A Psychological Support for Peacekeeping Soldiers and their Families: A Preliminary Model

Being a military family can be challenging, and the demands placed on soldiers and their families can become very complex. Military deployments are part of a soldier's military career that cannot be avoided and have the potential to influence military families directly. Separation within a military family is an inherent consequence of military deployments. Military deployments consist of various phases. Each phase has unique emotional and psychological challenges attached to it. These challenges can significantly influence every member in the military family. It is therefore imperative that the military, soldier and military families be sensitized around these phases and their unique challenges. A model is proposed to empower military families in the face of deployment.     

The Significance of Military Contexts and Culture for Understanding Family Well-Being: Parent Life Satisfaction and Adolescent Outcomes

Formal systems and informal networks are presumed to be significant contexts that affect military families. Their effects on both parents and adolescents in active duty military families are examined (N = 236 families). Social organization and contextual model of family stress theories are employed as frameworks for the analyses of how dimensions of military culture influence parents’ life satisfaction, as well as key developmental outcomes of their adolescents (for example, mental health). Key findings from our analyses included a positive relationship between parents support from military leaders and fellow soldiers and parental well-being findings revealed the importance of civilian parents’ satisfaction with military life on adolescent outcomes for families that have experienced stressful military contexts. These findings provide support for the significance of multiple contexts for understanding resilience among military members and their families.     

Very Young Child Well-being in Military Families: A Snapshot

Since the September 11th attacks on the U.S., more than 2 million children have experienced parental deployment during their early years, with potentially lasting impact. When a parent is deployed, a number of factors may affect the well-being of the service member and his/her family. One parental factor—posttraumatic stress disorder or distress—might be particularly powerful in its effect on young children and the family system. We analyzed baseline data from an intervention development project which focused on supporting military families with very young children during post-deployment. The purpose of this research is to understand the relationships between parental mental health status, parenting stress, couple functioning, and young child well-being. The effects of mental health status of home-front and service member parents and the role of couple functioning on parent–child interactions and behavioral problems of young children were examined in a sample of military families during the post-deployment period. Findings suggest that service member posttraumatic stress symptoms are associated with higher parental report of child behavior problems. Higher quality of the couple relationship appears to lessen the impact of parental posttraumatic stress but is not related to parent perceptions of child behavior concerns. Implications for future research with military families are discussed.     

Enhancing Family Resilience Through Family Narrative Co-construction

We draw upon family resilience and narrative theory to describe an evidence-based method for intervening with military families who are impacted by multiple wartime deployments and psychological, stress-related, or physical parental injuries. Conceptual models of familial resilience provide a guide for understanding the mechanics of how families respond and recover from exposure to extreme events, and underscore the role of specific family processes and interaction patterns in promoting resilient capabilities. Leading family theorists propose that the family’s ability to make meaning of stressful and traumatic events and nurture protective beliefs are critical aspects of resilient adaptation. We first review general theoretical and empirical research contributions to understanding family resilience, giving special attention to the circumstances, challenges, needs, and strengths of American military families. Therapeutic narrative studies illustrate the processes through which family members acquire meaning-making capacities, and point to the essential role of parents’ in facilitating discussions of stressful experiences and co-constructing coherent and meaningful narratives. This helps children to make sense of these experiences and develop capacities for emotion regulation and coping. Family-based narrative approaches provide a structured opportunity to elicit parents’ and children’s individual narratives, assemble divergent storylines into a shared family narrative, and thereby enhance members’ capacity to make meaning of stressful experiences and adopt beliefs that support adaptation and growth. We discuss how family narratives can help to bridge intra-familial estrangements and re-engage communication and support processes that have been undermined by stress, trauma, or loss. We conclude by describing a family-based narrative intervention currently in use with thousands of military children and families across the USA.     

Family-Centered Care to Promote Successful Community Reintegration After War: It Takes a Nation

The papers in this section focus on public health responses and implementation considerations in addressing the challenges military families confront when parents go to war. While many military families show resilience, the challenges resulting from a decade of war with multiple deployments are detailed, as are innovative military and civilian programs designed to help service members and their families reintegrate successfully into the community. As more and more service members leave active duty, the burden of meeting military families’ psychological needs will transition from the Department of Defense (DoD) and into the Veterans Administration (VA) and civilian arenas. While many strategies to support successful readjustment are offered, in this time of dwindling mental health resources and competing needs, it is unclear what priority the broader society places on meeting the needs of returning service members and their families. A growing emphasis on family-centered care in the Veterans Administration may help meet this gap.     

