TRANSFORMING VETERANS’ EXPERIENCES DURING MILITARY-TO-

CIVILIAN TRANSITION: GAPS AND OPPORTUNITIES

The VA Center for Innovation (VACI) is a team of innovators and doers within the VA who are dedicated to driving innovation at the largest civilian agency in the United States Government. The team at VACI does not believe in innovation for its own sake, but rather, in innovation that provides a tangible value to VA and to Veterans. The work of VACI is driven by a strong commitment to a Veteran-centered approach to service delivery, a dedication to data-driven decision making, and a commitment to design thinking.

Since 2011, VACI has worked to identify, test, and evaluate new approaches to VA’s most pressing challenges. Balancing the practical with the inspirational, VACI enables a steady influx of high value innovations into the VA, moving them from concept to operational implementation.

PROJECT TEAM

Jonathan Robinson, Entrepreneur-In-Residence, VA Center for InnovationPatrick Littlefield, Executive Director, VA Center for InnovationAmber Schleuning, Deputy Director, VA Center for Innovation

THANK YOU

John Medve, Executive Director, Office of Interagency Collaboration and Integration, Department of Veterans AffairsRaun Lazier, Director of Policy, Office of Enterprise Integration, Department of Veterans AffairsNathan Williamson, Senior Policy Analyst, Office of Enterprise Integration, Department of Veterans AffairsJulia Kim, Senior Advisor, Department of Veterans AffairsJohn Basso, Director of Strategy and Risk Management, Department of Veterans AffairsNiloo Afari, Psychologist, VA San Diego and Professor of Psychiatry, University of California San DiegoMeredith Kleykamp, Associate Professor of Sociology and Director of the Center for Research on Military Organization, University of Maryland Phil Carter, Amy Schafer, and the team at Center for New American SecurityMike Haynie, Jim McDonough, Nicolas Armstrong, and the team at Institute for Veterans and Military Families, Syracuse UniversityCarl Castro, Nathan Graeser, and the team at Center For Innovation and Research On Veterans and Military Families, University of Southern CaliforniaCynthia Gilman, The Jackson Foundation for the Advancement of Military MedicineDawne Vogt, Co-Principal Investigator on Veterans Metrics Initiative, National Center for PTSD and VA BostonChris Ford, Founder & CEO at National Association of Veteran-Serving Organizations (NAVSO)

… and to the Veterans, families and community members who shared their stories and offered us a glimpse into their experiences with military transition.

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TRANSFORMINGVETERANSEXPERIENCESDURINGMILITARY-TO-CIVILIANTRANSITION:GAPSANDOPPORTUNITIES

TableofContents

INTRODUCTION:WHYREEVALUATEMILITARY-TO-CIVILIANTRANSITION?.........................................2

WHATISMCT?...................................................................................................................................6AParadigmShiftintheFederalGovernment’sIntegratedMCTPolicy....................................................................................7ADefinitionofMCT.....................................................................................................................................................................................8LearningfromAnalogousPopulationsinTransition........................................................................................................................9MCTFrameworks...................................................................................................................................................................................10CommonCriteriaWithinExistingFrameworks........................................................................................................................10

THENEEDFORMOREANDBETTERDATA.........................................................................................13EvaluatingMCTSuccess.......................................................................................................................................................................14ReimaginingOurMCTDataNeeds..................................................................................................................................................15TowardaFederatedDataAcquisitionStrategy..............................................................................................................................17MCTPersonasandPredictiveOutreach.......................................................................................................................................18

GAPSINMCTSUPPORT....................................................................................................................19MovingMCTPreparationUpstream...............................................................................................................................................19Self-ActualizationinCivilianLife.....................................................................................................................................................21AnticipatingMentalHealthNeedsSpecifictoMCT..................................................................................................................22TransitionLiteracy:MakingBetterChoices................................................................................................................................23TheMilitaryFamilyinMCT................................................................................................................................................................25

CONCLUSIONANDNEXTSTEPS........................................................................................................27AParadigmShiftintheFederalGovernment’sIntegratedMCTPolicy.................................................................................27ADefinitionofMCT..................................................................................................................................................................................27LearningfromAnalogousPopulationsinTransition.....................................................................................................................27CommonCriteriaWithinExistingFrameworks........................................................................................................................28EvaluatingMCTSuccess.......................................................................................................................................................................28ReimaginingOurMCTDataNeeds..................................................................................................................................................28TowardaFederatedDataAcquisitionStrategy..............................................................................................................................28MCTPersonasandPredictiveOutreach.......................................................................................................................................28MovingMCTPreparationUpstream...............................................................................................................................................28Self-ActualizationinCivilianLife.....................................................................................................................................................29AnticipatingMentalHealthNeedsSpecifictoMCT..................................................................................................................29TransitionLiteracy:MakingBetterChoices................................................................................................................................29TheMilitaryFamilyinMCT................................................................................................................................................................29APPENDIX:BIBLIOGRAPHY...............................................................................................................30

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INTRODUCTION:WHYREEVALUATEMILITARY-TO-CIVILIANTRANSITION?

Mostveteransundergoingseparationfromthemilitaryaretaughttoviewmilitary-to-civiliantransition(hereafterreferencedasMCT)asabasketofeconomicchoices:onemustsecureemployment;pursueadditionaleducationorvocational training;possiblyrelocate;securehousing;accesshealthcareandbenefits–allwiththe intent toassumeanewroleasasatisfied,productiveandpurposefulcivilian.Hereweproposeadifferentconception.MCTisfundamentallyapsychologicalandculturalevolution,in which veterans need to find a path to reorientation and self-redefinition, sometimes whileacclimatizingtoanewdefinitionofwellness,butalwayswhilemovingquiteabruptlyfromacollectivistcommunitytoanindividualistone.

Lifetransitionsofanykindaresomeofthemostchallenging,mostimpactful,andoftenmisunderstoodexperiencesinthehumancondition.Everyonewillundertakeatransitionduringlife–somevoluntary,somenot,andmany inevitable: fromchildtoadult; fromlivingwithparentsto living independently;from student to worker; from single to married; from married to single; from employed tounemployed. Every transition has complexity, and individuals respond with great variety to thechallenges that theypresent.Transition isnotsynonymouswithchange,which ismoresituational—one may change jobs, healthcare providers, accommodations, communities, and more, withoutnecessarily undertaking a transition. The key difference is that a transition is, at its core, apsychologicalprocessprecipitatedbychange,notonlythechangeitself.1

The transition from the military to post-military life is but one type of evolution among manyundertakeneverydayaround theworld,but rare in that it encompasses somanydimensionsof anindividual’slifeatonce:economic,physical,familialandsocial,psychological,andcultural.2

Giventhescopeofthechallengethatanytransitionpresents,aswellasthenumberofdimensionsofan individual’s life often impacted by it, it should not be surprising that more than two-thirds ofveterans report difficulty undertakingMCT3and adjusting to civilian culture4, and felt un- or under-

1ThisnuancedunderstandingofchangeandtransitionfeaturesprominentlyintheworkofWilliamBridges,whohaswrittenextensivelyonvarioustypesandmodesoftransitionandpracticedfor40yearsasaconsultanttoindividuals,companiesandpublicagencies.Someofourunderstandoftransitioncomesfromhisbooks,Transitions(2004)andManagingTransitions(2009).2Theconceptoftransitiondoesnotfiteasilyintoasingleacademicdisciplineandwhileacademicliteratureontransitionitselfissparse,muchrelevantinformationcanbefoundonitsdisparatecomponentsfromliteratureinsociology,anthropology,psychology,psychiatry,economics,andmore.3CarlAndrewCastro,SaraKintzleandAnthonyHassan,“TheStateoftheAmericanVeteran:TheLosAngelesVeteransStudy”(2014),20-21.Accessiblefrom:http://cir.usc.edu/research/research-projects/los-angeles-veterans-survey.4CorriZoli,RosalindaMauryandDanielFay,“MissingPerspectives:Servicemembers’TransitionfromServicetoCivilianLife.”(2015),3.Accessiblefromhttps://ivmf.syracuse.edu/wp-content/uploads/2016/05/MissingPerspectives_Forward.pdf.

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prepared to do so.5Many military spouses, too, report experiencing difficulty withMCT, especiallywhenthespouseisunder-orunemployed.6

It is probably unavoidable that MCT will be difficult for the nearly 200,000 veterans, on average,separatingfromthemilitaryeachyear:thesacrificesinherenttomilitaryserviceimposedonboththeveteranandimmediatefamilywillalwaysbegreat;thecultureofthemilitary,ofcourse,cannotandshould not model that of civilian society; the paucity of connection and comprehension betweenmilitaryandciviliancommunitiesisunlikelytochange;thedemandsofmilitaryservicewillneverallowforsufficienttimepriortoseparationfortheveteranandimmediatefamilytopreparefullyforpost-militarylife.However,thereisevidencethatthedifficultiescanbefurtherreduced,thestressesbettermanaged, thequalityof theveterans’experiences improved, theprogressbettermeasured,andthesuccessesbetterdefined.

It is clear that MCT will have great bearing on the entire post-military lives of veterans and theirfamilies,andontheirpropensityforsuccessinalldimensionsofpost-militarywellness.Acknowledgingthis, theDepartmentofVeteransAffairsCenter for Innovation (VACI)hypothesized thatadvancingamore complete understanding of the veteran’s MCT experience and the determinants of MCToutcomeswouldenableveteranserviceprovidersand, importantly,veteransthemselves,to improveMCToutcomes,andthemeansbywhichwemeasureandevaluatethoseoutcomes.

Therefore,inthespringof2016,theVACIbegananexpansivereexaminationofMCT,lookingbeyondtheexistingpublicandprivateresourcesandprogramssupportingtransitioningveteranstoconsiderhowtheyexperience thisprocessofmovingbetween twoverydistinct cultures to findpost-militarysuccess, as well as to better understand the variables impacting that experience. This is a positionpaper. It is informedbyexisting literature, thatwhich is focusedonveteransandtheresources thatsupport them, but importantly also by research on other topics and constituencies still relevant toveterans. It isalsobasedondozensof interviewsandconversationswithveteransandsupportersofvarioustypes.

We intended for this project to examine the universal elements and nature of transition – that itshouldbe relevant toeveryveteranand familyundertakingMCT,notprioritizing theexperiencesorneedsduringMCTthatareuniqueordisproportionatelyimportanttosubsetsofthatpopulation.Thatsaid,we acknowledge that are additional factors requiring additional scrutiny for subsets, includingwomen veterans, minorities, LGTBQ veterans, those managing physical or mental health

5CarlA.Castro,SaraKintzle,andAnthonyM.Hassan,“TheCombatVeteranParadox:ParadoxesandDilemmasEncounteredWithReintegratingCombatVeteransandtheAgenciesThatSupportThem”(2015),TraumatologyVol.21,No.4,299–3106Trougakos,J.,Bull,R.,Green,S.,MacDermid,S.,&Weiss,H.,“InfluencesonJobSearchSelf-EfficacyofSpousesofEnlistedMilitaryPersonnel,”(2007),accessedfromhttps://www.mfri.purdue.edu/publications/reports.aspx.

