Collateral Damage Floridians Coping with the Aftermath of War by hkksew3563rd


                                                       Number 68 | February 2011
                                                      Trusted Solutions for a Better Florida

                                               Collateral Damage:
                                  Floridians Coping with the Aftermath of War
    Rear Admiral
                                                           Dr. Susan A. MacManus
   LeRoy Collins Jr.                                   Distinguished University Professor,
                                                           University of South Florida

                                                              Dr. Susan C. Schuler
                                                  President, Susan Schuler & Associates, Inc.
                                    With the assistance of USF Honors College Undergraduate Students
                                                    Mary L. Moss and Brian D. McPhee

                                                             David Gulliver, Editor
                                               Foreword                        an exhaustive survey that went beyond
                                  After more than a decade of war involving    traditional polling and conducted focus
                               U.S. forces in Iraq and Afghanistan, there is   groups to obtain an “up close and per-
    This study is dedi-
                               a growing realization of the problems and       sonal” perspective.
cated to the memory
of an exemplary public         special needs of the Florida veterans who          The inescapable conclusion is that
servant who was tragi-         served there and                                                  much work remains
cally killed in July 2010                                                                        to be done to ensure
                               of the military
as the result of a traffic
                               personnel who                                                     that those problems
crash. Rear Admiral Le-
Roy Collins Jr. served         continue to                                                       are addressed and that
for nearly four years          serve, whether                                                    the needs are met. Al-
as Executive Director                                                                            though government at
                               on active duty or
of the Florida Depart-
                               in the Reserves                                                   all levels bears much of
ment of Veterans Affairs
(FDVA) after a long and        and National                                                      the responsibility and
distinguished career in        Guard.                                                            must perform better,
the U.S. Navy. At a time                                                                         there is a major role
                                  In addition, there has been a growing
when many govern-
                               realization of the collateral damage on the     for non-governmental entities: families
ment agencies tend to
be defensive when an           home front as military personnel and their      and friends, of course, but also private
outside entity conducts        families cope with the aftermath of war.        philanthropy. Indeed, there is reason to
research that could in-                                                        believe that the non-profit private sector
                                  To gain a better understanding of the
clude an evaluation the
agency’s performance of        problems and a better assessment of             is uniquely qualified to deliver needed
its duties, the FDVA was       the needs, The Gulf Coast Community             services efficiently at the community
unfailingly cooperative.       Foundation of Venice and The James              level, complementing the government
The authors of this study                                                      programs in a concerted effort to solve
                               Madison Institute partnered to commis-
very much appreciate
his leadership.                sion the study discussed in this report. It     the problems and meet the needs. These
                               included a first-in-the-nation component:       brave men and women deserve no less.
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                      Dr. Marshall DeRosa, Professor of Political Science, Florida Atlantic University
                            Dr. Thomas V. DiBacco, Professor Emeritus, American University;
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                       Collateral Damage:
          Floridians Coping with the Aftermath of War
Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

       Where they have fallen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
       Florida’s major role in the Iraq and Afghanistan conflicts . . . . . . . . . . . . . . . . . 6
       Charities step in, with support from a silent benefactor . . . . . . . . . . . . . . . . . . . 7

Key Findings: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
43 grants to 26 nonprofit organizations have been awarded through the Florida
BRAIVE Fund by Gulf Coast Community Foundation in a 25-county area: . . . . . . . . . 9
Grants made collaboratively to ensure statewide coverage. . . . . . . . . . . . . . . . . . . . .11

Issue Briefs and Stories
       Brief 1: The invisible injuries of a new kind of war . . . . . . . . . . . . . . . . . . . . 12
       Story:     Saving Jose: A mother and sister sacrifice to save a soldier with TBI . . 13
       Brief 2: Stresses of war lead to problems in the home. . . . . . . . . . . . . . . . . . . 15
       Story:     Sgt. 1st Class. Kenneth Lovett in Qatar,
                  comforting aid for his wife at home . . . . . . . . . . . . . . . . . . . . . . . . . . 16
       Story:     A new battle: A combat veteran fights brain injury and
                  red tape to rebuild his life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
       Brief 3: Trained as soldiers, they see few jobs, many challenges . . . . . . . . . . . 18
       Story:     To protect and serve, again: Reserve mom
                  hopes to become deputy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Recommendations and Key Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

       Components of the Gulf Coast Community Foundation’s research project. . . . . .29
       Analysis of BRAIVE Agency Administrator Perspectives . . . . . . . . . . . . . . . . . .29
       Veteran Focus Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29
       Family Focus Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29
       Florida Veterans Issues Statewide Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30

APPENDIX B:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31

                                Executive Summary

       The purpose of this report is to document and recommend ways of helping our
    servicemen, servicewomen, and their families re-establish peaceful, productive
    lives during wartime.
       The research funded by Gulf Coast Community Foundation through its
    BRAIVE Fund has shown that Floridians applaud Iraq and Afghanistan vet-
    erans’ service and want them and their families to receive needed assistance
    as they deploy, then reintegrate. They also show that veterans appreciate that
    support, but are concerned that the public is tiring of the conflicts and that
    support for the troops serving in these theaters may be short-lived.
       Veterans interviewed are not always receiving the government benefits
    they have earned. In part, this is because of an institutional belief that they
    should be able to handle most of their own problems. After separation, there
    is sometimes a reluctance to register with the Department of Veterans Affairs.
    Consequently, when problems eventually emerge, many do not know where
    to turn for help, nor understand the benefits to which they are entitled.
       Obstacles to getting treatment for mental health issues, including post
    traumatic stress disorder (PTSD) and depression are more formidable than
    receiving other benefits because military personnel do not want to admit a
    personal weakness. They also strongly believe that both their military and
    post-military careers will suffer if treatment for PTSD is on the record.
       Family reintegration is another serious concern, as returning deployed
    active duty military and those separating from military service grapple with
    reestablishing ties with their spouses and children. Veterans generally accept
    that they are the ones who need to adjust and fit in.
       For the veterans returning home and looking for employment, finding a
    job is extremely difficult and frustrating, and worsened by the recession and
    Florida’s higher-than-the-national average unemployment rate. Unemployment
    amplifies problems related to family reintegration.
       Veterans are aware of care packages sent to them when on deployment;
    they appreciate personal messages from civilian adults and school children.
    But their awareness of not-for-profit support agencies is low. Few are able to
    name any nonprofit other than the Red Cross.
       At a time when government’s abilities are limited, it is imperative that
    services provided by local non-profit organizations reach those in need. It is
    also important that local residents’ support for and involvement in such efforts
    is strengthened. Success depends upon finding more effective ways to spread
    the word.about available services.

       That is not to absolve government agencies of their duty to improve their
    services; in many cases, pilot programs already have identified
    how to do a better job within their current resources. However,
    this isn’t to say that there may not be a need at some point to
    expand what the Department of Defense and the Department
    of Veterans Affairs provide, in order to cope with the increased
       It is important to note that in the statewide survey, 92
    percent of Floridians said assistance for Iraq and Afghanistan
    veterans was “very important.” And 50 percent or more said
    they believed the federal and state Veterans Affairs agencies,
    county and city governments and the media needed to do more
    to help the returning veterans.
       Those figures indicate there is broad-based support for efforts
    to improve services for veterans. They suggest an opportunity
    for policy-makers to restructure and increase support for these
    programs, even at a time when other initiatives might see
    considerably less support.

               Introduction                      sheriff’s deputy, but cannot find the money
                                                 to pay for training.
   The purpose of this report is to docu-           In North Port, a former Army Ranger who
ment and recommend ways of helping               fought in Iraq and Afghanistan now wants
our servicemen, servicewomen, and their          to train for a career in nursing, but lost his
families re-establish peaceful, productive       tuition support when injuries in a car crash
lives during wartime.                            caused a break in his college enrollment.
                                                    In Zephyrhills, an Army wife and mother
                                                 of seven searches for help when her air
        Where they have fallen
                                                 conditioning fails, her husband is thousands
                                                 of miles away and they have too little money
   Near Tampa, a Marine who returned to
                                                 for repairs.
service as a National Guardsman lies in a
                                                    Stories like these can be found every-
bed, his skull shattered by a rocket-propelled
                                                 where in Florida, where thousands of
grenade. Beside him are his mother and
                                                 servicemen and servicewomen and their
sister, who gave up jobs, college, and a
                                                 families have returned after heeding their
home to help him fight for his life.
                                                 country’s call to fight terrorism and aid
   In Bradenton, a young mother and
                                                 fledgling democracies. And too many have
National Guardsman who drove convoys in
                                                 been themselves left seeking help when
Iraq now hopes to serve her hometown as a
                                                 government programs failed them.

                     As they lost hope, however, charities        members in the service past their expected
                  stepped in to meet their needs, filling the     discharge dates.
                  gaps that government programs did not an-          And in 2007, as coalition members
                  ticipate. The experiences of those charities,   withdrew their troops, the United States had
                  and of the people they have aided, provide      to press its military for another 20,000-plus
                  a clear mandate for how the country must        troops, part of a strategy that became known
                  improve the support it provides to those        as the surge.
                  who have given the most.                           When OIF officially ended, on Aug. 31,
                                                                  2010, more than 4,400 U.S. troops were
                         Florida’s major role in the              killed. Nearly 32,000 more were wounded,
                      Iraq and Afghanistan conflicts              often returning home with grievous injuries.3
                                                                                     Meanwhile, Operation
                     The citizens of Florida                                      Enduring Freedom, which
                  have provided a major por-                                      began with combat in Af-
                  tion of U.S. forces.                                            ghanistan after the Sept. 11
                     More than 22,400 Flo-                                        terrorist attacks, entered an
                  ridians have served in the                                      expanded phase.
                  active-duty military in Opera-                                     As in Iraq, coalition troops
                  tion Iraqi Freedom and Op-                                      initially routed the opposi-
                  eration Enduring Freedom.1                                      tion, but now are fighting a
                  Nearly 2,000 have been                                          growing insurgency. Some
“To date, more    wounded. Florida also has                                       American troops who fought
    than 1,300    sent nearly 22,000 National                                     long campaigns in Iraq are
    U.S. troops   Guard members to the two                                        now being redeployed to
     have been    combat theaters.2                                               fight the Taliban. To date,
                     Operation Iraqi Freedom began March          more than 1,300 U.S. troops have been
     killed and
                  20, 2003, as some 248,000 U.S. soldiers led     killed and another 9,800 wounded.4
 another 9,800    the invasion of Iraq, with another 47,000          Florida also has served fallen soldiers
    wounded.”     troops from partner nations.                    from all across America. The state is home
                     In less than three weeks they broke the      to 13 military installations and Tampa’s
                  Iraqi military, swept the country and cap-      James A. Haley Veterans’ Hospital, the busi-
                  tured Baghdad with minimal losses. But OIF      est of the Veterans Affairs trauma centers,
                  went on for another seven and a half years,     with services from cardiac and spinal cord
                  as coalition forces — in the end, almost        surgery to pain management and mental
                  exclusively American — battled an elusive       health care.
                  insurgency that fought from shadows and            The returning troops return with needs
                  ambushed them with improvised bombs.            unlike those seen after other wars. They
                     With a smaller, volunteer force and the      have served longer deployments — 14 or
                  war’s long duration, the military was forced    15 months at a time, compared with the
                  to press its members into more and longer       common year or less in Vietnam or Kosovo.5
                  deployments than it had in Vietnam. It          And they were much more likely to have
                  also employed stop-loss orders, keeping         served in multiple deployments — three is

