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Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families (2013)

Chapter: Appendix E: Individual Ethnographic Assessments of Six Communities

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Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
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APPENDIX E

INDIVIDUAL ETHNOGRAPHIC ASSESSMENTS OF SIX COMMUNITIES

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Westat conducted a series of ethnographic assessments for the Committee. The communities visited include: Jacksonville, North Carolina; El Paso, Texas; Watertown, New York; Lakewood and Lacey, Washington; Georgetown, South Carolina; and Little Falls, Minnesota. This appendix contains each of those individual assessments and Chapter 7 provides a summary and conclusion regarding the impact of military deployments on communities.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
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Understanding the Community Effect of Multiple Military Deployments

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Case Study Report

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
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Jacksonville, North Carolina

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Case Study Report

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
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Impacts of Multiple Deployments: Jacksonville, North Carolina

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OVERVIEW

This report presents the study team’s findings from a weeklong site visit (April 18–25) to Jacksonville, North Carolina, a midsized city on the coast that is adjacent to Marine Corps base Camp Lejeune. A key finding from this location was that multiple deployments appear to have had little effect on the overall local economy. Many interviewees attributed this to Project CARE, a Chamber of Commerce–initiated effort to mitigate negative community effects from deployments by providing support to service members’ families, communicating with businesses, and promoting a positive community spirit toward the military. Community members spoke of their concerns that additional mental health care services are needed both on base and in the community, where some service members prefer to seek help. They also spoke of the need for more federal resources to address infrastructure problems in the community related to the growing military population.

Data Sources

• Chamber of Commerce

• Churches

• City Government

• Fire and Police Chiefs

• Health Department

• Jacksonville Jamboree

• Kindergarten Readiness Program

• Onslow County Partnership for Children

• Recreation and Parks Department

• School Board and Transition Counselors

• Social Services Department

• United Way

GEOGRAPHIC ORIENTATION

Community: Jacksonville, North Carolina

Jacksonville, North Carolina, lies on the eastern shore of the state in Onslow County and adjacent to the southern Outer Banks and is contiguous with both Marine Corps Base Camp Lejeune and Marine Corps Air Station New River. According to the 2010 Census, Jacksonville’s population of 70,1451 represents an increase of about 5% over the 2000 population. Demographically, 9.7% of the population of the city is age 5 or younger, compared with 6.6% for North Carolina and 6.5% for the United States. Only 5.4% of Jacksonville residents are age 65 years or older, compared with 12.9% for North Carolina and 13.0% for the United States. Jacksonville also has a proportionately larger male population than the rest of the state or country, at 58.8% of the population. The young age distribution and high proportion of males are likely due to the presence of the Marine Corps in the community.1

Race and ethnicity trends in Jacksonville are similar to those in the state of North Carolina, with 67.7% reporting their race as white, 20% reporting their race as black, and 13% reporting Hispanic or Latino origin. Home ownership rates in Jacksonville are disproportionately

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1 All population statistics are from the 2010 Census and the American Community Survey (http://quickfacts.census.gov/qfd/states/37/3734200.html). As will be noted throughout this report, Jacksonville officials and other community members do not believe these figures accurately represent the local population.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
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low (38.8%) when compared with the rates for North Carolina (68.1%) and the United States (66.6%). The median household income in Jacksonville during the years 2006–2010 was $42,469, compared with $45,570 for North Carolina and $51,914 for the United States.

Military Installation: Camp Lejeune

Camp Lejeune is home to the largest concentration of Marines and U.S. Navy personnel in the world and currently encompasses 156,000 acres. The base was established in 1941 to meet the need for an East Coast amphibious training facility and has grown over the years to train men and women to fight wars in the Pacific Islands, Korea, Vietnam, Kuwait, Afghanistan, and Iraq. Several satellite facilities offer infantry training and serve as the home of the amphibious assault Marines and vehicles, the Marine Corps Engineer School, and the Coast Guard’s Port Security Training Detachment. The Marine Corps Air Station New River, a helicopter base, is also located in Jacksonville.

According to its website, Camp Lejeune is the “Home of Expeditionary Forces in Readiness,” and troops from the base have played a crucial role in both Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). The author of an August 2010 article from the Jacksonville Daily News explains how “the contribution of the corps—with a heavy emphasis on the efforts of Camp Lejeune-based troops—played a vital role in rounding a corner in the war and securing a victory pennant.”2 As one city official recounted:

I have a vivid memory … after everything took place and 9/11 became apparent, there were some announcements made as to how we were going to be impacted … we were going to be the first ones in.

Since 2003 when the first U.S. troops entered Iraq, Jacksonville has been faced with a steady stream of deployments. Members of the Social Services Department explained how the deployment patterns have changed over time:

[Deployments are] more frequent than they used to be…. [They] used to be a little longer, would go a year or 18 months, but then they’d be back for at least a year or 2 years … now they are gone anywhere between 6 and 9 months, they are here a couple of months, and then they are gone again for the same amount of time. [Social services representative]

Many of the troops deployed to Iraq and Afghanistan from Camp Lejeune are infantrymen, and the base has suffered a high proportion of troop deaths compared with other military installations.

Relationship Between Community and Military Installation

The relationship between the base and the community is best described as dichotomous. Although there are extremely close ties between the base and both the city and the county, in other regards the military and civilian worlds are separate. The close ties are noticeable

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2 See http://www.jdnews.com/articles/success-82029-iraq-vital.html.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

everywhere: Military families may live on base but shop, work, and send their children to school in the county school system; military members may live on base or in civilian housing and purchase goods and services in the city or county; civilian contractors and other business people provide goods and services to the base; and civilian staff work on the base. Military and civilian personnel, such as police officers and firefighters, respond to emergencies together and occasionally train together on or off the base. Military personnel may serve as volunteer coaches for school or community sports teams.

The areas of separation, though not as immediately apparent, are equally widespread. Military or military-affiliated status confers a set of rights and privileges that is not shared by those without military status. A social service professional pointed out, for example, that women who are in relationships with service members but are not legally married cannot seek services on base. Conversely, a military member who obtains a restraining order against an abusive spouse through military channels will find that the restraining order cannot be enforced off base because it is not recognized in a civilian jurisdiction.

The base is the main economic driver in the area, with effects felt both in the city and throughout Onslow County. One Jacksonville Chamber of Commerce member said that the “entire market is the base.” According to the Camp Lejeune 2012 Base Guide, the base and surrounding community are home to an active duty, dependent, retiree, and civilian employee population of more than 180,000 people and the base contributes more than $3 billion each year to the local economy in payroll, contracts, construction, and other services. The economic and social effects are mixed:

Positive effects of the military presence include

• Source of income and employment (e.g., as the leading employer in Onslow County, the Marine Corps Community Services employs more than 2,200 civilians at Camp Lejeune),

• Strong consumer base, and

• Source of civic pride and cultural continuity.

Negative effects of the military presence include

• Traffic congestion and strains on infrastructure,

• Overreliance on one source of income, which decreases the level of available employment opportunities,

• Prevalence of high-risk behaviors associated with hosting a large population of young men and women (e.g., drinking and driving), and

• Need to provide social services beyond those available on base to those who do not have access.

Historically, Jacksonville saw a substantial drop in its population during the first Gulf War as dependents left to return to their families for support during deployments.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

In the first Gulf War … a lot of people broke their leases because they thought that war was going to be an incredibly long period of time … they picked up and went back home to be with their loved ones. [City official]

In that time period, Jacksonville pretty much emptied out. Not only did the service members leave, but a lot of their dependents left as well. [Community college representative]

In an effort to prevent this flight from reoccurring, the Onslow County Chamber of Commerce put an innovative program called Project CARE in place. This effort, which was activated several times starting in 2003, combines the efforts of various local government, military, Chamber of Commerce, and community organizations to provide support to families of deployed services members, assist businesses in dealing with the deployments, and increase community spirit toward the military. Project CARE was cited by many interviewees as a successful strategy to mitigate the potential negative effects of multiple deployments:

I think the community as a whole … made it important to let the dependents know during the second Gulf War that they could stay here, that people in the community cared about them and were going to take care of them. It made a very big difference. Jacksonville certainly didn’t clear out. [City official]

This intervention has helped to create social and economic stability in Jacksonville throughout the OIF/OEF engagements.

EFFECTS OF DEPLOYMENT ON THE COMMUNITY

Economic Impacts

Multiple deployments appear to have had no discernible effects on the broad, communitylevel economy. Interviewees regularly described the local economy as robust and benefiting from the nearby presence of Camp Lejeune. There were suggestions that deployments may cause microlevel economic shifts (e.g., increased storage unit rentals before deployments, increased large-item purchases by young soldiers upon return from deployment), but interviewees did not indicate multiple deployments to be behind these small-scale rhythms.

Overall Commerce

As suggested above, the overall economy in the area has seen continued growth, strong military incomes, a good business climate, and relatively low unemployment rates. As of March 2012, unemployment rates were lower in Jacksonville and Onslow County (8.7% and 8.4%, respectively) than in North Carolina (9.7%) and the United States as a whole (9.1%) (http://data.bls.gov). Pay and housing allowances to military families have spurred a construction boom in homes, apartments, retail stores (including major consumer goods such as furniture and cars), restaurants, hotels, child care facilities, and ancillary services such as barbershops and storage facilities. Jacksonville officials noted that there is a large amount of construction work being done on base, and the restaurants in town are always full.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

Every restaurant in town has a long line … hotels are packed … over the past several years there has been a lot of construction and work on base, and that has put a lot of construction workers … into our community…. [Emergency services representative]

Some of these businesses experience cyclical ups and downs related to deployments. For example, barbershops see less business during deployments, but storage facilities flourish. In addition, the Basic Allowance for Housing (BAH), hazard pay, and savings while overseas tend to make the military-affiliated population stronger consumers than civilians are. Spikes in spending for consumer goods can probably be linked to deployment cycles, with young single service members reportedly making large purchases (e.g., cars, motorcycles) upon return from the combat theater. Importantly, the change in deployment cycles (shorter duration, but more frequent) was perceived by some respondents to have helped reduce the impact on the local economy:

They’re only gone for 6 to 9 months now; it doesn’t hit the economy within the county as hard as it used to when they deployed for a year at a time…. [Social services representative]

For the most part, the data suggest that the community has been insulated from the national economic recession. Some interviewees did note one probable effect of the recession, namely, that many family members of deployed Marines have moved to Jacksonville to help the nondeployed spouse because they themselves are unemployed and thus able to relocate.

We’ve been seeing a lot of family members relocate here … to help them take care of the kids … and once they’ve been here for 3 or 4 months, they start getting into the job market … it’s not a short-term thing, it’s a long-term thing. [Chamber of Commerce member]

Although the supports are undoubtedly welcomed by the nondeployed spouse, unemployed relatives can put an extra strain on family finances. And if these family members do find work, they often end up being underemployed, as discussed below.

The community also has been spared an economic blow in that the Department of Defense has not chosen to pursue any large-scale Base Closure and Realignment (BRAC) actions at the base. The only BRAC action taken at the base to date is the closing of the brig in an effort to consolidate correctional facilities in the mid-Atlantic Region.3 Although several respondents mentioned that the Marine Corps plans a gradual drawdown of service members, to date this has not significantly affected the area and business leaders say it will likely take place over the nextseveral years.

Although the economy of the area remains fairly robust, economic conditions for individuals can vary:

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3 See http://www.jdnews.com/news/brac-14971-lejeune-gombar.html.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

Single Marines receive hazard pay, housing allowances, and other benefits; are typically economically stable; and can afford to make major purchases such as cars and furniture upon their return from deployments.

Civilians may experience more dire economic situations, social services may be stretched because of the alleged Census undercount that affects federal funding for local programs (see below), high-paying jobs are scarce, housing is expensive, and consumer goods like cars may be high-priced because local businesses set their prices relative to the military salaries:

When I purchased my car, I went to Wilmington because I can’t buy in Jacksonville … the prices in Jacksonville are significantly higher … they know they are going to get those young military guys who have all this pocket change. [Community member]

Military families’ economic situations may depend on their number of dependents, employability of the “at-home” spouse, and their skills in managing money.

Unofficial military dependents (e.g., girlfriends and children) can experience more economic stresses depending on available jobs and how much the military member is willing and/or able to support them.

Family spending cycles may be related to deployments. For example, the number of pregnancies increases dramatically when Marines return from overseas, potentially resulting in increased spending for health care and, ultimately, food, clothing, and other items needed for the new family member.

Labor Supply and Employment

Military activities have had a significant effect on high turnover of the labor supply in Jacksonville and Onslow County, but this must be seen as a result not necessarily of deployments, but of regularly scheduled Permanent Change of Station (PCS) rotations. One member of the Chamber of Commerce representing a large national retailer told us that each year about 4% to 5% of his staff members ask for “hardship transfers” to other national locations because of a family member’s PCS transfer. Representatives of child care facilities, the hospitality industry, automotive sales, and city government all reported that military-affiliated employees have a lot of turnover and it is difficult to replace good staff members who leave:

You get some really good ones, and you know they are going to leave one day and you just hate it … our office manager … we are just dreading the day when she leaves and how we are going to replace her. [Chamber of Commerce member]

There’s about 700 volunteers for fire and rescue in the county. I’d say about 85 to 100 of those are direct military connected, and that is a constant revolving door in that area. They’ll be here for a while and then they’ll leave for deployments. [County EMS representative]

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

It has been a struggle these last couple of years trying to keep staff, and we’ve tried to be as consistent as possible because with the kids dealing with transition at home, we want them to at least be able to come to the Rec site and see familiar faces. [Recreation and Parks Department representative]

It’s almost like if I could ask two nonlegal interview questions, it would be are you pregnant, or are you a spouse of an active duty military, because I know what is going to happen. [Health Department representative]

The Onslow Police and Fire Departments are particularly prone to seeing turnover because many of their staff members are affiliated with the military. Among paid staff, they said, Police Department members are about 50% retired military; paid Fire Department staff members are about 20% retired military. They see turnover of about 15% per year. A representative of the County Health Department said turnover is a major problem in the Health Department as well, where many positions require specialized, long-term training and have licensure and certification requirements. For example, a nurse specializing in treating sexually transmitted diseases may require up to 2 years of training in order to function independently in the position; if staff members are prone to leave every 3 years, it is difficult for the county to justify the cost of such trainings.

Deployments also directly affect the labor supply. During the Health Department and Police/Fire Department interviews, interviewees mentioned that local employers must be flexible in terms of spouses’ issues during deployment, such as finding child care and spending time with active duty spouses before and after deployments. One interveiwee told us that following one return from deployment, 19 of 20 waitresses at one restaurant became pregnant. For employers, it is illegal to ask a potential employee if they are married to a Marine or if they are pregnant, so businesses are forced to be flexible to accommodate military families to meet their staffing needs:

A girl that works for us, her husband was just injured, that’s a major thing. For childcare, they are the only one at home [and we] just have to work with them on their schedules. [Chamber of Commerce member]

[As an employer, we’re sensitive … you’ve got a mom who is weeping, or it was just really hard to come in the day after she put her husband on the bus…. [Mental health representative]

In addition, and as suggested previously, deployments and PCS transfers together contribute to a scenario where underemployment is common. Unlike communities with universities or large-company headquarters that draw long-term residents who are highly educated, Jacksonville is focused on providing goods and services to the highly transient base population and to civilians in and around the city. Many local residents are underemployed in low-pay, semiskilled retail or service jobs. Underemployment disproportionately affects military dependents and individuals moving to Jacksonville to support their families; these people are more likely to have higher skills than the local job market can accommodate:

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

A lot of them are coming from larger cities where there’s a lot of hi-tech or tech or manufacturing firms. So when they get here, we don’t have the same firms and we definitely don’t have the same pay scales that they have. [Chamber of Commerce representative]

I think the issue for us is underemployment…. We are so heavily reliant upon retail sales…. We have seen a decline in the ability to be self-sufficient in that even though you may be … employed, you still require economic assistance to maintain family stability. [Social services representative]

Thus, even though the overall unemployment situation in Jacksonville and Onslow County looks good, findings from the site visit suggest that multiple deployments have potentially exacerbated an already dynamic labor market by contributing to high staff turnover rates, increasing the need for employers to make periodic accommodations for military spouses, and leading to a high underemployment rate among extended members of military families.

Housing Market

Continued overbuilding of the housing stock was a topic of concern to almost everyone interviewed. As one city official explained, the “housing market is soft because it’s been overbuilt.” The BAH is high enough for many Marines to purchase homes or rent recently constructed apartments. This has created a strong housing market that has had several effects.

• Growth in areas outside the city has put severe pressure on infrastructure and EMS services:

The city taxpayers bear the burden … [we] need resources for infrastructure and road improvements … funding for that would be really helpful. [EMS representative]

… infrastructure … we are way behind the 8-ball on that…. [Chamber of Commerce representative]

• Home and apartment prices are driven by the BAH, putting adequate housing well out of reach for many nonmilitary individuals and families:

The housing that is being built is really being built to those housing allowances. [Chamber of Commerce member]

I can’t afford to live in Onslow County, I’d love to. I work here … but I can’t [afford it]…. [Community member]

As a result, individuals and families that do not receive the BAH may spend a high proportion of their income on housing, leaving them in danger of having insufficient

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

funds for food, gasoline, medical care, and other necessities. This situation leads to higher demand for social services.

• Because large builders can price new homes competitively with older homes, military personnel preparing for a PCS may not be able to sell their homes, especially if the home is not brand new:

[There have] … been a lot of people who are affected by the lower property values and a significant number of new built houses. People, if given the choice, want to buy new instead of buying old. [City official]

A Marine told us he is preparing for a 2-year assignment in another region of the United States. Because he and his family own an older home, they have been unable to rent or sell it. His wife and young son will stay in Jacksonville while he moves to another state, creating a State-side situation that is, in his words, “essentially a 2-year deployment.”

Many respondents expressed concern about the future of the real estate market in the area, especially in light of a housing construction plan that is, in the words of Colonel Lecce, the base commanding officer, “the largest in this base’s history,” as stated in a 2011 letter to Military.com (http://www.military.com/opinion/0,15202,231435,00.html). This new base construction plan will result in nearly 700 new homes, for a total of more than 5,000 homes on base by 2013. In response to the increased availability of on-base homes,

[The Marines] are making [service members] move back on base because their occupancy rate is so low … and they are building with taxpayer dollars and [those houses] cannot sit empty. [Chamber of Commerce representative]

This may result in a severe drop in housing prices off base and cause a negative ripple effect in the local economy.

Changes in Population Size

Census data indicate that the population of Jacksonville has increased by 5.1% between 2000 and 2010. City officials and Police and Fire Department representatives, however, discussed their belief that the Census numbers are inaccurate because they do not count deployed military members as part of the local community. More specifically, the Census enumerates overseas soldiers as “deployed,” not in the locations where they were last stationed4:

The rules for Census counting impacted on us, because of the deployments … financially and otherwise … it is because of a rule established from the fallout from Vietnam and doesn’t account for the current way that we deploy our forces…. [City official]

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4 For more information, see: www.census.gov/hhes/veterans/about/faq.html#Q9 and http://www.mcclatchydc.com/2011/02/07/108265/census-undercount-of-overseas.html#storylink=cpy.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

From a resource standpoint, that has probably hurt us more than anything in the past 4 or 5 years. [EMS representative]

Several respondents told us they believe that, despite the official Census count, the community has shown substantial growth in recent years. A Health Department official provided data showing a 30% increase in the military population from 2000 to 2012. A child care provider reported that at least half the population is affiliated with the military and that even with a downsizing of the military, the city will still have a larger population than before the Gulf War. This is partly due to the trend for extended family members to relocate to Jacksonville. A school board member told us that last year, 18,000 local Marines were deployed. The County Health Department told us that the population of Onslow County is approximately 170,000 and of these, 27% are active duty and 18% are retirees. Counting family members/dependents, close to 70% to 80% of the population is affiliated with the military.

Information and Communication

Open Discussion of Deployment-Related Issues

The military is very much on everyone’s mind in Jacksonville, according to all interviewees, and that level of understanding is what makes Jacksonville feel like home for so many military families:

You don’t want to hang the yellow ribbon on the trees in your front yard if you are the only one in the neighborhood whose husband is deployed … but they couldn’t tell because everyone had yellow ribbons. [City official]

City government officials pointed out the symbolism of Jacksonville’s Beirut and Vietnam War memorials. Local media sources, such as the Jacksonville Daily News (JDN), continually report on items of interest to military-affiliated individuals and families. The JDN website includes a “Lejeune Deployed” blog that publishes news and photos from deployed units and links to specific unit webpages; they also have a reporter assigned to cover the military. A targeted online newspaper, The Globe, is published by a private company but dedicated to the military reader. Other local and countywide news sources, such as television news programs, provide Marine-related news. Also, Lejeune Underground and Lejeune Yard Sales are two local online bulletin boards where individuals can exchange news and seek help and advice from peers.

Community events also serve as a venue for passing along information about the military. For example, the first annual Jacksonville Jamboree, a community fair widely publicized throughout Onslow County, hosted booths for organizations specifically dedicated to militaryrelated issues as well as booths for the general community. Booths included

P.S. Charities, which was raising money to build an accessible home for a veteran with triple amputations and severe burns sustained from an IED blast in Afghanistan;

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

Paws for Veterans, which was promoting their efforts to provide therapy dogs for veterans with PTSD, TBI, or mobility issues; and

A chiropractic practice where military members could discuss their medical and chiropractic needs with the clinic’s staff.

These issues are being seen as both challenges for all those involved and opportunities for the area to retain its population and provide the services residents need.

Sources of Information for Military Families

Military members and their families may find out about resources in a number of ways. The base offers predeployment and postdeployment briefings to service members and their families; targeted briefings such as the Kindergarten Readiness program, which focuses on ways families can prepare for sending their children to school; and information on supportive resources. Representatives of programs such as the FOCUS project (Families OverComing Under Stress), Relocation Assistance Program, and Exceptional Family Member Program will sometimes attend these targeted briefings and set up tables with program materials and staff members to answer questions. For example, the FOCUS project provides resiliency training to military families and children and teaches practical skills to meet the challenges of deployments and reintegration. Family members can also contact the base Family Readiness Program to discuss specific needs.

Outside the base, military members and families obtain information about community resources through a variety of sources. For example, and as noted previously, Project CARE has been activated at times of high deployments to make a communitywide push to inform military families of the resources available to them.

The city helped to organize an effort called the Caring Communities Committee that was to try to help provide some services to persons of deployed families. With the Chamber, we institutionalized that into the Community Action Readiness Effort, which memorialized that caring communities program…. [City official]

During more “normal” times, two Marines told us, wives of Marines like to use online social networking to find answers to their needs. This statement was reinforced by a mental health care provider who told us that “brochures don’t work for 18- to 20-year-olds; we have stopped printing them, it’s a waste;” and “on paper, young women are connected to services, but don’t have real connections.” The mental health care provider believes this is a generational phenomenon linked to the popularity of cell phones and Facebook. This may also be tied to what one Marine wife told us, that she believes it is difficult for Marine wives to talk to each other about their problems when their spouses differ in rank.

Shared-interest organizations, such as churches, also appear to play a key role in supporting military family members. Church members, for example, often are aware of the challenges being experienced by military families within their congregations, and they can offer resources from within the church membership.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

Information Sources for Civilians

The Jacksonville Chamber of Commerce and city officials are very committed to supporting information flow between the base and the community, especially to business members. The city receives biweekly reports from the base on the number of Marines to be deployed and who will return from deployments, and it disseminates this information to aid local businesses in planning. According to one Chamber of Commerce member, these updates “are well received and help our businesses not be taken by surprise by a large influx of people.” She was not aware of any other such services in Jacksonville to provide updates on projected deployments and returns. Civilians receive general information on resources through the local media; at community fairs such as the Jamboree; and through friendships at work, church, and recreational groups.

Community Health

As discussed in more detail below, existing physical and behavioral health challenges have intensified since the OIF/OEF deployments began, and some new problems have emerged. Demand for mental health services has increased, according to Chamber of Commerce members, and city officials noted that they are seeing more homeless veterans. The demographics of homeless veterans reportedly are also changing:

A significant number of those veterans were single, and a surprising number of them were female and … had family members with them. [City official]

A United Way representative told us that the population of homeless veterans has increased 70% in the past few years. According to one mental health provider, the deployments “created a lot of stressed young women glued to CNN.” Overall, the need for more mental health services was emphasized, especially as the community braces for the return of troops with severe physical and behavioral health issues that they will experience for the rest of their lives.

Mental and Behavioral Health

Almost all interviewees concur in noting a growing demand for mental health services in the community.

Mental health … [is] one of the biggest areas and issues wholeheartedly for the families…. [Chamber of Commerce member]

There is a lot of need for counseling and they’re not gonna go on base. I don’t care how many times you tell them it’s not going to affect their career, there is a pervasive urban legend [that seeking mental health services will affect one’s career]. [Mental health provider]

Individuals are experiencing symptoms whether or not they have received a mental health diagnosis. A Health Department representative described a situation where the county had

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

moved away from providing direct services and now provides only referrals. As a result, the Onslow Memorial Hospital emergency room became overwhelmed with mental health cases, which strained resources:

The emergency room was just inundated with mental health type patients … you’re bogging down an emergency system … with mental health patients that are very time-consuming, that prevent you from handling that heart attack … but that person needs their needs met and you are not able to meet them in a 15-minute, in-and-out emergency room visit. [Health Department representative]

Mental health difficulties express themselves in a variety of ways. These include

Prescription drug use and abuse: A mental health care provider told us that prescription drug use is huge and people use these drugs “like candy” and they have “huge amounts of medications in cabinets.” In response, she has seen a rise in people seeking alternative therapies in order to reduce their reliance on pharmacologic agents:

I’ve known people who just pay out of pocket and go on their own [to a chiropractor or for acupuncture] because they are tired of taking the pills, can’t function on the pills, don’t want to be addicted to the pills….

This provider indicated a need for educational services to help people overcome their addictions to prescription drugs.

A social services representative added that military spouses are also showing high levels of addiction to prescription drugs:

One of the biggest things we’ve seen, especially with military spouses, is prescription drug use…. A lot of them have their own prescriptions, are misusing those prescriptions, are shopping with different doctors, different pharmacies to get those prescriptions.

Illegal substance use: The Chamber of Commerce and County EMS representative noted an increase in the use of SPICE (synthetic marijuana) and bath salts (synthetic methamphetamine). They worked with the base to get statistics on this and went to the state legislature to outlaw these substances. According to representatives of the School Board, this problem is not isolated to adults; many children in Jacksonville are dealing with substance use issues as well.

Automobile accidents: Accidents originating from reckless driving, driving under the influence, and substance use have increased, according to County EMS, Jacksonville Police, and the Health Department. The county EMS representative noted that Marines come back from deployments with an “adrenalin addiction, addicted to driving fast.” He noted that the area has the highest rate in the state of accidents based on substance use, and the second-highest crash rate in the state.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

In 2002 we went from 10 or 11 DUIs to … 484 last year … that was one thing we did see, prior to a deployment, people would get intoxicated. A lot of times we would take ‘em straight to the base. [EMS representative]

When they’re deployed that adrenalin is constantly there for them, and they come back, and they need it, it’s like an addiction. [Chamber of Commerce member]

PTSD: A social services representative noted that “countless families have been dissolved because of untreated PTSD.” Individuals self-medicate for PTSD with pharmaceuticals or alcohol and do not want to disclose their problem. A Health Department representative told us PTSD has never been seen at such high rates, and we are seeing how it affects employability and risk-taking behavior:

With the rapid succession, there has been no time to debrief, or to reintegrate with your family … or seeking services … it continues to be a double-edged sword for that service member, fearful that their career will inadvertently be harmed. [Social Services representative]

Suicide attempts: County EMS and police representatives both discussed the rise in suicide attempts, and a Health Department representative described an increase in gun accidents:

We had two officer-assisted suicides where the people charged the officer with guns, and we’ve seen some other suicides…. [EMS representative] We’ve had a lot of fatalities from gun accidents … you’ve got military guys … and it’s really hard to always know what exactly is going on in those situations … he was cleaning his gun, but was he? [Health Department representative]

Traumatic brain injuries and the concomitant cognitive difficulties: These conditions are affecting young veterans’ abilities to plan for their futures:

You’ve got a lot of 22, 23, 24-year-olds getting out of the military that joined right out of high school … gonna get out with the GI bill and go to college…. Well, depending on their cognitive abilities when they get out, they can’t. [Mental health provider]

Despite this array of reported problems, it is important to note that interviewees did not necessarily link these issues to multiple deployments. Three deployments to an installation “behind the lines” may have no effect on a service member, whereas a single deployment to a “hot” combat zone may have a profound impact on a Marine. Some of the behavioral changes noted by interviewees may simply be the result of an American military at war.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

Family Challenges

Interpersonal difficulties and violence also arise from untreated mental health issues. According to data from the Police Department, there was a 15% increase in calls for emergency services between 2008 and 2011. These interpersonal issues include

Child abuse: A police official, the County EMS representative, and a mental health provider all told us they see child abuse reports originating in parental anxiety, depression, and anger issues:

Some of the most significant maltreatment issues and abuse are military affiliated. [Mental health provider]

The call volume on these kinds of cases increases each year. According to the Police and Fire Departments, there has been a 73% increase in child abuse and neglect in the last 2 years. Prescription drug abuse by nondeployed spouses undoubtedly has added to these numbers.

Spousal abuse: Domestic violence reports and police calls have greatly increased. A social services respondent said that it is possible to tell when deployments end and when Marines are back because their caseloads increase:

There are tremendous reintegration problems that are causing havoc for families… oftentimes the report may be domestic violence, but once you dig a little deeper you can see how gravely the children are impacted. [Social services representative]

Separation and divorce: A mental health provider told us she is now getting calls from more senior members of the military and officers: “They’re tired and never thought they’d need counseling, but now their families are falling apart.”

Violent acts: The police representative told us of recent acts of violence conducted by Marines, including a man stabbing dogs in his house.

We’ve seen some other things that are quite disturbing…. We had another Marine who was intoxicated, sitting on top of his roof with an M4, pointing it at people…. Those kinds of things we have seen on an occasional basis. [EMS representative]

Physical Health Issues

Physical problems are also on the rise. One respondent mentioned that many Marines are coming back from overseas with significant hearing loss, or orthopedic injury and pain that will disqualify them from obvious postmilitary career choices.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

They are probably not going to be a firefighter or police officer … depending on their joint injuries … and back injuries….

A staff member at the chiropractic practice booth at the Jacksonville Jamboree confirmed this, saying that older military members are almost completely disabled at 38 or 40 years old and are living in constant pain. Following deployments, the Health Department representative also sees many cases of sexually transmitted diseases among Marines at the county STD clinic, as well as cases of travel-related illnesses such as malaria and tuberculosis at their communicable disease clinic.

Children’s Issues

Children of both military and civilian families are affected by the mental and physical health difficulties experienced by military families. Representatives of the Recreation and Parks Department told us that the friends of military children are always moving away and it is hard on them. Their fathers are home for only short periods of time between deployments and cannot get too reattached when they are home. Returning Marines may not be able to reintegrate into the family easily; they are “trained to wake at a pin-drop and come back to 2-year-olds jumping on [the] bed in the middle of the night.” Or, for example, they are trained to yell at fellow Marines to get the job done and keep them safe, and use the same approach to talk to their kids and their teachers;

or you get a dad who’s freshly back from Afghanistan … [and] the past year [he] has been yelling at a Marine because he is going to die if he doesn’t pay attention to the IED. [Now his] child is failing math and [he] comes across the table [at the teacher] … it’s just difficult for the faculty. [School system representative]

Often, even when military members are not deployed, they are still away from home on trainings as much as if they were deployed; this creates added stress for the spouse.

Physical health issues also arise among military families. For example, one provider reported seeing cases of mumps among children from the base because their parents do not have them vaccinated as a result of either frequent relocation or differing vaccine schedules by state. Overall, there is a young parent population in Jacksonville. According to one mental health provider, the average age of mothers delivering their first child at Onslow Memorial Hospital is 23, and at the Naval Hospital it is 20. One school representative estimated that 75% of military children in the area are in fifth grade or below. Other child-related issues include the fact that no systems are in place to prevent both parents from being deployed at once if they are both active duty. In these circumstances, unique custody arrangements need to be put in place. For example, a representative from a local child care facility reported that one of the teachers and her husband took in and helped raise two of her students whose parents had been deployed. “We are the only family that the parents have,” she said.

