Delivering Psychological Services to Military Members

Since 2001, less than half of one percent of the American public have volunteered to serve in the United States Armed Forces. With high-tempo repeated deployments and unconventional warfare, the Post 9/11 military has been exposed to unique trauma and stressors during an unprecedented two-decade long conflict. In voluntarily taking on this role, members are immersed in the total institution of military culture and required to make countless personal sacrifices, often experiencing trauma or other stressors that most in a civilian population will never face. Prevalence rates of mental health problems in active duty as well as veteran populations suggest that approximately 15-30% have acquired mental health conditions (including PTSD, TBI, depression). Substance use and suicidality are often comorbid and may complicate the clinical profile considerably. Current treatment approaches include those well validated and common in general clinical populations (i.e., CBT, PE, CPT) although many have been modified for use with veterans. Nonetheless, despite billions of dollars in public support, many military members continue to not receive the mental health services they need. Challenges include system and access barriers, a lack of military cultural competency in providers, as well as societal and institutional stigma leading to veteran reluctance to seek mental health treatment. Best practice recommendations are offered to clinicians who seek to better serve clients who are military members (both active duty and veterans)

How Do Patients with Mental Health Diagnoses Use Online Patient Portals? An Observational Analysis from the Veterans Health Administration

Online patient portals may be effective for engaging patients with mental health conditions in their own health care. This retrospective database analysis reports patient portal use among Veterans with mental health diagnoses. Unadjusted and adjusted odds of portal feature use was calculated using logistic regressions. Having experienced military sexual trauma or having an anxiety disorder, post-traumatic stress disorder, or depression were associated with increased odds of portal use; bipolar, substance use, psychotic and adjustment disorders were associated with decreased odds. Future research should examine factors that influence portal use to understand diagnosis-level differences and improve engagement with such tools

How Military Service Influences the Transition to Adulthood Among Post-911 Young Adult Female Veterans with Service Related Disabilities

Over 280,000 female servicemembers have served in the Iraq and Afghanistan conflicts, and a significant number of them are experiencing hidden and/or visible wounds of war. Recent reports indicate that female servicemembers have service-connected disability ratings higher than that of their male counterparts. Female servicemembers often find themselves negotiating roles that are at once ‘inside’ as well as ‘outside’ of a hierarchical, proscribed military institution whose rituals, norms, and hierarchies privilege males in positions of power. Their transition to adulthood as young veterans with service-related disabilities, within a present-day civilian society that can be more ambiguous and discontinuous than in the past decades can often be difficult; particularly during the early years after separation. Fifteen young, female veterans with service-related disabilities, who have left active duty within three years were interviewed for this study, of which 12 met the study criteria. The narratives of their pre-during-and post-military lives contribute to a grounded theory of female veteran transition to adulthood that validates the integration of the Life Course Perspective, Disability Theory, Role/Exit Theory, and theories of Identity and Belonging in ways heretofore unexplored. This study also validates the premise that the female veteran experience is sufficiently different from the male veteran experience in substantive ways. Finally, this research suggests that transition planning and post-military service supports should be customized specifically to address the needs of female servicemembers with disabilities, oriented towards preparing them to resume their civilian lives after exiting the military institution

Domains of Intellectual Functioning and Posttraumatic Stress Disorder Symptoms Among Traumatized Youth

This investigation examined the association between Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) posttraumatic stress disorder (PTSD; American Psychological Association, 1994) symptoms as measured by the Children’s PTSD Inventory (CPTSDI; Saigh, 2003a) and the Wechsler Intelligence Scale for Children, 3rd Edition (WISC-III; Wechsler, 1991) scores of 78 traumatized children (mean age = 13.42 years, SD = 2.68 years). Child diagnostic interviews determined that the participants did not have major comorbid disorders and were not taking medications that could influence cognitive functioning. Significant inverse correlations were observed between the different symptom CPTSDI clusters and the WISC-III Verbal indices. Moreover, with the exception of the WISC-III Block Design subtest, nonsignificant correlations were observed between the WISC-III Performance measures and the CPTSDI symptom clusters. Theoretical and clinical implications are considered

Veterans in higher education : an ethnographic study of veterans' higher education experience

