Army Families: Forging a Stronger Future Support for Army Children and Families Kris Peterson MD Military Child and Adolescent Center of Excellence

Slide 2 of 22

Slide 3 of 22

Impact • Deployment is related to increases in internalizing symptoms, particularly depression and anxiety Externalizing symptoms (preschool aggression) • Adolescents exhibited symptoms of depression and anxiety and had a lower threshold for emotional outbursts and acting out • Amount of time deployed impacts on Military Families – Spouses with increase risk of depression/anxiety – Increase in Child Maltreatment/ issues of neglect

• Increase in utilization of mental health services – Outpatient/Inpatient – Long Term impacts unclear Slide 4 of 22

Military Family Challenges Deployment *transient stress now with multiple years chronic *modify family roles/function*temporary to now chronic accommodation *reunion adjustment repeartedly *military community maintained initially *probable sense of growth and accomplishment but overwhelmed over time

Injury *trans or perm stress *modify family roles/function *temp or permanent accommodation *injury adjustment *military community jeopardized *change must be integrated before growth

Psych Illness *trans or perm anent stress *modify family roles/function *temp or perm anent accommodation *illness adjustment *military community jeopardized *change must be integrated before growth

STRESS LEVEL

Death *perm anent stress *modify family roles/function *permanent accommodation *grief adjustment *military community jeopardized or lost *death must be grieved before growth

The Challenges • Underlying Cause: Deployments Continue • Effect of War/ Deployment on Children and Families  1 of 3 school-aged child at risk for psychosocial problems. About 30% of children with have significantly increased anxiety1  Children 3 years and older of have significantly more behavioral problems 2 Children 6-12 had clinically significant increases in anxiety • Lack of Behavioral Health System of Care for Children and Families • Inadequate National and TRICARE resources in most areas near installations 1 Flake et al, 2009 J Dev Behavioral Pediatr 30:271-278 2 Lester et al, 2009 3 Chartrand et al, 2008 Arch Pediatr Adolesc Med 162:1094-1095; Gibbs, et al. JAMA, 2007 298:528-535 Rentz, et al., Am J Epidemiol 2007 165:1199-1206 4 Faran and Saito, unpublished 5 Batzer and Devera, unpublished, Lester Peterson Impact of Deployment on 6-12 year olds

National Shortages

Graduated Tiers of Intervention Pyramid of Resilience

Disequilibrium

Illness

Avoid complicating factors

At Risk

Support toward Resilience

Healthy

Military Child and Adolescent Center of Excellence: Strategic Plan Execute a plan that provides direct Behavioral Health Support for Army Children and their Families • Coordinate assets (MEDCOM, IMCOM and civilian) to develop comprehensive/integrated behavioral health systems of care • Build capacity and decrease barriers to care (single portal of entry - CAFAC) with focus on prevention and building resiliency • School Behavioral Health Programs (SBH) to improve access, reduce stigma, and promote resilience

Objectives • Train and partner with primary care providers in evaluation and treatment of common behavioral health disorders • Reduce stigma and promote “health seeking behavior” through Command and community support, active marketing, and education • Provide repository of expertise for evidence-based interventions for Army Behavioral Health

Expected Outcomes • Better Service – Coordinated, accessible Behavioral Health Services • Improved Outcomes – Decrease in Soldier and Family Member psychiatric hospitalizations/morbidity – More resilient and healthy Army community

– Overall decrease in use of medical services (long term) – Fewer evacuations from OIF/OEF for family behavioral health issues

© 2008 National Fatherhood Initiative. All rights reserved. National Fatherhood Initiative and www.fatherhood.org the National Fatherhood Initiative logo are registered trademarks of National Fatherhood Initiative. 2008 National Fatherhood Initiative

Supporting Army Dads

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The Facts of Father Absence 2008 National Fatherhood Initiative

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The Facts of Father Absence 







In 1960, 8 million children lived apart from their fathers Today, over 24 million children live in homes without their fathers 1 out of 3 children nationally live in father-absent homes 2 out of 3 African American children live in father-absent homes

