SERVING OUR NATION'S HEROES: AN EXAMINATION OF REFERRAL SYSTEMS AVAILABLE TO ASSIST MILITARY AND VETERAN FAMILIES WITH YOUNG CHILDREN IN CHICAGO

 
SERVING OUR NATION'S HEROES: AN EXAMINATION OF REFERRAL SYSTEMS AVAILABLE TO ASSIST MILITARY AND VETERAN FAMILIES WITH YOUNG CHILDREN IN CHICAGO
Serving Our Nation’s Heroes:
           An Examination of Referral Systems Available
              to Assist Military and Veteran Families
                  with Young Children in Chicago

This project was made possible by a generous grant from the Prince Charitable Trusts, Chicago, Illinois.
SERVING OUR NATION'S HEROES: AN EXAMINATION OF REFERRAL SYSTEMS AVAILABLE TO ASSIST MILITARY AND VETERAN FAMILIES WITH YOUNG CHILDREN IN CHICAGO
Acknowledgments
    ZERO TO THREE would like to thank Prince Charitable Trusts, Chicago, Illinois, for making this study
    possible through their generous funding and support. Also, we would like to acknowledge the
    support and participation from many agencies in the Chicago area, especially the Administration
    for Children and Families and the Office of Child Care/Region V (Health and Human Services), Illinois
    National Guard, Illinois Network of Child Care Resource and Referral Agencies, ChildServ of Chicago,
    Easter Seals, Illinois Children’s Home and Aid Society, Illinois Veterans Task Force, Illinois Health and
    Disability Advocates, Erikson Institute, Michael Reese Health Trust, and the McCormick Foundation.

    ZERO TO THREE is a national nonprofit that promotes the health and development of infants and toddlers,
    specializing in a research-based multidisciplinary approach to child development that brings together the
    interdependent social, emotional, intellectual, language, and physical perspectives of the many fields and
    specialties that influence the lives of young children.

    ZERO TO THREE is proud to support military families and endeavors to stay abreast of the ever-changing needs of
    military families. Through the generous support of the Prince Charitable Trusts, ZERO TO THREE has been working
    to examine the community-based systems available to families with young children who may be experiencing
    social and emotional stress associated with military separation, parental injury, and/or postdeployment
    reintegration. The overarching goal of this study has been to identify the needs of veteran families who have very
    young children; the availability of, and access to, services that meet those needs; the identified gaps in meeting
    the needs of veteran families who have very young children; and the types of services that might be helpful in
    addressing those identified gaps.

    For more information about this study, or about Military Family Projects at ZERO TO THREE, please visit
    our website at www.zerotothree.org, or email us at mprojects@zerotothree.org.

2   Serving Our Nation’s Heroes: An Examination of Referral Systems Available to Assist Military and Veteran Families with Young Children in Chicago
SERVING OUR NATION'S HEROES: AN EXAMINATION OF REFERRAL SYSTEMS AVAILABLE TO ASSIST MILITARY AND VETERAN FAMILIES WITH YOUNG CHILDREN IN CHICAGO
Serving Our Nation’s Heroes:
An Examination of Referral Systems Available to Assist Military
and Veteran Families with Young Children in Chicago

T
Statement of Need

                 he end of combat operations in Iraq and the reduction of troops in Afghanistan
                 mean there are more troops leaving the service and returning to their civilian
                 communities. There are over 581,000 veterans of the post-September 11, 2001
                 (post-9/11), military conflicts known as Operation New Dawn (OND), Operation
                 Enduring Freedom (OEF), and Operation Iraqi Freedom (OIF) in the State of
                 Illinois (Westat, 2010). Many of those Illinois veterans have children, and many
continue to have children upon their return to civilian status. Of all U.S. veterans, almost 30% have
dependent children (Westat, 2010). Although there is little, if any, information regarding the number
of veterans who have very young children, approximately 42% of the children of active duty service
members are between the ages of 0 to 5 years (Office of the Deputy Under Secretary of Defense,
(Military Community and Family Policy 2010). For those OND/OEF/OIF veteran parents who have
recently separated from active duty service, it can be assumed that many of their children will also
be very young. In Chicago, 7.3% of the population are combat and postservice veterans living,
working, and, for recent OIF/OEF veterans, trying to raise young children (Westat, 2010). In light
of these facts, ZERO TO THREE is concerned that veteran families could slip through the cracks of
service as they are thrust back into mainstream life without the structured supports of the military
systems with which they are familiar.

In a study done by the Pew Research Center, 44% of post-9/11 veterans say their readjustment
to civilian life was difficult. About half (48%) say they have experienced strains in family relations
since leaving the military, and 47% say they have had frequent outbursts of anger. Whether or
not they were formally diagnosed, nearly 4 out of 10 (37%) veterans express their belief they
have suffered from posttraumatic stress (Taylor, 2011). These kinds of family stressors can have
implications for the children of veteran families. Although children may not understand the
meaning of what they see and hear, they are deeply affected and influenced by the emotions of
the people that they rely on for love and security.

