Bereaved UK military families: A mixed methods study on the provision of practical and emotional support.

Traumatic deaths of military personnel can have tragic consequences for the lives and health of bereaved significant others. To mitigate the effects, the UK Armed Forces enhanced the support for bereaved military families. However, little is known about whether the support has been satisfactory. The present research applied mixed methods to explore the experiences of bereaved UK military families (N = 264) with different types of support and how it historically changed over time. The findings suggest that although support has improved, further improvements are required in the provision of financial information, administrative support, and access to psychological support for all bereaved family members.

Engaging veterans in the research process: a practical guide.

Aims: Provide guidance for engaging military veterans in various research teams to help overcome veterans' lack of trust in research. Methods: We draw from our combined experience to present four case studies of veteran research on sensitive topics to illustrate successful engagement with veterans. Results: For each case example, we describe veterans' contributions at different phases of research. We then share practical guidance for realizing benefits and overcoming challenges of engaging veterans in research at each phase. In our experience, successful engagement has built trust by aligning research with participants' own experience as veterans. Conclusion: Investigators wishing to engage veterans in research may benefit from the lessons presented through these case studies.

Developing an Integrated Model of Care for Veterans with Alcohol Problems.

Introduction: Veterans often do not present with alcohol problems in isolation, they may have a wide range of social, physical, and psychological needs. The aim of this study was to facilitate the development of a co-designed integrated model of care for veterans with alcohol problems. Methods: Following the development model by the Agency for Clinical Innovation, a planning symposium was held in North East of England to engage health and social care planners, public health leads, clinical commissioning groups and providers. Service users were empowered in discussions to provide insights and look for solutions (N = 43). Results: Using diagramming techniques, three examples of health and social care provision were created demonstrating the current commissioning landscape, one veteran's experience of accessing services and a proposal for a new integrated model of care for veterans with alcohol problems. Discussion: By engaging stakeholders and service users, the model proposed a potential solution to reducing the number of veterans 'falling through the gaps' or disengaging from services. The collaborative approach highlighted the difficulties in navigating the current complex health and social care systems. The co-designed hub and spoke model aims to enable alcohol misuse services to adapt and evolve so that they better fit the needs of veterans.

Rehabilitation and transition in military veterans after limb-loss.

PURPOSE: This study aims to explore the physical, psychological and social wellbeing of veterans who have experienced limb-loss and to ascertain the factors that contribute to the ability of veterans to maintain their independence at various stages in their lives. METHODS: Sixty two life-story interviews were conducted with 32 veterans (aged between 40 and 95) who had experienced limb-loss either during or after military service. RESULTS: Three overarching superordinate themes and related sub-themes were generated from a detailed Framework Analysis "Barriers to transition" describes issues related to employment, legal support and compensation, stigma and loss of identity. "Disparity of care" highlights the issues related to military and civilian care and prosthetics service user experience. The final superordinate theme, "Enduring challenge of limb loss," considers stoicism, dealing with pain, mobility, physical isolation and social networks. CONCLUSIONS: The outcomes offer an opportunity to shape future health and social care policy around the requirements of veterans who have experienced limb-loss by understanding the complexity, and ascertaining the factors that contribute to, maintaining long-term independence.Implication for RehabilitationThe outcomes offer an opportunity to shape future health and social care policy around the requirements of veterans who have experienced limb-loss by understanding the complexity, and ascertaining the factors that contribute to rehabilitation and maintaining long-term independence.

Housing Needs of Ageing Veterans Who Have Experienced Limb Loss.

Military veterans can experience limb loss as a direct result of conflict, an accident, illness or injury. Whatever the cause, there is a need to recognise the long-term consequences and challenges of limb loss on maintaining independence in one's home. This study aimed to examine the housing needs of veterans experiencing limb loss, and the impact of limb loss on housing needs and home adaptations of ageing military veterans. Thirty-two military veterans (aged 43-95) participated in this study and up to three life-story interviews were carried out with each participant. Two themes were generated: availability of support and changing housing needs. It is evident from the findings that military veterans are unique in various ways, specifically due to military culture, geographical relocation and the additional support that is available to the Armed Forces Community. This must be considered in long-term support to maintain independence in the home.

Utilisation of the principles of the Armed Forces Covenant in NHS Trusts and Clinical Commissioning Groups across England: a freedom of information investigation.

