Continuity of Mental Health Care Across Military Transitions

Multiple deployments, a prominent characteristic of operations Enduring Freedom, Iraqi Freedom, and New Dawn, have been linked to increased risk for various mental health conditions. It is also well known that military transitions, such as a change of duty station or discharge, are an inevitable part of military life. While military transitions can be stressful for any service member or veteran, those with mental health conditions face additional challenges. Transition stress can exacerbate a mental health condition that in turn hinders ability to manage the transition, resulting in a cycle of stress. As a result, those receiving mental health care while transitioning often experience difficulty continuing treatment post-transition. This article describes a unique and innovative transition coaching program designed to address this emerging issue.     

Managing the process of change in residential child care: A consultancy approach

This article explores the impact of a consultancy undertaken with groups of residential child care staff within a large local authority who were experiencing considerable changes in their working environment as a result of a review of residential care structures. The authors were invited to engage directly with staff on an individual and group basis to help them work through the barriers they perceived to changing their approach to practice. The theoretical underpinning for the work was Charles Handy's [1993, Understanding Organisations (Harmondsworth, Penguin)] belief that change is more likely to have a positive outcome when staff have an investment in and contribution to the change processes. The model of change utilised within the sessions with staff was Kurt Lewin's three stages of 'unfreezing', 'change' and 'refreezing'. The consultancy raised a number of issues about the process of change and how this can be achieved within the residential child care context. In particular, it highlighted the problems of assuming that change is a linear process which can be directly controlled and managed in the flux and uncertainty which characterises this sector.     

Homeless Military Veterans and the Intersection of Partner Violence

The objective of this paper was to identify, screen, and assess homeless veterans through outreach for domestic abuse services. This study focuses on 507 homeless veterans, from 2002 to 2007 identified in a homeless shelter and a transitional housing program. Homeless veterans completed the Domestic Violence/Abuse Screen (DV/AS) and psychosocial assessment. The majority were males, African American, divorced, Army, Vietnam, substance-dependent, and homeless, while the minorities had combat-PTSD; were charged and convicted of domestic violence; were on supervised parole or probation; had juvenile records; were victims of domestic violence during rearing; had a perpetrator relative; had prior domestic violence treatment; and were referred for domestic abuse treatment services. There is a lack of research evidence for the effectiveness for screening of homeless veteran partner violence. This sample shows the benefit of integrating domestic abuse screening into homeless programs and more research.     

Campus-Based College Health Services Before the Amherst Program (1860): Military Academies Lead the Way

Abstract

Over the past 70 years a legend has evolved that the first college health program in the United States was established at Amherst College in 1861. Although the program at Amherst was innovative in its day and served as a model for the field of college health, several other institutions prior to 1860 appropriated funds, hired staff, and established on-campus programs to improve the health of their students. The military academies led the way, and the first of these early programs to become operational was located at the US Military Academy at West Point, New York, in 1830.     

Suffering in the Shadows: Interviews with Wives of Combat Veterans Suffering from Post-Traumatic Stress Disorder and/or Traumatic Brain Injury

The body of research examining issues confronting combat veterans of the Afghanistan and Iraq wars continues to grow. However, this research focuses primarily upon veterans with very less attention given to the challenges confronting their spouses. Using a semi-structured interview methodology and a feminist perspective, this study examines what it means to be a wife of a combat veteran who suffers from post-traumatic stress disorder (PTSD) and/or traumatic brain injury (TBI). Our findings indicate these women—who experience tremendous emotional, financial, and social challenges that arise from being the caregiver for their husbands—feel isolated from and abandoned by both the military community and the civilian community. Furthermore, the social and emotional disconnection of these women experience amplify the stresses they confront in daily life—stresses that are unique to their relationship to being with a combat veteran spouse who has PTSD and/or TBI. We argue future research should build upon this exploratory study to better understand how both the military community and the civilian community impact the subjectivity of these women and their efforts to reintegrate themselves and their families into civilian life.     

