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NASP Dialogues: Military Families and the Reintegration Process

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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 reintegration process and the impact on families in the community.

I'm going to turn it over now to Mark Pisano.

Mark Pisano:  Thanks, and what I'd like to do is welcome you to the podcast and ask the panel members, a very distinguished group, to give us your name and your connection with military families. Let's start with Dr. Sharon Cooper.

Dr. Sharon Cooper:  Hi. My name is Sharon Cooper and I am a developmental and forensic pediatrician. I'm also on the faculty of the University of North Carolina at Chapel Hill. I am a retired military officer. I retired as a colonel from the Department of the Army and served as the Chief of Pediatrics for six years at Fort Bragg Womack Army Medical Center which is the largest pediatric population in the Army.

Since that time for the past 12 years, I've devoted my care of military children, medical care of military children, specifically in my area of expertise which is developmental pediatrics and behavioral pediatrics, as well as that area of childhood treatment. I'm glad to be here. Thank you.

Mark Pisano:  Mark.

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

And my work with military families has fallen into two areas. I am a Red Cross mental health volunteer. And in our community we had an initiative called the Porch Light Initiative where the whole community got together in terms of trying to provide services to soldiers and their family members and I was involved with that.

And then more recently, we've worked with statewide with our Illinois Army Reserve National Guard at Illinois State University providing a program evaluation of their statewide reintegration program.

And I, as well, am very pleased to be here. Thank you for the invitation.

Mark Pisano:  And my name is Mark Pisano. I'm a school psychologist at Fort Bragg schools. I've been there for 27 years. And, I'm also the stateside coordinator for the military families interest group for NASP.

Our goal today for about the next 50 minutes is to make you more informed about military reintegration and what school psychologists need to know to assist their families and communities in this process.

And, keep in mind that reintegration is a process. It's not an event. It can take up to about seven months before the service member feels comfortable being back home. And, we have a very exciting model to talk with you about today that's being used in Illinois with their returning National Guard and Reserve soldiers.

In fact, that will be our future segment for this podcast. So, please stay tuned.

Most of you listening are not working at military bases. Worldwide though, I want you to know that 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 very proud of that.

So, since you’re not working on military installations, you are more than likely serving natural born reserve families. And, some of these families have never experienced a deployment and don't know what to expect. Others have been through deployments before. But routinely, these families have declared that dealing with deployment doesn't get any easier the more times they do it. And, this is true both from active duty families, as well as civilian families.

In fact, there's 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, the prolonged and multiple deployments are taking their toll on many military families as evidenced by the escalating divorce rate which presently is at 3.5 percent of its 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 relations to the test and too many of them fail.

In January, just last month, you've probably read or seen data from the Army that revealed there were 17 suspected suicides compared to 16 combat deaths. In 2008, there were 128 soldiers of suicide which was the highest yearly number on record. So, these families need some help. And, we believe we can help you to give it to them by listening today.

I invite you to also catch another podcast we're doing on the Deployment Cycle and the Emotional Challenges Faced by Military Families During Deployment. That will also, I think, be well worth your listen. So, please try to catch that.

Let's turn our attention now to the reunion and reintegration of these military families and their returning soldiers. But, let's first get a working definition for what we're dealing with today.

Reintegration. It's the act of helping soldiers return to the lives they left behind. And the goal is to get back to normal. The problem is that many service members have forgotten what normal is. There are many dynamics that impact the reintegration. One of the biggest ones is that over these many months family members change. They've been through a lot and they're bringing to the table different things from before the deployment.

Dr. Sharon Cooper:  That's correct. What you often see are that the non‑deployed spouse has adjusted his or her behavior to become a geographic single parent taking care of children. And in that process, has taken on roles that may have been previously the role of the soldier who has deployed.

And sometimes when that soldier comes back, the non‑deployed spouse doesn't really feel that they weren't doing a good job. And, it's sometimes hard to relinquish that responsibility.