As military veterans and their families gradually transition into the larger community, it is
essential that civilian professionals who work with them have the information and resources to
be fully responsive to their distinct needs. Materials that promote awareness and understanding

Serving Our Nation’s Heroes: An Examination of Referral Systems Available to Assist Military and Veteran Families with Young Children in Chicago   1
SERVING OUR NATION'S HEROES: AN EXAMINATION OF REFERRAL SYSTEMS AVAILABLE TO ASSIST MILITARY AND VETERAN FAMILIES WITH YOUNG CHILDREN IN CHICAGO
of military and veteran parents’ experiences, challenges, strengths, and resources can equip
    community-based professionals, including those working in health care, early care, family
    support, or mental health settings, with the tools and resources that they need to support these
    families and their young children. Ultimately, such assistance will promote the development of
    social and emotional skills necessary for optimal development and intergenerational resilience.
    As one participant in the ZERO TO THREE study shared, “When you support the veteran, you’re
    supporting the family. When you support the family, you’re supporting the veteran…it’s
    ultimately part of that larger mission, and it’s a national investment, really.”

    Study Design

    In order to better understand available services for military and veteran families in Chicago, ZERO
    TO THREE developed a study to capture information from professionals within Chicago and the
    Illinois area currently serving families with young children. Using a mixed-methods design, both
    quantitative and qualitative data were captured via a survey of multidisciplinary professionals,
    followed by a focused discussion with key stakeholders supporting young children in Chicago and
    Illinois.

    ZERO TO THREE staff began this project by contacting key stakeholders from multiple agencies
    across Chicago in order to introduce and generate interest in the study. An initial phone meeting
    included representatives from mental health, family support, child care resource and referral
    agencies, and leaders in Illinois advocating on behalf of both military and veteran families.
    Conference call participants expressed enthusiasm over the project, acknowledging the need to
    learn more about supporting veterans and their families. During the initial phone call, participants
    suggested additional agencies for inclusion in the study. They also suggested additional survey
    questions to capture the current state of support for veteran and military families in Chicago, as
    well as to identify possible gaps in services.

    The study proposal was submitted to the George Mason University Human Subjects Review Board
    (HSRB) and approved on October 17, 2011.

2   Serving Our Nation’s Heroes: An Examination of Referral Systems Available to Assist Military and Veteran Families with Young Children in Chicago
SERVING OUR NATION'S HEROES: AN EXAMINATION OF REFERRAL SYSTEMS AVAILABLE TO ASSIST MILITARY AND VETERAN FAMILIES WITH YOUNG CHILDREN IN CHICAGO
The Survey

Through the use of snowball sampling, key stakeholders who participated in the study also
assisted in the distribution of the survey to personnel within their agencies, as well as to external
agency administrators who could further disseminate the study to their own employees. The
ZOOMERANG Survey was utilized to capture the data. The survey period was December 12, 2011,
through January 12, 2012. Approximately 1,000 professionals received the invitation to complete
the survey. Of these, 75 professionals visited the survey and 32 professionals completed the
survey. The survey asked professionals the following questions:

   • Who are they serving?
   • What are the identified needs?
   • How do they receive referrals?
   • How they refer families for services?
   • What services are available?
   • What material resources are they using to support families?
   • What do they identify as gaps or needs in services?

Survey Results

Sample Size: Investigators determined that the relatively low response to the survey was
reflective of professionals’ limited awareness of the military and veteran status of the families in
their care. When the investigators queried the points of contact from the agencies disseminating
the survey about the low response rate, the feedback they received from their staff was “we don’t
serve veteran families,” or “none of my families are military,” or “we don’t work with babies, so it
didn’t apply.” During the focus group discussion, it became evident that in many instances, agency
professionals were not asking if a family was military connected in any way, nor were they asking
if any family member had been deployed with the military—information that can be critical to
include in the intake process. We have posited that the sample size may be indicative of the lack
of awareness of the unique needs of veteran families within the community

Prevalent Issues: The data suggest that the most prevalent issues affecting OEF/OIF veterans
with children, from birth to 3 years old, are related to mental health, finance, and employment
difficulties. With regard to issues affecting spouses of OIF/OEF veterans who have young children
from birth to 3 years old, respondents reported employment and family issues as the most
prevalent. Finally, childcare access and availability emerged as the most prevalent issue affecting
children from birth to 3 years old of OIF/OEF veterans.

Services Available: Respondents identified individual counseling, parent education, and family
counseling as the primary services they provide to veterans. Respondents identified few services

Serving Our Nation’s Heroes: An Examination of Referral Systems Available to Assist Military and Veteran Families with Young Children in Chicago   3
“And in terms of the
                                                                                                     wounded warriors
    offered specifically on behalf of the spouses of veterans with young
    children. Respondents identified regularly scheduled, ongoing child                              . . . the child is being
    care as the primary service specifically available to young children of                          overlooked in that
    veterans. It was not indicated that this care was unique to children of
    veterans in any way.
                                                                                                     process. We have a lot
                                                                                                     of programs that cater
    Material Resources: The respondents reported that their                                          to taking care of the
    organizations offer several different resources for veterans, spouses,
    and young children. Materials on behalf of veterans include
                                                                                                     soldier that is injured….
    educational books, children’s books, and DVDs. Respondents                                       But the child is often
    identified flyers, DVDs, and educational books as material resources                             neglected in the process.
    available to veterans’ spouses. Children’s materials were identified as
    flyers, children’s books, and graphic novels.                                                    How do you attend to a
                                                                                                     child who is also dealing
    Accessibility/Availability of Services: Findings from the “access and
    availability to services” survey items suggest that that respondents,
                                                                                                     with the healing process
    for the most part, neither agreed nor disagreed that their                                       of their parent?
    organizations offered access and availability of services to veterans
    with young children.

