should forecast earnings, how did CAT do during that period? How about a decline to $22 from $84, about a 75% retracement.
So, if you believe that a collapse in Europe, which seems more imminent by the day, will crush credit and kill many big construction projects that need Caterpillar tractors and engines, you ain't seen nothing yet. Caterpillar's headed to $29 from its high of $116.
At that price you would have a 6% yielder, certainly accidentally high, but CAT has boosted its dividend. But wait a second. If CAT's doing that badly, the dividend will be sliced and sliced big.
So, now let's think about the owner of CAT shares. It is reasonable to presume that the owner might be fearing exactly what happened in 2008-2009.
Now, let's look at it another way. Rather than calculate the loss in stock price relative to 2008-2009, let's look at the earnings decline analogue. Right now analysts estimate that CAT is going to earn $9.74 a share. You give CAT the same earnings per share crushing you got in 2008-2009 and you have earnings bottoming at $4. What's the appropriate multiple for a company that could earn $4? Right now it's about 9x future estimates. That puts the stock at $36. Still nothing to write home about. So, you can see how these sellers might think they are getting ahead of a gigantic decline. Here's the issue, though. The price-to-earnings ratio would not contract like that, it would most likely expand as people recognize that CAT could be in a trough earnings phase. In those cases, P/Es go up, not down. You could see an expansion say, to roughly 16x to 17x earnings, as I have seen P/Es almost double in these situations. That puts the stock at roughly, say, $70 in earnings based on the $4 figure. Not coincidentally, that's exactly where it traded to in the bottom of 2011, as stock traders figured on exactly that kind of earnings decline. At that price it does yield 4%, where other industrials have held.Select the service that is right for you!
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Brisbane wedding photographer, Deb Boots documents Australian love stories. Specialising in photographing a couple's love story – lovebird portraits, engagement photography and wedding photography.
Deb Boots is committed to providing couples getting married with the best wedding photography experience and strives to create memorable images that are romantic and fashionable. Named by The Knot Australia as one of the 10 Best Wedding Photographers in Brisbane for 2015 and a member of the international photography organisation, Fearless Photographers, a directory of the world's best wedding photographers for couples who truly love photography.
Deb's style is a mix of unscripted documentary and story telling images to capture emotion and the fun candid moments of a wedding day and fine art portraits to capture romantic moments between the couple. The images are feminine and romantic, creative, and throw in a the must have family portraits to keep your folks happy too. Deb will edit your wedding photos to take on an analogue film flavour with either beautiful soft pastel or a bright colour palette depending on the feel of the session or wedding day.
Deb grew up in Sydney and where she spent most of her adult life before making Brisbane her home in 2006. With family back in Sydney, she moves between the two cities frequently. Deb is available for engagement portraits and wedding photography assignments in Queensland and the greater Sydney region including Byron Bay in Northern NSW. Deb loves an adventure involving travel, so wholeheartedly will jump on a plane to photograph your love story whether in Australia or an international destination wedding.
the best wedding day experience
Life doesn't get much better than on a wedding day. It's a chance to get dressed up, have some laughs over a few drinks, catch up with loved ones, and show your moves on the dance floor! … Every wedding needs a funny story to tell, right!
Modern weddings definitely aren't stuffy with the popularity of country style weddings in barns, urban weddings being held in alternative spaces like industrial warehouses and festival style weddings with cushions on persian rugs and hay bales for seating, gathering under tipis and fairy lights strung from trees… It's an opportunity for couples to choose what is relevant to them and how they want to uniquely celebrate their marriage, maybe dropping a few silly traditions like mock cake cuttings, while making the real wedding day a fun experience for all.
It's an exciting time to be a professional wedding photographer with couples putting their unique style and personalities into their wedding with pretty DIY details, a relaxed approach to celebrating their marriage and focusing on bringing their loved ones together for the festivities. Even receptions aren't boring any more with couples organising games to entertain their guests, photo booths, dessert bars {yum} and even caricature artists.
Deb can provide couples with all day wedding photography coverage to capture from the time the bride and groom start getting ready in the morning, through to the crazy dance floor moves well into the reception. Deb finds the best way to describe modern Australian weddings is "a big celebration with a marriage somewhere in the middle".
Deb provides a personalised customer service experience by limiting the number of couples taken on, to focus on developing a relationship with each couple to ensure on their wedding day they feel comfortable in front of the camera. From start to finish, Deb works directly with her couples to learn about their unique love story, photographs each and every engagement session and wedding day, and following the wedding works directly with the couple designing their wedding album through to delivery of images.
wedding photography packages and prices
How much should you budget for professional wedding photography?
Wedding photography collections including digital files start at $2800.
Also Elopement photography packages are available if you are eloping or having a fun popup wedding.
