Staff Perspective: Caring for the Mental Health Needs of the Military Child (& Adolescent)
Originally, this blog entry was going to be titled “Working with the Military Child as the Identified Patient”. As a psychologist who has worked with children in many different settings, the thought was to present common mental health, behavioral and educational concerns experienced by this special population, along with relevant clinical resources to address those issues. But living among a robust military community and working with military children and adolescents and their families brings to mind that, for the most part, military children are extremely resilient and certainly have more strengths than weaknesses. (See my blog on Celebrating & Caring for the Military Child: Honoring our Youngest Heroes Year-Round). In fact, military kids tend to flex, adapt and overcome in parallel to their parent’s experiences.
While military families make up a unique sector of the American population and have numerous strengths evidenced in the face of unique challenges and adversity, it is important to note that military families are still families and military children are still children. As such, military kids are still prone to experiencing the same issues experienced by their civilian child counterparts, albeit as impacted by military-specific cultural factors. For example, some studies have shown increased occurrences of depression and ADHD among children with a parent deployed to a combat zone versus a noncombat assignment. Importantly, the wellbeing of the military child, no doubt, has as strong an impact on parental/familial wellbeing and – in some ways – the operational readiness of the military Service member and family.
While, at one time, the focus was primarily on the emotional wellbeing of the Service member or Vet and how various mental health issues might in turn impact the family, more recently, the mental health of the military child has been spotlighted as having an important impact on the family system.
Child 1: “Whenever I see the something bad happening in Afghanistan on the news, I wonder if my Dad is still alive.”
Child 2: “Me too.”
This was a conversation between two of my younger patients, one a teenager and the other a preteen. Working as a civilian clinician (new from the VA and a university medical clinic) in a psychiatric facility that was a Tricare provider for services for military children, I learned that I would have even a lot more to learn. In addition to providing care for children and adolescents of various age ranges along with their families who all represented a unique military typology, I needed administrative and clinical information to support my work with each child or adolescent I saw. This included growing my awareness about military culture (especially the unique challenges faced by the military child) and community resources specifically designed to help military children and their families. Although I live in an area with a large military presence and I myself am from a military family, I sought out my first CDP training in 2008 in hopes of learning more about military culture. In addition to this, I read and I learned through trial and error about TRICARE, EMFP, ECHO, FOCUS and FAP. All confusing acronyms to me, at first, but all very important programs for supporting military children.
During the course of my time working with military children in a community setting, I voraciously read, consulted and reached out to other military providers and care installations in order to gather the intelligence and resources necessary to provide quality care to my patients. I found myself learning about the ins and outs of deployment and its impact on the family, difficulties with continuity of care for acute child educational, behavioral or mental health issues given frequent relocation, and unusual workarounds for maintaining best practice with these families and their kids. And so I learned the acronyms, met various points of contact who were generous with their time and knowledge and learned that caring for military children can be just as complex and rewarding as caring for the Veteran or Service member themselves.
Complications included considering the similarities and differences between military children and their civilian counterparts and working within a military care supported framework. Initiating and maintaining communication with families was also a huge part of my job, and I recall doing therapy with a child stateside, while one parent and sibling were OCONUS in Germany and the other parent was serving downrange in Afghanistan. This particular family had been subjected to multiple traumas related to violence and being radioed in to dad downrange did not help this. Whenever we lost connection with dad, the family became extremely distressed and thoughts were for the worst, despite this having happened numerous times. Thank goodness for a very patient communications person at a local base who not only provided tech support for our sessions, but also offered reassurance during those times when we lost connection…
Putting the Military Child First: Lessons Learned by a Civilian Provider
Importantly, some military kids (just like their civilian counterparts) may present with severe mental health issues such as major depression, PTSD, OCD, pediatric bipolar disorder or early onset schizophreniform processes. These families required additional support and I frequently filled out EFMP (Exceptional Family Member Plan) paperwork and made calls to ensure wraparound services were in place prior to discharge. A few parents, worried about post-treatment adjustments to work and school, asked the same question: “Will coming home from treatment be like coming home from deployment?”
