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Staying Healthy: Mental Health Needs

Children and families often deal with stressful situations that put their mental health at risk. Deployment is a reality for many military families. It affects the well-being and mental health of children and families. This lesson helps you support children and families dealing with stressful life events.

Objectives
  • Describe the emotional effects of stressful events, such as deployment, on children and families.
  • Describe strategies you can use before, during, and after deployment to support children and families.
  • Provide support to children and families who experience stressful life events.

Learn

Know

It is likely that some children and families in your care will face challenging life events that can put their mental health and overall well-being at risk. Such events might include death, divorce, job loss, relocation, violence in the home, or separation. As a child development professional you will also likely work with children who experience deployment, or you may experience deployment in your own family. Deployment is a difficult time in the lives of children and families. Each family handles these challenges differently, and each child will have unique needs. The findings of studies comparing children from military families to those from civilian families seem to indicate a greater likelihood of mental health and behavioral concerns among children in military families (Cramm et al., 2019). Nevertheless, there are typical changes you can expect as children experience challenging and stressful transitions and life events.

This lesson describes the effects of stressful events on young children's lives while highlighting ways you can support children and their families during times of crisis. You will learn the typical emotional and behavioral experiences of preschool children before, during, and after deployment, and ways you can support children and their families at each stage of deployment.

Stress in Young Children's Lives

Young children's reactions to stress may be different from older children's reactions. Unlike older children, younger children may not always be able to verbally express exactly what they are feeling; for example, whether they are afraid, anxious, confused, angry, sad, or feeling helpless (Zero to Six Collaborative Group, National Child Traumatic Stress Network, 2010). Often their feelings are manifested in their behaviors and these behaviors can be clues about what they feel inside. When dealing with stressful events, children may: become clingy or fearful of new situations; demonstrate aggression; experience difficulty sleeping; or even appear to lose recently acquired skills. Let's consider deployment and how it can affect children and families.

Emotional Characteristics of Deployment

Deployment is a challenge for any family. For families faced with repeated or multiple deployments, the following seven-stage emotional cycle describes their typical emotional cycles.

Seven-Stage Cycle

  1. Stage 1 — Anticipation of Departure
  2. Stage 2 — Detachment and Withdrawal
  3. Stage 3 — Emotional Disorganization
  4. Stage 4 — Recovery and Stabilization
  5. Stage 5 — Anticipation of Return
  6. Stage 6 — Return Adjustment and Renegotiation
  7. Stage 7 — Reintegration and Stabilization

Figure 1. Emotional Cycles of Deployment. Adapted from Pincus, S. H., House, R., Christenson, J., & Adler, L. E. (2001). The emotional cycle of deployment: A military family perspective. US Army Medical Department Journal, 4(5), 6.

When families learn about the deployment, they are faced with preparing themselves financially, emotionally, and physically. The deploying parent may need to spend extra time at work prior to the departure. Both parents may spend a great deal of time getting ready for the deployment, packing, filling out paperwork, performing routine home or auto maintenance, finding babysitters or making extra childcare arrangements.

Before Deployment

For many families, especially those who have been deployed before, there may be a period of detachment or withdrawal prior to deployment. Family members might emotionally prepare themselves for the pain of separation by isolating themselves. During this period, there might be fights or anger.

Children experience a variety of emotions prior to a deployment. They may not understand why their mother, father, or other family member has to leave. It is common for young children to feel that it is their "fault" that their parent is leaving. This happens often when children have unanswered questions about the deployment. Because preschool children's sense of time is not fully developed, they may feel anxious or confused about when a family member is leaving. They may not understand how long the separation will last or even that the separation is temporary. They may be confused by the changes they see in their household. The deploying parent may need to spend extra hours at work in preparation for deployment, and the spouse may be making arrangements for life as a single parent by attending to necessary legal, medical, or financial matters.

