Combat Social Work During the Surge in Iraq

The military has long recognized the short-term psychiatric effects of war upon soldiers, a significant factor for combat operational readiness and strength (NATO, 2008). Currently referred to as combat stress reaction or combat operational stress reaction (COSR), the condition has debilitating, immediate effects as well as long-term consequences for soldiers and military units. For the wars in Iraq and Afghanistan, commanders expected psychiatric casualties rates equaling physical ones, stemming from the intensity and duration of these conflicts, nonlinear nature of the battlefields, unit morale, and soldier experiences and preparedness. For these recent wars, the concept of behavioral health, combat stress, and its military importance has dramatically changed, as have the protocols dictating the delivery of preventive and restorative combat behavioral health care. This article outlines the conceptual foundation of modern combat stress control, protocols, and the efforts of one social worker–led combat stress prevention team, forward deployed to a small base in a volatile area of Baghdad during the height of the surge in 2006–2007.     

Using Two Intersubjective Perspectives in Combat Deployment: A Military Mental Health Professional’s Experience

The stress and demands of combat deployment create challenges for a military mental health provider (MMHP) to operate in a helper role in an environment adverse to the helping process. A case is presented featuring the experience of a MMHP while deployed to establish the existence of two types of intersubjective space in a combat environment. Modern attachment theory and interpersonal neurobiology are used as a theoretical framework, and concepts of emotional self-regulation, implicit communication, and attunement are applied to the case. The work of the MMHP is shown within and between the two types of intersubjective space and emphasize the seizing of unexpected clinical moments. The MMHP must remain emotionally regulated to participate in the implicit communicative process and rapidly form a therapeutic relationship. Creative and improvisational methods are demonstrated by the MMHP that challenge rigid adherence to clinical models. Applicability is significant to the specialty field of MMHP’s to improve deployment preparation, clinical skill development, and personal health management. Work with veterans can be enhanced by understanding deployment experiences and recognizing the importance of attunement by regulating affect for both the provider and client.     

COMBAT EXPOSURE,CIGARETTE CONSUMPTION,AND SUBSTANCE USE

This study estimates the relationship between combat exposure and several risky health behaviors: cigarette consumption, binge drinking, and drug use. We find that the U.S. active duty military personnel deployed to combat zones with enemy firefight are more likely to subsequently smoke cigarettes, consume alcohol, and use illicit drugs than their counterparts deployed to noncombat operations. Our results suggest that the mental health effects of combat can explain up to two‐thirds of the estimated association between combat exposure and risky health behaviors. (JEL H56, I12)     

“A Fear Like I've Never Felt”: Experiences of Parents Whose Adult Children Deployed to Combat Zones

Despite the increase of research with military families, less is known about the experiences of those parents who have adult children deployed overseas for military operations. This article presents parents’ experiences of having adult children deployed to combat zones. Qualitative data were gathered through an Internet-based survey during 2010. Analyses revealed important themes within the parents’ portrayals expressing strong reactions of fear, worry and concern for their children's safety and well being throughout their experiences. Parents also described frustrations communicating with their deployed children. Support from formal and informal sources was important to their coping, as was assistance from religious and military organizations. Finally, parents reported varied impacts of the adult children's deployment on the parents’ marriages. Implications for future military family research and family life education are provided.     

The Buffering Effect of Relationships on Combat Exposure,Military Performance,and Mental Health of U.S. Military Soldiers: A Vantage Point for CFTs

This study examined the role of cumulative combat experiences with regard to military performance and conduct and mental health among a sample of young soldiers from the Army STARRS dataset (N = 5,283). Higher levels of cumulative combat experiences were directly related to poorer performance and conduct and a greater likelihood of anxiety, depression, and post-traumatic stress disorder (PTSD). Military performance and conduct served as a linking mechanism between combat experiences and mental health. Using moderated mediation structural equation modeling, relationship disruptions were found to exacerbate the adverse effects of combat experiences; conversely, unit cohesion buffered the impact of combat experiences. Implications for military helping professionals include identifying leverage points for intervention, particularly strengthening the social connections of service members within and outside the military.     

Health disparities in military veterans with PTSD: influential sociocultural factors

Health disparities based on sociocultural factors such as gender, race and ethnicity, socioeconomic status, culture, and access to health care can potentially complicate the early diagnosis and effective management of posttraumatic stress disorder (PTSD). Research indicates that among those individuals affected by health disparities, there is a greater burden of illness and disability, higher morbidity and mortality rates, and increased behavioral risk factors. The purpose of this article is to highlight the sociocultural factors that affect the development of PTSD and to publicize health disparities in military combat veterans.     

