Transcript Families and Deployment Hero Stories & Horror Stories

Families and Deployment
Hero Stories & Horror Stories
LTC (Ret) Mark Chapin, Ph.D., LISW, BCD
Department of Social Work
Walter Reed Army Medical Center
The Deployment Cycle
• Deployment is a “developmental” crisis
• Family’s experience parallels soldier’s
experience
• Source of both stress and growth
• Resiliency Model of Family Stress,
Adjustment, and Adaptation
– Hamilton McCubbin, 1996
– Components tied to measures
– Based on ABCX Model of Reuben Hill (1949)
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Chapin: Families and Deployment
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Resiliency Model
Family Meaning
And Schema
Stressor
Events
Situational
Appraisal
Family ProblemSolving and
Coping Skills
Family
Type
Family
Adaptation
Family
Resources
Pile-up of
Demands
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Social
Support
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Source: McCubbin & McCubbin, 1996
3
Deployment Cycle
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Chapin: Families and Deployment
Slide courtesy of Dr. David Riggs,Center for Deployment Psychology
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Slide courtesy of Dr. David Riggs,Center for Deployment Psychology
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Pre-Deployment
Notification
Stressor
Events
Rumors
Open-ended
deployment
timing
Lack of information
Deployment Date
Family Meaning
And Schema
Perception of
mission purpose
Situational
Appraisal
Expected length
of upcoming
deployment
Short prep time
Family
Type
Anticipated threat
to soldier
Unit preparation
Pile-up of
Demands
Family preparation
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Chapin: Families and Deployment
Family
Resources
Changes in
Family Dynamics
Social
Support
6
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Slide courtesy of Dr. David Riggs, Center for Deployment Psychology 7
Deployment
Change job or move
Family Meaning
And Schema
Stressor
Events
$$$
30%
Child Maltreatment
Kids’ reactions
to war events
Situational
Appraisal
Family ProblemSolving and
Communication Coping Skills
Family
Type
Family
Resources
Pile-up of
Demands
Loneliness
Single Parenting
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Chapin: Families and Deployment
Social
Support
Family
Adaptation
Length of Deployment
FRG’s in military community
vs going home to Mom
8
Stressors
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Slide courtesy of Dr. David Riggs, Center for Deployment Psychology 9
Children’s Coping
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Slide courtesy of Dr. David Riggs, Center for Deployment Psychology 10
Deployment and Spouse Satisfaction
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Slide courtesy of Dr. David Riggs, Center for Deployment Psychology 11
Child Neglect (1-2 year olds)
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Slide courtesy of Dr. David Riggs, Center for Deployment Psychology 12
Post Deployment
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Slide courtesy of Dr. David Riggs, Center for Deployment Psychology 13
Post-Deployment
Changed Roles & Responsibilities
Family Meaning
And Schema
Stressor
Events
Situational
Appraisal
Reunion
Family
Type
Glad for help or
resentful
Family
Resources
Family ProblemSolving and
Coping Skills
Family
Adaptation
Single to mutual
decision-making
Divorce or Family
Distress
Pile-up of
Demands
“Just wait til your
father gets home!”
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Resilience &
Return to
Normal
Chapin: Families and Deployment
Social
Support
Shift back to pre-deployment
structure
14
A One-Year Deployment
Changed Roles & Responsibilities
Notification Change job or move Family
Deployment Date
Meaning
And Schema
Stressor
Events
Rumors
Reunion
Kids’ reactions
to war events
$$$: 30%
Lack of
information
Short
prep
time
Unit
preparation
Pile-up of
Demands
Family
Type
Situational
Appraisal
Anticipated threat to soldier
Family
preparation
Glad for help or
resentful
Communication
Family
Resources
Loneliness
Single Parenting
“Just wait til your
father gets home!”
