Strengthening the
MILITARY FAMILY
READINESS SYSTEM
for a Changing American Society
Committee on the Well-Being of Military Families
Kenneth W. Kizer and Suzanne Le Menestrel, Editors
Board on Children, Youth, and Families
Division of Behavioral and Social Sciences and Education
A Consensus Study Report of
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
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This activity was supported by a contract awarded to the National Academy of Sciences and funded by the U.S. Department of Defense through Basic Ordering Agreement No. HHSP233201400020B, Task Order No. HHSP23337071. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-48953-9
International Standard Book Number-10: 0-309-48953-9
Library of Congress Control Number: 2019947790
Digital Object Identifier: https://doi.org/10.17226/25380
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Suggested citation: 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. https://doi.org/10.17226/25380.
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COMMITTEE ON THE WELL-BEING OF MILITARY FAMILIES
KENNETH W. KIZER, (Chair), School of Medicine, Betty Irene Moore School of Nursing, and Institute for Population Health Improvement, UC Davis Health, University of California, Davis
DAVID ALBRIGHT, The University of Alabama School of Social Work
STEPHEN J. COZZA, U.S. Army (retired), Uniformed Services University of the Health Sciences
ELLEN DEVOE, Boston University School of Social Work
ABIGAIL GEWIRTZ, Institute of Child Development and Institute for Translational Research in Children’s Mental Health, University of Minnesota
MARY M. KELLER, Military Child Education Coalition
PATRICIA LESTER, University of California, Los Angeles, Semel Institute for Neuroscience and Human Behavior
SHELLEY MacDERMID WADSWORTH, Military Family Research Institute, Purdue University
LAURA L. MILLER, RAND Corporation
TRACY NEAL-WALDEN, U.S. Air Force (retired), Steven A. Cohen Military Family Clinic at Easterseals
DANIEL F. PERKINS, Clearinghouse for Military Family Readiness, The Pennsylvania State University
ASHISH S. VAZIRANI, Executive Director and Chief Executive Officer, National Military Family Association
IVAN C. A. WALKS, Ivan Walks & Associates
SUZANNE LE MENESTREL, Study Director
DAVID BUTLER, Scholar, Director, Office of Military and Veterans Health
SHEILA MOATS, Program Officer (February–June 2018)
PRIYANKA NALAMADA, Associate Program Officer (July 2018–present)
STACEY SMIT, Senior Program Assistant
JUDITH JONES, Archer Fellow (May–August 2018)
LAURA MINERO, Christine Mirzayan Science and Technology Policy Graduate Fellow (January–April 2019)
SUNDONIA WILLIAMS WONNUM, Consultant, U.S. Air Force
BOARD ON CHILDREN, YOUTH, AND FAMILIES
ANGELA DIAZ (Chair), Icahn School of Medicine at Mount Sinai
DAVID V. B. BRITT (Co-Chair), Sesame Workshop (retired)
HAROLYN BELCHER, Kennedy Krieger Institute and Johns Hopkins University School of Medicine
RICHARD F. CATALANO, University of Washington School of Social Work
DIMITRI CHRISTAKIS, Seattle Children’s Research Institute, University of Washington
JEFFREY W. HUTCHINSON, The Wade Alliance, LLC
STEPHANIE J. MONROE, The Wrenwood Group, LLC
JAMES M. PERRIN, Harvard Medical School and MassGeneral Hospital for Children
NISHA SACHDEV, Bainum Family Foundation
DONALD F. SCHWARZ, Robert Wood Johnson Foundation
MARTÍN J. SEPÚLVEDA, IBM Corporation (retired) and CLARALUZ LLC
MARTIN H. TEICHER, Harvard Medical School and McLean Hospital
JONATHAN TODRES, Georgia State University College of Law
NATACHA BLAIN, Director
Acknowledgments
Supporting the well-being of military families is essential to ensuring the readiness of military personnel. Military families encompass a broad spectrum of American society and have diverse needs that have materially changed in recent years. In an effort to make sure its efforts to support military families are addressing their needs in a rapidly changing American society, the U.S. Department of Defense asked the National Academies of Sciences, Engineering, and Medicine to study 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. The National Academies appointed the Committee on the Well-Being of Military Families in 2017 to address this charge. The committee thanks the sponsor of this study, the Office of Military Community and Family Policy, U.S. Department of Defense, for their support of the committee’s activities.
This report would not have been possible without the contributions of many people. Special thanks go to the members of the committee who dedicated extensive time, expertise, and energy to the drafting of the report. The committee also thanks the members of the National Academies staff for their significant contributions to the report: Suzanne Le Menestrel, Priyanka Nalamada, David Butler, and Sheila Moats. Stacey Smit provided key administrative and logistical support and made sure that committee meetings ran smoothly.
