Currently being implemented as a large-scale service project through the US Navy Bureau of Medicine and Surgery, FOCUS family resiliency training is a strength-based, trauma-informed, preventive intervention for military families and is designed to promote resiliency and mitigate the impact of wartime deployment stress.19 It provides parents and children with training that addresses the impact of wartime deployment and helps them learn emotional regulation and communication and problem-solving skills to address their specific challenges. Early evaluation of this program indicates that parents and children who participated in FOCUS experienced significant improvement in emotional and behavioral adjustment.20
Lessons from FOCUS provide guidance for clinicians, such as the following interventions to consider when working with military families:
• Education regarding family deployment stress, combat-related psychological stress, and developmental stress reactions in children
• Resiliency skills training related to emotional regulation (including traumatic stress reminder management techniques), goal setting, problem solving, and family communication
In FOCUS, a deployment time line and family narrative framework are used to increase family understanding, communication, support, and cohesion. An essential component of family-based treatment lies in developing and strengthening skills that support parental leadership and positive parent-child interactions in the face of heightened stress.
Parents benefit from information about typical child development, expected emotional and behavioral reactions of children to stressful situations, and ways to mitigate the effects of deployments on children. For example, parents can be reminded to help infants by providing a calm, consistent environment. Likewise, they can help toddlers feel protected by providing a predictable routine and additional attention when one parent is deployed.
Preschoolers benefit from repeated explanations of a parent’s departure and separation, along with assurances that the separation is not the child’s fault. If a child regresses to past behaviors, parents can recognize this as a sign of distress. Efforts designed to increase self-sufficiency, reduce stress, and increase emotional support may be effective. School-aged children sometimes need encouragement to express themselves and reassurance that it is acceptable to feel sad and cry. Parents can support emotional awareness and regulation through modeling communication and effective coping regarding their own reactions to stress.
During deployments, concrete representations of the deployed parent and of the parent-child relationship (maps, transitional objects, images) are helpful and provide opportunities for communication about the context and meaning of the separation. Strategies that support the deployed parent’s participation in the child’s life enhance the parent-child relationship. If possible, it is helpful for the deployed parent to send regular messages to each child (separate letters or sections of audio tapes or videotape). Calendars, schedules, plans for communication, and other orienting tools can help the child perceive a sense of time left until a family reunion.
Encouraging children to engage in an activity or hobby they enjoy and do well can enhance their self-sufficiency and provide social support. Regular family communication should be a goal of all parents. Discussions about how things might be different when the family is reunited are often overlooked; however, the family is encouraged to have these discussions before and during reintegration. Topics may include how family roles have changed, meaningful interim experiences, and ways in which the children have matured. It may be helpful to plan time to become reacquainted with each other.
The monitoring and regulation of emotional states and related behaviors can be used to identify daily fluctuations in feelings, including stress reactions. A feeling thermometer can help families monitor their emotional states and the effectiveness of the strategies they use to lower their emotional distress. Key emotions to monitor include anger, sadness, guilt, shame, and anxiety/fear. It is then possible to identify internal and external reminders that contribute to these emotional reactions and escalations of distress and discuss how these responses affect interpersonal behavior in the family. For example, a parent may come to see how his combat-related hypervigilance leads to an overly authoritarian parenting style and increased family conflict.
Coping strategies for parents typically include communicating with other family members when they are experiencing a stress reminder; developing a plan for how family members can respond supportively; and practicing ways, such as relaxation or distraction techniques, to alter arousal and unhelpful reactions when they are triggered or while in potentially triggering situations.