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OCR for page 121
7
Postdeployment Reintegration
INTRODUCTION
Family- and Work-Related Problems of Deployment
Although it has come to be well understood that deployments to combat or
operations other than war can be highly stressful experiences, the challenges of
the return home for service members and their families are frequently given less
attention. Nonetheless, aspects of readjustment to the home environment have
proved to be significant sources of concern to returning veterans. Many return-
ing Vietnam veterans struggled with relationships with their bosses, coworkers,
wives, family, and sexual partners (Egendorf, 1982~. Egendorf and colleagues'
interview of veterans for their Legacies of Vietnam study found that about 50
percent of the veterans interviewed showed signs of disturbing, unresolved war
experiences that affected their everyday lives (Egendorf et al., 1981~. The Na-
tional Vietnam Veterans Readjustment Study found that 45 and 37 percent of
men and women, respectively, serving in the Vietnam theater reported having at
least one serious postwar readjustment problem and that roughly one in four
Vietnam theater veterans continued to experience at least one such problem
when they were surveyed in 1990 (Kulka et al., 1990~. Veterans who were ex-
posed to war-zone stress displayed poorer levels of adjustment in family roles
and marital relationships than civilians or veterans from the same era who were
not deployed to Vietnam (Kulka et al., 1990~.
After the Gulf War, veterans reported concern about family-related matters,
money, and employment. In one group, although 12 percent suffered moderate
or severe war-zone stress reactions, 19 percent experienced moderate or severe
family adjustment problems (Figley, 1993b).
Although no two deployments are alike, some of the experiences of recent
deployments may be helpful when considering future needs and possible pre-
ventive interventions. Separation from family has always been an important
stressor during deployments, but the changing makeup of the deployed force has
led to some new challenges. During the Gulf War, the percentages of deployed
women and reserve-component service members were larger than they have ever
121
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122 STRATEGIESTOPROTECTTHEHEALTHOFDEPLOYED U.S. FORCES
been. About 7.2 percent, or roughly 50,000 of the 670,000 service members de-
ployed were women, 9.8 percent were members of the Reserves, and 6.2 percent
were members of the National Guard (Gray et al., 1998~. More single parents
and military career couples were also among the deployed than in the past
(Figley, 1993b). For example, 16 percent of Vietnam veterans were married with
children during their service in Vietnam (U.S. Department of Defense, 1991),
whereas 60 percent of Gulf War service members were married with children
during their service in the Gulf (Dove et al., 1994a,b).
The first major deployment of women in a war was during the Gulf War,
which also took a different type of toll on some families, in that significant
numbers of men or extended family members were left in unaccustomed roles of
caring for young children or infants. For financial reasons, many of these fami-
lies chose to leave military bases to join relatives, but this placed them some
distance from the support services available at the bases (Scurf~eld and Tice,
1992~. Upon the return of service members from deployment, families needed to
readjust both to changed roles and often to changed locations. For the more than
20,000 single parents or almost 6,000 couples deployed to the Gulf (U.S. De-
partment of Defense, 1991), finding appropriate long-term child care was an
additional source of stress before, during, and, perhaps, after deployment.
The health and well-being of the family members left behind is often a chief
concern of deploying service members. Some have mentally or physically dis-
abled dependents (elderly parents, special-needs children) whose medical care is
a particular worry. The availability of adequate support services for these fami-
lies during the deployment and into the reintegration period is crucial
(Holloway, 1999~.
The unprecedented call-up of National Guard and Reserve units for the Gulf
War had a strong effect on service members and their families. Even after the
fall of the Berlin Wall, many reserve personnel were under the impression that
they were a reserve to the active component, to be called only in case of another
world war. Following notification that they would be deployed, their unit mobi-
lization plans included 30 to 90 days of training before deployment. Therefore,
they had never planned to deploy in just a few days' time (Meyer, 1999~. Others
had not anticipated that they would ever be called to a regional conflict and felt
inadequately prepared, either emotionally or in terms of training, for participa-
tion in warfare (Scurf~eld and Tice, 1992~. Extremely rapid deployment of
troops (some within 36 hours) allowed little preparation for departure. Reserve
component members thus frequently left behind disrupted families and careers.
This rapid deployment also affected thousands of service members and their
families who served in European theaters away from combat during the Gulf
War (Ford et al., 1998~. After the deployment, many who were self-employed
returned to find their businesses in trouble (Yerkes and Holloway, 1996~. A re-
cent literature review considering stress and the Gulf War postulates reservists
and reserve units to be at greater risk for stress reactions for the several reasons
cited above (Marshall et al., 1999~.
