From Military to Community Life: Reintegrating Veterans with Invisible Injuries

从军事到社区生活：让隐性受伤的退伍军人重新融入社会

• 批准号: 10264822
• 负责人: Nicholas Rattray
• 金额: --
• 依托单位: RLR VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-10-01 至 2023-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10264822
• 关键词: Address; Adopted; Attention; Award; Awareness; Caring; Clinical; Communities; Complex; Data Set; Diagnosis; Distress; Early Diagnosis; Employment; Ensure; Ethnography; Event; Evidence based treatment; Family; Family member; Freedom; Friends; Future; Goals; Gold; Health; Health Services; Healthcare; Home; Injury; Instruction; Intervention; Intervention Studies; Iraq; K-Series Research Career Programs; Knowledge; Life; Long-Term Effects; Longitudinal Studies; Longitudinal cohort study; Mental Health; Mentors; Methods; Military Personnel; Modeling; Morbidity - disease rate; Motivation; Outcome; Ownership; Pattern; Phase Transition; Prevalence; Process; Prospective cohort study; Qualitative Methods; Quality of life; Recovery; Rehabilitation Outcome; Rehabilitation therapy; Research; Research Personnel; Resources; Shapes; Training; Translating; Traumatic Brain Injury; Unemployment; Variant; Veterans; Work; base; career; career development; community based participatory research; community reintegration; cost; depressive symptoms; design; experience; functional outcomes; health assessment; improved; informant; injured; injury recovery; innovation; intervention mapping; military service; operation; outreach; patient oriented; person centered; post-traumatic stress; preference; prospective; psychosocial; psychosocial stressors; recruit; rehabilitation research; rehabilitative care; social relationships; success; therapy design; uptake; working group; wound

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.

背景：参加过持久行动的退伍军人的康复和医疗保健需求 自由行动（OEF）、伊拉克自由行动（OIF）和新黎明行动（OND）导致了 对“看不见的伤害”的认识，这个术语呼吁人们关注心理健康状况和大脑创伤 损伤（TBI）。尽管人们越来越认识到创伤后应激障碍、创伤性脑损伤和 OEF/OIF/OND 退伍军人中的抑郁症状，这些情况的长期影响和成本 与伤口或更明显的身体状况相比，人们对这些疾病的了解仍然知之甚少。特别是关键差距 继续了解受伤后恢复并重新融入社区生活的过程 兵役。这些挑战对于受到隐形伤害的退伍军人来说尤其困难——诸如此类的情况 例如创伤性脑损伤和心理健康相关的困扰，但对其他人来说可能不太明显。研发工作 专家组强调缺乏评估重返社会关键方面的黄金标准，以及 需要评估以患者为中心的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检测、深入理解，最终， 将采取有效手段支持受伤的 OEF/OIF/OND 退伍军人重新融入社会的困难 改善康复和生活质量。 目标：此职业发展奖提案旨在了解 OEF/OIF/OND 退伍军人如何 隐形伤害引导军人重返社会。指导和培训计划扩展了 通过混合方法、康复方面的指导，候选人在定性方法方面的专业知识 干预措施以及对隐形伤害的循证治疗的知识。 方法：利用纵向混合方法，该项目将研究复杂的重新整合 通过快速人种学调查、前瞻性队列研究和 流程图。对于目标 1，我们将探讨遭受隐形伤害的退伍军人如何经历初始阶段 通过对退伍军人外展活动和退伍军人事务部进行快速人种学评估，从兵役过渡 部署后健康评估。在目标 2 中，60 名患有心理健康诊断或 TBI 的退伍军人最多 将招募 60 名护理伙伴（家庭成员、合作伙伴、朋友或邻居）作为潜在的、 纵向队列研究评估重返社会、社会心理经历、生活质量结果以及 分居后两年的康复期。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管理局临床医生确定策略和未满足的需求，以支持退伍军人经历 重返社会的挑战。由退伍军人和其他主要利益相关者组成的专家小组将使用 基于社区的参与性研究（CBPR）方法和“干预映射”，以开发 根据目标 1 和 2 的调查结果进行干预。专家小组将评估改进的机会 当前的实践并设计一个社区知情的概念模型来支持未来的社区 重新融入社会。收敛三角测量设计将指导重返社会定量评估分析 生活质量结果和定性数据集，以生成有关过渡模式的假设。 创新：拟议的研究旨在通过以退伍军人为中心的研究来改善重返社会的结果 方法，这是 VA 康复研究的一个高度优先事项。纵向方法和纳入 关键信息提供者为研究提供了生态有效性。也许更重要的是，基于社区的方法 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 的使用对于增加干预措施的采用具有巨大的潜力，因为 每个参与其中的人都有一种主人翁意识和以成功为导向的动力，这些动力来自于积极的 参与整个过程。