Military Culture & Treatment - 101

Military Culture & Treatment - 101 A 90 minute overview the culture of the military and its families, issues affecting treatment, and sources of support Peter McCall Exec Dir, www.CareForTheTroops.org petemccall1@gmail.com 770-329-6156

Introduction and Ground Rules • This is not a political forum • Questions are encouraged for group discussion • Be respectful of others • If the discussions, material, or videos at any time become too disturbing feel free to leave the room till you feel comfortable enough to return

Sources of Materials • CareForTheTroops 2009/2010 Military Culture 101 Workshop • The Fraser Counseling Center Staff, Hinesville, GA • Dr Blaine Everson, Clinical Dir, Samaritan Counseling Center, Athens, GA • Chris Schmink, LPC • Major Chris Warner, Winn Army Community Hospital, Fort Stewart , GA • Spiritual Wounds of War material • Kent D. Drescher, Ph.D., National Center for PTSD – Menlo Park • LTC Peter E. Bauer, MS USAR, LMFT, currently at Ft Hood • Chaplain Bill Carr, D. Min., LMFT, VA Hospital, Atlanta, Ga • Alan Baroody, LMFT, Presbyterian Minister, Exec Dir Fraser Counseling Center • VA Website • 2010 AAMFT Annual Conference Workshop 303 • TriWest Healthcare Alliance “Help From Home” DVD • Tricare South / Value Options • “Care For Returning Vets” presentation from the ELCA Bureau for Federal Chaplaincies • Other citations on charts and handouts

Presentation Goals • There are 5 goals of this presentation: • Understand the basics of themilitary culture and veteran issues • Review key issues that can impact the mental health of a military family • Review the recommended treatments for military trauma, what triggers to look for, and commonly encountered issues • Provide an understanding of resources available and how CFTT and others can help • Ultimately, build more credibility for working with military families

Opening Videos These three movie trailers provide a good backdrop to the Veterans Issues we are about to discuss. Please take notes as a discussion will be conducted after the next section. The run time is approximately 8 minutes.

Veteran Issues • Multiple deployments are common causing stress and family attachment issues. • As of Oct 2008, multiple deployment breakdown: 60% = 1x 36% >= 2x 4% >= 4x • As of Mar 2013, NG and Reserve deployments: 62% = 1x 24% = 2x 8% = 3x 6% >= 4x • “Typical Deployment Durations” Army and Marine 1 year** Navy 6-9 months Aviation and Spec Forces 4-6 months Air Force ~6 months ** In 2012 Army went to 9 months – but in 2014 expected to be back to 12 months • An April ‘08 Rand Study reported 37% have either PTSD, TBI, or significant Mental Stress (5% all 3). Some estimate >50% return with some form of mental distress • Feb 2013 CRS Report…17% have a TBI Diagnosis (77% of these are Mild) (CRS=Congressional Research Study) • Mar 2013 VA Report… 20% of patients have PTSD vs 7-8% in general population per the NC-PTSD • Mar 2013 NC-PTSD Report indicates Vietnam Vet lifetime rates are 27% for women, 31% for men • 2013 GWU Report indicates PTSD increases one’s healthcare costs 3.5x …. $8,300 in the 1st year • Other mental health, marriage, and family problems often occur with or leading up to PTSD requiring attention so they don’t get worse • July 2012 Med Surveillance Report indicates that Top 3 diagnosis over past 10 years are1. Depression 2. Adjustment Disorder 3. Alcohol Abuse/Dependence • Insomnia has risen from 7.2 per 10K to 135.8 per 10K

Veteran Issues • In 2009, military children and teens sought outpatient mental health care 2 million times, a 20% increase from ‘08 and double from the start of the Iraq war (‘03) • 43% of Service Members have children • Average number of children per military family is 1.97 (AAMFT 2010 Annual Conference) • 42% rise in children’s visits in 2009 over 2004 per Tricare • During deployments, 1 in 5 coped poorly or very poorly • 84% of Regular Military Service Members’ children attend public school, non-DOD base schools • Casualties – a Feb 2013 CRS Report indicated that 98% were male OIF - 31,925 OND - 295 OEF - 18,230 • Where Did They Come From? Family Income? -- based on nccp.org report as of May 2010 • Active NG/Reserve Active 33% < $42K / yearSmall Town 44% 40% 50% $42K - $65K / yearLarge Town 27% 30%Urban Area 29% 30% NG/Reserve has a median income of $46K / year

