Preparing for Deployment – Spousal Support

by Jay Morse & Heidi Radunovich, PhD

Deployment of a spouse can be stressful for the partner left at home. As the family prepares for deployment, attention may be focused on the military member preparing to deploy with packing, getting chores done, visiting friends, saying goodbye and many other activities. During deployment, the spouse and children can feel disconnected, communication with the deployed spouse may be challenging, and the family at home will worry about the service member’s safety.

Mollie Gross offers support, comedy to military spouses

Mollie Gross, a comedian, motivational speaker and author of “Confessions of a Military Wife,” made Marine Corps Base Hawaii spouses and service members laugh – and sometimes cry in a recent presentation.  (DVIDS, U.S. Marine Corps photo by Kristen Wong)

No matter how well a military family is prepared for deployment, the shift in family roles adds to the stressors experienced by the military family, and the role of social support for the spouse becomes more important. In a recent article, Skomorovsky (2014) surveyed spouses of Canadian military service members regarding their level of stress, well-being and depressive symptoms, and their sources of social support during and after deployment. Four types of support were examined: 1) Military spouse; 2) Family of both the military member and spouse; 3) Friends; and, 4) Military contacts. During deployment, having strong social support from family members was key for the non-military spouse’s adjustment and well-being. After deployment, support from friends and the returned spouse, as well as family members, helped predict better adjustment. Both during and after deployment, support from military contacts did not appear to provide significant help to the military spouse.

Implications

Social support, particularly from partners, family, and friends outside of the military play an important role when considering the psychological well-being of spouses when a partner is deployed. When working with military spouses, clinicians may consider emphasizing the importance of seeking social support both during and after deployment.

For videos to help spouses and families talk about deployment and illustrating social support, visit Sesame Street’s Talk, Listen, Connect. Other recent MFLN blogs related to this topic can be found here: Marital Adjustment After Deployment; Deployment and Single Parenting: A snapshot into the Experience of Navy Moms.

Reference

Skormorovsky, A. (2014). Deployment stress and well-being among military spouses: The role of social support. Miiltary Psychology, 26:1, 44-54.  doi: 10.1037/mil0000029

This post was written by Jay Morse & Heidi Radunovich, PhD, members of the MFLN Family Development (FD) team which aims to support the development of professionals working with military families. Find out more about the Military Families Learning Network FD concentration on our website, on Facebook, on Twitter, You Tube, and on LinkedIn.

Caregiver Webinar Recap: Give Care, Take Care

iStock_000020584967MediumLast week the Military Caregiving Concentration team presented on the topic of Give Care, Take Care. The webinar included tips for military professionals and caregivers working with wounded service members in areas of autonomy and decision-making ability, Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs), and finally learning to take care and give care. The goal of the presentation was to provide basic knowledge and some critical thinking skills so caregivers can effectively “give care” to their wounded warrior, while “taking care” of themselves.

Below we will briefly review lessons learned from the event. Remember, you can still view the presentation and receive continuing education credit and a certificate of completion by going to Give Care, Take Care.

Autonomy & Decision-Making

We togetherWhen a service member becomes wounded our first instinct as a caregiver is to take on all responsibilities and decisions. However, we often forget the importance that is placed on making one’s own decision and choices and how to respect the autonomy of the warrior as a surrogate decision-maker. Independence and self-esteem are promoted when the service member is able to have a say, even when the decision is simply to pick out an item of clothing for the day. Caregivers must be able to assess and recognize the services member’s abilities which will ultimately encourage the individual to feel that he/she still has some form of control.

ADLs & IADLs

ADLs are basic tasks which must be accomplished to function independently such as bathing, eating, dressing and undressing, toileting and transferring and positions. IADLs are tasks which support independent function and support life but are NOT necessarily critical. Examples of IADLs include grooming and hygiene, walking, cooking, grocery shopping, managing medications, etc.

When a wounded service member is unable to perform these activities, caregivers must step-in to provide assistance. These activities do not come without their challenges and is where the “give care” and “take care” theory comes into play.

Woman caring for sick manGive Care, Take Care

The term “give care” is simply stated–caregivers are providing care through assistance with various ADLs and IADLs. A few examples of caregiver strategies for “giving care” when it comes to eating include:

  • Beware of food hot enough to burn if the service member has weakness, shakiness or problems with grip.
  • Make sure service member’s mouth is empty before each subsequent bite.
  • Don’t rush the service member while he/she is eating.

In order to “give care,” “caregivers must learn to “take care” as well. By learning “take care” strategies, caregivers not only provide enhanced care for the service member but will increase their own personal well-being. For example, learn to practice good body mechanics and know your limitations to providing care.

