Counseling Children of Military Families Dealing With Deployment

1. Counseling Children of Military Families Dealing With Deployment Presented by: Amanda Andrews, Jennifer Breier, and Emily Shields

2. I. OVERVIEW Military Culture • Military has their own cultural, demographic, and personal constructs • Unique demands of military life include change of duty stations on average every 2-3 years and prolonged absence of the active duty member during deployments, temporary duty assignments, and frequent trainings • Mental health professionals and educators must be sensitive to the unique needs of military families during times of transition. • https://www.youtube.com/watch?v=yHgzc6dh8cs

3. I. OVERVIEW • The mobility of over 1.2 million school-aged dependents each school year as a result of change of duty station is a significant hardship for military families. (Lowe, et al., 2012) • Repeated family adjustment; negative impact of family instability increased for spouses and children as compared to nonmilitary families. • Challenges include: • lack of uniformity in educational programming • Frequent moves: lapses in general education curriculum, individual education plans (IEP), and disruption to instructional and behavioral interventions (i.e., Response to Intervention, RTI). • Parents express ongoing concern over educational challenges faced by their children and lack of specialized support for military children

4. I. OVERVIEW • Stress on families and children due to prolonged absence of the active duty member during deployments, TDYs, and frequent trainings. (Lowe, et al., 2012) • Since September 11, 2001, more than 1.3 million American service members have been deployed • Some mothers and children may experience separation anxiety, inadequate maternal role functioning, poor emotional functioning, depression, and anxiety. (Hillier, et al., 2013)

5. I. OVERVIEW • Multiple and often lengthy combat-related deployments: United States (U.S.) service members deployed for Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) is nearing 3 million with approximately 2 million children being separated from a parent for an extended period of time. (Walisky, et al., 2012). • Primary source of stress stems from difficulties in adjusting to new roles and responsibilities in post deployment stage (Ternus, 2010). • Effect of parental deployment is large because more than 50% of US service members are married with children, more than any other wartime conflict (Aronda, et al., 2011).

6. I. OVERVIEW • Communication difficulties after return from deployment (Lowe, et al., 2012) • spouses concealing true feelings to avoid confrontation • extended time needed to re-establish bonds with returning family member • family role readjustment, reestablishment, and role clarification are important considerations

7. I. OVERVIEW • Special Definitions • Combat-related Deployment- more likely to occur with less preparation, more variability in length and duration (4-15 months or longer), and increased stress on family members (Hollingsworth, 2011) • Redeployment- preparation for conclusion of deployment; typically one month prior to the active duty member's return. Preparations are made by spouses to prepare the home and children in a manner believed to be desirable to the active duty member. Such efforts place high demands on the children who must take on more responsibilities without much attention from the dependent spouse. (Lowe, et al., 2012)

8. I. OVERVIEW • Reunion- when the active duty member returns; can last hours or days depending on the base or unit activities used to welcome home the deployed serviceman. Involves physical reintegration back into the family and is where the military member visibly sees the impact of the deployment time on his/her children and spouse. (Lowe, et al., 2012) • Reintegration-renegotiation of family roles and responsibilities that shifted during deployment. If not properly addressed can have long term impact on family stability. (Lowe, et al., 2012) • Resilience- sources of strength that help individuals cope with adversity and thrive (Ginsburg, et al., 2013).

9. II. SPECIAL CONSIDERATIONS • Socio-cultural: Deployment affects the entire family, not just the child (Hollingsworth, 2011). • Family-centered interventions should be considered • Importance of school staff in promoting healthy positive role-models in a safe environment; military children who experience deployment have increased reliance on school staff for emotional and social support (Ternus, 2010). • Communication and addressing fear of unknown are key components when working with adolescents experiencing deployment (Ternus, 2010). • Literature supports that school staff are underprepared to deal with issues related to military students experiencing deployment (Ternus, 2010).