common, and many report five or more.6           Gulf Coast Community Foundation of Ven-
   And the wounded are returning with            ice. Together, they established the Florida
more grievous injuries, both because of the      BRAIVE Fund, intended to support the
enemy’s use of powerful roadside bombs           state’s population of military and National
and because advanced medical care has            Guard personnel and families.
allowed many to survive wounds that would
have been fatal a decade ago.
   In all, it combines to place never-before-
seen stresses on the veterans, their families,
and those who care for them.

    Charities step in, with support
      from a silent benefactor

   In 2006, recognizing that government
agencies were inadequately supporting
returning troops, the California Community                                                      “The $250
Foundation established the Iraq Afghanistan                                                     million
Deployment Impact Fund (IADF).
   The $250 million program resulted
from an anonymous donation, and the
donor’s identity would remain a secret for                                                      from an
three years. But in 2009, the publicity-shy                                                     anonymous
California philanthropist David Gelbaum                                                         donation, and
reluctantly confirmed he was the source of
                                                                                                the donor’s
the IADIF funding.
    In the meantime, IADIF began its nation-        The foundations divided the state into      identity would
wide program. It built relationships with the    three geographic regions where they would      remain a
Department of Defense and Department of          best invest their respective $5 million.       secret for three
Veterans Affairs. It funded groups that sup-        Over two years, Gulf Coast Commu-           years.”
port military personnel and families, both       nity Foundation provided grants to 26
during and after deployment. It supported        organizations, from proven groups like the
research on the challenges facing veterans       American Red Cross to Operation Helping
and volunteer networks to help veterans          Hand, a small grassroots organization that
find what they need. And it proved that          covered the costs of families traveling to
charities could step up to meet the needs        visit wounded service members in Tampa’s
that government did not or could not fulfill.    James A. Haley Veterans Hospital.
   And in 2008, the fund, trusting communi-         This report summarizes research from
ty-based charities to best know local needs,     several sources, primarily the Iraq Afghani-
awarded $5 million grants to three Florida       stan Veterans Association, the California
foundations: the Miami Foundation, the           Community Foundation, and RAND Cor-
Community Foundation in Jacksonville, and        poration.

                        It also provides Florida-based research     congruent work from other organizations
                     based upon:                                    to recommend ways of helping our service-
                        •	 a statewide telephone survey of          men, servicewomen and their families
                             Florida residents,                     re-establish peaceful and productive lives
                        •	 a focus group with OEF/OIF veterans      during wartime.
                        •	 a focus group with OEF/OIF veterans’        Ultimately, devising effective programs
                             families                               for deployed and returning military service
 importantly,           •	 interviews with the directors of non-    members and their families depend on
     this report             profit groups that received BRAIVE     understanding the unique nature of these
offers five key              fund grants.                           war and the difficulties with reintegration
   findings on          Most importantly, this report offers five   it causes. We discuss those difficulties in
                     key findings on how the wars in Iraq and       the following issue backgrounders and
how the wars
                     Afghanistan still affect Floridians. The       profile stories.
   in Iraq and       findings draw upon the four studies and
      still affect
                                                          KEY FINDINGS:

                       1. Veterans and their families report stresses when the service member returns
                          home. But a stigma attached to mental health care makes reluctant to seek
                          help; when they do, counseling and other services can be difficult to access.

                       2. Returning service members face major difficulties finding post-military
                          employment and obtaining services in spite of a new GI Bill.

                       3. Veterans, who typically come from a military culture that emphasizes self-
                          reliance, often go without the help they need -- either because they lack
                          confidence in government agencies or are unaware of services.

                       4. Private, local not-for-profit organizations can play a vital role by offering
                          help that governments cannot or do not provide. Veterans find those
                          services valuable, but they are often unaware of what’s available. There
                          is limited communication between private groups and government, and
                          some nonprofit leaders have expressed concerns about their organizations’
                          inability to provide ongoing services for veterans because of special needs
                          and lack of steady revenue.

                       5. In assessing needs in order to prepare recommendations for local action,
                          service providers can benefit by obtaining information not only from those
                          being directly served, but also from their wider interpersonal networks –
                          family members, friends, and others.

 43 grants to 26 nonprofit organizations have been awarded through the Florida
     BRAIVE Fund by Gulf Coast Community Foundation in a 25-county area:

AVET Project, $25,000
  Providing deployed service members in Afghanistan and Iraq with a gender-specific
Empowerment Equipment Bag to meet their immediate need for basic hygiene items.

BayCare Behavioral Health, $52,468
   Providing counseling services for families of veterans and military personnel experiencing
transitory adjustment problems, behavioral problems, or substance use issues.

Charlotte Behavioral Health Care, $100,000
  Addressing mental health, substance use, and related psychosocial needs of veterans
and their families.

Civilian Military Community Foundation, $30,000
   Providing assistance with childcare costs resulting from deployment to Iraq or Afghani-
stan, and to support community-building dinners at reintegration seminars for returning
reservists and their families in Brevard County.

Community Legal Services of Mid-Florida, $30,000
   Expanding the current veterans’ project to target outreach, education, and free legal
representation of Operation Iraqi Freedom and Operation Enduring Freedom Veterans in
Brevard, Orange, and Seminole counties without regard to income.

Florida Gulf Coast Paralyzed Veterans of America, $68,768
   Converting a vacant 1,000-square-foot building into a wheelchair-accessible, all-purpose
activities facility for veterans and their families.

Genesis Health Services, $85,000
   Supporting collaboration with Manasota’s Operation Troop Support to provide counsel-
ing, financial assistance, and other help to military service members and their families in
Manatee and Sarasota counties.

Gulfcoast Legal Services, $95,000
   Providing legal assistance and education for veterans to ensure they receive the benefits
for which they are eligible.

Haley House Fund, $165,000
   Providing temporary lodging to the families of active-duty military personnel being
treated for life-threatening injuries and diseases at James A. Haley Veterans’ Hospital and
Polytrauma Unit in Tampa.

     Jewish Family and Children’s Service of Sarasota-Manatee, $400,000
       Providing homelessness prevention case management, mental health counseling, and
     emergency financial assistance to military families.

     Military Spouse Corporate Career Network, $124,500
       Providing targeted, focused, and intensive employment support services to military
     family members affected by Operation Iraqi Freedom and Operation Enduring Freedom.

     Manasota Operation Troup Support (With collaboration/Jewish Family
     and Children’s Service of Sarasota-Manatee, Inc.) $179,700
       Developing a service center to provide services not available through the military or
     veterans’ organizations in Manatee and Sarasota counties, and to advocate for military
     personnel as they return from deployment and re-enter civilian life.

     Operation Helping Hand, $80,000
        Providing travel and other expense for family members to visit wounded or injured
     active-duty military patients being treated at James A. Haley Veterans’ Hospital.

     Operation Homefront, $60,000
       Providing emergency financial assistance to help military families with mortgage pay-
     ments, home or car repairs, healthcare, utility bills, and other essential living expenses.

     Quantum Leap Farm, $628,566
       Promoting and improving physical, mental, and social well-being for disabled veterans
     and active military personnel by engaging them in a variety of equestrian activities.

     Seminole Behavioral Healthcare, $49,479
       Providing treatment and early intervention services for troops who have significant
     mental health or substance use issues.

     Special Operations Warrior Foundation, $500,000
       Providing immediate financial assistance for special operations personnel who have been
     severely wounded, to have his/her family travel and be bedside.

     State College of Florida Foundation, $219,775
       Creating a globally accessible, multimedia Web site to help
     veterans of the wars in Iraq and Afghanistan and their families prepare for and access
     postsecondary education.

     Tampa Area Marine Parents Association, $21,000
        Purchasing and distributing The Wounded Warrior Handbook with information on medi-
     cal treatment, rehabilitation, counseling, and support to all eligible Marine service members.

Twelfth Judicial Circuit Court of Florida, $50,000
  Providing case management for the Courts Assisting Veterans program in Manatee,
Sarasota, and DeSoto counties.

Veterans Plus $180,132
  Providing educational outreach initiatives and financial education service options to

Welcome Home Vets, $235,500
   Providing counseling and other clinical services for returning veterans and their families,
care packages to overseas troops, and outreach efforts to improve the community’s sensitivity
to the needs of veterans.

WorkNet Pinellas, $150,000
  Providing training and employment to veterans of Operation Iraqi Freedom and Operation
Enduring Freedom.

           Grants made collaboratively to ensure statewide coverage

American Red Cross – Tampa Bay Chapter, $790,500
   Providing assistance, including direct emergency financial relief, to soldiers and veterans
of Operation Iraqi Freedom and Operation Enduring Freedom and their families.

Florida National Guard Foundation, $325,056
  Providing emergency financial assistance to personnel of Operation Iraqi Freedom and
Operation Enduring Freedom.

