Tag Archives: militaryfamilies

The Impact of Network Supports Among Military Caregivers with CSHCN

Mother and son in forest having fun

Nearly 2 million children and youth are military-connected; the largest group under 5 years of age, and it’s estimated that 20 percent or more have special needs (NIH & HSC Foundation, 2014). Understanding these families who have children with Special Healthcare Needs (CSHCN) can impact both formal and informal network support.

Formal and informal networks can contribute to caregiver resiliency among mothers with CSHCN. Formal network supports are intentionally systems that include expert providers such as human service agencies.

Like civilian caregivers, military caregivers rely most on informal network supports such as fellow unit members, spouses, neighbors, and family. Formal network supports for caregivers with CSHCN include early intervention programs, the Exceptional Family Member Program (EFMP), TRICARE, and family readiness programs and support from military leaders.

Effects of having CSHCN include: parenting stress, marital distress, and increased rates of divorce. Caregivers with CSHCN are more likely to experience hardships, even if income, education, and family structure are controlled. Like many caregivers, mothers of CSHCN are more likely to stop or reduce work. However, in a recent study from the Journal of Applied Family Studies found mothers with CSHCN experience significantly less formal and informal network support than their counterparts. More informal and formal network support was generally associated with higher resilience.

Highlighting family assets and coping resources is a critical aspect of intervention programs for children with disabilities. Parents of children with disabilities oftentimes seek social support, although their social supports are relatively smaller and offer less support than families with developing children.

Social supports may offset some economic and psychological costs that caregiver’s experience. It’s important that we strengthen our communities, making opportunities for children with disabilities to participate fully within the community.  We can distinguish between informal and formal networks using the social organization theory of community action and change, which can generate social capital and promote family resiliency.


Our goal then is spouse/caregiver resiliency – the extent to which spouses know and use their individual and community resources, experience a meaningful connection to the service branch, and meet the challenges of military life. (Bowen & Martin, 2011).


Farrell, A., , Bowen, G., & Swick, D. (2014). Network Supports Resiliency among U.S. Military Spouses with Children with Special Health Care Needs. Journal of Applied Family Studies , 63, 55-70.

This MFLN-Military Caregiving concentration blog post was published on September 02, 2016.


Caregivers of Veterans with “Invisible” Injuries

iStock_000017481456_XXXLargePosttraumatic stress disorder (PTSD) and traumatic brain injuries (TBI) together have often been called the “signature, invisible” injury of the Iraq and Afghanistan conflicts. PTSD is defined as the reaction to a traumatic event, such as combat exposure.1 Those with PTSD might have nightmares, flashbacks, hypervigilance, hyperarousal and an avoidance of crowded places or situations that tend to trigger memories of trauma. TBI is often caused by a traumatic injury to the head or neck and can cause physical, behavioral and cognitive changes.

Caregivers play an important role in the recovery of those individuals and veterans with PTSD and TBI, although little is known of them. According to Tenielian et al (2013), an estimated 275,000 to 1 million people are currently caring for, or have cared for, an individual returning from Iraq and Afghanistan. What is unique about these caregivers is that they are young, sometimes with children, and they are caring for a unique and understudied population for long periods of time.

In the 2010 report from the National Alliance for Caregiving (NAC), it was reported that “80 percent of veterans live in the same household as their caregiver, with 96 percent of caregivers being women and 70 percent of those being wives.”1 Alternately, in non-military caregiving (NMCG) populations, around 65 percent of caregivers are women with only 6 percent being wives. Given the amount of military family caregivers, it is important to have an understanding of the stresses the caregivers are faced with.