30 25 20 15 10 5 0 1960

2000

Source: U.S. Census Bureau 2008 National Fatherhood Initiative

www.fatherhood.org

The Costs of Father Absence Children of father-absent homes are:  Five times more likely to live in poverty  Three times more likely to fail in school  Two times more likely to develop emotional or behavioral problems  Two times more likely to abuse drugs  Two times more likely to be abused and neglected  Two times more likely to become involved in crime  Three times more likely to commit suicide Source: Horn, Wade F., and Tom Sylvester. Father Facts, 5th Edition. Gaithersburg, MD: National Fatherhood Initiative, 2007. 2008 National Fatherhood Initiative

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

In 2006, the federal government spent $100 billion dollars on 13 means-tested benefits programs and child support enforcement to support father-absent homes – this is nearly 4% of the entire federal budget  Medicaid ($23 billion), TANF ($15 billion), and EITC ($15 billion) accounted for more than half the costs 2008 National Fatherhood Initiative

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Benefits of Father Involvement Studies show that children with involved fathers display:  better cognitive outcomes, even as infants  higher self-esteem and less depression as teenagers  higher grades, test scores, and overall academic achievement  lower levels of drug and alcohol use  higher levels of empathy and other pro-social behavior Source: Horn, Wade F., and Tom Sylvester. Father Facts, 5th Edition. Gaithersburg, MD: National Fatherhood Initiative, 2007. 2008 National Fatherhood Initiative

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Military Fathers & Families 2008 National Fatherhood Initiative

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Military Fathers & Families 

Active Duty Members (1.4 M)    

516K (37%) are dads 5.4% are single dads 1.17M kids total 41% of children are under 5



Reserve Members (880K)    

300K (34%) are dads 5.6% are single dads 713K kids total 24% of children are under 5 Source: Military Family Resource Center

2008 National Fatherhood Initiative

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Military Fathers 

Approximately 165,000 fathers are currently deployed or on hardship duty 

About 333,000 kids are separated from Dad because of deployment!

Sources: GlobalSecurity.org Military Family Resource Center 2008 National Fatherhood Initiative

www.fatherhood.org

Military Dads. . .Who Are They? 

Regular Dads . . .   

Parents Providers Husbands



That have faced or are facing     

 

Deployment Separation Reunion / Reintegration Combat Stress Health Issues Communication Challenges Child Custody Divorce

Photo Courtesy of the National Military Family Association. Used with Permission. 2008 National Fatherhood Initiative

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Why a Military Father Program? 

Research reports tell us:  





Military and family compete with each other Service members are looking more for work/family “fit” than ever before Service members make re-enlistment decisions based on family circumstances, leader support & satisfaction with services Service members are more able to focus on mission when family concerns are addressed and . . .

2008 National Fatherhood Initiative

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Why a Military Father Program? Military kids need their fathers too!

Photo courtesy of http://tennesseemilitaryfamily.bravejournal.com. Used with Permission

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Who We Are: 



Non-profit, non-partisan, nonsectarian organization Founded in 1994 to combat the most consequential social trend of our time:

Widespread Fatherlessness in the Lives of Our Nation’s Children 2008 National Fatherhood Initiative

www.fatherhood.org

NFI’s mission:

To improve the well-being of children by increasing the proportion of children growing up with involved, responsible, and committed fathers in their lives.

2008 National Fatherhood Initiative

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NFI’s Three-E Strategy Educate and inspire Equip fathers and develop leaders Engage all sectors of society

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Three-E Strategy - Educate

Educating and inspiring all Americans, especially fathers, through public awareness campaigns, research, and other resources.

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Educate - Print PSA, “Swing”

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Educate - Research

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Educate - NFI Website 

Information on NFI programs, events, and trainings



free on-line resources



parenting tips



PSAs



2,000 visitors each day



.

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Three-E Strategy - Equip

Equipping fathers and developing leaders of national, state, and community fatherhood initiatives through curricula, training, and technical assistance.

2008 National Fatherhood Initiative

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Who can Equip Military Fathers?     



Child Development Centers Family Advocacy New Parent Support Programs Chaplains ACS and Leadership

2008 National Fatherhood Initiative

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Are you Father Friendly?

2008 National Fatherhood Initiative

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How do you Equip Military Dads     



Training specifically for Fathers Provide resources specifically for Fathers Reunion/Reintegration events Pre-Deployment briefings Fatherhood Resource Centers Educating Leadership

2008 National Fatherhood Initiative

www.fatherhood.org

Equipping the Mobile Military Dad

Provide your own Fatherhood Resource Center!

