Center for the Study of Traumatic Stress PROCEEDINGS Workgroup on Intervention with Combat Injured Families Sponsored by the Center for the Study of Traumatic Stress, part of the Department of Psychiatry of Uniformed Services University and a partnering center of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury PROCEEDINGS Workgroup on Intervention with Combat Injured Families Tuesday – Wednesday December 11–12, 2007 Bethesda, MD Workgroup Sponsored by: Center for the Study of Traumatic Stress Department of Psychiatry Uniformed Services University of the Health Sciences ! DEFENSE CENTERS OF EXCELLENCE For Psychological Health & Traumatic Brain Injury Center for the Study of Traumatic Stress Uniformed Services University of the Health Sciences 4301 Jones Bridge Road | Bethesda, MD 20814-4799 Tel: 301-295-2470 | Fax: 301-319-6965 www.usuhs.mil/csts | www.CSTSonline.org WORKGROUP ON INTERVENTION WITH COMBAT INJURED FAMILIES Editor’s Note: This transcript has been edited, however, as in most transcripts some errors may have been missed. The editors are responsible for any errors of content or editing that remain. IPD 2009 by Center for the Study of Traumatic Stress Department of Psychiatry Uniformed Services University of the Health Sciences 4301 Jones Bridge Road Bethesda, Maryland 20814-4799 Printed in the United States of America First Edition Workgroup on Intervention with Combat Injured Families Edited by Stephen J. Cozza, M.D. 1. Combat Injury. 2. Military Family Stress 3. Principles of Injury Care. I. Cozza, Stephen J. PROCEEDINGS Workgroup on Intervention with Combat Injured Families EditOR Stephen J. Cozza, M.D. ASSOciate EditOR Nancy T. Vineburgh, M.A. Transcript EditORS Carol S. Fullerton, Ph.D. Danielle Marks, B.A. Patricia Martinez, M.S.N, M.P.H. Janet A. Schmidt, Ph.D. Center for the Study of Traumatic Stress Department of Psychiatry Uniformed Services University of the Health Sciences 4301 Jones Bridge Road Bethesda, Maryland 20814-4799 Table of Contents Workgroup Participants VII Executive Summary 1 Session 1: Clinical Problems and Core Principles of Intervention with Injured Military Families 9 Introduction of Workgroup Participants 9 Workgroup Aims and Agenda 11 Introductory Presentation: The Impact of Combat Injury on Military Families and Children, Dr. Cozza 12 Introductory Presentation Discussion 17 Clinical Problems and Core Principles: Medical Center Participant Presentations 19 Walter Reed Army Medical Center (WRAMC) 19 Brooke Army Medical Center 23 Navy Medical Center, San Diego Presentation 30 Medical Center Presentation Discussion 32 Discussion and Revision of Core Principles 36 Intervention Strategies Discussion 44 Session 2: Practical Application and the Components of Effective Intervention 55 From Clinical Reality to Family-Focused Intervention 55 Project FOCUS: UCLA and NCTSN 61 Practical Application and Components of Effective Interventions 74 Summary and Reflection: Day One 88 Session 3: Integration and Programmatic Intervention 95 Summary of Proceedings 95 Programmatic Application and Future Study 96 Family Systems Perspective 103 Family Communication and Connectivity 105 Family Meaning and Connectivity 109 Parenting Function and Injury Communication 112 Community Reintegration 115 Outcome Measures 118 Closing Comments 124 Bibliography 129 Appendix 137 Participants Theresa Arata-Maiers, Psy.D. Child and Family Coordinator, Warrior Resiliency Program Child and Adolescent Psychology Service, Brooke Army Medical Center (Name will change to San Antonio Military Medical Center, effective Sep 30, 2011) [email protected] William Beardslee, M.D. Director, Baer Prevention Initiatives and Chairman Emeritus Department of Psychiatry, Children’s Hospital Boston [email protected] Ryo Sook Chun, M.D. Director, Wounded Warrior Child and Family Program Clinical Director, Child and Adolescent Psychiatry Service Walter Reed Army Medical Center [email protected] Stephen Cozza, M.D. Professor, Department of Psychiatry Uniformed Services University of the Health Sciences Associate Director, Center for the Study of Traumatic Stress [email protected] Carol Fullerton, Ph.D. Research Professor, Department of Psychiatry Uniformed Services University of the Health Sciences Science Director, Center for the Study of Traumatic Stress [email protected] LCDR Scott Kane, M.D. Child and Adolescent Psychiatrist Head, Child Guidance Division Department of Mental Health Navy Medical Center San Diego [email protected] Workgroup on Intervention with Combat Injured Families — Conference Proceedings • VII Patricia Lester, M.D. Physician, Child and Adolescent Psychiatry Center for Community Health, UCLA [email protected] Patricia Martinez, MSN, CNS-BC