Fine art wedding albums and a range of other beautiful artisan products are available.
Deb would rather let her images speak for her. Please have a browse through the recent Love Stories above or choose from the LOVE STORIES galleries.
One little piece of advice Deb would offer brides and grooms when selecting a wedding photographer, if your wedding photos fall in your top priorities, don't just focus on the price. Make sure you fall in love with the photographer's portfolio – its a good start to ensuring you will be happy with the end result once the wedding day is over. Remember not all photographer's services and products are equal – make sure you are comparing apples against apples. Deb also recommends you share chemistry with your photographer to ensure you are on the same page. Great photos are a result of good communication and trust between the photographer and couple. It's equally important to discuss what you don't like as much as what you do like. Trust your gut instincts. A wedding day is a one time deal, so remember the advice we often hear in hindsight: "you get what you pay for". Past couples have left their reviews here.
If you're looking for an enthusiastic, passionate photographer to capture the day you marry the love of your life, please say hello via the contact form or call Deb direct on 0419 043030. Or use Deb's simple and easy appointment scheduler. Deb will be happy to provide you with detailed pricing and answer any questions.
Thanks for stopping by.


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China Woman Killed By Runaway Shopping Cart A man lost control of his loaded shopping cart on an escalator which plowed... 6/26/2013 4:39:45 PM 30,771 50
Riding a Shopping Cart On The Highway This is probably not the safest thing in the world. 8/7/2012 12:00:00 AM 12,558 28
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Returning Shopping Carts Like a Boss This dude is king at the grocery store. 9/16/2011 12:00:00 AM 37,180 48
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If your situation is urgent, consider calling instead of sending an email.
The Timken Company (Gne-03)
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Learn more about Guadalupe:
Category Keywords: Archaeology Christianity Christians Documentary History Mexico Religion Religious Beliefs
See more in Foreign
"Now and Then We Encounter a Symbol That Seems to Embody the Major Hopes and Aspirations of an Entire Society. Such a Master Symbol is Our Lady of Guadalupe, Mexico's Patroness and Empress of the Americas. --Brother John M. Samaha"
Spanish archaeologists Jose Maria and his sister Mercedes travel to Mexico to investigate newly discovered information on the Virgin of Guadalupe. While Jose Maria discusses the phenomenon with experts, Mercedes joins her friend Diego, a handsome Mexican, on a pilgrimage to the Basilica, participating in celebrations along the way. Through these journeys, each learns the history of Mexico and the meaning behind many of its traditions. The story of the 16th century native Mexican, St. Juan Diego, and his encounters with the Virgin is interwoven with the present-day story of Jose Maria, who reassesses his own neglect of his wife and children, and Mercedes, who comes to terms with her desire for a home and family. As these stories unfold, Our Lady of Guadalupe reveals herself to each of the characters, guiding them toward the happiness and serenity they seek. Guadalupe is an epic film that inspires, informs and entertains...and one that should be seen by everyone! |
Editor's Note
This epic journey follows a brother-sister archeologist team on their adventures in current day Mexico while a parallel story unfolds in the 16th century.
Cast & Crew
Eric del Castillo | |
Gemma Guilemany | |
Ivana Mino | |
Pedro Armendariz, Jr. | |
Carlos Arenal - Cinematographer | |
Juan Manuel Langarica - Original Music By | |
Pablo Jose Barroso, et. al. - Producer | |
Roberto Girault - Writer | |
Santiago Parra - Director | |
Txarly Gomez - Art Director |


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With the news that a remake of "Ben Hur" is in the works, we thought we would come up with a list of movies that should never be remade. We focused on films from 1970 through the end of 2010. So here are our "99 hands off flicks."


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Top 12 Ways To Improve Your Workouts
Here are 12 handy ways to dramatically improve your workouts.
Number 12
Do a proper warmup
Before lifting weights, do a 10-15 minute warmup at a moderate pace on the treadmill, stationary bike or cross-trainer. Another way to warm up is to pump out 10 reps using one third of the maximum weight you'll be lifting in that particular exercise. A proper warmup reduces the overall wear and tear on your body, which means that you'll be able to stick with a program longer and see better results.Number 11
Use gloves and wrist wraps
You'd be amazed at how often people have to stop an exercise before reaching their true maximum number of reps because the pressure from the bar is causing them too much discomfort. Also, many people can't add more weight to "pushing" exercises, such as the bench press, because their wrists can't withstand it. This means that their pectoral muscle development is limited by their wrist strength. Wrist wraps can help get you to the next level.Number 10
Use lifting hooks
I've advocated the use of hooks for over 10 years because I've seen the progress people can make by using them. Hooks can assist you with important exercises, such as dead lifts, barbell shrugs, lat pulldowns, and chinups, where grip fatigue is the usual reason people fail to do more reps and use heavier weights. Don't let your grip strength limit the development of all those major muscle groups. I recommend the hooks made by 1TonHooks.com.Number 9
Know your body fat percentage
Two men of the same height can both weigh 190 pounds, yet one of them can look flabby, while the other can look lean and athletic. The difference lies in their respective percentages of lean tissue vs. fatty tissue.It's important to measure your percentage of body fat with fat calipers or special water tanks designed for this purpose, because a simple scale alone cannot reveal this information. If you gain five pounds of muscle and lose five pounds of fat, your bathroom scale will say your weight hasn't changed, and you may feel as though you are getting nowhere and lose motivation, when this is clearly not the case. So, try having your body fat measured about once a month, and you'll see your true results.
