Military Family Fitness Model - Human Performance Resource Center

Military Family Fitness
Model
Col Stephen Bowles1, Ph.D.
Monique Moore2, Ph.D.
Colanda Cato2, Ph.D.
Liz Davenport Pollock3, MS, LGMFT
Mark Bates2, Ph.D.
Uniformed Services University of the Health Sciences1 Defense Centers of Excellence2
Human Performance Resource Center3
Forging the Partnership: 2011 DoD/USDA Family Resilience
Conference, 27 April 2011, Chicago, IL
Agenda
•  Organizations Overview
•  Background
•  What is Fitness and Total Force Fitness?
•  Military Demand-Resource Model (MD-RM)
•  Military Family Fitness Model (MFFM) •  Strength Building Exercises
•  Case Example
•  DoD Resources •  The Way Ahead With You and Others
Disclaimer: Opinions in this presenta2on are those of the presenters and do not necessarily represent the opinions of DCoE, USUHS, the Army, or DoD. Acknowledgements
• The Defense Centers of Excellence
• Force Health Protection and Readiness, Psychological
Health Strategic Operation
• Military Community & Family Policy
• Headquarters, Air Force Air Education and Training Command
• Military Family Research Institute
• The Uniformed Services University of the Health Sciences DCoE Overview
•  Created in November 2007
Structure Mission •  Six directorates and six component centers
•  Partners and collaborates with the Department of
Veterans Affairs (VA) and other military and national
civilian networks, agencies, leaders, clinical experts, and
academic institutions
  Assess, validate, oversee, and facilitate prevention,
resilience, identification, treatment, outreach,
rehabilitation, and reintegration programs for
psychological health and traumatic brain injury (TBI)
  Ensure the Defense Department meets the needs of the
military community, warriors and families
USUHS Overview
•  Chartered September 1972
Structure •  Students include members of the Army, Air Force, and Navy
•  Education paid for by the Department of the Defense
•  University includes the F. Edward Hébert School of Medicine
and the Graduate School of Nursing Mission To provide the Nation with health professionals
dedicated to career service in the Department of
Defense and the United States Public Health Service and
with scientists who serve the common good
To serve the uniformed services and the Nation as an
outstanding academic health sciences center with a
worldwide perspective for education, research, service,
and consultation
Human Performance Resource Center
The
HPRC provides
information and
resources online that
enable our warriors
and their families to
enhance and sustain
their physical, mental,
and relational
performance to carry
out their mission as
safely and effectively
as possible.
Deployment and Stress in Military Families
•  Active duty service members prefer some deployments to
none at all (Hosek, 2004; Hosek et al., 2006; Karney & Crown, 2007)
•  Families adapt better to deployments if they understand the
value and purpose of the mission (Booth et al., 2007; Rohall & Martin, 2007; Weins & Boss,
2006)
•  Longer deployments (i.e., beyond one year) are more difficult
and increase family problems (Booth et. al., 2007; Hosek et al, 2006; Karney & Crown, 2007; Kirby &
Naftel, 1998)
•  Adverse effects of stress are caused by differences between
expected and actual length of deployment (Hosek et al., 2006; Hosek & Totten,
2002)
•  Deployment and duty-related separations are challenging for
families, and stress is expected (Burrell, et al., 2006; Hosek et al., 2006; Wiens & Boss, 2006)
•  More active duty spouses report experiencing higher levels of
stress than normal in 2008 (47%) than in 2006 (41%) (ADSS 2006;
ADSS 2008)
Source: OUSD(Military Community & Family Policy) Briefing, "Impact of Deployment on Military Families: Recent Research Highlights & Current DoD Research", January 2010 Social Support and Communication •  Supportive social relationships are a resilience factor critical to
healthy family coping (Spera, 2008; Wiens & Boss, 2006)
•  Children and adolescents who feel supported by others cope better (Perkins & Borden, 2003)
•  Sense of community is predicted by unit support and informal
community support (Bourg & Segal, 1999;Bowen et al., 2000; Burrell et al., 2003; Rohall & Martin)