OBJECTIVES: To determine the extent to which National Health Service (NHS) service providers appoint a named Armed Forces veteran lead or champion, and to explore the commissioning of veteran-specific services by Clinical Commissioning Groups. DESIGN: A convergent mixed method design was used to improve understanding obtained from the information provided by respondents on their practice. The study comprised two parts: phase 1 involved NHS Trusts, and phase 2 involved Clinical Commissioning Groups. SETTING: All NHS Trusts and Clinical Commissioning Groups in England were contacted using a freedom of information request. PARTICIPANTS: All NHS trusts and Clinical Commissioning Groups across England. INTERVENTIONS: Initially, existing national websites were searched to gather information within the public domain. An audit was carried out, using the Freedom of Information Act (FOIA) 2000 to gather further information. PRIMARY AND SECONDARY OUTCOME MEASURES: The FOIA 2000 applies to UK Government departments and public authorities, including NHS Trusts in England, Wales and Northern Ireland. RESULTS: Responses from the freedom of information requests illustrate inconsistencies in relation to adopting the principles of the Armed Forces Covenant. The inconsistencies extend to the practice of appointing an Armed Forces Veteran Lead or an Armed Forces Veteran Champion. There is also evidence to suggest a lack of commitment to and understanding of policy guidance in relation to Clinical Commissioning Group responsibility for commissioning veteran-specific services. CONCLUSIONS: Findings from this study support the case for making improvements to, and improving the consistency of, commissioning practices for veterans.

Resisting decline? Narratives of independence among aging limbless veterans.

'Maintaining independence' is a core project for many older people; a project which has received critical attention within aging studies. In this paper, we extend the critique by exploring how aging intersects with disability and militarism as additional critical subjectivities. The empirical focus of the paper is the narratives of older military veterans who had lost a limb either during or post-service. Data reveal the long legacy of military experience in the lives of these veterans; a legacy which is manifested in both negative and positive outcomes. A dominant narrative of 'struggling against decline' is identified, while 'minimization', 'victimhood', and 'life-as-normal' emerged as further narrative types through which veterans articulated their experiences of aging with limb loss. Findings from this study highlight both resilience and vulnerability as features of older veterans' experiences of aging with limb loss. Building on previous critiques, we add further nuance to understandings of how older people might respond to the narrative of decline, and illustrate multiple possible meanings of claims to 'normality'. By sharing the stories of older limbless veterans, we aim to contribute to - and connect - several fields of study including aging studies, critical disability studies, and critical military studies. Findings are discussed in light of current trends in each of these fields.

Are veterans different? Understanding veterans' help-seeking behaviour for alcohol problems.

Alcohol misuse in the United Kingdom's veteran community is not an isolated phenomenon. Internationally, alcohol and wider substance misuse would appear to be an historic and current global issue within veteran communities. Although research has been undertaken both in the United Kingdom and the United States into why veterans are reluctant to seek help for mental health problems, little is understood as to why veterans encounter difficulties in engaging with treatment for alcohol misuse. The aim of this study was to understand why veterans in the United Kingdom are either reluctant or have difficulty in accessing help for alcohol problems. An applied social policy research methodology was used, employing in-depth semi-structured interviews with 19 UK veterans in the North East of England, who had a history of alcohol misuse. The findings showed that participants appeared to excuse or normalise their excessive alcohol consumption, which led to a delay in meaningful engagement in substance misuse services, resulting in complex and complicated presentations to health and social care services. The findings of this study clearly suggest that veterans who misuse alcohol have a range of distinctive and unique difficulties that subtly differentiate them from the wider civilian substance misuse population, and that the use of peer-support models would appear to mitigate against them disengaging from alcohol treatment services.

Application of a new resource-constrained triage method to military-age victims.

OBJECTIVE: Evaluate the resource-constrained, evidence-based, and outcome-driven Sacco Triage method (STM) for military-age victims of blunt, penetrating, and blast overpressure-like trauma. METHODS: STM is based on a mathematical model of resource-constrained triage. Its objective is to maximize expected survivors given constraints on transport and treatment resources. STM uses estimates of time-dependent victim survival probabilities and expected deteriorations. A respiration, pulse, and best motor response (RPM) score predicts survivability. Logistic function-generated survival probability estimates from 99,369 military-age victims were assessed using calibration and discrimination statistics. The consensus building Delphi method was used to provide aggregate expert opinion on victim deterioration rates. The models were solved using linear programming. Rule-based (not requiring software) protocols were determined using a greedy algorithm for Iraqi combat scenarios, and simulations enabled comparison of STM to the widely known Simple Triage and Rapid Treatment (START) method. RESULTS: RPM was an accurate predictor of survival probability, equivalent to the Revised Trauma Score and exceeding the Injury Severity Score. In 18 simulations, STM and STM rule-based protocols increased survivorship over START from 20% to an 18-fold increase. CONCLUSIONS: STM offers lifesaving and operational advantages for military-age victims of blunt, penetrating, and blast overpressure-like trauma.