NASP Dialogues - Military Families: The Deployment Cycle

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Dan Florell:  Welcome to NASP Dialogues, the dialogues podcast focused on events and issues in school psychology. Today we're discussing the emotional cycle of military deployment and the impact on military families with Mark Pisano and a couple other distinguished speakers. So, Mark, why don't you go ahead and take it away.

Mark Pisano:  What I'd like to do is ask each panel member to introduce themselves and tell us your name and your connection with military families. We'll start with Dr. Cooper.

Sharon Cooper:  Hi. My name is Sharon Cooper and I'm a developmental and a forensic pediatrician. I'm also a retired Army officer who spent 21 years as a pediatrician for the military taking care of children in the Army, Navy, Air Force and Marine Corps.

In the last 12 years, I've devoted my practice to the developmental and educational problems of children from birth to 23 years of age at Fort Bragg, North Carolina, which is the largest military installation in the Army and has the largest pediatric population.

Mark Swerdlik:  Hello. I'm Mark Swerdlik. I'm a professor of psychology and coordinator of the graduate programs in school psychology at Illinois State University. I'm also a certified school psychologist and licensed clinical psychologist in Illinois.

And my involvement with military families was first as a Red Cross mental health volunteer. In our community, we had a National Guard unit deploy and our community initiated a Porch Light program, and I was involved in providing mental health services to the families.

And then, more recently, we're working with the Illinois Army Reserve National Guard in Illinois. In Illinois State University, we're evaluating their statewide reintegration program.

Mark P.:  And my name's Mark Pisano. I'm a school psychologist in the Fort Bragg schools and I've been there 27 years. And I'm also the stateside chairperson for the Military Families Interest Group.

Our goal today for about the next 60 minutes is to make you more informed about military deployment and how it can impact the military family.

Most of you listening are not working at military bases. Although I do want you to know that worldwide, there are about 107 school psychologists hired through the Department of Defense to work in the schools on military installations.

And just as a point of reference, most of us are NASP members. So, I'm proud to say that.

So since most of you are not working on military installations, you're working with National Guard Reserve families and some of these families have never experienced a deployment before and don't know what to expect. Others have been through multiple deployments.

But routinely, whether it's a civilian family or a family of active duty, they have repeatedly said that even though they've been through multiple deployments, it doesn't make it any easier the more times they go through it.

So when we look at some of the data, there is data to suggest that the newest casualty of war is the military family. Some military spouses, it seems, are fighting two wars: the conflict in Iraq and the campaign at home for the custody of their children.

No doubt that prolonged and multiple deployments are taking a toll on many military families, as evidenced by the divorce rate which has escalated up to 3.5% of the 287,000 married troops. And in 2008, an estimated 10,200 active duty soldiers ended their marriages.

Increasing demands on these families put their intimate relationships to the test and too many of them fail. Data in January, you probably read or heard about it on television, the Army disclosed there were 17 suspected suicides in January compared to 16 combat deaths. And in 2008, there were 128 soldiers that suicided, the highest yearly number on record.

So these families need some help and we believe we can help you give it to them by listening today. So let's start looking at military deployment.

Now, depending on what branch in service the member belongs to, deployments are going to vary. Special Operations soldiers are deployed for four to six months and will be home in about seven months before being deployed again.

Infantry service members are deployed for six to eight months and will next be deployed in about eleven months. Other deployments, which are more standard, usually go twelve and twelve. They're home for twelve and then they're deployed for twelve.

What you need to know, though, is while they're home for those twelve months, they sometimes are sent for training, so they're not home all the time. The Army certainly likes to train their soldiers, and they'll do that quite frequently.

Midway through the deployment there is something called "R&R," which stands for "Rest & Relaxation." We're going to talk about the impact on that. This is when the deployed solider returns home for about a week during the middle of their deployment.

So as we examine the deployment cycle, there is six manager stages we're going to look at. The first one is pre‑deployment. This is when detachment and withdrawal is experienced by the family. The second is deployment, which is where there is emotional disorganization typically.

Sustainment, which is when the military family starts stable and used to the parent being deployed. The next is anticipation of the return, which is a very happy time, but it's also a very nervous time.

Then reunion, which is where the family will have to renegotiate their roles basically, and use open communication to do so. Then reintegration, which is usually about seven months is how long it takes to do that. As we'll talk about later, the problem with that is a lot of times soldiers are redeployed before completion of the reintegration process.

So I encourage you listeners to not only attend to the current podcast, but we're doing another one that I'd like you to listen to as well that reviews specifically the reunion stage and the reintegration process. I do think that will be well worth your listen.