At that time many years ago, research was less widely available regarding the above, but as the importance of caring for the whole military family, and specifically the military child, has come into focus in recent years, such information is more readily available. Very recent journal articles focus less on prevalence rates or comorbidities of psychiatric conditions and more on the holistic care and resources available to support the psychosocial wellness of the military child. Resources address the educational, social, mental and physical health of the child. I wished I had access to these sources years ago and have summarized some of the most useful recent resources below as a useful reference:
CDR Huebner’s (2019) comprehensive report on the “Health and Mental Health Needs of the Military Child” importantly states that although the problems experienced by military children may be familiar to those uniformed and civilian providers working at an MTF (military treatment facility), that up to 50% of the military children requiring care will be seen in the civilian sector. His research goes on to discuss the specifics of military children’s health and mental health needs, along with providing useful information about Tricare resources and developmentally appropriate supportive programming for military children in need of care. (If you have time to only read one article, read this one!)
Cramm, McColl, Aiken and William’s 2019 research on the mental health of the military child included a literature review of over 3000 articles and with the inclusion of 86 articles on this topic. In summary, overall results of this research indicated that the “children growing up in military families experience more mental health problems than children in civilian families and use more mental health services”.
Fairbank et al. (2018) discusses the results of the Millennium Cohort Family Study looking at the mental health of children of deployed and nondeployed service members. Overall results indicated that most military children were not reported to have a greater likelihood of behavioral, emotional or mental health difficulties regardless of parental deployment status. However, this study did also note that those children with parents deployed to a combat zone versus those deployed to a noncombat zone, were more likely to experience depression and/or ADHD. Higher incidence of child depression were found in those children whose parents were deployed to a combat zone.
Hathaway, Russotti, Metzger & Cerulli’s (2018) qualitative study of the PEACE (Promoting Emotional Adjustment in [Military] Children Experiencing Challenges) Project utilized focus groups in order to better determine the needs of military-connected children.
Ridings and Petty (2018) reference other research indicating that although highly resilient, military children are more likely to experience exposure to emotional and behavioral difficulties, child maltreatment and intimate partner violence. Further, children with deployed versus non-deployed parents were shown to have a higher utilization rate of child mental health outpatient visits, higher rates of mental health issues, and psychosocial impairment. Interestingly, this study looked at the provision of child/family focused TF-CBT within the VA setting, with the VA System being tasked with providing more family interventions for Veterans since 2008.
Ohye, Roizner, Laifer, Chen & Bui’s (2017) article on training clinicians to provide culturally competent treatment to military-connected children has highlighted the importance and challenges of initiating a joint effort to train clinician in providing culturally informed mental healthcare to military-connected children.
*Please note that due to limited space, this blog is only able to provide a few select resources, so I have chosen the ones that I think might be most beneficial to both the civilian and military provider treating a military child.
Clinical Child Resources for Providers and Parents:
Home and Educational Resources:
- The Military Child Education Coalition [www.militarychild.org]
- DODEA (Dept. of Defense Educational Activity) [www.dodea.edu]
- Military Child Care [www.militarychildcare.com]
Special Needs Child Resources:
- EFMP Quick Reference Guide: [http://download.militaryonesource.mil/12038/MOS/ResourceGuides/EFMPQuick...
- EFMP Special Needs Toolkit: [http://download.militaryonesource.mil/12038/EFMP/PTK_SCORs/ParentToolkit...
- Autism Care Demonstration: [https://Tricare.mil/Plans/SpecialPrograms/ACD/GettingCare]
- Operation Autism [www.operationautismonline.org]
- Tricare Mental Health [https://Tricare.mil/mentalhealth]
Resources for Family and Kids:
- MilitaryOneSource [www.militaryonesource.mil]
- CDP MILITARY CHILD RESOURCES
- STRoNG Military Families Program for families with young children
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Kimberly Copeland, Psy.D., is a Senior Military Internship Behavioral Health Psychologist at the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. Dr. Copeland is currently located at Naval Medical Center Portsmouth.