James Madison Institute, $105,000
   Identifying and clarifying why there are still unmet needs faced by deployed and returning
military personnel and their families with recommendations for filling these gaps in honor
of our communities’ obligation to our military heroes, and with a special emphasis on the
important role of private philanthropy and non-profit groups in complementing government
programs and providing efficient delivery of needed services at the community level.

United Way of Florida, $50,000
   Providing capacity for the Florida Alliance of Information and Referral Services to create
a statewide network of call centers with live, 24-hour crisis counseling, and a searchable,
online database of services for Operation Iraqi Freedom and Operation Enduring Freedom
military personnel, veterans, and their families.

                    FIRST ISSUE BRIEF:                                mates more than 320,000 service members
                    The ‘visible and invisible injuries’              have a probable TBI.8
                    of war
                                                                         Post-traumatic stress disorder (PTSD),
                       The counter-insurgency efforts in Iraq         recognized for decades as “shell shock,”
                    and Afghanistan resulted in an unprec-            is a psychological condition that develops
                    edented use of improvised bombs, devices          after a person experiences a traumatic or
“But thousands      that struck with terrible force but little        life-threatening event. Symptoms include
  more suffered     precision.                                        persistent memories of the trauma, height-
   damage that         Two-thirds of all injuries in Operation        ened alertness, nightmares, insomnia and
      is usually    Iraqi Freedom are blast-related.                  irritability. Depression may express itself as
                       Coalition forces, though, had access to        persistent sadness, irritability, changes in
                    medical skills and systems, and time and          sleep or appetite, difficulty in concentrating
     but no less    again saved the lives of soldiers who just a      and feelings of guilt or hopelessness.
   devastating,     decade ago would not have survived. Thou-            The conditions come from wounds that
       a class of   sands of servicemen and servicewomen              sometimes draw no blood and leave no
         wounds     returned home with grievous injuries,             scars. Bomb blasts cause percussive waves
                    recognizable in an instant: missing limbs,        that can bruise the brain, strain neurons
                    burn scarring, and paralysis.                     or tear blood vessels, all without leaving
      known as         But thousands more suffered damage that        a mark. Victims can develop neurological
        invisible   is usually invisible but no less devastating, a   problems long after the event, and are at
        injuries:   class of wounds becoming known as invis-          greater risk of Alzheimer’s and Parkinson’s
      traumatic     ible injuries: traumatic brain injury, post-      diseases. And invisibility is a major problem:
                    traumatic stress disorder, and depression.           Studies show that nearly six out of 10
   brain injury,
                                                                      military personnel reporting probable TBI
 post-traumatic              Traumatic Brain Injury                   are not evaluated for it.9
           stress      The best-known, perhaps, is trau-                 TBI also is closely linked to depression
  disorder, and     matic brain injury (TBI). It became               and PTSD, according to a landmark 2008
   depression.”     better known after a bomb nearly killed           RAND study, which found that each condi-
                    ABC television reporter Bob Woodruff,             tion affected about 14 percent of returning
                    embedded with a unit in Iraq. Staff Sgt.          veterans.10 And the problem grows with time:
                    Jose Pequeno (next featured story), now              A study of 80,000 troops, published in
                    living near Tampa, also suffered a TBI and        the Journal of the American Medical As-
                    is perhaps the Iraq war’s most seriously          sociation in 2007, found 17 percent screened
                    injured soldier to survive. At least 5,500        positive for mental health problems shortly
                    servicemen have suffered TBIs in the Iraq         after returning from combat, but six months
                    and Afghanistan wars.                             later, that rate had climbed to 30 percent. 11
                       Service members have suffered 195,547             Depression and PTSD are treatable by
                    TBI cases from 2000 through November              psychotherapy, where a therapist helps the
                    2010, more than 35,000 classified as mod-         patient learn to think about the traumatic
                    erate, severe or penetrating, the Defense         event without experiencing stress. Medica-
                    Department reports.7 An outside study esti-       tions can treat the symptoms of PTSD but

   Saving Jose: A mother and sister sacrifice to save a soldier with TBI

  Nellie Bagley never forgets the promise she made to her son, as he struggled to
survive the massive brain injury he suffered in Iraq.
  Staff Sgt. Jose Pequeno was in Bethesda Naval Hospital, three days after a rocket-
                             propelled grenade exploded next to him on the streets
                             of Ramadi. Jose was in a coma. Doctors told Nellie he
                             would die. But she and Jose’s sister Elizabeth, sitting
                             at his bedside, told Jose of their faith and hope:
                                “We told him, if you want to let go, we still love
                             you and we will see you again. But if you choose to
                             fight we will never leave your side.”
                                And they didn’t, for almost three years, through
                             21 surgeries, until Jose came home. They kept the
                             promise with help from many charities, including
                             Tampa-based Operation Helping Hand, which is
                             supported by grants from Gulf Coast Community
                             Foundation’s BRAIVE Fund.
                                “They took care of my bills. They took care of flying
my grandkids. They allowed my daughter to fly back and forth to New Hampshire,”
Nellie says. “Helping Hand has been a godsend for us.”
  Jose chose to go to Iraq. He served in the Marines, and then became a police
chief in a small town in his home state of New Hampshire. He enlisted in the
Army National Guard. And when the Guard needed volunteers to fill gaps in a
Pennsylvania regiment, he volunteered.
  He believed his experience might make a difference. “I can help those kids come
home to their families,” Nellie remembers him saying.
  “What do you say to that?” she asks now. “You bless him and let him go.”
  By March 1, 2006, he had been in Iraq for more than nine months. Jose was
patrolling a main road in Ramadi, riding in the front passenger seat of a military
Humvee, when bullets and rocket-propelled grenades started flying.
  One grenade sailed in and exploded by his left side, killing the driver instantly.
Jose had just opened his door, and the blast threw him from the vehicle. Medics
believe that’s what saved him, but they didn’t realize it at first.
  They arrived within 90 seconds and found him with his head blown open,
brain tissue in the sand. They thought he was dead, and moved on to care for
the Humvee’s wounded gunner. Then they heard Jose choking on his blood and
rushed to his side.

                      At about 1 p.m., Nellie got the phone call telling her Jose had been hurt and
                   was headed to surgery. Three days later, the family saw him at Bethesda, and they
                   made their promise.
                      He rallied, first for a day, then a week. All that time, either Nellie, Elizabeth,
                   Jose’s wife Kelley, or another family member was there. “He chose to fight, and
                   we have never left his side,” Nellie says.
                      Neurologists have learned that the brain is a remarkable organ. In people who
                   have had radical surgery, even with half the brain removed, the organ rebuilds
                   connections and redevelops functions believed to be associated with the missing
                   portion of the brain.
                      Doctors believe that is happening in Jose. In November 2009 and April 2010,
                   they performed surgeries that used a muscle from his back and bone from his skull
                   to reconstruct the brain cavity. They hope that by creating space and relieving
                   pressure in his skull, it will allow his brain to keep healing and rewiring itself.
                      Gradually, painfully, the improvement is coming, Nellie says. Jose, now 36, com-
                   municates with facial expressions and groans, which sometimes sound like names.
                   He recognizes friends and family members, and responds to their communication.
                      Jose’s children — daughters Mercedes, 15, and Alexandria, 13, and son Gaige,
                   12 — spent this summer with their father in Tampa. Jose recognized them, tracked
                   them with his eyes, and smiled at them.
                      In late August, when they left for the airport to return to their mother in New
                   Hampshire, they saw perhaps the truest sign of what Jose still thinks and feels,
                   and what may be to come.
                      “His eyes got red and teary,” Nellie says. “But not until they left did the tears
                   come rolling down.”
                      According to several published accounts, Jose is the most grievously wounded
                   soldier to return from Iraq. His case, and his family’s remarkable support, has
                   drawn attention: Nellie has been to the White House twice.
                      But the encounter she cherishes most came during a long day in Bethesda,
  “The country     waiting for Jose to emerge from treatment. Vice President Joseph Biden and his
                   wife, Dr. Jill Biden, came in to visit families. The Bidens asked Nellie to dinner.
 needs to build
                   She accepted, but when Jose’s fever spiked, she called to decline the invitation.
 better support       Later that night, she said, Mrs. Biden returned to the hospital, without the usual
    systems for    entourage, but with plates of food for Nellie, Elizabeth, and -- not knowing his
        both the   condition — for Jose.
                      Nellie, humble, says the encounters have allowed her to spread her message:
  veterans and     The country needs to build better support systems for both the veterans and their
their families.”   families. “When an injury like this happens, it doesn’t just happen to the soldier,”
                   she says. “It affects the entire family.”

do not cure the cause of the injury.            itself. Some two million children have
   But military culture and poor follow-up      experienced a parent’s deployment.14 In
mean most troops do not get that treatment.     one study of Iraq and Afghanistan veterans
By one study, more than half of those           seeking behavioral health care, almost one
screening positive for PTSD or depression       quarter said their children seemed distant
do not seek help.12                             or afraid of them.15

SECOND ISSUE BRIEF:                                       Alcohol and Drugs
Stresses of war lead to problems in                Alcohol and drug abuse is increasing
the home                                        and going untreated. On post-deployment
   The wars in Iraq and Afghanistan have        forms, 12 percent of soldiers report alcohol   “In one study
placed unique stresses on the men and           problems, but less than 1 percent of them      of Iraq and
women serving in the United States military.    were referred to treatment — again, because    Afghanistan
During the Vietnam War, a draft supplied        of career ramifications.16                     veterans
the military with new manpower, allowing           As of 2008, some 7,400 Iraq and Af-
                                                ghanistan veterans have been treated at VA
single, shorter tours of duty.
   But today’s all-volunteer force has been     hospitals for drug addiction, 16,200 have      behavioral
pressed into multiple deployments — three       been diagnosed with alcohol dependence,        health care,
or more is common — and with slightly           and 27,000 have been diagnosed with            almost one
longer durations and less down time             excessive drug use.17                          quarter said
between missions than the military has
                                                             Homelessness                      their children
typically recommended.13
   It means that troops are trained in boot
                                                    Studies show that veterans whose PTSD      seemed distant
camp to perform their duties, but receive
                                                goes untreated have a greater chance           or afraid of
                                                of becoming homeless. Homelessness
no training, no “de-boot camp,” to allow                                                       them.”
                                                plagues the entire veteran population — in
them to adjust and prepare for their return
                                                2009, some 107,000 were homeless on any
to civilian life.
                                                given night, and more than half had been
   They go from deployment, where fellow
                                                homeless for 12 months or more.18 And the
soldiers have clearly defined roles, support-
                                                problem may be growing more acute.
ing each other, to home, where roles are
                                                    More than 3,700 veterans of Iraq and
fluid, but others are largely dependent on
                                                Afghanistan have been seen through VA’s
the veteran. In the field, they must respond
                                                homeless outreach program.19 The head
immediately, and often with force, to any
                                                of VA’s homeless programs said Iraq and
provocation; at home, they must forego
                                                Afghanistan veterans were entering the
what has become almost instinct
                                                homeless population within 18 months
   It’s little wonder, then, that returned
                                                of discharge, faster than with previous
troops display signs of everyday stress at
                                                wars.20 The nation’s housing collapse has
greater rates and with more dire conse-
                                                contributed, as foreclosures were running
quences than ever, and far more than their
                                                four times the national average in military
civilian counterparts.
                                                communities. 21 And it should come as
   The place that should be their refuge
                                                little surprise that studies show PTSD and
— their home — often is a source of stress

