Transcript Slide 1

Debra Klemann, MS, LCPC
Cameo Borntrager, Ph.D
Amy Foster-Wolferman, MA
 Psychosocial
adjustments
 Family Structure Changes
 Indicators of Struggles
 Strategies for Schools to Help
 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
AGE
Active Duty Parents
National Guard and
Reserve Parents
Ages 0-5
43% (481,103)
28% (174,401)
Ages 6 to 11
32% (368,850)
52% (327,342)
Ages 12 to 18
25% (279,319)
20%(126,284)
National Center for Children in Poverty
 Fear,
uncertainty, worry for the loved one’s
safety
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May be exasperated by media coverage
 Lengthy
deployments
 Possibility of multiple deployments and short
turn around time between 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
Infants: Reactions in response to the
caregiver distress
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Increased irritability
Sleep disruption
Eating problems
Increased periods of crying
Toddlers
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More clingy to the at home parent
More resistance to daily activities
Preschoolers
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Regression of previously acquired milestones
More aggressive, crying, clingy
 School-Aged
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Children
Aware of the threats of war and danger
Difficulty regulating emotions
Worry
Sleep difficulties
Poor attention spans
 Adolescents:
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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)
 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
 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
 Some
children coping well
 Interfering with children’s school functioning
and ability to learn
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Student uncertainty about deployment
Perceived mental health issue of at-home parent
Increased responsibility and stress at home
Study by Chandra et al. (2009)
A
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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)
 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
 Poor
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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
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Increases during deployment and reunification
 Recent
relocation
 Lower SES
 First separation
 Existing internalizing or externalizing
disorders
 Returned solider with PTSD, TBI, or
depression
 Anxiety
 Depression
 Childhood
Traumatic Stress
 Parent/Child dysfunction
 Disruptive behavior
 “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
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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
 Hyperarousal
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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
 Re-experiencing
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Nightmares or trouble sleeping
Thinking about the trauma all the time
Flashbacks
Intrusive thoughts
Sense of Foreshortened future
o
o
Withdraw from family/friends
Decrease in interests/activities
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Changes in affect
Feeling
o Feeling
o Feeling
o Feeling
o
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anger, sometimes for no reason
shame
guilty
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
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 Parent-Child
Interactive Therapy (PCIT)
 Trauma Focused Cognitive Behavioral
Therapy (TF-CBT)
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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)
COGNITION
BEHAVIOR
EMOTION
 Family
involvement
 Toolbox analogy
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Phase-based treatment
Treatment generalization
Support
Support
Support
 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
 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 selfidentified trusted staff member who can
check in with the student throughout the
school year
1.
2.
3.
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
My
Family
Friends
Teachers
Other adults in the
community
Places
I go to relax
Places I go to socialize
Places I go in the
community
Remember
my qualities
Use positive thoughts
Talk to people when I feel
bad
See a counselor
Religious
practices and
events
Cultural practices and
events
Exercise
Healthy
Eating
Staying away from drugs
and alcohol
Going to the doctor when
sick
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
 Identify
cohorts of children
 Initiate peer mentoring
 Increase support
 Education about common reactions to the
stress of deployment
 Relaxation training
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Progressive relaxation
Mindfulness
 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
 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
 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
 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?
 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
 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
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.
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), 984992.
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.
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military deployment. Journal of Adolescent Health 46 (2010) 203-206.