ADSM Relational Health: Impact and Intervention in Family ... · ADSM Relational Health: Impact and...

ADSM Relational Health: Impact and Intervention in Family Systems

Lauren A. Messina, PhD, LCMFTSenior Social Health Scientist

Consortium for Health and Military PerformanceDepartment of Military and Emergency Medicine, Uniformed Services University

National VA/DoD Women's Mental Health Mini-Residency: Building Clinical Expertise to Meet Women's Unique Treatment Needs Crystal City, Virginia | August 28-30, 2018

“Medically Ready Force…Ready Medical Force” 1

Disclosures

The opinions and assertions expressed herein are those of the authors and should not be construed as reflecting those of the Uniformed Services University, Department of the Army, Department of the Air Force, Department of the Navy or the United States Department of Defense.

This continuing education activity is managed and accredited by the Department of Veterans Affairs, Employee Education System (VA-EES).

Lauren Messina has no financial interest to disclose. Commercial support was not received for this activity.


Why focus on relationships?


“I live with one perennial truth: the quality of your relationships is

what determines the quality of your life.”

– Esther Perel

Learning Objectives

At the conclusion of this presentation, participants will be able to: Explain how relational health is a component of mental health and

wellness. Describe how relational health impacts female Service Members

and Veterans performance. Distinguish relational health concerns through the stages of

deployment. Discuss relational health issues through case vignettes. Construct treatment plans to address relational health concerns.


What is Relational Health?

∎Health of one’s relationships∎ Skills in establishing and maintaining relationships∎ Knowledge and awareness of relational processesCommunication, conflict resolution, interpersonal

intelligence

∎Quality, depth, breathe of one’s social support system All individuals are embedded in social settings

∎Military service and relational health


Relational Status of our Women Service Members

∎About 40% of Female Service Members (FSM) are mothers, many are single parentsActive Duty FSM are 3 times more likely to be single parentsGuard/Reserve FSM are twice as likely to be single parents

∎Approx. 30,000 single moms deployed last year∎Divorce rate for deployed women is nearly 3 times

higher than male Service Members∎ Report feeling less supported by peers and superiors∎ Female veterans are more likely to be unmarried


Relational Status of our Women Service Members

Girlfriend

Mom

Sister

Wife

Daughter

Friend

Community Member

Niece

Leader AuntGranddaughter

Mentor

Service Member


Relational Health Challenges forNew Recruits (and others)

∎ Contemplate: Is pregnancy compatible with my career in the military? What kind of support would the command give if I choose to

have a family? How can I be a good mom and in tune with my kids while also

embracing military culture that doesn’t encourage disclosure of emotions?

Can I manage the physical requirements to return to duty soon after giving birth?

How will my service impact my romantic relationship?


The Deployment Cycle and Relational Health

∎ Pre-deployment Providers can: Encourage attendance at briefings, with caution Review Family Care Plan and assess comfort Roleplay conversations to have with children Discuss realistic expectations

Credit: Media.Defense.gov



∎ Deployment Providers can can:Normalize discomfort Encourage proactiveness Foster understanding of children’s

developmental changes over time Support discussions of communication and co-

parenting strategies




∎ Reintegration Providers can: Facilitate in reuniting the family

▻ Explore fears of intimacy and personal touch (with partner and with kids)

Discuss relinquishing, resuming, rebalancing roles and responsibilities Explore how to cope with kids mixed emotions Manage anger, frustration so it’s not directed towards family Support women who feel driven to make major life decisions

upon return



Female Veterans and Relational Health

∎Difficulty sharing military experiences with family and friends

∎ Cognitively, behaviorally can avoid trying to improve relationships

∎ PTSD and relationships Associated with poorer relationship and family functioning Lower intimate relationship satisfaction Challenges parenting with PTSD

∎ Child care as a barrier to accessing services


Addressing Relational Health in Sessions

∎Fear is reduced when we feel a part of a cohesive unit

∎Assess support system, secure attachments, attachment injuries

∎Encourage development of healthy relationships, good boundaries, capacity to ask for help