The school representatives to whom we spoke told us that, on base schools, they see mental health issues with younger populations, such as a second-grader with suicidal thoughts, and middle school substance use. In one school, 40 of 400 middle school students were

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

investigated for substance use. Substance use, depression, anxiety, and anger issues are heightened not just for the children, but for their parents as well:

We’ve seen a lot of attendance issues with that, at least aboard the base schools … mom is depressed and doesn’t get out of bed, so she doesn’t get the kids ready for school… [School system representative]

Representatives of the Recreation and Parks Department told us that “younger kids deal by outbursts, teens are more inward until they are set off, ADHD is on the rise, and kids lash out physically.” The city police representative told us he sees a correlation between deployments and juvenile crime. We also met a church-going parent whose 8-year-old son was recently diagnosed with PTSD.

The Onslow Partnership for Children is one organization focused on improving children’s lives. The partnership is home to a Child Advocacy Center, parent education classes, and a multitude of services to support the area’s children. In addition, the school system employs military transition counselors and school liaisons to help children with military-related stresses. The PEERS program is also available to military families and offers free drop-in child care, parenting classes, and an adolescent parenting program.

Community Competence

Throughout Jacksonville and Onslow County and on base, there is a wealth of resources available to help military and civilian families and individuals cope with the stresses of deployments. On the macro level, agencies communicate regularly: “We don’t duplicate efforts,” said one city official. “We work hand in hand with MCCS.” For example, the city has regular meetings of service agencies to help streamline efforts for veterans, and the Local Inter-Agency Children’s Council meets monthly to coordinate efforts.

On the interpersonal level, individuals and families are quite connected as well. Word-of-mouth networks through churches, online forums, and other groups help to connect people with informal services (e.g., child care assistance, financial, or around-the-house support).

As soon as anything happens, people just show up … word of mouth, Facebook … everyone is comfortable doing that with one another. [School system representative]

I think it’s more word of mouth now. I think there still is that group of people who are saying, “Oh, contact them, they helped me through this” and I hear a lot through my church. [Social services representative]

Eligibility Requirements

Services on base are available to service members and their dependents. According to the 2012 Camp Lejeune Base Guide, these services include, but are not limited to, car service, banks, child care, restaurants, shopping, schools, libraries, employment assistance for families, new parent support programs, marriage preparation workshops, religious education, substance abuse

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

prevention and counseling, and hospital, dental, and health clinics. Base services are not available to civilians, and we heard that military members and their dependents sometimes choose to seek services off base, especially for mental health issues. Certain city and county programs have income eligibility requirements that place these services out of reach for military families whose wages are too high to qualify. In addition, partners who are not legally married cannot access base services and must rely on the county; this is a far-reaching issue according to many service providers.

We have a lot of pregnant girls…. I know they are military connected in some way … they don’t tell us that, but then if you get into asking about the absent parent a lot of times they tell us it’s a Marine and they don’t know who it is….

Most of our pregnancies, if they are single, are Marine related in one way or another. [Social services representative] Most people are not getting married until later in life, so we’ve got a young active duty lance corporal who is here, and his girlfriend follows him here, and she receives no benefits, she’s not able to go on base…. [Health Department representative]

One social service provider estimated that one third of pregnant women they see are connected to the military in some way. Without established paternity, however, neither the mom nor the child is eligible for base services.

Barriers to the Provision of Services

Although there is a wide array of services available to Jacksonville residents, it is still possible for individuals to fall through the cracks. According to a mental health provider, there was a recent death of an infant in Jacksonville. The mother was an active duty spouse whose husband was deployed. She ran out of formula and started feeding water to her baby, who then developed nutrition-related health issues and subsequently died. This mental health provider explained how it is difficult to figure out how to reach a mom like this who had so many services available to her.

That was a young mom who was eligible for a variety of services … how do you reach that new mom who is so overwhelmed … or didn’t know how to connect with someone who could help her…. [Mental health provider]

Additional barriers to service provision include

• Fear of damage to career,

• Lack of awareness of services,

• Pride/take care of own problems,

• Too much “drama” on base, and

• Confidentiality concerns.

In addition, many services designed to help military families and individuals during deployments are tied to grants that may end as the drawdown in troops begins. For example, the military transition counselors in the school system are funded through a Department of Defense

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

Education Activity (DoDEA) grant that started in 2009. These positions were initially funded to help students deal with deployments, but they now help with reintegration and assist children in working through confusing issues to them, such as one that a school official described: “Daddy yells at me a lot and I don’t know why.” These staff positions have filled a major gap in services, and the school system is working to ensure that funding for these positions continues.

Social Capital

Many interviewees explained that compassion fatigue has not been a large problem for the community. “It’s been a constant level of support,” said one city official. Reportedly, support for the troops has become “a way of life” ever since the 1983 Beirut bombing; the Beirut memorial is the largest military memorial constructed with private funds and was viewed as a testament to the community’s commitment to the troops. Although Jacksonville as a community is still very committed, some interviewees felt that many residents are not as emotionally engaged as they might have been earlier in the war efforts:

Sometimes I think there is a tendency, especially in a large military town where it’s the norm, … sometimes people are … kind of calloused to that … there is a lot of support, but sometimes people get calloused and desensitized to it because everybody is going through it…. [Health department representative]

Overall, however, there was a sense that individual families are “very networked” and there is a strong commitment in the community to fundraising to help each other with projects and hardships, as described by these school system representatives:

We had a parent who had a back injury, and her husband was deployed, and she had three kids and couldn’t pick her kids up from school … and the principal and the faculty got together and paid for child care to get kids to stay until a neighbor could pick them up. [School system representative]

Our findings suggest that the largest source of informal support was the faith-based community. According to one pastor, “It is amazing what church can do for those families.” He described the challenges faced by one active duty spouse with five children whose husband is on his seventh deployment. When this woman sought services on base, she was told by one program that the situation with her family was “too severe” and they would have to go to the command; she did not want the family’s issues to bring her husband home and jeopardize his career. The pastor said that the church “bent over backwards” to help this woman and her family get the supports they needed. Another church member believed that it was nice to have the church to go to, they are mostly military and “understand, but without the drama.” One pastor said the church can offer confidentiality and immediate supports “without the red tape.” Churches in Jacksonville offer the following services:

• Military luncheons,

• Men’s PTSD support group,

• Deployed member support group,

• Care packages, and

• Financial, respite, and household support.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

One pastor explained how one of his parishioners sought PTSD support from a facility in another state and said he never would have had the courage to go if he had not started attending the PTSD support meetings the church offered. This pastor explained his belief that “certain things, only God can do,” and his aim was “for these men to be restored to wholeness,” because “they shouldn’t be doomed to nightmares and being forever shattered.” This same pastor explained how one church member decided to stay in Jacksonville during her husband’s deployment solely because of the deployed member support group. Her family “thought she was crazy” and did not understand why she chose to stay during the deployment.

The strength the church gives to service members and their families both at home and when deployed is evidenced in a letter sent to and shared by a pastor we met with. In a letter to the pastor from the battlefield, written on a piece of cloth, this service member said, “Thank you for all that you have done for me and my wife [redacted] and all that you continue to do for our community … my extended thanks to the support group for the care package that I just received, the timing was perfect … it is difficult to be positive 100% of the time but I find a well of strength when I look to God.”

SUMMARY OF STRENGTHS AND CHALLENGES

Model Programs and Services

Project CARE successfully maintained and strengthened the city of Jacksonville’s population, even during deployments.

• The city’s agencies and services are well networked and communicate regularly.

• The Chamber of Commerce regularly alerts businesses of upcoming deployments and returns.

Needs and Challenges

Mental health services were touted by many interviewees as the largest current and anticipated need for the community. Individuals’ concerns about the perceived adverse effect of help-seeking on the service member’s career was cited as a significant barrier to service.

Infrastructure improvements are needed to keep up with the growing population. Because of how the Census Bureau counts service members (they are counted as part of the U.S. overseas population and not Jacksonville’s), interviewees said the region is not receiving adequate federal resources to support the expanding population.

Suggestions from the Community

• Increase the focus on mental health and service availability.*

• Continue to build partnerships among the city, county, and base.

• Create transition programs for returning troops.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

• Address child custody issues during deployments.*

• Increase access to prescription drug use education.

• Continue funding wartime programs (e.g., transition counselors at schools).

• Increase funding for Family Readiness Groups.

• Address Census issues to support emergency services and infrastructure development.*

• Improve employment and assimilation opportunities for spouses seeking work.

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*Suggestions noted with an asterisk were cited by multiple respondents.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

El Paso, Texas

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Case Study Report

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

 

Impacts of Multiple Deployments: El Paso, Texas

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OVERVIEW

Fort Bliss, a massive Army training installation for armored units and infantry, is located in the northeastern part of El Paso, Texas, and, along with the adjacent White Sands Missile Range, stretches north into New Mexico. During a study team site visit (May 8–13, 2012), representatives from El Paso provided their perspectives on the impacts of multiple deployments from Fort Bliss on their community. Site visit findings indicate that as a result of Base Realignment and Closure (BRAC) decisions, Fort Bliss growth has had a huge, positive impact on El Paso’s local economy. Potential impacts from multiple deployments were not readily discernible by interviewees. The greatest concern expressed by community members was the need for more mental health services for service members and their families. Although the area is rich in informal services and supports, the capacity of the formal service delivery system was described as “strained” even for civilians, let alone military-affiliated individuals. Children’s services were called out as an area of increasing need.

Data Sources

• City government

• Chamber of Commerce

• El Paso Independent School District (EPISD) Administration and Faculty

• County Domestic Relations Office

• Churches

• Rotary Club

• Social Service organizations

• United Way

• Fort Bliss Garrison Command

• Fort Bliss MWR

• Military families

• El Paso Police Department

• Ethnographic observation

GEOGRAPHIC ORIENTATION

Community: El Paso, Texas

El Paso is situated in the westernmost corner of Texas, bounded on the north by New Mexico and on its south, just across the Rio Grande, by the Mexican city of Juarez (Figure 1). The city is bisected from south to north by the Franklin Mountains, whose dry, rugged peaks stretch northward some 15 miles and rise in places to an altitude of more than 7,000 feet.1 El Paso’s landscape is also visibly marked by its location in the Chihuahuan Desert: Light brown sandy soil hosts few plants, and tumbleweeds are common. City residents’ “lawns” are similarly arid, with some sporting a thin layer of small, dark brown rocks to create a more consistent appearance.

El Paso and Juarez combined include more than 2 million people. Together they represent a single metropolitan area, which is clearly evident at night when city lights south of El Paso stretch as far as the eye can see. In numerous respects, the border at the Rio Grande is simply another local geologic feature and not a political

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1 See http://www.geo.utep.edu/pub/lemone/1301/franklin_mts.html.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

boundary: 80% of El Paso’s 650,000 residents, for example, self-identify as Hispanic.2 Traditional Mexican food can be found throughout the city, Spanish is so commonly spoken among El Paso residents that city council meetings have a Spanish interpreter in addition to an American Sign Language (ASL) interpreter, and thousands of residents from Juarez make daily commutes across the river. In other respects, however, the border clearly demarcates two dramatically different lifestyles. For several years in a row, El Paso has been one of the safest U.S. cities with a population over 500,000, a designation the study team heard about during almost every interview. In 2010, for example, there were only five homicides in the city. In contrast, Juarez has received notoriety as one of the most dangerous cities in the world outside of a declared war zone because of a flare-up of drug cartel–related violence.3 In Juarez in 2010, 3,075 residents were murdered, a number that sits in stark contrast to its sister city across the river. As a result of a murder rate of more than eight persons per day, there has been an exodus from Juarez. Since the drug wars began in 2008, an estimated 250,000 people—possibly twice that number—have emigrated from Juarez.4 From El Paso’s perspective, the border has become a one-way valve: People are still coming into El Paso from Mexico,5 but the State Department has warned Americans against crossing into Juarez.

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FIGURE 1 El Paso geographic orientation.

What is happening in Juarez is germane to this report, for there is recognition throughout El Paso that posttraumatic stress disorder (PTSD) is not unique to the soldiers who are returning from their fourth or fifth deployment to Iraq or Afghanistan. Some counselors who work with soldiers with PTSD indicated they needed no additional training because they are already serving traumatized families from Juarez; at least one school faculty member directly compared the experiences of children in military families with those of some of the children fleeing Mexico, noting that the latter have often witnessed the death of a parent. Also, as discussed later in this

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2 See http://quickfacts.census.gov/qfd/states/48/48141.html.

3 See http://www.chron.com/news/nation-world/article/Ciudad-Juarez-passes-2-000-homicides-in-09-1593554.php.

4 See http://borderzine.com/2010/08/exodus-from-ciudad-juarez-impacts-el-paso-economy.

5 See “Bridging a Gap Between Fear and Peace,” New York Times, Feb. 15, 2011: A8 of the New York Edition (also available at: http://www.nytimes.com/2011/02/15/world/americas/15juarez.html).

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

report, the El Paso Police Department received training from Fort Bliss personnel on crisis situations and PTSD, but department leaders also told us that their concerns about their officers encountering community members with PTSD extended to the Spanish-speaking immigrants. In short, the city is working to address the harmful effects of PTSD, but is doing so because it is host to two large and potentially traumatized populations.

Military Installation: Fort Bliss

With 3.2 million acres, the Fort Bliss installation is larger than the state of Rhode Island; it is home to the country’s largest unrestricted airspace and is the second largest restricted airspace (Washington, DC, is the largest). Because of its position on the border with Mexico, El Paso has long held strategic significance for the United States. After the end of the Mexican-American War (1848), which solidified U.S. annexation of Texas from Mexico, a military garrison was established in the greater El Paso area. Although the post’s exact location shifted several times in its first 50 years, the foundation of what is today Fort Bliss was settled by 1893.

Although the installation was initially developed to maintain security along the southern border, by the early 20th century Fort Bliss had developed a more global focus. The area hosted more than 100,000 National Guard troops in the middle of the First World War, and by WWII Fort Bliss hosted the largest cavalry unit in the United States. By the end of that war, Fort Bliss had been transformed into the nation’s largest facility for anti-aircraft training.6 Indeed, up until 2005, when the installation was affected by Base Realignment and Closure (BRAC) decisions, Fort Bliss was home to the Army’s Air Defense Artillery (ADA). As a result of BRAC, however, the ADA was sent to Fort Sill, Oklahoma, and Fort Bliss was converted into a massive training installation for armored units and infantry, most notably the 1st Armored Division.7 The Army estimates that by 2013 the installation will have gone from hosting 13,000 soldiers to more than 33,000 young infantrymen. It is also estimated that these soldiers will be accompanied by an additional 30,000 family members.

Although the garrison commander indicated that large deployments from Fort Bliss to Iraq and Afghanistan did not begin until 2008, area units were engaged from the start of Operation Iraqi Freedom and suffered early casualties. Among them were Lori Piestewa, Jessica Lynch, and Shoshanna Johnson, whose convoy was ambushed near Nasiriyah in 2003. Piestewa was killed in the attack, and Lynch and Johnson were captured by Iraqis. The El Paso Times estimated that more than 25,000 soldiers have been deployed from the installation over the course of the last 9 years of war, accounting for nearly 240,000 total deployments. As one service provider told us: “You don’t know anybody who’s only been deployed once. It’s multiple, multiple deployments.”

Effects of BRAC

The BRAC-related changes, as described above, have had a marked impact on El Paso. Interviewees repeatedly commented on the rapid population growth, which has necessitated the

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6 See https://www.bliss.army.mil/Secure/Military/MaDBDE/SECURE/DoD,%20DA,%20AD%20Mil/Welcome%20Packet/Fort%20Bliss%20History.pdf.

7 For more on the BRAC decisions about Fort Bliss, see http://www.globalsecurity.org/military/facility/fort-bliss.htm.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

development of an infrastructure capable of supporting such a large influx of residents. The Chamber of Commerce estimated that the BRAC changes brought more than $5 billion into the local economy, an addition that several said effectively allowed the city to weather the recession. As part of this investment, El Paso and Fort Bliss collaborated to build the world’s largest inland desalinization plant, which is located on Fort Bliss property. The desalination plant afforded the post access to a brackish groundwater bolson that would have otherwise been unusable. Consequently, the post does not draw on the desert city’s water supply.

More important than their focus on the construction, however, was civilian interviewees’ assessment of the changing characteristics of on-post personnel. Numerous interviewees described the installation as now having a “different type of soldier” as a result of BRAC:

When I was growing up, especially air defense artillery kids, for the most part we were pretty well-behaved kids … back when I was growing up it was an honor and a privilege to serve in the Army and there were very high standards. You couldn’t have certain tattoos showing in areas, your hair had to be a certain way, and, I mean, that’s just how it was. People kind of respected that code…. After 9/11, especially when we started to really deploy, it just seemed like, I don’t think we had enough in the military and it just seemed like they were really pulling in anybody who wanted to join. Unfortunately, some of those people do not have the cleanest backgrounds, and I think that kind of came out a little. The kids have changed, they’re a little bit rowdier and parents have changed, they’re a little bit more crass and they’re impatient and it’s “I’m military, my husband/wife is serving, I deserve X, Y, Z.” I feel like it wasn’t as prestigious as it used to be. [Social services provider]

I’ve seen the transition from only having sergeant major academy children there to a different type of soldier…. So we have grown and there is a difference in the structure, in the dynamics. [What’s the difference?] … The family structure with the sergeant major family is a little bit more disciplined, more structured. As a family unit, there’s a little bit more organization. With the younger soldier, I’m not seeing the educational background, there’s not as much discipline or structure in the family. I don’t know if it’s because the soldier is out more, deployed more, I’m not sure. But the family dynamic is not as stable as when we had only the sergeant major children. I saw something very different. [School faculty member]

Our prior military community … was air defense artillery. That’s a completely different set of educational skills, a higher level of education, a different—may I say, social class of soldier…. It’s very cerebral … even the lowest level soldier was trained to fight through video technology…. We now have shipped off air defense artillery and brought in armored divisions…. And armored division soldiers and infantry soldiers are trained to pull triggers. There’s a lower level of education … and remember when people are chosen, when they’re given their jobs in the military, they’re chosen based on their background and their skills…. So we have a lot of kids who’ve been shipped into El Paso who maybe are not as educationally advanced and have not had some of the same economic benefits as soldiers that we previously had. It’s a different social class of

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

soldier. And I hate to say it, but it’s a reality. The numbers, the impact on the community is significant…. [Attorney]

Importantly, roughly 70% of the soldiers stationed at Fort Bliss live off post. Military families live throughout El Paso, but the largest concentration of military residences is directly west of the post, in the neighborhood called “the Northeast,” and south of the post. Many veterans also live in the northeastern area of the city. Partly as a result of the BRAC-related enhancement of the transportation infrastructure, some military families have chosen recently to locate throughout the city and even in somewhat-distant locations, such as Socorro and Horizon City. At the suggestion of Mayor John Cook, however, the study team focused on City Council Districts 2 and 4, the areas immediately adjacent to the post that would most likely be affected by multiple deployments.

Relationship Between Community and Base

In certain respects, El Paso is the ideal location for young troops preparing for the wars in Iraq and Afghanistan. Several community members pointed out, for example, the similarities between the local terrain and what the soldiers face when they deploy to one of these two combat theaters. The photographs in Figure 2 illustrate the similarities.

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FIGURE 2 Similar landscapes.

What makes the area ideal, however, also creates its own set of problems. Reminders of the desert landscape are seen from the post and in the front yards of nearly every home. The rocky Franklin Mountains are within plain view of the post. At least three interviewees pointed out that the landscape is so similar to what soldiers face overseas that just getting up in the

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

morning and looking out the window can trigger an individual’s PTSD. One interviewee remarked that his stepson, who has been deployed three times, often struggles with driving in the area because of its unfortunate similarity to what he faced in theater.

The landscape also led to a small dustup between City Council District 2 Representative Susie Byrd and the Fort Bliss Garrison Command. District 2, located directly west and south of Fort Bliss, is home to McKelligon Canyon, a popular recreational area where the photograph in Figure 2 was taken. Representative Byrd reported receiving complaints from constituents that the Army was not using the canyon only for training, but at one point had closed the area to the public in order to carry out an exercise. Numerous discussions reportedly ensued before the command was willing to acknowledge that the military had overstepped its bounds. Our understanding is that the area continues to be used for Army training, but that improved communications have prevented any additional problems from arising between soldiers and city residents.

One of the few general complaints we heard from civilians, which came from a couple of interviewees, was that military families sometimes convey a sense of entitlement simply because of their army affiliation. Examples all involved situations where a military-affiliated individual—often the wife—requested that standing rules be broken because of their relationship with the Army. Overall, though, residents interviewed by the study team perceived their community to be quite welcoming to the military and appreciative of the sacrifices made by service members and their families. Not only did stores throughout the city post signs advertising discounts for military members, but numerous businesses displayed photographs of, or mementoes from, service members out of respect for the men and women who had passed through their community on the way to war. Anecdotally, the study team heard about individuals in restaurants picking up the tabs for service members. Parents in the Socorro School District were delighted when the District had “Purple T-shirt Day,” during which students and staff all wore purple T- shirts to show solidarity with the military.

Several military-affiliated individuals the study team talked to offered a counter perspective, perceiving the community appreciation as superficial, at best. One observer said:

Politically, it’s very well received. I think that you’ll find areas and pockets where … what I’ve witnessed far too often is, it’s politically correct to say, ”Welcome and we’re glad you’re here.” But I think in their heart a lot of people are kind of holding their nose [sic] at the same time. It’s not as genuine as I’d like it to be.

As an example, a military spouse described how a friend’s husband shattered both ankles in an IED blast and the couple was trying to get a wheelchair ramp built to their apartment. Our interviewee said that if the ramp does not work out, the couple will have to relocate, but the complex manager is refusing to let them break the lease without paying a “couple hundred dollars” penalty. She reported that the Family Readiness Group (FRG) had come through with the money for the penalty, but she was dismayed by the manager’s attitude:

I’m thinking, to me, her husband was fighting for you … and you can’t even forgive that couple hundred dollars? That’s another example of unsincere [sic] gratitude.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

When individuals associated with the Fort Bliss Garrison Command were presented with the above apartment manager example, the command pointed out that there is a strategy in place not only to help young families in such situations (the FRG), but also to ensure that the business owner does not have to suffer financial consequences because of what’s happening to soldiers and their families. They also reiterated the post’s extensive collaborative efforts with the city that are intended to mitigate any potential negative effects of the post on the community at large, including the physical disabilities that might result from combat. Incidents such as the one with the apartment are clearly frustrating to the Army families; nevertheless, it is perhaps just these kinds of situations that might lead civilian community members to perceive a sense of entitlement among their military neighbors.

EFFECTS OF MULTIPLE DEPLOYMENTS ON THE COMMUNITY

Economic Impact

Interviewees described numerous, large-scale changes to the El Paso economy in recent years, including infrastructure growth (e.g., highway construction), increased commerce, and residential expansion into outlying areas east of the city. Because of the large infusion of capital into the region resulting from BRAC decisions, however, interviewees were unable to tie any of these changes to multiple deployments.

Commerce

Overall, and as suggested above, we were unable to link impacts on the El Paso general economy to multiple deployments. One business leader suggested that this was by design:

From the business sector [perspective], [the multiple deployments are] relatively benign. [If] there are some negative impacts, I haven’t had anybody articulate that to me. I haven’t seen it personally. But I think the reason is because as there’s a deployment occurring there’s also a circular motion occurring where troops are coming back…. It used to be where we would see a deployment then we would feel the impact because the families would go home and so all of a sudden the grocery stores weren’t as busy, clothing stores, the shopping centers … we don’t see that so much anymore because a lot of families stay here…. Part of the reason for that is the community is extremely welcoming. Soldiers with families who actively engage in the community, they see a genuine, a sincere approach toward “You’re part of our community and you’re welcome here and we want to support you.”

The BRAC-prompted growth at Fort Bliss reportedly buffered El Paso from the recession, but accommodating the growth required substantive changes in El Paso’s infrastructure, particularly in housing and transportation. Though bounded by New Mexico to the north and Juarez to the southwest, expansion went outward. Along with new housing were shopping developments, located primarily on the west side of El Paso and on the southeast along I-10, stretching into adjacent towns such as Horizon City and Socorro. In contrast, the team observed aging, often neglected, structures from the 1960s or earlier in established

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
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neighborhoods in downtown El Paso and the Northeast, adjacent to Fort Bliss. These areas seem to have changed very little as a result of BRAC-related growth.

Housing

When BRAC was first announced, Fort Bliss projected an average stay in El Paso of 7 years for a service member. Although there was a housing shortage on post,8 El Paso, with nearly 5,000 houses standing empty in 2005, had the capacity to readily absorb the newcomers and their families. Soldiers coming to the installation, however, have been a younger and more mobile cohort than expected, and were reported to have neither the resources nor the stability to purchase single-family homes. The result, according to city leaders, is that El Paso’s housing market has required an increase in rental housing, a type of housing the team was told had never really existed in the city. To encourage building this new type of housing, the Chamber of Commerce brought together the post, the city government, and developers. The city also instituted incentives that allowed developers to secure loans more easily. So great is the need for rental housing that even though developers continue to work hard to meet the demand, as one city leader put it, “We can’t build them [the units] fast enough.”

Transportation

Since 2003, El Paso has invested $1.5 billion in several major transportation projects. Notable additions include the 601 spur that connects Highway 375 and Highway 54 and has six off-ramp exits onto Fort Bliss. The Highway 375 “loop” has been expanded, and two major freeway interchanges (or “spaghetti bowls”) have been built. These transportation improvements have allowed military families to live farther away from post and still have manageable commutes to the post. Growth has increased, particularly in the west side of El Paso and in Horizon City and Socorro, which are suburban towns southeast of El Paso. Long-time residents complain about the increased traffic.

Job Opportunities

Despite the BRAC-related growth, El Paso’s poverty rate remains well above the national average. In 2010, 24% of El Pasoans lived in poverty, compared with 15% nationwide.9 El Paso struggles to find good-paying jobs for its permanent residents. In March 2012, El Paso’s unemployment rate was 9.5%,10 above the national rate of 8.2%.11 Moreover, El Paso’s business community is structured on low-wage labor; many of the region’s largest private employers are minimum-wage call centers. Many military spouses we spoke with said they could not find good-paying jobs, and instead choose to volunteer, especially if they have children at home. Business leadership envisions opportunities that leverage technological advancements driven by Fort Bliss, such as energy improvements and metal bending that can absorb the expected influx of retiring soldiers into El Paso. Fort Bliss aims to be a net-zero installation in energy, waste, and water by 2018.1

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8 The study team was told that the wait time to get into housing on post is at least 2 years.

9 American Community Survey, U.S. Bureau of the Census, 2010.

10 See http://www.elpasotimes.com/news/ci_20442789/el-paso-unemployment-rate-unchanged-march?source=rss.

11 See http://www.bls.gov/news.release/pdf/empsit.pdf.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

Information and Communication

Civic and military leaders described several formal communication channels that have been established to ensure the timely and accurate flow of information about deployments to the civilian community. Civilian recipients included the business community, educators, and law enforcement. Information about the availability of particular services and supports in the community was said to occur through informal channels (e.g., word of mouth) rather than through more formal communication mechanisms.

El Paso leaders repeatedly pointed out the importance of good communication between the community and the post. Fort Bliss has been part of the El Paso community for more than a century, and the city values the contributions of the military to the city. At the same time, community leaders recognize challenges associated with military culture. These leaders have made concerted efforts to build bridges with Fort Bliss, and Fort Bliss, in turn, has responded. Below are just two comments we heard regarding communication as the key to mitigating any potential negative effects of the post and of multiple deployments:

We integrate directly into Fort Bliss. We have breakfast every month with the commanding general. He tells us what he needs and we tell him what we think—it’s communication. You have to integrate into the post. You can’t let the walls and the gates keep you outside. And it has to be a two-way street. The military has a mindset as to how they will be received by the community, and they get here and they aren’t the first to reach out to us. We reach out to them, every time we get a new garrison commander …

we overtly reach out to say, “We want you to know we’re here for you, let’s get together.” They brief at our monthly Board meeting—we have a segment of the meeting dedicated to Fort Bliss briefing our board. [Chamber of Commerce member] Communication is critical, whether it be what’s happening at the school, construction on the post, new families coming in, dates when they anticipate growth to happen, deployments, reintegrations, all those things … and we’ll continue to accommodate them … we feel like it’s part of our community and so we’ll continue to work with them. [School administrator]

The Greater El Paso Chamber of Commerce plays an important role in brokering conversations between the city government and the post. In addition to having the garrison commander present an update about the post at the Chamber’s monthly meetings, the Chamber has an Armed Services Division that serves as the liaison between Fort Bliss and the business and regional communities and advocates for Fort Bliss initiatives at all levels of government. It is through these mechanisms that the city becomes aware of upcoming issues related to deployments that will affect the city and, in conversation with the post, can identify strategies to address them.

Also, the El Paso mainstream media prominently features stories of public interest about Fort Bliss. Several major media outlets—including the El Paso Times, the local ABC news affiliate, and the local Fox news affiliate—have sections on their website dedicated to military news. As an example of the media attention El Paso pays to the stories involving the military, the

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

study team’s site visit generated front-page coverage from these news outlets,12 and during the course of the team’s stay in El Paso, several community members with whom the team had unscheduled interviews said they recalled hearing about the study on the local news. In addition, Fort Bliss publishes the Fort Bliss Monitor, a free weekly newspaper that is readily available to civilians and service members throughout El Paso.

Representatives from the El Paso Independent School District (EPISD), which runs all of the schools located on Fort Bliss, described early challenges they faced related to deployments. The school districts depend on reliable, accurate communication from the base about deployments and their anticipated impact on schools. Shortly after BRAC, for example, conversations with Fort Bliss led the EPISD to prepare for a large influx of soldiers and family members, including school-age children. The soldiers, however, deployed shortly after arriving and did not bring their families. The families arrived later. This situation presented forecasting challenges and underscored the need for ongoing communication with Fort Bliss about deployments and their anticipated impact on public schools.

All nine El Paso school districts participate in the Fort Bliss Process Action Team with military leadership and military parents. This coalition serves as a conduit of information between the community and the post, addresses questions related to command turnover, and gives incoming command information about the school districts and their activities. This coalition has improved communication flows between the post and the school districts and eased the transition between commands on post. Through this improved communication, the post has also alerted the districts to Department of Defense (DOD) grant opportunities for additional programs at schools that benefit all children.

In the schools, teachers require day-to-day information about military activities, such as deployments that will affect students in their classrooms. To address this need, EPISD instituted a Military Family Liaison Program in its schools with large populations of students from military families. Military liaisons are entry-level positions, often held by military spouses or veterans. The liaisons interface with the post, military families, and the teachers and counselors. They help school staff understand military culture, notify them about upcoming deployments or returns, and help defuse challenges that arise, such as students’ transitioning to a new school or giving extrasupport to students whose parents are deployed.13 This highly regarded program has been adopted by DOD schools in Germany as a best practice.

One of the biggest challenges in El Paso is not the availability of community services, but the ability to connect people in need with the appropriate services (see the Community Competence section). Interviewees said that “word of mouth” is one of the primary means of communication, but that it is not the most effective approach. The team learned of at least two efforts to address this challenge. The Northeast coalition is an organization of approximately 200 schools, elected officials, agencies, community organizations, and the post to link services and identify ways to identify existing capacities. In the field of public education, the Fort Bliss

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12 Selected local news coverage of our visit: http://www.elpasotimes.com/news/ci_20570359/ep-joins-study-effects-deployment; http://www.kvia.com/video/31030911/index.html; http://www.kfoxtv.com/news/news/new-study-shows-how-afghan-war-impacted-soldiers/nNzBY.

13 More information about the EPISD Military Family Liaison Program is available at http://www.episd.org/_schools/mil.php?KeepThis=true&TB_iframe=true&height=290&width=350.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

Process Action Team is a coalition of Fort Bliss military leadership, military parents, and school administrators from nine local school districts that informs members of current activities and plans for upcoming education needs.

Community Health

Service Member Behaviors

Community members described numerous behaviors by service members that were the cause of significant concern. First and foremost, they said, were issues related to the operation of motor vehicles, including an increased number of arrests for driving while intoxicated (DWI). Respondents debated whether the DWIs were simply the result of an influx of young soldiers (“That’s what young men do”) or because soldiers were self-medicating with alcohol to quell the symptoms of deployment-induced PTSD. Regardless, the garrison command was alerted to the problem, and the Fort Bliss Monitor, the local military newspaper, displayed on page 2 the number of DWI arrests the previous week by unit, as well as the total number of arrests for each unit for the year as a whole.

Numerous interviewees spoke about reckless driving and the number of deadly highspeed crashes by service members, particularly on motorcycles. Interviewees did not say that these crashes were the result of multiple deployments per se, but suggested that service members returning from deployment may simply be looking for an adrenaline rush. Nevertheless, the behaviors were a cause for community concern.

