Military Deployment, Children, and Resiliency

1. Military Deployment, Children, and Resiliency Debra Klemann, MS, LCPC Cameo Borntrager, Ph.D Amy Foster-Wolferman, MA

2. What We Will Cover • Psychosocial adjustments • Family Structure Changes • Indicators of Struggles • Strategies for Schools to Help

3. A Few Statistics On Deployment • More than 2,000,000 children have had a parent deployed since 2001 • At least 19,000 children have had a parent wounded in action • Over 2,000 children have lost a parent in Iraq or Afghanistan

4. Children of Military Families Experiencing Direct Impact of Deployment (Taken from: 2010 National Center for Children in Poverty) National Center for Children in Poverty

5. War Time Deployment vs. Peace Time • Fear, uncertainty, worry for the loved one’s safety • May be exasperated by media coverage • Lengthy deployments • Possibility of multiple deployments and short turn around time between deployment

6. How Children Fare During Deployment • Children are resilient • Expect some “normative” stress in response to the absence of a parent • Secure attachment to a parent= foundation for a healthy development • Threat of separation = stress • Stress can manifest into psychosocial disturbances and a possible decrease in functioning

7. Reactions to Deployment per Developmental Level • Infants: Reactions in response to the caregiver distress • Increased irritability • Sleep disruption • Eating problems • Increased periods of crying

8. Reactions to Deployment per Developmental Level • Toddlers • More clingy to the at home parent • More resistance to daily activities • Preschoolers • Regression of previously acquired milestones • More aggressive, crying, clingy

9. Reactions to Deployment per Developmental Level • School-Aged Children • Aware of the threats of war and danger • Difficulty regulating emotions • Worry • Sleep difficulties • Poor attention spans

10. Reactions to Deployment per Developmental Level • Adolescents: • Angry • Indifferent • Loss of interest in usual activities • Take on extra responsibility in the household • Feelings of being overwhelmed • Decrease in school performance, lack of exercise, poor diet during the mother’s deployment (Turnas 2010)

11. Family Development • Older children may have to take care of younger children • Children may have increased responsibilities • Children feel an increasing need to fulfill the role of emotional support for the parent at home

12. How Deployment Affects Learning • Evidence to suggest that parental deployment is associated with lower test scores (Engel et al. 2009) • May affect levels of concentration • Increased family responsibility at home may increase days tardy, absences, and late homework

13. Observations of School Staff • Some children coping well • Interfering with children’s school functioning and ability to learn • Student uncertainty about deployment • Perceived mental health issue of at-home parent • Increased responsibility and stress at home Study by Chandra et al. (2009)

14. Observations of School Staff Continued • A difficult time for families is reintegration • Children may want and expect attention, parent may need space • Return may feel confusing • Described school as a safe haven for children, arrive early and stay late • Children are more “emotionally needy” at school • Difficulties in accessing mental health services Study by Chandra et al. (2009)

15. Reactions of Children to Reunions • Infants/Toddlers (1-3): May not know or remember the solider and may be slow to warm up. • Preschoolers (3-6): May still feel guilty or scared over separation • School-age (6-12): May want a lot of attention • Teenagers: May act ambivalent The Emotional Cycle of Deployment: A Military Perspective

16. Factors that Influence Children’s Level of Distress During Deployment • Poor mental health of the at-home parent • The most significant predictor of child psychosocial functioning during wartime deployment = parenting stress (Flake, et al. 2009) • Family dysfunction • Lack of family supports • Child maltreatment & domestic violence • Increases during deployment and reunification

17. Factors Continued • Recent relocation • Lower SES • First separation • Existing internalizing or externalizing disorders • Returned solider with PTSD, TBI, or depression

18. Clinical Manifestation of Deployment Stress • Anxiety • Depression • Childhood Traumatic Stress • Parent/Child dysfunction • Disruptive behavior

19. What is Childhood Traumatic Stress? • “An exceptional experience in which powerful and dangerous events overwhelm a person’s capacity to cope.” (Fitzgerald & Groves) • Not an event, but a response to a stressful experience, where one’s ability to cope and adapt is overwhelmed and feelings of helplessness and terror are generated

20. A range of situations that can be traumatic • Automobile Accidents • Life-Threatening illness • Witnessing or experiencing community violence (shootings, stabbings, robbery, fighting at home, in the neighborhood, or at school) • Natural Disasters • Terrorism • Physical or sexual abuse • Abandonment • Witnessing Domestic Violence • Death or loss of a loved one • Bullying • Neglect • Living in a chronically chaotic environment • Military deployment

21. Responses to Trauma • Hyperarousal • Feeling scared for no reason • Feeling “crazy” or out of control • Being on guard; feeling like something bad is going to happen • Jumping when there is a loud noise

22. Responses to Trauma (cont) • Re-experiencing • Nightmares or trouble sleeping • Thinking about the trauma all the time • Flashbacks • Intrusive thoughts • Sense of Foreshortened future • Withdraw from family/friends • Decrease in interests/activities

23. Responses to Trauma (cont.) • Changes in affect • Feeling anger, sometimes for no reason • Feeling shame • Feeling guilty • Feeling sadness/grief/loss • Avoidance and Numbing • Wanting to NOT think or talk about the trauma • Avoiding places, people, or things that are connecting with the event • Not being able to remember parts of what happened • Having physical health problems and complaints

24. Evidence-Based Treatments for Children with Psychosocial Disturbances • Parent-Child Interactive Therapy (PCIT) • Trauma Focused Cognitive Behavioral Therapy (TF-CBT) • Loss/Traumatic Grief • Childhood Traumatic Stress • Cognitive Behavioral Intervention for Trauma in Schools (CBITS) • Cognitive behavioral therapy or Behavioral therapy for specific problem areas (i.e., anxiety, depression, disruptive behavior)