Veteran Issues (cont.) • Suicide is rising. In 2010: military suicides exceeded civilian suicides. • Army and Marine have higher suicide rates than Navy and Air Force • More are occurring Stateside and many go unreported for insurance reasons and are post-discharge • Female suicide rate triples when deployed (recent NIMH study), though still lower than male rate • In GA, per the CDC from 2006-2008, 500 suicides of people identified as current or former military . This represents 19.4% of all suicides during those years. The Age breakdown is as follows: 20-29 8.4% 50-59 21.2% 30-39 10.8% 60-69 31.8% 40-49 16.3% 70+ 55.8% • VETS: On average, 18 Vet suicides out of 30 attempts per day; 5 are already being treated by the VA. • ACTIVE DUTY: On average there has been 1 suicide per day (2013 GWU Report) • Women try more with less success than men …Army Times 04/2010 • 2013 IAVA Report indicates: 30% have considered suicide 37% know someone(IAVA – Irag Afghan Vets of America) • Addiction, alcoholism, drug abuse, domestic abuse, violent crime rates are rising: • Illicit drug use in the military was 5% in 2005, but now nonmedical use of prescription drugs is the most common form of drug abuse. SPICE is becoming very common. • PBS and others in Oct 2013 reported the VA in several locations is over prescribing pain killers • 24.8% reported binge drinking >1x per week in the past 30 days vs 17.4% for same-age civilians • SAMSHA reports: half of substance abuse treatment admissions among Veterans aged 21 to 39 involve alcohol as the primary substance of abuse (vs 34% non-vets). Marijuana and Other Opiates were at 12.2% each

Veteran Issues (cont.) • Military Sexual Trauma (MST) – includes Assault, Coercion and Unwanted Attention • 2008 Rand Report indicated the rate was 16-23% • VA Report in December 2012 breakdown as follows: Women MenAssault 3% 1%Coercion 8% 1%Attention 27% 5% Total 38% 7% • Almost as significant among males as among females (Newsweek, April 2011) • Mostly enlisted personnel under 25 yrs old (DOD 2010 Annual Report) • Single strongest predictor of PTSD in women - whereas combat is for men (Natelson, 8/05/10). • 80% of assault victims fail to report the offense. (Natelson, 8/05/10) • DoD and VA facilities are stretched … • the Aug 2009 VA claims backlog was 900,000; • the April 2010 backlog was improved to 605,000 • the April 2011 back up to 756,000 with 450,000 claims taking over 125 days (USA Today, Apr 2011) • the Nov 2011 rise to 864,000 with 529,000 claims taking over 125 days (AJC, Nov 10, 2011) • The Oct 2013 backlog is 725,000 with 420,000 over 125 days (VA Weekly Report) • The VA Goal is 98% under 125 days by end of 2015.

Veteran Issues (cont.) • The U.S. Bureau of Labor Statistics reports the unemployment rate among post 9/11 veterans as 15.2% in January 2011, well above the 9.6 percent rate for non-veterans. • The 2013 IAVA Report is 16% with 45% > 1 year • The VA said in Dec 2010 that more than 9,000 OIF/OEF vets were homeless (UPI) • Women are the fastest growing segment of this population. • Jan 2012 VA Report indicates 62,619 homeless vets and 180,000 are at risk • 2013 nchv.org Homeless Report: 13% are vets 20% of male homeless are vets 51% have disabilities 70% have substance abuse issues 51% are white males vs 38% of non-vets 50% are > 51 years old vs 19% non-vets • Many more Reservists & Guard than previous wars (54% as of mid ‘08) and they and families are more distant from DoD and VA support facilities. This may be one of the most significant factors affecting the future mental health impact on our communities and our society • Current numbers are in the 40-45% range • By design, approximately 33% should be Guard and Reserve • With 2013-14 budget cuts, NG/Reserve numbers may come down further and faster than Active Duty • A large number of civilian contractors are also part of the deployed forces • Rand Study (‘08) estimates that PTSD and depression among service members will cost the nation up to $6.2 billion in the two years after deployment. Investing in proper treatment would actually save $2 billion within two years.

