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Suggested Citation:"9 Committee Recommendations." National Academies of Sciences, Engineering, and Medicine. 2019. Strengthening the Military Family Readiness System for a Changing American Society. Washington, DC: The National Academies Press. doi: 10.17226/25380.
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Suggested Citation:"9 Committee Recommendations." National Academies of Sciences, Engineering, and Medicine. 2019. Strengthening the Military Family Readiness System for a Changing American Society. Washington, DC: The National Academies Press. doi: 10.17226/25380.
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Suggested Citation:"9 Committee Recommendations." National Academies of Sciences, Engineering, and Medicine. 2019. Strengthening the Military Family Readiness System for a Changing American Society. Washington, DC: The National Academies Press. doi: 10.17226/25380.
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Suggested Citation:"9 Committee Recommendations." National Academies of Sciences, Engineering, and Medicine. 2019. Strengthening the Military Family Readiness System for a Changing American Society. Washington, DC: The National Academies Press. doi: 10.17226/25380.
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Suggested Citation:"9 Committee Recommendations." National Academies of Sciences, Engineering, and Medicine. 2019. Strengthening the Military Family Readiness System for a Changing American Society. Washington, DC: The National Academies Press. doi: 10.17226/25380.
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Suggested Citation:"9 Committee Recommendations." National Academies of Sciences, Engineering, and Medicine. 2019. Strengthening the Military Family Readiness System for a Changing American Society. Washington, DC: The National Academies Press. doi: 10.17226/25380.
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Suggested Citation:"9 Committee Recommendations." National Academies of Sciences, Engineering, and Medicine. 2019. Strengthening the Military Family Readiness System for a Changing American Society. Washington, DC: The National Academies Press. doi: 10.17226/25380.
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Suggested Citation:"9 Committee Recommendations." National Academies of Sciences, Engineering, and Medicine. 2019. Strengthening the Military Family Readiness System for a Changing American Society. Washington, DC: The National Academies Press. doi: 10.17226/25380.
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Suggested Citation:"9 Committee Recommendations." National Academies of Sciences, Engineering, and Medicine. 2019. Strengthening the Military Family Readiness System for a Changing American Society. Washington, DC: The National Academies Press. doi: 10.17226/25380.
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Suggested Citation:"9 Committee Recommendations." National Academies of Sciences, Engineering, and Medicine. 2019. Strengthening the Military Family Readiness System for a Changing American Society. Washington, DC: The National Academies Press. doi: 10.17226/25380.
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Suggested Citation:"9 Committee Recommendations." National Academies of Sciences, Engineering, and Medicine. 2019. Strengthening the Military Family Readiness System for a Changing American Society. Washington, DC: The National Academies Press. doi: 10.17226/25380.
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Suggested Citation:"9 Committee Recommendations." National Academies of Sciences, Engineering, and Medicine. 2019. Strengthening the Military Family Readiness System for a Changing American Society. Washington, DC: The National Academies Press. doi: 10.17226/25380.
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Suggested Citation:"9 Committee Recommendations." National Academies of Sciences, Engineering, and Medicine. 2019. Strengthening the Military Family Readiness System for a Changing American Society. Washington, DC: The National Academies Press. doi: 10.17226/25380.
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Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