Number 8
Build your forearms
Forearms are the most neglected body part in the world of training. When was the last time you saw a guy in the gym doing barbell wrist curls, reverse wrist curls or grip exercises? But forearms are one of the most noticeable body parts, especially in the warmer months when you wear short-sleeved shirts.And it's not just about having "bowling pin" forearms. Grip strength is the foundation of many other important exercises. Plus, I can think of at least a dozen sports, such as martial arts, rock climbing, golfing, and water-skiing, that all benefit from having more power in your grip and forearms.
Find out how working out less often can help you reach your fitness goals...


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This chapter addresses the characteristics of the TRICARE beneficiary population and the mental health issues that they face. It begins with a brief summary of the demographics of the population and a discussion of their special exposures, risk factors, and protective factors. Information on mental health disorders follows, focusing on the conditions identified in the committee's statement of task and on psychosocial issues for US military families. The chapter concludes with a presentation of data on patients under the care of counselors.
The intent of the chapter is to provide background information on patients that might be seen by mental health professionals who deliver diagnostic and treatment services to TRICARE beneficiaries.
TRICARE submits yearly reports of its operations to Congress that include details on the demographics of its beneficiary population. That information is summarized below.
In 2008, TRICARE served a population of 9.4 million beneficiaries (TRICARE, 2009). The 8.8 million who reside or are stationed in the United States are divided into three regions—North, South, and West—that provide care to roughly equal proportions of that population (HealthNet Federal Services, 2009; Humana Military Healthcare
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OCR for page 47
TRICARE Beneficiaries and Mental
Health Issues in Military Families
his chapter addresses the characteristics of the TRICARE benefi-
ciary population and the mental health issues that they face. It
begins with a brief summary of the demographics of the popula-
tion and a discussion of their special exposures, risk factors, and protec-
tive factors. Information on mental health disorders follows, focusing
on the conditions identified in the committee's statement of task and on
psychosocial issues for US military families. The chapter concludes with
a presentation of data on patients under the care of counselors.
The intent of the chapter is to provide background information on
patients that might be seen by mental health professionals who deliver
diagnostic and treatment services to TRICARE beneficiaries.
DEMOgRAPHICS OF THE TRICARE POPuLATION
TRICARE submits yearly reports of its operations to Congress that
include details on the demographics of its beneficiary population. That
information is summarized below.
In 2008, TRICARE served a population of 9.4 million beneficia-
ries (TRICARE, 2009). The 8.8 million who reside or are stationed in
the United States are divided into three regions—North, South, and
West—that provide care to roughly equal proportions of that popula-
tion (HealthNet Federal Services, 2009; Humana Military Healthcare
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MEnTAL HEALTH CoUnSELInG SERVICES UnDER TRICARE
Services, 2009; TriWest, 2009). The remaining beneficiaries—about
0.6 million—are covered in overseas regions.
Only about 20% of beneficiaries are active-duty members of the
armed forces or activated members of the National Guard or Reserves;
26% are family members (including children) of active-duty or activated
personnel, and 54% are retirees and their families (TRICARE, 2009).
Almost half the beneficiaries are female (48.5%). Figure 2.1 shows the
beneficiary population's age diversity.
Appendix B contains additional demographic and socioeconomic
information about the general military population (including families)
and the Operation Iraqi Freedom (OIF) and Operation Enduring Free-
dom (OEF) warfighters. The data there are intended to provide more
background on the similarities and differences between the TRICARE
population and other managed–health-care populations.
SPECIAL ExPOSuRES AND RISK FACTORS IN THE
TRICARE POPuLATION
Military life presents a number of exposures and risk factors that
may influence the likelihood of experiencing a mental health problem.
Different factors affect different segments of the beneficiary population.
They are discussed below to highlight some of the issues that must be
considered in evaluating the readiness of practitioners to provide diag-
noses to and treat the population.