    Qualitative Data: Emergent themes in the qualitative data included lack of awareness of the needs
    of veterans and their families, the need for additional services for veterans with posttraumatic stress
    disorder (PTSD), and the prevalence of psychological injuries. As one respondent wrote, “Spouses
    are sometimes inconsistent in attending services, stating that they feel overwhelmed with heavy
    demands for care of their veteran and their children. It would be nice if they had more respite
    services available to caregivers, not just for caregivers of the severely physically wounded veterans,
    but those veterans with severe PTSD, which prevents them from being able to adequately care for
    their children or from being reliable at completing tasks in the home.”

    Stakeholder’s Meeting

    ZERO TO THREE investigators facilitated a focus group for the purpose of gathering additional
    qualitative information. This meeting took place March 7, 2012, in Chicago and included
    approximately 20 representatives from across Chicago and Illinois. Participating agencies included
    representatives from military services, mental health, early care, family support, and referral and
    advocacy programs. The focused discussion was recorded. The discussion reflected that there is
    much yet to do to ensure our veterans and their families are well supported. We asked the group
    specific questions about the needs of veterans and their families, the services available, the access
    and barriers to service, and the gaps in services. The findings entailed the following:

    Needs of veterans and their families who have young children from birth to 3 years old: In terms of

4   Serving Our Nation’s Heroes: An Examination of Referral Systems Available to Assist Military and Veteran Families with Young Children in Chicago
the needs of veterans and their families who have young children, the respondents identified the
following issues: (a) services being siloed, serving only one member of the family group without
considering the needs within the family system; (b) the instability of the military in terms of
unpredictable deployments or discharges; and (c) postdischarge challenges. Regarding the narrow
focus of organizations serving only one family member, one participant noted that sometimes
providers are focusing a lot on providing resources for the children while neglecting the spouse,
adding that “…when we focus on youth, perhaps the spouse gets left behind.” The discussion of
the current instability of the military stressed that the military was undergoing significant changes
that influence the deployment patterns of the military Service members. One participant stated,
“And as I’m hearing you talk—what I’m thinking is there’s already so much inherent instability there,
with what the families were already experiencing in terms of all the changes that just accompany
deployments and returning and transitioning out, getting back again.” Downsizing of the military
was also discussed as a factor in the instability of military service: “But right now what they’re doing
is before their contracts are completed, these are 14-year Service members, 14 years in, and then
before your contract is completed, they’re saying, hey, you have to go, here’s 6 months’ severance,
see you later.” Postdischarge challenges suggested by the participants included mental, physical,
and economic concerns. Participants noted other challenges such as domestic violence, substance
abuse, and various mental health issues: “And when we think of wounded warriors, it’s not just the
physical wounds that are seen. There are those invisible wounds that we talk about quite a bit.”

Needs of veterans’ young children, from birth to 3 years old: Two core themes emerged from this
category: family members’ sense of isolation and parents’ limited understanding of their children’s
developmental processes. Respondents indicated that more attention and resources are given to
the adults than to the children. In addition, the data suggest that the children of military families
are often isolated and have a limited sense of connection to other children who share similar
experiences and emotions. As one respondent indicated, “And so for children, there’s this sense
of isolation, because they are not around other children necessarily whose parents, friends are
going through that same process or experience.” Another respondent added, “And in terms of the
wounded warriors . . . [the] child is being overlooked in that process. We have a lot of programs
that cater to taking care of the soldier that is injured…. But the child is often neglected in the
process. How do you attend to a child who is also dealing with the healing process of their parent?”
Respondents also indicated a need to build parents’ awareness of how stressful family circumstances
could affect their young children’s health and well-being. For example, one individual said, “Too
many times we hear, ‘Oh, they’re little, it doesn’t matter, you know. I can take them to, you know,
if they witness a spousal abuse type situation, it doesn’t matter, because they’re little, they won’t
remember.’ And so helping them to understand the impact of their emotions, their depression or
their anxiety or their anger on their baby and toddler’s development is critical.”

Access to services currently available for veterans and their families: The Chicago area provides
many different programs and support services for military families, including child development
education for parents and caregivers. Other services include early care and education, mental

Serving Our Nation’s Heroes: An Examination of Referral Systems Available to Assist Military and Veteran Families with Young Children in Chicago   5
health care, and provision of informative webinars. The findings suggest that participants generally
    feel there is a significant amount of services available for families who need them. “And so what I also
    find in terms of gathering resources is that there are so many, [that] you can piece together for what
    a child might need…” However, access to these resources and services is limited due to the sheer
    volume of resources and a lack of clear organization for the resources. According to one respondent,
    “There’s just so many resources out there that we can’t keep up as providers.”