∎ Role clarity at home, with children

Credit: Media.Defense.gov“Medically Ready Force…Ready Medical Force” 13


∎Address/improve relationship dynamics Communication skills Assertive communication Active constructive responding

Problem solving and conflict resolution skills

∎ Cognitive distortions in relationships Mind reading Jump to conclusions

∎ Warrior ethos and relationships




∎ Family optimization RitualsMeaning makingWorld view Flexibility Unity Trust



Handout: Family Optimization

16


∎Parenting Parent’s ability to manage stress is a key predictor

of a child’s ability to manage adversity Emotion coaching Labeling feelings, offering appropriate coping skills Offer support and encourage self-soothing

Reflective functioning Understand how kids’ emotions drive their

behaviors


Human Performance Resource Center

∎One stop shop for evidence-based information and key resources on

∎Online, public facing, purple website

http://hprc-online.org

http://humanperformanceresourcecenter.org/

http://humanperformanceresourcecenter.org/

Relational Health Handouts and Resources

∎ Google Doc Spreadsheet with hyperlinks to relational health resources

∎ Sign up and we’ll email you the link


Vignettes and Treatment Planning

∎Tanya Early 20s, new recruit, Navy, single mother Dating another Sailor Scheduled to deploy for the first time in a few

months Recently had first anxiety attack Concerned about young child and about keeping

in touch with grandma, who is ill, while deployed



∎ClaireMid 30s, Army, 15 years of service so farMarried to a civilian, mom to 3 children Returned from deployment 5 months ago Complains of headaches, difficulty

concentrating Reports turmoil in relationship with spouse,

youngest child is acting out



∎Alexandria Early 40s, Air Force Veteran Recently divorced, one teenage child Separated from the Air Force a few months ago,

after returning from a challenging deployment Reports feeling disconnected, confused, unsure

about next steps Shares she hasn’t been getting along with her

teenager


Key Takeaways

Relational health is a key component of the mental health and performance of female Service Members.

Providers are positioned to address relational health issues, teach relational health skills, and increase patients’ awareness of how relational health concerns influence individual mental health

The stages of deployment can challenge a female Service Member’s relational health by putting strain on family relationships.

Providers can address concepts like mapping a social support network, exploring role clarity, addressing emotion coaching and reflective functioning, discussing family optimization, communication, and conflict resolution skills to boost patients relational health.


References (1)

∎ Agazio, J., Hillier, S. L., Throop, M., Goodman, P., Padden, D., Greiner, S., & Turner, A. (2013). Mothers going to war: The role of nurse practitioners in the care of military mothers and families during deployment. Journal of the American Association of Nurse Practitioners, 25(5), 253–262. http://doi.org/10.1111/j.1745-7599.2012.00811.x

∎ Bean-Mayberry, B., Yano, E. M., Washington, D. L., Goldzweig, C., Batuman, F., Huang, C., … Shekelle, P. G. (2011). Systematic review of women veterans’ health: Update on successes and gaps. Women’s Health Issues, 21(4), S84–S97. http://doi.org/10.1016/j.whi.2011.04.022

∎ Biggs, R. L., Douglas, B. H., O’Boyle, A. L., & Rieg, T. S. (2009). The impact of pregnancy on the individual and military organization: A postpartum active duty survey. Military Medicine, 174(1), 61–75. Retrieved from https://er.lrc.usuhs.edu/

∎ Boyd, M. A., Bradshaw, W., & Robinson, M. (2013). Mental health issues of women deployed to Iraq and Afghanistan. Archives of Psychiatric Nursing, 27(1), 10–22. http://doi.org/10.1016/j.apnu.2012.10.005


References (2)

∎ Carlson, B. E., Stromwall, L. K., & Lietz, C. A. (2013). Women veterans: Implications for practice. Social Work, 58(2), 105–115. http://doi.org/10.1093/sw/swtOOl