2008 National Fatherhood Initiative

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Three-E Strategy - Engage

Engaging every sector of society through strategic alliances and partnerships.

2008 National Fatherhood Initiative

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Engage – Everyone

2009 Military Fatherhood Award

U.S. Navy Chief Quartermaster John Lehnen Accepts His 2009 National Fatherhood InitiativeLockheed Martin Military Fatherhood Award

2008 National Fatherhood Initiative

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Military Programming—Where We’ve Been          

    

Pentagon Fort Belvoir Bethesda National Naval Medical Center National Guard Bureau Army Chief of Chaplains Fort Carson Nellis AFB Fort Meade Fort Hood Andrews AFB Quantico Marine Corps Base Hanscom AFB Hill AFB Bolling AFB 76th Brigade of Indiana National Guard

                

2008 National Fatherhood Initiative

96th Army Reserve Command, SLC Utah DC National Guard Fort Irwin Edwards AFB San Diego Naval Station Miramar/MCRD Fort Benning US Army Reserve Command Fort Monroe Commander, Naval Installations Fort Lewis McChord AFB Bremerton Naval Station Patrick AFB Lemoore Naval Station California National Guard USS Reagan

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"By profession I am a soldier and take great pride in that fact. But I am prouder - infinitely prouder - to be a father." - General Douglas MacArthur, 1942

QUESTIONS ? 2008 National Fatherhood Initiative

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Tim Red [email protected] Work Number: (972) 296-0451 Cell Number: (214) 478-1635 www.fatherhood.org

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Military Family Forum Washington DC October 2009

Mom Deploys! Effect on Military Women’s Health & Adolescent Risk Factors Mona P. Ternus, PhD, RN, CNS, CCRN, Lieutenant Colonel, United States Air Force, NC Commander 911 Aeromedical Staging Squadron, Pittsburgh Associate Professor, Director Academic Outreach George Mason University

Women in the Military The total number of US military personnel is over 3.5 million.  Women comprise over 142,000 (17%) of the reserve force and over 200,000 (15%) of the active duty force. 

Adolescents associated with Military Families 297,638 associated with active duty between the ages of 12 to 18  124,576 ages 15 to 18 associated with reserve members. 

Critical Issues  

  

Experiences of war affects women’s health War-induced separation impacts family life with unique stressors related to the dangerous aspects of deployment Adolescence is a turbulent period with an increased number of health risk behaviors Mother–adolescent relationships effect the health and well-being of the family Mothers’ absences have significant effects on adolescents

Purposes/Aims 



The purpose of this study was to identify issues military mothers of adolescent children may experience before, during, and after deployment. Specific aims of this study were to  1)

describe the health of military mothers of adolescents after deployment;  2) identify issues for military mothers’ of adolescents associated with deployment; and  3) examine the relationship between military mothers’ health, length of deployment, family structure, support during deployment, and adolescent behaviors.

Methods  





Mixed methods study Web Survey of military mothers  Must have deployed and  At the time of deployment were parenting an adolescent child Quantitative methodology consisted of a cross-sectional one group correlational design with four instruments Qualitative methodology used a grounded theory approach

Sample   

n = 77 Mean age 42 (SD = 6), range of 31 – 57 years. Multi-Racial 



Deployment Location  

 

Caucasian/White (78%) and African American (8%) 64% had been deployed to Iraq, Afghanistan, or the Middle East 17% were deployed within the United States (CONUS)

Number of days deployed 9–784 days, median of 128 days Time post-deployment 0-181 months, median of 15 months

Sample 

All Services  Majority  Army (n



Air Force (n = 55; 71%) = 19; 25%)

All Ranks  Enlisted (n = 43; 56%)  Officers (n = 34; 44%).