10. II. SPECIAL CONSIDERATIONS • Risk factors/ “red flags” • Many children and family members are at risk of increased stress due to strain of deployment cycles, as well as emotional or physical loss of a parent (Waliski, et al., 2012). • Military children experience emotional and behavioral difficulties at rates above the national average (Waliski, et al., 2012). • 14-20% of US school aged children have an emotional and behavioral disorder (Aronda, et al., 2011)

11. II. SPECIAL CONSIDERATIONS • Children with military parents who are deployed are also at risk for depression, anxiety, behavior problems, and difficulty in school (Waliski, et al., 2012). • Studies show an increased risk of child maltreatment during combat-related deployments (Ternus, 2010). • One-third of military children at high risk for “psychosocial morbidity” with parenting stress as most significant predictor of child psychosocial functioning (Ternus, 2010).

12. III. Interventions • School and community support services • Goals: 1) Identify needs of families early on; 2) Have supportive procedures in place; 3) Provide families with resources and connect them with other families • Initial questionnaire when students register for school to identify families dealing with deployment • Even children who are independent and self-sufficient may be suffering from stress and overwork due to shifting roles and responsibilities in the family

13. III. Interventions • Multi-Disciplinary Approach • School-based mental health interventions • Peer support groups in schools • Connecting military families with other families in the community • Teacher and counselor training on how to help students and families cope with deployment of a parent (Carpenter-Aeby, Aeby, & Raynor, 2012) • “School connectedness” - School climate, including respectfulness of students, rapport with teachers, and feeling of safety, helps new students acclimate (Berg, 2008)

14. III. Interventions • Family-centered intervention • FOCUS - Families OverComing Under Stress, Family Resilience Training (Lester, et. al., 2013) • Implemented by the U.S. Navy Bureau of Medicine and Surgery in conjunction with UCLA & Harvard • Individual child and parent resilience skill-building, consultations, briefings, and educational workshops • “Designed to enhance specific family processes that support resilience in the context of stress”

15. III. Interventions • Methods - Family-level education about: • Stress reactions and identified triggers that illicit breakdowns in family cohesion, communication, routines, and parenting activities • Similarities and differences in family members’ reactions to deployment and reintegration experiences • Identifying and using family strengths • Guidance about child development and common stress reactions

16. III. Interventions • Family-level CBT skills to promote resilience (such as emotional regulation, goal-setting, problem-solving, trauma/separation/loss stress reminder management, and communication) • This intervention can be offered by trained clinicians in a school setting over a set period of time, to multiple or individual families • Lester et. al study showed decreased stress in children, civilian parent, and military parent, and improved family functioning following the program

17. III. Expressive Arts Group Therapy • Goal: Provide an age-appropriate, supportive environment for children to express emotions, connect with peers, build skills, and encourage resilience (Huebner, Mancini, Wilcox, Grass, & Grass, 2007). • Example: 8-session, topic-focused group in a classroom setting. Art projects (drawing, painting, sculpting, poetry, etc.) facilitate discussion and group cohesion (Kim, Kirchhoff, & Whitsett, 2011) • Finding meaning in the uncertainty and loss of a parent’s deployment (Boss, 2006, as cited in Huebner et al., 2007) • Clarifying boundaries and roles • Building strengths

18. IV. Working with Parents, Teachers, and Professionals Figure 1. An ecological model of stress and trauma in military families Campbell et al. 2011

19. Parents • Enlighten parents about the benefits of counseling for both children, themselves, and other family members. • Inform parents about preventative care while they anticipate reuniting with a service member currently deployed (Wadsworth, 2013). • Educate parents about the benefits of engaging in current research that would benefit themselves as well as other military families (Chandra and London, 2013).

20. Resources for parents • Military OneSource: http://www.militaryonesource.mil/ • http://www.youtube.com/watch?v=dCpju4Tz6fk&feature=player_profilepage • Non-medical Counseling: Face-to-Face Counseling, Online Counseling, Telephonic Counseling. • Specialty Consultations: Adoption, Adult Disability Care, Education, Elder Care, Health and Wellness Coaching, Special Needs, and Wounded Warrior. • Other Services and Counseling: Document Translation, Financial Counseling, Language Interpretation Services, SECO Counseling, and Tax Services.

21. Military OneSource Continued • Military Life Topics: • Casualty Assistance, Child and Domestic Abuse, Children Youth and Teens, Crisis and Prevention, Deployment, Disaster Relief, K-12 and College Education, Legal Information, Money Management, Parenting, Transition, Spouse Education and Career Opportunities, Relationship Health and Family Wellness, and others.

