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Background Numerous programs exist to support veterans in their transitions to civilian life. Programs are offered by a host of governmental and non-governmental stakeholders. Veterans report encountering many barriers to program participation. This study identified barrier reduction strategies offered by programs that new post-9/11 veterans reported using, determined which strategies veterans use and value, and examined veteran characteristics that impact their odds of using programs that offer barrier reduction strategies. Method This study reflects findings from the first wave of data collection of The Veterans Metrics Initiative (TVMI), a longitudinal study examining the military-to-civilian reintegration of new post-9/11 veterans. The websites of programs used by respondents were coded for barrier reduction components. Veterans also indicated which barrier reduction components they found most helpful in meeting their reintegration goals. Results Of 9566 veterans who participated in Wave 1 data collection, 84% reported using a program that offered at least one barrier reduction component. Barrier reduction components included tangible supports (e.g., scholarships, cash), increased access to programs, decreased stigma, and encouraged motivation to change. Although only 4% of programs that were used by veterans focused on helping them obtain Veterans Administration benefits, nearly 60% of veterans reported that this component was helpful in reaching their goals. Access assistance to other resources and supports was also reported as a helpful barrier reduction component. For instance, approximately 20% of veterans nominated programs that offered transportation. The study also found evidence of a misalignment between the kinds of barrier reduction components veterans valued and those which programs offered. Veterans from the most junior enlisted ranks, who are at most risk, were less likely than those from other ranks to use barrier reduction components. Study limitations and ideas for future research are discussed. Conclusions Despite the evidence that barrier reduction components enhance access to programs and contribute to program sustainability, many programs used by post-9/11 veterans do not offer them. There was also a misalignment between the barrier reduction strategies that veterans value and the strategies offered by programs. Veteran serving organizations should increasingly implement barrier reduction strategies valued by veterans.

A comprehensive guide to empirically supported approaches for child protection cases The Wiley Handbook of What Works in Child Maltreatment offers clinicians, psychologists, psychiatrists and other professionals an evidence-based approach to best professional practice when working in the area of child protection proceedings and the provision of assessment and intervention services in order to maximize the well-being of young people. It brings together a wealth of knowledge from expert researchers and practitioners, who provide a comprehensive overview of contemporary work informing theory, assessment, service provision, rehabilitation and therapeutic interventions for children and families undergoing care proceedings. Coverage includes theoretical perspectives, insights on the prevalence and effects of child neglect and abuse, assessment, children's services, and interventions with children, victims and families.

The COVID‐19 pandemic was a world‐wide health emergency that resulted in individuals experiencing challenges in numerous life domains. Life domains affected included physical and mental health, finances, and social isolation. Many health and research professionals evidenced concern that veterans were more likely than civilians to experience COVID‐19 related problems due to their “at‐risk” health status. Veterans are at‐risk for health problems due to encountering unique military experiences such as traumatic exposures, development of trauma‐related mental health symptoms or disorders, combat‐related injuries, and disability, exposure to toxins such as burn pits and biological agents, and living with chronic stress during their transition to civilian life. It was suggested that the disruptions and challenges the COVID‐19 pandemic created could trigger mental health problems among veterans. Indeed, based on cumulative stress theory, female veterans and veterans from racial and ethnic minority groups were thought to be particularly vulnerable for experiencing mental health challenges. The current study examined changes in the symptoms of depression and anxiety before, during, and after the COVID‐19 pandemic among a large and diverse sample of post‐9/11 veterans. As predicted, when compared to White male veterans, male and female veterans from racial and ethnic minority groups reported having higher symptom levels of anxiety and depression before, during, and after the COVID‐19 pandemic. All veterans, except for females from racial and ethnic minority groups, reported experiencing increases in symptoms over time. Exposure to adverse childhood experiences (ACEs), combat exposure, and length of longest deployment were inconsistently associated with symptoms over time. The results suggest that the COVID‐19 pandemic was associated with individuals experiencing increased anxious and depressive symptoms over time, although not in a wholly consistent manner. Future global health emergencies may have differential gender‐ and race/ethnicity‐based effects on veterans; thus, veteran‐serving organizations should carefully plan their responses to such crises.