All Components  Active duty (n = 33; 43%)  Reserve (n = 19; 25%)  National Guard (n = 25; 33%)

Marital Status

Change in marital status since deployment

Marital status at time of deployment

Frequency Married Divorced

Separated Never Married Total

Percent

No change in marital status

53

68.8

20

26.0

Married

2

2.6

Divorced

2

2.6

Separated

77

100.0

No change in status, spouse also deployed

Total

4% were dual military

Frequency

Percent

62

80.5

2

2.6

7

9.1

3

3.9

3

3.9

77

100.0

Current Overall Health Status

**= p 10 Behaviors

Before Deployment

75%

16%

5%

4%

0

0

0

During Deployment

23%

31%

17%

10%

7%

4%

8%

After Deployment

25%

40%

17%

9%

5%

3%

1%

Associated with Deployment

51%

33%

9%

7%

1%

0

0

Risk Behavior

Risk Behaviors

Before Deployment

During Deployment

After Deployment

Non-Accidental Physical Injury

1(1%)

4(5%)

2(3%)

1(1%)

Physical Fights

4(5%)

12(16%)

8(10%)

12(16%)

Incidents Involving Weapons

0

1(1%)

0

1(1%)

Cigarette Smoking/ Chewing Tobacco

3(4%)

8(10%)

2(3%)

6(8%)

Alcohol

8(10%)

7(9%)

3(4%)

5(7%)

Illegal Drug Use

3(4%)

3(4%)

2(3%)

5(7%)

Self Mutilation

3(4%)

0

0

0

Drop in School Grades

8(10%)

35(45%)

21(27%)

24(31%)

Suicide or Attempted Suicide

1(1%)

0

0

0

Sexual Activity

6(8%)

8(10%)

7(9%)

6(8%)

0

0

0

0

Negative Change in Diet and Nutrition

3(4%)

19(25%)

7(9%)

16(21%)

Negative Change in Physical Activities

3(4%)

13(17%)

8(10%)

7(9%)

0

14(18%)

7(9%)

12(16%)

Sexually Transmitted Disease

Other Behavior

Related to Deployment

Trajectory of Adolescent Risk Behaviors Before, During, and After Deployment and those Behaviors that Mothers Associated with the Deployment 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

0

s

2 1-

B

s

or vi a eh

Before Deployment

4 3-

B

or vi a eh

6 5-

During Deployment

B

rs io v a eh

s

s

8 7-

B

r io av

or vi a eh

After Deployment

10 9-

h Be

>

10

B

io av h e

rs

Associated with Deployment

Family Dynamics   

    

Family routines were disrupted Roles changed Had to be the disciplinarian Financial problems created difficulties Different expectations (of caregivers) When one parent is gone, the other is the decision maker Missed family gatherings, holidays, events Missed each other terribly

Impact on Spousal Relationship Dealing with the emotional, physical, sexual trouble that I have with my husband. Women experience I think more problems then men do. Our husbands don't want us to go either, not just the kids. Husbands a lot of the time are worse than the children. You didn’t look at that at all. Big problem.

Mother-Adolescent Relationships    

Majority of comments reflected that relationships became more strained after the deployment 14% noted that the relationship improved and brought them closer 13% indicated that there was no change in the relationship. Representative comments on the closeness in the relationship after deployment: 

I think it made it better. I think he has opened up to me more.  Yes it has made us closer. She realized that how important I am in her life.  It brought us closer to each other. We discuss topics that we had only touched on before.

Difficulties in the Relationship



I feel that we are not as close as we once were. It is getting better but there just feels like something is missing between us. My son and I used to be able to talk about anything now he doesn’t talk to me because he thinks I don’t understand him and abandoned him when I deployed to Iraq. … He is afraid to upset me.



When I came back I was distant and she was apprehensive.



He said I have changed. I said I had a shorter temper and this bothered him.



Maternal Guilt 

I believe it may have left some abandonment feelings with my son that he still carries today. I had never left him before and he mentioned that it was our first Christmas apart. That was painful for me to realize. I think it hurt him to know I could leave him behind, even if it was my job.



The constant desensitization that occurs when you deal with injured and dead Soldiers on a daily basis when deployed(as a nurse in the ER), has made me distant and at times I am unable or can't be the nurturing mother I need to be.

Planning Ahead for Child Care 

[What was most difficult?] Childcare issues due to spouses rotating work schedule. Finding suitable caregivers for the odd hours the shift work created and still maintaining some semblance of a normal schedule for the two younger children (including the adolescent).