Clinical Nurse Specialist, Psychiatry Center for the Study of Traumatic Stress Uniformed Services University of Health Sciences [email protected] LTC Kris Peterson, M.D. Child and Adolescent Psychiatry Consultant to the Army Surgeon General Chief, Department of Psychiatry Madigan Army Medical Center [email protected] John Richters, Ph.D. Research Scientist Center for the Study of Traumatic Stress Uniformed Services University of Health Sciences [email protected] William Saltzman, Ph.D. National Center For Child Traumatic Stress UCLA [email protected] LTC Brett Schneider, M.D. Chief, Child and Adolescent Psychiatry Service Walter Reed Army Medical Center [email protected] Robert Ursano, M.D. Professor and Chairman, Department of Psychiatry Uniformed Services University of the Health Sciences Director, Center for the Study of Traumatic Stress [email protected] Observers Rachel Kaul, LCSW Public Health Analyst, Crisis Counseling Program, Emergency Services and Traumatic Stress Branch, SAMHSA/CMHS [email protected] James McCarroll, Ph.D. Director, Family Violence and Trauma Project Center for the Study of Traumatic Stress [email protected] VIII • Workgroup on Intervention with Combat Injured Families — Conference Proceedings John Newby, Ph.D. Research Scientist Center for the Study of Traumatic Stress [email protected] Nancy Vineburgh, M.A. Assistant Professor, Department of Psychiatry Uniformed Services University of the Health Sciences Director, Office of Public Education and Preparedness Center for the Study of Traumatic Stress [email protected] Dorinda Williams, LCSW-C Senior Training and Consultation Specialist Military Projects at ZERO TO THREE [email protected] Workgroup on Intervention with Combat Injured Families — Conference Proceedings • IX WORKGROUP Participants Dr. Stephen Cozza, LTC Peterson, Chief of Dr. Lester, a child and Ms. Martinez, a retired Associate Director of the Psychiatry at Madigan adolescent psychiatrist Army nurse now working Center for the Study of Army Medical Center and Director of a Child with Dr. Cozza and the Traumatic Stress (MAMC), and Child and and Adolescent Trauma Workgroup on Intervention Adolescent Psychiatry Psychiatry Clinic. with Combat Injured Consultant to the Surgeon Families at CSTS. General of the Army. LTC Schneider, Chief of Dr. Arata-Maiers, Child and Dr. Saltzman, Project Focus Dr. Fullerton, Scientific Child and Adolescent Family Coordinator for the Team at UCLA, a child Director CSTS and Psychiatry at WRAMC, an Warrior Resiliency Program psychologist, Professor, a Professor in the adult, child and adolescent at Brooke Army Medical and director of a Family Department of Psychiatry psychiatrist, as well as a Center (BAMC). Therapy Program at of Uniformed Services forensic psychiatrist. California State University University of the Health at Long Beach. Sciences (USUHS) Dr. Chun, Child and LCDR Kane, head of Child Dr. William Beardslee, Dr. Robert Ursano, Director, Adolescent Psychiatry and Adolescent Psychiatry Director, Baer Prevention Center for the Study of Service at WRAMC. at Naval Medical Center, Initiatives and Chairman Traumatic Stress; Chair, San Diego (NMCSD). Emeritus, Dept. of Psychiatry, Department of Psychiatry, Children’s Hospital Boston. USUHS. X • Workgroup on Intervention with Combat Injured Families — Conference Proceedings Combat injury is a Executive Summary life-altering event that Workgroup on Intervention with Combat Injured Families impacts not just the service member but his/ Introduction: Addressing the Needs of Combat Injured Families Combat injury is a life-altering event that impacts not just the service mem- her family and children. ber but his/her family and children. The affected population is significant in number and in terms of the unique challenges that include the short-term dis- ruptions of individual and family routines and sense of safety, to longer-term issues around parenting and family health. On December 11th and 12th, 2007, a number of prominent clinicians and researchers in the fields of child and adolescent psychiatry, military medi- cine and family trauma met to conceptualize the hitherto unaddressed needs and challenges of the combat injured family. This expert consensus gathering, referred to as the Workgroup on Intervention with Combat Injured Families, included six Chiefs of Psychiatry from major military medical centers and a renowned Children’s Hospital, and the Child and Adolescent Psychiatry Con- sultant to the U.S. Army Surgeon General. The Workgroup’s primary objective, which was met, was to develop and disseminate a set of core Principles of Caring for Combat Injured Families and Children (see appendix). These principles