Question 1

Which aspect of military service directly impacts daily life occupations, habits, roles, and routines?&#10;A) Community reintegration&#10;B) Civilian life&#10;C) Deployment&#10;D) Mental health intervention

Accepted Answer

Returning from extended deployments or transitioning to live outside military installations requires Veterans and their families to adapt and reintegrate into their new communities. Reintegration into the civilian community post-deployment can be a complex, lengthy, and nonlinear adjustment process involving changes in life relationships and responsibilities. In the rehabilitation literature, community integration refers to "being part of the mainstream of family and community life, discharging normal roles and responsibilities, and being an active and contributing member of one's social groups and of society as a whole" (Dijkers, 1998, p. 1). Community (re)integration (CR) as it relates to Veterans refers to "returning to participation in home, social and community living after deployment and, in many cases, after injury" (Hawkins, McGuire, Linder, & Britt, 2015, p. 527), and being "happily situated, productively occupied, and effectively supported in the community" (McColl, Davies, Carlson, Johnston, & Minnes, 2001, p. 429). Deployment refers to the movement of military personnel and equipment into places where they can be used when needed. The focus of this chapter is on military service members who were deployed and are returning from war zones in the Middle East. However, many of the topics covered in the chapter could easily be applied to Veterans who served in other conflicts.

Question 2

Veterans 65 and older often receive reimbursable health care through which program?&#10;A) Medicare&#10;B) Medicaid&#10;C) Medicare supplement&#10;D) Tricare

Accepted Answer

Military cultural competence is essential to caring for the biopsychosocial needs of military and Veteran populations (Meyer, Writer, & Brim, 2016). Veterans continue to be seen in many sectors of the health-care system, including both Veterans Health Administration (VHA) and non-VHA facilities. According to the U.S. Census Bureau (n.d.), Veterans experience a disparity in health-care coverage based on age and employment status. For example, in 2016, about one-half of Veterans received medical coverage through Medicare because they were 65 years or older. The other half of Veterans of working age (19-64) were covered by employer-sponsored, TRICARE, direct purchase, or Medicaid insurances, with 5.5% of Veterans remaining uninsured.

Question 3

Eligibility for health care services for a Veteran is based upon which of the following factors?&#10;A) Type of service&#10;B) Division of the military&#10;C) Number of deployments&#10;D) If disability was acquired during military service

Accepted Answer

Health care for Veterans is not guaranteed by military service alone. Eligibility and health-care benefits requirements vary by whether or not the Veteran's disability is related to military service (service connection), as well as period of service, employment status, and income.

Question 4

The largest demographic of Veterans in today's society served in which war era?&#10;A) World War I&#10;B) World War II&#10;C) Gulf War&#10;D) Vietnam War

Accepted Answer

Gulf War-era (1990-present) Veterans now comprise the largest demographic of the Veteran population, accounting for nearly 7.2 million of the 20 million Veterans. According to the U.S. Department of Veterans Affairs (VA) (2018a), the total Veteran population is predicted to decrease from 20 million in 2017 to 13.6 million in 2037. As these trends emerge, Veteran culture may be impacted by generational differences and race and ethnicity, as well as the geographical locations where service members reside. For example, Veterans from underrepresented groups are predicted to increase from 23.3% percent of the total Veteran population in 2017 to 32.8% in 2037, as the proportion of white Veterans declines. Additionally, 50% of Veterans live within 10 states, with the largest concentration residing in the West and South (VA, 2018a). Understanding the nuances of Veteran culture should better inform community health promotion programming, resulting in improved health outcomes.

Question 5

The most common health issue for Veterans from the wars in Iraq and Afghanistan is:&#10;A) Traumatic brain injury&#10;B) Chronic pain&#10;C) Posttraumatic stress disorder&#10;D) Polytrauma

Accepted Answer

Compared to other conflicts, recent advances in battlefield medicine and protective armor have improved the ability of OIF/OEF Veterans to survive common mechanisms of injury, including small-arms fire and explosive munitions (e.g., blasts from improvised explosive devices [IEDs]). Although lives have been saved, polytrauma, defined as "two or more injuries to physical regions or organ systems one of which may be life threatening, resulting in physical, cognitive, psychological, or psychosocial impairments and functional disability" have become the signature injuries of the wars in Iraq and Afghanistan (VA, n.d., para. 2). The "polytrauma triad" of mild traumatic brain injury (mTBI), chronic pain, and posttraumatic stress disorder (PTSD) have proven to be a difficult diagnostic and therapeutic challenge for the current medical system (Cifu et al., 2014). To address these challenges, the VHA Polytrauma System of Care has been established to provide an integrated network of specialized rehabilitation programs dedicated to serving Veterans and service members with both combat- and civilian-related traumatic brain injury (TBI) and polytrauma.

