Exploring the deployment and reintegration experiences of active duty military families with young children

Active duty military families are experiencing increased stress as service members deploy to and return from lengthy and repeated deployments to multiple war zones. These deployments have a cumulative impact on the behavioral health and well-being of not only the service member, but also the family, particularly in families with very young children (Lester et al., 2016). Emergent research concerning families with young suggests that greater attention to the military spouse is needed to ensure effective, supportive service provision for these families. The purpose of the present study is threefold: (1) to identify the challenges faced by families with young children during and after deployment, (2) to understand resource utilization by these families, and (3) to explore the strengths and strategies used during these experiences. Data were collected through semi-structured interviews with 19 active duty Marine Corps family members with young children (under 5 years old) and 10 key program providers on or near a large military base in the southeast region of the United States. Findings reveal significant social isolation, which is consistent with the literature, the need for formal and informal social supports as well as self-care for the at-home parent, challenges in co-parenting and utilizing known resources, and a range of strategies used to manage deployment and reintegration. Implications for practice are discussed.     

Volunteers and the risk of posttraumatic stress disorder

Symptoms of posttraumatic stress disorder (PTSD) result from exposure to a traumatic event and influence a person's ability to cope psychologically. Recent documentation from emergency rooms shows that medical personnel, including volunteers who treated severely injured people, can develop symptoms of PTSD even though the volunteers themselves were not personally subjected to the stressful event. This article finds similar results among adolescents who volunteered with Magen David Adom (MDA), Israel's national emergency medical, disaster, ambulance, and blood bank service. Because of the security threats Israel has faced, these adolescents are likely to be exposed to traumatic events during their volunteer service, and some may develop PTSD. This article explores who is most susceptible to developing PTSD and the underlying theories of why that may be the case. Since the adolescents' motives to volunteer vary, the article proposes that volunteers with certain motives retain their enthusiasm for volunteering despite the danger of developing PTSD symptoms. It also finds that some of the motives to volunteer correlated with a reduction in the level of PTSD symptoms. Understanding the adolescents' motivations to volunteer will help nonprofit leaders and managers allocate volunteers according to their motivations and the levels of threat a particular job entails.     

Military‐Related Posttraumatic Stress Disorder and Intimate Relationship Behaviors: A Developing Dyadic Relationship Model

The protracted conflict in Iraq and Afghanistan and an all‐volunteer military has resulted in multiple war zone deployments for many service members. While quick redeployment turnaround has left little time for readjustment for either the service member or family, dealing with the long‐term sequelae of combat exposure often leaves families and intimate partners ill‐prepared for years after deployments. Using a modified grounded theory approach, digitally recorded couple interviews of 23 couples were purposefully selected from a larger sample of 441 couples to better understand the impact of war zone deployment on the couple. The veteran sample was recruited from a randomly selected cohort of men in treatment for posttraumatic stress disorder (PTSD). Overall, it was found when veterans experiencing deployment‐related PTSD reenter or start new intimate relationships they may bring with them a unique cluster of interrelated issues which include PTSD symptoms, physical impairment, high rates of alcohol and/or drug abuse, and psychological and physical aggression. These factors contributed to a dynamic of exacerbating conflict. How these couples approached relationship qualities of mutuality, balanced locus of control and weakness tolerance across six axes of caregiving, disability, responsibility, trauma, communication, and community impacted the couple's capacity to communicate and resolve conflict. This dyadic relationship model is used to help inform implications for clinical practice.     

Intimate partner violence and PTSD: the moderating role of emotion-focused coping

Intimate partner violence (IPV) affects millions of women every year, often resulting in posttraumatic stress disorder (PTSD). The strength of the relationship between IPV and PTSD has been shown to be affected by factors such as the amount of violence exposure and the style of coping in which the individual engages. For example, emotion-focused coping has been shown to be strongly related to IPV exposure and the expression of PTSD symptoms. This topic was explored in IPV survivors, with the finding that more frequent use of emotion-focused coping was associated with both higher violence exposure and heightened PTSD symptoms. Regression analyses revealed that emotion-focused coping moderated the relationship between IPV exposure and PTSD symptoms. More specifically, the results suggest that while individuals low on emotion-focused coping had fewer PTSD symptoms than women who frequently used emotion-focused coping, these individuals reported higher PTSD symptoms in the presence of frequent violence exposure. For individuals who frequently engaged in emotion-focused coping, violence exposure was less strongly associated with symptoms of PTSD.     

