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Treating Military-Connected Children in the Civilian Sector: Information and Resources for Health Care Providers

Published:February 10, 2020DOI:https://doi.org/10.1016/j.apmr.2019.12.003

      Background and Significance

      More than 50% of those currently serving in the armed forces are married with families. Since the onset of the wars in Iraq and Afghanistan more than 2.1 million military-connected children have had a parents deployed. Many of these children have made tremendous sacrifices to support their parents. As a result, they are exposed to stressors related to their parents’ military service. These stressors can affect their overall physical, psychological, and behavioral health and lead to toxic stress.
      • Gorman G.H.
      • Eide M.
      • Hisle-Gorman E.
      Wartime military deployment and increased pediatric mental and behavioral health complaints.
      Military-connected children also develop tremendous resiliency when their needs are adequately addressed. It is the time for health care providers to join forces with military families to mitigate the effect of parental military service on military-connected children.

      Call to Action

      Long parental deployments and the unique nature of the military lifestyle are associated with increased physical, psychological, and behavioral health challenges for military-connected children.
      • Gorman G.H.
      • Hisle-Gorman E.
      Increased mental health visits for children of deployed military.
      ,
      • Mansfield A.J.
      • Kaufman J.S.
      • Engel C.C.
      • Gaynes B.N.
      Deployment and mental health diagnoses among children of US Army personnel.
      Identifying military-connected children in your practice is critical. Changes in a child’s behavior, academic performance, physical symptoms, or emotional state could signal difficulties related to military lifestyle stressors, such as a parent’s deployment.
      Therefore, we issue a call to action for all health care providers to do the following: (1) identify military-connected children in your health care setting; (2) become better informed about military culture and the effect of military service on military-connected children; (3) recognize the physical, psychological, and behavioral health risk factors and comorbidities associated with parental military service; and (4) identify referral agencies and resources available to support military children in the civilian sector.

      Identifying and supporting military-connected children in your practice

      Families of active duty service members may or may not have access to care within the military health care system. If availability is limited or unavailable, active duty family members will receive their care in civilian health care settings. Often the only way a provider will learn of their patient’s military connection is by noting their TRICARE insurance, which is unique to the military.
      Families of Reserve and National Guard service members are not eligible to receive care within the military health care system and receive all of their health care within the civilian sector. Families of Reserve and National Guard service members do not typically have TRICARE insurance.
      Simply asking all patients, “Do you (or does your child) have a parent, sibling, or other family member that has served in the military?” can help identify military-connected children. This information prompts the provider to screen the child for physical, psychological, or behavioral health concerns and risk factors associated with parental military service by using the I Serve 2 Pocketcard of Healthcare Providers Caring for Military Children (supplemental fig S1, available online only at http://www.archives-pmr.org/).
      • Rossiter A.G.
      • Patrician P.A.
      • Dumas M.A.
      • Ling C.G.
      • Johnson H.L.
      • Wilmoth M.C.
      I serve 2: identifying and caring for military children in civilian primary care settings.
      The ICARE support strategy—Identify, Correlate, Ask, Ready Resources, and Encourage and Educate—can be used as a guideline once the military-connected child is identified. It prompts the provider to ask age-appropriate questions and to provide resources for both the child and parent.
      • Rossiter A.G.
      • Patrician P.A.
      • Dumas M.A.
      • Ling C.G.
      • Johnson H.L.
      • Wilmoth M.C.
      I serve 2: identifying and caring for military children in civilian primary care settings.
      ,
      • Hamilton L.A.
      • Ling C.G.
      • Rossiter A.G.
      Impact of parental military service on the health of military connected children.

      Become informed on military culture and available resources

      It is important to know if the military-connected child’s parent is on active duty or in the Reserve or National Guard because services and available resources differ based on the service type.
      Active duty service implies that the military is the service member’s full-time job, complete with all the pay and benefits afforded to one serving in that capacity. The average child of an active duty service member moves every 2-3 years—military-connected children average 6-9 schools during their secondary school career.
      United States Department of Defense Education Activity (n.d.).
      Children of active duty parents may be geographically separated from extended family. Other military families replace or augment the extended family because they share a common bond of military service and sacrifice. Finally, these children have access to a multitude of resources and support systems on both the military installation as well as in the community in which they live. Should access to services on the military installation be limited or unavailable, military families can access resources or services in the civilian sector and use their TRICARE insurance policy.
      For people in the reserves or National Guard, military service is typically in addition to their full-time civilian job. Reserve and National Guard jobs require a minimum of 1 weekend a month and 2 weeks of annual training and can also include deployments in the continental United States or abroad in support of a state and national emergency or a humanitarian and/or wartime contingency. The children of reserve and National Guard parents may be geographically stable, with the service member parent travelling periodically for military service obligations. Regardless of their proximity to a military installation, these children cannot access the military resources or support services afforded to their active duty counterparts. Furthermore, these children may be unidentified in communities and schools.
      Although military families face many challenges, they also develop many good qualities. Military-connected children learn to be flexible and adapt to new environments. They often demonstrate great resiliency in response to difficult situations. Military-connected children build social skills to integrate into new communities with each move. They also learn military values, including public service, work ethic, and physical fitness.
      • Ahmann D.
      What growing up with military parents teaches our children.

      How to be a Military-Connected Child Advocate

      Being an effective advocate is critically important to mitigating the effect of parental military service on military-connected children. A few things you can do to manage those effects and mitigate risk factors include the following:
      • Educate yourself about the unique health risks and health care issues of military-connected children and how military service can affect families.
      • Ask the question, “Do you (or does your child) have a parent, sibling, or other family member who has served in the military?”
      • Listen carefully to the answer. You may be the first health care professional with whom the military-connected child has shared this information.
      • Incorporate physical, psychological, and behavioral health issues into your history and physical examination. Consider using the I Serve 2 Pocketcard of Healthcare Providers Caring for Military Children (see supplemental fig S1).
        • Rossiter A.G.
        • Patrician P.A.
        • Dumas M.A.
        • Ling C.G.
        • Johnson H.L.
        • Wilmoth M.C.
        I serve 2: identifying and caring for military children in civilian primary care settings.
      • Document what the military-connected child and/or the parent tells you. Your records may be used to request referrals or resources for the military-connected child.
      • Identify referral agencies and options on military instillations as well as in the community and the local school district.
      • Support the military-connected child by acknowledging his or her service as a military family member. Your patient is likely to be very sensitive to an automatic response instead of an authentic expression of appreciation. By displaying even basic knowledge of the unique aspects of military life and providing a safe environment that is patient focused, you allow them to discuss the effect of military service on their physical and psychological health.
      • Provide well-targeted referrals when needed.

      Resources for Health Care Providers

      Additional Resources

      Authorship

      This page was developed by Alicia Gill Rossiter, DNP, FNP, PPCNP-BC, FAANP, FAAN (e-mail address: [email protected] ); Larry Cervelli, OT, FACRM; Alison M. Cogan, PhD, OTR/L; and Catherine Ling, PhD, FNP-BC, CNE, FAANP, FAAN.

      Disclaimer

      This information is not meant to replace the advice from a medical professional and should not be interpreted as a clinical practice guideline. You should consult your health care provider regarding specific medical concerns or treatment. This Information/Education Page may be reproduced for noncommercial use for health care professionals and other service providers to share with patients or clients and their caregivers. Any other reproduction is subject to approval by the publisher.

      Supplementary data

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      1. United States Department of Defense Education Activity (n.d.).
        (Available at:) (Accessed August 1, 2019)
      2. Learning Liftoff. 8 benefits of being a military child.
        (Available at:) (Accessed August 1, 2019)
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