Military Deployment Cycle: The Effect on Service Members and Families

1. Military Deployment Cycle: The Effect on Service Members and Families Georgene Rea, LCSW Director of Psychological Health, Nevada National Guard Dave Kaul, MHC, NCC Director of Psychological Health, Hawaii National Guard

2. 1500 Break • “A Day in the Life of a DPH” cont… • Daily Activity Log • Comprehensive Assessment Forms – Intake, Consultations, Referrals • Statement of Understanding, • Policy and Procedures NGB Policy 300 – 303. • MOS Referral Resource Policy • 1730 End of Day One  -- Homework Assignment: Complete the Military Acronym and Terms Training Template Military Deployment Cycle: The Effect on Service Members and Families The goals of this presentation are: • To introduce you to general information regarding the deployment cycle and how it impacts both the Service Members and family units • To gain a better understanding of common reactions to war and reintegration/readjustment • To provide you with an additional tool to assist in safely responding and interacting with a member of the military community who might be experiencing an emotional crisis

3. Ground Rules • This is not a political debate • Questions are encouraged for group discussion • Please be respectful of others • If the dialogue or material become too troubling, feel free to leave the room until you feel comfortable enough to return http://youtu.be/CbILpVzT_J8 Video: U.S. Military Tribute – I’m Already There

4. Learning Objectives •  Discuss demographic and risk characteristics of military families •  Describe general and deployment related stressors for military families and the stages of the deployment cycle •  Gain a basic understanding of the readjustment behaviors exhibited by returning veterans • Take away contact information for several national resources

5. Today 1% of American men and women are fighting our wars – willingly taking on the ultimate responsibility of protecting our nation. They do not make these sacrifices alone – when our troops are called to action, so are their families/friends/employers/support systems. • Since 2001, there have been over 1.6 million deployments in support of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). • 1/3 have served at least two tours in combat zones • 70,000 have been deployed at least five times • To date, approximately 2 million children have experienced a parental deployment in support of OEF/OIF

6. The Service Member Experience – This war is different • Volunteer vs. draft • Multiple deployments • Type of suicide bombings • Never any safety, lacking real recovery time • Use of civilians as shields and decoys by the enemy • Deliberately targeting our moral code • Ability to communicate via Internet and cell phones • IEDs, RPGs (Traumatic Brain Injury, hearing loss, neuro-chemical effects) • Advancement in medical treatments • Nation-building activities and interactions with local leaders

7. The Service Member Experience – Profile of Era Differences • OIF / OEF • Heterogeneous • Active duty • Reservists/National Guard- • Joined for variety of reasons • Did not expect to be deployed • Civilian contractors • Age range: 18-60+ • Married • Parenting/grand-parenting job/career • Financial responsibilities (e.g. mortgage, family) • Multiple deployments with unknown duration are typical • Instant communication • More indirect combat (IEDs and suicide bombers) • Wounded/killed ratio 15:1 • Vietnam • Military cohorts • Relatively homogenous • Enlisted and drafted • Fewer Reservists/Guard • Fewer civilian contractors • Average age 18-22 • Not married • No children • No career developed • Adolescents— early stages of development • One tour (12-13 mo) • Communications via phone, mail • Wounded/killed ratio 3:1

8. Military CultureActive Duty vs. Guard/Reserve Units Active Duty Guard/Reserve Units Units are small & based in local communities. Part-time citizen soldiers, often working with local police, fire, and EMS. Families may be left in a town with little or no support services. Mostly support units (transport, Military Police) Likely to work within local communities Can’t relocate easily when activated Lack of military related health services Need to make use of family or local supports (church, etc.) though Family Readiness Groups (FRG) are very helpful • Units are based at major military installations. • Full-time soldiers who expect to be deployed • Families are left at their post where a variety of support is in place both on-post & in communities. • Live on-post or nearby; other family support • Less need to relocate when deployed • Access to a variety of health, welfare, & educational services • Support groups in-place through soldier’s unit

9. Service Member Demographics From 2010 AAMFT Annual Conference Workshop #303

10. Deployed Military – current statistics • Men = 90% • Women = 10% • Married = 53% • with children = 68% • without children = 32% • Single = 47% • with children = 13% • without children = 87% Center for Deployment Psychology and Army OneSource

