Navigating the Road to Reintegration

181 Pages·2015·1.22 MB·English

Research Report
Navigating the Road to
Reintegration
Status and Continuing Support of the
U.S. Air Force’s Wounded Warriors
Carra S. Sims, Christine Anne Vaughan, Haralambos Theologis, Ashley L. Boal,
Karen Chan Osilla
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Preface
The United States has been at war for over a decade. As is inevitable, war imposes
costs upon nations, not least of which is the cost to the nation’s servicemembers.
Although, comparatively speaking, the U.S. Air Force has suffered few casualties
(Fischer, 2010), many airmen were injured in hostile or combat-related incidents. The Air
Force wanted to understand the well-being of its members who were injured in combat,
including their quality of life and the challenges that will confront them over the long
term following separation or retirement. It was also interested in gauging the quality of
support given to its veterans. The Air Force turned to RAND’s Project AIR FORCE for
help in assessing these areas of concern and requested an approach that would provide a
foundation for a longitudinal exploration of the reintegration of its wounded warriors,
with the ultimate goal being an ability to conduct such a longitudinal exploration. This
report describes that baseline research effort.
The research reported here was commissioned by the Assistant Secretary of the Air
Force for Manpower and Reserve Affairs (SAF/MR); the Director, Air Force Directorate
of Services (AF/A1S); and the Air Force Surgeon General (AF/SG). The analysis was
conducted within the Manpower, Personnel, and Training Program of RAND Project AIR
FORCE as part of a fiscal year 2010–2012 project, “Tracking the Effectiveness of
Warrior and Survivor Care.” This report should interest those concerned with the status
of the Air Force’s wounded warriors and the quality of support they are receiving.
RAND Project AIR FORCE
RAND Project AIR FORCE (PAF), a division of the RAND Corporation, is the U.S.
Air Force’s federally funded research and development center for studies and analyses.
PAF provides the Air Force with independent analyses of policy alternatives affecting the
development, employment, combat readiness, and support of current and future air,
space, and cyber forces. Research is performed in four programs: Force Modernization
and Employment; Manpower, Personnel, and Training; Resource Management; and
Strategy and Doctrine. The research reported here was prepared under contract FA7014-
06-C-0001.
Additional information about PAF is available at:
http://www.rand.org/paf/

iii

Contents
Preface ................................................................................................................................ iii

Figures............................................................................................................................... vii

Tables ................................................................................................................................. ix

Summary ............................................................................................................................ xi

Acknowledgments ........................................................................................................... xvii

Abbreviations ................................................................................................................... xix

1. Introduction ......................................................................................................................1

Project Objectives ..................................................................................................................... 1

Analytical Approach ................................................................................................................. 2

Organization of the Report ....................................................................................................... 3

2. Literature Review: A Holistic Approach to Reintegration Is Necessary .........................5

Mental Health ........................................................................................................................... 7

PTSD ................................................................................................................................... 7

Depression ......................................................................................................................... 10

Substance Use and Abuse .................................................................................................. 12

Consequences of Comorbid PTSD and Depression .......................................................... 13

Physical Health ....................................................................................................................... 13

Traumatic Brain Injury ...................................................................................................... 13

Other Relevant Domains of Functioning ................................................................................ 14

Social Functioning and Interpersonal Relationships ......................................................... 14

Unemployment and Financial Issues ................................................................................. 16

Housing Instability ............................................................................................................ 20

Opportunities for Intervention ................................................................................................ 22

Mental and Physical Health ............................................................................................... 23

Social Functioning and Interpersonal Relationships ......................................................... 25

Unemployment and Financial Issues ................................................................................. 25

Housing Instability ............................................................................................................ 26

Summary ................................................................................................................................. 27

3. Survey Method ...............................................................................................................29

Sampling of Participants ......................................................................................................... 29

Procedure for Administering the Survey ................................................................................ 30

Measures Used in the Survey ................................................................................................. 31

Sociodemographic and Service History Characteristics .................................................... 34

4. Survey Results ...............................................................................................................35

Participants in the Survey ....................................................................................................... 35

v
Mental Health and Substance Abuse ...................................................................................... 38

Physical Health and Medical Care .......................................................................................... 41

Screening for Traumatic Brain Injury ............................................................................... 41

General Physical Health .................................................................................................... 42

Mental Health Services Utilization, Barriers, and Preferences .............................................. 43

Barriers to Treatment ......................................................................................................... 46

Preferred Setting ................................................................................................................ 50

Interpersonal Relationships .................................................................................................... 54

Occupational Functioning ....................................................................................................... 57

Financial Stability ................................................................................................................... 62

Housing Instability .................................................................................................................. 63

Program Evaluation ................................................................................................................ 68

Air Force Wounded Warrior Program ............................................................................... 68

Air Force Recovery Care Coordinator Program ................................................................ 70

5. Conclusions and Recommendations ..............................................................................75

Brief Caveats .......................................................................................................................... 76

Mental Health ......................................................................................................................... 78

Inform Airmen About the Quality of Care Available to Them ......................................... 78

Emphasize and Enhance Confidential Treatment Options ................................................ 81

Seek Ways to Address Scheduling Difficulties ................................................................. 83

