Establishing Persistent and Positive Behaviors Among Military Veterans in Distress: Factors contributing to successful change in the face of challenges.

Personal goals, expectations, and needs evolve over a lifetime. Supports available to assist individuals to meet their needs varies by situation and circumstance. Military service members who have exited service and returned to civilian life confront a transition of circumstance and culture that often may not be appreciated by those without a history of prior military service. The literature documents variety of supports needed by military veterans as they integrate with civilian settings (Dudley-Miller & Radel, 2020). When we explored the needs reported by students at an academic medical center who also had a military background, our participants placed special emphasis on the importance of positive interactions with faculty and with student peers. Chronological and experiential maturity of these students with a military background were noted contrasts with traditional undergraduate students, and many reported challenges related to responsibilities with family and with work (Dudley-Miller & Radel, 2020). These observations in the context of academic learning underscored the wider complexity of veterans’ needs, even among veterans long after they separate from service. I was struck by how often our participants report ways in which interpersonal relationships influenced the quality of the overall learning experience. Early in my term as a doctoral student, I was invited to join a team of researchers studying the influence of Warriors’ Ascent, a 501(c)(3) program designed for active military service members, veterans, and first responders and focused on addressing mental health issues and improving quality of life. Beginning in 2016, I took part in recruiting military veterans to collect survey data exploring characteristics, concerns, and mindset of veterans prior to participating in Warriors’ Ascent retreats, to explore effectiveness of the program. The curriculum focused on addressing symptoms experienced by participant cohorts related to depression, anxiety, post-traumatic stress, and suicidal ideations. Important goals of the program were to improve self-care for the participants, and to improve relations with their friends and family. Initial evaluation of the military veterans’ pre-participation surveys suggested possible associations between their relationship stressors and the high-risk behaviors in which they tended to engage. This observation emphasized to me the importance of addressing ways to improve social interactions of these veterans and to assist them in continued practice of the positive behaviors taught during these retreats once the Warriors’ Ascent program ended and they returned to their daily activities and home environments. Dissertation Summary: Insight and Implications The quality of life for these military veterans is closely related to each individual’s ability to sustain and practice healthy behaviors following completion of the Warriors’ Ascent program. My dissertation findings advance knowledge related to military veterans and their confidants, and to peer-volunteer programs generally, by contributing to a better understanding of key factors underlying successful outcomes involving positive behavior change. A strengths based approach coupled with a social work perspective suggests alternate strategies and effective approaches that may be feasible for organizations, administration, and clinicians to adopt, particularly in those organizations having a goal to promote persistent positive behavior change. Structure of this document This dissertation reports outcomes of the research that evolved from my earlier exposures to the needs of military veterans. Chapter One explores a popular learning style inventory, Kolb’s Learning Style Inventory (KLSI). Researchers cite concerns with the KLSI’s psychometric properties, yet the inventory continues to be used world-wide. The KLSI is explored using Roger’s Theory of Diffusion on Innovation to gain a better understanding of the inventory’s perennial properties. Insightful information about the versatility of the KLSI and the likelihood of this contributing to its adoption and on-going use today emerged. As a novice researcher, this provided an opportunity to gain a better understanding of how inventories are developed and how their psychometric properties evaluated, with both insights being fundamental for guiding my approach to the dissertation research. Chapter Two explores the perspective of students with a military background (SMB) at an academic medical center. Online surveys with these SMB explored their experiences at an academic medical center and their views about the university’s effectiveness toward their overall learning. Qualitative feedback was gathered for some of the survey items. Main factors related to the SMB experiences at an academic medical center included (a) relations with peers and faculty, (b) learning experiences, and (c) navigating campus services. Similarities between the team approach used in the university’s curriculum and the SMB’s experiences with military culture offered suggestions to other academic settings. This helped me to appreciate the experience of having a military background while functioning in civilian society, and the particular needs for support this situation may generate. This, in turn, allowed me to begin to formulate a plan for the studies that became my dissertation. Chapter Three explores writing a grant proposal in preparation for my dissertation proposal. Writing a grant prepared me to think about research in logical ways, to develop a proposal for research in a concise and thorough manner, and to apply clinical practices and protocol