9 Committee Recommendations In this chapter, the committee provides its recommendations to the U.S. Department of Defense (DoD) in three major areas: (i) how to enhance DoD’s ability to understand the breadth and diversity of today’s service members and their families and address their needs; (ii) how to improve the programs and services of the Office of Military Community Family Policy (MC&FP); and (iii) how to strengthen the broader Military Family Readiness System (MFRS). These recommendations are built on our conclusions about the evidence of what is known about family well-being in the context of military service, together with the demographic and military service characteristics of military families and the opportunities and challenges that are unique to military life, all of which was reviewed in chapters 1 through 4 of this report. The recommendations further emerge from the committee’s understanding of the impact of stressors on child development and on military families, reviewed in chapters 5 and 6. In chapters 7 and 8, the committee presented a framework for building a more comprehensive and coherent approach to military family well-being and readiness, relying on what research has found concerning the translation and scaling of evidence-based and evidence-informed policies, programs, services, resources, and practices into larger systems, which point the way toward an adaptive process that can help build and sustain an effective and responsive MFRS. ENHANCE UNDERSTANDING OF TODAY’S SERVICE MEMBERS AND THEIR FAMILIES Through its review of the evidence, the committee finds that while many of DoD’s policies, programs, services, resources, and practices focus on the well-being of military families, they do not adequately address the current breadth and diversity of service members and their families and their correspondingly diverse needs. Today’s military families are dynamic social systems whose diversity includes single service members, service members in committed long-term relationships with nonmarital partners, service members co-parenting with ex-spouses or partners, children and other family members with special needs, same-sex couples, and people for whom English is a second language, among others. These families have varied and ever-changing stressors and needs ranging from the commonplace to the exceptional. The following recommendations are aimed at increasing DoD’s understanding of the diversity and complexity of today’s military families and consequently better supporting all military families, regardless of their diversity and complexity, as they strive to fulfill their responsibilities at home and at work. PREPUBLICATION COPY, UNCORRECTED PROOFS 9-1

RECOMMENDATION 1: To facilitate synthesis and comparison of information across administrative and survey datasets and research studies, and to support evaluations of the effectiveness of service member and family support programs, the Department of Defense (DoD) should develop and implement a standardized, military–specific definition of “family well-being.” This definition should incorporate self-definitions of family and objective, subjective, and functional perspectives. DoD should also develop and implement military-specific definitions of “family readiness” and “family resilience,” as well as a set of standard indicators of family well-being, readiness, and resilience for routine use. When concepts that matter to DoD are insufficiently defined, and countless varieties of indicators are used across analytic efforts, it becomes difficult for DoD leaders, the Congress, and the public to discern the meaning of conflicting or fluctuating findings. These operationalized definitions and indicators should utilize existing or newly-developed valid and reliable measures that consider the special circumstances of families who are currently ‘invisible’ to DoD (e.g., co-parenting but unmarried service members and same-sex couple households) and assess exposures to and the accumulation of adversity and how these affect families. Until such time that DoD develops its own definitions, it should consider adopting and operationalizing the following definitions: Family: service members’ own definition of their family, which could include:  People to whom service members are related by blood, marriage, or adoption, which could include spouses, children, and service members’ parents or siblings;  People for whom service members have—or have assumed—a responsibility to provide care, which could include unmarried partners and their children, dependent elders, or others; and  People who provide significant care for service members. Family well-being:  Objective well-being refers to resources considered necessary for adequate quality of life, such as sufficient economic and educational resources, housing, health, safety, environmental quality, and social connections.  Subjective well-being is the result of how individuals think and feel about their circumstances.  Functional well-being focuses on the degree to which families and their members can and do successfully perform their core functions, such as caring for, supporting, and nurturing family members. Family readiness: The potential capacity of families as dynamic [human] systems to adapt successfully to disturbances that threaten the function, survival, or development of these systems.1 1 Adapted from Masten (2015), p. 187. PREPUBLICATION COPY, UNCORRECTED PROOFS 9-2