Child’s Fear & Mom’s Response I understand about my children's fear of their mother dying. Chances are their peers cannot relate to this, as most children don't have parents whose main job is military during a time of war. However, I did validate my daughter's feelings and let her know that is must be very scary, but that I made the choice (military) that I did because it was the best decision for me and the best for them (due to benefits, health/dental care for kids, etc.) and for the preservation of women around the world. I was fighting for freedom of all people, especially girls of dictators whose lives are still not considered as valuable as a man's. Of course--and most of all--to protect the freedom of this country--to ensure their freedoms are protected. At the very least, I told her who else's Mom could say they'd die for their kids and mean it.

Recommendations 

Improve communication means 

More phone calls  Write more letters  Email more (jokes, pictures, different items, mix it up)  Webcams 

Improve Depth of Communication    

Bring out his feelings, concerns, thoughts Take more time to explain what is going on Address the real issues… talk about her fears and anxiety Ask in-depth personal questions, not just general questions



Shorter deployment cycles



Choose a good role model

Mediators ~ Moments for Intervention FAMILY Members

-->

CATALYST --> Military Deployment

MEDIATORS

EFFECTS/OUTCOMES Health & Behavior

Mediators  



COMMUNICATIONS CAREGIVERS SUPPORT   



Family/Caregivers/Friends Community Work (military & civilian)

SYSTEM SUPPORT 

Health Care System  



Non-Health Care   



Military & Civilian Military System Policies Readiness for War Preparations for Family

MEDIA/PUBLIC SUPPORT 

Context of current events

Implications Understanding the issues of military mothers of adolescent children at this pivotal time in life has the potential to:  Minimize the effects of war-induced separation  Support the mother’s ability to deliver appropriate care before, during, and after deployment  Enhance readiness in military operations  Promote healthy practices.

Selected References 







Cozza, S. J., Chun, R. S., & Polo, J. A. Military Families and Children During Operation Iraqi Freedom. Psychiatric Quarterly, 76(4), (2005): 371-378. Gibbs, D. A., Martin, S. L., Kupper, L. L., & Johnson, R. E. Child Maltreatment in Enlisted Soldiers’ Families During Combat-Related Deployments. JAMA, 298(5), (2007): 528-535. Hardin, S. B., Hayes, E., Cheever, K. H., & Addy, C. Impact of War on American Adolescents. Journal of Child and Adolescent Psychiatric Nursing, 16(2), (2003): 81-87. Huebner, A. J., & Mancini, J. A. Adjustments Among Adolescents in Military Families When a Parent is Deployed. Final report to the Military Family Research Institute and Department of Defense Quality of Life Office. West Lafayette, IN: Purdue University Military Family Research Institute. (2005, June 30).

Acknowledgements Originally Funded by the University of New Mexico, College of Nursing  Currently supported by George Mason University  Thank you to all those who serve  Questions? 

Thank YOU! You make a difference

We’re giving together

Our Dual Mission Our dual mission supports Aid for Wounded Soldiers worldwide and youth and special needs projects in Northern Virginia Azalea Charities is made up of 100% volunteers who donate their time and talents because they believe in our mission. Beyond minimal expenses, all the funds we raise go to charitable causes.

Aid for Wounded Soldiers A non-profit project that provides comfort and relief items for soldiers, sailors, airmen and marines sick, injured or wounded from service in Iraq and Afghanistan, as well as their families. The purpose of our mission is to lift their spirits and enhance their morale as well as affect a lifetime support program.

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Supporting Soldiers & Their Families • Distributed over 28,000 comfort items 1 million+ phone minutes • Special needs projects from cribs to international travel • Christmas parties, football & baseball games

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PROJECT HOMEFRONT A Clinical Mental Health Resilience and Rejuvenation Service A Joint Project of the Fort Hood-AUSA and Scott & White Healthcare Presented by: Matthew G. Wright, JD

What is Scott & White • • • • • •

9 Hospitals, 50 Primary & Specialty Clinics 8,000 Employees Top 1% of NICUs Internationally 775 Physicians & Scientists 1.7 Million Outpatient Visits Only Level 1 Trauma Center between Dallas and San Antonio • 500 Research Scientists • Only multi-disciplinary healthcare system with excellence in clinical medicine, research and education. (8thPh.D./MD) • Only Texas healthcare system that has bench research to commercialization capabilities.

