Military children and families
Author: Pattii Johnson, PhD, Editor CYF News Winter 2013/CYF Member
Over the past decade, the U.S. military has been engaged in the longest period of conflict in its history. The protracted wars in Iraq and Afghanistan, associated with multiple deployments and post-combat physical and psychological sequelae, have had a tremendous impact on the behavioral health of military children and youth. Service members have repeatedly deployed to war zones for periods up to 15 months. Unlike previous eras, a majority of the current military force is married with children. Approximately two million children in the United States have or have had a parent serve in the military. These children and youth have had to cope with frequent parental absences, the threat of potential harm to their parents, as well as the aftermath of wartime deployment including parental physical injury, psychological injury, and, at times, death. In light of this, there has been a call from the highest levels (i.e., First Lady Michelle Obama’s Joining Forces initiative) to systematically identify and address the social-emotional-behavioral needs of this population in order to promote healthy functioning and adjustment. As such, this issue of the CYF News is devoted to addressing the impact of deployment and trauma on military children and youth, their unique social-emotional-behavioral needs, strategies to build resiliency and coping in this population, and programs to address their unique challenges.
The article by Alfano and her colleagues provides an overview of what is currently known about the behavioral health needs of military children and youth based on research conducted during the last decade. Their review of the literature suggest ways in which youth are affected both directly by the stresses of combat-related deployments, as well as indirectly, via the impact of the war on service members and adult family members. In addition, they identify factors that might protect children and youth from the negative impact of military deployments. Finally, they make recommendations for future research and policy considerations based on the current status of knowledge.
What is clear from the literature review is that there are many gaps in our understanding of the impact of deployment on military children. The “Spotlight on Research” by Dr. Friedman makes recommendations regarding areas that need further investigation and understanding. Hers is a call for more rigorous studies from psychologists engaged in academic research to add to our knowledge base and inform intervention programs and policies.
Despite the gaps in our knowledge, research to date suggests that these children and youth are at risk for multiple negative outcomes. As such, several initiatives and promising programs have been implemented to assist these children and youth, and the remainder of the articles in this newsletter focus on four such programs. Whitsett and Saito review an Army initiative to implement behavioral health services within school settings. They discuss the tenets of this approach, implementation strategies, and preliminary program effectiveness data. Embedding behavioral health care providers in school settings allows the opportunity to provide a range of services, from prevention to early intervention to specialty care services for those children with bona fine behavioral health diagnoses. Evaluation of the advantages of this approach in terms of access to care, as well as program effectiveness, demonstrates that the Army’s School Behavioral Health initiative is a very promising one.
Gurwitch and her colleagues describe their efforts to systematically adapt a widely recognized evidence-based treatment program for young children, Parent Child Interaction Therapy, for military-connected children and families. This model focuses on improving parenting skills and the parent-child relationship, highly relevant to this population given the frequency of parental war-time absences. Gurwitch and her research team have trained behavioral health care providers who treat military children in this model of care, and are evaluating outcomes to determine its effectiveness with this population.
The final two articles describe intervention programs targeting National Guard and Reserve families. In the article by Hanson and her colleagues, they describe a web-enhanced, group based intervention program modeled on an empirically-supported parent management training model. Their military unique adaptation, After Deployment Adaptive Parenting Tools (ADAPT), also includes a module focused on teaching parents emotion socialization skills, an important component given that combat stress symptoms can impact emotional functioning of parents. A randomized effectiveness trial of ADAPT will further our knowledge of effective intervention programs for military youth and families. Finally, Devoe and Ross describe the Strong Families Strong Forces program developed to enhance treatment engagement and participation of military families. This home-based program focuses on enhancing the quality of the parent-child relationship, and will also include a randomized trial to determine treatment effectiveness.
Military-connected children and youth are clearly at-risk for social, emotional and behavioral health concerns. Gaining a better understanding of the specific nature of these risks, variables that increase those risks, and most importantly, factors that increase coping and resiliency, is critical. In addition, targeted intervention programs, based on the identified need and rooted in the current evidence base, need to be systematically evaluated in order to better understand the effectiveness of these treatment strategies for this particular population. The articles in this issue help shed light on these issues, and inform future research and policy efforts.
Patti L. Johnson, PhD, is the director of the training division of the U.S. Army Medical Command’s Child, Adolescent, and Family Behavioral Health Office (CAF-BHO) located at Joint Base Lewis-McChord, Wash. She received her doctorate degree from the State University of New York at Stony Brook. She served 20 years on active duty in the U.S. Army. Dr. Johnson’s professional interests include the impact of deployment on children, optimizing resiliency in military families, early child development, parenting, prevention and health promotion, and enhancing the behavioral health of children with chronic health or developmental conditions. In 2006-2007, she served on APA’s Presidential Task Force on Military Deployment Services for Youth, Families and Service Members, and was a co-author on one of the first studies examining the impact of deployment on children during the current Global War on Terror. Her ongoing focus is identifying and implementing strategies to promote optimal development of children who face the many challenges of the military lifestyle, including parental deployment, trauma and loss.