Infants and Young Children in Military Families: A Conceptual Model for Intervention

Infants and young children of parents in the military deserve special attention because the first years of life are pivotal in establishing trusting attachment relationships, which are based on the developmental expectation that parents will be reliably available and protective both physically and emotionally. For young children in military families, the stresses of extended absences of mothers and/or fathers as the result of deployment abroad, recurrent separations and reunions resulting from repeated deployments, or parents struggling with the emotional sequelae of their war experiences, and the traumatic impact of parental injury and death can strain and derail the normative expectation of parental availability and protectiveness. This article describes the key features of mental health in infancy and early childhood, the developmentally expectable early anxieties that all children experience in the first years of life across cultures and circumstances, and the ways in which these normative anxieties are exacerbated by the specific circumstances of military families. The article also describes interventions that may be helpful in supporting military families and their children with the specific challenges they face.     

National Guard Couples Communicating During Deployment: The Challenge of Effective Connection

Communication during a combat deployment has changed significantly in current times. Couples can now communicate with each other frequently and through multiple modes. Despite this greater availability of communication options, there remain unanswered questions related to how healthy deployment communication is best achieved between couples, particularly regarding navigating the uncertainty of deployment. In this qualitative study, we report on the experiences of 31 National Guard couples who endured a combat deployment in support of Operation Enduring Freedom. Couples were interviewed three months after the soldier returned from deployment. Through the lens of relational turbulence theory, we provide a conceptual framework related to effective and non-effective deployment communication, along with structural communication barriers in the military that may negatively affect the mental well-being of partners. Finally, we provide recommendations to guide couples through these difficult deployments.

     

Military children and families: strengths and challenges during peace and war

Throughout history, military children and families have shown great capacity for adaptation and resilience. However, in recent years, unprecedented lengthy and multiple combat deployments of service members have posed multiple challenges for U.S. military children and families. Despite needs to better understand the impact of deployment on military children and families and to provide proper support for them, rigorous research is lacking. Programs exist that are intended to help, but their effectiveness is largely unknown. They need to be better coordinated and delivered at the level of individuals, families, and communities. Research and programs need to take a comprehensive approach that is strengths based and problem focused. Programs for military children and families often focus on the prevention or reduction of problems. It is just as important to recognize their assets and to promote them. This article reviews existing research on military children and families, with attention to their strengths as well as their challenges. Issues in need of further research are identified, especially research into programs that assist military children and families. Military children and families deserve greater attention from psychology.     

A qualitative examination of the work–family interface: Parents of children with autism spectrum disorder

Within the work–family literature little is known about the work–family challenges and opportunities faced by families that have one or more children with autism spectrum disorder. However, it has been consistently demonstrated that parents of children with autism spectrum disorder are at a higher risk of experiencing a host of negative outcomes. Using a qualitative design, within grounded theory, the present study sheds light on the needs, experiences, and challenges that parents of children with autism spectrum disorder face and also offers insight into ways to expand the scope of work–family research in this area. The present research provides evidence of how the family domain can greatly impact experiences and decisions made in the work domain for families with special needs. The present research adds to the small but growing literature examining the interplay between home and work life for families with special needs and demonstrates that this is an important research domain in need of additional conceptual and empirical consideration.     

A qualitative examination of the work–family interface: Parents of children with autism spectrum disorder

Within the work–family literature little is known about the work–family challenges and opportunities faced by families that have one or more children with autism spectrum disorder. However, it has been consistently demonstrated that parents of children with autism spectrum disorder are at a higher risk of experiencing a host of negative outcomes. Using a qualitative design, within grounded theory, the present study sheds light on the needs, experiences, and challenges that parents of children with autism spectrum disorder face and also offers insight into ways to expand the scope of work–family research in this area. The present research provides evidence of how the family domain can greatly impact experiences and decisions made in the work domain for families with special needs. The present research adds to the small but growing literature examining the interplay between home and work life for families with special needs and demonstrates that this is an important research domain in need of additional conceptual and empirical consideration.     

Race-Related Differences in the Experiences of Family Members of Persons with Mental Illness Participating in the NAMI Family to Family Education Program

Families play an important role in the lives of individuals with mental illness. Coping with the strain of shifting roles and multiple challenges of caregiving can have a huge impact. Limited information exists regarding race-related differences in families’ caregiving experiences, their abilities to cope with the mental illness of a loved one, or their interactions with mental health service systems. This study examined race-related differences in the experiences of adults seeking to participate in the National Alliance on Mental Illness Family-to-Family Education Program due to mental illness of a loved one. Participants were 293 White and 107 African American family members who completed measures of problem- and emotion-focused coping, knowledge about mental illness, subjective illness burden, psychological distress, and family functioning. Multiple regression analyses were used to determine race-related differences. African American caregivers reported higher levels of negative caregiving experiences, less knowledge of mental illness, and higher levels of both problem-solving coping and emotion-focused coping, than White caregivers. Mental health programs serving African American families should consider targeting specific strategies to address caregiving challenges, support their use of existing coping mechanisms and support networks, and increase their knowledge of mental illness.     