In addition, that person who returns has been through some major psychologically, sometimes traumatizing events. And, the presence of anxiety, depression and PTSD are certainly issues that can impact upon their ability to parent in a manner that causes children and families to feel that they have a stranger in their home.

Very often these individuals are more withdrawn, have less happiness or sense of happiness. And, all of the family begins to feel that we didn't know it would be this way when this person came back. So, they can be very disenchanted by that process.

And I think one of the other challenges from a school perspective is that the stay at home...now the non‑deployed spouse often has put school as a priority and has been trying very hard to work with children on homework and making sure that things are going OK. And when that deployed spouse returns, school is not a priority.

It is not unusual for me to see my patient population, parents, recently returned spouses who take their children out of school altogether and will say, well, I just want to spend time with them. I don't want them to have to go to school, that doesn't seem necessary, etc. And, that may be a holiday to some extent for the child, but it's not necessarily in the child's overall best interest. So, we do have some real challenges in that sense.

Mark Pisano:  And when the soldier returns, the children have become more mature, the non‑deployed spouse has learned new skills, learned to be the disciplinarian, the financial expert. I mean all these things that have been working like a nice machine in now interrupted with the return of the soldier.

Mark, what are some things you could tell us about with the reunion phase of the reintegration phase that is along these lines?

Dr. Mark Swerdlik:  Well, one of the analogies I kind of like that we use as part of the statewide mandatory reintegration program in Illinois is the idea of a canoe on the sea of life. And I think this is helpful. If anybody's been in a canoe, you know it can be easily toppled.

So, you have kind of a family in the canoe on the sea of life and everything is going smoothly. And then all of a sudden, the soldier gets the orders to be deployed and it's like everybody's standing up in the canoe. Everything is rocking. What's going to change? Obviously, there's fear associated with it, the unknown.

And then what happens is as soon as they start to adjust to that, somebody jumps off the canoe. The deployed soldier jumps off the canoe and the rest of the family is left in there. And then as you just mentioned, Mark, they renegotiate roles. The remaining spouse takes over. And all of a sudden things are kind of smooth again on lake, obviously missing the service member but things are moving along.

Then during the reintegration process, somebody swims to the canoe. The deployed soldier comes back, gets back on the canoe, and as you were indicating, there is a whole host of issues that come up.

In Illinois they have approached this by implementing a statewide reintegration program. I do want to acknowledge, though, the developer of that program, Second Lieutenant Justin Anweiler. We had hoped he could be with us today, but was unable to make the trip. And also the support of his commanding officer Colonel Heard‑Thompson, who is now retired, and his current commanding officer, Colonel Schweigert, who is very supportive in these efforts.

I've gotten to know more about the Illinois program through my efforts in our team at Illinois State University to evaluate the effectiveness of the program. Basically the program focuses on soldiers returning from war. It is a mandatory program for them.

There are volunteer events for family members, spouses, significant others, parents and siblings. The program again was designed to benefit the soldiers, their families but also community and civilian employers. The goal is to better prepare the soldiers and their families and the community for successful reintegration of the soldiers.

I thought I would talk just a little bit about the various components of the program and also refer back, Mark, to what you were saying and that is, things are not normal. When reintegration occurs, I think, what families and people in the community, employers and other have to realize that the normal that service members and their families knew at one time is really gone forever.

What it is is helping them find a new normal and that really is what reintegration is all about. I should mention for our listeners, before I go into the components, that Illinois has been a leader along with Minnesota, perhaps some other states, in terms of developing these reintegration program.

But now it is federal law that all states for their national guard as well as the active military have to have some type of reintegration program.

Mark Pisano:  And it's not consistent is it, Mark? One state can be doing something completely different than the next.

Dr. Mark Swerdlik:  Exactly they recently held a conference in St. Louis called "Tying the Yellow Ribbon Conference," which was open to representatives from every state. Although I didn't attend the conference I was talking with some who did. What they shared with me is every state is different. They are at different points in terms of the development of their program.