Central Access for Military Concentration of Active Duty, Reserve & Guard

Scott & White Primary Service Area -Patients from all Texas Counties & all States. -Patients from foreign countries including Mexico & China

Why did Scott & White Engage? • Right Place: Fort Hood as Neighbor • Right People: Clinical Experts, Research Capacity, Education System

• Right Time: An increase in demand and request for help from US Army. • “Why treat in our ER, when we can prevent.” • Formula: # of Service Members x Army Military Suicide Rate = # of Projected Clients

The Project • Co-locate mental health counselors into the process of primary care: remove stigma, increase access and provide immediate assistance. • Free, Unlimited Sessions

• In addition, families can call-in, walk-in or be referred by other medical professionals. • In addition, Rejuvenation Week-Ends to connect children and spouses with others facing the same issues. • Home Front is a licensed, clinical-based program rooted in clinical behavioral medicine.

Other Points • Consists of unlimited clinical counseling sessions, as opposed to the limited 2-4 sessions of existing military assistance. • Counselor stays consistent throughout the entire 18+ month process of deployment rampup, separation, and reintegration. • Counselors trained in military culture. • Counselor is available for an entire unit’s FRG, and there to support FRSA’s referrals if desired.

After Action Report Goal: 900 in 24 months Results: 900 in 6.5 months 4,000 in 18 months 16 Group Sessions 11 Resilience Workshops

Other Data Collected • Self-administered written surveys using the following measures: – Beck Depression Inventory II(BDI-II) – Everyday Stress Index(Hall,1985) – The Resilience Scale (www.resiliencescale.com) – Strengths and Difficulties Questionnaire (SDQ)(www.sdqinfo.com) – Screen for Child Anxiety Related Disorders (SCARED)(Birmaher, 1999)

The Future of Home Front • To establish a center for excellence in training mental health counselors from around the US in military culture and counseling practices. • Closer collaboration with existing DOD services.

• Further retreats for couples and families to reconnect after deployment “boot camp.” • Identification of demographic that is the most vulnerable.

• Research into the effects of and treatment for multiple deployments on families.

Operation Give a Hug Providing military children a way to hug their deployed parents until they can do it for real

“My clinical experience with the success of this intervention and reports from numerous parents and children on their improved adjustment with the dolls results in my full endorsement of this valuable intervention tool. These dolls fill a special need for young children.” Dr. David Callies, Psy. D Pediatric Psychologist

www.operationgiveahug.org

Operation Give a Hug Providing military children a way to hug their deployed parents until they can do it for real

“These dolls are a Godsend to the children, to their families and to us who work with them daily. They are really symbols of hope and support for the kids.” Sandy Bonvouloir Hillside Elementary School Counselor, Fort Lewis, WA

www.operationgiveahug.org

Operation Give a Hug Providing military children a way to hug their deployed parents until they can do it for real

“ I under estimated it’s true value. Thank you so much for your program, you must know you are making an immeasurable difference in these little lives.” Brandy, Fort Campbell, KY

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Operation Give a Hug Providing military children a way to hug their deployed parents until they can do it for real

To Request Dolls for Your Unit: •Request forms can be downloaded at our website •Dolls are provided to children/units that are in the predeployment process or are currently deployed •It is best to place your request with as much notice as possible •Dolls are shipped in the order of the units deployment timeline •Dolls are shipped within 30 days of your request being received - upon availability

www.operationgiveahug.org

INOVA HEALTH SYSTEM

Presented by: Daniel Nichols, MBA, Executive Director, Military to Medicine

Bringing Military Talent Home to Healthcare

INOVA HEALTH SYSTEM

Employment, is one of the few endeavors whose outcome is 90 to 95% accidental … until now

INOVA HEALTH SYSTEM

The U.S. health care system needs talent from the entire military and veteran community

INOVA HEALTH SYSTEM

Healthcare careers and military life can be compatible

INOVA HEALTH SYSTEM

Daniel Nichols (703)205-2134 [email protected] www.inova.org www.militarytomedicine.org

The Army Reserve Employer Partnership: a model solution to bringing military talent home to healthcare