So let's being with the pre‑deployment stage. It begins with the soldier receiving word that they're going to be deployed. It's 30‑60 days notice prior to the soldier having to be deployed, so they do have about a month or two to prepare. Special operation soldiers can be given as little as 48 hours or as much as a month.

Either way, the anticipation departure triggers a variety of feelings from the spouse, and sometimes it cleaves denial, confusion, sadness, and sometimes even anger. The anger sometimes is an easier emotion to handle then it is confronting the pain and the loss of saying goodbye.

Sometimes a service member is already psychologically deployed, and those few days before the deployment, that impacts often on the family trying to function in making their memorable moments. We'll talk about that a little bit too.

The service member may appear distant or distractive from the family, because they're trying to focus not only on their role in the deployment, but also trying to connect with their fellow service members.

It is recommended that the service member not only find time to be with the whole family, but also individually with each child, and then also to leave them with some sort of a token or a gift like a diary, or a scrapbook, or a watch, or a bracelet, just as long as it's something the child can hold onto and look at when she's missing her parent, or his.

Depending on where the person is going, they may not have daily access to computers and phones. It's hard to know. A lot of times when they're deployed, they don't know what's going to be there as far as communications.

So there is one thing though, visual conferencing, which is a new form of communication between the families and the soldiers. The family running this group is sponsoring this, and it's actually where there's a visual cookout through the computer for the soldier and for home, with a live meal. It's provided about once a month for the soldiers, depending on where they are.

Also, when you're working with these families during the pre‑deployment stage, try and encourage the non‑employed spouse to get involved in other things, whether it be social groups or take up a hobby, also with the child maybe join a team or some sort of a club to keep them occupied in new ways. That will help them dealing with the stress of a parent being deployed.

Also, one thing a lot of soldiers like to do is to videotape themselves reading children's books or actually a tape recording of them talking with their family or their child, so that can be played over and over during the deployment. It's almost like the child can listen to their parent reading a bedtime story every night. Even if it's a same story, it doesn't matter, the kids love it. That's something to also please encourage these families to do.

I think what we want to do now is dive into deployment, and there's only one of us on the panel that's got any experience with this. That would be Sharon, so, Sharon, I want you to talk about not only the insight from the soldier's perspective but what do you think, as a pediatrician, maybe families can do to make it easier for the kids?

Sharon:  Yes, deployment is very challenging for families, especially military families who are early in their military career. Very often these parents and are very young, many times less then 22 years of age. To all of the sudden be given the responsibility of taking care of the household, managing the budget, being a single parent, what we refer to as a "geographic single parent" can be very challenging for them.

I think also that just prior to the soldier actually leaving physically, the training component before entails a great deal of "battle buddy bonding," is how it's sometimes phrased, so that soldiers begin to become united with the people they're going to be fighting with, so that they'll be cohesive. They'll understand all the nuts and bolts of entry, seizure, search, all of the different activities they have to participate in the field, in the actual war zone.

Because of this ‑‑ in addition to their normal work day in preparation to deploy ‑‑ they have to spend additional time getting to know their battle buddies very well, which takes time away from their family. This is a phenomenon that many families have a hard time understanding. In fact, it's often not verbalized well, so that the family can appreciate its importance.

Consequently, a typical military family just prior to deployment, if you were to go to their home, you would find the living room is just absolutely saturated with equipment. And all different kinds of instruments and clothing, boots and things that have to be taken with the service member. The whole house smells like equipment because this equipment does have an "I've been in storage" smell.

And you can imagine then for children how focused everything becomes in that household regarding the departure of this person. And for parents ‑ wives, for example, who are going to be the stay at home parent or who are going to be remaining here in the United States while that service member is deployed ‑‑ having to work becomes for them an additional anxiety.

Partly because they feel they need to work in order to financial continue to support the family, but then they have mixed emotions about being away from there children and from there spouse prior to there deployment.

When the actual deployment itself occurs it's usually a very patriotic experience. The families often go to a certain area on the installation where huge jets are waiting to transport the troops to the places that they have to go to.

The families bid them farewell, but often there is some degree of pomp and circumstance, where you have music and people who are very excited about seeing the warriors off. In fact, we have established over the last seven to eight years a concept called the "Warrior Ethos," which means that instead of allowing the public to think this is just another job like everybody else's job, we have come to understand this is so far above and beyond the call of duty, when you think about typical jobs in the United States.

So recognizing a person is in fact a warrior and that they are spending every waking hour not only trying to survive but also to make sure there comrades will survive, and that they successfully execute a mission and that they do so with the least amount of what is referred to sometimes as "collateral damage," all of these things are important concepts for all of us to understand.

