As a vulnerable cultural group, military veterans present unique challenges to mental healthcare providers as a result of their experiences. Since 9/11, there has been an increase in post 9/11 veterans seeking treatment across civilian mental health organizations, along with a growing demand for culturally competent care. This qualitative review and thematic analysis of the literature explores specific mental health needs of post 9/11 veterans and investigates military cultural competence best practices in mental health care for veterans in civilian and/or non-governmental outpatient mental health settings. Using purposive sampling, 33 studies were identified and analyzed in relation to approaches central to an underlying multicultural theoretical framework for emerging themes. Key findings emphasize incorporating military cultural competency in treatment implementation to address the unique mental health dynamics of the veteran community as a whole and diverse community. Recurring themes related to best practices for treating this population highlighted an interorganizational collaborative approach that encourages the importance of community collaboration among civilian and government mental health providers to work together in treating the veteran population. Findings informed the development of the action research monograph deliverable for key stakeholders. Moreover, findings present new questions related to veteran mental healthcare pertaining to clinical program staff members and how to increase their level of cultural sensitivity and professional development. These questions can lead to further research substantiating the positive changes that can occur among the administration of veteran mental health services by practitioners that are culturally component and qualified to work with this population.
References
[1]
American Psychological Association (APA) (2017). Clinical Practice Guideline for the treatment of PTSD. American Psychological Association. https://www.apa.org/ptsd-guideline/ptsd.pdf
[2]
Angel, C. M. (2016). Resilience, Post-Traumatic Stress, and Posttraumatic Growth: Veterans’ and Active-Duty Military Members' Coping Trajectories Following Traumatic Event Exposure. Nurse Education Today, 47, 57-60. https://doi.org/10.1016/j.nedt.2016.04.001
[3]
Atuel, H. R., & Castro, C. A. (2018). Military Cultural Competence. Clinical Social Work Journal, 46, 74-82. https://doi.org/10.1007/s10615-018-0651-z
[4]
Barth, S. K., Kimerling, R. E., Pavao, J., McCutcheon, S. J., Batten, S. V., Dursa, E., Peterson, M. R., & Schneiderman, A. I. (2016). Military Sexual Trauma among Recent Veterans: Correlates of Sexual Assault and Sexual Harassment. American Journal of Preventive Medicine, 50, 77-86. https://doi.org/10.1016/j.amepre.2015.06.012
[5]
Bayley, J., & Phipps, D. (2019). Extending the Concept of Research Impact Literacy: Levels of Literacy, Institutional Role and Ethical Considerations. Emerald Open Research, 1, Article No. 14. https://doi.org/10.35241/emeraldopenres.13140.2
[6]
Belotto, M. J. (2018). Data Analysis Methods for Qualitative Research: Managing the Challenges of Coding, Interrater Reliability, and Thematic Analysis. Qualitative Report, 23, 2622-2633. https://doi.org/10.46743/2160-3715/2018.3492
[7]
Bonanno, G. A. (2004). Loss, Trauma, and Human Resilience: Have We Underestimated the Human Capacity to Thrive after Extremely Aversive Events? American Psychologist, 59, 20-28. https://doi.org/10.1037/0003-066X.59.1.20
[8]
Botero, G., Rivera, N. I., Calloway, S. C., Ortiz, P. L., Edwards, E., Chae, J., & Geraci, J. C. (2020). A Lifeline in the Dark: Breaking Through the Stigma of Veteran Mental Health and Treating America’s Combat Veterans. Journal of Clinical Psychology, 76, 831-840. https://doi.org/10.1002/jclp.22918
[9]
Bovin, M. J., Miller, C. J., Koenig, C. J., Lipschitz, J. M., Zamora, K. A., Wright, P. B., Pyne, J. M., & Burgess Jr., J. F. (2019). Veterans’ Experiences Initiating VA-Based Mental Health Care. Psychological Services, 16, 612-620. https://doi.org/10.1037/ser0000233
[10]
Byrd, V. D. (2019). Leadership Practice and Organizational Culture in the U.S. Military: A Qualitative Study Investigating the Perception of Preferred Leadership Styles and Organizational Culture in the U.S. Military. Ph.D. Thesis, Northeastern University. https://doi.org/10.17760/D20328925
[11]
