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

2. 26 June 2008Chapin: Families and Deployment2 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)

3. 26 June 2008Chapin: Families and Deployment3 Resiliency Model Stressor Events Pile-up of Demands Family Type Family Meaning And Schema Situational Appraisal Family Resources Social Support Family Adaptation Family Problem- Solving and Coping Skills Source: McCubbin & McCubbin, 1996

4. 26 June 2008Chapin: Families and Deployment4 Slide courtesy of Dr. David Riggs,Center for Deployment Psychology Deployment Cycle

5. 26 June 2008Chapin: Families and Deployment5 Slide courtesy of Dr. David Riggs,Center for Deployment Psychology

6. 26 June 2008Chapin: Families and Deployment6 Pre-Deployment Stressor Events Pile-up of Demands Family Type Family Meaning And Schema Situational Appraisal Family Resources Social Support Short prep time Lack of information Rumors Unit preparation Deployment Date Changes in Family Dynamics Perception of mission purpose Expected length of upcoming deployment Anticipated threat to soldier Open-ended deployment timing Notification Family preparation

7. 26 June 2008Chapin: Families and Deployment7 Slide courtesy of Dr. David Riggs, Center for Deployment Psychology

8. 26 June 2008Chapin: Families and Deployment8 Deployment Stressor Events Pile-up of Demands Family Type Family Meaning And Schema Situational Appraisal Family Resources Social Support Family Adaptation Family Problem- Solving and Coping Skills Child Maltreatment Length of Deployment Communication FRG’s in military community vs going home to Mom Loneliness Single Parenting Kids’ reactions to war events Change job or move $$$ 30%

9. 26 June 2008Chapin: Families and Deployment9 Stressors Slide courtesy of Dr. David Riggs, Center for Deployment Psychology

10. 26 June 2008Chapin: Families and Deployment10 Children’s Coping Slide courtesy of Dr. David Riggs, Center for Deployment Psychology

11. 26 June 2008Chapin: Families and Deployment11 Deployment and Spouse Satisfaction Slide courtesy of Dr. David Riggs, Center for Deployment Psychology

12. 26 June 2008Chapin: Families and Deployment12 Child Neglect (1-2 year olds) Slide courtesy of Dr. David Riggs, Center for Deployment Psychology

13. 26 June 2008Chapin: Families and Deployment13 Post Deployment Slide courtesy of Dr. David Riggs, Center for Deployment Psychology

14. 26 June 2008Chapin: Families and Deployment14 Post-Deployment Stressor Events Pile-up of Demands Family Type Family Meaning And Schema Situational Appraisal Family Resources Social Support Family Adaptation Family Problem- Solving and Coping Skills Changed Roles & Responsibilities Reunion “Just wait til your father gets home!” Glad for help or resentful Shift back to pre-deployment structure Single to mutual decision-making Resilience & Return to Normal Divorce or Family Distress

15. 26 June 2008Chapin: Families and Deployment15 A One-Year Deployment Stressor Events Pile-up of Demands Family Type Family Meaning And Schema Situational Appraisal Family Resources Social Support Family Adaptation Family Problem- Solving and Coping Skills Changed Roles & Responsibilities Reunion “Just wait til your father gets home!” Glad for help or resentful Shift back to pre-deployment structure Single to mutual decision-making Resilience & Return to Normal Divorce or Family Distress Change job or move $$$: 30% Kids’ reactions to war events Loneliness Single Parenting Communication Length of Deployment Child Maltreatment FRG’s in military community vs going home to Mom Notification Rumors Lack of information Deployment Date Short prep time Open-ended deployment timing Unit preparation Family preparation Perception of mission purpose Expected length of upcoming deployment Anticipated threat to soldier Changes in Family Dynamics

16. 26 June 2008Chapin: Families and Deployment16 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

17. 26 June 2008Chapin: Families and Deployment17 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

18. 26 June 2008Chapin: Families and Deployment18 Riggs et al., 1998 PTSD Impact on Relational Problems * * * * Slide courtesy of Dr. David Riggs, Center for Deployment Psychology

19. 26 June 2008Chapin: Families and Deployment19 PTSD and Relationship Quality * * * Riggs et al., 1998 * Jordan et al., 1992 Slide courtesy of Dr. David Riggs, Center for Deployment Psychology

20. 26 June 2008Chapin: Families and Deployment20 PTSD and Partner Distress * * * * * Slide courtesy of Dr. David Riggs, Center for Deployment Psychology Calhoun et al., 2002

21. 26 June 2008Chapin: Families and Deployment21 PTSD Impacts Resilience Stressor Events Pile-up of Demands Family Type Family Meaning And Schema Situational Appraisal Family Resources Social Support Family Adaptation Family Problem- Solving and Coping Skills Caregiver Burden PTSD Behaviors One-sided Withdrawal from Intimacy Level of Disability Parenting impacted “Back to Normal” or “Not Quite Right” “Important work” or “Why are we there?” Spouse acts as social “buffer” Impaired

22. 26 June 2008Chapin: Families and Deployment22 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

23. 26 June 2008Chapin: Families and Deployment23 Injury Impacts Resilience Stressor Events Pile-up of Demands Family Type Family Meaning And Schema Situational Appraisal Family Resources Social Support Family Adaptation Family Problem- Solving and Coping Skills Notification of Injury Unplanned travel Needs of injured soldier vs needs of children Availability of extended family Conflicts with extended family about care decisions Are we still a Military Family? Fight to stay in or take medical retirement? Impact of TBI on cognitive skills Cabin Fever Delays in processing medical boards

24. 26 June 2008Chapin: Families and Deployment24 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

25. 26 June 2008Chapin: Families and Deployment25 Soldier Death Impact on Resiliency Stressor Events Pile-up of Demands Family Type Family Meaning And Schema Situational Appraisal Family Resources Social Support Family Adaptation Family Problem- Solving and Coping Skills Unexpected Loss $400K SGLI Casualty Assistance Officer Military Funeral How do we go on? Move household Bereavement Process Extended Family T.A.P.S. and other support organizations Meaning and context of soldier’s death Notification Trauma

26. 26 June 2008Chapin: Families and Deployment26 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)

27. 26 June 2008Chapin: Families and Deployment27 QUESTIONS & DISCUSSION