References:
Cramm, H., McColl, M. A., Aiken, A. B., & Williams, A. (2019). The mental health of military-connected children: A scoping review. Journal of Child and Family Studies, 28(7), 1725-1735. doi:10.1007/s10826-019-01402-y
Fairbank, J. A., Briggs, E. C., Lee, R. C., Corry, N. H., Pflieger, J. C., Gerrity, E. T., Amaya-Jackson, L.M, Stander, V.A., Murphy, R. A. (2018). Mental health of children of deployed and nondeployed US military service members: The millennium cohort family study. Journal of Developmental and Behavioral Pediatrics : JDBP, 39(9), 683-692. doi:10.1097/DBP.0000000000000606
Hathaway, A., Russotti, J., Metzger, J., & Cerulli, C. (2018). Meeting military children's biopsychosocial needs: Exploring evidence-based interventions. Best Practices in Mental Health, 14(1), 54.
Huebner, C. R., CDR, COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH, & SECTION ON UNIFORMED SERVICES. (2019). Health and mental health needs of children in US military families. Pediatrics, 143(1), e20183258. doi:10.1542/peds.2018-3258
Ohye, B. Y., Roizner, M., Laifer, L. M., Chen, Y., & Bui, E. (2017). Training clinicians to provide culturally competent treatment to military-connected children: A collaborative model between the massachusetts society for the prevention of cruelty to children and the red sox foundation and massachusetts general hospital home base program. Professional Psychology: Research and Practice, 48(3), 149-155. doi:10.1037/pro0000143
Ridings, L. E., Moreland, A. D., & Petty, K. H. (2019). Implementing trauma-focused CBT for children of veterans in the VA: Providing comprehensive services to veterans and their families. Psychological Services, 16(1), 75-84. doi:10.1037/ser0000278
Originally, this blog entry was going to be titled “Working with the Military Child as the Identified Patient”. As a psychologist who has worked with children in many different settings, the thought was to present common mental health, behavioral and educational concerns experienced by this special population, along with relevant clinical resources to address those issues. But living among a robust military community and working with military children and adolescents and their families brings to mind that, for the most part, military children are extremely resilient and certainly have more strengths than weaknesses. (See my blog on Celebrating & Caring for the Military Child: Honoring our Youngest Heroes Year-Round). In fact, military kids tend to flex, adapt and overcome in parallel to their parent’s experiences.
While military families make up a unique sector of the American population and have numerous strengths evidenced in the face of unique challenges and adversity, it is important to note that military families are still families and military children are still children. As such, military kids are still prone to experiencing the same issues experienced by their civilian child counterparts, albeit as impacted by military-specific cultural factors. For example, some studies have shown increased occurrences of depression and ADHD among children with a parent deployed to a combat zone versus a noncombat assignment. Importantly, the wellbeing of the military child, no doubt, has as strong an impact on parental/familial wellbeing and – in some ways – the operational readiness of the military Service member and family.
While, at one time, the focus was primarily on the emotional wellbeing of the Service member or Vet and how various mental health issues might in turn impact the family, more recently, the mental health of the military child has been spotlighted as having an important impact on the family system.
Child 1: “Whenever I see the something bad happening in Afghanistan on the news, I wonder if my Dad is still alive.”
Child 2: “Me too.”
This was a conversation between two of my younger patients, one a teenager and the other a preteen. Working as a civilian clinician (new from the VA and a university medical clinic) in a psychiatric facility that was a Tricare provider for services for military children, I learned that I would have even a lot more to learn. In addition to providing care for children and adolescents of various age ranges along with their families who all represented a unique military typology, I needed administrative and clinical information to support my work with each child or adolescent I saw. This included growing my awareness about military culture (especially the unique challenges faced by the military child) and community resources specifically designed to help military children and their families. Although I live in an area with a large military presence and I myself am from a military family, I sought out my first CDP training in 2008 in hopes of learning more about military culture. In addition to this, I read and I learned through trial and error about TRICARE, EMFP, ECHO, FOCUS and FAP. All confusing acronyms to me, at first, but all very important programs for supporting military children.