22. Military OneSource Continued • Social Media Hub • Facebook, Twitter, Pintrest, Itunes, Tublr, and YouTube • Blog Brigade: a space where military spouses can connect with others around the world and share what they are going through. THis is a great place for parents to connect and share what is going on with their children. • PodCasts: Children, Youth and Teens • Choosing a college that’s right for you, Getting up and Getting active, Going green, How to stay safe online, Staying in touch with old friends, and youth sponsership among others.

23. Resources Continued • National Military Family Association: children’s resources • www.militaryfamily.org • Armed Services YMCA, Child Development Institute Stress, Management for Parents, Military 4-H Programs, Military Child Education Coalition (MCEC), Military Community Youth Ministries, Military Interstate Children's Compact Commission, Military Kids Connect, Military Teen Online, Military Youth on the Move, Our Military Kids, Sesame Street "Talk, Listen, Connect: Helping Families Cope with Military Deployment",Tutor.com, United Through Reading, Zero to Three

24. Sesame Street "Talk, Listen, Connect: Helping Families Cope with Military Deployment" http://www.sesameworkshop.org/what-we-do/our-initiatives/military-families/

25. Working With Teachers • Encourage teachers to identify and reach out to military families • Inform teachers of the special needs of military children and families • Encourage teachers to integrate learning into the classroom that normalizes military life • Ex. When reading about family, read a story about a military family, or talk about acquired disabilities in health class

26. Resources for Teachers • http://www.naeyc.org/files/yc/file/200803/BTJ_Military_Deploy_Resources.pdf • Offers an extensive list of books for children and for parents. Can be used in the counseling setting or sent home for parents. • http://www2.ed.gov/about/offices/list/os/homefront/homefront.pdf • Educator’s Guide to the Military Child During Deployment

27. Working With Clinicians • Educate clinicians in various settings about the rights of clients of military families: health care, education, disability, legal protection etc. • Clinicians need to be aware of the limits of competence and refer when necessary. • Clinicians must be careful of confidentiality and multiple relationships.

28. Resources for Clinicians • www.operationmilitarykids.org • Create community connections • Before, During, and After Deployment • Academic Support, Mentoring, and Intervention Services • Arts, Recreation, and Leisure Activities • Life Skills, Citizenship, and Leadership Opportunities • Sports, Fitness, and Health Options

29. V. Ethical and Legal Issues • Integrated Care • Competence i. Professionals are often put into situations such as the “Just in time” training where they are forced to learn and execute new information and practices as quickly as possible. Professionals must remember to stay within their scope of practice while also meeting the demands of deployed service members. ii. Beneficence and non-maleficence: Psychologists and social workers and other healthcare providers are bound to work under the rule of doing what is good for others and doing no harm to others. iii. Appropriate training is mandated for healthcare professionals to be consistent with promoting the wellness of others. BHC and AF settings require direct clinical training rather than simple review of manuals.

30. Legal and Ethical Issues Continued • Multiple Relationships • AMA Code emphasizes having open conversations about confidentiality • Physician-clients should not assume that healthcare providers already know about existing conditions and should be as open as possible. • Recommendations • More explicit guidelines for multiple relationships are established for healthcare professionals.

31. Legal and Ethical Issues Continued • Children with Special Needs • Rate of children diagnosed with disabilities in military families is rising • Families need help and identifying and securing available services and support • TRICARE, SSI, and Medicaid: While military personnel may be familiar with TRICARE through DoD’s health care system they may be less familiar with SSI and Medicaid and should educate themselves aboutthese valuable resources for military families with children with disabilities. • Special education benefits and protections • Advocating for the needs of special children: 504, IDEA, mandate free and appropriate education for all American school children.

32. Legal and Ethical Issues Continued • Long-term considerations including guardianship planning and special needs trusts • Planning for the future: legal assistance attorneys should be familiar with the nature of disability, its severity, progression, and level of care necessary. They should be able to properly advise their clients as to whether they need to execute guardianship of their adult child or set up a special needs trust. • Ultimately, legal assistance attorneys should be familiar with the rights of their clients, services available, and be able to comfortably counsel their clients with diverse and special needs.