                      For Sgt. 1st Class Kenneth Lovett in Qatar,
                         comforting aid for his wife at home

        In Qatar, where Sgt. 1st Class Kenneth Lovett was deployed with the Army
     National Guard, 153rd Cavalry, Bravo Troop, the early August heat peaked at
                           107 degrees.
                              Back home in Zephyrhills, temperatures topped out at just
                           98 degrees. But his wife Amanda was stuck at home with
                           their seven children, including year-old Katherine — and
                           the air-conditioning had broken down.
                              “I hate playing the helpless female,” Amanda said, “but
                           as soon as he left, every single appliance started breaking
                           down left and right.”
                              The trouble began in January, when heating ducts started
                           falling apart. Then the well pump, which supplies water
                           to their home, failed. Kitchen sink plumbing cracked and
                           flooded the kitchen. Then the dishwasher went. And finally,
                           in late July, the air-conditioning system sprung a major Freon
                           leak, damaging it beyond repair.
        And if having no respite from the sweltering heat wave wasn’t stressful
     enough, the series of repair jobs had wiped out their financial reserves. “When
     the air-conditioning went, we were at the bottom of the barrel,” Amanda said.
     “There was nothing left. We were neck-deep in credit cards.”
        She began trying all the usual sources of help, like the Army Emergency Relief
     program. But the organization no longer covers home repairs.
        From Qatar, Kenneth suggested calling the local Army Family Readiness Group,
     which pointed her to the Tampa Bay chapter of the American Red Cross. There
     she found Ruby Smith.
        As a Red Cross coordinator of service to the armed forces, Smith could tap the
     chapter’s $250,000 grant from Gulf Coast Community Foundation of Venice BRAIVE
        Gulf Coast’s BRAIVE Fund helps families and service members who have been
     deployed to Iraq and Afghanistan, where Kenneth had been deployed in 2006. Smith
     verified his service, then asked Amanda to put together a budget and estimates
     from three companies.
        Amanda found a company that said it could do the work for $4,200. The firm
     sent the estimate to Smith at the Red Cross office, who in turn responded with a
     check for $3,000. With some juggling, Amanda swung the rest of the cost, but the
     Red Cross support through the BRAIVE Fund made it possible. Government did
     not have the help they needed.
        “It was a blessing,” Amanda said. “I don’t know what we would have done
     without it.”

                            A new battle:
   A combat veteran struggles with TBI and red tape to rebuild his life

   Sgt. Brock Horner took on some of the most dangerous jobs of Operation Iraqi
Freedom and Operation Enduring Freedom.
   In the first week of the Iraq war — March 26, 2003, Brock says with precision
— he parachuted into Iraq with the 173rd Airborne Brigade. They
seized Bashur Airfield, then secured the city of Kirkuk. On later
patrols, searching for insurgents, Brock stormed through doors,
never knowing what waited on the other side.
   But in the brigade’s next deployment, the enemy found him.
In Afghanistan, a rocket-propelled grenade struck his Humvee,
putting him in the military hospital in Landstuhl, Germany for
18 days.
   It may be his long road to health that has inspired Brock’s plans
for his future. Now 25 and living in North Port, he is studying
to be a nurse anesthetist, thanks to financial support from Gulf
Coast Community Foundation of Venice BRAVE Fund through the
support of Jewish Family and Children Services.
   At Landstuhl, he had surgery on his face and mouth, and CT scans to check for
internal trauma. It wasn’t until then that he and his superiors realized Brock had
suffered some form of brain injury. It manifested as headaches, a wracking pain
that left him unable to even open his eyes. He struggled on for six months, finally
receiving a medical discharge in 2007 and returning to Florida.
   Doctors learned oxygen therapy could reduce the frequency and intensity of the
headaches, and Brock soon was able to begin school at State College of Florida.
But a car accident in September 2009 forced him to miss classes and exams, and
the resulting poor grades cost him his financial aid.
   He spent his savings on the spring 2010 semester, hoping that would re-qualify
him for aid. But under a GI Bill technicality, he would not be eligible again until
he completed his associate’s degree. Frustrated, he dropped out and occasionally
drank to excess. At one point, he was arrested and charged with misdemeanor
disorderly conduct.
   A judge agreed to withhold any conviction as long as Brock continued his work
and counseling at Manasota Operation Troop Support. There, he learned about
Jewish Family and Children’s Service and its Operation Military Assistance program.
   With financial support from Gulf Coast’s BRAIVE fund, the program paid Brock’s
tuition and charges for his summer and fall classes at State College of Florida,
about $4,500. With that support, he completed the requirements for his associate’s
degree in August — including perfect 4.0 grades in algebra and statistics.
   “I needed this,” said Brock, who, like many veterans, is reluctant to accept
assistance. “I wouldn’t have graduated without it.”

                  TBI — when untreated — lead to increased         among non-veterans. 28 But the rate for
                  chances of family problems, drug abuse,          young male veterans, 24 or younger, was
                  and suicide.22                                   about 22 percent — more than one in five,
                                                                   and greater than among non-veterans.29
                                    Suicide                           The jobs of reserve and Guard members
                     Suicide among military personnel is
                                                                   are protected by the Uniformed Services
                  perhaps the greatest tragedy of the wars.
                                                                   Employment and Re-employment Rights
                  The military suicide rate has increased
                                                                   Act (USERRA), and joblessness is far lower,
                  every year since 2004, and the Army and
                                                                   but they too face problems. More than 40
                  Marine suicide rate now exceeds that of
                                                                   percent see income fall while deployed30
                  the civilian population. 23 From 2005 to
                                                                       A Congressional study found that among
   “From 2005     2009, more than 1,100 service members
                                                                   Guard and Reserve members deployed since
       to 2009,   took their own lives — 309 in 2009 alone.24
                                                                   September 2001, 11,000 were not promptly
     more than    In September, Secretary of Defense Robert
                                                                   re-employed, 22,000 lost seniority, pay, and
                  Gates called suicide prevention a top issue
  1,100 service                                                    benefits, and 11,000 lost health insurance.31
                  facing the military, noting the issue of the
 members took     stigma attached to mental illness and PTS.25
                                                                      In another study, about 47 percent of
                                                                   Reserve and Guard members who had jobs
their own lives
                                                                   before deployment, but received unemploy-
— 309 in 2009     THIRD ISSUE BRIEF:
                                                                   ment after their return, said they had been
                  Trained as soldiers, they see few
        alone.”   jobs and many challenges                         laid off or not offered a job.32 Three-quarters
                                                                   did not seek the protections available by
                     Business schools’ management programs         law.33 Those who knew of their protections
                  teach problem-solving, decision-making,          often chose not to fight: Claims typically
                  teamwork, leadership — all of them skills        take almost two years to resolve.34
                  military personnel put into practice daily.         Female veterans have even more post-
                     But when they return from deployments in      military challenges than their male coun-
                  Iraq and Afghanistan, many are finding their     terparts. They earn about $10,000 a year
                  skills carrying no weight in the civilian job    less than male veterans, and they have
                  market. While a struggling national economy      significant problems finding jobs with sala-
                  certainly plays a role, returning service mem-   ries equivalent to their military earnings.35
                  bers face their own distinct challenges.            The new GI Bill, passed in 2008, greatly
                     Employers often do not understand how         improved educational benefits for veterans,
                  military skills and experience translate to      but it still has some weaknesses: It covers 36
                  the workplace; a survey found 61 percent         months of tuition, and has significant limits
                  felt they did not completely understand the      on veterans pursuing vocational training
                  qualifications former service members of-        and certificate prorams.
                  fer.26 Three-quarters of veterans, meanwhile,      FIRST KEY FINDING—Keep
                  said they were unable to translate their         Healthy Relationships
                  military skills into civilian terms.27              1. Veterans and their families report
                     As a result, unemployment among               stresses surfacing when the service
                  veterans from the active-duty military was       member returns home. But a stigma
                  over 10 percent in 2009, slightly more than      attached to mental health care makes

most reluctant to seek help; when they           •	 DOD and VA should also fight the
do, counseling and other services can be            mental health care stigma with a
difficult to access.                                national campaign promoting use of
                                                    services like Vet Centers and Suicide
   In the Gulf Coast Community Founda-              Prevention Hotline.
tion study, both veterans and their families     •	 DOD should examine the concept of
identified PTSD or depression as a signifi-
cant problem.
                                                    a fixed period between tours to allow    “Family
                                                    personnel to recover and maintain
   Family members of Florida veterans                                                        members
                                                    family relationships.
expressed greater concern about PTSD and         •	 DOD should study best practices          of Florida
general mental health than the veterans             for protecting the privacy of mental     veterans
themselves. They often see veterans refusing        health care patients.                    expressed
to admit they may need mental health care.
They also often report problems resulting      Creating a trusted informal support           greater concern
from the veteran returning to find new rou-    system:                                       about PTSD
tines and responsibilities in the household.     •	 Military units should foster local       and general
                                                    support group systems, patterned
   But service members see mental health                                                     mental
counseling as a barrier to career advance-          after those on bases that could assist
                                                    family members with re-integration.      health than
ment and, often, as an unacceptable admis-
sion of weakness. Only half those who            •	 Local support groups should build        the veterans
eventually sought mental health care                and distribute lists of mentors, pat-    themselves.”
reported that need via the military’s previ-        terned after the sponsors that wel-
ous paper-based screening system.                   come new personnel to installations,
   Service members also often believe that          who can help guide newly returned
counselors cannot understand the stresses of        soldiers through the transition from
combat theater deployments, making some             military to home life.
unwilling to undergo counseling and therapy.   Making care more accessible:
                                                 •	 To address the shortage of counselors
RECOMMENDATIONS: Keeping                            both in the services and at home,
healthy relationships with families,
                                                    DOD and VA must recruit more
friends, and the community
                                                    behavioral health professionals with
Eliminating the mental health care                  special pay and incentives, and
stigma:                                             ensure screenings are conducted by
  •	 Psychological evaluations should be            properly trained personnel.
     made mandatory for all personnel            •	 DOD and VA should develop and
     before separation from the service.            distribute combat stress injury train-
  •	 To maintain privacy and alleviate              ing for civilian behavioral health
     concerns about career advancement,             professionals.
     mental health evaluations of active-        •	 DOD and VA should authorize service
     duty personnel between deployments             members to seek care from licensed
     should be conducted by private,                mental health counselors under
     independent care providers.                    TRICARE, the military health system.