When comparing caregiver burden between NMCG and veteran caregivers (VCG) populations, 65 percent of VCGs reported caregiver burden versus the 31 percent of NMCGs. NAC also found that 95 percent of caregivers caring for a veteran with PTSD reported helping the veteran with mood regulation. The toll on the VCGs was also significant as they suffer more physically, psychologically and emotionally compared to NMCGs. “A common theme with caregivers is that families no longer recognized the veteran who has returned from combat and are unprepared or unwilling to hear about the psychological impact of warfare on the veteran (PATEL).”1

Another downfall for VCGs is the stigma within the military culture surrounding mental health disorders. According to Phelan et al, (2001) there are different types of stigma associated with veterans with PTSD or TBI as well as their caregivers. The three categories are as follows:

  1. Caregivers feeling discriminated against or being treated differently because of the veteran’s condition
  2. Stigma associated with being a caregiver
  3. Caregivers’ need to conceal or to explain the veterans condition


It is suggested by Patel that further exploration into the type of stigma caregivers experience be further studied, as some forms of stigma appear to have a greater affect on caregiver burden than others.

For more information about the affects on caregivers of veterans with PTSD and TBI, as well as the implications for social work practice, read the article written by Bina R. Patel entitled “Caregivers of Veterans with “Invisible” Injuries: What We Know and Implications for Social Work Practice.”



  1. Patel, B.R., (2015). Caregivers of veterans with “invisible” injuries: what we know and implications for social work practice, Social Work. 60(1). 9-17. Doi:10.1093/sw/swu043
  1. Phelan, S.M., Griffin, J.M., Hellerstedt, W.L., Sayer, N.A., Jensen, A.C., Burgess, D.J., & Ryn, M.V. (2011). Perceived stigma, strain and mental health among caregivers of veterans with traumatic brain injury. Disability and Health Journal, 4, 177-184. Doi:10.1016/j.dhjo.2011.03.003
  1. Tanielian, T., Ramchand, R., Fisher, M.P., Sims, C.S., Harris, R.S., & Harrell, M.C., (2013). Military caregivers: Cornerstones of support for our nation’s wounded, ill, and injured veterans. Retrieved from http://www.rand.org.pubs.research_reports/RR244



This MFLN-Military Caregiving concentration blog post was published on August 26, 2016.


Expert Advice Series: TRICARE ECHO – Public Facilities

Expert Advice Series

In a recent webinar entitled “TRICARE® Extended Care Health Option (ECHO)” participants were able to gather more information about the supplemental services for active duty family members with qualifying mental and physical disabilities provided through TRICARE® ECHO.

Question: What does it mean when it says that you must use a public facility first, before accessing care?

Advice: The ECHO requires that public facilities be used first for services and items related to training, rehabilitation, special education, assistive technology devices, institutional care in private nonprofit, public, and state institutions and facilities and, if appropriate, transportation to and from such institutions and facilities to the extent that they are available and adequate. The public facility use certification is a written confirmation that the requested Extended Care Health Option (ECHO) services or items are either not available from public facilities or are not adequate to meet the needs of the beneficiary’s qualifying condition. There are some exceptions:


  • Services available through state-administered plans for medical assistance under Title XIX of the Social Security Act (Medicaid) are not considered available and adequate facilities for the purpose of the ECHO.


  • Services and items available through the ECHO Home Health Care (EHHC) or Respite Care benefits do not require a public facility use certification.


  • No public facility use certification is required for medical services and items that are provided under Part C of the Individuals with Disabilities Education Act (IDEA) in accordance with the Individualized Family Service Plan (IFSP) and that are otherwise allowable under the TRICARE Basic Program or the ECHO.


The public facility use certification may be issued by the Military Treatment Facility (MTF) Commander/Enhanced Multi-Service Market (eMSM) Manager or an authorized administrator of the public facility.  The contractor will determine that services or items are not available from a specific public facility when the beneficiary provides a written statement that the facility refused to provide the required certification. A case-specific determination of public facility availability is conclusive and is not appealable.


Expert: Richard Hart, Senior Health Policy Analyst, Defense Health Agency, Health Plan Execution of Operations.

For more advice from Mr. Hart about ECHO, watch and listen to the professional development training entitled TRICARE® Extended Care Health Option (ECHO).

The new blog series provides monthly advice from subject matter experts on issues surrounding military caregiving for service providers and families. We take questions and concerns from military helping professionals and families and provide the necessary feedback from credible experts in the field of study. Whether you are a provider or a caregiver, what questions do you have? We want to hear from you.


