Family-Focused Interventions and Resources for Veterans and Their Families

Abstract

Accelerated by the decreasing military presence in Iraq and Afghanistan, many military members are currently transitioning out of active duty into civilian life. Many of these new veterans have recently experienced combat deployment(s), and some are struggling with the aftermath of combat exposure, separation from family, and reintegration stressors. These challenges often follow these military families as they enter the civilian world, a time with its own major life changes vocationally, socially, and interpersonally. Although numerous resources have been developed to assist service members during their transition to the civilian world, relatively fewer exist for partners, children, and broader family systems. Family psychoeducation is a nonpathologizing, strengths-focused model of care that has documented benefits in the arena of mental illness. This article describes some manualized family psychoeducational programs and online and phone-based resources that may be useful to veteran families during this time of change. The programs and resources described herein are all available for free, primarily online. Because of a wide variety of barriers and limitations for family based care in the Veterans Affairs health care system, veteran families are and will continue to seek mental health care in public sector settings. Community providers can enhance their military culture competence by familiarizing themselves with these resources and drawing upon them in working with transitioning military families.

Full text

Family-Focused Interventions and Resources for
Veterans and Their Families
Michelle D. Sherman
University of Minnesota–Twin Cities
Jessica L. Larsen
Lukin Center for Psychotherapy, Hoboken, New Jersey
Accelerated by the decreasing military presence in Iraq and Afghanistan, many military members are currently
transitioning out of active duty into civilian life. Many of these new veterans have recently experienced
combat deployment(s), and some are struggling with the aftermath of combat exposure, separation from
family, and reintegration stressors. These challenges often follow these military families as they enter the
civilian world, a time with its own major life changes vocationally, socially, and interpersonally. Although
numerous resources have been developed to assist service members during their transition to the civilian
world, relatively fewer exist for partners, children, and broader family systems. Family psychoeducation is a
nonpathologizing, strengths-focused model of care that has documented benefits in the arena of mental illness.
This article describes some manualized family psychoeducational programs and online and phone-based
resources that may be useful to veteran families during this time of change. The programs and resources
described herein are all available for free, primarily online. Because of a wide variety of barriers and
limitations for family based care in the Veterans Affairs health care system, veteran families are and will
continue to seek mental health care in public sector settings. Community providers can enhance their military
culture competence by familiarizing themselves with these resources and drawing upon them in working with
transitioning military families.
Keywords: family psychoeducation, veterans, military, transition, interventions
Increasing numbers of military members are transitioning out of
active duty service into civilian life. These transitions are largely
due to a 2016 Pentagon initiative to reduce the size of the military
in response to a decreased presence in Iraq and Afghanistan (Tice,
2016), as well as normal changeover in an all-volunteer force.
Military members and families face a variety of challenges when
exiting the military, from meeting basic housing and welfare needs
to securing employment and health care. Although all military
personnel receive a standard transition assistance program, the
needs of military family members, including partners and children,
are often not formally addressed by the military during the tran-
sition period. This article focuses on the unique challenges that
families face during the transition from the military and explains
how civilian providers are well situated to meet these needs. After
describing four provider trainings to strengthen knowledge about
military culture, we summarize four manualized interventions and
six phone-based/online resources that providers can employ in
working with transitioning veterans and their families.
Military to Civilian Life Transition
The transition from the military into civilian life poses signifi-
cant and predictable challenges for military families. Research
directed on this time period is largely underdeveloped, and has
primarily focused on the experience of military members during
reintegration following combat deployments. Military members
face challenges in numerous domains following their return from
military deployments, including mental health, social and role
functioning, relationship functioning and family life, spirituality,
physical health, and financial well-being (Sherman, Larsen, &
Borden, 2015). Despite what is known about reintegration chal-
lenges, there is growing recognition of the need to better under-
stand family challenges as they leave the military, a time period
that can overlap with reintegration, but is often a distinct and
separate time frame. Two independent reviews have articulated the
possible needs of families transitioning out of the military (Insti-
tute of Medicine, 2010;Søndergaard et al., 2015), highlighting
interpersonal, psychosocial, and vocational challenges that fami-
lies face during the transition.
Prior to focusing on family issues related to the transition from
the military to civilian roles, it is important to acknowledge that
many new veterans have recently experienced deployment(s) to
Iraq and/or Afghanistan; the psychosocial and interpersonal issues
during the reintegration process after combat deployments have
been well documented. Deployment to Iraq and Afghanistan has
been associated with increases in rates of posttraumatic stress
disorder (PTSD; Fulton et al., 2015), depression (Bonde et al.,
2016), substance abuse (Jacobson et al., 2008), and risk-taking
behaviors (Adler, Britt, Castro, McGurk, & Bliese, 2011). Deploy-
Michelle D. Sherman, Department of Family Medicine and Community
Health, University of Minnesota–Twin Cities; Jessica L. Larsen, Lukin
Center for Psychotherapy, Hoboken, New Jersey.
Correspondence concerning this article should be addressed to Michelle
D. Sherman, Department of Family Medicine and Community Health,
University of Minnesota–Twin Cities, 420 Delaware Street SE, MMC 381,
Minneapolis, MN 55455. E-mail: Sherman@umn.edu
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Psychological Services © 2018 American Psychological Association
2018, Vol. 15, No. 2, 146–153 1541-1559/18/$12.00 http://dx.doi.org/10.1037/ser0000174
146

ments have been shown to have a cascade effect on the family
members. Research on active duty military families has shown that
war deployments have been associated with increased mental
health problems in partners (Mansfield et al., 2010), child emo-
tional and behavioral problems (Chartrand, Frank, White, &
Shope, 2008;Mansfield et al., 2011), alcohol use (Lipari, Forsyth,
Bose, Kroutil, & Lane, 2016), child maltreatment (Rentz et al.,
2007), intimate partner violence (Taft et al., 2009), and marital
instability (Cohen & Segal, 2009). Further, there is a strong link
between PTSD symptoms and relationship distress in military
couples (Campbell & Renshaw, 2013). In particular, PTSD symp-
toms are associated with poorer communication, lower intimacy,
and frequent parenting disagreements for service members and
partners (Dekel & Monson, 2010). Importantly, the sequelae of
mental health problems associated with combat deployments often
follow post-911 military families as they enter the civilian world
(Sayer et al., 2010).
