This CDA-2 research proposal aims to describe veteran specific family reintegration processes and identify facilitators and barriers to family reintegration. This foundational research will be used to develop an item bank and develop a preliminary screening tool to identify family strains specific to veterans and their families that need to be addressed to support rehabilitation interventions and veteran family quality of life. The work is grouped into two phases; the first is to conduct 80 in-depth, semi-structured interviews with OEF/OIF veteran- partner dyads, for 160 total interviews. A guiding conceptual framework views veteran family reintegration occurring in each of three family domains 1) individual identity; 2) partner relationship; and 3) parent-child relationship. There will be four distinct groups of veteran-partner dyads interviewed; 20 dyads in which the veteran has a confirmed diagnosis of mild TBI; 20 dyads comprised of veterans with a PTSD diagnosis but no TBI diagnosis; 20 dyads in which the veterans has a SCI; and 20 dyads in which the veteran has no disability. Interviews will be audio tape recorded, and transcribed verbatim for analysis using a Grounded Theory Method approach, and analyzed for thematic patterns. A review of available family function instruments for veteran- family relevant items will occur concurrently for items in the thematic categories of family identified above (i.e., identity, partner relationship, and parent-child relationship). Relevant items will be used to create a core item bank of questions. To ensure that the core item bank is veteran specific, items will be compared to thematic patterns from the interview data. Where appropriate, new items will be crafted, and extant items revised so that items are veteran family specific. The second phase will consist of testing, revising, and retesting pool items to establish content validity and relevance to the veteran population. This will be done by conducting two focus groups with OEF/OIF reintegration clinical experts to 1) present items from the item bank to identify conceptual gaps, and 2) identify newly emergent items relevant to veteran family reintegration. The data from focus groups will be used to revise questions in the item pool. These questions will then be presented to 15 veteran and 15 partners for individual cognitive interviews (for a total of 30 cognitive interviews). Cognitive interviews will test for 1) question comprehension; 2) question related memory retrieval; 3) the response decision process; and 4) the response process. Data from cognitive interviews will inform item revision. Following cognitive interviews and item content validation, an operational item bank will be created in which items have been revised and winnowed, selectively reducing the item pool to only those questions that are most relevant and non- redundant. The operational item bank will provide items used in the creation of a veteran specific family reintegration instrument. This instrument will be a resource for supporting post-deployment rehabilitation and overall quality of life by identifying veteran specific family strain. The benefit of early family strain detection is the prevention of family dissolution and the loss of social supports needed to help veterans manage their physical, mental, and rehabilitative health care.
This CDA 2 proposes to create an empirically-based veteran family reintegration assessment instrument that is veteran specific and sensitive to the issues faced by veterans and their families upon return from operational deployment. A veteran family reintegration instrument will allow for the standardized assessment of the family reintegration process. A standardized assessment tool to monitor veterans' family reintegration can prevent family strain from exacerbating veterans' physical and mental health conditions through the early detection of that strain. This assessment tool allows VA to monitor quality of life and identify, target, and intervene before family reintegration problems negatively affect veteran disability, rehabilitation mental health, and overall quality of life. Targeted family interventions have been shown to be cost-effective via fewer patient hospitalizations and fewer bed-days of care.