The Trauma Trifecta of Military Sexual Trauma: A Case Study Illustrating the Integration of Mind and Body in Clinical Work with Survivors of MST

Military sexual trauma (MST) has recently received much attention from the media in contemporary society. With the ever-increasing population of United States service members returning from the Iraq and Afghanistan wars, it is vital for any mental health practitioner to be aware of the epidemic that is sexual assault in the military, the unique trauma experiences of the MST survivor, and treatment implications incorporating multiple psychological theories. This article explores three factors, referred to as the trauma trifecta, in which the effects of MST are exacerbated: the loss of professional and personal identity, the regulatory functions of self harm behaviors, and the retraumatization that many service members endure as a result of the distinctive characteristics of the military culture and its service to veterans. A case study with clinical interventions will be utilized to demonstrate this concept of “the trauma trifecta” and the unique challenges in treating the PTSD symptoms that can result from MST in clinical therapy. Drawing from multiple theories in clinical treatment, this paper illustrates the strengths and limitations of cognitive-behavioral techniques, highlights the integration of feminist theory to illustrate the obstacles of power structures, and mind–body interventions, bridging the gap between talk therapy and body therapy. Through this unique integration of multiple therapies, the case study illustrates the veteran’s reengagement with her body and the reformulation of her identity post MST.     

Elderly Korean immigrants' socially and culturally constructed definitions of elder neglect

Little research has been conducted among the elderly on the topic of neglect. Not only is there a paucity of research, but also there is the problem of widely varying definitions of neglect. These two challenges led to a study of how neglect is understood by elderly Korean immigrants as it pertains to behaviors of adult children and family members. Interviews with 124 elderly Korean immigrants were conducted to assess conceptualizations of elder neglect. Data were analyzed using a grounded theory approach. Results revealed five interrelated themes with strong connections to dimensions of health and mental health: (a) culture-specific definitions of elder neglect, (b) contexts in which elder neglect occurs, (c) impact of neglect on elders, (d) expectations from adult children, and (e) strategies for dealing with elder neglect. Implications for culturally competent, family-centered service delivery to elderly Korean immigrants are discussed, specifically focusing on service provision of health and mental health care.     

Building a Faith-Based Human Service Agency

Abstract

Interest in faith-based organizations has increased substantially since the Bush administration made them a priority in the presidential campaign of 2000 and established a special office in the White House to promote their involvement in government supported human services. The primary goal of this initiative is to encourage faith-based organizations, usually understood to mean congregations, to engage their members in supporting services to those most in need. While most research on faith-based organizations is limited to the past decade or two, very little is known about how they operate. This case study of Community Ministries of Rockville, Maryland (CMR) is designed to address this issue. CMR differs from most faith-based organizations in that it neither represents a single congregation nor the traditional faith-related social service agency like Catholic, Jewish, or Lutheran Social Services. The case study features the twenty-five year history of the Executive Director of a faith-based human service organization supported by twenty congregations. It concludes with the identification of major challenges and lessons learned.     

Intimate Partner Communication From the War Zone: A Prospective Study of Relationship Functioning,Communication Frequency,and Combat Effectiveness

This study examined (a) the association between relationship functioning prior to and during deployment, and the frequency of communication during deployment; and (b) the association between relationship functioning and depression during deployment and their influence on service members’ ratings of duty performance. Participants were 144 partnered Airmen assessed immediately before and during a one‐year high‐risk deployment to Iraq. Results showed an overall high frequency of partner communication during deployment. High relationship distress at predeployment predicted lower frequency of communication during deployment. Changes in relationship distress from before deployment to during deployment independently predicted frequency of communication, above and beyond predeployment distress levels. Level of relationship distress and depression during deployment independently predicted service members’ ratings of impact on duty performance.     

Challenges in Governance for the PSA as a Regional Sociological Association

In this essay we identify and discuss some of the challenges currently faced by the Pacific Sociological Association (PSA) related to its governance. The PSA is not unlike other regional associations and faces similar challenges. The rapid growth in membership for the association has repeatedly placed strains on the governance structure, particularly on the office of the Executive Director. The formal organization of governance has not always matched the actual ways in which governing is carried out, almost entirely by volunteers. Although there is growth, there is also significant turnover in members from year to year and this presents a challenge for maintaining an active, vibrant organization. The governing structure of elected committees and officers has not changed with membership growth but the number of standing committees has increased dramatically, spreading the volunteer membership thin. To meet these challenges, we make several suggestions. We argue for the importance of maintaining a stable membership; that the PSA should continue its work to formally define roles and positions including a restructuring of its committees; and an emphasis should be placed on providing an intellectual home for the members of the PSA. We elaborate on these responses to the challenges faced by the PSA and suggest considerations for the association as it moves into the final decade of its first 100 years.     