                 To protect and serve, again: An Army Reserve mom
                          hopes to become sheriff’s deputy
        Even while serving in Iraq, almost 7,000 miles from her family, Amanda Kraft
     found a way to read bedtime stories side-by-side with her two daughters.
        That seems nearly impossible, but it would surprise few who know her. People
     don’t expect a petite, 5-foot-4 woman to drive Army trucks or guard a prison. But
     Kraft has a lifelong habit of defying expectations and achieving more than others
        “You tell me I can’t do something, and I’ll show you that I can,” she said.
        Her latest goal is to continue serving her community, this time as a sheriff’s
     deputy in her hometown of Bradenton.
        She’s won support from a number of groups, including Jewish Family and
     Children’s Service of Sarasota County, which has financed some of her training
     costs through Gulf Coast Community Foundation of Venice BRAIVE Fund.
        She starts law enforcement officer training this fall. But her journey began six
     years ago, when she received a letter she both welcomed and dreaded.
                   Since she was a little girl, Amanda had a respect for the military: She
                drew on her uncle’s stories of his Navy service in World War II for a
                grade-school report, and joined ROTC in high school.
                   She researched all four service branches for a year before signing with
                the Army Reserves. “It was the kind of life I liked,” she said. “I like the
                discipline, it teaches you so much. It changes you as a person.”
                   She always knew that could mean service abroad, possibly under fire,
                and that was fine. “I was never scared about deploying. I knew it was
                realistic. I looked forward to the opportunity.”
                   But the letter arrived just a few weeks after her second daughter,
                Taylor, was born. Amanda remembers thinking the letter would arrive
     any day. And then it was there. “I remember walking to the mailbox at the end of
     the road. I saw the letter and I just started crying.”
        Her husband, Bernard, was in basic training, so the Reserves granted her a
     deferment. But a year later — a week before Taylor’s first birthday — she went
     into training at Fort Leonard Wood in Missouri.
        Bernard ended up with a stateside posting, allowing him to care for their children,
     and freeing her for an overseas deployment. By Christmas, she was at Tallil Air
     Base in Iraq, driving in convoys some 190 miles northwest to Baghdad or shorter
     runs southeast to Kuwait.
        Convoys have been infamous as targets for insurgent attacks, and they often
     came under small arms fire, she said. But her unit, the 1116th Transportation
     Company, saw no IEDs or serious casualties her whole year.
        Her hardships were emotional: the separation from Taylor and older sister
     Mackenzie. She missed their birthdays and a Christmas. But while in training,
     she sent them letters every day. And in Iraq, she found a novel way to read with
     them at bedtime.
        Before she left, she splurged on a computer with a webcam, a rarity at the time.
     They had a similar computer at home, allowing them to have video chats over

the Internet.
   But they were no ordinary chats: Bernard would get two copies of a children’s
book, and send one to Amanda. Then she could read to the girls, and the girls
could turn the pages along with her at home.
   “It was so important for me to keep some sort of a connection,” she said.
   After a year, she returned to Tennessee, where they had been living before
entering training. As she returned, Bernard was about to deployed to Iraq, and the
repeated separations led to a divorce.
   She took a job as a corrections officer for a year, but decided to return to roots
in Florida. She moved to Orlando, working at Disney’s Magic Kingdom. But with
her father and many friends still in Bradenton, she moved back to her home turf
a year later.
   Then fate struck again, in the unlikely form of a shoplifter.
   Kraft was training as an assets protection officer at retailer Target, and she and
her supervisor caught the would-be thief. They called the Manatee County Sheriff’s
Office to take the suspect, and a deputy suggested Kraft consider working for the
   That offhand remark sparked an idea. “I’ve always thought about law enforce-
ment, but I didn’t think it was within reach,” she said.
   The Manatee Technical Institute’s programs include a law enforcement training
program. Completing the six-month course allows graduates to take Florida’s
certification test for all law enforcement positions.
   There were two obstacles. Kraft had to pass a series of physical fitness tests,
including a 1.5-mile run, a 100-yard dash, sit-ups, push-ups, and weightlifting.
   Those she could handle. But admission also required a number of expensive
prerequisites, including a medical physical, a polygraph test, uniform purchase,
and more. Her social worker at Veterans Services connected her with Jewish Family
and Children’s Service.
   The group tapped into its $300,000 from Gulf Coast’s BRAIVE Fund grant to
assist Kraft with the costs of the tests, and to help her move to a less expensive
apartment, saving her nearly $200 a month.
   Kraft took all the preliminary tests and in early August, received another letter
that both thrilled her and broke her heart.
   The academy’s advisory board approved her application — but she would also
need $575 for uniforms before she could start the school. At that point, pride set
in. She didn’t want to ask JCFS for more help.
   “I made it, but I’m going to have to walk away from it,” she told her social
worker at Veterans Services. “I’m not asking for any more help.” But the worker
called JCFS on her own, and the group quickly approved a payment to Kraft for
the uniform.
   They still had to persuade Kraft to accept it, finally convincing her that the check
was an investment in her future. “They pretty much made it clear to me that this
is just for now. ‘You’re not asking for help. We’re giving it to you. This will be
worth it, and next year you’ll be fine.’ “
   And when that happens, she said, she hopes to make a gift to JCFS to pay it back.
   “I’m really thankful for the organization, for everything. I’ve met some amazing

     SECOND KEY FINDING—Create                              ployers to hire Iraq and Afghanistan
     opportunity for jobs                                   veterans by extending tax credit
       2. Returning service members face                    programs.
     major difficulties finding post-military
                                                         •	 Military branches should devote
     employment and obtaining services in
                                                            a portion of their advertising and
     spite of a new improved, GI Bill program.
                                                            outreach to promote the hiring of
        It is unclear if employment problems can
     be seen as particular to Florida’s veterans,        •	 Expand and publicize the Vocational
     at a time when the entire state has high               Rehabilitation and Employment
     unemployment. Nonetheless, veterans face               program for disabled veterans, which
     unique obstacles.                                      is effective but underutilized.
                           Military personnel sur-       •	 Increase use of the Transition As-
                        veyed said that finding a           sistance Program (TAP), a job-finding
                        job is the biggest problem          collaboration between DOD, VA, and
                        they face.                          the federal government, by making
                           Their skills often don’t         its scheduling more flexible.
                        translate to the civilian
                                                         •	 Clean up mismanagement of the VA’s
                        world, and some employ-
                                                            Center for Veterans Enterprise to get
                        ers, they feel, distrust vet-
                                                            more assistance to veterans who own
                        erans because of concerns
                                                            or launch businesses.
                        over PTSD or depression.
                           National Guard members       Making Reserve members’ careers
     report that upon return, their prior jobs have     stable:
     been eliminated or filled and they can find
                                                         •	 Government should encourage em-
     only a lower position, or none at all. Those
                                                            ployers to hire Iraq and Afghanistan
     who own and operate businesses can lose
                                                            veterans by extending tax credit
     the most because of their long absence from
     daily operations.
        Veterans seeking a college education via         •	 Government should support via tax
     the GI Bill are benefitting from the program’s         credits any businesses that train
     2008 overhaul, but they report struggles               returning Guard and Reserve mem-
     with technicalities and inadequate support             bers, and that set Reserve members’
     of vocational training.                                pay levels to cover the gap between
                                                            military and civilian wages.
     RECOMMENDATIONS: Finding new                        •	 Better enforce USERRA laws, which
     homes in the business world and
                                                            protect Guard and Reserve members’
     training for new careers
                                                            civilian jobs, by creating penalties
     Helping veterans find post-military                    and adding protections for claimants.
     jobs:                                               •	 Provide more access to assistance for
       •	 Government should encourage em-                   Guard and Reserve members who

         own businesses, allowing them to                                   •	 Allow all former active-duty person-
         hire replacement staff while deployed                                 nel and Guard and Reserve members
         and recover and expand upon return.                                   to qualify for in-state tuition rate to
                                                                               all public universities.
Making education more accessible
                                                                            •	 Help veterans’ families improve
and diverse:
                                                                               career options by ensuring that
   •	 Government should encourage em-                                          the benefits for the survivors’ and
      ployers to hire Iraq and Afghanistan                                     dependents’ Educational Assistance
      veterans by extending tax credit                                         Program keep pace with inflation
      programs. Expand the new GI Bill to                                      and the number of survivors and
      fully cover four-year tuition, and to                                    dependents being served.
      cover apprenticeships, training, and
      vocational programs.

                                                           Figure A-1
              Most Important Problems Facing Returning Iraq and Afghanistan Vets
                             (Statewide Survey of 800 Floridians)

Note: Horizontal bar percentages add to greater than 100% due to the multiple response question format.
The “Other” responses include reintegration/readjusting, housing, rehabilitation, public support, and political actions.
Source: Statewide telephone survey of 800 Floridians 18 and older, conducted by Susan Schuler & Associates, Inc, July 13-26, 2010,
margin of error +/-3.5%.