Deployment Stress and Well-Being Among Military Spouses: The Role of Social Support

The demands of military service, including the intensity and frequency of military operations, can have numerous effects on military families. Evidence suggests that spousal support may play an important role in the resiliency of military families. The present study examined the roles of deployment stress and social support in the psychological well-being of spouses of deployed military personnel (N = 639). The results showed that deployment stress and perceived social support from family, nonmilitary friends, and military partner played independent roles in the psychological wellbeing of military spouses. This evidence suggests the importance of taking perceived social support into account when explaining the variance in the psychological wellbeing of military spouses. Results are discussed in light of some methodological constraints, and the potential implications related to heightening families’ perceptions of interpersonal relationships are emphasized.     

Pathways of Risk and Resilience: Impact of a Family Resilience Program on Active‐Duty Military Parents

Over the past decade, studies into the impact of wartime deployment and related adversities on service members and their families have offered empirical support for systemic models of family functioning and a more nuanced understanding of the mechanisms by which stress and trauma reverberate across family and partner relationships. They have also advanced our understanding of the ways in which families may contribute to the resilience of children and parents contending with the stressors of serial deployments and parental physical and psychological injuries. This study is the latest in a series designed to further clarify the systemic functioning of military families and to explicate the role of resilient family processes in reducing symptoms of distress and poor adaptation among family members. Drawing upon the implementation of the Families Overcoming Under Stress (FOCUS) Family Resilience Program at 14 active‐duty military installations across the United States, structural equation modeling was conducted with data from 434 marine and navy active‐duty families who participated in the FOCUS program. The goal was to better understand the ways in which parental distress reverberates across military family systems and, through longitudinal path analytic modeling, determine the pathways of program impact on parental distress. The findings indicated significant cross‐influence of distress between the military and civilian parents within families, families with more distressed military parents were more likely to sustain participation in the program, and reductions in distress among both military and civilian parents were significantly mediated by improvements in resilient family processes. These results are consistent with family systemic and resilient models that support preventive interventions designed to enhance family resilient processes as an important part of comprehensive services for distressed military families.     

Dissemination of Family-Centered Prevention for Military and Veteran Families: Adaptations and Adoption within Community and Military Systems of Care

In response to the needs of military families confronting the challenges of prolonged war, we developed Families OverComing Under Stress (FOCUS), a multi-session intervention for families facing multiple deployments and combat stress injuries adapted from existing evidence-based family prevention interventions (Lester et al. in Mil Med 176(1): 19–25, 2011). In an implementation of this intervention contracted by the US Navy Bureau of Medicine and Surgery (BUMED), FOCUS teams were deployed to military bases in the United States and the Pacific Rim to deliver a suite of family-centered preventive services based on the FOCUS model (Beardslee et al. in Prev Sci 12(4): 339–348, 2011). Given the number of families affected by wartime service and the changing circumstances they faced in active duty and veteran settings, it rapidly became evident that adaptations of this approach for families in other contexts were needed. We identified the core elements of FOCUS that are essential across all adaptations: (1) Family Psychological Health Check-in; (2) family-specific psychoeducation; (3) family narrative timeline; and (4) family-level resilience skills (e.g., problem solving). In this report, we describe the iterative process of adapting the intervention for different groups of families: wounded, ill, and injured warriors, families with young children, couples, and parents. We also describe the process of adopting this intervention for use in different ecological contexts to serve National Guard, Reserve and veterans, and utilization of technology-enhanced platforms to reach geographically dispersed families. We highlight the lessons learned when faced with the need to rapidly deploy interventions, adapt them to the changing, growing needs of families under real-world circumstances, and conduct rigorous evaluation procedures when long-term, randomized trial designs are not feasible to meet an emergent public health need.     

The Role of Natural Support Systems in the Post-deployment Adjustment of Active Duty Military Personnel

This study examined the relations among three different types of naturally occurring social support (from romantic partners, friends and neighbors, and unit leaders) and three indices of service member well‐being (self reports of depressive symptoms, satisfaction with military life, and perceptions of unit readiness) for service members who did and did not report negative experiences associated with military deployment. Data were drawn from the 2011 Community Assessment completed anonymously by more than 63,000 USAF personnel. Regression analyses revealed that higher levels of social support was associated with better outcomes regardless of negative deployment experiences. Evidence of moderation was also noted, with all forms of social support moderating the impact of negative deployment experiences on depressive symptoms and support from unit leaders moderating the impact of negative deployment experience on satisfaction with military life. No moderation was found for perceptions of unit readiness. Subgroup analyses revealed slightly different patterns for male and female service members, with support providing fewer moderation effects for women. These findings may have value for military leaders and mental health professionals working to harness the power of naturally occurring relationships to maximize the positive adjustment of service members and their families. Implications for practices related to re‐integration of post‐deployment military personnel are discussed.     