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POSTDEPLOYMENT REINTEGRA TION
Effects of Downsizing and Increased Operational Tempo
123
The National Guard and Reserves were not the only service members to
return home to financial uncertainty. As the Gulf War deployment came to an
end, the services were carrying out a substantial downsizing that meant many
who might have liked to continue on active duty did not have that option
(Johnson and Broder, 1 99 1; Lancaster, 1 992; Leavitt, 1 996; McCormick, 1 996;
Landay, 1997~. In 1992, when the U.S. Congress contemplated cuts of up to $15
billion in the defense budget, Defense Secretary Richard Cheney announced that
300,000 active-duty personnel would be let go to allow savings of that magni-
tude (Lancaster, 1992~. The Army active-duty force was reduced from 800,000
people at the height of the Gulf War to about 500,000 by the end of 1995. In
April 1995, Defense Secretary William Perry notified the Army that it must pre-
pare for further personnel cuts to 475,000 people, the smallest number of Army
personnel since 1939 (McCormick, 1996~. The numbers of Selected Reserve
personnel were at their largest (1.2 million) in 1989 (Leavitt, 1996~. However,
by 1998, the total had fallen to roughly 890,000 (Kohner, 1999a).
Decreases in support services frequently accompany decreases in numbers
of personnel. Thus, at the same time people are downsized or encouraged to
leave active duty, there are decreases in resources and support to make their
transitions easier or mitigate their effects (Holloway, 1999~. Often the people
who provide such support services are members of the reserve component, and
they are deactivated just as they are needed for the reintegration process.
At the same time that the sizes of the services have been decreasing, the op-
erational tempo of the military has increased to an historic high. Between 1960
and 1991, the Army engaged in only 10 operational events, excluding training and
alliance-related events. Since 1991, however, the Army has conducted 28 opera-
tional events. The Marines had 15 contingency operations during the years 1982 to
1989; however, since the fall of the Berlin Wall the Marines have had 62 contin-
gency operations (Baseman, 1999~. The Air Force is undergoing long-term de-
ployments such as Operations Southern Watch and Northern Watch in Southwest
Asia. The likely length of the deployment of U.S. forces as part of the North At-
lantic Treaty Organization deployment to Kosovo is unknown as of this writing.
The added deployments and contingency operations have come at a time
when the number of Army divisions has been reduced from 18 to 10, the number
of Navy ships has been cut from 546 in 1992 to 333 today, and the number of
Air Force fighter wings has been slashed from 25 to 13. The quality of life of
members of the military is slowly eroding because of the increased operational
tempo and the continued reduction in personnel and resources (Baseman, 1999~.
The health of veterans themselves is another particular challenge of home-
coming. After the return of the military from deployment to Panama, families
reported concern and confusion over symptoms exhibited by some of the re-
turned service members. Symptoms included isolation, moodiness, detachment,
and sleep disturbances (Scurf~eld and Tice, 1992~. The symptoms experienced
by many Gulf War veterans also caused considerable concern to families, con
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124 STRATEGIESTOPROTECTTHEHEALTHOFDEPLOYED U.S. FORCES
cern that was heightened following reports of"mystery illnesses" that began to
appear in the media in the years following the return of service members from
the Gulf War.
Given the array of challenges described above, the period of return and re-
integration after a deployment is a time when service members face particular
hardships. The section that follows reviews the literature for available evidence
about steps that might be effective in assisting service members upon their re-
turn. A description of the programs that are currently in place in the military to
help service members with reintegration follows.
MILITARY REUNION AND REINTEGRATION
LITERATURE REVIEW
Information Gathering
Psychological, sociological, and medical literature databases were surveyed
for information on reintegration and reunion topics for the period from World
War II to the present. Databases were accessed through the National Library of
Medicine's MedLine, the American Psychological Association's PsycFirst,
PsycINFO, and PsycLit, and from Sociological Abstracts, Inc.'s Sociological
Abstracts database.
Few studies on reintegration into the home environment for nonmilitary
workers have been published in the searched literature. Similarly, few studies on
the reintegration of military personnel of other countries were found. As a result,
the literature review that follows primarily reflects findings from studies of U.S.
military personnel and their families.
Coping with family separations and reunions is a frequent reality of military
life. Although much has been written on the process of separation of family and
the service member in terms of emotional outcomes and coping strategies, there
is relatively little systematic research on the specific theme of reunion-
reintegration and emotional behavior (Mateczun and Holmes, 1996~. The fol-
lowing summarizes the current understanding of features of reunion and reinte-
gration based on information found in the literature.