                                                       medical or financial difficulties develop,
                                                       veterans may have no connection to the
                                                       system designed to assist them.

                                                       Connecting veterans and families
                                                       with the services they need

                                                       Connecting veterans to services:
     Service Members and families to                     •	 Military branches should automati-
     the right service providers                            cally enroll all troops in Department
                                                            of Veterans Affairs health care as they
        3. Veterans who typically come from                 leave active-duty service, with the
     a military culture that emphasizes self-               choice to opt out later.
     reliance often go without the help they             •	 New veterans should be matched
     need because they lack confidence in                   with an experienced veteran who can
     government agencies or are unaware of                  serve as a mentor. The mentor or VA
     services.                                              personnel should proactively contact
                                                            the new veteran 60 to 90 days after
        Veterans and families interviewed for               discharge to see if any issues have
     the Gulf Coast Community Foundation                    arisen.
     study repeatedly cite problems finding and          •	 The National Guard and Reserve
     accessing the services they need.                      branches should develop a program
        They have seen firsthand what study                 establishing that every unit has a
     after study has reported: The Department of            member trained on available state
     Defense and Department of Veterans Affairs             and federal benefits.
     use cumbersome, multi-stage, paper-driven
                                                         •	 VA should open more regional offices,
                                                            with sufficient staff for face-to-face
        VA centers are often too far for veterans to
     visit when questions arise, and caseworkers
     are overloaded. The agency has one Florida
                                                       Making existing services work
     regional office, and some staff handle 3,500      better:
     or more veterans. Hospital appointments
                                                         •	 VA should phase out its current dis-
     can require drives of several hours.
                                                            ability assessment system, replacing
        Expecting complex paperwork and
                                                            it with the shorter, simplified Joint
     lengthy struggles with bureaucracy, service
                                                            Disability Evaluation system cur-
     members often do not register with the
                                                            rently in development.
     VA upon their return. Military culture also
     leaves service members reluctant to admit           •	 VA needs to continue increasing staff
     they need help with problems until those               and to change its evaluation system
     problems become crises.                                for claims processors to reward ac-
        As a result of these problems, when                 curacy, not just volume.

                                                         Figure A-2
       Percent Who Think More Needs to be Done For Returning Iraq & Afghanistan
                                Veterans: By Group
                         (Statewide Survey of 800 Floridians)

Source: Statewide telephone survey of 800 Floridians 18 and older, conducted by Susan Schuler & Associates, Inc, July 13-26, 2010,
margin of error +/-3.5%.

FOURTH KEY FINDING—                                                     Veterans and family members inter-
Philanthropy and private nonprofit                                   viewed for the Gulf Coast Community
sector fill gaps fill gaps in services                               Foundation study agreed strongly that
left by military and government                                      nonprofits supported through BRAIVE Fund
agencies                                                             grants address high-priority needs. But they
                                                                     also say that the charities have not done
   4. Local not-for-profit agencies provide                          enough to inform the military and veterans
helpful services that governments cannot                             communities about their services. From
or do not perform. Veterans find those                               their viewpoint, nonprofit leaders report dif-
services valuable, but often are unaware                             ficulties in creating a working relationship
of them because there is a disconnect                                with VA. They also are concerned about
between private, nonprofit organizations                             ongoing funding for their services.
and government agencies. Nonprofits                                     Those programs include assistance with
leaders are concerned about their ability                            military families’ travel and living expenses,
to provide ongoing services for veterans                             mental health counseling for families,
because of special needs and lack of steady                          reimbursement for non-tuition educa-
revenue.                                                             tional expenses, legal assistance, innovative

     physical therapy and rehabilitation, career       and local charities that offer services
     counseling and job placement for military         valuable to veterans.
     families, scholarship grants, preventative
                                                   •	 VA should increase claims depart-
     health care and more.
                                                      ment staffing, allowing nonprofits to
                                                      work more effectively with veterans’
     Expanding partnerships between
     government, philanthropy, and
     private nonprofits to improve                 •	 VA should explore subcontracting-
     services                                         style partnerships with not-for-profit
       •	 Nonprofits need to build relation-          organizations that have proven track
          ships in their communities, both            records with veterans and military
          with media and opinion leaders, and         personnel.
          with business owners and college         •	 VA should improve access to health
          graduates. The Gulf Coast Com-              care by contracting with local com-
          munity Foundation survey showed             munity health care providers in areas
          both groups had weak recognition of         far from hospitals or clinics and
          their services and would be potential       where access is difficult.
          sources of expert and financial sup-
                                                   •	 VA should develop a network of
                                                      drivers for vets trying to find trans-
       •	 Nonprofits respond more quickly             portation to a hospital and provide
          than government agencies, but need          cost reimbursement to those forced
          to be even more streamlined, as             to travel long distances for care.
          military personnel and veterans often
                                                   •	 VA should expand programs to cer-
          need help within a few days.
                                                      tify and train family caregivers as
       •	 Nonprofits see a need for more              personal care attendants, allowing
          programs and funds to help military         them to receive compensation from
          personnel and veterans find afford-         the agency.
          able hous-
          ing, espe-
          cially when
          they have a
          spouse and

       •	 VA needs a
          that trains
          and encour-
          ages its staff
          to work
          with state

FIFTH KEY FINDING                                  RECOMMENDATIONS
In assessing needs in order to
prepare recommendations for                           Many of the recommendations made by
local action, service providers can                our interviewees do not call for expensive
benefit by obtaining information
                                                   program start-ups.
not only from those being directly
served, but also from their wider                     The suggestions for local community
interpersonal networks – family                    level actions fall into two categories: (1)
members, friends, and others.                      better coordination of local efforts across
                                                   the public, private, and nonprofit sectors,
    5. Input into program development,             and (2) greater utilization of local media
evaluation, and readjustment should not            and businesses to publicize available ser-
be limited to potential beneficiaries or           vices and help recruit volunteers to assist
users of a service or program.                     in local efforts.                             “It is wise
    As these research efforts have shown,
                                                                                                 to use more
family members, employers, and the general           •	 Local non-profit groups, in coop-
public can provide valuable perspectives on             eration with the military branches
the needs of Iraq and Afghanistan veterans              and the Veterans Administration,         definitions
and the shortcomings of programs designed               need to establish and promote            of “family”
to help them, as well as recommendations                websites such as MyRebootCamp.           when
for reform.                                             com, which can guide military
    It is wise to use more inclusive definitions        personnel and veterans to services
of “family” when soliciting input as to how             in their area. The websites would
                                                                                                 input as
to structure and improve intervention and               include contact information and          to how to
assistance programs. Family structures are              program descriptions for all local       structure
changing. Often extended family members                 government, not-for-profit agencies      and improve
or close friends and mentors play just as, or           and organizations offering services
even more, important a role in the veteran’s            to the veterans and their families. It
life than immediate family.                             would provide the same information
    A wider net should be cast to determine             about support groups active in the       assistance
the needs of in-home caregivers who make                local area. The website could also be    programs.”
long-term sacrifices of their time, resources,          promoted by local businesses as part
and careers when their wounded warriors                 of their regular advertising efforts
are released to go home.                                and touted as a public service.
    A greater effort should be made to target
Florida’s female veterans in local program           •	 Create a data base of local veterans
outreach and in local program materials,                who have volunteered to serve
promotions, and events. Although Florida                as mentors to returning veterans
has the third largest percentage of female              (similar to sponsors on instal-
veterans, a majority of Floridians have little          lations who welcome and assist
knowledge of how many women are in the                  newly-arrived active duty military
military or of their special needs as they              and their families). The list and the
deploy or reintegrate.                                  data base access website could be

        given to a service member during            graduates and business owners—
        the separation process so that he/          each generally supportive of veterans
        she could immediately connect with          assistance—know little about what
        a local mentor upon returning home.         the local agencies are doing.
        This could be a very effective way to
                                                •	 Make better use of local media.
        assist returning Iraq and Afghanistan
                                                   Local television, radio, newspapers,
        veterans in Florida, with its large
                                                   and popular websites can be used to
        veteran population.
                                                   spread the word about available ser-
     •	 Create a local support group system        vices to veterans and their families.
        (spouses, families, fellow veterans)
                                                •	 Give local businesses a bigger role
        patterned after those common on
                                                   in helping to spread the word about
        military installations. Such groups
                                                   potential services for veterans and
        could play a major role in helping
                                                   their families in their advertising.
        the reintegrating veterans and their
                                                   Both groups—veterans and families—
        families find someone to talk to who
                                                   praised efforts by local businesses to
        has shared their deployment experi-
                                                   help the troops, usually around the
        ences and difficulties.
                                                   holidays. This could become a year-
     •	 Help not-for-profit agencies and           round effort. A local “Troop-Friendly”
        organizations devise ways to better        designation campaign (similar to the
        spread the word about their vet-           “Green Business” designation) would
        eran assistance efforts to potential       be inviting to a lot of businesses and
        supporters (money, jobs). As the           draw media attention.
        statewide survey has shown, college

