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Family Needs Across the Deployment Cycle

Mid-Atlantic. MIRECC. VA Mental Illness Research, Education & Clinical Center. Family Needs Across the Deployment Cycle. Kristy Straits- Tröster , Ph.D., ABPP Assistant Clinical Director, MIRECC. Cycles of Deployment. Scope of Deployment On Any Day…. 73,000 Couples Separated Length:

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Family Needs Across the Deployment Cycle

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  1. Mid-Atlantic MIRECC VA Mental Illness Research, Education & Clinical Center Family Needs Across the Deployment Cycle Kristy Straits-Tröster, Ph.D., ABPP Assistant Clinical Director, MIRECC

  2. Cycles of Deployment

  3. Scope of DeploymentOn Any Day… • 73,000 Couples Separated • Length: • Army: 15 Months • Reservists: 20+ Months away from Home • Multiple tours: • 85% 1 Tour • 44% 2 Tours • 20% 3 Tours

  4. Emotional Cycles of Deploymentfor Service Members and their Families http://deploymenthealthlibrary.fhp.osd.mil • Anticipation of Departure • Detachment and Withdrawal • Emotional Disorganization • Recovery and Stabilization • Anticipation of Return • Return Adjustment and Renegotiation • Reintegration and Stabilization

  5. Stage 1: Anticipation of Departure • Reality sinks in—denial and anticipation of loss • Pre-deployment checklist—taking care of items while striving to make time for “memorable” moments • Stage 1 may begin again before adapting to changes from previous deployment

  6. Stage 2: Detachment and Withdrawal • Becoming psychologically prepared • Focused on the mission and their unit • May create emotional distance within the marriage • Sadness and anger to protect from hurt of separation • May lead to shutting down emotions, numbness

  7. Saying Goodbye

  8. Stage 3: Emotional Disorganization • Adjusting to new responsibilities and being alone • Although familiar, may lead to fatigue and “burn-out” with multiple deployments • Feeling overwhelmed at starting again

  9. Stage 4: Recovery and Stabilization • Spouses realize they are resilient, able to cope • Develop increased confidence, positive outlook • May need additional help to muster emotional strength with back to back deployments

  10. Stage 5: Anticipation of Return • Generally a happy and hectic time • Need to talk about realistic plans • Discuss expectations for the return and reunion

  11. Stage 6: Return Adjustment and Renegotiation • Couples and families reset expectations • Renegotiate family roles • Key is open communication • Dealing with effects of combat stress • May be irritable, guarded, isolative • Possible “numbing” behaviors to deal with stress

  12. Stage 7: Renegotiation and Stabilization • Stabilizing relationships anew • Working with roadblocks • Combat stress • Stigma • Change of station • Health/mental health problems • Children’s adjustment • Current events, economy

  13. Challenges During Deployment • Disconnects due to distance • Loneliness “I didn’t get married to live alone…” • Loss of trust

  14. Challenges During Deployment • Single Households: Lack of mutual support • Children / Parenting / Child care • Life Decisions: Money, Cars, Appliances, Jobs “…you paid how much for that?!” • At-The-Front Spouse: “… my children won’t even remember me…”

  15. Mid-Atlantic MIRECC VA Mental Illness Research, Education & Clinical Center Veterans’ Perspectives on Post-Deployment Needs:Focus Group Results Kristy Straits-Tröster, Ph.D., Patrick Calhoun, Ph.D., Harold Kudler, M.D.

  16. The OEF/OIF Focus Groups Methods • Designed to complement medical record data • Telephone recruitment by contractor to fill 6 focus groups with 12 participants each: • 2-Active Component (Active Duty or Separated) • 2- National Guard or Reservist • 1- Female Veterans • 1- Female Spouses

  17. Confidential Neutral Setting

  18. The OEF/OIF Focus Groups • Focus group leaders utilized a moderator’s guide • All sessions were audiotaped and later transcribed • Information collected: • Deployment Health Concerns • Family Concerns and Support • Preferences for healthcare services & info • Barriers to care • Recommendations

  19. Focus Group Participants • Time since last deployment • Mean = 27 months (SD 11) • Most had returned 2004-2005 • 23 of 54 veterans had accessed VA services (43%) • Most served in Army or Marines

  20. Focus Group Findings Post-Deployment Problems: • Social avoidance • Noise sensitivity, jumpiness • Anger, irritability, lack of patience • Sleep problems • Chronic joint pain • Trouble concentrating, memory lapses • Drinking or smoking too much • Personality changes, emotionally labile • Digestive and bowel problems, weight changes • Hearing loss

  21. Focus Group Findings Post-Deployment Family Problems: • Marital problems, divorce • Overprotective of family, dealing with distressed children and spouses • Easily angered, jumpy in family setting • Restless sleep problems • Difficulty adjusting to running household together, being together again • Body image problems due to weight gain • Employment problems, anger at work

  22. Post-Deployment Problems “When I get home I don’t even want to be with my family. It’s like I just go into my office area and work on my computers and stuff. Anybody really talks to me or anything like that, it just aggravates me.” Active Duty, Separated

  23. What Helped? Services used and preferences: • Mixed report of VA experiences • Mixed report of TriCare experiences • Community providers confused about fee basis process, dental • Churches helped, prayer • Buddies helped • Working out, martial arts • Also reported drinking, smoking, driving to relax

  24. What Helped? “I’m a student-- I go to school so I would go early and stay late just in the library where it is quiet. I went deer hunting a ton last year and didn’t kill a single thing, just sat up there because there is peace and quiet.” National Guard, post-deployment

  25. Barriers to Care • Pride, beliefs that “I should handle it” • Stigma associated with MH treatment • Concern about being “labeled” and its impact on military promotion or security clearance • Too much red tape and paperwork • No options outside VA • Don’t like lectures and large groups • Beliefs that treatments “don’t work anyway”

  26. Top Five Services of Interest • Help dealing with anger • Help dealing with stress • Marriage and family counseling • Information about benefits and services • Job and school counseling

  27. Recommendations? “Maybe include … financial counseling, how to deal with the difference in pay or something, if you get a pay cut. Something like that. Because I know when I got out it took me longer than I expected to find a job …..as a result I ended up in quite a bit of debt, so I’m just now getting out of it. Active Duty, Separated

  28. Summary of Recommendationsfrom Veterans/Spouses • More education after demobilization • More web-based information • Knowledgeable unit liaisons • Easier VA appointment access • More caring staff • Decrease stigma • Offer evening and weekend clinics • Use peer supports

  29. How is VA Responding? • More education after demobilization • OEF/OIF Program Managers • Participation in PDHRA & Yellow Ribbon events • Collaborative Outreach • More web-based information • See www.va.gov • See www.oefoif.va.gov • See www.afterdeployment.org • Knowledgeable unit liaisons • Working closely with active duty and NC ARNG

  30. How is VA Responding? • Easier VA appointment access • CBOCS and Vet Centers • Greenville Mobile Vet Center

  31. How is VA Responding? • More caring staff • New employee orientation “Face of the New Veteran” • AHEC workshops, AHEC connect webinars • MIRECC webcasts • Reduce stigma • Integrated PC/MH; Post Deployment Health Clinics • Web-based resources • Offer evening and weekend clinics • DVAMC Thursday night clinic • Saturday/Sunday outreach events • Use peer supports • GWOT coordinators • Community college and NCSU

  32. Mid-Atlantic MIRECC VA Mental Illness Research, Education & Clinical Center Questions? Kristy.straits-troster2@va.gov

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