Predicting help-seeking behavior: The impact of knowing someone close who has sought help

ABSTRACT

Objectives: This study sought to replicate and extend research on social facilitators of college student's help seeking for psychological problems. Participants: We collected data on 420 ethnically diverse college students at a large public university (September 2008–May 2010). Methods: Students completed a cross-sectional online survey. Results: We found that students who were aware of close others' (eg, family, friends) help seeking were two times more likely to have sought formal (eg, psychologist) and informal (eg, clergy) help themselves. Tests of moderation revealed the incremental effect (ie, controlling for help-seeking attitudes, internalizing symptoms, cultural demographics) of close others' formal help seeking was strong and significant for men (R² = 0.112), while it was negligible and nonsignificant for women (R² = .002). Conclusions: We discuss the importance for students—particularly men—to learn about close others' help seeking for facilitating their own help seeking during times of distress.     

Women in the Workplace:

This study examined the influence of employee sponsored child care service on employee stress level and job satisfaction. The findings revealed that women who used company sponsored child care services manifested significantly lower levels of stress and higher levels of job satisfaction than women who were not utilizing this service. In addition, a higher level of satisfaction with child care arrangements was associated with women involved in company sponsored child care service compared to women who had to make their own child care arrangements.     

Navigating the Shifting Sands of Social Work Terrain: Social Work Practice in Postmodern Conditions

In an effort to inform social work education, this article reports on part of a study examining the factors that hinder or facilitate involvement in social justice efforts. Based on a case example of Canadian international development nongovernmental organizations, the article presents the findings of an analysis of organizational documents. I argue that international development organizations' conceptions of involvement reproduce inequitable North-South power relations through a perpetuation of colonial discourses of the South. This perpetuation of inequitable power relations is evident in three main themes: the tragic South; the hero/victim binary; and the ideal of one world. The implications of these findings for social work education are outlined.     

Implementation of a Collaborative Care Initiative for PTSD and Depression in the Army Primary Care System

Collaborative care models hold promise as a means to improve the Military Health System (MHS) to better meet the mental health needs of U.S. military personnel. This article describes an Army-wide collaborative care initiative, RESPECT-Mil (“Re-engineering Systems of Primary Care Treatment for Depression and PTSD in the Military”), aimed at improving care for soldiers with depression and post traumatic stress disorder. Essential to the implementation of RESPECT-Mil has been the use of a centralized coordinating team to facilitate collaborative care practice and policy activities across the multiple levels of the MHS. The article explores the relevance of collaborative care frameworks to the social work profession and concludes with a discussion of future directions for the social work field to promote greater involvement in the integrated care movement.     

Common Challenges in Conducting Prolonged Exposure Therapy With Active Duty Service Members: Case Discussion and Strategies for Intervention

Prolonged Exposure (PE) Therapy receives most of its empirical support from trials conducted with civilian posttraumatic stress disorder (PTSD) populations. There has been only limited research on its use with military personnel with combat-related PTSD, and as a consequence, there has been less clinical discussion detailing its application with active duty service members. The purpose of this paper is to highlight two challenges that commonly arise when conducting PE with active duty service members: 1) selecting the most appropriate index event to focus on in imaginal exposure out of the numerous traumas an active duty patient is likely to have experienced, and 2) patients’ tendency to engage in “safety behaviors,” which undermine the effectiveness of in vivo exposure. The nature of these challenges is explored from a theoretical perspective, along with two case examples to illustrate their presentation in treatment. Specific strategies for addressing them are reviewed.     

Multifamily therapy in the community mental health network: A pragmatic randomized and controlled study

Multifamily therapy (MFT) is a psychotherapeutic group intervention for patients with severe mental disorders (SMDs) and their families. The present study is a multicenter, randomized, and controlled trial that analyzes the benefit of MFT during outpatient treatment. The recruited patients were randomly assigned to the experimental group (n = 26), which received 24 MFT sessions in addition to their treatment as usual (TAU), or to the control group (n = 29), which received only TAU (individual and family sessions). Six months after the inclusion in the MFT, the experimental group showed a significant decrease in number of visits to the psychiatric emergency services, number of psychiatric admissions, and the days of admission. The need for hospital care 6 months after recruitment was also lower in the experimental group compared to the control group. These results suggest that the implementation of MFT during outpatient treatment facilitates community management of people diagnosed with mental health problems.     

