Family

Photo: AF Photo/ SSgt Chris Willis

Many times families will confuse normal

adjustment issues for serious problems or vice

versa.

Most service members and families expect that the service member or the family will remain

unchanged.

Knowing the difference between expected

adjustment issues and

mental health problems

often depends on

time.

Family Re-Adjustmentcan be like driving in San

Antonio

It can be hard to figure out how to

merge safely

So why is re-adjustment a challenge?

From the ExpertsHow does deployment

change the military family?

Pre-Deployment StressorsPreparedness

Practical preparationPower of attorney/Will/Financial planLocation of important papersEmergency contact proceduresChild care arrangements

Emotional preparationPrepared to cope with unexpected

problemsTrust service member will be protectedSupport mission

Briefing by David Riggs, June 2007

Pre-Deployment Stressors

Lack of preparation time Unit preparation vs. family preparation

Shifting expectations Length of upcoming deployment

Open-ended deployments Deployment date

Clarifying changes in family dynamics

Anticipation of threats to service member

Perception of mission purpose

Lack of information

Rumors

Briefing by David Riggs, June 2007

Pre-Deployment Stressors - Spouses

Confusion

Denial

Resentment

Arguing

Worrying

Planning

Briefing by Doug Lehman, May 2008

Pre-Deployment Stressors -

Kids

Confusion Regression Anger Outbursts Sadness Surprise Guilt Behavioral problems

Briefing by Doug Lehman, May 2008

Pre-Deployment Stressors - Adolescents

“I don’t care”

Fear of rejection

Denial of feelings

Anger

Higher value on friends

Briefing by Doug Lehman, May 2008

Typical Course of Reintegration

Family resilience is the rule, not the exception.

Usually, families return to the normal routine.

Common to incorporate changes without major disruption in family functioning.

HOWEVER…

Post Deployment Reunion and Reintegration

Reunion can be very stressful Unmet or unrealistic expectations Changed roles/responsibilities New independence of spouse Lack of time Tug on loyalties Extended family Health/Mental health problems Unresolved marital issues haven’t vanished

Post Deployment Reunion and Reintegration

Most frequently identified stressors following a soldiers’ returnReadjustment to marital and family

relationshipsLack of time for family reintegrationCouple jealousy and suspicionsOngoing military stressorsUncertainty about future retention

Teitelbaum (WRAIR,1992) conducted a study with the Army after ODS

Post Deployment Stressors – Service Members

Physical: traffic, crowds, unarmed, access to alcohol

Cognitive: loyalty issues to family vs unit, secrecy vs disclosure, boredom, regrets, thoughts of losses

Emotional: grief, anger, feeling unsafe, guilt, withdrawal from war “rush,” numbness

Social: separated from buddies, overwhelmed or misunderstood by family, feelings of alienation

Spiritual: asking why buddies died, lack of purpose, changed faith, conflicting values

Editors Charles Figley and William Nash, Combat Stress Injury (2007)

Mindset When DeployedStay focused on mission /nothing else matters

Truly life or death / always on the edge

Constant adrenaline “rush”

Black or white / all or nothing

Sense of purpose, invincibility

Only trust battle buddies /others are threat

Need to control environment

Real problems and needs exist in Iraq

Adapted from briefing by COL Kevin Gerdes, May 2008

Mindset When HomeLife is now unfocused and complex

No longer on the verge of life or death

What can replace the “high” of war?

Things aren’t clear cut

No sense of purpose, nothing matters

Can’t trust anybody

Can’t be in control of surroundings

Problems at home pale in comparison to those in Iraq

Adapted from briefing by COL Kevin Gerdes, May 2008

Mindset When Deployed vs. Mindset When Home

SURVIVAL SKILLS HOMEWHILE DEPLOYED

Buddies (cohesion) vs. WithdrawalAccountability vs. ControllingTargeted Aggression vs. Inappropriate AggressionTactical Awareness vs. Hyper-vigilanceLethally Armed vs. “Locked and Loaded” at HomeEmotional Control vs. Anger/DetachmentMission OPSEC vs. SecretivenessIndividual Responsibility vs. GuiltNon-Defensive Driving vs. Aggressive DrivingDiscipline and Ordering vs. Conflict

Battlemind.org

Changes in the Family

FAMILY HAS New routines New responsibilities More independence and confidence Made many sacrifices Worried, felt lonely Gone through milestones that were missed

Adapted from briefing by COL Kevin Gerdes, May 2008

Coming Home to the Family

VETERAN’S RETURN CAN

Interrupt routine

Disrupt space

Throw off decision making

Cause family to walk on tip toes

Not make everything perfect

Not replace the sacrifices and missed milestones

Adapted from briefing by COL Kevin Gerdes, May 2008

Post-Deployment Stressors – Spouses

• Apprehension

• Excitement

• Worry

• Exhaustion

• Uncertainty

Briefing by Doug Lehman, May 2008

Protective Factors for Adjustment

Building Resilience

Preparedness

Social Support

Optimism

Acceptance of Military Lifestyle

Risk Factors for Poor Adjustment

Threats to Resiliency

Inexperience with Challenges

History of Family Dysfunction

Social Isolation

Fewer Resources

ResourcesDefense Centers of Excellence (DCoE)

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Mobile Applications

Co-Occurring Conditions Toolkit

Mood Tracker Breathe To Relax

mTBI Toolkit PTSD Coach Tactical Breather

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Mobile Applications

Breathe2Relax: Breathe2Relax is a portable stress

management tool. Built on the iPhone mobile app platform, Breathe2Relax is a hands-on diaphragmatic

breathing exercise. Breathing exercises have been documented to decrease the body's

“fight-or-flight” (stress) response, and help with mood stabilization, anger control, and anxiety management.

