Working Effectively with Military Families

on Saturday, 30 May 2015. Posted in News

Military Families Product    Click to Read More 

The NCTSN is pleased to announce a product for providers working with military families. Working Effectively with Military Families: 10 Key Concepts All Providers Should Know is now available. This brief tip sheet outlines the top ten things to keep in mind when working with military families and, for each key concept, includes links to additional information.

Also, the NCTSN childhood Traumatic Grief Committee has developed three new factsheets:

CNN Report Highlights VA Partnership with North Shore Hospital

Highlights NCTSN partner Mayer Bellehsen, Ph.D. talking about this unique partnership to serve veterans and their families with the VA.
CNN Report on Military related Suicide

The Uncounted:

The Tragedy Assistance Program for Survivors has amassed a database of more than 44,000 family members grieving a service member's or veteran's death. Several times each month, TAPS receives a call or responds to an online message from family members who indicate they may be considering harming themselves, said spokeswoman Ami Neiberger-Miller. The nonprofit has safety protocols that ensure people get connected with mental health professionals.

Suicide on the homefront in military families
Recent Research and Resources

Ross, A. M. and E. R. DeVoe (2014 Online First). "Engaging OEF/OIF/OND Military Parents in a Home-Based Reintegration Program: A Consideration of Strategies." Health & Social Work.
For more than a decade, the long wars in Afghanistan and Iraq have placed tremendous and cumulative strain on U.S. military personnel and their families. The high operational tempo, length, and number of deployments—and greater in-theater exposure to threat—have resulted in well-documented psychological health concerns among service members and veterans. In addition, there is increasing and compelling evidence describing the significant deleterious impact of the deployment cycle on family members, including children, in military-connected families. However, rates of engagement and service utilization in prevention and intervention services continue to lag far below apparent need among service members and their families, because of both practical and psychological barriers. The authors describe the dynamic and ultimately successful process of engaging military families with young children in a home-based reintegration program designed to support parenting and strengthen parent–child relationships as service member parents move back into family life. In addition to the integration of existing evidence-based engagement strategies, the authors applied a strengths-based approach to working with military families and worked from a community-based participatory foundation to enhance family engagement and program completion. Implications for engagement of military personnel and their loved ones are discussed.

Walsh, T. B., C. J. Dayton, et al. (2014 Online First). "Fathering after Military Deployment: Parenting Challenges and Goals of Fathers of Young Children." Health & Social Work.
Although often eagerly anticipated, reunification after deployment poses challenges for families, including adjusting to the parent–soldier's return, re-establishing roles and routines, and the potentially necessary accommodation to combat-related injuries or psychological effects. Fourteen male service members, previously deployed to a combat zone, parent to at least one child under seven years of age, were interviewed about their relationships with their young children. Principles of grounded theory guided data analysis to identify key themes related to parenting young children after deployment. Participants reported significant levels of parenting stress and identified specific challenges, including difficulty reconnecting with children, adapting expectations from military to family life, and coparenting. Fathers acknowledged regret about missing an important period in their child's development and indicated a strong desire to improve their parenting skills. They described a need for support in expressing emotions, nurturing, and managing their tempers. Results affirm the need for support to military families during reintegration and demonstrate that military fathers are receptive to opportunities to engage in parenting interventions. Helping fathers understand their children's behavior in the context of age-typical responses to separation and reunion may help them to renew parent–child relationships and reengage in optimal parenting of their young children.

Farrell, A. F., G. L. Bowen, et al. (2014). "Network Supports and Resiliency among U.S. Military Spouses with Children with Special Health Care Needs." Family Relations 63(1): 55-70.
Understanding how military families who have children with special health care needs (CSHCN) successfully cope in the context of exceptional demands of the military lifestyle can inform scholarship, policy, and practice to the benefit of families. Using data from 775 female civilian parents (mothers serving as Key Spouses) married to active duty Air Force members, this study examined differences on dimensions of network support and spouse resiliency between mothers who do and do not have CSHCN, as well as the relative contribution of formal and informal network support to variation in self-reports of resiliency among mothers with CSHCN. Mothers with CSHCN experience significantly less formal and informal network support than their counterparts. Despite this, they reported equivalent overall resiliency, with lower perceived resiliency on only one of four resiliency outcomes. More formal and informal network support was generally associated with higher resilience. Implications for policy, practice, and research are discussed.

