Photo AF Photo SSgt Chris Willis Family Many

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Photo: AF Photo/ SSgt Chris Willis Family

Photo: AF Photo/ SSgt Chris Willis Family

Many times families will confuse normal adjustment issues for serious problems or vice versa.

Many times families will confuse normal adjustment issues for serious problems or vice versa.

Most service members and families expect that the service member or the family will

Most service members and families expect that the service member or the family will remain unchanged.

Knowing the difference between expected adjustment issues and mental health problems often depends on

Knowing the difference between expected adjustment issues and mental health problems often depends on time.

Family Re-Adjustment can be like driving in San Antonio

Family Re-Adjustment can be like driving in San Antonio

It can be hard to figure out how to merge safely

It can be hard to figure out how to merge safely

So why is re-adjustment a challenge?

So why is re-adjustment a challenge?

From the Experts How does deployment change the military family?

From the Experts How does deployment change the military family?

Pre-Deployment Stressors Preparedness Practical preparation Power of attorney/Will/Financial plan Location of important papers Emergency

Pre-Deployment Stressors Preparedness Practical preparation Power of attorney/Will/Financial plan Location of important papers Emergency contact procedures Child care arrangements Emotional preparation Prepared to cope with unexpected problems Trust service member will be protected Support mission Briefing by David Riggs, June 2007

Pre-Deployment Stressors Lack of preparation time Unit preparation vs. family preparation Shifting expectations Length

Pre-Deployment Stressors Lack of preparation time Unit preparation vs. family preparation Shifting expectations Length of upcoming deployment Open-ended deployments Deployment date Clarifying changes in family dynamics Anticipation of threats to service member Perception of mission purpose Lack of information Rumors Briefing by David Riggs, June 2007

Pre-Deployment Stressors Spouses Confusion Denial Resentment Arguing Worrying Planning Briefing by Doug Lehman, May

Pre-Deployment Stressors Spouses Confusion Denial Resentment Arguing Worrying Planning Briefing by Doug Lehman, May 2008

Pre-Deployment Stressors - Kids Confusion Regression Anger Outbursts Sadness Surprise Guilt Behavioral problems Briefing

Pre-Deployment Stressors - Kids Confusion Regression Anger Outbursts Sadness Surprise Guilt Behavioral problems Briefing by Doug Lehman, May 2008

Pre-Deployment Stressors Adolescents “I don’t care” Fear of rejection Denial of feelings Anger Higher

Pre-Deployment Stressors Adolescents “I don’t care” Fear of rejection Denial of feelings Anger Higher value on friends Briefing by Doug Lehman, May 2008

Typical Course of Reintegration Family resilience is the rule, not the exception. Usually, families

Typical Course of Reintegration Family resilience is the rule, not the exception. Usually, families return to the normal routine. Common to incorporate changes without major disruption in family functioning. HOWEVER…

Post Deployment Reunion and Reintegration Reunion can be very stressful Unmet or unrealistic expectations

Post Deployment Reunion and Reintegration Reunion can be very stressful Unmet or unrealistic expectations Changed roles/responsibilities New independence of spouse Lack of time Tug on loyalties Extended family Health/Mental health problems Unresolved marital issues haven’t vanished

Post Deployment Reunion and Reintegration Most frequently identified stressors following a soldiers’ return Readjustment

Post Deployment Reunion and Reintegration Most frequently identified stressors following a soldiers’ return Readjustment to marital and family relationships Lack of time for family reintegration Couple jealousy and suspicions Ongoing military stressors Uncertainty about future retention Teitelbaum (WRAIR, 1992) conducted a study with the Army after ODS

Post Deployment Stressors – Service Members Physical: traffic, crowds, unarmed, access to alcohol Cognitive:

Post Deployment Stressors – Service Members Physical: traffic, crowds, unarmed, access to alcohol Cognitive: loyalty issues to family vs unit, secrecy vs disclosure, boredom, regrets, thoughts of losses Emotional: grief, anger, feeling unsafe, guilt, withdrawal from war “rush, ” numbness Social: separated from buddies, overwhelmed or misunderstood by family, feelings of alienation Spiritual: asking why buddies died, lack of purpose, changed faith, conflicting values Editors Charles Figley and William Nash, Combat Stress Injury (2007)

Mindset When Deployed Stay focused on mission /nothing else matters Truly life or death

Mindset When Deployed Stay focused on mission /nothing else matters Truly life or death / always on the edge Constant adrenaline “rush” Black or white / all or nothing Sense of purpose, invincibility Only trust battle buddies /others are threat Need to control environment Real problems and needs exist in Iraq Adapted from briefing by COL Kevin Gerdes, May 2008