While caring for a service member may seem a natural extension of one’s relationship, basic tasks associated with caregiving can become challenging and daily activities that were once simple may result in new approaches to care. For an in-depth look into decision-making, ADLs & IADLs, and giving and taking care, checkout the full presentation at Give Care, Take Care.

This post was published on the Military Families Learning Network blog on September 23, 2014.

Resource Discovery: Why Domestic Violence Victims Don’t Leave

By Kacy Mixon, PhD, LMFT

In recent weeks media has focused on domestic violence and highlighted the pervasiveness of this issue in our society. The increased attention to this topic in the media follows leaked footage of NFL player, Ray Rice, physically abusing his partner in an elevator and his partner, subsequently, defending this incident when career repercussions were placed on him. Reactions to this incident in the media have brought up the poignant question: Why do victims of domestic violence stay?

TEDxRainier 2012, Leslie Morgan Stainer

Today’s Resource Discovery features a TEDxRainier video from 2012, titled Why Domestic Violence Victims Don’t Leave, in which Leslie Morgan Steiner details her experience with “crazy love”–or being madly in love with someone who abused and threatened her. Steiner is the author of the New York Times best-selling memoir “Crazy Love” as well as the manager of the Washington Post Magazine from 2001 to 2006. In this video,

“Steiner tells the dark story of her relationship, correcting misconceptions many people hold about victims of domestic violence, and explaining how we can all help break the silence.”

More insight into Steiner’s experience can be found in her recent article, “He held a gun to my head. I loved him” published in the Washington Post on September 12, 2014.

The influx of media attention surrounding why victims of intimate partner violence stay with their partners has also ignited a new #whyIstayed twitter initiative which has provided a platform for many victims/survivors of domestic violence to tell their story. Below are additional resources (videos, websites) that may provide more insight into this topic:

This post was written by Kacy Mixon, PhD, LMFT, Social Media Specialist. She works with other members of the Family Development team to support the development of military professionals working with families. Find out more about the Military Families Learning Network here and on Facebook/Twitter.

 

Predicting Compassion Fatigue and Burnout in Practitioners

By Rachel Dorman, MS & Heidi Radunovich, PhD

In previous posts we have discussed the importance of mental health providers protecting their own well-being by being aware of risks associated with compassion fatigue, secondary traumatic stress, and burnout. Today we will continue our discussion by looking at factors that may put one at risk or protect one from both compassion fatigue and burnout.

Thompson, Amatea, and Thompson (2014) conducted an online survey to learn more about how gender, length of career, appraisal of working conditions, and personal resources relate to burnout and compassion fatigue among mental health counselors. The study consisted of 213 mental health or licensed professional counselors who completed a master’s degree in counseling, had been practicing for at least six months, and were working with clients 20 hours per week or more. Those practitioners who had positive working conditions, had worked in the field longer, and who used mindfulness were found to be less likely to experience compassion fatigue or burnout. However, maladaptive and emotion-focused coping were related to compassion fatigue and burnout. There did not appear to be a gender difference in report of burnout, but women were more likely to report compassion fatigue than men.

The authors provide many recommendations for counselors and supervisors. They suggest that counselors who are working in a less supportive environment seek support from colleagues, work with their employers to try to improve working conditions, and do what they can to take care of themselves. Supervisors should be sensitive to the possibility of burnout and compassion fatigue among their supervisees, and should try to educate their supervisees on the nature of stress in the counseling relationship, as well as making sure that they are using effective coping strategies to deal with work stress. Finally, the researchers strongly encourage practitioners to explore positive coping strategies to offset the potential negative effects of job stress, such as using mindfulness. For more information on burnout and compassion fatigue check out our previous blogs: Self-care When Caring for Others or Self-care for the Military Family Advocate.

Resource: 

Thompson, I., Amatea, E., & Thompson, E. (2014) Personal and contextual predictors of mental health counselors’ compassion fatigue and burnout. Journal of Mental Health Counseling, 36(1), p. 58 – 77. ISSN: 1040-2861

This post was written by Rachel Dorman, M.S. and Heidi Radunovich, PhD, members of the MFLN Family Development (FD) team which aims to support the development of professionals working with military families. Find out more about the Military Families Learning Network FD concentration on our website, on Facebook, on TwitterYou Tube, and on LinkedIn.

Working with Members of the Military: Secondary Traumatic Stress

By Rachel Dorman, MS & Heidi Radunovich, PhD

Due to the growing rate of military members suffering from PTSD and seeking mental health treatment, mental health providers may be exposed to indirect trauma more than ever. As a result, providers are at risk of experiencing secondary traumatic stress. In today’s blog we will be taking a closer look at secondary traumatic stress by discussing a study conducted by Cieslak and colleagues (2013).