Kline, A., M. D. Weiner, et al. (2014). "Increased risk of alcohol dependency in a cohort of National Guard troops with PTSD: A longitudinal study." Journal of Psychiatric Research 50(0): 18-25.
Studies show high rates of co-morbid post-traumatic stress disorder (PTSD) and alcohol use disorder (AUD) but there is no consensus on the causal direction of the relationship. Some theories suggest AUD develops as a coping mechanism to manage PTSD symptoms and others that AUD is a vulnerability factor for PTSD. A third hypothesis posits independent developmental pathways stemming from a shared etiology, such as the trauma exposure itself. We examined these hypotheses using longitudinal data on 922 National Guard soldiers, representing a subsample (56%) of a larger pre- and post-deployment cross-sectional study of New Jersey National Guard soldiers deployed to Iraq. Measures included the PTSD Checklist (PCL), DSM-IV-based measures of alcohol use/misuse from the National Household Survey of Drug Use and Health and other concurrent mental health, military and demographic measures. Results showed no effect of pre-deployment alcohol status on subsequent positive screens for new onset PTSD. However, in multivariate models, baseline PTSD symptoms significantly increased the risk of screening positive for new onset alcohol dependence (AD), which rose 5% with each unit increase in PCL score (AOR = 1.05; 95% CI = 1.02–1.07). Results also supported the shared etiology hypothesis, with the risk of a positive screen for AD increasing by 9% for every unit increase in combat exposure after controlling for baseline PTSD status (AOR = 1.09; 95% CI = 1.03–1.15) and, in a subsample with PCL scores <34, by 17% for each unit increase in exposure (AOR = 1.17; 95% CI = 1.05–1.31). These findings have implications for prevention, treatment and compensation policies governing co-morbidity in military veterans.

Wright, K. M., H. M. Foran, et al. (2014). "COMMUNITY NEEDS AMONG SERVICE MEMBERS AFTER RETURN FROM COMBAT DEPLOYMENT." Journal of Community Psychology 42(2): 127-142.
To build on research concerning the development of postdeployment community-based programs, we surveyed active duty soldiers from two Brigade Combat Teams (N = 693; N = 1,385) after return from a combat deployment. The Brigade Combat Teams were located on different installations in rural areas representing 2 large military communities. The survey included an assessment about a range of community services (social events, cultural integration opportunities, family, chaplain, and mental health services, etc.). We also examined whether ratings of services varied as a function of Posttraumatic Stress Disorder symptoms, deployment experiences, organizational leadership and support, and attitudinal variables related to mental health. Differences in ratings between the 2 communities suggest the measure detected perceptions of community needs that are idiosyncratic to the particular community, and may be useful for informing program planning and service needs. [ABSTRACT FROM AUTHOR]

Vest, B. M. (2014 Online First). "Reintegrating National Guard Soldiers After Deployment: Implications and Considerations." Military Behavioral Health: null-null.
Abstract: US Army National Guard members are serving overseas on deployments at a level well above expectations of reserve service and successful reintegration of citizen-soldiers post-deployment has become a significant concern. This paper examines soldiers experiences transitioning post-deployment and offers preliminary observations on one state's Yellow Ribbon reintegration program. Data from interviews and participant-observation identified post-deployment experiences in three areas: 1) remembering the positive, 2) dealing with American civilian socio-cultural norms and values, and 3) coping with mental and emotional health needs. Data suggest that the social context of reintegration is important, and existing programs may not adequately meet soldiers needs.

Gallaway, M. S., M. Mitchell, et al. (2014 Online First). "Combat Exposure Factors Associated With the Likelihood of Behavioral and Psychiatric Issues." Military Behavioral Health: null-null.
ABSTRACT The objective was to evaluate correlated combat exposure factors among active-duty combat veterans deployed to Afghanistan; and then determine how these factors are associated with behavioral and psychiatric issues postdeployment. Active duty Soldiers from one brigade combat team (N = 1,739) were surveyed to assess their most recent combat exposures and behavioral outcomes. Combat exposures were factor analyzed and included in a larger structural equation model. Three factors emerged from the analysis; some combat exposures (e.g., Active Exposure) are protective of screening positive for post-traumatic stress, while others (Passive Exposure and Exposure Invoking Emotion) are predictive of screening positive for post-traumatic stress. These varying relationships should be considered during implementation of intervention and treatment of redeploying Soldiers.