The transition out of the military poses several of its own unique
challenges which contribute to overall family stress and likely
compound preexisting issues. Military life affords many tangible
family benefits, including access to stable income, housing, em-
ployment, and basic necessities. Programs to protect families from
financial distress, such as emergency relief loans, are available to
active duty families who encounter unexpected hardships. Despite
programs to assist veterans in making the military to civilian
transition, such as the Transition Assistance Program (Faurer,
Rogers-Brodersen, & Bailie, 2014), many veterans struggle as they
make the transition and lose access to these and many other
military specific resources (Schnurr, Lunney, Sengupta, & Spiro,
2005). A loss of stable income may pose financial problems for
families (Tsai, Pietrzak, & Rosenheck, 2013;Widome, Jensen,
Bangerter, & Fu, 2015). In addition to basic needs, social needs
may also be negatively impacted during the transition. As families
move away from the supportive military social networks to pursue
civilian employment or education, the adjustments to the new
environment can be difficult (Elliott, Gonzalez, & Larsen, 2011).
Mental health challenges can also arise after separation from active
military service as families adjust their identities to being civilians
(Orazem et al., 2016).
Military partners face their own unique vocational challenges
during a service member’s transition out of the military. Military
service itself has been shown to limit spouses’ employment (His-
nanick & Little, 2015), likely due to the demands of military life,
frequent moves, and increased domestic demands during deploy-
ments. As families transition out of the military, transition support
services are focused primarily on service members directly, and
fewer supports are available for military spouses (Sherman,
Hawkey, et al., 2015). Further, military spouses lose access to
health care and childcare resources as the family makes the tran-
sition. Together, these challenges likely contribute to significant
family stress during the military to civilian transition. In sum,
while research has historically focused on the needs of military
service personnel during the military to civilian life transition, it is
clear that military families also experience stress associated with
the shift from the protections inherent in military life to the civilian
community.
Given the challenges military families face during this transi-
tion, community providers are well situated to be a vital support
for military spouses, partners, and children as they leave the
military for civilian communities. To facilitate this process, it is
important for providers to familiarize themselves with military
culture. Several organizations, including the Department of Vet-
erans Affairs, the Department of Defense, and the National Child
Traumatic Stress Network, have developed tools for community
providers to orient them to the special needs of military members
(see Table 1). A recent compilation of military culture trainings
and resources is available online (Gunty et al., 2016), but several
tools that are especially focused on military families include:
The Department of Veterans Affairs Community
Provider Toolkit
Recognizing the important role that community providers have
in helping veterans, the Community Provider Toolkit links com-
munity providers with relevant information and resources to foster
veterans’ health and well-being. Information on screening for
military service, handouts and trainings about military culture, and
Table 1
Military Culture Trainings and Resources for Providers
Name Description Website
The Department of Veterans
Affairs Community
Provider Toolkit
Website with handouts and
information on trainings about
military culture, veteran
behavioral health, and wellness
www.mentalhealth.va.gov/communityproviders/
National Child Traumatic
Stress Network’s
(NCTSN) After Service
Pamphlet
Pamphlet with information about the
family experience of leaving the
military, assessment
considerations for clinicians, and
family-based resources
www.nctsn.org/sites/default/files/assets/pdfs/veterans_families_final.pdf
VA Working With Couples
Training
Free, 5-module online training that
teaches clinicians basic skills in
working with veteran couples
www.vacouplestherapy.org
Military Child Education
Coalition’s Supporting
Veterans’ Children
Though Transitions
Day-long training for professionals
who work with military children
regarding challenges associated
with family transitions
www.militarychild.org/professionals/supporting-veterans-children-through-transitions
Note. VA ⫽Veterans Affairs.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
147
INTERVENTIONS AND RESOURCES FOR VETERAN FAMILIES

trainings focused on behavioral health and wellness are available
at http://www.mentalhealth.va.gov/communityproviders/.
National Child Traumatic Stress Network’s (NCTSN)
After Service Pamphlet
NCTSN provides a useful pamphlet on military transition for
families and children. The pamphlet includes a brief overview of
the challenges of transition from military service, key assessment
considerations for military families, and links to resources to help
military families. The pamphlet is available at http://www.nctsn
.org/sites/default/files/assets/pdfs/veterans_families_final.pdf.
Veterans Affairs Working With Couples Training
One particularly relevant resource is a free five-module online
training created by Michelle Sherman and Michael Kauth. Funded
by the Veterans Affairs (VA) South Central Mental Illness Re-
search, Education and Clinical Center (MIRECC), the Working
with Couples training teaches clinicians basic skills in working
with veteran couples. Modules address communication problems,
anger and conflict, mental illness, trauma, and reintegration into
the family after deployment. This training is helpful for both VA
and non-VA providers who work with veterans and their partners/
spouses. The free training is available at www.vacouplestherapy
.org.
Military Child Education Coalition’s Supporting
Veterans’ Children Though Transitions
The Military Child Education Coalition is a worldwide non-
profit organization that provides services for military youth and
parents and professional development opportunities for educa-
tors and others who care for military youth. Their newest
day-long professional training, Supporting Veterans’ Children
though Transitions (http://www.militarychild.org/professionals/
supporting-veterans-children-through-transitions), specifically tar-
gets the challenges associated with leaving the military.