Some are mandatory for service members, others aren't. So I think our listeners, one of the things they may want to talk with families, perhaps representatives of national guard in their communities is what kind of reintegration program the families have actually experienced. Some of the reintegration programs in fact include many events for children as well.

In terms of the different components of the Illinois program, there are what are called family academies and really the goal is to empower and prepare the families so they can address the effects of combat stress and other reintegration issues on families.

These events occur 45 days prior to the return of the unit to the United States . Again, it's open to spouses, significant others, parents, siblings and others. There's a variety of breakout sessions available that are conducted. Some are conducted by combat veterans themselves who have recently returned.

A chaplain conducts some of the sessions, local mental health, community agency personnel conduct some of the sessions. They are just basically breakout sessions, a menu of different topics that includes things like reconnecting with your spouse, helping facilitating the returning service member to reconnect with their children, issues about medical and education, benefits issues that the employed or the returning service member may deal with with returning to work or returning to school.

Some of the things we know is sometimes that adjustment is difficult for the returning service member. Particularly some of the issues post‑secondary education is dealing with because there are a large number of service members who return from war and then drop out of college. They try to go back and it's very difficult to reconnect with their peers who have had a very different experiences.

Mark Pisano:  This, Mark, I think is a really critical period in that anticipation of return, for school psychologists to maybe work with the child and the non‑deployed spouse to alert them as to what expectations, the realistic expectations should be with the return.

And I want to talk about what we can share with these families in regard to what the soldier has been through and what they are coming back to. And what the needs are for the soldier and what the needs are for the family.

So if Sharon could talk about what the soldier is looking for upon return from a deployment, it's sometimes not exactly what the family is expecting.

Dr. Sharon Cooper:  That's correct. Very often when active duty service members return they do want solace and they do want rest and relaxation but they also want control. Because control is very similar to structure in their mind's eye.

And when they come back to a household, for example, that has a totally different structure from the one that they left it causes them to feel more anxious as if they don't belong, as if they don't know what role they are playing in that household.

Consequently, they want to be able to exert their position as a parent and as a spouse and sometimes that's not well received. Some of the dysfunctional behaviors that we can see in service members' return in respect to their children, has to do with their accepting things that have happened to their children during their absence.

For example, if a child is determined to have a developmental disorder during the course of the service member's deployment, and is receiving special services such as speech therapy or occupational therapy, it is not unusual for the service member to resist that implementation.

And part of it of course stems from the fact that the non‑deployed spouse has been through their grief process over the fact that the child has a developmental problem and has already gone through anger and denial and is often at a point of accepting what's going on with the child and moving towards a therapeutic solution.

On the other hand, this newly returned spouse is back at anger and denial again. So you have a couple who are not on the same sheet of music and the child sometimes is the one who suffers from that perspective. We particularly see that in early intervention scenarios where you have very, very young children who are demonstrating a need for services but for whom once that service member returns that's part of their need for control… “I want you to know that there's nothing wrong with our child, you're just nervous and anxious. He's just like I was. I didn't talk until I was five. ” All those kinds of things that we are seeing.

Then a second problem that we see for service members who are returning are those who have had mild traumatic brain injury. Not so severe that they have required neurosurgical procedures or things of that nature, but who have had difficulties with memory, difficulties with anger management in particular and some of their executive function.

These scenarios can be very hard for the non‑deployed spouse to be able to adjust to, because the non‑deployed spouse can easily see that he or she is more competent at some of the everyday household tasks that need to be done. Yet the newly returned service member may want to take charge in that situation.

Mark Pisano:  I think in working with these families, school psychologists can talk with the families prior to the return about how their child's behavior more than likely will change. The child's emotions will be like a roller coaster. They will recognize, we'll just say the soldier's the father, recognize their father a little but he will look different, his mannerisms will be different, the way the person talks might be different.