Family resilience: Positive adjustment in the aftermath of adversity. Also: “the manifested capacity of families as dynamic [human] systems to adapt successfully to disturbances that threaten the function, survival, or development of these systems”2 RECOMMENDATION 2: To establish policies, procedures, and programs that will better support military family readiness, the Department of Defense (DoD) should (i) take immediate steps to gain a more comprehensive understanding of the diversity of today’s military families and their needs, well-being, and readiness to support service members; and (ii) develop policies and procedures to continuously improve and strengthen the information it collects, analyzes, and publicly reports about service members and their families to keep pace with societal, organizational, and operational changes. To accomplish these things, DoD should:  Stand up an Implementation Science and Evaluation Unit that specializes in the design and execution of program implementation and outcome evaluations and is able to provide programs with guidance on developing recommendations for improvement. A unit dedicated to program evaluations will improve, strengthen, and more fully utilize the information DoD collects, analyzes, and publicly reports. In addition, it could provide input on the commissioning of studies (cross-sectional and longitudinal) of military-connected children, spouses, and partners to support the larger goals of tracking short-term and long-term outcomes and taking intersectional approaches to data analyses.  Sponsor robust longitudinal studies that assist with understanding temporary versus long-term outcomes and help address cross-sectional research limitations (e.g., limitations of respondent memory and recall) by using multiple methods and informants, as noted in Chapter 5. In addition, robust longitudinal studies of military- connected children and families can better provide a clear understanding of resilience processes over time and the protective factors that these individuals and families draw on within themselves and their communities. Such information can provide direction as to the type of efforts within the Continuum of Coordinated Support (i.e., promotional and prevention efforts) that are needed.  Sponsor a large-scale study of family members who play a major role in the care of military children, utilizing standardized measures, as well as interviews, focus groups, and other feedback channels to solicit input from nonmarital cohabitating partners of service members and primary caregivers of service members’ children (e.g., service members’ parents, siblings, ex-spouses, or ex-partners).  Conduct a study focused on the well-being of racial/ethnic minority service members and their families, including minority military families to characterize their own well- being, their top concerns, and how well they feel the military family readiness system is supporting them.                                                              2 Adapted from Masten (2015), p. 187. PREPUBLICATION COPY, UNCORRECTED PROOFS 9-3  

 Support analyses of existing data as well as new research that better identifies the effect on stress-related outcomes of contextual moderators, including National Guard or Reserve status, membership in a nontraditional family, socioeconomic status, race and ethnicity, faith and belief systems, and families affected by medical or neurodevelopmental conditions. These more inclusive and more refined data should be used to better understand the macro and micro segments of the military community and not be used to single out individuals. To make the most of its investments, DoD should publish and otherwise disseminate actionable information from the above recommended studies, along with other relevant demographic information, in reports and educational programs to inform service providers, program managers, community partners, and researchers. This information sharing should be multidirectional: DoD should actively collaborate with and engage stakeholders, including diverse military families, military leaders, and civilian communities, to gather their voices and lived experiences to ensure that policies, programs, services, resources, and practices are adapted to and effective with diverse military families. RECOMMENDATION 3: The Department of Defense (DoD) should more fully identify, analyze, and integrate existing data to longitudinally track population- based military child risk and adversity, while also ensuring the privacy of individual family member information. The integration of various databases will enable DoD to more accurately understand risk and resilience factors and short- and long-term outcomes of the children of service members, thereby informing the development and delivery of programs that are tailored, streamlined, and effective. More specifically, the committee recommends that DoD link data from multiple surveys and administrative data, and potentially from program participation data, as is sometimes done for service member or military spouse research. Too little is known about children in military families, too often researchers rely solely on input from parents, and data about children collected across surveys are insufficiently mined. Barriers to studying minor children can be significant, and DoD endorsement could help with both feasibility and access. The committee notes that DoD should attend to accumulations of risk, as children’s functioning may be as much due to the accumulation of risk as to any individual risk factor. This monitoring of risk could occur as a matter of course for children attending DoD schools and child development centers, through military youth programs, through the Millenium Cohort Family Study, and/or when children are seen for psychological or medical treatment. Evidence suggests that there are two primary concerns: (i) What are the accumulations that have been experienced by any individual child who is presenting a need; and (ii) In the general military population, what are typical patterns of accumulation and how important are they for children’s outcomes? Regarding longitudinal studies, to date no study has been conducted that matches military and civilian children to systematically discern how they differ and how they are similar. The CDC Youth Risk Behavior Survey does collect data from both military and civilian children, but focuses only on a narrow aspect of children’s outcomes, and it provides no information at all about resilience factors or the factors that predict those outcomes. Consequently, there are PREPUBLICATION COPY, UNCORRECTED PROOFS 9-4  

