Shoba Sreenivasan

Coming home from prison: Adapting military resilience training to enhance successful community reintegration for justice-involved Iraq-Afghanistan veterans.

We propose a veteran-centric justice model of resilience training developed by the military for assisting service members coming home from war and modify it to assist Iraq/Afghanistan veterans coming home from prison. Incarceration has been identified as a stress aftereffect of the prolonged Iraq and Afghanistan combat deployments. Notably, the rate of Iraq and Afghanistan–era incarcerated veterans increased from 4% to 13% between 2004 and 2012 for all incarcerated veterans. Successful reentry to the community from prison incarceration is difficult, with rearrest and reincarceration a frequent occurrence. Moreover, combat stress conditions may weaken the justice-involved Iraq/Afghanistan’s veteran’s ability to face challenges posed by the return home from prison. As in the war zone, the return home from prison may be idealized with unrealistic expectations and/or goals, thus setting up the returning veteran for disappointment, anger, deepening of alienation and disconnection from larger civilian society, and the risk of return to maladaptive mechanisms for coping. Resilience training can be provided in psychoeducational venues prior to prison release and with follow-up postrelease. Resilience building offers promise as an intervention to enhance the justice-involved veteran’s successful community reentry.

A Rehabilitative Justice Pathway for War-Traumatized Offenders Caught in the Military Misconduct Catch-22:

The United States and Canada, among others, have recognized that “misconduct stress behaviors” can be a “hidden” by-product of war-zone deployments. The American military’s paradigm of punishment over treatment creates a “military misconduct Catch-22,” in which the service member’s treatment need is identified as a result of, or only after, violations of military law. Civilian society then bears the justice, familial, and social costs of the military’s failure to address combat stress–based misconduct. As an alternative to existing punitive military pathways, we propose a rehabilitative justice pathway that builds on the successes of civilian criminal justice mental health courts—to be implemented during active duty service, before separation from the Armed Forces. The approach, predicated on the circumstances of each case, promotes resilience, honorable discharge, and successful reintegration of service members into society.

Veterans in Prison for Sexual Offenses: Characteristics and Reentry Service Needs:

Among prison-incarcerated men in the United States, more veterans (35%) have a sexual offense conviction than nonveterans (23%). Limited research has investigated factors explaining the link between military service and sexual offending. Nationally representative data from prison-incarcerated men (n = 14,080) were used to examine the association between veteran status and sexual offenses, adjusting for demographic, childhood, and clinical characteristics. Veterans had 1.35 higher odds (95% confidence interval = [1.12, 1.62], p < .01) of a sexual offense than nonveterans. Among veterans, those who were homeless or taking mental health medications at arrest had lower odds and veterans with a sexual trauma history had higher odds of a sexual offense compared with other offense types. Offering mental health services in correctional and health care settings to address trauma experiences and providing long-term housing options can help veterans with sexual offenses as they transition from prison to their communities.

Balancing safety against obstruction to health care access: An examination of behavioral flags in the VA health care system.

In 2003, the Veterans Affairs (VA) instituted an alert, known as behavioral flags, in the veteran’s nationwide electronic medical record. The flag can be placed for those who demonstrate physical or verbal aggression, and functions as a “warning” to staff that the patient poses an increased risk of harm to others. The flag also gives directives regarding actions to be taken before seeing the veteran (such as, VA police presence, restricting appointments to areas with metal detectors, restricting care to specific clinics or medical centers). Critics have alleged that behavioral flags are a method to punish those who complain about their health care by imposing restrictions at VA facilities. Indeed, data suggest that the overwhelming majority of “flagged” VA patient behaviors have been verbal. Behavioral flags may discourage veterans from seeking needed VA care, particularly, when restrictions such as VA police escorts to clinic appointments may be perceived as humiliating. Given this, alternatives to flag placement would be a comprehensive violence risk assessment and interventions that enhance a veteran’s control over disruptive behavior.