•  National Guard and Reserve families are widely dispersed and
typically do not have access to the same level of informal
community support (Carroll et al., 2008; Faber et al., 2008; Wisher & Freeman, 2006)
•  Consistent and regular communication of service member to family
while on deployment is critical to sense of connection and family
resiliency (Bell et al., 1999; Wiens & Boss, 2006)
•  Problems communicating with family while on deployment predicts
greater stress for the service member and his/her family (Ender, 1995)
Source: OUSD(Military Community & Family Policy) Briefing, "Impact of Deployment on Military Families: Recent Research Highlights & Current DoD Research", January 2010 Financial Well-Being
Summary of Findings
2008 ADSS
•  Nearly two-thirds (62%) described their financial condition as
comfortable; 12% described it as not comfortable
–  No percentage point differences over time for not comfortable for
total, Service, or pay grade
•  Over two-thirds (69%) of spouses reported having $500 or more in
emergency savings
•  About half (46%) reported their spouse contributes to the Thrift
Savings Plan •  More than one-quarter (26%) of spouses indicated having at least one
financial problem in the past 12 months (excluding paying overdraft
fees)
Source: DMDC Briefing, "Family Program Needs: Select results from the 2008 Ac2ve Duty Spouse Survey (ADSS2008) and Reserve Component Spouse Survey (RCSS2008)", January 2010 Military Family Fitness Model What is “Fitness”?
Total Force Fitness A state in which the individual, family,
and organization can achieve and
sustain optimal well-being and
performance under all conditions
Source: Bates & Bowles (2010) Psychological Fitness The integration and optimization of
mental, emotional, and behavioral
abilities and capabilities to optimize
performance and strengthen the
resilience of Warfighters
Source: Bates & Bowles (2010) Total Force Fitness
Environment Source: Jonas, O’Connor, Deuster et al., (2010); CHAMP, USUHS, Samueli Ins2tute Total Force Fitness Domains
Social Social support
Task cohesion
Social cohesion
Psychological Coping
Awareness
Beliefs/appraisals
Decision making
Engagement
Total
Force
Fitness
Total
Fitness
Heat/Cold
Altitude
Noise
Air quality
Access
Food quality
Immunizations
Nutrient requirements
Screening
Supplement use
Prophylaxis
Service values
Food choices
Dental
Positive beliefs
Meaning making
Ethical leadership
Accommodate diversity
Spiritual Source: Jonas, O’Connor, Deuster et al., (2010); CHAMP, USUHS, Samueli Ins2tute Environmental Substance abuse
Hygiene
Risk mitigation
Strength
Endurance
Flexibility
Mobility
Military Demand-Resource Model
Basis
Conservation of Resources (Hobfoll, 1989) &
Job Demand Resource Model (Demourti et al., 2001)
Definition
A high-level heuristic model for leaders, policy makers, and program
managers to see the full picture and give equal attention across a
variety of ways health can be improved (Bates et al., 2010)
Military Demand-Resource Model
Resource Environment Desired Psychological Fitness End State Internal Resources Resilience Enhancing Outcomes Posi2ve Performance Outcomes External Resources Resilience Undermining Outcomes Nega2ve Performance Outcomes Demands Source: Bates et al., 2010 Military
Demand-Resource Model
Internal Resources
Description
Beliefs & Appraisals
Coping
Thoughts and behaviors a person uses to
manage the demands of stress and to maintain
optimal levels of energy and capacity to work
Decision Making
Thoughts and behaviors used for evaluating
and choosing courses of action to solve a
problem or reach a goal
Engagement
Sustained experience of strong identification
with unit members, unit, and mission
characterized by high levels of energy and full
involvement in mission tasks
Awareness & Attention
Source: Bates et al., 2010 What a person notices about his/her inner
states and surroundings
What a person holds to be true and how a
person interprets what is happening
Military Demand-Resource Model
External Resources
Description
Communicate and model constructive beliefs/
behaviors, provide clear expectations, etc.
Provide esprit de corps, motivation, satisfaction,
caring, teamwork, group pride, and status etc.