Mens Sana: The Growth of Mental Health in the American College Health Association

Abstract

In 1910, the first college mental health service sought to help college students with personality development and building a healthy mind. In 1920, the meeting that founded the American College Health Association (ACHA) identified “mental hygiene” as important, although a separate Mental Health Section was not established in ACHA until 1957. Between 1920 and 1960, a series of national meetings helped define the role and functioning of college mental health and counseling services. Most colleges employed a multidisciplinary staff of psychologists, psychiatric social workers, and psychiatrists to provide clinical services for students and consultation and education for faculty and staff. Mental health services on college campuses grew rapidly in the 1960s and 1970s, leading to discussions in the late 20th century of the use of brief psychotherapies, prevention and treatment of drug and alcohol abuse, prevention of suicide and homicide, the use of psychotropic medications, and effective campus interventions.     

Impact of child sexual abuse disclosure on the health of nonoffending parents: A longitudinal perspective

The impact of child sexual abuse (CSA) disclosure on parents’ psychological health has been documented among samples of nonoffending parents. Much less is known about the parents’ physical health. This study assesses the longitudinal impact of CSA disclosure on both the mental and physical health of parents and explores potential gender differences. Interviews with 92 mothers and 32 fathers were completed approximately 12 months and 18 months following disclosure. Generalized as well as mixed model analyses revealed that mothers reported more psychological distress, Posttraumatic Stress Disorder (PTSD) symptoms and activity limitation than fathers. With the exception of PTSD symptoms which showed a significant reduction over time, all other psychological and physical symptoms persisted. The findings highlight the importance of ensuring services for an extended period for the small proportion of parents who display especially high vulnerability.     

Psychometric validation of the PERMA-profiler as a well-being measure for student veterans

Abstract

Objective: The current study aims to validate the PERMA-Profiler, a well-known well-being measure, among a sample of student veterans. Participants: A sample of 205 student veterans were recruited from universities across the United States. Method: Cross-sectional research design was used in this study. Measurement structure of the PERMA-Profiler was evaluated using exploratory factor analysis (EFA). Convergent, divergent, and criterion-related validity was tested using Pearson correlation coefficients and Kruskal-Wallis test. Results: The EFA results yielded a two-factor solution for student veterans. Factors are named as emotional character strengths and performance character strengths. Conclusions: The PERMA-Profiler is a multidimensional scale with good reliability and acceptable levels of convergent, divergent, and criterion-related validity. The PERMA-Profiler can help researchers and practitioners better gauge well-being in student veterans. Implications will be discussed.     

The Postadoption Needs of Adoptive Parents of Children With Disabilities

Adoptions of children with disabilities are considered special needs, due to the higher level of support needed pre- and postadoption by families and children for adoptions to succeed. Despite this fact, very few studies examine the specific postadoption experiences of families with children with disabilities. Using secondary analysis of a national survey of adoptive parents, as well as interviews and a focus group with adoptive parents in one state, this study examines families’ with adopted children with disabilities challenges and unmet needs after adoption, as well as the postadoption needs and experiences of adoptive families with children with developmental and intellectual disabilities and adoptive families of children with emotional, behavioral, and mental health disabilities. Findings indicate that families with children with disabilities do report higher rates of challenges and barriers to service access, and that this is particularly true in families with adopted children with emotional, behavioral, and mental health disabilities. Implications for research and practice are discussed.     

Veterans-by-proxy: A conceptual framework of ambiguous loss among children of combat veterans

There are tens of millions of children (youth and adult) of parents who are veterans. These individuals can experience traumatic injury alongside the parent who is a combat veteran. It is a parallel process called “veterans-by-proxy.” A proxy is an individual that acts on behalf of another individual. The proxy witnesses how combat traumatizes their parent and vicariously experience the trauma themselves. When a proxy suffers secondary trauma, ambiguous loss, and insecure attachment, one or more ego functions fail to adequately develop. This article proposes a conceptual framework of the proxy’s loss as it relates to the parent’s trauma and discusses research-based resiliency-focused interventions critical to healing the relationship between the proxy and the parent who is a combat veteran.     

