Background: The rehabilitation and health care needs of Veterans who have served in Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) have led to increased awareness of ?invisible injuries,? a term that calls attention to mental health conditions and traumatic brain injuries (TBI). Despite increased awareness about the prevalence of post-traumatic stress, TBIs, and depressive symptoms among post OEF/OIF/OND Veterans, the long-term effects and cost of these conditions are still poorly understood compared to wounds or more visible physical conditions. In particular, critical gaps remain in understanding the process of recovery from injuries and reintegration into community life following military service. These challenges are particularly difficult for Veterans with invisible injuries -- conditions such as TBIs and mental health-related distress that may not be readily apparent to others. An RR&D Working Group has highlighted the lack of a gold standard for assessing key aspects of reintegration, as well as the need for assessing patient-centered perspectives on treatment preferences and goals for recovery related to reintegration. An upstream approach focused on early detection, in-depth understanding, and ultimately, effective means of supporting injured OEF/OIF/OND Veterans experiencing reintegration difficulties will result in improved rehabilitation and quality of life outcomes. Objectives: This career development award proposal aims to understand how OEF/OIF/OND Veterans with invisible injuries navigate military to civilian reintegration. The mentoring and training plans extend the candidate's expertise in qualitative methods through instruction in mixed-methods approaches, rehabilitation interventions, and knowledge of evidence-based treatment of invisible injuries. Methods: Utilizing a longitudinal mixed methods approach, this project will investigate complex reintegration processes and associated outcomes through rapid ethnographic inquiry, a prospective cohort study and process mapping.
For Aim 1, we will explore how Veterans with invisible injuries experience the initial phase of transition from military service through rapid ethnographic assessment of Veteran outreach events and VA post-deployment health assessments.
In Aim 2, 60 Veterans with mental health diagnoses or TBIs and up to 60 care partners (family members, partners, friends, or neighbors), will be recruited as part of a prospective, longitudinal cohort study assessing reintegration, psychosocial experiences, quality of life outcomes, and rehabilitation for two years following separation.
For Aim 3, we will partner with Veterans, community and family stakeholders, and VA clinicians to identify strategies and unmet needs to support Veterans experiencing reintegration challenges. An expert panel comprised of Veterans and other key stakeholders will use a community-based participatory research (CBPR) approach and ?intervention mapping,? to develop an intervention based on findings from Aims 1 and 2. The expert panel will assess opportunities for improving current practices and design a community-informed conceptual model to support future community reintegration. A convergent triangulation design will guide analysis of quantitative assessments of reintegration and quality of life outcomes and qualitative data sets to generate hypotheses about patterns of transition. Innovation: The proposed study seeks to improve reintegration outcomes through a Veteran-centered approach, which is a high priority in VA rehabilitation research. The longitudinal approach and the inclusion of key informants lends ecological validity to the study. Perhaps more importantly, a community-based approach engages Veterans and other stakeholders in all aspects of the research? not simply as subjects, but also as project partners. The use of CBPR holds great potential for increasing the uptake of interventions since everyone involved has a sense of ownership and success-oriented motivation that comes from active participation in the entire process.
While VA has invested considerable resources in treating the health care needs of injured Veterans who served in Operation Enduring Freedom, Operation Iraq Freedom, or Operation New Dawn, important gaps remain in understanding transition between military service and civilian life. Challenges in community reintegration are particularly difficult for Veterans with ?invisible injuries?, including conditions such as traumatic brain injuries and mental health conditions. The proposed career development project is a mixed methods, longitudinal study that investigates how Veterans with invisible injuries navigate military to civilian reintegration. Rapid ethnographic inquiry, a prospective cohort study and intervention mapping will be used to examine factors associated with reintegration and quality of life outcomes through a Veteran-engaged, participatory approach involving an expert panel. Research findings will contribute to VA efforts to ensure seamless integration for Veterans successfully reintegrating into community life.
