In an effort to familiarize medical providers with addressing deployment-related health concerns of Service members and their families, DoD has developed a new easy-to-use that outlines key questions to ask patients, and provides a list of resources for additional support and guidance on how to make necessary referrals.
The guide identifies a number of experiences that are unique to military families. These include frequent absences of the Service member due to training and deployments, many of which carry risks that can create worry and anxiety. Families make frequent moves, often to remote areas away from extended family and other sources of support. They are often young and many have young children. There is also a large single military population, and many of them also have children. Health-related deployment or separation concerns can occur with both the deployed Service member, and the adult and child family members staying behind.
The Psychological Health Strategic Operations (PHSO) directorate within the Department of Defense Office of Force Health Protection & Readiness combined forces this summer with the Military Community and Family Policy office (MC&FP) to create the guide. The idea for the quick reference guide arose after Dr. Clifford Lutz, Vice Chair of the Department of Military and Emergency Medicine at the Uniformed Services University of the Health Sciences (USUHS), noticed a need to sensitize students to the needs of military families with deployed Service members.
Dr. Lutz reached out to MC&FP for assistance in developing a lecture on the topic, and MC&FP then contacted PHSO’s Family Programs Liaison, Judith Dekle. “I gave them suggestions on the content for the guide,” Dekle said. “They had a brochure already prepared for another purpose. We reworked it for this audience. I thought it could be something the students could use in their daily practice, so it was not only for the class. It went over pretty well.”
In July, Dekle introduced the guide during a guest lecture to 200 fourth-year medical students at USUHS. “Following the lecture the students were going to do a two-week field exercise and then return to the hospital where hopefully they began to use the guide along with what we taught them,” she said.
The guide could also be used by practicing physicians or as a template for other clinical services. It should be useful not only for medical students, but for any military or civilian clinician seeing military family members, including TRICARE network providers. Dekle said the guide has two primary ways of aiding physicians. “One is to make them more sensitive to the need of families to discuss deployment effects; the other is to raise awareness of resources and the importance of making appropriate referrals,” she said. “Family members will often take advice from a physician when they will not take that same advice from someone else. That is a lot of responsibility for the physician and this guide is designed to help them perform that duty.”
Recognizing the Need
The guide highlights the importance of assessing the impact of a Service member’s deployment on the entire family and offers suggested ways providers can speak with family members about their experiences and needs when they come in for an appointment. Often stressors related to deployment such as relationship or separation difficulties, and health and financial concerns can co-occur in family members, who may not be aware of available resources that can assist them with these issues.
“The first thing is to ask the family member to tell you why they are there and to give them time to express their needs,” Dekle advised. “When they say, (for example), ‘my child is having trouble sleeping’, you respond to that but then say, ‘now, what else can I help you with today?’ Don’t assume what they are writing down on the intake form is the only thing on their mind. Give them time and permission to tell you everything that is going on.”
Providers should observe patients’ energy level, eye contact, facial expressions, posture, and other indicators of physical and emotional distress. “Listen to what they say, but also to what they do not say,” the guide suggests.
The child may not be sleeping well, but the spouse may be having symptoms of her own that the child is manifesting, Dekle advised. The parent may not even be aware of their own issues, but they are very sensitive of their child’s issues.
Dekle said concerns a family member may experience run the gamut from children’s issues, financial management problems or even simple things such as not having anyone to mow the lawn or help with housework and driving the kids to events. Healthcare concerns may not even be the primary reason for their visit to the doctor. Since patient appointments are only about 15 minutes long, she said it is incumbent on the provider not to wait until the end of the visit to ask the family member if there is anything else on their mind. “The real issue is often the one they bring up as they exit the exam room, leaving little time to respond or to make a good referral,” she said.
If the provider asks what else is wrong, the patient might respond by saying something like, ‘My husband is deployed.’ The provider could then ask how that is affecting her and her family. She could be suffering from lack of sleep, and may feel overwhelmed by having to run the household alone. The provider could then ask if she has considered talking to someone about it, and provide her with a number to call. It is very important to let her know that feeling stress during deployment is normal. “They need to hear that this is not unusual,” Dekle said. “That it is not a sign of mental illness.”
Providers should recognize that given the high military operations tempo in recent years for Iraq and Afghanistan, there is a good chance that the family member they are seeing has had to deal with a loved one’s deployment. So the guide advises the provider to ask if deployment has occurred or if one is pending, and if so, what concerns the family member has about it. The provider should ask what support systems the family member has in place, and refer them to other appropriate resources if needed. A direct referral can be made for additional support, and a return visit can be scheduled to ensure the family member has followed through.
Knowing the Resources
Included in the guide is a list of MC&FP resources that are available online, such as Military OneSource, Military HOMEFRONT, Plan My Move, MilitaryINSTALLATIONS, and Military Youth on the Move. These services provide the practical support that most families need at some point when facing the challenges of military life. They are particularly useful when the family is dealing with the stress of deployment.
As military families move from place to place to coincide with Service members’ orders, they should think of their local installation family center as a primary source of support. When a physician sees a patient for the first time, it is a good idea to be sure they have the base family center’s phone number. “The center staff can refer the family to a financial manager or to a parenting class, for example, or to whatever support they need,” Dekle said. “Often what a family member needs is some practical day-to-day support with managing the household and kids. We want to normalize this and to reassure them that there is nothing ‘wrong’ with them.”
When a family member just needs someone to talk to or if they think their child might benefit from talking with someone other than a parent about a non-medical problem, a referral to a Military Family Life Consultant can be made. “They provide a wide range of family assistance, and it’s all free,” Dekle advised. Guard and Reserve families living off base and active duty families assigned to remote locations also have access to a network of non-medical support through Military OneSource.
There are other programs available that can help with a variety of concerns. The Joint Family Support Assistance Program has teams composed of referral specialists, personal financial counselors and military family life consultants. Other programs include summer camps for military children, and programs for family members with particular needs, new parent support, and child or domestic abuse prevention.
Dekle said the joint development of the guide is a good example of the ongoing collaboration between MC&FP and PHSO to provide improved services for families and providers. “The guide is targeted to the clinical provider community,” Dekle advised. “It’s important for physicians to raise issues of the effects of deployment with family members. They don’t have to wait for the family member to bring it up. That needs to be a part of their assessment. We rely on physicians to identify the family member’s concerns early, and to make appropriate referrals rather than try to address them all themselves.”