All of these emotions can show themselves in different ways. During this stage, the child may act withdrawn, sad, or quiet. Changes in routines may make the child more likely to act out. You might see more aggressive behaviors, tantrums, crying, or regressing (e.g., problems with toilet training or thumb sucking).

During Deployment

When a family member begins their deployment, the at-home family members go through a period of disorganization. They may be sad and anxious about how the family will function. The at-home caregiver may feel overwhelmed by responsibility. It takes time to settle into new routines. Eventually the family recovers and develops routines that work for them; they have a new "normal."

Once the parent has deployed, children will go through a range of emotions. They may be sad, lonely, confused, angry, or scared. Fear of separation is one of the major concerns of preschool children. They may be afraid that the remaining parent will leave or abandon them. They may need constant reassurance that their parent or guardian is close by or will pick them up from child care. They may be afraid that the deployed parent is in danger.

In child development programs, you may see children behaving more aggressively. You may also see children become clingy, shy, quiet, or fearful. Fears are common for all preschool children, and deployment may increase their fears. They may be drawn to adults for comfort.

You can help the child to feel connected to the deployed family member by offering ways to the family to help the child to cope and foster resilience (Siegel, B. S., 2013). Many of these can be done at home with the caregiver but can also occur in your classroom to build that connection between home and school:

  1. Continue the discussion about the deployed parent on a regular basis.
  2. Communicate to the deployed parent frequently and regularly: write letters, draw pictures, put together “goodie” packages.
  3. Keep a calendar for each child so he or she can see when the deployed family member is coming home.
  4. Have a picture of the deployed parent with the children or with the family. Pictures can be hung up or put in prominent places. This is especially important for the preschool-age child.
  5. Protect younger children from seeing or hearing about the war effort or violence on television or in the newspapers.
  6. Have deployed parent audio or video record a favorite bedtime story before leaving, especially if reading was a normal routine before leaving.
  7. Seek support from extended family or a trusted adult (mentor, for school-age child) who can be available for the children.
  8. Ask family and friends not to talk about the painful or scary aspects of deployment.
  9. Keep up the family routine.
  10. Try to spend extra time with the child or children, if possible and respond empathically to the needs for more attention.
  11. Encourage ways for children to express their feelings. For younger children, it may be drawing or playing with dolls, and for older children, it may be telling stories or keeping a journal and possibly sharing the journal, especially at bedtime.
  12. Appreciate that young children will act out scary and fearful feelings through play. Support and understand this process and monitor the behaviors and feelings during times of family or school activities.
  13. Request the free Sesame Street video Talk, Listen, Connect (https://www.militaryonesource.mil/leaders-service-providers/children-youth-and-teens/sesame-workshop-tool-kits/). Request free Military Child or Youth videos, Mr. Poe and Friends Discuss Reunion After Deployment (https://www.militaryonesource.mil/products/mr-poe-and-friends-discuss-family-reunion-after-deployment-47/) for younger children.
  14. Communicate to teachers about the deployment and continue to check in on their school performance and behaviors.
  15. Develop a scrapbook of children’s activities and accomplishments to be shared when there is reunion. This will allow the child to “show and tell.”

After Deployment

As the day for the return draws closer, the family prepares for more changes. They may be excited about the family member's return. They may feel a little nervous about whether their relationship with the deployed family member has changed. When the deployed family member returns, the family goes through another transition. The non-deployed caregiver might have mixed emotions about their changing role; this person has "done it alone" for quite some time and must renegotiate roles and expectations. Children may also have a hard time bringing the deployed family member back into their daily routines. The deployed person may have doubts about where they fit into the family. Again, over time, the family stabilizes.

Immediately before and after the parent returns, the child may be excited and energetic. The child may also feel a little nervous and shy about the parent returning. Children may be scared that they won't recognize their parent. They may also be afraid that the parent will leave again. They may be confused by the changes happening in their home as family members visit and their parents negotiate new roles.

See

How can programs support children facing challenging life situations? Listen as this manager discusses how she and her program support families who experience deployment. If no parents in your program experience deployment, consider similar circumstances where a family caregiver is absent for an extended period such as incarceration or a serious long-term illness.