The committee is also grateful to Anthony Bryant, Faye Hillman, and Lisa Alston for their administrative and financial assistance. From the Division of Behavioral and Social Sciences and Education Office of Reports
and Communication, Kirsten Sampson Snyder, Viola Horek, Patricia L. Morison, Douglas Sprunger, and Yvonne Wise guided the report through the review and production process and assisted with its communication and dissemination. The committee also thanks the National Academies Press staff, Clair Woolley, Holly Sten, Autumn Rose, and Barbara Murphy for their assistance with the production of the final report; Daniel Bearss and Rebecca Morgan in the National Academies research library for their assistance with fact checking and literature searches; and the report’s editor, Marc DeFrancis, for his expert editing. Finally, throughout the project, Natacha Blain, director of the Board on Children, Youth, and Families, together with Mary Ellen O’Connell and Monica Feit, provided helpful oversight.
Many individuals volunteered significant time and effort to address and educate the committee during our public information session. Their perspectives and personal experiences were essential to the committee’s work. We thank Ashley Broadway-Mack, president, The American Military Partner Association; Karen Ruedisueli, government relations deputy director, National Military Family Association; Chaplain (COL) Jimmy Nichols, installation command chaplain, Fort Sill, Oklahoma; Edward Tyner, associate director, Office of Family Readiness/Office of Special Needs, U.S. Department of Defense; Kelly Hokanson, spouse of National Guard Bureau Vice Chief (LTG) Daniel R. Hokanson; Jill Marconi, director, Airman and Family Readiness, U.S. Air Force; Susan Lukas, director, Legislation & Military Policy, Reserve Officer’s Association; Anthony A. Wickham, J1 program director, National Guard Bureau; Col. (Ret) Anthony Cox, Army, former manager, HQDA Family Advocacy Program; Ellyn Dunford, spouse of Gen. Joseph F. Dunford, chairman of the Joint Chiefs of Staff; Elka Franco-Giordano, Chief of Naval Operations OMBUDSMAN-at-Large and spouse of Master Chief Petty Officer of the Navy Steven S. Giordano; and Donald R. Neff, United States Special Operations Command.
The committee also appreciates the contributions of Sarah Beehler (University of Minnesota), David Chambers (National Cancer Institute), Schelomo Marmor (University of Minnesota), Lisa Militello (The Ohio State University), Nathaniel Mohatt (University of Colorado, Denver), Inbal Nahum-Shani (University of Michigan), Wynne Norton (National Cancer Institute), and Barbara Thompson (U.S. Department of Defense, retired) for their valuable commissioned papers, which informed our report. We would also like to extend our gratitude to our unpaid consultants, Diana Timba (University of Minnesota) and Sundonia Williams-Wonnum (U.S. Air Force) and our graduate fellows Laura Minero and Judith Jones. Many individuals also submitted memos for the committee’s consideration; a listing of these individuals can be found in Appendix C in this report.
This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of
this independent review is to provide candid and critical comments that will assist the National Academies in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.
We thank the following individuals for their review of this report: Nicholas J. Armstrong, Institute for Veterans and Military Families, Syracuse University; Ron Avi Astor, Suzanne Dworak-Peck School of Social Work, Rossier School of Education, University of Southern California; Kelly Blasko, Connected Health Branch, Defense Health Agency; Kenneth A. Dodge, Sanford School of Public Policy, Duke University; Richard Fabes, School of Social and Family Dynamics, Arizona State University; Eric M. Flake, Developmental Behavioral Pediatrician, Madigan Army Medical Center; Stacy A. Hawkins, Research Facilitation Laboratory, Army Analytics Group; Jay A. Mancini, Human Development and Family Science, The University of Georgia; Ann S. Masten, Institute of Child Development, University of Minnesota, Minneapolis; Sarah O. Meadows, Pardee RAND Graduate School, RAND Corporation; Lyndon A. Riviere, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research; and Jonathan Woodson, Institute for Health System Innovation and Policy, Boston University.
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report nor did they see the final draft before its release. The review of this report was overseen by Dan G. Blazer, Duke University Medical Center, and Bradford H. Gray, The Urban Institute (retired). They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.