currently no strong available data to determine at the population level whether or how military and civilian parents behave differently. This has been of grave concern during recent conflicts, because it is impossible to determine whether military and civilian children were on “equal footing” and it is also not possible to know what was “typical” of military children. IMPROVE MILITARY COMMUNITY AND FAMILY POLICY PROGRAMS AND SERVICES Continuous conflict over the past two decades and associated increases in operational tempo, with an all-volunteer force, have variably impacted family well-being and resulted in support needs that are more urgent for some military families, including National Guard and Reserve families. DoD has made significant investments in supporting service member and family well-being. However, the costs of supporting and managing personnel (not just family programs and services) have become quite high (see Figure 9-1), and have led to efforts to examine spending and identify savings. Thus, we are mindful that in an era of concerted efforts to contain escalating costs, DoD will not be eager to spend even more to cover more family members (such as domestic partners) and compensate military families even further for the demands of the military lifestyle. The military lifestyle does not have to include many of these stressors to the degree that it does, however. Thus, the committee considered not only how DoD could help military families cope with military stressors, but whether it could reduce some of the stressors in the first place, such as the frequency of PCS moves. For example, the FY 2019 John S. McCain National Defense Authorization Act (NDAA) authorizes (but does not require) DoD to use greater flexibility in the management of officer careers.3 The 38-year-old one-size-fits-all up-or-out system created some of the pressures to frequently move officers so that they can obtain the diversity of assignments and experiences necessary to be promoted within a standard, limited window of time. The Services also created systems for enlisted personnel that mirrored the officer system by standardizing and limiting time to promotion in order to remain in the military. With the new NDAA, Congress allows DoD to support a wider variety of career progressions by repealing age-based officer appointment requirements, removing predetermined officer promotion timelines, allowing officers to go up for promotion multiple times, and permitting officer careers to extend to 40 years of service. Such changes could ostensibly ease work-family conflict for military personnel by reducing the need for so many military moves and corresponding family moves or separations.                                                              3 For a general summary of the NDAA, see: https://www.armed- services.senate.gov/imo/media/doc/FY19%20NDAA%20Conference%20Summary1.pdf; and for a reference tool regarding laws, policies and practices in the management of military officers see http://dopma- ropma.rand.org/index.html. PREPUBLICATION COPY, UNCORRECTED PROOFS 9-5  

FIGURE 9-1 Trends in the Department of Defense’s support costs, 1980–2016 SOURCE: Congressional Budget Office (2017, p. 6). In this section, the committee provides recommendations for reducing stressors and improving access to and the quality of DoD’s programs and services. RECOMMENDATION 4: The Department of Defense should review its current policies, programs, services, resources, and practices for supporting military families—as service members define families—to ensure that they recognize the wide diversity of today’s military families and address the special circumstances of military life, especially with regard to major transitions such as entering military service, moving to new duty stations, deploying, shifting between active duty and the reserve component, and transitioning to veteran status. This review should include, among other things, assessments of  The current delivery and content of relocation and other types of transition resources to determine their comprehensiveness with regard to life skills that can help families deal with these major life changes;  The inclusiveness of these transition resources, such as whether the websites clarify that they are also concerned about single service members or refer only to spouses and not also partners or other family members, and whether dates or partners are made to feel welcome at military events, regardless of whether the law permits them to be military dependents; and  Application of the new flexibilities granted by the National Defense Authorization Act for Fiscal Year 2019, which could ease the need to move personnel as frequently, allow them to move up the career ladder more slowly, and allow them to have longer military careers; these new options may benefit military family well-being by reducing turbulence and work-family conflict. PREPUBLICATION COPY, UNCORRECTED PROOFS 9-6