Fraser Center Experiencewww.frasercenter.com THE FRASER CENTER SETTING: Clients include Veterans, Active Duty Soldiers, and Military Dependents Clients primarily from FT Stewart (3rd Infantry Division) and Hunter Army Airfield GENERAL OBSERVATIONS MADE BY FRASER CENTER THERAPISTS WHO WORK WITH OIF/OEF VETERANS, ACTIVE DUTY SOLDIERS, AND MILITARY DEPENDENTS: The children of military families are often the first to be brought in for therapy – secondary trauma. “Is daddy going to die?” The length, number, and frequency of deployments decreases family resiliency upon re-deployment (returning home from a deployment). The number of engagements “outside the wire” increases the likelihood of Combat Stress Symptoms (transient, acute, & PTSD). Over time, the constant threat of incoming mortar rounds and IED incidents increases likelihood of CSS and PTSD for those who remain primarily in “green zones.” The primary concerns of combat troops are: Mission First, staying safe, keeping their buddies safe, getting home, and what is happening at home with their spouse and families.

Fraser Center Experiencewww.frasercenter.com GENERAL OBSERVATIONS (continued…): While deployed, soldiers also fight on the homefront via internet and cell phone with their spouses. Homefront stressors may be higher than combat stressors. Viewing internet pornography and internet sex chat is becoming a norm for deployment and effects marriages upon return. Many soldiers maintain their unit bonds following re-deployment to the detriment of their family bonds. Returning soldiers rarely talk with spouses about combat experiences. There is a high rate of infidelity among soldiers and spouses during deployments. This is not necessarily the “deal breaker” that it might be in civilian life. Illegal/prescription drugs and alcohol are prevalent and are used as common coping mechanism by soldiers (deployed and at home) and by their spouses. While deployed, many soldiers are constantly sleep deprived and share each others medications (i.e. ambient, provigil). Hooked on Energy Drinks. The suicide rate of re-deployed) soldiers and spouses is on the increase. Most soldiers know of at least one other soldier in their unit who “ate his gun” or was blown up by an IED. There is a high incidence of rape and sexual molestation of deployed female soldiers. Soldiers and spouses express a great deal of anger toward perceived incompetency in the chain of command, or in procedures, which have a direct negative impact upon their lives.

Fraser Center Experiencewww.frasercenter.com GENERAL OBSERVATIONS (continued…): Home is no longer a safe place to live. Many now carry weapons when not on military installations at home. The vast majority of returning troops are filled with undifferentiated anger and a short fuse. 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. A primary therapeutic issue is the soldier’s inability to re-connect emotionally with spouse and children. (exacerbated by anger and lack of patience). Chaplains are the mental and spiritual health “first responders” at home and in the combat arena. Special attention needs to be given to National Guard and Reserve Chaplains. There is a high incidence of their leaving the ministry. Both spouse and soldier recognize that the soldier is “changed” by combat deployment. Important family milestones and transitions have been missed. Soldiers may pursue activities which replicate the adrenaline rush of combat and sometimes re-enlist without spousal consultation in order to maintain the rush. Spousal dissatisfaction and resentment: power control issues upon redeployment. “I didn’t sign up for this.” The military spouse sacrifices education and career 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 meds, increase of gangs in the army.

Fraser Center Experiencewww.frasercenter.com GENERAL OBSERVATIONS (continued…): Due to young age, immaturity, and low educational levels, many soldiers and spouses have poor life skills: money management, parenting, communication, etc. Some soldiers return to empty bank accounts and houses. The military has greatly increased mental health support resources at home and abroad. The Army recognizes that it is still not adequate. The military is going out of their way to encourage soldiers to seek out mental health treatment, yet the stigma against seeking help continues to exist. Spirituality is an important tool in the healing process as it is an important issue among those who have been in combat. It may not be express in typical “religious” language.

Discussion …Does a Therapist Have To Be a Vet? • Without extended military combat experience, a therapist cannot understand (that's OK) • Let the soldier know that you know you cannot understand • Let the soldier know you have no expectations that they will tell you about his experience unless they want to • Let the soldier know you may need their help in understanding terms sometimes

The next few charts cover the Military Culture and organizational background to help you better understand the client, where he/she was positioned, and to better interpret the information and stories they might tell during their therapy

Military Culture Sociologists define culture as … • Language - nomenclature; acronyms, abbr. • Beliefs – defenders of Democracy • Value Systems – leave no one behind • Norms & Rules – formal & informal conduct • Material Products – weapons systems Culture is associated with a social system and unique to a given system.