Mindset When Home Life is now unfocused and complex No longer on the verge

Mindset When Home Life is now unfocused and complex No longer on the verge of life or death What can replace the “high” of war? Things aren’t clear cut No sense of purpose, nothing matters Can’t trust anybody Can’t be in control of surroundings Problems at home pale in comparison to those in Iraq Adapted from briefing by COL Kevin Gerdes, May 2008

Mindset When Deployed vs. Mindset When Home SURVIVAL SKILLS WHILE DEPLOYED Buddies (cohesion) Accountability

Mindset When Deployed vs. Mindset When Home SURVIVAL SKILLS WHILE DEPLOYED Buddies (cohesion) Accountability Targeted Aggression Tactical Awareness Lethally Armed Emotional Control Mission OPSEC Individual Responsibility Non-Defensive Driving Discipline and Ordering HOME vs. vs. vs. Withdrawal Controlling Inappropriate Aggression Hyper-vigilance “Locked and Loaded” at Home Anger/Detachment Secretiveness Guilt Aggressive Driving Conflict Battlemind. org

Changes in the Family FAMILY HAS New routines New responsibilities More independence and confidence

Changes in the Family FAMILY HAS New routines New responsibilities More independence and confidence Made many sacrifices Worried, felt lonely Gone through milestones that were missed Adapted from briefing by COL Kevin Gerdes, May 2008

Coming Home to the Family VETERAN’S RETURN CAN Interrupt routine Disrupt space Throw off

Coming Home to the Family VETERAN’S RETURN CAN Interrupt routine Disrupt space Throw off decision making Cause family to walk on tip toes Not make everything perfect Not replace the sacrifices and missed milestones Adapted from briefing by COL Kevin Gerdes, May 2008

Post-Deployment Stressors – Spouses • Apprehension • Excitement • Worry • Exhaustion • Uncertainty

Post-Deployment Stressors – Spouses • Apprehension • Excitement • Worry • Exhaustion • Uncertainty Briefing by Doug Lehman, May 2008

Protective Factors for Adjustment Building Resilience

Protective Factors for Adjustment Building Resilience

Preparedness

Preparedness

Social Support

Social Support

Optimism

Optimism

Acceptance of Military Lifestyle

Acceptance of Military Lifestyle

Risk Factors for Poor Adjustment Threats to Resiliency

Risk Factors for Poor Adjustment Threats to Resiliency

Inexperience with Challenges

Inexperience with Challenges

History of Family Dysfunction

History of Family Dysfunction

Social Isolation

Social Isolation

Fewer Resources

Fewer Resources

Resources Defense Centers of Excellence (DCo. E)

Resources Defense Centers of Excellence (DCo. E)

Mobile Applications Co-Occurring Conditions Toolkit Mood Tracker Breathe To Relax m. TBI Toolkit PTSD

Mobile Applications Co-Occurring Conditions Toolkit Mood Tracker Breathe To Relax m. TBI Toolkit PTSD Coach Tactical Breather 36

Mobile Applications Breathe 2 Relax: § Breathe 2 Relax is a portable stress management

Mobile Applications Breathe 2 Relax: § Breathe 2 Relax is a portable stress management tool. § Built on the i. Phone mobile app platform, § Breathe 2 Relax is a hands-on diaphragmatic breathing exercise. Breathing exercises have been documented to decrease the body's § “fight-or-flight” (stress) response, and help with mood stabilization, anger control, and anxiety management. § Breathe 2 Relax can be used as a stand-alone stress reduction tool, or can be used in tandem with clinical care directed by a healthcare worker. For more information, please visit http: //t 2 health. org/apps/breathe 2 relax 37

Mobile Applications PTSD Coach: Intended to be used as an adjunct to psychological treatment

Mobile Applications PTSD Coach: Intended to be used as an adjunct to psychological treatment but can also serve as a stand-alone education tool. Key features of the app include: Self-Assessment: Self-assessment of PTSD symptoms with individualized feedback, and ability to track changes in symptoms over time. The assessment does not formally diagnose PTSD. Manage Symptoms: Coping skills and assistance for common kinds of posttraumatic stress symptoms and problems, including systematic relaxation and self-help techniques. Find Support: Assistance in finding immediate support. The app enables individuals to identify personal sources of emotional support, populate the phone with those phone numbers, and link to treatment programs. And in an emergency, users can quickly link to the National Suicide Prevention Hotline. Learn about PTSD: Education about key topics related to trauma, PTSD, and treatment. For more information, please visit http: //t 2 health. org/apps/ptsd-coach 38