There were also quiet discussions about an increased number of suicides by returning service members. The study team did not receive hard numbers from anyone, and the police did not perceive an increase in relation to multiple deployments. Nevertheless, it was a concern expressed by community members to the team.

Finally, there was a perception that soldier-on-soldier community violence had increased. A few weeks prior to the site visit there had been a shooting in a bar frequented by military personnel on Dyer Street (adjacent to the post) that resulted in the death of a service member and injury to two others.14 Interviewees also reported that a couple of the bars frequented by service members had been closed recently because of violent incidents. Interestingly, when interviewees were recounting the perceived increase in community violence, they tended to refer to thesesame, few incidents. The relatively low crime rate and the fact that these events were tied to “the different type of soldier” suggest that these events do not happen regularly, but rather that a rare negative incident may take on heightened relevance in the public imagination.

Health of Military Families

Although the above behaviors by service members were hard for interviewees to link to multiple deployments, they were profoundly concerned about the toll these deployments are exacting on young families. Two features of the deployments in particular were cited as problematic: the many times these service members are being asked to deploy and the lack of

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14 See http://www.kvia.com/news/30224247/detail.html.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

sufficient reintegration time for families before the service member is deployed again. Numerous interviewees described the challenging family dynamics created by the rapid and multiple deployment cycles. One spouse, who was working in a counseling setting and whose husband had deployed numerous times, offered the following description:

It just shifts the whole dynamics of the home, because here you are as a spouse, you have control of your kids and the household and the yard and the bills and everything, and here comes the soldier who’s supposed to be the king of the castle and you’re wanting to give it back to him, but you’re not. How much do you keep? How much are you wanting to give back knowing that he’s going to be gone in a few months again. And then your kids are like, “Well, ok, who do I ask now? Who’s boss now? Now that dad’s home do I ask Dad, do I ask you? What?”

A counselor at another facility, whose son and his wife were both in the Army, made a similar statement, noting in particular the effects on the children:

It’s very hard, and when there are multiple deployments—you get, how long before he knew he was leaving? There’s not even time for the soldier to recoup, much less the family, and when the kids know this they don’t even have the opportunity to think “Let’s get comfortable” because they’re on their guard—“I want to be prepared, I don’t want to get hurt again.”

Despite the shortening of the deployments (from well over a year down to 9 months or fewer), the continued need for combat troops in Afghanistan has led to more rapid rotations. One young spouse described the transition period between her husband’s seventh and upcoming eighth deployment:

[My husband] just returned in December from a deployment and they’re deploying again in June. So for us, we lacked reintegration time. My husband returned on November 27th and found out December 22nd that he was leaving again. So although we’ve had time in between there, they’ve attended training, things like that, been in the field, and while he has been home for 5 months, that reintegration time was taken away from us. So for us, we honestly didn’t tell the kids for a couple months because we wanted them to experience that reintegration time and to have that weight lifted off their shoulders.

Interviewees expressed significant concern about how the children of military families are faring. The family upheaval associated with the repeated deployment of one parent was problematic, but several individuals noted additional challenges faced by children from single -parent households as well as households in which both parents were service members:

With dual or single-soldier families, you have kids that don’t even have their own room—they go live with a relative or a friend … teenagers have to go live with a friend. Could you imagine living with a teenager you don’t know? I mean, I didn’t even like living with my own kids when they were teenagers! I can’t imagine bringing someone else in who’s going through the stress of having a deployed parent and you’re trying to be

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

a surrogate. There’s a lot of, “I don’t even get my own room because both my parents are deployed right now and I’m living at grandma’s.” [Counselor]

The room situation is interesting because when we were both deployed my daughter ended up staying with a family member and didn’t have her own room, and that above everything else [upset] her. She went from being an only child to one of five and not having a place of her own. And what I noticed, too … there was more resentment towards me as a mother than there was towards her dad as a father. It was almost expected that the father would do that type of thing, but as a mother, I abandoned her. [Parent]

Some interviewees viewed the youth as “resilient,” noting that their tendency to handle these changes with aplomb and even provide assistance to other children struggling with similar situations. Others, however, were not so convinced:

I had one soldier explain to me, “Is it [being] resilient or detachment? Detachment is a way to cope, but that’s kind of scary. And I wonder 5 years down the line, 10 years, what are we going to see?”

Others suggested that the resilience might be superficial at best. One counselor said, “Sometimes the hostility overshadows everything for me on a day-to-day basis with these kids.”

Just as important is the distress these deployments are causing for the spouse who is left behind to take care of the household. One interviewee, herself a military spouse, offered the following description of the problem:

We’re sort of missing a piece of our population to some degree in that the spouses have this emotional burden that is this bubble that is beyond comprehension right now…. And that’s a whole other piece that I don’t know if you guys have looked at that all yet … the extent to which a huge piece of the population that—it’s sort of this “stuck” situation that we as the spouse are in because we have to always tell our soldier, “Don’t worry, we got it, Honey, you go. We got it.” And no matter what’s happening we’re not allowed to talk about that because he has to be safe downrange. And to our kids—“Don’t worry, we got it! We got you, we got me, we got Dad, we got it all!” And it’s affecting our spousal population to a huge, huge degree. And although the resources are out to get the counseling and things like that, right now we’re so busy being stellar … that we’re not going after it. We’re not seeking the support that we need right now because we don’t have time to seek that. We’re too busy being stable … we’re too busy with our feet on the ground that we don’t have the chance to crumble.

In sum, the El Paso community appears to be seeing an occasional “burst” of adverse effects from multiple deployments in the form of DWIs, bar violence, and so forth. But the bigger challenges are in the homes, where each family is struggling to cope with a set of issues that not only change with each deployment, but compound over time. And because 70% of these families are living in the greater El Paso area, and those whose children are attending public

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
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schools attend El Paso–run schools, these issues ultimately will find their way into the broader community.

Community Competence

Between the offerings on post and in El Paso, there are many services available to service members and their families. School administrators have a long relationship with the post and, as deployments increased, instituted new strategies to anticipate upcoming needs at the system and school levels. However, many other El Paso community services remain underused. As one military spouse put it, “There are so many options, it’s difficult to choose.” Despite this wealth of services, El Paso residents noted a lack of sufficient behavioral health facilities on post and in the community. Each of these service areas is discussed below.

Education Supports

Educators described numerous efforts to ensure that military-affiliated students who attend public schools receive the services and supports they need to cope with multiple deployments. One of the most important efforts, they believed, was the use of military “liaisons” in the public schools, that is, military-affiliated individuals (usually spouses of service members) who can help translate military culture and its stressors to school faculty. These individuals also function as an in-school source of support for youth who need to discuss their problems with an adult.

Training efforts are also being undertaken to increase teacher and counselor awareness of deployment-related issues with students in their schools. In partnership with Fort Bliss, EPISD counselors are invited to “soldier for a day” trainings where they learn “military speak” and find out about behavioral issues to expect in children of service members experiencing multiple deployments. Also, Fort Bliss is working with the University of Texas at El Paso to develop a curriculum to train teachers about working with students from military families so that teachers will be prepared to understand the ways in which deployments—indeed, multiple deployments—may adversely affect military students.

Behavioral and Mental Health Services

Interviewees described mental health services as the greatest need in the community. Long wait times exist for services on post, and interviewees voiced concern about the lack of available mental health facilities in the community, especially with the projected increase in need with the drawdown of troops. Within military health care, military leaders noted that military support systems for active duty service members and veterans had waiting lists. Psychiatric careis a particular area of need in El Paso. In Texas, psychologists cannot prescribe medications; therefore, people in need of additional mental health care must obtain referrals for psychiatrists. Waiting times to get an appointment to see a psychiatrist can be several months.

To help reduce the wait times, between 2007 and 2010 the San Antonio Federation partnered with The Dallas Foundation and the Permian Basin Area Foundation to establish the Texas Resources for Iraq-Afghanistan Deployment (TRIAD) Fund. The goal of the grants was to

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
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support Texas-based military families affected by deployment to Iraq or Afghanistan. More than $11.9 million in grants was made to Texas community organizations, including 14 in El Paso. Grantees included mental health providers, food banks, and children’s services. These grants have been important in building behavioral health capacity and expanding community resources for military families.

Other programs are still in early development, but indicate El Paso’s efforts to expand mental health capacity. In addition to a 24-hour suicide prevention hotline, Emergence Health Network offers peer support groups to service members and their families. The program draws funds from a Texas-based program, and facilitators receive 40 hours of training prior to leading the groups. Fort Bliss Morale, Welfare and Recreation (MWR) Program supports Emergence Health Network, and it in turn sponsors events on post to promote its services.

Interviewees noted that there have been efforts to expand behavioral health capacity on Fort Bliss itself to meet the needs of service members who have been deployed multiple times. Although well intended, they said, the effort has had some unanticipated negative effects. One is that service members reportedly have been required to leave their community providers and receive behavioral health services on post. Community counselors worried that individuals who truly need assistance may be reluctant to follow through with military-provided care out of fear that it may have a negative effect on their military careers. Many service members and their families seek counseling off post, they said, explicitly to avoid this problem.

The second effect of the capacity building on post has been to reduce capacity in the community provider agencies. More specifically, several interviewees said that the military can pay mental health providers much higher salaries than can community-based agencies; this has resulted in a “brain drain” in the community as counselors leave their agency positions to take a job at Fort Bliss. These vacant positions also were hard to fill because of this same salary differential.

Law Enforcement

There was general community concern about the behaviors of service members returning from deployment, including reckless driving, driving while intoxicated, bar fights, and other public disturbances. Concerns were also expressed about more serious negative behaviors, including suicides, hostage situations, domestic violence, and situations requiring the use of crisis management teams. Although these more serious negative behaviors rarely occur, the team heard that when they do occur they get “sensationalized” in the press. Nevertheless, Fort Bliss and El Paso law enforcement have collaborated to increase awareness of possible issues in the community that are triggered by PTSD. The following programs are examples of the types of collaborative efforts we heard about during our visit:

Veterans Court. Veterans Court is a specialty court akin to a drug or mental health court.15 Under the program, combat veterans or active-duty service members who find themselves in the civilian criminal justice system receive assistance from mental health counselors, court administrators, and veterans’ advocates. Participants must have a

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15 See http://www.texaspolicy.com/pdf/2009-11-PB22-VeteransCourts-ml.pdf.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
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service-related disability such as PTSD, traumatic brain injury (TBI), or severe depression. El Paso County has had a Veterans Court since September 2010, but in February 2012, the program was expanded to two subprograms for felony and misdemeanor cases.16

PTSD Training. Fort Bliss worked with the El Paso Police Department to train police officers to recognize situations that might have a mental health component and to try to stabilize the situation long enough for the department’s crisis management team to arrive on the scene. Situations envisioned by the police ranged from a traffic citation that might rapidly escalate to a crisis situation, such as a service member taking someone hostage or threatening to commit suicide. It is important to note, however, that the department’s awareness that officers might be encountering mental health issues in the community stemmed not solely from the soldiers stationed at Fort Bliss, but also from citizens fleeing the drug violence in Juarez.

Domestic Relations/Legal Issues

The study team heard from numerous interviewees that multiple deployments are having a significant negative impact on the family structure. In part, they observed a tendency for young people who have known each other for a relatively short time to enter into marriage just prior to deployment. A local attorney offered the following observations:

We’ve been hearing about people getting married without knowing the other person. [One soldier on leave for 2 weeks in the United States] met a girl in a bar, fell in love … they were married, he went back to Afghanistan, they had a baby … and now they’re getting divorced. And this is PTSD issues, shrapnel from IEDs, he’s been blown up three times in IED incidents, he’s had horrible [experiences, such as] stuffing intestines back into the guy that was driving … he was [this soldier’s] best friend throughout basic camp, throughout their first deployment. And so he comes home … he drinks all the time. She doesn’t know him; his personality is such that he just blows up. And it scares the snot out of her. Well, of course, she doesn’t know him!

The weak foundation of this and similar relationships, she believed, was unable to withstand the strains of one or both partners deploying multiple times. She also gave us a list of the following observations of how multiple deployments are affecting military families that she sees:

1. Increased marriages between service members; increased marriages between service members and nonservice members with weak relational foundations;

2. Approximately 40% increase in parent-child [court] orders between service members, and between service members and local residents, after deployment;

3. Increase in the number of parent-child orders entered in local courts with one or both parents leaving the jurisdiction (impact on child) with little or no understanding of the

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16 See http://www.elpasotimes.com/news/ci_19958322.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
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result of such a move on the child-support case;

4. Increase in the number of administrative writs of withholding issued to DFAS [Defense Finance and Accounting Services]; service member separated from active duty-Reserve status and delinquent child support case; and

5. Increase in the number of long-distance child-support orders with one or both parents (and children) leaving the El Paso jurisdiction.

In short, it is easy for young people to enter into marriage, interviewees said, but much harder for them to get out of one, particularly when children are involved. Issues of child custody, visitation, and payment of child support are additionally challenging across state lines. Challenges related to divorce and child custody could also be exacerbated when service members seek assistance from Judge Advocate General (JAG) attorneys who are not necessarily familiar with Texas family law, as well as by service members’ attempts to avoid paying lawyers’ fees by using LegalZoom to get the paperwork to file for divorce. We heard of at least two interventions in El Paso that are designed to mitigate these challenges:

• The HEROES Program (Help Establishing Responsive Orders and Ensuring Support for children in military families), which is run through the Texas Office of the Attorney General, helps service members with child custody disputes across state lines.17 It is supported in part by the Department for Health and Human Services Administration for Children and Families. The program has been operating since 2008.

• The El Paso County Domestic Relations Office worked with the Fort Bliss JAG office to train JAG lawyers on Texas child custody law and pro se divorce. They also worked with the Fort Bliss Morale Welfare and Readiness office on seminars about military and the law.

Social Capital

Community members described an array of informal supports and services for service members and their families. Sources of such supports ranged from the faith community, mutual interest groups, and the community at large.

Faith Community

One source of support is the faith community. On a church-by-church basis, the community is providing whatever services they can. We interviewed the leadership of one church, for example, that had adopted a unit as part of a larger community effort—the AUSA/Bradley Strong Foundation (described below). This congregation and its leadership were moved to take action specifically because of the repeated deployments of soldiers from the post:

We consciously three and a half years ago, as a staff, saw the deployments and what they were doing to the families. So, on a staff planning meeting for the next year we said, “We’re going to do everything we can to reach out to our military community and meet them where their need is.” [Church leader]

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17 See http://www.acf.hhs.gov/programs/cse/pubs/2011/csr/csr1112.pdf.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
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This church has an extensive counseling ministry that reportedly is overwhelmed by service members coming back from combat with a whole array of challenges. Some of the issues require individual counseling, such as service members who are addicted to alcohol, drugs, or pornography. And yet many of the marriages also need support. One of the church counselors we interviewed indicated he was currently working with a young couple that had been married only a few months. The now-husband had been deployed once before they got married, but he would soon be heading out for his second deployment. “They’ve had no chance to establish a life as husband and wife,” the counselor said, and he expressed concern about the ability of that relationship to endure over the long term.

Given the practical time limitations of the site visit, the team did not hold a group discussion at another church in the area. We did attend services at two different churches in the Northeast area, however, and observed very little in the way of military connections (one church had a photograph of apparently the only service member in the congregation who was currently deployed). We also spoke with another church that was working with military families struggling with the effects of multiple deployments, but doing so on a case-by-case basis. As this pastor explained, “We try to treat them normal, not segregated in any way, so they have the opportunity to be part of the community … and get out of the military culture on base.” That being said, we cannot say that there are no other churches within the area that are providing significant supports to members of their congregation who are being affected by multiple deployments. Indeed, given the large number of houses of worship in the El Paso community, there undoubtedly are other congregations that offer relevant services and counseling to these families.

AUSA/Bradley Strong Foundation

The community is also supporting service members and their families through the AUSA/Bradley Strong Foundation. The Foundation, which has the backing of the Chamber of Commerce, describes itself as a “bridge” between El Paso and the installation. The website18 offers a message of hospitality for the military that is similar to what we heard from numerous civilian interviewees:

The City of El Paso has a great love for Soldiers and respects their commitment to serve our great nation. We view their assignment to Fort Bliss as an opportunity for the community to welcome them into our home, “Mi casa es su casa.” The Bradley Chapter is one of the primary organizations in El Paso that helps the local community understand the culture of the Army. We help El Paso citizens and businesses understand the joys and challenges of service in the greatest Army in the world. For Soldiers and their family members coming to El Paso for the first time, the Chapter attempts to provide them with a taste of the rich 400-year history of El Paso and its culture.

Through this program, sponsors—including churches, defense contractors, and ice cream companies—are linked with a unit at Fort Bliss ostensibly to provide a link between the unit and the community while the unit is stationed in El Paso as well as deployed overseas. The sponsor also connects with the FRG affiliated with the particular unit and provides support for the family members while the unit is deployed. Although the program may be helping to better integrate the

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18 See http://www.ausabradleychapter.com/info.php?pnum=3.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

soldiers and their families into the community, activities are up to the individual sponsor. And sponsors may not necessarily be offering supports specifically related to the effects of multiple deployments. For example, none of the spouses with whom we spoke made any mention of their unit sponsor when recounting where they can go to find services or supports to deal with the stresses accumulating after four, five, or six deployments.

Mutual Support Networks

The study team did see some evidence of various informal mutual support networks throughout the community. For example, while dining out one afternoon, the team was seated next to two tables of motorcycle riders, all of whom sported a back-of-the-jacket patch that read: “Combat Veterans Association.” Most of these diners were young men, all of whom had “Iraq” or “Afghanistan” combat patches on the front of their outer wear. Further research indicated that the Combat Veteran Motorcycle Association (CVMA) is a nationwide group of riders who advocate peer-to-peer supports. Chapter 23-2, which is based in El Paso, is one of seven Texasbased chapters of CVMA.19

Peer support is also available through other venues. As mentioned earlier, Emergence Health Network, one of the few behavioral health providers in the city, is establishing peer-topeer support groups for active duty service members and for female service members specifically. Not only are the support groups held off post, but they are not affiliated in any way with either Fort Bliss or the Department of Veterans Affairs (VA); consequently, we were told, active duty service members can feel more secure that their participation will not get to their commanders. Emergence is also developing spouse support groups that are structured to avoid some of the common issues we heard described about the Family Readiness Groups (FRGs). For example, several interviewees described the “drama” associated with spouse groups on post in terms similar to the quote below:

The FRG is helpful to many and for many it’s their worst nightmare. A lot of it is the ranking—“What rank is your husband? My husband has more rank than yours so you don’t have the say.” That sort of stuff.

In the current spouse groups at Emergence, there reportedly is no disclosure of rank in a concerted effort to avoid the discord that would result.

Hearts Apart, a program run through the Fort Bliss Army Community Service, also offers support to families with a deployed soldier. They run a support group and organize activities several times a month for families of service members stationed at Fort Bliss. At Thanksgiving, for example, they organized a group meal at Cattleman’s Steakhouse, a popular restaurant on the outskirts of the city. Although run by the installation, Hearts Apart received a TRIAD grant that allowed them to expand services to more than 300 families.

The city is also host to many of the more familiar veterans associations, such as the Veterans of Foreign Wars (VFW) and the American Legion. Prior to the site visit, a Vietnam veteran told the study team during a telephone interview that the younger service members do

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19 See http://combatvet.org.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
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not engage with these organizations because, he believed, “they feel they can take care of whatever issues emerge on their own.” An evening visit to a VFW post in the Northeast, however, revealed a mix of young service members and older veterans. The degree to which veterans of the Iraq and Afghanistan wars feel comfortable seeking support from organizations like the VFW remains to be explored. Similarly, the degree to which Vietnam-era veterans are comfortable supporting these young soldiers remains unclear. The study team spoke with one Vietnam veteran who characterized his cohort’s ambivalence as follows:

I came back from both tours in uniform and the second time I caught a lot of crap getting off the plane and was spit on. And I wanted to talk my devils away, I wanted to talk about it, I wanted to explain to somebody what I was feeling. Nobody wanted to hear what I had to say! I took everything I felt … and put it in a box, wrapped it in chains, and buried it in my mind. Today people say, you know, “Oh, thanks for your service. Let me buy your meal. We appreciate what you’re doing.”’ So what you’ve got are essentially two groups—you’ve got the disgruntles, “They never did it for me, so I ain’t gonna do it, screw them guys!” Or, like me, ”Thank god the attitude is changing! And it didn’t happen for me, but I’m glad it’s happening to somebody else and let me help it happen.”

Online Supports

In addition, and perhaps consistent with the young age of this group of service members and their families, numerous interviewees reported seeking support through Internet-based channels. Each of the FRGs, for example, has its own Facebook page, and spouses can contact each other through that venue outside of the regular meeting times. The then-garrison commander, Colonel Joseph Simonelli, also started a Facebook page (“Colonel Joe Wants to Know”) that was serving as an information and support forum for military-affiliated individuals.20 Colonel Simonelli stated that the El Paso media as well as service providers in the city regularly log in to the site to keep abreast of any issues that may be arising. He said that when the page was first started, individuals would post about a problem they were having and he would tackle the issue immediately. Now “it’s taken on a life of its own,” as the posters are taking it upon themselves to help out their fellow soldiers and families and frequently offer recommendations based on their own experiences. Of note, though, is that most of the posts were about day-to-day challenges at Fort Bliss, not about how to deal with the effects of multiple deployments. This broader focus is not surprising, given that this is a public forum.

Facebook was not the only avenue for online communication. We also heard from a young woman who said she regularly goes to her church website to post requests for prayers for her husband, who is currently deployed to Afghanistan. The church’s minister, who was participating in the same discussion, indicated that although the discussion group we held was the first time he had met this woman in person, he does see her prayer requests and every week the group says a special prayer for her spouse. Although these and numerous other virtual connections may be unsatisfying to an older cohort, the young soldiers currently stationed at Fort Bliss are intricately familiar with online social networking and may be finding numerous sources of support there to cope with the stresses caused by multiple deployments.

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20 On May 24, 2012, Garrison Commander Brant Dayley established a new Facebook page Tell It To Col D, that continues the model established by his predecessor: https://www.facebook.com/TellittoColD.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
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Retired Veterans as Support

Finally, and as noted elsewhere in this report, El Paso is home to a large population of retired veterans who have been through combat and fully appreciate the sacrifices made by these soldiers and their families. The study team had numerous opportunities to engage these individuals informally (e.g., brief discussions after the District 4 weekly community breakfast and the Northeast Rotary Club), and all expressed their concern about the toll these rapid deployment cycles had taken on service members and their families. As one retired service member said, “We never had to go through anything like what they’re going through.” Some of the Army spouses may have questioned whether the community was “genuine” in its support of their partners’ service, but the study team was left with the impression that, at least among retired veterans (if not the broader community), there is tremendous empathy for what these service members and their families are being asked to endure.

SUMMARY

In many ways, El Paso and Fort Bliss are working well together under difficult circumstances. Though they do not always see eye-to-eye, they share a mutual respect, and both post and community are making concerted efforts to work with each other.

What’s Working

The El Paso community is welcoming to military families and makes earnest attempts to show appreciation for their service. Symbols of the town’s appreciation of the military are all around—on Franklin Mountains, on Wal-Mart storefronts, and at the local liquor store. Businesses of all types make efforts to offer discounts to military families.

The relationship between post and city is reinforced by established communication mechanisms. Fort Bliss interacts with the city and Chamber of Commerce, the school districts, and community leadership. Through coalitions and regular meetings, there are ongoing opportunities for city stakeholders to learn about deployments, changes on post, or other factors that may affect the community. These coalitions also offer an opportunity for conflict resolution, when needed.

For service members and their families, several programs in El Paso were mentioned as making a positive impact and defusing some of the challenges introduced by deployments.

The AUSA/Bradley Strong Foundation sponsorship of units connects individual service members to local community organizations and is a tangible way for local organizations to connect with the units on post and show appreciation for their service.

TRIAD grants increased the service capacity of community organizations. In 2010, when Fort Bliss knew their services would be under strain, the post referred service members to these grantees.

The HEROES program, managed by the Texas Office of the Attorney General, helps service members navigate the complex legal terrain of child custody disputes across state lines.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
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Hearts Apart, run by the Fort Bliss Army Community Service, builds friendships and eases the stress and demands on the family during times of separation.

• With a cohort of families accustomed to seeking out solutions online, “Colonel Joe Wants to Know,” started by the former garrison commander and now transformed by the new garrison commander as “Tell It to Col. D,” is an example of effective digital community building using Facebook. This online page, run by the garrison commander’s office, is a bulletin board for community events, answers routine day-today questions posted by military families, and also connects families in need with appropriate services. It effectively makes the garrison commander accessible to those on and off post.

• Although faced with the significant challenges of a large transitory population, limited tax base, and overcrowding, the EPISD has instituted strategies such as the Military Family Liaison Program and counselor training that bridge the gaps between community and post. These trainings raise awareness with teachers and counselors of the challenges faced by military families and offer best practices in how to help families deal with these stressors. The liaisons help the teachers and counselors address day-to-day military-related challenges that may adversely affect a child’s behavior in the classroom.

Needs and Challenges

Leaders perceived an urgent need to increase behavioral health capacity. Community leaders and El Pasoans working in the health sector identified civilian mental health services, especially psychiatric care, as a broader area of need in El Paso. As indicated in the “Community Orientation” section of this report, families fleeing the violence in Juarez are also coming into the city with trauma from what they have witnessed across the broader. And with the upcoming drawdown in troops, leaders observed there would be an increase in need for mental health services that would exceed the capacity of current systems.

Many service members reportedly are also reluctant to seek care. Conditions such as PTSD or depression may be hard for the individual to recognize, and help-seeking behavior may run counter to messages of resilience and toughness coming from command. Although military policy states that accessing mental health care services cannot be considered when making promotions, we heard that there is still concern about the potential fallout from seeking mental health services. Many soldiers fear that the chain of command will learn that they sought psychological care and that such knowledge would place their military career or retirement at risk. Military spouses are also reluctant to seek care or divulge too much information because they do not want to damage their spouses’ careers. Mental health providers and church leadership spoke of the need to provide a “safe space” for service members. Staff at one mental health organization, well aware of these concerns, said the counselors who work with soldiers stagger the appointments to ensure that service members do not encounter each other in the parking lot.

Interviewees also said the families at home are subjected to considerable stress during the deployment process. During predeployment they prepare for the time away, and that preparation often includes protracted trainings that require the service members to be away from home. During deployment, spouses are in essence single parents, managing family

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

responsibilities, home, and work on their own. When their service member spouses return, they must work with them to renegotiate household division of labor and act as a support as the service member attempts to readjust to a noncombat setting. The rapid pace of redeployment, they said, ultimately disrupts all attempts the family is making to settle into the “old normal” life, and for some, the “new normal” is simply untenable.

Community members identified underserved constituencies of military families for whom additional supports may be needed. Fathers whose wives deploy contend with the challenges associated with being single fathers, but may also have additional social challenges because they are performing nontraditional family roles. These men may be less likely to reach out to established military support mechanisms such as FRG activities, which are mostly attended by women. Conversely, women who have been deployed may encounter genderassociated challenges in theater (e.g., sexual assault) and they may not receive the support they need from the current military support systems. Moreover, as they reintegrate, military mothers may face different challenges in reestablishing bonds with children and their routines at home. Finally, we heard from several interviewees about the strains placed on children in single-parent households or in households where both parents are deployed at the same time.

Suggestions from the Community

The community offered suggestions for possible improvements or next steps that may help address the needs associated with multiple deployments. For many community members, recommendations emerged from their assessment that the multiple deployment strategy is problematic for families and children. They desired wider recognition from the public and from the Army that the multiple deployments were having adverse effects on many families and children.

Concerns were voiced about anger and hostility issues in children, and attachment disorders for children whose parents deploy while they are still babies. Those we interviewed relied on anecdote and personal observation for these negative impacts. To build an evidence base of the long-term effects, the community suggested a longitudinal study of the behavioral health of children with parents who experienced multiple deployments.

Finally, the community underscored the importance of maintaining good communications between city and the post as the command leadership changes. During our visit, Fort Bliss was preparing for a change in garrison command. City leaders wondered how receptive the incoming garrison commander would be to working with them, and what efforts they would have to undertake to maintain the relationships they had previously established with the leadership on post.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

Watertown, New York

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Case Study Report

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

 

Impacts of Multiple Deployments: Watertown, New York

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OVERVIEW

This report summarizes findings from Westat’s ethnographic site visit (May 12–18, 2012) to Watertown, New York. The study goal was to assess impacts on the Watertown community from multiple deployments to Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) from neighboring Fort Drum, a large Army installation. Interviews with Watertown government, business, and community leaders and other community representatives include the following highlights. Fort Drum has experienced both large growth and many deployments in recent years, and it was difficult for interviewees to identify community effects stemming solely from deployments. Positive effects from the military presence have included economic stimulus for the area and a large supply of health care providers available to all residents. Interviewees said, though, that multiple deployments have contributed to a tight housing market, a shortage of mental health care services (especially for children), and new demands on school staff. Residents would like more information about posttraumatic stress disorder (PTSD) to recognize symptoms and provide appropriate responses. An integrated military/civilian community promotes strong resident support for deployed service members and their families.

Data Sources

• Community members

• Chamber of Commerce

• Churches

• City government employees

• Emergency service providers (i.e., fire, police, emergency medical personnel)

• Community college

• Regional partnership organizations

• Social service organizations

• Behavioral health organizations

• Hospitals

• Local businesses

• Media and the arts

• Observation

• Secondary sources (e.g., news articles, Internet videos, survey results provided by respondents)

GEOGRAPHIC ORIENTATION

Community: Watertown, New York

Watertown is a small city in rural upstate New York located approximately 70 miles north of Syracuse and 30 miles from the Canadian border. It is the seat of Jefferson County, which has a population of 116,229, including 27,023 Watertown residents and 12,955 Fort Drum residents. The tri-county area of Jefferson, St. Lawrence, and Lewis Counties covers 5,223 square miles, with a population of 241,128.1

The terms Greater Watertown and “North Country” (and less frequently, “Drum Country”) were used by interviewees and secondary sources2 to define the community (Figure 1).

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1 See http://quickfacts.census.gov.

2 E.g., see http://www.drumcountry.com/index.cfm.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

This report focuses on the city of Watertown, where most of our interviewees are employed, and the surrounding villages and towns of Jefferson County, where many of them live.

Historically, Watertown has been relatively homogeneous with regard to race and ethnicity; the city and county are predominantly white. A few interviewees mentioned that military families have had a diversifying effect. We were informed that poverty is an issue in the community and confirmed that the median household income is lower in Watertown than in the state of New York and the United States.

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FIGURE 1 Community orientation.

The community has experienced extensive growth and development in recent years as a result of the approximate doubling of the active duty personnel assigned to Fort Drum in 2004–2005. The community has formed two homegrown nonprofit organizations to identify and address military-civilian challenges: the Fort Drum Regional Liaison Organization (FDRLO), which grew out of a committee formed in the1980s, addresses community planning generally and any specific issues as they arise; and the Fort Drum Regional Health Planning Organization (FDRHPO), which focuses on meeting physical and behavioral health needs. The boards of both organizations represent the local civilian and military communities.

Although our visit occurred during a temperate spring week, most persons the team interviewed mentioned long winters and lake effect snowfall averaging more than 112 inches per year as characteristic of the region. Multiple interviewees also described how the region’s harsh climate can create adjustment, transportation, and home maintenance challenges for newcomers, especially military families from warmer climates. Several of them described how the community helps those struggling to adjust to regional and other challenges, pointing out how its culture is reflective of “small town attitudes” and a willingness to help anyone in need.

Military Installation: Fort Drum

Fort Drum is home to the 10th Mountain Division (Light Infantry) and other units (Figure 2). It was primarily a training camp until 1984–1985, when it was designated as home to the reactivated 10th Mountain Division. The 10th Mountain Division was described by several interviewees as “the most deployed force” in the country. Two respondents separately commented, “they are either gone or training to go.” The post is responsible for the mobilization and training of almost 80,000 troops annually, including Reserve and National Guard members.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

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FIGURE 2 Map of Watertown and Fort Drum. (Source: Google Maps.)

The post covers 107,265 acres. The division includes four brigades, including aviation, a sustainment brigade, and associated companies including engineering, ordinance, and public affairs. The installation also supports Air Force units, Army and Navy Reserve, and some crossbranch training.

