“Seeking improved quality of life for Veterans” – Testimony of Kathy Roth-Douquet

Testimony of Kathy Roth-Douquet, CEO, Blue Star Families before a Joint Hearing of the House Committee on Veterans’ Affairs and Senate Committee on Veterans Affairs, March 6, 2024

Chairmen Tester and Bost, Ranking Members Moran and Takano, and distinguished Members of the Committee, thank you for the opportunity to provide testimony on Blue Star Families’ 2024 priorities today.

I am Founder and CEO of Blue Star Families — the nation’s largest grassroots military family support organization, with nearly 275,000 members in our network and impacting more than 1.5 million military family members every year. By cultivating innovative programs and partnerships, Blue Star Families seeks to ensure that our military and Veteran families always feel connected, supported, and empowered to thrive, wherever their service takes them, in order to ensure military readiness, retention, and recruiting.

Blue Star Families’ research calls attention to the unique experiences and challenges faced by military and Veteran families. Our annual Military Family Lifestyle Survey (MFLS) — developed in partnership with Syracuse University’s D’Aniello Institute for Veterans and Military Families (IVMF) and fielded since 2009 — is the largest annual comprehensive survey of military and Veteran families and is widely regarded as the gold standard among military family surveys. Data from the MFLS and other research by Blue Star Families has been used at every level of government to help inform those tasked with making policy decisions that impact our military-connected communities.

With 13 Chapters strategically located across the country, Blue Star Families provides both virtual and in-person support, creating a local presence that resonates with military, Veteran, Guard, and Reserve families. These Chapters serve as vital hubs where innovative programs, events, and services are offered, fostering a sense of community and connection. By facilitating interactions with civilian neighbors, institutions, and organizations, we aim to integrate military families seamlessly into their local communities.

This past year we witnessed a remarkable commitment to the well-being of Veterans and military families. Craig Newmark, Founder of Craigslist, exemplified this dedication by pledging $100 million to address pressing challenges such as mental health and suicide prevention, housing and homelessness, and food insecurity. Blue Star Families is honored to be a recipient of Mr. Newmark’s generosity, as he personally committed to supporting the establishment of three to five new Chapters and 12 new Blue Star Outposts.

These Outposts, building upon our existing Chapter structure, are a testament to the power of collaboration. By partnering with local organizations, we will expand our reach and bring events, programs, and resources to even more local Veteran and military-connected communities across the nation.

At Blue Star Families, we know that behind every statistic is a story, and it is my honor to share data and stories with you. Today, I want to share with you four main areas of concern which relate to military-to-civilian transition, how to ensure success after service, and ultimately how these affect our All-Volunteer Force in terms of recruitment and retention. These areas are suicide prevention, the Honoring our PACT Act, education, and transition.

Suicide Prevention

Preventing Veteran suicide is an urgent and non-negotiable duty that our country owes to those who have bravely served and sacrificed for our freedom. The alarming rate of Veteran suicides is not just a statistic; it is a stark reminder of the profound challenges that many of our service members face upon returning to civilian life. Suicide is the second-leading cause of death for Veterans^[1] and Veterans are “1.5 times more likely to die by suicide than nonveteran adults.”^[2]

Despite efforts to expand mental health care, Veteran families continue to face many barriers to accessing mental health services during these stressful events. There is a clear need for mental health support, and it is critical to increase the capacity of service providers throughout Veteran communities. Addressing the stigma surrounding mental health within the military and Veteran communities is crucial. Encouraging open conversations about mental health, normalizing seeking help, and providing education on the available resources can contribute significantly to reducing the reluctance some Veterans may feel in seeking assistance.

In addition, given the barriers to accessing mental health resources, and the tendency of Veteran families to turn toward informal support, we should also activate and encourage engagement with less formal mental health supports such as wellness centers, chaplains, and friends and families. These supports cannot and should not replace mental health care, but they can support and extend mental health if given psychoeducation about the signs and symptoms of mental health challenges and how to talk to someone about their mental health.