    Referral to services for veterans and their families who have young children, from birth to 3 years
    old: The focus group did not specifically outline any referral systems or address how veterans and
    their families are referred. However, one individual noted the importance of provider awareness
    and understanding of certain issues so that a referral to the proper professional could be made:
    “And I think that developing sort of more of a family sort of systems perspective to working with
    whomever one is working with, whether you’re working with the adult or the infant or the middle
    school child, is really important in terms of developing an appropriate referral service, because then
    it helps us think about who am I thinking about here and what kind of questions I need to ask, and
    then who’s a proper referral?” A major factor in determining an appropriate referral is including
    questions about military experience as part of the agency’s standard intake process. One agency
    representative stated that he and his colleagues had begun asking existing client families about
    their military service, and they were surprised to find out just how many were in fact veterans.

    Existing gaps in services for veterans and their families who have young children, from birth to
    3 years old: Overall, three themes emerged from this category. The first theme emerged from
    the concern that resources were not always getting to the families with the greatest need. For
    example, one participant noted that “those resources and the information just isn’t getting to
    those people that really need it, you know, the ones with the small kids.” Even though services
    are provided, people may not take advantage of those resources due to their circumstances,
    as indicated by one participant’s feedback that “…if you’ve got a spouse whose husband is
    deployed, and they’ve got four kids, it’s very hard for them even just to try to come together for a
    support group. So, most of the time the attendance is very low.”

    Another theme that emerged was families’ limited awareness of services available to them. For
    example, one individual noted “Well, I think part of the problem, too, is the Service members
    don’t relay that information to their spouses at home. I know there are a lot of resources out there,
    and we’ll have the spouse at home say, ‘I never knew,’ and the issue has already happened at that
    point. The child has already been acting out or already been traumatized and hasn’t had any help.”
    Participants identified challenges in promoting integration of services for families.

    The third theme that focus group participants identified was a need for more respite services
    across family situations and circumstances. The need for respite care in the context of crisis
    and family preservation was specifically addressed. As one person indicated, “I think one of the
    partners that probably needs to be at the table would be Protective Services, because when you

6   Serving Our Nation’s Heroes: An Examination of Referral Systems Available to Assist Military and Veteran Families with Young Children in Chicago
“...the infants and
mentioned the respite, I wondered, how do military families fit into
                                                                                                     toddlers don’t
family preservation? Do those programs serve military families?” The                                 have a voice, and I
participant noted that many services, including respite care, would be                               think it is up to all of
available to families active with child protective services, and that family
preservation programs could be a significant resource for military and
                                                                                                     us to figure out not
veteran families with young children.                                                                only giving them
                                                                                                     attention but how to
Gaps in services for the young children, from birth to 3 years old, of OIF/
OEF veterans and their families: Lack of services for children with special                          formally integrate
needs emerged as a core theme within the study. Respondents indicated                                them into family
that supporting a young child with special needs may be complicated by
the stressors associated with the military lifestyle, as well as postservice
                                                                                                     support programs
transition. According to one focus group member, “…it’s a Navy family                                and other programs.”
who’s been told you no longer get to be in the Navy, and here’s your 6
months’ notice of that. And they have, two of their three children [with]
autism. And so they are now reaching out looking for help from the
community but from talking to the family, they should have been, they needed help a long time
ago.” Another participant noted: “Well, I think working with families that have young children with a
disability and more specifically with autism, I think that there’s just not enough support or resources
out there for the military, the veterans …if you have a spouse that’s deployed and that, you know,
the mother is home, we’re seeing about three or four families within our schools that are faced with
that. So we’re trying to give them as much support that we can with raising a child with autism.”

The focus group noted that the youngest child seems to be especially vulnerable, with few
programs specific to their unique needs. For example, one member noted that “When we focus on
camp programs, the infants and toddlers don’t get the attention…the infants and toddlers don’t
have a voice, and I think it is up to all of us to figure out not only giving them attention but how to
formally integrate them into family support programs and other programs.” It was also noted that
there is no emergency respite care program in Chicago. Respite care may be especially important
for veterans in crisis.