According to our interviewees and publicly available information, the role of the 10th Mountain Division in OEF/OIF theaters has been continuous but variable since October 2001. Early on in OEF/OIF, soldiers were deployed by brigade for tours longer than 1 year, but now smaller units (e.g., battalion or company) are deployed for shorter times. Deployments have included cavalry, light infantry, field artillery, signal and intelligence, and combat aviation.3 A 2007 article in the Army Times describes how 10th Mountain Division’s 2nd Brigade out of Fort Drum

has served the most time on the battlefield since 2001 …. The brigade is in its 14th month of an extended 15-month tour—“the most-deployed brigade in the U.S. Army,” he noted. On its return home, which should be completed over the next several weeks, it will have served 40 months overseas since December 2001.4

Relationship between Community and Post

An overwhelming majority of interviewees described the social and economic relationship between Watertown’s civilian community and the military as positive, supportive, and symbiotic. It was reported to have been strained in the 1980s and early 1990s by perceptions among long-time residents that soldiers were receiving unfair economic advantages. A civilian and long-time resident of the area explained:

A lot of the local people—and I say a lot because I witnessed it—were very negative about the military coming, primarily for what it would do to their small town…. Now it’s much better. But … a lot of military were mistreated because people were resentful

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3 See http://www.drum.army.mil/2ndBCT/Pages/History_lv2.aspx.

4 See http://www.armytimes.com/news/2007/10/ap_mountaindivision_home_071005.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

if they [military] received percentage-off discounts for anything from buying cars, to dinner out, to hotels. [Social services provider #1, spouse of a veteran]

A variety of interviewees reported that the relationship is now quite good, both professionally and personally, across multiple aspects of community life. The intentional integration of Fort Drum personnel and their families with the civilian community for housing, schooling, and medical and social services was cited by several community members as the underlying reason for this exceptionally close civilian/military partnership. Respondents also described an affective bond between the two communities:

I just think that the rest of the country just doesn’t get it … that, “We’re at war?” … I just don’t think they get it. And we get it…. We get it when Mary’s husband is getting deployed and I know she’s going to be scared every day…. I just think the whole community feels these things. How can we not? This is our community—our friends, our neighbors … we are so closely integrated that there is … no one here who is not working with a military spouse…. Every time you see a casualty, you think, you know that is somebody’s somebody…. But, it’s kind of a strange thing because I also think it makes us a united community. [Regional partnership organization representative, civilian]

EFFECTS OF DEPLOYMENT ON THE COMMUNITY

It was not always possible for interviewees to tease out the effects of multiple OEF/OIF deployments from increases in population because of the significant growth of Fort Drum over the past several years. Overall, the most visible positive effects of a large military presence in the Watertown and Jefferson County community are support for the economy and the increased availability of general and specialist medical care for entire community, which we heard about from a variety of interviewees. Nearly every interviewee also connected the continued mutual support among soldiers, military families, veterans, and the civilian community to multiple deployments.

Numerous interviewees said the greatest negative effects of multiple deployments include a shortage of behavioral health care services (particularly for children), added demands and stressors on school staff, and a small number of apparently isolated, high-profile violent crimes speculated (but not confirmed) to be related to soldiers’ deployment experiences.

Economic Impact

Multiple persons with whom the team spoke suggested that any potential economic impact on the community from multiple OEF/OIF deployments may have been buffered or masked by the simultaneous growth of the post and surrounding community. Many of them also stated they could not differentiate between the impact of multiple deployments and major growth, which began in 2004–2005, as well as external factors nationwide (i.e., the recession).

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

Commerce

Although there have been fluctuations in the types of businesses serving the community over time, with more chain restaurants and retailers near the Interstate Highway and fewer family-owned businesses in town, interviewees were not able to tie this specifically to multiple deployments. Several interviewees did identify small boosts in select businesses shortly after large numbers of soldiers returned to Watertown after deployment. Deployment cycles reportedly had more of an economic impact in the early years of OEF/OIF, with deployments lasting up to 18 months and larger numbers of soldiers deploying at the same time. In recent years, however, with smaller numbers of troops deploying at the same time, economic impacts are less noticeable. Changes consistently reported with demobilization include increased hotel and restaurant business, demand for home rental and purchase, and increased purchases of bigticket items among returning soldiers, particularly those soldiers who are young and single. At the same time, several interviewees reported younger soldiers often lose large down payments on major purchases when they are unable to make monthly payments. This affects their credit ratings and may adversely affect their careers.

Housing

Most interviewees found it difficult to differentiate the housing impact of the growth of Fort Drum since 2004–2005 from that of multiple deployments. However, a few remarked that the ongoing shortage of available housing units is felt most sharply with large demobilizations, forcing people into hotels that are often booked to maximum capacity. Several interviewees told us that some military families relocating to the area are willing to rent or buy whatever is available. One respondent described how this urgent process can lead to disappointment:

And you’d get people who buy houses sight unseen…. Some of them were over in Iraq and Afghanistan still, but they were coming back to this area … they’d buy the house. And pictures of the inside that they saw over the Internet or from the realtor’s site looked great, but when you actually look at the house in the neighborhood, it didn’t warrant the price that they’re paying. [Local government employee and spouse of retired military member]

We were also told that when service members deploy and their property is left vacant, they often neglect to arrange for maintenance during their absence (e.g., turning off their water during the winter months) or fail to pay mortgages and/or property taxes. This reportedly puts a strain on local government offices as they attempt to locate service members or their families to help resolve these issues.

Public Services

Interviewees reported that the demand for public services also changes with the deployment cycles. This includes requests for marriage licenses and ceremonies, real estate transactions, property tax collections, water/sewer usage, trash services, and roadway usage. Several interviewees mentioned increases in sales tax revenue resulting from these boom times, commensurate with decreases during larger deployments. Multiple interviewees also reported

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

problems with increased traffic volume after large numbers of troops demobilize, particularly along the new commercial corridor near the Interstate Highway.

Jobs

There was no clear consensus at the macro level regarding employment and labor challenges connected to multiple deployments. Several community members indicated that soldiers bring skilled, hard-working spouses and sometimes young adult children who enrich the local labor pool. Veterans and retired military, including those who had been deployed in OEF/OIF, were also reported by several respondents to provide specialized and reliable labor that may not otherwise be available in the community. One resident described how deployment cycles and employment patterns coincide:

When we need more workers, [it’s] because folks are home and everybody’s going out to eat and everybody’s buying. It’s also the time when the spouses are here and they’re all living here and they need more jobs…. I can tell you—local businesses love it when they’re all home. [Regional partnership organization representative, civilian]

Information and Communication

Interviewees said that military issues, including deployment-related topics such as welcome- home ceremonies, are frequently discussed in the Watertown community. More detailed information, however, such as how to access particular services or how to identify PTSD symptoms, was reported to be much more challenging to find.

Public Discussion of Deployment-Related Issues

Local news media, including the Watertown Daily Times and Watertown News 7 television, routinely cover deployment-related topics, such as welcome home celebrations and efforts to support soldiers and their families. Conversely, there is little evidence of town hall meetings or other events specifically intended to discuss potential deployment-related issues in the community or how to respond to them. Interviewees offered mixed perspectives on the need for additional communication. One of them told us, “I don’t have any specific contacts with the military … at Drum. And like I said, the only way I know that there’s people deployed or people coming home is by watching the news. So we don’t get any special bulletin.” [Emergency services provider]. In contrast, another interviewee reported regular communication between him and his military counterpart:

As far as Fort Drum, my interactions with them is sometimes several times a week…. We communicate via phone and email on a regular basis—3 to 4 times a week, and more if necessary. He does alert me to times that they are expecting deployed troops home. We have discussed posttraumatic stress syndrome at length. [Emergency services provider, civilian]

Many family challenges related to deployment have been vetted through the docudrama In My Shoes, performed several times in Watertown area schools, on Fort Drum, and on a nearby

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

college campus. This play was written in the words of and performed by military teenagers and includes their views on the effects of their parents’ deployments. The play was mentioned by several interviewees as an important opportunity to increase awareness and understanding within the community, and to collectively address a broad set of issues affecting military families and civilians in the community. For example, in these lines from In My Shoes, one teen describes how she feels about lost time resulting from multiple deployments:

I used to be like, the biggest daddy’s girl in the world, like, I would prefer being with my dad. But now, I really prefer being with my mom. Maybe it’s because he’s missed, uh, 4 years of my life, but he’s back from deployment now…. He’s never gonna get that back, and, it’s just, it’s hard. [Garrett, from In My Shoes]

And a civilian teen, who participated in the production of the play, shared her feelings in a CNN interview about how her involvement has changed her views:

I’ve been here my whole life. I’ve known nothing but being a civilian in a military world…. It was weird to see it from their angle for once. I thought everyone had a mom and dad always there.5

Information about the play has been published by local and national media sources and is currently in production for broadcast on local television.

Information Sources for Military Families

The post has extensive information about services available to military members and their families, including a downloadable welcome package. Family Readiness Groups (FRGs) are available to all military members and their families, and can be an important source of information and support. Many interviewees also identified schools as a valuable resource, particularly through efforts such as the Military and Family Life Consultants (MFLCs) program (described in the Community Competence section). In addition, there are informal networks within the community that reach out to military families, or are available to those that seek them out. However, some of the most important resources, such as behavioral and mental health information related to deployment, were not always readily available in locations most frequented by those in need or by their families. For example, one interviewee described a search for information about deployment-related behavioral health:

I am shocked by how little information is out on post about PTSD…. I was already seeing things that worried me before the guys came back from deployment, so I actively went around looking for information that I could bring to the FRG Leaders…. The first place that I went to was the local chapel because typically … people will go to their chaplain for help because it feels like it’s not part of the chain of command. It’s a safe place. The chaplains really didn’t know anything about PTSD and they didn’t have any resources and they were shocked that I was asking…. The second place I went to was the clinic…. There was nothing to be found there about PTSD. The only information I could find about PTSD was in the behavioral health center … they had a lot of

_____________________

5 America’s anomaly: The place where war is a constant, http://www.cnn.com/2011/10/07/us/afghanistan-fort-drum/index.html.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

information. But how many people go there? [Social services provider and spouse of active duty military member]

Information Sources for Civilians

The challenges related to multiple deployments and sacrifices made by military members and their families were mentioned very generally in a variety of community contexts, including the Armed Forces Day luncheon sponsored by the Greater Watertown-North Country Chamber of Commerce, the FDRHPO Annual Meeting, and during the course of several interviews. A few persons mentioned reading about potential issues related to multiple deployments in the newspaper or research literature. A few interviewees in law enforcement, health care, social services, and the faith community also mentioned regular information exchange with the post. In addition, several interviewees who provide key services reported receiving training in identifying and responding to the hidden wounds of war. One of them said:

We routinely have meetings between state police, the sheriffs, and myself and military police. When there is a soldier they’re worried about, they share that with us…. We had a Ph.D. from the Fort Drum Behavioral Science come and talk to a group of 40 people in law enforcement and medical staff about posttraumatic stress … to help us basically understand it and to try to defuse it. [Emergency services provider, civilian]

In general, community members do not seem to be talking formally about issues of greatest concern regarding OEF/OIF deployment. However, community members articulated common impressions regarding potential challenges associated with multiple deployments—specifically, behavioral and mental health issues and criminal activity—some of which they explicitly said they heard on the news. They described the perceived impacts on their community as more dramatic than experts in the community reported them to be. Several interviewees mentioned that community members could benefit from being trained more broadly in addressing potential problems associated with multiple deployments. In addition, many of them emphasized that information on deployment-related issues (e.g., PTSD) should be more proactively disseminated.

Community Health

Physical Health Issues

Physical health care for soldiers, their families, and the general community was not described as being challenged by multiple deployments. Instead, through the efforts of medical practices throughout the Army and civilian communities, as well as the influence of a local health planning organization, the quality of general and specialty care throughout the region was reported to be exceptional, particularly for a rural area.

Behavioral and Mental Health

Behavioral health issues, such as depression, anxiety, substance abuse, PTSD, and suicide were identified by multiple respondents as one of the most serious negative effects of multiple

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

deployments. Many described how multiple deployments put an overwhelming strain on military personnel, their families, and behavioral health services in the community. One mental health provider noted how “greater demand for services has increased stress levels” among service provider staff:

The average service member has experienced four deployments and some as many as eight…. The stress on both the service member and families … [has] led to numerous behavioral health issues, which has increased the demand on our services. [Medical/behavioral services]

One social service provider described how a behavioral health issue stemming from combat can shock family members and friends, particularly when the signs are delayed, which can also present a treatment challenge:

It’s sad, because I think multiple deployments gives more opportunity for more and more issues with the people who are in combat…. [Talking about the spouse of a friend of his] One of [the husband’s] deployments involved some very graphic, horrendous human suffering. And some of the things that he had to do really affected him…. It didn’t manifest until … he’d been home for his 9 months’ stint … because it was like a year out, then 9 months home, a year out, then 9 months home. He went back…. And they ended up sending him back. He … [had] terrible, terrible issues, to the point where he was cutting himself and doing all kinds of crazy things. [Social services provider, spouse of veteran]

Another military spouse told us that when Army spouses try to talk to a physician about their struggles related to a spouse’s deployment, they are offered medication as a “quick fix” and an opportunity is lost:

The other thing I don’t like and I saw it happened time and time again when I went in to doctor on post…. They would always ask, “How are you feeling?” I was always very frank. “Some days I’m feeling great, and some days, oh, I’ve been crying.” You know, you just go through those stages. And the first thing I was always offered were antidepressants…. And I would say, “No, I don’t want antidepressants. I’m just sad at the moment. I’ll get through it.” But I was shocked to find out how many women take them up on antidepressants…. I had a fascinating conversation in the car one day. There were seven us in a car going down to a women’s conference…. Come to find out, that six of the seven of us were on antidepressants. And these were young women. These were 20-year-olds. And I get it—they are tired of feeling unhappy and this kind of shuts off their emotions, but they’re given nothing [else] … no counseling. And so they get used to feeling no emotions. [Social services provider and spouse of active duty soldier]

Suicide

Although there is evidence that suicide is a deployment-related issue at Fort Drum, it has not overtly affected the civilian community. According to the Watertown TV news station, “Fort Drum saw its highest level of active-duty suicides in almost a decade … seven Fort Drum

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

soldiers took their own lives in 2011 … that makes 31 suicides among Fort Drum soldiers since 2003.”6 Suicide of soldiers was mentioned by several community members as a particular issue of concern associated with multiple deployments. One army spouse described the post’s effort to reduce the incidence of suicide and suicide attempts:

They know what their purpose is overseas…. And when they come home … they’re lost…. There’s a lot of suicide. They’ve only been back since November. And a lot of suicide watches with our guys. And they’re not allowed to go anywhere for 2 weeks after being home … they are deliberately kept local so that an eye can be kept on them to make sure they’re getting their feet under them before they’re allowed to go out of the area. [Social services provider, spouse of active duty service member]

Although suicide is a concern for the community of Watertown, it seems that most, if not all, military-related suicides are confined to the post. We found no evidence of deployment-related suicides in Watertown. As one emergency service provider told us, “I have read in the paper that military suicides are up. I don’t know of any in the city of Watertown … in the last 6 years.” [Emergency service provider]

Family Issues

Several interviewees confirmed marital problems were a negative consequence of multiple deployment cycles, but also noted that family challenges are confounded by those faced by military families in general, including frequent moves and long periods of separation. Some interviewees suggested that the duration of deployment in combination with the level of associated risk is a better indicator of the extent to which deployments affect service members and their families and in what ways. One military spouse explained how the most recent deployment was very different than previous ones:

Previous to this particular deployment, I didn’t notice it [signs of PTSD] because of the jobs that he had previous to this one. His first tour out … was a civil affairs thing, and they were … not really in the line of fire…. His second tour … he never fired his weapon one time…. This [third] time … was scary. His job was to take a bullet before the colonel did…. So this time, I’ve really noticed quite a bit. Noises get him. We were just in Washington, D.C…. and we got out of the car and he’s doing one of these things—looking [and] scanning constantly … he’s tense and I could feel it in his body and I could see it in his arms and I said, “Sweetheart, calm down. It’s ok. Nobody is trying to kill us.” … He had to sit down on a bench. He’s like, “I can’t do this … I don’t know what’s wrong. I don’t know if it’s the smells. I don’t if it’s the number of people. I don’t know if it’s all the faces. I don’t know, but I can’t do this.” And he was unglued for the rest of the day…. My kids had never seen this. My 15-year-old was just like, “Dad, what’s wrong?” My 11-year-old was just beside himself. He was like, “Daddy, did we do something wrong? You didn’t want to go to the zoo with us?” [He responded] “No buddy. I wanted to. I just couldn’t do it.” That was really hard because that’s never happened before. That was really difficult. [Medical/behavioral services provider and spouse of active duty service member]

_____________________

6 See http://www.wwnytv.com/news/local/Fort-Drum-Sees-Highest-Level-Of-Active-Duty-Suicides-137775573.html.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

Children’s Issues

An overwhelming majority of interviewees expressed concern about the impact of multiple deployments on military children. One respondent summarized her feelings about the impact on the Watertown community:

I think multiple deployments have put an ungodly amount of stress on our military … it has been really, really hard in these past 2 years, because you see families breaking apart. You see the cost to our children…. And there’s no mental health that is directed towards our children. There’s none. I mean, they have MFLCs, and I’m telling you, the MFLCs are [the] best things since sliced bread…. Most public schools have MFLCs in the schools. Private schools do not…. There’s nobody for those kids to talk to. They are under an extraordinary amount of pressure. They see things, you know, that kids shouldn’t see. [Social services provider, spouse of active duty member]

Another respondent echoed this sentiment, but acknowledged some improvements in deployment cycles during OEF/OIF that may reduce some of the stress experienced by military children:

I think multiple deployments are hard. I think since they went down from 18-month deployments, it’s better. The 18 months was just … too much [Respondent got a little teary eyed at this point]. So it’s better that they went down from that. I think if they went back to 9 months, it would be way better. I think that it’s hard on the families. It’s hard on children. [Regional partnership organization representative, civilian]

Importantly, several interviewees pointed out civilian children are also affected by multiple deployments, in particular those attending schools with high percentages of enrolled military dependent children with parents deploying to OEF/OIF theaters. These civilian children often share in grief experienced by their friends, as explained by one civilian resident:

When a 9-year-old has a best friend, and their dad gets deployed and they’re sad, their friend is sad with them. Personally, I don’t think that’s a bad thing. You know, I think that learning different cultures and different ways of life is a good thing for kids and is a good thing for families. I think when we have causalities is when it’s a … hard thing…. Obviously, Fort Drum is heavily deployed and we have casualties regularly. [Regional partnership organization representative, civilian]

Teenagers in the community, those from both military and civilian families, have knowledge of the OEF/OIF combat theater in general and are sometimes aware of incidents before they make the news. Civilian adolescents serve a supportive function to their friends who are anxious about the safety of a deployed parent and the frustrations associated with repeated absences for deployment. Several interviewees told us that military families are more likely to stay in Watertown during deployment or after the conclusion of military service if their children are in high school or college, in part because of the bonds the teens have formed with civilian peers. Respondents also mentioned that the community’s children, both military and civilian, are

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

both more empathetic and also more resilient because of their exposure to the challenges of repeated deployments. Still, we were told by a few interviewees that many teens know more about fatalities than they can effectively handle without adult assistance or a constructive outlet. The docudrama In My Shoes was reported by several interviewees to serve as a very important opportunity for teens in the community, both from military and civilian families, to express themselves. One interviewee emphasized that importance:

In My Shoes has … [given] a voice to kids…. They need more [opportunities] … where these kids have a voice about what their experiences are on a regular basis. [Social services provider and spouse of former activated and deployed military Reserve member].

The impact of multiple deployments on civilian teens in the Watertown community was highlighted in a CNN piece that featured the play:

Amy Lapp, 17, dressed in an Army uniform for her role in In My Shoes. Her best friend, Aurora Adams, was one of the military kids who talked about her father, Mark Adams, a chief warrant officer who has deployed several times. Amy saw her friend agonize when a chopper went down in Afghanistan. There was every chance that it might have been her father. “I cry with her,” Amy says. “I let her talk and vent as much as possible. I think: ‘What if that were my father?’”7

Interviewees explained that school faculty and staff, particularly in primary schools, face the added stressors of working with an ever-changing list of students, some of whom leave midyear when one or both parents deploy, while others appear from another military post before or after a parent’s deployment. On return from deployment, parents were reported by school personnel to be “too quick to anger” over little issues like scheduling changes, which in turn affects the children.

Law Enforcement and Domestic Relations

Several community members suggested a possible relationship between increases in crime and multiple deployments, but others were unable to make that connection. For example, one leader in the business community stated:

I’m not sure if it’s directly related to the military … [Is the] crime rate … a little bit higher? People you know basically say yes…. There’s significant change in the crime rate and of those individuals they may be military family or military dependent…. When they’re back from deployment … we did see more military families needing services … some mental health services, intervention when there was physical, emotional abuse within the family. Things like that. [Business leader and former social service provider, civilian]

Implying that crime levels were not associated with multiple deployments, one veteran who is employed at Fort Drum suggested that a particular community leader “would give the line that

_____________________

7 America’s anomaly: The place where war is a constant, http://www.cnn.com/2011/10/07/us/afghanistan-fort-drum/index.html.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

crime goes down during a deployment and goes up after one comes home.” Despite perceptions among some community members regarding increases in crime and deployment cycles, representatives of emergency services and social service agencies felt uncomfortable drawing conclusions about any relationships between multiple deployments and increases in crime or domestic violence. One of them indicated that Watertown had around 1,800 domestic incidents in the past year, but pointed out that “a little over 10% would somehow be related to the military and that is not abnormal.” [Emergency services provider, civilian]

Another community member seemed to understand the stress of deployments on military families, but could not link this to patterns of domestic violence:

Sometimes, when the troops return, we might see a little spike in domestic violence incidents. But on the whole, it stays level. [Social services provider, civilian]

Law enforcement representatives reported that from 2009 to date, there were five highprofile violent crimes in Watertown and three others in surrounding communities that involved military or their family members. These include a young veteran convicted of killing an adoptive infant, a female soldier who stabbed another in a bar fight, and two armed robberies by a wounded soldier seeking pain killers. We were told these incidents were possibly deployment related, but law enforcement was not aware of any connection between these cases and the deployment histories of those involved.

Community Competence

Between offerings on post and in the surrounding community, there are many services available to address the challenges presented by multiple deployments. Medical providers and schools have long-standing relationships with the post that have allowed them to institute new strategies as needs arise. Although there are many comprehensive and targeted services available, including some that are free of charge, there are still gaps. Moreover, several interviewees pointed out that these resources are helpful only if people are aware of them and ask for them. In addition, interviewees from the business and health care sectors expressed concern that younger, single soldiers who are not involved in the civilian community may be particularly at risk after deployments.

The needs of the military associated with the multiple deployments, combined with military reliance on civilian medical care and regional collaboration, have prompted a variety of improvements in general and an increase in the specialized medical care available to service members (pre- and postdeployment), military families, and civilians. Recognized interdependence in medical care, education, and economic well-being appears to have enhanced community resilience associated with multiple deployments. The study team was assured in multiple interviews and informal conversations with health care providers that many challenges associated with multiple deployments have been met through the collaborative efforts of military and civilian providers in the region. Two major challenges in this community are an insufficient number of behavioral health care providers, particularly for children, a need that is clearly tied to multiple deployments, and the 70-mile distance for treatment through the Department of Veterans Affairs (VA), for which the connection to multiple deployments is less clear.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

Education

Because there are no schools on Fort Drum, schools in the community have borne a large responsibility for monitoring all children for ill effects of deployment and counseling them about loss and grief. Indian River Central School District has absorbed the largest number of military families: Overall, approximately 66% of the students are children from military families; at two individual elementary schools, they make up more than 80% of the student population.

Several interviewees described how area schools provide support for military and civilian children affected by multiple deployments. Counselors, teachers, and administrators with military/family experience and special school-hosted programs are also available. It appears that schools have become a very important support system to military children, as noted by one school administrator:

When a soldier dies in combat, [the] FRG gives us information before the official notification. We know quickly. It’s outstanding. We coordinate quickly to help the family…. A counselor goes into the classroom when the child is pulled from class. That counselor talks to the class…. Another counselor, sometimes with a parent, talks to the child. The child goes back to class…. The child is out 1 or 2 days for the funeral and … back in the classroom with their peers. It’s where they want to be. [Educator]

Among the programs implemented in schools to help those affected by multiple deployments, the most frequently mentioned was the Military Family Life Consultants (MFLCs) program. MFLCs have been trained to confidentially address family issues related to multiple deployments and are available to provide information, support, and guidance to all students, parents, teachers, and school staff, regardless of military affiliation.8Despite these and other efforts implemented in schools to help children affected by multiple deployments, several interviewees emphasized that more is needed, both in schools and throughout the community. For example, although most large public schools in the area have MFLC programs, we were told that parochial schools and smaller school districts either have few or no MFLCs available to address deployment-related issues.

Jefferson Community College (JCC) was said to provide important services to the community. For example, one college representative explained that the college is working to train more health care professionals, both to meet local service needs and to provide career opportunities for military and civilian residents. At least two interviewees specifically boasted that JCC has increased the size of its registered nurse program and currently offers a nationally ranked program with a 98% first-time board passing rate. JCC reportedly provides courses at Fort Drum, counselors who are knowledgeable about military benefits, a military lounge on campus in Watertown, an inexpensive child care facility, and flexibility in completing courses that are interrupted by deployment or associated stressors.

_____________________

8 See http://www.ircsd.org/students.cfm?subpage=27341.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

Physical Health Services

Fort Drum and the Watertown area provide a multitude of medical health services to active duty service members, veterans, family members, and community members affected by multiple deployments. Medical services on the post include primary care, a small obstetrician/ gynecological clinic, some behavioral health care services, an urgent care clinic, and a specialized recovery unit for wounded soldiers. Within the Jefferson County community, respondents reported that military and civilians have access to primary care, a growing array of specialty care, urgent care, and emergency medical services. The two major hospitals are located in Watertown and Carthage.

Several interviewees described the quality of medical care available in the region as exemplary, and many attributed this high quality to the partnership established between the civilian and military medical communities through the FDRHPO. Because Fort Drum has no hospital on post, service members and their families receive the majority of their health care from civilian doctors. Interviewees emphasized that the military has tried very hard to work with the community to ensure minimal disruption and enhanced medical services for military and civilians alike by infusing money into the civilian hospitals. Consequently, they expressed the view that both military and civilian patients receive top-notch advanced care that is rare, if not nonexistent, in most rural areas.

We also were told that medical practitioners are among the most informed members of the community about what to expect regarding soldiers’ needs before and after deployments. Interviewees, including a former manager of a medical specialty practice, told us that they offer more “ASAP” appointments and extended hours immediately before deployments to accommodate the military population. In addition, others are on alert regarding what to expect and when. One person explained how medical organizations prepare for returning deployments:

[Military and civilian medical personnel meet regularly] … so that they can talk about what’s happening. What are the challenges? What are the expectations? Who came home from where? And when are we expecting the 90-day [post-deployment] glow to wear off? And what is our plan? And how are we going to work on these things? What kind of training do we need to get done out there? [Regional partnership organization representative, civilian]

Behavioral and Mental Health Services

One of the greatest negative effects of multiple deployments in the community that was articulated was an increased need for behavioral health care, particularly for children. Only one location in the area, Watertown’s Samaritan Medical Center, has an inpatient behavioral health care unit. Many interviewees emphasized this as an issue, and one mentioned waiting lists as long as 6 months for military families and other civilian members of the community. All behavioral health care for military families at Fort Drum is provided in the civilian community.

One person expressed concerns about the lack of community preparedness for dealing with mental health issues that may result from multiple deployments:

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

They bring the military guys right from Iraq, drop them off, and go. Do they know anything about our community? Some of them are just coming here for the first time. We are seeing a big [in]flux of PTSD, the calls for family disturbances that we have never seen before…. I don’t think we are as prepared for the mental part of it as much as we should be…. There are a lot of mental issues that none of us really know how to deal with in the community. [Local government employee and spouse of retired military member]

Others expressed more optimism in this area:

On a positive note, one thing that I have learned through contacts at Fort Drum is that when units come back from deployment, everybody does go through a prescreening for mental-health-type issues … they take a pretty active approach to it. Do they get to everybody? And is everybody coming back that’s having problems honest with the interviewers? I don’t know the answer to that, but I would guess maybe not. But I also know that Samaritan Medical Center … [is] there for people that need assistance…. Can more be done? I’m sure you can always do more…. But I think when things get presented to them, they try to address it. [Emergency services provider, civilian]

Some interviewees reported that there is still some stigma associated with seeking mental health services. One of them was adamant that even a spouse seeking behavioral health services could adversely affect the military member’s career:

If your husband’s looking to get promoted, and you as the wife goes and gets help with some mental health issues—for your husband that could affect his promotion. They’d like to say it doesn’t, but it does. [Social services provider and spouse of a veteran]

Other interviewees, however, suggest the situation has improved in recent years. One person explained how her husband set an example for his unit:

My husband is a rock…. Nothing shakes him…. He, himself, out of his own accord, made an appointment to go to behavioral health…. And he’s done it for himself … and the other reason he did it was to show his soldiers that there was no shame in doing so. If he did it, then they can do it. So his boys have all … made the appointments…. It is diminishing greatly—the stigma of it. [Medical services provider and spouse of active duty soldier]

Social Services

A wide variety of social services are available to military personnel and their families both on the post and in the greater Watertown community. The Jefferson County Department of Social Services (Jefferson County DSS) offers the following services to Jefferson County residents who meet eligibility criteria: volunteer income tax preparation; temporary financial assistance for shelter, fuel and basic needs; medical assistance through participating providers; food stamps; child support enforcement services; custodial care for adults; adult services, including in-home services and transportation; and family and child services to “enhance the

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

preservation of family life.”9 It also compiles a newsletter describing available services and events that is available on the county website.

Specialized social services are also available from private agencies, including the following:

• The Jefferson County Victim’s Assistance Center has a 24-hour telephone hotline that can connect victims of sexual assault or domestic violence to emergency shelter services and provide emotional support, information, and referrals. The agency offers individual and group counseling and support groups and a child advocacy center that provides services to child victims and nonoffending family members. The agency also provides community outreach and preventative training and has two advocates at Fort Drum to build rapport and increase accessibility.

• Transitional Living Services of Northern New York (TLS) is a private not-for-profit agency that provides residences, supported housing, and homeless and case management for the mentally ill population. Its 24-hour emergency crisis hotline is available to all community members, including military, and callers can remain anonymous.

• Disabled Persons Action Organization (DPAO) provides developmentally disabled children and adults in Jefferson County and Lewis County with a variety of services geared toward helping families cope with the stress of caring for their disabled loved ones. Its Snoezelen room for sensory stimulation was identified by an interviewee as a unique resource for service members with PTSD.

The limitations of local recordkeeping systems to track data on military affiliation and deployment status may hide issues related to multiple deployments in the community. Several interviewees in key positions indicated that it was difficult to assess whether or not problems could be connected to deployments, simply because many providers do not routinely identify and monitor military or deployment status. One first responder explained:

Unfortunately, we don’t have a mechanism to track whether someone is in the military, related to a military person, or here on behalf of Fort Drum. There [is] just no way for us to track that. But there are times that we are aware of that…. I have one, two, three, four, five cases that I would share with you as being [military related]. Two involved deaths, two were shootings, and three others were shooting-assault type situations. And it worries me because guns are involved. [Emergency services provider, civilian]

In sum, there are multiple points at which people can be connected to formal services, and those who provide social services are familiar with a variety of what’s available and can provide contact information. In addition, many individual members of this small community were reported to be informed and eager to help those in need find appropriate services. Most agree that there is room for improvement in services that may be required as a result of multiple deployments, but we heard about and witnessed individuals and organizations serving as leaders in addressing key deployment-related needs in one or more sectors of the community.

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9 See http://www.co.jefferson.ny.us/index.aspx?page=115.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

Social Capital

Outside of services provided directly by the military, there is a range of efforts to support deployment-related issues. Three organizations are mentioned on the army.mil community covenant page for Fort Drum, namely, the Association of the U.S. Army (AUSA), the Adopt a 10th Mountain Platoon Program, and FDRLO. These organizations, which are linked to the Army but not funded by it, were also commonly mentioned by interviewees as informal supports to which community members can turn to minimize or address issues related to multiple OEF/OIF deployments.

Membership in AUSA, a private nonprofit organization, is available to all individuals, as well as to companies that wish to show support for Army communities. AUSA supports several programs that were specifically mentioned by interviewees. These include Adopt a 10th Mountain Platoon, which, like similar programs around the country, gets local organizations to send care packages to deployed soldiers. Interviewees said what makes this program unique is that every unit deployed from Fort Drum has had a sponsor, and it is not uncommon for organizations to hold events with soldiers before or after a deployment.