In 2022, Blue Star Families was awarded the Staff Sergeant Parker Gordon Fox Suicide Prevention Grant established within the Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019. Chairman Tester and Ranking Member Moran, we thank you for your leadership in developing this legislation and both Committees for working to enact this landmark law. You truly honored Veterans Affairs’ commitment, and prioritized and invested in comprehensive Veteran suicide prevention measures.

Through our Fox Grant, Blue Star Families provides an innovative community-based outreach prevention program called Blue Star Support Circles | Upstream Solutions to Crisis. Through this program, we empower Veterans and their friends and family members to recognize, understand, and intervene with their Veteran before their struggle becomes a crisis. While this non-clinical approach does not replace critical clinical mental health care, empowering loved ones to step in to support their Veteran can address a growing mental health concern before it becomes a suicide crisis.

This program offers facilitated, non-clinical, closed-group cohorts for supporters of Veterans. Over eight weeks, participants engage in virtual sessions designed to foster peer-based connections, deliver evidence-based training, and provide resources and referrals. The program empowers participants to effectively support their Veterans.

Blue Star Families has partnered with experts in the field such as PsychArmor, the American Red Cross, Spiritune, and the Tragedy Assistance Program for Survivors (TAPS) to provide world-class, relevant, and actionable strategies and techniques to recognize, address, and intervene before an issue becomes a crisis. In addition, participants are provided tangible resources such as lockboxes so those participants can take critical steps to keep their Veteran safe. Every participant also develops a crisis plan in the event their loved one becomes suicidal, so they are prepared if the situation arises.

In December 2023, Blue Star Support Circles successfully completed its first year of the program reaching 55 participants across nine cohorts that were recruited from our national network and partnering organizations.^[3] While the majority of the sessions were held virtually, one session was held in person in the Washington, D.C.-area. Sessions consisted of 60-minute educational lessons with 30 minutes of debriefing and discussion amongst the facilitator and participants.

A comprehensive mixed-method evaluation was conducted by a team of researchers from the University of Alabama (UA) which concluded that the first year went “very well.”^[4] Participants were very satisfied with the program and reported they would recommend this program to a friend or colleague (9.2 out of 10 with 10 being “most likely”).^[5] The statistically significant pre-post changes in the key outcome variables clearly indicate the tangible and meaningful impact of the Support Circles program. More specifically, results show the program:^[6]

• Positively impacted participants’ opinions and attitudes toward suicide and suicide prevention.
• Improved confidence in talking about suicide and suicide prevention.
  • For instance, the number of participants who felt they did not have enough knowledge to talk about suicide dropped by 16.8% after the program, while those who said nothing would stop them from talking about suicide increased by 17.7%.^[7]
• Increased knowledge of proper language to talk about suicide and suicide prevention.
• Improved use of available resources.
• Taught participants skills to reduce means and risk factors, including getting each participant to create firearms safety plans.

Additionally, it was statistically significantly found that people were more likely to think that “seeing a mental health professional” is “a sign of strength” and participants showed statistical significance in their views on the effectiveness of suicide prevention in terms of suicide being prevented.^[8]

Participant quote: “For me one of the biggest benefits was that I got to be in a group of people who I could relate to because we were all spouses of Veterans … that brought a level of comfort. I know from being in that community that it is much easier for military spouses to be open, especially when you are talking about difficult conversations, to be able to have those conversations with people who they feel like understand them and aren’t judging them.”

The evaluation results unequivocally illustrate that the Blue Star Support Circles program is catalyzing a profound shift in participants’ perspectives on suicide prevention. By actively engaging in the program, individuals are not only gaining a deeper understanding of the complexities surrounding suicide but are also experiencing an increase in their perceived ability to make a difference in preventing suicide.

Moreover, the program is succeeding in fostering a heightened sense of agency among participants, empowering them to take meaningful actions in the realm of suicide prevention. This shift is essential in creating a proactive and supportive community that actively contributes to breaking down the barriers and stigma associated with discussing and addressing suicide.