There's lots of things impact the functioning of a person after going through what they have gone through in battle. Also, the impact of the return on the child will probably manifest itself in school. So the child may appear distant, may appear not to be attending, may be overly talkative, and possibly even emotional. In an instance like that, the child may be showing characteristics of ADHD, when in reality it's merely nothing more then a grief or a trauma sort of reaction after having their father or mother away for so long, and dealing with it the best that they can.

So, keep the child's teacher abreast as to what's going on with the family through the deployment cycles. Also I think the child can experience just a very broad spectrum of feelings from happiness to being afraid that, when's my dad going to be deployed again? Maybe next time he won't come home alive, excited, being able to see their parent again, proud.

There's lots of pride in military families, and I sense the same with National Guard and Reserve families as well. There's also some jealousy from the spouse knowing that the father or that the husband's gone again, wanting the attention and then, of course, worry. So there's just a whole host of emotions that are being felt not only by the non‑deployed spouse but by the children.

Dr. Mark Swerdlik:  I think this issue of community and social support is sometimes something that those of us that aren't in the military sometimes de‑emphasize and it is just critical. I know that in the Illinois program there is a strong component that involves community reintegration training, in other words events for the community including; school psychologists, other mental health workers, social workers and teachers.

I think for our listeners in who are dealing with perhaps children of deployed service members, you may want to find out or investigate whether these types of trainings are available in your communities. The goal is really to educate the community about the challenges of reintegration, what they can do to assist the combat veterans and their families successfully integrate back into their communities. Really, focus again is on challenges and what the reintegration experience will be for families, and I think this is really critical.

In Illinois they really reach out and hold separate sessions for educators, teachers and others, administrators. There's also faith‑based training where the focus is on trying to provide education, the clergy and others to understand the effects of deployment on service members and their families. So this whole area of the community, in fact kind of representation for the Illinois program, is a three‑legged stool where you have the soldier kind of the seat of the stool, and the supporting legs are the community, the employer, and the soldier's families, and so there's a really focus on that.

I know in our state there's an effort to reach out to large employers, for instance in our community, Bloomington‑Normal State Farm Insurance, the Illinois National Guard has reached out to them, thinking about how things are different in the families. Things are also different for the service member returning to work. Although they may still have their job, their peers might have been promoted, things might have changed for them.

Also, it was mentioned earlier the challenge of returning to school, where they are now with peers who have very different experiences than they did. In a sense it's an opportunity, and this is one way I think to work with the service members. It's a kind of opportunity to look at other avenues for them, in terms of their education and their future, but it also generates a great deal of anxiety.

Dr. Sharon Cooper:  If I could tap on to that, and speak of the fact that as a community bringing together the entertainment industry is also very helpful in supporting these particular initiatives. One of the things that happens very often in our community is that our country-western singers, who are very good at writing the best music you can ever imagine that support service members, almost frequently will come to do concerts or are brought specifically to do concerts several times a year, which kind of sort of bolsters the whole community to a different thought process.

I'm so grateful to our country that we learned our lessons from the Vietnam War, and have learned not to vilify service members who are serving in the Armed Forces. Because we have learned that lesson, we have taken on a new concept and that's a concept of honoring those who have served our country so that when they come back people recognize that, especially National Guard and Reserve, who do not every single day have this as their primary employment; have really sacrificed a great deal, a great deal. They do deserve not only our honor, but our support 100 percent of the way. So I think that we are as a country very much improved in that respect.

Dr. Mark Swerdlik:  Some of our research has looked at that, in terms of Illinois National Guard returning and in the sense of asking questions; did somebody you did know say, "I'm proud of what you did, and I appreciate it"? We're finding correlations with successful reintegration. So there's no question, and I think all our listeners are part of those communities, not only in their role of educators, but just as being members of a community.