≤4 ≥65
5-14 15-17 18-24 25-34 35-44 45-64
Age range
FIguRE 2.1 Age distribution of the TRICARE beneficiary population.
NOTE: Percentages shown are percentages for each sex, not the whole beneficiary
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TRICARE BEnEFICIARIES AnD MEnTAL HEALTH ISSUES
Combat Exposure and Traumatic Stressors
Combat exposure is one of the greatest stressors that a person can
experience. In theater, combat veterans report frequent encounters with
roadside improvised explosive devices (IEDs), suicide bombers, snipers,
and an omnipresent insurgence characterized by an inability to differ-
entiate combatants from noncombatants. Patrol operations may entail
attacking, being attacked, killing, and witnessing mutilations and other
carnage. OIF and OEF troops report distress over ethical violations to be
a central problem (MHAT, 2006). Although most soldiers and marines
reported receiving adequate battlefield-ethics training, over one-fourth
reported encountering situations in which they did not know how to
respond (MHAT, 2006). Feelings of helplessness and guilt may fuel the
experience of emotional turmoil and depression. Multiple deployments,
longer deployments, and the constancy of a 24/7 threatening living
environment characterize tours of duty. A state of anxiety interferes with
sleep (a major protective factor in survival) and erodes resilience.
A sample of service members who had been deployed to OIF or
OEF reported exposure to a wide array of traumatic events; 50% noted
that they had a friend who was killed or seriously wounded, and 45%
saw people who were dead or seriously wounded (Tanielian and Jaycox,
2008). In a study conducted by Hoge et al. (2004), 2,586 Army and 815
Marine Corps combat infantry troops were interviewed and completed
postdeployment surveys. During their tours of duty in Iraq, 92% were
attacked or ambushed; 95% received small arms fire; 94% saw dead
bodies or human remains; 89% received artillery, rocket, or mortar
fire; 86% knew someone who was killed or seriously injured; and 56%
reported being responsible for the death of an enemy combatant.
Research indicates that TRICARE may experience a relatively high
volume of OIF and OEF veterans seeking treatment for posttraumatic
stress disorder (PTSD) in the coming years. A team of researchers with
the San Francisco Department of Veterans Affairs (VA) Medical Center
discovered a time lag in reporting of mental health problems among
OIF and OEF veterans—up to 2 years postservice (Seal et al., 2009).
The data point to a need for providers, not only in the VA system but
in TRICARE, to be prepared for waves of OIF and OEF veterans and
their family members seeking mental health and psychosocial services.
Research findings generated by Charles Hoge and his team at the Walter
Reed Army Medical Center Research Center suggest that spouses
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0 MEnTAL HEALTH CoUnSELInG SERVICES UnDER TRICARE
manifest rates of mental health problems similar to those in soldiers;
TRICARE probably also needs to be prepared to respond to mental
health issues presented by family members (Eaton et al., 2008).
Active-duty servicewomen face some unique experiences during
their deployments. They participate in a wide array of duties and have
experienced comparable exposure to combat (IOM, 2008). Female
service members face issues related specifically to physical violence,
sexual harassment, and assault. Over the last 2 decades, there has been
increasing attention to violence and sexist harassment against female
service members. The emphasis on strong masculine traits, the war
culture, the devaluing of feminine traits, and sexual slurs increase the
risk of victimization of women (Donohoe, 2005). In a convenience
sample of 270 female veterans, 33% reported experiencing a sexual
assault during their service in the military (Surís et al., 2004). Women
who reported rape or dual victimization (both rape and other forms
of violence) were more likely also to report chronic health problems,
prescription drug use for emotional problems, failure to complete
college, and annual income less than $25,000. Women who reported
dual traumas also reported the most severe impairment (Sadler et al.,
2000). In a more recent study conducted by Street et al. (2008), the
coinvestigators discovered a high prevalence of sexual harassment and
assault and rates higher among female service members. Such victim-
ization was associated with not only more immediate physical and
mental health effects but long-term health-care needs. Higher rates
of PTSD in women are statistically associated with increasing rates of
military sexual assault. In a meta-analysis of 21 papers, Goldzweig et
al. (2006) reported rates of sexual harassment of 55–99% and rates
of sexual assault of 4.2–7.3% in active-duty women compared with
11–48% in female veterans. The noteworthy disparity in reported
rates can be partially explained by victimized active-duty soldiers' fear
of retaliation, especially if the offenders were superior officers or if
allegations had been countered with censure.
Issues for Military Families and Retirees
Demographic data compiled by the Department of Defense (DOD,
2007a) show that 57.7% of active-duty service members have family
responsibilities; that is, they have spouses, one or more children, or other
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TRICARE BEnEFICIARIES AnD MEnTAL HEALTH ISSUES
dependents. The demographic profile of Reserve and National Guard
families is similar.