∎ Chauhan, S. P., Johnson, T. L., Magann, E. F., Woods, J. Y., Chen, H.-Y., Sheldon, I. V., & Morrison, J. C. (2013). Compliance with regulations on weight gain 6 months after delivery in active duty military women. Military Medicine, 178(4), 406–411. http://doi.org/10.7205/MILMED-D-12-00394

∎ Creech, S. K., Swift, R., Zlotnick, C., Taft, C., & Street, A. E. (2016). Combat exposure, mental health, and relationship functioning among women veterans of the Afghanistan and Iraq wars. Journal of Family Psychology, 30(1), 43–51. http://doi.org/10.1037/fam0000145

∎ DeVoe, E. R., & Ross, A. (2012). The parenting cycle of deployment. Military Medicine, 177(2), 184–90. http://doi.org/http://dx.doi.org/10.7205/MILMED-D-11-00292


References (3)

∎ Frayne, S. M., Parker, V. A., Christiansen, C. L., Loveland, S., Seaver, M. R., Kazis, L. E., & Skinner, K. M. (2006). Health status among 28,000 women veterans: The VA women’s health program evaluation project. Journal of General Internal Medicine, 21(3), S40–S46. http://doi.org/10.1111/j.1525-1497.2006.00373.x

∎ Gewirtz, A. H., McMorris, B. J., Hanson, S., & Davis, L. (2014). Family adjustment of deployed and nondeployed mothers in families with a parent deployed to Iraq or Afghanistan. Professional Psychology: Research and Practice, 45(6), 465–477. http://doi.org/http://dx.doi.org/10.1037/a0036235

∎ Holman, T. B., & Jarvis, M. O. (2003). Hostile, volatile, avoiding, and validating couple-conflict types: An investigation of Gottman’s couple-conflict types. Personal Relationships, 10, 267–282. http://doi.org/10.1111/1475-6811.00049

∎ Hooper, L. M., Moore, H. M., & Smith, A. K. (2014). Parentification in military families: Overlapping constructs and theoretical explorations in family, clinical, and military psychology. Children and Youth Services Review, 39, 123–134. http://doi.org/10.1016/j.childyouth.2014.02.003


References (4)

∎ Jobe-Shields, L., Flanagan, J. C., Killeen, T., & Back, S. E. (2015). Family composition and symptom severity among veterans with comorbid PTSD and substance use disorders. Addictive Behaviors, 50, 117–123. http://doi.org/10.1016/j.addbeh.2015.06.019

∎ Maguen, S., Cohen, B., Ren, L., Bosch, J., Kimerling, R., & Seal, K. (2012). Gender differences in military sexual trauma and mental health diagnoses among Iraq and Afghanistan veterans with posttraumatic stress disorder. Women’s Health Issues, 22(1), e61–e66. http://doi.org/10.1016/j.whi.2011.07.010

∎ Maiocco, G., & Smith, M. J. (2016). The experience of women veterans coming back from war. Archives of Psychiatric Nursing, 30(3), 393–399. http://doi.org/10.1016/j.apnu.2016.01.008

∎ Malebranche, K. (2011). OEF/OIF veterans initiatives [PowerPoint Slides] Retrieved from https://www.va.gov/womenvet/docs/2011summit/Malebranche.pdf


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∎ Mattocks, K. M., Haskell, S. G., Krebs, E. E., Justice, A. C., Yano, E. M., & Brandt, C. (2012). Women at war: Understanding how women veterans cope with combat and military sexual trauma. Social Science and Medicine, 74(4), 537–545. http://doi.org/10.1016/j.socscimed.2011.10.039

∎ Meyers, S. A., Stollak, G. E., Aronoff, J., Messé, L. A., Loraas, J. A., & Woike, B. A. (1996). Boundary regulation in family and personal systems: Perceptions of late adolescents. Contemporary Family Therapy, 18(2), 279–290. http://doi.org/10.1007/BF02196728

