1 . Which branch of the military has the largest number of active-duty members?
| A) | | Army |
| B) | | Navy |
| C) | | Marines |
| D) | | Air Force |
MILITARY PERSONNEL: DEMOGRAPHIC OVERVIEW
According to the U.S. Department of Defense, there were 3.41
million military personnel as of 2024 [6]. The
Army has the largest number of active-duty members, followed by the Air Force, the Navy, and
the Marine Corps [6]. In 2024, California,
Virginia, Texas, and North Carolina were home to the greatest number of active-duty military
personnel [6]. Men make up the majority of
active-duty personnel at 82.1%, with women comprising the remaining 17.9%. Women are a growing
segment of users of Veterans Administration services [8]. The majority of the Military Force are White, with 32.5% classifying
themselves as belonging to a racial/ethnic minority group. Among activity-duty members, Black
Americans are the largest racial/ethnic minority group (17.7%); the smallest segment is Native
American Indians (1.0%) [6]. The total
Military consists of 81.7% enlisted members and 18.3% officers. More than 38% are 25 years of
age or younger [6].
2 . As of 2024, which of the following states was among those with the greatest number of active-duty military personnel?
| A) | | Georgia |
| B) | | California |
| C) | | Washington |
| D) | | South Carolina |
MILITARY PERSONNEL: DEMOGRAPHIC OVERVIEW
According to the U.S. Department of Defense, there were 3.41
million military personnel as of 2024 [6]. The
Army has the largest number of active-duty members, followed by the Air Force, the Navy, and
the Marine Corps [6]. In 2024, California,
Virginia, Texas, and North Carolina were home to the greatest number of active-duty military
personnel [6]. Men make up the majority of
active-duty personnel at 82.1%, with women comprising the remaining 17.9%. Women are a growing
segment of users of Veterans Administration services [8]. The majority of the Military Force are White, with 32.5% classifying
themselves as belonging to a racial/ethnic minority group. Among activity-duty members, Black
Americans are the largest racial/ethnic minority group (17.7%); the smallest segment is Native
American Indians (1.0%) [6]. The total
Military consists of 81.7% enlisted members and 18.3% officers. More than 38% are 25 years of
age or younger [6].
3 . Which of the following statements regarding the effects of frequent relocations on military families is TRUE?
| A) | | Military spouses' wages tend to be higher compared to their civilian counterparts. |
| B) | | Children express gratitude at getting to leave established relationships and routines. |
| C) | | Parents report that multiple relocations can help children learn important skills of adjusting. |
| D) | | Military spouses tend to have an easier time finding jobs because their experiences make them more desirable to employers. |
MILITARY CULTURE AND LIFESTYLE
It has been said that the military is an example of a social
institution that is "greedy," meaning that the military requires from its members a great
amount of commitment, loyalty, time, and energy, which ultimately affects other role
commitments [10]. In the military, these
expectations have largely been placed on men, though women are increasingly affected as well
[5]. Family members of military personnel
are expected to relocate frequently, and this uprooting necessitates spouses and children to
make transitions and adjustments to their lifestyles, to make new friends, and to develop new
social networks [10]. For example, it is
estimated that 20% of families in the United States relocate annually; however, approximately
33% of military families relocate each year [11]. It is estimated that children of active-duty parents will move more than 20 times over the
course of their childhood, three times more often than their civilian counterparts [7]. Inevitably, the frequency of relocations
brings about multiple levels of stress. In a focus group of military youths, military spouses,
and school personnel, the youths stated that they sometimes felt angry toward their parents
for having to move multiple times and expressed a feeling of loss for having to separate from
friends. Some wondered whether it was even worthwhile to invest in making new friends. Some
parents felt that multiple relocations could help children learn important skills of
adjusting, but indicated concern that it would affect the children's ability to make
commitments to relationships.
4 . Which of the following is a benefit of the military lifestyle?
| A) | | Camaraderie |
| B) | | Supportive family networks |
| C) | | Job security and retirement benefits |
| D) | | All of the above |
MILITARY CULTURE AND LIFESTYLE
Despite the negatives of a military lifestyle, there are many
positive benefits for families as well. There is a sense of belonging among families living on
base or post, and they rely on each other for support. Military service members experience a
sense of camaraderie, and their family members may also experience this sense of deep
rootedness and affiliation. There are also financial benefits, as military families have
access to medical care, job security, and other benefits, often extending into retirement
[10].