Service members and their families rely upon DoD for assistance with major transitions. For National Guard and Reserve personnel and their families, an app, roadmap, interactive website, infographic, or other user-friendly means of conveying how their pay, allowances, benefits, and program eligibility change along with changes to military status could help reduce service access barriers and support gaps. Even when these service members are not on Title 10 active duty status, maintaining individual and family readiness among members of the reserve component is critical so that they are fully prepared when their nation needs to call on them yet again. The committee recommends that policies, programs, services, resources, and practices incorporate the resilience factors that are more fully described in Chapter 2. These include  Developing shared belief systems;  Improving and strengthening families’ organizational patterns;4  Strengthening communication and problem-solving skills;  Fostering social interaction in the military and nonmilitary communities in which they are embedded;  Addressing physical and psychological health concerns and needs; and  Building the effectiveness of family support systems—through both informal supports and formal resources, programs, and services. STRENGTHEN THE BROADER MILITARY FAMILY READINESS SYSTEM Through its review of the evidence, the committee finds that DoD recognizes the importance of families to the military performance of service members and has built an MFRS for which there is no U.S. civilian equivalent. In order to meet the ever-changing demands, the MFRS needs to be a flexible and adaptive system designed to keep up with the needs of families as they exist in their communities and at different points in time. The committee recognizes that Military OneSource5 provides a valuable service in helping to match the unique needs of individual families to available DoD, Service, and certain civilian programs for which they are eligible. In addition, Military OneSource provides crisis resources and posts a wealth of military- specific information online. However, the committee finds that an even more comprehensive and coordinated approach is needed to be responsive to the diversity of families and their needs. Inconsistent attention to and utilization of empirical evidence about program alignment and implementation reduces program effectiveness. The following recommendations address ways to strengthen the broader MFRS.                                                              4 As stated in Chapter 2: “Organizational patterns—Family members spend time together in constructive activities, the family is organized to provide effective support to its members with a good balance of flexibility and connectedness, family members play appropriate roles, and the family has adequate social and economic resources that it manages adequately.” 5 Military OneSource is a DoD program that provides comprehensive information, referral, and assistance on aspects of military life for active-duty, National Guard, and Reserve service members and their families. Military OneSource services are accessible via a helpline or website (https://www.militaryonesource.mil/). See Chapters 4 and 7 for examples of the use of Military OneSource. PREPUBLICATION COPY, UNCORRECTED PROOFS 9-7  

RECOMMENDATION 5: To help military leaders and nonmilitary service providers in civilian communities better understand and prioritize issues specific to their local communities, the Department of Defense (DoD) should provide guidance for military leaders and service providers on how to readily and reliably access and utilize information about the surrounding communities in which their personnel are situated. DoD should task an entity with leading the charge of compiling and reporting information on a regular basis about the surrounding communities in which their personnel are situated. Military bases do not exist in isolation, and more service members and families live off military installations than on. The neighborhoods that surround military bases are not all equivalent—they can vary in social and economic conditions, which has implications for the strength of social networks to support military families, the quality and quantity of nonmilitary resources that families could tap into, job opportunities for military spouses, educational and other opportunities for military children, the personal safety of military families, and other factors. If military leaders and nonmilitary service providers know only about the characteristics of individuals on their installations, they may be blind to issues some families are facing in their neighborhoods and the extent to which community resources are already overtaxed by a civilian population with great needs that therefore cannot supplement military ones. Using existing data from “outside the gate” will enable key military leaders and nonmilitary service providers to make data-driven decisions about needed policies, programs, and services. The DoD MFRS as a whole, as well as commanders on the ground, must be able to work effectively with community organizations to support military families in a well-integrated way. Aggregate statistics on local unemployment rates (U.S. Bureau of Labor Statistics), poverty levels (U.S. Census Bureau), school district data (U.S. Census Bureau), crime rates (Federal Bureau of Investigation), cost of living (DoD) and the like are free and publicly available from government websites. In addition, such statistics could be added to the DoD administrative, survey, and program databases to assist with larger-scale efforts to identify variation in needs. Supplementing survey data is especially important because it can be challenging to identify, reach, and gain sufficient response rates from military families, including nonmarital partners. There are a few published reports that illustrate that some neighborhoods around military bases are much better off than others, thus suggesting that the allocation of military base resources should take this more into account than installation population size. RECOMMENDATION 6: The Department of Defense (DoD) should build its capacity to support service members and families by promoting better civilian understanding of the strengths and needs of military-connected individuals. These efforts should particularly address misinformation, negative stereotypes, and lack of knowledge. DoD should authorize MC&FP to partner with the Office of Communications to conduct an ongoing media relations campaign to promote the civilian community’s understanding of military-connected individuals as assets. Clear informational awareness campaigns and educational efforts are needed to address misinformation, combat negative stereotypes, and promote understanding. The MC&FP-funded Military Families Learning Network is a sound PREPUBLICATION COPY, UNCORRECTED PROOFS 9-8  