Leadership
Unit Support
Training to span lifecycle; establishes standards
and expectations, creates safe and supportive
Training, Policy & Research environment, provides structure with compliance
with legislation, establishes basis for behavioral
accountability
Programs & Services
Culture
Source: Bates et al., 2010 Established and new programs (chaplain, family
support, medical, recreation)
Underlying shared values (e.g., towards
psychological health symptoms and resources)
Military Family Fitness Model
Basis
ABC-X Model (Hill, 1949; McCubbin & Patterson, 1983)
&
Ecological Framework (Bronfrenbrenner, 1977) Definition
A process oriented, multi-level systems model for Service Members,
their families, leaders, policy makers, and program managers to see
how family fitness can be achieved/maintained
Case Example #1
Army medic Staff Sgt. Megan Krause knew the warning signs of depression and post-­‐trauma2c stress disorder, yet didn't recognize them in herself a\er returning home. She was drinking a bo^le of wine “just to go to sleep” and to avoid intrusive deployment memories. Fortunately, others in her chain of command and family recognized the signs and helped her see that she needed help and that it was okay to seek treatment. DCoE Real Warriors Campaign Military Family Fitness Model "
Resource Environment Source: Bowles, Pollock, Cato, et al. (in prepara2on) Work-­‐Life Integra>ve Health Demands External Resources Family Resources Individual Resources Desired Family Fitness End State Posi>ve Outcomes Nega>ve Outcomes Military Family Fitness Model
Demands
•  Deployment
•  Operations tempo
•  Deployment tempo
•  Finances
•  Relationship stressors
•  Separation
•  Under/unemployment
Military Family Fitness Model
Individual Resources
•  Awareness •  Appraisals and Beliefs
•  Stress Management and
Coping
•  Decision-making •  Individual Traits and Skills •  Communication
Military Family Fitness Model
Family Resources
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• 
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• 
• 
• 
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Communication
Cohesion
Flexibility
Appraisals and Beliefs
•  locus of control •  mastery of environment
Coping
Problem Solving
Rituals/Routines/Narratives
Parenting Styles
Couples Relationship
Financial Stability/Literacy
Military Family Fitness Model
External Resources
•  Leadership •  Interpersonal
Relationships (support) +
•  Programs and Services
(Community and military)
•  Community Involvement
Military Family Fitness Model
Outcomes
Positive
•  Communication
•  Adaptation
•  Reintegration
•  Family strengths
•  Enhanced resilience
•  Military readiness
•  Total Force Fitness
Negative •  Maladaptation
•  Family strife/violence
•  Suicide/homicide
•  Job loss
•  Emotional distance
•  Non-reintegration
•  Cohesion
Break &
Practical Exercises Military Family Fitness Model "
Resource Environment Source: Bowles, Pollock, Cato, et al. (in prepara2on) Work-­‐Life Integra>ve Health Demands External Resources Family Resources Individual Resources Desired Family Fitness End State Posi>ve Outcomes Nega>ve Outcomes Practical Skills
Individual Skills Mindfulness Deep Breathing Guided Imagery Cogni>ve Restructuring Family Skills Communica>on Skills Problem Solving Skills Military Family Fitness Model Individual Skills •  Awareness •  Appraisals and Beliefs •  Stress Management and Coping •  Decision Making •  Individual Traits and Skills •  Communica2on What are mind-body skills….?
•  A cornerstone of a new approach for enhancing
resilience and effectively preventing and treating
stress-related illnesses
•  Things you can do on your own, without
equipment or a therapist, to improve health and
performance
•  Examples: mindfulness meditation, yoga, tai chi,
breathing training, and imagery
•  Over 35 million U.S. adults use mind/body
practices
•  Use of mind-body therapies in the military is equal
to or greater than in the general population
BMC Complementary and Alternative Medicine 2007, 7:16
Regula>ng the Autonomic Nervous System Most mind-­‐
body therapies evoke a “relaxa2on response” that directly counters the stress response Source: Benson, Fricchione, et al. Benefits of Deep Breathing
•  Induces relaxation response
•  Enhances management of
–  Stress (Hoffman, Benson, et al.; 1982).