How these gaps in services can be addressed: In terms of suggestions on how these gaps in services
can be addressed, several members of the focus group suggested that the community resources
be consolidated into one information and resource service, such as a webpage. “Well, I like the
consolidated either website or some sort of a resource, single resource, page out there that they
could go to that lists all the services that are available instead of having to search the Internet.
… I just recently found out about your program helping the youth with special needs through
the Military OneSource program.” However, having a website listing programs may have its own
challenges, including determining criteria for listing the program, the quality of the program, and
the agency responsible for maintaining the website information. It was noted that veterans and
their families do not have a service such as Military OneSource available to assist them in finding

Serving Our Nation’s Heroes: An Examination of Referral Systems Available to Assist Military and Veteran Families with Young Children in Chicago   7
“One of the things
    appropriate services within the community or within the Veterans                                 that’s come up for us,
    Administration. Military OneSource is a free information, referral, and                          in terms of thinking
    counseling program provided by the Department of Defense for active
    duty and reserve military Service members and their families.
                                                                                                     about being military
                                                                                                     friendly and under-
    Providers discussed the need to build stronger professional                                      standing military
    communities and networks. For example, one person noted that, “We
    need to, kind of as a community, figure out how could we organize
                                                                                                     culture, it’s not just
    that better to give them resources that are trusted, that, you know,                             understanding sort of
    are, that they can feel comfortable referring their families to….”
                                                                                                     who they are and who
    Finally, participants discussed the need to promote cross-cultural                               might be coming but
    understanding of community systems and resources, noting the                                     how does that then
    following examples: “One of the things that’s come up for us, in terms
    of thinking about being military friendly and understanding military
                                                                                                     change our practices
    culture, it’s not just understanding sort of who they are and who                                and our understanding
    might be coming but how does that then change our practices and                                  of ourselves?”
    our understanding of ourselves?” And “What are their beliefs about
    civilians, what don’t we get, what do we need to change, including our
    language, so they will want to work with us to resolve their issues.” Participants discussed the need to
    do a better job preparing military families for accessing services within the civilian community. How
    do they find needed services? How do they know they are veteran friendly? Do they understand
    fee structure, meeting the criteria for need-based services, and coordinating care delivered through
    multiple agencies? Many come from installations where all of the mental health services are free,
    and they are coordinated under one office such as family advocacy or medical services. Learning
    to navigate programs and services within the civilian community may be daunting as veterans also
    cope with the many transition issues of leaving the military community. One participant observed: “I
    also think one of the parts that we have a little more trouble with is how do we educate and provide
    training for our military and veteran partners about us or about our system, I mean, just some of the
    basic cultural differences about our civilian social service system….”

    Risk Factors: The participants discussed the situational risk factors associated with Service
    members leaving the military and returning to civilian communities. These included the following:

      • Financial difficulty and high unemployment or under employment
      • Domestic violence
      • Divorce
      • Substance abuse
      • F amily distress and parental unavailability in association with the Service member’s physical
         and/or psychological injury.

8   Serving Our Nation’s Heroes: An Examination of Referral Systems Available to Assist Military and Veteran Families with Young Children in Chicago
Suggestions for Action

The participants in the stakeholder’s meeting identified strategies for addressing the needs of
veteran and military families with young children:
     1.	Define “Military Friendly”: It is easy for an agency program to call itself military friendly.
         What does that really mean? The community needs to develop criteria and standards
         for designating a program as military or veteran friendly. Military and civilian agencies
         assisting Service members with the transition from active duty back into the civilian
         community need to have access to a master listing of military- and veteran-friendly
         programs that have been vetted. Establishing military- and veteran-friendly criteria
         will also help to prevent veterans from being harmed by unscrupulous businesses.
         Agencies need to start by asking “Are you military connected? Have you experienced
         a combat deployment?” Statistics need to be kept so agencies can better understand
         this population and their needs. Additional suggestions were made regarding the
         development of a certificate that would document an organization’s basic level of
         understanding of the military and veteran culture, their knowledge of the resources
         available to assist through the Veterans Administration and other veteran benefits
         programs, and the quality of their services.

      2.	Build community capacity through awareness campaigns and training on military
          culture, trauma informed interventions, and veteran benefits. Provide training that
          specifically addresses the needs of early care and education professionals serving
          veterans and their young children. These efforts need to include all programs that touch
          the lives of families with young children. Materials that provide tips and strategies to
          address the needs of veteran families and their infants and toddlers should be developed
          and widely disseminated across programs and communities.

      3.	Develop resources and materials that serve as a road map for military families as
          they transition out of the military and begin accessing civilian-based services. The
          development of specialized resources to support veteran families’ access to early
          intervention programs and services as they transition out of active duty service was
          identified as a priority. Participants also suggested that a “Veteran OneSource” type
          information and referral service would be beneficial and could utilize criteria developed
          to determine agencies that are military friendly. Decisions would need to be made
          regarding who would host the portal, which services would be included, and how the
          quality of that service would be evaluated. The primary purpose of the system would be
          to assist military and veteran families in navigating the multiple agencies that provide
          services. Participants stressed that one may have only one opportunity to engage a
          veteran family in crisis; therefore, professionals must have the capacity to readily engage
          and build trusting relationships with families from the initial contact.

Serving Our Nation’s Heroes: An Examination of Referral Systems Available to Assist Military and Veteran Families with Young Children in Chicago   9
4.	Build coalitions to help raise awareness of the needs and optimize use of scarce resources.
               Currently, the Michael Reese Health Trust has funded Community Action Teams in
               northern Illinois, southern Illinois, and metropolitan Chicago. They are bringing together
               agencies by focusing on the needs of veterans in mental health, homelessness, and
               employment. There is another project to strengthen the Illinois Inter-Service Family
               Assistance Committee. These groups are working to build continuity while raising
               competence in working with both military and veterans. This may help to improve quality
               of available programs. A system of care could be developed across not only Chicago but
               all of Illinois. Although there is a rise in need, limited funding is available to address those
               needs. By incorporating a system of care, funding can be allocated efficiently.

