Families and Deployment Hero Stories & Horror Stories

1. Families and DeploymentHero Stories & Horror Stories LTC (Ret) Mark Chapin, Ph.D., LISW, BCD Department of Social Work Walter Reed Army Medical Center

2. The Deployment Cycle • Deployment is a “developmental” crisis • Family’s experience parallels soldier’s experience • Source of both stress and growth • Resiliency Model of Family Stress, Adjustment, and Adaptation • Hamilton McCubbin, 1996 • Components tied to measures • Based on ABCX Model of Reuben Hill (1949) Chapin: Families and Deployment

3. Resiliency Model Family Meaning And Schema Stressor Events Situational Appraisal Family Adaptation Family Type Family Problem- Solving and Coping Skills Family Resources Pile-up of Demands Social Support Chapin: Families and Deployment Source: McCubbin & McCubbin, 1996

4. Deployment Cycle Chapin: Families and Deployment Slide courtesy of Dr. David Riggs,Center for Deployment Psychology

5. Chapin: Families and Deployment Slide courtesy of Dr. David Riggs,Center for Deployment Psychology

6. Notification Pre-Deployment Stressor Events Perception of mission purpose Family Meaning And Schema Rumors Open-ended deployment timing Lack of information Expected length of upcoming deployment Situational Appraisal Deployment Date Short prep time Family Type Anticipated threat to soldier Unit preparation Family Resources Changes in Family Dynamics Pile-up of Demands Social Support Family preparation Chapin: Families and Deployment

7. Chapin: Families and Deployment Slide courtesy of Dr. David Riggs, Center for Deployment Psychology

8. Change job or move Deployment Family Meaning And Schema Stressor Events Child Maltreatment Kids’ reactions to war events Situational Appraisal $$$ 30% Family Adaptation Family Type Family Problem- Solving and Coping Skills Communication Family Resources Length of Deployment Pile-up of Demands Social Support Loneliness FRG’s in military community vs going home to Mom Single Parenting Chapin: Families and Deployment

9. Stressors Chapin: Families and Deployment Slide courtesy of Dr. David Riggs, Center for Deployment Psychology

10. Children’s Coping Chapin: Families and Deployment Slide courtesy of Dr. David Riggs, Center for Deployment Psychology

11. Deployment and Spouse Satisfaction Chapin: Families and Deployment Slide courtesy of Dr. David Riggs, Center for Deployment Psychology

12. Child Neglect (1-2 year olds) Chapin: Families and Deployment Slide courtesy of Dr. David Riggs, Center for Deployment Psychology

13. Post Deployment Chapin: Families and Deployment Slide courtesy of Dr. David Riggs, Center for Deployment Psychology

14. Changed Roles & Responsibilities Post-Deployment Family Meaning And Schema Stressor Events Resilience & Return to Normal Situational Appraisal Reunion Family Adaptation Family Type Family Problem- Solving and Coping Skills Glad for help or resentful Single to mutual decision-making Family Resources Divorce or Family Distress Pile-up of Demands Social Support Shift back to pre-deployment structure “Just wait til your father gets home!” Chapin: Families and Deployment

15. Changed Roles & Responsibilities Perception of mission purpose Notification Change job or move A One-Year Deployment Family Meaning And Schema Expected length of upcoming deployment Stressor Events Deployment Date Resilience & Return to Normal Kids’ reactions to war events Open-ended deployment timing Rumors $$$: 30% Situational Appraisal Child Maltreatment Lack of information Reunion Length of Deployment Family Adaptation Short prep time Family Type Anticipated threat to soldier Family Problem- Solving and Coping Skills Glad for help or resentful Communication Single to mutual decision-making Family Resources Unit preparation Family preparation Changes in Family Dynamics Divorce or Family Distress Pile-up of Demands Loneliness Social Support FRG’s in military community vs going home to Mom Single Parenting Shift back to pre-deployment structure “Just wait til your father gets home!” Chapin: Families and Deployment

16. Deployment and PTSD • 18% of soldiers return with diagnosable Mental Disorder • All are affected by deployment • Soldiers typically minimize symptoms on PDHA • Symptom levels increase over next 6 months • PTSD affects couples on multiple levels Chapin: Families and Deployment