Rationale for Family-Level Focus in Care
The Department of Defense and VA systems have created
numerous programs to assist military personnel during the transi-
tion period, but these large governmental bodies cannot bear the
responsibility for the large scope of needs and issues across the
broad range of geographic locations and diverse communities to
which veterans and their families transition. The array of diverse
programs to support military families is immense including, but
not limited to, state and community-based organizations, large
businesses, American Red Cross, Boys and Girls Club, 4-H pro-
grams, colleges and universities, faith-based organizations, phil-
anthropic groups, professional sports teams (e.g., Boston Red
Sox), nonprofit groups, private foundations, and many more.
Although many of the programs focus on the service member/
veteran, some focus their supports to spouses/partners, offering
resources in domains of employment, education, relocation, and
mental health issues (Kuhl et al., 2015). Although separate pro-
grams for each member of the family are important, the focus of
this review is helping the entire family unit more broadly. Al-
though a few isolated family based models exist such as the
Unified Behavioral Health Center for Military Veterans and Their
Families in Long Island that provides services to all members of
veteran families in an integrated-care facility, most programs do
not take the larger family perspective in developing services.
The importance and benefits of engaging families in care of
mental health concerns have been documented for decades (e.g.,
Leff, Kuipers, Berkowitz, & Sturgeon, 1985). One approach to
working with families, family psychoeducation, holds consider-
able potential for supporting military families as they transition to
the civilian world. At its core, family psychoeducation values
family members as collaborative team members in the treatment
plan, offers education and support regarding psychiatric symptoms
and their management, and teaches skills in communication,
problem-solving, and stress management. Family psychoeducation
has been included as a core component of psychosocial rehabili-
tation and the recovery movement, with measurable benefits for
clients, family members, and intimate relationships (Lucksted,
McFarlane, Downing, & Dixon, 2012). Practice guidelines for
some serious mental illnesses recommend family psychoeducation
as a central component of comprehensive treatment. In sum, fam-
ily psychoeducational models can be economical, feasible, effec-
tive, and acceptable to families; as reviewed in detail subsequently,
these approaches have the potential to be engaging and relevant for
military families as they transition out of the military.
Psychoeducational Programs and Resources Focused
on Military Families
Numerous programs and resources have been developed in the
military and private sector to support military/veteran families
across their military careers and beyond. The following two sec-
tions describe several manualized programs and online resources
that practitioners can use to support transitioning families; the
programs and resources and corresponding websites are listed in
Tables 2 and 3.
Manualized Programs
Programs vary in focus, intensity, target population, duration,
local availability, and evidence base. In an attempt to make this
review most helpful to practitioners supporting families during and
shortly after the transition period, we used the following selection
criteria for programs: (a) curriculum is readily available (online or
published work), (b) program is not specifically focused on
deployment-related stress and/or reintegration, and (c) program is
not traditional psychotherapy. These criteria exclude some valu-
able programs such as FOCUS (Families OverComing Under
Stress) Family Resilience Training which is offered at limited
locations and whose curriculum is not publicly available (Lester et
al., 2012); ADAPT: After Deployment: Adaptive Parenting Tools
(Gewirtz, Pinna, Hanson, & Brockberg, 2014); American Red
Cross military family classes (http://www.redcross.org/about-us/
our-work/military-families) that focus on deployment, and more
traditional couples therapy models for PTSD such as Cognitive-
Behavioral Conjoint Therapy for PTSD (Monson & Fredman,
2012) and Structured Approach Therapy (Sautter, Glynn, Cretu,
Senturk, & Vaught, 2015). The focus herein is on easily accessible
family psychoeducational models that go beyond deficits to build-
ing resilience and strengths.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
148 SHERMAN AND LARSEN

Four family psychoeducational programs met our inclusion cri-
teria, three of which are facilitated by a mental health professional
and one which is peer led. For each program, we describe program
structure, logistics, available data, and websites for curricula and
further information.
Support and Family Education (SAFE) Program. The
SAFE Program (Sherman, 2003,2006) is an 18-session manual-
ized family education program to educate and support adults who
care about a veteran living with mental illness or PTSD. It has been
identified as a best practice in the VA health care system, and has
been implemented in military and private sector settings across the
county.
The program was originally created in 1999 at the Oklahoma
City VA Medical Center with funding from the South Central
Mental Illness Education and Clinical Center and is in its third
edition. Ninety-minute workshops are provided on a monthly basis
and participants can attend whenever they wish. Each workshop
has three sections: (a) group discussion/peer support, (b) a didactic
presentation, and (c) a question and answer period with a psychi-
atrist. Each session has a specific topic, such as “PTSD and Its
Impact on the Family,” “Creating a Low-Stress Environment and
Minimizing Crises,” and “Limit Setting and Boundaries with Fam-
ily Members.” Detailed session outlines include ready-to-present
text reviewing basic information on the session’s topic, group
activities (e.g., role plays), discussion questions, suggested video
clips, and session handouts.
Program evaluation efforts revealed very high levels of satis-
faction, with families especially appreciated the opportunity to talk
Table 2
Manualized Family Education Curricula
Name Description Website
Support and Family Education
(SAFE) Program
a
18-session program for adults who care
about someone living with mental
illness or PTSD
www.ouhsc.edu/SAFEProgram
Operation Enduring Families (OEF) Five-session program for OEF/OIF
veterans and family members
focusing on post-deployment issues
www.ouhsc.edu/OEF
Reaching Out to Educate and Assist
Healthy, Caring Families
(REACH) Program
a
Three-phase multi-family group
program for veterans and their
family members dealing with PTSD
www.ouhsc.edu/REACHProgram
NAMI’s Project Homefront Six-session peer-led program for adults
whose veteran has experienced
deployment and has a mental health
condition
www.nami.org/Find-Support/NAMI-Programs/NAMI-Homefront
Note. PTSD ⫽posttraumatic stress disorder; OIF ⫽Operation Iraqi Freedom; NAMI ⫽National Alliance on Mental Illness.
a
Has program evaluation data.
