Introduction: Many Veterans with PTSD struggle with symptoms of social dysfunction, including isolation [1] and physical violence [2]. Current Veterans Affairs (VA) treatments effectively decrease posttraumatic stress symptoms (PTSS) [3, 4, 5, 6], but do not directly target social dysfunction. In the current study, we investigate deficits in two potential mechanisms: trust and social responsiveness. We propose to use the iterated Trust Game [7, 8]– an economic exchange task that operationalizes trust and social responsiveness– to investigate differences due to PTSS severity. We will also investigate changes after treatment using the Trust Game in a dataset of Veterans undergoing residential treatment for PTSD at a VA Medical Center. We hypothesize that those with greater PTSS severity will show deficits in trust or social responsiveness, and these deficits will assuage with PTSS improvement after treatment. Methods: We analyze a cross-sectional dataset of combat-exposed Veterans (n = 153) and a dataset undergoing residential treatment for PTSD (n = 36). PTSS are measured using the PTSD CheckList (PCL). Each Veteran plays a ten-round variant of the iterated Trust Game. Each round involves exchange between the Veteran (or “investor”) who is endowed $20 each round, and a “trustee”, in whom the investor may entrust any portion of the $20. The investment is tripled before being sent to the trustee, and the trustee may return any proportion. Trust is operationalized as investment, and social responsiveness is operationalized as the ability of the trustee’s changes in response to the investor—“trustee reciprocity”—to predict changes in the investor’s next round investment. We investigate the two potential mechanisms in the cross-sectional dataset. To determine the relationship between trust and PTSS, we regress investment onto PCL. To investigate the relationship between social responsiveness and PTSS, we regress round change in investment onto the interaction of PCL and trustee reciprocity. We next investigate the impact of treatment in the residential treatment dataset. To determine the impact of PTSS improvement on trust, we regress change in investment onto PCL score change (posttreatment–pretreatment). To determine the impact of treatment-related change on social responsiveness, we regress round change in investment onto the interaction of change in PCL (posttreatment–pretreatment), visit, and trustee reciprocity. Results: In the cross-sectional dataset, higher PTSS correlates with decrease in trust, operationalized as investment (β1 = −0.002, p = 0.003, n = 153). Increase in trustee reciprocity correlates with increase in round change in investment (β1 = −0.25, p < 0.001, n = 153), indicating Veterans were socially responsive. There was no PTSS-related variation in social responsive- ness (0 < β3 < 0.001,p = 0.5,n = 153). In the residential treatment dataset, less PTSS improvement correlated with decrease in trust after treatment (β1 = −0.006, p = 0.015, n = 36). Veterans were socially responsive (β1 = 0.39,p < 0.001,n = 36), with a decrease in responsiveness at posttreatment (β5 = −0.29,p = 0.001, n = 36) and a greater decrease posttreatment in those with less improvement in PTSS (β7 = −0.01, p = 0.02, n = 36). Conclusions: In the cross-sectional dataset, trust decreased with higher PTSS, while social responsiveness did not change with PTSS severity. This suggests that Veterans with more severe PTSS show deficits in trust, but not social responsiveness, and supports deficit trust as a mechanism for the social dysfunction observed in Veterans with PTSD. In the residential treatment dataset, both trust and social responsiveness decreased with less improvement in PTSS after treatment. This suggests that Veterans whose PTSS do not improve with treatment experience further decline in mechanisms of social functioning after discharge. In the absence of a control group, it is hard to determine whether this decline is due to symptom-related order effect, or unsuccessful treatment itself. These findings suggest decreased trust, but not social responsiveness, is a mechanism of social dysfunction observed in PTSD. Further investigation into mechanisms of social dysfunction and treatment-related change in Veterans with PTSD, the iatrogenic effects described, and the way these effects can be minimized is also necessary. These findings lend support to treatments that directly target social dysfunction in the context of treatment-resistant post- traumatic stress disorder. / National Institute of Health, 1I01RX000120, NIH-I01 2009-2010, 2013-2014, NIH-I01 2018-2019 National Institute of Health, 5I01RX002354, NIH-I01 2018-2019, 2020-2021 / Master of Science

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The Polytrauma/TBI Rehabilitation Center (PRC) of the Veterans Affairs Hospital (VAH) treats patients with Traumatic Brain Injury (TBI). These patients have major motor and cognitive disabilities. Most of the patients stay in the hospital for many months without major improvements. This suggests that patients, family and the VAH could benefit if healthcare provider had a way to better assess or "predict" patients' progression. The individual progress of patients over time is assessed using a pre-defined multi-component performance measure Functional Independence Measures (FIM) at admission and discharge, and a semi-quantitative documentation parameter Clinical Pathway (CP) at weekly intervals. This work uses already de-identified and transformed data to explore developing a clinical outcome predictive model for patients with TBI, as early as possible. The clinical outcome is measured as percentage of recovery using CP scores. The results of this research will allow healthcare providers to improve the current resource management (e.g. staff, equipment, space) through setting goals for each patient, as well as to provide the family more accurate and timely information about the status and needs of the patient.