BackgroundAlthough research has shown that exposure to potentially traumatic and morally injurious events is associated with psychological symptoms among veterans, knowledge regarding functioning impacts remains limited.MethodsA population-based sample of post-9/11 veterans completed measures of intimate relationship, health, and work functioning at approximately 9, 15, 21, and 27 months after leaving service. Moral injury, posttraumatic stress, and depression were assessed at ~9 months post-separation. We used Latent Growth Mixture Models to identify discrete classes characterized by unique trajectories of change in functioning over time and to examine predictors of class membership.ResultsVeterans were assigned to one of four functioning trajectories: high and stable, high and decreasing, moderate and increasing, and moderate and stable. Whereas posttraumatic stress, depression, and moral injury associated with perpetration and betrayal predicted worse outcomes at baseline across multiple functioning domains, moral injury associated with perpetration and depression most reliably predicted assignment to trajectories characterized by relatively poor or declining functioning.ConclusionsMoral injury contributes to functional problems beyond what is explained by posttraumatic stress and depression, and moral injury due to perpetration and depression most reliably predicted assignment to trajectories characterized by functional impairment over time.

PurposeEfforts to promote the health and well-being of military veterans have been criticised for being inadequately informed of veterans’ most pressing needs as they separate from military service, as well as the programmes that are most likely to meet these needs. The current article summarises limitations of the current literature and introduces The Veterans Metrics Initiative (TVMI) study, a longitudinal assessment of US veterans’ well-being and programme use in the first three years after they separate from military service. Veterans were assessed within 3 months of military separation and will complete five additional assessments at 6-month intervals during the subsequent period.ParticipantsThe TVMI study cohort consists of a national sample of 9566 newly separated US veterans that were recruited in the fall of 2016.Findings to dateThe TVMI sample includes representation from all branches of service, men and women, and officers and enlisted personnel. Although representative of the larger population on many characteristics, differential response rates were observed for some subgroups, necessitating the development of non-response bias weights. Comparisons between unweighed and weighted results suggest that the weighting procedure adequately adjusts for observed differences.Future plansAnalyses are under way to examine veterans’ well-being and programme use in the period following separation after military service, as well as factors associated with poor outcomes. We have also begun to decompose programmes into their core components to facilitate examination of how these components relate to well-being. Once our third data collection is complete, we will examine factors related to different patterns of readjustment over time.

Collective efficacy refers to a perceived sense of connectedness and willingness to intervene among youth, and is a potential aspect of positive youth development (Larson in Am Psychol 55:170–183, 2000 ; Lerner et al. in Child Dev 71:11–20, 2000 ; Sampson et al. in Science 277:918–924, 1997 ). Theoretically, those who feel connected to a group that is empowered to positively influence the behavior of their peers may demonstrate fewer problem behaviors. Few studies, however, have measured the impact of youth perceptions of collective efficacy. As a relatively new child-related research topic, there is much to be learned. One contribution to the foundation of this research agenda begins by evaluating the reliability and validity of a measure of collective efficacy with elementary children attending community-based afterschool programs. This paper describes the internal consistency reliability and various indicators of construct and concurrent validity of the Collective Efficacy Among Children Scale. The measure was found to have high internal consistency reliability. Construct validity was tested using exploratory factor analyses of collective efficacy including the dimensions of willingness to intervene and cohesion found in previous research (Sampson et al. in Science 277:918–924, 1997 ). Concurrent validity assessed relations between the scale and other measures in theoretically congruent ways. Using Hierarchical Linear Models to account for children's nestedness in after-school programs, connectedness was found to be more related to emotional adjustment, particularly children’s prosocial attitudes (caring about others and sharing). Children’s perception of the willingness of the group to intervene was found to be related to less problem behavior, (i.e. smoking tobacco, drinking alcohol, vandalism, and stealing). The implications suggest that future research should further explore children’s collective efficacy, and ways to foster its development in youth-serving afterschool settings.