Mental health service navigation: a scoping review of programmatic features and research evidence

ABSTRACT

Service navigation is a care coordination approach that is designed to resolve barriers and facilitate access to needed services. Originating within primary and specialty health care sectors, navigation models have recently emerged to support engagement with mental health services. Presently little is known about the nature, extent, and research evidence for mental health service navigation programs. To address this gap in knowledge, this study undertook a scoping review to identify, describe, and appraise current models of mental health service navigation. Data sources included PsychINFO, Medline, CINAHL, and Google Scholar. Inclusion eligibility required studies to describe a study design, recruitment strategy, navigation approach, sample characteristics, and study outcomes. Searches were constrained to English language and published after January 1, 2000. Twenty-five studies met the inclusion criteria. Navigation programs targeted diverse populations and were delivered in-person, by telephone, and online. Navigators included peers, paraprofessionals, clinicians, teams, and web applications. Eleven studies reported results from randomized trials, remaining programs employed program evaluation, qualitative, or CBPR methodologies. Common features of navigation programs included engagement, assessment, service identification, referral, and monitoring/follow-up. Current evidence for mental health service navigation is promising, although additional rigorous randomized controlled trials are needed.     

Depression screening,education, and treatment at the workplace: A pilot study utilizing the CDC Health Scorecard

Depression is a significant health issue for many Americans, ranking among the top worksite issues resulting in referrals to Employee Assistance Programs (EAPs) with prevalence rates in the working population of more than 6%. This study was part of a larger statewide assessment conducted using the Centers for Disease Control and Prevention (CDC) Worksite Health Scorecard. The purpose of this study is to examine the number of Kentucky workplaces currently offering screening, education, and treatment related to depression. The study also aims to compare the number of Kentucky workplaces offering these elements by size and industry type. The one-time, cross-sectional assessment surveyed a random sample of 1,200 worksites to examine worksite offerings of screening, education, counseling, management training, and health insurance coverage related to depression. Results showed that the majority of worksites do not provide employee depression screening, education and counseling, management training on identifying warning signs of depression, or comprehensive treatment and follow-up for employees with depression. Smaller worksites (<250 employees) were even less likely than larger companies to provide screening, education, counseling, training, and insurance coverage for depression. Increasing the provision of these wellness components at the worksite has potential to improve the quality of life for employees and reduce the financial burden to employers.     

Coming out in camouflage: A queer theory perspective on the strength,resilience, and resistance of lesbian,gay, bisexual,and transgender service members and veterans

ABSTRACT

Lesbian, gay, bisexual, and transgender (LGBT) service members have made profound contributions to the U.S. military despite serving under anti-LGBT military policies. Little is known about their everyday acts of strength and resistance, which is vital information for developing strengths-based services. This article utilizes a queer theory framework to (a) discuss LGBT military contributions and anti-LGBT military policies, (b) explore three LGBT-specific military minority stressors, and (c) identify four strategies of strength and resistance used to manage an anti-LGBT military environment. Clinical suggestions are proposed for integrating military and LGBT identities and designing interventions that blend military and LGBT cultures.     

Over 1000 Aluminium Cans for Forty Dollars: The Provisioning Contributions of Older Children from the Perspectives of Welfare‐Reliant Lone Mothers

In this article, as a child and family mental health therapist, I connect the feminist concept of ‘provisioning’ and the experiences of ‘young carers’ to critically examine the family care contributions made by older children living in poverty. I present the findings of a qualitative study consisting of two focus groups in which ten (n = 10) welfare‐reliant lone mothers living in Toronto, Canada described the nature and significance of the contributions made by their older children (11–17 years old) to help their families ‘make ends meet’. Using grounded theory, two main categories emerged: (1) the nature of the provisioning by older children, and (2) the significance of the contributions. The implications of the findings suggest that mental health approaches with older children living in poverty inappropriately misrepresent and pathologise their emotional distress and family contributions.