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Working With Military Families

Posted By Angela L. Lamson, Meghan H. Lacks, Wednesday, May 25, 2016

 

There are over 3.5 million military personnel in the U.S., including Department of Defense (DoD) Active Duty, Coast Guard, and Reserve members (DoD, 2014). Along with the active duty population, it is estimated that there are currently over 22 million Veterans in the U.S. (U.S. Census Bureau, 2012). The number of family members- spouses, children, and others-is staggering. While services on military bases and Veterans Affairs clinics or hospitals are available for both mental and physical health care needs, military and veteran families also receive services for their health care in civilian communities. Yet research indicates 87% of civilian clinicians are not equipped to meet the unique needs of military service members (Tanielian et al., 2014).

 

As such, clinicians must become more involved in professional development that includes a cultural awareness to military and veteran health and healthcare systems, regardless of a clinician’s own healthcare system delivery methods (see list of select training opportunities and books are provided below). Understanding the unique health experiences of military, veterans, and their families is relevant because it is almost inevitable that clinicians and providers will encounter someone who has either served or had a family member who served in the military.

 

Given the likelihood that most clinicians and providers will care for military personnel, it is important to recognize some unique differences between military and civilian families. For example, service members often marry younger, divorce less, have more young children in the home, and relocate homes more frequently than their civilian counterparts (Clever & Segal, 2013). In addition, the family dynamics of military and veterans differ from civilians, particularly due to child school and peer adjustments because of frequent relocation and family adjustment after parental injury (Hisle-Gorman, Harrington, Nylund, Tercyak, Anthony, & Gorman, 2015). Furthermore, parents in military and veteran families have commonly had to navigate the role of a deployed parent, role of the stateside parent, trustworthy and reliable child care services, family support, and school based support for children.

 

Differences between branches or reserve components, rank, number of deployments, and experiences with combat are also important to recognize when delivering services or designing research projects. Demographic differences provide only a small piece of a very big picture. For example, what is known about active duty women’s health is often times limited to her reproductive or sexual health matters, (Lacks, 2016), and even less is known about the complexities associated with single parenting, dual military couples, or the health of LGBT couples and their families.

 

Based on our experiences, our charge to clinicians and researchers is to recognize and honor the diversity of military and veteran families. This is possible when extending care or research programs through a biopsychosocial-spiritual (BPSS) framework (Engel, 1977, 1980; Wright, Watson & Bell, 1996), and attending to the relational dynamics that emerge through common military and veteran health matters. Some of the most common BPSS challenges include: amputations, traumatic brain injury, insomnia, chronic pain, intimate partner violence, military sexual trauma, substance use, and relational distress (Blaisure, Saathoff-Wells, Pereira, MacDermid Wadsworth, & Dombro, 2016; Goff, Crow, Reisbig, & Hamilton, 2007; Mansfield, Kaufman, Marshall, Gaynes, Morrissey, & Engel, 2010; Trump, Lamson, Lewis & Muse, 2015).

 

In our clinical work, through integrated behavioral health care and traditional therapy sessions, we quickly recognized the complex interaction between physical or behavioral health challenges and relational distress unique to military and veteran lives. There was the civilian husband and his active duty wife, who was preparing for her first deployment. His physical health had begun to decline, resulting in increased weight gain that he attributed to stress about the unknown expectations for his wife’s safety while on deployment. The integrated care team worked with the couple on behavioral health goals for the husband and constructing ways to support one another during the deployment. In another example, a service member in his early 30’s had come into his medical visit reporting back pain that he believed occurred during a training exercise.

 

This resulted in loss of sleep, limited ability to play with his children, and distress in his marriage due to irritability associated with the pain. The medical provider and family therapist collaborated on a variety of treatment strategies for this patient for both his physical and psychosocial concerns and discussed a treatment plan with the patient including exercises and medications that would not interfere with his job duties. In addition, the therapist provided techniques to reduce relational stress. In a follow up visit, the patient and his wife reported the relational techniques were very helpful for them as a family. The patient reported a lower score on the pain scale. He believed his pain was more manageable because of the medication, exercises, and positive experiences he and his wife had shared through the techniques they learned from his integrated care visit.


However, we have also met with individuals, couples, or families who struggled to imagine a future without the presence of physical, emotional, relational, or spiritual pain. Many of our nation’s heroes fight a battle beyond those in the air, field, or sea; many fight the internal battles of guilt, shame, or confusion that result in suicidal ideation. Some are left with moral injuries, leaving lacerations on the soul and spirit. Service members and veterans are trained to be strong for the unit and strong for the country. Vulnerability is contrary to the mission. Yet, guilt and shame in relation to active duty experiences have emerged as predictive of suicide among military and veteran populations. Military and veteran family members serve by-proxy, and often do not know of or how to navigate life alongside a loved one who is suffering from mental health concerns.