Many interviewees also cited Operation Yellow Ribbon, a partnership between Fort Drum leaders and North Country communities, as an important informal support. The organization encourages the display of yellow ribbons and the 10th Mountain Division insignia throughout the civilian community to recognize soldiers’ service and, as appropriate, to signify retail discounts. During our visit, we observed yellow ribbons displayed on many businesses, faith and service organizations, and government office buildings.

Also present is an involved faith community, which was described as interconnected and a significant source of deployment-related support. Several interviewees mentioned that a meeting held in November 2010 between civilian clergy and military chaplains was a key to addressing issues around multiple deployments for military and their families, as well as the community as a whole.10

Online social networks were also seen as an important set of informal supports for connecting people about important issues. One Army spouse said that she set up a private group on the Facebook website to connect soldiers under her husband’s command and, at home, the units’ spouses and adolescent children. She described it as a way to get pictures of important community events, such as school graduations, to soldiers in the field so that they could remain connected. Other persons mentioned online bulletin boards (such as craigslist.org “rants and raves”) as sounding boards used by a handful of individuals—military, veteran, and civilian—to vent and communicate about a range of community issues.

Several interviewees suggested that it would be an improvement to provide something constructive in the community for young soldiers—the 18- to 20-year-olds—to do off duty, perhaps including athletics or another activity that allows them to connect to one another and/or to civilians. Two interviews also highlighted the need to provide additional support to those soldiers coming back from deployment “to no one, while everyone else hugs their wives and

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10 See http://www.watertowndailytimes.com/article/20101118/NEWS03/311189981/-1/NEWS.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

kisses their kids,” or worse, to a process server handing them divorce papers. One community member expressed an understanding of the struggle faced by single soldiers returning to Fort Drum after deployment:

If you’re a younger person in the military … the single soldiers … [there’s] such a stigma … with mental health … there needs to be something more there for soldiers to … invest in. So that when they’re back here or back from deployment, there’s a purpose…. Lord only knows what they see…. So to be able to come back and be a part of something … if you don’t have your family here. [Business leader and former social service provider, civilian]

SUMMARY

Watertown, the surrounding area of Jefferson County, and Fort Drum are working effectively, although not seamlessly, to support a blended community in the wake of significant growth of the post since 2004–2005. Civilian and military leaders have made joint progress in addressing challenges in the community associated with multiple deployments. Meeting the unmet needs and supporting community strength will require continued collaboration and creative problem solving.

What’s Working

For the most part, the Watertown area is very supportive of Fort Drum soldiers and their families. In the face of challenges associated with post expansion and related community growth, the civilian and military communities in Watertown and surrounding Jefferson County appear to have cultivated a mutually respectful and beneficial partnership. Symbols of the community’s appreciation for Fort Drum soldiers and their families is evident; yellow ribbons and the 10th Mountain Division insignia appeared on road side signs, on banners on buildings, and on flyers in store front windows.

• The city’s agencies and services are well networked and communicate regularly among one another. Several key agencies communicate regularly with and receive training from experts associated with Fort Drum, notably regarding policing, EMS, schooling, housing, and counseling in the faith community.

Adopt a 10th Mountain Platoon has ensured that every company is connected to a sponsor to receive letters and care packages when deployed, as well as optional social networking and support before and after deployment.

• The Fort Drum Regional Health Planning Organization connects civilian and military medical providers and records, as well as providing military families with information about local health care options.

• The locally written and performed play In My Shoes offers adolescents from both military and civilian families the opportunity to express and discuss their feelings about multiple deployments and initiate a series of community conversations about their experiences and needs.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

Needs

Mental health services, particularly for children, were identified by many interviewees as the largest current and anticipated need for the community, in part because of national shortages.

• The long duration of deployments and short time back home to relax and reconnect between missions pose stressors on soldiers and families that affect social networks and community resilience over time.

• Efforts to identify soldiers who may return from deployment without family or other social supports present were requested. Programs may be needed to connect or reconnect these individuals to community resources.

• More proactive information throughout the community about what families and civilians might expect from returning soldiers over time (e.g., PTSD) and how best to address their needs is needed. In addition, community agencies might provide more data about trends to inform and dispel any incorrect perceptions about, for example, crime among returning soldiers.

Continued communication and planning is imperative to ensure that collaborative efforts supporting positive civilian-military connections persist.

Suggestions from the Community

• Integrate medical records and benefits systems between DOD and VA.*

• Proactively provide more/visible information about potential mental health needs associated with deployments to help reduce the stigma in the community and help the community respond effectively to posttraumatic stress issues.*

• Provide young soldiers with mandatory counseling on better use of their money.*

• Make seed money available for creative collaborative solutions to the challenges that face military communities.*

• Provide constructive activities in the community for 18- to 20-year-old soldiers to do off duty, perhaps including athletics or a business that allows them a space to connect to one another and/or to civilians in the community.*

• Rotate MFLCs in schools less often; they need time to build rapport.

• Involve soldiers and their spouses more deeply as leaders in education systems to help bridge the gap between the challenges faced by the military and civilian communities and identify potential solutions.

• Support artistic outlets, particularly those that provide constructive outlets for children, and foster communication between the military and civilian communities.*

*Suggestions noted with asterisks were cited by multiple interviewees.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

Lakewood and Lacey, Washington

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Case Study Report

 

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

Impacts of Multiple Deployments: Lakewood and Lacey, Washington

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OVERVIEW

Joint Base Lewis-McChord (JBLM), home to about 45,000 active duty service members, is located about an hour south of Seattle, Washington. During a week-long site visit (May 16– 22, 2012) to two nearby cities—Lakewood and Lacey—representatives from both communities provided their perspectives on the diverse effects of multiple deployments on their cities.

As in other sites, interviewees were not able to determine if recent changes in the local economy (primarily large-scale growth) were related to multiple deployments or Base Realignment and Closure (BRAC) decisions. A joint planning partnership between JBLM and Lakewood has been established to manage this growth over time. Community members and mental health providers alike did report a recent increase in posttraumatic stress disorder (PTSD) symptoms among returning service members, as well as other behavioral health issues that have potential long-term effects for the communities. Many believed these issues to be a result of the multiple deployments of service members to Iraq and Afghanistan. School representatives also reported behavioral problems among younger children from military families, as well as some negative experiences with stressed military parents. In response, school district leaders are working closely with the command to implement school-based programs to support military families and students. A major identified need is for more behavioral health services for military families, both on base and in the community.

Data Sources Lakewood, Washington

• City Government (City Manager and Asst. City Manager)

• Department of Economic Development

• South Sound Military and Communities Partnership

• Department of Human Services

• School District Superintendents

• Mental Health Providers

• Public Health Administrator

• Faith-Based Housing & Social Services Provider

• Boys and Girls Club

• YMCA

• Police Department

• Lakewood City Council Member

• Realtor Group

• Hospital Administrator

• Kiwanis Club

• Armed Forces Day Events at JBLM

• Ethnographic Observation Lacey, Washington

• City Government (Mayor and City Manager)

• Department of Recreation and Parks

• Police Department

• School District Administrator

• Lacey Spring Fair

• Ethnographic Observation

GEOGRAPHIC ORIENTATION

Community: Lakewood, Washington

Lakewood is located in Pierce County, about an hour south of Seattle. Originally

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

settled in 1849 by the U.S. Army, the city evolved during the 20th century into an urban region outside of Tacoma and was incorporated as a city in 1996. Lakewood borders the northern edge of JBLM, which includes the National Guard’s Washington State headquarters at Camp Murray (Figure 1). The layout of the city is an urban/suburban model with pockets of rural areas, some of which surround a lake community that was established as a resort area in the early part of the 20th century. The city is a popular area for sportsmen and tourists. Census data for 2010 indicate that Lakewood has a population of about 60,000 residents, most of whom are English speaking and under the age of 55.1 Approximately 44% of Lakewood households are married couples living together, and about 30% have children under the age of 18. Lakewood officials said that about 10% of Lakewood residents are active duty military living off base.2

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FIGURE 1 Geographic orientation: Communities and JBLM.

Initiating contact with local officials in Lakewood was challenging. The study team was aware that this city has been in the national media spotlight for the past several months because of violent crimes committed by service members stationed at JBLM.3 Also, because of Lakewood’s close proximity to Madigan Army Medical Center, the city has been the subject of numerous inquiries and criticisms about the effects of multiple deployments and the treatment of

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1 See also http://www.cityoflakewood.us/community/about-lakewood.

2 This was validated by a regional population distribution chart the team received during its interview with the Lacey City Manager.

3 Examples of media coverage include the following: “Home Base of Accused Soldier Has Faced Scrutiny,” New York Times, March 13, 2012. (http://www.nytimes.com/2012/03/14/us/more-scrutiny-of-lewis-mcc); “Branding a Soldier with ‘Personality Disorder,’” New York Times, February 24, 2012 (http://www.nytimes.com/2012/02/25/us/a-military-diagnosis-perso), “Madigan Team Reversed 40 Percent of PTSD Diagnoses,” News Tribune, March 21, 2012 (http://www.thenewstribune.com/2012/03/21/v-printerfriendly/2076608).

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

service members who have been diagnosed with PTSD. After the study team did make contact with local officials, team members learned that city officials have been fielding calls from the media on a daily basis, leading them to become wary of granting interviews and reluctant to discuss issues related to JBLM. When one nongovernment interviewee was told how difficult it had been to make contact with the city, she laughed and knowingly said, “Yep, circling the wagons.” Study findings suggest that Lakewood is a community that is proud and supportive of service members and their families, all of whom are woven seamlessly into the larger fabric of the city. Limiting outsiders’ access to the city is simply one more way in which Lakewood supports its military residents.

Community:
Lacey

Lacey, Washington, is located in northern Thurston County, about a 10-minute drive west of JBLM on Interstate 5 (I-5). Although Lakewood originated as an offshoot of Tacoma, Lacey was established as a suburb of Olympia, the state capital. According to 2010 Census data, most Lacey residents are white, English-speaking, and under the age of 45. A little more than 50% of city households in 2010 were married couples living together, and nearly 35% of those households had children under the age of 18. Lacey does not physically border JBLM; however, data received from the Lacey City Manager’s Office indicated that 16% of the city’s approximately 42,000 residents are active duty personnel. Lacey has a regional reputation for being family-friendly and is known to attract service members and their families.

Lacey, in the words of one local official, is “South of the River” and physically separated from Lakewood and most of JBLM by a bridge. Making contacts with officials in Lacey proved to be a relatively simple task and officials were willing to speak with the study team about the impacts of the deployments on this city, which has not received the media attention experienced by Lakewood. City officials noted that although a high number of military families live in Lacey, it has not been stigmatized around the issue of PTSD the way Lakewood has been:

Many of the families as well as the single service men have said that people “North of the River” do not welcome them into their community. They said that’s not true of Lacey. People that move here, who come into Lacey say, “This community is different than any other we’ve lived in. People like us here, they’re not antimilitary, there’s no perceived bias that we have PTSD or that we’re bad people. People accept us, they welcome us … our neighbors are friendly.” [City official]

Military Installation: Joint Base Lewis-McChord (JBLM)

JBLM is the largest military installation in the western United States, covering more than 415,000 acres. It was formally established as a joint base on October 1, 2010, through the merging of Fort Lewis (Army) and McChord Air Base (Air Force) under BRAC decisions.4 An Army-led joint base garrison provides all installation functions to the Army, Air Force, Navy,

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4 See http://www.lewis-mcchord.army.mil.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

and Marine Corps Services that operate on base. In addition to the estimated 45,000 active duty personnel assigned to JBLM, there are about 7,500 civilians and Department of Defense employees and another 5,000 contractors who work on base.

In 2011, the South Sound Military and Communities Partnership (SSMCP)5 conducted a “Community Needs Survey of Joint Base Lewis-McChord Personnel and Families” in collaboration with JBLM Garrison Command.6 The purpose of the study was to provide the SSMCP, JBLM, and local communities with a demographic profile of JBLM personnel and military families living in the area and to identify needs for services and supports. These needs would be targeted for improvement to keep up with the expected growth at the installation in the coming years. Among the approximately 3,250 survey respondents, 66% were active duty service members or their spouses. The 2011 survey included questions relevant to this ethnographic study of the region:

• 40% of service members had been stationed at JBLM for a year or less. Only 35% of service members had been assigned to JBLM (on the current tour) for 3 years or longer. Length of stationing at JBLM tended to be longer for Air Force service members (4+ years) than for Army service members (3 or fewer years).

• 77% of active duty respondents had been deployed at least once since September 2001, and one-third of them had been deployed three or more times. The number of deployments tended to be slightly higher for service members in the Air Force (3+ deployments) than for Army soldiers.

• Nearly 40% of service members stationed at JBLM said they had been deployed within the past 2 years. Most interviewees seemed aware that multiple deployments are the norm for service members, with several government and community leaders saying they had heard of individuals receiving orders to go on their fourth, fifth, and sometimes sixth deployments. Local leaders also suggested that the time between deployments seems to be getting shorter, especially for those in Special Forces (e.g., sniper squadrons). A social service provider offered the following observation:

I think when a civilian sees a 20–40 something soldier in uniform or finds out that they are a veteran, it is just assumed by the civilian that the veteran has been deployed multiple times. I think most people find it rare to meet a soldier who has not deployed in support of conflicts over the past decade and the younger the solider or veteran appears to be, the more deployments are assumed.

Several interviewees also discussed the return of about 10,000 service members from two Stryker brigades during the summer of 2010 and how the influx of a large number of people in such a short time affected the region. Figure 2 depicts a bar graph extracted from the 2010 JBLM Growth Coordination Plan that shows the patterns of deployments and returns for Army

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5 The SSMCP is described in more detail later in the report.

6 See http://jblm-growth.com/sites/default/files/JBLM%20Survey%20Report%20Final.pdf

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

service members stationed at JBLM between 2004 and 2010.7 During 2009 and 2010 in particular, the region clearly experienced several fluctuations in its population as a result of large-scale deployments to the wars in the Middle East.

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FIGURE 2 Deployment/returning schedule JBLM 2004–2010.

Relationship Between Communities and Base

Interviews and observations suggest that service members and their families are not seen as strangers or temporary residents, but are regarded as regular members of these communities. Service members are routinely seen in camouflage fatigues at local stores and restaurants, and vehicles bearing Department of Defense stickers are a part of everyday life in these cities. Every person interviewed by the study team either had personal experience in the military (often at JBLM), or was directly related to or otherwise acquainted with someone stationed at JBLM. In support of this observation, both Lakewood and Lacey have statues in prominent locations that pay tribute to service members and their families.

In 2009, Lakewood was awarded a grant from the Department of Defense Office of Economic Adjustment (DOD-OEA) to conduct a regional study to identify and prepare for the impacts of the merging of Fort Lewis and McChord Air Force Base that had begun a few years earlier under BRAC. That effort led to the creation of the South Sound Military and Communities Partnership (SSMCP), which was established within the Lakewood City Department of Economic Development and now operates under the City Manager’s Office. The SSMCP serves to foster communication, planning, and collaboration between JBLM and regional communities. The SSMCP coordinated the regional impact study and released thefindings to the public in the 2010 JBLM Growth Coordination Plan.8 The study identified

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7 Air Force personnel were also deployed from JBLM during this time period but those data were not available to the research team.

8 See http://www.jblm-growth.com/plan.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

portions of the region that could anticipate the greatest impact of growth from JBLM, and recommendations were generated to address the following core needs:

• System of planning, coordination, and collaboration between local communities and JBLM

• Housing (low-cost rentals and privately owned)*

• Education and child care*

• Transportation and traffic*

• Land use (regional planning)

• Public safety

• Community infrastructure (e.g., utilities)

• Physical and behavioral health services*

• Social services

* These items represent community domains with multiple-deployment-related effects identified both in the JBLM Growth Coordination Plan and during the site visit.

Although the SSMCP regional study and resulting growth plan were intended to identify a broad scale of community needs related to growth at JBLM, lessons learned from the needs assessment and the resulting action plans have helped to mitigate the impacts of multiple deployments on this region.

EFFECTS OF MULTIPLE DEPLOYMENTS ON THE COMMUNITIES

Interviewees did not attribute recent economic changes to multiple deployments, but did report numerous behavioral health issues that they believed to be tied to this deployment pattern. Contributing to this perception were several recent violent events committed by service members from JBLM. Although numerous formal and informal services and supports are available in the community, interviewees indicated the need for a more comprehensive community-based behavioral health system. The current system capacity, they said, was insufficient to meet the current needs of service members and their families, and interviewees anticipated these challenges to persist well after the drawdown of troops in Afghanistan.

Economic Impact

Multiple deployments of service members from JBLM do not appear to have had largescale direct effects on general commerce and consumer demand, employment, and the housing markets in Lakewood and Lacey.

General Commerce and Consumer Demand

Multiple deployments do not appear to have had a major impact on commerce and demand for consumer goods and services in Lakewood and Lacey. Expansion of businesses in these cities is ongoing, but seems to be related more to the general population growth at JBLM

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

than to the deployment and return of service members. Local businesses around Lakewood did experience an increase in demand in 2010 after the return of the two Stryker brigades, which, in turn, brought an increase in city tax revenues for the third and fourth quarters of 2010 and the first quarter of 2011. Officials in both cities also mentioned that, upon returning from deployment, younger soldiers (those in their twenties) tend to make high-dollar purchases, such as expensive vehicles and recreational equipment. Younger soldiers who do not have family in the area usually need to purchase civilian clothing and furniture and find a place to live if they are unable to stay on base. Interviewees, however, did not describe a purchasing pattern reflecting multiple deployments among service members.

Lakewood’s public website describes the city as having about 1,100 businesses.9 Discussions with a variety of interviewees in the city, including staff from the Department of Economic Development, suggested that Lakewood receives a great deal of daily business from active duty personnel, family members, and affiliated persons working at JBLM. Several of the main entry gates are located on the Lakewood side of the base, making this city the closest location for those seeking meals and other resources (e.g., department stores) off base. This was confirmed by the study team’s personal observations while in town. It was not unusual to enter a local restaurant at lunchtime and see at least half of the patrons dressed in camouflage fatigues.

Lacey, which is a few minutes’ drive from JBLM, has a variety of newly built shopping areas, restaurants, and hotels, especially near I-5 exits. Business appeared to be steady around town and seemed to be concentrated in the morning and late afternoon/evening during weekdays and throughout the day on the weekends.

Employment

According to interviewees, multiple deployments from JBLM have had some impact on employment in this region. Some employers, they said, have had to deal with staff turnover when spouses of deployed service members leave the area. They reported that this has been more of a problem for specially trained and/or certified employees, such as nurses and teachers, because they are difficult to replace. Some employers reportedly have been reluctant to hire spouses of service members out of concern that they may stay only for a short time and need to be replaced. One employer said

You have the issue of military spouses getting work. They’re probably not going to be here more than 2 or 3 years; employers here know that and I think that impacts the spouse’s ability to get good, long-term employment.

In addition, a couple of interviewees said they have heard comments from community members, including a few local employers, about a reluctance to hire service members who have separated from the military because employers have concerns about these veterans’ emotional stability. Some interviewees wondered if the message about this bias might be reaching service members, given that some retired soldiers have not been listing their military service on job applications.

_____________________

9 See www.cityoflakewood.us.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

Housing

Seventy-two percent of JBLM active military and their family members live off base in local communities, mostly in Lacey, Lakewood, and Tacoma. During interviews with staff from the SSMCP and Lakewood city government, the study team learned that some family members leave Lakewood to stay with relatives while their service members are deployed. Although a precise number was not given, one official commented that “it feels like 50%.” An example was given by a city official who is a regularly attending member of a local church located close to JBLM; he said that the church experienced a 50% drop in attendance after family members moved away during a deployment. In Lacey, such departures are reportedly less common. Lacey government officials reported that not only do family members tend to stay in Lacey during the service members’ deployment, but often other family/supports arrive in Lacey to stay with them.

Interviews with officials from Lakewood city government and a focus group conducted with 13 regional real estate agents suggested that the multiple deployments have created a mindset among service members that has had a negative impact on the local housing market. For decades, service members had been purchasing homes in the region because they expected to be stationed at JBLM for a few years. Even if deployed, many expected to return to JBLM and live in the area for a while. In recent years, however, home sales have declined, particularly around Lakewood, and increasing numbers of families stationed at JBLM have turned to renting. Local real estate agents believed the switch from ownership to renting has been related to a few factors:

• Service members are no longer secure in knowing how long they will be stationed at JBLM. The current trend has been for service members to be based at JBLM for only a few years before being transferred to another base. Sometimes orders for transfer come during deployment, in which case family members may need to move before the service member returns. This has made it difficult, and impractical in some instances, for service members to purchase a home and “commit” to a community.

• Younger service members seem to choose Lakewood for residency given its proximity to the base, and this age group tends to represent a “renting” population.

• Renting has become a more desirable option for service members whose spouses may move out of the area during the deployment.

• When some service members get orders to move to a new base, they need to sell their homes quickly and sometimes take a financial loss on the sale. This type of financial loss may affect a service member’s credit score, which, if too low, could interfere with the individual’s security clearance.

Data from the 2011 Community Needs Survey support interviewees’ reports of a decline in home buying and an increase in rentals in the area. The survey indicates that approximately 60% of active duty service members who live off base rent. Staff from Lakewood’s Department of Economic Development reported that the decrease in home ownership has led to a decrease in the use of home-related services, such as lawn care, construction, and the like. During the realtors’ focus group, one interviewee said that every home sale results in an additional $60,000 in spending in the local economy of Lakewood; the decline in sales, this individual believed, has thus had an effect on local revenues. Further research indicates that this figure more accurately

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

reflects new home construction and that in Washington State, a typical home sale yields up to $42,500 in a combination of income generated from real estate activities, consumer purchases such as furniture and remodeling, and a “multiplier effect” of spending on local restaurants, sporting events, and so forth.10

The realtors’ comments notwithstanding, it cannot be ruled out that some of the changes in home ownership in this region are related not to service members’ deployment experiences, but to the economic downturn of the last few years. Additional research would need to be conducted in order to determine how much deployment experiences have figured into service members’ decisions.

Transportation

The most frequently mentioned issue that interviewees of all types tended to tie to the deployments from JBLM had to do with increased traffic in the area. This was most evident in the summer of 2010 when about 10,000 service members returned to JBLM (followed by any family members that had left temporarily) and joined daily commuter traffic on I-5. Lakewood and the SSMCP have been working on securing DOD/Office of Economic Adjustment (DODOEA) grants and funding from the Washington State Department of Transportation to upgrade the roads because traffic is expected to increase over time. A Lacey official described how the multiple deployments negatively affect traffic in his city11:

When [service members are deployed], family stays here…. A great deal of time other members of the family come up … and they stay here for a while and they bring in other cars during that 9-month period when the military component is gone. So that has a major impact on our roadways, on our corridor.

Officials in these communities noted that they continue to work with JBLM and officials in Washington to figure out ways to alleviate the transportation stresses caused by multiple deployments.

Information and Communication

Lakewood government officials and the school districts have good channels of communication with JBLM. Lacey community leaders receive military information more informally, as do local residents. They rely on public media, personal communications with people they know who work at JBLM, and online information to learn about JBLM activities and resources.

_____________________

10 Economic Impact of Real Estate Activity: Washington. National Association of Realtors Research, February 2012. Available at http://www.realtor.org/sites/default/files/reports/2012/economic-impact-real-estate-activity-washington-2012-02.pdf.

11 This same official also indicated that despite the adverse effects of the traffic increases, incoming family members have helped the local economy generally: “We would like to say we also are enhanced somewhat with the additional monies they bring in to spend in our communities and we reap the sales taxes and other fees and taxes they pay while they’re here.”

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
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Public Discussion of Deployment-Related Issues

During interviews, the team asked respondents how information about the deployments and demobilizations are communicated in the region and how residents learn about available resources. Respondents in the “general public” said they “formally” learn about the deployments from local TV and print media, but often obtain information informally from relatives or acquaintances assigned to JBLM. Although the personal and family challenges related to multiple deployments, such as mental health disorders and family stress, were mentioned in a variety of community contexts and during the course of several interviews, several interviewees, including the police, indicated relatively poor communication about services available for managing deployment-related disorders, such as PTSD.

Communication Between JBLM and City Government

Lakewood’s government officials are kept apprised of deployment schedules through the SSMCP’s ongoing planning partnership with JBLM. In addition, the city’s Department of Social Services facilitates the Lakewood Community Collaboration, a community organization that includes representatives from numerous social service agencies who meet quarterly. A military representative from Army Community Services (ACS) is invited and often attends.

In contrast to Lakewood, Lacey government officials said they tend to learn about deployments the same way as the general public, that is, through the media or personal contacts affiliated with JBLM. The only group indicating it had a formal system of communication to learn about the deployment schedule was the Clover Park School District (CPSD), which operates the schools around Lakewood and on JBLM. Details about this communication effort are described in the next section of the report. Law enforcement officials noted a strong relationship with their counterparts at JBLM, but said they learn about deployments and demobilizations through “word of mouth.”

Communication Between JBLM and Local Law Enforcement

The relationship with, access to, and communication between local law enforcement and JBLM seemed to differ by city. Lakewood police described an “excellent relationship with JBLM,” well-established formal connections with the military police, and an ability to always be in communication with JBLM as needed. All incidents involving a service member are immediately directed to officials at JBLM and “all staff know how to contact the provost marshal or MP [military police unit] on base.” A JBLM liaison officer is stationed at the Lakewood police station every weekend, specifically to deal with any service member who becomes involved in police-related activity. Lacey police described a different relationship. Although they are part of a law-enforcement breakfast group in South County that is attended by the JBLM provost marshal, this venue does not result in regular communication between the city and JBLM or a way to address arrests involving service members. Information about troop deployment and return cycles are learned informally (e.g., through personal contacts and acquaintances on base) by the Lacey police; there is no formal notice for the city of when to expect deployment-related changes.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

Information Sources for Military Families

JBLM has extensive information about military-sponsored services available to military members and their families, including a downloadable orientation document. Family Readiness Groups (FRGs) appear to be available to all military members and their families and can be an important source of information and support, especially for the nondeployed spouse. There was evidence of some informal networks, such as Facebook pages for South Sound military spouses, and the team learned of some efforts within the community to reach out to military families. Yet except for the YMCA, which offers programs for military families, identifying or connecting with these programs during the site visit proved difficult. Armed Forces Day, held on base and open to the public, had virtually no community-based (off-base) resources advertised to military families except for the Veterans of Foreign Wars (VFW) and the American Legion. There was no outward evidence of support groups, for example, and there were no faith-based organizations, social services, mental health, or child care organizations present at this event. Yet one of the most important services mentioned by every person interviewed was the need for behavioral and mental health information, education, and counseling related to multiple deployments. Services to meet the mental health needs of service members and their families were described as not readily available and with long waiting lists. Yet the few nonmilitary organizations at the event included only mortgage services, Internet-based educational programs for college degrees, and chiropractors.

Community Health

In discussions about the effects of multiple deployments on community health, interviewees focused on the spillover effects in school of deployment-related stress experienced by children and their parents. They also discussed perceptions that service members who have been deployed multiple times are returning home with PTSD and a concomitant propensity for violence.

Children’s Issues

School district representatives said that some children from military families, especially those of elementary age, have exhibited behavioral problems. They discussed issues they see their students from military families confronting, such as dealing with the culture that comes with living on base, dealing with one or both parents being deployed, having to move and being uprooted every few years, and experiencing the loss of family members. They described these children and their parents as experiencing periods of readjustment both when a parent deploys and when the parent returns. Interviewees described school-age children with a deployed parent as often having difficulty with anger management and dealing with feelings of loss. They also said some children seem to internalize their feelings about the deployed parent and worry about the parent who has stayed home and who must assume new responsibilities and the role of a single parent.

Interviewees from the school districts and community programs also talked about the challenges that many families face when service members return home. This relearning and change of roles when the service member returns can be just as stressful as when that parent deployed, as described by one community interviewee:

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

One parent described how her children thought their Dad was coming back. They thought he would be the same person, laugh the same way, act the same way to them, but he is a different person now.

School representatives and community program staff also described seeing an increase of “belligerent” behavior from parents in military families toward school and program staff in the past few years. The interviewees said they assume the behavior comes from parents who are dealing with the stress of single parenting during multiple deployments and then reconnecting and reestablishing the family roles when the service member returns. This has been especially challenging for families in which there is only a short period of time between deployments. Said one program staff member:

They (service members) don’t have enough time to shut it off (state of constant vigilance needed for combat situations) before they go out again.

The school systems have responded to their students’ needs by making mental health supports more available and finding ways to honor military families through special events (see the Community Competence section). Many school representatives suggested that mental health counseling was a significant need for children from military families, especially those with deployed parents.

Service Members’ Behaviors

Interviews with law enforcement officers offered a mixed picture of service member behaviors that affect the community and are possibly related to multiple deployments. Lacey officers reported that in recent years the city has been experiencing an increase in domestic violence calls, as well as an increase in arrests of service members driving while intoxicated. In the past few years, they said, officers in this city have been encountering negative attitudes toward law enforcement from some of the service members:

The other thing we’ve noticed … the military members who are arrested have an extremely different view of the police department…. It’s markedly different and it’s only been in the past 4 to 5 years that we’ve seen the change, but it’s a radical change. It’s a disrespect for law enforcement, just a complete and utter disrespect. We’re lower than potato peelers and privates to them. Whereas before that it was “Sir, yes, Officer”—it was very formal 4 or 5 years ago, now it’s “You’re not my chain of command, expletive, expletive, expletive.” That’s pretty routinely what we’re running into now. I don’t know what exactly changed to fuel that, but something changed. It’s very noticeable.

In addition, Lacey police reported encountering increasing numbers of service members who, while under arrest, have said doctors told them that their diagnosis of PTSD “excused them” from being charged with any crime.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

In contrast, the Lakewood Police were not able to identify differences in service members’ behavior from any other time in the past 25 years. While they did describe encountering incidents of after-hours disorderly conduct from service members, no tie was made to the deployment cycles or population increases at JBLM. In fact, Lakewood police described these incidents as “business as usual.”

Numerous interviewees in both cities spoke about relatively recent, local incidents of serious, negative behavior involving service members that reached the media. There were at least two instances of attempted suicide by service members: one that necessitated response by a SWAT team, and a second incident that involved the fatal shooting of a service member who had a gun pointed at police. They also cited two recent hostage situations involving active duty service members, one of whom was an officer. Interviewees described these events as being sensationalized in the press, which has added to an increasing perceived association between local crime and PTSD. Members of the Lacey Police Department suggested that a component should be integrated into local police training so that they can be better prepared to understand issues related to combat and stresses felt by returning service members.

Hospital representatives also reported seeing an increase in patients with PTSD symptoms and “special needs” instructions, such as to not slam doors, enter quietly, and so forth, related to PTSD. Although no data were provided, representatives of the health care system described seeing increased smoking and use of alcohol and more obesity, on top of PTSD and traumatic brain injuries, among service members and that the incidence of these health issues was higher upon return from deployments. They expressed concern that these trends will have significant public health effects that the community will have to absorb for years to come.

Community Competence

Interviewees described a wide array of services and supports available for service members and their families. These include various school-based services for military youth and numerous formal services and supports for service members dealing with either physical or emotional injuries related to multiple deployments. Despite the variety of resources, community members expressed the need for additional services to a demand they perceived to be increasing.

Education

Community representatives from both Lakewood and Lacey described having relatively large populations of students from military families (military dependent children) in some of their schools. Site visit interviews focused primarily on the Clover Park School District (CPSD) because it runs all of the schools on JBLM. Out of 25 elementary schools in the CPSD, 6 operate on base, with a population of 90% or more military dependent children in attendance. Two additional schools are located very close to the base and also have high numbers of military dependent children. In other elementary schools in this district, about 15% of the students are from military families. All secondary schools in the district are located off base, and in three of them military dependent children make up 50% to 75% of the population. Recognition of the military presence in the CPSD was noticeable. The CPSD administrative offices are located in one local school and had “Welcome Home” posters developed by the city of Lakewood in the

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

student services building. CPSD also had a picture of a service member in uniform in its most recent annual report.

As noted previously, the school district was the only agency interviewed during the site visit that appeared to receive any direct communication about deployment cycles. The CPSD interfaces with a military liaison at JBLM who attends school board meetings and provides teacher training on military life and issues affecting military dependent children. CPSD representatives also noted that the superintendent meets monthly with the garrison commander. Communication has been more frequent in the past 2 years as the district prepares to rebuild five of the six schools located on base. Yet despite the open lines of communication, the SSMCP report indicated that regional schools are affected negatively by multiple deployments that result in either overburdened or underused classrooms; the report also indicated that district schools receive short notice of population changes that will affect staffing and budgets.12 Families in these districts tend to be “mobile”; interviewees cited a 50% mobility rate of students, the majority of which is attributable to military moves. School district administrators described this constant transition of students as having a negative impact on the schools and the children themselves, who may be relocated in the middle of a school year.

