Family-Centered Care to Promote Successful Community Reintegration After War: It Takes a Nation

The papers in this section focus on public health responses and implementation considerations in addressing the challenges military families confront when parents go to war. While many military families show resilience, the challenges resulting from a decade of war with multiple deployments are detailed, as are innovative military and civilian programs designed to help service members and their families reintegrate successfully into the community. As more and more service members leave active duty, the burden of meeting military families’ psychological needs will transition from the Department of Defense (DoD) and into the Veterans Administration (VA) and civilian arenas. While many strategies to support successful readjustment are offered, in this time of dwindling mental health resources and competing needs, it is unclear what priority the broader society places on meeting the needs of returning service members and their families. A growing emphasis on family-centered care in the Veterans Administration may help meet this gap.     

Evaluation of a Sesame Street Multimedia Intervention for Families Transitioning Out of the Military

Although transitioning out of the military can be stressful for everyone in the family, the children’s experience has received minimal attention in both clinical lore and research. This study is an evaluation of Sesame Workshop’s multimedia program for families who are transitioning out of the military into civilian life; the program is aimed at improving parents’ confidence and skills in assisting their children with the transition, and at improving young children’s transition-related adjustment. Via a randomized controlled trial design, we evaluated the utilization, acceptability, and impact of this free, online program with 200 military caregivers. Caregivers who received the Sesame program reported increased self-efficacy in helping their child cope with the transition (e.g., making new friends, talking with their child about leaving the military) compared to those assigned to the control condition. Further, caregivers in the intervention condition reported fewer overall child emotional and behavioral problems and a significant reduction in levels of hyperactivity/inattention in their children. Further, the primarily online modality of the Sesame program yielded high caregiver satisfaction and utilization; this approach may warrant further research as an effective means of reaching busy military families.     

The Transition Experiences of British Military Veterans

The aim of the current research was to investigate the transition experiences of British military veterans upon exiting the military and rejoining civilian society, asking the specific research question: What effect does the transition from military to civilian life have on the individual's identity? Interpretative Phenomenological Analysis was employed and seven semistructured interviews were carried out with ex‐military personnel. Analysis of the data revealed three superordinate themes: (1) Several Selves: Identity; (2) Soldier and Society: Separation, and (3) Transition Time: Personal Perspective. Current findings suggest that transition from the military back to civilian life is often problematic, with identity complications, feelings of loss, and disconnection both from the military and from society in general. Individuals with a more salient military identity had more difficult transition experiences. Findings are discussed with reference to theories of identity formation, maintenance, and salience and recommendations for future research are made.     

Family Systems and Ecological Perspectives on the Impact of Deployment on Military Families

The scope of sustained military operations in Iraq and Afghanistan has placed great demands on the Armed Forces of the United States, and accordingly, military families have been faced with deployments in more rapid succession than ever before. When military parents fulfill occupational duties during wartime, military children and families face multiple challenges, including extended separations, disruptions in family routines, and potentially compromised parenting related to traumatic exposure and subsequent mental health problems. Such challenges can begin to exert a significant toll on the well-being of both individuals and relationships (e.g., marital, parent–child) within military families. In order to respond more effectively to the needs of military families, it is essential that mental health clinicians and researchers have a better understanding of the challenges faced by military families throughout the entire deployment experience and the ways in which these challenges may have a cumulative impact over multiple deployments. Moreover, the mental health field must become better prepared to support service members and families across a rapidly evolving landscape of military operations around the world, including those who are making the transition from active duty to Veteran status and navigating a return to civilian life and those families in which parents will continue to actively serve and deploy in combat zones. In this article, we utilize family systems and ecological perspectives to advance our understanding of how military families negotiate repeated deployment experiences and how such experiences impact the well-being and adjustment of families at the individual, dyadic, and whole family level.     

Anticipatory Anxiety in the Treatment of Combat Veterans with Posttraumatic Stress Disorder

Combat veterans have experienced a transformational process during war zone deployment, including emotional, cognitive, and sensory processing changes. They also return entrenched in military expectations of conduct and behavior. These changes result in anticipatory anxiety that makes it difficult to reintegrate into the civilian world, and are related to symptoms of posttraumatic stress disorder (PTSD). The PTSD Recovery Program at the McGuire Veterans Affairs Medical Center (VAMC) is a manualized treatment that focuses on the personal and daily experiences of combat veterans rather than exposure to traumatic memories. Program evaluation data demonstrated significant reduction in PTSD symptoms and improvements in general self-efficacy and adaptive behaviors. Results support the PTSD Recovery Program as an effective treatment that enhances readjustment to civilian life.     

Income and support during transition from a military to civilian career

This study examined experienced military members (N= 136, average age 51 years) transitioning to a 2nd occupation, specifically K–12 teaching, and revealed correlations between the length of their transition to both perceived support and income. Perceived support from family and friends had a small, positive correlation with transition time (r= .31), while income had a small, negative correlation with transition time (r=?.28). The Career Transitions Inventory ( Heppner, 1991 ), the Satisfaction with Life Scale ( Diener, Emmons, Larsen, & Griffin, 1985 ), demographic questions, and open‐ended questions were used. Implications for career counselors working with transitioning military members are discussed, along with future implications for research and practice.     