Family Factors
The nature of a service member's homecoming is related to the terms on
which she or he left the family. The type and frequency as well as the interper-
sonal tone of communication during the period of separation also shapes expec-
tations upon return. Leaving home at a time of unresolved conflict can result in
hurtful discussions and angry feelings with family members while the service
member is away. Leaving home on good terms enhances communication and,
consequently, facilitates a pleasant homecoming (Yerkes and Holloway, 1996~.
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POSTDEPLOYMENT REINTEGRA TION
125
Families are encouraged to write letters, send electronic mail, telephone, and
send audiotapes. Service members are encouraged to do the same, but it is sug-
gested that they address the family members individually to personalize their
communications (Black, 1993~.
An easy transition back into the home environment also depends on how
well a family has adapted to the long absence. Studies of prisoners of war
(POWs) suggest that longer separations require more time for a family to reach
equilibrium upon the POW's release and return (McCubbin et al., 1975; Nice et
al., 1981~. Wives of POWs who have children or wives of POWs who work or
who are more active and socially oriented through community activities, family
support groups, and church functions cope better than those who do not perform
such activities (Black, 1993; Figley, 1993b; Wood et al., 1995~. Work by Hunter
(1984) indicated that those at great risk for poor adaptation to the separation
were "immature, extremely dependent spouses, foreign-born spouses, and
spouses who were isolated within a civilian community and expected veterans to
make up for lost time by devoting more time to family matters" (Mateczun and
Holmes, 1996, p.376~.
Factors in the marital relationships of POWs were also relevant for success-
ful readjustment. Spousal agreement on the husband's future career plans was
crucial, and agreement on relationship roles was more important than who actu-
ally performed the roles (Hunter, 1984; Mateczun and Holmes, 1996~.
Reunion Period
The literature indicates that during the reunion period, the service member
goes through three phases: return, readjustment, and reintegration (Mateczun
end Holmes, 1996~.
Return Phase
The return phase of reunion entails the anticipation of the reunion and the
actual physical reunion of those who have been separated. This is a stressful
period because changes in both the service member and his or her family have
taken place during the separation, and there is apprehension about what these
might be and how they will be responded to (Mateczun and Holmes, 1996~.
Readjustment Phase
The readjustment phase is the time during which service members and their
families tend to modify their behavior to fit back into a lifestyle together. As
mentioned above, each family member will have changed over the course of the
separation. The readjustment period involves reaching an understanding that
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126 STRATEGIESTOPROTECTTHEHEALTHOFDEPLOYED U.S. FORCES
these changes have occurred and allowing time to establish homeostasis (Figley,
1993a; Mateczun and Holmes, 1996~. During the readjustment phase, the re-
turning service members typically experience initial culture shock and emotional
overload that may cause the spouses to be emotionally separate. Some couples
may have some sexual difficulties during this time. These may be due to factors
such as unresolved feelings about the separation, known and unknown marital
infidelities, or unresolved, unchannelled aggression (Peebles-Kleiger and Klei-
ger, 1994~. In some families, however, the opposite may occur during the read-
justment phase. There may be feelings of physical closeness, euphoria, and ex-
citement with children and spouses. Couples may go through a honeymoon
phase during which talking and reestablishment of intimacy take place until the
first argument sets in.
Reintegration Phase
The reintegration phase is a time when the service member eases his or her
way back into a routine, and returns to the day-to-day civilian or garrison life. To
avoid upsetting the balance established during the service member's absence, the
veteran must slowly work his or her way back into the family. The married couple
works to reestablish intimacy as children and parents also try to reestablish famili-
arity and connectedness (Peebles-Kleiger and Kleiger, 1994~. Families may need
to be reminded to give each other some time to get reacquainted and learn the new
roles and perspectives that may have been acquired during the separation. Families
who expect changes in each other may be better able to cope with those changes
and renegotiate their new relationship (Blount et al., 1992~.
Ordinarily, changes in the handling of financial matters, household chores,
and other responsibilities among family members have been made while the
service member has been away, and attempts to maintain a lifestyle like the one
before the separation may no longer be welcomed. The spouse who is left at
home as the head of the household often matures, develops greater independence
and self-confidence, and provides a different lifestyle for his or her family in the
absence of the spouse (Boss et al., 1979; Nice et al., 1981; Ford et al., 1993;
Wood et al., 1995~. A reliance on negotiation and compromise to work toward
sharing the responsibilities can help during the reintegration phase.
