Family Needs Across Family Needs Across the Deployment the Deployment CycleCycle
Kristy Straits-Tröster, Ph.D., ABPPKristy Straits-Tröster, Ph.D., ABPPAssistant Clinical Director, MIRECC Assistant Clinical Director, MIRECC
MIRECCMIRECCMid-AtlanticMid-Atlantic
VA Mental Illness Research, Education & Clinical Center
Cycles of DeploymentCycles of Deployment
Scope Scope ofof Deployment DeploymentOn Any Day…On Any Day…
73,000 Couples Separated 73,000 Couples Separated Length:Length:
• Army: 15 MonthsArmy: 15 Months• Reservists: 20+ Months Reservists: 20+ Months
away away from Home from Home
Multiple tours:Multiple tours:• 85% 1 Tour85% 1 Tour• 44% 2 Tours44% 2 Tours• 20% 3 Tours20% 3 Tours
Emotional Cycles of DeploymentEmotional Cycles of Deploymentfor Service Members and their Familiesfor Service Members and their Families
Anticipation of Departure Anticipation of Departure Detachment and Withdrawal Detachment and Withdrawal Emotional Disorganization Emotional Disorganization Recovery and Stabilization Recovery and Stabilization Anticipation of Return Anticipation of Return Return Adjustment and Renegotiation Return Adjustment and Renegotiation Reintegration and StabilizationReintegration and Stabilization
http://deploymenthealthlibrary.fhp.osd.mil
Stage 1: Anticipation of Departure Stage 1: Anticipation of Departure
• Reality sinks in—denial and anticipation of loss
• Pre-deployment checklist—taking care of items while striving to make time for “memorable” moments
• Stage 1 may begin again before adapting to changes from previous deployment
Stage 2: Detachment and WithdrawalStage 2: Detachment and Withdrawal
• Becoming psychologically prepared• Focused on the mission and their unit• May create emotional distance within the
marriage• Sadness and anger to protect from hurt
of separation• May lead to shutting down emotions,
numbness
Saying GoodbyeSaying Goodbye
Stage 3: Emotional DisorganizationStage 3: Emotional Disorganization
• Adjusting to new responsibilities and being alone
• Although familiar, may lead to fatigue and “burn-out” with multiple deployments
• Feeling overwhelmed at starting again
Stage 4: Recovery and StabilizationStage 4: Recovery and Stabilization
• Spouses realize they are resilient, able to cope
• Develop increased confidence, positive outlook
• May need additional help to muster emotional strength with back to back deployments
Stage 5: Anticipation of ReturnStage 5: Anticipation of Return
• Generally a happy and hectic time• Need to talk about realistic plans• Discuss expectations for the return and
reunion
Stage 6: Stage 6: Return Adjustment and RenegotiationReturn Adjustment and Renegotiation
• Couples and families reset expectations• Renegotiate family roles• Key is open communication• Dealing with effects of combat stress• May be irritable, guarded, isolative• Possible “numbing” behaviors to deal
with stress
Stage 7: Stage 7: Renegotiation and StabilizationRenegotiation and Stabilization
• Stabilizing relationships anew• Working with roadblocks
Combat stress Stigma Change of station Health/mental health problems Children’s adjustment Current events, economy
Challenges During DeploymentChallenges During Deployment
• Disconnects due to distance• Loneliness
“I didn’t get married to live alone…”• Loss of trust
Challenges During DeploymentChallenges During Deployment
Single Households: Lack of mutual support Children / Parenting / Child care Life Decisions: Money, Cars, Appliances,
Jobs “…you paid how much for that?!”
At-The-Front Spouse: “… “… my children won’t even remember my children won’t even remember
me…”me…”
Veterans’ Perspectives Veterans’ Perspectives on Post-Deployment on Post-Deployment Needs:Needs:Focus Group ResultsFocus Group Results
Kristy Straits-Tröster, Ph.D., Patrick Calhoun, Ph.D., Harold Kudler, M.D.