Table 3
Online and Phone Resources for Veteran Families
Name Description Website
Coaching Into Care Free phone-based coaching for veterans
and family members to encourage
help-seeking and connect families
with local resources
www.mirecc.va.gov/coaching
PTSD Family Coach Smartphone
App
Smartphone App with information about
PTSD, self-care, communication tips,
and counseling
Free download on iTunes
Make the Connection Website with brief videos of over 400
veterans and family members sharing
their experiences with mental health
problems
http://maketheconnection.net/
Sesame Street’s Transition
Program
a
Free, online, 12-module interactive
program that supports military
parents with young children as they
leave the military
www.sesamestreet.org/toolkits/veterans
Parenting for Veterans and Service
Members (Corresponding App is
Parenting2Go)
Free, online 6-module interactive course
and mobile app to help military
parents, especially surrounding
reintegrating after deployment
www.veterantraining.va.gov/parenting/
Veteran’s Guide to Talking With
Kids About PTSD
Interactive pamphlet for veteran parents
living with PTSD to educate and
empower them in their role as parent
www.mirecc.va.gov/VISN16/docs/Talking_with_Kids_about_PTSD.pdf
Note. PTSD ⫽posttraumatic stress disorder.
a
Has program evaluation data.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
149
INTERVENTIONS AND RESOURCES FOR VETERAN FAMILIES

to other families, to feel appreciated by VA providers, and to have
the opportunity to ask doctors questions about PTSD/mental ill-
ness. In addition, significant positive correlations emerged be-
tween the number of SAFE sessions attended and family members’
understanding of PTSD/mental illness, awareness of VA re-
sources, decreased levels of caregiver distress (Sherman, 2006).
The detailed therapist manual and participant workbook are
available for free download at www.ouhsc.edu/SAFEProgram.
This website includes an Implementation Toolkit to support pro-
fessionals who wish to offer the SAFE Program. Importantly,
mental health providers and family members may find the hand-
outs and general information in the SAFE Program useful even if
not participating in the group-based program as written. For ex-
ample, handouts such as “PTSD and its Impact on the Family” or
“What can I do when my family member is depressed” can stand
alone and may be useful for providers and clients.
Of note, the SAFE Program was adapted to meet the needs of
families of Iraq and Afghanistan wars in a briefer family education
program titled Operation Enduring Families (Bowling, Doerman,
& Sherman, 2011). This five-session program includes sessions on
family relationships, communication and intimacy, anger, PTSD,
and depression. A sixth optional session focuses on traumatic brain
injury. The entire manual and participant workbook are available
for free at www.ouhsc.edu/OEF. Although anecdotal feedback
from participants has been positive, formal evaluation of Operation
Enduring Families has yet to be conducted.
Reaching out to Educate and Assist Caring, Healthy Fami-
lies (REACH) Program. The REACH Program (Reaching out
to Educate and Assist Caring, Healthy Families) is an adaptation of
the evidence-based multifamily group model (McFarlane, 2002)
for a VA setting and for veterans living with PTSD and mood
disorders (Sherman, Fischer, Sorocco, & McFarlane, 2009).
REACH has three phases, beginning with four single-family
sessions focused on rapport building and goal setting. Phase II
consists of six weekly 90-minute sessions for cohorts of 4 to 6
veterans and their families. Session topics include problem-
solving, psychoeducation about symptom management, communi-
cation, managing symptoms of depression, stress management, and
anger/conflict resolution. Each of the Phase II sessions includes
time with veteran/family dyads together, and separate break-out
groups for veterans and family members. In Phase III, veterans/
families attend six monthly multifamily groups to support main-
tenance of gains.
Longitudinal research of the REACH program has found high
levels of attendance, retention, and participant satisfaction (Sher-
man et al., 2009). Research with 100 veterans with PTSD and their
partners showed significant improvements over time on levels of
empowerment, family problem solving and communication, rela-
tionship satisfaction, social support, symptom status, knowledge of
PTSD, self-efficacy in coping with PTSD, and quality of life
(Fischer, Sherman, Owen, & Han, 2013). Family members showed
similar statistically significant improvements on most measures.
Changes over time in individual participants’ relationship satisfac-
tion, social support, symptom status, and quality of life were
attributable to changes in program-targeted knowledge and skill.
Similar positive findings emerged among a cohort of veterans
living with mood disorders and their partners who participated in
the REACH program (Sherman, Fischer, Owen, Lu, & Han, 2015).
The entire therapist manual and participant workbook are avail-
able for free download: www.ouhsc.edu/REACHProgram. The
detailed online manual includes specific didactic scripts, suggested
interactive exercises, handouts, and homework activities. This
website also describes a specific motivational-interviewing style
engagement procedure for how to encourage veteran families to
participate in REACH.
Of note, the multifamily group model has also been used in the
VA system with veterans living with traumatic brain injury and
their family members. Preliminary outcomes show this as a feasi-
ble and acceptable model, warranting additional research (Perlick
et al., 2013).
National Alliance on Mental Illness (NAMI)’s Project
Homefront program. Project Homefront is a free, six-session
family education program for adults who care about a military
member who has experienced deployment and has a mental health
condition. Classes are facilitated by volunteer, military-connected
family members, and are offered in several states across the
country. Sessions focus on problem solving, effective communi-
cation, self-care, connecting with resources, and understanding
PTSD and mental illness. This course is adapted from NAMI’s
popular Family to Family course which has documented positive
outcomes for family members of adults living with mental illness,
including decreased burden and increased empowerment (Dixon et
al., 2004). Evaluation of the Project Homefront program is cur-
rently underway, and an online format is being developed. Infor-
mation about this program including currently available groups
is available online at http://www.nami.org/Find-Support/NAMI-
Programs/NAMI-Homefront.