Question 6

A factor associated with chronic pain in the Veteran population is:&#10;A) Smoking&#10;B) Chronic headache&#10;C) Balance problems&#10;D) Visual disturbances

Accepted Answer

According to the Institute of Medicine (2011), 25% of the U.S. population experiences chronic pain; however, 50% of Veterans are affected by chronic pain. The prevalence of moderate to severe chronic pain in the Veteran population is approximately 27%. Chronic pain is defined as "ongoing or recurrent pain, lasting beyond the usual course of acute illness or injury or more than 3 to 6 months, and which adversely affects the individual's wellbeing" (American Chronic Pain Association, n.d., para. 1). Chronic pain is pain without biological value that has persisted past the expected time for tissue healing. Of the types of chronic pain, musculoskeletal (61%) and back pain (24%) have the highest prevalence in VA primary care settings. Factors associated with chronic pain in both Veteran and civilian populations are lower levels of education, smoking, and emotional distress (Van Den Kerkhof, Carley, Hopman, Ross-White, & Harrison, 2014).

Question 7

The most common mental health diagnosis for active-duty service members is:&#10;A) Posttraumatic stress disorder&#10;B) Depression&#10;C) Anxiety&#10;D) Insomnia

Accepted Answer

According to the Defense Health Agency, the prevalence of active-duty service members (ADSM) diagnosed with any mental health condition varies by military force (i.e., Army, Navy, Air Force, Marines), and has increased from 2005 to 2012, with a reported decline from 2013 to 2016. For example, the peak point prevalence for ADSM was 30% in 2013. The most common diagnoses across all services include anxiety disorders (5%), depressive disorders (7%), insomnia (5%), and PTSD (2.5%). Other diagnoses related to alcohol and substance abuse ranged from 0% to -1.5% (Crum-Cianflone, Powell, LeardMann, Russell, & Boyko, 2016).

Question 8

Mr. Edwards is 29-year-old male who recently returned from a deployment after sustaining a hand injury from an explosive device. He lost two of his fellow soldiers during the incident. His hand rehabilitation is making progress but he reports being really tired, not sleeping well, and some irritability. Mr. Edwards is most likely experiencing a physical manifestation of what?

A) Grief
B) Challenges with community reintegration
C) Anxiety
D) Insomnia

Accepted Answer

In a study by Toblin et al. (2012), infantry brigade soldiers experiencing combat-related grief were at least 2.4 times more likely to experience negative health outcomes as those who reported no difficulty with grief. The top five physical health symptoms reported by those having difficulty coping with grief were: fatigue (58.1%), sleep problems (55.4%), musculoskeletal pain (49.7%), back pain (41.3%), and headaches (32.7%). Other symptoms associated with grief included feeling easily annoyed or irritated (62.3%), concentration problems (37.3%), and memory problems (24.0%). Toblin et al. (2012) indicated it was the emotional reaction of grief, rather than the actual experience of loss, that was associated with diminished physical health.

Question 9

Moral injury, a state of inner conflict and turmoil that often precipitates feelings of shame, guilt, grief, anxiety, anger, and remorse, can often be confused with:&#10;A) Grief&#10;B) PTSD&#10;C) Anxiety&#10;D) Insomnia

Accepted Answer

According to Litz et al. (2009), moral injury is a consequence of "perpetrating, failing to prevent, bearing witness to acts that transgress deeply held moral beliefs and expectations" (p. 695). Acts that may precipitate moral injury include incidents causing harm to civilians during war, friendly fire deaths, military sexual assaults, and betrayals by leadership. Moral injury is a "broad clinical concept that exists in the intersection of multiple emotional, cognitive and social pathways" (Farnsworth, Drescher, Nieuwsma, Walser, & Currier, 2014, p. 258). It is a state of inner conflict and turmoil that often precipitates feelings of shame, guilt, grief, anxiety, anger, and remorse. Other reactions include purposelessness and alienation from self and others. Behavioral manifestations of moral injury may include self-harm, social withdrawal, substance abuse, and social instability. Although moral injury and PTSD have some common characteristics, "each has unique components that make them separable consequences of war" (Maguen & Litz, 2012, para. 6). PTSD is emotionally characterized by fear, while moral injury is emotionally characterized by shame. Moral injury can co-occur with depression and substance use disorder, as well as in the absence of active PTSD symptoms (Farnsworth et al., 2014).