Suicidal or self-harming ideation in military personnel transitioning to civilian life

Suicides have markedly increased among military personnel in recent years. We used path analysis to examine factors associated with suicidal/self-harming ideation among male Navy and Marine Corps personnel transitioning to civilian life. Roughly 7% of men (Sailors = 5.3%, Marines = 9.0%) reported ideation during the previous 30 days. Results suggest that combat exposure, substance abuse, and resilience are associated with suicidal ideation/self-harming thoughts through the mediation of posttraumatic stress disorder symptoms and/or depression symptoms. Substance abuse plays a moderating role. Resilience had a direct effect only among the Marines. Implications for improving the transition to civilian life are discussed.     

Lessons Learned from Two Peer-Led Mutual Support Groups

Abstract

This case report and analysis describe the formation of two peer-led mutual support groups conducted within the context of a Veterans Administration Medical Center. Based on our assessment of the success of one of these groups and the failure of the other, we offer several recommendations and suggestions to help promote this modality. More specifically, we hypothesize that such groups are more likely to be successful (1) if participants are transferred en masse from another group, (2) that, at least initially, housing the group in the same context as formal clinician-led groups or overlapping clinician-led and peer-led groups may help smooth the transition from authority-led treatment to a mutual peer support format, and finally, (3) that prior experiences in interpersonal process groups may promote the skills and cohesion to promote successful transition to mutual support.     

Family-Centered Care for Military and Veteran Families Affected by Combat Injury

The US military community includes a population of mostly young families that reside in every state and the District of Columbia. Many reside on or near military installations, while other National Guard, Reserve, and Veteran families live in civilian communities and receive care from clinicians with limited experience in the treatment of military families. Though all military families may have vulnerabilities based upon their exposure to deployment-related experiences, those affected by combat injury have unique additional risks that must be understood and effectively managed by military, Veterans Affairs, and civilian practitioners. Combat injury can weaken interpersonal relationships, disrupt day-to-day schedules and activities, undermine the parental and interpersonal functions that support children’s health and well-being, and disconnect families from military resources. Treatment of combat-injured service members must therefore include a family-centered strategy that lessens risk by promoting positive family adaptation to ongoing stressors. This article reviews the nature and epidemiology of combat injury, the known impact of injury and illness on military and civilian families, and effective strategies for maintaining family health while dealing with illness and injury.     

The Significance of Military Contexts and Culture for Understanding Family Well-Being: Parent Life Satisfaction and Adolescent Outcomes

Formal systems and informal networks are presumed to be significant contexts that affect military families. Their effects on both parents and adolescents in active duty military families are examined (N = 236 families). Social organization and contextual model of family stress theories are employed as frameworks for the analyses of how dimensions of military culture influence parents’ life satisfaction, as well as key developmental outcomes of their adolescents (for example, mental health). Key findings from our analyses included a positive relationship between parents support from military leaders and fellow soldiers and parental well-being findings revealed the importance of civilian parents’ satisfaction with military life on adolescent outcomes for families that have experienced stressful military contexts. These findings provide support for the significance of multiple contexts for understanding resilience among military members and their families.     

Understanding the impact of attachment insecurity on PTSD symptoms among male Veterans and military personnel

ABSTRACT

Attachment insecurity (i.e., attachment anxiety and attachment avoidance) has been found to contribute to PTSD symptom severity in Veterans. However, little is known of the unique contribution of attachment insecurity on individual PTSD symptom clusters. In a community sample of 106 combat-deployed Veterans, active duty service members, and reservists, this study examined: (1) the relationships between childhood family experience, combat experience, attachment insecurity, and PTSD symptom clusters, and (2) the influence of attachment insecurity on PTSD symptom clusters. Results revealed significant correlations between attachment anxiety and all PTSD symptom clusters (rs = .22 –.43) and attachment avoidance and PTSD symptom clusters, except the avoidance cluster (rs = .21 ?.36). Four multiple regression analyses were employed to address the second study aim. Childhood family experiences predicted negative alterations in cognitions and mood (β = –.30) and alterations in arousal and reactivity (β = –.20). Further, combat experience significantly predicted each symptom cluster of PTSD (βs = .03 –.44). In the second step, attachment anxiety and attachment avoidance were added to each model. Attachment anxiety and attachment avoidance predicted negative alterations in cognitions and mood (βs = .22 and .35) and alterations in arousal and reactivity (βs = .27 and .17). Inconsistent with previous research, attachment insecurity did not predict symptoms of avoidance. These results highlight the impact of attachment among a diverse sample of trauma exposed individuals and may provide insights for clinical implications and therapeutic approaches when working with Veterans and military personnel high in attachment insecurity.     