During the course of my time working with military children in a community setting, I voraciously read, consulted and reached out to other military providers and care installations in order to gather the intelligence and resources necessary to provide quality care to my patients. I found myself learning about the ins and outs of deployment and its impact on the family, difficulties with continuity of care for acute child educational, behavioral or mental health issues given frequent relocation, and unusual workarounds for maintaining best practice with these families and their kids. And so I learned the acronyms, met various points of contact who were generous with their time and knowledge and learned that caring for military children can be just as complex and rewarding as caring for the Veteran or Service member themselves.
Complications included considering the similarities and differences between military children and their civilian counterparts and working within a military care supported framework. Initiating and maintaining communication with families was also a huge part of my job, and I recall doing therapy with a child stateside, while one parent and sibling were OCONUS in Germany and the other parent was serving downrange in Afghanistan. This particular family had been subjected to multiple traumas related to violence and being radioed in to dad downrange did not help this. Whenever we lost connection with dad, the family became extremely distressed and thoughts were for the worst, despite this having happened numerous times. Thank goodness for a very patient communications person at a local base who not only provided tech support for our sessions, but also offered reassurance during those times when we lost connection…
Putting the Military Child First: Lessons Learned by a Civilian Provider
Importantly, some military kids (just like their civilian counterparts) may present with severe mental health issues such as major depression, PTSD, OCD, pediatric bipolar disorder or early onset schizophreniform processes. These families required additional support and I frequently filled out EFMP (Exceptional Family Member Plan) paperwork and made calls to ensure wraparound services were in place prior to discharge. A few parents, worried about post-treatment adjustments to work and school, asked the same question: “Will coming home from treatment be like coming home from deployment?”
At that time many years ago, research was less widely available regarding the above, but as the importance of caring for the whole military family, and specifically the military child, has come into focus in recent years, such information is more readily available. Very recent journal articles focus less on prevalence rates or comorbidities of psychiatric conditions and more on the holistic care and resources available to support the psychosocial wellness of the military child. Resources address the educational, social, mental and physical health of the child. I wished I had access to these sources years ago and have summarized some of the most useful recent resources below as a useful reference:
CDR Huebner’s (2019) comprehensive report on the “Health and Mental Health Needs of the Military Child” importantly states that although the problems experienced by military children may be familiar to those uniformed and civilian providers working at an MTF (military treatment facility), that up to 50% of the military children requiring care will be seen in the civilian sector. His research goes on to discuss the specifics of military children’s health and mental health needs, along with providing useful information about Tricare resources and developmentally appropriate supportive programming for military children in need of care. (If you have time to only read one article, read this one!)
Cramm, McColl, Aiken and William’s 2019 research on the mental health of the military child included a literature review of over 3000 articles and with the inclusion of 86 articles on this topic. In summary, overall results of this research indicated that the “children growing up in military families experience more mental health problems than children in civilian families and use more mental health services”.
Fairbank et al. (2018) discusses the results of the Millennium Cohort Family Study looking at the mental health of children of deployed and nondeployed service members. Overall results indicated that most military children were not reported to have a greater likelihood of behavioral, emotional or mental health difficulties regardless of parental deployment status. However, this study did also note that those children with parents deployed to a combat zone versus those deployed to a noncombat zone, were more likely to experience depression and/or ADHD. Higher incidence of child depression were found in those children whose parents were deployed to a combat zone.
Hathaway, Russotti, Metzger & Cerulli’s (2018) qualitative study of the PEACE (Promoting Emotional Adjustment in [Military] Children Experiencing Challenges) Project utilized focus groups in order to better determine the needs of military-connected children.
