WASHINGTON, DC—How can servicemembers with injuries and their families be better helped to reintegrate following a deployment? Researchers at the Uniformed Services University of the Health Sciences and the Center for the Study of Traumatic Stress hope to find answers through a $6.5 million grant that will be used to pilot interventions designed to help combat injured servicemembers and their families cope following a deployment. “We know that many of these families are very strong and have a tremendous capacity to deal with the challenges they have, but we want to better understand what the impact of these challenges is, and how as a community we can support the families to remain healthy and strong through the rehabilitation period,” said Dr Stephen Cozza, MD, who is the associate director of CSTS and the principal investigator for the study.

When a servicemember returns home injured, the entire family must come to terms with the injury, Dr Cozza explained. “When there is profound injury or illness in the family, it affects all family members, and can lead to—in some of the preliminary pilot work we have done—elevated distress in the family,” he noted.

The grant will focus on piloting interventions to help these families improve their overall family functioning during the recovery period. Researchers are currently working out the details of the study. “We are hoping that it is something that will be really helpful to the families and make a difference,” he said.

Studying Families

An assessment study will be conducted prior to the intervention study to understand the impact of injuries on servicemembers and their families. While civilian literature has found that when a parent sustains a traumatic brain injury it can profoundly impact children in families, Dr Cozza said that there has never been a study on the impact of combat injury on military families. “We really need to understand what that impact is, and we need to understand what the consequences are for children,” Dr Cozza said.

Following the assessment study, a separate study will tailor interventions that are based on a program called Families Overcoming Under Stress that helps family members of deployed servicemembers deal with the challenges of combat operational stress during wartime. In addition, case management will be given to those in the intervention group that is based on a case management model that will provide support during the recovery period after a traumatic injury.

“Our grant is called “Families Overcoming Under Stress-Combat Injured,” he said. “It is specifically being developed for the purposes of addressing the needs of combat injured families. It is comprised of a strength-building approach in families, as well as a long-term case management functioning that will attempt to address their needs and provide support to the families through the recovery trajectory.”

Dealing with an Injury

The intervention study will include 120 injured servicemembers and spouses with at least one child between the ages of 5 and 18. Participating medical centers include Walter Reed Army Medical Center, Brooke Army Medical Center, and Madigan Army Medical Center. Half of the families will receive the standard of care from the existing support programs available at the participating medical centers, while the families in the intervention group will receive the introduced interventions.

Families who are in the intervention group will participate in an initial seven or eight sessions in which researchers will obtain baseline measures to better understand areas of strength and areas of concern from the families. Researchers will also initiate a discussion about “injury communication” with those in the intervention group. This is designed to help parents talk with their children, each other, the community, and their health care providers about their injury experience.

One of the activities that those receiving the interventions will participate in will be a narrative, in which each member of the family will describe what the experience of the injury has meant to him or her, and what they expect in the future. The family will then together develop a family narrative. “It will allow an appreciation of every individual’s experience and build more of a solidarity about the family and what it may need to address in the future,” he said. “Parents may find that children were more distressed than they were initially aware. It lends the opportunity for that parent to be available to that child, and to talk to that child in a way that addresses any concerns that come up.”

The family narrative will also help the family develop family goals, Dr Cozza explained. “What does the family need to do to be more healthy as we move into the future based upon the challenges resulting from the injury?” he said. A case manager will contact the families receiving the intervention every 3 months to find out what concerns the families may have. At the 6-, 12- and 24-month mark after the initial assessment, researchers will repeat assessments and will provide booster sessions to the families that need it.

Helping Families

Doctor Cozza explained that the initiatives used in the intervention group are prevention initiatives. “It is really to help identify and support family functioning in families presumed to be at some risk. If for example we recognized that there was PTSD or depression, part of the prevention intervention would be to help those families identify/recognize those problems and activate their own going out and getting help for those problems.”

At the conclusion of the study, researchers will evaluate how well the families who received the interventions are doing compared with those that did not receive them. “The purpose and the hope is that this will support functioning and reduce morbidity in all family members over time,” he said. Researchers are currently funded to follow the participants in the intervention study for two years. “Depending on the circumstances and how the study moves forward, we might hope to follow them even longer than that,” he said.

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