Beyond the individual impact, the Support Circles program is playing a pivotal role in building a strong and supportive community for families of Veterans, particularly in the sensitive context of suicide awareness and prevention. The sense of community provided by the program is proving invaluable, offering a safe space for families to share experiences, exchange insights, and find solace in the understanding and support of like-minded individuals who are navigating similar challenges.

Blue Star Families also recommends that the VA facilitate grantee professional networking opportunities to enable the sharing of best practices, instead of existing one-way updates from the VA. We also encourage rigorous Congressional oversight of the execution of the existing Fox Grant-funded programs to assess the effectiveness of each and to expeditiously reauthorize the most effective solutions with the necessary funding.

Separate from the VA-led effort, we recommend authorization of this program — or a similar one with necessary funding and resources — to provide military families this innovative, community-based, personalized approach to suicide prevention. Participating organizations will need DOD “buy-in” in order to have access to military facilities and organizations, and command leadership for related training to enhance the ability to get far upstream of the military and Veteran suicide crisis.

Thank you for establishing this generous and critical grant program. Please do not miss this opportunity to strengthen and expand it to ensure we provide this critical training to the entire military and veteran community in need,

The Honoring Our PACT Act

The passage of the Honoring Our PACT Act in August 2022 marked a monumental and long-awaited victory for Veterans and military families who have endured the devastating consequences of toxic exposures during their deployments. The tireless advocacy efforts of many Veterans and military family support organizations have culminated in a groundbreaking piece of legislation that significantly enhances VA benefits and health care for the millions affected by toxic exposures, such as those from burn pits.

Before the enactment of the PACT Act, the stark reality was that the VA was disapproving approximately 80% of disability claims filed by Veterans with toxic exposures.^[9] This disheartening statistic underscored the urgent need for legislative action to rectify the systemic shortcomings in recognizing and addressing the health consequences of toxic exposures experienced by our service members.

The transformative impact of the PACT Act becomes evident in the incredible turnaround witnessed post-implementation. The VA is now approving disability claims at the same percentage that was previously disapproved — a staggering 75%.^[10] This remarkable shift reflects a paradigmatic change in the way the military and Veteran community is supported, with tangible benefits and health care now reaching those who have suffered from toxic exposures.

According to the VA’s latest information, 764,443 people have had PACT Act claims approved.^[11] The monumental impact potential this translates to is staggering. I want to share one story that’s quite personal for me. My Chief of Staff lost her 35-year-old Special Forces Veteran husband to a service-connected cancer last year. He developed symptoms and died within a year. When disease acts that quickly, families are reeling. Thanks to the PACT Act, his claim was quickly approved and linked to his service, meaning that she no longer had to worry about the more than $1 million dollars in medical expenses accrued as her husband fought for his life. She could fight alongside him and support him and their young children as they moved to be closer to family for his final days. In fact, access to VA benefits had two unique upsides that were instrumental to her family: they did not have to change insurance companies after they moved across state lines, and the VA covered the cost of liquid meals, which most private insurers do not. This benefit alone saved their family thousands of dollars a week. Without the PACT Act, her family would be faced with impossible financial choices. Instead, she and her kids have been able to focus on healthy grieving and finding small moments of joy in their new community. Imagine this experience multiplied by over three-quarters of a million people.

While the VA is doing a commendable job reaching out to encourage application for PACT Act benefits, including enrollment in VA health care, we encourage the Department of Defense to ensure the approximately 200,000 service members who transition out of the military each year are well-informed of this generous new benefit. These service members and their families need to be fully educated about their new benefits and why they should enroll in the VA system, even if they are not suffering any symptoms at the time. With all of those who have deployed to Iraq and Afghanistan presumed to be exposed to burn bits and other toxins, commanders need to ensure their service members and their families know that they can turn to the VA for health care and benefits.

Blue Star Families calls on your Committees to work to strengthen the PACT Act and to provide new VA authorities when needs arise, and to stand against any attempts to weaken the new law.