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considerations, those managing certain economic considerations relevant to transition, and thoseseparatingfromthemilitarywith“badpaper”discharges.7

Wesoughttoapplyfresheyestotheentireecosystemintowhichveteranstransition–thelargeanddiversearrayofpublicandprivatebenefitsandserviceproviders,advocatesandemployers.Ourintentwasnot todiscountordevalue theexistingapparatus in supportof transitioningveteransand theirfamilies, but rather to consider the MCT experience in a manner agnostic of any existing set ofinterventionsoravailableresources.

Thekeyfindingsofthisexaminationaretwofold.

• First, our ability to effectively support veterans and their families as they undertakeMCT ishamstrungbyourpoorunderstandingof theirexperiencesandoutcomes–moreandbetterveteran-centricdata is vital ifweare to improve thequalityof support theentireecosystemprovides.

• Second,werecommendwhatamountstoaparadigmshiftinhowVAandtheentireecosystemview the challenges of MCT: Transition is, first and foremost, a psychological and culturalevolutionforwhichagreatmanyveteransareunder-prepared,ratherthanprimarilyabasketofeconomicchoices.

WhiletheVAmaynotneedorbeabletoassumethefullburdenofthischallenge,thereisaclearrolefortheDepartmenttoplayinadvancingamorecompleteunderstandingofthecomponentsofMCT,fordirectlymeetingtheneedsoftransitioningveteranswherepossibleanddesirable,andinindirectlysupportingthemthroughotherarmsofgovernment,civilsocietyandotherassetsintheMCTsupportecosystem.

Throughoutthisexploration,weremainedcognizantofVA’scommitmenttoimproveveterans’actualand perceived quality of life and self-reported wellness, to make meaningful improvements toveterans’capacityforcontributingtothehealthandprosperityoftheirfamily,theircommunity,andtheircountry,andtoreturnveteransandtheirfamiliesascloseas ispossibletoastateof individualwellnessandproductivitytowhichtheywereentitledpriortoserving.

Existing literature and data on MCT, as well as interviews with more than 100 veterans andprofessionalssupportingveteransundertakingMCThaveledustoconcludethatthereareanumberofways inwhichMCTexperiencesandoutcomesmightbe improvedforallveteransandtheirfamilies,

7Thephrase“badpaper”referstoanydischargetypebelowGeneral(UnderHonorableConditions).Veteranswith“badpaper”areineligibleformostveteransbenefitsdespite,inmanycasespost-9/11,havingreceivedcampaignorseaservicedeploymentmedalsand/ormanagingservice-connectedmedicalconditions.AnimportantprimeronthissubsetoftheveteranpopulationwaspublishedlastyearbytheSanFrancisco-basedVeteranServingNonprofit,SwordstoPlowshares,basedonresearchbytheVeteransLegalClinicatHarvardLawSchool.(“Underserved:HowtheVAWrongfullyExcludesVeteransWithBadPaper,”(2016),accessedFebruary2017fromhttps://www.swords-to-plowshares.org/2016/03/30/Underserved).

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andinwhichallofthevariousassetsintheecosystemofsupportforMCTmightbebetterharnessedtomeettheneedsofthiscommunity.8

8Wehavetakenpainsthroughoutthisprojecttotailorourrecommendationstothebenefitofalltransitioningveteransandtheirfamilies,andnottofocusourattentionsontheneedsorexperiencesofanyparticularsubgroupofthatpopulation.Whilewecertainlyacknowledgethatveteranswithphysicalorhiddeninjuries,orthosetransitioningintoanenvironmentthatmaymakethematgreaterriskforhomelessness,forexample,haveparticularneedsduringMCT,wesoughttoadvanceagreaterunderstandingofMCTforthebroadestpossibledefinitionoftransitioningveteranandfamily.

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WHATISMCT?

In recent years the VA and other assets in the veteran support ecosystem have developed amuchimproved understanding of veterans’ experiences in accessing healthcare and benefits, securingemployment,housing,andmore.Butthisefforthasbeenlargelyself-referentialforserviceprovidersand policymakers, focusedon veterans' access to and the performance of various benefits, servicesand programs. The crux of our argument is this: As a nation, we need, and do not yet have, acommitment across the entire veteran support ecosystem to understanding, prioritizing, andrelentlesslypursuingpositiveveteranoutcomesinMCT.Thisrequiresaparadigmshiftfromafocusonthesystemsofveteranssupport–thehandoffbetweenFederaldepartmentsandtotheprivatesector,and the performance of our services – to a posture that elevates veteran outcomes above all else.Moreover,wearenotguidedbyadefinitionofMCTandanunderstandingofsuccessthatisrelevanttoevery individualveteranand familymembersundertakingMCT,nomatter theirneedsor levelofengagementwithVAandotherassetsinecosystem.

This shift begins with an abiding commitment to bettering our understanding of our veterans’experiences.After demographic detail and labor participation rates, thequalitative andquantitativedataVAcollectsfromandabouttheveteranpopulationlargelyfocusesonitsawarenessanduseofVAand other government benefits and services.We are not well equipped to evaluate when and if aveteranhasbeen,inthewordsoftheBradleyCommission,“return[ed]…asnearlyaspossibletothestatustheywouldhaveachievedhadtheynotbeeninmilitaryservice.”9

Theneedtohavebetterindividual-veteran-levelqualitativeandquantitativedataduringtheperiodofMCT cannot be overstated. It is nearly impossible at this time to accurately evaluate both theperformanceofveteransandtheirfamiliesundertakingMCT,and,justasimportantly,theefficacyofvarious interventions – the programs, services and benefits provided across the veteran supportecosystemtotheMCTpopulation.Asaresult,mosteffortstoconnectoutcomestotheseinterventionsarestatisticallyinvalid.Thefurtheraveterangetsfromher/hisseparationdate,thelessweknowatanindividuallevelabouther/hisqualityoflife:physical,mentalandeconomichealth;socialconnectivity;productivityandself-actualization;andmore.10Weconsidertheproblemswithouracquisitionanduseofdataingreaterdetailinthenextsection.

9ThePresident’sCommissiononVeterans’Pensions,“Veterans’BenefitsintheUnitedStates”(1956),4.Accessiblefrom:http://www.veteranslawlibrary.com/files/Commission_Reports/Bradley_Commission_Report1956.pdf10Theinadequaciesofcurrentdataandmeasurementinstrumentshavebeenobservedwidelyinacademia.Citationsonthispointaretoomanytolistcomprehensively,buttheyinclude:

• U.S.DepartmentofVeteransAffairsOfficeofEnterpriseIntegration,“VeteransPolicyResearchAgenda:FiscalYear2017”(2016),3.Accessiblefrom:http://www.va.gov/op3/docs/StrategicPlanning/FY_2017_Veterans_Policy_Research_Agenda.pdf.

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AParadigmShiftintheFederalGovernment’sIntegratedMCTPolicy

WearearguinginthisreportthatFederalpolicyshouldemanatedirectlyfromashareddefinitionandconceptual framework for MCT, and that these should be anchored to veterans’ experiences andoutcomes.Itfollows,therefore,thatifthereisnotashareddefinitionandconceptualframework,oriftheyareill-defined,thepoliciesthatfollowwillmissthemark.ThisisthestateinwhichwebelievetheFederal Government currently resides. We have a fragmented approach that exacerbates thesomewhatinevitableinter-departmentalseamsinservice:Whileanoversimplification,webelievetheDepartmentofDefense’s(DoD)policiesonMCTrevolvearoundtheconceptofa“warmhandoff”11ofveteransandtheirfamiliesfromtheirrostersto,primarily,theDepartmentofVeteransAffairs(VA)forhealthcareandmostbenefits,totheDepartmentofLabor(DoL)forsupportinretainingemployment,andtotheSmallBusinessAdministrationforsupportinstartingacompanyorsoleproprietorship.Fortheirpart,thepoliciesofVAandtheotherdepartmentsmightbestbedescribedasensuringaccessto,and sometimes quality of experience with, their benefits and services. Our data collection effortsfollowthis,asdoourapproachestomeasurementanddefinitionsofsuccess.Ourrecommendationsinthis report amount to a paradigm shift in Federal policy, throughwhichwebegin by anchoring ourdefinitions of success to, above all else, veterans’ outcomes and experiences during MCT. It isinsufficient to effect a “warm handoff” from one department to another and to ensure access tobenefits and serviceswithout setting goals for veterans’ holistic quality of life after separating fromserviceandtrackingtheirprogresstowardthem.

In our view, this beginswithmore and better data on veterans’ and families’MCT outcomes at anindividuallevel.First,though,inordertoacquirethis,thereneedstobeabroaderagreementamongkeyassetsintheveteransupportecosystemonthedefinitionofMCT,andaframeworkforsupportingveterans’successintransition.ThisagreementwillallowformoreconsistencyinwhatdataonMCTweneed,howweacquireitandoverwhatduration.

• Sayer,Frazier,Orazem,etal.“MilitarytoCivilianQuestionnaire:AMeasureofPost-Deployment

CommunityReintegrationAmongVeteransUsingDepartmentofVeteransAffairsMedicalCare,”(2011),JournalofTraumaticStress,660-670

• Resnick,Plow,Jette,etal.“DevelopmentofCRIS:MeasureofCommunityReintegrationofInjuredServiceMembers”(2009),JRehabilResDev,469-480

• InterviewsconductedwithresearchersfromtheJacksonFoundationFortheAdvancementofMilitaryMedicine’sVeteransMetricsInitiative,fromIndianaUniversity,fromSyracuseUniversity,fromtheUniversityofSouthernCaliforniaSuzanneDworak-PeckSchoolofSocialWorkCenterforInnovationandResearchonVeteransandMilitaryFamilies,andfromVAMedicalCenterBostonandVAMedicalCenterSanDiego.

11ThisphrasewasemphasizedtousinnearlyeveryinterviewwithDoDanduniformedmilitarypersonnel.WhilepresentinsomeoftheprintedandonlinecollateralrelatedtoMCT,inconversationsitusuallyemergedasthecenterpieceofDoD’sapproachtoMCT,whichiswhywearesuggestingherethatitisthedefactopolicy,absentanofficialone.

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NextSteps:

Collaboratively develop an integratedMCT policy formalized forallFederalGovernmentdepartmentsthatisanchoredtoveterans’outcomesandexperiencesinsteadofFederalinputsandoutputs.

ADefinitionofMCT

There is no widely held, consistent, coherent definition of MCT, neither at VA, nor across otherrelevantarmsofgovernment,civilsocietyandtheprivatesector.Ourintenthereistoproposeasetofcriteria for a definition that is inclusive of all veterans, agnostic of any particular profile, type ofdischarge,setofneeds,orwhetherornottheveteranisacustomeroftheVA.Weseektofurtheranunderstanding of the nature of MCT as not only a process of seeking post-service occupation,educationandtraining,healthcareandbenefits,but,mostimportantly,asapsychologicalandsocio-culturalevolutionthatculminatesinarenewedsenseofpurposeandanunderstandingofone’splaceinthelargercontextofciviliansocietyandthemilitaryandveterancommunity.