procedures to a research platform. It was at this point in my research practice I began to explore preliminary findings from data collected from the Warriors’ Ascent program. The grant proposal focused on the importance of exploring social supports in the military veterans’ lives post-Warriors’ Ascent and how to incorporate the input of a military veteran’s chosen confidant in the research process. Chapter Four explores the perspective of two Warriors’ Ascent staff members who were peer-volunteers during Warriors’ Ascent retreats. Interviews with these peer-volunteers explored their experiences with the Warriors’ Ascent curriculum and their views about the program’s impact on military veterans specifically once participation in a Warriors’ Ascent retreat ended. Considering the themes emerging from the peer-volunteers’ reports of their peer-volunteers’ observations and impressions provides insight about strengths of the Warriors’ Ascent curriculum. What emerged was insightful information on ways to enhance application of the Warriors’ Ascent skills that were taught and practiced during the programming using peer-support interactions with the military veterans (and presumably the other participants who were not veterans). In addition, exploring the peer-volunteers’ input allowed triangulation among Warriors’ Ascent program curriculum, mission statement, and goals and identified additional, previously unrecognized opportunities for influencing program growth and effectiveness. Chapter Five explores the experiences of military veterans who took part in Warriors’ Ascent programs, with added insight provided by a person identified as a close confidant by the veteran. We explored self-care skills that continued to be practiced long after the end of the Warriors’ Ascent retreat, such as mindfulness, yoga, meditation, journaling, and eating healthy. I also felt it was critical to identify any challenges that accompanied the pursuit of these activities so these barriers could be anticipated and addressed proactively as part of the Warriors’ Ascent programming and, once identified, may be studied further in the context of other, similar programs for behavior change. Other factors emerged as being important for persistence of these behavior changes during interviews; deeper probing revealed the veterans’ need to establish new boundaries as part of expanded self-care practices, coupled with appreciating potential consequences of boundary-setting in established relationships. The association between veterans setting boundaries, healthy behaviors, and the feelings of loss were an unexpected part of the veterans’ journey toward making healthy behavior changes to reach their overall goals. This association of factors was not addressed preemptively by The Warriors’ Ascent program’s curriculum. This represents a valid and addressable training opportunity for any program having a goal of establishing healthy behaviors, particularly when this positive change also represents a change in the fabric of relationships. Chapter Six considers findings emerging from interviews with peer-volunteers (Chapter 4) and veteran/confidant dyads (Chapter 5) in the context of Prochaska’s Transtheoretical Model (TTM) (Prochaska, 1999, 2008). This approach allowed examination of potential alignment among the TTM’s four central constructs with how military veterans described their experience of pursing positive and persistent behavior change. Alignments are discussed between the military veterans’ experiences with change and elements in the stages of change, processes, decision-making, and self-efficacy constructs described by the TTM. The TTM did not, however, account for all experience elements or the underlying dynamics contributing to the military veterans’ persistent behavior change. These elements may, however, be captured by considering aspects of other theories related to behavior change and several additional theories commonly employed in social work practice are considered and discussed as alternate or supplemental options. Chapter Seven is an integration and synthesis of findings from the peer-volunteer interviews (Chapter 4) and from dyad interviews (Chapter 5) as viewed through the lens of the TTM theory (Chapter 6). I also discuss my own journey as a developing researcher and how my growth as a researcher has refined my clinical skills as a social worker; I am hopeful my own positive behavior changes also will persist! In addition, I provide a few remarks about how these personal insights may be helpful in supporting future students in their own doctoral journey. References Dudley-Miller, V., & Radel, J. (2020). Experiences and Challenges of Students with a Military Background at an Academic Medical Center. Journal of Veterans Studies, 6(1), 112-121. https://doi.org/10.21061/jvs.v6i1.114 Prochaska, J. O. (1999). How do people change, and how can we change to help many more people? - PsycNET. In M. A. Hubble, B. L. Duncan, & S. D. Miller (Eds.), The Heart & Soul of Change. American Psychological Association. http:///doiLanding?doi=10.1037/11132-007 Prochaska, J. O. (2008). Decision making in the transtheoretical model of behavior change. Medical Decision Making, 28(6), 845-849. https://doi.org/10.1177/0272989X08327068

Grantor dc:publisher

University of Kansas

Year dc:date.issued

2021

Author dc:creator

• Dudley-Miller, Vanessa Nichoel

Advisors dc:contributor.advisor

• Radel, Jeff JR
• Mische-Lawson, Lisa LML

• Mental health
• Social work
• Behavior program
• Military Veterans
• Post-traumatic stress
• Support system

Statement dc:rights

• Copyright held by the author.

Language dc:language.iso

en

Dc Identifier Other

http://dissertations.umi.com/ku:18061

OAI identifier oai:identifier

oai:kuscholarworks.ku.edu:1808/39116