Connecting During Deployment

Watch a manager discuss how she and her program support families during deployment.

Do

Protective Factors: Fostering Resilience in Young Children and Families

There are characteristics of children and families that can protect them as they go through stressful events. Research on resilience in children demonstrates that a significant protective factor for children is the consistent presence of a caring, positive, and protective caregiver (Zero to Six Collaborative Group, National Child Traumatic Stress Network, 2010). This person can be an ongoing resource for the particular child, and can encourage them to talk about their experiences, and provide reassurance that adults in the child's life are working to keep them safe.

According to the Centers for Disease Control and Prevention and the National Center for Injury Prevention and Control, you can support children facing stressful challenges when you:

  • Maintain consistent classroom routines as much as possible. This provides children with a much-needed sense of stability and safety.
  • Provide opportunities for children to talk about what is going on, but do not force them to talk if they don't want to. Encouraging children to talk about their feelings and validating them strengthens children's coping as they hear that all their feelings are OK.
  • Be watchful of changes in children's behaviors over time. Changes in behaviors, for example acting out or withdrawing from friends, may indicate that a child needs extra support.
  • Encourage families to connect with other families who may be dealing with similar stressors. Connecting with others allows families to share experiences and healthy coping strategies.

The remainder of this lesson focuses on how you can support children and families before, during, and after deployment.

Support Before Deployment

Most importantly, you can help families find the resources they need, such as Military One Source (https://www.militaryonesource.mil/) or other resources available in their particular Service. Pre-deployment counseling can help families learn ways to prepare children for the deployment.

Encourage families to talk with their children honestly about the deployment. It is important for families to help children understand:

  • Why the parent is leaving: The deploying parent has an important job to do and they know how to do the job well; they are not going alone.
  • When the deploying parent is leaving
  • What the family will do together before the parent leaves
  • How the child will communicate with the parent while they are deployed
  • What will stay the same when the parent leaves: for example, one parent will still be here for breakfast and dinner, the child will still go to the same child-care program, the family will still have fun together, etc.

Also encourage families to start thinking about ways to help the child feel close to the deployed parent. Are there personal items the parent and child can exchange before the deployment (e.g., a picture or favorite t-shirt)? Having items available in your classroom that the children can visit regularly will support their understanding of the deployed parent and help them to remain connected as much as possible.

Support During Deployment

During periods of deployment, it is especially important that you help the child and family maintain normal routines. Early in the deployment is not the time to transition a child to a new classroom or caregiver. Reassure the child that their parent will pick the child up as usual. Provide lots of hugs and comfort. Answer the child's questions as simply and matter-of-factly as possible.

Integrate emotional literacy and problem-solving into your curriculum. Help children learn to recognize and deal with emotions. Talk about emotions every day. Look at pictures of children with different emotions, read stories about feelings and deployment, do activities that let the child identify and talk about their feelings. Help the child develop strategies for calming down and dealing with anger or fear.

Be prepared to help the parent with problems that arise. Parents may be confused by changes in their child's behavior. A parent may feel alone and unsure of how to provide discipline or guidance. The parent may feel frustrated by challenges with toilet training, tantrums, or baby talk. The parent may go through periods of self-doubt, depression, or helplessness. Remember that it is important for parents to take care of their own mental and physical health. Help them connect with a Family Readiness Group, behavioral health counseling, or clergy. You can provide resources, training, and support around positive guidance and discipline. You can also help families think of ways to make life easier during the deployment. Use conversations, newsletters, and family nights to help families share ideas like:

  • Keeping track of time by putting a coin in a jar each day of the deployment; the child can buy the parent a homecoming gift upon their return
  • Going on family hikes
  • Have a family movie night
  • Draw pictures or write letters to the deployed family member
  • Have a family camp-out in the yard
  • Schedule "date nights" (or days) with each child individually
  • Create a family calendar
  • Figure out a special way to say goodnight to the deployed family member each night
  • Revisit photo books of the family together and of the deployed family member at work
  • Create an emotions book and discuss with the child how they are feeling in that particular moment and what they can do to help regulate their emotions if needed