This MFLN-Military Caregiving concentration blog post was published on August 19, 2016.

Budgeting and Calories: Is There a Connection?

By Barbara O’Neill, Ph.D., CFP®, Rutgers Cooperative Extension, oneill@aesop.rutgers.edu

There are three major things that people budget in life- money, time, and calories- and they are all related. For example, physical activity to burn calories and working at a job both take time and eating less food saves money.

Photo by Alan Cleaver. CC BY 2.0
Photo by Alan Cleaver. CC BY 2.0

Many articles have been written in the health field about “budgeting” calories as a way to lose weight. People can visit an online Calorie Calculator and get their recommended daily calorie “budget” (a.k.a., calorie salary) based on factors such as age, gender, height, weight, and activity level.

Then it is up to individuals to “spend” their calories wisely throughout the day on meals and snacks and try not to exceed their “number.” Similarly, people make choices with the money they have available to spend. Barring an infusion of cash, such as a settlement or contest prize, most people build wealth slowly by living below their means.

Let’s go back to a calorie analogy. The basic principle to lose weight is to eat fewer calories than you burn in a day. For example, if the calculator says you need 1,874 calories to maintain your weight, you’ll lose a pound a week if you consume 1,374. A financial equivalent example is earning $50,000, living on $46,000, and saving $4,000.

How do you live below your means? Many experts recommend starting with a detailed written or computerized budget with specific dollar amounts and categories. While this sounds great in theory, the reality is that only 32% of American households actually prepare a written budget or use budgeting software.

So what else works? Many people live on less than they earn by automating their savings. Commonly called “pay yourself first,” this strategy gives savings the high priority of a rent or secured loan payment. Savings gets deposited before people receive their take-home pay and they somehow learn how to live on less. Another strategy that works well for some people is personal “decision rules” that restrict their spending.

Consider this analogy from the world of NASCAR Motor Sports. Ever since a car wreck nearly killed hundreds of spectators in the grandstands at Talladega in 1987, when a speeding car went airborne, races at Daytona International Speedway in Florida and Talladega SuperSpeedway in Alabama have required drivers to use “restrictor plates” that limit the horsepower of their cars and slow them down.

To avoid overspending, people also need “restrictors.” In other words, cues that they’ve “had enough.” Not everyone will have the same restrictions, however. Rather, the amount that people spend relative to their income will vary. Looking for some specific ideas? Consider the following examples of personal financial restrictors:

  • Spend no more than $800 on holiday gifts and parties
  • Carry a revolving credit card balance of no more than $500 at any time
  • Charge no more than $200 per month in new purchases
  • Spend no more than $75 per week at the supermarket

If you want to lose weight, you monitor calorie intake by writing down what you eat and how much. Want to get ahead financially? You do the same thing by tracking income and spending. By writing things down- be it food intake or household expenses- you increase awareness of current practices and motivation to change. You also look at food and spending choices in a different light and mentally ask yourself “can I afford it?” For tracking worksheets for health and finances, see http://njaes.rutgers.edu/sshw/workbook/01_Track_Your_Current_Behavior.pdf.

Small Steps to Health & Wealth logoResearch conducted with a Rutgers University online quiz suggests a positive association between a wide array of recommended health and financial practices. This is not surprising since many of these activities require a time commitment, discipline, and/or sacrifice. Conversely, some people overeat and overspend and say they’ll cut back later to “balance things out.” Unfortunately, many never do.

Healthy and Happy with the Blues

CC Flickr Blue Angels Practice by OkiGator taken Nov 11, 2011
CC Flickr Blue Angels Practice by OkiGator taken Nov 11, 2011

by Robin Allen

I had the honor of watching the Navy Blue Angels perform in July from a boat on the Pensacola Sound in Pensacola Beach, Fl.  I will also have the pleasure of watching the Air Force Thunderbirds on Lake Michigan in Chicago, IL. I grew up in Pensacola and have a cousin who was in the Blue Angels, so I have watched them all my life, usually from the beach.  This time was especially poignant in the light of the recent tragedy of losing a Blue Angels pilot.  The crowds were enormous, and as I looked around, I saw thousands of people, many on the beach, some on boats, some swimming, some stuck in their cars fighting traffic.  We were the lucky ones who came by water. In our group was a nurse, pilot, and a few dietitians.  So naturally, as we watched the show, we discussed flying, health and nutrition.  I decided to write this blog on how to be safe and healthy for a long day out in the sun at 90+ degrees temperature and high humidity.