Griffith, J. (2014 Online First). "Prevalence of Childhood Abuse Among Army National Soldiers and Its Relationship to Adult Suicidal Behavior." Military Behavioral Health: null-null.
The present study examined childhood abuse (namely, self-reported early childhood harsh punishment and physical abuse from parents) and its relationship to adult suicidal behavior among Army National Guard soldiers. Data were obtained from routinely administered surveys to soldiers, called the Unit Risk Inventory (N = 12,567 soldiers in 180 company-sized units). Due to the grouped nature of survey responses (soldiers within units), hierarchical logistic regression was used to estimate the prevalence of self-reported childhood abuse and its relationship to current suicide risk. Results showed prevalence rates of 16.0% for harsh punishment and 7.8% for physical abuse, generally consistent with those of past studies investigating childhood abuse among civilian and military populations. Soldiers who reported childhood abuse were 3 to 8 times more likely to report suicidal behavior (i.e., thought about suicide, made plans, or had attempted), with the highest likelihood of such behaviors for self-reported physical abuse. Level 2 or unit level effects were also evident: Harsh punishment and physical abuse were associated with suicidal behaviors, but the effects were less evident. Accordingly, individual self-reported experience of punishment and abuse were prominent risk factors for suicidal behavior.

Eads, K. A. (2014). The military child: An examination of anxiety occurring during parental deployment, CAPELLA UNIVERSITY. PhD: 91. (Dissertation)
Over the past decade, there has been a noticeable increase in mental health concerns among military families. Children raised in military families develop anxiety and worry that manifests itself behaviorally, educationally, developmentally, and socially. The current study sought to gain further insight into the anxiety felt by military children during parental deployment. 77 total participants completed the study demographic questionnaire and Spence Children's Anxiety Scale. Correlational methods were utilized to determine the presence of potential relationships between the anxiety felt by military children and the level of threat of the deployment location. The results of data analysis statistically opposed the expected outcomes of this study; with the exception of two points: (a) Children of reserve families exhibit higher anxiety during deployment than do those of active duty military families, and (b) Children of Air Force families' exhibit higher anxiety than those of Army or Navy families. Due to the nature of the sample the outcomes of the study are questionable; therefore the study should be repeated while controlling for the discussed limitations.

Salloum, A., M. S. Scheeringa, et al. (2014). "Development of Stepped Care Trauma-Focused Cognitive-Behavioral Therapy for Young Children." Cognitive and Behavioral Practice 21(1): 97-108.
Young children who are exposed to traumatic events are at risk for developing posttraumatic stress disorder (PTSD). While effective psychosocial treatments for childhood PTSD exist, novel interventions that are more accessible, efficient, and cost-effective are needed to improve access to evidence-based treatment. Stepped care models currently being developed for mental health conditions are based on a service delivery model designed to address barriers to treatment. This treatment development article describes how trauma-focused cognitive-behavioral therapy (TF-CBT), a well-established evidence-based practice, was developed into a stepped care model for young children exposed to trauma. Considerations for developing the stepped care model for young children exposed to trauma, such as the type and number of steps, training of providers, entry point, inclusion of parents, treatment components, noncompliance, and a self-correcting monitoring system, are discussed. This model of stepped care for young children exposed to trauma, called Stepped Care TF-CBT, may serve as a model for developing and testing stepped care approaches to treating other types of childhood psychiatric disorders. Future research needed on Stepped Care TF-CBT is discussed.

Deitz, M. F. (2014). Explaining Combat Related Posttraumatic Stress Disorder: An Integrated Mental Illness and Military Process Model. Department of Psychology, East Tennessee State University. Doctor of Philosophy in Psychology with a concentration in Clinical Psychology: 103.
The purpose of the current study was to examine a process model of combat-related and mental illness related processes that explain increased likelihood of Posttraumatic Stress Disorder (PTSD). This dissertation proposed the development of PTSD may occur due to cultural, social, and self-related pathways associated with veterans' dual encounters with combat (i.e., severity) and mental illness symptoms. Participants were 195 military veterans recruited from multiple sites and strategies to maximize sample size and representation. Participants were asked to complete several self-administered assessment inventories, including: the Posttraumatic Stress Disorder Checklist-Military, the Trauma Symptom Checklist, the Combat Experiences scale, the Self-Stigma of Mental Illness Scale, an adapted version of the Iraq War Attitude Scale, a perceptions scale, an adapted version of the Likelihood of Disclosure Scale, the Unit Support Scale, the Post-Deployment Support Scale, the UCLA Loneliness Scale (Version 3), as well as covariates that included demographics and details of military service (e.g., deployment information). Overall, results revealed that the impaired social support indicator of social isolation was linked to PTSD, whereas impaired unit support and impaired post deployment support were not predictive of PTSD. Results also revealed that it is the cultural stereotypes and stigma associated with military and war but not of mental illness that plays a role in social isolation and subsequently PTSD. Overall, evidence supports the combined explanations of combat-related processes and mental illness processes in understanding likelihood of PTSD.