PreciselanguageforadefinitionofMCTshouldbedevelopedandadoptedinpartnershipwithleadingresearchersandpractitioners intheveteransupportecosystem,butbasedonthecommonalitieswesee in existing literature, we believe the following to be a good starting point for a collaborativedefinition:

“Military-to-CivilianTransitionisdefinedastheprocessthroughwhichmilitaryveteransand their immediate family members achieve and maintain a stable level ofpsychological,physicalandeconomicwell-being.Theyaresatisfiedwiththeirabilitiestomeet their immediate and long-term economic needs and are committed to a post-military identity and senseof purpose that allows them to engage in productiveworkandsocialconnectivitycommensuratewithindividualgoals,desiresandabilities.”

WhilenocompetingdefinitionoftransitionexistsinbroaduseatVAorDoD,thisdefinitiondiffersfromapproacheswehaveobserved acrossUSGbyprioritizing thequality of experiences of veterans andtheirfamilymembersthroughoutthecourseofMCT,anddefiningoutcomesofself-actualizationandproductivity,notonlyaccesstoandawarenessofthesuiteofbenefitsandservicesavailabletothemduringMCT.

NextSteps:

Convene a working group of VA, DoD and civil society thoughtleaders and practitioners to generate a definition of MCT thatadherestotheessentialcriteria (qualityofexperience,rooted inself-actualization and productivity outcomes), and that can be

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disseminated and supported broadly across VA, DoD and theentireveteransupportecosystem.

LearningfromAnalogousPopulationsinTransition

Veterans and their families are not alone in undertaking a transition that brings to bear so manydimensions of an individual’s life. Although little evidence exists in the literaturedirectly comparingMCTtoanalogouspopulations’transitions,somecomparisonsarepossible,evenhelpfulindevelopinga definition of transition that draws on the common experiences of multiple constituenciesundertakingvariationsontransition.Themajorityofliteratureontransitionsfocusesontheprocessesandexperiencesofchildhooddevelopment,movementbetweenstagesofeducation, fromschoolingto the workforce, and from the workforce into retirement and toward end-of-life.While there areundoubtedlylessonstobedrawnfromeachofthesetransitions,wesuggestthatacloserexaminationofdistinctsubsetsofthebroaderpopulationwouldbemostinstructive.Tothisend,wepaidparticularattention to the processes and experiences of the formerly incarcerated, and of immigrants,expatriatesandeliteprofessionalathletes.

Manywouldbereluctanttodrawacomparisonbetweentheveteranpopulationandthepopulationofformerly incarcerated individuals, and yet there is documented consistency in these two groups’transitionexperiences:stressassociatedwithextremeculturalshift;themovementfromasysteminwhichmost individual needs are anticipated andmet by persons other than the individual, to onewhere far greater executive function, practical intelligence and cultural and contextual fluency arenecessary forsuccess; the lossof identityand, insome instances,acohesivecommunityof support;theneedtoidentifyanddevelopadditionaltrade,professionalandpersonalhardandsoftskillstobeemployable in the broader society; and the need tomanage conditions acquired through traumaticexperience.12

We might also recommend looking to the experiences of immigrants, expatriates, and eliteprofessionalathletes,althoughtheliteratureandsupportservicesforthesecommunitiesarefarfewerthan for the veteran population or the formerly incarcerated. These populations, too, undertaketransitionswithsomeofthesameelementalcomponents.Weseevalueinthesecomparisons,becausestudyingalternativecontextsforsimilarproblemsets is likelytoyieldmorecreativesolutionsandtoworkagainstthenotionthatonlyveteran-specificresourcescanbeengagedtosolveveteran-specificchallenges.

12Althoughwefoundnoliteraturecomparingthetransitionexperiencesofanalogouspopulations,theexperiencesoftheformerlyincarceratedundertakingreintegrationhavebeenstudiedextensively.AwealthofrelevantinformationcanbefoundintheresearchoftheUrbanInstitute’ssix-yearstudy,“ReturningHome:UnderstandingtheChallengesofPrisonerReentry,”alongitudinal,multistatestudyconductedinMaryland,Illinois,OhioandTexasinthe2000s.Thesepaperscanbefoundathttp://www.urban.org/policy-centers/justice-policy-center/projects/returning-home-study-understanding-challenges-prisoner-reentry.

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NextSteps:

Initiate comparative studies on analogous populationsundertaking transitions. Look for commonalities in transitionvariablesandindividuals’responses,efficacyofinterventions,andindicatorsofsuccessorfailure.

MCTFrameworks

Whydoweknowsolittleaboutveterans’qualityoflifeafterservice?Significantly,becausewedonotadheretoaconsistentdefinitionofMCT,aspreviouslydiscussed,andaconceptualframeworkforhowtosupport it.Absentaconsistent,coherentandcomprehensiveunderstandingofveterans’ journeysthrough MCT, including the processes and experiences therein, acquiring rich qualitative andquantitativedataonveterans’outcomesduringthisphaseintheirlivesisimpossible.AsourcolleaguesintheVAOfficeofEnterpriseIntegrationhighlightedintheoffice’smostrecentresearchagenda,“theabsenceofabroadconsensusonaunifyingorconceptualframeworkforMCThasbeenidentifiedasasignificant gap that may impede the development of effective policies, programs, and services tosupportservicemembers,veterans,andtheirfamilies.”13

CommonCriteriaWithinExistingFrameworks

LeadingcentersofresearchonveteransissueshavedevelopedconceptualframeworksortheoriesforMCT,includingtheUniversityofSouthernCalifornia14,SyracuseUniversity15andtheCenterforaNewAmerican Security16. Eachof these frameworks differs in emphasis, timeline anddetail, but exhibitsnotable consistencies, too. In calling for broad consensus on a conceptual framework, we do notsuggestthatonesingleversionbeadoptedacrosstheveteransupportecosystem–this isunrealistic

13U.S.DepartmentofVeteransAffairsOfficeofEnterpriseIntegration,“VeteransPolicyResearchAgenda:FiscalYear2017”(2016),3.Accessiblefrom:http://www.va.gov/op3/docs/StrategicPlanning/FY_2017_Veterans_Policy_Research_Agenda.pdf.14CarlAndrewCastro,SaraKintzleandAnthonyHassan,“TheStateoftheAmericanVeteran:TheLosAngelesVeteransStudy”(2014),14-15.Accessiblefrom:http://cir.usc.edu/research/research-projects/los-angeles-veterans-survey.15NicholasJ.Armstrong,COLJamesD.McDonoughJr.,USA(Ret.)andDanielSavage,“DrivingCommunityImpact:TheCaseforLocal,Evidence-BasedCoordinationinVeteranandMilitaryFamilyServicesandtheAmericaServesInitiative”(2015).Accessiblefrom:https://ivmf.syracuse.edu/wp-content/uploads/2016/06/Driving-Community-Impact.pdf.16NancyBerglassandMargaretC.Harrell,“WellAfterService:VeteranReintegrationandAmericanCommunities”(2012).Accessiblefrom:https://www.cnas.org/publications/reports/well-after-service-veteran-reintegration-and-american-communities.

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andinoppositiontothebenefitsofacompetitivemarketplaceofideas–butwedoreinforcetheneedthat researchers and practitioners alike should use a conceptual framework for guiding their MCTsupportefforts,andthataviableframeworkshouldadheretoafewkeytenets17:

1. AframeworkforsuccessfulMCTbeginssignificantlyupstreamoftheseparationdate.2. AframeworkforsuccessfulMCTextendssignificantlydownstreamoftheseparationdate.3. A framework for successfulMCT encompassesmultiple dimensions of transitioning veterans’

wellness,includingthefollowing(whichmay,ofcourse,bewordeddifferently):a. MentalHealthb. PhysicalHealthc. Familyd. Housinge. Transportationf. Occupation/Employmentg. EducationandTrainingh. FinancialHealthi. LegalInteractionsj. SocialCapital&Connectednessk. Self-Actualization18l. “TransitionLiteracy”19

4. AframeworkforsuccessfulMCTstipulatesrequiredrolesandresponsibilitiesfor:a. Theindividualveteranb. Her/hisfamilyc. Federalgovernment(notablythedepartmentsofVeteransAffairs,Defense,Labor,and

theSmallBusinessAdministration)d. Stateandlocalgovernmente. Community-based support assets (including civil society, faith-based, and the private

sector)f. Privatesectorhealthcareproviders,whenrelevantg. Employers

Incentivizing and encouragingwidespread adoption of a consistent set of frameworks forMCT thatadhere to the above criteria is an appropriate leadership role for VA within the veteran supportecosystem, and, if successful, would notably improve the efficiency and effectiveness of thatecosystem; in so doing, VA would empower local community navigation and coordination efforts,

17Theunderpinningsfortheseminimumrequirementsforaviableconceptualframeworkaretoonumeroustolisthere,butarebasedintheconsistenciesbetweenleadingframeworks,intheliteratureonMCT,andonmorethan100interviewsconductedoverthecourseofthedevelopmentofthisreport.18Thistopicisaddressedinsection4.3ofthisreport.19Thistopicisaddressedinsection4.4ofthisreport.

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increase the consistencyandqualityof servicesprovided, and indirectly improveMCToutcomes forveteransthemselves.

NextSteps:

Convene a working group of VA, DoD and civil society thoughtleaders and practitioners to develop an agreed-upon set ofminimum criteria for any MCT framework to which individualframeworks can adhere, and that can be disseminated andsupportedbroadlyacrossVA,DoDandcivilsociety.

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THENEEDFORMOREANDBETTERDATA

With awidely held definition and criteria for conceptual frameworks, researchers, practitioners andpolicymakers will be equipped to acquire better data on veterans’ transition outcomes, as well asprogress toward those outcomes and utilization of the various resources available to them in theveteran support ecosystem.We should seek richer information on individual transitioning veterans’progress toward establishedMCT goals: success and key performance indicators in the domains ofpreparedness for MCT prior to separation, adjustment to post-military life (following separation),physical and mental health, economic performance, social connectivity and other dimensions ofholisticwellness.Aswesuggested in the introduction to this report,VA’sdataacquisition strategiesfollowpolicy,whichwebelievemeanstheyweredesignedtoguideVAservicesandtomeettheneedsof Congress and other Federal departments, not to assess veterans’MCT outcomes or to resourceserviceproviders and thepublic at largewithuseabledataon veterans’ experiences,outcomesandneedsduringMCT.ThisisanopportunityforVAandtheentireveteransupportecosystemtoimproveour understanding of the population of veterans undertakingMCT and to equip all types of serviceproviderswithessentialdata.

It is also possible and desirable to seek comparative data from civilian peer sets, so as to betterunderstandveterans’performanceinrelationtotherestofciviliansociety.Demonstratingthatmilitaryserviceisnotinherentlyinjuriousand,indeed,oftencontributivetocareerandpersonalfulfillmentandproductivity, is important intheeraoftheAll-VolunteerForce.Asresearchers fromtheCenter foraNewAmericanSecurityhaveargued,“Thereisarguablyaconnectionbetweentheeconomicsuccessofveteransafterservice,thepropensityofveteransandnon-veteranadultstorecommendservice,andthe propensity of youth to join themilitary.”20While the argument that veterans should expect tobenefitfromtheirserviceintheirpost-militarycareersisstrongenoughtostandalone,theinabilitytodemonstrate this with data and a compelling narrative may also have negative repercussions formilitaryrecruiting,readinessand,therefore,ournationalsecurity.

