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Military Youth: The Forgotten Casualties of War

Military Youth: The Forgotten Casualties of War. Amy Hedges, MD Grand Rounds 13 April 2010. Objectives. Review impact of Global War on Terrorism Review recent studies focused on Military Youth Discuss ways we as providers can help Overview of resources available to Military Families.

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Military Youth: The Forgotten Casualties of War

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  1. Military Youth:The Forgotten Casualties of War Amy Hedges, MD Grand Rounds 13 April 2010

  2. Objectives • Review impact of Global War on Terrorism • Review recent studies focused on Military Youth • Discuss ways we as providers can help • Overview of resources available to Military Families

  3. Military Family Statistics • Active duty military members = 1,387,674 • Reserve/Guard members = 846,248 • 38 % of active duty are married with kids • 2.9% in dual military families • 5.3 % of active duty are single parents • 33.2 % of Reserve/Guard are married with kids • 1.4% in dual military families • 8.7 % of Reserve/Guard are single parents 2008 Demographics Profile of the Military Community

  4. Military Child Statistics • Active duty military children = 1,149,350 • 0-5y = 496,727 (43.2%) • 6-11y = 372,585 (32.4%) • 12-18y = 280,038 (24.4%) • Reserve/Guard children = 634,901 • 0-5y = 185,961 (29.3%) • 6-14y = 324,448 (51.1%) • 15-18y = 124,492 (19.6%) 2008 Demographics Profile of the Military Community

  5. Deployment Statistics (thru 2007) • Deployed since 2001 ≥ 1 time = 1.6 million • 34% more than one deployment • 42% of deployed members have children • About 30,000 children have experienced parental injury or death Lemmon et al. Caring for America’s Children: Military Youth in Time of War.Pediatr Rev. 2009;30:e42-e48.

  6. Statistics from DMDC 2010 • All currently deployed (9/09) = 230,500

  7. Why does this matter in PA? • Ranked 38th in number of Active Duty • 2,701 members • Ranked 4th in number of Reserve/Guard • 33,124 members (over 17,000 Guard have deployed) • 14,000 Guard children in PA • 10,000 have experienced at least 1 deployment

  8. PA casualties • Dead = 239 • Active = 178 • Reserve = 19 • Guard = 42 • Wounded = 1563 • Active = 1121 • Reserve = 149 • Guard = 326 Defense Manpower Data Center as of March 2010

  9. Really PA? • Extended family in PA caring for children. • Families returning “home” to PA for support during deployments.

  10. Problems of being away from base • Not near other military children who understand. • Not near resources available on base. • Not near military medical facilities. • May be first time navigating “civilian medical care”.

  11. Reserve and National Guard • “Citizen Soldiers”, “Suddenly military” • Mobilize from local communities, which are often remote from military installations/resources. • May be taking a financial hit when going from civilian to military paycheck. • May be only kid in their school/community.

  12. Active Duty • Members have “chosen” the military as their careers. • Families usually live on or near military installations. • Access to military support systems • Around persons familiar with their situation

  13. Deployment “Cycle” • Deployments may be routine, planned or unexpected. • To combat or non-combat zones • Last 1 to 15 months • Standard Army deployment 12 months • Often longer for Reserve/Guard Units due to need for pre-deployment training

  14. War in the modern era • Ability for more frequent and rapid communication. • Email • Phone • Video • Live news from the front.

  15. How can we identify these families? • Ask! Ask! Ask! • Stay alert to news reports of local Reserve and Guard Unit Deployments. • Red flags • Tricare • New to the area

  16. Pre-Deployment • Prepare • Reassure • Lots of 1-on-1 time

  17. Deployment • Maintain routines • Stay connected • Letters, art work, phone calls, videos, email… • Keep busy • Keep return date open

  18. Homecoming • Kids are both anxious and excited. • Take things slowly!!! • Routines and roles change at home during deployment. • The parent will often need to “work” back in.

  19. Coping with injuries • Integrate kids into the recovery process. • Dr.’s appointments, PT/OT, prosthesis fittings • Then they’re not surprised! • Feelings of anger and guilt are normal. • It’s okay to ask questions. It’s okay to ask for help. (both for children and parents)

  20. “Hidden” Injuries • Traumatic Brain Injuries (TBIs) • Post Traumatic Stress Disorder (PTSD) • “Hurt on the Inside” • Harder to explain injuries you can not see. • Very important because these often make it harder for the parent to reconnect with the family.

