Cover: The Road to Reintegration

The Road to Reintegration

Status and Continuing Support of the U.S. Air Force's Wounded, Ill, and Injured

Published Nov 1, 2023

by Carra S. Sims, Christine Anne Vaughan, John A. Hamm, Brent Anderson, Angela Clague

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Research Questions

  1. What is the well-being of airmen who experience injuries and illness during Air Force service?
  2. What challenges impede injured, wounded, or ill airmen's reintegration into society in the long term?
  3. How can the Air Force improve services for wounded airmen?

The U.S. Air Force asked RAND Project AIR FORCE (PAF) to help assess the well-being of its wounded members and the quality of services provided to facilitate their recovery and reintegration. RAND PAF fielded a survey in the fall of 2016 to assess wounded airmen's functioning in the domains of physical health, mental health, interpersonal relationships, unemployment, and financial status, as well as their utilization and perceptions of Air Force nonmedical programs for wounded airmen. The authors of this report invited all 713 wounded airmen enrolled in the Air Force Wounded Warrior program to complete the survey, and 270 airmen (38 percent) completed it. One-third of airmen reported difficulty obtaining care for physical or mental health conditions, and one-quarter expressed dissatisfaction with coordination of care. Similar proportions of airmen reported barriers to care for physical and mental health conditions. Difficulty scheduling appointments was the most commonly endorsed barrier for both types of conditions. Small but notable proportions of airmen reported potential social support deficits, unemployment, and financial problems. For many of the Air Force's programs for wounded airmen, over 80 percent of program users reported overall program satisfaction. The authors recommend that the Air Force consider focusing on improving care coordination, increasing health care system capacity, continuing employment assistance, and improving marketing of programs with low uptake.

Key Findings

Wounded airmen report barriers to care; satisfaction with nonmedical care

  • Airmen receive healthcare in multiple locations, often in Military Treatment Facilities
  • About one-third of airmen reported difficulty in getting treatment over the past year
  • The most commonly endorsed barrier to obtaining physical and mental health care was difficulty scheduling an appointment
  • Other commonly endorsed barriers to obtaining physical and mental health care were not knowing where to get help or whom to see, belief in one's own ability to handle the problem, and belief that the available treatments are not very good
  • Specific to mental health care, concerns that friends, family, or coworkers would respect one less and concerns about being denied a security clearance in the future were endorsed as barriers to obtaining care by roughly one-third of airmen who reported having desired but not obtained treatment at some point in the past year
  • Airmen reported uneven coordination of care among providers
  • A substantial minority of airmen lacked a primary supporter to assist them in the recovery process
  • There is a high unemployment rate among non-serving airmen
  • Airmen reported high satisfaction with their nonmedical case management
  • Some programs for wounded airmen had low rates of uptake

Recommendations

  • Consider providing assistance from a professional with a designated care coordination role to improve care coordination outcomes.
  • Continue consideration of system capacity and navigability initiatives to address the complexity and lack of capacity of the health care system.
  • Continue efforts to collect and publicize data on the quality of care provided and engage airmen in discussions of treatment options.
  • Consider revising U.S. Department of Defense policies on the confidentiality of mental health treatment.
  • Connect airmen with social support deficits to available resources that provide social support and integrate family and friends into airmen's recovery process.
  • Continue providing employment assistance to transitioning airmen.
  • Continually assess the uptake and performance of new programs for wounded airmen and consider revisions or discontinuation as warranted.

Research conducted by

The research reported here was commissioned by the Assistant Secretary of the Air Force for Manpower and Reserve Affairs, the director of the Air Force Directorate of Services, and the Air Force Surgeon General and conducted by the Workforce, Development, and Health Program within RAND Project AIR FORCE.

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