Military CultureBelief and Value Systems; Norms and Rules • Beliefs: Defenders of Democracy Trust in the leadership Role clarity Distrust of civilians • Value Systems: Leave no one behind “The Group” practically becomes a “family system” Top Cover-defend and support the boss Violence: many have a history of violence which often plays a role • Norms & Rules: Formal and informal conduct Stigma of mental health and PTSD Cover of the boss (Top Cover) Back-logging trauma

Military CultureBranches of the Military Georgia’s Military presence is dominated by Marine and Army units, though Air Force and Navy are well represented too. Georgia’s National Guard also has a large number of transportation units subject to IEDs on roads and highways. It was ill-prepared when first deployed in 2003. Georgia is 3rd largest National Guard State. With the current base closing plan, GA will be one of the 5 largest military states along with TX, CA, NC, VA NOTE: Coast Guard is now under Homeland Security

Military CultureLanguage - Glossary of Military Terms / Acronyms OEF Operation Enduring Freedom – The multinational military operation in Afghanistan; commenced on Oct. 7, 2001. OIF Operation Iraqi Freedom - The Iraq War; began on 3/20/2003. OND Operation New Dawn – post OIF operations USAR United States Army Reserve (Federal) USANG United States Army National Guard (State) E1-E9; O1-O10 Enlisted Ranks; Officer Ranks SPC Specialist, rank of E4, often referred to a “Spec 4” First SGT First Sergeant, rank of E7, lead enlisted person in a company. It and SSG, Staff Sergeant are key leadership ranks with lots of job pressures Gunnie A Marine First Sergeant NCO Non-Commissioned Officer, ranks E6 through E9 IEDs Improvised Explosive Devices FOB Forward Operating Base Sandbox Iraq and Afghanistan Down Range Deployed to anyplace where there is shooting. Outside the Wire Leave the safety of the “enclosed” military base (FOB) Top Cover Making sure the boss looks good / or air support PCS –TDY Permanent Change of Station – Temporary Duty JAG - Article 15 Military Lawyers – Mini Trial (called MAST in Navy) Chaptered Out Forced out of the Service www.rivervet.com/oif_glossary.htm Army Soldier Navy Sailor Marine Marine Air Force Airmen

Military CultureRegular/Active Duty vs Reserve/Guard Units Regular / Active Reserve / Guard • 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 • Units are small & based in local communities. • Part-time 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 in Georgia (transport, MP, etc) • 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 FRG’s are very helpful

Military CultureIssues Affecting Everyday Life • Regimented well beyond civilian sector • 24 / 7 military – often no weekends, no holidays, 24+ hour duty, even no days off • Very low pay initially for enlisted – some are even on Medicaid • Frequent pay problems • On-base housing has significant limits, and often poor responsiveness re: maintenance • Family Support Groups (FRGs) may be positive or negative experience for non-military spouses • Military can enhance the belief that the soldier is “in charge” in his/her household • Domestic violence dealt with by “employer” (first sergeant, commander, etc.) • UCMJ – commander is investigator, judge, jury • Sometimes it can seem they are subject to “double jeopardy” (civilian + military charges for same offense)

…a closing thought on the Military Culture “The capacity of Soldiers for absorbing punishment and enduring privations is almost inexhaustible so long as they believe they are getting a square deal, that their commanders are looking out for them, and that their own accomplishments are understood and appreciated.” GENERAL Dwight Eisenhower, 1944

The next few charts cover the Veteran Experiencesand Stressors that are related to combat vets (OEF, OIF, Vietnam, etc.) and their families to help you better understand your client and their presenting story and issues.

The Veteran ExperienceWhy is this war different? • Volunteer vs. draft • Multiple deployments • Type of suicide bombings • Never any safety, no real recovery time • Use of civilians as shields and decoys by the enemy • Deliberately targeting our moral code • COMMUNICATION! Internet, cell phones, etc. • IEDs, RPGs (TBI, hearing loss, neuro-chemical effects) • Advancement in medical treatments • Nation-building activities and interactions with local leaders

The Veteran ExperienceWhy is this war different? • IEDs potentially everywhere • Bags/packages on side of road • “Odd” bumps or depressions in road • Tell-tale cell phone use by locals • NO signs (but constant state of alert) • Range from limited to devastating • Being “blown up” (multiple times) • Frequent mortars/rockets • Snipers • Frequent and repeated witness to unimaginable carnage (“fine red mist”) • Potential for killing children (exacerbated by having children back home)

Suicide bombers (vehicle and on foot) Cars approaching check points Large trucks Vest bombers in heavily populated areas Stationary vehicles with large explosive charges Vehicles in traffic or on the highway Even pregnant women with children involved Allies may be enemies by your side Even children can be directly involved One year or more with no let-up (except possible R&R) Open-ended orders with unknown return date until sometimes days before return 2nd, 3rd, or greater deployment even while still being treated for issues related to previous deployment(s) resulting in re-experiencing traumas not resolved from past deployment(s) The Veteran ExperienceWhy is this war different?