As in society at large, the health of a military family is influenced by
the health of the service member, and the health and productivity of the
service member are integrally related to and enhanced by the health and
welfare of the family. Military occupation and duties involve a variety
of stressors. They include a mobile lifestyle, isolation from the civilian
community and extended family, adjustment to the rules and regula-
tions of military life, and frequent family separations due to frequent
deployments. In addition, stressors for female spouses are complicated
by worries about jobs, child rearing, and household duties while male
service members are deployed. Along similar lines, the male partner of
a deployed female service member may encounter difficulties in adjust-
ing to new roles in caretaking and management of the home. For single
mothers, added stress is related to the enlisting of family members,
friends, or hired child-care workers to provide care for their children
during deployment. In general, if the nondeployed civilian partner of a
service member finds military life stressful or unsatisfactory, the service
member also becomes dissatisfied and more likely to leave the military
(Eaton et al., 2008). Eaton and colleagues found, in their study of 940
spouses of service members deployed to Iraq or Afghanistan, that spouses
reported types and magnitudes of mental health problems similar to
those of the service members and that spouses were more likely to seek
mental health services for those problems. Spouses did not seem to be
as concerned about the stigma of mental health care as service members.
Spouses most often sought and received care from their primary-care
physicians; this may be related to the lack of mental health services for
spouses on military installations. A DOD Task Force on Mental Health
report indicated that mental health services for spouses are not adequately
provided through the TRICARE insurance network (DOD, 2007b).
Much attention has been given to the needs of service members and
spouses, but many military families are concerned about having adequate
mental health resources for their children, especially school-age and
adolescent youth. Parental concerns expressed, in addition to facilitating
typical childhood development, include parenting skills to manage fre-
quent deployments, reintegration and reentry programs when the service
member returns to the family, addressing anxiety and fears experienced by
children with regard to the deployed parent, managing multiple moves,
and bereavement support (National Military Family Association, 2006).
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MEnTAL HEALTH CoUnSELInG SERVICES UnDER TRICARE
Retirees make up a substantial portion of the TRICARE beneficiary
population. Many of them are also veterans. Among the veterans seeking
care, depression is one of the most common chronic conditions treated
in VA Medical Centers (Cully et al., 2008). That may be the result of
untreated mental health conditions incurred during military service or
independent of military service. Retirees may be coping with the loss of a
spouse or managing chronic or long-term illness other than mental health
problems. Other studies have shown that veterans have higher rates of
alcohol misuse, which is often associated with depression (IOM, 2008).
Risk Factors
The greatest risk factors for mental health problems during deploy-
ment include higher intensity of exposure to combat stressors; greater
length of deployment; female sex; lower socioeconomic status; lower
rank; absence of peer, social, and family supports; and a history of child-
hood trauma1 (IOM, 2008).
One major risk factor associated with the onset of PTSD is physical
injury. In a study of returning OIF veterans conducted by Hoge et al.
(2007), those who were physically injured had 3 times as great a risk
of developing PTSD, regardless of the severity of the injury, as the non-
injured. The incidence of PTSD increases significantly with the number
of injuries suffered.
Rates of PTSD and major depression were highest among Army sol-
diers, Marines, and those who were no longer on active duty (people in
the Reserves and those discharged or retired from the military). Women,
Hispanics, and enlisted personnel were more likely to report symptoms
of PTSD and major depression; the best predictor of these conditions
was exposure to combat (Tanielian and Jaycox, 2008).
Protective Factors
Many service members arrive home fortified by their resilience
and reintegrate into their communities without adverse mental health
effects. Pride and a sense of accomplishment often prevail. In consid-
In contrast, however, Yehuda and colleagues report that managing the legacies of
childhood traumatic events provides a combat soldier with a sense of protective mastery and
efficacy (Yehuda et al., 2006).
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TRICARE BEnEFICIARIES AnD MEnTAL HEALTH ISSUES
ering resilience, it is important to recognize the important influences
of protective factors that mediate the effects of adverse events. First,
constitutional hardiness often refers to the "healthy-soldier effect" based
on physical fitness and psychological readiness to assume an assertive,
active, coping style. Second, during all phases of the deployment cycle,
service members who have experienced the most comprehensive train-
ing, strong leadership, unit cohesion, and an esprit de corps are buffered
against adverse health effects. In reservists and members of the National
Guard, in particular, navigating assignments to a new unit and estab-
lishing new connections may undermine resilience. Third, a validating
and supportive homecoming is also important. Research points to
the centrality of family and social supports as major protective factors
(Friedman, 2006). The social supports include loved ones; immediate-
family and extended-family members; work colleagues; members of
a church, mosque, or temple; support networks for military partners
and families; and a wide array of health-care and mental health–care
providers. Such positive social supports serve as vital buffers against the
emergence of mental health problems.