  1. Allow plenty of time to get to the show. I saw too many people still stuck in traffic in the heat while the show was going on.
  2. Water, water, water. Stay hydrated; you cannot have too much water on these hot days. The Institute of Medicine, National Academy of Sciences recommends consuming is 3.7 liters water or approx. 7 quarts, for adult men and 2.7 liters, approx. 5.7 quarts for adult women per day.  People who are elderly, obese or who have other chronic health issues are more at risk for heat stroke.
  3. Be careful of your alcohol intake. Alcohol lowers the body’s tolerance for heat and acts as a diuretic, speeding up dehydration. It also affects the body’s ability to regulate its temperature. Alcohol can also raise the body’s blood pressure, increasing the risk of a heat-related illness like hyperthermia overheating and heat stroke especially for people with high blood pressure.
  4. Sunscreen, apply before you leave the house and reapply frequently. You need a sunscreen with broad-spectrum or multi-spectrum protection for both UVB and UVA. Most people will do fine with SPF 15 which filters out 93%UVB, SPF 30 Screens out 97%UVB.If you’re going to be exercising or in the water, it’s worth getting a sunscreen that is resistant to water and sweat. But this means that it is effective for only 40 minutes of swimming.  You will need to reapply after 40 minutes. The sensitive skin of babies and children is easily irritated by chemicals in adult sunscreens, so avoid sunscreens with para-aminobenzoic acid (PABA) and benzophenones like dioxybenzone, oxybenzone, or sulisobenzone. Children’s sunscreens use ingredients that are less likely to irritate the skin, like titanium dioxide and zinc oxide.
  5. Get a babysitter! Especially if your baby is six months or younger. The American Academy of Pediatrics recommends infants six months or younger should stay out of the sun. Infants cannot handle the heat or exposure, and many infants end up in the Emergency Room.  Keep babies out of the hot sun with a canopy and do not overdress. It only takes 15 minutes for skin to be damaged by the sun.
  1. Have the correct pair of sunglasses. You can burn your retina spending hours in the sun resulting in solar retinopathy. Solar retinopathy can cause permanent damage to the retina and your eyesight. Look for sunglasses that block 99 percent or 100 percent of all UV light. Also look for impact resistant, polarized (sunlight bounces off the lens), medium to dark lenses depending on the amount of sun exposure, and a wraparound frame offers more protection from all angles.
  2. Food safety! Keep your food safe by packing it in an insulated container with a lot of ice or ice packs. Do not let foods stay out longer than 2 hours and if temperatures are above 90 degrees, not more than 1 hour.
  3. Have plenty of life jackets. The US Coast Guard requires one life jacket per person. Some states require children to be wearing a life jacket, not just have it available. You should also consider one for your pet. Our dog proudly wears her “Outward Hound” life jacket.

Now that you have some safety tips also remember to have fun! We packed gulf coast steamed shrimp, turkey wraps, lots of fruit and veggies, cheese and crackers, deviled eggs, nuts and of course water.

What are your favorite foods to take to the beach?

Pensacola Beach Blue Angels july 2016 by Robin Allen
Pensacola Beach Blue Angels July 2016 by Robin Allen














This post was written by Robin Allen, a member of the Military Families Learning Network (MFLN) Nutrition and Wellness team that aims to support the development of professionals working with military families.  Find out more about the MFLN Nutrition and Wellness concentration on our website, on Facebookon Twitterand LinkedIn.

Part II: Adult Learning – Life Experiences and Knowledge

Adul Learning Series

How can life experiences aid in the way we learn and process information?  As helping professionals many of us “learn from doing” or learn from experience. Did you know that learning from experience is a key principle of adult learning? Malcolm Knowles, the pioneer of adult learning, identified four principles to adult learning: (1) Autonomous and Self-Directed, (2) Life Experiences and Knowledge, (3) Goal-Oriented and Relevancy-Oriented and (4) Practical.