The Veteran ExperienceProfile of Differences by Era • 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 mos) were typical • communications via phone, mail • wounded/killed ratio 3:1 • no appreciation for service or sacrifice • OIF / OEF • not homogenous---heterogeneous • Active duty • Reservists/Guard- • joined for variety of reasons • likely did not expect to be deployed • Large number of civilian contractors • wide 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 e.g. IEDs and suicide bombers, constant threat • wounded/killed ratio 15:1 Korea and World War II ???

The Veteran Experience Demographics From 2010 AAMFT Annual Conference Workshop #303

The Veteran Experience Realizing the bridge is down… “Home—the place many think is the safe haven to find relief from the stress of war—may initially be a letdown. When a loved one asks, ‘What was it like?’ and you look into eyes that have not seen what yours have, you suddenly realize that home is farther away than you ever imagined.” Down Range: From Iraq and Back, by Cantrell & Dean, 2005

Deployment CycleChris Warner’s Sources of Stress --->> Number of Months Warner CH, Breitbach JE, Appenzeller GN, et.al. “Division Mental Health: It’s Role in the New Brigade Combat Team Structure Part I: Pre-Deployment and Deployment” Journal of Military Medicine 2007; 172: 907-11.

Deployment Cycle • Pre-deployment - Period of training and equipping prior to deployment (30-90 days). • Deployment- Combat and Humanitarian missions anywhere in the world (3-18 months). • Drawdown – OIF drawdown transition period • Redeployment - Return from operations to home base (30 days). (For Reserve and National Guard components this includes demobilization and return to civilian life).

Family readjusts - Consequences for behavior The Military Deployment Cycle … or The Military Family Life Cycle Pre-deployment Conflict & Previous Stressor pile-up Revitalize Relationships and “honeymoon” Pre-deployment Stress – anxiety and concern Reunion and homecoming – joy and anticipation Soldier Deployment Pre-reunion Stress – anxiety and worry about behavior away Separation Stress – Depression & Anxiety Family Adjustment w/o Soldier in Home – Out-of-Ordinary Behaviors

Military Family Life Cycle(…Career View) <May be 1st deployment for both partners> <Missed 1st year of marriage> New family begins in absentia -Courting -Pregnant -Marriage Parental adj & young children Resume normal routines Deploy Mid-tour leave Return & Reunion <Divorce & remarriages w/ kids for previous relationships are common – complex stepfamily> Families w/ teens & possibly steps Return & Reunion Family w/ school agers ETS or Retire Deploy Relocation Transitions are often marked by crisis points in the family life cycle.

Deployment CycleMilitary Family At-Risk Factors Frequent Relocation 3.3 years average Previous Deployments 87% Longer Separations 7.3 month average Larger Families 42% ≥ 3 children Younger Mothers 26.5 median age Blended Families 31% step-parents Education 21% w/o HS diploma Working Outside Home 44% Median Income < $30,000 (34%) Quality of Life Among U.S. Army Spouses During OIF, Dissertation, 2005, Dr. Blaine Everson

Military CouplesSummary of Stressors to the Couple Relationship • Level of Commitment and Maturity • Deployment Cycle / Adaptability • Roles / Power issues • Sexual Issues • Infidelity • Disabilities / Chronic illness • Financial Issues • Parenting • Additional for Reserve/Guard Families • “Citizen Soldier” • Mobilization and Deployment • Separation from School, Jobs, etc • Demobilization 2010 AAMFT Annual Conference Workshop #303

Military CouplesRelated Stressors for Non-Deployed Spouses Warner CH, Appenzeller GN, Warner CM, Grieger T. “Psychological Effects of Deployments on Military Families” Psychiatric Annals 2009; 14: 56-62.