Methods: Multivariable analysis weighted to represent the sampling frame and account for attrition at follow-up examined the association between gender and self-reported healthcare utilization overall and in the VHA. VHA healthcare, formerly dominated by Vietnam-era or older male veterans, has increasingly needed to adapt to younger patients and to women's healthcare needs.2 Barriers to healthcare include cost, transportation, stigma, and intra- and interpersonal factors.3-6 Veterans may undervalue seeking help for problems, feel that help-seeking is counter to their military cultural values, or distrust the healthcare system.7,8 The VHA seeks to improve access by increasing options for VHA-paid care in community settings through the highly publicized Veterans Choice Program (VCP) and increased capacity for women's healthcare.9 Congress enacted the Veterans Access, Choice, and Accountability Act of 2014 to improve access to VHA-mediated care, making it easier for veterans to get appointments through the VHA, with providers outside the VHA, paid for by the VHA. Villagran et al found that less use of healthcare correlated with declines in health during women's transition out of the military.11 Another study of 283 post-9/11 veterans reported high rates of psychosocial risk factors among the women.12 VHA data from 5 million veterans connected psychosocial factors and Gulf War service with obesity for both genders.13,14 The purpose of this study was to examine gender differences in the use of VHA and non-VHA health services during the first 15 months of the transition from military to civilian life. Binge drinking was indicated as drinking 5 or more drinks for men or 4 or more for women, at least once a month.20 Some measures were not collected at baseline to minimize respondent burden. [...]obesity was measured by self-reported height and weight collected at an interim follow-up 6 months post baseline with a retrospective request for \"weight when you left the military.\"

This study assessed the Moral Injury Symptoms Scale – Military Version – Short Form’s (MISS-M-SF) factor structure and construct validity. Participants included 3650 combat-deployed U.S. veterans who answered all 10 MISS-M-SF items from the sixth wave of The Veterans Metric Initiative (TVMI). EFA results suggested a two-factor solution, based on item wording, fit best. CFA results indicated a bifactor model (one general factor and two method factors, based on item wording) fit best. Further investigation revealed that a one-factor model could be used despite the data’s multidimensionality. Item-level analyses revealed four items represented the general factor exceptionally well, potentially simplifying assessment in research and clinical applications. Construct validity was also demonstrated through moderate to high correlations with conceptually related measures.

This study assessed the effectiveness of employment programs components, which resulted in the identification of content and process components that increase employability. Employment program use was studied among 1172 United States of America military veterans to determine which content (i.e., interviewing skills) and process (i.e., working with a mentor/coach) components influence job attainment during a time of career and identity transition. Components were distilled utilizing a common components analysis approach (Morgan et al., 2018). Associations with finding employment up to 15 months after the military-to-civilian transition were explored. Veterans who engaged with employment programs were primarily accessing the following components: career planning, resume writing, and interviewing skills. However, only a few content components were significantly related to obtaining employment: interviewing (with mentor/coach), resume writing (online tools), translating military to civilian work (with mentor/coach), entrepreneurship (with mentor/coach), and virtual career fairs. Furthermore, not all processes or modes of instruction for content components were associated with success in the job market. Having a mentor/coach was one of the most effective delivery strategies. For example, veterans using programs delivered by a mentor/coach that translated military skills to civilian work were more likely to find a job at 6–9-months (84%) and 12–15-months (91%) post military separation. In addition, risks that predicted lower use of employment program components by veterans were identified such as junior enlisted rank, combat exposure, combat arms occupation, and physical health problems. With these findings, program developers, implementers, and funders can channel efforts towards the utilization of employment programs with effective components.

Objective Using an ecological resilience model, we sought to identify protective factors that buffer against the effects of stressful deployment‐related experiences on symptoms of posttraumatic stress disorder (PTSD) among active duty U.S. Air Force personnel who were married or in a committed relationship. Background Stressful deployment experiences are associated with PTSD symptoms among active duty military personnel. However, certain protective factors may buffer against negative effects of such experiences. Method Analyses for the present study were active duty military personnel who completed the 2011 Air Force Community Assessment Survey, were married or in a committed relationship, and had completed at least one deployment at the time of the survey (N = 12,166). Results Regression analyses indicated that stressful deployment experiences were statistically related to elevated PTSD symptoms but also that both personal and contextual factors moderated those symptoms. Furthermore, self‐efficacy, family coping, spouse/partner support, financial resources, and religious participation moderated the relation between stressful deployment experiences and PTSD symptoms. Conclusion PTSD symptoms were positively associated with stressful deployment experiences, and symptoms were less likely to occur when service members experienced support from individual, family, and community sources. Implications Interventions that promote self‐efficacy and social support from multiple ecological contexts may help reduce PTSD symptoms among combat‐exposed Air Force personnel.