Although the return home from a deployment and reintegration into the
home and work environment are challenging enough for the typical active-duty
service member, they pose particular challenges for those who retire or who are
discharged from the military upon their return. These persons must not only re-
adjust to the family and home routine but must also begin an entirely new work
life, with the attendant stresses of the job search and a new set of expectations in
a very different work culture (Wolfe, 1 99 1; Figley, 1 993b).
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POSTDEPLOYMENT REINTEGRA TION
127
Return of the Wounded or Ill
Veterans who are wounded or ill also face special challenges. Family and
coworkers expect a quick return to normal and wonder why, once the physical
wounds are healed, the returned service member is not the same as before the
deployment. Complete healing may come slowly for some, if at all. Approxi-
mately 479,000 (15.2 percent) of the estimated 3.14 million men who served in
the Vietnam theater had posttraumatic stress disorder (PTSD) in 1990. An esti-
mated 8.5 percent (610) of the 7,166 women who served in Vietnam had PTSD
in 1990 (Kulka et al., 1990~.
Role of Family in Readjustment
Families have an important role in promoting readjustment behaviors in the
returned service member. This role can be manifested in four related ways: (1)
detecting traumatic stress, (2) confronting the trauma, (3) urging the recapitula-
tion of the tragedy, (4) facilitating resolution of the trauma-inducing conflicts
(Figley, 1995~.
Changed patterns of behavior can be detected because family members are
aware of each others' habits and dispositions and can easily detect a behavior
change or traumatic stress once the family member has returned from the deploy-
ment (Figley, 1995~. Once the behaviors are recognized, family members are in a
position to confront the traumatized person about them either by approaching him
or her directly or in a more subtle and indirect manner (Figley, 1995~. Families can
promote readjustment behavior by encouraging the traumatized veteran to summa-
rize what had happened before the return through answering five basic questions:
(1) What happened to me that was so traumatic? (2) Why did it happen to me? (3)
Why did I and others in the same situation act as we did? (4) Why have I acted as I
have since then? (5) If something like this happens again, will I be able to cope
more effectively? (Figley, 1988, 1995~. Addressing these questions may be more
difficult when the behavior change is a response to more subtle challenges than a
particular traumatic event. For example, the veteran could be disappointed that the
family he or she returned to differs from the one that he or she remembered and
envisioned while on deployment.
Finally, families can help in facilitating resolution of the internal conflicts.
For example, they can help with the healing by providing more positive or opti-
mistic ways to view the stressful events and their consequences (reframing)
(Figley, 1995~. With supportive listening, they can help the traumatized person
with clarifying insights and help with more appropriate assignment of blame and
credit (Figley, 1995~.
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128 STRATEGIES TO PROTECT THE HEALTH OF DEPLOYED U.S. FORCES
Family Roles in Readjustment in Non-Military Settings
Like families of military personnel, family members of corporate executives
also must frequently reorganize the family system when a spouse is away on
business. Although the absences are often not as prolonged as in military sepa-
rations, a spouse is sometimes gone long enough to require a reorganization of
family roles. Boss and colleagues used a coping inventory to study 66 corporate
wives. A factor analysis indicated that wives coped with the stress of routine
absence of a husband or father by fitting into the corporate lifestyle, developing
maturity and interpersonal relationships, and establishing independence (Boss et
al., 1979~. Although several studies of coping behaviors for separations in the
civilian community have been conducted, research is lacking concerning family
coping upon reintegration (Boss et al., 1979; Mateczun and Holmes, 1996~.
Prevention of War-Related Stress for Family Members
No studies have confirmed the effectiveness of specific programs for pre-
venting war-related stress for families of service members (Figley, 1993b). How-
ever, Figley describes several factors associated with lower levels of family mem-
bers' stress due to separation and reintegration: (1) preparation of the service
member and his or her family for all aspects of deployment with briefings and
educational materials; (2) frequent contacts with other families in similar situa-
tions to provide support groups for families and service members; (3) provision of
educational programs for the community so that it can support and encourage the
families of service members; (4) provision of accurate and timely information
about the health, safety, and return schedule of the service member; and (5) provi-
sion of a contact point for returning service members to ensure provision by the
military of adequate health and human services especially for those who do not
live near military installations, for example, members of the reserves and their
families (Hill, 1949; McCubbin et al., 1974; McCubbin et al., 1976; Hunter, 1982;
Kaslow and Ridenour, 1984;Hobfolletal., l991;Wolfe, 1991~.