Phone and Online Resources for Veteran Families
A large number of websites, services, and programs have been
developed for veteran families, and it is beyond the scope of this
review to describe all of them. We selected a variety of resources
that span modality and focus, all of which are being commonly
used in the VA system and are easily accessible to community
providers and families. The first four focus on veterans and family
members broadly, whereas the latter three target issues related to
parenting. The first two resources are telephone-based, whereas
the others in the list are online resources.
Coaching Into Care (http://www.mirecc.va.gov/coaching/).
Coaching Into Care is a free telephone-based service for adults who
care about a veteran who may benefit from mental health services.
Family members and friends can call the toll free number (888-823-
7458) between 8 AM and 8 PM, Monday through Friday and have a free
consultation with a social worker or psychologist. Coaching sessions
typically last 10 to 30 minutes, and callers can have follow-up ses-
sions if desired. Coaches work with callers to explore veterans’
ambivalence and fears about reaching out for help, drawing upon
motivational interviewing techniques. Coaches can connect callers
with resources anywhere in the country, and help families navigate
oftentimes overwhelming, confusing health care systems.
PTSD Family Coach Smartphone App (https://www.ptsd
.va.gov/public/materials/apps/ptsdfamilycoach.asp). The Nat-
ional Center for PTSD and the Department of Defense’s National
Center for Telehealth and Technology have created a plethora of free
mobile apps to support veterans managing mental health issues. Apps
provide information and support on skills such as deep breathing,
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
150 SHERMAN AND LARSEN

imagery, mindfulness, and behavioral activation. One popular app
titled PTSD Coach has a companion app for families, PTSD Family
Coach, both of which are available for free download in iTunes.
PTSD Family Coach provides information about PTSD, support on
coping with a loved one with PTSD, self-care suggestions, and
information about counseling for couples/families managing PTSD. A
clinical trial examining the feasibility, acceptability, and effectiveness
of this app is currently underway.
Make the Connection (http://maketheconnection.net/).
Created by the U.S. Department of Veterans Affairs, the Make the
Connection website includes videos of over 400 veterans and
family members sharing their experiences in managing mental
health problems. Site visitors can select videos most relevant to
their situations, sorting by gender, war era, military branch, topic,
and more. The videos describe a wide array of topics, and convey
messages of empowerment, hope, and recovery for the entire
family. A special section of the website focuses on transi-
tioning out of the military (http://maketheconnection.net/events/
transitioning-from-service).
Sesame Street’s Transition Program (http://www.sesame
street.org/toolkits/veterans). Sesame Street Workshop has cre-
ated a free, online Adventure Campaign to support families with
young children as they leave the military. The program consists of 12
modules delivered by e-mail, each of which includes a newsletter, a
video link for parents and children to view together, and a fun
challenge with a small prize. Module themes include communication,
making new friends, connecting as a family, and maintaining a
positive attitude through change. Although the program acknowl-
edges the challenges faced by all family members with leaving the
military, it also celebrates families’ strength and resilience, helping
them consider this time as an adventure. A randomized control trial of
200 transitioning active duty and veteran families found very high
levels of parental satisfaction, a positive impact on caregivers’ self-
efficacy in helping themselves and their children cope effectively with
the transition, and reductions in overall child emotional and behav-
ioral problems, including levels of hyperactivity/inattention (Sher-
man, Monn, Bowers, Larsen, & Gewirtz, 2017).
Parenting for Veterans and Service Members (http://www
.veterantraining.va.gov/parenting/). Created as a joint effort
between the VA system and the Department of Defense, Parenting
for Veterans and Service Members is a free online six-module
parenting course. It includes practical information, interactive ex-
ercises, and handouts for military parents across the following
topics: Reconnecting with your child after deployment, positive
parent– child communication, helping children deal with challeng-
ing behaviors and emotions, positive approaches to discipline,
managing stress as a parent, and parenting with physical and
emotional challenges. The website also features powerful videos of
military families sharing their feelings and experiences.
Much of the content of this website was used for a smartphone
application called the Parenting2Go Mobile App which is free at
the Apple store. The app includes support in coping with parenting
stressors, tips on effective communication, and stress management
exercises.
Veteran’s Guide to Talking With Kids About PTSD (http://
www.mirecc.va.gov/VISN16/docs/Talking_with_Kids_about_
PTSD.pdf). This 25-page interactive pamphlet for veteran par-
ents is a source of reflection and empowerment in parenting with
PTSD. The pamphlet can be used independently by veterans,
included as part of individual or group therapy, or integrated into
a psychoeducational class or workshop. The guide is interactive,
filled with activities such as a pros and cons list about sharing with
children. The pamphlet not only addresses family challenges; it
also empowers veterans to identify and focus on their strengths as
parents as well as their children’s strengths. Sample sections of the
pamphlet include the following: What Do You Enjoy About Par-
enting? How Can PTSD Affect Families? Should I Tell My Kids
About PTSD? What Should I Do If I Get Upset When Talking
With My Kids About PTSD? How Do I Deal With Questions My
Child Asks?
Content for this pamphlet is based on a three-site, mixed meth-
ods research conducted by the authors and funded by the VA South
Central MIRECC. Focus groups and key informant interviews
explored veterans’ perceptions of the impact of PTSD and their
parenting and children, as well as parent– child communication
about parental PTSD (Sherman, Gress Smith, Straits-Troster,
Larsen, & Gewirtz, 2016;Sherman, Larsen, Straits-Troster, Erbes,
& Tassey, 2015). Selected quotations from veterans in this re-
search are included in the pamphlet which lends credibility and
poignancy to the messages.