"Signature" Mental Health and Psychosocial Issues
Unlike Vietnam-era veterans, for whom PTSD was the prominent
adverse mental health outcome, veterans of recent conflicts report high
rates of various distinct yet interrelated syndromes, including PTSD,
depression with suicidal ideation and behavior, substance misuse and
abuse, and traumatic brain injury (TBI). Milliken and colleagues (2009)
found that when service members who had returned from Iraq were
rescreened about 6 months after an initial assessment, they reported
more adverse mental health concerns and were referred for care at sig-
nificantly higher rates; this suggests that some problems take time to
manifest after deployment.
A 2008 Institute of Medicine (IOM) report focused on the physi-
ological, psychological, and psychosocial effects of deployment-related
stress. Findings revealed "sufficient evidence" of a positive association
between deployment to a war zone and a number of specific health
outcomes in studies in which chance and bias, including confounding,
could be ruled out with reasonable confidence. The outcomes included
psychiatric disorders, including PTSD, other anxiety disorders and
depression; alcohol abuse; accidental death in the years after deployment;
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MEnTAL HEALTH CoUnSELInG SERVICES UnDER TRICARE
suicide in the early years after deployment; and heightened marital and
family conflict, such as intimate-partner violence (IOM, 2008).
Thus, military personnel returning from deployment in Iraq and
Afghanistan—a part of the TRICARE beneficiary population that may
have high demand for services—may present with a complex array of
mental health and substance-use problems and psychosocial difficulties.
Because many syndromes involve symptoms that mirror other mental
and physical health diagnoses, advanced skills in differential clinical
diagnosis are required to work with this client population.
Box 2.1 contains a fictitious vignette2 featuring a returning OIF
veteran viewed in the context of his partnership, family, and social
environment. The diagnosis and course of treatment presented are
intended to highlight the complexity and acuteness of the physical, psy-
chological, and psychosocial issues confronted by clinicians who deliver
services through TRICARE. This case is delineated in greater detail in
Appendix F.
ATTENTION BY THE TRICARE MANAgEMENT ACTIvITY
The committee's statement of task—spelled out in Chapter 1—lists
several health outcomes that were identified for special attention by the
TRICARE Management Activity. The sections below provide back-
ground information on them and briefly summarize their signs and
symptoms, incidence, and recognized treatments. They are intended
to provide context for understanding issues related to the diagnosis of
and treatment for disorders that may be found in the TRICARE benefi-
ciary population. In reviewing this text, it is important to consider that
these conditions can co-occur in a person and make treatment needs
More complete descriptions of the diagnostic criteria and etiol-
ogy of these conditions are contained in the Diagnostic and Statistical
Manual of Mental Disorders (DSM). A table in Chapter 5 (Table 5.3)
lists examples of evidence-based psychosocial interventions for many of
these disorders.
The case was adapted and expanded from a clinical vignette contained in Basham
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TRICARE BEnEFICIARIES AnD MEnTAL HEALTH ISSUES
BOx 2.1
Case vignette—Sergeant Arrozo
Kathryn Basham, PhD, LICSW (Member of the Committee)
Sergeant Carlos Arrozo, a 30-year-old Army OIF veteran of Puerto
Rican descent, returned home after a 12-month tour of duty with
second- and third-degree burns to his arms and face and a broken pelvis
as a result of an IED blast. After his homecoming, he reunited with his
29-year-old wife of 10 years and his three young children, all under the
age of 10 years. Although the reunion brought great relief and pride to
the family, within 6 weeks Sgt. Arrozo started to experience pervasive
anxiety, insomnia, and nightmares. Flashbacks of horrific combat experi-
ences of violent actions were often triggered by smells of burning rubber,
sights of men and women cloaked in heavily layered garments, sounds
of cars backfiring, and visions of a vast expanse of sand blowing on the
beach. Such events stimulated an intense traumatic stress response that
activated arousal that alternated with numbness and detachment; this
was consistent with posttraumatic stress and/or PTSD. Sgt. Arrozo's
affect was totally dysregulated. When his wife, Maria, and children
experienced terror during these episodes, they would retreat to safety as
quickly as possible by hiding in distant rooms throughout the house or
garage. Fighting ensued between the marital partners, with Sgt. Arrozo
yelling at his children when they failed to follow his directives quickly
enough. He sought refuge by drinking eight beers four or five times each
week with his buddies and did not view this level of alcohol intake as a
His home environment was characterized by fear, uncertainty,
and detachment combined with pervasive anxiety in everyone involved.