–  Anxiety (Kirkwood, Rampes, et al.; 2005); (Krisanaprakornkit; 2006).
–  Depression (Pilkington, K., G. Kirkwood, et al., 2005).
–  Pain (Nespor, K.;1991); (Morone and Greco; 2007)
Meditation in a nutshell
2 common features:
1. Self regulation of ATTENTION
2. Establishment of INTENTION
2 main types:
1. Concentration meditation:
• 
Goal: Stabilize the mind
2. Mindfulness meditation
• 
Goal: Watch the mind
Meditation: Benefits
•  Improves attention stability, emotion regulation,
flexibility in thinking, negative thoughts (through
reducing task effort)
•  Protects against functional impairments in working
memory capacity, which is involved in managing
cognitive demands and emotion regulation
Source: Jha AP, Krompinger J, Baime MJ. Cogn Affect Behav Neurosci. Jun 2007;7(2):109-­‐119.; As2n JA. Psychother Psychosom. 1997;66(2):97-­‐106.; Slagter HA, et al. PLoS Biol. Jun 2007;5(6):e138; Jha AP, et al. Emo@on. Feb 2010;10(1):54-­‐64. What is Guided Imagery?
•  Using all the senses to
create an experience in
the mind
•  Brain interpreting images
similarly to actual
situations
• Replaces negative thoughts with peaceful scenes.
• Allows person to escape for brief periods.
• Desensitizes body to stressful stimuli.
• Body is able to recharge.
Potential Applications of
Guided Imagery
•  Anxiety
•  Depressive
symptoms
•  Goal-setting
•  Grief issues
•  Pain management
•  Post-traumatic
stress disorder
•  Preparation for
surgery and medical
procedures
•  Rehabilitation
•  Relaxation training
•  Sleep disorders
•  Smoking cessation
•  Stress management
•  Survivors of abuse
•  Weight management
Typical Guided Imagery Session
Focus on the Breath
Progressive Muscle Relaxation
Rehearsal or Relaxing Imagery
Relationship Techniques
for Building Individual,
Couple, and Family
Fitness/Skills Practical Family Skills
Family Resources
  Communication
 Cohesion
 Flexibility
  Appraisals &
Beliefs
  Coping
  Problem Solving
 Rituals/Routines
 Parenting Styles
 Couples Relationship
 Financial Stability
Individual Skills
Cognitive
Restructuring
Deep Breathing
Guided Imagery Family Skills
Communication
Skills
Problem Solving
Skills
Communica2on & Decision Making Military Tailored Understanding
• Consistent and regular
communication between
SM and family while on
deployment leads to:
 Connection & family resilience (Bell et al.,
1999; Wiens & Boss, 2006);
 Better child coping (ADSS & RCSS, 2009).
• Problems communicating
= greater stress
•  Couples create their own
optimal deployment
communication routines
(Merolla, 2010):
  Balance talk of everyday
with more meaningful
conversations
•  Lowered stress
•  Families with a SM with
PTSD who deal directly
with problems and focus
on positive, progressive
steps predict better family
functioning (Tiet et al., 2006). The Expresser & The Listener Expresser: 1) 
2) 
3) 
4) 
Makes I-statement (with an emotion)
Specific
Only one main idea
Pick a good time and place for expressing
Listener:
1) Summarize and restate what you heard
(reflection)
2) Do not ask questions; react to what your
partner said, offer solutions, or interpret
the meaning
3) Assess tone of voice, facial expressions,
and posture
4) Put yourself in the expresser’s shoes
Source: Epstein & Baucom, 2002 Decision-Making Skills
1) State the issue clearly
2) Clarify why it is important/your needs
3) Discuss possible solutions
4) Decide on a solution that
is agreeable to both of you
5) Decide on an amount of time to try the solution 6) Modify solution as needed
Source: Epstein & Baucom, 2002 Debrief
•  Can integrate individual and relational skills for
optimal outcomes •  SM and family members can model integrative
skills and family skills for their children
•  Individualize these skills for each relationship & situation
•  Can use these skills
to anticipate military specific stressors
