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At times during the conflicts in Iraq and Afghanistan, National Guard (NG) and Reserve service members have constituted as much as 40 to 50 percent of all
U.S. forces in combat zones. Unfortunately, NG Soldiers fare significantly worse than active component Soldiers following their return home. In a recent
study, 41 percent of NG Soldiers reported mental health symptoms or psychosocial concerns warranting further evaluation or a continuation of mental health
care at the three-month post-return mark.1
Although the reasons for higher symptom levels among NG Soldiers are unclear, NG Soldiers face unique challenges before and after deployment. Their
training is more time-limited than that of Soldiers in the active component, and when they return from deployments, NG Soldiers are not stationed on
military bases and have fewer built-in supports, such as easy access to peers and military health services. Instead, NG Soldiers are dispersed throughout
their home states and must rapidly re-enter their civilian communities and civilian jobs. In the current economy, they have often faced financial
difficulties and unemployment, both of which are factors associated with increased risk for PTSD. 2
To respond to these needs, the Department of Defense, National Guard State Organizations, VA, and local communities have developed a variety of programs to
assist returning NG Soldiers with re-integration challenges. Peer-to-peer services have achieved a particularly high level of acceptance in military
circles; as a result, VA and other agencies have developed and implemented several peer programs for NG Soldiers.
One of these peer outreach programs, BuddytoBuddy (B2B), was developed as a joint effort by the Department of Veterans Affairs HSR&D and University of
Michigan faculty, Michigan State faculty, Veteran advocates, and National Guard leadership. In the B2B program, volunteer Veterans from the community are
trained in communication techniques, confidentiality, and relevant local resources. After training, these volunteer Veterans are available in person to
Soldiers in their armories during drill weekends and by telephone between drill weekends. The goal of the B2B program is to provide returning NG Soldiers
with a listening ear and to identify Soldiers with emerging needs such as legal, financial, and mental health needs. Volunteer Veterans then connect the
Soldiers to appropriate resources. Volunteer Veterans receive ongoing guidance from program staff, and the program contains all elements recommended by an
expert consensus on peer interventions in military settings and the Defense Center of Excellence white paper on Best Practices for Peer Programs.3 B2B program staff are now working with VA leaders to develop plans to expand B2B by partnering with VA facilities in other states.
In 2010, the HSR&D Service funded a formative evaluation of the B2B program (SDP 10-047) to guide ongoing program modifications and facilitate future
dissemination efforts. We are using an embedded mixed-methods design to assess B2B implementation in the Michigan Army National Guard (MI ARNG) and a
quasi-experimental approach to assess its efficacy.
We are surveying all MI ARNG soldiers who returned from overseas deployments between July 2010 and December 2012 at approximately 6 and 12 months following
their return. To date, we have had a 51 percent response rate and have collected over 1,379 surveys at 6 months and 854 surveys at 12 months. Data
collection from MI ARNG units is scheduled for completion in October 2013. With the goal of guiding implementation and program modifications, study
investigators meet regularly with NG leaders to present aggregate data on Soldier well-being and participation in the program.
Preliminary data from our surveys and B2B program records indicate that mental health symptoms remain an issue for many NG Soldiers at 12 months following
their return. However, the B2B program is achieving reasonable levels of uptake within the MIARNG.
The B2B program currently relies on 83 active volunteers in 35 armories, and the numbers of volunteer contacts with individual Soldiers is rapidly
increasing. Study surveys indicate that approximately 10 to 15 percent of returning National Guard Soldiers have talked to a volunteer Veteran about
re-integration issues, and that Soldiers who have talked to volunteer Veterans report high levels of satisfaction.
Several papers are in progress that outline findings from baseline survey data. A recently submitted paper uses data from this Service Directed Project
along with data from earlier cross-sectional surveys completed by study investigators to assess changes in reported barriers to care over time. The
percentages of Soldiers reporting treatment barriers related to negative beliefs about mental health treatment or stigma declined significantly over the
three periods of data collection.
Study of B2B implementation continues, and more complex analyses that examine factors influencing various units' adoption of B2B are pending. Our goal
remains to use the rich data being collected to inform VA Central Office of Mental Health Services, the DoD, and other interested organizations about peer
program implementation and sustainability in addition to providing preliminary data on program effectiveness.
1. Milliken, C.S. at al. "Longitudinal Assessment of Mental Health Problems Among Active and Reserve Component Soldiers Returning From the Iraq War Journal of the American Medical Association
2. Riviere, L.A. et al. "Coming Home May Hurt: Risk Factors for Mental Ill Health in US Reservists after Deployment in Iraq,"
British Journal of Psychiatry 2011; 198:136-42.
3. Money, N. et al. Best Practices Identified for Peer Support Programs. Washington DC: Defense Center of Excellence, 2011.