              APPENDIX A:                        Veteran Focus Groups
                                                    Two focus panels comprised of military
Components of the Gulf Coast                     service members with experience in the
Community Foundation’s                           Afghanistan and/or Iraq conflicts were
research project
                                                 conducted in Tampa and Cocoa Beach,
   This report is based on personal inter-
                                                 Florida during June, 2010. A total of 13
views with agency heads, OIF/OEF veteran
                                                 veterans participated in these panels; 3
focus groups, OIF/OEF veteran family mem-
                                                 other veterans were interviewed separately.
ber focus groups, and a statewide telephone
                                                    Veterans participating in the focus groups
survey of Floridians 18 and older.
                                                 represented most branches of the US Armed
   It is supplemented by research drawing
                                                 Forces: Army, Air Force, Marines, Coast
many sources, primarily position papers by
                                                 Guard, Reserves and National Guard. Most
the Iraq Afghanistan Veterans Association,
                                                 were men, but four women participated.
the California Community Foundation’s
                                                 Ages ranged from 24 to 51, and both enlisted
Iraq Afghanistan Deployment Impact Fund,
                                                 personnel and officers participated.
RAND Corp., the Government Account-
                                                     The focus group panels were designed
ability Office, the Florida Department of
                                                 to: (1) identify the problems faced by
Veterans Affairs, and the federal Depart-
                                                 returning Iraq and Afghanistan veterans
ments of Defense, Commerce and Labor.
                                                 and their families in the central Florida
                                                 BRAIVE region and determine the relative
                                                 importance of addressing each, (2) denote
Analysis of BRAIVE Agency
Administrator Perspectives                       the veterans’ awareness of and interaction
   Personal interviews were conducted May        with local not-for-profit agencies, and (3)
3-24, 2010 with the heads of 25 nonprofit        give recommendations as to how services
leaders that received BRAIVE grants from         and communication could be improved.
the Gulf Coast Community Foundation of           Specially, they were asked about the im-
Venice to meet the needs of Operation En-        portance of addressing problems related
during Freedom (OEF) and Operation Iraqi         to education, medical care, mental health
Freedom (OIF) military personnel and their       (including PTSD), employment, housing,
families. The BRAIVE grant was to enable         finances, relationships, substance abuse,
the agency to provide innovative forms of        benefits, social support, and legal issues.
support or meet needs that had not been
addressed before.                                Family Focus Groups
    The purposes of this survey were to:            Two family member focus groups were
(1) document the types of services being         conducted in Tampa and Cocoa Beach,
provided to OIF/OEF service people and           Florida during June, 2010. A total of 13
their families, and (2) identify further         family members and friends of Afghanistan
actions that not-for-profit and government       and Iraq war veterans participated in these
agencies can take to help these individuals      panels. Family members included spouses,
lead productive lives as they reintegrate into   parents, siblings, uncles, cousins, and
the civilian world.                              in-laws.

         Focus group participants were asked        the importance of helping Florida’s service
     to identify the importance of problems         members returning from service in Iraq
     facing their military service member and       and Afghanistan, (2) the problems faced
     them as well—behavioral health, counsel-       by Operation Enduring Freedom (OEF) and
     ing, reintegration to family life, financial   Operation Iraqi Freedom (OIF) veterans
     management, employment, medical care,          and their families, (3) the degree to which
     education, housing information, substance      various institutions (U.S. Department of
     abuse, and family assistance. They were        Veterans Affairs, State of Florida Depart-
     also asked for recommendations as to how       ment of Veterans Affairs, county and city
     to improve existing services, interactions     governments, local employers, not-for-profit
     with government agencies, and informa-         organizations, the media, the general public)
     tion flows.                                    need to help veterans more and how they
                                                    can do so, and (4) citizens’ major sources of
     Florida Veterans Issues                        information about Florida’s veterans.
     Statewide Survey                                   The large sample size permits analyses of
        A statewide telephone survey of 800         Floridians across the state who have served/
     randomly-selected adults 18 & over was         are serving in Iraq and Afghanistan, have
     conducted from July 13-26, 2010 (margin-       had military service, are family members of
     of-error +/- 3.5%). It is the first public     Iraq/Afghanistan veterans, and are employ-
     policy-focused survey asking Floridians        ers and managers with hiring authority. The
     about veterans issues.                         results of this larger survey are consistent
         The goal of the survey was to provide      with those observed in the focus groups,
     a statistically valid representation of the    thereby bolstering our confidence in the
     views of Florida residents regarding: (1)      findings generated from them.

                                          APPENDIX B:

                                                Table 1
               Unmet Needs & Policy Recommendations: A Summary
          (Agency Head, Veteran, Family Member, and Public Perspectives)

Problem/Need                                               Interviewee Suggestions
Information about Benefits/Help Sources
Many personnel resist registering with the        Start VA registration while still in the service, such
VA due to expectation of bureaucracy and          as during the separation process.
paperwork or they are reluctant to continue       Match returning veterans with more experienced
dealing with military and related agencies        veterans as mentors during the reintegration period
                                                  after deployment.
There is a large and confusing array of           Provide better guidance for separated military to
benefits programs in the VA                       apply for the correct program for their situation.
Changes in benefits policies. The new GI Bill     VA should provide better training/databases for
passed last year already has 31 amendments.       staff that assist veterans.
It’s hard to keep up with all the changes.

Even VA counselors can have difficulty
determining which programs are appropriate
for a given veteran’s situation.
Military presentations about benefits contain     Provide information in smaller, discussion groups
too much information to absorb and retain.        with less information at any one session.
                                                  Provide checklists for actions to take after
                                                  Provide wallet card with helpline number and/or
Veterans resist admitting to needing help for     Proactively contact veterans about benefits a few
problems until they are in crisis, typically      months after separation from the service.
months after separating from the service
Not all personnel are computer-savvy.             Provide option for personal counseling.
Some personnel prefer personal interaction to     Provide “one-stop” centers covering all sources of
Website-based benefits resources                  help, preferably private rather than government.

They don’t know how to file claims. They          VA should formulate policies that allow for more
lose benefits in 180 days.                        private providers of services.
Personnel unaware of private, not-for-profit      Publicize information services such as FLAIRS
agency resources                                  2-1-1.
                                                  Not-for-profits focus on community outreach,
                                                  newsletters and website design.
Too few Senators and Representatives served
in the military. Many don’t respond to
veterans requests made to their offices.

     Access to Benefits/Help
     VA Regional office too far away to easily visit   Florida needs more than one regional VA office.
     by agencies attempting to help veterans get
     Time it takes for veterans to get help from       VA needs to hire more employees.
     VA, but emergency cases can be expedited.
     Caseworkers handle too large a caseload

     VA staff don’t seem to appreciate the veteran     VA should hire more veterans and military spouses
     is in crisis                                      to assist and counsel veterans.
     VA can’t meet all of the needs by itself          There should be more dialog between states and
                                                       the federal government. States can’t just assume the
                                                       Federal government will take care of the needs of
     Some veterans with multiple acute issues or       The VA should focus on modernizing its
     many issues over time can get “lost in the        information systems.
     (VA) system”.
     Transition time from active duty to VA
     services is the biggest issue and is a cause of
     Some private not-for-profit help efforts are      Organizations sending care packages should focus
     not optimally designed                            their efforts on truly needed items.
                                                       There should be communication protocols for
                                                       support groups to link to individual deployed
                                                       persons and find out what they need.
     Not-for-profit approval delays. We give help      Agencies should focus on expedited approval
     in 1-2 days, other agencies much longer.          systems for emergency needs.
     Needs are measured in a few days.

     Veterans won’t use not-for-profit services, if    Agencies should make applications as user-friendly
     the application process is perceived as too       as possible, with minimal paperwork, or someone
     much trouble.                                     to fill out the application for the veteran.
     Some veterans don’t use all the benefits to       Agencies provide more case management services,
     which they are entitled because they don’t        help figuring out exactly what they need and
     know about them.                                  helping them find it.
     Veterans may not relate to older veterans.        Organize meetings and service by each war instead
                                                       of pooling all veterans together.
                                                       More dedicated programs for veterans. Veteran-
                                                       specific programs, rather than fold them into the
                                                       general population.

     Caregiver Issues
     Injured warriors are often treated far from       A greater effort by government to help families of
     their families due to lack of facilities. When    the wounded.
     they are sent home, no support system is in

Families of the severely wounded need a
lot of help for in-home care during often
extended recovery times (years).

Transportation and daily errands for
wounded warriors and caregivers.
Because they need an at-home caregiver; a
family member stays home and can’t work,
leading to financial needs
Deployment Issues
Wives are often young and inexperienced            The military should develop better communications
about the system. (Problem during                  to families of the deployed, particularly those who
deployment)                                        don’t live near bases.
Support groups for spouses depends on the
initiative of local volunteers
Support group interaction may be impacted
by attitudes of spouses of higher ranking
At home spouses may encounter home repair          Military and private not-for-profit groups could
or other financial emergencies, even lawn          provide more support for spouses at home who face
mowing may be a problem                            financial and/or home repair emergencies.
Difficulty of families coping with absence of      Private or not-for-profit groups could mentor or
a spouse                                           “adopt” families of the deployed.
Unit preparing to deploy. Soldiers quit
jobs and sell possessions, only to have
deployment cancelled 3 weeks prior to
departure date.

Post deployment, often prior job is gone, or       Fund programs to incentivize employers to
they are downgraded to a lower position.           facilitate placement, improve employment services
Military personnel shoulder heavy                  programs and training.
responsibilities including being entrusted with
multi-million dollar equipment, but civilian
employers don’t value this experience
Military skills often difficult to translate to    Provide more job/skills retraining.
civilian careers
Lack of computer skills (fear of computers)
in some applicants, even young ones, since
everything is so computer-dependent now.
Job placement - perception that companies
shy away from hiring combat veterans
because of PTSD concern.
Deployment derails one’s career path in            Work with veterans on starting and maintaining
civilian life especially for those who choose to   small businesses; match them with a mentor such
own and operate a small business                   as SCORE.

     There needs to be more emphasis on breaking       Train and use disabled veterans to work as
     the cycle - i.e. focus more on employment         counselors out of their homes.
     and that will enable a lot of other needs to be
     handled by the veteran.

     Reintegration to Family
     Returning military spouse/parent                  Mandate a transition period for entire units before
     unaccustomed to family routines, practices.       their separation from the service. Include spouses
     Spouses at home take on more responsibility       in these programs.
     and authority for the family, leading to
     leadership friction when the deployed return
     Despite frequent contact via Internet and         Provide family counseling.
     telephone systems, families at home develop
     new relationships that tend to exclude the
     deployed military person
     It is a challenge to reconnect with children
     after deployment
     Both the deployed and spouses may feel
     entitled to a break from responsibilities after
     deployment ends
     Difficult transition from military to civilian.
     Civilian life seems chaotic compared to
     the relatively simple, disciplined life of

     Mental Health/PTSD Stigma/MST
     Stigma to having problems. Higher ups expect      The military should require all personnel to receive
     them to not have issues, and/or deal with         psychological evaluation and counseling to lessen
     them.                                             the stigma of getting evaluated.
     Fear that treatment will adversely impact
     career choices later
     Fear that seeking treatment will result in an
     undesired early discharge from the service.
     Many avoid coming forward, lose job due to
     Even speaking to a chaplain or counselor          Allow for confidential, off-base treatment by
     creates gossip and the perception that the        private counselors.
     military person has a problem
     Many mental health counselors cannot relate       Provide counselors who have experienced combat
     to the military experience                        themselves.
     Mental health needs for the whole family.
     VA concerns that private providers unqualified    Provide training & education on evidence-based
     to treat PTSD etc                                 practices and treatments to private providers.