11. The Deployment Cycle

12. Coping with unique demands • Pre-deployment stressors • Leaving loved ones behind • Fear of physical danger, injury, death • Deployment stressors • Adjusting to a new place or foreign country • Reintegration after returning home • Parent absence • Being in a war zone • Harsh living conditions • Excessive heat, cold, noise • Constant risk of injury and death • Death or injury of fellow soldiers or civilians • 73% of Iraq/Afghanistan veterans know someone who was seriously injured or killed National Guard - Managing PTSD and Other Combat-Related Stress Reactions, 2010

13. Cycle of Deployment

14. Stage 1: Anticipation of DeploymentPre-deployment Phase Timeframe: When family members receive orders • Increased feeling of stress in home • Reality of change ahead is “sinking in” • Denial & anticipation of loss • Focus is on completing family pre-deployment activity checklist • Members may feel more emotional • In case of multiple deployments . . . new cycle may begin before family has had time to renegotiate shared vision from previous deployment

15. Stage 1: Anticipation of DeploymentPre-deployment Phase - Checklist Family • Birth certificates, power of attorney, marriage license, insurance papers, service agreements, lease, address book, vehicle Personal • Wills, Passports, Social Security cards, plans while apart, payment books, budget book Military • Copies of orders, ID card Medical • Dental, check-ups, immunizations, counseling Knowing the answers to problems or situations that may arise while the Service Member is away will not only ease strain on the family, but will help the deployed individual feel secure knowing that things at home are under control.

16. Stage 2: Detachment & WithdrawalPre-deployment Phase Timeframe: Last week before Service Member leaves • Service Member is focused on preparing for mission and may distance self from family • Anger, arguments may occur as family prepares to protect themselves from “hurt” of separation • Communication may be difficult • In preparation for loss, family may begin to act like the service member is already gone • Multiple deployments can result in need to repeatedly create distance; to feel “numb” and avoid emotional connection

17. Stage 3: Emotional DisorganizationDeployment Phase Timeframe: 1-6 weeks into deployment • Life without the Service Member may initially feel overwhelming • Routines change, responsibilities may be added • Kids may feel . . . • Numb and not interested in doing much • More irritable than usual • Have difficulty concentrating – particularly at school • Wish things would go back to “normal” • Surprised because things seem to be moving more smoothly now that the service member is gone

18. Stage 4: Recovery & StabilizationDeployment Phase Timeframe: Usually between weeks 3 and 5 after deployment • Family finally starts to settle into routine of life without the Service Member • It is not uncommon for the spouse to experience: • Independence • Self-growth • Financial Problems • Loss of sleep, appetite changes • Being busier than usual • Increased crying, depression, anger • Increased loneliness and anxiety

19. Stage 4: Recovery & StabilizationDeployment Phase – Children & Adolescents Infants to School-Aged Children • Tantrums • Toileting accidents • Separation anxiety • Aggression • Behavioral changes at home/school • Physical/somatic complaints • Fear of abandonment Coping with changes can be positive: • May enjoy newfound responsibility • Sense of independence • Relief that family is functioning well Teenagers • Angry, moody • Poor school performance, grades • Worry about deployed parent • Caretaker of stateside parent • Drug/alcohol use • Withdrawal

20. Stage 5: Anticipation of ReturnDeployment Phase Timeframe: About 6 weeks before the Service Member returns • Homecoming is coming! • Family is happy, excited, and feeling a boost of energy • Trying to make everything “perfect” for the return • Sense of relief that the Service Member will be home, combined with worries about whether or not they will be the same • If the Service Member came home on leave at some point during deployment, that experience may be what family members expect: • Positive Leave Experience = Positive Homecoming • Challenging Leave Experience = Challenging Homecoming

21. Stage 5: Anticipation of ReturnCommon thoughts and reactions Spouse • How strong is our relationship? • Have I made good decisions? • How has he changed? Service Member • Knows it will be hard not to feel like a stranger in his own home • Feels guilty for missing important milestones (birthdays, holidays) • Wants to understand & accept the decisions made during deployment • Worries that young kids won’t recognize him Infants & toddlers • Not know or remember the parent • Act shy, clingy, have a temper • Revert to behavior they’ve outgrown Preschoolers • Think they caused parent to leave • Test limits Children ages 5-12 • Mixed feelings • Resent parent for missing out/leaving • Wanting to please, asking questions Teenagers • Exert their independence • Be concerned about rule changes

22. Homecoming = Honeymoon period

23. Stage 6: Return, Adjustment & RenegotiationPost-deployment Phase Timeframe: About 6 weeks after the Service Member returns, after initial joy and relief have diminished (honeymoon period is over) • During time of separation the service member and all family members have changed • Changes may hold pleasant surprises or may cause conflict • Family members may feel overwhelmed by the Service Member’s attempts to get to know everyone again • Everyone needs space and time to readjust • Entire family must begin to renegotiate how household will look now that everyone is together again

