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Many service members struggle with mental-health problems when they return from combat. What is known about the effects on their spouses and children? The long-term implications of repeated combat deployments on the psychological health of family members are still being studied, but a growing body of evidence suggests that up to one-third of military children show clinically significant symptoms of anxiety, and that both military children and military spouses have higher rates of referral for inpatient and outpatient mental-health treatment. These long periods of separation in the context of danger are not something you see in a civilian population. For families, this means major milestones in which the parent is not there, and a much greater level of separation anxiety among the children. For spouses who stay home, there is a higher risk of depression, child neglect and maltreatment as they juggle double parenting duties while being worried and distracted about their loved one’s safety. And when the military parent returns coping with mental-health issues, it may be difficult to fully engage in family activities, and some of these behavior changes may be confusing to a child. What are the key components of the FOCUS program? We use an approach called indicated prevention — preparing families to better manage the stressful times before there is a clinical need. Over the course of eight weeks, families meet with FOCUS providers. The program starts with an assessment — a resilience “check-in” using Web- based technology to screen for issues known to affect military families — to help tailor the intervention. Through education, families become more aware of the potential impact of deployment on each of them, including the effects of child separation, post-traumatic stress and traumatic brain injury. Family members make a timeline of their experience, documenting their ups and downs in a way that allows them to build on strengths and address stress. They are then taught five resilience skills: emotional regulation, communication, problem solving, goal setting and traumatic-stress-reminder management — learning how to cope with triggers that recall separation, trauma or loss. Often, these families have never really discussed some of the difficult things they’ve been through. Learning honest and effective communication helps them to come together, address misunderstandings and have a clearer sense of their experience, which we know is an important feature of family resilience. FOCUS has been expanded to include customized versions specifically for couples, families with young children and in schools, and for veterans who have returned home to their communities. What is known about the efficacy of the program? We’re in the process of a long-term study of the effects of FOCUS on military families, but preliminary work has found improvements in family communication and functioning. Benefits have included reductions in anxiety and depression in the adults, as well as less emotional distress and fewer problem behaviors in the children and improvements in their peer relationships, pro-social skills and coping. How has FOCUS been received by the military branches? FOCUS has been very well received. We have expanded the program so that customized versions are now offered specifically for couples, families with young children and in schools. In addition, we have adapted the program for veterans who have returned home to their communities. We are working with UCLA Operation Mend and other partners to deliver FOCUS prevention services through a range of innovative platforms: video teleconferencing, mobile applications and Web-based delivery. “With feedback from military providers and family members, we adapted resiliency- promoting interventions our group had developed and tested for families facing other types of adversity, customizing FOCUS to the specific circumstances of military families.” For more information about FOCUS, go to: focusproject.org 7 UCLA Physicians Update