     Financial Issues
     Many don’t know how to handle money.              Make personal finance education available, online
     They’re well paid while deployed, and don’t       or classes, or personal counseling.
     save for future needs.

Between deployments, some military people         Provide more financial counseling, either from
waste bonus money                                 superiors in the military, or other sources to help
Large purchases, such as vehicles and             personnel avoid financial missteps.
consumer electronics, they may not even be
able to keep when the next deployment comes
Reduced family income at the end of               Provide emergency assistance, especially for
deployment                                        non-recurring needs; with counseling on financial
                                                  management .
State law prohibits gifts to active duty          Repeal this law (in process).
Some you help and help and help and they          Refer more cases to mental health services.
don’t get there; because they are unable
(PTSD etc) or they don’t do enough.

Medical Treatment
Delays in getting appointments for medical        Use private providers for families and for military
care                                              personnel that are not deployed or injured.
Family members agreed that, after the initial
180 days, it is much harder to get attention
from the VA.
Some people overuse limited medical
resources to the detriment of others that
genuinely need access to them.
Military base family centers, staffed by          Military family help specialist should be military
subcontractors - some don’t care and show it      spouses or veterans who understand the military
                                                  culture and family centers should be able to fire
                                                  poor employees.
Inconvenient hours at VA clinics.
Low provider reimbursement rates from

Veterans lack understanding of education          VA and agencies provide better information and
benefits under the new GI Bill                    counseling about educational benefits .
GI Bill tuition benefits fall short of covering   The State of Florida should grant in-state tuition
out-of-state tuition rates                        rates to recently separated veterans, with the
                                                  requirement that they remain in Florida some
                                                  minimum number of years when starting their
Education funding delays.                         VA or agencies provide proactive reminders to
                                                  veterans to apply timely for educational benefits.
Surviving spouse college education. Many          Agencies should add spouse education to services
spouses in their early 20’s. Educating them       provided.
would help the whole family for years, and
set up a good role model for the children
when they reach college age. Spouses are not
eligible for government education benefits
like children are.

     Adjustment to campus life for an older            Establish student veteran organizations on campus,
     student transitioning from military               campus offices devoted to veterans.

     Housing Issues/Homelessness
     Housing for active duty personnel. Too little
     on-base. Off-base housing stipend insufficient.
     Esp. for spouse/children.
     Difficult housing market for military people
     frequently reassigned
     Help children of the deployed. Schools are        Focus more help on female military personnel
     cutting back on their programs & when school      and veterans, especially single mothers and their
     is out, kids lack services and meals.             children.

     There’s a lack of resources to assist homeless
     female veterans. Even care packages lack
     female products. Women come back with no
     job due to repeated deployments and kids.

     Legal Issues
     Pro Bono services are limited; attorneys are
     selective who they provide it to.
     Most economic problems have a legal
     Young soldiers need legal advice before
     signing away benefits for a one-time payment.

     Government/Non-Profit Interaction
     Some agencies perceive lack of cooperation/       Agencies need a governmental affairs specialist on
     referral from military and/or VA staff.           staff
     Some county offices are very open and willing     Agencies should initiate more outreach to county
     to talk, others are more reluctant. Some ap-      offices
     pear to be protecting their turf.
     Inconsistent exchange of information
     VA staff overwhelmed with all the needs and
     they are approached by would-be providers
     who may or may not be qualified.

     Substance Abuse
     Large bonuses facilitate heavy drinking, drug     Government or agencies should train family
     abuse, especially by young, single military       members on substance abuse
                                                       Military should provide training, counseling on
                                                       substance abuse

     Informal Support Networking
     To make social connections with veterans          Military, VA and/or agencies facilitate mentoring
     from earlier conflicts, because the nature of     of younger veterans by older veterans, and
     the experience is the same.                       make better use of social networking-based
                                                       communication channels

                   Endnotes                            14    Molinda M. Chartrand, et al. “Effect
                                                            of Parents’ Wartime Deployment on the
1    Florida Department of Veteran Affairs Annual           Behavior of Young Children in Military
     Report, 2009, p. 6                                     Families,” Archives of Pediatric and
                                                            Adolescent Medicine, 2008, 162(11), p. 1009.
2    Florida Department of Veteran Affairs Annual
     Report, 2009, p. 6                                15    Steven L. Sayers et al, “Family Problems
                                                            Among Recently Returned Military Veterans
3    U.S. Department of Defense Web site, www.
                                                            Referred for a Mental Health Evaluation,”
                                                            Journal of Clinical Psychiatry, Feb. 10, 2009;
4    U.S. Department of Defense Web site, www.              online, p. e2.
                                                       16    M i l l i ke n , Au c h t e r l o n i e, a n d H o g e,
5     Vanessa Williamson, “Supporting Troops,               “Longitudinal Assessment of Mental
     Veterans, and Their Families: Lessons Learned          Health Problems Among Active and Reserve
     and Future Opportunities for Philanthropy,”            Component Soldiers Returning from the Iraq
     California Community Foundation, Report                War,” p. 2144.
     on the Iraq Afghanistan Deployment Impact
                                                       17    Vanessa Williamson, “Invisible Wounds:
     Fund, November 2009, pp. 13-14.
                                                            Psychological and Neurological Wounds
6     Vanessa Williamson, “A Breaking Military:             Confront a New Generation of Veterans,”
     Overextension Threatens Readiness,” Iraq               Iraq and Afghanistan Veterans of America,
     and Afghanistan Veterans of America, Issue             Issue Report, January 2009, p. 10.
     Report, January 2008, p.6.
                                                       18    John H. Kuhn and John Nakashima,
7    U.S Department of Defense, Military Health             “The Sixteenth Annual Progress Report,
     System Web site, “Department of Defense                Community Homelessness Assessment,
     Numbers for Traumatic Brain Injury,” www.              Local Education and Networking Group                  (CHALENG) For Veterans,” Department of
                                                            Veterans Affairs, March 17, 2010, p. 8, p. 21.
8     Terri Tanielian and Lisa H. Jaycox, Eds.
     “Invisible Wounds of War: Psychological           19   Iraq and Afghanistan Veterans of America,
     and Cognitive Injuries, Their Consequences,            “2010 Legislative Agenda,” January 2010,
     and Services to Assist Recovery,” RAND                 p. 18.
     Corporation, 2008. p. xxi.
                                                       20    Vanessa Williamson and Erin Mulhill,
9    Tanielian and Jaycox, “Invisible Wounds of             “Coming Home: The Housing Crisis and
     War,” p. xxi.                                          Homelessness Threaten New Veterans,” Iraq
                                                            and Afghanistan Veterans of America, Issue
10   Tanielian and Jaycox, “Invisible Wounds of
                                                            Report, January 2009, p. 4.
     War,” pp. 96-97.
                                                       21    Williamson and Mulhill, “Coming Home,”
11    Charles S. Milliken, Jennifer L. Auchterlonie,
                                                            p. 4.
     and Charles W. Hoge, “Longitudinal
     Assessment of Mental Health Problems              22   Williamson, “Invisible Wounds,” pp. 8-11.
     Among Active and Reserve Component
                                                       23    Department of Defense Task Force on the
     Soldiers Returning from the Iraq War,”
                                                            Prevention of Suicide by Members of the
     Journal of the American Medical Association,
                                                            Armed Forces, “The Challenge and the
     298(18): 2141-2148. (November 14, 2007).
                                                            Promise: Strengthening the Force, Preventing
12   Tanielian and Jaycox, “Invisible Wounds of             Suicide and Saving Lives,” Final Report,
     War,” p. xxi.                                          August 2010, p. 15.

13    Lawrence Korb, Peter Rundlet, et al., “Beyond    24    DoD Task Force, “The Challenge and the
     the Call of Duty,” Center for American                 Promise,” p. ES-1.
     Progress, March 6, 2007, pp. 3-6.
                                                       25    Secretary of Defense Robert M. Gates,

          remarks on launch of National Alliance for                  31 Vanessa Williamson and Erin Mulhill,
          Suicide Prevention, National Press Club,                       “Careers After Combat: Employment
          Washington, D.C., Sept. 10, 2010.                              and Education Challenges for Iraq and
                                                                         Afghanistan Veterans,” Iraq and Afghanistan
     26, “ Study Reveals
                                                                         Veterans of America, Issue Report, January
        Profound Disconnect between Employers
                                                                         2009, p. 5.
        and Transitioning Military Personnel,” www.,15929,                       32 David Loughran and Jacob Alex Klerman,
        PRarticle110507,00.html, Nov. 5, 2007.                           “Explaining the Increase in Unemployment
                                                                         Compensation for Ex-Service Members during
     27, “ Study Reveals
                                                                         the Global War on Terror,” RAND, 2008, p.
        Profound Disconnect between Employers
        and Transitioning Military Personnel.”
                                                                      33 Government Accountability Office, “Military
     28 U.S. Department of Labor, Bureau of Labor
                                                                         Personnel: Federal Management of Service
        Statistics, “Employment Situation of Veterans
                                                                         Member Employment Rights Can Be Further
        Summary,” March 12, 2010.
                                                                         Improved,” October 2005, p. 5
     29 Department of Labor, “Employment Situation
                                                                      34 Government Accountability Office, “Military
        of Veterans Summary.”
                                                                         Personnel: Federal Management of Service
     30 G o v e r n m e n t Ac c o u n t a b i l i t y O f f i c e,      member Employment Rights Can Be Further
        “Preliminary Observations Related to Income,                     Improved,” p. 6.
        Benefits and Employer Support for Reservists
                                                                      35 Williamson and Mulhill, “Careers After
        During Mobilizations,” March 19, 2003.
                                                                         Combat,” p. 4.

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