**GAO-09-22R**                      Published: Oct 22, 2008. Publicly Released: Oct 22, 2008.                  

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## Highlights

As the military operations in Afghanistan and Iraq--known as Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), respectively--have progressed, increasing numbers of OEF/OIF servicemembers have transitioned to veteran status and have begun receiving care from the Department of Veterans Affairs (VA). VA data show that as of March 2008, over 868,000 OEF/OIF servicemembers, including National Guard and Reserve members, had left active duty and become eligible for VA health care, and over 340,000-- about 40 percent--had accessed VA health care services. Returning OEF/OIF veterans may have a range of health care needs, such as treatment for mental health conditions like posttraumatic stress disorder (PTSD), treatment for traumatic brain injury (TBI) or other injuries, or counseling to address difficulties readjusting from wartime military service to civilian life. Family members can play an important role in helping and supporting OEF/OIF veterans. For example, family members may notice symptoms the veteran has, such as anxiety or difficulty sleeping, and encourage the veteran to seek care. They may also help the veteran identify health care services and ensure that the veteran receives needed services. Family members may also provide emotional support--such as encouragement and reassurance--to the veteran. For example, they can support the veteran's efforts to reach rehabilitation goals by providing encouragement and helping the veteran stay motivated to participate in rehabilitation therapy. To help the veteran, family members may need a range of education and support from VA. They may need information about symptoms of mental or physical conditions, how those conditions can affect the veteran and the veteran's family, and the health care resources and treatment options that are available. They may also need information on potential readjustment difficulties that the returning veteran may face, as well as ways in which family members can help and support the veteran. At the same time, family members may experience difficulties--such as stress, uncertainty, or strained relationships-- due to the veteran's medical conditions or readjustment difficulties. According to VA officials, educated and supportive family members can help facilitate a veteran's readjustment and recovery. Congress asked GAO to provide information on the education and support available from VA for families of OEF/OIF veterans. In this report, we describe selected national initiatives and local programs VA has in place that address education and support for families of OEF/OIF veterans who are receiving VA health care.

In summary, VA has national initiatives and a range of local programs that address education and support for families of OEF/OIF veterans with post-deployment readjustment, mental health, and other health care needs. VA has two national initiatives that address education and support for families of OEF/OIF veterans, but it is too early to tell what impact these initiatives will have on VA's provision of education and support for families of OEF/OIF veterans. In June 2008, VA established an interdisciplinary Caregiver Advisory Board that is to develop a caregiver assistance program that addresses caregiver issues across VA's various health care disciplines and programs. The board's activities are to include the identification of core caregiver needs systemwide, the development of initial recommendations for VA caregiver support services, and the oversight of eight caregiver assistance pilot programs to assess the feasibility and advisability of various mechanisms to expand and improve VA caregiver assistance services. In April 2007, VA established the VA Advisory Committee on OIF/OEF Veterans and Families, which is responsible for reviewing VA services and benefits; providing advice to the Secretary of Veterans Affairs on health care, benefits, and family support issues; and making recommendations for tailoring VA services and benefits to meet the needs of OEF/OIF veterans and their families. Issues affecting families, including dependents and survivors, is one of nine priorities the committee is expected to address. The VA medical centers we reviewed offered a range of local programs for families of OEF/OIF veterans. We identified examples of medical center programs that addressed the following five issues: post-deployment counseling, PTSD, serious mental illness, caregiver assistance, and serious injuries. Post-deployment counseling programs included an education and support program for veterans who have recently returned from a combat theater and their families. The PTSD programs we identified at VA medical centers included marriage and couples therapy on an individual basis or in a group setting, as well as other types of group-oriented programs. Programs to address serious mental illness included family psychoeducation pilot programs for families of veterans with illnesses such as schizophrenia, bipolar disorder, and major depression. With regard to caregiver assistance, VA announced in December 2007 that it would establish eight caregiver assistance pilot programs at selected VA medical centers nationwide, to examine ways to improve education and provide training and resources for caregivers assisting veterans. Among the VA medical center programs focusing on serious injuries was the Family Care Map pilot program at VA's four Polytrauma Rehabilitation Centers (PRC)--regional centers that provide acute comprehensive medical and rehabilitative care for the severely injured. The Vet Centers we reviewed offered a range of programs for families of OEF/OIF veterans, including group-oriented programs and programs offered on an individual basis, such as couples and family counseling.18 Group-oriented programs addressing issues related to veterans' military service included a relationship enrichment group to provide education and skills to couples to address the impact of PTSD on interpersonal relationships; a parenting class to help veterans and their partners learn effective strategies for successfully raising their children; and a spousal support group providing education about PTSD, TBI, or other deployment-related issues affecting spouses of veterans.

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## Topics

Veterans

Aid for the disabledEducation program evaluationFamiliesHealth care programsHealth care servicesHealth centersLocally administered programsMental health care servicesPost-traumatic stress disordersProgram evaluationQuality improvementRehabilitation programsTrauma careVeteransVeterans benefitsVeterans' medical careVeterans' rehabilitation