Examining the Health Outcomes Associated with Participation in Veteran-Centered Therapeutic

Recreation services

Preliminary Findings

Jasmine Townsend Ph.D., CTRSClemson University

Brent Hawkins, Ph.D., CTRSClemson University

Jessie Bennett, Ph.D., CTRSUniversity of New Hampshire

Jamie Hoffman, Ph.D., CTRSCalifornia State University Sacramento

Tamar Franklin Ph.D.Hunter College - CUNY

Neil Lundberg, Ph.D., CTRSBrigham Young University

Introduction

More than 1.4 million non-profit organizations in U.S. 64,000 have the word Veteran in their title

Recreation programs for veterans are popping up everywhere!!

Introduction

Program structures vary greatly 1-time event for a few hours

to multi-day retreats to weeks/months long therapeutic sessions

Post-9/11 veterans only, veterans from all wars

Veterans only, others serve the family or other supporters

Some serve veterans with specific injuries (PTS or TBI)

Therapeutic and non-therapeutic focus

Introduction

Research involvement Program evaluation to rigorous outcomes research (e.g.,

well-being, chronic pain, psychological or physical functioning)

Rarely coordinated

Different facets of the experience

Hard to generalize

Results are limited in scope

R4 Alliance Research

Developed in response to rapid growth

Research is the first R in R4 Develop a strong foundation of evidence-based

knowledge

All member organizations administer the same set of surveys to their participants

3 years in development, pilot testing in 2014

R4 Alliance Research – Who can be involved?

Eventually…every member organization

Eligibility criteria for involvement in current study Programs with therapeutic focus/therapeutic

goals Number of participants served in a year, 50 or

more Number of years in existence, 3 years Dedicated Research Liaison Must be an Alliance member in full standing

R4 Alliance Research – What?

Health Outcomes Depression, anxiety, and stress (DASS) – 21

items PCL-M, PTS levels – 17-items VR-12, physical and mental health and

functioning – 12-items

Personal and military demographics

R4 Alliance Research – How?

4 time points Pre, post, 3 and 6 mo follow-up

Online survey

Paper/pencil

Research Liaisons (RLs) Identifying and managing participants Administering questionnaires at appropriate time

points Getting participant by-in

Preliminary Findings

Male

Female

0 10 20 30 40 50 60 70 80 90

84.3

15.7

Single

Separate, Divorced

Married

Widowed

Other

0 10 20 30 40 50 60 70 80 90

5.7

10.6

81.6

0.7

1.4

African-American

Caucasian

Hispanic

Native American

Pacific Islander

Other

0 10 20 30 40 50 60 70 80

9.2

69.7

14.1

3.5

0.7

2.8

No

Full-time

Part-time

0 5 10 15 20 25 30 35 40 45 50

46.8

45.4

7.8

Median income: $45,000 – $54,999Range: < $14,000 – over $125,000

Military Demographics

Vietnam

Desert Shield

Desert Storm

OIF

OEF

OND

Other

0 10 20 30 40 50 60 70

0.7

9.5

10.9

66

61.2

15.6

7.5

Air Force

Army

Marine Corp

Navy

0 10 20 30 40 50 60 70 80

14.9

68.8

10.6

5.7

E-3E-4E-5E-6E-7E-8E-9

W-2W-3O-2O-3O-4O-5

0 5 10 15 20 25 30 35 40

4.320.6

34.820.6

7.81.4

0.70.70.7

2.13.5

2.10.7

Active Duty

Guard/Reserve

Active Guard or Reserve (AGR)

Retired or Discharged

Other

0 10 20 30 40 50 60 70

27.9

5

1.4

62.1

3.6

  Range Average# of years of military service 2 - 32  11.08# of months deployed 0 - 54 19.90VA rating 0 - 100 76.93

Health Conditions

Yes

No

0 10 20 30 40 50 60 70

62.8

37.2

Neurological

Amputation (leg)

Anxiety

Burns

Cancer

Cardiac

Depression

Hearing Impairment

Military Sexual Trauma

Orthopedic

PTS

Sleep Disorder

SCI (para)

Stroke

Substance Abuse

TBI

Visual Impairment

Other Combat Related

0 10 20 30 40 50 60 70 80

14.3

1.4

65.3

2.7

1.4

4.8

59.2

44.9

8.2

66.7

63.3

64.6

0.7

0.7

13.6

38.8

13.6

15.6

Receiving other Tx services

More Findings

PCL-M Pre MeanPost Mean

% Change

Significantly Different? p-value

PTSD total score 48.55 43.39 6.45 No 0.08

Re-experiencing 13.73 12.77 3.84 No 0.141

Avoidance 18.92 16.96 6.53 No 0.127

Hyperarousal 15.89 14.32 6.28 Yes 0.04

DASS Pre MeanPost Mean % Change

Significantly Different? p-value

DASS total score 23.64 20.01 5.76 Yes 0.046

Depression 6.99 5.18 8.22 Yes 0.002

Anxiety 6.72 6.68 0.2 No 0.858

Stress 9.81 8.22 7.57 No 0.099

More Findings

Treatment services No Treatment Services

Pre Post%

change Pre Post%

change

PTSD total 55.88 51.58 5.375 40.06 37.61 3.06

Re-experiencing 15.68 14.55 4.52 11.6 11.59 0.04

Avoid 21.84 20.55 4.3 15.32 13.84 4.93

Hyper 18.36 16.7 6.64 13.13 13 0.52

Depression 8.55 6.41 10.19 4.39 3.8 2.8

Anxiety 8.39 8.44 0.23 4.14 4.87 3.47

Stress 11.97 10.39 7.52 6.64 6.4 1.14

DASS total 29.3 24.87 7.03 14.95 15.33 0.6

Still More Findings

Pre Post % changeSignificant Change? p-value

PTSD total 57.2 51.94 6.57 Yes .021

Re-experiencing 16.84 15.5 5.36 Yes .057

Avoid 22.16 20.35 6.03 Almost .067

Hyper 18.85 16.65 8.8 Yes .004

Depression 8.91 6.27 12.52 Yes .002

Anxiety 8.8 8.55 1.19 No .732

Stress 11.96 9.9 9.8 Yes .033

DASS total 29.28 24.03 8.33 Yes .032

Individuals who identified PTS as a health condition

Still More Findings

Pre Post%

changeSignificantly

different? p-valuePTSD total 58.03 53 6.28 Yes 0.035Re-experiencing 16.97 15.31 6.6 Yes 0.04Avoid 23.29 21.38 6.36 Almost 0.077Hyper 18.78 16.96 7.24 Yes 0.007Depression 9.75 6.84 13.8 Yes 0.001Anxiety 9.18 8.51 3.17 No 0.368Stress 11.86 9.86 9.5 Yes 0.039DASS total 30.51 24.51 9.5 Yes 0.018

Individuals who identified Depression as a health condition

The Pains of Research

Challenges to Research Small sample sizes Response rates Participant by-in Organization by-in Program variability Impacts of cognitive/psychological impairments Blinded, randomized controlled studies

There’s a customer-satisfaction questionnaire for you to fill out and for us

to not look at and immediately throw away.

The End

Questions? Comments?