Family-Centered Care for Military and Veteran Families Affected by Combat Injury

The US military community includes a population of mostly young families that reside in every state and the District of Columbia. Many reside on or near military installations, while other National Guard, Reserve, and Veteran families live in civilian communities and receive care from clinicians with limited experience in the treatment of military families. Though all military families may have vulnerabilities based upon their exposure to deployment-related experiences, those affected by combat injury have unique additional risks that must be understood and effectively managed by military, Veterans Affairs, and civilian practitioners. Combat injury can weaken interpersonal relationships, disrupt day-to-day schedules and activities, undermine the parental and interpersonal functions that support children’s health and well-being, and disconnect families from military resources. Treatment of combat-injured service members must therefore include a family-centered strategy that lessens risk by promoting positive family adaptation to ongoing stressors. This article reviews the nature and epidemiology of combat injury, the known impact of injury and illness on military and civilian families, and effective strategies for maintaining family health while dealing with illness and injury.     

On the home front: stress for recently deployed Army couples

Military couples who have experienced deployment and reintegration in current U.S. military operations frequently experience stress regarding the dangers and effects of such experiences. The current study evaluated a sample of 300 couples with an active duty Army husband and civilian spouse who experienced a deployment within the year before the survey (conducted in 2007). Wives generally reported greater levels of emotional stress compared with husbands. Overall, higher levels of stress were found for couples who reported lower income and greater economic strain, perceive the need for more support and are unsure about how to get support, have more marital conflict, and are generally less satisfied with the Army and the current mission. Husband combat exposure was also associated with more stress for husbands and wives. Additionally, for wives, stress was related to greater child behavior problems and a sense of less Army concern for families. The results suggest areas of intervention with military couples to help them cope with the challenges of military life and deployment.     

Implementation and Dissemination of Military Informed and Evidence-Based Interventions for Community Dwelling Military Families

Community dwelling military families from the National Guard and Reserve contend with deployment-related stressors in relative isolation, living in communities where mental health providers may have little knowledge of military culture. When they are community residents, active duty service members and families tend to live in close proximity to their military installations. This article will focus primarily on the challenges to quality mental health care for reserve component (RC) families. Where studies of RC families are absent, those of active component (AC) families will be highlighted as relevant. Upon completion of a deployment, reintegration for RC families is complicated by high rates of symptomatology, low service utilization, and greater barriers to care relative to AC families. A paucity of providers skilled in evidence-based treatments (EBTs) limits community mental health capacity to serve RC military families. Several emergent programs illustrate the potential for better serving community dwelling military families. Approaches include behavioral health homes, EBTs and treatment components, structured resiliency and parent training, military informed schools, outreach methods, and technology-based coping, and psychoeducation. Methods from implementation science to improve clinical skill acquisition and spread and sustainability of EBTs may advance access to and quality of mental health treatment and are reviewed herein. Recommendations related to research methods, military knowledge and treatment competencies, and transition to a public health model of service delivery are discussed.     

Long-Term Trajectories and Service Needs for Military Families

The deployment of US military personnel to recent conflicts has been a significant stressor for their families; yet, we know relatively little about the long-term family effects of these deployments. Using data from prior military service eras, we review our current understanding of the long-term functioning and needs of military families. These data suggest that overseas deployment, exposure to combat, experiencing or participating in violence during war deployment, service member injury or disability, and combat-related post-traumatic stress disorder (PTSD) all have profound impacts on the functioning of military families. We offer several recommendations to address these impacts such as the provision of family-centered, trauma-informed resources to families of veterans with PTSD and veterans who experienced high levels of combat and war violence. Recent efforts to address the needs of caregivers of veterans should be evaluated and expanded, as necessary. We should also help military families plan for predictable life events likely to challenge their resilience and coping capacities. Future research should focus on the following: factors that mediate the relationship between PTSD, war atrocities, caregiver burden, and family dysfunction; effective family-centered interventions that can be scaled-up to meet the needs of a dispersed population; and system-level innovations necessary to ensure adequate access to these interventions.     

Mental Health Concerns of Older Adults Living in Long-Term Care Facilities: An Area of Expansion for MFTs

As baby boomers reach retirement age, the number of older adults living in long-term care will inevitably increase. Living in long-term care often brings psychological, relational, and emotional challenges for older adults, their families, and professional care-providers. Despite these trends and associated challenges, there appears to be an underrepresentation of attention addressing the mental health care of older adults and their families in marriage and family therapy (MFT) literature. Emphasis needs to be turned to assessing the quality and effectiveness of mental health resources for older adults in residential facilities, and to filling the gap where needed services are unavailable. The current review summarizes research addressing residential care for older adults, detailing a) mental health challenges faced by residents, families, and professional care-providers, b) effective mental health treatment options, and c) how MFTs are uniquely suited to working in long-term care settings.