PROGRAMS TO ASSIST FAMILIES AND
SERVICE MEMBERS WITH REINTEGRATION
The armed services have developed various programs to assist service
members and their families through their return and to ease the transition into
the home environment. Because no studies have confirmed the effectiveness of
specific programs to help families and service members, the military programs
were developed on the basis of experience and anecdotal evidence. Few of the
programs offered by the services are mandatory. Instead, it is generally up to
service members to seek out the programs for themselves and their families.
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POSTDEPLOYMENT REINTEGRA TION
129
Navy Support Services
Some of the earliest programs to assist service members with homecoming
were developed by the Navy. The Navy's return and reunion programs are based
on three assumptions: (1) separations due to deployments are normal, even
though they are stressful events in Navy family life; (2) Navy families are not
dysfunctional; they are basically healthy families; and (3) increasing a family's
cohesion, adaptability, and communication supports the overall goal of the pro-
grams offered by the Navy (Tinney, 1998~. Because they are a part of the Navy,
Marines also have access to the Navy programs.
During deployment, several means are used to maintain communication
between families and deployed personnel. For example, the Navy established
services whereby families can make videotapes of themselves and send them to
the service member. Aboard ships service members have opportunities to do the
same. This service is rapidly being supplanted, however, by the increased use of
electronic mail and sailor phones aboard ships (Stokoe, 1999~.
This change has been evident at the world's largest naval base in Norfolk,
Virginia, which contains 300,000 sailors, Marines, civilian employees, and fam-
ily members. During the recent deployment Operation Desert Fox, the use of
electronic mail was far greater than that during any other deployment and was a
family's primary means of staying in contact with service members (Vogel,
1998~. Some service members feel that electronic mail gives them a great boost
in morale and allows them to help resolve problems at home faster because of
the faster communication with family members (Della Cava 1998~.
The Navy Family Ombudsman program is another way to keep families
abreast of relevant news and information during the deployment and the return.
The program was developed in 1970 and was standardized in 1994 to provide
each command with an official representative to provide information and refer-
rals to families, serve as a point of contact between the commands and families
during deployment, and provide newsletters that contain family information (B.
Ray, 1998~.
The Navy established the first family service center in Norfolk, Virginia,
and now has 68 centers throughout the world to provide assistance and counsel-
ing for families of service members (Tinney, 1998~. In the early 1970s, Navy
chaplains began providing informal support and help for sailors as they prepared
for the return home. In 1980, an official return and reunion homecoming pro-
gram was developed at the Norfolk Family Service Center (Stokoe, 1999~. As
part of this program, a team of two to six individuals, usually education and pro-
gram specialists, meet with the sailors at sea and with family support groups at
home before the service member's return. They find out what some of the ap-
prehensions and common concerns are and then relay the information between
groups to provide service members and families with better coping strategies
(U.S. Army Combined Arms Command, 1991; Tinney, 1998~. The time is spent
facilitating group discussions and giving interactive presentations both in person
and through closed-circuit television (Tinney, 1998~. Programs for couples, sin
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130 STRATEGIESTOPROTECTTHEHEALTHOFDEPLOYED U.S. FORCES
ale sailors, sailors reuniting with children, and others are also available (Tinney,
1998~. Frequently, command leadership requires attendance for briefings cov-
ering financial concerns and reintegration with family (Stokoe, 1999~.
Upon their return, Navy service members go through a redeployment proc-
ess that includes checklists about their medical and dental status and any family
problems that might exist (for example, family health problems). Since the
service member is eager to return home, he or she may not necessarily bring up
problems that might delay the return (Conner, 1999~.
Lifelines is a new initiative introduced by the Secretary of the Navy. It uses
the Internet (www.lifelines4qol.org), teleconferencing, satellite broadcasting,
and cable television to respond to quality-of-life needs of active-duty members,
reservists, U.S. Department of Defense (DoD) civilian employees, and their
families. This system of care allows families and service members to access
community information and services at their own pace in their homes or local
libraries without traveling long distances (Stokoe, 1999~.
Army Support Services
The other armed services have developed similar family center programs.