CPSD has several programs to help students in their districts cope with impacts from the deployments and other issues associated with a military presence in the area. In the CPSD, schools located on base, in partnership with JBLM, can access a school-based mental health program that provides psychiatric care to all students in the schools if requested. The administration of this program is being piloted through CPSD, which is the second district in the country to use it.13 The schools also have access to licensed social workers and other licensed/credentialed master’s-level or Ph.D.-level practitioners through Military Family Life Consultants (MFLCs), who provide outreach to students and their families needing mental health and other support services (e.g., formal counseling sessions or referrals to other resources). CPSD has also benefited by receiving several Department of Defense Education Activity (DoDEA) grants, one for academic support and professional development and another for providing school-based mental health counselors in three of the secondary schools off base that have high military-dependent student populations. At the time of the site visit, this grant program was in its second year and was cited as very successful. The counselors’ presence in the schools was described as providing support either informally, by talking in the hallway, or by formal counseling sessions with children and family members, or both. At the time of the site visit, the CPSD also was waiting to hear about an award of a $2.5 million grant to fund mental health services.

The North Thurston Public School (NTPS) district, which serves Lacey, also has programs in place to support the estimated 20% of the district’s student population who are from military families. For example, NTPS secured a DoDEA grant to provide children in 6 of their 13 elementary schools with positive behavioral social and emotional supports. These include support groups for children with parents who have been deployed to allow them an opportunity to share with other children who are in similar situation at home. These lunch-time groups have engaged parents, including nondeployed spouses, to share what it is like to adjust to being the only parent

_____________________

12 See the Joint Base Lewis-McChord Growth Coordination Plan (December 2010), available at www.jblm-growth.com.

13 The program has been modeled after a successful program administered in on-base schools in Hawaii.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

at home. Returning service members also attend and share what it was like to be separated from the family. Other activities sponsored by the NTPS include participating in the creation of special floats to honor children from military families in the local town parade and provide them with “bracelets” that help instill a sense of pride in their service member parents.

The school programs are supplemented by community programs that offer support to children and their parents. Discussions with staff from community programs such as the Boys and Girls Club, the Kiwanis Club, and the YMCA suggest that these and other local programs recognize the unique stressors that military families have been experiencing from the deployments.

Physical and Mental Health Care Services

By observation, the region appears to have numerous physical health providers available to serve active duty military, veterans, and their family members. In addition to Madigan Army Medical Center and hospitals in both Lakewood and Lacey, there are several community health centers in Pierce County. Almost all community members spoke highly of Madigan Army Medical Center and cited its reputation and level of care as major reasons that active duty service members request JBLM as their last posting. Indeed, it is only one of three designated Level 2 trauma centers in the entire United States Army Medical Command. One of the barriers to accessing care, however, is that the military-connected population is increasingly dispersed throughout the region and Madigan Army Medical Center is located on an old section of highway not designed to accommodate the current volume of traffic. Recently, the SSMCP was awarded nearly $6 million to reconfigure a bridge and highway interchange closest to the hospital to decrease travel time and increase safety and increase use of the facility. In a similar vein, Lacey residents were described as regarding services on base as “North of the river” or “over the bridge” and therefore inaccessible.

Both Lakewood and Lacey host many urgent care centers, physician offices, and other medical service providers, but it was challenging to identify or contact a representative from the health care system who could speak to issues in the region and provide an overview. This observation was validated by a representative of the health care system who described health care in the region as “fragmented” and “lacking coordination,” especially with respect to care for military families. On base, multiple deployments have resulted in increased turnover of case managers whose job is to facilitate referrals to community providers. When a case manager is deployed, any collaborative relationships that the manager had established in the community are lost because the case manager’s replacement has no history of working with the community “outside the gate.”

Within the region, access to health care by service members and their family members was described as increasingly problematic because of a serious lack of primary care providers who accept TRICARE health insurance. Although “on paper” it appeared that many providers will take the insurance, “in reality” most providers are at their capacity and are closed to new TRICARE patients. In addition, interviewees said there was a serious shortage of primary care providers overall in the region to care for the increasing population, much of it military affiliated. Interviewees described how some providers will provide limited care to military families out of a

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

“feeling of obligation” or as their “patriotic duty,” and there is a project that engages providers in donating services on a short-term basis. Project Access, started in 2009, is a network of physicians and other ancillary providers in both Thurston and Pierce counties who voluntarily donate health care to people without health insurance or to those who meet poverty criteria. Interviewees indicated almost critical shortages of behavioral and mental health care, and the SSMCP described serious shortages of dental care, indicating that dental health care is not affordable and a major concern among military families.

Although hospital representatives did not describe a major influx of patients or emergency room (ER) visits during deployment and return cycles, one of their suggestions was to be better informed of these cycles so that they could be better prepared for possible increases in ER visits. Several interviewees mentioned that service members and their family members will access the local ER because of its proximity to their homes, and many interviewees described how service members and their families will seek drug and alcohol treatment and/or mental health care off base and pay out of pocket so that they are not reported in the military system as needing or receiving these services. In the words of one interviewee:

If you are an officer or an officer’s wife, you don’t want to be seen walking in to the building where everyone knows it is where the mental health providers are. For enlisted, you don’t want to be seen as showing any weakness.

The high rate of PTSD subsequent to multiple deployments has had a significant impact on off-base availability of licensed mental health practitioners (e.g., LCSW-C, psychologists, and psychiatrists) in this area. Reportedly, JBLM has been heavily recruiting these practitioners from off-base facilities around the region, offering salaries that exceed what many off-base providers can afford to pay. And because of the salary differential, off-base providers then have a hard time replacing staff members who have left to work at JBLM. This reportedly has resulted in a staffing shortage in community provider agencies and a reduced availability of behavioral health services in the civilian sector.

Social Capital

Support Networks

The region overall appears to show ongoing support for service members and their families. Lakewood has had a military presence for more than a hundred years, and Lacey appears to have welcomed military families to join its community. Community programs in these cities, such as the Boys and Girls Club, the YMCA, and the Kiwanis Club, are among many that offer programs and activities for military families. Many of the informal supports that are available around JBLM seem to be generated from and operate at the “grassroots” level and tend to be referred by word of mouth around the region. One military spouse who is also a social service provider commented on the informal support networks:

I am part of a wives group on Facebook…. I have noticed recently a lot of questions from wives about how others get through and handle deployments … as well as how to handle some of the changes they notice in their husbands when they return. It seems that

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

wives are reaching out more to others that have experienced deployments rather than seek help from … Military Family Life Consultants.

The team learned about several support programs during the site visit, including the following:

Project New Hope Military Family Retreats. This program was developed in 2008 in Minnesota and then started in Washington State with the support of the local Lions Club. It sponsors free retreats targeting military families who have experienced multiple deployments and are experiencing high stress personally and within their families, or both, including mental health concerns and PTSD. The program aims to “facilitate the reintegration of veterans and active duty combat veterans back into their family and community environs.”14 Professional counseling is available at the retreat.

The Pet Brigade (www.thepetbrigade.com). This program helps coordinate foster care and other boarding services for pets of service members who are getting ready to be deployed from JBLM. A similar program, Concern for Animals, provides low cost/free veterinary care and helps find homes for animals that have been abandoned by service members who have been deployed.

YMCA. The Lakewood YMCA offers a variety of activities for military families: “Parents Night Out” gives nondeployed spouses time to work out or enjoy recreational activities at the YMCA while staff watch their children. “Oxygen for Your Relationship” is a program designed to help couples who have experienced deployment separation to reconnect.

Kiwanis Club. During the interviews with members of the local chapter, the team learned about several different activities and events that this group sponsors for local children, including those with parents who have been deployed. Among these events are gift donations and donation trees (pick a family name from the tree and buy their wish list) during the holidays, camps, and various seasonal recreational events (e.g., fishing, swimming, hiking).

VA Hospital golf course. The local VA hospital funded the modification of a local 18-hole golf course to enable service members who became disabled during deployment to play the course.

The Association of the United States Army (AUSA). AUSA has a local chapter in both Lakewood and Lacey. The chapters enlist the support of local businesses to fund services such as care packages for the troops, holiday dinners for military families, bon voyage and welcome home rallies for deploying and returning service members, packages for returning service members who are single, financial grants to JBLM charities, and recreational events.

Women of Valor, Princess Warrior Group. This is a support group for female service members who had been sexually assaulted during their military service.

_____________________

14 See http://www.projectnewhopewa.com/ and http://www.projectnewhopewa.com/about.html.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

Both social service and city representatives mentioned that the local emergency food network and other food banks in the region are other community resources used by military families. Meeting the housing needs for service members recently released from duty, primarily young families or single men, was described as challenging, and neither Lakewood nor Lacey has a homeless shelter. Housing assistance is most commonly provided by a private program in Tacoma, the Associated Ministries, which provides referrals to emergency, transitional, and permanent housing as well as some rental and utility assistance.

Faith Community

Most interviewees in this region had word-of-mouth knowledge about local churches that conduct support activities for deploying service members and their families. But despite its efforts, the study team was not able to secure an interview with any of these groups to learn the specifics of their programs. And a discussion with a minister who runs a shelter in the county similarly revealed no specific details about any churches near JBLM that provide supports explicitly for service members and their families. Thus, although support programs may be available to service members and their families through faith-based organizations, referral to such programs may occur on a case-by-case basis rather than through broad publicity.

SUMMARY

What Is Working

This region has already put into operation certain elements that seem to have helped local communities support service members and their families, as well as the community as whole, during the current deployments.

• The work supported by the South Sound Military and Communities Partnership (SSMCP) has given this region a head start in identifying and preparing for impacts from the expected increase in population at JBLM and, in turn, any associated impacts from deployments from the base. Surveys sponsored by the SSMCP have provided vital information about community needs and demographic characteristics of service members, which is facilitating community planning efforts. The SSMCP enables JBLM leadership to participate in the coordination and implementation of planning efforts for the City of Lakewood and other parts of the region and keeps the Lakewood government in the loop about changes and activities planned for the base.

• Military liaisons, where they exist in these communities (e.g., schools, Lakewood Police Department), have been instrumental in keeping the community systems they are involved with informed about activities and changes affiliated with JBLM.

• Local schools have been identifying needs and organizing supports to meet the mental health needs of students living on and off base. They have been coordinating these efforts with JBLM and seeking grant funds to maintain these support programs throughout the deployment cycle.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
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• There appear to be a multitude of grassroots programs in the region that are designed to offer support and services to military families. Staff in these programs appear to be well aware of the unique stressors and needs facing military families in the region.

• The general attitude toward service members and their family members in these communities is one of acceptance. Members of these communities, whether affiliated with the military or not, do not treat service members as outsiders and have been willing to offer support and honor these men and women for their service.

Needs and Challenges

• Emergency services and health care providers reported not having good communication channels with JBLM. As a result, they described not feeling sufficiently prepared to deal with the needs of service members and their families who are dealing with the stresses of multiple deployments.

• Although there are many grassroots programs in the region that offer supports for service members and their families, learning about such programs seems to come by talking to the right person at the right time. There remains no central point of contact for obtaining information about these important programs.

• Lakewood Police have access to a military liaison; however, other local police departments, such as Lacey’s, do not. The Lacey police have been seeking training from JBLM to better understand the stressors that service members are facing and be prepared to deal with them.

• Local mental health providers have been hearing from clients and co-professionals that JBLM has been encouraging service members and their family members to seek services on base. Some service members and their families prefer to go to off-base providers and will even pay in cash to keep their need for such services “off the radar screen.” Off-base providers are concerned that there is fast becoming an insufficient supply of licensed and certified off-base providers because JBLM has been recruiting these professionals to work on base. They are also concerned that JBLM is not meeting the demand for mental health services—they hear of long waiting lists and lengthy times between appointments.

Suggestions from the Community

• Various interview sources saw a need for public education about what PTSD is and what it isn’t to help minimize the growing stigma that returning service members are facing.

• Local law enforcement suggested that information about PTSD be integrated into police training so that officers can be better prepared to understand what actions might trigger a negative response in service members.

• Local law enforcement also suggested that service members should be briefed on local laws when they arrive at JBLM so that they are not surprised by the legal consequences of certain crimes (e.g., a DUI charge results in automatic arrest and their car being towed).

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

• Staff from community support programs (formal and informal) would like to see a central point of contact for referral and information dissemination to help the public become more aware of the different programs that are available for service members and their families.

• School representatives said there is a need for mental health counseling for children in military families.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

Georgetown, South Carolina

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Case Study Report

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

 

Impacts of Multiple Deployments: Georgetown, South Carolina

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OVERVIEW

This report summarizes findings from the study team’s ethnographic site visit (June 17– 22, 2012) to Georgetown, South Carolina. Overall, the study team did not find that the two deployments by the local National Guard unit had any effects—positive or negative—on the local community as a whole. Data supporting this finding are presented in the pages that follow, including information obtained from interviewees about the local economy, school system, and the community at large. Although the team does not discount the possibility that the community was largely unaffected by these events, we also present several possible explanations for this result.

Data Sources

• National Guard members

• National Guard family members

• Mayors

• Chamber of Commerce

• Greater Georgetown Business Association

• Georgetown County School District staff

• Social service organizations

• VFW and the American Legion

• VFW Ladies Auxiliary

• United Way

• Family Readiness Group leader

• Georgetown emergency services personnel (fire and police)

• Andrews Police Department

• Georgetown County Sherriff’s Office

• Georgetown Hospital

• Georgetown County Mental Health

Georgetown Times (newspaper)

• Secondary sources (newspaper articles, videos, town/county websites)

• Ethnographic observation

GEOGRAPHIC ORIENTATION

Community: Georgetown, South Carolina

Georgetown (population 9,0001) is situated on the coast of South Carolina, 35 miles south of Myrtle Beach and 60 miles north of Charleston. It is located on the Winyah Bay in South Carolina’s Low County, the tidal region along the coast that has a rich and distinctive cultural heritage. Throughout much of its history, African Americans have represented the greatest proportion of area residents, and still do so today: In 2010, 56% of the town’s citizens were African American, 36% were white, and 5% self-identified as Hispanic. Georgetown is the county seat of Georgetown County, which includes several small unincorporated communities and the major cities of Andrews, Murrells Inlet, and Pawley’s Island. The National Guard unit of interest—the 1st Battalion of the 178th Field Artillery—has its headquarters at the National Guard Armory in Georgetown, but also includes armories in Andrews, Manning (Clarendon County), Clinton (Laurens County), and

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1 See http://quickfacts.census.gov/qfd/states/45/4528870.html.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

Hemingway (Williamsburg County). For the purposes of the site visit, the study team focused primarily on the community of Georgetown.2

Even to the casual observer, it is clear that Georgetown’s history has shaped its present: Thanks to the nutrient-rich soils in this area, early 18th century plantation owners amassed enormous wealth through the cultivation and export of indigo. To get their products to market more quickly, the town became the official port of South Carolina in 1732 and for many years ranked as the third largest port in the country. This piece of Georgetown’s history is reflected in its many stately pre–Revolutionary War homes, historic markers dedicated to the Winyah Indigo Society, and countless businesses around town that have incorporated “indigo” into their names (e.g., Indigo Vision Center, Indigo Physical Therapy). The area also played a significant role in the American Revolution: Two Georgetown residents (Thomas Lynch, Sr. and Jr.) were signers of the Declaration of Independence, and a third resident, Francis “Swamp Fox” Marion, became (in)famous for his use of guerrilla tactics against the British. Revolutionary War markers can be found throughout town, and in homage to their fearless predecessor, the local National Guard unit is named the “Swamp Fox Unit.”

By the end of the war, the agricultural focus of the region had changed—indigo had begun to be cultivated in other, easily accessed regions of the world, thus reducing the profitability of the crop. Rice, which was readily grown in the tidal region, became the next source of wealth. By 1840 Georgetown County alone was producing almost half of the entire rice crop in the United States. This crop’s importance to the region can be learned about in the Rice Museum, which is located along historic Front Street downtown. Predictably, the Civil War and Reconstruction brought about significant changes to the area. With the abolition of slavery, large-scale cultivation of rice was no longer possible and the area settled into a long period of economic downturn. At least two legacies of the Reconstruction era remain: African Americans, who historically greatly outnumbered white settlers, represent the majority of the current population, and Georgetown has never recovered its earlier economic prosperity and prominence.

This period of history notwithstanding, there are certain companies in the area that remain strong: International Paper, for example, operates a mill in Georgetown that has over 600 employees; the local steel mill, currently owned by Luxembourg-based Acelor-Mittal, is down from its height of 1,200 workers, but still employs approximately 300 area residents; and there are numerous power generation plants in the county that residents said offer job opportunities. Also, Georgetown business leaders continue to promote tourism in the area, highlighting both the excellent recreational fishing opportunities in the bay and regional rivers, as well as the town’s rich history. In addition to several museums in town (e.g., Rice Museum, Georgetown History Museum, and a soon-to-open Maritime Museum), local entrepreneurs have created excellent

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2 The study team made numerous efforts before the site visit to set up appointments with individuals in Andrews, all to no avail. The one appointment that was made was canceled by the interviewee; and on-site efforts to talk with city officials proved limited, at best. For reference, Andrews is located about 19 miles to the northwest of Georgetown, away from the coastal traffic. Numerous interviewees said they were saddened by that town’s loss of industry over the years. A drive down the main thoroughfare fully supported their concerns, as storefront after storefront sat empty and quiet. Census data suggest a slight decline in residents over the last 10 years: In 2000, the town had 3,068 residents; by 2010, this number had dropped by 6.7%, to 2,80 0. As in Georgetown, the majority of residents self-identify as African American (65%), 30% are white, and 4% are Hispanic. These data can be found at http://www.city-data.com/city/Andrews-South-Carolina.html.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

dining and shopping opportunities in the town’s Historic Waterfront district. The downtown area appeared busy, and business was relatively brisk during the study team’s visit.

These new opportunities notwithstanding, interviewees expressed the opinion that job options are limited in the region and that incomes are low. As of 2009, median household income in Georgetown was $29,831, compared with a statewide median of $42,442 and a national median of $50,221. In the same year, the median per capita income in Georgetown in 2009 was $17,383, far lower than South Carolina’s median ($31,653) and the national median ($38,846). Household income in Georgetown differed greatly by race, with whites bringing in $22,808 and African Americans at roughly half that amount ($11,958).3 As of May 2012, the unemployment rate throughout Georgetown County stood at 9.5%.4 These data support interviewees’ assertions that the National Guard offers many local residents an important way to supplement their income through monthly drills, and bring in more household income while deployed.

Military Installation: South Carolina National Guard Unit

Georgetown Armory is the headquarters of the 1st Battalion 178th Field Artillery Unit of the South Carolina National Guard. The unit consists of several hundred (500+) National Guard members from armories throughout South Carolina, but the local communities of Georgetown, Andrews, Manning, Clinton, and Hemmingway are also strongly represented. Interviewees estimated approximately 200 unit members are “local,” with roughly 100 to 120 based inGeorgetown and another 80 or so residing in Andrews.5 Murrells Inlet and Pawley’s Island also contributed citizens to the unit, but reportedly not in such large numbers.

The battalion’s history is as old as Georgetown’s, for it helped to defend South Carolina against the British. The unit primarily served as a home guard through the Civil War, but its composition changed markedly for a two-decade period during Reconstruction. At this time, ex-Confederate soldiers were not permitted to serve in the state militia; thus, the unit included only African Americans. By the end of the 19th century, however, several Reconstruction-era laws were rescinded; the unit was racially integrated by the turn of the 20th century. Today, interviewees said, the unit has roughly equal numbers of African Americans and whites.

Although the 1/178th was deployed to battle and served admirably in both World Wars, after the Second World War it served in its more traditional role, that is, providing support for civic unrest or during local emergencies (e.g., Hurricane Hugo in 1989). In June 2004, however, as the war in Iraq was intensifying, the unit was put on alert for deployment to that combat theater. Interviewees reported that the orders, which came quickly,6 caught the entire community by surprise:

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3 Georgetown 2009 data obtained at http://www.city-data.com/city/Georgetown-South-Carolina.html. National household income data for 2009 were obtained at http://www.census.gov/prod/2010pubs/acsbr09-2.pdf. National and South Carolina per capita income for 2009 obtained at http://bber.unm.edu/econ/us-pci.htm.

4 See http://eascinc.com/unemployment_rate.html.

5 Interviewees gave the study team significantly different numbers about how many members deployed with the unit each time and, of those, how many were from Georgetown County. Our working assumption is that most local Guard members deployed each time; the team is awaiting confirmation on that number from the Georgetown armory.

6 The adverse effects on the community of this short notice are discussed later in this report.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

It was the Saturday of drill we got the alert and then by the Monday it became official. It was that fast, it was head-spinning. [Guard member]

The first time it was 6 weeks, “Hey, you’re going.” And 6 weeks later they were gone. [Family member]

Guardsmen said that after arriving in Iraq they conducted convoy security operations, logging some 5 million miles while transporting goods and people between the Iraq and Kuwait borders. The first deployment lasted 15 months, and, despite driving over heavily IED-seeded roads, interviewees reported only minor casualties (i.e., one serious IED wound and no deaths).

The second deployment was to Afghanistan in 2010. This time, soldiers were given notice of the deployment a year in advance. This second deployment lasted about 9 months and consisted of mixed assignments, such as supporting Provincial Reconstruction Teams (PRTs) and providing various security forces around the country. The unit had two members (both from Pennsylvania) killed during the second deployment, but interviewees said that most other casualties were minor. They also noted that it was difficult to generalize about posttraumatic stress disorder (PTSD) within the unit following this second deployment because unit members were assigned such different tasks from one another. While one service member served on a NATO air base, they said, others were in the countryside conducting counter-insurgency missions. Exposure to combat and the potential for PTSD thus varied greatly among unit members.

Although the 1/178th traditionally has been a “home-town unit,” members said that after the first deployment, the makeup of the unit changed:

When I got in [over a decade ago], everybody lived within 35 to 40 miles away from [the Georgetown] Armory. Now … we’ve got guys coming from Florence … we’ve got kids coming from Columbia … we’ve got people that live out of state…. But when I first got in, it was, you know we had 120 people from the unit and 20 of those people live somewhere else [but] the other 100 were from this area. They were born and raised in Georgetown…. The entire communications section either worked at the power plant or International Paper or the steel mill. Every one of them. And those guys have all retired. In the meantime, we get new kids—“Hey I’m from New Hampshire, I’m going to Coastal Carolina [University] and I’m going to join the Guard to help pay for college.” So he has no real ties here, he’s got no family here. It’s different.

Interviewees said the second deployment did not result in a similar wave of retirements. Although the unit itself was deployed to combat twice in a 6-year period, some unit members continue to volunteer for “individual deployments,” that is, signing up with another South Carolina unit that is set to deploy, in an effort to bolster the family’s income. One individual interviewed by the study team, for example, was about to leave for his third deployment and said his sole objective in volunteering was to bring in additional money that could support him and his wife during their retirement. In addition, interviewees believed that individuals could be ordered to the combat theater if they had skills that were needed in another deploying unit.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

Thus, in assessing the community effects of the National Guard deployments, it is important to realize that the 1/178th has been deployed twice in support of the OIF/OEF engagements. But numerous unit members have deployed additional times—some voluntarily, some involuntarily—to Iraq, Afghanistan, or to other regions of the world where American troops are maintaining a strong presence (e.g., Kosovo, Kuwait). Although the study team focused primarily on the effects of the two unitwide deployments, it is important to bear in mind that some interviewees had been affected by the absence of a family member or employee for additional periods of time.

Relationship Between Community and National Guard

The Georgetown community presented itself as very supportive of its National Guard unit. Everyone with whom the study team spoke knew there was a local unit, could direct the team to the armory’s location, and knew that the unit had been deployed more than once. Not everyone personally knew of someone in the National Guard, but many did. In fact, some interviewees began an interview saying, “I don’t really know anything about the Guard,” but after talking with the team for a few minutes, thought of one or two people they know—or that their friends or family know—who had been deployed.

Regardless of the degree of personal connectedness, Georgetown residents who spoke with the study team said that Guardsmen are family, friends, and neighbors who make up the everyday fabric of the community. Residents also knew that the unit’s primary mission historically has been to defend their hometown and that these are the men who help save their homes and families during a natural disaster. The presence of these citizen soldiers has two implications. First, community members said they are not always thinking of “John Smith” as a National Guard member; rather, they think of him as the person he is and the role he serves in the day-to-day community (e.g., police officer, school staff). In some respects, then, an individual’s role in the National Guard may go unnoticed on a regular basis. Yet because the National Guard’s original role has been hometown defense, when a need arises, the community rallies. One interviewee spoke of the “quiet visibility” of the National Guard:

This [Georgetown] group is almost nonexistent … from my point of view. I don’t see them, like visible. They are low key. They are down at the armory doing their thing or they are out wherever they are being sent to take care of firefighting or whatever. Very low key. But if ever it comes in that something needs to be done, then the community is right there with them. Nobody steps back.

A second interviewee echoed this perspective:

Our National Guard is really a hometown defense. If you erect fundraisers for the National Guard for a project, everybody in the community jumps in. There is no issue on that. We’ve done a golf tournament, the fundraiser for the school kids, I have had several things that have been like immediate and the money has just poured in, just from the community. Andrews is the same way. They are smaller, closer. Their group is really tight over there.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

Guard members noted that even with the composition of the unit changing over time, from town members to people from outside of the area, “90% of the community has been supportive regardless of the makeup.” They attributed this support to the fact that lifelong residents of Georgetown have seen a parent, grandparent, uncle, cousin, or friend in the unit at some point, and thus unit composition hardly matters: “The unit as a whole has always been a local thing, something for the community to support, even if you don’t know the people being deployed.” One interviewee summed up local attitudes when she said, “The community, in my opinion, has always been behind the National Guard troops. We have our favorite word—‘our’ unit.”

EFFECTS OF MULTIPLE DEPLOYMENTS ON THE COMMUNITY

Economic Impact

Effects of Deployments on the Economy

Data collected during the site visit suggests that the multiple deployments have had little noticeable effect on the local economy. Only one source suggested a potential economic loss to the community resulting from the deployments, specifically, a loss of the hotel and restaurant income the city would otherwise receive if Guard members were home and coming to Georgetown once a month for drill. The team did not hear a similar concern expressed by any other interviewees, but it is possible that in a small town like Georgetown, even this once-amonth decline would be noticed by local businesses.

Employers also did not recount any major negative effects from the deployments. For the most part, employers said, the numbers were small and they simply redistributed the individuals’ duties among the remaining staff members. Interviewees reported no disruptions to any of the major businesses in the area, such as International Paper or the steel mill. One interviewee said, “Nobody shuts down because the Guard guys go, other than the armory.”

The idea of a “small number,” however, is relative to the size of the business. Although the hospital, which reportedly employs more than 2,000 individuals, might be able to absorb the absence of a couple of staff, small businesses had more difficulties. One interviewee provided the following example:

We had one guy—he was a chiropractor. He had his own practice. He had to shut his practice down to go on deployment—for both deployments. He referred his clients over to another chiropractor who [he] has a friendly relationship with. [His patients] continued to get treatment and he got back and flipped his sign—“Yes, we’re open”—and said, “Hey, I’m back.” And [his patients] came right back to him.

Most employers described the deployments as, at worst, “disruptive” and “creating turmoil” for the workers left behind. For example, the Fire Department reported the strain of having to promote another member of the department twice to fill the gap of the deployed soldier, only to demote that same person each time the soldier returned home:

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

He’s probably the one who got affected the most. Because he moved up for a year, came back down, moved up for, I think, 9 months, and then back down again.

In addition, employers reported that Guard members are participating in many more trainings since the deployments began and compared with their once-a-month and 2-week summer drills in the past. Employers said they cannot replace these individuals for such a short amount of time, which leaves other employees to pick up the extra work and less time off for those workers who are not in the Guard:

We’re not going to start saying, “You’re fired because you’re doing this.” But it creates operational issues for us. When he [goes to] training for a month or two, I don’t have time to promote someone back and forth for a month. If he’s gone for a year, we can do that. [But] what it also does for us, it limits the people allowed to take off other times. Because if he’s gone, my shift is already down and I let two more people off, then I have to hire overtime to come back in and fill in.

Soldiers returning to some of the positions, such as fire fighters, were said by interviewees to need additional time for retraining so that they can be brought back up to speed on any new protocols, group dynamics, or any training they may have missed:

He has a big learning curve to get back … it takes a couple of months to get him back up to where we feel comfortable, so that people [he works with] feel comfortable. [Emergency services worker]

Employers also mentioned that as a result of changes to the Family and Medical Leave Act, spouses can take up to 12 weeks of leave during a calendar year to attend military-related events (e.g., training, meetings, support groups, and dinners for Guard members or their families). Spouses can also use this time to take care of their children or attend to other responsibilities they may have taken on while their spouse was away. One employer said it is “fortunate” he doesn’t have more than one Guard or family member on staff, and a similar sentiment was expressed by others. The impacts have been small, but only because the number of Guard members deployed has been small. Some employers said that if that number had been greater, even by one, the impact on their businesses would have been much more severe.

Effects of the Economy on Deployments

Although the deployments per se reportedly had no large-scale effects on the local economy, respondents did indicate the reverse, namely, that the economy had effects on deployments. Few job opportunities in the area, when combined with extraordinarily low wages, make deployments a win-win for Guard members and businesses alike. Guard members said that during deployment, some members end up earning twice as much as they would be making in their regular Georgetown jobs. In addition, they said, although not common, a couple of individuals received not only their military pay while deployed, but also their salaries for their civilian jobs, giving them nearly three times their normal salary for the time they were deployed. One individual said, “[That Guard member] is making a lot of money. That’s getting forwarded into local business … paying off his debt.” Although not on a grand scale, deployments were

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

said by interviewees to have increased cash flow for many families, as well as for the local economy.

The earning potential associated with the deployments has had other effects. Interviewees said that the potential for high earnings has led many members of the National Guard and the Individual Ready Reserve to either volunteer for additional deployments or take positions with military contractors, such as Blackwater. Blackwater positions were said to be particularly attractive for members of local law enforcement, who reportedly could earn as much as five times their annual salary for a year’s service in Iraq or Afghanistan. Interviewees said that the former chief of police in Andrews left for such an opportunity, as did three officers with the Georgetown Police Department, two from the Georgetown Fire Department, and nearly 15 Sheriff’s Office deputies. A representative from the Sheriff’s Office said these departures have created more turnover in the department’s workforce than the National Guard deployments did, not simply because of the numbers but because even when they return home after a year, many individuals decide to return to the combat theater because they have gotten used to living on the higher salary.

In addition to the appeal of extra money, interviewees said individuals may voluntarily redeploy because they miss the excitement and adrenaline associated with combat activities. Emergency medical services (EMS) personnel offered the following observations:

It’s kind of “The Hurt Locker” mentality. You feel like you’re a part of something, something bigger than you. And then you come back and they’ve got to answer a dog call down on Front Street or, you know, shoplifting at Wal-Mart. And you say, “Man, I could be where it’s at.” [EMS provider 1]

It’s not the same because it’s not the same level. Like he said, dog call, shoplifting call, my guy’s going to install a smoke detector at Mrs. Smith’s house at 3 o’clock in the morning, or help little Johnny across the street here for the school guard or going to a car fire or car wreck, there is nothing to it. As opposed to dodging bullets or looking for roadside bombers or some of these other things … and even when we do have the big call, a shooting call, or a large structure fire, that’s only short lived, then it’s over, versus the constant [adrenaline] pumping the whole time while you’re there. [EMS provider 2]

Interviewees suggested that the experiential and financial opportunities the wars have created for local residents have led some individuals to voluntarily deploy several times, and those deployments, in turn, have had an adverse effect on their business operations.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

INFORMATION AND COMMUNICATION

Communication About Deployments

Interviewees consistently said that word-of-mouth is the primary channel through which information flows, a not-unexpected finding in a small, close-knit community. In many cases, such as when a community need arises, that channel functions quickly and efficiently:

If it ever comes in that something needs to be done [for the Guard unit], then the community is right behind it. Nobody steps back from that. Just go to one Council Meeting, say what’s gonna happen, before you know it, whoever they’re having breakfast with downtown … the old men sit there, and all you gotta do is tell ’em once and the whole street knows…. They’re like the fathers in this little city here, and if there’s issues going on, every business knows about it because they’ll be talking fast and personal to ’em. [Community member]

But when dealing with a large bureaucratic organization such as the U.S. military, word-of-mouth has not always been sufficient. As noted previously, the first deployment occurred so quickly that informal communication channels were not able to keep up. One newspaper reporter said that prior to the first deployment he had been hearing rumors within the community about the possibility and wanted to confirm those stories with the state headquarters in Columbia. “We wanted simply to let folks know, ‘Hey, there’s going to be a deployment in 5 months or whatever,’ because these are our relatives, our neighbors, our friends, [and] our church members.” Yet efforts to obtain official information about the rumored event proved “challenging.” This interviewee described the irony of trying to get the “official word” to support information that was already widely known throughout the community. “It’s going to be common knowledge amongst the community, so why not [give us information]?”