MIRECCMIRECCMid-AtlanticMid-Atlantic
VA Mental Illness Research, Education & Clinical Center
The OEF/OIF Focus GroupsThe OEF/OIF Focus Groups
MethodsMethods• Designed to complement medical record dataDesigned to complement medical record data• Telephone recruitment by contractor to fill 6 Telephone recruitment by contractor to fill 6
focus groups with 12 participants each:focus groups with 12 participants each: 2-Active Component (Active Duty or 2-Active Component (Active Duty or
Separated)Separated) 2- National Guard or Reservist2- National Guard or Reservist 1- Female Veterans1- Female Veterans 1- Female Spouses1- Female Spouses
Confidential Neutral SettingConfidential Neutral Setting
The OEF/OIF Focus GroupsThe OEF/OIF Focus Groups Focus group leaders utilized a
moderator’s guide All sessions were audiotaped and later
transcribed Information collected:
• Deployment Health Concerns• Family Concerns and Support• Preferences for healthcare services & info• Barriers to care• Recommendations
Focus Group ParticipantsFocus Group Participants
Time since last deployment • Mean = 27 months (SD 11) • Most had returned 2004-2005
23 of 54 veterans had accessed VA services (43%)
Most served in Army or Marines
Focus Group FindingsFocus Group FindingsPost-Deployment Problems:Post-Deployment Problems:
• Social avoidance• Noise sensitivity, jumpiness• Anger, irritability, lack of patience• Sleep problems • Chronic joint pain • Trouble concentrating, memory lapses• Drinking or smoking too much• Personality changes, emotionally labile• Digestive and bowel problems, weight changes• Hearing loss
Focus Group FindingsFocus Group FindingsPost-Deployment Family Problems:Post-Deployment Family Problems:
• Marital problems, divorce• Overprotective of family, dealing with
distressed children and spouses• Easily angered, jumpy in family setting• Restless sleep problems • Difficulty adjusting to running household
together, being together again• Body image problems due to weight
gain• Employment problems, anger at work
Post-Deployment ProblemsPost-Deployment Problems
“When I get home I don’t even want to be with my family. It’s like I just go into my office area and work on my computers and stuff. Anybody really talks to me or anything like that, it just aggravates me.”
Active Duty, Separated
What Helped?What Helped?
Services used and preferences:Services used and preferences:• Mixed report of VA experiences• Mixed report of TriCare experiences• Community providers confused about
fee basis process, dental • Churches helped, prayer• Buddies helped• Working out, martial arts• Also reported drinking, smoking, driving
to relax
What Helped?What Helped?
“I’m a student-- I go to school so I would go early and stay late just in the library where it is quiet. I went deer hunting a ton last year and didn’t kill a single thing, just sat up there because there is peace and quiet.”
National Guard, post-deployment
Barriers to CareBarriers to Care• Pride, beliefs that “I should handle it”• Stigma associated with MH treatment• Concern about being “labeled” and its
impact on military promotion or security clearance
• Too much red tape and paperwork• No options outside VA • Don’t like lectures and large groups• Beliefs that treatments “don’t work
anyway”
Top Five Services of InterestTop Five Services of Interest
• Help dealing with anger• Help dealing with stress• Marriage and family counseling• Information about benefits and
services• Job and school counseling
Recommendations?Recommendations?
“Maybe include … financial counseling, how to deal with the difference in pay or something, if you get a pay cut. Something like that. Because I know when I got out it took me longer than I expected to find a job …..as a result I ended up in quite a bit of debt, so I’m just now getting out of it.
Active Duty, Separated
Summary of RecommendationsSummary of Recommendationsfrom Veterans/Spousesfrom Veterans/Spouses
• More education after demobilization• More web-based information• Knowledgeable unit liaisons• Easier VA appointment access• More caring staff• Decrease stigma• Offer evening and weekend clinics• Use peer supports
How is VA Responding?How is VA Responding?
• More education after demobilization OEF/OIF Program Managers Participation in PDHRA & Yellow Ribbon events Collaborative Outreach
• More web-based information See www.va.gov See www.oefoif.va.gov See www.afterdeployment.org
• Knowledgeable unit liaisons Working closely with active duty and NC ARNG
How is VA Responding?How is VA Responding?
• Easier VA appointment access CBOCS and Vet Centers Greenville Mobile Vet Center
How is VA Responding?How is VA Responding?• More caring staff
New employee orientation “Face of the New Veteran” AHEC workshops, AHEC connect webinars MIRECC webcasts
• Reduce stigma Integrated PC/MH; Post Deployment Health Clinics Web-based resources
• Offer evening and weekend clinics DVAMC Thursday night clinic Saturday/Sunday outreach events
• Use peer supports GWOT coordinators Community college and NCSU
Questions?Questions?
MIRECCMIRECCMid-AtlanticMid-Atlantic
VA Mental Illness Research, Education & Clinical Center
