1. The Impact of War on Military Families LTC Harvey D. Leighnor The view expressed in this abstract/manuscript are those of the author and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the U.S. Government.

2. References The Psychological Needs of U.S. Military Service Members and Their Families: A Preliminary Report, American Psychological Association Presidential Task Force on Military Deployment Services for Youth, Families, and Service Members, February 2007 The Psychological Needs of U.S. Military Service Members and Their Families: A Preliminary Report, American Psychological Association Presidential Task Force on Military Deployment Services for Youth, Families, and Service Members, February 2007 Dr. Thomas Hardaway, Department of Behavioral Medicine, Brooke Army Medical Center Dr. Thomas Hardaway, Department of Behavioral Medicine, Brooke Army Medical Center

3. Demographics of Military Community Since September 11, 2001 Since September 11, 2001 Approx 1.5 million American troops deployed to combat zones Approx 1.5 million American troops deployed to combat zones 1/3 served at least 2 tours in combat 1/3 served at least 2 tours in combat 70,000 deployed 3 times 70,000 deployed 3 times 20,000 deployed at least 5 times 20,000 deployed at least 5 times

4. Families 700,000 children in America have at least 1 parent deployed 700,000 children in America have at least 1 parent deployed Deployed primary caretaker is most stressful event for children Deployed primary caretaker is most stressful event for children Strain on parent left behind Strain on parent left behind

5. Exposure Over 3,240 killed in combat to date Over 3,240 killed in combat to date Over 23,000 returned with wounds up to permanent disabilities Over 23,000 returned with wounds up to permanent disabilities As many as 1/4 th returning are struggling with visible psychological injuries As many as 1/4 th returning are struggling with visible psychological injuries Majority report exposure to life-changing stressors challenging ability to reintegrate on return Majority report exposure to life-changing stressors challenging ability to reintegrate on return Disruptive to civilian life Disruptive to civilian life Family functioning is affected by combat exposure Family functioning is affected by combat exposure

6. Twenty-First Century Military Changed since last prolonged war Changed since last prolonged war Today Today Approximately 3 million serving in uniform Approximately 3 million serving in uniform Army, Navy, Air Force, Marines, Coast Guard, Reserves, and National Guard Army, Navy, Air Force, Marines, Coast Guard, Reserves, and National Guard Over ¼ are members of ethnic minority Over ¼ are members of ethnic minority 1/4 th million preparing to deploy or are deployed 1/4 th million preparing to deploy or are deployed 3 out of 5 of deployed have family responsibilities 3 out of 5 of deployed have family responsibilities Women are 16% of military Women are 16% of military Women assigned to 90% of job categories Women assigned to 90% of job categories

7. General Family Information Resilience plays major factor in deployment Resilience plays major factor in deployment Most families rise to the occasion Most families rise to the occasion Family readiness is considered key factor in resilience Family readiness is considered key factor in resilience Family preparedness is a protective factor when deployments are announced Family preparedness is a protective factor when deployments are announced

8. Spouse Active Coping Styles Make meaning of the situation Make meaning of the situation Receive community and social support Receive community and social support Accept military life style Accept military life style Are optimistic and self reliant Are optimistic and self reliant Adopt to flexible gender roles Adopt to flexible gender roles

9. Factors That Risk Difficult Transition History of rigid coping styles History of rigid coping styles Family dysfunction Family dysfunction Young families (especially first military separation) Young families (especially first military separation) Families recently moved to new duty station Families recently moved to new duty station Foreign born spouse Foreign born spouse Families with young children Families with young children Families without unit affiliation Families without unit affiliation Pregnancy Pregnancy Dual career/single parents Dual career/single parents

10. Stages of Deployment Pre-deployment (varies) Pre-deployment (varies) Deployment and Sustainment Deployment and Sustainment Re-deployment/Reunion (last month) Re-deployment/Reunion (last month) Post-deployment (3-6 months after deployment) Post-deployment (3-6 months after deployment)

11. Pre-deployment Service Member Normal duties plus Normal duties plus Necessary military training (12 to 16 hr days) Necessary military training (12 to 16 hr days) Complete wills and power of attorney Complete wills and power of attorney Updating all immunizations Updating all immunizations Completing numerous screenings/evaluations Completing numerous screenings/evaluations Family needs Family needs Prepare family for separation and increased independence Prepare family for separation and increased independence Noted service member becomes mission focus and emotional withdrawal Noted service member becomes mission focus and emotional withdrawal Wants to educate spouse on financial matters and spend more time with children Wants to educate spouse on financial matters and spend more time with children

12. Pre-deployment Spouse and Children Pending deployment initiates significant stress Pending deployment initiates significant stress Separation and loss anticipated Separation and loss anticipated Possible periods of anger and protest followed by emotional detachment Possible periods of anger and protest followed by emotional detachment National Guard and Reserve families face unique stressors National Guard and Reserve families face unique stressors Short periods of preparation Short periods of preparation Need information on pay and resources Need information on pay and resources Military pay may not match civilian pay Military pay may not match civilian pay Service members job may not be there on return Service members job may not be there on return

13. Deployment Service Member Difficult events may produce intense feelings Difficult events may produce intense feelings Fear Fear Horror Horror Helplessness Helplessness (required for diagnosis of PTSD) (required for diagnosis of PTSD) Traumatic events magnified by Traumatic events magnified by Harsh living conditions Harsh living conditions 130 degree temperatures 130 degree temperatures Unrelenting noise Unrelenting noise Lack of privacy Lack of privacy Constant threat of attack Constant threat of attack Multiple deployments increases likelihood of mental health problems Multiple deployments increases likelihood of mental health problems