Beyond getting the formal notice, the communication challenges associated with the first deployment had real effects within the community. First, interviewees said, because of the lack of information, the towns were not prepared to give their community members an appropriate send-off to war:

The first deployment, nobody knew about it, nobody understood it. The send-off was very, very small. Some people didn’t even know it was happening. [Family member]

The first time it was so fast and the public affairs people at State HQ were in denial. “No, this unit’s not going anywhere.” Because of operational security, they didn’t want to spill the beans too much until, “Hey, the buses are at the armory, you guys [in the community] get together and do a parade for them going out.” [Guard member]

In addition, the Family Readiness Groups (FRGs), a key resource for spouses of deployed service members, had neither the experience nor adequate time to prepare for the first deployment:

Our first deployment, there really wasn’t a good FRG system in place … because it was

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

so quick—we got FRGs in the units, we’ve had them for years, but … it was always maybe once a year they’d get together to talk about the Christmas dinner or a springtime family day, something like that. So it was pretty much a nonexistent FRG really. We found out when we deployed to Iraq and you had some people that they volunteered, “Ok, I’ll be the FRG leader or whatever” … but they had really no idea of how to do it. They were just there to get everybody together. [Guard member 1]

And it may have been that way because our people just didn’t know, we had no exposure to it. [Guard member 2]

Although communication challenges existed before and throughout the first deployment, interviewees consistently stated that “lessons learned” from the first deployment helped improve information flow for the second one. For example, a much greater proportion of the community was involved in the send-off for the soldiers as they left for Afghanistan on the second deployment than when they left for Iraq:

There was a lot more local preparation…. It was much more involved…. They actually hired their Guard people full-time that were here locally to prepare for leaving the second time. So it was a whole different approach to how they were leaving….

Supposedly that was learned from the first deployment. [Reporter] The coming and going for Afghanistan was vastly more superior and more heartfelt and everything else than Iraq. [For Iraq], it was just a little cluster of families at whatever armory you were leaving from. [For the second deployment], coming out of Georgetown all the way out past Andrews, both sides of the road, traffic was lined up, flags, and honking, and fire truck with the ladder out and a flag over it…. We also had a local motorcycle crew of guys, the American Legion Riders … they escorted us out with a little motorcycle motorcade on the way going out to the airport. [Guard member 1]

Interviewees also described the FRG as having gone through some positive changes as a result of lessons learned:

The Family Readiness Group … learned some things that would be better to do when the second deployment came around. And it seemed like they were better organized…. They have been sharing information with us, if they have a family activity—a yard sale or whatever—to raise funds…. Not that there were lots and lots of those, but we knew about more of them and they did more of them for the second deployment. [Reporter] Following [the Iraq deployment], I think the State, the Guard, realized, “Wait, we need to get something going here where we actually train these volunteers to kind of know what to do at an FRG meeting and to anticipate what questions are going to be asked and how to answer them.” And so they put together basically a training program for the volunteers…. At the end of it, you’ve got an FRG leader who has contacts across the state [and] has a list of resources. [Guard member]

Despite the establishment of more formal communication patterns in these areas, community members said communication challenges persist in several critical domains. During a

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

focus group with school faculty and staff, for example, an administrator said she had not noticed any effects on her students and, before coming to the group, had asked her guidance counselors what, if any, problems they had seen. “They really could not think of very many kids who were affected.” When the moderator offered, “So no news is good news?” the administrator responded:

I don’t know if that’s the case or not because there may be some things we need to put in to place so we can find out if there are some issues. We don’t have anything like that going on.

Others in the group said that although an organization7 had come into town during the second deployment and offered to set up a communication plan with the district, “that never happened.” As a result, participants said schools would have only learned about students with deployed parents through word of mouth:

The [guidance counselors] wouldn’t have known unless the parent contacted them. [Participant 1]

And personal history, if you knew that parent had contacted you about something as a teacher or if you were a principal. [Participant 2]

One participant added:

It would have been good if [staff] could have known and the guidance counselor could’ve checked in on [the children] to give them that added level of support.

Employers found themselves in a similar position to school staff and also indicated the need for more formal communication from Guard leaders instead of having to rely on word of mouth:

You’ll start to get a rumbling…. “The rumor is there’s going to be a deployment.” So you start to get the rumor that it’s happening. And usually these guys will go to Guard duty one weekend and find out that it’s becoming real. [How much notice do you have? ] Six months out you start hearing the rumors. [EMS provider 1]

As it becomes closer, the employees will start talking about it because they talk among themselves. And probably 2 to 3 months out it becomes pretty much knowledge that it’s going to happen. [EMS provider 2]

According to the Uniformed Services Employment and Reemployment Rights Act (USERRA), employees are instructed to show their employers the letters they receive from the National Guard saying that their units are being deployed. The National Guard is not responsible for alerting employers. Employers the team talked to said they did see these letters, but they would have liked some type of official announcement as early as possible so they could put plans in place. One individual, frustrated with the disruptions caused by trainings, added, “I would just

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7 No participants were certain of the name of the group.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

like to know if these are all mandatory or my staff member is volunteering to go.” A human resources director for one company said he believed he has to keep the individual’s position open, regardless of whether the National Guard member’s deployment was voluntary or involuntary. And, according to USERRA, both voluntary and involuntary service in support of National Guard unit deployments confer job protections if the law’s criteria are met by service members. Clearly, however, some employers in Georgetown felt they had insufficient information about these pending disruptions and the legal protections regarding deployed service members’ jobs. As noted earlier, more formal communications with the National Guard might help alleviate some of the related stresses.

Communication About Available Resources

As discussed in the next section, formal resources for National Guard members, their families, or other community members affected by multiple deployments appeared to be in relatively short supply. Interviewees described a mental health service delivery system that is lean, at best, and most Department of Veterans Affairs (VA) services are located elsewhere (e.g., in Myrtle Beach or Charleston). But for those services and supports that are available locally, communication appears compromised. One example stood out for the study team. In preparation for the visit, the team had identified through the Internet a VA center in Georgetown and had endeavored to get in touch with the contact person, but with no success. During an interview onsite with a community member whose husband helps link veterans with medical services, the team heard that the local VA center was closed. The woman said her husband had been driving people all the way to Myrtle Beach to complete the paperwork necessary to qualify for services.

Team members accepted the woman’s account as an explanation for the inability to contact anyone at the clinic, but were confused by the apparent currency of the clinic’s Internet site. Early one afternoon the team tried to locate the facility and found the building at the address listed on the Internet. The building, however, did seem closed: No cars were parked out front, and the American flag was noticeably absent. One team member walked up to the door and, seeing no lights on in the facility, returned to the car and started to drive away. Another team member asked if she had actually tried to open the door and, not having done so, she returned to the building and found the door unlocked. At the sound of the door opening, a staff member came out and the study team member told her the community rumor that the facility had closed. The woman replied, “We’re not closed. We just moved from the old County Building back in March.”

It was unclear how information about the move had been conveyed to the veterans’ community, but it was clear why rumors persisted of the facility’s closure: The team had already spotted the old County Building, a one-story modular building on the north side of town that clearly was undergoing a complete rehabilitation. Its parking lot was surrounded by construction vehicles, and men in hardhats were seen coming in and out of all sections of the building. Yet the new location did not appear to be open, either. During subsequent drives past the facility, the team saw few cars in the parking lot and no raised American flag. In a community that relies heavily on interpersonal communication, outward appearances can easily misinform.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

Community Health

Although the team heard a few stories of individuals struggling from the deployments, there did not appear to be any large-scale adverse effects on community health. Most reported that “everything is okay” and there was nothing stated during the interviews or observed by the site visit team to suggest otherwise. If there are health issues because of the deployments, they likely exist at the individual or family level and do not appear to be affecting the larger community.

Physical Health

The deployments did not result in any deaths, and the team heard reports of only one major injury during the first deployment (an IED tore into a unit member’s arm, but interviewees reported that “he is fully recovered”). Although two unit members were killed during the second deployment, neither individual was “local.” Any other casualties from that deployment were reported as “minor injuries.” Thus, it was not surprising that when interviewees were asked about community effects of the deployments, they had difficulty naming any effects, much less physical ones. Study team members did not make any observations that countered citizens’ perspectives in this regard; for example, they did not see young service members in wheelchairs.

Mental/Behavioral Health

The study team asked numerous interviewees if they had concerns about National Guard members’ returning home with PTSD, traumatic brain injury, or other mental health issues. Most interviewees reported they had not heard of any significant problems among unit members. And interviews with employees of the County Mental Health Office, as well as with individuals from social service agencies such as the Family Justice Center and the Center Against Spousal Abuse (CASA) similarly suggested that mental and behavioral health issues related to the deployments were minimal and well within the realm of what was to be expected after emerging from a combat zone. In fact, one unit member said that “everyone comes back with PTSD,” an attitude that he believed to be widely shared and that made seeking behavioral health supports more palatable to members of the unit. Unit members and their spouses also noted that after the second deployment, there was an increased focus placed on behavioral and mental health by the State Headquarters of the National Guard. Specific activities associated with reintegration included having the National Guard members work on reconnecting with spouses and friends, as well as learning how to watch for warning signs of possible suicidal behavior in their fellow soldiers.

The very few cases described to the study team of National Guard members who suffered from one or more serious behavioral health issues were not specific. It was also not clear whether these cases were a result of multiple deployments, or of just being deployed in general. In addition, because of overlapping social networks, the study team began to surmise that the various cases described by interviewees might, in fact, be the same one or two instances.

Although no one described any community-level behavioral health effects from the deployments, several interviews said that because the second deployment was fairly recent, they would not be surprised to see problems emerge in a couple of years. At present, the study team

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

believes, the community appears to be lacking adequate resources to meet the mental health needs of Guard members and their families should the onset of problems be delayed.

Children’s Health

Interviewees did not describe any noticeable stresses the deployments placed on children or any problems that have been observed as a result of the multiple deployments. Family members said their children often were sad and confused about the father8 being deployed, butno one described any cumulative adverse effects from the multiple deployments. In some cases, particularly for the younger soldiers who have been through two or more deployments, their children were very young (infants) during the first deployment or not even born yet. In these cases, certainly, any behavioral health issues cannot be directly attributed to the fact that the father was deployed twice. One Guard member said that his child was in his early teens during the second deployment; the second deployment wasn’t easier per se, he said, but his son was at an age where he was better able to understand what was going on.

As noted earlier, school staff did not report any issues with children whose parents had deployed. As mentioned, however, the lack of communication between Guard leaders and the schools may have prevented teachers or faculty from recognizing which children might be experiencing deployment-related distress.

Substance Abuse/Domestic Violence Rates

Interviewees consistently reported no rise in alcohol or drug use in Georgetown as a result of the multiple deployments. The study team was told that drug-related crime is a significant problem within the city, but that officers did not see returning service members engaged in any of these activities.

The team also spoke with representatives of two social services agencies devoted to family issues, and neither believed the deployments have had any effect on local domestic violence rates. There were a couple of cases described by interviewees in which an individual who had returned from a deployment appeared to have behavioral health issues that contributed to domestic violence, but they reported these to be isolated instances within the community. Law enforcement representatives similarly reported no increase in emergency calls related to domestic issues.

Community Competence

As suggested elsewhere in this report, formal services related to the stresses of multiple deployments—in particular, mental health services—are in limited supply in Georgetown and surrounding communities. Discussion with a provider at the County Mental Health facility revealed the extent of the problem:

• In a need to cut some of its low-revenue services, she said the hospital shut down its inpatient psychiatric unit a couple of years earlier. Currently, individuals experiencing

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8 Reportedly there are no women in the 1/178th.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

a psychiatric crisis can be taken to the hospital, but will be held in the emergency room (sometimes for a couple of days, she said) until an inpatient bed can be found elsewhere (e.g., in Myrtle Beach or Charleston).

• She also said that because so few residents have adequate insurance or the financial resources to pay for private health care, there were very few private mental health practitioners in the area. Those who are available are based in Pawley’s Island or Murrell’s Inlet, and both locations, she believed, would necessitate a substantial drive (at least 15 miles one way to Pawley’s) and thus a significant expenditure on gasoline.

• She reported there is one full-time psychiatrist working for the county and several “temporary” psychiatrists who rotate through the facility. The county does provide some telepsychiatry services, but patients must come into the Georgetown building to be video linked to a physician and must otherwise be eligible for county-funded services.

• As a result of budget cuts throughout the state, the provider said that there are strict eligibility criteria for county-funded mental health services. Individuals who have PTSD, for example, must also be diagnosed with another major psychiatric disorder (co-occurring depression, schizophrenia, anxiety, or bipolar disorder) before they are eligible to receive services.

Consistent with what the team heard from other interviewees, this provider said service members or their families who are eligible for VA services are referred to either the VA hospital in Charleston or the VA clinic in Myrtle Beach. Because both locations are about a 1-hour drive from Georgetown, it is likely that individuals would have to take time off from work to receive care.

Although the Georgetown National Guard unit was fortunate in having survived two deployments to a combat theater with only one local casualty (an injury, not a death), the team wondered how a community so lacking in behavioral health resources would have handled things had one or more National Guard members been killed in action. Interviewees from law enforcement, the fire department, and even the schools noted that they have critical incident response9 capabilities that can be put into place on a moment’s notice; but services for dealing with the day-to-day stresses of deployments do not appear to be readily available to residents of Georgetown and the surrounding rural communities. Moreover, it did not appear to the study team that sufficient services were available for those few individuals mentioned by respondents who reportedly had struggled after returning from deployment.

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9 School staff said the school district does not use this term, but has a plan in place for helping students and teachers cope with similar situations, e.g., death of a student.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

Social Capital

The ties binding members of this community together create what appears to be a strong and effective informal support system. The team heard about many types of informal supports. As noted earlier, several interviewees spoke of the area’s long history of “patriotism” and “support for the military” and how that history lives on through the area’s continued support for its citizen soldiers. This was further enhanced by the National Guard’s role of helping the local community deal with the effects of a natural disaster. In short, interviewees said the National Guard takes care of the community and the favor is returned by the community supporting the Guard. That support, they suggested, bolstered the emotional health of the Guard members and their families.

Also, interviewees regularly pointed out the role of churches in providing supports such as financial assistance and pastoral counseling. Although no interfaith or multicongregational efforts were noted, the study team was told often that if a need is present, a church will take care of members of its own congregation.10 Similarly, employers in the emergency services arena described their units as a “family” and said that when members of the unit are deployed, theymake sure to invite these individuals’ spouses and children to any unit social events (e.g., Christmas parties, summer picnics).

In addition, the National Guard members were said to provide each other with mutual support; one family member said she understands the importance of the once-a-month “weekends with the boys” in helping her husband cope with any residual effects of the deployments. Although some spouses might resent these events, this family member believed the trainings provided her husband with invaluable peer support and a safe place to talk through any deployment-related issues.

Finally, the team heard that extended families are themselves a critical form of informal support. For example, the team spoke by telephone with a National Guard member who was about to leave on his third deployment and asked where his wife finds support during his extended absences. He described a social geography of support, noting that his wife’s sister lives next door on one side of their home, her brother lives next door on the other side, one of his relative lives directly across the street from their home, and a second relative of his lives next to that individual. “She has plenty of support when I’m gone,” he laughed. One interviewee, a relative newcomer to the area, said she was envious of her neighbors who could say to each other, “Well, when your grandmother went to grade school with my grandmother….” The roots are deep and the interrelationships are strong.

SUMMARY

In most respects, the study team found little indication that the multiple deployments of the local National Guard unit or of its members had any major adverse effects on the community.

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10 The study team did hear one counter-example from a woman whose son had been deployed three times. She said she had wanted to send a care package to him during one deployment and asked her pastor for financial assistance in mailing the packa ge. Her request was refused, she said, and it ultimately cost her more than $50 to send the p ackage overseas. She explained the pastor’s refusal as being rooted in greed, saying the church is always asking its members for donations, but then it is unwilling to provide support when members of the congregation express a need.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

Interviewees noted no large-scale impacts on the economic health of the area; no one could detail any broad, community-level experience with National Guard members’ returning from combat with PTSD or other theater-related challenges; school staff had difficulty recalling any major impacts within the district, either in terms of student distress or having to compensate for the large-scale loss of faculty or staff. Some interviewees recounted stories about “one person I know….” (e.g., a colleague, family member, or acquaintance), but the greater Georgetown community appears to have been largely unaffected by the deployment experiences.

At some level, the lack of apparent community-level effects is not surprising. The team’s understanding is that about 200 local unit members deployed each time and suffered few physical casualties across the two deployments. Further, some observers might argue that because this was a National Guard unit rather than a regular active duty unit, it had not deployed to the worst of the combat theaters and the lack of community effects is consistent with a less severe level of combat experience.

The study team does not discount that as a possible explanation, but, in keeping with good social science practice, cannot rule out other competing, but plausible, explanations. First, it is possible that interviewees could describe no major effects because they themselves had not heard of anything happening among their friends and neighbors. This would be consistent with the large body of sociological literature on Southern culture that notes, in particular, the cultural importance of keeping one’s “personal business” private. Interviewees did describe a couple of individuals and their families who, they believed, had experienced difficulties as a result of the deployments, but they also indicated that if a family were struggling, that struggle might be shared only within the family or with their church pastors.

Second, and in keeping with this value, it is also possible that community members were reluctant to share the community’s “personal business” with strangers. In point of fact, the study team was told more than once that some community members’ reticence might be because the study team was from the North. The team is hesitant to embrace that explanation because it would be hard for so many interviewees, with such different backgrounds, to so consistently “keep up appearances.” Nevertheless, it cannot be ruled out.

Third, and importantly, the team would be remiss not to discuss the possible role of race and race relations in the findings. Georgetown, like many towns in the Deep South, remains largely segregated along racial lines; and if the economy is driving some individual deployments, income disparities by race (as noted earlier in the report) could have a differential effect on which unit members volunteer for additional deployments. Although the team made numerous efforts to establish connections with the African American community, those efforts were largely unsuccessful. A few contacts obtained through staff at the hotel yielded brief, on-site telephone interviews, but the team did not establish enough credible connections to determine if the African American community was affected differently by the multiple deployments. This is an important limitation of this report that the reader should bear in mind when considering the implications of the site visit findings.

Finally, the reader should consider the importance of the long-standing social ties within the community and the strength of these deeply rooted informal networks (e.g., families,

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

neighbors, coworkers, faith community). While social scientists may have slightly overromanticized life in small towns or villages, there is little question that “community,” in its purely sociological sense, is a powerful force that can bolster a group of individuals through the toughest of times. The study team surmises that Georgetown’s sense of community may have served as a protective factor to both deployed National Guard members and their families alike.

Any or all of these explanations may be valid; additional, longer term research would need to be conducted, however, to determine which factors are most relevant to the study team’s finding of a negligible effect of multiple deployments on the community.

Challenges

Community members noted a couple of challenges they faced during the deployments and supports they believe could be put in place should the unit be deployed again to a combat area. Formal communication between the community and National Guard leadership was described by numerous interviewees as “complicated” and “problematic.” In most instances, the “rumor mill” worked faster than official reports from National Guard leaders, leaving many residents uncertain about which rumor they heard was closest to the truth. As a result, the community was described as being unprepared to appropriately send its citizens off to their first combat deployment and to provide support for the family members who remained behind. Although respondents said communications improved between the first and second deployments, they believe there is continued room for improvement.

A second area of potential need is the formal mental health service delivery system. According to interviewee descriptions, it appears to be lean: Interviewees reported no inpatient mental health beds in town, few private-pay mental health practitioners (such as psychologists), and only one full-time psychiatrist. In addition, the team was told that severe state budget cuts had resulted in strict eligibility requirements for county mental health services. Any individual service members struggling with the effects of their deployments likely are going outside of the area to get the professional supports they need. And although interviewees did not describe any large-scale negative behavioral health effects from the deployments, concern was expressed that the presentation of symptoms may still happen. If so, the area does not appear to have the service capacity to meet a large-scale emerging need.

Community Suggestions

The primary suggestion from community members was for improved communication with National Guard leaders. Areas specifically mentioned included the more timely flow of information to local media outlets (e.g., the Georgetown Times) and the development of a mechanism to keep school district personnel, particularly principals and guidance counselors, apprised of which children may be experiencing distress because a parent is deployed.

The need for a more robust mental health system was not mentioned by interviewees, but is noted by the study team as a possible service gap. The informal support networks are strong and may have mitigated many adverse effects of multiple deployments on service members, their families, and the community; but these networks may not be strong enough to deal with

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

significant behavioral health challenges. Consideration might be given to ways in which individuals with more pressing issues could receive the services they need closer to home.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

Little Falls, Minnesota

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Case Study Report

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

 

Impacts of Multiple Deployments: Little Falls, Minnesota

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OVERVIEW

Data Sources

• Mayor

• City government employees (i.e., convention and visitors bureau)

• County government employees (i.e., sheriff and veterans service, social service, public health employees)

• Community service organizations

• Behavioral and mental health organizations

• Hospital employees

• Community members

• Churches

• Local businesses

• Camp Ripley command and key staff

• Family Readiness Group leaders

• Observation

• Secondary sources (e.g., news articles, Internet videos, survey results provided by respondents)

This report contains summary findings from Westat’s ethnographic case study of Little Falls, Minnesota. The study goal was to assess how the Little Falls community has been affected by military deployments to Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) from neighboring Camp Ripley, a 53,000-acre training facility run by the Minnesota National Guard. Data were collected through telephone interviews and a site visit to Little Falls (July 8–11, 2012). Because the National Guard units that deploy from Camp Ripley include members from various communities, it is difficult to pinpoint the impact of multiple deployments on Little Falls. Interviewees described challenges in the community that include limited economic opportunities, insufficient mental health resources for families throughout the deployment cycle, and a need for more timely mental health screenings for National Guard members postdeployment. Little Falls has a strong, organized group of leaders working to develop and enhance services for National Guard members and families, but collective reliance on individuals and small organizations has contributed to compassion fatigue among individuals doing the most.

GEOGRAPHIC ORIENTATION

Community: Little Falls, Minnesota

Little Falls is a small city (population of 8,427) in central Minnesota, approximately 100 miles northwest of Minneapolis. Its origins are traced to 1848, making Little Falls one of the oldest communities in Minnesota. Early development was prompted by a sawmill and a set of dams, built and rebuilt, on the Mississippi River. The

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

sawmill and logging facilitated the construction of Fort Ripley, a frontier outpost located on land that is now part of Camp Ripley. Thus, ties between Little Falls and the military are as old as the town itself. The current Camp Ripley installation opened in 1931.

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Camp Ripley has been a military base around Little Falls since the creation of this community. It is there and it is a part of our lives and that’s just the way it is. [Mayor]

These days, Little Falls is home to—as one interviewee describes it—“a good mix” of tourism, industry, and farming. Camp Ripley employs approximately 1,000 civilians and active duty soldiers, making it the largest local employer. Many residents also find jobs in local government because Little Falls is the county seat of Morrison County. Other notable employers include a hospital, Larson Boats, a snowplow manufacturer, and a direct mail company.

Surrounding rural farmland, especially south of town, supports mostly corn and soy bean crops. Less than 40 miles to the north is the Brainerd Lakes region, which attracts hunters, fishermen, and outdoorsmen from across the state. Anyone walking through downtown Little Falls in the summertime is likely to see passenger trucks towing boats, all-terrain vehicles, personal watercraft, or campers. According to the 2010 U.S. Census, most of the population of Little Falls is white (96%), as is surrounding Morrison County (98%).

Unemployment and jobs are important concerns among locals, although unemployment rates are well below the current national unemployment rate, which is above 8%. Residents noted that Morrison County and neighboring counties in central Minnesota have historically had higher levels of unemployment than elsewhere in the state. One hosptial staff member said, “We are still one of the 10th to 12th poorest counties in the state, despite having Camp Ripley. It’s just always been that way.” Residents also noted that there were fewer good jobs in the community because of recent downsizing of Larson Boats and the closing of Crestliner, another large boat manufacturer.1 However, as of May 2012, the unemployment rate in Morrison County was 5.7% and had been on the decline, no longer noticeably different from the average 5.6% unemployment rate in Minnesota.2 Alcohol and substance abuse were also of general concern to the community. Participants widely regarded alcohol as “an issue in Morrison County,” and sources at the local hospital observed that alcohol-related deaths were “significantly up” in 2012. Substance abuse among teens, particularly heroin and methamphetamine, was also noted as a public concern by hospital sources.

Military Installation Orientation: Minnesota National Guard

Approximately 13,000 soldiers and airmen serve in the Minnesota National Guard, making it the fifth largest National Guard, even though Minnesota is the 26th most populous state.3 The National Guard’s mission statement declares that under the “new normal” they have three separate missions: federal, state, and community. In times of war, Minnesota National Guard soldiers and airmen can be called into federal active service with the president of the

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1 See http://www.startribune.com/sports/outdoors/84191752.html.

2 Federal Reserve Economic Data (FRED). See http://research.stlouisfed.org.

3 Minnesota National Guard 101 http://www.minnesotanationalguard.org/aboutus/assets/Guard101.ppt.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
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United States as commander in chief. They can also be used by the governor to assist the state during disasters and other state emergencies. Finally, National Guard units are expected to contribute to their communities through participation in the workforce and educational institutions and by performing community service.4

The geographic orientations of people who serve in the units are loosely coupled with the location of the unit. Although a National Guard unit is based out of a town, only a subset of the unit includes town residents. Sources familiar with the National Guard told us it is not uncommon for members of the Minnesota National Guard to drive 3 hours for their monthly drill. A source at Camp Ripley explained that people may sign with different National Guard units across the state for promotion and career advancement. Because individuals may augment and deploy with other units depending on their skill set or military occupational speciality (MOS), deployments can also occur separately from unit affiliation.

A History of Deployment

The Minnesota National Guard has a history of deploying units under their federal mission, going back to Bosnia in the 1990s. Relevant to the site visit study, the Minnesota National Guard has had multiple deployments under OIF and OEF—as of 2011, approximately 8,000 soldiers have deployed to Iraq.5 The Minnesota National Guard has also contended with long deployments. Between 2005 and 2007, the Minnesota 34th Infantry based out of Camp Ripley was “extended indefinitely,” ultimately to a 22-month deployment, the longest deployment of any infantry unit since World War II.6

Military Installation: Camp Ripley

Camp Ripley’s main entrance is 8 miles north of Little Falls. Camp Ripley was a mobilization station for troops during World War II and Korea and reached its current 53,000-acre size in the early 1960s. Camp Ripley now serves as a regional training center and is home to three armories and several units of the Minnesota Army National Guard, most notably the 1st Brigade Combat Team, 34th “Red Bull” Infantry Division. It employs approximately 1,000 fulltime civilian and military staff.

As an installation of the Minnesota National Guard, Camp Ripley is state—not federal—property, and it shares its resources with several other state services. It has been the host for the Minnesota State Patrol Academy since 1996 and also supports training for the Minnesota Department of Public Safety, Minnesota Department of Natural Resources, and the Minnesota Department of Transportation.7

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4 Minnesota National Guard: Vision, Mission and Values; available at http://www.minnesotanationalguard.org/tagscorner/assets/091026_Vision_Mission_and_Values.pdf.

5 Minnesota National Guard Annual Report 2011; available at: http://www.minnesotanationalguard.org/aboutus/assets/2011_Annual_Report.pdf.

6 “Pentagon has committed to paying bonuses to 2,500 Minnesota National Guard soldiers”; available at http://www.minnesotanationalguard.org/press_room/e-zine/articles/index.php?item=2440.

7 Minnesota National Guard Annual Report 2011; available at http://www.minnesotanationalguard.org/aboutus/assets/2011_Annual_Report.pdf.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
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Camp Ripley’s use as a military training center has expanded over the last few years. Annual National Guard training, which used to occur only in the summer months, has been extended to February, and community members noted that the installation is in use for “8 to 9 months.”8 Camp Ripley now provides training for active duty military and National Guard units from many states. During the site visit, the team observed units from the Illinois National Guard. Because of the cold Minnesota winters, Camp Ripley also hosts international troops for training, including a long-standing partnership with the Norwegian Army.

Relationship Between Community and Base

Community members described Camp Ripley as “a good neighbor” and felt that Little Falls and Camp Ripley had a “strong relationship” and a “partnership.” They pointed out that the base is the largest employer in the community and is an “important economic factor in Morrison County.”

Community members said that Camp Ripley hosts community events, such as activities for the schools, the Boy Scouts, and veterans. Moreover, the base is open to the public. Team members noted that the military museum on base was widely publicized in the community. In addition, participants mentioned the Camp Ripley/Veterans State Trail, which is being planned on Camp Ripley’s western borders. When completed, it will be a paved public trail for cyclists and motorized vehicles, part of a larger network of biking trails that extend the length of the Mississippi River.9

Roots between the community and Camp Ripley, which many intervieweess seemed to describe interchangably with the National Guard as a whole, are also personal. Participants explained that most families in Little Falls have some connection to Camp Ripley, either through a family member who works there or someone who is in the National Guard. Sources in the local schools noted that “there is hardly a kid that walks through our school that doesn’t know someone that’s in the miliary, either their next door neighbor, their uncle, their aunt, their brother, their sister, their mom, their dad.”

Community residents describe Little Falls as a “military friendly” town. Shows of support for the troops and veterans are quite visible. At the intersection of Broadway and First, the main intersection in town, the American National Bank proudly displays a “We Support Our Troops” banner. Nearby, the Veterans Memorial honors Morrison County residents who have died in service (only one OIF casualty in Morrison County). To cross the Mississippi river, one takes the Memorial Bridge, a Works Project Administration construction “dedicated to all veterans who have honorably served our country.” The bridge is lined with flags from each of the five branches of the military, a gift from the Little Falls American Legion in 2011.10 The local Wal-Mart displays a “wall of fame” of employees who have deployed. One community member supported the team’s observations, noting that the deployments “drew the community so close…. Everybody is involved in something to say thank you.”

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8 See also http://m.brainerddispatch.com/news/2012-04-03/thunder-camp-ripley-looks-forward-busy-summer.

9 See also http://www.crvtrail.com.

10 See also http://www.cityoflittlefalls.com/cityuploads/M%2002-07-11%20REGULAR.pdf.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

In Little Falls, team members repeatedly heard that “everyone wants to help, they just aren’t sure how.” Under the surface, however, cracks were beginning to show. Because of the length of the conflicts and the length of some of the deployments, many community members were noticing compassion fatigue. One interviewee, for example, noted a sharp decline in partcipation in the Beyond the Yellow Ribbon program; over a year ago, he said, there were 32 members; that number had dwindled to 4 at the most recent meeting. The study team also heard that fewer businesses offer discounts to the military than they used to, and the team both heard and observed that, if they are offered, businesses do not seem to be advertising them prominently. Another community member felt that the military was not as appreciative of the community’s “heroic” efforts as it had once been. As a result, he said, the communities were beginning to focus on other local populations in need of assistance.

EFFECTS OF DEPLOYMENT ON THE COMMUNITY

Economic Impact

Multiple deployments per se have not had a strong overall economic impact on the community, but some individual employers have had deployment-related problems.

Commerce

Overall, the team observed minimal economic impact on Little Falls from multiple deployments. Because the National Guard units include members from throughout the state, it was not uncommon for only a handful of Little Falls residents to deploy at any given time. Residents felt these numbers were too low to present any economic impact at a community level. One city official said, though, that Camp Ripley has a positive economic impact because the base brought soldiers and contractors into the community, who in turn brought revenue into the community’s restaurants and shops, “millions of dollars … hundreds of millions of dollars.”

Housing

The housing market in Little Falls appears to be stable. One leader said that houses are on the market for only short periods of time because of new staff moving into the area to work at Camp Ripley. Driving through the community, the study team did not see many “For Sale” signs and noted only a handful of new, small-scale housing developments. Unlike in other communities in this study where active duty military relocate every few years, most National Guard members the study team spoke with had lived in Little Falls for many years, if not their whole lives. When they deployed, their families remained in the community.