Support After Deployment

Celebrate with the family and the child. Answer questions and let the child talk. Acknowledge the child's feelings, and help the child find words or pictures to describe those feelings. Make sure they know all feelings are OK. It is normal to feel shy or nervous when you haven't seen someone for a while. Recognize that this is a major transition for the family, and they will likely need to be connected with resources and supports. Work with your program to identify resources you can share.

Case Example

Read the following scenario and think about the suggestions provided to support children in your care during the different phases of deployment.

Wayne and Natalia, parents of a child in your class, both serve in the military. They met while on assignment in Asia and have been serving together around the world ever since. They love travel and living in new places. In their eight year marriage, they have had two international assignments. They had their first child, Ximena, four years ago, and she is now a child in your preschool program. Although they have moved frequently, they have never been deployed at the same time-- until now. Wayne and Natalia have both been assigned six month tours of duty. In some regards, Wayne and Natalia feel well prepared for the trip: they know Natalia's mother will care for Ximena, and they have completed all the pre-deployment paperwork for Ximena's insurance and care. They feel less prepared for the emotional toll of such a long separation. What can you and your program do to help this family, and particularly Ximena, before, during, and after the dual deployment?

You may consider the following:

  • Encourage the family to begin talking with Ximena about the upcoming deployment.
  • Talk about where the parents are going and why.
  • Prepare Ximena for what will stay the same: she'll sleep at grandma's like she does sometimes now, she'll still go to your child development program, play her favorite games, eat her favorite foods, and have her special dolls and toys.
  • Create personalized stories about her parents and what is going on while they are away for Ximena to read while she is at preschool.
  • Create special items that could comfort Ximena during difficult times in the classroom (e.g., make a pillow out of one of mom or dad's shirts for Ximena to sleep with).
  • Provide Ximena with a consistent routine and predictable rituals at child care.
  • Include reminders at child care about routines that seem difficult for Ximena. You can do the same about routines that have been challenging at home as well.
  • Talk with Ximena about emotions and encourage her to share her emotions by drawing pictures or writing notes to her parents. Remember, you can help young children write the words they share aloud. Comfort her when she needs extra support.
  • Share messages or notes that the parents sent to the child development center to be shared with Ximena.
  • Provide honest responses to Ximena's questions or comments about her parents. For example, if she shares that she is scared, you can say, "I am scared sometimes too," or you can address a question about her parents by saying, "Your mommy and daddy are doing everything they can to be safe." Avoid elaborate responses which can be overwhelming to her.
  • When Ximena's parents return home, help Ximena talk about her emotions: anxiety, shyness, excitement. Make sure she knows all emotions are OK.
  • Organize a special activity that involves Ximena and her parents once they are back from deployment. For example, a parent-child lunch or picnic.
  • Encourage Ximena to express her feelings and share how she feels.
  • Have open and honest communication with Ximena’s grandmother; she will be experiencing many changes as well and this will affect Ximena while she is in your care.

Take Care of Yourself

You provide crucial support for children and families. You cannot do that, however, if you don't take care of yourself. Helping children through difficult and sometimes tragic times can be incredibly challenging. You might find that your own mental health mirrors that of the people around you. Make sure you take time to reflect on your own needs. Talk to people around you about your feelings. Talk to your supervisor about resources in your community for families experiencing deployment or loss. Taking care of yourself will make you better able to care for children. You can also learn more about your own self-care in the Social & Emotional Learning for Teachers (SELF-T) and the Self & Cultural Understanding courses.

Explore

The odds are likely that you will work with a child who is affected by deployment. Therefore, it's important to think about how you will support these children and their families. Read the scenarios in the Supporting Children of Deployed Families activity, and answer the questions. Share your responses with a trainer, coach, or administrator. Then compare your answers to the suggested responses.

