Veteran families with complex needs: a qualitative study of the veterans' support system.

BACKGROUND: Families with complex needs face significant challenges accessing and navigating health and social services. For veteran families, these challenges are exacerbated by interactions between military and civilian systems of care, and the density of the veterans' non-profit sector. This qualitative study was designed to gather rich, detailed information on complex needs in veteran families; and explore service providers' and families' experiences of accessing and navigating the veterans' support system. METHODS: The study comprised participant background questionnaires (n = 34), focus groups with frontline service providers (n = 18), and one-on-one interviews with veteran families (n = 16) in Australia. The semi-structured focus groups and interviews were designed to gather rich, detailed information on four study topics: (i) health and wellbeing needs in veteran families; (ii) service-access barriers and facilitators; (iii) unmet needs and gaps in service provision; and (iv) practical solutions for improving service delivery. The study recruited participants who could best address the focus on veteran families with complex needs. The questionnaire data was used to describe relevant characteristics of the participant sample. The focus groups and interviews were audio-recorded, transcribed, and a reflexive thematic analysis was conducted to identify patterns of shared meaning in the qualitative data. RESULTS: Both service providers and families found the veterans' support system difficult to access and navigate. System fragmentation was perceived to impede care coordination, and delay access to holistic care for veteran families with complex needs. The medico-legal aspects of compensation and rehabilitation processes were perceived to harm veteran identity, and undermine health and wellbeing outcomes. Recovery-oriented practice was viewed as a way to promote veteran independence and self-management. Participants expressed a strong preference for family-centred care that was informed by an understanding of military lifestyle and culture. CONCLUSION: The health and wellbeing needs of veteran families intensify during the transition from full-time military service to civilian environments, and service- or reintegration-related difficulties may emerge (or persist) for a significant period of time thereafter. Veteran families with complex needs are unduly burdened by care coordination demands. There is a pressing need for high-quality implementation studies that evaluate initiatives for integrating fragmented systems of care.

Using maintenance rehearsal to explore recognition memory.

We examined associative and item recognition using the maintenance rehearsal paradigm. Our intent was to control for mnemonic strategies; to produce a low, graded level of learning; and to provide evidence of the role of attention in long-term memory. An advantage for low-frequency words emerged in both associative and item recognition at very low levels of learning. This early emergence casts doubt on explanations based on the traditional concept of recollection. A comparison of false alarms supports a role for item information or the joint use of cues but not familiarity in producing associative false alarms. We may also have found a way to measure the amount of attention being paid to a to-be-learned item or pair, independently of memory performance on the attended item. This result may be an important step in determining whether coherent theories about the role of attention in long- and short-term memory can be created. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Contexts and control operations used in accessing list-specific, generalized, and semantic memories.

The human ability to focus memory retrieval operations on a particular list, episode or memory structure has not been fully appreciated or documented. In Experiment 1-3, we make it increasingly difficult for participants to switch between a less recent list (multiple study opportunities), and a more recent list (single study opportunity). Task performance was good, although there was a cost associated with switching. In Experiment 4, list-specific learning experiences were used to create a generalized memory as a step towards semantic memory. List-specific memories intruded during attempts to retrieve the generalized memory and the generalized memory enhanced list-specific performance. The generalized memory also intruded in a free-association task. We propose that a hierarchy of contexts and control operations underlie the human ability to access different memory structures and that there is no sharp discontinuity in the control operations needed to access list-specific, generalized, and semantic memories.

What you get out of memory depends on the question you ask.

Following study, participants received 2 tests. The 1st was a recognition test; the 2nd was designed to tap recollection. The objective was to examine performance on Test 1 conditional on Test 2 performance. In Experiment 1, contrary to process dissociation assumptions, exclusion errors better predicted subsequent recollection than did inclusion errors. In Experiments 2 and 3, with alternate questions posed on Test 2, words having high estimates of recollection with one question had high estimates of familiarity with the other question. Results supported the following: (a) the 2-test procedure has considerable potential for elucidating the relationship between recollection and familiarity; (b) there is substantial evidence for dependency between such processes when estimates are obtained using the process dissociation and remember-know procedures; and (c) order of information access appears to depend on the question posed to the memory system.