33. VI. References Aronda, M. C., Middleton, L. S., Flake, E., Davis, B. E. (2011). Psychosocial screening in children with wartime deployed parents. Military Medicine, 176 (4), 402-407. Berg, K. F. (2008). Easing transitions of military dependents into Hawaii public schools: An invitational education link. Journal of Invitational Theory & Practice, 14, 41-55. Campbell, Brown, & Okwara. (2011). Addressing Sequelae of Trauma and Interpersonal Violence in Military Children: A Review of the Literature and Case Illustration. Cognitive and Behavioral Practice, 18, 131–143. Carpenter-Aeby, T., Aeby, V. G., & Raynor, M. (2012). The Catholic school community as a protective factor for students whose military parents have been deployed. Journal of Instructional Psychology, 39(3/4), 201-213. Chandra, A., & London, A. (2013). Unlocking Insights about Military Children and Families. The Future of Children, 23(2), 185-187. Clever, M. & Segal, D. R.. (2013). The Demographics of Military Children and Families. The Future of Children, 23(2), 13-39. Dobmeyer, A. C. (2013). Primary Care Behavioral Health: Ethical Issues in Military Settings. Families, Systems, and Health, 31(1), 60-68. Easterbrooks, M. A., Ginsberg, K., & Lerner, R. M. (2013). Resilience among military youth. The Future of Children, 23(2), 99-120. Fitzsimons & Krause-Parello. (2009). Military Children: When Parents Are Deployed Overseas. The Journal of School Nursing, 25(40), 40-47. Hillier, S. L., Goodman, P. Greiner, S., Agazio, J., Turner, A., Padden, D., & Throop, M. (2013). Deployment of military mothers: Supportive and nonsupportive military programs, processes, and policies. Military Medicine, 178 (7), 729-734.

34. VI. References Hollingsworth, W. G. (2011). Community family therapy with military families experiencing deployment. Contemporary Family Therapy, 33 (3), 215-228. Huebner, A.J., Mancini, J.A., Wilcox, R.M., Grass, S.R., & Grass, G.A. (2007). Parental deployment and youth in military families: Exploring uncertainty and ambiguous loss. Family Relations, 56 (April 2007),112-122. Kim, J.B., Kirchhoff, M., & Whitsett, S. (2011). Expressive arts group therapy with middle-school aged children from military families. The Arts in Psychotherapy(38) 356-362. Kudler, H. & Porter, R. I. (2013). Building Communities of Care for Military Children and Families. The Future of Children, 23(2), 163-185. Laser, J. A. & Stephens, P. M. (2011). Working with military families through deployment and beyond. Clinical Social Work Journal, 39 (1), 28-38. Lester, P., Stein, J. A., Saltzman, W., Woodward, K., MacDermid, S. W., Milburn, N., & ... Beardslee, W. (2013). Psychological health of military children: Longitudinal evaluation of a family-centered prevention program to enhance family resilience. Military Medicine, 178(8), 838-845. doi:10.7205/MILMED-D-12-00502 Lowe, K. N., Adams, K. S., Browne, B. L., & Hinkle, K. T. (2012). Impact of military deployment on family relationships. Journal of Family Studies, 18 (1), 17-27. Meek. (2012). Advising Military Families with Special Needs Children: A Legal Primer. Army Lawyer, 36- 54. Osofsky & Chartrand. (2013). Military Children from Birth to Five Years. The Future of Children, 23(2), 61-77.

35. VI. References Ternus, M. P. (2010). Support for adolescents who experience parental military deployment. Journal of Adolescent Health, 46 (3), 203-206. Waliski, A., Bokony, P., & Kirchner, J. E. (2012). Combat-related parental deployment: Identifying the impact on families with preschool-age children. Journal of Human Behavior in the Social Environment, 22 (6), 653-670. Williams, B. (2013). Supporting middle school students whose parents are deployed: Challenges and strategies for schools. Clearing House, 86(4), 128-135. doi:10.1080/00098655.2013.782849