The researchers in this study examined indirect exposure to trauma, and its relationship to secondary traumatic stress among mental health providers working with military members. The authors defined secondary traumatic stress (STS) as having “PTSD-like symptoms” after indirect exposure to trauma. The study participants included 223 psychologists, counselors, or social workers who provide mental health services to military service members, and as a result have been exposed to indirect trauma within the past year of working. The participants completed a survey which assessed level of indirect exposure to traumatic stress, appraisal of the impact of exposure, direct exposure to trauma, symptoms of secondary stress, and workplace and professional support characteristics.

In relation to prevalence of STS, the researchers found that over 19% of the participants met the criteria of intrusion, arousal, and avoidance associated with a PTSD diagnosis. Intrusion was found to be the most common criteria at 57%, then arousal at 35%, and lastly avoidance at 30%. The researchers found that seeing higher numbers of traumatized clients in practice increased the likelihood of experiencing STS. It was also found that how practitioners viewed indirect exposure to trauma impacted likelihood of STS, such that the more negatively a practitioner felt about the indirect exposure, the higher the number of STS symptoms. Overall, having too many clients, higher levels of a personal history with trauma, and higher levels of negative appraisal of indirect exposure were the strongest predictors for STS symptoms.

The researchers call for the need for more awareness and appraisal of secondary traumatic exposure for mental health providers working with the military population. To learn more about dealing with secondary traumatic stress check out previous blogs: Self-care for the Military Advocate  or Self-care When Caring for Others.

Resource:

1. Cieslak, R., Anderson V., Bock. J., Moore, B., Peterson, A., & Benight, C. (2013). Secondary traumatic stress among mental health providers working with the military: Prevalence and its work- and exposure-related correlates. The Journal of Nervous and Mental Disease, 201(11), p. 917 – 925. DOI:10.1097/NMD.0000000000000035

This post was written by Rachel Dorman, M.S. and Heidi Radunovich, PhD, members of the MFLN Family Development (FD) team which aims to support the development of professionals working with military families. Find out more about the Military Families Learning Network FD concentration on our website, on Facebook, on TwitterYou Tube, and on LinkedIn.

Financial Planning for the Second Half of Life

By Molly C. Herndon
Social Media Specialist

On September 23, Dr. Barbara O’Neill will present Financial Planning for the Second Half of Life. More than a webinar about retirement planning, this 90-minute session will focus on:

  • Common financial errors of older adults
  • Statistics about older adult finances
  • Common later life financial characteristics and required decisions
  • 15 key later life financial planning topics (e.g., creating a retirement “paycheck,” required minimum distributions, untitled property transfers, and leaving a legacy)
  • Personal finance resources for older adults and financial practitioners
https://creativecommons.org/licenses/by/2.0/legalcode
Photo by Jon Rawlinson. Licensed Creative Commons. 

This webinar will allow participants to engage in an interactive discussion of the realities of retirement finances, including selecting and paying for health care benefits, managing asset withdrawals, and creating workable retirement planning strategies for older adult clients.

This webinar is approved for 1.5 CEUs for AFC-credentialed participants. To join, review the slides and for more information about the speaker, click here. 

 

This post was published on the Military Families Learning Network blog on September 9, 2014.

 

Mental Health Needs of Military Wives

By Rachel Dorman, MS & Heidi Radunovich, PhD

Overcoming stigma and barriers to seeking mental health treatment is not an uncommon issue for military members and their families. Identifying barriers can help shed light on strategies needed to overcome such obstacles and how to provide care for those who need it. In today’s blog we are going to learning more about barriers military wives encounter when seeking mental health treatment.

Lewy, Oliver, and McFarland (2014) conducted a study to learn more about military wives, their mental health needs, and barriers they may have to seeking mental health treatment. The study consisted of 569 female participants who completed an online survey. The survey examined depressive symptoms, nonspecific psychological distress, and barriers to obtaining mental health services. The study found that over half (51%) of the participants reported high levels of depressive symptoms, and another 27% indicated depressive symptoms, but at a lower level. The study also found that 37% of the wives surveyed reported serious psychological distress, and 44% did not receive the mental health treatment they felt they needed (higher than the general population). Those who were older and higher levels of distress were more likely not to get needed treatment.