 You can also consider how this activity could be used to support children in families experiencing other kinds of separation such as long-term illness, incarceration, or frequent travel.

Apply

The death of a parent is perhaps the most emotionally challenging event that can happen to a child. Use the resources listed in Helping Children Deal with Grief, to help you support the mental health of children as they process their grief. Also refer to Supporting Children Who Are Experiencing Stress from Child Care Aware to better understand how to support preschoolers experiencing anxiety.  

Child Welfare Information Gateway provides a list of helpful resources that could be shared with families. The listed resources focus on helping children and families deal with the deployment process, including preparing for deployment and family reunification following deployment. 

Child Welfare Information Gateway: https://www.childwelfare.gov/topics/systemwide/diverse-populations/military/deploymentresources/

Glossary

Deployment:
The relocation of forces or materials to desired operational areas. Military family members may be relocated to war zones or other areas as needed
Mental health:
Mental health is a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community (World Health Organization, 2012)

Demonstrate

The most important time to provide support when a child and her family are facing deployment is…
Which of the following are ways you can support children who face stressful challenges?
Carlita is afraid her mom won’t recognize her when she comes home from deployment. The nature of Carlita’s mom’s assignment has made video conference calls and Skype calls impossible. What can you recommend to Carlita’s dad to help ease Carlita’s fears?
References & Resources

Centers for Disease Control and Prevention, National Center for Injury Prevention and Control: 
Coping With Stress. 

Cramm, H., McColl, M.A., Aiken, A.B. & Williams, A. The mental health of military-connected children: A scoping review. J Child Fam Stud 28, 1725–1735 (2019). https://doi.org/10.1007/s10826-019-01402-y

Huebner C.R. (2019). Health and Mental Health Needs of Children in US Military Families. AAP Section on Uniformed Services, AAP Committee on Psychosocial Aspects Of Child And Family Health. Pediatrics. 143(1).  http://pediatrics.aappublications.org/content/pediatrics/143/1/e20183258.full.pdf

Morse, M. D. (n.d.). A Closer Look for Current Conditions: A Fresh Glance at the Emotional Cycles of Deployment. More information at http://sutter.networkofcare.org/veterans/library/article.aspx?id=2127

Pincus, S. H., House, R., Christenson, J., & Adler, L. E. (2001). The emotional cycles of deployment: A military family perspective. US Army Medical Department Journal, 4(5), 6. https://www.military.com/spouse/military-deployment/dealing-with-deployment/emotional-cycle-of-deployment-military-family.html

Sesame Workshop. (n.d.). Helping Kids Grieve.  https://sesamestreetincommunities.org/topics/grief/

The National Child Traumatic Stress Network (NCTSN). (2016).  What is a Trauma-Informed Child and Family Service System? 
https://www.nctsn.org/sites/default/files/resources//what_is_a_trauma_informed_child_family_service_system.pdf

The National Child Traumatic Stress Network (NCTSN). (2019). Video 1:  The Impact of Interpersonal Trauma in Early Childhood. 

The National Child Traumatic Stress Network (NCTSN). (2019). Video 2: The Ways We Can Help Children with Early Childhood Trauma. 

Siegel, B. S. & Davis, B. E. Committee on Psychosocial Aspects of Child and Family Health and Section on Uniformed Services (2013). Health and mental health needs of children in US military families. Pediatrics131(6), e2002–e2015. https://doi.org/10.1542/peds.2013-0940

Zero to Three (n.d.). Coming Together Around Military Families (CTAMF). More information 
available at www.zerotothree.org/about-us/funded-projects/military-families

Zero to Six Collaborative Group, National Child Traumatic Stress Network. (2010). Early childhood trauma. Los Angeles, CA & Durham, NC: National Center for Child Traumatic Stress. http://www.nctsn.org/sites/default/files/assets/pdfs/nctsn_earlychildhoodtrauma_08-2010final.pdf