When the children therefore find their parent is gone, though, this particular component ‑‑ the part that has to do with esprit de corps and morale ‑‑ is gone, because the service member is gone and a huge void very often is left in the home. You don't have all of that equipment, you don't have all of those banners and other things that would remind a child of the fact their parent are sacrificing so much for them.

And consequently the children begin to experience some of that let‑down that so does the remaining parent experience. I think the first thing that becomes apparent is the sense of insecurity, and particularly it is a simple insecurity, the insecurity of the home. I hear very often from my parents, and I have experienced this myself ‑‑ is that sense that your home is really not as safe as it was when this person was in the country.

Many of these families have already experienced a sponsor leaving to go for training, but they're in the country, they can be reached by telephone. They may be in another state, et cetera. But when they leave to go to a war zone, there is that additional factor that they may clearly not come back, or they may not come back the way that they were.

So we find sleeping difficulties are so ubiquitous in this population. Our children are often up late at night. They sleep with there parents. And mothers describe getting up very often and walking around the house numerous times during the night checking the locks and checking the doors over and over again, as if they haven't done it before, and yet but not being able to stop themselves from doing those kinds of behaviors.

Mark P.:  And then I think when the psychologist they're listening or they're working with these families prior to deployment, with families that I've worked with, there's a repeating theme that the children, their foremost fear is a break‑in to there house, because the soldier is leaving. And that is where most of the fear is coming from so it's not surprising that the stay‑at‑home parent would be checking and doing things trying to make the child feel more comfortable.

This often leads to nightmares. And one thing that I recommend is the families that when I'm talking to them and their child is having sleeping difficulties, is to have the soldier leave behind a pair of combat boots. You put them under your bed, and that keeps all the monsters away.

Sharon:  And it works very well. The other point about sleeping difficulties ‑‑ and that's a very good one ‑‑ is that in the school, teachers and psychologists can have a clue that sleep dysfunction is emerging because these children will fall asleep in the classroom.

And that should be a first marker to begin a dialogue with the family, about what can we do, how can we help you and the child.

The other component is that because mothers ‑‑ and I'll use mothers as the most common stay‑at‑home or remaining parent - because mothers are wanting to support their children they set aside their normal structured behavior, which can of course make children feel that things are even more at odds with what's supposed to be happening.

And very often I hear my parents describing their children not being able to go sleep until very late at night. And I end up saying, "What time is bedtime? And what time does your child actually go to sleep?

And the parent can't tell me a bedtime anymore. "Well, I just let them sit on the couch until they fall asleep," which of course is not a good thing. And it's very helpful if we reinforce for parents to have significant structure. More structure perhaps then they had before, because this is what tends to make children feel more secure.

And they can predict. "This is what's supposed to happen next. Oh, it's bath time, and then there's going to be a story, and I know I have to get into my bed." Even if I get up and I go get into mommy's bed, at least it started out the right way as compared to me sitting in front of a cable television channel until I am so exhausted I'm done.

So that's one of the simple things that you can see. Children can also regress significantly. Bed wetting, starting to have difficulty with even sometimes there language. I have some children who begin to baby talk and parents will be distressed about that and not understand why it is that this child's having such regressive behaviors.

But it is important for us as a support system to help the parent know this is not unusual, however we should not encourage it, we should try to find a way. And we should avoid phrases such as "good" and "bad," because the child isn't being bad.

We want instead for the parent to use terms such as "big" and "small." "Small kids do that, but you're a big boy and this is what we want you to do." And that takes away the negativity of parental discipline in that situation.

Mark P.:  Yes, the child is going through grief and those of us that are in the schools know when children are going through grief or trauma, sometimes it manifests itself to look like ADHD.

And many times folks will jump to conclusions and put that label on a child inappropriately, especially in incidents like these where we've got a child struggling through a deployment and in the classroom they seem inattentive, they have a difficult time staying in their seat, they're talkative. All these characteristics that are normally ADHD, isn't.

And that's something that I think the teachers of these children need to know. So I would encourage the listener to encourage the parent to let the teacher know that the child is experiencing a deployment with a parent and if you can repress ‑‑ especially as to a return, because emotions are on just a huge roller‑coaster throughout the entire process but particularly in the anticipation of a soldier returning.

It's tough for the child to function, you know, whatever normal is, as normal.

Mark S.:  I know the use of community and social supports can be a protective factor. I'm wondering in terms of families reaching out to other families of deploying soldiers, the children talking with other children in these families who are leaving can also be helpful.

Sharon:  It's very important. And I think there are two points related to what you've just said. One is that when you have a very large installation, such as Fort Bragg, our families are scattered over nine counties. They live in nine counties. Not everyone lives on the installation.