           5.	Change policy: Different programs speak different languages yet have a common call for
               the preservation of vulnerable families. Military and veteran families are vulnerable and
               need to be defined and identified as such, and more services need to made available to
               this demographic across all states. Support for veteran families needs to be placed into the
               State Plan. Examples of these changes can be made available to county and community
               programs, encouraging the same policy change.

    Other potential steps that the focus group members mentioned included the creation of
    Veteran Treatment Courts. Veteran Treatment Courts are being established in cities across the
    country. These centers provide a coordinated response that involves the cooperation of the U.S.
    Department of Veterans Affairs, helping to connect veterans with benefits available to them
    through the Veterans Administration, as well as substance abuse and mental health agencies
    within the community in order to get vets needing mental health and substance abuse treatment
    out of jail and into therapeutic programs (U.S. Department of Veteran Affairs, 2012).

10 Serving Our Nation’s Heroes: An Examination of Referral Systems Available to Assist Military and Veteran Families with Young Children in Chicago
Conclusion
As Service members transition back into our communities as veterans, the visible and invisible
injuries, including PTSD or other combat-related stressors, may create relationship challenges
that have implications for the social–emotional development of their young children. Veterans
may be physically present but emotionally unavailable. They may find it difficult to rebuild
relationships with their children. In each instance, very young children are vulnerable to the
resulting stress and loss. Young children may exhibit increased aggression, fear, or clinginess.
They may be irritable or have difficulty sleeping. Young children may withdraw, fuss, or cling
more than usual while looking for reassurance. They may go back to old behaviors such
as thumb sucking or waking in the night. These responses put additional stress on already
burdened parents who may not recognize these “negative” behaviors as an infant’s or toddler’s
way of signaling distress. The smiles, games, laughter, and joy that typically reflect a healthy
parent–child relationship may fade as family dynamics become more challenging. It’s even
possible that situations may progress to the point where the parent is not able to take care of
their child’s basic needs (Gorman, Fitzgerald, & Blow, 2009).

Partly because very young children lack the ability to verbalize their emotional concerns, their
reactions to a painful event such as deployment or the loss of a parent are often overlooked or
minimized. Yet very young children are particularly susceptible to these losses because early
relationships with parents and caregivers lay the foundation for their future readiness for school
and life (Williams & Mulrooney, 2012). For babies and toddlers whose brains are literally being
wired cognitively and emotionally, these early relationships and experiences are critical for their
healthy development. It is imperative, therefore, that those individuals who care for very young
children have the knowledge, skills, resources, and tools to help nurture the relationships young
children have with the significant adults in their lives—whether at home or at war (Gorman et al.,
2009).

Chicago is already engaging in multiple efforts to promote the health and well-being of veteran
and military families. As noted by focus group members, there are many quality services
available in the immediate and surrounding areas. However, the results of this study indicate
there still is much to be done to create a supportive, systems-wide approach to supporting
veterans and their families within the city of Chicago. Continued work to build a collaborative
approach to meet the needs of our veteran community, to inform professionals of the unique
culture of military and veteran families, and to inform the transitioning Service member on
navigating civilian services and reviewing and revising policies to address the vulnerability of
young children from military families will serve to mitigate the potential long-term effects of the
chronic stress these families have experienced and promote intergenerational resilience.

Serving Our Nation’s Heroes: An Examination of Referral Systems Available to Assist Military and Veteran Families with Young Children in Chicago   11
References
    Gorman, L. A., Fitzgerald, H. E., & Blow, A. J. (2009). Parental           Westat. (2010). National survey of veterans, active duty Service
    combat injury and early child development: A conceptual                    Members, demobilized National Guard and Reserve members,
    model for differentiating effects of visible and invisible                 family members, and surviving spouses. Rockville, MD:
    injuries. Psychiatric Quarterly, 81, 1–21.                                 Author. Retrieved from http://www.va.gov/vetdata/docs/
                                                                               SurveysAndStudies/NVSSurveyFinalWeigh
    National Center for PTSD. (2012). Keeping veterans with PTSD               http://www.va.gov/SURVIVORS/docs/NVSSurveyFinalWeighted
    out of the justice system. Washington, DC: U.S. Department                 Report.pdf
    of Veteran Affairs. Retrieved July 24, 2012, from http://www.              Williams, D., & Mulrooney, K. (2012). Research and resilience:
    ptsd.va.gov/public/pages/keeping-PTSD-vets-out-JS.asp                      Creating a research agenda for supporting military families
                                                                               with young children. Zero to Three, 32(4), 46–56.
    Office of the Deputy Under Secretary of Defense (Military
    Community and Family Policy). (2010). 2010 demographic
    profile of the military community. Retrieved July 1, 2012,
    from http://www.militaryhomefront.dod.mil/12038/
    Project%20Documents/MilitaryHOMEFRONT/Reports/2010_
    Demographics_Report.pdf