Calley, N. G. (2009). Comprehensive Program Development in Mental Health Counseling: Design, Implementation, and Evaluation. Journal of Mental Health Counseling, 31, 9-21. https://doi.org/10.17744/mehc.31.1.u018125603371233
[12]
Carrola, P., & Cordin-Burdick, M. (2015). Counseling Military Veterans: Advocating for Culturally Competent and Holistic Interventions. Journal of Mental Health Counseling, 37, 1-14. https://doi.org/10.17744/mehc.37.1.v74514163rv73274
[13]
Carry the Load (2019). About Carry the Load. Carry The Load. http://www.carrytheload.org/site/PageServer?pagename=about
[14]
Clarkson-Hendrix, M., & Carroll-Barbuto, J. (2019). C Curriculum Implications for Collaborative Practice From Veterans Health Care Sector Social Workers Serving OIF/ OEF Veterans. Journal of Social Work Education, 55, 115-127. https://doi.org/10.1080/10437797.2018.1491357
[15]
Davis, D. E., DeBlaere, C., Owen, J., Hook, J. N., Rivera, D. P., Choe, E., Van Tongeren, D. R., Worthington Jr., E. L., & Placeres, V. (2018). The Multicultural Orientation Framework: A Narrative Review. Psychotherapy, 55, 89-100. https://doi.org/10.1037/pst0000160
[16]
De Luca, S. M., Blosnich, J. R., Hentschel, E. A., King, E., & Amen, S. (2016). Mental Health Care Utilization: How Race, Ethnicity and Veteran Status Are Associated with Seeking Help. Community Mental Health Journal, 52, 174-179. https://doi.org/10.1007/s10597-015-9964-3
[17]
DeBeer, B., Baack, S., Bongiovanni, K., Borah, E., Bryan, C., Bryant, K., Cassidy, R., Clafferty, S., Franciosi, G., Heise, J., Hoffmire, C., Keene, R., Mignogna, J., Mohatt, N., Monteith, L. L., Peterson, A., Pierson, D., Villarreal, E., Weinberg, K., Williams, M., Synett, S., & Benzer, J. (2020). The Veterans Affairs Patient Safety Center of Inquiry-Suicide Prevention Collaborative: Creating Novel Approaches to Suicide Prevention among Veterans Receiving Community Services. Federal Practitioner, 37, 512-521. https://doi.org/10.12788/fp.0071
[18]
Dennis, B. K. (2014). Understanding Participant Experiences: Reflections of a Novice Research Participant. International Journal of Qualitative Methods, 13, 395-410. https://doi.org/10.1177/160940691401300121
[19]
Finley, E. P., Noël, P. H., Lee, S., Haro, E., Garcia, H., Rosen, C., Bernardy, N., Pugh, M. J., & Pugh, J. A. (2018). Psychotherapy Practices for Veterans with PTSD among Community-Based Providers in Texas. Psychological Services, 15, 442-452. https://doi.org/10.1037/ser0000143
[20]
Glick, P., & Fiske, S. T. (1996). The Ambivalent Sexism Inventory: Differentiating Hostile and Benevolent Sexism. Journal of Personality and Social Psychology, 70, 491-512. https://doi.org/10.1037/0022-3514.70.3.491
[21]
Guenole, N., Ferrar, J., & Feinzig, S. (2017). The Power of People: Learn How Successful Organizations Use Workforce Analytics to Improve Business Performance. Pearson FT Press.
[22]
Hasenfeld, Y. (2015). What Exactly Is Human Services Management? Human Service Organizations: Management, Leadership & Governance, 39, 1-5. https://doi.org/10.1080/23303131.2015.1007773
[23]
Heath, R. G., & Isbell, M. G. (2017). Interorganizational Collaboration: Complexity, Ethics, and Communication. Waveland Press.
[24]
Hester, R. D. (2017). Lack of Access to Mental Health Services Contributing to the High Suicide Rates among Veterans. International Journal of Mental Health Systems, 11, Article No. 47. https://doi.org/10.1186/s13033-017-0154-2
[25]
Holliday, R., & Monteith, L. L. (2019). Seeking Help for the Health Sequelae of Military Sexual Trauma: A Theory-Driven Model of the Role of Institutional betrayal. Journal of Trauma & Dissociation, 20, 340-356. https://doi.org/10.1080/15299732.2019.1571888
[26]
Jayawickreme, E., Infurna, F. J., Alajak, K., Blackie, L. E., Chopik, W. J., Chung, J. M., & Zonneveld, R. (2021). Post-Traumatic Growth as Positive Personality Change: Challenges, Opportunities, and Recommendations. Journal of Personality, 89, 145-165. https://doi.org/10.1111/jopy.12591
[27]
Johnson, T. S., Ganz, A., Berger, S., Ganguly, A., & Koritzky, G. (2018). Service Members Prefer a Psychotherapist Who Is a Veteran. Frontiers in Psychology, 9, Article 1068. https://doi.org/10.3389/fpsyg.2018.01068
[28]
Keeler, W. (2021). Hierarchy in America. Anthropology Today, 37, 21-25. https://doi.org/10.1111/1467-8322.12631
[29]
Kettner, P. M. (2017). Designing and Managing Programs (5th ed.). SAGE Publications.