Last month we identified principle (1) Autonomous and Self-Directed and provided strategies for military service providers  who’s clientele prefers to be actively involved in learning and working around personal goals and interests. This month our focus shifts to principle (2) Life Experiences and Knowledge.

Life Experiences and Knowledge

Adults often bring their life experiences and knowledge to learning experiences. This could include family responsibilities, work-related activities as well as previous education.

As a service provider, when providing education and training to military families try to ask the individuals about their life experiences, part-time work, family commitments, schools or university experiences thus far, hobbies and leisure activities. Help your families connect their learning with their life experiences and previous knowledge. One way you could do this is to present a scenario and ask them if they have every experienced anything similar. By having your families connect to their personal experiences and knowledge you are encouraging a better connection to the topic, lesson, or idea you are teaching them.

Over the course of the next few months the MFLN Military Caregiving concentration will be discussing the remaining two principles of adult learning, as well as adult learning styles. If you missed our first post in this series covering Autonomy and Self-Direction, you can find it in our Adult Learning Series homepage. Our goal with this series is to provide service providers working with adults with a better understanding of how adults learn.


This MFLN-Military Caregiving concentration blog post was published on August 12, 2016.


Difficulties Military Families with Special Needs Children Often Face

Military homecoming, navy servicewoman with family

Military families face challenges when navigating the demands of military life, however when military families include children with disabilities the challenges are more unique and often more challenging.

On average children in military families switch schools six to nine times between Kindergarten and 12th grade1. Although all children in military families face the struggles of losing friends, familiar surroundings and their routines, the impact can by more detrimental on children with special needs.

In a study conducted by Jessica Carol Jagger and Suzanne Lederer, entitled “Impact of Geographic Mobility on Military Children’s Access to Special Education Services,” military parents of children with special needs were surveyed to describe the relationships between schools following placement.

The following difficulties were encountered with disabilities related to permanent change of station (PCS) and local public schools.

  • Parents feel they must battle school systems.
  • Different state/local educational authorities’ approaches to achieving educational goals lead to parent concerns about quality of services.
  • Uncertainty about place of residence limits proactive planning and precludes warm handoff.
  • Gaining schools are not prepared for student arrival when records were sent in advances.
  • Americans with Disabilities Act of 1990 non-compliance or inaccessibility.

To find out more difficulties as well as resources and recommendations for military families with special needs children, read the study “Impact of Geography Mobility on Military Children’s Access to Special Education Services.”

Resources Cited:

  1. Jagger, J.C., & Lederer, S. (2014, January). Impact of Geographic Mobility on Military Children’s Access to Special Education Services. Children & Schools, 36(1). Doi:10.1093/cs/cdt046


This MFLN-Military Caregiving concentration blog post was published on August 05, 2016.


Called To Serve: A Military Women’s Wellness Series

This week our Friday Field Notes focuses on a program created by two Assistant Professor’s at South Dakota State University to address the needs of an under-served military population…women.    Read on for information on this great program, which utilized cooperative extension specialists as part of the program.

Friday Field Notes

Females associated with the military (service members, veterans, dependents) experience varying stressors.  Today, the United States maintains the largest proportion of females currently serving in the armed forces in history. Females are experiencing more combat than in the past and are returning from combat with varying psychosocial stressors including an increase risk of harassment, sexual assault, mental illness, and unemployment.  Female military dependents may experience impairments in relationships due to the effects of trauma from deployments as well as symptoms of secondary trauma and other mental health issues.

Women associated with the military, including spouses and dependents, are currently an under-served population.  Few programs are available which address the specific needs of females who have a connection to the armed services. A lack of resources can increase stress and negatively impact the overall health and wellness of service men and women. Therefore, programs are needed to provide support and promote wellness among military personnel and families.