Using Relational-Cultural Theory to Conceptualize International Student Transitions

ABSTRACT

In this article, Relational-Cultural Theory (RCT) is applied to international student transition experiences. The purpose of this phenomenological study was to describe the lived experiences of international students transitioning to college life in the rural United States using the principles of RCT. Five women and four men enrolled at a mid-sized university agreed to participate in the study. In the data analysis phase, four components of RCT emerged as themes. The authors provide implications for campus-based mental health professionals (e.g., college counselors).     

Aborted Transition Between Two Dichotomous Cultures as Seen Through Dialogical Self Theory

The purpose of this article is to further advance the understanding of self-identity work amid transition from military to civilian life, with emphasis on the complexities between and within the military and civilian cultural I-positions of a dialogical self. An analysis of a longitudinal case study of an aborted transition leads to the hypothesis that a culturally dominant military I-position that sustains a cultural dichotomy may hinder dialogical advancement toward reintegration into civilian life. The insights from this article can be used to better understand self-identity issues amid transition and may also have relevance for nonmilitary persons who are exposed to cultural transitions.     

On the home front: stress for recently deployed Army couples

Military couples who have experienced deployment and reintegration in current U.S. military operations frequently experience stress regarding the dangers and effects of such experiences. The current study evaluated a sample of 300 couples with an active duty Army husband and civilian spouse who experienced a deployment within the year before the survey (conducted in 2007). Wives generally reported greater levels of emotional stress compared with husbands. Overall, higher levels of stress were found for couples who reported lower income and greater economic strain, perceive the need for more support and are unsure about how to get support, have more marital conflict, and are generally less satisfied with the Army and the current mission. Husband combat exposure was also associated with more stress for husbands and wives. Additionally, for wives, stress was related to greater child behavior problems and a sense of less Army concern for families. The results suggest areas of intervention with military couples to help them cope with the challenges of military life and deployment.     

Military Veterans' Experiences with Suicidal Ideation: Implications for Intervention and Prevention

We sought to understand Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) veterans' experiences with suicidal ideation. Semi‐structured interviews with 34 OEF/OIF veterans addressed circumstances leading up to disclosure of suicidal ideation during brief clinical assessments. We used an iterative, inductive and deductive thematic analysis approach. Results revealed three pervasive, persistent domains that reinforce the uniqueness of veteran suicidal thoughts: military culture, difficult deployment experiences, and postdeployment adjustment challenges. Within postdeployment, we identified four themes that serve as intervention targets: adjusting to civilian culture, changes to sense of self, feeling overwhelmed by stressors, and lacking life purpose or meaning.     

Renew: An Integrative Psychotherapy Program for Women Veterans with Sexual Trauma

Renew is an integrative treatment consisting of 210 hours of programming for women Veterans to address sexual trauma, including military sexual trauma. The curriculum consists of a holistic approach to healing and is based on the principles of Holographic Reprocessing. Of the 119 women Veterans enrolled in an uncontrolled outcome study (e.g., completed pre- and post-treatment questionnaires), 80 of the participants reported multiple traumas across their lifespan and 95 experienced military sexual trauma. Of the 112 who started treatment, 97 graduated (13 % dropout rate). Graduates showed a significant reduction in posttraumatic stress disorder (PTSD), psychiatric symptoms, and posttraumatic negative cognitions (up to 60 % had reliable clinical change at the 95 % confidence interval), and significant increases in self-esteem, optimism, and satisfaction with life with large to moderate effect sizes. These initial data are promising and further research is warranted to test if Renew is effective to treat women Veterans with complex issues including sexual trauma, PTSD, medical problems, chronic pain, and histories of homelessness and substance abuse.     

Experiences with stigmatization among transgender individuals after transition: A qualitative study in the Netherlands

Abstract

Background: Transgender individuals belong to one of the most stigmatized groups in society. Although the social stigma of transgender individuals has been examined many times, post transition stigma experiences among transgender individuals have received limited research attention. The aim of this study was to examine experiences with stigmatization among Dutch transgender individuals after their transition.

Method: Ten trans women (age: M?=?58.50, SD?=?9.49) and 10 trans men (age: M?=?42.90, SD?=?13.62) participated in face-to-face semistructured interviews. Grounded theory was used to conceptualize and analyze the data. We examined the positive and negative reactions that transgender individuals experienced in the period after their transition. Furthermore, we explored differences between experiences of trans men and trans women. Finally, we examined differences between cisgender men and women regarding their reactions toward transgender individuals.

Results: Participants reported improved psychological well-being since transition. However, they still experienced different forms of stigmatization. Trans women appeared to experience stronger social stigma than trans men. Trans women also experienced lower social status after their transition. They mainly experienced negative responses from cisgender men. Participants emphasized the importance of social and peer support.

Conclusion: The current study findings demonstrate the presence of stigmatization after transition and argue for psychological aftercare. Social and peer support appeared to be important for coping with stigmatization, and improving the social network of transgender individuals is beneficial. Health providers and researchers are recommended to promote the development of constructive coping skills for transgender individuals with interventions especially targeting trans women.