Mobile Applications T 2 Mood Tracker: § T 2 Mood Tracker is a mobile

Mobile Applications T 2 Mood Tracker: § T 2 Mood Tracker is a mobile application that allows users to self-monitor, track and reference their emotional experience over a period of days, weeks and months using a visual analogue rating scale. § Users can self-monitor emotional experiences associated with common deployment-related behavioral health issues like post-traumatic stress, brain injury, life stress, depression and anxiety. Additional rating can also be added. With each selfrating, notes on environmental influences on emotional experiences can be added. Selfmonitoring results can be a self-help tool or they can be shared with a therapist or health care professional, providing a record of the patient’s emotional experience over a selected time frame. T 2 Mood Tracker received first place in the "General Wellness" category during the Apps 4 Army (A 4 A) competition. For more information, please visit http: //t 2 health. org/apps/t 2 -mood-tracker 39

Family Resource Military. Kids. Connect § Military. Kids. Connect (MKC) helps children prepare for

Family Resource Military. Kids. Connect § Military. Kids. Connect (MKC) helps children prepare for the challenges faced during significant family transitions. Through participation in MKC's monitored online forums, children can share their own ideas, experiences, and suggestions with other military children, helping them to know they are not alone in dealing with the stresses of deployment. § MKC's focused parent and educator tracks provide information to help them understand what it takes to support military children in athome and school settings For more information, please visit the MKC website at www. Military. Kids. Connect. org 40

Family Resource This Emotional Life: A Handbook for Family & Friends of Service Members

Family Resource This Emotional Life: A Handbook for Family & Friends of Service Members § A collaboration with Public Broadcasting Service (PBS) for military families. § The handbook covers a variety of topics to help service members and their families develop skills to become more resilient throughout the deployment process. Divided into three distinct sections: pre-deployment, deployment and post -deployment. Each segment explores topics related to relationships, self-care, communication and staying informed. - What to expect during a deployment - Tools to keep your family and community strong throughout a deployment - Skills to strengthen or repair relationships - Tools to create open lines of communication with your spouse/partner/child For more information, please visit the DCo. E website at www. dcoe. health. mil 41

Family Resource FOCUS: Family Resiliency Training™ for Military Families Strengthening the Home Base §

Family Resource FOCUS: Family Resiliency Training™ for Military Families Strengthening the Home Base § FOCUS (Families Over. Coming Under Stress™) provides resiliency training to military children and families. It teaches practical skills to meet the challenges of deployment and reintegration, to communicate and solve problems effectively, and to successfully set goals together and create a shared family story. § Developed by a UCLA-Harvard team, FOCUS teaches military children and families affected by multiple deployments to understand their emotional reactions, communicate more clearly, solve problems more effectively, and set and achieve their goals. Parents and children—from preschoolers to teens—learn to use tools that For more information, please visit the will better prepare them for each new FOCUS website at http: //focusproject. org deployment. 42

Family Resources Coaching into Care § Coaching Into Care works with family members or

Family Resources Coaching into Care § Coaching Into Care works with family members or friends who become aware of their veteran’s post-deployment difficulties -- and supports their efforts to find help for the veteran. § This is a national clinical service providing information and help to veterans and the loved ones who are concerned about them. § Coaching Into Care focuses on the mission: helping those who care about veterans and encourage them to seek help. 43

Service Member Support § Provides support to service members receiving mental health services as

Service Member Support § Provides support to service members receiving mental health services as they transition between health care systems or providers § Provides voluntary one-on-one coaching to service members § Designed as a bridge of support for service members when: – relocating to another assignment – returning from deployment – transitioning from active duty to reserve, reserve to active duty or returning to For more information, please visit the civilian life in. Transition website at www. health. mil/in. Transition 44

DCo. E Outreach Center Support § Established January 2009 § Available 24/7 § Staff

DCo. E Outreach Center Support § Established January 2009 § Available 24/7 § Staff by trained professional health resource consultants § Connects the right resources to the right person at the right time § Provides information and resources Resilience Programs Suicide Prevention Initiatives Family and relationship support Alcohol/substance abuse programs Psychological Health/TBI Programs Health care system navigation For more information, please visit the DCo. E website at www. dcoe. health. mil 45

Service Member Support Real Warriors Campaign § Realwarriors. net, information for: § Active -

Service Member Support Real Warriors Campaign § Realwarriors. net, information for: § Active - duty service members Guard & Reserve Veterans Families/loved ones Health professionals Website features: Articles/message boards/blogs Profiles featuring Real Warriors Deployment cycle guidance and resources Links to resources including the 24/7 DCo. E Outreach Center, National Suicide Prevention Lifeline Multimedia products/Campaign Material 46