5 . Military culture may be described as
| A) | | open. |
| B) | | hierarchical. |
| C) | | undemanding. |
| D) | | female-dominated. |
MILITARY CULTURE AND LIFESTYLE
Military culture is also hierarchical and male-dominated.
Consequently, ideals of being tough, self-sufficient, and strong (i.e., "the masculine
warrior") are reinforced, with the belief that these norms will help to ensure that service
members are mission-prepared and will survive in difficult circumstances [16,17,61]. Emanating from this
norm is the belief that all problems can be solved given enough time and effort [103]. This belief, referred to as the "warrior
ethos," is based on the conviction that the mission is paramount and defeat should not be
accepted [104]. The common mottos "tough it
out" and "push through" conveying the importance of perseverance, stoicism, and overcoming
adversity [136]. Hypermasculine behaviors are
emphasized, which reinforces the warrior identity, and female military members are often
confronted with having to suppress their femininity [61,63]. This belief is
conveyed at the very start of recruits' training, during which they are taught that selfless
service is paramount [136]. Social learning
begins at training, and it encourages its members to adopt and adapt to the military
collective norms and rituals, fostering a strong sense of shared military identity and
cohesion [61]. However, the downside of this
type of promoted ideal is that experiences of psychological, social, and/or emotional distress
are viewed as signs of weakness; the military tends to reinforce the notion that a true
soldier (or airman, seaman, etc.) does not need assistance [13,16]. Therefore, obtaining
formal help further places them at risk for stigmatization [16]. As a result, many rely on the peer support of other military service
members rather than professional help [18].
This mutual support has its benefits, but it only goes so far.
6 . Which of the following is NOT a phase in the cycle of deployment?
| A) | | Acceptance |
| B) | | Deployment |
| C) | | Sustainment |
| D) | | Reintegration |
The cycle of deployment and the associated transitions made by military personnel and their family members are significant. This cycle consists of five different phases: pre-deployment, deployment, sustainment, redeployment, and post-deployment or reintegration. In each of these phases, military personnel, spouses, children, and other family members experience a range of challenges and adjustments [21].
7 . The loss associated with deployment is ongoing and psychological. This is referred to as
| A) | | traumatic grief. |
| B) | | ambiguous loss. |
| C) | | complicated grief. |
| D) | | disenfranchised loss. |
It is the separation phase, and for some families, the holding pattern of the pre-deployment phase is so stressful that the actual deployment is viewed as a temporary relief of the anticipation of separation [21]. This loss associated with deployment is referred to as "ambiguous loss," meaning it is not physical but psychological [23]. Unlike death, a permanent physical loss, the family of the military personnel experiences ongoing psychological loss, and this uncertainty can lead to difficulties in decision making and planning for the future [22]. Within this context, spouses may experience negative mental health symptoms. In one study, spouses of deployed service members experienced higher levels of anxiety, depression, sleep disorders, and adjustment disorders compared with those without deployed spouses [24]. In a qualitative study about the stressors impacting military families during the Desert Storm deployment in the early 1990s, researchers found that families experienced three types of stressors: emotional (e.g., missing the deployed family member, feeling anxious about his/her safety), the day-to-day practicalities of life (e.g., budgets, powers of attorney, child care), and general life events [25]. The major stressors the families identified were loneliness, financial concerns, and childcare and disciplining. Findings from the Millennium Cohort Family Study showed that military spouses get their support from primarily family and friends during deployment [125]. However, not all families had social support networks readily available, as family, friends, and/or other extended family members were often not living nearby [25]. Couples may experience marital distress, divorce, and decreased marital satisfaction. Lack of communication also becomes challenging [155]. With modern video communication options (e.g., Skype), family members can see and speak in real time with the deployed family member. These opportunities may mitigate anxiety and loneliness, but witnessing realities of combat (e.g., hearing explosions or seeing injuries) may be traumatic, especially for children [105].