Conclusion
Military families reside in every large community across the
country, attend public schools and universities, bring their kids to
the same orthodontists, play in the same parks, and work in the
same businesses as civilian families. Military families often bring
a sense of civic pride and commitment to our country, and civilians
owe them respect and appreciation for their sacrifices. Although
military families have had extra supports and buffers while in the
military, they may have also faced challenges and trauma that are
unparalleled in the civilian sector. At this time of transition,
military families simultaneously lose access to supportive pro-
grams and services as they engage in major life changes that often
call for increased needs for support. Many families will manage
the transition well, drawing upon natural supports of family,
friends, religious/spiritual groups, and peer networks. However,
some veterans, partners, and children will struggle with the tran-
sition and will benefit from more formal mental health treatment.
Although some of the programs and resources described herein
have promising evaluation data, much more rigorous research is
needed to examine the short and long-term impacts of these
programs. This call for strong evaluation of family programs for
Iraqi and Afghanistan veteran has been made for over a decade
(Johnson et al., 2007), but high-quality research is expensive and
time-intensive and obtaining funding can be difficult. Dedication
of resources to evaluate and strengthen family based resources is
vital to developing a robust array of evidence-based services for
families.
Although some veterans have access to health care in the VA
system, data from a nationally representative sample of veterans
showed that fewer than 20% of veterans use VA as their primary
source of health care (Wisco et al., 2014). In addition, most VAs
do not provide individual services for nonveteran family members
or for children. For these reasons, it is important for community
providers to familiarize themselves with military culture and avail-
able resources.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
151
INTERVENTIONS AND RESOURCES FOR VETERAN FAMILIES

Thus, veteran families are and will continue to seek mental
health care in public sector settings. It is essential that civilian
providers seeking to work with this population familiarize them-
selves with the military culture. Military families can quickly
discern when providers do not comprehend their distinct culture,
and they will go elsewhere if they do not feel understood. Mental
health providers can seek out trainings as described herein, and
explore family psychoeducation as a model for care. Although
many of the family curricula described herein were created in the
VA system, they can and should be used in the private sector.
Almost all of these resources are available for free download
online, and the curricula have clear implementation guides to assist
programs in the start-up phase. Civilian providers can also gain
credibility by empowering their veteran families with reputable
online and phone-based resources as adjunctive supports. Veteran
families do not expect civilian providers to know every military
abbreviation or policy, but they deserve a provider who is knowl-
edgeable, open to learn, concerned about the entire family, respect-
ful of military culture, and appreciative of the family’s service.
References
Adler, A. B., Britt, T. W., Castro, C. A., McGurk, D., & Bliese, P. D.
(2011). Effect of transition home from combat on risk-taking and health-
related behaviors. Journal of Traumatic Stress, 24, 381–389. http://dx
.doi.org/10.1002/jts.20665
Bonde, J. P., Utzon-Frank, N., Bertelsen, M., Borritz, M., Eller, N. H.,
Nordentoft, M.,...Rugulies, R. (2016). Risk of depressive disorder
following disasters and military deployment: Systematic review with
meta-analysis. The British Journal of Psychiatry, 208, 330 –336. http://
dx.doi.org/10.1192/bjp.bp.114.157859
Bowling, U. B., Doerman, A. L., & Sherman, M. D. (2011). Operation
enduring families: Support and education for returning Iraq and Af-
ghanistan veterans and their families (2nd ed.). South Central Mental
Illness Research, Education and Clinical Center.
Campbell, S. B., & Renshaw, K. D. (2013). PTSD symptoms, disclosure,
and relationship distress: Explorations of mediation and associations
over time. Journal of Anxiety Disorders, 27, 494 –502. http://dx.doi.org/
10.1016/j.janxdis.2013.06.007
Chartrand, M. M., Frank, D. A., White, L. F., & Shope, T. R. (2008). Effect
of parents’ wartime deployment on the behavior of young children in
military families. Archives of Pediatrics & Adolescent Medicine, 162,
1009 –1014. http://dx.doi.org/10.1001/archpedi.162.11.1009
Cohen, J., & Segal, M. W. (2009). Veterans, the Vietnam era, and marital
dissolution. Armed Forces and Society, 36, 19 –37. http://dx.doi.org/10
.1177/0095327X09332146
Dekel, R., & Monson, C. M. (2010). Military-related post-traumatic stress
disorder and family relations: Current knowledge and future directions.
Aggression and Violent Behavior, 15, 303–309. http://dx.doi.org/10
.1016/j.avb.2010.03.001
Dixon, L., Lucksted, A., Stewart, B., Burland, J., Brown, C. H., Postrado,
L., . . . Hoffman, M. (2004). Outcomes of the peer-taught 12-week
family-to-family education program for severe mental illness. Acta Psy-
chiatrica Scandinavica, 109, 207–215. http://dx.doi.org/10.1046/j.0001-
690X.2003.00242.x
Elliott, M., Gonzalez, C., & Larsen, B. (2011). US military veterans
transition to college: Combat, PTSD, and alienation on campus. Journal
of Student Affairs Research and Practice, 48, 279 –296. http://dx.doi
.org/10.2202/1949-6605.6293
Faurer, J., Rogers-Brodersen, A., & Bailie, P. (2014). Managing the re-
employment of military veterans through the Transition Assistance
Program (TAP). Journal of Business & Economics Research, 12, 55.
http://dx.doi.org/10.19030/jber.v12i1.8378
Fischer, E. P., Sherman, M. D., Owen, R., & Han, X. (2013). Outcomes of
participation in the REACH multifamily group program for Veterans
with PTSD and their families. Professional Psychology, Research and
Practice, 44, 127–134. http://dx.doi.org/10.1037/a0032024
Fulton, J. J., Calhoun, P. S., Wagner, H. R., Schry, A. R., Hair, L. P.,
Feeling, N.,...Beckham, J. C. (2015). The prevalence of posttraumatic
stress disorder in Operation Enduring Freedom/Operation Iraqi Freedom
(OEF/OIF) Veterans: A meta-analysis. Journal of Anxiety Disorders, 31,
98 –107. http://dx.doi.org/10.1016/j.janxdis.2015.02.003
Gewirtz, A. H., Pinna, K. L., Hanson, S. K., & Brockberg, D. (2014).