25. The integrative CBT model COGNITION BEHAVIOR EMOTION

26. Important Points for CBT • Family involvement • Toolbox analogy • Phase-based treatment • Treatment generalization

27. #1 Cited Method for Helping Children and Families of Military Deployment Support • Support • Support • Support

28. What Can Schools Do To Help? • Ask kids if their family member has been deployed • Be sensitive to timing issues • Reach out to the at-home parent see what he or she sees as needed for their child in the school • Be sensitive to how current events are taught ~Professor Robert Blum, as cited in AASA Toolkit: Supporting the Military Child

29. Encourage Self-Care • Guidance/health curriculum on increasing coping skills • (STAR)Students, Trauma, and Resiliency: classroom curriculum designed for increasing coping for traumatic stress • Mentoring: matching students with a self-identified trusted staff member who can check in with the student throughout the school year

30. Help Your Students Develop a Support Plan • List supports: Positive people, places, and things • Identify when and how often to engage in these supports • Remind you student to utilize their support plan

31. Safe, Positive People who Care About Me • My Family • Friends • Teachers • Other adults in the community

32. Places I Feel Comfortable • Places I go to relax • Places I go to socialize • Places I go in the community

33. What I Do to Take Care of My Emotional/Mental Health • Remember my qualities • Use positive thoughts • Talk to people when I feel bad • See a counselor

34. What I Do to Take Care of My Spiritual Health • Religious practices and events • Cultural practices and events

35. What I Do to Take Care of My Physical Health • Exercise • Healthy Eating • Staying away from drugs and alcohol • Going to the doctor when sick

36. Building the Support Plan • Use the lists of support activities • Identify actives that can be done: • Daily • Weekly • Monthly • Remind the child to do this plan • Share plan with family, if okay with child

37. Support Groups/Counseling Groups Elements • Identify cohorts of children • Initiate peer mentoring • Increase support • Education about common reactions to the stress of deployment • Relaxation training • Progressive relaxation • Mindfulness

38. Support Groups/ Counseling Groups Elements Continued • Feelings identification and sharing • Cognitive therapy to challenge anxiety provoking or negative thoughts • Social and Family Problem Solving • Address issues of loss: identify activities to keep connection to deployed loved ones

39. School-Wide Support • Possibly soldiers and their families do not maintain the same level of recognition as towards the start of the conflicts • Host school wide activities that show support for veterans, soldiers, and their families

40. Universal Strategies: for ALL students • Build positive, trusting relationships with students and families • Create safe, nurturing environments • Provide consistent, predictable routines • Create clear behavioral expectations • Provide specific, positive feedback often • Use reinforcement systems • Teach social skills • Provide pre-corrects (reminders) and actively supervise • Use consistent consequences that teach

41. Universal Strategies: for ALL students • Model appropriate behavior • Create behavior support teams • Consult with mental health professionals • Establish and practice emergency procedures • Psycho-education Students’ Trauma and Resilience (STAR) • Self-care training and support teams for staff • Data collection – • why is the behavior occurring? • Are these interventions working?

42. Targeted Interventions: for SOME students • Provide choices (build sense of control) • Provide warnings before changes • Intensive social skills instruction (relaxation techniques, coping, anger management, etc.) • Check-in/Check-Out program • Mentorship program • Behavior Support Team • Peer network • Cognitive Behavioral Interventions for Trauma in Schools (CBITS) groups

43. Individualized Interventions: for a FEW • Individualized strategies to address individual symptoms (aggression, impulsivity, short attention span, social isolation, etc.) – Functional Behavioral Analysis (understanding triggers and antecedents which may be trauma based) • Trauma focused individualized counseling or therapy • Behavior support team connects student to counselor or therapist, works with family

44. References American Association of School Administrators. AASA toolkit: Supporting the Military Child. (2009). Retrieved from, http://www.aasa.org/MilitaryChild.aspx Chandra, A., Martin, L. T., Hawkins, S. A., Richardson, A., The impact of parental deployment on child social and emotional functioning: Perspectives of school staff. 2010 Journal of Adolescent Health. 46(2010) 218-223. Engel R.C., Gallagher, L.B., Lyle, D.S., Military deployment and children’s academic achievement: Evidence from Department of Defense Education Activity Schools. Economics of Education Review 2009. Flake, E., Davis, B.E., Johnson, P. L., The psychosocial effects of deployment on military children. Journal of Developmental Behavior Pediatric 2009; 30: 271-8. Jensen P., Maritn D,. Watanabe H. Children’s response to parental seperation during Operation Desert Storm. Journal of American Academy Child Adolescent Psychiatry 1996; 35: 433-41. Lincoln, Alan; Swift, Erika.; Shorteno-Fraser, Mia. 2008 Psychological Adjustment and Treatment of Children and Families with Parents Deployed in Military Combat. Journal of Clinical Psychology 64 (8), 984-992.

45. References Continued Lincoln, Alan; Swift, Erika.; Shorteno-Fraser, Mia. 2008 Psychological Adjustment and Treatment of Children and Families with Parents Deployed in Military Combat. Journal of Clinical Psychology 64 (8), 984-992. Pincus, S.H., House, R., Christenson, Jl, Adler, L., E.The emotional cycle of deployment a military family perspective. In Operation: Military Kids, Ready, Set, Go! A training manual.6th Edition, Chapter 5 Us Army Med Dep J. 2001. Sogomonyan, F., Cooper, J. L. (2010) Trauma faced by children of military families: What every policymaker should know. Retrieved from: Columbia University, National Center for Children in Poverty website: http://www.nccp.org/publications/pub_938.html. Ternus, M. P., Editorial: Support for adolescents who experience parental military deployment. Journal of Adolescent Health 46 (2010) 203-206.