The most common barrier to seeking mental health treatment was finding time during the day to attend treatment (38%). Other barriers commonly mentioned included fears that the treatment would not be confidential (26%), concerns about how others in the community might perceive the treatment (19%), lack of knowledge of where to go for treatment (25%) and concerns about cost (19%). Over a third of military wives, 35%, reported concern that mental health providers would not understand the issues facing military spouses, and 29% expressed concerns about whether they could trust a therapist.

The authors recommend that clinicians seek education regarding best practices for serving military service members and their families, including programs such as RESPECT-Mil. The researchers also highlight that, because social media was found to be an effective tool in reaching military wives for recruitment in this study, it might also be an effective means of providing information about mental health services. To learn more about helping individuals overcome barriers to seeking treatment check out our previous blog, Shifting the Stigma: Mental Health and the Military 

Resource:

1. Lewy, B., Oliver, C., & McFarland, B. (2014). Barriers to mental health treatment for military wives. Psychiatric Services, Brief Reports, p. 1 – 4. doi:10.1176/appi.ps.201300325

This post was written by Rachel Dorman, M.S. and Heidi Radunovich, PhD, members of the MFLN Family Development (FD) team which aims to support the development of professionals working with military families. Find out more about the Military Families Learning Network FD concentration on our website, on Facebook, on TwitterYou Tube, and on LinkedIn.

September Caregiving Webinar: Give Care. Take Care.

Join us on Wednesday, September 17 @ 11:00 a.m. EDT as we host our FREE monthly professional development webinar entitled, Give Care. Take Care, presented by Andy Crocker.

Watch and listen as Andy provides a sneak peek into what you can expect from the upcoming September 17th webinar.

How to Join the Webinar

*No registration is required; simply go to Give Care. Take Care. the day of the event to join. The Military Families Learning Network will be providing 1.0 National Association of Social Workers (NASW) continuing education credit to credentialed participants. Certificates of Completion will also be available for training hours as well.

The webinar is hosted by the Department of Defense so you must install security certificates if you are not located on a military installation. Instructions for certificate installation can be found by clicking on DCO Adobe Certificate Installation.

For those who cannot connect to the Adobe site, an alternative viewing of this presentation will be running on Ustream. You can connect to the Adobe webinars using iPhone, iPad, and Droid apps. Search for DCO Connect in the respective stores.


This post was published on the Military Families Learning Network blog on September 2, 2014.

Caregiver Mini Series: 444 Days in the First Year (Series Finale)

“…to this day I still cringe when someone refers to me as a widow.”

The first few days following my husband passing are still very much a blur.  I can remember the flight home, the loneliness that consumed me, and the reality that slowly began to sink in.  I was used to not having my service member home, however knowing I would never hear his voice, feel his touch, or have him hold me was almost too much for my mind to comprehend.

There was so much to do, and I was extremely overwhelmed.  I had plenty of friends and family around me but I still felt very alone.  There was so much to do and I was not quite sure where to start.  My mind raced. My heart pounded.  With every new thought I was once again reminded that I was alone.

No one could have prepared me for the transitional process, or the journey I was about to embark on.  I felt separated from those around me.  I was no longer part of the “active duty” family that I had known for so long, yet I did not quiet feel as though I fit in with the civilian world either.  I felt like an imposter in many ways, simply because I didn’t know what to feel or where I fit in.

My military friends were beginning to welcome their service member’s home, and I was in the beginning processes of “clearing housing.”  I didn’t want to be treated differently and to this day I still cringe when someone refers to me as a “widow.”  My entire world and everything in it was different.

Things moved so quickly that there was no time for me to even process what was going on around me.  Before I knew it, I was packing up our household goods and placing our entire life in boxes.  I was once again saying goodbye to something that I could never get back.  The last home Steve and I shared together would soon be occupied by another family trying to make their way in the uncertain world of the military life–I was to begin mine alone without him.

Grieving for what is Lost

For the military spouse, packing up and moving regularly is part of the military culture. However for a military spouse whose service member has passed away, the familiarity of packing up household goods, and clearing quarters quickly becomes unfamiliar territory.

Typically speaking, when a loved one passes away we are able to choose a little more freely the rate at which we will go through the grieving process.  We are able to reminisce with friends and family as we rummage through our memories, shared experiences, and material belongings or we have the ability to say, “I don’t feel up to this right now.”

When a Service Member passes away however, the entire process seems to be expedited.  Quickly quarters are to be cleared, a new home must be found, and papers must be signed. I remember feeling angry. I felt robbed of the ability to have any time to process what was going on around me, and it was the one time I wanted someone to understand and realize what it was they were asking me to do…I was a widow.

The transitional process that a military family will go through after their service member passes is different in many aspects than that of a civilian. Getting “stuck” in the grieving process is highly possible, especially for those families who never have the opportunity such as I, to be with their loved one during their final hours.