8 . The phase during which family members are notified that the deployed individual will be returning home is the
| A) | | sustainment phase. |
| B) | | reintegration phase. |
| C) | | redeployment phase. |
| D) | | post-deployment phase. |
The redeployment phase, also called the reunion phase, involves notification that the deployed family member is returning home. Both the deployed individual and the family members prepare themselves for the homecoming, and there is a tremendous amount of anticipation [26,27]. As with any potential change in the family system, there may be some anxiety about how the returning family member will affect the routines that have been established and the power and role dynamics and relationships [26,27]. During this time, family members are often attempting to prepare for the homecoming to ensure that everything is as perfect as possible [28]. Children may be asked to help in order to prepare.
9 . The rate of relationship and family problems is highest during what phase of the deployment cycle?
| A) | | Deployment |
| B) | | Redeployment |
| C) | | Pre-deployment |
| D) | | Post-deployment |
Some military families will encounter challenges during the post-deployment phase, including substance abuse, post-traumatic stress, and domestic violence. In fact, it is estimated that the rate of relationship and family problems is four times higher during this phase than the other phases [29]. In a study involving 19,227 active U.S. soldiers from brigade combat teams who served in Iraq or Afghanistan between 2003 and 2009, problems of marital quality were reported and separation/divorce intentions increased during the reintegration period [51].
10 . What theoretical framework is based on the core assumption that alignment between individuals and the environment in which they operate is necessary?
| A) | | Ecologic theory |
| B) | | Resilience theory |
| C) | | Family systems theory |
| D) | | Strengths-based perspective |
Ecologic theory is based on the inter-relationships of the individual and his/her behaviors on four different levels: macrosystem, exosystem, microsystem, and ontologic [34]. The core assumption is that alignment between individuals and the environment in which they operate is necessary, as resources and support are derived from the environment [35,175].
11 . Which of the following is a category of resilience?
| A) | | Overcoming the odds |
| B) | | Sustained competence |
| C) | | Recovery from trauma |
| D) | | All of the above |
There are three categories of resilience [39]. The first is overcoming the odds, which encompasses positive outcomes despite adverse conditions. The second category is sustained competence, which involves being able to harness inner and outer resources to cope with adverse conditions. Finally, the third category is recovery from trauma, which comprises the capacity to move on, progress, and function in a healthy manner despite past and ongoing stressors.
12 . Military families tend to be resourceful, flexible, and adaptable due to the many transitions they have undergone.
There is a misconception that military spouses fall apart when their spouses are deployed. Some research indicates that spouses who are left behind take over family decision making, assume new roles, and seek assistance, ultimately demonstrating tremendous role flexibility [41]. Indeed, military families tend to be resourceful, flexible, and adaptable due to the many transitions they have undergone. Examples of resiliency in these families include an enhanced ability to make new friends, deftly transitioning from dual-parent to single-parent households and back, and adjusting to diversity [39].
13 . What is a core assumption of the strengths-based perspective?
| A) | | Positive outcomes occur despite adverse conditions. |
| B) | | The sociocultural context of the military affects families. |
| C) | | Humans have the strengths and resources necessary to change the circumstances of their lives. |
| D) | | Within all family structures, there are boundaries that determine who belongs in which subsystem. |
The strengths-based perspective was developed in the 1980s in order to move away from traditional theoretical models in mental health care that emphasized deficits and pathology [42]. It is now applied in many areas of mental and behavioral health. The core assumptions of the strengths-based perspective are that humans have the strengths and resources necessary to change the circumstances of their lives, and in doing so, they can learn and grow [42]. Strengths include a client's innate abilities and skills as well as external resources in the community and family. After the problem is identified, the goal is to move away from focusing on naming the problem or deficit and to move toward identifying possible solutions [43]. The strengths-based perspective encompasses honoring the past and acknowledging the gifts of varied life experiences [111]. In the case of working with families with a deployed member, the practitioner will not necessarily focus on asking one family member why he or she is depressed. Instead, the practitioner will spend time and effort with the client identifying the strengths within the individual, the family, and the community that can be garnered to help support the family members during deployment. Military families, like any family, experience challenges and strengths, and the strengths-based perspective is beneficial in working through issues unique to these families' circumstances [44]. For example, a family can focus on the benefits that result from the numerous relocations (e.g., new skills, adaptability) [103]. Families that value the social connectedness of living on a military base are more likely to adjust to family stressors [144].
14 . Families who have experienced multiple deployments may have developed coping mechanisms and family rituals to handle the family member's departure.