Furthermore, it is not currently possible to provide a verifiable cost to the American taxpayer of aveteran’ssub-optimalMCToutcomes.Thereisalreadyanactivemovementtobuildastrongbusinesscaseforveteransupportthatgoesbeyondcharitableambitionandasenseofnationalobligation;thiscasewouldonlybe strengthenedwereweable todemonstrate– inparallel to the costsassociatedwith veterans support by both public and private actors – the costs of veterans’ sub-optimalMCToutcomes,enablingamoreaccurateaccountingofveteranssupport,andastrongercaseforimprovedandincreasedinterventions.21

VA’sOffice ofDataGovernance andAnalysis22, theU.S. CensusBureau23, local assets24, and variousprivate research institutions25will continue to be a source of essential data on veteran population20PhillipCarter,KatherineKidder,AmySchaferandAndrewSwick,“AVF4.0:TheFutureoftheAll-VolunteerForce”(draft)19-2021ChrisFord,founderandchiefexecutiveofficer,theNationalAssociationofVeteran-ServingOrganizations,hasbeenattheforefrontofthoughtleadersandpractitionersinmakingthisargument22NationalCenterforVeteransAnalysisandStatistics,https://www.va.gov/vetdata.

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demographyandgeography,andonutilizationandawarenessofVAservicesandbenefits. Likewise,the U.S. Bureau of Labor Statistics26provides rich data on veteran employment, pay and benefits,spending, and more. These data sources, however, currently leave gaps in our understanding ofveterans’MCTprogressandoutcomesfortwoimportantreasons:first,theydonottargetveteransbyweeks,monthsandyearsfromseparation,andcannottrackhowthesevariousindicatorschangeovertime during MCT; second, they offer detail about aggregated veteran populations, not individualperformanceinMCT.

NextSteps:

Initiate a research project to assess public costs of sub-optimaltransitionoutcomes.

EvaluatingMCTSuccess

Withoutany consistent setof frameworksonMCT, it isdifficult todefine successfulMCToutcomescomprehensively,beyond theconfinesofany individualdimensionof transition.Whileconsiderable,essential attention is paid to veterans’ outcomes in key dimensions (homelessness, mental andphysical health, criminal justice involvement, and more), these do not, in aggregate, amount to adefinitionofsuccess.Asoneveteraninterviewedforthisprojectemphasized,“Theavoidanceofbadoutcomes should not substitute for achieving good ones. If that’s themeasure, then the bar is setmuchtoolow.”Thissentimentrecurredininnumerableotherinterviewsweconductedwithveteransandsupportersalike.Moreover,thisisakeytenetinthemedicalprofession:absenceofdiseasedoesnotnecessarilyindicatehealth.27WerequireanaffirmativedefinitionofMCTsuccess,withsupportingmetricsandameanstoevaluatethem.

23U.S.CensusBureau,http://www.census.gov/topics/population/veterans.html.24Forexample,theTristateVeteransCommunityAllianceisanexcellentsourceofdemographicdataonveteransintheOhio-Kentucky-Indianatri-statearea.https://www.tristatevca.org/data25Ofparticularnote:

• SyracuseUniversity’sInstituteforVeteransandMilitaryFamilies(https://ivmf.syracuse.edu/research/data-tools/veteran-strategic-analysis-research-tool/)

• TheCenterforaNewAmericanSecurity(https://www.cnas.org/publications/reports/needs-assessment-veterans-in-the-dallas-fort-worth-region)

• TheUniversityofSouthernCaliforniaSuzanneDworak-PeckSchoolofSocialWorkCenterforInnovationandResearchonVeteransandMilitaryFamilies(http://cir.usc.edu/research/research-projects)

• BlueStarFamilies(https://bluestarfam.org/research-policy/)26U.S.BureauofLaborStatistics,http://www.bls.gov.27Thisisacommontenetinhealthcare,butperhapsmostcommonlycitedfromtheConstitutionoftheWorldHealthOrganization,whichbegins,“Healthisastateofcompletephysical,mentalandsocial

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NextSteps:

Developandtestimproved,veteran-centeredsuccessmetricsandoutcomesforMCT.

ReimaginingOurMCTDataNeeds

ToproperlyunderstandMCTprocesses,experiencesandoutcomes,wefirstrequirefargreaterdetailabouttheindividualtransitioningveteran’sservicehistory,including:

• Dutystationfromwhichtheveteranseparates• Homeofrecordmaintainedthroughouttimeinservice• MilitaryOccupationalSpecialty/specialties• Numberanddurationofdeployments,andtimebetweenlastdeploymentandseparation• Combatexperienceandtrauma• Timeingradeandservice• NegativeinteractionswithintheUniformedCodeofMilitaryJusticeandwithfinancialservices• Changesandnotableeventsintheveterans’familystatus

Over time it may be possible to identify which of these variables, if any, are correlated to MCToutcomes,andthentodesignadditionalsupportsorinterventionsforthoseveteransatagreaterriskforsub-optimalMCToutcomes.

From there, there are host of indicators that can illuminate veterans’ progress toward successfultransition.BasedonconversationswithVAstaffandothersocialworkers,psychologists, researchersandveterans,arudimentarylistoftheseindicatorsshouldinclude:

• Mental Health: (1) Presence, severity and change over time of indicators of mental healthconditions, including post-traumatic stress, depression, anxiety, suicidal ideation and actions,sexualtrauma,andalcoholanddruguse,satisfaction.(2)Accesstomentalhealthprovidersandothernon-medicalcounselors(e.g.chaplainsandlaycounselors):easeofaccessandfrequencyoftreatment,satisfaction.

• Physical Health: (1) Presence, severity and change over time of pain and other symptoms;satisfaction. (2) Access to providers: ease of access and frequency of appointments;satisfaction.

well-beingandnotmerelytheabsenceofdiseaseorinfirmity.”AccessedFebruary2017athttp://www.who.int/about/mission/en.

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• Family:Marital/relationshipstatus;parentingstatus;cohabitatingornot;spousalemploymentstatus; family access to health care; family access to education anticipated changes tomarital/relationshipstatus;satisfaction.

• Housing: Current status (renting, owning, staying with family/friends, homeless); majorrelocationacrosscountyorstatelines;recentchangestocurrentstatus;anticipatedchangestocurrentstatus;satisfaction.

• Transportation: Access tomodes of transport permitting regular attendance at employment,residence,healthcareproviders,majorcommercialzones;satisfaction.

• Occupation/Employment:Currentstatus(full-time,part-time,unemployedandactivelylooking,unemployed and not actively looking; unpaid occupation); type of work (public/private/self-employed; industry; career-level within industry); job satisfaction; tenure in currentemployment; recent changes to employment history; anticipated changes to employmenthistory; reason for unemployment (if applicable); secondary occupation (volunteerism,supplementarywork,etc.);utilizationofresources(benefits,programs);satisfaction.

• Education/Training: Credentials held; in a full/part time program; applying to a program;frequency of attendance; progress to completion; anticipated impediments to completion;confidencethatprograms/credentialswillleadtoemployment;satisfaction.

• FinancialHealth:Usingapersonal/familybudget;income;savings;percentageofincomeputtosavings;debt;insuranceprotection(health,life,home,etc.);satisfaction.

• Legal Interactions: Itemizing pending or past criminal and civil legal issues, detainments orincarcerations.

• Social capital and connectedness: Self-reported connectedness in social, family and workenvironments; other evidence of community engagement (participation in membershiporganizations, recreational sports, volunteerism opportunities, community activism, etc.);satisfaction.

• Self-actualization:Thisreferstotherealizationorfulfillmentofone'stalentsandpotentialitiesacrossthebroadestdefinitionofaperson’saspirations–work,family,community–especiallyconsidered as a drive or need present in everyone. A variety of instruments exist for themeasurement of self-actualization or purposefulness, including several that are commonlyemployed in psychotherapy andhave receivedNIH funding: Shostrum’s PersonalOrientationInventory, the SeekingofNoeticGoals (SONG) test, the LifePurposeQuestionaire (LPQ), theMeaninginSufferingTest,andLifeAttitudeProfileRevised(LAP-R).

• “Transition Literacy”: “Transition literacy” is the umbrella heading under which we arecategorizingthesetofpracticalandintangibleskillswebelievenecessaryforveterans’tomakeproductivechoicesduringMCT.Moredetailcanbefoundelsewhereinthisreport.

NextSteps:

Developandtest improved,veteran-centered indicators forMCTprogressandoutcomes.

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TowardaFederatedDataAcquisitionStrategy

It is unreasonable to suggest that VA or any other public or private entity could conduct such anextensive evaluation of every transitioning veteran. However, a pilot research effort with a largerepresentative sample of the population of veterans undergoing MCT would serve to validate aninstrument for comprehensive evaluation of MCT progress and outcomes across a broad array ofserviceproviders.

Moreover, by making the instrument open-source and incentivizing widespread use and iterativeimprovementbyassetsacross theveteransupportecosystem, includingwithinVA itself,VAandtheentire ecosystem can benefit from a broader data acquisition strategy with many owners andcontributors.Thisfederatedapproachwouldhavethreekeybenefits:

• First, VA could provide great value across the ecosystem as an aggregator and curator ofcontinuously updated qualitative and quantitative data on veterans’ performance andoutcomes during MCT. Contributors to this effort should be from a broad array of serviceproviders – VA, DoD, Department of Labor, the Small Business Administration, otherdepartmentsinFederalandlocalgovernment,VeteransServiceOrganizations(VSOs),Veteran-ServingNon-Profits(VSNPs)andothercivilsocietyorganizations,andemployers;

• Second, in fieldinga federateddataacquisition strategy rather thana top-down,prescriptivemodel,VAcanenablethesharinginformationnotanticipatedbyVAdataplanners.ThismightincludequalitativeandquantitativedatafromserviceprovidersunknowntoVA,self-reportedfromsurveys,scrapedfromsocialmediaplatforms,literatureandtraditionalmedia,andmore.

• Third,thisapproachwouldaddadditionalweighttoothertypesofMCTdata,includingthekindofrichqualitativedataontheexperiences,satisfaction,desiresandopinionsandveteransandtheirfamiliesthatVACIandVA’sVeteranExperienceOffice(VE)haveprioritizedinrecentyears,andthatisirreplaceableinfurtheringamorecompleteunderstandingofoutcomes.

The success of such an effort would hinge on an effective strategic partnerships strategy, thedevelopment of a dashboard anddata input tool, and an aggressivemarketing anduser acquisitionstrategy. Users of the instrument could be convened periodically for the sharing of best practices,improvingtheinstrument,andcreatingwhatwouldeffectivelybeaStateoftheTransitioningVeteranconferenceandreport.