Employment ............................................................................................................................ 84

Offered Employment Assistance Should Focus on Individual Skill Sets and Their
Translation to New Contexts ...................................................................................... 85

Reserve Component Members Need Continuing Attention .............................................. 86

Conclusion .............................................................................................................................. 86

A. Detailed Measures Information .....................................................................................87

B. Survey Instrument .........................................................................................................99

C. Additional Results .......................................................................................................131

References ........................................................................................................................139

vi
Figures
Figure 2.1. Holistic Model of Interrelationships and Intervention Opportunities .............. 6

Figure 4.1. Positive Screens for PTSD and MDD, by Current Duty Status ..................... 40

Figure 4.2. Service Utilization and Need for Those Who Screened Positive for
PTSD or MDD ....................................................................................................... 44

Figure 4.3. Receipt of Past-Year Mental Health Services, by Duty Status ...................... 45

Figure 4.4. Differences in Mental Health Treatment Barriers, by Current Duty
Status (N = 199) ..................................................................................................... 49

Figure 4.5. Preferred Settings for Mental Health Treatment (N = 459) ........................... 52

Figure 4.6. Number of Different Residence Locations Within the Past Six Months ........ 65

Figure 4.7. Housing Situation in Prior Six Months of Airmen with Lifetime
History of Homelessness ........................................................................................ 66

vii

Tables
Table 3.1. Survey Measures Overview ............................................................................. 32

Table 4.1. Respondent Characteristics (N = 459) ............................................................. 37

Table 4.2. Positive Screens for PTSD and MDD (N = 459) ............................................. 38

Table 4.3. Rates of Alcohol and Illicit Drug Use in the Past 12 Months (N = 459) ......... 41

Table 4.4. Positive Screens for Injuries and Possible TBI Sustained During
Deployment or Deployment-Related Activities (N = 459) .................................... 42

Table 4.5. Current Physical Health (N = 459) .................................................................. 43

Table 4.6. Medical Care Utilization and Desire and Health Insurance Status and
Need (N = 459) ...................................................................................................... 43

Table 4.7. Barriers to Mental Health Services Utilization (N = 459) ............................... 47

Table 4.8. Mental Health Services Utilization in the Past 12 Months (N = 459) ............. 49

Table 4.9. Mental Health Treatment Settings, by Current Duty Status (N = 459) ........... 50

Table 4.10. Mental Health Services Preferences (N = 459) ............................................. 51

Table 4.11. Final Multivariate Regression Model Predicting Civilian Provider
Preferences (N = 459) ............................................................................................ 54

Table 4.12. Current Relationship Status and Length of Current Relationship
(N = 459) ................................................................................................................ 55

Table 4.13. Relationship of Primary Supporter to Airman (N = 459) .............................. 56

Table 4.14. Average Levels of Relationship Satisfaction with Marriage or
Relationship with Primary Supporter (N = 459) .................................................... 57

Table 4.15. Current Employment Status (N = 459) .......................................................... 57

Table 4.16. Current Employment Status, Excluding Active Duty (N = 332) ................... 59

Table 4.17. Job Performance and Satisfaction (N = 210) ................................................. 60

Table 4.18. Perceived Barriers to Employment (N = 152) ............................................... 61

Table 4.19. Financial Resources and Responsibilities ...................................................... 62

Table 4.20. Lifetime History of Homelessness (N = 459) ................................................ 64

Table 4.21. Classification of Housing Situation Options ................................................. 65

Table 4.22. Self-Reported Housing Situation During the Past Six Months of
Airmen with a Lifetime History of Potential Homelessness (N = 99) ................... 67

Table 4.23. Housing Resources That Have Been Received or Would Be Helpful
(N = 459) ................................................................................................................ 67

Table 4.24. Air Force Wounded Warrior Program Utilization (N = 459) ........................ 68

Table 4.25. Air Force Wounded Warrior Program Perceptions (N = 437)....................... 69

Table 4.26. Air Force Recovery Care Coordinator Program Utilization (N = 459) ......... 71

ix
Table 4.27. Air Force Recovery Care Coordinator Program Services Utilized
(N = 91) .................................................................................................................. 72

Table 4.28. Air Force Recovery Care Coordinator Program Perceptions (N = 91) .......... 73

Table 4.29. Potential Concerns about AFRCC Services Utilization (N = 91) .................. 73

Table C.1. Comparison of Medically Retired and Active-Duty Airmen Served
by the Air Force Wounded Warrior Program to Survey Completers
(N = 872) .............................................................................................................. 131

Table C.2. Health Insurance Status (N = 459) ................................................................ 133

Table C.3. Specific Details on Mental Health Services (N = 459) ................................. 134

Table C.4. Number and Ages of Dependents ................................................................. 134

Table C.5. Household Structure (N = 459) ..................................................................... 135

Table C.6. Perceived Social Support Available to Airman from Different People
in His/Her Life (N = 459) .................................................................................... 135

Table C.7. Work Involvement (N = 459) ........................................................................ 136

Table C.8. Financial Aid for Education and Job Training (N = 459) ............................. 136

Table C.9. Vocational Rehabilitation Services Utilization (N = 459) ............................ 137

x