 

In providing both traditional and integrated behavioral health care to service members and veterans as well as their partners and families, we have come to learn several important lessons: (1) extend a genuine and curious stance to assessment, diagnosis, and treatment with these populations, (2) honor the biospsychosocial-spiritual complexities of health, as most health visits included at least one significant behavioral health concern (primarily challenges with quality sleep and pain management), (3) promote integrated behavioral health care (it was very well received by the patients as well as by the providers), and (4) encourage and deliver couple-centered or family-centered health care visits in medical and mental health venues, particularly when treating complex biopsychosocial-spiritual health issues.

 

References

Blaisure, K. R., Saathoff-Wells, T., Pereira, A., MacDermid-Wadsworth, S., & Dombro, A. L., (2016). Serving Military Families (2nd Ed). Florence, GA: Routledge.

Clever, M., & Segal, D. R. (2013). The demographics of military children and families. The Future of Children, 23(2), 13-39. doi:10.1353/foc.2013.0018

Department of Defense (DoD). (2014). Demographics report. Retrieved from http://download.militaryonesource.mil/12038/MOS/Reports/2014-Demographics- Report.pdf

Goff, B. S. N., Crow, J. R., Reisbig, A. M. J., & Hamilton, S. (2007). The impact of individual trauma symptoms of deployed soldiers on relationship satisfaction. Journal of Family Psychology, 21(3), 344-353. doi:10.1037/0893-3200.21.3.344

Hisle-Gorman, E., Harrington, D., Nylund, C. M., Tercyak, K. P., Anthony, B. J., Gorman, G. H. (2015). New research: Impact of parents’ wartime military deployment and injury on young children’s safety and mental health. Journal of the American Academy of Child & Adolescent Psychiatry, 54, 294-301 doi: 10.1016/j.jaac.2014.12.017

Kang, H. K., MA, T. A., Smolenski, D. J., Skopp, N. A., Gahm, G. A., & Reger, M. A. (2015). Suicide risk among 1.3 million veterans who were on active duty during the Iraq and Afghanistan wars. Annals of Epidemiology, 25(2), 96-100. doi:10.1016/j.annepidem.2014.11.020

Lacks, M. H. (2016). The biopsychosocial-spiritual health of active duty women: Service members in need of service. (Unpublished doctoral dissertation). East Carolina University. Greenville, NC.

Mansfield, A. J., Kaufman, J. S., Marshall, S. W., Gaynes, B. N., Morrissey, J. P., & Engel, C. C. (2010). Deployment and the use of mental health services among U.S. Army wives. The New England Journal of Medicine, 362(2), 101–109. doi:10.1056/ NEJMoa0900177.

Tanielian, T., Farris, C., Batka, C., Farmer, C. M., Robinson, E., Engel, C. C. … Jaycox, L. (2014). Ready to serve: Community-based provider capacity to deliver culturally competent, quality mental health care to veterans and their families. Santa Monica, CA: RAND Corporation.

Trump, L. J., Lamson, A. L., Lewis, M. E., & Muse, A. R. (2015). His and hers: The interface of military couples’ biological, psychological, and relational health.Contemporary Family Therapy,37(3), 316-328. doi:10.1007/s10591-015-9344-8

U.S. Census Bureau. (2012). A snapshot of our nations Veterans. Retrieved from https://www.census.gov/library/infographics/veterans.html

 

Recommended Resources or Readings

Select Recommended Trainings

1. The Center for Deployment Psychology offers an archive of resources for civilian providers. This website also includes free military culture training modules for healthcare professionals that encourage providers to better understand military culture and its impact on health-related behaviors. http://deploymentpsych.org/psychological-training

2. The Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury offer free monthly webinars that discusses content on a variety of topics related to military life. http://www.dcoe.mil/Training/Monthly_Webinars.aspx

3. The National Center for PTSD offers a large array of resources and training opportunities for providers regarding trauma. http://www.ptsd.va.gov/

 

Select Recommended Books

Anderson, W. (2015). Battlefield Doc: Memoirs of a Korean War combat medic. St. Louis, MO: Moonbridge Publications.

Benimoff, R. (2010). Faith under Fire: An Army chaplain's memoir. New York, NY:Three Rivers Press.

Bonsper, D. (2015). Vietnam memoirs: Part 1. AroSage Publishing.

Kyle, T. (2015). American wife: A memoir of love, war, faith, and renewal. New York, NY: Harper Collins Publishers.

Miller, T. & Brotherton, M. (2015). Tough as they come. New York, NY: Convergent Books.

Tillman, M. (2008). Boots on the ground by dusk: My tribute to Pat Tillman. New York, NY: Rodale, Inc.

 


Dr. Angela Lamson is Associate Dean for Research and Graduate Studies (CHHP) at East Carolina University. 

Dr. Meghan Lacks currently serves as the policy and research analyst for AAMFT where she is responsible for implementing military and Veteran training, research, and policy initiatives for MFTs across the nation.

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