[30]
Kim, P. Y., Britt, T. W., Klocko, R. P., Riviere, L. A., & Adler, A. B. (2011). Stigma, Negative Attitudes About Treatment, and Utilization of Mental Health Care among Soldiers. Military Psychology 23, 65-81. https://doi.org/10.1080/08995605.2011.534415
[31]
Kimerling, R., Pavao, J., Greene, L., Karpenko, J., Rodriguez, A., Saweikis, M., & Washington, D. L. (2015). Access to Mental Health Care among Women Veterans: Is VA Meeting Women’s Needs? Medical Care, 53, S97-S104. https://doi.org/10.1097/MLR.0000000000000272
[32]
Kivunja, C. (2018). Distinguishing between Theory, Theoretical Framework, and Conceptual Framework: A Systematic Review of Lessons from the Field. International Journal of Higher Education, 7, 44-53. https://doi.org/10.5430/ijhe.v7n6p44
[33]
Korstjens, I, & Moser, A. (2017). Series: Practical Guidance to Qualitative Research. Part 2: Context, Research Questions and Designs. The European Journal of General Practice, 23, 274-279. https://doi.org/10.1080/13814788.2017.1375090
[34]
Laws, H. B., Glynn, S. M., McCutcheon, S. J., Schmitz, T. M., & Hoff, R. (2018). Posttraumatic Stress Symptom Change after Family Involvement in Veterans’ Mental Health Care. Psychological Services, 15, 520-528. https://doi.org/10.1037/ser0000200
[35]
Mac Donald, C. L., Barber, J., Andre, J., Evans, N., Panks, C., Sun, S., & Temkin, N. (2017). 5-Year Imaging Sequelae of Concussive Blast Injury and Relation to Early Clinical Outcome. NeuroImage: Clinical, 14, 371-378. https://doi.org/10.1016/j.nicl.2017.02.005
[36]
Mathewson-Chapman, M., & Chapman, H. J. (2017). Addressing Military Cultural Competence in Medical Education. Academic Medicine, 92, 1653-1654. https://doi.org/10.1097/ACM.0000000000001977
[37]
Meyer, E. G., & Wynn, G. H. (2016). The Importance of US Military Cultural Competence. In L. Roberts, & C. Warner (Eds.), Military and Veteran Mental Health (pp. 15-33). Springer. https://doi.org/10.1007/978-1-4939-7438-2_2
[38]
National Academies of Sciences, Engineering, and Medicine (2018). Evaluation of the Department of Veterans Affairs Mental Health Services. The National Academies Press. https://doi.org/10.17226/24915
[39]
Navjit Sanghera, O. D. (2017). Developing Military Cultural Competency to Better Serve Those Who Have Served Us. Optometric Education, 43. https://journal.opted.org/article/developing-military-cultural-competency-to-better-servethose-who-have-served-us/
[40]
Nedegaard, R., & Zwilling, J. (2017). Promoting Military Cultural Competence among Civilian Care Providers: Learning through Program Development. Social Sciences, 6, Article No. 13. https://doi.org/10.3390/socsci6010013
[41]
Netting, F. E., Kettner, P. M., McMurtry, S. L., & Thomas, M. L. (2017). Social Work Macro Practice (6th ed.). Pearson.
[42]
Olukemi, A. (2012). Mental Health and Social Oppression: Seeing the Connection. LSE. https://blogs.lse.ac.uk/equityDiversityInclusion/2012/10/mental-health-and-social-oppression-seeing-the-connection/
Plano Clark, V. L., & Ivankova, N. V. (2016). Mixed Methods Research: A Guide to the Field. SAGE Publications. https://doi.org/10.4135/9781483398341
[45]
Pokorny, J. J., Norman, A., Zanesco, A. P., Bauer-Wu, S., Sahdra, B. K., & Saron, C. D. (2018). Network Analysis for the Visualization and Analysis of Qualitative data. Psychological Methods, 23, 169-183. https://doi.org/10.1037/met0000129
[46]
Purcell, N., Zamora, K., Bertenthal, D., Abadjian, L., Tighe, J., & Seal, K. H. (2021). How VA Whole Health Coaching Can Impact Veterans’ Health and Quality of Life: A Mixed-Methods Pilot Program Evaluation. Global Advances in Health and Medicine, 10. https://doi.org/10.1177/2164956121998283
[47]
Ramsey, C., Dziura, J., Justice, A. C., Altalib, H. H., Bathulapalli, H., Burg, M., Decker, S., Driscoll, M., Goulet, J., Haskell, S., Kulas, J., Wang, K. H., Mattocks, K., & Brandt, C. (2017). Incidence of Mental Health Diagnoses in Veterans of Operations Iraqi Freedom, Enduring Freedom, and New Dawn, 2001-2014. American Journal of Public Health, 107, 329-335. https://doi.org/10.2105/AJPH.2016.303574
[48]
Richards, L. K., Bui, E., Charney, M., Hayes, K. C., Baier, A. L., Rauch, P. K., Allard, M., & Simon, N. M. (2017). Treating Veterans and Military Families: Evidence Based Practices and Training Needs among Community Clinicians. Community Mental Health Journal, 53, 215-223. https://doi.org/10.1007/s10597-016-0013-7
[49]
Roger, K., Bone, T. A., Heinonen, T., Schwartz, K., Slater, J., & Thakrar, S. (2018). Exploring Identity: What We Do as Qualitative Researchers. The Qualitative Report, 23, 532-546. https://doi.org/10.46743/2160-3715/2018.2923
[50]
Royse, D., Thyer, B. A., & Padgett, D. K. (2016). Program Evaluation: An Introduction to an Evidence-Based Approach (6th ed.). Cengage Learning.