Combat veterans often return from war with psychological as well as physical injuries. Armed service members who are bodily injured routinely go to hospitals for treatment, first at military hospitals and later in the U.S. Department of Veterans Affairs (VA) system. But those with psychological injuries like post-traumatic stress disorder (PTSD) often go years, if not a lifetime, without treatment, in large part because the VA denies their claims with dubious justification. Veterans’ service organizations like the Veterans of Foreign Wars (VFW), the American Legion, and others, as well as state and county governments, have knowledgeable service officers whose job is to help guide veterans through the VA system and through the many appeals that are often needed to get treatment and an adequate disability rating that could result in monetary payments. This report tells the story of one VFW post in Burnet, Texas, its veterans, their families, and how their success in getting treatment for PTSD has positively affected their lives. It has also enabled them, as they recover, to help other veterans seek treatment and win compensatory disability ratings too. The report focuses on one Vietnam veteran, who four decades after his discharge from the Army came to be treated for PTSD. / text

The purpose of this study was to examine a select set of organizational variables and determine their relationship to nursing assistants' intentions to quit in state-owned veterans' long-term care facilities located across the United States. America's long-term care industry (e.g., nursing homes, assisted living facilities) is a multibillion dollar industry. Because the U.S. government is projecting a 250% increase in the elderly population, staffing these nursing homes and related facilities is a critical concern. A vitally important but often overlooked factor of the long-term care industry is employee turnover. Of the staff in long-term care facilities, the nursing assistant (NA) position is particularly susceptible to turnover. Approximately 80% of NAs who enter the workforce leave within the 1st year and many leave within the first 3 months of employment. Some facilities report that they are unable to accept new residents because of a lack of qualified NAs. While many studies have researched this issue, staff turnover in long-term care facilities remains a serious and widespread problem. This study provides a foundation for future research related to the perceptions of intentions to quit of nursing assistants (NAs) working in state-owned veterans long-term care facilities by providing primary data regarding NAs intentions to quit. Results of this study indicate that NA intentions to quit might be reduced provided that pay and rewards are increased, workplace violence is addressed, and better access to patient care plans is provided. This research is useful to state-owned and operated long-term care facilities by giving them additional insights into nursing assistants' intentions to quit perhaps resulting in lower rates of turnover. It is suggested that future research be performed using populations of individuals from other segments of the long-term care industry, mainly, for-profit institutional care nursing homes, and federally owned veterans long-term care facilities.

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Unemployment was a major problem faced by the ex-servicemen in Malaysia since the early seventies. Recognising the needs of ex-servicemen, the government through the organisation of the Veterans Affairs Division (VAD) introduced the resettlement program for the ex-servicemen with the aim of assisting the veterans to find employment. However despite the implementation of training programs, the rate of unemployment among the ex-servicemen was relatively very high, whilst the extent of the as well as the underlying factors remained unknown, with the resultant ambiguity of the role of VAD. This case study was designed to investigate issues related to the employment situation of the ex-servicemen by surveying those in the capital territory of Kuala Lumpur and the states of Selangor, Negeri Sembilan and Melaka, who participated in resettlement training and were discharged in 1993. In addition the states of Johor, Perak and Penang were included for the survey on the non participants of resettlement training. The study found that the rate of employment of the ex-servicemen in the states surveyed was substantially lower than that of the national average. The study also found that participation in the resettlement training organised by the VAD had significant effect on increasing the rate of employment besides higher income, shorter period of unemployment, better readjustment and higher satisfaction with civilian life. Among the factors analysed, ability to speak English and the economic activity and the stage of development of the states were found to have significance influence on the rate of employment. Other factors found to be associated with the employment of the ex-servicemen included age, education level, rank, urban or rural background, and matching of training to application. Based on the findings of this case study recommendations were made to improve the selectivity of, and access to, resettlement training by all ex-servicemen. Other recommendations included improving the standard of education and spoken English before discharge, lowering age of discharge with pension, provision of information related to employment and counselling service, setting up of data bank of ex-servicemen and further research.

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This paper explores the issues underlying the Scott v. Canada veteran class action lawsuit. In particular it seeks to provide context to these issues by examining the cultural and legal structure of the Canadian military, the historic developments of veteran benefits in Canada, and the difficulties veterans face navigating the institutions that disseminate these benefits. The Scott v. Canada veteran class action lawsuit was launched against the Federal Government in 2012, in response to the Canadian Forces Members and Veterans Re-establishment and Compensation Act (the “New Veterans Charter”), which replaced the disability pension regime for many Canadian Forces Members and veterans under the Pension Act. / Graduate