Kenneth W. Kizer, Chair
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Contents
2 FAMILY WELL-BEING, READINESS, AND RESILIENCE
Linkages Between Family Issues and Military Readiness
Military-Focused Definitions of Well-Being
Implications for the Department of Defense
Ecological and Life Course Models of Military Family Well-Being
Resilience in the Military Context
3 DEMOGRAPHIC AND MILITARY SERVICE CHARACTERISTICS OF MILITARY FAMILIES
Information Sources: Within DoD
Information Sources: External to DoD
Organizational and Individual Characteristics
Characteristics that Change Over Time
Attention to Intersectionality
4 MILITARY LIFE OPPORTUNITIES AND CHALLENGES
The Context of Military Family Life: Yesterday vs. Today
Geographic Assignment and Relocation
Training, Sea Duty, and Deployments
National Guard and Reserve Service
Transition Out of Military Service
5 STRESS, RISK, AND RESILIENCE IN MILITARY CHILDREN
The Impact of Stress on Youth Development
How Parenting Affects the Development of Stress Regulatory Capacities
Resilience in Children’s Development
6 HIGH-STRESS EVENTS, FAMILY RESILIENCE PROCESSES, AND MILITARY FAMILY WELL-BEING
Stress and Family Resilience Processes
Opportunities for Bolstering Resilience by Addressing Risk Pathways
7 THE MILITARY FAMILY READINESS SYSTEM: PRESENT AND FUTURE
The Structure of the Military’s Service Member and Family Well-Being Support System
A Population-Level System Promoting Well-Being
Evidence-Based and Evidence-Informed Policies, Programs, Services, Resources, and Practices
Accountability and Measurement
Community Engagement and Participatory Partnerships
8 DEVELOPING AND SUSTAINING A LEARNING SYSTEM TO SUPPORT MILITARY FAMILY READINESS AND WELL-BEING
Background on Family-Based Promotion and Prevention Interventions
Barriers to Translating Evidence into Practice
Remediating the Bridge from Evidence to Practice
Ongoing Adaptation Framework for a Complex Military Family Readiness System
Adaptation and Continuous Quality Monitoring Using a Learning System Framework
Enhance Understanding of Today’s Service Members and Their Families
Improve Military Community and Family Policy Programs and Services
Strengthen the Broader Military Family Readiness System
A Biosketches of Committee Members and Project Staff
B Agenda for Public Information Gathering Session
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Boxes, Figures, and Tables
BOXES
S-1 Definitions of Key Terms Used in the Report
S-2 Family-Strengthening Goals to Promote Family Resilience and Well-Being
1-1 Definitions of Key Terms Used in the Report
1-3 U.S. Code, Title 37, Section 401: Definition of Family Dependent
1-4 Guiding Principles for the Report
1-5 Characteristics, Strengths, and Challenges of the All-Volunteer Force
2-1 The Rise of Digital Technology and Its Impact on Service Member Privacy and Security
3-1 Military Student Identifier Reporting
4-1 Examples of Prominent Themes Associated with Transition into and Service in the Military
4-2 Examples of Prominent Themes Associated with Military Pays and Benefits
4-3 Examples of Prominent Themes Associated with Geographic Assignment and Relocation
4-5 Examples of Prominent Themes Specific to Members of the National Guard and Reserves
4-6 Examples of Prominent Themes Associated with Diversity and Inclusion
4-7 Examples of Prominent Themes Associated with Transition from Military to Civilian Life
6-1 Family-Strengthening Goals to Promote Family Resilience and Well-Being
7-2 Community Engagement and Community Participatory Research
8-1 Applying a System-Level Approach: The Building Capacity Consortium
8-2 Adapting a Program Sunsetting: The Joint Family Support Assistance Program
8-3 Just-In-Time Adaptive Interventions (JITAIs): An Example
FIGURES
1-1 All family relationships are interdependent
2-1 Bronfenbrenner’s ecological theory of development
3-1 Distribution of service members, by service and component
3-2 Service members’ age (percent distribution)
3-3 Service members’ race (percent distribution)
3-4 Service members who are women, by service and component
3-5 Family status of all service members (percent distribution)
3-6 Family status of active and reserve component service members (percent distribution)
3-7 Ages of military spouses (percent distribution)
3-8 Employment status of active and reserve component spouses (percent distribution)
3-9 Ages of children in military families (percent distribution)
4-1 The military family well-being and readiness model and illustrative elements
4-2 Overlapping qualifications of programs serving children with special needs
7-1 Continuum of coordinated support within the Military Family Readiness System
7-4 Integrated information infrastructure to support a complex adaptive system, such as MFRS
7-5 Types of outcomes in implementation research
8-1 Dynamic sustainability framework
8-2 Sources of intervention adaptations
9-1 Trends in the Department of Defense’s support costs, 1980–2016
TABLES
2-1 Key Factors in the Production of Resilience
3-1 Total Number of Exceptional Family Members in 2016, by Military Service
3-2 Characteristics of Caregivers of Military Personnel and Veterans Who Served Post-9/11
6-1 Negative Effects of PTSD Symptom Clusters on Family Resilience Processes
7-1 Examples of Service-Specific Information, Resource, and Referral Centers
7-2 Definitions of the Continuum of Coordinated Support Domains and Program Examples