To meet this need, we received funding from the Women and Giving Foundation at South Dakota State University (SDSU) to design a series of wellness workshops. Each workshop was informed by one of the Pillars of Wellness established by the National Guard Bureau. In partnership with Michelle Ruesink, Director of Veterans Affairs at SDSU, the workshops were provided to female students and community members with military connections.  The Pillars of Wellness represent elements of one’s overall health including emotional, physical, spiritual, social, and family wellness. SDSU Extension state and field specialists with expertise in the pillars led the activities in each of the workshops. This pilot project was implemented at minimal cost, can be easily replicated, and helped to establish connections with local military organizations.

The following describes each of the workshops in more detail:

Physical Wellness: The health and physical activity extension field specialist facilitated a workshop on healthy eating and physical activity. During the session, participants learned about updated nutritional recommendations from the United States Department of Agriculture (USDA) and National Institute of Food and Agriculture (NIFA), as well as mobile apps that could be used to quickly estimate calorie intake. Additionally, participants learned and practiced basic yoga exercises for relieving tension.

Emotional Wellness:  A 4-H youth development and resiliency extension field specialist presented a workshop on the qualities associated with resilient individuals, as well as coping strategies that can foster resiliency. Participants formed small groups to discuss challenges that families may experience during military service and brainstormed coping strategies to help overcome those challenges. Additionally, time was provided for self-reflection related to a personal challenge and the development of an individual plan, which included coping strategies discussed during the workshop.

Spiritual Wellness:  A family, life, and child care extension state specialist presented on mindfulness, which is the process of focusing thought and attention on the present moment.  She led the workshop in a yoga studio in the wellness center on campus. Participants had a chance to engage in various mindfulness activities including a basic body scan, mindful walking, and mindful eating. These activities help limit preoccupation with past stressors or future obligations in an effort to reduce anxiety.

Family Wellness:  A family resource management extension state specialist provided strategies for managing family finances. Participants evaluated their needs versus wants and were provided with budget templates and debt calculators. A common concern among participants was related to student loans as many workshop participants were currently attending college or had college-aged children.

Social Wellness:  The last session served as a relaxing social event to wrap up the series. Participants were invited to a food and canvas painting event. A local merchant who hosts private painting parties facilitated the final session. Each participant had the opportunity to create a military-themed painting on her own canvas. During the session, an emphasis was made on the importance of community and maintaining relationships.

Our goal is to expand the programming to the other universities in South Dakota as well as within rural communities across the state.  By utilizing expertise within the University Extension System, we can provide effective programming to meet the needs of military service members and their families.  For more information on the pilot project, please view our publication in the Journal of Military and Government Counseling.

Bjornestad, A., & Letcher, A. (2015). Called to serve:  A military women’s wellness series.  Journal of Military and Government Counseling, 3(3), 215-228.

Meet the authors:

Andrea BjornestadAndrea Bjornestad, Ph.D., LPC, NCC, is an Assistant Professor and extension mental health specialist in the Department of Counseling and Human Development at South Dakota State University.  She is a licensed professional counselor in South Dakota.  Her research has focused on examining secondary traumatic stress symptoms in military spouses and the impact of Post Traumatic Stress Disorder on military families.  A current project includes designing a wellness inventory for military service members and veterans.  She is a former military spouse who has served on numerous committees to help plan and support events for military veterans and their family members.

Amber LetcherAmber Letcher, Ph.D., is an Assistant Professor and 4-H youth development specialist in the Department of Counseling and Human Development at South Dakota State University.  Her research focuses on youth development and risk taking in the context of early peer relationships. Her previous work compared the self-reported and observed attachment characteristics of adolescent couples and the relationship between romantic attachment and risk behaviors.  Current projects are exploring youth risk behavior within rural communities, sexual education programming, as well as the effects of youth mentoring.

Reaching Rural Veterans Program Created Via Community Collaborations

For this weeks Friday Field Notes we will hear from two women who work with the Reaching Rural Veterans program with the Military Families Research Institute at Purdue University about a collaboration between  land grant universities, rural faith communities, and faith-based food pantries to provide food, benefits, services, support and education to low income, homeless and at-risk veterans and their families living in rural areas.