After receiving a medical discharge based on his physical injuries, PTSD,
and depression, Sgt. Arrozo felt plagued by the impending threat of
divorce, joblessness, and obsessional thoughts related to his "accidental
killing" of a young child during combat. Sadness and unrelenting guilt
overwhelmed him as he battled traumatic grief and depression, and they
reactivated unresolved mourning surrounding his mother's death from
cancer when he was 8 years old. In his words, Sgt. Arrozo felt "tense,
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MEnTAL HEALTH CoUnSELInG SERVICES UnDER TRICARE
BOx 2.1 Continued
distractible, agitated, irritable, enraged and numb" most of the time.
Those symptoms not only are compatible with a diagnosis of PTSD
but suggested syndromes of depression, substance abuse, or TBI. For
example, sleeping poorly and suffering nightmares and headaches and
then grogginess in the morning may be related to PTSD, or they could be
related to depression, substance abuse, or TBI. The differential diagnosis
of Sgt. Arrozo's distress leads to a complex nexus of PTSD, depression,
TBI, substance abuse, and family conflict.
When Sgt. Arrozo agreed to seek mental health assistance, his
wife telephoned to get access to a mental health provider authorized by
TRICARE. After receiving the name of a nonmedical licensed mental
health clinician, Sgt. Arrozo was invited to attend an individual session
to embark on an assessment. After a 1-hour meeting, a preliminary diag-
nosis of PTSD and depression was established on the basis of a patient
self-report. To help Sgt. Arrozo to find rapid relief from his combat-
related psychological injuries, the clinician referred him to a colleague
for prolonged exposure therapy and recommended meeting for 1 hour
each week to address his symptoms of depression. The latter treatment
plan included psychoeducation related to PTSD and depression and the
use of cognitive-behavioral skills to track his depressed mood through
journaling. Sgt. Arrozo could not concentrate on his daily writing assign-
ments and felt ashamed of his incapacity to improve. After 3 weeks of
the combined treatment plan, flooding of emotions from the exposure
therapy overwhelmed him, and he decompensated, reporting many sui-
cidal thoughts. He terminated the therapy.
Major Depressive Disorder
Major depressive episodes are characterized by symptoms (Table 2.1)
that are persistent and interfere with a person's daily living, functioning,
and interactions with others (NIMH, 2009b). The episodes are not the
result of normal bereavement due, for example, to the death of a loved
one. Major depressive disorder (also known as major depression) is diag-
nosed when a person experiences one or more major depressive episodes
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TRICARE BEnEFICIARIES AnD MEnTAL HEALTH ISSUES
Was Sgt. Arrozo a failure, or were there unintended iatrogenic
effects that were based on the absence of a thorough biopsychosocial
assessment and differential diagnosis? Did the clinician fail to attend to
the totality of this veteran's struggles and to explore areas in his social
context (a faith-based community or cultural traditions, for example)?
Were Sgt. Arrozo's competences, resilience at work and school, and mili-
tary leadership skills explored and affirmed? Apparently, his undiagnosed
mild TBI interfered with his benefiting from a cognitive-behavioral
method that requires reasonably sound functioning. Finally, the absence
of attunement to the volatile relationship between the marital partners
and between the parents and children set the stage for increasing decom-
pensation and further destabilization. Was a risk assessment completed
to determine the safety or lack of safety in this home? Are there aspects of
intimate-partner violence that are concealed? Are the children expressing
symptoms of secondary trauma evidenced by heightened insecurity?
The treatment provided to Sgt. Arrozo and his family revealed vari-
ous problems. They included an incomplete biopsychosocial assessment,
inattention to safety risks, an inadequate treatment plan, the absence
of collaboration with other providers, and lack of attunement to socio-
cultural influences. The complexity of the issues facing Sgt. Arrozo and
his family requires strong clinical expertise that would permit a complex
and detailed biopsychosocial assessment, including structured clinical
interviews; the use of standardized clinical measures; and collaboration
with other health professionals followed by a phase-oriented, relational,
culturally responsive, and evidence-based practice plan.
A complete case summary of Sgt. Arrozo and his family is available
in Appendix F.
with no history of manic symptoms. It is often an episodic illness, but
persons with major depression can also experience chronic depressive
symptoms (Judd et al., 1998).
The lifetime prevalence of major depression in the United States is
nearly 17% (Kessler et al., 2005). In a study by Lapierre et al. (2007) of
Iraq and Afghanistan war veterans, 37 and 38%, respectively, reported
symptoms of depression. Hoge et al. (2004) found that 7.1–7.9%
of troops returning from Iraq met criteria for depression and were
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0 MEnTAL HEALTH CoUnSELInG SERVICES UnDER TRICARE
Employment, Finances, and Homelessness
A previous IOM (2008) research effort concluded that there was
inadequate evidence to determine whether an association exists between
deployment and homelessness and adverse employment outcomes. That
conclusion may have been driven by the dearth of methodologically rig-
orous studies available at the time. More recent anecdotal reports of the
transitions of OEF and OIF veterans suggest increasing difficulty with
financial stability, employment, and housing (MHAT, 2006). Because
social supports remain the major protective factors in mediating adverse
mental health outcomes while also promoting healing, attention should
be focused on the social contexts of service members and their families
during any phase of clinical intervention.