example of how to increase awareness and knowledge within the military-serving practitioner and academic community. Efforts to increase civilian understanding of military-connected individuals are required to ensure that the professionals and organizations military families will encounter in communities are well prepared to serve them. The lack of awareness and stereotypes about military families among civilians can be harmful. Ignorance and negative stereotypes can limit military families’ social support networks or result in harmful, unwarranted community reactions toward them. For example, if teachers, doctors, coaches, and others do not know about how children may act or respond when a parent is deployed, they may not understand why a child is behaving in a certain manner, an appropriate way to respond, and how to potentially engage other support resources rather than berate, punish, or label the child as a “problem.” As another example, civilians who hold stereotypes of veterans as possessing deficits, being unstable, mentally ill, prone to violent outbursts, or displaying other negative behaviors may be less willing to rent to them, hire them, socialize with them, and let their children socialize with veterans’ children. DoD can build its capacity to support service members and families through a social marketing information campaign and joint civilian-military events that include educational elements (e.g., educational booths, exhibits, videos, plays dispelling myths that are part of a family-friendly carnival, air show, Fourth of July celebration, or other event). School liaison officers are also very important in preparing educational systems to better serve military- connected children and their families, although they may not be present in areas where military children are uncommon. RECOMMENDATION 7: The Department of Defense (DoD) should enable military family support providers, civilian or in uniform, who work for military systems, and consumers to access effective, evidence-based and evidence-informed6 family strengthening programs, resources, and services. To meet the diverse and ever- changing needs of service members and their families, and address the current significant gap between research and practice, DoD should strengthen the Military Family Readiness System (MFRS) so that it  Provides a comprehensive continuum of support across medical and nonmedical providers, locations, and changing benefit eligibility;  Facilitates adaptive and timely approaches to stepped-care7 delivery;  Draws upon effective evidence-based or evidence-informed approaches;  Integrates routine screening and assessment tools in the delivery of family support programs;  Builds and employs a robust data infrastructure, for both implementation and outcome data, that supports a continuous quality improvement system; and                                                              6 See Chapter 1 for descriptions of evidence-based and evidence-informed. 7 Stepped care models of prevention and intervention in health and behavioral health services match the type and intensity of services to family and service members’ needs. Given the diverse and dynamic nature of family needs and resources, prevention and intervention services are offered along a continuum of intensity from prevention and assessment, through ‘watchful waiting,’ up to high intensity, targeted treatments for specific distressing or more severe conditions. PREPUBLICATION COPY, UNCORRECTED PROOFS 9-9  