Dr. Sharon Cooper:  As a health care provider, and I teach health care providers, one of the standard questions we should be asking in our pediatric encounters today when children come into our office is, "Is there someone in your family who is deployed?" That's a very important piece of information, and then if a family says, "My brother, my uncle, my dad," whomever, then we need to have one more part to that question, and it is an answer and that is, "Well, we really appreciate what they're doing for our country." That means so much to the family and will cause them to look at that health care provider as a positive liaison, someone who can seek to understand what's going on with them, as compared to criticizing them for the accommodations that they're trying to make to their children's distress.

Mark Pisano:  One thing interesting, I was talking with a friend of mine who's been through several deployments. She said that when her husband returned from his most recent deployment, they wanted to make a point to change in their family functioning some of the things that they were doing before that they didn't think was best. Like too much TV, not enough bedtime stories, and things of that nature. But she said, "You know, it just didn't happen. We went right back to the old niche, and it was so easy to do."

I think with these returning soldiers, school psychologists can talk with these families and give them a heads up and say, "Make this an opportunity. Make this a chance to get back where you want to be where maybe try and find more quality time with family. Make a difference in making more quality time with your kids, and trying to take advantage of it."

Dr. Mark Swerdlik:  I think one of the challenges that we alluded to earlier is with a large number of multiple deployments in a sense, many including those in the National Guard, are perhaps anticipating another deployment, and so that's another issue they need to deal with.

Very quickly, I just kind of rounded out the other family program. We talked about the family, academies, and the community reintegration training that includes faith‑based training for clergy in the community, as well as training for educators. There is a 45‑day program, which is 45 days after the soldier returns. It's an opportunity to kind of reconnect with their battle buddies, people they were in war with.

Although it is mandatory in Illinois for the National Guard soldiers, family members are also invited. It's kind of meant to be a one‑stop shop. They basically have large group sessions on common reintegration reactions. It's kind of an effort to normalize some of the reactions, we've talked about here.

Then there's a series of break‑out sessions that deal with a wide variety of issues from; how to handle partying when you return, re‑connecting with your spouse, reconnecting with your children, returning to school, health care and education benefits, reemployment benefits, how do you handle finances, which often is a challenge, some of the issues for single soldiers deployed, for veterans returning from war.

There's also an informational fair, where they have various community agencies and services serving the military that provide information. So it's meant to be a one‑stop shop. Here are some of the issues to deal with, but also the resources to help connect.

Then the next event as part of the reintegration program occurs at 75 days after returning from war. This is unique in the Illinois program from what we can tell from other states. That is, it's a series of focus groups that are run in a group therapy format, in that they're facilitated by trained mental health counselors.

Many of them have extensive experience with the military who, based on our feedback from the participants, really make it a more effective experience because somebody facilitating is quite knowledgeable about these issues. This is where sessions are held on a number of negative behaviors that are related to combat stress that occur.

For instance, issues relating to problems with reconnecting with your spouse, reconnecting with your children, anger management, potential risk for substance abuse, and compulsive behaviors such as gambling. Those have been very effective. The feedback from participants has been very positive about that. So that occurs at 75 days.

Then at 90 days is something that's held just for soldiers, and that's where a more extensive mental and physical health assessment occurs. I think some of the things we've learned and the military has learned is that you can't really mandate reintegration. It's not something you can have one briefing on. But rather, as Mark you mentioned at the very start, it's a process.

I think in Illinois we're learning that that process, the reintegration, really starts prior to the soldier coming home in terms of preparing not only the family but the community.

Mark Pisano:  I think that's key, Mark. When we're looking at the family that's looking so forward to having the soldier return, it's easy to overlook what the soldier's gone through. The main thing the kids are thinking is, "Oh, great. Dad's going to be home," or "Mom's going to be home."

During the deployment, I think that the communication and the caliber of communication that has been going on has a direct impact on how the reunion goes. For example, if at the end of every phone conversation between the husband and wife, it ends up in an argument, then when the [laughs] soldier returns they're just going to pick up where the phone conversation left off.

So if we could talk about what we could help these families do to prepare for the reunion stage, I think one of them would be a suggestion to be very positive with phone conversations and other sorts of communication during the deployment stage.