In fact, when you have a very large installation, usually a very small percentage of your soldier population will live on the installation because you just don't have that much housing.

Therefore it isn't unusual for children and mothers to be relatively isolated, sometimes in rural communities, where if you're fortunate, they are around other military families, but they may not be.

And there is this anxiety that parents will have of letting people know that they have a deployed family member because they're fearful that individuals will then take advantage of them or perhaps break into their house or victimize them in that manner.

So on the one hand we do want them to reach out so that they can have that camaraderie and that support. On the other hand, they are fearful of allowing people to know what is going on for them.

And I think also, Mark, the other point that you made about ADHD issues is that we clearly underestimate the amount of anxiety that our children experiencing in this situation.

In my clinic, when a parent might bring the child in for the purpose of not paying attention in school ‑‑ father recently deployed or has been gone for three or four months, didn't have this problem before ‑‑ one of the first things that I examine are their fingernails and toenails because these children will eat their fingernails down to the hub.

And their parents are always stunned when I ask the child. "And so do you bite your toenails too?" And the child looks very sheepishly and says, "Only at night."

But it's really a part of assessing children better, to be looking for this issue of anxiety, because when parents are so anxious themselves that they can't pick up on the fact that their child's attention difficulties and distractibility are not so much related to your primary ADHD but more so anxiety.

Mark P.:  And I think there's a difference, Mark, between when we're looking at active duty parents, or children, rather, with civilian National Guard or Reserve kids. At least at Fort Bragg these kids all understand what it's like to go through a deployment.

But a Reserve or National Guard child, it may be in school where their dad or mom is the only one deployed, and they're out there without any support. Needless to say, the non‑deployed spouse who doesn't have a support group, at least in comparison to what on army installation support groups that are there because so often these families rely on each other.

I recall at Fort Bragg several years ago at the beginning of the Middle East war we tried to do a social activity where we had representatives from all backgrounds, got psychologists, Red Cross, and we wanted to have a forum and invite parents to come so we could answer questions about support groups that were available. And we were on the radio publicizing, we sent flyers home with every kid, and then when the time came, nobody showed up.

We had a handful of parents, and so we had an intimate dialogue with them, but we said, "Where is everybody?" and they said, "Well, a lot of parents don't think they need this because they have each other." So there's a strong bond with these military families, and I don't think in the National Guard and Reserve sector that that's as prominent.

Mark S.:  I think that's really a critical point in terms of for our listeners why it's important. One of the roles, of course, as a school psychologist is a consultant. And as you're indicating, Mark and Sharon, they may be the only child in their school who is experiencing this. So our listeners can come up to speed on some of these issues and sort of think what role as a consultant to other educators in fact.

In Illinois, there's a state‑wide program to reach to other educators to give them the information about the kinds of things both Sharon and you, Mark, as well, are talking about in terms of common reactions, support services that are available because there's a tremendous amount of misunderstanding about this.

Mark P.:  And let's talk more about that sustainment stage and what families can do during the deployment. One thing we like to try and encourage families to do, the groups that I've work with, is to keep a calendar that marks significant events going on in the child's life. Whether it be a ballgame or a play or a good score on a test, but have like a book or a diary that they can share with the soldier when they return.

Another thing we like to try and encourage them to do is create maybe like a chain of paperclips that represents the weeks or months that the deployed soldier is away and they can take a paperclip off every week that goes by. So they have a visual reminder that it's coming, you know, Dad or Mom's going to be home soon. There's only five paperclips left.

Sharon:  One of the things that we sometimes ask our parents to do when sleep issues are present is we ask the parent to silk screen a picture of the deployed family member on the child's blanket for their bed. So that when they get ready to walk into the room to go to bed at night, they see their parent's face and it makes the child feel a little more secure about the fact that, "Well, you know, maybe Daddy's really here with me," or, "Mommy's really here with me."

And the other piece is that some of our children are children of single‑parent deployed individuals or are children of dual‑parent deployed individuals, which can be very challenging, as you can imagine. Therefore we have alternate caregivers. Usually the caregiver is a family member, an aunt, an uncle or grandparents.

But that requires even more support on our part because these wonderful people who've chosen to step in and take care of their grandchildren, for example, are not necessarily seriously knowledgeable about the challenges of military life. They themselves have sometimes relocated to take care of the child in the location we are. Because living on a military installation can be less costly. In some respects if you live on post housing you have very little electricity, telephone, those kinds of expenses are not present.

And you can also facilitate and use our on‑post facilities such as our commissaries and post exchanges and et cetera, where things are less expensive. So we have grandparents that will relocate for that purpose.