24. Service Members and Families – video profilewww.realwarriors.net

25. Stage 7: Reintegration & StabilizationPost-deployment Phase Timeframe: Up to 6 months (and beyond) after the Service Member returns • Family continues to adjust to having the service member home • A “new normal” is established regarding routines and expectations • Members may begin to feel secure, relaxed, and comfortable with one another again • If readjustment challenges resurface, support is important

26. Why do some Service Members have difficulties readjusting after deployment?

27. Traumatic Events in Combat • Taken prisoners of war • Responsible for the care of enemy prisoners • Involved in cleanup of war zones, handling dead bodies • Sexually assaulted or harassed during active duty • Witness to or victims of injuries during training, friendly fire • Exposed to terrorist attacks • Involved in peacekeeping missions • Exposed to chemical, nuclear, or biological weapons • Death or maiming of women and children • Killing someone up close National Guard - Managing PTSD and Other Combat-Related Stress Reactions, 2010

28. Realities of Combat • Fear in combat is universal • Unit members will be injured and killed • There will be communication breakdowns • Leadership failures will be perceived • Combat impacts every soldier mentally and emotionally • Combat has lasting mental health effects • Soldiers are afraid to admit that they have a mental health problem • Deployments place a tremendous strain upon families • Combat environment is harsh and demanding • Combat poses moral/ethical challenges WRAIR Land Combat Study Team http://youtu.be/XzbpW5NMfls

29. Battlemind Training • Battlemind skills helped the Service Member survive in combat, but may cause him/her problems if not adapted after returning home • Buddies (cohesion) vs. Withdrawal • Accountability vs. Controlling • Targeted Aggression vs. Inappropriate Aggression • Tactical Awareness vs. Hypervigilance • Lethally Armed vs. “Locked and Loaded” at Home • Emotional Control vs. Anger/Detachment • Mission OPSEC vs. Secretiveness • Individual Responsibility vs. Guilt • Non-Defensive Driving vs. Aggressive Driving • Discipline and Ordering vs. Conflict

30. Deployment vs. Post-deployment stressors

31. Service Member mindset when deployed • Stay focused on mission /nothing else matters • Truly life or death / always on the edge • Constant adrenaline “rush” • Black or white / all or nothing • Sense of purpose, invincibility • Only trust battle buddies /others are threat • Need to control environment • Real problems and needs exist in Iraq/Afghanistan Adapted from briefing by COL Kevin Gerdes, May 2008

32. Mindset of Service Members returning home • Life is now unfocused and complex • No longer on the verge of life or death • What can replace the “high” of war? • Things aren’t clear cut • No sense of purpose, nothing matters • Can’t trust anybody • Can’t be in control of surroundings • Problems at home pale in comparison to those in Iraq/Afghanistan Adapted from briefing by COL Kevin Gerdes, May 2008

33. Post-combat driving: Unsafe on American roads In Combat • Drives as far as possible from road edge to avoid IED • Changes lanes & direction unexpectedly • Always moving, always has right of way, does not stop for traffic or people • Speeds as fast as the lead vehicle in a convoy • Hypervigilant of roadside elements At Home • Drives in middle of road, straddling lanes • Weaves through traffic, does not signal turns or lane changes • Anxious when stopped, rolls through traffic lights & stop signs, does not yield right of way • Drives over posted speed limit • Overly attentive to roadside elements (trash, dead animals, parked cars) • 2012 USAA Returning Warrior study found: • 13% overall increase in at-fault accidents for troops within the first • six months of returning from deployment • 22% for Enlisted E1-E4

34. Other Post-Deployment Reactions • Combat Stress: Natural result of heavy mental and emotional work when facing danger in tough conditions; physical symptoms (headaches, racing heart, fatigue, anger) generally gets better with rest and replenishment • Post-Traumatic Stress Disorder: Possible response when deployment has occurred to war zone, natural disaster site, or urban riot location: physical, mental, and emotional symptoms that require professional assistance • Secondary Traumatic Stress: Possibly experienced by family members upon return of soldier; stress resulting from helping or wanting to help a suffering or traumatized person

