Developing a Measure for OEF/OIF Veterans' Family Reintegration

描述 这CDA-2研究提案的目的是描述退伍军人具体的家庭团聚过程，并确定促进者和障碍，家庭团聚。这项基础研究将用于开发一个项目库，并开发一个初步筛选工具，以确定退伍军人及其家庭特有的家庭菌株，这些菌株需要得到解决，以支持康复干预措施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“持久自由行动”/“伊拉克自由行动”的资深伙伴进行80次深入的半结构化访谈，共计160次访谈。一个指导性的概念框架认为，退伍军人家庭的重新融合发生在三个家庭领域：1）个人身份; 2）伙伴关系; 3）亲子关系。将有四组不同的退伍军人-伴侣二人组接受采访; 20个二人组中，退伍军人被确诊为轻度TBI; 20个二人组由患有创伤后应激障碍诊断但没有TBI诊断的退伍军人组成; 20个二人组中，退伍军人患有SCI; 20个二人组中，退伍军人没有残疾。访谈将被录音，并逐字转录分析使用扎根理论方法，并分析主题模式。对退伍军人家庭相关项目的可用家庭功能工具进行审查， 同时发生在上面确定的家庭主题类别中的项目（即，身份， 父母与子女的关系（parent relationship）。相关项目将用于创建问题的核心项目库。为了确保核心项目库是退伍军人的具体，项目将比较从采访数据的主题模式。在适当的情况下，新的项目将制作，并修改现有的项目，使项目是退伍军人家庭的具体。第二阶段将包括测试，修改和重新测试池项目，以建立内容的有效性和相关性的退伍军人人口。这将通过与OEF/OIF重返社会临床专家进行两个焦点小组来完成，1）从项目库中提出项目，以确定概念差距，2）确定与退伍军人家庭重返社会有关的新出现的项目。焦点小组的数据将用于修订项目库中的问题。然后，这些问题将提交给15名老兵和15名合作伙伴进行个人认知访谈（总共30次认知访谈）。认知面试将测试1）问题理解; 2） 问题相关记忆提取; 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项目库，其中项目已被修订和“筛选”，选择性地将项目池减少到仅那些最相关和非冗余的问题。业务项目库将提供用于创建退伍军人家庭重返工具的项目。该工具将成为一种资源，通过确定退伍军人的具体家庭压力，支持部署后康复和整体生活质量。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： 该CDA 2提议创建一个基于经验的退伍军人家庭重返社会评估工具，该工具针对退伍军人，对退伍军人及其家人从作战部署返回后面临的问题敏感。一个经验丰富的家庭重新融合工具将允许对家庭重新融合过程进行标准化评估。一个标准化的评估工具，以监测退伍军人的家庭团聚，可以防止家庭压力加剧退伍军人的身心健康状况，通过早期发现这种压力。这种评估工具使退伍军人事务部能够监测生活质量，并在家庭团聚问题对退伍军人残疾、康复心理健康和整体生活质量产生负面影响之前进行识别、定位和干预。有针对性的家庭干预措施已被证明是具有成本效益的，因为病人住院和护理床日更少。

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.