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The general public has become increasingly interested in the health and well being of the children and families of military service members as the war in Iraq continues. Observers recognize the potential stresses or traumas that this population might undergo as a result of the military deployment or the possible injury or death of military family members. While such concern is welcomed, it is sometimes misplaced. Not infrequently, conclusions that are drawn are fraught with misunderstanding and bias based upon lack of understanding of the military community or a preconceived notion of the vulnerabilities of the population. This problem is compounded by the paucity of scientific study. In this article the authors review the strengths of military families as well as the unique challenges that they face. The authors also highlight parental deployment, parental injury and parental death as unique stresses to military children and families. Available and pertinent scientific information is reviewed. Clinical observations of children and families during the ongoing war in Iraq are presented.

LAY SUMMARY Creative arts therapists (art therapists, dance/movement therapists, and music therapists) administer assessments and interventions that support the holistic well-being of military families affected by traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD). Through participation in the Creative Forces: United States National Endowment for the Arts Military Healing Arts Network, military families discovered strengths, inspired connections, and improved understanding of their relationships. Creative arts therapies (CATs) motivated engagement, which ultimately boosted family resilience. CATs are an integral part of interdisciplinary care to address behavioural and rehabilitative conditions of military families impacted by TBI and PTSD. Future research should examine the efficacy of creative arts therapies in improving resilience in military families.

SOMMAIRE NON SCIENTIFIQUE Les thérapeutes en psychothérapie de créativité (art-thérapeutes, thérapeutes par la danse/le mouvement, musicothérapeutes) évaluent et interviennent pour favoriser le bien-être global des familles militaires touchées par un traumatisme crânien (TC) et le trouble de stress post-traumatique (TSPT). Avec une participation à Creative Forces: National Endowment for the Arts Military Healing Arts Network aux États-Unis, les familles militaires découvrent des forces, des liens inspirés et une meilleure compréhension de leurs relations. Les thérapies en psychothérapie de créativité (TPC) ont encouragé l'interaction, ce qui a fini par renforcer la résilience de la famille. Les TPC font partie intégrante des soins interdisciplinaires pour améliorer les problèmes comportementaux et de réadaptation des familles militaires touchées par un TC et par le TSPT. Les études futures devraient examiner l'efficacité de la psychothérapie de créativité dans l'amélioration de la résilience des familles militaires.

LAY SUMMARY Creative arts therapists (art therapists, dance/movement therapists, and music therapists) administer assessments and interventions that support the holistic well-being of military families affected by traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD). Through participation in the Creative Forces: United States National Endowment for the Arts Military Healing Arts Network, military families discovered strengths, inspired connections, and improved understanding of their relationships. Creative arts therapies (CATs) motivated engagement, which ultimately boosted family resilience. CATs are an integral part of interdisciplinary care to address behavioural and rehabilitative conditions of military families impacted by TBI and PTSD. Future research should examine the efficacy of creative arts therapies in improving resilience in military families.

To date, the U.S. military has made major strides in acknowledging and therapeutically addressing trauma and Posttraumatic Stress Disorder (PTSD) in service members and their families. However, given the nature of warfare and high rates of losses sustained by both military members (e.g., deaths of fellow unit members) and military families (e.g., loss of a young parent who served in the military), as well as the ongoing threat of loss that military families face during deployment, we propose that a similar focus on grief is also needed to properly understand and address many of the challenges encountered by bereaved service members, spouses, and children. In this article, we describe a newly developed theory of grief (Multidimensional Grief Theory) and apply it to the task of exploring major features of military-related experiences during the phases of deployment, reintegration, and the aftermath of combat death—especially as they impact children. We also describe implications for designing preventive interventions during each phase and conclude with recommended avenues for future research. Primary aims are to illustrate: (1) the indispensable role of theory in guiding efforts to describe, explain, predict, prevent, and treat maladaptive grief in military service members, children, and families; (2) the relevance of multidimensional grief theory for addressing both losses due to physical death as well as losses brought about by extended physical separations to which military children and families are exposed during and after deployment; and (3) a focus on military-related grief as a much-needed complement to an already-established focus on military-related PTSD.

Recent theory and empirical research suggest that child neglect is a heterogeneous phenomenon characterized by various types. This study examined family risk factors associated with five neglect types including failure to provide physical needs, lack of supervision, emotional neglect, moral–legal neglect, and educational neglect in 390 substantiated cases of neglect in four U.S. Army communities. Family factors associated with elevated risk of each neglect type relative to other types were identified using multivariate regression. Relatively distinct sets of family risk factors were differentially associated with the neglect types. Family mental health problems and larger family size were associated with risk of failure to provide physical needs, childcare problems and larger family size were associated with risk of supervisory neglect, and family disagreements were associated with risk of emotional neglect. None of the family factors were associated with elevated risk of moral–legal or educational neglect. Results can inform the development of indicated and relapse prevention strategies for families affected by different neglect types.

Increases in combat deployments have been associated with rises in rates of child neglect in U.S. military families. Although various types of child neglect have been described in military families, it is unknown whether deployment status is associated with specific types of child neglect and whether other factors, such as substance misuse, play a role. To determine the contribution of service member deployment status to the risk of specific child neglect types, data were collected from 390 substantiated U.S. Army child neglect case files. The contributions of deployment status at the time of the neglect incident and parental alcohol or drug-related misuse to risk of neglect types were examined controlling for military family rank and child age. Compared to never deployed families, families with a service member concurrently deployed at the time of the neglect incident were at higher risk for failure to provide physical needs, lack of supervision, and educational neglect, but at lower risk for emotional neglect. Being previously deployed incurred risk for moral–legal neglect. Substance misuse added risk for moral–legal and educational neglect. Findings indicate the need for tailored prevention strategies to target different periods within the deployment cycle.

BackgroundDistinguishing a disorder of persistent and impairing grief from normative grief allows clinicians to identify this often undetected and disabling condition. As four diagnostic criteria sets for a grief disorder have been proposed, their similarities and differences need to be elucidated.MethodsParticipants were family members bereaved by US military service death (N = 1732). We conducted analyses to assess the accuracy of each criteria set in identifying threshold cases (participants who endorsed baseline Inventory of Complicated Grief ⩾30 and Work and Social Adjustment Scale ⩾20) and excluding those below this threshold. We also calculated agreement among criteria sets by varying numbers of required associated symptoms.ResultsAll four criteria sets accurately excluded participants below our identified clinical threshold (i.e. correctly excluding 86-96% of those subthreshold), but they varied in identification of threshold cases (i.e. correctly identifying 47-82%). When the number of associated symptoms was held constant, criteria sets performed similarly. Accurate case identification was optimized when one or two associated symptoms were required. When employing optimized symptom numbers, pairwise agreements among criteria became correspondingly 'very good' (κ = 0.86-0.96).ConclusionsThe four proposed criteria sets describe a similar condition of persistent and impairing grief, but differ primarily in criteria restrictiveness. Diagnostic guidance for prolonged grief disorder in International Classification of Diseases, 11th Edition (ICD-11) functions well, whereas the criteria put forth in Section III of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) are unnecessarily restrictive.