Military and Veteran Kids:
Supporting Their Many Transitions
Gregory A. Leskin, Ph.D.
Director, Military and Veteran Families Program
UCLA/Duke University National Center for Child Traumatic Stress
UCLA Semel Institute
Gleskin@mednet.UCLA.edu
Goals of Presentation
Describe goals, resources, strategies to promote civilian capacity to
better serve the needs of military and veteran families and children.
Describe NCTSN approaches to training and implementing traumainformed practices for military and veteran families and children.
Collaboration and Sharing Knowledge
• Applaud the efforts of MCEC to bring together NCTSN to train
professionals who work with service members, veterans and their
families.
• Working toward greater collaboration
• Unique circumstances and context for military and veteran children
• Mission to advance trauma-informed military and civilian work force
• Process to integrate and innovate
National Child Traumatic Stress Network
(NCTSN)
 The National Child Traumatic Stress
Network was established by
Congress in 2000 to raise the
standard of care and improve access
to services for traumatized children,
their families and communities
 The NCTSN serves as a resource for
developing and disseminating
evidence-based interventions,
trauma-informed services, and public
and professional education
Child
Welfare
Military
Families
Medical
Settings
Continuum
of
Clinical
Care
Juvenile
Justice
Schools
National Center for Child Traumatic Stress
Military and Veteran Families Program
• Licensed Clinical Psychologist and worked across multiple systems
including DoD, VA, State Programs, Forensic, Prison, local.
• Major Career Milestones: PTSD, panic disorder, sleep research; deployed
to Pentagon following 9/11 to serve at the Family Assistance Center;
Program Development and Implementation (FOCUS, NCTSN Military,
Family Assistance Program training).
• Philosophy: Share best practice information and engagement strategy
knowledge, develop evidenced based resources and materials, build
partnerships, utilize technology, keep serving families and children at risk.
Transitions for Military and Veteran Families
• Permanent Change in Station (PCS): Movements around the world.
Some families describe travel as one of the greatest parts of the
adventure being in a military family. But can also potentially impact the
family in terms of social life, academic disruption, and continuity in
interests and activities.
• Many military families have endured repeated and extended
deployments for service member to Iraq and Afghanistan. It’s possible
for a 12 year old child to have grown up and knows only of life through
the lens of deployment. Development throughout deployment.
• Transition to civilian life may be difficult for these families with potential
for loss of structure, economic security, housing, benefits. Relief can
also be difficult and challenging.
Psychological and Physical Injury and Death
• Studies and reports suggest that 10-20% of SM might be
impacted by psychological health issue, including PTSD,
Depression and Anxiety
• Some reports suggest TBI at or above 20%.
• Over 51,979 physically injured (OIF/OEF/OND through May 12,
2014).
• The number of individuals who were killed or died in
OIF/OEF/OND from FY 2002 through 4th quarter FY 2013
(October 1, 2001 – May 12, 2014) was 6,791.
Support for Military and Veteran Families and Children
• Large numbers of married service members and
service members with children.
• Responsibility for physical and psychological
healthcare.
• Service member, spouse, children can all share
strong identification as Military Family.
• Family shares service member with military.
• Roles and responsibilities can shift rapidly in the
family as a result of military
life/deployment/transitions (including to veteran
life).
• Families may contend with separation from
parent/partner (physically, psychologically)
• Family’s resilience can support service member
and veteran’s resilience.
Who is at Risk for negative outcomes?
• Younger children, school age boys, adolescent females
– Single parenting, role changes, fears and worries
• Pre-existing psychiatric or developmental problems
• Non-deployed spouses that exhibit higher distress or poor
function
• Higher exposure (multiple deployments, single parent or dual
parent deployments, complicated deployments)
• Lack of social/resource connectedness (National Guard,
Reserve component, dispersed and rural, few friends/family
available)
• Lack of access to support resources/stigma associated with
help seeking
• Family and parenting risk factors (parental anger,
disconnection, marital conflict, poor financial support)
NCTSN Military and Veteran Families Program
• Coordinate NCTSN activities related to direct services for
military and veteran families and children
• Develop and adapt assessment, prevention, interventions
• Produce high quality educational and training products
• National partnerships and collaboration with other national
organizations (i.e., CWLA, MCEC)
• Work with SAMHSA, DoD (MC&FP, T2)
Alignment of Programs
with Military Families and Veterans
Evidence Based Engagement Strategies
• Families are important gateway to services,
given the multiple barriers to care
• Opportunity for screening, prevention and
intervention
• Destigmatizing framework for promoting
psychological health and overcoming
barriers and stigma
• Supporting readiness, recovery, and
reintegration
Child and Family Psychotherapies
A selection of Evidence Based Interventions
Developed for or Adapted to needs of Military or Veteran Families
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Parent Child Interactive Therapy (PCIT)
Trauma-Focus Cognitive Behavior Therapy (TF-CBT)
Child Parent Psychotherapy (CPP)
Traumatic Grief Component Therapy
FOCUS/FOCUS CI
Strong Families, Strong Forces
Cognitive Behavioral Therapy
ADAPT
Working Effectively with Military Families
Key concepts for behavioral
health staff to understand
unique context and
circumstances of military
families and military life.