Follow Me: BG Reuben Jones Twitter: http://twitter.com/BGreubenjones http://twitter.com/FamilyMWR Facebook: http://facebook.com/FamilyMWR Websites: http://www.ArmyOneSource.com http://www.armyMWR.com http://www.armyfrg.org http://www.myarmyonesource.com/AFRC YouTube: http://youtube.com/FamilyMWR Shaunya Murrill, /FMWRC Family Programs /[email protected]

21 1700 (R) APR 09

Back up Slides

Deployment Cycle Background Lit: 1985-2007 McNulty P (2003)

Navy Deployed vs non deployed (Spouse +Child)

Psych surveys (10)

Higher abuse rates, psych consult rates, routine visits (children)

Jensen, et al (1996) n=383

ODS Deployed vs nondeployed (Spouse+ Child)

Psych survey (CDI, CBCL, RCMAS)

Increase CDI, no change in CBCL or anxiety scores; boys most effected

Koshes et al (1994) n=274

ODS Deployed vs. ND (Spouse + Child)

Utilization- inpatient psych hosp

No difference

Haas, et al (2005) n=140

OIF Deployed vs ND (pregnant spouses)

survey

Higher stress levels (spouses)

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Background Lit: 1985-2007 Kelley (1994) n=62

ODS- 3 phases (Child and Spouse)

Psych scales (FACES III, PDI, CBCL)

Decrease in family Organization, cohesiveness, increase CBCL (mid deployment)

Levai (1995) n=103

Navy ODS- 3 phases (Child only)

Utilization-psych inpatient

Increase rates of hosp (mid deployment).

Rosen (1995) n=587

ODS deployed vs postdeployment (spouse only)

Psych survey (HSCL, ASLES)

2x more symptomatic during deployment

McNulty (2005)

Navy-OIF- 3 phases (C+S)

Utilization- outpt counseling Psych survey

Higher abuse rates (mid – deployment), higher # sessions (mid and post deployment)

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Director

Training Center

Behavioral Health for PCMs

Training in Resilience and Prevention

Medical

Assistant

Director

Director

Admin

Repository Of Knowledge

Outreach

School Based Behavioral Health

Strategic Commo

Child and Family Assistance Center

Program Evaluation

GAPS • Standardized, synchronized, and coordinated services • Monitoring needs and tracking responses to interventions (development of metrics to assess response) • Identification and dissemination of best practices and evidence informed practices • Provider shortages, especially in remote areas to care for Children and Families

• Easily accessible behavioral health services

Youth in Excess of Capacity Figure 2 Direct comparison of psych services between military catchment areas Each child psychiatrist can provide services for an estimated population of 6,500 youth.

November 2007

Military Catchment Areas Ft. Bragg Ft. Lewis Ft Campbell Ft. Hood Ft. Drum Ft. Carson Ft. Bliss Ft. Benning Fort Polk Ft. Wainwright Ft. Gordon Ft. Stewart Ft. Riley Ft. Richardson Ft. Huachuca Ft. Sill Ft. Leonard Wood Ft. Knox Hawaii DC Ft. Sam Ft. Leavenworth

Number of Youth in Excess of Current Clinical Capacity 27,200 23,900 22,000 20,200 12,200 9,800 9,000 8,200 7,600 7,000 6,600 6,600 5,200 5,100 3,700 2,400 1,300 0 0 0 0 0

School Mental Health Promotion Intensive Intervention

1-5% Targeted Individual, Group, Family Intervention

5-40% Selective Prevention

All Students

Universal Prevention Relationship Development Systems for Positive Behavior Diverse Stakeholder Involvement Climate Enhancement

Long Term Recommendations • Construct Child and Family Assistance Centers and School Behavioral Health Programs at major deployment installations • Remove any vestiges of stove-piping • Ensure coordination and integration with IMCOM resources and other Military and Civilian resources • Increase pool of Child and Adolescent Specialists  Competitive salary for Military (AD, GS, Contract)  Competitive reimbursement (TRICARE)  Use AD Child Psychiatrists as Child Psychiatrists not for Adults

Key Points • Direct Command involvement in system is critical and essential • System of Care must include Community Outreach • Train and coach providers in evidenced-based interventions • Collaboration with other agencies is fundamental—the “Community of Practice” with shared priorities is a good model • Stigma addressed up front and continuously—requires Promotional Campaign • Resources are best coordinated under umbrella organization with single “Command and Control”