Education

When we think about our service members and their families, access to education is pinnacle for transition to civilian life and an opportunity to create financial stability outside of their time in service. We know our service members are eligible for various education benefits both during and after their time in service, however the Post 9/11 GI Bill (GI Bill) is the VA’s largest education program. Since FY2013, 70% of Veterans have utilized their GI Bill benefits and spent 80% of the allotted budget each year.^[12]

Additionally, 54% of eligible enlisted military Veterans used their higher education benefits and 8% of eligible Veterans transferred their GI Bill to their spouse or dependents between 2009 and 2019.^[13]

Our data also shows that a majority of Veterans (62%) are using their GI Bill benefits, and many have reported their spouse (9%) or their child(ren) (11%) had used their GI Bill benefits,^[14] while others had not yet used the benefits but planned to use them in the future. Of those that had not used the benefits, 11% of Veterans plan to use them in the future, 2% plan for their spouse to use them, and 7% plan for their children to use them.^[15]

Among active-duty family members, many had not yet used their benefits. Just 22% of active-duty service members said they had used their GI Bill benefits, 15% reported their spouse had used the benefits, and 8% reported their child(ren) had used the benefit. The majority (57%) of active-duty service members who had not already used the benefit planned for their child(ren) to use their GI Bill benefit in the future. My husband used his GI Bill benefit to help fund our children’s college educations, and we are grateful and proud of that benefit.

Blue Star Families applauds Congress for improving education benefits for military-connected students and refusing to make cuts to the Post-9/11 GI Bill over the last decade. We also express our profound appreciation for passing long-sought bipartisan legislation to close the 90-10 loophole and curtail the abuse of the benefits by bad-acting schools, and we ask that you stand against any efforts to weaken or eliminate those protective provisions.

As military and Veteran families continue to serve both at home and abroad, the education benefits provided become not just a gesture of gratitude but a strategic investment. It serves as a powerful incentive for prolonged service, fostering a sense of commitment and loyalty. Our research shows that one of the most common reasons military families would recommend military service to others is the access to benefits like education, including the GI Bill.^[16] Moreover, it acts as a crucial draw for those considering military service, ensuring that the best and brightest are attracted to the cause of safeguarding our nation.

In these challenging times, where sacrifice and service are constant companions, we implore Congress to stand firm against any potential cuts or reductions in education benefits for our military and Veteran families, and to also oppose any efforts to undo the hard-fought gains our community has achieved through closing the 90/10 loophole and reducing abuse of these generous benefits by bad acting schools.

Transition

The enduring collaboration between Blue Star Families and IVMF over the past decade has provided invaluable insights into the experiences of military and Veteran families. Our annual MFLS has served as a powerful tool, unraveling the intricate tapestry of the transition and post-service life for Veterans and their families.

One consistent and sobering revelation from the survey is the persistent challenge faced by Veterans during their transition. In the 2023 MFLS, approximately half of the Veteran respondents described their overall transition as “difficult” or “very difficult.”^[17] This statistic underscores the profound and complex nature of the hurdles encountered by Veterans as they navigate the shift from military to civilian life.

The DOD’s Transition Assistance Program (TAP) serves as a critical resource for service members, providing them with essential support as they prepare for the transition from military service to civilian life. According to DOD guidelines, service members are permitted to commence TAP one year before separation or two years prior to retirement, allowing them a significant window to access the program’s valuable resources.^[18]

While the actual timing of participation in TAP may vary among service members, the VA strongly advocates for an early engagement with the program. The rationale behind this encouragement lies in the belief that early participation equips transitioning service members with the necessary tools, information, and skills to make a successful and smoother transition into civilian life.

Insights from our 2023 MFLS shed light on the perceived preparedness of Veterans for the military-to-civilian transition. We found that when Veteran respondents have more time to get ready to separate from the military, they feel more prepared for a successful transition. Yet, retired Veteran respondents generally report more time to prepare than non-retired Veterans.^[19] While the DOD and VA recommend taking TAP one to two years before separation or retirement, many Veterans either do not or are not able to start preparing that early. Some of this may be due to unit mission and staffing demands, but it is important to consider from a sustainability perspective.

When Veteran respondents have a smooth transition, they are more likely to recommend military service to a young family member, regardless of retirement status.^[20] Military and Veteran families are perhaps the most critical untapped resource to address the recruiting crisis. While there are many factors that go into someone’s recommendation of military service, a difficult transition could sour their perspective, and thus their willingness to help recruit the next generation.