And I think providing support to the grandparents under that rubric is also equally important to help them understand what's going on.

Mark S.:  Important, that idea of sustained communicating, I know there is a move in Illinois to look at more game playing. And I know, Mark, you had mentioned at the outset that not all our service members have access to computers, but those who do, in terms of some experimentation where they can play games together on the Internet as a way to kind of keep in touch with each other.

I also know we kind of touched on it earlier but the whole idea of biblio‑therapy, the idea of books written for children as well as teenagers and families on coping with deployment.

There are other aspects that I think, again, as school psychiatrist the more we're aware of these resources the more we can suggest them not only to the families but to the other educators that we work with.

Sharon:  Don't you also think that if you are a school psychologist in an off‑post environment, so therefore the children that you’re caring for are not highly ingrained in the military culture, that it's important to validate a child's fears?

Because children will hear from their family members ‑‑ not directly spoken to them ‑‑ but issues of people who've gotten killed, certainly we will hear of a person in a unit that gets killed and the whole unit really focuses around that family. But of course all of that trickles down to those individuals who haven't lost a family member in the war and a child's anxiety can dramatically rise.

And I think if a school psychologist is providing some support to that child, it's important not to give them the impression this can never happen to you. Because then I think a child would feel they would have to keep that back, or keep that fearfulness back. Would you agree, Mark?

Mark P.:  I would. And the other thing I would add to that is with the non‑deployed parent, they're going to be very abreast as to what's going on in the area where the spouse is. And children often read the parent to see how they should feel. So if the stay‑at‑home parent is crying, say for example, or very emotional, very upset, then the child is going to be like that nine times out of ten and take it to school.

And sometimes the parents don't know how to handle providing information to the child. But I challenge the listener to tell the parent to remember no news is worse then bad news. And they need to know ‑‑ to a degree, no gory details ‑‑ but they do need to know what's going on.

And also I don't know that parents, at least all parents, understand that even though they are children, they do feel stress and anxiety just like they do. And that something that is overlooked in some instances.

Mark S.:  And I think the school psychologist can be helpful in working with parents and not only encouraging them to communicate, but communicate in a developmentally appropriately way. Depending on what obviously what you say to a five‑year‑old is different than what you would communicate to a teenager.

Certainly the kids are aware and it's a tragic reality of the situation and that, as you're suggesting, death is a possibility, and this creates a whole new set of experiences for families. I'm sure one of the first things they think about, Sharon, you mentioned earlier this idea of the reality that this person may not come back.

Sharon:  Precisely.

Mark S.:  I think for those of us that aren't in the military and haven't gone through this, it's hard to imagine how that must feel.

Sharon:  Absolutely. One of the things that I think is helpful is that during the sustainment period, should a crisis occur in a family ‑‑meaning without the service member being aware ‑‑ we do have the option of notifying the Red Cross and bringing that service member back. We certainly have done that on numerous occasions for things that the stay‑at‑home parent may not recognize is a crisis.

That's a very important component. If we have a child, for example, who is very distressed and having major psychological and perhaps psychiatric difficulties and is just really in dire straits, if we're considering hospitalization or if we're considering out‑of‑home placement or residential treatment, et cetera, that is something we would absolutely notify the Red Cross about.

Because the deployed service member would need to know and could not do anything in a war zone about that, and has not only a right but it is our duty to support his family or her family to that degree. And therefore it's not unusual for me to notify the Red Cross for various reasons.

Sometimes mothers ‑‑ and this is another phenomenon that can happen during the sustainment period ‑‑ mothers may become ill, and don't want their spouses to be aware because they’re trying to support the spouse. And they can get very seriously ill and try very hard to hold it back.

And when that occurs, it can be really counter‑productive to the relationship. Because then later if the soldier finds out from the Red Cross or in other ways that his wife, for example, has a brain tumor and has had surgery and is getting chemotherapy, there is not only guilt and self‑blame that begins to grow in that relationship becomes very detrimental to the integrity of their relationship.

So we have many roles to play with respect to not just supporting the child but supporting the family, and helping them makes the right decisions. Yes, it's good to support your spouse, but let me tell you, your spouse would want to know this. And this is something we would want the battalion surgeon wherever that person is to be aware of.

Any message that comes any where from the Red Cross doesn't go directly to the soldier. It goes to the battalion surgeon, who makes a decision about what impact this would have on that soldier at this particular moment. If they’re in the middle of a special assignment that is very dangerous, et cetera, they'll decide whether or not we can afford to let this person be aware of this at this moment in order to keep that person safe.

Mark S.:  Are you suggesting sometimes they may even bring the service member home?