Friday Field Notes

One of the biggest challenges that the Veterans Administration (VA) faces when it comes to providing services to veterans is to reach them where they live. In 2013, the Veterans Health Administration announced a new strategic plan that focused on ensuring that veterans have convenient access to tailored information and services, regardless of their location or circumstances. This kind of strategy has been productively used for many health- and poverty-related initiatives.pic for FFN purdue

Many organizations such as universities and the Department of Labor have created “one stop” offices to make it easier for veterans to meet requirements for education or employment (U.S. Department of Labor, 2011). Because rural veterans are a low-density population, any program aimed at serving them needed to leverage existing community resources in order to minimize expense, assist in sustaining and strengthening existing community programs, and infuse into local communities awareness of, and support for, veterans.

pic for FFN purdue 3Mindful of these principles, the Military Family Research Institute (MFRI) partnered with the VA Office of Faith-Based and Neighborhood Partnerships, the VA Office of Rural Health and the Roudebush VA Medical Center to create Reaching Rural Veterans (RRV). The result: a collaboration between land grant universities, rural faith communities, and faith-based food pantries to provide food, benefits, services, support and education to low income, homeless and at-risk veterans and their families living in rural areas.

The pilot program launched after 10 faith-based pantries located in Indiana and Kentucky were selected through a competitive application process. Each pantry received a grant of approximately $5,000 as well as training, materials and resources to use to reach out to veterans in their service area. About once a month, each pantry held an outreach event, bringing together multiple resources for veterans, making it easy, efficient, and nonthreatening for them to obtain benefits and services while building support with other veterans and the community. Through RRV, veterans gained access to behavioral health professionals, county veteran service officers, personal care providers (e.g. haircuts), veteran service organizations and more. VA facilities participated; so did nutrition educators and SNAP-education paraprofessionals, who provided food samples and information on nutrition and healthy choices.

Our initial goal for RRV was to reach an average of 25 veterans per county or a total of 300 veterans. But we far exceeded that. In six months, RRV reached more than 1,100 veterans in two states. And while the pilot project has ended, each of the 10 participating pantries has shared that the RRV events have been so successful that they intend to continue veteran programming.

pic for FFN purdue 4But the real success of RRV is seen best through the eyes of those on the front lines who work daily with veterans in need.

“My office has been able to help a veteran at least once per each of the last three [RRV] events,” said a VSO for Indiana’s Marion County. “I was able to change the life of two veterans by helping them get signed up for VA healthcare and I was able to help a veteran who was at risk for becoming homeless with a considerable increase in his pension. This veteran was a Korean War veteran and he is a Purple Heart recipient. He never received any services or benefits from the VA previously and has significant hearing loss. He now has access to VA benefits and we are helping him get a hearing aid to improve his quality of life.”

To learn more about RRV, visit the MFRI website at www.mfri.purdue.edu.

Meet the Authors:

bethjohnsonheadshot for FFNBeth Johnson currently serves as the director of external relations for the Military Family Research Institute (MFRI) at Purdue University. There she oversees a variety of projects including public relations, community relations, strategic communication, events and government affairs. Prior to joining MFRI, Johnson held public relations and communications positions with the Marine Corps Marathon, George Mason University and Salsa Labs, Inc. She received her bachelor’s degree in communication from Auburn University and holds her master’s degree in communication from George Mason University. Johnson’s military connections include her husband (former Marine captain and OEF veteran), brother (former Army captain and OIF veteran) and father (former Coast Guard officer).

andrea wellkin for FFNAndrea Wellnitz currently serves at the Project Manager for the Reaching Rural Veterans program with the Military Family Research Institute (MFRI) at Purdue University.   Andrea has over eleven years of experience working with diverse audiences on a range of social service, community outreach and educational projects and programs.  These audiences have ranged from at-risk youth in the United States, multi-generational populations around the world, and at-risk Veterans and their families. She received her master’s degree in Social Work from The Ohio State University. 

Nutrition, Exercise and Renal Disease webinar discussion. New publication by Dr. Ken Wilund!