While this has the potential to have a dramatic impact on the ecosystem of support for veteransundertakingMCT,webelieve its true valuewould not become apparentwithout aminimally viableproduct deployed to determine if and how the resource would be adopted, and by what types oforganizations.

Combining a large-scale commitment to MCT data acquisition and outcomes measurement andevaluation with VA’s ongoing commitment to a veteran-centered experience with VA services andbenefitswould, in time,help todemonstrate theoutcomesand impactof thateffort, and furtherabetter understandingof theuse andeffectivenessofVA services andbenefits in the context of thebroaderveteransupportecosystem.

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NextSteps:

ExpandVA’sdataacquisitionstrategywithapilotforafederatedapproach to MCT data acquisition, including a public-facingdashboard and data input platform, and supporting strategicpartnershipsanduseracquisitionplan.

MCTPersonasandPredictiveOutreach

AnimportantbenefitofanexpandedMCTdataacquisitionstrategyisthedevelopmentofacapabilityto create and employ detailed personas of transitioning veterans and immediate supporters (e.g.,familymembersandcaregivers),akintothepersonascreatedbyVACIin2014.28

Acknowledging that transitioningveteransand their familiesarenotamonolithicgroupwith similarexperiences,motivations,capabilitiesandpreferences,butratheraboutasdiverseasthesocietyfromwhichtheyaredrawnis,asVACIhasshown,essentialtoimprovingqualityofexperiencewithVAandtheentireecosystem.Thesepersonas,informedbydataanddesigner-ledinterviewswithveteransandfamilies undertaking MCT, would help service providers design and implement more responsive,veteran-centeredprograms, services, andproducts for thoseundertakingMCT in the sameway theVACIpersonashavebeenessential in thedevelopmentofVE’s JourneysofVeteransmap29andVE’sdesignofimprovedservicesacrossVA.

BuildingfromtheworkundertakenbyVEandVACI,thiseffortwouldallowustoexpandthesectionsofVA’s Journeys of Veterans map that contain components of MCT, and facilitate the creation ofadditional“moments thatmatter”– the inflectionpointsofMCTduringwhichveteransmaybenefitfrompreemptive,predictiveoutreachfromserviceproviders,includingVA.

NextSteps:

Initiate a design project to create MCT personas and an MCTjourneymapwith“momentsthatmatter.”

Design a predictive outreach strategy to enable VA and otherserviceproviderstoreachouttoveteransduring“momentsthatmatter.”

28VACenterforInnovation,“VoicesofVeterans:IntroducingPersonastoBetterUnderstandOurVeterans”(2014),accessedinJanuary,2017,from:http://www.innovation.va.gov/docs/Voices_Of_Veterans_11_12_4.pdf.29VAVeteranExperienceOffice,“JourneysofVeterans”(2016).Thisreportisnotavailableonline.

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GAPSINMCTSUPPORT

There are many bright spots in the veterans support ecosystem’s response to the needs of thoseundertaking MCT. The population continues to benefit from the “Sea of Goodwill”30, within whichthere exist a greatmany impactful resources for transitioning veterans and their families. FollowingpassageoftheVOWtoHireHeroesActof2011,everyservicememberisnowrequiredtoattendtheDoD’sTransitionGPScourse,aswellasmandatorymodulesonVAbenefitsandaDepartmentofLaboremployment workshop, and have various optional, supplementary modules available to them – amajorityofveteransdescribethesecurriculaashelpfultotheirtransitions31andeffectiveinexplaininghow to access various benefits. With the roll-out of a number of collective impact models forcoordinatedservicesincommunitiesaroundthecountry,includingVA’sMyVACommunitieseffort,aswellasvarietyoftoolstohelpveteranslocateservicesnearthem,thoseundertakingMCThaveeasieraccesstoamorediversegroupofserviceprovidersthaneverbefore.

However, our assessment of the landscape has identified a number of gaps or inefficiencies intransitionassistance thatwebelievecan improveveterans’experiencesandoutcomes throughMCTmovingforward.

MovingMCTPreparationUpstream

“Theyspent13weeksturningmeintoaMarine,butonly3daysturningmebackintoacivilian.”

Weheardthissentimentconsistentlyfromveteransandserviceprovidersalike:Transitionassistanceistoobrief,andcomestoolate.Inthesamebreath,however,mostwentontosaythattheyunderstandtheimperativesofmilitarydutiesprecludeaseparationprocessthatmirrorsintakeatthebeginningofamilitarycareer,sayingwithsomefrustration,“It’snotDoD’sjob.”

And yet, at some installations, DoD has enabled a far more aggressive timeline. Joint Base Lewis-McChord,inpartnershipwiththeWashingtonStateDepartmentofVeteransAffairs,hasimplementedaprocessthatallowsfortransitionassistancebeginningat least18monthspriortoseparationdate,includingextensivecounseling,courseworkandworkshops.32Similareffortsarebeingimplementedat

30JohnCopelandandDavidSutherland,“SeaofGoodwill:MatchingtheDonortotheNeed”(2010),accessedJanuary,2017,fromhttp://r4alliance.org/wp-content/uploads/2014/10/White-Paper-Sea-of-Goodwill-17-May-2010.pdf31BlueStarFamilies,“MilitaryFamilyLifestyleSurvey”(2016),accessedDecember,2016fromhttps://bluestarfam.org/wp-content/uploads/2016/12/ExecutiveSummary-Survey16-Finalpages.pdf32JointBaseLewis-McChordServiceMemberForLifeTransitionAssistanceProgram(SFL-TAP).http://www.dva.wa.gov/sites/default/files/SFL-TAP%20and%20WA%20State%20Transition%20Process%20Map%20-%2029%20Jan%2015.pdf

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FortRiley33andCampPendleton34.Becausetheprocessesexistandareavailabledoesconnoteimpactonveterans’MCT,soadditionalresearchisneededtodeterminethedegreetowhichtheseprocessesarewidelyusedbycommandsand theseparatingveteransand families,andhowtheyareaffectingveterans’MCToutcomes.

The variability of the Transition Assistance Program is an underappreciated and critically importantelement of the Federal Government’s response to the needs of veterans and families undertakingMCT. While the DoD Transition to Veterans Program Office and the Joint Executive CommitteeadministeringtheTransitionAssistanceProgramhave,pursuanttotheVOWAct,establishedminimumrequirementsfortransitionassistance35,eachservice,andindeedeachinstallation,mayexceedthoserequirements, and so the experiences of the separating servicemember and family with transitionassistance likely vary significantly around the world. There is no data to show comparativeperformanceduringMCT for veteransand families separating fromdifferent installations, aswell asthe impacttomilitarycommands’readinessofanupstreamapproachtotransition,butsuchastudywouldbeoftremendousvalueinmakingthecaseforamorestringentsetofrequirementsacrossDoD.

AnyconsiderationoftheimperativetomoveMCTpreparationfurtherupstreamofseparationmustbetempered by the fact that VA is statutorily constrained in its ability to access veterans and familiesprior to separation, severely limiting the department’s ability to serve veterans prior to separation.However, VBA leadership is currently exploring means to improve this access, and there is broadrecognitionacrossthedepartmentthat,inthewordsofVA’sprevioussecretary,BobMcDonald,“theseamsbetweenVA andDoDmust be further bridged ifwe’re going to improve veterans’ transitionexperiences.”

Many veterans and service providers also acknowledge the tremendously valuable role that civilsociety and theprivate sector can – and sometimesdo – play inMCTprior to separation, but hereagaintheconstraintsaremanyandthecurrentstateisfarfromoptimal.Affinitygroups,mentorshipandcoachingprograms,employerrecruitingeffortsandagreatmanyprogramsadministeredbyVSOs,Veteran-Serving Nonprofits, state and local governments help to fill in many of the large gaps inFederalGovernmentMCTsupport,butaccess tomilitary installations isproblematicandallof theseeffortsareseverelyhamstrungintheirabilitytoconnectefficientlyandeffectivelywithveteranswhowouldbenefit tremendously fromthevaluetheyprovide.Addressingthismissedopportunity,whichgoes farbeyond thecurrenteffortsaroundcoordinationof servicesandenablingveterans tobetternavigatetheecosystemofsupport,mustbeapriorityinanyefforttoexpandMCTtotheleft.

NextSteps:

33FortRileySoldierforLifeTransitionAssistanceProgram.http://www.riley.army.mil/Portals/0/Docs/Services/SoldierSvcs/SFL/12-month%20SFLTAP%20Process%20with%20Events.pdf34MCCSCampPendletonTransitionReadinessProgram.http://www.mccscp.com/transition/35DetailsofDoDTAPcurriculaandprocessescanbefoundathttps://www.dodtap.mil/

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InpartnershipwithDoD,initiateacomparativestudyofveterans’experiencesandoutcomeswithalternativeTAPeffortsatvariousinstallations,includingimpactonmilitaryreadiness.

Explore current and aspirational statutory authority for VA toreachmilitarypersonnelandfamiliesat least18monthspriortoseparation.

Self-ActualizationinCivilianLife

Asdescribedintheintroductiontothisreport,itbearsrepeatingthatthecurrentconceptionofMCTneglectsthattransitionisfundamentallyapsychologicalandculturalevolution,inwhichveteransneedtofindapathtoreorientationandself-redefinition,sometimeswhileacclimatizingtoanewdefinitionofwellness,butalwayswhilemovingquiteabruptlyfromacollectivistcommunitytoan individualistone.Considerableattentionhasbeenpaid to thedivide thatundeniablyexistsbetween themilitaryandciviliansociety36,butthelion’sshareofthisfocusesonthenationalsecurityimplicationsandnotontheculturaldifferencesandtheirbearingonMCT.Thisisunfortunate,becausethecultureshockisnearlyauniversalexperienceforveteransandtheirfamiliesduringMCT,onethatwehaveheardtimeandagainhasmeaningfulnegativeimpactonexperiences.

Self-actualization is a concept in clinical psychology that described the motivation to identify andrealizeone’spurpose.MostcommonlyassociatedwithAbrahamMaslowandhishierarchyofneeds37,the concept recurs throughout psychological literature as an elemental psychological need,alternativelyreferredtoasself-realization,thesearchforpurpose,meaningoridentity,or,intheworkof neurologist andHolocaust survivor, Viktor Frankl, logotherapy, that striving to find ameaning inone’slifeisaprimarymotivationalforce.38WithintheliteratureonMCT,thisconceptappearsregularlyas an experience common to many veterans: an imperative to find a post-military identity. Theexperienced isolation fromciviliansociety, challenges toaveteran’s senseof self,andanunrealizedneedtolivepurposefully-whateverthatmightmeantotheindividual’sprioritizationofwork,family,community ties, etc. – after service is anear-constant refrainamong recently separatedveterans. Ifexperiencedmoreacutely,thismaygrievouslyimpairaveteranineffortstofindorretainemployment,

36Muchhasbeenwrittenanddiscussedonthistopicbyveterans,servicemembers,journalistsandresearchers,buttwosourcesinparticularareessentialtoanunderstandingoftheCivilian-MilitaryDivide:

• TheresearchcurrentlyunderwayattheCenterforaNewAmericanSecurity,withpapersonthetopicforthcoming.