This ethnographic study examined the higher education experience of six Global War on Terrorism combat Veterans, using two research questions: 1) How does a Global War on Terrorism (GWOT) Veteran student perceive his/her educational experiences at a four year university? 2) What are the educational, emotional, and psychological needs of the (GWOT) combat Veteran while pursuing higher education? The findings indicated that the Veterans interviewed experienced three major themes through their higher education process: 1) Transitions, all Veterans interviewed experienced a series of rapid transitions which forced them to shift their focus and daily routines from extremes of rigidity during military service to the non-directive life as student. 2) Alienation, all Veterans interviewed expressed a sense of isolation and alienation as they transitioned from military life to the life of a student. 3) Disability, all Veterans interviewed discussed stereotypes of disability to include PTSD, not necessarily their own, but of other Veterans they knew.Thesis (D. Ed.)Department of Educational Studie

Therapeutic Horseback Riding With Military Veterans: Perspectives of Riders, Instructors, and Volunteers

Statistics reveal that over 353,000 military members have been diagnosed with PTSD and/or TBI resulting from war-related activities. With the rising number of war stress injuries, there have not been enough psychotherapeutic services to meet the current demand for the care of returning veterans from Iraq and Afghanistan. Although some intervention strategies have been deemed successful, the current standards of care (e.g., exposure therapy, cognitive therapy) are limited by training inadequacies, accessibility, and outcomes (e.g., retention, early drop out, resistance, non-responsiveness). Furthermore, it is unclear whether these treatments are efficacious in addressing the unique symptom presentations of this population. The unavailability of services and their tendency to inadequately address the needs of veterans has opened the door to the development of alternative and complementary approaches. One such new approach was the therapeutic use of animals, specifically horses, as a treatment option for returning military members. Preliminary studies of therapeutic horse activities, while methodologically flawed, suggest clinical benefits for veterans. The purpose of this qualitative case study was to describe the activity and unique experience of THR as an intervention used with military veterans struggling with war stress injuries. The perspectives of nine veterans, equine instructors, and volunteers were collected through in-depth interviews, observations, and audio/visual material. Through phenomenological analysis, a comprehensive understanding of THR, what it involves, what happens to the veterans as they relate to the horse and interact with it, and how this intervention impacts the veterans’ recovery process was garnered. Four primary themes were identified: community support, relationship, transferable skills, and motivation. The data from this study reflected clinically significant results, suggesting THR was efficacious for veterans and their recovery process, especially for those who did not respond well to traditional treatments. It is recommended that future research efforts be conducted to support the development of standardized curriculum, therapeutic practice, and assessment measures in order to refine THR and allow insurance panels, stakeholders, and providers to fund, resource, integrate, and recommend THR; increasing its accessibility for members of the military with war stress injuries. The electronic version of this dissertation is at OhioLink ETD Center, www.ohiolink.edu/et

The experiences of military veterans prior to and during incarceration in Scottish prisons: An analysis of mental and social wellbeing