17. PTSD Effects on Intimate Relationships • Changes roles: spouse becomes caregiver r • Changes intimacy (avoidance cluster) • Intrusive memories and vivid re-experiencing symptoms can be frightening • Arousal Cluster symptoms create irritability • Violent outbursts precipitate dynamics of intimate partner violence Chapin: Families and Deployment

18. PTSD Impact on Relational Problems * * * * Riggs et al., 1998 Chapin: Families and Deployment Slide courtesy of Dr. David Riggs, Center for Deployment Psychology

19. Riggs et al., 1998 Jordan et al., 1992 PTSD and Relationship Quality * * * * Chapin: Families and Deployment Slide courtesy of Dr. David Riggs, Center for Deployment Psychology

20. * PTSD and Partner Distress * * * * Calhoun et al., 2002 Chapin: Families and Deployment Slide courtesy of Dr. David Riggs, Center for Deployment Psychology

21. PTSD Behaviors “Important work” or “Why are we there?” PTSD Impacts Resilience Family Meaning And Schema Stressor Events “Back to Normal” or “Not Quite Right” Situational Appraisal Family Adaptation Family Type Family Problem- Solving and Coping Skills Impaired Family Resources Parenting impacted Pile-up of Demands Level of Disability Social Support Spouse acts as social “buffer” Withdrawal from Intimacy Caregiver Burden One-sided Chapin: Families and Deployment

22. Injured Soldiers • Crisis of whether soldier will survive, level of recovery/disability • Crisis of meaning: Can I still be a soldier? • Disruption and dislocation during recovery • Spouse torn between duty to soldier and duty to children • Rapidly shifting caregiver responsibilities • Balance between nurturing and pushing for maximum rehabilitation • Re-defining family identity after disability • Restoration of marital intimacy after disability Chapin: Families and Deployment

23. Notification of Injury Injury Impacts Resilience Family Meaning And Schema Are we still a Military Family? Stressor Events Unplanned travel Fight to stay in or take medical retirement? Situational Appraisal Conflicts with extended family about care decisions Family Adaptation Family Type Family Problem- Solving and Coping Skills Impact of TBI on cognitive skills Family Resources Delays in processing medical boards Pile-up of Demands Availability of extended family Cabin Fever Social Support Needs of injured soldier vs needs of children Chapin: Families and Deployment

24. Soldiers Killed in Action • Families lose not only their soldier, but also undergo changes that usually take them away from their military connections • Intensive initial support from military • Casualty Assistance Officer • Death Benefits and SGLI • Military Funeral • Bereavement complicated by move out of military housing or away from military base • Usually return to extended family home Chapin: Families and Deployment

25. Unexpected Loss Soldier Death Impact on Resiliency How do we go on? Family Meaning And Schema Stressor Events Meaning and context of soldier’s death Situational Appraisal Notification Trauma Family Adaptation Family Type Family Problem- Solving and Coping Skills Bereavement Process Extended Family Family Resources Pile-up of Demands $400K SGLI T.A.P.S. and other support organizations Social Support Military Funeral Move household Casualty Assistance Officer Chapin: Families and Deployment

26. Resources for Families Military Resources • DVBIC (Defense Veterans Brain Injury Center) • DHCC (Deployment Health Clinical Center) • Military One Source • Veteran’s Administration • VA Med Centers--inpatient treatment centers, Polytrauma centers • RCS community based counseling service centers • Private Organizations (just a few examples) • SOFAR: (Strategic Outreach to Families of All Reservists) • DSUSA (Disabled Sports USA) • TAPS (Tragedy Assistance Program for Survivors • Canine Companions for Independence • Give an Hour Foundation • Disabled American Veterans • Partnerships • Intrepid Fallen Heroes Fund (Center of Excellence for TBI & PTSD) • VA Seamless Transition workers placed in DoD Medical facilities • National Demonstration Program for Citizen-Soldier Support (UNC) Chapin: Families and Deployment

27. QUESTIONS & DISCUSSION Chapin: Families and Deployment