“Now that we can ask and tell: The social movement legacy of the DADT repeal”

The 2010 Don't Ask Don't Tell Repeal Act, along with the 2016 DOD announcement regarding the impending inclusion of transgender soldiers, created the possibility of open and unsanctioned military service for LGBTQs for the first time in US history. This article provides an overview of how these policy changes came about, from the emergence of DADT to the legal and activist challenges to its legitimacy, including its ultimate repeal and the subsequent move to extend open service to transgender people. After summarizing what we know so far about how the repeal has (and has not) changed the experience of service for LGBTQs, I consider how these policy changes have been received and interpreted by LGBTQ activists and scholars. Open military service is either viewed as one of the most exciting or the most damning developments of LGBTQ organizing in the 21st century, according to the two most prominent activist perspectives. This review outlines the key arguments of each perspective and concludes by considering the value of reconciling these disparate vantage points when analyzing the future of LGBTQ social movement strategy.     

Posttraumatic stress disorder (PTSD) symptoms among firefighters: Roles of resilience and locus of control

Firefighting is a an extremely stressful occupation that risks exposure to traumatic events as part of the job. Despite this, the literature on stress and trauma pays little attention to this occupation and its generalization to other, high risk occupations. This study examined resilience and work locus of control as predictors of posttraumatic stress disorder (PTSD) symptoms among Nigerian firefighters. Participants were 116 paid, professional firefighters (98 males and 18 females) who completed the Post-Traumatic Stress Disorder Checklist-Civilian Version (PCL-C), Resilience Scale (RS-14), and Work Locus of Control Scale (WLCS) and provided vital demographic information. Multiple regression analysis was used to analyze the data. Results showed that resilience negatively predicted PTSD symptoms such that higher resilience was associated with fewer symptoms of PTSD. Work locus of control was a positive predictor of PTSD symptoms, indicating that externality of control beliefs in the workplace was associated with more PTSD symptoms. Relevant demographic factors especially higher years of service, being a senior firefighter, and higher educational status were associated with lower PTSD symptoms. Findings underscore the potential value of resilience training and implementing behavioral health programs to modify firefighters’ external locus of control beliefs. Interventions should consider resilience and locus of control focused interventions as protective factors for PTSD.     

Do Secondary Trauma Symptoms in Spouses of Combat-Exposed National Guard Soldiers Mediate Impacts of Soldiers’ Trauma Exposure on Their Children?

This exploratory study examines the associated effects of combat exposure on Soldiers assigned to a Midwestern Army National Guard unit. It also explores the secondary and mediating effects of combat exposure on Soldier’s spouses and children. The correlations of combat exposure with trauma symptoms, substance abuse, domestic violence and secondary trauma symptoms among family members are identified. Survey results suggest that immediate family members of combat-exposed Soldiers with high levels of post traumatic stress disorder (PTSD) are at risk for developing secondary traumatic stress. Secondary trauma symptoms in these spouses are a risk-increasing mediating variable between trauma symptoms in combat-exposed Soldiers and secondary trauma symptoms in their children. Results from this investigation emphasize the need for further inquiry into this topic. They further highlight the need for preventive and treatment efforts targeted toward all family members and relationships in order to lessen the effects of combat exposure.     

The Psychiatrist's Role in Implementing an Open Dialogue Model of Care

The Open Dialogue approach is a family‐oriented early intervention model for mental health problems developed in the health district of Western Lapland, Finland. Since the 1990s the psychiatric service system in Western Lapland Health Care District has been organised according to Open Dialogue principles and applied to the treatment of any mental health concerns. The Open Dialogue approach considers the client and their family as active participants rather than as objects of treatment in its planning and implementation with a psychotherapeutic focus. In daily work, the responsibility for the treatment process is shared with the case‐specific team. The model of care requires a dialogical orientation from all staff members, psychiatrists included, to interact with the team and the client's network. In this article I describe the role of the psychiatrist in implementing an Open Dialogue model of care in psychiatric services leaning on my experiences of clinical work in the adolescent psychiatric team in Western Lapland.     

Traumatic Stress and Affect Management in Military Families

The war-time deployment of a service member creates significant stress for the family system that supports that person’s transition into combat, combat duty, and readjustment into civilian and family life upon return. The stressors associated with the deployment cycle are significant and can lead to depression, anxiety, and behavioral concerns for all family members including the children and partners. A family’s adaptation to these stressors can also impact the functioning of the service member during the phases of mobilization, deployment, sustainment, and reintegration. Social work interventions that offer support to the military family can reduce levels of distress within and between the members and improve overall family functioning. A case vignette will be presented that highlights some of the salient interpersonal challenges that can develop in a military family when a veteran returns home with posttraumatic stress that is left untreated. Recommendations for interventions will be considered through the application of psychoeducational approaches for managing traumatic stress in families.     