  21. Infants/Toddlers • Respond to changes in schedule/routine. • May see refusal to eat, changes in sleep. • Feed off the primary care giver.

  22. Preschoolers • May experience developmental regression. • Bed wetting, baby talk, separation anxiety • May develop somatic complaints. • Due to active imaginations may develop inaccurate explanations as to why their parent left. • Need reassurance, attention and routines.

  23. School Age Children • Have a more real understanding of the realities/risks of deployment. • Need to be able to discuss their fears. • Limit viewing of media coverage.

  24. Adolescents • Experience increased responsibilities at home to fill the void. • Can lead to bitterness, anger, depression. • Tend to express their feelings with destructive behaviors. • Communication and realistic expectations are key.

  25. Caregiver • Need to take care of themselves so they are available to take care of the children. • Utilize support system. • Utilize community/military resources.

  26. All • Routines (including discipline) • Reassuring, stabilizing • Communication • No news can be worse than bad news. • Open and honest • Provide accurate and developmentally appropriate information. • Outside social supports • Friends, teachers/school • Don’t make promises you can’t keep.

  27. Chandra et al. Effect of Parents’ Wartime Deployment on the Behavior of Young Children in Military Families. Arch Pediatri Adolesc Med. 2008;162(11):1009-1014. • Cross-sectional study of 169 families. • Surveyed parents and childcare providers of children 1 ½ - 5yo enrolled in on-base childcare centers on a large Marine base. • Stratified into < 3yo and ≥ 3yo. • Excluded children with known behavioral disorders or developmental disabilities. • 1/3 of participating children had a deployed parent. • 92% of deployed parents were fathers. • No simultaneously deployed parents. • Mean length of deployment 3.9 months.

  28. Effect of Parents’ Wartime Deployment on the Behavior of Young Children in Military Families. • Parents with a child 3yo or older and a deployed spouse had higher stress scores than those with a non-deployed spouse. • Children 3yo or older with a deployed parent had increased behavioral symptoms compared to their peers without a deployed parent. • Children under 3yo with a deployed parent had decreased behavioral symptoms compared to their peers without a deployed parent.

  29. Chandra et al. Children on the Homefront: The Experience of Children From Military Families. Pediatrics. 2010;125:16-25. • Computer-assisted telephone interview of children 11-17yo and their non-deployed caregivers. (n=1507) • Selected from the Operation Purple applicant pool. • 95% had experienced at least 1 deployment. • 38% currently had a deployed parent. • Average deployed time in the previous 3 years was 10.9 months. • Compared to national sample from 2001.

  30. Children on the Homefront: The Experience of Children From Military Families • Children had more emotional difficulties compared with national samples. • Girls and older youth had more school, family and peer-related difficulties. • Length of deployment and poorer non-deployed care giver mental health were associated with more challenges during deployment and re-integration.

  31. Wong et al. The Effects of Multiple Deployments on Army Adolescents. Strategic Studies Institute. January 2010. • On line survey of active duty soldiers at Army installations, their spouses and their children age 11-17yo. (36.4% deployed at the time of the survey) • Follow-up in person interviews conducted with 100 adolescents. • Ultimately used deployment history from soldier survey and stress scores from adolescent surveys. • 409 Soldier/Child pairs

  32. The Effects of Multiple Deployments on Army Adolescents. • Looked at 6 factors: • Number of deployments • Strength of family • Availability of supportive mentors • Degree of participation in activities • Frequency/depth of communication with deployed parent • Child’s beliefs about the war and the Army

  33. The Effects of Multiple Deployments on Army Adolescents. • Factors that are most associated with lower levels of stress: • High participation in activities – especially sports • Strong family • Belief that America supports the war • Factors that are associate with better coping with a life of deployments: • Perception that the deployed parent is making a difference • Strong family • At-home parent’s handling of the deployment • Participation in activities of religious or service nature

  34. The Effects of Multiple Deployments on Army Adolescents. – The surprise findings. • Lower levels of stress with deployments #2 and #3 compared to #1 based on child surveys but higher levels with increasing number of deployments on soldier survey. • Teens 14-16yo had lower self reported stress with deployed parent than those without a deployed parent. • Stress levels were higher for teens who communicated more frequently with their deployed parent.