14. Deployment Spouse and Children Periods of emotional destabilization and disorganization Periods of emotional destabilization and disorganization Reports of Reports of SadnessDepressionAnxiety SadnessDepressionAnxiety LonelinessAngerFeeling Overwhelmed LonelinessAngerFeeling Overwhelmed NumbnessRelief NumbnessRelief Physical reactions Physical reactions Sleep disturbances Sleep disturbances Health complaints Health complaints Added family responsibilities Added family responsibilities

15. As Deployment Progresses Family Period of recovery and stabilization Period of recovery and stabilization Reconfiguration of the family (reassigning authority and duties) Reconfiguration of the family (reassigning authority and duties) Develop new routines Develop new routines Increase sense of independence and self confidence Increase sense of independence and self confidence Develop new support systems Develop new support systems New friends New friends Family Readiness Groups (FRG) Family Readiness Groups (FRG)

16. Communication During Deployment Critical Importance Critical Importance Technological advances Technological advances PhoneCell phone PhoneCell phone Video callsFax Video callsFax Emails Emails Positive and negative Positive and negative Keep service member psychologically present Keep service member psychologically present Family matters/crisis at home may distract from focus on mission Family matters/crisis at home may distract from focus on mission Family members need open communication with Command, FRGs, and other families/spouses Family members need open communication with Command, FRGs, and other families/spouses

17. Reunion Deployment ends Deployment ends Homecoming Homecoming Excitement and apprehension increases Excitement and apprehension increases Role redefined Role redefined New family systems developed New family systems developed All family members have inevitably changed All family members have inevitably changed

18. Post Deployment Service Members Documented psychological problems within weeks of returning home Documented psychological problems within weeks of returning home Symptoms increased between homecoming and 3 to 4 months Symptoms increased between homecoming and 3 to 4 months Okie (2005) reported Traumatic Brain Injury (TBI) in 22% wounded Okie (2005) reported Traumatic Brain Injury (TBI) in 22% wounded Cyclical depression Hearing loss Cyclical depression Hearing loss Coordination problems Memory problems Coordination problems Memory problems Affective instability Decreased ability to concentrate Affective instability Decreased ability to concentrate May have problems disengaging from combat life style May have problems disengaging from combat life style

19. Post Deployment Spouse and Children Homecoming exciting and joyful event Homecoming exciting and joyful event Not uncommon for both spouses to have unrealistic expectations Not uncommon for both spouses to have unrealistic expectations Family roles and routines must be renegotiated Family roles and routines must be renegotiated Reintegration into a family that changed Reintegration into a family that changed May resent loss of independence May resent loss of independence Family members less supportive when hurt Family members less supportive when hurt

20. Deployment Stages and Childrens Responses (Amen et al., 1988; Murray, 2002; Pincus et al., 2001; Stafford & Grady,2003) Pre-Deployment InfantsFussy, changes in eating habits PreschoolersConfused, saddened School-AgedSaddened, angry or anxious AdolescentsWithdrawn, deny feelings about pending separation Deployment InfantsNo research PreschoolersSadness, tantrums, changes in eating/elimination habits, symptoms of separation anxiety may appear School-AgedIncreased somatic complaints, mood changes, decline in school performance AdolescentsAngry, aloof, apathetic, acting out behaviors may increase, loss of interest in normal activities, decline in school performance Post-Deployment InfantsMay not recognize returning service member and be fearful PreschoolersHappy and excited, but also experience anger at separation School-AgedHappy and angry, often leading to acting out behaviors AdolescentsDefiant, disappointed if their contributions at home are not acknowledged

21. Supporting the Child Whose Military Parent is Deploying: Tips for Parents 1. Talk as a family before deployment. 2. Bestow, rather than dump, responsibilities on remaining family members. 3. Make plans for the family to continue to progress together, and include the deployed parent in ongoing projects. 4. Continue family traditions and develop new ones. 5. Help children understand the finite nature of a deployment by devising developmental time- lines.

22. Tips Continued 6. To children, no news is worse than bad news. 7. Listen to a childs worries about the deployed parent and answer questions as truthfully as possible. 8. Maintain firm routine and discipline in the home. 9. Initiate and maintain a close relationship with the school and the childs teacher. 10. AS THE REMAINING PARENT, MAKE SURE YOU TAKE CARE OF YOURSELF.

23. References The Psychological Needs of U.S. Military Service Members and Their Families: A Preliminary Report, American Psychological Association Presidential Task Force on Military Deployment Services for Youth, Families, and Service Members, February 2007 The Psychological Needs of U.S. Military Service Members and Their Families: A Preliminary Report, American Psychological Association Presidential Task Force on Military Deployment Services for Youth, Families, and Service Members, February 2007 Dr. Thomas Hardaway, Department of Behavioral Medicine, Brooke Army Medical Center Dr. Thomas Hardaway, Department of Behavioral Medicine, Brooke Army Medical Center

24. LTC Harvey D. Leighnor Tripler Army Medical Center Dept of Social Work Honolulu, Hawaii 96859-5000 Phone: 808 433-6606 Email: harvey.leighnor@us.army.mil

25. Programs for Military Personnel Battlemind Training Battlemind Training SWAPP (Soldier Wellness assessment Pilot Program) SWAPP (Soldier Wellness assessment Pilot Program) SAFAC (Soldier and Family assistance Center SAFAC (Soldier and Family assistance Center Information Handouts Information Handouts

26. Programs for Children and Families Resiliency Resiliency Multimedia Resources Multimedia Resources Community Efforts and Outreach Community Efforts and Outreach