The subjective underemployment experience of post-9/11 veterans after transition to civilian work.

BACKGROUND: Underemployment is a challenge for the civilian workforce and a particular risk for veterans as they transition from military service to civilian employment. Workers' economic and demographic characteristics factor into underemployment risk. Veterans may be at greater risk due to specific economic and demographic factors, transitional factors (e.g., geographic relocation), and characteristics of their military service (e.g., military skill alignment with civilian jobs). OBJECTIVES: Describe underemployment experiences in employed post-9/11 veterans three years after their military transition to the civilian workforce. METHODS: The current study uses self-reported underemployment experience data from a longitudinal study of transitioning veterans. This study compares average perceptions of veteran underemployment experiences by specific groups (e.g., by race, gender, and paygrade) using analysis of variance and logistic regression. RESULTS: Veterans reported underemployment in their current jobs based on a perceived mismatch between the skills, education, and/or leadership experience they gained during military service. CONCLUSIONS: Veterans who were enlisted rank, identified as non-White, completed a bachelor's degree, and indicated PTSD symptoms reported higher pervasive underemployment. Intervention implications for the results, such as employer and veteran employment supports, are discussed.

The influence of employment program components upon job attainment during a time of identity and career transition.

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.

L'influence des composantes du programme d'emploi sur l'obtention d'un travail au cours d' une période de transition identitaire et professionnelle L'utilisation des programmes d'emploi a été étudiée parmi 1172 vétérans de l'armée américaine afin de déterminer quelles composantes du contenu et du processus influencent l'obtention d'un emploi. Une approche d'analyse des composantes communes (common component analysis, CCA) a été utilisée. Les associations avec l'obtention d'un emploi jusqu'à 15 mois après la transition de l'armée à la société civile ont identifié des composantes significativement liées à l'obtention d'un emploi: l'entretien (avec un mentor/coach), la rédaction d'un CV (outils en ligne), la transposition du travail militaire au travail civil (avec un mentor/coach), l'esprit entrepreneurial (avec un mentor/coach) et les salons de l'emploi virtuels. Le recours à un mentor/coach était l'une des stratégies de prestation les plus efficaces. Les risques prédisant une utilisation moindre des composantes du programme ont été identifiés: grade d'enrôlé junior, exposition au combat, occupation dans les armes de combat et problèmes de santé physique.

La influencia de los componentes del programa de empleo en la consecución del trabajo durante una época de transición de identidad y carrera Se estudió el uso del programa de empleo entre 1,172 veteranos militares de los Estados Unidos para determinar qué contenido y componentes del proceso influyen en la consecución del empleo. Se utilizó un enfoque de análisis de componentes comunes. Las asociaciones con la búsqueda de empleo hasta 15 meses después de la transición de militar a civil identificaron componentes relacionados significativamente con la obtención de empleo: entrevistas (con mentor / entrenador), redacción de currículos (herramientas en línea), traducción de trabajo militar a civil (con mentor / entrenador), emprendimiento (con mentor / coach) y ferias de carreras virtuales. Tener un mentor / entrenador fue una de las estrategias de ejecución más efectivas. Se identificaron los riesgos que predecían un menor uso de los componentes del programa: rango de alistados juveniles, exposición al combate, ocupación de armas de combate y problemas de salud física.

The interaction of exposure to adverse childhood and combat experiences on the current mental health of new post-9/11 veterans.

