When
a
Parent
Returns
with
Overseers Board Meeting
Visible or
Invisible
Wounds
December
7, 2010
of War
0
Co-Authors
Allison K. Holmes Ph.D
www.CIFamilies.org
Research Psychologist/Project Director
Uniformed Services University
Paula K. Rauch M.D.
www.stayingstrong.org
Home Base Program, Dir. Family Program
Massachusetts General Hospital
Special thank you to MCEC and the Future of Children journal series
Your Input
• What information would be interesting and
helpful to you?
• What are your personal experiences—
challenges and good outcomes?
• What would you like the group discussion
to address?
– Fill out post its for collection
Since 9/11
• From 2002-2010 approximately 2 million
military connected children have had a
parent deploy to Iraq or Afghanistan (1)
• Most return affected but uninjured
• “Wounds of war”
– Visible
– Invisible
– Loss of life
1. DOD, “Report on the Impact of Deployment of Members of the
Armed Forces on Their Dependent Children”, 2010
Visible Wounds
• ~50,000 physical injuries (2002-2010)
• Identified immediately (54% arms +legs, 29% head and neck)
• Identifiable – “visible”
–
–
–
–
Amputations
Eye injuries
Burns
Spinal cord injuries
• The severely injured survive more often,
complex treatments
• Difficult for families and children
Magnitude of the Problems
• Visible wounds are often accompanied by
invisible wounds
• About 1/3 of returning service members
have TBI, PTSD, or Depression
• 80% of service members with depression
or PTSD at 7m. screened negative at 1m.
• Emotional health impacts parenting, each
family member, and family functioning
• Pre existing challenges add risk
Traumatic Brain Injury
•
•
•
•
•
Numbers are unclear (250,000-320,000+)
TBI (mild, moderate, severe)
Can profoundly affect parenting capacity
Parent may seem like a different person
Research suggests more emotional and
behavioral issues in children and PTS
symptoms among children
• Effects very, very long-lasting
Post Traumatic Stress
•
•
•
•
Numbers are unclear (6-25%)
Only about half seek treatment
Quality treatment is often not accessible
Children of parent with PTSD have higher
levels of anxiety, depression, and PTSD
• Younger children may be at greater risk
• Dysregulation and disengagement impair
parenting
• Spouse emotional health is impacted
Combat Related Death
• 16,000 combat zone deaths (includes the
14% self inflicted/suicide in theater)
• Limited research
• Surviving spouse’s emotional health key
• Pride in service and community
recognition may support resilience
• Loss of social connections associated with
dislocation is a stressor
• Military provides special supports
Four Stages of Recovery
• Acute Care
• Medical Stabilization (1/4-1/3 involve a family
member relocating)
• Transition to Outpatient Care
• Long Term Rehabilitation and Recovery
– Family Impact
– Child’s Experience
9
Child’s Perspective
• Getting bad and often confusing news
• Long hospitalization with disruptions at
home (co parent may be absent or child
may move)
• Discharged from the hospital, but not
home yet (often many re hospitalizations
and set backs)
• Living with a new normal (difficult)
Seeing and Hearing
• How do I understand the mood at my
home?
• Who is talking to me? Do they care about
my experience?
• How is my routine changed?
• When will things go back to “normal”?
• Adjusting to a new normal…is this
forever?
A Child’s View of a Good Parent
•
•
•
•
•
Good parents are calm
Good parents are predictable
Good parents remember things
Good parents enjoy being with you
Good parents don’t name call
– Substance use, PTSD, depression and head
injuries can interfere with the above and can
leave a child feeling unloved
– Co-parent health and well being is key
12
Development is like a long hike up a series of hills
Resilience Support (PACT Model)
Family
Community
Developmental
Stage
Challenge
Temperament
Preventing Transgenerational Trauma
• Challenge: Difficult situation without a quick fix
– Faced with the support of connected caring others
– Builds important life skills
– Results in greater self confidence and courage
• Traumas: Difficult situation without a quick
fix/escape
– Surprise or out of control feeling
– Faced feeling alone, isolated and helpless
– Results in greater fear and insecurity
15
3 Generational Care
• Complicated deployment impacts the
whole family
– Identification
– Service member support
– Family members with primary mental health
and instrumental needs
• Resilience support and care must be
family centered
• National and local community commitment
Recommendations: Long Term
• We need to know more
• Supports through recovery or bereavement
must be family focused
• Non service member parents and children
need access to long term mental health care:
“service connected family”
• Community providers need education about
military family needs
• Program development & evaluation essential