  35. Daddy Dolls™ • 17in and 12in pillow-like “dolls” with full body images printed on 1 or both sides. • Available with voice recorder. • Easily portable for children. • Good for hugging, snuggling and talking to.

  36. Flat Daddies® • Flat Daddies and Flat Mommies are life-sized printed posters of parents who are actively serving overseas in the military • Families have taken them on vacation, to delivery rooms, in family photos. • Children can talk to them, crawl on them, etc.

  37. Even better… • You can always make your own! • Kids can even make them of themselves to send with or to their deployed parents. • Full body, just head, pillows, blankets, stuffed T-shirts, etc.

  38. Military Resources • Military OneSource: Consultants provide information and make referrals on a wide range of issues. Free face-to-face counseling sessions and their equivalent by phone or online. 1-800-342-9647 or http://www.militaryonesource.com • On installations: Army Community Service Center, Marine Corps Community Services, Fleet and Family Support Center, Airman and Family Readiness Center • National Guard Family Assistance Centers are available in every state, www.guardfamily.org to identify your closest center.

  39. One Source • Help with everything from finding child care to making a budget. • Excellent resource for persons not located near a military base. • Counseling – up to 12 sessions per person, per issue…free!

  40. Resources/Programs • Sesame Street Workshop • Talk, Listen, Connect: Deployments, Homecomings, Changes • AAP Video Support Program • Red Cross • Local chapters • United Through Reading • Our Military Kids

  41. Sesame Street Workshop • “Talk, Listen, Connect is a multiphase, bilingual, multimedia initiative that guides families through multiple challenges, such as deployments, homecomings, and changes that occur when a parent comes home.”

  42. Sesame Street Videos • “When Parents Are Deployed” • Describes the three stages of transition families go through when experiencing pre-deployment, deployment, and homecoming. • “Coming Home: Military Families Cope With Change” • Shares inspirational stories of military families experiencing physical, emotional, and psychological injury.

  43. Sesame Street Family Connections • SesameStreetFamilyConnections.org • a child-centered online space where both children and adults can interact and stay connected

  44. When Elmo talks, children listen • “Elmo wants you to know that you should talk to your mommy or daddy about your feelings. Doing that helps Elmo feel a lot better. And Elmo wants you to know that your mommy and daddy always love you ... forever! Oh, and Elmo loves you too!”

  45. AAP Video Support Program • Mr. Poe and Friends Discuss Reunion after Deployment (Elementary Age) • Military Youth Coping with Separation: When Family Members Deploy (Older Children and Adolescents)

  46. Red Cross Services • Confidential services to all military personnel- active duty, National Guard and Reserves-and their families. Counseling, guidance, information, referrals and other social services. • Coping with Deployments: Psychological First Aid for Military Families – 4 ½ hour course • Red Cross-verified information assists commanding officers with making a decision regarding emergency leave. Without this verification, the service member may not be able to come home during a family crisis.

  47. Red Cross – Emergency Communication • Full name • Rank/rating • Branch of service (Army, Navy, Air Force, Marines, Coast Guard) • Social Security Number or date of birth • Military address • Information about the deployed unit and home base unit (for deployed service members only)

  48. United Through Reading • The United Through Reading® Military Program helps ease the stress of separation for military families by having deployed parents read children’s books aloud via DVD for their child to watch at home. • Helps deployed military personnel parent from afar. • Reassures the child that Mom or Dad is safe and thinking of home.

  49. Our Military Kids • “A simple grant program that pays for children’s activities. Eligible families apply for a grant and within days of receipt in the Our Military Kids office, a packet is sent to the child thanking them for their service to our country and notifying them of the award, then a check is sent directly to the service provider.” • “Helps families who often fall outside the parameters of established support programs – the families of National Guard and Reserve service men and women.”

  50. National Camps • Operation Purple Camps • “The mission of the Operation Purple program is to empower military children and their families to develop and maintain healthy and connected relationships, in spite of the current military environment. … The program is joint or "purple"—encompassing all Service branches, including the National Guard and Reserve.” • TAPS’ Good Grief Camp for Young Military Survivors

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