This underscores the importance of effective transition programs and support mechanisms in not only facilitating a smoother shift to civilian life, but also in influencing Veterans’ perceptions of the overall value and benefits of military service. Early engagement with programs like TAP could support a smoother transition for Veterans. By initiating the transition preparation process well in advance, Veterans may be better equipped with the knowledge, skills, and confidence necessary to face the unique challenges associated with post-service life and, in turn, contribute positively to the perception and recommendation of military service to future generations.

Members of the Committees, thank you for inviting me here today to provide views on behalf of Blue Star Families. I am happy to answer any questions you may have.

 

---

^[1] Howard, J. T., Stewart, I. J., Amuan, M., Janak, J. C., & Pugh, M. J. (2022). Association of traumatic brain injury with mortality among military veterans serving after september 11, 2001. JAMA Network Open, 5(2), e2148150–e2148150. https://doi.org/10.1001/jamanetworkopen.2021.48150

^[2] DeAngelis,T. (2022). Veterans are at higher risk for suicide. Psychologists are helping them tackle their unique struggles. American Psychological Association. 53 (8), 56. https://www.apa.org/monitor/2022/11/preventing-veteran-suicide

^[3] Hamner, K., Bui, C., & Rodgers-Farris, S. (2023). Blue star family support circles: Year 1 evaluation report October 1, 2022-December 31, 2023. University of Alabama Office of Evaluation Research and School Improvement. http://evaluation.ua.edu/

^[4] Hamner, K., Bui, C., & Rodgers-Farris, S. (2023). Blue star family support circles: Year 1 evaluation report October 1, 2022-December 31, 2023.

^[5] Ibid.

^[6] Ibid.

^[7] Ibid.

^[8] Ibid.

^[9] Ramsey, J. (2022, July 21). The VA has denied most veterans’ burn pit claims. A new law would help care for them. Post and Courier. https://www.postandcourier.com/news/the-va-has-denied-most-veterans-burn-pit-claims-a-new-law-would-help-care/article_f4d23444-02e7-11ed-845a-3ffed940f658.html

^[10] Department of Veterans Affairs. (2024). VA PACT Act performance dashboard. https://department.va.gov/pactdata/wp-content/uploads/sites/18/2024/02/VA-PACT-Act-Performance-Dashboard-Issue-27-021624_FOR_RELEASE_508-1.pdf

^[11] Ibid.

^[12] Tofig, D. (2024, February 15). First in-depth assessment of the post-9/11 GI bill® provides insight on veterans’ post-secondary enrollment, degree completion, and earnings. American Institutes for Research.https://www.air.org/news/press-release/first-depth-assessment-post-911-gi-billr-provides-insight-veterans-post

^[13] Tofig, D. (2024, February 15). First in-depth assessment of the post-9/11 GI bill® provides insight on veterans’ post-secondary enrollment, degree completion, and earnings.

^[14] Blue Star Families. (2023). 2022 Military Family Lifestyle Survey.Unpublished data.

^[15] Blue Star Families. (2023). 2022 Military Family Lifestyle Survey.Unpublished data.

^[16] Blue Star Families (2023). 2022 Military Family Lifestyle Survey comprehensive report: Recommending military service. https://bluestarfam.org/wp-content/uploads/2023/03/BSF_MFLS_Spring23_Finding12_Recommending_Service.pdf

^[17] Blue Star Families (2024). 2023 Military family lifestyle survey comprehensive report.

^[18] Vergun, D. (2023, October 18). Military well prepared for civilian transition, official says. Defense.gov; U.S. Department of Defense. https://www.defense.gov/News/News-Stories/Article/Article/3561651/military-well-prepared-for-civilian-transition-official-says/#:~:text=Service%20members%20are%20allowed%20to

^[19] Blue Star Families (2024). 2023 Military family lifestyle survey comprehensive report.

^[20] Blue Star Families (2024). 2023 Military family lifestyle survey comprehensive report.