I am so grateful for the many wonderful people who were there during my time of darkness, and there are no words to describe the gratitude I have for those individuals. I realize I am blessed in many ways to have had the opportunities that I did, however I feel as though the need to take a closer look at the transitional process for the wounded family is real. I find myself wondering how many other spouses, children, mothers, fathers, and family members feel as though their ability to grieve has been stunted, or as if they are stuck within the process simply because of the expedited nature.

Missed the beginning of the series? Go to ‘The Phone Call’ to read the first installment of this caregiver series.


Tabitha_FamilyMeet Tabitha…

The caregiving mini-series, 444 Days in the First Year, was written by Tabitha McCoy. Tabitha is a contributor to the MFLN–Military Caregiving concentration team and is a former military caregiver to her husband, SGT Steve McCoy. In this mini-series, Tabitha shares her personal story of caregiving, loss, grieving, and transitioning, as well as insight and advice for both professionals and family caregivers as she recounts the 444 days following her husband’s injuries and then unfortunately his death in June 2008.

Tabitha holds a Bachelor of Science in Psychology, and is currently a graduate student at Valdosta State University where she is pursuing her Master’s degree in Marriage and Family Therapy.

This post was published on the Military Families Learning Network blog on August 29, 2014.

Intimate Partner Violence and Co-Occurring Conditions

Jay Morse and Heidi Radunovich, PhD

Last July and August, we published several blogs about domestic violence. During that month we highlighted definitions of domestic violence, pervasiveness, warning signs, how to differentiate between different types of violence, and work with different types of family violence.

In today’s blog we review Tinney and Gerlock’s (2014) recent article on distinguishing between Intimate Partner Violence (IPV) and violent behaviors associated with mental health issues. The researchers highlight a common combat-related mental health conditions including: post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), substance use disorder (SUD), suicide, and depression.

The researchers make two important distinctions when considering the interaction between IPV and other conditions: First, domestic violence can be present in many forms including coercive violence or resistive violence for instance; and second, the context of the violence (why is it occurring, and what is the impact on the victim) should be considered when making treatment recommendations. Sometimes there are co-occurring conditions, meaning that there could be IPV in addition to a mental health issue. At times it might be difficult to distinguish between what is a mental health-related issue and what is IPV.

According to the authors, “IPV occurs when there has been an act of physical or sexual violence in an intimate relationship and the range of offender behaviors continually remind victims that violence is always a possibility” [1].Tactics might include: intimidation, coercion, threats or other forms of emotional abuse. To distinguish between tactics associated with IPV, and symptoms of co-occurring disorders, the specific symptoms of the specific disorder (e.g., PTSD, TBI, or others) should be considered in relation to the tactics used in IPV (see table below).

It is important to note that these conditions do not occur only within the military, but also occur within the civilian population. In their review, the authors discuss other research studies that relate PTSD to IPV, however, any form of IPV involving military members can occur whether co-occurring conditions such as PTSD are present or not. For instance, a service member returning from combat or a civilian with a trauma history may experience PTSD symptoms including experiencing distressing events or nightmares. It can be difficult to determine whether violent acts associated with a disorder are related to IPV, or simply reflect symptoms of the disorder. Without considering the context, motivation, and possible other symptoms related to the act, the behavior may be indistinguishable. However, the authors note that all violent acts are dangerous, and potentially lethal, so regardless of the cause it is important for family members to have plans for safety in place.

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The Department of Defense offers a wide range of support programs for victims and survivors of domestic abuse through their Family Advocacy Program. The Military Families Learning Network is available to serve military family service professionals.

Information on IPV assessment and tools are available from the Centers for Disease Control and Prevention’s Measuring Intimate Partner Violence Victimization and Perpetration: A Compendium of Assessment Tools [2].

Resources:

1. Tinney, G., & Gerlock, A. A. (2014). Intimate partner violence, military personnel, veterans, and their families. Family Court Review, 52(3), 400-416. doi: 10.1111/fcre.12100

2. Thompson, M. P., Basile, K. C., Hertz, M. F. & Sitterle, D. (2006). Measuring intimate partner violence victimization and perpertration: A compendium of assessment tools. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Retrieved from http://www.cdc.gov/ncipc/pub-res/IPV_Compendium.pdf

This post was written by Jay Morse & Heidi Radunovich, PhD, members of the MFLN Family Development (FD) team which aims to support the development of professionals working with military families. Find out more about the Military Families Learning Network FD concentration on our website, on Facebook, on Twitter, You Tube, and on LinkedIn.