Family-Centered Care for Military and Veteran Families Affected by Combat Injury

Abstract

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.

The Impact of Parental Operational Stress Injury on Child Mental Health and Well-Being: A Scoping Review

“…Renegotiating parenting roles and responsibilities When parents live with OSIs they can experience a range of invisible issues, such as irritability, emotional unavailability, hostility, and hypervigilance, that are disruptive to family relationships (Arata-Maiers & Stafford, 2010;Cozza, Holmes, & Van Ost, 2013;Cozza & Lieberman, 2007;Danish & Antonides, 2013;Dekel & Goldblatt, 2008;Gewirtz, Pinna, Hanson, & Brockberg, 2014;Gorman, Fitzgerald, & Blow, 2010;Harrison, Albanese, & Berman, 2014;Janke-Stedronsky et al, 2016;Lester & Flake, 2013;Lieberman & Horn, 2013;Palmer, 2008;Reed, Bell, & Edwards, 2011;Sammons & Batten, 2008;Seamone, 2012;Ternus, 2010). These issues can impact a parent's ability to consistently negotiate and meet role expectations and household routines, which typically creates friction among family members as the distress an individual living with an OSI feels reverberates throughout the family (Boricevic Mar sanic, Aukst Margetic, Jukic, Matko, & Grgic, 2014;Campbell, Brown, & Okwara, 2011;Cozza, Holmes, et al, 2013;Lester & Flake, 2013;Lester et al, 2010;Lieberman & Horn, 2013), leaving the family with a lower threshold for everyday stressors .…”

“…These issues can impact a parent's ability to consistently negotiate and meet role expectations and household routines, which typically creates friction among family members as the distress an individual living with an OSI feels reverberates throughout the family (Boricevic Mar sanic, Aukst Margetic, Jukic, Matko, & Grgic, 2014;Campbell, Brown, & Okwara, 2011;Cozza, Holmes, et al, 2013;Lester & Flake, 2013;Lester et al, 2010;Lieberman & Horn, 2013), leaving the family with a lower threshold for everyday stressors .…”

“…A study that examined the impact of warm and caring maternal relationships on the children of PTSD veterans indicated that, as adults, children of PTSD veterans experienced less emotional distress and had a greater capacity for intimacy (Dinshtein et al, 2011). This closeness with the children may lead to friction in the spousal relationship and, in some cases, potential exposure to intimate partner violence (Campbell et al, 2011;Dekel & Goldblatt, 2008;Gorman et al, 2010;McFarlane, 2009;Palmer, 2008;Pearrow & Cosgrove, 2009) and negative impacts on the caregiver's psychological well-being and capacity to meet household maintenance demands (Ahmadi, Azampoor-Afshar, Karami, & Mokhtari, 2011;Cozza, Holmes, et al, 2013;Lester, 2012). …”

“…Nevertheless, these disruptions typically lead to interrelated family stress such that the OSI may be further exacerbated by family or child dysfunction, creating a vicious circle (Boricevic Mar sanic, Aukst Margetic, Jukic, et al, 2014;Campbell et al, 2011;Cozza, Holmes, et al, 2013;Danish & Antonides, 2013;Gorman et al, 2010;Janke-Stedronsky et al, 2016;Walsh et al, 2014). Cozza (2011) states that "we must appreciate that their health is intricately connected to the health of their parents and other family members, mutually affecting each other's outcomes" (p. 1045).…”

“…Parental distress and poor mental health, regardless of the source, leads to higher levels of emotional, behavioral, and adjustment problems in children (Chandra et al, 2010;Cozza, 2011;Cozza, Holmes, et al, 2013;Dekel & Goldblatt, 2008 Parental OSI symptoms have been shown to correlate strongly with children's depressive symptoms (Schick, Morina, Klaghofer, Schnyder, & M€ uller, 2013;Taheri et al, 2012) and anxiety Taheri et al, 2012). Adolescent children of male PTSD veterans admitted to inpatient psychiatry experienced higher rates of suicide attempts (Boricevic Mar sanic, Aukst Margetic, Zecevic, et al, 2014), with double the rate of reported internalizing and externalizing problems and significantly higher rates of emotional dysregulation, substance use, anger, aggression, and depression than adolescents of veterans without PTSD (Boricevic Mar sanic, Aukst Margetic, Jukic, et al, 2014).…”