The Army has provided increased support for service members and their fami-
lies since the Gulf War. New guidelines, training curricula, briefings, work-
books, and videotapes have been developed to better educate soldiers and their
families. These tools are a part of an Army-wide program called Operation
READY (Resources Educating About Deployment and You) that was developed
for both active duty and reserve component personnel including the National
Guard (Barnard, 1999~. Operation READY provides guidelines to facilitate
helping soldiers and families with issues concerning reunion into the home envi-
ronment. Using Operation READY, family centers assist families with financial
matters and other needs while the service member is deployed. Family support
groups formed at individual units, primarily at company levels, can receive help
from the Family Assistance Center staff (U.S. Army Combined Arms Com-
mand, 1991; Barnard, 1999~. Family Assistance Centers provide a contact that
families can turn to for questions and concerns, provide referrals to agencies
appropriate for their needs, and distribute monthly newsletters that provide accu-
rate information about the troops during a deployment (U.S. Army Combined
Arms Command, 1991~.
Air Force Support Services
The Air Force family support centers provide a variety of programs for
service members from all branches of the military. There are programs for relo-
cation assistance, transition assistance, career focus, information and referral,
personal financial management, volunteer services, resource networks for em
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POSTDEPLOYMENT REINTEGRA TION
131
ployment, family services, and family readiness (Coyle, 1999~. An array of
services provide support related to separation and reunion. Stress management
classes are offered to couples and families during and after deployment to help
in coping with the stresses of separation and reunion. At Boiling Air Force Base,
the First Sergeant's Adopt an Airman program offers service members of all
ranks an opportunity to talk about their deployments with a first sergeant and
discuss fears and anxieties about returning home. The first sergeant acts as a
liaison for higher-ranking officials and enlisted members (Coyle, 1999~. The
Hearts Apart program provides support groups to help families express their
feelings and concerns during a deployment and prepare them for their reactions
when their loved ones come home. The readiness program also provides video
teleconferencing, video electronic mail, and international calling cards for fre-
quent communication while the service members are away.
Programs to Help Support National Guard and Reserves
The three services have developed many programs to assist active-duty serv-
ice members and their families in coping with the emotional and mental chal-
lenges of reintegration and reunion after a deployment. Although all components
have addressed these issues to some degree since the Gulf War, the provision of
support services in the National Guard and Reserve has been more inconsistent
(Ogilvy-Lee, 1999~. Individuals who join National Guard and Reserve units are
civilians with regular jobs outside of military life. They frequently do not live
close to military bases. When they are called to military duty they are given the
assurance that their jobs will be waiting for them when they return. By law, their
jobs are protected for 5 years, but even with this legal protection, some reserve
members have reported subtle discrimination that is difficult to prove (Barnard,
1999~. Members of the reserves who own their own businesses may return from
service to find that their businesses have failed (Ogilvy-Lee, 1999~.
The Army Reserve uses the Operation READY training program to prepare
soldiers and their families for deployment and reintegration. The Army Re-
serve's Family Readiness Offices are located at its Regional Support Commands
and 7th ARCOM (Army Reserve Command) in Germany. These Family Readi-
ness Offices manage the mobilization assistance program (deployment assis-
tance) for family members. They also manage the unit Family Support Group
Programs that are essential in the Army reserve and receive strong program and
command emphasis. Since units are geographically dispersed, the unit support
groups are important in reaching out to help family members directly. Deployed
soldiers maintain contact with family members by telephone and through infor-
mational mailings (e.g., newsletters). Operation READY reunion materials are
used by family support group volunteers to help family members prepare for the
soldiers' return. Soldiers are now provided reunion briefings at the demobiliza-
tion station used for all Army Reserve soldiers returning to the United States
after a deployment. Chaplains and Family Readiness Offices coordinate reunion
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132 STRATEGIESTOPROTECTTHEHEALTHOFDEPLOYED U.S. FORCES
workshops for both soldiers and family members about 6 weeks after redeploy-
ment (which is often the time of the end of the "honeymoon phase"), as re-
quested by the units when problems begin to appear in families (Barnard, 1999~.
During the Gulf War in 1990 and 1991, the deployment of many more Air
Force reservists than in previous deployments raised concerns about providing
support for their reintegration to the home environment. Although no official
programs were in place for the Air Force Reserves immediately following the
Gulf War, programs to provide help in separation and reintegration issues began
in 1993 in response to a survey that showed a need for family support-type pro-
grams (Bassett, 1998~. Rather than relying on volunteers, the Air Force Reserve
Family Readiness Program employs professionals to provide help in separation
and reintegration issues for Air Force reservists and their families. Counseling
and educational workshops as well as relevant resource materials are available
on installations. In contrast to the other service reserves and National Guard, Air
Force Reserve personnel are located on active-duty installations and air reserve
bases, thus enabling ready access to programs and support (Bassett, 1998~.