The types of stressors that military families experience vary tremendously depending upon numerous factors; therefore, it is important to keep in mind that there is no one homogenous military family system. Families who have experienced multiple deployments may have developed coping mechanisms and family rituals to handle the family member's departure. Living on or off a military base can also affect the types of stress family members experience. For example, if a family is surrounded by others with deployed members, there may be a shared understanding of deployment and necessary adjustments. Living in a non-military community may translate to less understanding of the emotional strains that a military family member is going through and greater levels of isolation [29]. Young, recently married military families may experience the greatest amount of stress because they are less financially stable [13]. Young enlistees are usually a lower hierarchical rung of the military, with low pay, and the economic stress can be great for family members who are left behind. Some may require government assistance, which can negatively impact self-esteem [13]. Ultimately, how military-related stress was personally experienced mattered more for family well-being than objective measures of stress [176].
15 . Which of the following is NOT a barrier to communication between deployed military personnel and their spouses?
| A) | | Excessive lying |
| B) | | Security restrictions |
| C) | | Inability to convey intent with nonverbal gestures |
| D) | | Technical challenges related to unreliable communication |
In research involving deployed military personnel and their communication with their spouses, barriers to communication included security restrictions, technical challenges related to unreliable communication, and translation issues [145]. Using a large-scale dataset from the Millennium Cohort Family Study with a sample of 1,558 military service members and their spouses, stressful communication during the deployment stage affected both spouses' perceptions of stress at the reintegration or reunion stage [145]. Because family members are so far removed from the realities of a war zone, it can be difficult for military personnel to satisfactorily express their experiences and feelings. The problems with translation stemmed from being unable to convey intent with nonverbal gestures, facial expressions, and tone of voice can lead to "mistranslated" information [49].
16 . Which of the following factors contributes to higher stress among spouses at home than deployed spouses?
| A) | | Lack of information |
| B) | | Free communication |
| C) | | Excessive childcare help |
| D) | | Military training preparing spouses for long separations |
In a study of 300 married couples in which the deployed husband was active duty in the Army and the wife was a civilian, stress existed for both partners [52]. However, it was higher overall for the wives, despite the fact that the husbands experienced more physical threat. The researchers speculate that there may be several reasons for this trend. First, the husbands' military training may help them to better deal with the stressors or perhaps make them more reluctant to admit to stress. The lack of information given to the wives was found to increase their stress levels [52]. It is not surprising then that a study examining outpatient medical visits of wives of active-duty Army personnel during a three-year period found that 36.6% had at least one mental health diagnosis, compared with 30.5% of wives whose husbands were not deployed [24]. The most common diagnoses included depression, anxiety, sleep disorders, and acute stress and adjustment disorders [24]. Prolonged periods of deployment were associated with higher risks of mental health diagnoses and greater frequency of medical outpatient visits [24].
17 . In a study of wives of active-duty Army personnel, all of the following were common psychiatric diagnoses, EXCEPT:
| A) | | Anxiety |
| B) | | Depression |
| C) | | Sleep disorders |
| D) | | Antisocial personality disorder |
In a study of 300 married couples in which the deployed husband was active duty in the Army and the wife was a civilian, stress existed for both partners [52]. However, it was higher overall for the wives, despite the fact that the husbands experienced more physical threat. The researchers speculate that there may be several reasons for this trend. First, the husbands' military training may help them to better deal with the stressors or perhaps make them more reluctant to admit to stress. The lack of information given to the wives was found to increase their stress levels [52]. It is not surprising then that a study examining outpatient medical visits of wives of active-duty Army personnel during a three-year period found that 36.6% had at least one mental health diagnosis, compared with 30.5% of wives whose husbands were not deployed [24]. The most common diagnoses included depression, anxiety, sleep disorders, and acute stress and adjustment disorders [24]. Prolonged periods of deployment were associated with higher risks of mental health diagnoses and greater frequency of medical outpatient visits [24].
18 . All military marriages are burdened with stress and marital discord due to deployment.
It is interesting to note that anxieties and fears about deployment can also bring couples closer. Some military wives indicated that the fear of possibly losing their spouse increased the level of communication and intimacy in the marital dyad. The deployed husbands expressed similar sentiments, reporting valuing their wives and marriages more [48]. Consequently, it is crucial not to generalize all military marriages as burdened with stress and marital discord due to deployment. For example, older spouses, those who are married to military personnel in higher ranks, and spouses with more military experience tend to experience fewer challenges [53]. Protective factors that can mitigate marital stress and instability include couples' communication and their involvement with and access to formal and informal support and resources [146].