Military Family Fitness Model Resource Environment Source: Bowles, Pollock, Cato, et al. (in prepara2on) Work-­‐Life Integra>ve Health Demands External Resources Family Resources Individual Resources Desired Family Fitness End State Posi>ve Outcomes Nega>ve Outcomes Group Breakout Case Example #2
VigneMe Not long a\er returning from his third deployment, MSGT Smith, an Air Force Security Forces First Sergeant, knew that something "wasn't right." He was having trouble sleeping due to intrusive memories of young Airmen his unit lost in a convoy ambush in Iraq, and began to wonder “why he was spared." His spouse no2ced the changes first as he began to withdraw from normal ac2vi2es he used to enjoy, like going out with his friends, reading, and working out. They argued all the 2me about things that never bothered them in the past. His spouse believed that he was withdrawing to avoid being around her and the kids and that he was angry at her. Source: Cato (in prepara2on) Family Fitness Exercise
•  Imagine you are a:
•  Service member
•  Spouse
•  Child
•  External Social Support (Best Friend…)
•  Mental Health Clinician
•  Leader
•  Community Member
Family Fitness Exercise Given your role and guided by this model,
what could you do?
Are there specific strategies that you could
use to foster family fitness?
Utilize all resources discussed in the model Military Family Fitness Model Resource Environment Source: Bowles, Pollock, Cato, et al. (in prepara2on) Work-­‐Life Integra>ve Health Demands External Resources Family Resources Individual Resources Desired Family Fitness End State Posi>ve Outcomes Nega>ve Outcomes Conclusions for Exercise •  Empowering approach for ways that EACH member can get involved •  Each part of the system important –  Interconnec2ons within every level of the system –  Model is not reliant solely on clinicians and providers. •  What was your experience? The Way Ahead
Understanding that “Total Force Fitness” and “Military
Family Fitness” will likely be key
drivers in Defense Department
resilience efforts Partnering among federal and civilian agencies
will help synergize efforts and further
identify, define, and establish a
consensus on key topics such as
family fitness
Conclusions
The MD-RM and MFFM are tools to help
leaders, mental health providers, and families
better understand the complex interplay
between demands, resources, and outcomes.
Key Takeaways Individual, family, and external resources help
families overcome challenges and prevent
adverse outcomes.
DoD resources are available to assist military
families.
Adaptive, strength based, non-prescriptive
model with joint-service application.
DoD Resources
What are we doing?
•  Developing clinical practice guidelines
(VA/DoD, DCoE)
•  Identifying protective factors related to
resilience (DCoE)
•  Real Warriors Campaign (DCoE)
•  afterdeployment.org (T2)
•  Deployment Health Clinical Center,
Specialized Care Program and
RESPECT-mil (DHCC)
•  Training in evidence-based treatments
(CDP)
•  inTransition (DCoE)
•  Annual Conferences (DCoE/NIH/VA)
DCoE Resources
DCoE Outreach Center
http://www.nationalresourcedirectory.gov
Mind-Body Skills for Regulating the Autonomic Nervous
System Paper
http://www.dcoe.health.mil/ForHealthPros/
IntegrativeHealthWellness.aspx
Resources
For applied strategies and informa2on on rela2onship skill building, visit h^p://humanperformanceresourcecenter.org/family-­‐
rela2onships QUESTIONS? Feedback on model and use?
Follow-up meeting with interested
meeting participants?
Contact Informa2on COL Stephen Bowles, Ph.D.
Department of Medical & Clinical Psychology
Uniformed Services University
Colanda R. Cato, Ph.D.
Defense Centers of Excellence (DCoE) for Psychological Health & TBI
Office of the Assistant Secretary of Defense for Health Affairs
Monique Moore, Ph.D.
Defense Centers of Excellence (DCoE) for Psychological Health & TBI
Office of the Assistant Secretary of Defense for Health Affairs
Liz Davenport Pollock, MS, LGMFT
Human Performance Resource Center
Uniformed Services University