Traumatic Stress and Affect Management in Military Families

The war-time deployment of a service member creates significant stress for the family system that supports that person’s transition into combat, combat duty, and readjustment into civilian and family life upon return. The stressors associated with the deployment cycle are significant and can lead to depression, anxiety, and behavioral concerns for all family members including the children and partners. A family’s adaptation to these stressors can also impact the functioning of the service member during the phases of mobilization, deployment, sustainment, and reintegration. Social work interventions that offer support to the military family can reduce levels of distress within and between the members and improve overall family functioning. A case vignette will be presented that highlights some of the salient interpersonal challenges that can develop in a military family when a veteran returns home with posttraumatic stress that is left untreated. Recommendations for interventions will be considered through the application of psychoeducational approaches for managing traumatic stress in families.     

Part I. Work hardening for warriors: Occupational therapy for combat stress casualties

Combat stress is an occupational hazard of the military. Soldiers who become job-ineffective due to combat stress are termed "battle-fatigued." Occupational therapy, in the form of work hardening, is an important part of the management of these soldiers. Occupational therapists possess specialized knowledge and skills which make them uniquely qualified for this role. These assets include knowledge of neuromuscular and psychosocial aspects of occupational performance; the ability to do task analyses; the ability to assess occupational performance deficits; the ability to synthesize appropriate therapeutic occupations to rehabilitate functional deficits and match these to the needs of dysfunctional soldiers. These same resources serve occupational therapists equally well in civilian work hardening settings. This paper reviews the management of combat stress casualties, describes the Army units which minimize the impact of combat stress reactions, and delineates the Army occupational therapists' roles of soldier, mental health practitioner, and work hardening coordinator.     

“Why are you trying to destroy the last good thing men have?” Understanding resistance to women in combat jobs

This article argues that opposition to expansion of women's roles in the US military and peer armed forces, particularly into combat-related military occupational specialties, is based on defending a means of proving masculinity and preserving access to power. Research is based on policies of US, UK, and other NATO countries, public statements made by officials, academic articles, and interviews with current and former members of the US military. The article examines shifting definitions of combat, historical examples of American women’s military service, and common and persistent themes of resistance to women in combat roles. The article argues that resistance to women in combat roles is not only inconsistent with operational realities, but is both counterproductive to mission effectiveness, and may even put lives at risk. The article concludes that in an ever-shifting security environment requiring critical thinking, cross-cultural communication, and civil–military collaboration, rethinking gender roles may be advantageous.     

Organizational processes and gender integration in operational military units: An Israel Defense Forces case study

This study examines collective action by men and women in operational military units deployed on Israel's borders. Gender integration is generally perceived by soldiers and commanders in these units as a trivial matter rather than an issue for discussion or a disadvantage. The integration results from organizational qualities, which include military leadership with accumulated experience in gender integration; division of labour between men and women that gradually develops during protracted training; screening processes within the units; and professional development of commanders. Our findings negate a large corpus of sociological literature on gender integration in military organizations. We discuss the micro‐social processes that enable or deter mixed‐gender integration in operational units. Our findings are presented as an alternative to arguments on the inevitable marginality of women in the military and that equality is neither a prerequisite of a cohesive mixed‐gender unit nor a barrier for the inclusion of women into combat units.     

Comprehensive behavioral medicine in community mental health. A needs assessment that needs assessment.

It is suggested that the massive costs incurred nationally in health care are in large part a fitting concern of Community Mental Health (CMH). There is considerable data available to suggest that as much as half of the variance in common health disorders is associated with behavioral factors. There is a rapidly growing movement to provide interventions geared toward these behavioral components in health disorders, but much of this has occurred outside of the traditional mental health environment. There are arguments to suggest that CMH should be more involved in the development of comprehensive behavioral medicine services, both in terms of the expertise and resources that it can bring to bear upon these problems, and its potential to reach segments of the population which are otherwise likely to be underserved, if served at all. Implications for CMH planning and financing are discussed, drawing upon a selective literature review and clinical illustrations.     

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.     

Part II. Work hardening for warriors: Training military Occupational Therapy professionals in the management of combat stress casualties

The purpose of this article is to describe the training of military occupational therapy personnel in a unique application of their professional skills. Ergonomic principles of training for stressful environments were implemented to ensure training effectiveness and transfer of skills to combat situations. Training schedules, casualty role-play scenarios, critical incident stress debriefing principles and scenarios, unit survey guidelines, and premises for training persons to function under stressful conditions are provided. Comparisons with civilian applications are drawn, and suggestions for future roles and training for Occupational Therapy professionals are given.     

