When a service member is injured or dies in a combat zone, the consequences for his or her family can be profound and long-lasting. Visible, physical battlefield injuries often require families to adapt to long and stressful rounds of treatment and rehabilitation, and they can leave the service member with permanent disabilities that mean new roles for everyone in the family. Invisible injuries, both physical and psychological, including traumatic brain injury and combat-related stress disorders, are often not diagnosed until many months after a service member returns from war (if they are diagnosed at all-many sufferers never seek treatment). They can alter a service member's behavior and personality in ways that make parenting difficult and reverberate throughout the family. And a parent's death in combat not only brings immediate grief but can also mean that survivors lose their very identity as a military family when they must move away from their supportive military community. Sifting through the evidence on both military and civilian families, Allison Holmes, Paula Rauch, and Stephen Cozza analyze, in turn, how visible injuries, traumatic brain injuries, stress disorders, and death affect parents' mental health, parenting capacity, and family organization; they also discuss the community resources that can help families in each situation. They note that most current services focus on the needs of injured service members rather than those of their families. Through seven concrete recommendations, they call for a greater emphasis on family-focused care that supports resilience and positive adaptation for all members of military families who are struggling with a service member's injury or death.

The US military community includes a population of mostly young families that reside in every state and the District of Columbia. Many reside on or near military installations, while other National Guard, Reserve, and Veteran families live in civilian communities and receive care from clinicians with limited experience in the treatment of military families. Though all military families may have vulnerabilities based upon their exposure to deployment-related experiences, those affected by combat injury have unique additional risks that must be understood and effectively managed by military, Veterans Affairs, and civilian practitioners. Combat injury can weaken interpersonal relationships, disrupt day-to-day schedules and activities, undermine the parental and interpersonal functions that support children's health and well-being, and disconnect families from military resources. Treatment of combat-injured service members must therefore include a family-centered strategy that lessens risk by promoting positive family adaptation to ongoing stressors. This article reviews the nature and epidemiology of combat injury, the known impact of injury and illness on military and civilian families, and effective strategies for maintaining family health while dealing with illness and injury.

This study examined detached parenting among Early Head Start mothers, and associated maternal characteristics and child behavior. Participants included 81 mother-child dyads. Data were collected in participants' homes during two visits. Mothers reported on demographic factors, parenting stress, and children's problem behaviors. Children's neurodevelopment was assessed, and videotaped parent-child play interactions were coded. Path analyses indicated that demographic risk factors and parenting stress were associated with higher levels of detached parenting. As a mediator, detached parenting significantly predicted children's later problem behavior. There was a direct effect of parenting stress on children's behavior problems, but no direct effect of children's neurodevelopmental risk. Detached parenting partially mediated the influence of parenting stress on children's problem behavior. The final model moderately accounted for the variance in detached parenting and children's problem behaviors. The results suggest that parents who experience multiple risks and high levels of parenting stress are more likely to demonstrate detached parenting. In addition, detached parenting leads to higher levels of toddler problem behavior, and may increase the problem behavior displayed by toddlers of parents experiencing multiple risks and parenting stress. These findings are discussed in the context of infant mental health practice.

Current results highlight the need to focus on types, subtypes, and severity of neglect incidents that provide specific understanding of child risk to better inform policy. Further study should examine specific risk factors and their relationship to neglect types and severity outcomes.

No abstract