Renal and Cardiovascular Disease Research Laboratory University of Illinois at Urbana-Champaign
Renal and Cardiovascular Disease
Research Laboratory
University of Illinois at Urbana-Champaign

by Robin Allen

What a great webinar in June, Nutrition, Exercise and Renal Disease presented by Dr. Ken Wilund. We had 283 attendees and over 100 comments in the chat pod.  The discussion was lively and much information was shared.  If you missed the webinar, Registered Dietitians can still earn CPEUs by listening to the recording and completing the evaluation located on the Learn Event page https://learn.extension.org/events/2655.  Dr. Wilund and his lab recently published a paper in the Journal of Renal Nutrition, Modified Nutritional Recommendations to Improve Dietary Patterns and Outcomes in Hemodialysis Patients in the Journal of Renal Nutrition. This study was discussed in the webinar is now available at the link above and on the Learn Event page.

The following are some of the key takeaways the participants commented on:

  • The renal diet is difficult to follow, and compliance is poor. Dietitians closely monitor lab values individualize meal plans to provide a well-balanced diet.
  • The key to success is getting the entire clinical team involved. Repetition is important to helping patients stay on their diet especially for sodium (Na+) restriction.  Telling them once is not enough! It takes a team approach constantly to repeat the message, including the doctors, nurses, techs, family members and the bus driver.
  • Sodium restriction is vital to avoid chronic volume overload. The recommendation from this webinar is 1 mg sodium/ 1 kilocalorie as the rule. Once again, it takes the entire medical team to reinforce this rule.
  • Education should focus on sodium restriction. Liberalize the diet restrictions and focus on encouraging non-processed foods. Restrictions of potassium (K+) and phosphorus (P) from non-processed/whole foods should be largely eliminated. Differentiate between organic and inorganic P. Few restrictions should be placed on fresh fruit, vegetables, nuts, legumes, and dairy. The health benefits from these foods outweigh the unsubstantiated risks.
  • Intradialytic hypotension has reduced with Dr. Izmir volume control policy: Dr. Izmir’s clinic in Turkey has had great results with strict dietary salt restriction to limit intradialytic weight gain (IDWG) and cessation of anti-hypertensive medications to prevent intradialytic hypotension. This volume control strategy has also been associated with lower rates of hospitalization, lower mortality, normalized blood pressure (BP) in the absence of BP meds, improved cardiac structure and function, improved body composition and markers of nutritional status, and reduced intradialytic hypotension.
  • There is a difference in the way Europe and the U.S. treat end-stage renal disease (ESRD). In Europe dialysis is not started if life expectancy is not good.  Also, Doctors in Europe can stop dialysis if patients are non-compliant.  In the U.S. dialysis is started no matter the life expectancy and continued whether patients are compliant or not.
  • Exercise is an important component of chronic renal disease (CRD) treatment. Demonstrated benefits include better body composition, improved muscle strength and physical function, improved cardiovascular structure and function, improved dialysis efficiency and improved quality of life!

I encourage you to watch this webinar if you have not seen it and share this information with others.  Also please provide your opinion as to whether you would consider some of these options for treatment at your clinic. There are some great opportunities for discussion.


 Ozkahya M et al. Am J Kidney Dis 1999; 34: 218-21 http://www.ncbi.nlm.nih.gov/pubmed/10430965

Ozkahya M et al. J Nephrol 2002; 15: 655-60 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2770424/

Ozkahya et al. NDT2006; 21: 3506-13 http://www.ncbi.nlm.nih.gov/pubmed/17000733

Heiwe et al. Am J Kidney Dis. 2014 Sep; 64(3):383-93 http://www.ncbi.nlm.nih.gov/pubmed/24913219

Barcellos et al. Clin Kidney J. 2015 Dec; 8(6):753-65 http://www.ncbi.nlm.nih.gov/pubmed/24913219

This post was written by Robin Allen, a member of the Military Families Learning Network (MFLN) Nutrition and Wellness team that aims to support the development of professionals working with military families.  Find out more about the MFLN Nutrition and Wellness concentration on our website, on Facebookon Twitterand LinkedIn.