Sharon:  They will definitely do that and they'll bring them home very quickly. They certainly will.

Mark S.:  I suspect the school psychologist, because the school is such an important part of the child's life, if it's the reaction of the child, to be involved with communication.

Sharon:  Definitely.

Mark S.:  So the communication then goes through the family then the family to the Red Cross.

Sharon:  Usually it goes to a healthcare provider. Usually Red Cross requests have to come from the healthcare provider if it's about mental health or physical health. If there's been a death of a close family member then it comes typically through the chaplain, who will notify the Red Cross to let a soldier know his mother died or some immediate family member died.

But we always have to verify. Before the Red Cross will send a message it has to be verified that by one of us in the healthcare systems that it is legitimate.

Mark S.:  So if the school psychologist had significant concerns obviously they would be communicating with the family. But in terms of consulting with the family they would suggest then they would go to their family physician.

Sharon:  Precisely. Or the school psychologist could get the family to sign a consent and then dialogue directly with the health care provider.

Mark P.:  Earlier I talked about rest and relaxation what that is. I think we would be remiss not to hit that, because on the cover it sounds like that would be very, very happy, nice, perfect, rosy time. But what I want to do is open dialogue about the rest and relaxation period. It's about a week and it occurs midway through the deployment.

And the idea behind it is to not only give the soldier a break, but also get the family back together to rekindle at least for a week more normalcy. But we have found that a lot of times, even though it's a happy time, it's a very nervous time as well.

Sharon:  It can be. It's usually during the mid‑tour that soldiers will get this particular break. Although some soldiers can make a special request to have the respite break at a time of a birth of a child or some other anticipated event, so they can come home specifically for that, which is always very nice.

Its two weeks, but one week is travel. It takes a week very often to get back to your family, and then you only have one week. You're exactly right. And what we see very often is that mothers who have been staying at home or the caregiver who been staying at home feels the time has come for them to have respite, as well as the soldier.

So I was telling Mark that sometimes I will see children come into my clinic for refills for their medicine for ADHD and it's the father that brings them in. And I'll say, "Oh, I'm so glad to see him. What dose is he on?" And of course they will have no idea. And they will say, "Doctor, I have no idea of anything, but my wife told me it's my turn."

And that dynamic absolutely exists, because even though our family members who are still here in the country are supporting their spouses in what there doing, they also have experienced a significant feeling of "what about me." They definitely have that feeling. And when that person gets a chance to come home they’re really wanting to take a vacation sometimes. "You can have the children and I'm going on a cruise."

Mark P.:  Tag them on the shoulder, "It's your turn."

Sharon:  Right.

Mark P.:  And I think what a school psychologist can do in working with families prior to this event occurring, is to try to establish with realistic expectations. Now granted, that's got to go two ways. The soldier has to come home with realistic expectations and the family has to be realistic as well.

I don't know what the soldier is really, really needing when they come back. Some of them have been sleeping in ditches for weeks and weeks and what they want is a warm bed. Some of them only get showers once every couple of weeks.

So I think there has to be communication. Please encourage your families to communicate very clearly between the deployed spouse and non‑deployed spouse prior to them coming home on what each is going to realistically want.

And then of course brief the children that this is your father or mother, the same person. They may seem different, they may look different, but they are the same person that left six months ago.

Sharon:  I think as you talk about individuals coming home before the end of their deployment, there is that other scenario. We have the soldier that becomes wounded, and is brought home as a wounded warrior. In fact, most of the military installations have specific battalions that have been set up that are referred to as "warrior transition battalions" or "wounded warrior battalions."

These are typically soldiers who have not sustained a necessarily life‑threatening injury, but an injury that doesn't allow them to remain in a war zone. We certainly do have soldiers who have had life‑threatening injuries as well, but they don't typically come right back to the installation.

They usually are taken from a war zone to a major medical treatment facility. The most common one is in Germany . And they are stabilized and undergo important surgical procedures there and then are air evacuated back to the United States . Usually to a very large treatment facility such as the Burn Center at San Antonio or Walter Reed Army Medical Center or Bethesda Naval Medical Center. They are specifically‑sited large medical treatment facilities for this purpose.

So if you have a wounded family member in that sense, then the family begins to go back and forth. And fortunately the military has been very lucky to have corporate entities that have established houses very similar to the McDonald's houses at military hospitals like this. We have one at Fort Bragg that was donated by the Fischer Company.

So we still have that linkage, but that's where you have that additional stress, because specifically there's a traumatic brain injury involved and the soldier is walking and talking but has major difficulties with reasoning or communication, et cetera.

That's where the soldier sitting there in the home looking physically pretty reasonable, but may in fact may not be able to manage in a manner that the family had anticipated in the past.