    Taylor, P. (Ed.). (2011). The military-civilian gap: War and sacrifice
    in the post-9/11 era. Washington, DC: Pew Research Center,
    Social and Demographic Trends. Retrieved July 9, 2012, from
    http://www.pewsocialtrends.org/files/2011/10/veterans-
    report.pdf

12 Serving Our Nation’s Heroes: An Examination of Referral Systems Available to Assist Military and Veteran Families with Young Children in Chicago
Resources

Resources for                         Sesame Street Talk,                   to gather together during and         Tragedy Assistance Project
Children:                             Listen and Connect online             after deployment. Contact             for Survivors (TAPS) provides
                                      videos for children coping            Military Homefront at www.            resources including a hotline
Over There by Dorinda Silver          with parent deployment,               militaryhomefront.dod.mil for         for parents, kids camps,
Williams (published by ZERO           homecoming, changes                   your nearest installation-based       and peer support for those
TO THREE). There is a Mommy           and grief. Order from www.            Family Readiness Office. For          grieving the death of a loved
version and a Daddy version           miltaryonesource.com or from          the Joint Family Assistance           one in the Armed Forces. More
of this board book depending          www.sesameworkshop.org.               Programs and the Family               information is available at
on which parent is deployed.                                                Readiness programs in your            www.taps.org.
Turn this book into an activity       Referral Resources                    state, contact
that enables a young child to         for Parents:                          www.jointservicesupport.org.          Wounded Warrior Resource
connect with their deployed           Military OneSource at 800-                                                  Call Center (WWRCCC) pro-
parent by downloading the             342-9647 is available 24/7 to         Military Family Life                  vides Service members, their
version that allows you to add        connect Service members and           Consultant (MFLC) services            families, and primary caregivers
your own personal pictures,           their families with services and      are free for all military Service     a single point of contact for
either from photos or drawn.          information and provides a            men and women and their               assistance for obtaining health
Go to www.zerotothree.org             wide variety of information and       families. They provide private        care services for wounded war-
to download a copy, or go to          support such as free guides,          and confidential support              riors. Contact the center at 800-
www.militaryonesource.com             resources, referrals for services,    services including individual,        342-9647 or at www.wounded-
to purchase a hard copy.              and telephone counseling. Free        marital, and family issues (with      warriorresourcecenter.
                                      materials, books, resources,          the exception of mandatory
Home Again by Dorinda Silver                                                state, federal, and military          Department of Veterans
                                      and online counseling are
Williams and published by                                                   reporting requirements                Affairs assists veterans and
                                      available at no cost. Visit www.
ZERO TO THREE. This book                                                    in situations of domestic             their dependents and survivors
                                      militaryonesource.com to learn
illustrates the many different                                              violence, child abuse, and duty       in obtaining the benefits they
                                      more. Each state also has a
responses young children may                                                to warn situations).                  are entitled to under the laws
                                      Military OneSource consultant
have to a parent’s return from                                                 • Contact your state’s Joint       of the United States. Contact
                                      who is able to give briefings
deployment. Order from                                                      Family Assistance Center for          your state’s veteran affairs
                                      and answer questions specific
www.militaryonesource.com.                                                  the MFLC nearest you, or the          office or www.va.gov for more
                                      to resources in that state.
Also available for purchase                                                 Joint Service Support website,        information.
                                      Call your state’s Joint Family
from ZERO TO THREE Press at           Support Assistance Program to         www.jointservicesupport.org.
www.zerotothree.org.                  reach this representative (see
                                                                                                                  ZERO TO THREE
I’m Here For You Now by               below).                               Survivor Outreach Services            Resources to Share
Janice Im, Claire Lerner,                                                   delivers on the Army’s                With Parents
Rebecca Parlakian, and Linda          Family Readiness and                  commitment to the families
                                                                                                                  The following materials are
Eggbeer, published by ZERO            Family Assistance Centers             of the fallen. They provide
                                                                                                                  available for free. View or
TO THREE Press. This book             offer military families               information, referral, and
                                                                                                                  download them from
comforts young children               information and referral              supportive services to
                                                                                                                  www.zerotothree.org.
experiencing stress and               services. The staff assist            Army Active Duty, National
allows pictures of the child’s                                              Guard, and Army Reserve
caregivers to be inserted to
                                      families who are in need to
                                                                            families who have lost a
                                                                                                                     • Young Children on the
                                      discover the best resources                                                 Homefront: Family Stories,
personalize the story for each        available, whether it is              loved one. Contact www.
                                                                                                                  Family Strengths—Video:
child. Order from                     financial assistance, special         myarmyoncesource.com to
                                                                                                                  In this video, military
www.militaryonesource.com.            classes, counseling referrals,        learn more.
                                                                                                                  families share their unique
Also available for purchase           or general information, and           The Focus Project offers              deployment experiences, and
from ZERO TO THREE Press at           provide information and               resiliency training, guides,          early childhood professionals
www.zerotothree.org.                  referral support. They also           and tools for military parents.       offer tips and strategies for
                                      provide activities for families       www.focusproject.org                  families.