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Perception
of mission Expected length
purpose
Resilience &
of upcoming
Return to
deployment
Open-ended
Normal
deployment
Child Maltreatment
timing
Length of Deployment
Chapin: Families and Deployment
Social
Support
Family ProblemSolving and
Coping Skills
Single to mutual
decision-making
Changes in
Family Dynamics
Family
Adaptation
Divorce or Family
Distress
FRG’s in military community
vs going home to Mom
Shift back to pre-deployment
structure
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Deployment and PTSD
• 18% of soldiers return with diagnosable Mental
Disorder
• All are affected by deployment
• Soldiers typically minimize symptoms on PDHA
• Symptom levels increase over next 6 months
• PTSD affects couples on multiple levels
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PTSD Effects on Intimate Relationships
• Changes roles: spouse becomes
caregiver r
• Changes intimacy (avoidance cluster)
• Intrusive memories and vivid reexperiencing symptoms can be
frightening
• Arousal Cluster symptoms create
irritability
• Violent outbursts precipitate dynamics
of intimate partner violence
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120
PTSD Impact on Relational Problems
100
*
*
80
60
40
*
*
20
0
Fear of Intimacy
Relationship Problems
Fear of Intimacy
Veterans
Riggs et al., 1998
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Relationship Problems
Partners
PTSD
No PTSD
Slide courtesy of Dr. David Riggs, Center for Deployment Psychology 18
PTSD and Relationship Quality
100
Riggs et al., 1998
100
*
*
Percent Reporting Serious Problems
120
DAS Total
80
60
40
20
80
60
*
*
40
20
0
0
Veterans
PTSD
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Jordan et al., 1992
Partners
No PTSD
Chapin: Families and Deployment
Veterans
PTSD
Partners
No PTSD
Slide courtesy of Dr. David Riggs, Center for Deployment Psychology 19
PTSD and Partner Distress
*
3.5
3
PTSD
No PTSD
*
SCL-90 Score
2.5
2
1.5
*
*
*
1
0.5
0
GSI
Som
OC
Calhoun et al., 2002
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IPS
Dep
Anx/2
Hos/2
Phob
Par
Psych
Scale
Slide courtesy of Dr. David Riggs, Center for Deployment Psychology 20
PTSD Impacts Resilience
PTSD Behaviors
Stressor
Events
Family Meaning
And Schema
Situational
Appraisal
Family
Type
Level of
Disability
Caregiver Burden
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“Back to Normal” or
“Not Quite Right”
Impaired
Family
Resources
Pile-up of
Demands
“Important work” or
“Why are we there?”
Chapin: Families and Deployment
Social
Support
Family ProblemSolving and
Coping Skills
Family
Adaptation
Parenting impacted
Spouse acts as social “buffer”
Withdrawal from Intimacy
One-sided
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Injured Soldiers
• Crisis of whether soldier will survive, level of
recovery/disability
• Crisis of meaning: Can I still be a soldier?
• Disruption and dislocation during recovery
• Spouse torn between duty to soldier and
duty to children
• Rapidly shifting caregiver responsibilities
• Balance between nurturing and pushing for
maximum rehabilitation
• Re-defining family identity after disability
• Restoration of marital intimacy after disability
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Chapin: Families and Deployment
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Injury Impacts Resilience
Notification of Injury
Stressor
Events
Unplanned
travel
Conflicts with extended
family about care decisions
Family Meaning
And Schema
Situational
Appraisal
Are we still a Military Family?
Fight to stay in or take medical
retirement?
Family ProblemSolving and
Coping Skills
Family
Type
Family
Adaptation
Impact of TBI on cognitive skills
Delays in processing
medical boards
Pile-up of
Demands
Family
Resources
Availability of extended
family
Cabin Fever
Needs of injured soldier
vs needs of children
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Chapin: Families and Deployment
Social
Support
23
Soldiers Killed in Action
• Families lose not only their soldier, but
also undergo changes that usually take
them away from their military
connections
• Intensive initial support from military
– Casualty Assistance Officer
– Death Benefits and SGLI
– Military Funeral
• Bereavement complicated by move out
of military housing or away from
military base
• Usually return to extended family home
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Soldier Death Impact on Resiliency
Unexpected Loss
Stressor
Events
Family Meaning
And Schema
Meaning and
context of
soldier’s death
Notification
Trauma
Family
Type
How do we go on?
Situational
Appraisal
Bereavement Process
Extended Family
Family ProblemSolving and
Coping Skills
Family
Adaptation
Family
Resources
$400K SGLI
Pile-up of
Demands
Move household
Social
Support
T.A.P.S. and other
support organizations
Military Funeral
Casualty Assistance Officer
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Resources for Families
Military Resources
– DVBIC (Defense Veterans Brain Injury Center)
– DHCC (Deployment Health Clinical Center)
– Military One Source
• Veteran’s Administration
– VA Med Centers--inpatient treatment centers, Polytrauma centers
– RCS community based counseling service centers
• Private Organizations (just a few examples)
–
–
–
–
–
–
SOFAR: (Strategic Outreach to Families of All Reservists)
DSUSA (Disabled Sports USA)
TAPS (Tragedy Assistance Program for Survivors
Canine Companions for Independence
Give an Hour Foundation
Disabled American Veterans
• Partnerships
– Intrepid Fallen Heroes Fund (Center of Excellence for TBI & PTSD)
– VA Seamless Transition workers placed in DoD Medical facilities
– National Demonstration Program for Citizen-Soldier Support (UNC)
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QUESTIONS
&
DISCUSSION
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