'Courage to Care' Launches Help for Returning Combatants, Families

In particular, Courage to Care is aimed at helping combatants reintegrate back into their families after surviving the battlefields of Iraq and Afghanistan. In general, the campaign is geared toward the entire Defense Department community -- active duty servicemembers and members of the National Guard and Reserve and their families, as well as the health and community providers who serve them.

Courage to Care consists of ready-to-use fact sheets written for physician providers, as well as servicemen and women, on topics about military life and health. The fact sheets are in the public domain, intended for distribution to provider networks, and can be customized with a site's local contact information and resources.

The first of two fact sheets is titled "Reintegration Roadmap Shared Sense of Purpose," and is for the health and social service provider. Its companion sheet, "Becoming a Couple Again, Creating a Shared Sense of Purpose," is for military couples experiencing the transition.

The content derives from interviews conducted by the university's health professionals with affected servicemembers and families who have experienced combat stress and family separation. The fact sheets describe the reintegration challenges and offer a step-by-step process to help affected individuals re-establish their relationship as a couple and as a family.

Nancy Vineburgh, assistant professor of psychiatry, coined the campaign's name to convey the courage to care from military doctors, psychiatrists and counselors. It also conveys the courage to care that military families and communities must assume in caring for their own health.

Vineburgh, who has worked on national public education, health education and health promotion campaigns, designed the fact sheets to be concise, contemporary and attractive. That in turn should facilitate and sustain the health dialogue between provider and the military servicemen and women on the receiving end.

She said Army Col. Charles Serio, the university's brigade commander, sent a copy of the fact sheet to a relative just returned from the battlefield who commented that it made so much sense. "His wife said it was attractive enough to put on their refrigerator to remind them in the months ahead of the 'relationship makers and relationship breakers' outlined in the fact sheet," Vineburgh said.

"People tend to read and hold onto information that is attractive," Vineburgh noted. "These are issues that won't go away overnight. Our team wanted to address not just the issues, but the process of healing and recovery."

The university-based Courage to Care program is the brainchild of retired Air Force Dr. (Col.) Robert J. Ursano, professor and chairman of the Department of Psychiatry and director of the university's Center for the Study of Traumatic Stress.

Ursano was prompted to establish the program after receiving an e-mail message from a young woman whose brother, a member of the 101st Airborne Division at Fort Campbell, Ky., was returning home for two weeks of rest and recuperation in November 2003, according to Air Force Dr. (Col.) Molly Hall, an associate professor of psychiatry.

The woman wanted to know how the family should prepare to welcome her brother home from the battlefields of Iraq. She also wanted to know what issues the family should understand before he arrived to diffuse any combat trauma he might have suffered.

"That e-mail wound its way to us," Hall noted. "Out of that request came the first health fact sheet on coming home for service members and their families on reunion."

Hall said that first fact sheet on reintegration was posted on the center's Web site in advance of Courage to Care becoming a university-wide campaign.

Ursano said that Courage to Care speaks to the family's need and recognizes their energy, effort and caring. "Whether it's taking care of a soldier who's lost his legs or whether it's taking care of a child with chronic diabetes, we forget what it means and how much energy a families goes to those activities," said the retired Air Force colonel. "It requires their courage to face it every day in order to manage those types of health problems."

"Courage to Care is an extension of our work in educating health providers and to enhance their communication with military and their families," Ursano noted. He also directs the Center for the Study of Traumatic Stress, which began in the 1980s. It is a public/private partnership of the university and the Henry M. Jackson Foundation for the Advancement of Military Medicine. With its home in the Department of Psychiatry, the center is sponsored by multiple departments at the uniformed services university.

The Jackson foundation is dedicated to improving military medicine and public health. The private, not-for-profit organization helps military personnel conduct quality medical research and education programs. Since its creation, the center has been involved in nearly every large-scale disaster the nation has faced, said Ursano, the first chair of the American Psychiatric Association's Taskforce on Disaster Psychiatry.

"We are a central repository of information about mental health and behavioral issues related to disaster, trauma and terrorism," Ursano noted.

He said the center's earliest work included the Army's largest peacetime loss on Dec. 12, 1985, when a chartered DC-8 plane carrying 248 members of the 101st Airborne Division crashed during takeoff at Gander, Newfoundland. Center personnel were also involved when the 185th Fighter Wing of the Iowa Air National Guard was the first responders after United Airlines Flight 232 crashed and cartwheeled down the runway at Sioux City Airport on July 19, 1989. More than 100 people were killed, but 185 people aboard survived.

When devastating earthquakes hit Armenia on Dec. 7, 1988, the center set up a satellite bridge network to provide consultation into Armenia, where more than 25,000 people died, and over 500,000 lost their homes. The center also provided consultation after earthquakes in San Francisco, the embassy bombings in Africa, and the 9/11 terrorist attacks on the World Trade Center and the Pentagon, Ursano noted.

"In each of these settings, we've been involved in providing consultation, education or research," he said. "Most often it is all three. That is part of a working relationship and those we work with teach us. This develops the lessons learned to be used in the future to help others."

Vineburgh said, "There's a lot of health information out there, but it is often imbedded in comprehensive, health information Web sites. We wanted something simple and direct that could be used in provider offices as a take away for the military family or service member. The university provides access to some of the nation's leading military medicine experts and providers, and we wanted to bring that expertise to the DoD community."

Topics in future issues will include, "Workplace Re-entry of Guard and Reserve," "Deployment Impact on Children and Families," "Women's Health During Deployment," and "Talking About Injury With Spouse and Family."

Courage to Care fact sheets can be downloaded from the uniformed university's Web site. For more information, call 301-295-2470.