Dr. Sharon Cooper:  I would have to agree 100 percent. We often like to tell our parents that they have 1‑800 telephone contact for needing the mental health services prior to the service member coming home. For the Army, it's referred to Army OneSource. The Air Force and Marine Corps all have a OneSource mental health contact.

These are contracted agencies that provide mental health services, usually six encounters, within a two‑week period of the time that the family member has contacted their 1‑800 numbers. This is very helpful because it helps at least get that parent focused on what are the really key issues that you have your greatest concern about.

If you're arguing with your husband while he isn't here, while he's in a war zone every time, how can we find a way to help those communications improve, etc.? Then at the end of that six‑encounter mental health opportunity, the therapist will acknowledge to the person who has called whether they need more therapy. We are then, by that time, able to have put those kinds of consults in for the family members that try to facilitate access to mental health services.

I think the other piece about family members coming home and being different and are all having to recognize that, is that as a school psychologist, you really want to know that a family member has come home. Because if you see a change in a child's behavior, for the worse in particular, it would be very important to know.

And it would be really helpful for the psychologist to be willing to talk to that newly returned parent because many times a spouse doesn't have the influence that a school personnel will with such a person. [laughs] You know if the school personnel says, "You know, really we have to cut down on the HBO. It's just not [laughs] a good thing for this six‑year‑old" then it carries more credence. They can perhaps be part of the solution and not part of the problem in some of the reintegration issues that impact children.

Dr. Mark Swerdlik:  I know in terms of some of the issues that the National Guard, deployed veterans, and then returning war veterans deal with, unlike perhaps the regular Army, is they may be the only family, the only returning soldier in that whole community. And that's, I think, a particular issue that, at least in terms of the Illinois program, has been an impetus in terms of having the community reintegration training.

Something, too, in terms of the reintegration training, they also try to work with law enforcement in terms of understanding what it was like to drive for instance in theater, and then coming back on our highways. Some of the issues relating to the hypervigilance that was really a necessary survival mode in theater, but then coming back and how that might impact the soldier in terms of their driving.

I think educating families in terms of how often it's more challenging, where you get all the adrenalin‑producing effects of war, to be able to come back. I heard families talk about the first thing that their returning soldier did was run out and buy a Harley so that they could drive at high speeds, which was disconcerting to some families. But those are all important things to understand.

Dr. Sharon Cooper:  The other piece is that if we can help that returning service member to remember that they are, in fact, one of their child's most important role models and that if they can look at their own behavior from that perspective. How is my behavior going to impact upon my child?

In particular, I find many of my parents describing what I would call video game addiction on the part of the returning spouse, and how difficult it is for a non‑deployed spouse to limit video game access to children when the spouse is getting hours and hours and hours a day, especially on weekends, doing just that.

So helping that service member to recognize the role that they play as a role model for children is another piece that school psychologists could help with.

Mark Pisano:  I think, following along the same vein, the child maybe didn't see Dad doing that before he left. So now it's, "Is that my dad?" I think it's the same issue that we brought up before, that people change. That's what makes the reintegration and reunion so difficult.

Dr. Mark Swerdlik:  I think often a soldier comes back thinking, as we said earlier, that everything's back to normal. So they can move right in to being disciplinarian, that the children will react to them just the way they did prior to their leaving. We all know it takes time for children as well to readjust.

So I think some of the purposes of these reintegration programs is to educate soldiers about that. That doesn't mean their child loves them any less or is less happy, but these are some developmental kinds of considerations.

Mark Pisano:  I'd like to thank everyone on the panel for your time with this podcast and for your professional dedication to military families. And to the listener, we hope you've enjoyed listening and invite you to send questions to me, Mark Pisano, at mark.pisano@am.dodea.edu. Or you can call me: 910‑907‑2000 at extension 3087.

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

Dan Florell:  That concludes this Dialogues podcast. Please tune in again for future Dialogue podcasts available on the NASP website.