The Navy and Marine Reserve forces are provided with the same family
service centers, support groups, and programs provided to Navy active-duty forces
if they have been deployed continuously for 2 weeks or more. As with the Army
Reserves, however, there are problems of access for those reservists and their
families who live far from a base. However, activities such as the Reserve Mobili-
zation Exercises (drills and exercises that help reservists prepare for deployment)
and the newly begun Lifelines have the potential to provide greater access to pro-
grams that help reservists and their families during deployment and reintegration.
The National Guard has a dual federal and state role and mission and is made
up of the Army National Guard and the Air National Guard. During a period of 1
year from late August 1990 through August 1991, the National Guard set up 471
family assistance centers and served 257,731 military family members from all
services throughout the 54 U.S. states and territories (Ogilvy-Lee, 1999~. Each
state and territory has a full-time State Family Program Coordinator, who oversees
the unit family support programs. Support at the unit level for the Guard members
and their families is provided to a significant degree by specially trained volun-
teers, who are assisted by a unit military member trained in family assistance.
Training workshops, booklets, and referral within the state and the local commu-
nity are used extensively to assist and support Guard members and their families.
Guard units also have Operation READY program materials available to them. As
noted by other directors of readiness programs within the reserve component, not
enough family program funding and full-time employees are available to provide
the support needed for the National Guard (Ogilvy-Lee, 1999~.
VA Support Programs
The U.S. Department of Veterans Affairs (VA) also has programs to assist
in the return and reintegration of service members into the home environment
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133
after deployments. The U.S. Congress authorized the establishment of Vet Cen-
ters in 1979 to provide readjustment counseling, particularly for needs sur-
rounding war-related psychological trauma including PTSD (Flora, 1999~. Vet
Centers are administered by the VA's Readjustment Counseling Service (RCS),
and are community-based, nonmedical facilities intended to provide maximum
ease of access for local veteran populations and to emphasize postdeployment
rehabilitation in an informal setting.
Currently, 206 Vet Centers in the United States and its territories provide
services to veterans (both active-duty and reserve) of deployments to World War
II, the Korean War, Vietnam, the Gulf War, Lebanon, Grenada, Panama, and
Somalia (U.S. Department of Veterans Affairs, 1998a,b; Flora, 1999~. The
services include assessment for PTSD, counseling and psychotherapy, family
counseling, educational and supportive counseling to help veterans with current
civilian life, employment and educational counseling, and multiple referral
services (Flora, 1999~. Community outreach and local networking are important
components of the services provided by the Vet Centers as are collaborations
with local VA medical facilities. The Vet Centers serve as the community access
point for VA health care for many veterans (Flora, 1999~.
Vet Centers are typically staffed by a four-person team with a team leader,
two counselors, and an office manager. Vet Center teams include psychologists,
social workers, nurses, and other professional counselors and paraprofessionals.
Roughly 80 percent of all Vet Center counselors and team leaders are veterans
and about 60 percent have served in combat theaters (Flora, 1999~.
Vet Centers serve approximately 130,000 veterans each year and interact
with more than 700,000 veterans and family members. The Vet Centers also
make over 100,000 referrals to VA medical facilities each year. More than
96,000 Gulf War veterans have been seen at Vet Centers since April 1991.
There are some indications that Vet Centers are helpful to veterans. Ac-
cording to a Vet Center Readjustment Counseling Service client satisfaction
survey, more than 90 percent of veterans seen at Vet Centers said that they
would recommend the Vet Center to other veterans. Also, the Gulf War veter-
ans' prospective PTSD study, undertaken by RCS in collaboration with the
VA's National Center for PTSD, found that the rate of PTSD decreased in a
treatment-seeking veteran group (Litz et al., 1995~. In addition, the final report
of the Presidential Advisory Committee on Gulf War Veterans' Illnesses
(1996b), praised the outreach services that the Vet C~enters were nrovidin~ to
contact and inform Gulf War veterans.
After the Gulf War, the U.S. Congress established an additional readjust-
ment counseling resource specifically for Gulf War veterans. The Persian Gulf
Family Support Program operated from October 1992 to September 1994 to
provide services such as those carried out at Vet Centers as well as Gulf War
illness-related outreach from 36 VA medical centers. The outreach included
briefings for National Guard and Reserve units, local veterans service organiza-
tion chapters, and grassroots family support groups. At day-long Persian Gulf
Health Days, educational seminars on illnesses, traumatic stress, and VA bene
~. ~
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134 STRATEGIESTOPROTECTTHEHEALTHOFDEPLOYED U.S. FORCES
fits were held for veterans and the general public. Veterans were able to enroll in
the VA Registry at those seminars (Presidential Advisory Committee on Gulf
War Veterans' Illnesses, 1 996b).