Mark P.:  So rest, relaxation occurs, a soldier leaves, and when the get back together again that's reunion stage. And that is again another very happy time but also a very nervous time. And when you look at what the families have gone through over that deployment period, the non‑deployed spouse has had to be father and mother, learned independent skills, become the disciplinarian, and basically assume all the rolls and responsibilities of two parents.

So when the reunion stage comes around, the soldier returns and this is when there really has to be a renegotiation between parents on who does what. And the idea is that, especially with the reintegration process, getting life back to normal or getting life back to the way it was, but it's a very trying time not only for the soldier but for also for the non‑deployed spouse.

Sharon:  I'm laughing because I was sharing with Mark last night a family where one of my children who has mild developmental problems ‑ he was seven years old. And as I was talking to the mother, just for a routine follow up, she says he's doing fine but he's having trouble sleeping. And I'm thinking, why he is having trouble sleeping?

"Well, my husband was deployed but he's coming back now. And actually my son was sleeping well in his bed while his father was gone, but when he returned he wanted him to come and sleep with us because it just made the dad feel better, you know I got my child with me."

I said, "Well, I understand that, I understand that. When did the father come back?" And she said, "A year ago. And that's a good example of how renegotiating rules in the household can become difficult, based upon where psychologically that soldier is and what he wants to see happening in the family.

Mark S.:  Well I like to think of it really as adjusting to a new normal. It's not the same, it's never going to be the same as it was. It's trying to adjust stuff. I know one of the protective factors they find, and I think in some families this might be more challenging, is more flexible gender roles then what they would suggest.

Sharon:  Oh yes.

Mark S.:  Of the spouse at home not always, but sometimes the female is taking on different roles and now its letting go of those roles, renegotiating. And of course the more flexible parents can be better. Also roles in terms of discipline of the kids and how they react. As I mentioned in the beginning, we've been doing some research with the Illinois Reintegration Program.

I guess it's important to mention most soldier's family do readjust, reintegrate successfully. But some don't. Some of it revolves around these issues of the spouse renegotiating roles, the roles with discipline, with children. Sometimes soldiers may come back and expect the culture of the military, kids responding to orders, and so it becomes more challenging.

Sharon:  Definitely.

Mark P.:  I think the other thing too, Mark, is those soldiers that come back with combat stress or PTSD really makes it a whole new ball game. The expectation is that everything gets back to normal. That's hard enough. But if you're coming back with some combat stress or these other traumatic issues it makes it even more challenging.

Sharon:  And we can see some recreational behaviors that are not necessarily in the best interest of the child, when service members return. For example, many service members will come back having spent ‑‑ in their downtime in a war zone ‑‑ lots and lots of hours playing video games quite a bit.

And then when they come back the only way there children can interact with them is if they're willing to play video games with them, because the parent feels this is a great way for us to have fun. Of course for those of us who take care of young children, the kinds of video games that would entertain an adult male or not the kinds of video games that we would want young children to spend numerous hours with.

Plus the service member is role modeling to those children to those children that it's not necessary to read books, it's not necessary to go outside and play, it's really OK for you to sit for hours at a time playing video games.

Now these service members are going to work every day just like our children are going to school every day, but when they come home they are not necessarily taking the children out as the non‑deployed spouse was doing.

So here's a non‑deployed spouse who has adjusted, and taken on some of the behaviors, Mark, that you were recommending that helps children with resilience, team activities, et cetera. Which are not necessarily continued by that returning spouse who's been at war.

Mark S.:  Some of this, too, is kind of more adrenaline‑seeking kinds of behaviors of the more violent video games, give that intense high that one might experience in war. Also, I know there are some instances of reckless driving, and just adapting.

I think this gets back again at really the community's role in trying to understand. I know, in Illinois, part of our reintegration program is to work with local and state police on understanding ‑‑ I think what we can only imagine what it would be like to be so hyper‑vigilant when you're driving in Iraq and then you come back, what that must be like driving on our interstates..

Sharon:  Yes!

Mark P.:  Well, but not only that, but when you are driving in Iraq they are looking at every little piece of trash on the road because it could be a roadside bomb.

Mark S.:  Yes.

Mark P.:  So when the soldiers return, and they are driving and there is a piece of trash in the curb they are afraid of it. I mean, that's just common human nature.

Sharon:  I've had soldiers and families to talk about the fact that if the wife is driving the vehicle, and she's driving on the right lane of the road, some soldiers can become very anxious because they feel the wife should be in the middle on the yellow line. Because that's how you would drive if you were trying to avoid IEDs.