Broad Lens for civilian
providers to consider in
preparation to serve military
families and children.
Child Maltreatment in Military Families
Describes risk factors and
psychological impact and
interventions developed for
military applications.
Provides background, defintions
and introduction to subject
matter.
Child Maltreatment in Military Settings
• Overall rates of child maltreatment may be lower than in civilian
populations, except those for fatal child maltreatment and shaken baby
syndrome (except during deployment).
• Alcohol abuse and domestic violence may be more prevalent in military
than civilian populations.
• Alcohol abuse is a strong correlate of domestic violence which is in turn
associated with child maltreatment.
• Military family specific factors that may increase risk for child
maltreatment are isolation from extended families and duty station
moves.
• Family stress from combat deployment, psychological or physical injury,
impaired parenting.
• Distorted scripts from and of the parenting process.
Academy: on Child Traumatic Stress:
Sequence of Learning
Coursework
Foundational
Clinical Skills and
Knowledge
Self-paced
Curriculum for
Staff
Training and Fieldwork
FAP/NCTSN
Clinical Vignettes
Core Curriculum
NCTSN Cases
Learning Clinical
and System Issues
Training on EBPs
Problem-Based
Learning/Virtual
Interactive
Classroom
Learning
Collaboratives
Resources and
Activities
Learning Management System & Social Network
A Foundation in Clinical Skills and Knowledge
Self-paced curriculum for staff:
 Context and Characteristics of Child Maltreatment and Family Violence
 Demographics of Military Families
 Risk Factors and Risk Profiles for Child Maltreatment and Interpersonal Violence
 Protective Factors to Promote Well-being
 NCTSN Core Concepts
 Complexity of Traumatic Experience
 Developmental Approaches
 Trauma and Grief Reminders
 Secondary Adversities
 Evidence-Based Treatments
 Secondary Traumatic Stress and Provider Self-care
 Assessment
Foundational
Clinical Skills and
Knowledge
Self-paced
Curriculum for all
Staff
FAP/NCTSN Military Case Vignettes
Case vignettes developed with senior FAP and NPSP staff featuring
fictionalized military families drawn from four branches will include:
 Opportunities to learn family dynamics, risk and protective factors,
system issues related to cases
 Review FAP procedures for child maltreatment and family violence
 An introduction to problem- based learning (PBL)
 Activities to support and apply learning
 A resource library
 An introduction to Communities of Practice
FAP/NCTSN
Clinical Vignettes
Learning Clinical
and System Issues
Resources and
Activities
Core Curriculum and Clinical Case Vignettes
 Combines foundational, developmentally-informed trauma knowledge
together with treatments to address the pervasive effects of childhood
trauma
 Advances competency-based trauma treatment approach
 Improves capacity of FAP and NPSP to provide developmentally-informed
trauma care
 Prepares staff to deliver military appropriate,
evidence-based services to children, adolescents, and
families
Core Curriculum
 Describes the nature of child traumatic stress
NCTSN Cases
Problem-Based
 Uses problem-based learning
Learning
Virtual Interactive
Classroom
Training in Evidence-Based Interventions
 During online lectures, program developers will explain the theoretical
background and evidence for efficacy of EBPs
 Training will demonstrate skills, activities, and include homework
associated with each treatment
 Supportive resources (manuals, readings, materials) will be provided in
an online library
 Experienced mentors will be assigned to small groups
to coach FAP and NPSP staff in the EBPs
 Staff will learn approaches to measure outcomes
Training on EBPs
Learning
Collaboratives
Thank you!!
Please contact us at Gleskin@mednet.ucla.edu