Medical Family Therapy in Military and Veteran Health Systems
The military is the largest employer in the United States, with more than 3.5 million personnel currently serving in the Department of Defense (DoD) active duty, coast guard, and reserve (DoD, 2014a, b). As of 2017, there were 1,298,017 DoD active duty Service members, of which 1,055,972 were enlisted, 229,869 were officers, and 12,176 were cadets-midshipmen (DoD, 2017). In the reserve component, there are a total of 813,037 reservists: 131,928 officers and 681,109 enlisted (DoD, 2017). Alongside the active duty population, it is estimated that there are currently over 22 million veterans in the USA (U.S. Census Bureau, 2012). Couple these figures with the number of partners and dependents/children of current or former Service members, and the opportunity for practitioners in medical family therapy (MedFT) to extend relational care to military and veteran populations grows exponentially. To give some perspective, approximately 54% of all military personnel are married, with higher rates for men (58%) than women (45%), and just over 11% of all active duty marriages as “dual marriages” (DoD, 2015). About 45% of those in a reserve component are married, with higher percentages in the Air National Guard (56%) and Air Force Reserve (55%) than as compared to the Marine Corps Reserve (27%) (U.S. Census Bureau, 2015). Of all current veterans, about 65% of men and 49% of women identify as married (United States Department of Veterans Affairs, 2017a). Further, 2.2% of active duty men and 10.7% of active duty women identify as lesbian, gay, or bisexual (LGB) (Gates & Newport, 2012). While the true number of LGB veterans is unknown, it is estimated that 3% of all LGB Americans are U.S. veterans. Approximately 15,500 of active duty Service members identify as transgender, with at least 134,000 veterans who identify as transgender (Gates & Herman, 2014). Whether partnered or not, there are approximately 1.2 million dependent children in active duty families and almost 744,000 dependent children in guard and reserve families (DoD, 2012). Behind each of these statistics is a face that is situated within multiple relationships, and whose biopsychosocial-spiritual (BPSS) health is determined—at least in part—by their likelihood to sustain a career with the military.
Glossary of Important Terms in Military and Veteran Health Systems
Active duty; refers to Service members who serve full time in the armed forces.
Air Force Alcohol and Drug Abuse Prevention and Treatment Program.
Army Medical Department of the United States of America; refers to the Army’s healthcare organization.
Army Substance Abuse Program; the anti-substance abuse program in the U.S. Army.
Behavioral Health Integration Program; the U.S. Navy’s model for embedding behavioral health providers into primary care settings.
Behavioral Health Optimization Program; the U.S. Air Force’s model for embedding behavioral health providers into primary care settings.
Bureau of Medicine and Surgery; the organization that manages healthcare services for the U.S. Navy and U.S. Marine Corps.
Common Access Card; the standard identification for active duty personnel, selected reserve, DoD civilian employees, and eligible contractor personnel. It also allows the card holder to have access to buildings, controlled areas, and DoD computer systems.
Comprehensive Airman Fitness; refers to the well-being of Airmen from a four-pillar approach (mental, physical, social, and spiritual).
Community-based outpatient clinics; created by the VA to expand healthcare services to veterans in rural areas and/or those without access to the larger VA medical centers.
Civilian Health and Medical Program of the Department of Veterans Affairs; refers to a health benefits program.
Army’s Comprehensive Soldier and Family Fitness; uses five areas (physical, social, family, spiritual, and emotional) to promote resiliency and performance enhancement in soldiers, their families, and civilians.
Defense Enrollment Eligibility Reporting System; the database of military members and their beneficiaries to receive TRICARE benefits.
A long-term assignment, often situated in a combat zone.
Department of Defense; a branch of the federal government that oversees national security and the U.S. Armed Forces.
Embedded behavioral healthcare providers; professionals who work in units to help in preventing behavioral health issues from becoming a serious issue for the Service member or unit. They tend to teach classes on behavioral health and coordinate referrals to those who have a need for specialty services.
The Navy’s Family Readiness programs that include services for work and family life, counseling, advocacy, and prevention, as well as sexual assault prevention programs.
Integrated Disability Evaluation System; a joint process between the Department of Defense (DoD) and Department of Veterans Affairs (VA) to determine if a Service members have sustained wounds that may prevent them from performing their duties and their ability to continuing serving in the armed forces.
Generic term used for a military facility (e.g., base, camp, post, fort, or station).
Medical Evaluation Board; recommends whether a Service member’s medical condition prevents him/her from performing assigned work duties.
Military Health System; the organization within the DoD that provides healthcare to active duty and retired military personnel and their dependents.
Military occupational specialty; code used to identify a specific job in the military.
Military sexual trauma; refers to sexual assault or repeated harassment that occurs during military service.
Military treatment facilities; military hospitals and clinics at military installations around the world.
Operation Enduring Freedom; began in 2001 when the U.S. military deployed to Afghanistan to combat terrorism. The conflict ended in 2014.
Operation Iraqi Freedom; began in 2003 when the U.S. military deployed to Iraq. The initiative ended in 2011.
Permanent change of station; the mandatory relocation of an active duty service member to a different duty location.
Post-Deployment Health Reassessment; a comprehensive health screening that examines physical and behavioral health concerns associated with deployment, 3 to 6 months after return from deployment.
Physical Evaluation Board; reviews the findings from the MEB to determine the Service member’s ability to perform his/her work duties.
Periodic Health Assessment; an annual health screen to evaluate medical readiness.
An official document that prohibits a Service member from certain types of military duty due to injury or disability; can be temporary or permanent.
Substance Abuse Rehabilitation Program; the anti-substance abuse program for all active duty members.
Army Soldier Centered Medical Home; the U.S. Army’s version of the patient-centered medical home (PCMH).
Temporary duty assignment; refers to a travel assignment to a location other than the permanent duty station.
The readjustment period of transitioning from military back into civilian life; also known as “reintegration.”
Someone who has served in the military.
Veterans Health Administration.
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