Developing a Measure for OEF/OIF Veterans' Family Reintegration

描述 这项CDA-2研究提案旨在描述退伍军人的具体家庭重新融合进程，并确定促进家庭重新融合的促进者和障碍。这项基础性研究将用于开发题库和开发初步筛查工具，以确定需要解决的退伍军人及其家庭特有的家庭菌株，以支持康复干预和退伍军人家庭生活质量。这项工作分为两个阶段；第一个阶段是 对OEF/OIF资深合作伙伴二人进行80次深入的、半结构化的访谈，共160次访谈。一个指导性的概念框架认为，退伍军人重新融入家庭分别发生在三个家庭领域：1)个人身份；2)伴侣关系；3)亲子关系。将有四组不同的退伍军人伴侣二元组接受采访；20组二元组中，退伍军人被确诊为轻度脑外伤；20组二元组由患有创伤后应激障碍但未被诊断为脑外伤的退伍军人组成；20组二元组中，退伍军人患有脊髓损伤；20组二元组中，退伍军人没有残疾。访谈将被录音，并逐字转录，以便使用扎根理论方法进行分析，并分析主题模式。对退伍军人家庭相关项目可用的家庭功能工具的审查将 对于上述家庭主题类别中的项目同时发生(即，身份， 伙伴关系和亲子关系)。相关题目将用于创建核心题库。为了确保核心题库是老兵特有的，项目将与访谈数据中的主题模式进行比较。在适当的情况下，将制作新的物品，并修改现有的物品，以便物品是退伍军人家庭特有的。第二阶段将包括测试、修订和重新测试库项目，以确定内容有效性和与退伍军人群体的相关性。为此，将与OEF/OIF重返社会临床专家组成两个焦点小组，1)介绍题库中的项目，以确定概念差距，2)确定与退伍军人家庭重新融入相关的新出现的项目。来自焦点小组的数据将用于修改题库中的问题。然后，这些问题将被提交给15名资深员工和15名合作伙伴进行单独的认知访谈(总共30次认知访谈)。认知面试将测试1)问题的理解力；2) 与问题相关的记忆提取；3)反应决策过程；4)反应过程。认知访谈的数据将为项目修订提供信息。在认知访谈和项目内容验证之后，将创建一个可操作的题库，其中的项目已被修订和“筛选”，有选择地将题库减少到最相关和非多余的问题。业务项目库将提供用于编制退伍军人特定家庭重返社会文书的物品。这一工具将成为通过确定退伍军人特有的家庭品系来支持部署后康复和总体生活质量的资源。早期家庭压力检测的好处是防止家庭解体和失去帮助退伍军人管理他们的身体、精神和康复保健所需的社会支持。 公共卫生相关性： CDA 2建议建立一个以经验为基础的退伍军人家庭重返社会评估工具，该工具是退伍军人特有的，对退伍军人及其家人从行动部署返回时所面临的问题很敏感。一份经验丰富的家庭重新融合文书将有助于对家庭重新融合进程进行标准化评估。监测退伍军人重新融入家庭的标准化评估工具可以通过及早发现这种压力，防止家庭压力加剧退伍军人的身心健康状况。这一评估工具使退伍军人管理局能够监测生活质量，并在家庭重新融合问题对退伍军人残疾、康复精神健康和整体生活质量产生负面影响之前确定、确定目标和进行干预。有针对性的家庭干预已被证明是具有成本效益的，因为患者住院和卧床护理的天数减少了。

DESCRIPTION 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. PUBLIC HEALTH RELEVANCE: 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.