Question 10

Mary is 32-year-old Veteran who was an officer in the military. She has been successful in her community reintegration. Which of the following is a protective factor for community re-integration?&#10;A) Length of deployment&#10;B) Age at discharge&#10;C) College degree&#10;D) Length of service

Accepted Answer

Of the Veterans who have served since September 2001, 43% report having had a military-related experience that was emotionally traumatic, and nearly half of these Veterans say they have suffered from posttraumatic stress as a result. Veterans who reported a relatively easy transition were more likely to be commissioned officers, have a college degree, and attend religious services a least once a week. Variables that appear to have no effect on ease of transition were race/ethnicity, length of service, age at discharge, and number of deployments (Morin, 2011).

Question 11

Joe is a 31-year-old who has decided to transition out of the military due to the birth of his daughter. Joe is experiencing which type of transition?&#10;A) Anticipated transition&#10;B) Unanticipated transition&#10;C) Non-event transition&#10;D) Deployment

Accepted Answer

The answer of Joe is a 31-year-old who has decided...

Question 12

Kathryn is a 28-year-old who just transitioned out of military life. She reports feeling more connected to her military friends than her family. This experience, common to Veterans, often occurs because of:

A) Difficulty finding work
B) PTSD symptoms
C) Substance abuse
D) Changes in family life during deployment

Accepted Answer

The answer of Kathryn is a 28-year-old who just transitioned...

Question 13

Most military personnel are:&#10;A) Single&#10;B) Married&#10;C) Married with children&#10;D) Divorced

Accepted Answer

The answer of Most military personnel are:&#10;A) Single&#10;B) Married&#10;C) Married...

Question 14

The most common change in a partner relationship after a deployment is:&#10;A) Divorce&#10;B) Separation&#10;C) Heightened conflict&#10;D) Problems reconnecting

Accepted Answer

The answer of The most common change in a partner...

Question 15

An occupation typically limited during military deployment that can cause occupational deprivation is:&#10;A) Leisure&#10;B) ADLs&#10;C) Social participation&#10;D) Education

Accepted Answer

The answer of An occupation typically limited during military deployment...

Question 16

In the 4S model of transitions, personal assets necessary for successful transition and deficits or liabilities serving as roadblocks to transition fit into which aspect of the model?&#10;A) Situation&#10;B) Self&#10;C) Support&#10;D) Strategies

Accepted Answer

The answer of In the 4S model of transitions, personal...

Question 17

Mr. Elliott is a 27-year-old who has posttraumatic stress disorder. The most common theoretical approach in occupational therapy in the United States used for intervention with an individual like Mr. Elliott is:

A) The Canadian Model of Occupational Performance and Engagement
B) The Recovery Model
C) The Model of Human Occupation
D) Occupational Adaptation

Accepted Answer

The answer of Mr. Elliott is a 27-year-old who has...

Question 18

An appropriate assessment for occupational therapy for a Veteran transitioning to civilian life focused on community engagement is:&#10;A) COPM&#10;B) Community Integration Questionnaire&#10;C) Modified Interest Checklist&#10;D) Occupational Questionnaire

Accepted Answer

The answer of An appropriate assessment for occupational therapy for...

Question 19

A significant environmental barrier to community reintegration for Veterans is:&#10;A) Inadequate transportation&#10;B) Lack of financial assistance&#10;C) Negative attitudes of civilians&#10;D) No environmental barriers exist

Accepted Answer

The answer of A significant environmental barrier to community reintegration...

Question 20

In community reintegration for Veterans, social support can act as a(n):&#10;A) Inhibitor&#10;B) Facilitator&#10;C) Neither&#10;D) Both

Accepted Answer

The answer of In community reintegration for Veterans, social support...

Deck 21: Community Reintegration Services for Military Veterans Introduction