Military CouplesNon-Deployed Spouse - “Issues That Frequently Exist” • Becomes mom, dad, chauffer, maid, accountant, all without support from deployed soldier. • Begins to become more innovative and establishes own routine • “Unwritten house rules” may be very different when soldier returns – high potential for problems • Fear – death, finances, not being able to “handle it” etc. • No intimacy for long periods of time • On post housing can bring with it very contentious, intimidating, and/or malicious behavior by others, or can bring it out in your client

Military CouplesDeployed Spouse - “Issues That Frequently Exist” • Dangerousness to self / others • Suicide / Homicide • Domestic violence • Child abuse • Individual issues • PTSD, TBI • Medication abuse • Alcohol and drug use 2010 AAMFT Annual Conference Workshop #303

Military CouplesIssues While Deployed • Communications • Possible frequent phone and/or live video contact • Email as well as “care packages” and paper letters • Even significant business and/or legal issues can be handled including relatively remote deployments • Severe (often hidden) financial problems • Major over-spending • Mismanagement • Pay problems • Unfaithfulness of spouse OR deployed soldier • May be real or suspected • May be rumored (frequently, and viciously at times) • Spouse pregnancy “doesn't add up”

Military CouplesIssues Upon Redeployment • Deployed spouse tries to resume their “normal” role in the house but non-deployed spouse has a new “normal” • Deployed soldier is distant • Deployed soldier prefers buddies from unit • Deployed soldier is easily angered • Deployed soldier is withdrawn, even depressed • Dreams • Flashbacks • Triggering situations (e.g. driving habits) • Texting • Pornography

Soldier may be unwilling to talk to spouse about “what happened over there” Trust issues develop if not already present Soldier is “not the same person” – sometimes radically different TBI is a frequent, and likely under-diagnosed factor Children are unable to relate to redeployed parent (reciprocal) Where the soldier sits in a restaurant, place of worship, and other public areas Military CouplesIssues Upon Redeployment (…cont)

Military CouplesWhat Spouses Need to Know – Key Checklist • Do not ask what happened “over there” • Do NOT ask the “million dollar question” • Let the soldier know they are willing to listen IF the soldier wants to “talk about it,” but that the they do not expect the soldier to talk about their deployment – ever! • Tell the soldier that if they ever does want to talk and it gets too difficult for spouse, the spouse will gently let the soldier know and not blame the soldier. • If he's having a nightmare or even just restless during sleep, DO NOT TOUCH HIM ! • If the spouse feels a need to wake the soldier up while sleeping, stand more than arm's length away and gently call them by name, saying who the spouse is, where they are (home in Wherever, GA), and be prepared to repeat more than once

Know that the unwillingness to talk to IS NOT about the spouse, IS NOT about their relationship, IS NOT a trust issue Know that the spouse cannot, under any circumstances, understand what happened, or anything the soldier may have done “over there” The spouse and their behavior are not responsible for the soldier’s anger (assuming no major issues like adultery, massive spending..) That violence toward spouse or the children is not acceptable despite the soldier’s deployment experiences Although the soldier spends more time at the unit or friends says nothing about whether the soldier loves or values the spouse That at least part of the “taking over” things at home is not intended as control of the spouse, and is in part because of “simply” resuming “normal” life as it was before deployment That failure to spend much time with the children is no indicator of the soldier’s love for them That “getting out” may be a major fear/stressor Military CouplesWhat Spouses Need to Know – Key Checklist

ChildrenWhat Impacts Are Seen • Disruption of Routines • Boundary Issues & Parental Roles • Fear for Safety of Military Parent • Mimicry of Parental Responses • Sleep Disturbances and Phobias • Increase in Number of Physical Ailments • Secondary and Vicarious Traumatization

ChildrenDevelopmental Issues • Toddlers (3-5) - Separation Anxiety, Self-Comforting Behavior, Regression,Refusal to Eating and Sleep • Elementary (5-10) - Anxiety, Withdrawal, Regression, Fear, Uncontrolled Acting Out, Behavioral Contagion • Middle School (10-13) + Fighting, Isolation Behavior, Emotional Contagion, Difficulties with Concentration • Teenagers (13-18) + Rule Testing, Substance Use, Assaults, Use of External Systems for Support

ChildrenReserve and National Guard Family Concerns • Families are not as experienced with deployment and extended absences • Family members are less familiar with military support agencies • Live in local communities with less access to military support systems • Face integration back into civilian job or may need job assistance.

ChildrenItems to Remember • Children have individual reactions • Children take their emotional and behavioral cues from parents • Children are generally egocentric and see themselves as responsible for everything • Children may need an invitation to talk • Children need people to listen to them and their stories

ChildrenWhat Kids Need to Know – Key Checklist • That your military parent’s anger is NOT their fault • That your military parent still loves them even though they have a hard time showing it • Not to ask the same questions your non-military parent should not ask • Not to wake your military parent up during a nap by touching them, shaking them, jumping on them, etc.

The next few charts cover Trauma, PTSD, TBI and the Spiritual Wounds of War that are related to the OEFand OIF veteran.

Military Culture & Treatment - 101