[51]
Rubinson, C. (2019). Presenting Qualitative Comparative Analysis: Notation, Tabular Layout, and Visualization. Methodological Innovations, 12. https://doi.org/10.1177/2059799119862110
[52]
Salmen, A., & Dhont, K. (2021). Hostile and Benevolent Sexism: The Differential Roles of Human Supremacy Beliefs, Women’s Connection to Nature, and the Dehumanization of Women. Group Processes & Intergroup Relations, 24, 1053-1076. https://doi.org/10.1177/1368430220920713
[53]
Schaefer, H. S., Cotting, D. I., Proctor, E. S., Ryan, D. M., & Lerner, R. M. (2021). The Military Hypermasculine Mystique: Sex, Status, and Emotional Control at the United States Military Academy. Psychology of Men & Masculinities, 22, 611-626. https://doi.org/10.1037/men0000365
[54]
Smith, K., & Zajda, J. (2018). Qualitative and Quantitative Methodologies: A Minimalist View. Education and Society, 36, 73-83. https://doi.org/10.7459/es/36.1.06
[55]
Sridharan, S., & Nakaima, A. (2011). Ten Steps to Making Evaluation Matter. Evaluation and Program Planning, 34, 135-146. https://doi.org/10.1016/j.evalprogplan.2010.09.003
[56]
Stevenson, B. J. (2020). Psychotherapy for Veterans Navigating the Military-to-Civilian Transition: A Case Study. Journal of Clinical Psychology, 76, 896-904. https://doi.org/10.1002/jclp.22924
[57]
Stockton, H., Hunt, N., Joseph, S. (2011). Cognitive Processing, Rumination, and Posttraumatic Growth. Journal of Traumatic Stress, 24, 85-92. https://doi.org/10.1002/jts.20606
[58]
Tedeschi, R. G., & McNally, R. J. (2011). Can We Facilitate Posttraumatic Growth in Combat Veterans? American Psychologist, 66, 19-24. https://doi.org/10.1037/a0021896
[59]
The CITI Program (2021). Research Ethics and Compliance Training. CITI Program. https://about.citiprogram.org/en/homepage/
[60]
Tricare (2020). Mental Health Care. Tricare. https://www.tricare.mil/CoveredServices/Mental
[61]
Tsai, J., El-Gabalawy, R., Sledge, W. H., Southwick, S. M., & Pietrzak, R. H. (2015). Post-Traumatic Growth among Veterans in the USA: Results from the National Health and Resilience in Veterans Study. Psychological Medicine, 45, 165-179. https://doi.org/10.1017/S0033291714001202
[62]
U.S. Department of Health & Human Services (1979). The Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research. HHS. https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/index.html
[63]
U.S. Department of Veterans Affairs (2019). Vet Centers (Readjustment Counseling). U.S. Department of Veterans Affairs. https://www.vetcenter.va.gov/
[64]
U.S. Department of Veterans Affairs (2021). Office of Health Equity. U.S. Department of Veterans Affairs. https://www.va.gov/HEALTHEQUITY/Race_Ethnicity.asp
[65]
University of Southern California (USC) (2022). Military Social Work Track. https://dworakpeck.usc.edu/academics/master-of-social-work/curriculum/2021-curriculum/military-social-work-track
[66]
Whitworth, J. D., Lawrence, S., Dziegielewski, S. F., & Mandes, C. L. (2019). Perceptions of a Military Social Work Specialization Certificate Program: Implications for Future Programs. Journal of Teaching in Social Work, 39, 197-211. https://doi.org/10.1080/08841233.2019.1614712
[67]
Yilmaz, K. (2013). Comparison of Quantitative and Qualitative Research Traditions: Epistemological, Theoretical, and Methodological Differences. European Journal of Education, 48, 311-325. https://doi.org/10.1111/ejed.12014