19 . Which of the following statements regarding the impact of parental deployment on children is TRUE?
| A) | | Parental deployment may negatively impact a child's need for security. |
| B) | | Boys tend to have more difficulties during the reintegration phase than girls. |
| C) | | The most consistent predictor of how well a child will adjust to a parent's deployment is the length of the deployment. |
| D) | | It is the length of the current deployment, not the cumulative length of all separations, that correlates with psychological challenges for the child. |
Attachment theory may provide a helpful theoretical framework in understanding the potential effects of parental deployment on children. Attachment theory is based on the belief that children have a need to attach themselves to a key figure, such as a parent, and separation results in displays of emotional distress. The parental bond is crucial to developing healthy emotional relationships when the child moves to adulthood; childhood separation is linked to depression, anxiety, aggressive behaviors, and other emotional and psychological problems throughout life [54]. Based on attachment theory, lack of secure relationships with peers, teachers, and/or other authority figures could also have adverse consequences. It is estimated that, on average, military children attend six to nine different schools by the end of high school.
20 . According to data from the Family Advocacy Program, what is the most common type of intimate partner violence in military families?
| A) | | Neglect |
| B) | | Physical abuse |
| C) | | Financial abuse |
| D) | | Emotional abuse |
OTHER KEY SOCIAL PROBLEMS
A meta-analysis assessing 69,808 military participants found that the pooled prevalence rate for physical intimate violence was 21% among men and 13.6% for women [153]. In another study, most of the physical and verbal violence reported was mutual, and more research is needed to evaluate the extent to which mutual violence is occurring [154]. In 2023, the spouse abuse victim rate per 1,000 military couples was 8.3. In this same year, the Family Advocacy Program received nearly 11,789 reports of spouse abuse. This corresponds to almost 20 reports for every 1,000 married military couples. This represented a modest decline (6%) from the 2022 reporting rate. Slightly more than 6,200 cases of spouse abuse (10.5 confirmed incidents for every 1,000 military couples) met the criteria for confirmation by the Family Advocacy Program. Importantly, the 2023 rate was lower than the average rate observed over the past 10 years, indicating a meaningful downward trend. The most common type of abuse, reported by 66% of victims, was physical abuse, followed by emotional abuse [186].
21 . What proportion of active-duty military women report ever having experienced physical and/or sexual abuse by an intimate partner?
OTHER KEY SOCIAL PROBLEMS
Female veterans appear to be at increased risk of physical and sexual violence from their intimate partners (33%) compared with nonveteran counterparts (23.8%) [66]. Female veterans who experienced previous childhood sexual abuse are three times more likely to be victims of spousal abuse, and those who experienced an unwanted incidence of sexual victimization during military service were more likely to have experienced interpersonal violence in the last year. Being in the Army (versus other military branches) is also a risk factor for past-year victimization [131]. In a study examining directionality of abuse, a sample of 248 women enlisted in the Army and married to civilian spouses were assessed for domestic violence [64]. Researchers found that the enlisted women were four times more likely to be victimized by minor violence and three times more likely to be victims of severe violence than to be perpetrators. A disconcerting 60% of all types of violence reported was bi-directional (i.e., both parties were inflicting the violence) and severe [64]. These couples tended to be younger and more recently married. Furthermore, if an enlisted woman's spouse was employed less than full-time, bi-directional violence was more common compared to families with full-time employed civilian spouses.
22 . Child neglect is much lower in the military population than the civilian population.