Serving Our Nation’s Heroes: An Examination of Referral Systems Available to Assist Military and Veteran Families with Young Children in Chicago   13
• Coming Together Around              n Supporting Your Child           Hope and Healing: A                   National Child Traumatic
    Military Families—Flyers:                While a Parent is Deployed        Caregiver’s Guide to Helping          Stress Network provides
    Download parent flyers that              n Tips for Helping a Child        Children Affected by Trauma           resources for professionals
    emphasize the importance                 After Deployment                  by K. F. Rice and B. M. Groves        as well as information to
    of supporting babies and                 n Helping your Child Deal         (2005; published by ZERO              share with parents. They
    toddlers during deployment               With Relocation                   TO THREE). Developed as a             have a special emphasis
    and relocation. Flyers include           n The Importance of Caring        guide for early childhood             available for professionals
    the topics:                              for Yourself During Periods of    professionals who care for            working with military families.
      n Staying Connected: “We              Military-Related Stress           children in a variety of early        Visit their website to learn
         can be together while apart.”                                         care settings.                        about webinars, as well as
      n Relocation: “Moving?                • Little Listeners —This                                                to download resources to
          Doesn’t my vote count?”         brochure provides useful             Duty to Care: You Make a              further your understanding
      n Reunification: “More changes?    reminders about typical              Difference. This free, one-           of the effect trauma and
         Are you kidding me?”             behaviors in young children          hour training is available            stress might have on young
      n Self-Care: “Why don’t you        during stressful times. It           at www.zerotothree.org/               children. http://www.nctsn.
          baby yourself?”                 offers concrete guidance with        youmakeadifference. ZERO TO           org/resources/topics/military-
      n Stress: “You think you’re        suggested activities to provide      THREE, through the support            children-and-families
          stressed?”                      support throughout these             of the McCormick Foundation,
      n Nurturing: “Thanks, I            challenging events.                  has developed this e-learning
          needed that.”                                                        curriculum for early care
      n Routines: “Don’t even talk       Resources for                        providers to better understand
          to me until I’ve had my         Professionals:                       the unique needs of military
          morning milk!”                                                       and veteran families with very
                                          Honoring Our Babies and              young children.
       • Supporting Young                 Toddlers: Supporting Young
    Children Brochures:                   Children Affected by a               National Center for PTSD.
    Professionals can download            Military Parent’s Deployment,        This organization provides
    six brochures designed to help        Injury, or Death by A. Dombro        information for families and
    support babies and toddlers           (2009; published by ZERO             professionals on posttraumatic
    in today’s military families          TO THREE). Developed for             stress disorder along with
    focused on Deployment,                professionals to use to explore      downloadable guides for
    Homefront (self-care), New            the issues of stress, trauma,        military families. www.ncptsd.
    Families, Combat Stress,              grief, and loss as it relates to     va.gov
    Homecoming, and an                    supporting young children
    Overview Guide to show                affected by a military parent’s      National Guard. The National
    professionals how to use these        deployment, injury, or death.        Guard’s website offers links to
    brochures.                            In addition to essential             resources and links for school
                                          information and resources, the       personnel and professionals
       • Coming Together                  voice and perspective of the         working with National Guard
    Around Military Families—             youngest children are shared         families. www.guardfamily.org
    Articles: This is an informative      throughout this booklet for
    collection of articles that           family members, caregivers,          National Resource Directory
    you can download and                  and professionals to reference       (NRD) is a searchable website
    print, or even publish in an          and utilize in their support of      for wounded, ill, and injured
    organization’s newsletter.            babies and toddlers. Available       Service members, veterans,
    Titles include:                       as a free download from www.         their families and those
       n Helping Your Child Prepare       zerotothree.org/military.            who support them. www.
       for a Parent’s Deployment                                               nationalresourcedirectory.org

14 Serving Our Nation’s Heroes: An Examination of Referral Systems Available to Assist Military and Veteran Families with Young Children in Chicago
Published by:

    ZERO TO THREE
    1255 23rd Street, NW
    Suite 350
    Washington, DC 20037
    Phone: 202-638-1144
    www.zerotothree.org/military

    Copyright©2012 ZERO TO THREE
    All rights reserved.
    Printed in the United States of America.

    Acknowledgments
    Primary Investigators:
    Julia Yeary, LCSW, ACSW
    Director of Training and Resources, Military Family Projects, ZERO TO THREE, Washington, DC

    Dorinda Silver Williams, LCSW-C, ACSW
    Director of Military Family Projects. ZERO TO THREE, Washington, DC

    Anastasia Kitsantas, PhD
    Associate Professor of Educational Psychology, College of Education and Human Development,
    George Mason University, Fairfax, Virginia

    Photo Credits: Kiwi Street Studios
    Design: Austin Metze Design

    This project was made possible by a generous grant from the Prince Charitable Trusts, Chicago, Illinois.

16 Serving Our Nation’s Heroes: An Examination of Referral Systems Available to Assist Military and Veteran Families with Young Children in Chicago
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