Employment

Similarly, the overall labor supply has been unaffected by deployments. There was a general perception that unemployment was high and the community generally lacked a sufficient supply of jobs. In Little Falls, several residents believed that service members often signed up (and re-upped) for deployments because it was a job and paid well. Interviewees expressed concern that in the long term the drawdown of troops would return more service members

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
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without jobs to the community. Officers at Camp Ripley mentioned a recent Minnesota National Guard survey that identified unemployment as the leading concern among members. A January 2012 survey of the 1st Brigade Combat Team during a 1-year deployment in Kuwait (for which the Brigade Support Batallion is headquartered at Camp Ripley) showed that nearly 19% would be unemployed when they returned home and 44% were concerned about their employment.11

Though unemployment was a leading concern, some interviewees questioned service members’ desire to find a job in the short term. For example, a recent job fair held at the community college, promoted heavily at Camp Ripley, was underattended by veterans and service members. One contributer described veterans’ attendance as, “very disappointing given all the work that went into preparing this event.” Community members provided different explanations for why the event was so poorly attended. One felt there was a “breakdown in communication” between the command leadership and soldiers in making service members aware of the event. Another believed that many service members on base that day did not see the value of attending because they live in distant communities or were not in the job market at the time: “I live in Rochester, why would I go to a job fair in Little Falls?”

Impacts on Individual Employers

Although there appear to be negligible overall community-level effects, several community members said the multiple deployments were taking a toll on individual businesses. They pointed out that employers struggled if the business was small (e.g., one or two people) or if the person that deployed held a unique skill set that was not easily replaceable:

I think with … small companies, like with two soldiers, you know, they’re scraping by anyway and the two soldiers get deployed. Well, the company closes. We had a family that ran a cement company … he got deployed and nobody knew what to do and they ended up losing that big business. I [own a small business]. If I had gotten deployed I may as well just shut the doors ‘cause who’s gonna run it? Who’s gonna know how to order? It’s tough, it’s really tough, especially in a small town because it’s a lot of small businesses…. I would say a lot of small companies are closing their doors because of deployments. [Community member]

As a manager … I know the difficult part is trying to cover for somebody when it’s a temporary deployment. It’s not forever and we have to keep their position open. That’s really difficult…. We all felt it when Dr. [surgeon] was gone. You’re holding this spot and trying to fill it, but that’s hard for anybody filling it because they know it’s not permanent, and you really don’t know for sure when they will come back, if they are going to be able to come back…. [Hospital employee]

Hospital staff also pointed out that the loss of a key staff member for an extended period of time can potentially result in lost revenues for the facility, particularly if other staff are stretched too thin to cover the deployed individual’s workload.

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11 See http://www.minnesotanationalguard.org/units/unit_template.php?unit=134bc and http://www.minnesotanationalguard.org/generallyspeaking/120304_ERT_in_Kuwait.pdf.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
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Information and Communication

Leaders in the community were generally satisfied with Camp Ripley’s efforts to communicate with them, although two local residents said the base could do more to inform citizens of when soldiers are returning from deployment and provide more details about base activities open to the public.

Information on Deployments

Generally, community members said they believe issues around deployments are openly discussed. They felt that information about deployments was in the newspapers,12 and people were turning out to welcome troops home. Some community members, though, felt that they were not always aware of the details regarding deployments, such as when and where to welcome a returning unit, particularly one with a small number of local residents.

When they came home, they wanted to get the soldiers back to their families as quickly as possible, and to the nearest armory to their home. I think that created a lot of heartaches and issues with the families because you build this up in your mind when they’re gone and you want them to have this huge welcome home. My daughter got dropped off at the St. Cloud armory [and there was] maybe a handful of people there. They weren’t escorted in…. My husband’s unit, they returned at 11:30 at night. I will hand it to Little Falls. There were fire trucks, there were police, there was Sheriff’s Department and everything. They escorted them all the way out to camp, lights and sirens going all the way. It was midnight…. My husband and daughter have both said they feel like they were just dropped back in and supposed to be able to pick up. It’s hard for them not having that huge welcome home. [School employee]

Similarly, although events at Camp Ripley have been promoted in the local papers, it may not always be clear whether the events are for service members, their families, or the public.

When they do have events, it would be helpful if they’d say that the public was invited … if the public was encouraged to attend I think they would. A lot of times I think people don’t know: “Is this [just] a veterans and family thing? Am I kind of stepping into it [by] not being one of them?” … I think the public wants to support them, but sometimes they’re supporting them by not stepping in…. “Is it a family thing or is that something we should go to?” So that’s something they could do better … just having that outreach for people who care. [Community member]

The Family Assistance Center (FAC) also pointed out that not all family members have a good understanding of what the service member is doing while they are deployed. With the absence of information, they worry and jump to the worst conclusions because of stories they may have heard in the media. Community members stressed the importance of providing

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12 News in Little Falls is provided by two local newspapers (the weekly Morrison County Record and the daily Brainerd Dispatch), Little Falls Radio (KLTF AM 960, WYRQ FM 92.1, and KFML FM 94.1), and Lakeland News, a nightly local news broadcast on Lakeland Public Television. Events and stories regarding Camp Ripley were regularly covered by these news outlets.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

additional education to family members who may not have a long-standing relationship with the military.

Information About Services

Information about services and supports for military families often travels through gatekeepers. In particular, the FAC at Camp Ripley offers resources, referrals, and support to service members across branches and military family members, and the Veterans Service Officer (VSO) in Morrison County assists veterans, such as helping them access Department of Veterans Affairs (VA) benefits. The FAC liaison and VSO were visible and widely known in the community for working with service members, and in nearly every interview, team members were asked if they had spoken with them. Beyond the Yellow Ribbon, a statewide organization started by a few small cities that has spread through local communities, also seeks to connect service members with resources in their areas. FACs, VSOs, and the efforts of Little Falls to be designated as a Yellow Ribbon community are discussed later in this report.

Community Health

Mental and behavioral health concerns dwarfed discussions of other health issues expressed in most interviews, but were difficult for most interviewees to link specifically to deployments. Even counselors with knowledge of which community members had deployed were resistant to connecting mental health issues to multiple deployments. Alcohol use, which was said to be a problem in the region, was reported by two persons to be greater after deployment “when they have been without for so long,” with a potential to increase with multiple deployments. The absence of an inpatient mental health unit in the community and limited access to psychiatric care was expressed as a challenge. Several interviewees said that another particular challenge was that National Guard members fail to report health problems, including mental health issues and back injuries, to maintain their deployment status.

I see a lot of folks who their livelihood depends on their availability to stay in the Guard…. Where else will they go in the area where they can get secure employment that has fringe benefits? It pays well, compared to a lot of private sector jobs…. I’ve dealt with folks that have come back saying “I tweaked my back [but] I don’t want to say things about it because I don’t want to jeopardize my future and my family’s future…. Where am I going to go to get a job to pay my mortgage payment and help my kids through school?” … A lot of folks minimize the disabilities they’ve had simply because they’re protecting themselves and their families for that employment purpose. [County government employee]

Family and Children’s Issues

Among the concerns that community members voiced about multiple deployments, concerns about children were prevalent. Stressors for children of deployed families are seen as an unmet need that community members did not know how to address.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
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A variety of respondents reported that bonding was difficult for the youngest children, who might not recognize a parent returning from deployment even if they had seen them on the computer screen during video chats. Similarly, most interviewees perceive that older children and adolescents, as one leader put it, “are acting out … with anger, misbehaving,” but gave few ways in which this manifests itself. Conversely, two school employees told us that the National Guard kids are not the ones acting out. One said, “Most kids of dads who are deployed don’t want to add to the stress. They don’t get in trouble. I haven’t seen any adverse effects.” One person emphasized the importance of keeping children active in sports, Scouts, and other organized activities. Another described the Boys and Girls Club, which opened locally in the last few years, as busy and an important addition to the community.

A few interviewees explained that addressing children’s mental health predeployment could prevent some problems. One said that “a counselor that drops by the house to see how it’s going” during and after deployment could help children to process their feelings.

That would be helpful…. I think probably weekly or every other week, a little extra. Maybe a little counseling that looks like a visit to a kid, versus somebody that’s telling me what to do. Just chit chat with a couple of folks that might give them ideas, maybe do a little extra education stuff with them when they’re in that 5-6-7-8 years old. Because at that point, I don’t even think they know how to process their feelings. [City government employee]

Opinions on the benefits of Skype communication between family members were mixed. Several interviewees said it was a good way for a very young child to connect with and recognize a parent when they return from deployment. However, one National Guard member said that his roommate during deployment often started his day badly with his wife’s complaints about what was going on at home.

A county employee told us that the state of “might deploy” is stressful for the entire family. When deployment orders come in, additional training time—as much as a year—is required predeployment, and postdeployment events at bases around the country before returning home also take time away from the family. The stress takes its toll on the family. One member of the health community told us, “I feel the tension sometimes” between a returning soldier and spouse and said that couples struggle with how to manage the house when one parent has made decisions in the other’s absence. Although several interviewees reported that deployments cause an increase in divorce, a few explained that the dissolution of those marriages is caused by weak relationship foundations rather than by deployment. They told us that if a couple gets married too quickly, weeks before being deployed, or, as one person described, via videocast, the relationship is more likely to fail.

Behavioral Health Issues

Many community members reported substance abuse and suicidal thoughts as problems among National Guard members, but it is difficult to link them specifically to deployments. As noted in the description of formal supports, alcohol use is common in the community generally. Two interviewees who work closely with activated National Guard members indicated that

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
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drinking increases with deployments and is worse after multiple deployments. Similarly, drug abuse is a problem in the community. Team members were told that local civilians use marijuana, crystal methamphetamine, and heroin, but service members are tested monthly, so, as one counselor reported, they stick to “pills and alcohol.”

Suicide is a local concern, but has always been a concern. A few interviewees recalled a suicide at Camp Ripley a few years ago during annual training, as well as calls about suicidal ideation both at Ripley and in the community. National Guard suicides are evident in the press, but may not link directly to the community. When asked by the study team whether the suicides could be linked to mulitple deployments, interviewees said it was difficult to connect these instances to deployments.

Also, as discussed earlier, unaddressed mental health issues will put an extra burden on civilian health care providers in the future. As noted, the small emergency facility in Little Falls can quickly reach capacity if the ER is holding a patient with acute mental health needs who requires a locked room and law enforcement presence.

Physical Health Issues

Back pain was the most commonly mentioned physical health issue stemming from multiple deployments, though most interviewees did not discuss physical health issues. The prevalent concern was about what one interviewee termed the “young immortals”—National Guard members who want to remain deployable and therefore fail to report injuries (that may make them eligible later) for a VA disability claim. One counselor who works with veterans voiced concern for the future of OIF/OEF soldiers:

That 25-year-old limping around with the knee, now it’s no problem…. By the time he’s 35, he can’t get out of his own vehicle. We have to get these folks aware. I hear “Well, there’s a lot of guys that are worse off than me, I don’t want to jeopardize … my ringing in the ears isn’t that serious.” That’s all well and good when you’re younger, but when you get to that retirement age, where is your health insurance going to be and you’re not VA eligible anymore because you didn’t file a claim for disability?

Conversely, two interviewees who had deployed previously mentioned their own service-related back injuries as their reason for leaving military service.

As with mental health issues, unaddressed physical health issues may put an extra burden on civilian health care providers or go untreated. As one source knowledgeable about the National Guard pointed out, service-related disabilities are not covered by employer health care. With only a 5-year statute of limitations to file VA claims, Nation Guard members may be left without VA-covered care for a lingering injury.

Health Issues and Law Enforcement

The perception from law enforcement is that there has been no appreciable increase in DUI or suicides among the National Guard as a result of deployments, although statistics among

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
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the general population might indicate an increase. Community members were mixed in their perceptions of the impact of multiple deployments on law enforcement, particularly the issue of domestic violence. A law enforcement informant told us, “I haven’t seen it,” but representatives of a human service organization believe that domestic violence increases with deployments.

Community Competence

Several services are available to support service members and their families at Camp Ripley (during training and the deployment cycle), through the VA, and in the civilian community in Little Falls and Morrison County. There were no obvious gaps in formal health care supports for activated service members or veterans with a service-connected disability, though several of the supports that were said to be most valued are less than 5 years old. Moreover, team members were told about barriers to seeking services, including young National Guard members who do not report injuries in order to “remain deployable,” a stigma related to National Guard members’ seeking mental health assistance, resentful service members and spouses who want nothing to do with the military, and civilian unfamiliarity with the specific services available. Interviewees reported gaps in services for military families.

Behavioral and Mental Health Services

Interviewees almost uniformly identified local mental and behavioral health as the biggest deployment-related challenge for all age groups in their community. Financial management skills were also mentioned as a stressor for service members who deploy.

Mental health issues are beginning to be addressed with an approach that was described in an interview as evolving, primarily through nonprofit Northern Pines, which provides a range of mental health education, counseling, and psychiatry across six counties. Northern Pines is the mental health contractor supporting children in Little Falls community schools, as well as individuals training at Camp Ripley. According to interviews and documents available online, a Northern Pines employee who is an OIF/OEF Army veteran identified the need and garnered support from the executive director to provide services for veterans and families.13 Family eligibility has evolved to offer sliding-scale services, and “families” is now defined as spouses, children, and parents of deployed soldiers or veterans. Several respondents reported that the program has worked closely with the National Guard in the last few years to provide outreach and support at reintegration events, as well as responding to emergency mental health calls at Camp Ripley. The veterans program is run by a part-time coordinator and full-time VISTA national service program volunteer committed from Fall 2011 through 2013, and one interviewee reported that they are bringing another veteran counselor on board in August 2012. One mental health professional, however, said these services are still underused by eligible community members.

Several interviewees explained that a Mobile Crisis Outreach (MCO) and stabilization team serves the six counties through Northern Pines.14 In addition to responding to acute mental health needs in hospital emergency rooms, homes, and law enforcement facilities, the MCO team

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13 See also http://www.npmh.org/Veterans%20Service/NPVSMP%20Brochure2.pdf.

14 See also http://www.npmh.org/mobile-crisis-outreach.html.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
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has been called to Camp Ripley “on occasion … anyone in need is never turned away from here.” The value of MCO to Ripley, which includes a counselor with military experience, came up in several interviews and one person said, “We wouldn’t survive without them.” Another interviewee described several instances when the team was called to Camp Ripley and successfully identified issues of addiction and suicidal ideation.15

Several interviewees mentioned the contributions of Lutheran Social Service (LSS), a Minnesota not-for-profit organization, in providing services for veterans. LSS C.O.R.E. (Case Management, Outreach, Referral and Education) is a statewide program for military, veterans, and family members. A few interviewees emphasized the value of the program’s financial counseling. LSS C.O.R.E. also provides telephone mental health counseling and referrals. One person the study team spoke with, however, said that some community leaders described challenges in providing referrals to local resources, which are discussed in the following pages.

Physical Health Services

St. Gabriel’s Hospital is located in Little Falls. It provides full-service care, and underwent significant renovation in 2007, expanding patient care facilities. The hospital is the first place many local area residents arrive after being injured or if they experience a mental health crisis bceause it has the only emergency room (ER) in the area. They see occasional traffic in the ER from Camp Ripley related to the county’s MCO efforts. A hospital worker explained that with an eight-bed ER, the community’s resources are insufficient to address the most acute psychiatric needs. She went on to explain the value of the crisis team and mediating the security hazards posed by treating people in crisis in the ER:

It can take hours and hours to find a place to place someone that needs placement. They end up at the far corners of the state…. There is a safety problem both for them and for staff, in your small critical access hospitals, which is all Morrison County has, and surrounding us. We don’t have behavioral health units. We don’t have psychiatrists…. When you’ve got somebody in a locked room and you’re supposed to be watching them all the time with a sheriff outside guarding them. That wouldn’t happen if we didn’t have the crisis team there. We still have eight other rooms that are full, plus people in the waiting room. [Hospital employee]

Military and VA Supports

The National Guard and VA reportedly provide the first line of support to activated National Guard members and their families through the FAC and other services at Camp Ripley, FRGs, the VA clinic in Brainerd, and the expanded VA campus in St. Cloud. The mayor in Little Falls commented, “I would say they handle it among themselves.”

Formal events during predeployment, at demobilization, and at 30/60/90-day reintegration events were described by various respondents as important supports. At these large events, National Guard members are reportedly provided with information about benefits, asked

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15 See also Brunswick, M. (2012, January 29). Anti-suicide program for military runs low. StarTribune. Available at http://www.startribune.com/local/130949523.html.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

individually about service-connected injuries, enrolled in the VA Health Care System (with “80 to 90 percent enrollment in Minnesota” according to one military leader), and provided with contact information to access a range of services. Local providers, including the Morrison County VSO and Northern Pines veterans program, told us that they participate in these events. For example, the VSO speaks with returning soldiers individually to identify any serviceconnected injury or disability, including mental health issues that may be presenting, and help them complete VA paperwork. There was general agreement that many of the mental health issues the counselors see postdeployment with veterans and families present at or after a 1-year “honeymoon period.” One National Guard member informally mentioned a new 1-year reintegration event, but this does not appear to be a statewide program.

Both military-affiliated and civilian interiewees unanimously identified the FAC at Camp Ripley as a primary support for addressing stressors around the deployment cycle. Several of them described how counselors listen to stories of individual challenges, follow up on concerned phone calls from neighbors, and connect service members and their families to needed services. For example, the FAC provides assistance to National Guard families with financial issues by contacting community volunteers to shovel snow and by giving them grocery cards from the community or firewood from Camp Ripley. Several interviewees told us that the FAC proactively offered consistent individual outreach to those who might be struggling, and counselors told us that they are on call 24 hours a day. One source close to the Camp Ripley FAC told us:

Some of [the veterans served] you had to seek out. Maybe their neighbors would call and say, “I know he’s been out of work and his unemployment stopped from deployment. They have no groceries and I’m getting worried about them.” I would call them up and say something like, “I’m calling everybody that was deployed…. How are things going?” They always say, “It’s going great.” “Oh really? Are you working yet?” “No.” “Well how are you feeding your family and paying your bills?” “Well that’s an issue.” Then they start talking about it and pretty soon we’re paying their rent and their electric. You can’t wait for them to come in, because most of them won’t. They’ve still got that military pride. [Community member]

Interviewees identified FRGs as a support, but the effects are mediated because members of deployed units come from broad geographic areas. One FRG leader said the geographic distance “is hard. You send emails to these people, but very seldom will they travel 100 miles to attend a 2- or 3-hour FRG meeting…. We did make phone calls from time to time too, but most of the time you do not put a name and a face together.” In part because soldiers attach and reattach to multiple units, FRGs were said to be less active or even “dormant” when the unit was not deployed. In addition, two women service members said their husbands were unlikely to participate in FRG activities. Several National Guard members and spouses described the challenges and said the primary contacts used for support are the FACs.

Military OneSource was mentioned in passing in a few interviews as a resource during deployment, but its utility was limited for National Guard members and families before and after activation. In addition, two interviewees asked how you would counsel a child over the phone.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

Several persons the team spoke with said that the St. Cloud VA Health Center has expanded services to meet the growing demand, including adding a women’s health clinic and increasing the number of mental health care providers to “almost 30.” Both veterans and service providers in Little Falls said the St. Cloud VA was doing a good job. As one service provider in the community said, “I can’t say enough positive things about St. Cloud VA, one of the best because it’s got the small-town flavor. At the Minneapolis one, you never see the same person twice. Locally, I think we’re doing well.” Although improved, services for veterans are still reportedly stretched. In addition, team members were told that, although veterans are legally entitled to time off of work for health care, they may be laid off if they regularly miss work for appointments.

TRICARE was mentioned as the only health insurance some National Guard members could obtain for their families. However, one provider said that “there have been huge issues around TRICARE and behavioral health reimbursement” and the paperwork is “a nightmare.” But another provider was more positive, saying, “On the medical side, it doesn’t take as long as it once did.”

Other County Services

Several interviewees referred us to the Morrison County VSO, who helps those who were deployed to the OEF/OIF theaters to navigate the bureaucracy of the VA and access physical and mental health benefits after deployment. Although the VSO is state mandated, several interviewees told us that the supports provided by the Morrison County VSO are exceptional. These include presentations and brief one-on-one sessions during reintegration events, as well as assisting returning soldiers in filling out VA paperwork, reviewing VA decision letters, and helping with appeals as needed. The office provides counseling, assistance in obtaining benefits for any service-connected disability, and transportation in the Veterans Van once a week to the St. Cloud VA Health Center. At a time when other counties were downsizing their VSOs, the Morrison County Commission reportedly approved expanded staffing to include a veterans service case aide and provided more private office space in the county office building to increase confidentiality for veterans seeking help and offer more support than counties with larger veteran populations. As a result, in addition to serving OEF/OIF veterans and other veterans in Morrison County, two interviewees told the team that the office is now contacted by veterans from other counties for assistance.

Beyond the Yellow Ribbon of Morrison County

Beyond the Yellow Ribbon (BTYR) is a Minnesota program to link military members and their families to informal programs and supports in the community.16 The Morrison County effort, which several interviewees said is in process, has 12 subcommittees to address how to connect individuals with services across domains in what one committee member called “single touch.” Many interviewees described it as an important way for community members to show support and said it will be strong when in place. Yet there were questions from a few community members regarding the value of BTYR to National Guard members and their families; currently there are significant overlaps with FAC, which is the major point of referral; and one resident

_____________________

16 See http://www.beyondtheyellowribbon.org/yellow-ribbon-community-campaign.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

who was very familiar with the resources at Camp Ripley described the services provided by theBTYR as “vague.”

The Military Family Care Initiative, created by then-Minnesota First Lady Mary Pawlenty and mentioned by a few community members, has been incorporated into BTYR.17 One National Guard member said she had used the program to locate services. She contacted a Lions Club group in St. Cloud while she was deployed; they sent a group of volunteers to spend a day chopping wood for her family.

Gaining BTYR status involves identifying and connecting leaders in key areas, including city/civic/military, public safety/judicial, and businesses/employers.18 Although team members were told that the action plans have not been completed by the various committees, several interviewees reported increasingly systematic efforts to ensure that businesses are military friendly—for example, offering a discount to individuals with military identification and joining Employer Support of the National Guard and Reserve (ESGR). ESGR businesses receive tools to locate returning service members and a tax credit for participating. One small business owner in town showed us a statement of support that she had signed a few hours before.

Social Capital

Virtually all community members the team spoke with identified Little Falls as a small town with a “neighborly” culture, and informal supports appeared to be strong.

Small Town Relationships

Team members heard from a variety of sources that extended families live in the region, everyone knows everyone, families help families, and neighbors help neighbors in need. The community also appeared to be receptive to newcomers.19 Several residents who had relocated from elsewhere in Minnesota to work at Camp Ripley described informal supports they had received that the team viewed as comparable to the supports described by those whose families had been there for generations. Interviewees commonly offered the examples of shoveling snow or taking care of children without pay. One interviewee described a variety of informal supports provided to her husband and children while she was deployed:

[What] he did have was a friend at Ripley who provided childcare at Ripley…. My girlfriend’s family took my girls for free on weekends…. That was huge. [My husband] would get to drop them off on Friday, pick up on Sunday, mow the grass, do whatever … I have a church that’s very nice. While I was gone, someone picked up my child and brought her to school for a year, back and forth to daycare. So I think it’s individual help. [City government employee]

One downside of the reliance on informal supports, according to several interviewees, was that National Guard members and their families do not always ask for help when they need

_____________________

17 See https://www.militaryfamilies.state.mn.us/about.php.

18 See http://www.beyondtheyellowribbon.org/images/stories/PDF/YRRP_Min_Requirements_and_Best_Practices-City.pdf.

19 During the site visit, team members did not encounter anyone who was not origina lly from Minnesota.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

it. Virtually all interviewees told us that people want to help, but a few stated that “they don’t know how,” and another explained that needs must be identified by the individual or someone close. Local families were described as “proud,” and people may refuse help or be angry if help is provided without a request. However, interviews with residents indicated that even if someone does not ask for or refuses help, formal services, such as those from Northern Pines and the FAC are sometimes engaged by a call from a neighbor. One service provider recommended asking specific questions—for example: “Do you need anything? ‘No.’ Do you need your gutter cleaned? ‘Well, yes.’”

Extensions of Formal Supports

Several of the individuals who provide formal deployment cycle support were identified by interviewees as the go-to people to address the impact of multiple OIF/OEF deployments on Little Falls. This round-the-clock availability was also described in several interviews as a community stressor leading to “burn out” among the staff of the key programs. One community member described the continuing late-night calls she receives to drive a drunk National Guard member home after return from deployment. She went on to say:

Even though I’ve quit my job, I’m still doing it, kind of. I’m still out there and helping…. Families still call me, because I’ve been doing it for so long, to ask questions about retirement, “What if I get deployed again? How do I go about getting into the VA?” So I answer questions like that. If you go to the fair and things somebody is always stopping you and asking what can I do about that. Hopefully I can help them. If I can’t, I can’t, and I send them to the Family Assistance Center then … I’m probably always going to do that. [Community member]

Another resident told us about how serving local veterans presents a personal challenge:

I had an episode a couple of months ago. I went to the grocery store after work and one of these guys—not OIF/OEF ers—bumped into him in a parking lot, he’s chewing on my ass all the way into the grocery store, bitching about the VA … what kind of compensation is that … I told him to call me in the morning, I can’t do a damned thing about it at the grocery store. I give him the slip. He must have had a mission, because there I am going through checkout and he’s waiting to chew on me all the way out to the car. After a while that gets more than a little old. [County government employee]

Faith Community

The faith community does not appear to play a central role in addressing the impacts of multiple deployments in Little Falls. Churches were mentioned in only a few interviews, and military support was not evident on church websites. A church employee described a clergy forum at the St. Cloud VA to address issues they might see in their membership related to deployments, as well as available VA services. One community member described a church that assembled decks of playing cards for deploying soldiers; another mentioned sending care packages. Otherwise, the help provided from the faith community was described as “individual” by several community members.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

SUMMARY

As one interviewee told us: “People make the difference.” Though formal structures are slowly coming into place, Little Falls is a small town that still relies heavily on its people to support its community members.

What’s Working

In Little Falls, residents are the souce of many of its strengths in assisting active duty and activated National Guard members and families during deployment and reintegration. Such supports are often personal and occur on a case-by-case basis. Interviewees also praised strong leadership in the community for improving and expanding organized supports to assist military members and veterans and their familites, including those who have experienced multiple deployments. They spoke positively about the following efforts:

• The Veterans Service Office in Morrison County: This office helps veterans and National Guard members navigate the bureaucracy of the VA after deployment. Both the Morrison County office space and staff were expanded to meet growing needs.

• Northern Pines: With the increased the need for mental health services for veterans, service members, and their families, the leadership at Northern Pines has been extremely responsive, supporting half of the costs for the expansion under the organization’s overhead. One of the services provided by Northern Pines is the Mobile Crisis Outreach (MCO) program, a partnership among six counties that is meeting a need on base and in the community for soldiers that go into crisis or are suicidal or have suicidal thoughts. The program also provides needed security in hospital emergency rooms, providing staff to separate the patient from others seeking care at the ER.

• Beyond the Yellow Ribbon: Though still in development in Little Falls, many community leaders believe this program holds promise for offering a one-stop shop to connect service members with community resources. Because it is a joint effort between the community and the National Guard, it has the potential to organize community capacity, thereby reducing burden on key liaisons and preventing burnout. Other community leaders were less enthusiastic, however, and were waiting to see how the BTYR program distinguishes itself from other, extant community efforts.

• Good working relationship between Little Falls and Camp Ripley: Solid communications between the base and the town were believed to have helped mitigate the effects of multiple deployments on Little Falls.

Community Needs

Community members raised several concerns related to deployments, with some concerns focused on current needs but others addessing potential longer-term needs:

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

• Several community members raised concerns about the long-term mental well-being of service members and the future services they will need. National Guard members the study team spoke with believe the 30/60/90-day postdeployment screenings are valuable, but both those members and mental health professionals pointed out that mental health issues may arise later than 90 days—sometimes 12 to 18 months after they return from deployment.

• Two interviewees close to the National Guard were concerned that people are falling through the cracks. One described the challenge that exists when National Guard members want to remain deployable and do not seek needed services. If they do not report military-related injuries or health problems on a timely basis, they will not be eligible for VA disability claims later when their problems worsen and may affect their employability.

• Some mental health professionals interviewed by the study team indicated that postdeployment mental health screenings available to National Guard members are not as effective as they could be. One interviewee observed that these screenings are not as consistent as those available to Army soldiers. They said that mental health screening questions during the 30/60/90-day reintegration events were asked by VSOs, who might be great at referring service members to appropriate clinicians, but who generally are not trained in mental health issues and interventions. Unless service members self-report, they said, the responsibility is on the chain of command (especially the first sergeant) to identify symptoms of depression or posttraumatic stress and encourage service members to seek help.

• Most community members the team spoke with think there are insufficient mental and behavioral health supports for children in military families. Community members frequently had trouble articulating what the needs are, except to say “children act up.” But some members we spoke with observed anger among teenagers. Others were concerned about behavioral responses among elementary school-aged children, for example, ages 6 to 8.

• Community members also observed a general lack of formal supports for military families. Team members were told that the FRG model is not always a reliable support for families of the deployed because members of the National Guard units are geographically dispersed. Military spouses we spoke with were as likely to turn to the FAC as to their FRG leader. Moreover, there were no support groups in Little Falls. Northern Pines observed that when they attempted to set up groups on post, the main interest was from the spouses. However, the timing and location of the groups was not conducive to attendance by families or spouses.

• With the impending drawdown in troops, local community members pointed to the long-term need for economic opportunities for returning service members. Without jobs, these community members felt that behavioral and mental health problems would escalate.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×

• Some interviewees pointed to the need for supports for the supporters. Although the dedicated individuals that make up the fabric of Little Falls are unquestionably a strength, the emotional nature of the work takes a toll. One mental health professional said, “Everyone who works with the veterans burns out.” Supporters themselves have sought counseling to deal with the stress of working with service members and veterans.

• Though many community members were satisfied with Camp Ripley’s efforts to engage the community, a few raised questions about how effectively Camp Ripley communicated details about events, such as job fairs and welcome home activities for returning troops. Others said that, even though Camp Ripley publicized base events in the local newspaper, it was not always clear whether these events were for the public or military families only.

Suggestions from the Community

The community offered the following suggestions for possible improvements or next steps that may help address the needs associated with multiple deployments:

• The military should add a mental health screening beyond 90 days because mental health issues may surface later on.

• Providers of mental health supports should increase the number of mental health professionals with military experience. Interviewees said it is the shared experience that increases credibility and makes service members more willing to confide in a mental health professional: One OIF/OEF veteran who provides mental health services said, “We’ll send a professional out there. They’ll talk for 2 hours and will get almost nothing. I go out there for 10 minutes, they ask me where I served, I tell them. Boom, we have all the information we need.”

• Children with parents who are deployed should receive counseling. Rather than formal counseling, the visit could be an informal check-in. One participant suggested play therapy for toddlers, and another participant suggested a “chat” to help children process their feelings.

• There should be more education for the business community on mental health issues among service members. This type of outreach, such as a seminar or a forum, would help educate employers on what symptoms or issues to look for in service members they employed and how they could assist service members in reintegration efforts.

• More entrepreneurship supports should be provided in order to improve jobs in the region. As National Guard members reintegrate into the community, they may aspire to open their own businesses. Businees leaders said entrepreneurship supports would help the National Guard members to understand how to start and manage a small business.

Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
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Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
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Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
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Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
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Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
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Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
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Page 688
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
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Page 689
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
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Page 690
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
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Page 691
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
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Page 692
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
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Page 693
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
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Page 694
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
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Page 695
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
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Page 696
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
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Page 697
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
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Page 698
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 699
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
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Page 700
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
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Page 701
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 702
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 703
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 704
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 705
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 706
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 707
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 708
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 709
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 710
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 711
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 712
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 713
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 714
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 715
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 716
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 717
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 718
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 719
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 720
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 721
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 722
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 723
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 724
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 725
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 726
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 727
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 728
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 729
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 730
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 731
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 732
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 733
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 734
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 735
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 736
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 737
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 738
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 739
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 740
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 741
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 742
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 743
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 744
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 745
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 746
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 747
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 748
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 749
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 750
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 751
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 752
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 753
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 754
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 755
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 756
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 757
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 758
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 759
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 760
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 761
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×
Page 762
Suggested Citation:"Appendix E: Individual Ethnographic Assessments of Six Communities." Institute of Medicine. 2013. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. doi: 10.17226/13499.
×