Bioecological Implications of Narrative Exposure Therapy in Low‐Resource Settings: Individual,Family, Community,and Socio‐Political Contexts

Traumatic stress can have detrimental effects on individuals, families, and communities. Narrative exposure therapy (NET) is an evidence‐based intervention for decreasing individuals’ post‐traumatic stress disorder (PTSD) symptoms and has been tested in some of the most challenging contexts, such as in post‐conflict refugee camps. Although the focus of NET is on reducing individual PTSD symptoms, the impact of NET can be seen beyond the individual level. The purpose of this paper is to examine some of the ecological implications of using NET with trauma‐affected populations in low‐resource settings. We describe the implications of NET at the family, community, and sociopolitical levels using several case examples. Finally, we outline limitations and future directions for improving the delivery of NET in settings with limited resources.     

A Mixed Methods Exploration of Single Session Family Therapy in a Child and Adolescent Mental Health Service in Tasmania,Australia

Single session therapy (SST) is grounded in the belief that clients and families can effect change after one therapeutic encounter, using their own resources, with brief support and assistance from therapists. SST has been found to be an effective intervention for children, young people, and their families presenting with a wide range of difficulties. Research in child and adolescent mental health has shown that over 50% of families find one SST encounter is enough with no need for further specialist input. This study aims to explore family member experiences of SST (undertaken as single session family therapy and termed hereafter SSFT) as an initial intervention in a regional child and adolescent mental health service (CAMHS), specifically in terms of worry, confidence, and satisfaction outcomes. An exploratory, mixed methods convergent design was utilised using a combination of open questions and Thurstone scales. All eligible family members were invited to complete questionnaires before and after the SSFT, asking about level of worry, confidence, and overall satisfaction with SSFT. Quantitative and qualitative findings indicated most family members had a positive experience of SSFT, although differences were found between young people, parents, and siblings. Overall, family members’ level of worry decreased, while only parental confidence in managing the presenting issue(s) increased. Over half of the families did not require further contact with CAMHS following the SSFT. Our findings support previous research that SSFT is an effective, family-inclusive, and well received intervention for a variety of mental health issues facing children and young people. SSFT could be considered a beneficial and well received first response for the majority of CAMHS clients, which prioritises a family-inclusive approach. Future research could focus on attaining a more in-depth understanding of individual family member experiences with a view to improving SST delivery.     

Systemic Practice in the Time of COVID: Conversations Among Culturally Diverse Therapists

The COVID‐19 pandemic has changed the delivery of clinical services and education of health professionals, including family therapists. This paper distils two separate Zoom conversations between myself (as the lead author) and two eminent family therapists, Professors Maurizio Andolfi and Harry Aponte, where challenges and opportunities for the profession during and after the pandemic are discussed. Creativity and resourcefulness are two important elements therapists and educators have needed to access during the pandemic to find alternative ways to continue to provide clinical services and teaching. Most therapists have transitioned using online technology and various platforms such as Zoom and Skype; for some this has been a somewhat familiar experience, for most it has been a novel one. Key themes emerged from the conversations including the personal and professional ‘lived experiences’ of the pandemic; the financial impact on clients and students; the importance of touch for human social connection; the use of ‘self’ as an instrument of change and alternative platforms of service delivery and teaching. We reflected on what has been lost, such as the nuances inherent in face‐to‐face human interactions, and what has been gained, such as observing families in situ in their own environments.     

Toward an Integrated Theoretical Model of Risk Factors for Post-Deployment PTSD and its Implications for Justice-Involved Veterans

At present, very little knowledge exists about individual differences in susceptibility to posttraumatic stress disorder (PTSD) after combat trauma. Two differing perspectives have emerged. Some researchers maintain that a distinct linear dose-response relationship exists between the severity of combat trauma and the later development of PTSD. Conversely, others have questioned whether differential exposure to combat alone is sufficient to explain differences in the prevalence of post-deployment PTSD. This debate has implications for military veteran offenders who suffer from PTSD. In this paper, I propose a cumulative stress model that posits that it is the particular combination of psychosocial factors and combat exposure that interact to predict the likelihood of developing and maintaining PTSD after deployment. Therefore, PTSD influences post-deployment offending and antisocial behavior through this mechanism. Finally, this paper will discuss implications for criminal justice policy and practice.