From Military to Community Life: Reintegrating Veterans with Invisible Injuries

背景：参加过耐久行动的退伍军人的康复和保健需求 自由(OEF)、伊拉克自由行动(OIF)和新黎明行动(OND)导致 意识到“看不见的伤害”，这个术语唤起人们对精神健康状况和脑创伤的关注 受伤(TBI)。尽管人们对创伤后应激障碍的流行率有了更高的认识，但创伤性脑损伤和 OEF/OIF/OND后退伍军人中的抑郁症状、这些疾病的长期影响和代价 与伤口或更明显的身体状况相比，人们对此仍然知之甚少。特别是，关键差距 继续了解受伤后的康复和重新融入社区生活的进程 服兵役。这些挑战对于有隐形创伤的退伍军人来说尤其困难--比如 与其他人可能不太明显的精神创伤和精神健康相关的痛苦。R&D工作 工作组强调，缺乏评估重返社会的关键方面的黄金标准，以及 有必要评估以患者为中心的有关治疗偏好和康复目标的观点 重新融入社会。上游方法侧重于早期发现、深入了解，并最终 将产生支持受伤的OEF/OIF/OND退伍军人重返社会困难的有效手段 在改善康复和生活质量方面。 目标：这份职业发展奖提案旨在了解OEF/OIF/OND退伍军人如何 看不见的伤害促使军人重新融入平民社会。指导和培训计划延长了 通过教授混合方法、康复方法，候选人在定性方法方面的专业知识 干预措施，以及无形损伤的循证治疗知识。 方法：利用纵向混合方法，该项目将调查复杂的重返社会 通过快速人种学调查、前瞻性队列研究和 进程映射。对于目标1，我们将探索有隐形损伤的退伍军人如何经历 通过对退伍军人外展活动和退伍军人管理局的快速人种学评估实现退伍过渡 部署后健康评估。在AIM 2，60名有精神健康诊断或TBI的退伍军人 60名护理伙伴(家庭成员、伴侣、朋友或邻居)将被招募为未来计划的一部分， 评估重新融入、心理社会体验、生活质量和结果的纵向队列研究 在分居后康复两年。对于目标3，我们将与退伍军人、社区和 家庭利益相关者和退伍军人临床医生确定战略和未满足的需求，以支持退伍军人经历 重新融入社会的挑战。由退伍军人和其他关键利益攸关方组成的专家小组将使用 基于社区的参与性研究(CBPR)方法和“干预地图”，以制定 根据目标1和目标2的调查结果进行干预。专家小组将评估改进的机会 当前实践并设计社区信息概念模型，以支持未来社区 重新融入社会。会聚的三角测量设计将指导对重返社会的定量评估的分析 以及生活质量结果和定性数据集，以生成关于过渡模式的假设。 创新：拟议的研究旨在通过以退伍军人为中心的 方法，这是VA康复研究中的一个高度优先的问题。纵向方法和纳入 关键的信息来源为这项研究提供了生态有效性。也许更重要的是，以社区为基础的方法 让退伍军人和其他利益相关者参与研究的各个方面--不仅作为受试者，而且作为 项目合作伙伴。CBPR的使用在增加采用干预措施方面具有很大潜力，因为 参与其中的每个人都有一种主人翁意识和来自积极的以成功为导向的动力 参与整个过程。

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.