OTHER KEY SOCIAL PROBLEMS
It is unclear if child abuse rates differ among military and non-military families. A study using the National Child Abuse and Neglect Data System examined all cases of child maltreatment in Texas between 2000 and 2002 [69]. Researchers found that the rate of child maltreatment in military families was 5.05 for every 1,000 children, while in civilian families the rate was 7.89 for every 1,000 children. The higher rates in the civilian population were attributed primarily to greater financial difficulties (18.7%) and use of public assistance (28.2%) compared with their military counterparts (5.2% and 8.9%, respectively) [69]. Data from the Department of Defense and the Children's Bureau indicate that instances of child physical abuse are only slightly higher (19.7%) in the military population compared with the civilian population (18.3%) [156]. Child neglect is much lower in the military population (57.4%) than the civilian population (74.9%), but infants in dual military families are 2.5 times more likely to experience abusive head trauma [156]. Data from the Millennium Cohort Study indicate that military infants born prematurely were twice as likely to experience child maltreatment before their second birthday than those born in civilian families [157]. In a study of records from four Army installation bases, lack of supervision (35.3%) was the most common form of child neglect/abuse, followed by emotional neglect (31.8%) [120]. Instances of child abuse/neglect were most likely in young enlisted families [120].
23 . This lower rate of illicit substance use among military servicemen and women is due in part to the military's random testing procedures and zero-tolerance policies.
OTHER KEY SOCIAL PROBLEMS
Among all military service members, the overall prevalence rate for heavy alcohol use in the past 12 months is 5.4% [73]. A Department of Defense report indicates that the heaviest rates of drinking were among Marines (12.4%), followed by the Navy (6%), Army (4.1%), Coast Guard (3.5%), and Air Force (2.7%) [73]. When comparing illicit substance use among civilian and military populations, civilian past-year usage is higher (16.6%) compared with military servicemen and women (0.7%). This lower rate of illicit substance use is due in part to the military's random testing procedures and zero-tolerance policies [73]. According to the Department of Defense, in 2021, there were 100,000 deaths related to opioid misuse, an increase of 15% compared with 2020 [158]. There has been some speculation that veterans and service members with PTSD may be self-medicating with opioids [158]. Military spouses are also affected by the opioid crisis. In one study, 48% of military spouses had employed their health insurance to fill at least one opioid prescription in the Military Health System during a two-year time period [159]. During this same time, 7% met the criteria for high-risk opioid prescriptions. Adverse childhood experiences, social isolation, and experiencing physical pain were predictors of high-risk opioid prescriptions.
24 . Servicemen and women returning from deployment have a lower prevalence rate of new-onset drinking problems compared to nondeployed active-duty personnel.
OTHER KEY SOCIAL PROBLEMS
For military families, deployment and reintegration trigger additional stressors that can lead to substance and alcohol abuse. For example, servicemen and women returning from deployment have a higher prevalence rate of new-onset drinking problems compared to nondeployed active-duty personnel [76]. In a study examining veterans returning from Iraq, 13.9% of the veterans were determined to have probable post-traumatic stress disorder (PTSD), 39% probable alcohol misuse, and 3% probable substance abuse [77]. Military members who have been in combat and who have PTSD are more likely use substances and alcohol to cope [78]. However, one study found that a clinical diagnosis of PTSD was a less important predictor of alcohol, substance, or aggressive behavioral problems than the presence of symptoms of a stress response [78]. In another study, the prevalence rate for alcohol use disorder among transgender service members was 8.6%; the rate for drug use disorders was 7.2%, and the rate of comorbid alcohol and drug use disorders was 3.1% [161]. Social and economic stressors, such as housing instability, family problems, and military sexual trauma, were more prevalent among this group. The authors recommended targeting social and economic risk factors in screening and interventions for this highly marginalized group.
25 . All military personnel returning from deployment are required to complete the
| A) | | Military Visual Assessment Tool. |
| B) | | Post-Deployment Health Assessment. |
| C) | | Post-Deployment Psychological Screener. |
| D) | | post-traumatic stress disorder diagnostic evaluation. |
Military personnel returning from deployment are required to complete the Post-Deployment Health Assessment (PDHA) [79]. This medical screener is composed of 10 mental health questions and is completed by a medical provider within 30 days of returning from military assignment [79]. It also requires certification by an authorized healthcare provider. In addition, the mental health departments in the Army and Navy use the Post-Deployment Psychological Screener, which consists of 22 questions assessing for symptoms for depression, PTSD, communication issues, interpersonal problems, alcohol abuse, and anger [79]. These screening tools were developed to standardize postdeployment mental health evaluations and improve identification of service members at risk for ongoing psychological difficulties. PTSD is commonly assessed due to the many distressing events that military personnel experience in combat. However, avoidance behaviors such as substance and alcohol abuse, withdrawing from others, and dissociating should be assessed as well [80].