Breathe2Relax can be used as a stand-alone stress reduction tool, or can be used in tandem with clinical care directed by a healthcare worker.

For more information, please visit http://t2health.org/apps/breathe2relax

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Mobile Applications

Intended to be used as an adjunct to psychological treatment but can also serve as a stand-alone education tool. Key features of the app include:

Self-Assessment: Self-assessment of PTSD symptoms with individualized feedback, and ability to track changes in symptoms over time. The assessment does not formally diagnose PTSD.

Manage Symptoms: Coping skills and assistance for common kinds of posttraumatic stress symptoms and problems, including systematic relaxation and self-help techniques.

Find Support: Assistance in finding immediate support. The app enables individuals to identify personal sources of emotional support, populate the phone with those phone numbers, and link to treatment programs. And in an emergency, users can quickly link to the National Suicide Prevention Hotline.

Learn about PTSD: Education about key topics related to trauma, PTSD, and treatment.

PTSD Coach:

For more information, please visit http://t2health.org/apps/ptsd-coach

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T2 Mood Tracker: T2 Mood Tracker is a mobile application that allows

users to self-monitor, track and reference their emotional experience over a period of days, weeks and months using a visual analogue rating scale.

Users can self-monitor emotional experiences associated with common deployment-related behavioral health issues like post-traumatic stress, brain injury, life stress, depression and anxiety. Additional rating can also be added. With each self-rating, notes on environmental influences on emotional experiences can be added. Self-monitoring results can be a self-help tool or they can be shared with a therapist or health care professional, providing a record of the patient’s emotional experience over a selected time frame.

T2 Mood Tracker received first place in the "General Wellness" category during the Apps4Army (A4A) competition.

For more information, please visit http://t2health.org/apps/t2-mood-tracker

Mobile Applications

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Family Resource

MilitaryKidsConnect MilitaryKidsConnect (MKC) helps children

prepare for the challenges faced during significant family transitions. Through participation in MKC's monitored online forums, children can share their own ideas, experiences, and suggestions with other military children, helping them to know they are not alone in dealing with the stresses of deployment.

MKC's focused parent and educator tracks provide information to help them understand what it takes to support military children in at-home and school settings

For more information, please visit the MKC website at www.MilitaryKidsConnect.org

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Family Resource

This Emotional Life: A Handbook for Family & Friends of Service Members

A collaboration with Public Broadcasting Service (PBS) for military families.

The handbook covers a variety of topics to help service members and their families develop skills to become more resilient throughout the deployment process. Divided into three distinct sections:  pre-deployment, deployment and post-deployment. Each segment explores topics related to relationships, self-care, communication and staying informed.

- What to expect during a deployment- Tools to keep your family and community

strong throughout a deployment- Skills to strengthen or repair relationships- Tools to create open lines of

communication with your spouse/partner/child

For more information, please visit the DCoE website at www.dcoe.health.mil

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FOCUS: Family Resiliency Training™ for Military Families

Strengthening the Home BaseFOCUS (Families OverComing Under Stress™) provides resiliency training to military children and families. It teaches practical skills to meet the challenges of deployment and reintegration, to communicate and solve problems effectively, and to successfully set goals together and create a shared family story.

Developed by a UCLA-Harvard team, FOCUS teaches military children and families affected by multiple deployments to understand their emotional reactions, communicate more clearly, solve problems more effectively, and set and achieve their goals. Parents and children—from preschoolers to teens—learn to use tools that will better prepare them for each new deployment.

For more information, please visit the FOCUS website at http://focusproject.org

Family Resource

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Family Resources

Coaching into Care

Coaching Into Care works with family members or friends who become aware of their veteran’s post-deployment difficulties -- and supports their efforts to find help for the veteran.

This is a national clinical service providing information and help to veterans and the loved ones who are concerned about them.

Coaching Into Care focuses on the mission: helping those who care about veterans and encourage them to seek help.

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Service Member Support

Provides support to service members receiving mental health services as they transition between health care systems or providers

Provides voluntary one-on-one coaching to service members

Designed as a bridge of support for service members when:

– relocating to another assignment– returning from deployment– transitioning from active duty to reserve,

reserve to active duty or returning to civilian life

For more information, please visit the inTransition website at www.health.mil/inTransition

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DCoE Outreach Center Support

Established January 2009

Available 24/7

Staff by trained professional health resource consultants

Connects the right resources to the right person at the right time

Provides information and resources­ Resilience Programs­ Suicide Prevention Initiatives­ Family and relationship support­ Alcohol/substance abuse programs­ Psychological Health/TBI Programs­ Health care system navigation

For more information, please visit the DCoE website at www.dcoe.health.mil

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Service Member Support

Real Warriors Campaign

Realwarriors.net, information for:­ Active - duty service members­ Guard & Reserve­ Veterans­ Families/loved ones­ Health professionals

Website features:­ Articles/message boards/blogs­ Profiles featuring Real Warriors­ Deployment cycle guidance and

resources­ Links to resources including the 24/7

DCoE Outreach Center, National Suicide Prevention Lifeline

­ Multimedia products/Campaign Material