WASHINGTON, DC—When servicemembers are on active deployment, they are not the only ones who may be affected by their departure; their children may also feel strained.

Doctor Riggs, PhD, executive director of DoD’s Center for Deployment Psychology, an entity that educates providers on caring for servicemembers and their families, said that providers need to be aware of the stress that children may experience as a result of a deployment. “We try to make them aware of what kinds of problems the kids may be having, and how to help those kids if they do wind up in your office. It is clearly an area we need to keep an eye on,” he said.There is concern both within DoD and in the civilian community about the impact that the conflicts may be having on children.

According to DoD data, outpatient mental health visits for children of those on active duty doubled from 1 million in 2003 to 2 million in 2008. While Doctor Riggs said that he had not seen this data, he noted that any increase in the number of people seeing mental health care could be due to several factors.

One explanation is that children are experiencing additional stress due to deployments. Another possibility is that DoD’s efforts to reduce stigma and encourage servicemembers to seek care is also spurring parents to get their children checked out. “There has been a good deal of effort put forth by the military to try to overcome the sense of stigma.”

Another possible contributing factor is that non-deploying parents may be feeling more stressed. “If I am the nondeploying parent and I am feeling stressed out and my kids are not doing what I want them to do, it may be that I am more likely to take them in for a mental health visit or a health care visit because I am reaching out at my end to deal with them,” he said. “So, it may be that part of that increase reflects not that the kids are necessarily having more problems, but that the parent who is not deploying is having a harder time with his or her own stress.”

Children’s Needs

The experiences of families and children in the current conflicts differ somewhat from those of families in prior wars. Many families are undergoing the stress of a servicemember serving multiple deployments—a situation that most families in prior conflicts did not contend with, according to Dr Riggs.

“If you go back to WWII, people were essentially deployed for the duration. They entered the military and went off to war and they came back years later when the fighting was done. If you looked at Vietnam, the vast majority of them went a single time,” he said.

When children are undergoing stress it may manifest in a variety of ways. “Kids that have a tendency to become anxious and withdrawn when they are under stress, when a parent deploys and they are having problems with it, that is what they are going to look like,” he said. “If a child tends to act out and get aggressive when things aren’t going well, when they are placed under the stress of a parental deployment that is how it is going to express itself.”

Reaching Children

Various resources are available to help military children, including those found at www.realwarriors.net and the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury website at www.dcoe.health.mil. “There are a lot of resources out there,” said Dr Riggs. “I do sometimes think there is a challenge connecting a family member with the service he or she is looking for. One of the goals for the DCoE is to try and help them connect with what they are looking for.”

Dr Riggs said that since many military families are receiving care through a civilian provider in the Tricare network, the Center for Deployment Psychology is working to educate civilian providers on military culture and military families. “One of the things that our center was set up to do and that we have been doing is to try educate civilian providers about issues regarding military culture and military families and the kinds of stress they are under, so that they are better prepared to help the children and servicemember,” he said.

In addition to military resources, civilian organizations are also involved in providing assistance to military children. Zero to Three, a nonprofit organization, has a military-focused program that trains professionals to recognize the impact of trauma on small children. The training is offered at 12 military installations and 2 military medical centers. “We have gone out to these installations and have provided training. Our trainings have been focused on helping professionals recognize the impact that trauma, separation or loss is having on the very young child,” said Doctor Michele Mitchell, a senior medical analyst at Zero to Three, a nonprofit.

The organization also makes available a number of materials to help providers and families. “Our newest materials are focused on helping parents and professionals deal with trauma, injury—either physical or psychological—and then bereavement from a servicemember’s death,” said Dr Mitchell.

The National Military Family Association, an advocacy group for military families, also works to promote awareness of the needs of military children and families. Among its initiatives is a camp for military children called Operation Purple Camp, created in 2004 as a way to ameliorate war-related stresses. The program aims to help military children have fun while also learning coping skills.

NMFA Deputy Director of Government Relations Barbara Cohoon said she worries that there are not enough mental health resources available to help military families. According to Cohoon, shortages in mental health providers exist because many military behavioral health specialists are deployed in-theater. Those in the civilian network for care/services may choose not to take Tricare because of low reimbursement rates. “There are not enough resources to address the growing need with our military children,” she said via e-mail.

According to Cohoon, the NMFA has observed an increase in children arriving at their camps with medication for stress-related symptoms. The organization conducted a pilot study with Rand last year called “Understanding the Impact of Deployment on Children and Families” that asked the children and their caregivers about their camp experience and their stress. The NMFA, along with Rand, is conducting a follow-up longitudinal study on how both are coping.

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