Military veterans have greater exposure to adverse childhood experiences (ACEs) than civilians and many also encounter warfare exposures, which can increase the likelihood of mental health problems. The purpose of this study was to test an interaction between childhood traumas and warfare exposures on the mental health of a sample of nearly 10,000 new post-9/11 veterans. Results revealed that male veterans exposed to one or two ACEs, but no warfare, were more likely to experience anxiety, depression, suicidal thinking, and angry outbursts than the reference group (i.e., no ACEs and no warfare exposure). Female veterans exposed to one or two ACEs, but no warfare, were only more likely to experience suicidal thinking. Male and female veterans exposed to three or more ACEs and no warfare were more likely to experience probable posttraumatic stress disorder (PTSD), anxiety, depression, suicidality, and angry outbursts. Among those veterans who experienced corollaries of combat only (e.g., seeing someone killed or seriously wounded), male, but not female veterans were more likely to have probable PTSD, anxiety, and depression. Veterans exposed to warfare (i.e., combat and the corollaries of combat), irrespective of ACEs exposure, were the most likely to report mental health symptoms. Implications for community-based mental health services are discussed.

Multicenter Validation of an Emergency Department-Based Screening Tool to Identify Elder Abuse.

STUDY OBJECTIVE: Emergency department (ED) visits provide an important opportunity for elder abuse identification. Our objective was to assess the accuracy of the ED Senior Abuse Identification (ED Senior AID) tool for the identification of elder abuse. METHODS: We conducted a study of the ED Senior AID tool in 3 US EDs. Participants were English-speaking patients 65 years old and older who provided consent or for whom a legally authorized representative provided consent. Research nurses administered the screening tool, which includes a brief mental status assessment, questions about elder abuse, and a physical examination for patients who lack the ability to report abuse or for whom the presence or absence of abuse was uncertain. The reference standard was based on the majority opinion of a longitudinal, expert, all data (LEAD) panel following review and discussion of medical records, clinical social worker notes, and a structured social and behavioral evaluation. For the reference standard, LEAD panel members were blinded to the results of the screening tool. RESULTS: Of 916 enrolled patients, 33 (3.6%) screened positive for elder abuse. The LEAD panel reviewed 125 cases: all 33 with positive screen results and a 10% random sample of negative screen results. Of these, the panel identified 17 cases as positive for elder abuse, including 16 of the 33 cases that screened positive. The ED Senior AID tool had a sensitivity of 94.1% (95% confidence interval [CI] 71.3% to 99.9%) and specificity of 84.3% (95% CI 76.0% to 90.6%). CONCLUSION: This multicenter study found the ED Senior AID tool to have a high sensitivity and specificity as a screening tool for elder abuse, albeit with wide CIs.

Reducing barriers to post-9/11 veterans' use of programs and services as they transition to civilian life.

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.

Precision, Sensitivity and Patient Preference of Non-Invasive Thermometers in a Pediatric Surgical Acute Care Setting.

PURPOSE: The purpose of the project was to compare the temporal artery thermometer (TAT) to the digital probe thermometer readings at axillary or oral sites, to determine the relative precision and sensitivity of the three methods of thermometry, to compare their readings to core temperature when feasible, and to survey patient and family thermometer preferences. DESIGN & METHODS: A randomized crossover design in a 70-bed surgical unit over eight months. Two sets of temperature measurements were obtained for each patient: TAT, axillary, oral (depending on patient ability) and a bladder temperature representing core body temperature (when available). Each method was used twice on each patient, to examine within-method precision. Following measurement, patients or caregivers provided their thermometer preference. For younger/nonverbal patients, a professional observer recorded a disruption score. N=298 patients were enrolled RESULTS: TAT was more precise than oral and axillary thermometers (p<0.001 vs. axillary, p=0.001 vs. oral). TAT measurements were higher on average than axillary and oral, by 0.7°C and 0.6°C respectively (p<0.001). TAT's disruption score for younger patients was 0.6 points lower on average than axillary (p<0.001). 84% of patients and families who indicated a clear thermometry preference chose TAT. Only 3 patients had bladder-temperature devices, and therefore accuracy could not be analyzed. CONCLUSIONS: TAT is more precise, more fever sensitive, less disruptive to younger children, and more preferred by patients and families. PRACTICE IMPLICATIONS: TAT is an acceptable temperature measure that could be substituted for oral or axillary temperature in acute care pediatric settings.