DATA ON PATIENTS uNDER THE CARE OF COuNSELORS
In the statement of task, TRICARE requested that the committee
review and synthesize available data on the proportions of all patients
who had a series of specified disorders and were under the care of licensed
mental health counselors. The committee requested those data from the
TRICARE Management Activity; the information listed in Table 2.16
is derived from its response to the request. It is important to note sev-
eral limitations of the information. The table provides estimates of the
numbers of cases treated in the TRICARE population, but for several
reasons it probably does not reflect the true prevalences of the disorders.
The gold standard for determining diagnoses is the structured clinical
interview or chart review. The information in Table 2.16 was obtained
from administrative data based on usual care practice, which often does
not include structured diagnostic interviews by clinicians and therefore
can be less accurate. Research shows that accuracy of claims data can
vary by diagnosis. For example, administrative data have demonstrated
relatively high accuracy for bipolar disorder (Unutzer et al., 1998, 2000)
and schizophrenia (Lurie et al., 1992) but lower accuracy for depression
(Spettel et al., 2003). In addition, this information reflects only the
primary (or first) diagnosis entered in an insurance claim; if a patient
presented for treatment and the mental and substance-use (M/SU)
condition was not listed first (e.g., depression and SUD or hypertension
and generalized anxiety), the condition would not be included in the
table. Therefore, the table likely underrepresents the prevalence of these
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TRICARE BEnEFICIARIES AnD MEnTAL HEALTH ISSUES
TABLE 2.16 Patients in the Care of Mental Health Counselors in the
Military Health System
TRICARE Beneficiaries with Diagnosis
During FY 2008
Seen by Mental
Seen by Health Counselor
Mental Health (% of enrollees
Total Counselora with M/SU
Diagnosis (n) (n) diagnosis)
Major depressive disorder 204,078 10,480 5.1
Schizophrenia 4,335 182 4.2
Posttraumatic stress disorder 36,526 2,484 6.8
Bipolar disorder 40,970 2,573 6.3
Mental health disorder related to 9,681 144 1.5
a general medical condition
Somatoform disorder 529 9 1.7
Delirium 586 1 0.2
Dementia 1,042 8 0.8
Amnestic disorder 188 3 1.6
Substance-use disorder 66,067 974 1.1
Traumatic brain injury 38,159 11 0.03
Data may include providers who have different levels of licensure, certification,
education, and experience.
disorders in the treatment-seeking TRICARE population. Finally, the
table does not capture the complexity of co-occurring medical, M/SU,
and psychosocial problems that are often seen in this population.
Information provided to the committee indicates there were
9,197,927 TRICARE beneficiaries in FY 2008 (TMA, 2009). However,
the data in Table 2.16 excludes TRICARE for Life participants because
TRICARE is not their primary payer. Enrollees in the six designated
provider plans are also excluded. This reduces the overall number of ben-
eficiaries for whom outcomes are reported in the table to 7,217,566.
The committee attempted to identify and obtain other available
data on the proportions of patients who had various diagnoses and were
under the care of licensed mental health counselors. However, such data
are not present in the scientific literature and are not routinely compiled
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MEnTAL HEALTH CoUnSELInG SERVICES UnDER TRICARE
by care providers.6 Even if they were, the weaknesses in the TRICARE
data identified above suggest that they would be of little utility in
evaluating the ability of counselors to provide services to the TRICARE
beneficiary population as independent practitioners.
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text:
Short Circuit the Semis
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text:
Billy Crystal (in his first live-action film since 2002's Analyze That) and Bette Midler star as a couple asked to watch their daughter's three children for a week — but the worrywart mom (Marisa Tomei) just won't take off. "She has a lot of trouble leaving because she doesn't trust us," says Crystal, who conceived the story (Lisa Addario and Joe Syracuse wrote the script) after a hectic five days babysitting his grandkids. It seems his old-school child-rearing drew constant critiques. " 'Don't look at them this way. Feed them this. Don't feed them that,' " the actor recalls being told. "It's just different than it was 30 years ago." Family dynamics, though, never change.
Parental Guidance
OLD SCHOOL PARENTING Billy Crystal finds himself in a mess while babysitting his grandkids in Parental Guidance (Phil Caruso)
Posted October 19 2012 — 12:00 AM EDT
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