Promoting parenting to support reintegrating military families: After
deployment, adaptive parenting tools. Psychological Services, 11, 31–
40. http://dx.doi.org/10.1037/a0034134
Gunty, A., Richmond, A., Williams, R., Otto, M., & Borden, L. M. (2016).
Military culture. Report submitted to the U. S. Department of Defense.
Retrieved online https://reachmilitaryfamilies.umn.edu/sites/default/
files/rdoc/Military%20Culture%202016.04.29.pdf
Hisnanick, J. J., & Little, R. D. (2015). ‘Honey I love you, but’...
investigating the causes of the earnings penalty of being a tied-migrant
military spouse. Armed Forces and Society, 41, 413– 439. http://dx.doi
.org/10.1177/0095327X13512620
Institute of Medicine. (2010). Returning home from Iraq and Afghanistan:
Preliminary Assessment of readjustment needs of veterans, service mem-
bers, and their families. Washington, DC: National Academies Press.
Jacobson, I. G., Ryan, M. A., Hooper, T. I., Smith, T. C., Amoroso, P. J.,
Boyko, E. J.,...Bell, N. S. (2008). Alcohol use and alcohol-related
problems before and after military combat deployment. Journal of the
American Medical Association, 300, 663– 675. http://dx.doi.org/10
.1001/jama.300.6.663
Johnson, S. J., Sherman, M. D., Hoffman, J. S., James, L. C., Johnson,
P. L., Lochman, J. E.,...Palomares, R. S. (2007). The psychological
needs of U.S. military service members and their families: A preliminary
report. American Psychological Association Presidential Task Force on
Military Deployment Services for Youth, Families and Service Mem-
bers. Retrieved from http://www.ptsd.ne.gov/publications/military-
deployment-task-force-report.pdf
Kuhl, M., Rudi, J., Westerhof, L., Sherman, M., Bommarito, R., Steinham,
D.,...Borden, L. (2015). Supports for military spouses as active duty
service members transition out of the military. Retrieved from https://
pdfs.semanticscholar.org/4b82/795d691dea02ceeb7fcb1000fd5fd
15a8eef.pdf
Leff, J., Kuipers, L., Berkowitz, R., & Sturgeon, D. (1985). A controlled
trial of social intervention in the families of schizophrenic patients:
Two-year follow-up. The British Journal of Psychiatry, 146, 594 – 600.
http://dx.doi.org/10.1192/bjp.146.6.594
Lester, P., Saltzman, W. R., Woodward, K., Glover, D., Leskin, G. A.,
Bursch, B.,...Beardslee, W. (2012). Evaluation of a family-centered
prevention intervention for military children and families facing wartime
deployments. American Journal of Public Health, 102(Suppl. 1), S84 –
S54. http://dx.doi.org/10.2105/AJPH.2010.300088
Lipari, R. N., Forsyth, B., Bose, J., Kroutil, L. A., & Lane, M. E. (2016,
November). Spouses and children of U.S. military personnel: Substance
use and mental health profile from the 2015 National Survey on Drug
Use and Health. Retrieved November 15, 2016, from http://www.
samhsa.gov/data
Lucksted, A., McFarlane, W., Downing, D., & Dixon, L. (2012). Recent
developments in family psychoeducation as an evidence-based practice.
Journal of Marital and Family Therapy, 38, 101–121. http://dx.doi.org/
10.1111/j.1752-0606.2011.00256.x
Mansfield, A. J., Kaufman, J. S., Engel, C. C., & Gaynes, B. N. (2011).
Deployment and mental health diagnoses among children of US Army
personnel. Archives of Pediatrics & Adolescent Medicine, 165, 999 –
1005. http://dx.doi.org/10.1001/archpediatrics.2011.123
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
152 SHERMAN AND LARSEN

Mansfield, A. J., Kaufman, J. S., Marshall, S. W., Gaynes, B. N., Morris-
sey, J. P., & Engel, C. C. (2010). Deployment and the use of mental
health services among U.S. Army wives. The New England Journal of
Medicine, 362, 101–109. http://dx.doi.org/10.1056/NEJMoa0900177
McFarlane, W. (2002). Multifamily groups in the treatment of severe
psychiatric disorders. New York, NY: Guilford Press.
Monson, C. M., & Fredman, S. J. (2012). Cognitive-behavioral conjoint
therapy for PTSD: Harnessing the healing power of relationships. New
York, NY: Guilford Press.
Orazem, R., Frazier, P., Schnurr, P., Oleson, H., Carlson, K., & Sayer, N.
(2016). Identity adjustment among Afghanistan and Iraq war veterans
with reintegration difficulty. Psychological Trauma: Theory, Research,
Practice, and Policy. Advance online publication. http://dx.doi.org/10
.1037/tra0000225
Perlick, D. A., Straits-Troster, K., Strauss, J. L., Norell, D., Tupler, L. A.,
Levine, B.,...Dyck, D. G. (2013). Implementation of multifamily
group treatment for veterans with traumatic brain injury. Psychiatric
Services, 64, 534 –540. http://dx.doi.org/10.1176/appi.ps.001622012
Rentz, E. D., Marshall, S. W., Loomis, D., Casteel, C., Martin, S. L., &
Gibbs, D. A. (2007). Effect of deployment on the occurrence of child
maltreatment in military and nonmilitary families. American Journal of
Epidemiology, 165, 1199 –1206. http://dx.doi.org/10.1093/aje/kwm008
Sautter, F. J., Glynn, S. M., Cretu, J. B., Senturk, D., & Vaught, A. S.
