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Hidden Heroes: America's Military Caregivers

by Terri Tanielian Rajeev Ramchand Michael P. Fisher Christine Anne Vaughan Thomas E. Trail Caroline Epley Phoenix Voorhies Michael William Robbins Eric Robinson Bonnie Ghosh-Dastidar

Little has been reported about "military caregivers"--the population of those who care for wounded, ill, and injured military personnel and veterans. This report summarizes the results of a study designed to describe the magnitude of military caregiving in the United States today, as well as to identify gaps in the array of programs, policies, and initiatives designed to support military caregivers.

How Schools Can Help Students Recover from Traumatic Experiences

by Terri Tanielian Lisa H. Jaycox Bradley D. Stein Lindsey K. Morse

This tool kit describes how trauma exposure impacts students' performance and behavior and provides a compendium of programs for schools to support the long-term recovery of traumatized students. It also compares the programs with one another.

Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery

by Lisa H. Jaycox Terri Tanielian

Since October 2001, approximately 1.64 million U.S. troops have been deployed for Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) in Afghanistan and Iraq. Early evidence suggests that the psychological toll of these deployments many involving prolonged exposure to combat-related stress over multiple rotations--may be disproportionately high compared with the physical injuries of combat. In the face of mounting public concern over post-deployment health care issues confronting OEF/OIF veterans, several task forces, independent review groups, and a Presidential Commission have been convened to examine the care of the war wounded and make recommendations. Concerns have been most recently centered on two combat-related injuries in particular: post-traumatic stress disorder and traumatic brain injury. With the increasing incidence of suicide and suicide attempts among returning veterans, concern about depression is also on the rise. The study discussed in this monograph focuses on post-traumatic stress disorder, major depression, and traumatic brain injury, not only because of current high-level policy interest but also because, unlike the physical wounds of war, these conditions are often invisible to the eye, remaining invisible to other servicemembers, family members, and society in general. All three conditions affect mood, thoughts, and behavior; yet these wounds often go unrecognized and unacknowledged. The effect of traumatic brain injury is still poorly understood, leaving a large gap in knowledge related to how extensive the problem is or how to address it. RAND conducted a comprehensive study of the post-deployment health-related needs associated with these three conditions among OEF/OIF veterans, the health care system in place to meet those needs, gaps in the care system, and the costs associated with these conditions and with providing quality health care to all those in need. This monograph presents the results of our study, which should be of interest to mental health treatment providers; health policymakers, particularly those charged with caring for our nation's veterans; and U.S. service men and women, their families, and the concerned public. All the research products from this study are available at http://veterans.rand.org. Data collection for this study began in April 2007 and concluded in January 2008. Specific activities included a critical review of the extant literature on the prevalence of post-traumatic stress disorder, major depression, and traumatic brain injury and their short- and long-term consequences; a population-based survey of servicemembers and veterans who served in Afghanistan or Iraq to assess health status and symptoms, as well as utilization of and barriers to care; a review of existing programs to treat servicemembers and veterans with the three conditions; focus groups with military servicemembers and their spouses; and the development of a microsimulation model to forecast the economic costs of these conditions over time. Among our recommendations is that effective treatments documented in the scientific literature, evidence-based care--are available for PTSD and major depression. Delivery of such care to all veterans with PTSD or major depression would pay for itself within two years, or even save money, by improving productivity and reducing medical and mortality costs. Such care may also be a cost-effective way to retain a ready and healthy military force for the future. However, to ensure that this care is delivered requires system-level changes across the Department of Defense, the Department of Veterans Affairs, and the U.S. health care system.

Invisible Wounds of War: Summary and Recommendations for Addressing Psychological and Cognitive Injuries

by Terri Tanielian Lisa H. Jaycox Grant N. Marshall M. Audrey Burnam Terry L. Schell

Summarizes key findings and recommendations from Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery (Tanielian and Jaycox [Eds.], MG-720-CCF, 2008), a comprehensive study of the post-deployment health-related needs associated with post-traumatic stress disorder, major depression, and traumatic brain injury among veterans of Operations Enduring Freedom/Iraqi Freedom.

Military Caregivers: Cornerstones of Support for Our Nation's Wounded, Ill, and Injured Veterans

by Margaret C. Harrell Racine Harris Carra S. Sims Michael P. Fisher Rajeev Ramchand Terri Tanielian

Military caregivers are an essential part of our nation's ability to care for returning wounded warriors. Far too often, their own needs are neglected. The RAND Corporation and the Elizabeth Dole Foundation lay the groundwork to inform policy and program development relative to the needs of military caregivers that often differ from the needs of the general caregiving population.

Physical and Psychological Health Following Military Sexual Assault: Recommendations for Care, Research, and Policy

by Terri Tanielian Terry L. Schell Coreen Farris

This paper reviews data on the prevalence of sexual assault among servicemembers, predictors of disclosure, efforts to improve disclosure, victim needs and DoD efforts to provide necessary resources in the immediate aftermath of a sexual assault. The authors compared civilian and DoD guidelines for care and found them to be generally consistent. However, little is known about the fidelity with which DoD recommendations are implemented.

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