∎ Mulhall, E. (2009). Women warriors: Supporting she “who has borne the battle.” Iraq and Afghanistan Veterans of America, (October), 1–16. Retrieved from http://issuu.com/iava/docs/iava_womensreport_2009

∎ Leslie, L. A., & Koblinsky, S. A. (2017). Returning to civilian life: Family reintegration challenges and resilience of women veterans of the Iraq and Afghanistan wars. Journal of Family Social Work, 20(2), 106–123. http://doi.org/10.1080/10522158.2017.1279577


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∎ O’Neal, C. W., Lucier-Greer, M., Mancini, J. A., Ferraro, A. J., & Ross, D. B. (2016). Family relational health, psychological resources, and health behaviors: A dyadic study of military couples. Military Medicine, 181(2), 152–160. http://doi.org/10.7205/MILMED-D-14-00740

∎ Paris, R., DeVoe, E. R., Ross, A. M., & Acker, M. L. (2010). When a parent goes to war: Effects of parental deployment on very young children and implications for intervention. American Journal of Orthopsychiatry, 80(4), 610–618. http://doi.org/10.1111/j.1939-0025.2010.01066.x

∎ Perosa, S. L., & Perosa, L. M. (1993). Relationships among Minuchin’s structural family model, identity achievement, and coping style. Journal of Counseling Psychology, 40(4), 479–489. http://doi.org/10.1037/0022-0167.40.4.479

∎ Riggs, S. A., & Riggs, D. S. (2011). Risk and resilience in military families experiencing deployment: The role of the family attachment network. Journal of Family Psychology, 25(5), 675–687. http://doi.org/10.1037/a0025286


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∎ Saltzman, W. R., Lester, P., Milburn, N., Woodward, K., & Stein, J. (2016). Pathways of risk and resilience: Impact of a family resilience program on active-duty military parents. Family Process, 55(4), 633–646. http://doi.org/10.1111/famp.12238

∎ Segal, D. R., & Segal, M. W. (2004). America’s military population. Population Bulletin, 59(4), 1–44.

∎ Street, A. E., Vogt, D., & Dutra, L. (2009). A new generation of women veterans: Stressors faced by women deployed to Iraq and Afghanistan. Clinical Psychology Review, 29(8), 685–694. http://doi.org/10.1016/j.cpr.2009.08.007

∎ Tsai, J., David, D. H., Edens, E. L., & Crutchfield, A. (2013). Considering child care and parenting needs in Veterans Affairs mental health services. Evaluation and Program Planning, 39, 1–22. http://doi.org/10.1016/j.evalprogplan.2013.03.003


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∎ Tucker, M. M., & Kelley, M. L. (2009). Social support and life stress as related to the psychological distress of single enlisted navy mothers. Military Psychology, 21(2), S82–S97. http://doi.org/10.1080/08995600903249198

∎ Trump, L. J., Lamson, A. L., Lewis, M. E., & Muse, A. R. (2015). His and hers: The interface of military couples’ biological, psychological, and relational health. Contemporary Family Therapy, 37(3), 316–328. http://doi.org/10.1007/s10591-015-9344-8

∎ Vogt, D. S., Pless, A. P., King, L. A., & King, D. W. (2005). Deployment stressors, gender, and mental health among Gulf War I veterans. Journal of Traumatic Stress, 18(2), 115–127.

∎ Walsh, T. B. (2017). Mothers and deployment: Understanding the experiences and support needs of deploying mothers of children birth to five. Journal of Family Social Work, 20(2), 84–105. http://doi.org/10.1080/10522158.2017.1279576


Thank You!

Lauren Messina, PhD, [email protected]

Consortium for Health and Military PerformanceDepartment of Military and Emergency Medicine

Uniformed Services University



mailto:[email protected]

ADSM Relational Health: Impact and Intervention in Family ... · ADSM Relational Health: Impact and...

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