• KoriSchakeandJimMattis,“WarriorsandCitizens:AmericanViewsofOurMilitary,”Stanford,CA;HooverInstitutionPress(2016)

37A.H.Maslow,“ATheoryofHumanMotivation”(1943),originallypublishedinPsychologyReview,50,370-396.38ViktorE.Frankl,Man’sSearchforMeaningBoston,Beaconpress,1959.

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buildandmaintainsocialrelationshipsandconnections,and,atitsmostdire,leadtodepressive,self-destructive,orsuicidalbehavior.39

That there are few recommendable interventions operating at scale to help individuals with self-actualizationshouldnotbeviewedasanargumentagainstitsvalidityorimportance,butratherasanindicationofhowdifficultsuchaninterventionistomanageatscale.ItseemstousunreasonablethatVAor any other single service provider should seek to aid the nearly 200,000 veterans undertakingMCTeachyearinself-actualizing,but,ataminimum,curriculaaddressingself-actualizationshouldbemadeavailable toveterans–duringTAP,butalsoproactivelyofferedat the“moments thatmatter”duringMCTbeforeandafterseparation–andtocounselorstoprepareseparatingveteransforwhatdatashowisnearlyauniversallyexperiencedcomponentofMCT.

NextSteps:

InitiatefurtherstudyofthepsychologicalexperiencesinherenttoMCT, independent of other service-connected mental healthconditions.

Pilotinterventionstoimprovepreparationforseparatingveteransfor self-actualization, including curricula and/or workshops orcoachingtodeveloppost-militarypurposeandidentity.

Pilot interventions to equip separating veterans with skills andawarenessofresourcesformanagingMCT-relatedstresses.

AnticipatingMentalHealthNeedsSpecifictoMCT

ThestressesspecifictoMCTmustbeacknowledgedasreal,commonandinmanycasesindependentof–orcompounding–otherservice-relatedmentalhealthconcerns.Thesestressesthatariseduring,andperhapsinitiatedby,MCTaredeservingoffurtherstudy,pursuanttowhichitmayprovenecessarytoofferandencourageuseofmentalhealthcareduringMCTtoveteranswhodonotalreadyseparatefromthemilitarywithaservice-connectedmentalhealthdiagnosis.

Amongthemanytreatmentoptionsavailabletoveteransidentifiedasat-riskforanegativetransitionexperiences isapsychotherapeutic interventionalreadyemphasizedbymanyVAmentalhealthcare

39Here,again,thereisextensiveevidenceintheliterature.Mostnotably:

• CarlCastroandSaraKintzle,“SuicidesintheMilitary:ThePost-ModernCombatVeteranandtheHemingwayEffect”(2014),CurrentPsychiatryReports,16,460-469

• DavidLesterandCharlesThomas,WhyPeopleKillThemselves,SpringfieldIL,PergamonPress,2000

• SebastianJunger,Tribe,NewYork,HachetteBookGroup,2016.

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providers inthetreatmentofpost-traumaticstress.AcceptanceandCommitmentTherapy(ACT) isamindfulness-based behavioral therapy proven to be effective in treating a broad array of clinicalconditions, including depression, obsessive-compulsive disorder, workplace stress, chronic pain,anxiety, PTSD, drug abuse and schizophrenia. 40 ACT, moreover, has proven effective in helpingindividuals manage psychological suffering that does not fall into any category of clinical disorder:alienation, meaninglessness, low-self-esteem, loneliness, sexism and existential angst. Because webelievetransitiontobe,atitscore,apsychologicalexperience,equippingveteranswithACT’scopingstrategiescouldservetosoftenthejarringresponsesthatmanyveteranswillexperienceastheymovefrommilitarytociviliancontexts.41

NextSteps:

Initiate further study of the impact ofMCT on veterans’mentalhealthindependentofothercontributingfactors.

TransitionLiteracy:MakingBetterChoices

In the course of understanding the veteran’s experience of transition,we found ample evidence ofattention paid across the veteran support ecosystem to developing veterans’ requisite hard skills –applyingforemploymentoreducationopportunities,disability,andaccessinghealthcareandvariousbenefits.Farlessconsiderationisgiventoaddressingtheinternalprocessesatworkasveteransseektomakegoodchoicesduringtransition.“TAPthrewsomuchinformationatmewhenIwasn’treadyforitanddidn’tknowwhattodowithit.Ididn’tknowhowtoputitalltogether.”Thisstatementandminor variationson itwereunquestionably themost common responsesweheard fromveterans –and indirectly through service providers – in our interviews. A consensus emerged that existingtransitionassistanceresourceswereeffectiveinstructionmanualsforaccessingandusinggovernmentbenefitsandservices,butoffertheveteranslittleguidancehowtocombinethemtomaximumeffect,andhowtodevelopapathtowardaproductiveandsatisfiedpost-militarylife.

Putanotherway,theseprogramsareeffective insupportingveterans’navigating–followingaroutefrompointA topointB–butdid little tohelp veterans’ build skills inwayfinding.Wayfinding is animportant concept for the optimized design of a physical environment, but here a means tounderstand one’s position in andmake progress through a figurative space (transitioning from themilitarytopost-militarylifeacrossalldimensionsofMCT)withoutnecessarilyknowingwherepointsAandBare.Effectivewayfindingreliesonanindividual’sabilitytoorientherselfandcontextualizeandcomprehendinformationpresentedtoher,therebyallowinghertomakeproductivechoicestogettowhereshewantstobe.

40RussellHarris,“EmbracingYourDemons:anOverviewofAcceptanceandCommitmentTherapy,”(2006),PsychotherapyinAustralia,12,441BasedoninterviewswithNiloofarAfari,psychologist,VASanDiegoHealthCareSystem

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In the context ofMCT, veterans and their familiesmust employ self-assessment skills, perceive thebroadestpossibledefinitionoftheiropportunities,andunderstandthecontextforeachdecisiontheymake,allwhilemovingintoasocialculturefromwhichtheyhavebeenyearsdistant,andfromwhichtheirexperiences inuniformmayhave furtherseparatedthem.Transitionmust, therefore,prioritizeself-assessment, cultural adaptation, and the pragmatic setting of expectations on a path to self-redefinitionandmakingproductiveeconomicandsocialchoicesafterseparation.

Wegrouptheseskillsundertherubricof“transitionliteracy,”thesetofnon-cognitiveskillsthatenableveterans to adapt to their changing contexts andmake optimal decisions in their self-interest. Ourtheory of transition literacy draws from bodies of knowledge in practical intelligence and tacitknowledge, cross-cultural competency, and tenets of acceptance and commitment therapy, all ofwhichwebelievehaveessentialrolesinenablingbettertransitionoutcomes.

Practical intelligence – colloquially known as common sense or “street smarts” – is a quantifiablecategoryof intelligencedistinctfromIQoracademicintelligencethatenablestheindividualtoadaptto,shapeandselectenvironmentstoaccomplishone’sgoalswithinthecontextofone’ssocietyandculture.42Becausepracticalintelligenceisentirelyrootedinexperiencewiththeinteractionbetweenoneselfandone’senvironment,andbecausetheenvironmentofciviliansocietyisquitedistinctfromthatoftheactivedutycomponentsofthemilitary,itislikelythatmanyveteransdonotseparatefromthe military with the practical intelligence needed to be optimally successful in civilian society.Transition, therefore,mightbethoughtofas largelyaprocessofacquiring thetacitknowledge–anelementalcomponentofpracticalintelligence–neededtobesuccessfulinanewcontext.

Lackingthetacitknowledgeneededtoquicklysucceedinciviliansociety,veterans’transitionliteracymight be improvedwith interventions intended todevelop cross-cultural competence, the ability tomanageone’s responses to cultural differences andoperateeffectively in an intercultural context.43Themilitary’s specialoperationscommunity,aswell as the foreignandclandestine serviceshaveallemployed cross-cultural competence training to enable individuals to overcome their emotionalresponsestoforeigncultures,oftencitedasanxiety,disconfirmedexpectations,ambiguity,prejudiceandethnocentrism,andattribution,accordingtoresearchersattheUniversityofSouthernCaliforniaInstitute for Creative Technologies. It is feasible that numerous existing training resourcesmight beappliedtosupportthedevelopmentofveterans’cross-culturalcompetence.

Othernoncognitiveskills,whichmayalsobeconsideredtoencompasspracticalintelligenceandcross-cultural competence, are increasingly regarded as essential to success in bothworkplace and socialinterpersonal and intrapersonal interactions. There are a number of competing frameworks for

42RobertJ.Sternbergetal.,PracticalIntelligenceinEverydayLife(Cambridge;CambridgeUniversityPress,2000)43BasedoninterviewswithresearchersattheUniversityofSouthernCaliforniaInstituteforCreativeTechnologies

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assessing and building noncognitive skillsets, but most include some combination of:conscientiousness,agreeableness,neuroticism,openness,andextroversion.44

Forallofthecomponentsofourtransitionliteracyconcept,thereexistbothassessmentinstruments45and interventions designed to improve skills in these areas. Further study is required before VA oranother service provider could effectively pilot an intervention targeted to improve veterans’transition literacy skills, butwebelieve this to be an areaworth further attention.Were it deemedpossibletodoso,improvingveterans’intangibleskillsintheseareascouldeasethestressesofMCTbyequipping veterans and their families to more effectively organize and prioritize the tremendousamount of information presented to them duringMCT,make better choices, and prepare them tomoreeffectivelybuildsocialcapitalinciviliancommunitiesandwithcivilianemployersandcoworkers.

NextSteps:

Conduct a feasibility studyonassessingand improving veterans’intangibleskillsets–thecomponentpartsoftransitionliteracy–necessaryforimprovingperformanceduringMCT.

Develop,fieldandmeasureapilottransitionliteracyintervention.

TheMilitaryFamilyinMCT

Veteransandservice-providersalikehighlightedthevitalrolethatfamilyunitsplayasboththeveteranand immediate familymembers undertakeMCT. For example, there is some evidence that spousalemployment is correlated to betterMCT outcomes for the veteran46, as military spouses who areemployed afford greater financial flexibility for the transitioning veteran to take whatever stepsnecessary for success inMCT. That theunemployment rate formilitary spouses lingers around18

44BasedoninterviewswithRichardD.Roberts,Ph.D.,chiefscientist,CenterforInnovativeAssessments,ProfessionalExaminationService45Theseinclude:

• TheGeneralSelf-EfficacyScale(GSE-6)(2013)• TheSocialConnectednessandSocialAssuranceScales(1995)• VariousassessmentsdevelopedbytheProExamCenterforInnovativeAssessments

46Maury,R.&Stone,B.(2014).MilitarySpouseEmploymentReport.InstituteforVeteransandMilitaryFamiliesandMilitaryOfficersAssociationofAmerica.Syracuse,NY.AccessedinJanuary,2017,fromhttp://vets.syr.edu/wp-content/uploads/2014/02/MilitarySpouseEmploymentReport_2013.pdf

26

percent (andpossibly as high as 30 percent for spouses under 25) should, then, be cause for someconcern.47

Moreover, inour interviews, veterans reported that including immediate family in transition-relatedactivities, including transition assistance classes and counseling, improved transparency andcollaborationwithinthefamilyunitandenabledfamilymemberstobettersupportoneanotherduringstressfultransitionmoments.ThatMCTisstressfulinwaysspecifictothenon-veteranfamilymembersis largelyoverlookedbyresearchersandpractitioneralike,especiallybeyondtheconfinesofspousalemployment. There is a culture specific to military families that is sometimes observed as one ofhardshiprelatedtothecontinualdisruptionoffrequentmovesanddeployments,butthefullpicturemilitaryfamilycultureismorecomplicated.Familymembersinthemilitaryare,inmanywaysandwithvery good reason, exulted. Heralded as the backbone of the force, military families can becomeaccustomed to the pride of belonging, to the details unique to base life, and to the benefits andservices accorded to them. Separating from this can be jarring for spouses, and particularly forchildren,whooftenhaveknownnoother lifestyle.They, too,undertakeaculturalandpsychologicaltransitionthat isquiteuniquetothem.They,too,aredeservingofsupportastheyundertakeit,andthatsupportmayneedtoconsistofelementsdifferentfromthatprovidedtotheveteran.