Although evaluation of that program is beyond the scope of this report, the
study team suggests that elements of the program found to be effective be im-
plemented during rather than after future large deployments and given the flexi-
bility to continue as long as the needs remain apparent. Special strengths of the
Persian Gulf Family Support Program were its availability for both National
Guard and Reserve components, its family-focused interventions, and its out-
reach. Screening tools were used to help identify problems of individuals and
families and assess program effectiveness to some extent (Altheimer, 1999;
Murphy, 1999; Rathbone-McCuan, 1999~. Lessons learned from the program
should be applied to similar programs in the future. However, since the final
report of the program was presented to the U.S. Congress in 1994, no evalua-
tions of the Persian Gulf Family Support Program have been conducted
(Murphy, 1999; Rodell, 1999~.
The plan recently released by an interagency working group in response to
Presidential Review Directive 5 includes mention of the reintegration of service
members after deployments. Among the goals articulated in the Deployment
Health chapter is to "Preserve the health and well-being of those who have
served and their families" (National Science and Technology Council, 1998, p.
12~. Several related objectives with associated strategies are presented to address
this goal:
Strategy 3.1.1: Develop interagency solutions to provide access to the appropriate
levels of financial support, health services, and readjustment counseling for mili-
tary service members' transition to future military service or civilian life.
Strategy 3.1.2. Establish a combined DoD [U.S. Department of Defense], VA,
DHHS [U.S. Department of Health and Human Services] plan to respond
promptly and in a coordinated manner to both the anticipated and unanticipated
health needs and concerns of veterans returning from major deployments.
Strategy 3.2.4. Prepare DoD and VA plans for providing individual and family
counseling and mental health services for military members and members of their
families, especially in preparation for and upon the return home of the deployed
military member. (National Science and Technology Council, 1998, p. 13)
Although these strategies listed in the Presidential Review Directive 5 are
indeed sound and reasonable, to the study team's knowledge no steps have yet
been taken to carry them out.
FINDINGS AND RECOMMENDATIONS
Finding 7-1: The changing demographics of the deployed forces, increased
operational tempo, and increased reliance upon the reserve component all bring
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135
heightened needs for support services for service members and their families
both during and after deployments.
Recommendation 7-1: Planning and operational documents for military
deployments should be required to include plans for supporting the return
and reintegration of active-duty and reserve service members involved in
the deployment. These plans should specify
· anticipated problems and preventive and support strategies to deal
with anticipated and unanticipated problems;
· the resources required to carry out the strategies; and
· proposals for how the required resources will be funded and made
available.
The funding consequences of the resulting requirements should be reflected
in the regular funding cycle and in requests for supplemental funding asso-
ciated with deployments.
Finding 7-2: Since the Gulf War, the services, including the reserve compo-
nents, appear to have made progress in responding to the support needs of serv-
ice members and their families during reintegration. The resources and person-
nel to provide support to the reserve components appear to be less robust and
perhaps lacking, however, given the increasing operational tempo and reliance
upon these reserve forces.
Recommendation 7-2: As part of the planning described in Recommendation
7-1, particular attention is needed to address and provide resources for the
readjustment needs of reserve-component service members and families.
Finding 7-3: Evaluation of both the support programs and the premise for their
use appears to be limited.
Recommendation 7-3:
· Evaluate the efficacy of the readjustment programs in place on the
basis of clearly stated objectives. Currently, such evaluations exist but are op-
tional.
· Carry out research into the needs of service members and their fami-
lies during deployments and upon reintegration into the home environment.
Use the findings to reevaluate programs and policies.
Finding 7-4: It is crucial that service members returning from deployment have
seamless access to health care and support services and that they know what
services are available and how to access them. This is particularly important for
those who will no longer be part of the active-duty forces.
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136 STRATEGIESTOPROTECTTHEHEALTHOFDEPLOYED U.S. FORCES
Recommendation 7-4: As outlined by the National Science and Technology
Council, the U.S. Department of Defense and U.S. Department of Veterans
Affairs should coordinate plans to have reintegration support and health
care services available to service members upon their return and be pre-
pared to continue it while needs for such services remain widespread.
Representative terms from entire chapter:
national guard