 Coordinates referrals and care across military and nonmilitary resources, institutions, and communities. DoD should mobilize and task MC&FP and the Defense Health Agency to partner for the overall leadership, coordination, policy-making, and operationalization of the MFRS. The Services should be engaged in the tailoring of programs and services; however, the core components of those efforts must be consistent and established by MC&FP. Moreover, MC&FP should create an Implementation Science and Evaluation Unit that could lead a CQI effort involving monitoring and implementation support. It could widely promote sources of information available on evidence-based and evidence-informed programs, resources, and services. Program evaluation should be promoted, and when programs in military communities have been formally evaluated the results of these evaluations can be widely shared and promoted across DoD and the Services. The results of those evaluations should be shared in publicly accessible documentation, such as on the Military OneSource website, in the Defense Technical Information Center online (DTIC), and through other venues, including those results which show no effect or negative effects. RECOMMENDATION 8: To support high-quality implementation, adaptation, and sustainability of policies, programs, practices, and services that are informed by a continuous quality improvement process, the Department of Defense should develop, adopt, and sustain a dynamic learning system as part of its Military Family Readiness System. Such a dynamic learning system requires a process of tailoring and decision-making grounded in a sufficient level of evidence about screening, policies, programming, services, resources, and practices to understand and strengthen family well-being in the distinct cultural contexts of the different branches, in myriad domestic and international locations, and across ever-changing organizational and socioeconomic circumstances. By instituting ongoing accountability for system effectiveness, a high-functioning MFRS framework will incorporate assessment and the results of existing efforts, improve response capabilities, and point to the development of future resilience and readiness strategies for military families. RECOMMENDATION 9: The Department of Defense (DoD) should continually assess the availability and effectiveness of specialized family-centered policies, programs, services, resources, and practices to support the evolving and unexpected needs of families facing exceptionally high stressors (e.g., military service related injury, illness or death), in order to implement programs targeting emerging threats to military family well-being. In particular, DoD should seek to serve highly affected families through interdisciplinary, collaborative models in which military and nonmilitary service providers, health care providers, and other professionals, both within and outside the Military Health System, are prepared to rapidly develop and deliver family-centered services that address emerging, high-stress family challenges. Policies, programs, and services should be systematically evaluated and prepared to respond to evolving high-stress situations within the recommended Military Family Readiness Learning System. PREPUBLICATION COPY, UNCORRECTED PROOFS 9-10

Recent experiences have identified military families faced by illness, injury, or death as those most highly affected (see Chapter 6). However, future challenges to military families remain unknown. MC&FP8 shares responsibility for promoting health and well-being as part of its overall leadership role in coordinating, making policy for, operationalizing, and evaluating nonmedical programs and services that comprise the MFRS. The preventive care of the most vulnerable families must remain a primary mission of MC&FP. Such an effort reflects an investment in returning all military families to full functionality and provides a significant return on investment not only for those that are most affected but for all military families who trust in the resources that will be delivered under trying conditions. Programming for highly impacted military families should be incorporated as a major function of the newly established Implementation Science and Evaluation Unit in coordination with program analysts and managers. Candidly, the future challenges faced by military families are unknown, but are likely to include unanticipated threats, which will require the coordinated efforts of community service providers, health care providers, and others both within and outside of the military community. Currently, families turn to religious and spiritual leaders, school counselors, nonprofit organizations for war veterans, unions, city councils, first sergeants, and other resources in addition to the health care system for the issues they are facing. Future family challenges are likely to require as much if not more coordination of efforts across resources and platforms of care. We must always remember that families are not just groups of individuals, but individuals who interact as a system (see Chapter 2). Historically, this has been most relevant in military families affected by the most challenging circumstances. As a result, specialized programming targeting highly impacted families must attend to multilevel resilience pathways within families (see Chapter 6), and efforts to support them must focus on more than just the needs of individual family members. Multiple efforts, including strengthening couples, parental guidance, and programmatic counseling, as well as family-level efforts that target family communication, problem-solving, and conflict resolution skills all currently have evidence-based support. We must be prepared to address unforeseen high-impact stressors that are likely to affect military families in the future, requiring refinements to these existing strategies. Such refinements can be accomplished as defined by a dynamic Military Family Readiness Learning System (see Chapter 8). RECOMMENDATION 10: To enhance the effectiveness and efficiency of the Military Family Readiness System, the Department of Defense should investigate innovations in big data and predictive analytics to improve the accessibility, engagement, personalization, and effectiveness of policies, programs, practices, and services for military families. Among other things, this should include assessment of the utility of mobile applications, virtual service delivery, and wearables for strengthening family functioning by personalizing preventive interventions and 8 The committee notes that MC& FP is not a healthcare provider – that responsibility falls to the Defense Health Agency (DHA). However, this recommendation will require collaboration across DoD entities (i.e. DHA and MC&FP). PREPUBLICATION COPY, UNCORRECTED PROOFS 9-11