Alsorelevantwithinthis topic is theexperienceofservicemembersseparation fromthemilitaryandtransitioningtoanewstatusasamilitaryspouse.Theseveterans,amajorityofwhomarewomenduetothepropensityofwomenservicememberstomarryotherservicemembers,experienceavariationonMCTthatislittleunderstoodandresourced.48

While this area demands further research, there exists already sufficient evidence in favor ofdevelopingMCTservices–particularlyintheareasofemploymentandeducation–forentirefamilies,and for includingadult spouses inTAPcourses. Somechanges in thisdirectionwere included in theVOW act, but feedback from veterans, family members and service providers indicates that familyengagementcanbestrengthenedfurther.

NextSteps:

Initiate feasibility study fordeveloping family-inclusive transitionassistance resources, or including military spouses in existingtransitionassistance.

47BlueStarFamilies,“SocialCostAnalysisoftheUnemploymentandUnderemploymentofMilitarySpouses”(2016),accessedinJanuary,2017,fromhttps://bluestarfam.org/wp-content/uploads/2016/05/Social-Cost-Analysis-of-the-Unemployment-and-Underemployment-of-Military-Spouses_Final_4-5-1.pdf48BasedonconversationswithKaylaWilliams,directoroftheVACenterforWomenVeterans.

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CONCLUSIONANDNEXTSTEPS

Military-to-CivilianTransition is, inthescopeofaveteran’sentire life, themostcriticalof“momentsthatmatter.”EnablingsuccessinMCTforveteransandtheirfamilieswilloftenpreempttheneedforcriticalcareandserviceslater,butsolittleisknownabouthowandwhyveteransfareafterseparation.Inordertobestcareforveteransduringthiscriticalinflectionpointintheirlives,wemustfirstdevelopafarbetterunderstandingoftheirexperiencesandoutcomesduringMCT.Wemustengagewiththemearlier, involve and support their families more, and move beyond a posture in which we provideaccess to benefits and serviceswithout sufficient counsel on how they should be utilized.Wemustshiftour strategy fromavoidingveterans’badoutcomes toenabling thebestpossibleones,andweshould continue and expand our ability to partner effectively across the entire veteran supportecosystem.Wemustdoallwecanto“returnveteransasnearlyaspossibletothestatustheywouldhaveachievedhadtheynotbeeninmilitaryservice.”49

NextSteps:

AParadigmShiftintheFederalGovernment’sIntegratedMCTPolicy

Collaboratively develop an integratedMCT policy formalized forallFederalGovernmentdepartmentsthatisanchoredtoveterans’outcomesandexperiencesinsteadofFederalinputsandoutputs.

ADefinitionofMCT

Convene a working group of VA, DoD and civil society thoughtleaders and practitioners to generate a definition of MCT thatadherestotheessentialcriteria (qualityofexperience,rooted inself-actualization and productivity outcomes), and that can bedisseminated and supported broadly across VA, DoD and theentireveteransupportecosystem.

LearningfromAnalogousPopulationsinTransition

Initiate comparative studies on analogous populationsundertaking transitions. Look for commonalities in transitionvariablesandindividuals’responses,efficacyofinterventions,andindicatorsofsuccessorfailure.

49ThePresident’sCommissiononVeterans’Pensions,“Veterans’BenefitsintheUnitedStates”(1956),4.Accessiblefrom:http://www.veteranslawlibrary.com/files/Commission_Reports/Bradley_Commission_Report1956.pdf

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CommonCriteriaWithinExistingFrameworks

Convene a working group of VA, DoD and civil society thoughtleaders and practitioners to develop an agreed-upon set ofminimum criteria for any MCT framework to which individualframeworks can adhere, and that can be disseminated andsupportedbroadlyacrossVA,DoDandcivilsociety.

EvaluatingMCTSuccess

Developandtestimproved,veteran-centeredsuccessmetricsandoutcomesforMCT.

ReimaginingOurMCTDataNeeds

Developandtest improved,veteran-centered indicators forMCTprogressandoutcomes.

TowardaFederatedDataAcquisitionStrategy

ExpandVA’sdataacquisitionstrategywithapilotforafederatedapproach to MCT data acquisition, including a public-facingdashboard and data input platform, and supporting strategicpartnershipsanduseracquisitionplan.

MCTPersonasandPredictiveOutreach

Initiate a design project to create MCT personas and an MCTjourneymapwith“momentsthatmatter.”

MovingMCTPreparationUpstream

InpartnershipwithDoD,initiateacomparativestudyofveterans’experiencesandoutcomeswithalternativeTAPeffortsatvariousinstallations,includingimpactonmilitaryreadiness.

Explore current and aspirational statutory authority for VA toreachmilitarypersonnelandfamiliesat least18monthspriortoseparation.

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Self-ActualizationinCivilianLife

InitiatefurtherstudyofthepsychologicalexperiencesinherenttoMCT, independent of other service-connected mental healthconditions.

Pilotinterventionstoimprovepreparationforseparatingveteransfor self-actualization, including curricula and/or workshops orcoachingtodeveloppost-militarypurposeandidentity.

Pilot interventions to equip separating veterans with skills andawarenessofresourcesformanagingMCT-relatedstresses.

AnticipatingMentalHealthNeedsSpecifictoMCT

Initiate further study of the impact ofMCT on veterans’mentalhealthindependentofothercontributingfactors.

TransitionLiteracy:MakingBetterChoices

Conduct a feasibility studyonassessingand improving veterans’intangibleskillsets–thecomponentpartsoftransitionliteracy–necessaryforimprovingperformanceduringMCT.

Develop,fieldandmeasureapilottransitionliteracyintervention.

TheMilitaryFamilyinMCT

Initiate feasibility study fordeveloping family-inclusive transitionassistance resources, or including military spouses in existingtransitionassistance.

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APPENDIX:BIBLIOGRAPHY

“ReturningHome:UnderstandingtheChallengesofPrisonerReentry,”alongitudinal,multistatestudyconductedinMaryland,Illinois,OhioandTexasinthe2000s.Thesepaperscanbefoundathttp://www.urban.org/policy-centers/justice-policy-center/projects/returning-home-study-understanding-challenges-prisoner-reentry

A.H.Maslow,“ATheoryofHumanMotivation”(1943),originallypublishedinPsychologyReview,50,370-396

Albert-LászlóBarabási,Linked:HowEverythingisConnectedtoEverythingElseandWhatItMeansforBusiness,Science,andEverydayLife(NewYork:Penguin,2003)

AngelaDuckworth,Grit:ThePowerofPassionandPerseverance(NewYork:Scribner,2016)

Angevine,J.,(2015),“Veterans’NewHorizons:RedefiningMilitaryTransition,”BrookingsExecutiveEducation,WashingtonD.C.

Banai,M.,Maxwell,B.,O’Neal,J.,andGallagher,M.,(2011),“UnsungHeroes:MilitaryFamiliesAfterTenYearsofWar,”IraqandAfghanistanVeteransofAmerica,Washington,D.C.

Benmelech,E.,andFrydman,C.,(2012),“MilitaryCEOs,”NationalBureauofEconomicResearch,Cambridge,MA.

Bhawuk,D.andBrislin,R.,(2000).“Cross-culturalTraining:Areview,”AppliedPsychology:AnInternationalReview,49,1,162-191

BlueStarFamilies,“MilitaryFamilyLifestyleSurvey”(2016),accessedDecember,2016fromhttps://bluestarfam.org/wp-content/uploads/2016/12/ExecutiveSummary-Survey16-Finalpages.pdf

BlueStarFamilies,“SocialCostAnalysisoftheUnemploymentandUnderemploymentofMilitarySpouses”(2016),accessedinJanuary,2017,fromhttps://bluestarfam.org/wp-content/uploads/2016/05/Social-Cost-Analysis-of-the-Unemployment-and-Underemployment-of-Military-Spouses_Final_4-5-1.pdf

CarlA.Castro,SaraKintzle,andAnthonyM.Hassan,“TheCombatVeteranParadox:ParadoxesandDilemmasEncounteredWithReintegratingCombatVeteransandtheAgenciesThatSupportThem”(2015),TraumatologyVol.21,No.4,299–310

CarlAndrewCastro,SaraKintzleandAnthonyHassan,“TheStateoftheAmericanVeteran:TheLosAngelesVeteransStudy”(2014),TheUniversityofSouthernCaliforniaSuzanneDworak-PeckSchoolofSocialWorkCenterforInnovationandResearchonVeteransandMilitaryFamilies,LosAngeles.

31

CarlAndrewCastro,SaraKintzleandAnthonyHassan,(2014)“TheStateoftheAmericanVeteran:TheLosAngelesVeteransStudy.”

CarlCastroandSaraKintzle,“SuicidesintheMilitary:ThePost-ModernCombatVeteranandtheHemingwayEffect”(2014),CurrentPsychiatryReports,16,460-469

CarolDweck,Mindset:TheNewPsychologyofSuccess(NewYork:RandomHouse,2006)

Carter,P.,(2012)“UpholdingthePromise:SupportingVeteransandMilitaryPersonnelintheNextFourYears,”CenterforaNewAmericanSecurity,WashingtonD.C.

Carter,P.,andKidder,K.,(2015),“ChartingtheSeaofGoodwill,”CenterforaNewAmericanSecurity,WashingtonD.C.

Carter,P.,Kidder,K.,andSchafer,A.,“NeedsAssessment:VeteransintheDallas-FortWorthRegion,”CenterforaNewAmericanSecurity,Washington,D.C.

CommitteeontheAssessmentoftheReadjustmentNeedsofMilitaryPersonnel,Veterans,andTheirFamilies;BoardontheHealthofSelectPopulations;(2013),“ReturningHomefromIraqandAfghanistan:AssessmentofReadjustmentNeedsofVeterans,ServiceMembers,andTheirFamilies,”InstituteofMedicineoftheNationalAcademies,WashingtonD.C.