Background: Concern has been voiced over the needs of ex-military personnel following their discharge from military service and subsequent transition to community living. This concern has extended to include veterans, particularly those who have mental health, drug or alcohol problems, who come into contact with criminal justice services and are imprisoned. Research examining the experiences of military veterans prior to and during their incarceration in Scottish prisons was carried out. This study sought to examine whether veteran prisoners form a unique prison sub-group with different health, social and criminogenic needs when compared to non-veteran prisoners, and how veteran prisoners differ from non-prisoner veterans. Additionally an exploration of veterans’ experiences of prison, and what they believed caused or contributed to their imprisonment, was conducted. This sought to identify whether veterans in prison had unique vulnerability/ risk factors and whether they had a common or idiographic pathway that led to their incarceration. Methods and design: This study comprised of three separate but linked parts. It adopted a mixed-method approach combining quantitative analysis of survey data (Part 1) with qualitative interpretative phenomenological analysis of focus group (Part 2) and interview data (Part 3). Survey data examined, through the use of standardised questionnaires, a range of themes; including, mental health and wellbeing, substance and alcohol use, childhood experiences, offending histories, and military experience. In Part 1 participants were recruited into three separate groups. Group 1 consisted of veterans in prison, while Group 2 consisted of prisoners who had no military experience and Group 3 comprised of Scottish Prison Service staff who had previous military experience. In Parts 2 and 3 participants were recruited from the veteran prisoner population, with participants in Part 3 having declared current mental health and/or substance use problems. Findings: Analysis of survey data identified many differences in health and wellbeing, and some differences in length of, and discharge from, military service, when comparing veteran prisoners with a non-imprisoned veteran group. Both groups, however, appeared to have similar levels of combat exposure. Comparison between veteran prisoners and non-veteran prisoners identified more similarities than differences across most of the measures. Many of the mental health drug or alcohol problems experienced by veteran prisoners were also experienced by non-veteran prisoners. Post-traumatic stress disorder did appear to be a specific problem for veteran prisoners but this did not appear to be attributable to their military experience. Additionally, veterans being raised by a mother-figure other than their birth-mother appeared to be a unique risk factor for veteran imprisonment but this finding should be viewed with caution as the number of participants raised by a mother-figure other than their birth mother was small. Findings were mixed regarding how veterans described their experience of imprisonment: some found it unchallenging yet unstimulating while others described feelings of ongoing punishment and a sense of being embattled. Reciprocal processes of dehumanising both prisoners and staff were also evident, as were contradictory experiences on the availability and quality of care provision in prison. Veteran prisoners appeared to identify with their prisoner identity rather than their veteran identity, believing that they were the same as other prisoners and had the same needs. This was evident when veterans described their experiences of forming and maintaining interpersonal relationships, albeit within-prison relationships appeared superficial in nature. While some veterans appeared reluctant to ask for assistance in prison, concerns about the inadequacies or availability of support services appear valid. Gaps in provision of care, particularly mental health care, existed at the time of the study. Lastly, some participants appeared to feel unprepared for their release from prison back to the community. This may stem from their previous experience of transitioning from the military to civilian living but it is more likely the recognition that many prisoners leave prison only to return back to custody. For some veteran prisoners this is because they believe community services are unavailable or unable to help as they struggle to cope with community living. As such, some may consider prison living the easier option. Conclusions and implications: Many of the findings suggested that veteran and non-veteran prisoners had, or were believed to have had, by veteran prisoners, similar ‘needs’ and reasons for offending. Veteran prisoners should, therefore, not be regarded as a specific sub-group of the prison population, and addressing prisoner needs should not be prioritised according to their pre-prison occupational status. Lastly, where gaps in service provision exist, the SPS and its partner agencies, including the NHS, should continue to address these. This should include giving consideration to the adoption of a trauma-informed approach within the prison environment

Vicarious Trauma in Spouses/Intimate Partners of Law Enforcement Officers and the Relationship between Trauma and Relationship Functioning

The phenomenological study is to understand better the impact of vicarious trauma (VT) on the spouses/intimate partners of law enforcement officers (LEO)s in Alabama and allow researchers to attain a meaningful understanding of real-life events and the complexity of the social phenomenon. The goal is to highlight the inequity in the treatment of spouses/intimate partners of LEOs and develop protocols for mandatory reporting trauma. The theories guiding this study are constructivist self-development theory (CSDT), secondary trauma theory (STT), and family stress theory (FST). The participants were former/current spouses/intimate partners of LEOs who experienced trauma while in the line of duty. The primary data source is interviews of participants who lived the phenomenon. The data were analyzed using the modified Van Kaam method, which guides the formation of themes related to mandatory reporting and treatment services to LEOs and their spouses/intimate partners

Examining Help-Seeking Intentions Among Female Veterans With Military Sexual Trauma

An estimated 38.4% of military women have experienced military sexual trauma (MST) at some point in their careers. Because MST experiences can be confounding, navigating beliefs toward treatment resources and seeking help can be challenging. The problem under study was that no literature examined multiple constructs of the health belief model (HBM) together as a foundational tool to identify perceptions of help-seeking intentions among female veterans with MST experiences. Guided by the HBM, the purpose of this study was to examine the relationship between health motives, perceived severity of emotional or nervous problems, perceived benefits of getting help for emotional and nervous problems, perceived barriers to getting help for emotional and nervous problems, and help-seeking intentions among female veterans who have experienced MST. Using survey data collected from 120 participants, a multiple linear regression showed that the HBM constructs account for 41% of the variation in help-seeking intentions. Results also indicated that health motivation and perceived benefits significantly correlate with increased help-seeking intentions, which informs health professionals about which health constructs should be included in outreach efforts. Additional insights include that perceived barriers did not significantly predict help-seeking intentions. Therefore, it is suggested that health professionals focus less on barriers to seeking help and provide information to female veterans about the benefits of seeking help, which may increase health treatment utilization. Female veterans with MST experiences may benefit from the results of this study by further understanding their help-seeking intentions and having the findings used to inform best practices in health education