So they are literally sweating, holding onto the sides of their seat in the car. Very anxious, very nervous about the fact that they are not in the middle of the road. Even though cognitively they do understand, they can't override those feelings of anxiety.

Mark S.:  Hyper‑vigilance that was such a necessary survival strategy. I also understand, and have seen many service members when they return the first thing they buy is a Harley, and they go out, and they kind of race around.

Sharon:  And it's the biggest dealership in Fayetteville. It's a two‑story store!

Mark P.:  That's right. That's right.

Mark S.:  It's all kind of the speed again to create this, and that is a challenge for some of our service members returning, and obviously it has an impact on the family as well.

Mark P.:  It is a big adjustment period. In fact, Sharon was talking the other evening about when soldiers return, there may be a tendency to go reckless with spending.

Sharon:  Yes, yes we've definitely seen that, and that can have a major impact on a marital relationship. If you have a non‑deployed spouse who has been home for a year or 15 months trying very hard to handle the budget correctly, and sacrificing, in fact, financially in order to make sure that everything is going to be on the up and up.

And then when he or she meets their spouse who has returned, and the spouse gets off the plane saying, "You know, I'm never going to deny myself again. Anything that I want, I'm going to get." We've had cases where returning spouses went out and bought a new house within a month of returning from deployment, and not necessarily putting their spouse’s name on the house note!

So I think that it is important to recognize that some of our returning service members have a shortened sense of future. So they have a need for immediate gratification, now, of material things they may have put off in the past. Which can really cause major marital stress.

Mark P.:  Mark, part of what Illinois is doing is that when there are three‑fold full reintegration program. I really like that. If you could talk about the three phases that you include, and stress the point that the whole idea is to really instill hope with these returning soldiers.

Mark S.:  Kind of the figure that is used to kind of communicate is kind of a three‑legged stool. The seat, the base is soldier, but then the supporting legs are the family, the community, and the employer.

I think what Illinois has been is one of the leaders, along with Minnesota and perhaps other states as well. I know now the whole idea of a reintegration program is mandated federally, and each state is kind of in a different stage of developing that program.

In Illinois, as I mentioned, they kind of view it as this three‑legged stool. Although it started out primarily focusing in reintegration, they've expanded it now to really understand that reintegration is a process and not an event.

What it includes is there are family academies that occur 45 days prior to the unit's return to the United States . That's open to spouses, significant others, other family members, parents, siblings, where they really try to educate the families regarding what kinds of reactions they might see, and many of the kinds of things we've mentioned here are included in that discussion.

There's also community awareness events, where they invite law enforcement, government officials, physicians, mental health specialists, educators, where they try then to educate the community, not only on what to expect, but how that can be helpful.

Again, this idea of social support I think is so important. We're in, tragically, now wars that most of us don't have to sacrifice. It's not something on our mind every day, and so the education of the community is very important. In fact, some people might have seen in "Time Magazine" recently that they had an article where they identified these sanctuary communities.

I know in Illinois they're using the term "yellow ribbon" communities. These are communities that are particularly sensitive to this. This is something they're trying to initiate. Then there are two events as part of the Illinois program, whereas the family academies and the community, awareness events are obviously voluntary.

There are two events that are mandatory for the soldiers. That's a 45‑day event, which consists of some large group sections on trying to normalize some of these reactions, and then particular breakout sessions on topics, employment, benefits, single soldier needs, reconnecting with their children, etc.

Then there is a 75‑day event that's kind of unique in Illinois in that one of the focus groups in kind of a group therapy format. They're facilitated by trained mental health counselors. They try to deal with particular issues relating to anger management, different types of compulsive behaviors like gambling, substance abuse with issues related to reconnecting with your spouse.

Then there is a 90‑day event that is just for the soldiers where they go through a more intensive physical and mental health screening.

I think some of the things we've learned is again, it's not something you can mandate. It's not something that you can hold a briefing and everything is going to be fine. It's really a process. It's really the family, the community, and the employer supporting our service members.

Mark P.:  I've heard some soldiers refer to feeling like strangers in their own body, because of the intense thoughts, and the intense memories of combat. So, support is really done correctly.

I want to thank everyone for being on the panel today, and their professional dedication to military families.

To the listener, I hope you've enjoyed listening. I also want to encourage you to listen to our other podcast on reintegration reunion. If you've got any questions, you can send them to me at mark.pisano@am.dodea.edu or you can call me at 910‑907‑2000. My extension is 3087.

So again, thank you for listening, and strive to be a charismatic adult in a child's life today, won't you?

Dan:  That concludes this dialogues podcast. Please tune in again for future dialogue podcasts available on the NASP website.