26 . The goal with visual assessment tools is to have family members tell their stories about deployment individually and describe how it brought about concerns, stresses, and challenges.
Visual assessment tools can be helpful during the assessment phase. Deployment narrative maps, for example, can be used. The goal with these tools is to have family members tell their stories about deployment individually and describe how it brought about concerns, stresses, and challenges [82]. Any family challenges identified in the stories are graphically depicted on a timeline. After everyone completes their narrative, all family members are brought into a family session to review the deployment narrative maps and see how certain events triggered stress or reactions. Not only can narrative maps be used as an assessment tool but they can instigate greater communication and foster problem-solving strategies [82].
27 . Which of the following approaches may be used to regulate emotional responses?
| A) | | Yoga |
| B) | | Deep breathing |
| C) | | Physical exercise |
| D) | | All of the above |
Interventions to teach family members and military personnel how to regulate emotional responses, such as anger, frustration, and numbness, are vital. This includes skills such as deep breathing, yoga, meditation, exercise, and other deactivation activities that can decrease the intensity of stress reactions and even trauma [84]. When a deployed man or woman returns home, it is inevitable that things will have changed for the whole family. All family members will have to adapt to a "new normal" [84]. This "new normal" may mean adjusting to physical injuries and the new caregiving activities associated with new limitations. Practitioners may help the caregiving spouse engage in self-care and reduce stress [85]. During deployment, there is also a "new normal," however temporary, and the now single parent may benefit from concrete child-rearing and parenting strategies (e.g., specific scripts to use when feeling angry or tips for providing clear directions to children) [85]. Similarly, children may require assistance regulating their emotions and communicating their fears and anxieties when a parent deploys or returns home injured or traumatized [85].
28 . Home visiting interventions have become more popular for military families in part because they reduce the stigma of public help-seeking.
Home visiting interventions have become more popular for military families in part because they reduce the stigma of public help-seeking [126]. These interventions are implemented in the home and reflect a strengths-based perspective; many help family members handle deployment, address communication challenges, cope with isolation and loneliness, and connect family members to support and resources [126].
29 . One of the main ethical dilemmas for practitioners employed by the military is the issue of dual relationships.
One of the main ethical dilemmas for practitioners employed by the military is the issue of dual relationships. Practitioners working with military families often have multiple roles, which can cause ethical tension [128]. They may be the only provider in a small unit or work closely in a unit in which colleagues may also be patients and part of the same chain of command. These situations can limit access to peer support and increase pressure on the provider. As a result, professional boundaries may become less clear, and ethical challenges related to the provider-patient relationship may be intensified [202]. A counselor has a goal of building rapport and conveying empathy, but this can be difficult if the counselor outranks the client. Alternatively, counselors are expected to act in the role of expert, but this can be difficult if he or she is subordinate to the client [128]. Furthermore, practitioners who reside and work on military bases may frequently encounter their military clients and family members, which challenges personal and professional boundaries [171].
30 . What is vicarious trauma?
| A) | | A gradual lessening of compassion over time |
| B) | | Traumatic physical injury experienced by bystanders |
| C) | | The natural, consequent behaviors and emotions resulting from knowledge of a traumatizing event |
| D) | | Extreme stress experienced by practitioners that depletes emotional, mental, physical, and psychological resources |
Burnout refers to extreme stress experienced by practitioners that depletes emotional, mental, physical, and psychological resources [96]. Signs of burnout include depression, physical and mental exhaustion, anger, cynicism, acting out, frustration, lack of productivity at work, and difficulty controlling feelings [97]. A practitioner experiencing burnout often feels drained or tired and at times emotionally detached from clients [96]. Vicarious trauma is defined as "the natural, consequent behaviors and emotions resulting from knowledge about a traumatizing event experienced by a significant other. It is the stress resulting from helping or wanting to help a traumatized or suffering person" [98]. Vicarious trauma can affect practitioners' beliefs about the world, others, and self, including concepts of safety, trust, control, and intimacy [99]. Hearing stories of trauma, military missions, and killings, as well as family members' anxieties and fears, can affect practitioners' worldviews, their own sense of safety and control, and sense of self [100]. Some practitioners will help deal with a military member's death and family members' loss and grief, which can ultimately raise personal reactions to death [100].
