Overcoming Barriers to Care for Returning Veterans: Expanding Services to College Campuses

INTRODUCTION The need to expand mental health and social work care available to Veterans in the community and for increased Department of Veterans Affairs (VA) and community partnership has become increasingly recognized [1]. Over 2.4 million men and women have served in Operation Iraqi Freedom (OIF), Operation Enduring Freedom (OEF), and/or Operation New Dawn (OND) since 2001 [2]. Following their deployments to combat zones and separation from the military, many Veterans are faced with the choice of obtaining employment, enrolling in college, or both. The Post-9/11 GI Bill, passed by Congress in 2008, greatly expanded educational benefits for Veterans who served in the Armed Forces on or after September 11, 2001 [3], and increasing numbers of former servicemembers are using this benefit. According to the Veterans Benefits Administration (VBA) Office of Educational Services, the number of Veteran students and beneficiaries (i.e., dependents or spouses) accessing VBA educational benefits across the United States has increased from 397,598 Veteran beneficiaries in 2000 to 564,487 in 2009 and to 1,014,227 in 2012, totaling over $10.5 billion in utilized benefits (in 2011 alone) [4]. However, while the number of Veterans enrolled in college has dramatically increased, student Veterans have generally had lower graduation rates than their civilian counterparts [5]. Although the majority of student Veterans will complete their postsecondary programs, it has been estimated that about 30 to 40 percent will not [6], placing them at risk for adverse outcomes such as increased unemployment. This indicates a critical need to better understand and respond to the factors contributing to psychosocial difficulties among student Veterans that lead to poor academic outcomes. In this article, we will illustrate a replicable model that provides multifaceted Veterans Health Administration (VHA) healthcare, social work, and mental health services on the college campus and discuss ways in which clinicians and campus partners can promote wellness and academic success for student Veterans. Veteran students arrive on campus with a military background that includes unique experiences, knowledge, skills, and codes of behavior. Factors that can influence adjustment from military service to student life include the amount of time between discharge and entry into college, differences between military and civilian culture, balance between academic and other life responsibilities, and psychological consequences of combat or other trauma exposure. Military culture, which emphasizes service, respect, camaraderie, structure, discipline, and order, can differ from that of civilian or traditional college student life [7]. While military life can bring its own challenges and stressors, there are also significant benefits, such as having stable housing and income, healthcare, and support from superiors and/or peers, as well as generally more consolidated, centrally located or familiar resources. Loss of one's social network and need to obtain one's own housing, healthcare, and source of income can compound an often challenging cultural transition from the military to the college campus. Less than 10 percent of U.S. citizens serve in the military [8], and many civilian students may lack an understanding of the servicemember's experience. This disconnect is compounded by the often nontraditional status of student Veterans, who are typically older and often need to balance family (including parenting responsibilities), work, and academic demands. Indeed, nearly half (49.4%) of servicemembers and Veterans who have deployed to Iraq and Afghanistan are married [9]. In addition to general cultural or experiential differences, Veterans who have deployed to Iraq and Afghanistan are at higher risk for a number of adverse medical, psychiatric, and social outcomes. Milliken et al. reported exposure to deployment-related stressors in Reserve and Active Duty soldiers at rates of 69. …