Ridings and Petty (2018) reference other research indicating that although highly resilient, military children are more likely to experience exposure to emotional and behavioral difficulties, child maltreatment and intimate partner violence. Further, children with deployed versus non-deployed parents were shown to have a higher utilization rate of child mental health outpatient visits, higher rates of mental health issues, and psychosocial impairment. Interestingly, this study looked at the provision of child/family focused TF-CBT within the VA setting, with the VA System being tasked with providing more family interventions for Veterans since 2008.
Ohye, Roizner, Laifer, Chen & Bui’s (2017) article on training clinicians to provide culturally competent treatment to military-connected children has highlighted the importance and challenges of initiating a joint effort to train clinician in providing culturally informed mental healthcare to military-connected children.
*Please note that due to limited space, this blog is only able to provide a few select resources, so I have chosen the ones that I think might be most beneficial to both the civilian and military provider treating a military child.
Clinical Child Resources for Providers and Parents:
Home and Educational Resources:
- The Military Child Education Coalition [www.militarychild.org]
- DODEA (Dept. of Defense Educational Activity) [www.dodea.edu]
- Military Child Care [www.militarychildcare.com]
Special Needs Child Resources:
- EFMP Quick Reference Guide: [http://download.militaryonesource.mil/12038/MOS/ResourceGuides/EFMPQuick...
- EFMP Special Needs Toolkit: [http://download.militaryonesource.mil/12038/EFMP/PTK_SCORs/ParentToolkit...
- Autism Care Demonstration: [https://Tricare.mil/Plans/SpecialPrograms/ACD/GettingCare]
- Operation Autism [www.operationautismonline.org]
- Tricare Mental Health [https://Tricare.mil/mentalhealth]
Resources for Family and Kids:
- MilitaryOneSource [www.militaryonesource.mil]
- CDP MILITARY CHILD RESOURCES
- STRoNG Military Families Program for families with young children
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Kimberly Copeland, Psy.D., is a Senior Military Internship Behavioral Health Psychologist at the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. Dr. Copeland is currently located at Naval Medical Center Portsmouth.
References:
Cramm, H., McColl, M. A., Aiken, A. B., & Williams, A. (2019). The mental health of military-connected children: A scoping review. Journal of Child and Family Studies, 28(7), 1725-1735. doi:10.1007/s10826-019-01402-y
Fairbank, J. A., Briggs, E. C., Lee, R. C., Corry, N. H., Pflieger, J. C., Gerrity, E. T., Amaya-Jackson, L.M, Stander, V.A., Murphy, R. A. (2018). Mental health of children of deployed and nondeployed US military service members: The millennium cohort family study. Journal of Developmental and Behavioral Pediatrics : JDBP, 39(9), 683-692. doi:10.1097/DBP.0000000000000606
Hathaway, A., Russotti, J., Metzger, J., & Cerulli, C. (2018). Meeting military children's biopsychosocial needs: Exploring evidence-based interventions. Best Practices in Mental Health, 14(1), 54.
Huebner, C. R., CDR, COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH, & SECTION ON UNIFORMED SERVICES. (2019). Health and mental health needs of children in US military families. Pediatrics, 143(1), e20183258. doi:10.1542/peds.2018-3258
Ohye, B. Y., Roizner, M., Laifer, L. M., Chen, Y., & Bui, E. (2017). Training clinicians to provide culturally competent treatment to military-connected children: A collaborative model between the massachusetts society for the prevention of cruelty to children and the red sox foundation and massachusetts general hospital home base program. Professional Psychology: Research and Practice, 48(3), 149-155. doi:10.1037/pro0000143
Ridings, L. E., Moreland, A. D., & Petty, K. H. (2019). Implementing trauma-focused CBT for children of veterans in the VA: Providing comprehensive services to veterans and their families. Psychological Services, 16(1), 75-84. doi:10.1037/ser0000278