Cushner,K.andBrislin,R.,(1996),“InterculturalInteractions:APracticalGuide,”CrossCulturalResearchandMethodology,9,ThousandOaks,CA

Cushner,K.,(1989),“AssessingtheImpactofaCulture-GeneralAssimilator,”InternationalJournalofInterculturalRelations,13,125-146

DavidJ.Morris,TheEvilHours:ABiographyofPost-TraumaticStressDisorder(NewYork:HoughtonMifflin,2015)

DavidLesterandCharlesThomas,WhyPeopleKillThemselves,SpringfieldIL,PergamonPress,2000

DeGroat,A.,andCrowley,R.,(2013),“LookingCriticallyatReintegrationofPost-9/11EraVeterans,”KansasStateUniversityOfficeofMilitaryAffairs,Manhattan,KS.

DetailsofDoDTAPcurriculaandprocessescanbefoundathttps://www.dodtap.mil/

EnricoMoretti,TheNewGeographyofJobs(NewYork:FirstMariner,2013)

GeorgeE.Vaillant,TriumphsofExperience:TheMenoftheHarvardGrantStudy(Cambridge,MA:HarvardUniversityPress,2012)

32

Hardison,C.,Sims,C.,Ali,F.,Villamizar,A.,Mundell,B.,andHowe,P.(2009).“Cross-CulturalSkillsforDeployedAirForcePersonnel:DefiningCross-CulturalPerformance,”RANDCorporation,SantaMonica,CA:2009.

Harris,R.,(2006),“EmbracingYourDemons:anOverviewofAcceptanceandCommitmentTherapy,”PsychotherapyinAustralia,12,4,2-8

Hassan,A.,(2014),“TheCommunityQuarterback:VeteransandTheirFamiliesareComingHome.AreWeReady?”USCCenterforInnovationandResearchonVeterans&MilitaryFamilies,LosAngeles.

Hayes,S.,Luoma,J.,Bond,F.,Masuda,A.,andLillis,J.,(2005),“AcceptanceandCommitmentTherapy:Model,processesandoutcomes,”BehaviourResearchandTherapy44,1–25

Haynie,J.,(2016),“RevisitingtheBusinessCaseforHiringaVeteran,”InstituteforVeteransandMilitaryFamilies,SyracuseUniversity,Syracuse,NY.

Huitink,Z.,(2016),“AdvancingVeteranSuccessinHigherEducation,”InstituteforVeteransandMilitaryFamilies,SyracuseUniversity,Syracuse,NY.

JohnCopelandandDavidSutherland,“SeaofGoodwill:MatchingtheDonortotheNeed”(2010),accessedJanuary,2017,fromhttp://r4alliance.org/wp-content/uploads/2014/10/White-Paper-Sea-of-Goodwill-17-May-2010.pdf

JonathanShay,OdysseusinAmerica:CombatTraumaandtheTrialsofHomecoming(NewYork:Scribner,2002)

Kealey,D.andProtheroe,D.(1996).“Theeffectivenessofcross-culturaltrainingforexpatriates:Anassessmentoftheliteratureontheissue,”InternationalJournalofInterculturalRelations,20,2,141-165

KoriSchakeandJimMattis,“WarriorsandCitizens:AmericanViewsofOurMilitary,”Stanford,CA;HooverInstitutionPress(2016)

Lancaster,SandHart,R.(2015),“MilitaryIdentityandPsychologicalFunctioning:APilotStudy,”MilitaryBehavioralHealth,3,1,83-87

Lee,RandRobbinsS.(1995),“MeasuringBelongingness:TheSocialConnectednessandtheSocialAssuranceScales,”JournalofCounselingPsychology,42,2,232-241

LewisB.Puller,Jr.,FortunateSon(NewYork:Grove,1991)

33

MarkWilliamsandDannyPenman,Mindfulness:AnEight-WeekPlanforFindingPeaceinaFranticWorld(NewYork:Rodale,2011)

Maury,R.&Stone,B.(2014).MilitarySpouseEmploymentReport.InstituteforVeteransandMilitaryFamiliesandMilitaryOfficersAssociationofAmerica.Syracuse,NY.AccessedinJanuary,2017,fromhttp://vets.syr.edu/wp-content/uploads/2014/02/MilitarySpouseEmploymentReport_2013.pdf

Mol,S.,Born,M.,Willemsen,M.,andVanDerMolen,H.(2005),“PredictingExpatriateJobPerformanceforSelectionPurposes:AQuantitativeReview,”JournalofCross-CulturalPsychology,36,5,590-620.

Mueller-Hanson,R.,White,S.,Dorsey,D.,andPulakos,E.(2005),“TrainingAdaptableLeaders:LessonsfromResearchandPractice,”U.S.ArmyResearchInstitutefortheBehavioralandSocialSciences,FtBelvoir,VA

NancyBerglassandMargaretC.Harrell,“WellAfterService:VeteranReintegrationandAmericanCommunities”(2012).

NationalCenterforVeteransAnalysisandStatistics,https://www.va.gov/vetdata

NationalVeteransLegalServicesProgram,LegalServicesCenterofHarvardLawSchool,(2016)“Underserved:HowtheVAWrongfullyExcludesVeteransWithBadPaper,”SwordstoPloughshares,SanFrancisco

NicholasJ.Armstrong,COLJamesD.McDonoughJr.,USA(Ret.)andDanielSavage,“DrivingCommunityImpact:TheCaseforLocal,Evidence-BasedCoordinationinVeteranandMilitaryFamilyServicesandtheAmericaServesInitiative”(2015)

PhillipCarter,KatherineKidder,AmySchaferandAndrewSwick,“AVF4.0:TheFutureoftheAll-VolunteerForce”(draft)

Pietrzak,R.,Russo,A.,Ling,Q.,andSouthwick,S.(2011),“SuicidalIdeationinTreatment-SeekingVeteransofOperationsEnduringFreedomandIraqiFreedom:TheRoleofCopingStrategies,ResilienceandSocialSupport,”JournalofPsychiatricResearch,45,6,720-726

RobertD.Putnam,BowlingAlone:TheCollapseandRevivalofAmericanCommunity(NewYork:Simon&Schuster,2000)

RobertGraves:GoodbyetoAllThat(NewYork:RandomHouse,1998)

RobertJ.Sternbergetal.,PracticalIntelligenceinEverydayLife(Cambridge;CambridgeUniversityPress,2000)

34

Romppel,M,Herrmann-Lingen,C.,Wachter,R.,Edelmann,F.,Düngen,H.,Pieske,B.,andGrande,G.(2013),“AShortFormoftheGeneralSelf-EfficacyScale,”GMSPsycho-Social-Medicine,10.

RussellHarris,“EmbracingYourDemons:anOverviewofAcceptanceandCommitmentTherapy,”(2006),PsychotherapyinAustralia,12,4

SanderA.,ClarkA.,PappadisM.,(2010),WhatisCommunityIntegrationAnyway?:DefiningMeaningFollowingTraumaticBrainInjury,”TheJournalofHeadTraumaRehabilitation,25,2,121-127

SayerN.,FrazierP.,OrazemR.,etal.(2011),“MilitarytoCivilianQuestionnaire:AmeasureofPost-DeploymentCommunityReintegrationDifficultyAmongVeteransUsingDepartmentofVeteransAffairsMedicalCare,”JournalofTraumaticStress,24,6,660-670

Sayer,N.,Noorbaloochi,S.,Frazier,P.,etal.(2010)“ReintegrationProblemsandTreatmentInterestsAmongIraqandAfghanistanCombatVeteransReceivingVAMedicalCare,”PsychiatricServices,61,6,589-597

Schafer,A.,Swick,A.,Kidder,K.,Carter,P.,(2016),“OnwardandUpward:UnderstandingVeteranRetentionandPerformanceintheWorkforce,”CenterforaNewAmericanSecurity,WashingtonD.C.

SebastianJunger,Tribe,NewYork,HachetteBookGroup,2016

Semaan,B.,Britton,L.,andDosono,B.,(2016),“TransitionResiliencewithICTs:‘IdentityAwareness’inVeteranRe-Integration,”SchoolofInformationStudies,SyracuseUniversity,Syracuse,NY

StevenJohnson,WhereGoodIdeasComeFrom:TheNaturalHistoryofInnovation(NewYork:Riverhead,2010)

SyracuseUniversity’sInstituteforVeteransandMilitaryFamiliesVeteranStrategicAnalysisResearchTool(https://ivmf.syracuse.edu/research/data-tools/veteran-strategic-analysis-research-tool/)

Tanielian,T.,andJaycox,L.,(2008),“InvisibleWoundsofWar:PsychologicalandCognitiveInjuries,TheirConsequences,andServicestoAssistRecovery,”RANDCenterforMilitaryHealthPolicyResearch,Arlington,VA.

ThePresident’sCommissiononVeterans’Pensions,“Veterans’BenefitsintheUnitedStates”(1956).Accessiblefrom:http://www.veteranslawlibrary.com/files/Commission_Reports/Bradley_Commission_Report1956.pdf

ThePresident’sCommissiononVeterans’Pensions,“Veterans’BenefitsintheUnitedStates”(1956),4.Accessiblefrom:http://www.veteranslawlibrary.com/files/Commission_Reports/Bradley_Commission_Report1956.pdf

35

Trougakos,J.,Bull,R.,Green,S.,MacDermid,S.,&Weiss,H.,“InfluencesonJobSearchSelf-EfficacyofSpousesofEnlistedMilitaryPersonnel,”(2007)

U.S.CensusBureau,http://www.census.gov/topics/population/veterans.html

U.S.DepartmentofVeteransAffairsOfficeofEnterpriseIntegration,“VeteransPolicyResearchAgenda:FiscalYear2017”(2016),3.Accessiblefrom:http://www.va.gov/op3/docs/StrategicPlanning/FY_2017_Veterans_Policy_Research_Agenda.pdf

U.S.DepartmentofVeteransAffairsOfficeofEnterpriseIntegration,“VeteransPolicyResearchAgenda:FiscalYear2017”(2016),3.Accessiblefrom:http://www.va.gov/op3/docs/StrategicPlanning/FY_2017_Veterans_Policy_Research_Agenda.pdf

VACenterforInnovation,“VoicesofVeterans:IntroducingPersonastoBetterUnderstandOurVeterans”(2014),accessedinJanuary,2017,from:http://www.innovation.va.gov/docs/Voices_Of_Veterans_11_12_4.pdf

ViktorE.Frankl,Man’sSearchforMeaningBoston,Beaconpress,1959

WilliamBridges,Transitions:MakingSenseofLife’sChanges(Cambridge,MA:DaCapoPress,2004)

Williamson,V.,(2009),“SupportingOurTroops,VeteransandTheirFamilies:LessonsLearned&FutureOpportunitiesforPhilanthropy,”CaliforniaCommunityFoundation,LosAngeles.

Zoli,C.,Maury,R.,andFay,D.,(2015),“MissingPerspectives:Servicemembers’TransitionfromServicetoCivilianLife,”InstituteforVeteransandMilitaryFamilies,SyracuseUniversity,Syracuse,NY.