(2015). Efficacy of structured approach therapy in reducing PTSD in
returning veterans: A randomized clinical trial. Psychological Services,
12, 199 –212. http://dx.doi.org/10.1037/ser0000032
Sayer, N. A., Noorbaloochi, S., Frazier, P., Carlson, K., Gravely, A., &
Murdoch, M. (2010). Reintegration problems and treatment interests
among Iraq and Afghanistan combat veterans receiving VA medical
care. Psychiatric Services, 61, 589 –597. http://dx.doi.org/10.1176/ps
.2010.61.6.589
Schnurr, P. P., Lunney, C. A., Sengupta, A., & Spiro, A., III. (2005). A
longitudinal study of retirement in older male veterans. Journal of
Consulting and Clinical Psychology, 73, 561–566. http://dx.doi.org/10
.1037/0022-006X.73.3.561
Sherman, M. D. (2003). The S. A. F. E. Program: A family psychoeduca-
tional curriculum developed in a Veterans Affairs Medical Center.
Professional Psychology, Research and Practice, 34, 42– 48. http://dx
.doi.org/10.1037/0735-7028.34.1.42
Sherman, M. D. (2006). Updates and five-year evaluation of the S. A. F. E.
program: A family psychoeducational program for serious mental ill-
ness. Community Mental Health Journal, 42, 213–219. http://dx.doi.org/
10.1007/s10597-005-9018-3
Sherman, M. D., Fischer, E. P., Owen, R. R., Jr., Lu, L., & Han, X. (2015).
Multifamily group treatment for veterans with mood disorders. Couple
& Family Psychology, 4, 136 –149. http://dx.doi.org/10.1037/
cfp0000040
Sherman, M. D., Fischer, E. F., Sorocco, K., & McFarlane, W. (2009).
Adapting the multifamily group model to the Veterans Affairs system:
The REACH program. Professional Psychology, Research and Practice,
40, 593– 600. http://dx.doi.org/10.1037/a0016333
Sherman, M. D., Gress Smith, J. L., Straits-Troster, K., Larsen, J. L., &
Gewirtz, A. (2016). Veterans’ perceptions of the impact of PTSD on
their parenting and children. Psychological Services, 13, 401– 410.
http://dx.doi.org/10.1037/ser0000101
Sherman, M. D., Hawkey, K. R., Smith, B., Rudi, J. H., Kuhl, M. W.,
Bommarito, R., & Borden, L. M. (2015). Supports for military spouses
as active duty service members transition out of the military. Report
submitted to the U.S. Department of Defense.
Sherman, M. D., Larsen, J., & Borden, L. M. (2015). Broadening the focus
in supporting reintegrating Iraq and Afghanistan Veterans: Six key
domains of functioning. Professional Psychology, Research and Prac-
tice, 46, 355–365. http://dx.doi.org/10.1037/pro0000043
Sherman, M. D., Larsen, J., Straits-Troster, K., Erbes, C., & Tassey, J.
(2015). Parent-child communication about parental PTSD. Journal of
Family Psychology, 29, 595– 603. http://dx.doi.org/10.1037/
fam0000124
Sherman, M. D., Monn, A., Bowers, J., Larsen, J., & Gewirtz, A. (2017).
Evaluation of the Sesame Street for military families: Transitions pro-
grams. The Adventure Campaign. Prepared for Sesame Workshop, Min-
neapolis, Minnesota.
Søndergaard, S., Robertson, K., Silfversten, E., Anderson, B., Meads, C.,
Schaefer, A., & Larkin, J. (2015). Families support to transition: A
systematic review of the evidence. Cambridge, UK: RAND.
Taft, C. T., Weatherill, R. P., Woodward, H. E., Pinto, L. A., Watkins,
L. E., Miller, M. W., & Dekel, R. (2009). Intimate partner and general
aggression perpetration among combat veterans presenting to a posttrau-
matic stress disorder clinic. American Journal of Orthopsychiatry, 79,
461– 468. http://dx.doi.org/10.1037/a0016657
Tice, J. (2016). Army headed for 30,000 active and reserve units in 2016.
Army Times. Retrieved from https://www.armytimes.com/story/military/
capitol-hill/2015/11/19/army-headed-30000-active-and-reserve-cuts-2016/
75870074
Tsai, J., Pietrzak, R. H., & Rosenheck, R. A. (2013). Homeless veterans
who served in Iraq and Afghanistan: Gender differences, combat expo-
sure, and comparisons with previous cohorts of homeless veterans.
Administration and Policy in Mental Health, 40, 400 – 405. http://dx.doi
.org/10.1007/s10488-012-0431-y
Widome, R., Jensen, A., Bangerter, A., & Fu, S. S. (2015). Food insecurity
among veterans of the US wars in Iraq and Afghanistan. Public Health
Nutrition, 18, 844 – 849. http://dx.doi.org/10.1017/S136898001400072X
Wisco, B. E., Marx, B. P., Wolf, E. J., Miller, M. W., Southwick, S. M., &
Pietrzak, R. H. (2014). Posttraumatic stress disorder in the US veteran
population: Results from the National Health and Resilience in Veterans
Study. The Journal of Clinical Psychiatry, 75, 1338 –1346. http://dx.doi
.org/10.4088/JCP.14m09328
Received December 6, 2016
Revision received May 11, 2017
Accepted May 22, 2017 䡲
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
153
INTERVENTIONS AND RESOURCES FOR VETERAN FAMILIES