Quality of life among U.S. Army spouses during the Iraq war

ABSTRACT

During the course of previous military conflicts, attention has been focused on separations experienced by service members and their loved ones. This study utilized the ABC-X model of Family Stress and Resiliency Theory to provide information about specific family and parental stressors, family coping, appraisal of stress and coping abilities, and quality of life for spouses at various stages of a recent military deployment. Three groups of spouses differed primarily for levels of family stress and quality of life. In addition to comparative analysis, path analyses were conducted for each group to determine the influence of stressors, coping, wellbeing, and sense of coherence on quality of life. The model for the group of spouses with service members deployed longest accounted for the greatest amount of variability in quality of life. Implications for family counseling, social work practice, and community policy have been provided.     

Accuracy in communication. A contextual approach to child behavior assessment

This article analyzes the problem of accuracy of communication in clinical settings and argues that clinical language is replete with theoretical constructs that may not have shared meaning among speakers and listeners in mental health settings. It is suggested that mental health providers be trained in a contextually based data language. The value of such a data language employed in behavioral assessment is emphasized. The authors contend that events and behavior are products of the contextual environment; contextual variables are more accurately identified and agreed on; and the use of contextual variables in treatment intervention increases consequential validity. A developmental ecological approach, coupled with applied behavior analysis, are discussed and offered as a foundation on which clinical interventions should be planned and assessed. Using objective methods that yield demonstrable and meaningful outcomes can help improve children's mental health service delivery and the lives of children.     

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.     

UNEQUAL RISK: COMBAT OCCUPATIONS IN THE VOLUNTEER MILITARY

This study evaluates the characteristics of the men who served in the volunteer military in combat occupations. It examines whether these characteristics stem from supply-side or demand-side decisions, or reflect class bias. The findings suggest that, on the supply side, men who had greater academic abilities were more likely to go to college, thereby avoiding military service and the possibility of serving in a combat occupation. On the demand side, the armed forces were more likely to exclude men with lower academic abilities but were more likely to assign such men in the military to combat occupations. Net of the impacts of these supply-side and demand-side decisions, men who served in combat occupations still differed from those who did not in terms of their family background. The impact of family background was stronger on entering the military than on being assigned to combat occupations once in the military.     

Fathers’ Perspectives on Strengthening Military Families: A Mixed Method Evaluation of a 10-Week Resiliency Building Program

A recent Institute of Medicine report on “The Assessment or Readjustment Needs of Veterans, Service Members, and Their Families” http://nationalacademies.org/hmd/Reports/2013/Returning-Home-from-Iraq-and-Afghanistan.aspx, (2013) underscored the need for effective support for military families with young children, and that effective engagement into existing services remains a challenge. This mixed-method study involved 14 fathers (previously deployed military) who engaged in the Strong Military Families Program, a resiliency-building group for families with young children. The purpose of this paper was twofold: first, to identify the efficacy of this brief intervention for reducing mental health symptomatology among previously deployed military fathers who completed the group, and second to better understand the perceptions and reflections of fathers who completed an effective symptom management program in order to fill the literature gap around this issue and guide future efforts at increasing engagement of this population. Pre- and post-group assessments were administered including depression and posttraumatic stress symptom ratings. Assessments also included interviews designed to elicit fathers’ expectations before the program and to capture their reflections after completion. Quantitative analyses examined changes in symptoms pre- to post-group, and qualitative analyses aimed to better understand fathers’ experiences and help guide future efforts to increase engagement of this population. A grounded theory approach was employed to analyze interview content, and two themes were identified reflecting a desire for (1) connection and (2) learning. The prominence of these themes both before and after group underscored the value of connection to others who shared experience and opportunity for learning effective parenting strategies. Corresponding quantitative analyses indicated a significant decrease in self-reported posttraumatic stress (p?<?.05) and trend level reduction in depression (p?<?.10), suggesting participation may contribute to more effective symptom management. Subgroup analyses contrasting the pre-group interviews of fathers who endorsed higher (n?=?9) versus lower (n?=?5) levels of symptoms revealed that those with greater symptomatology expressed more themes related to fear of committing to the program. Discussion will focus on effective outreach and engagement, and the need to align programs to the interests of previously deployed fathers of young children.