delivering them “just in time” (i.e., in real time, at the needed dose, and in the preferred formats for families). An analysis of data with learning-enhanced approaches may be used to detect mental health issues, such as suicidality and well-being, and may lead to more effective methods of comparing intervention options. Harnessing new technologies for program delivery could broaden the range of available program options, including program intensity and dosage. Virtual service delivery and online self-directed interventions offer the user an opportunity to engage anytime, anywhere. Wearables have the potential to track individual stress points (e.g., during or just prior to a stressful event that could lead to child abuse, substance use, or other risky behavior) and consequently interrupt maladaptive behaviors, encouraging and teaching more adaptive strategies instead. Of course, DoD will need to be prudent as it evaluates the options, to manage privacy and national security concerns and other unintended consequences, as well as assess whether technologies have sufficiently evolved to be able to live up to the hype. RECOMMENDATION 11: To facilitate the consistency and continuation of its policies regarding military family readiness and well-being across political administrations and changes of senior military leadership, the Department of Defense should update and promulgate its existing instruction that operationalizes the importance of military family well-being by incorporating the conclusions and recommendations contained in this report. While DoD has made some commitments about objective family well-being, such as setting standards for housing and allowances, it has not yet committed to comprehensive standards in this regard. With regard to subjective family well-being, no standard has been declared, but DoD regularly monitors satisfaction with the military lifestyle. In addition, DoD has not addressed functional family well-being. For instance, does DoD aspire for all parents to be able to provide appropriate warmth and limits for their children? Does it aspire for all spouses or partners to effectively communicate? The committee recommends that DoD consider the research findings we have reviewed in Chapter 5 on what is required for families to be able to function effectively during service members’ absences and on how to prevent maltreatment, divorce, and other family events that may prove incompatible with military service. Policy can help clarify DoD’s overarching goals and priorities in a lasting way. Because there is frequent turnover in leadership, there can be a lack of institutional memory and continued momentum after program champions have gone. Some of the committee’s recommendations are for long-term action (e.g., longitudinal studies, types of data to be collected and reported). Policy can help ensure that longer-term efforts are carried through, initial steps were not wasted, and trends over time and potential causal explanations can be identified. Consistency is also important for fairness, so that service members and families in one Service are not underserved relative to service members and families in other Services. Additionally, as DoD and the Services operate with limited funds and competing demands, what is not documented in policy can be more difficult to achieve or sustain. PREPUBLICATION COPY, UNCORRECTED PROOFS 9-12  

REFERENCES Congressional Budget Office (2017). Trends in the Department of Defense’s Support Costs. Retrieved from https://www.cbo.gov/system/files/115th-congress-2017- 2018/reports/53168-dodsupportcosts.pdf Masten, A. S. (2015). Pathways to integrated resilience science. Psychological Inquiry, 26(2), 187–196. PREPUBLICATION COPY, UNCORRECTED PROOFS 9-13  

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The U.S. military has been continuously engaged in foreign conflicts for over two decades. The strains that these deployments, the associated increases in operational tempo, and the general challenges of military life affect not only service members but also the people who depend on them and who support them as they support the nation – their families.

Family members provide support to service members while they serve or when they have difficulties; family problems can interfere with the ability of service members to deploy or remain in theater; and family members are central influences on whether members continue to serve. In addition, rising family diversity and complexity will likely increase the difficulty of creating military policies, programs and practices that adequately support families in the performance of military duties.

Strengthening the Military Family Readiness System for a Changing American Society examines the challenges and opportunities facing military families and what is known about effective strategies for supporting and protecting military children and families, as well as lessons to be learned from these experiences. This report offers recommendations regarding what is needed to strengthen the support system for military families.

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