35. How is this information relevant to my job as a CIT officer?

36. 911 – What is your emergency? Identified problems leading to calls to law enforcement: • Viewing internet pornography and internet sex chat is becoming a norm for deployment – increase in stateside sexually based offenses • There is a high rate of infidelity among Service Members and spouses during deployments – resulting in conflict upon reunification (DV) • Illegal/prescription drugs and alcohol are prevalent and are used as common coping mechanism by soldiers (deployed and at home) and by their spouses (buying pills off the street) • Suicide (ideations, attempts) • Military Sexual Trauma is running at 16%-23% among deployed female soldiers (predictor of PTSD) • Home is no longer viewed as a safe place to live - many now carry weapons when at home

37. 911 – What is your emergency? • There is a statistically verifiable increase in domestic violence and child abuse among military families. Child abuse increases as the stressors increase in the life of the non-deployed spouse. • While deployed, many Service Members are constantly sleep deprived and share each others medications (Ambien, pain pills). Hooked on Energy Drinks. • Service Members may pursue activities which imitate the adrenaline rush of combat (increase in cocaine use upon returning home, extreme driving) • With increased monetary incentives and a lowering of recruitment standards the quality of the troops has been increasingly lowered: no GED necessary, accepting recruits with DSM-IV diagnosable conditions and on medications, increase of gangs.

38. Did you know? • 18.5% of veterans returning from Afghanistan and Iraq meet the criteria for Posttraumatic Stress Disorder (PTSD) and/or major depressive disorder. • 19.5% report traumatic brain injuries (TBI) such as concussions during deployment. • 79% of those with TBI met the criteria for alcohol abuse; 37% met the criteria for drug abuse. • Substance abuse represents one of the leading causes of medical leave for military personnel, accounting for approximately 400,000 medical encounters and approximately 75,000 days of enforced bed rest each year. • 30,000 suicides are committed each year on average, more than 20% are veterans. Defense Manpower Data Center 2011, National Military Family Association 2011

39. Did you know? • On average, a military veteran commits suicide every 24 hours. • The unemployment rate of post 9-11 veterans is 10.4%, compared to a non-veteran rate of 9%. The unemployment rate for veterans between 18-24 is 21.9%. The unemployment rate among Reservists/National Guard may be as high as 40%. • Female veterans are four times more likely to become homeless than men and are more likely than men to have dependent children. • Three out of four homeless veterans have alcohol, drug, or behavioral health problems. Defense Manpower Data Center 2011, National Military Family Association 2011

40. Did you know? • More than 50% of military spouses report stress; up 20% from 4 years ago. • Children of Service Members are 2.5 times more likely to develop psychological problems. • 44% of military children have moderate-to-difficult emotional or behavioral difficulties. Defense Manpower Data Center 2011, National Military Family Association 2011

41. Identify Indicators of Military Service & Support • Stickers or emblems on rear of vehicle • License plates (Gold Star, Disabled Veteran, Purple Heart) • DOD base permit lower left corner of windshield • Dog tags/lanyards on rearview mirror • Flags – POW, military branch, KIA • Photos, plaques or awards displayed on walls • Uniforms/hats, t-shirts with branch logo • Military equipment • Tattoos • Demeanor

42. Evaluate Level of Distress – Suggested Practices • Hypervigilance and exaggerated startle response • Fight, Flight, or Freeze • Psychotic breaks/dissociation

43. Evaluate Level of Distress – Suggested Practices • Does probable cause exist to believe the Service Member/Family Member is likely to harm him/herself or others if allowed his or her liberty? • Has he/she attempted or admitted a plan to commit suicide? OR • Feeling depressed, angry, confused but no signs of violence or untreated mental illness = No probable cause for involuntarily commitment.

44. De-escalation • Proxemics • Voice/body language control • ‘Positive’ instructions: tell me what you want me to do • Veteran status: soldiers talk to soldiers

45. Resolve - Arrest or mental health referral? Army OneSource www.myarmyonesource.com Military OneSource (800) 342-9647 www.MilitaryOneSource.com National Crisis Prevention Hotline (800) 273-TALK press #1 for Veterans www.suicidepreventionlifeline.org Vets4Warriors (855) 838-8255 www.vets4warriors.com American Red Cross Armed Forces Emergency Communication (877) 272-7337 Marine DSTRESS Line (877) 476-7734 National Homeless Veterans Hotline (877) 424-3838 Information & Referral Services 211 www.211.org

46. Questions/Comments NATIONAL GUARD BUREAU PSYCHOLOGICAL HEALTH PROGRAM Dave Kaul, MHC, NCC Director of Psychological Health Hawaii National Guard Phone: (808) 295-7818 Email: dave.kaul@ceridian.com Georgene Rea, LCSW Director of Psychological Health Nevada National Guard Phone: (775) 224-4991 Email: georgene.rea@ceridian.com