family photo: af photo/ ssgt chris willis many times families will confuse normal adjustment issues...
TRANSCRIPT
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