Following our discussion of the evidence-based movement, I would like to highlight the recent work of Future of Children contributor Col. Stephen Cozza (U.S. Army, retired) and the National Military Family Bereavement Study. In a recent interview, Cozza, who is a professor of psychiatry and associate director of the Center for the Study of Traumatic Stress at the Uniformed Services University of the Health Sciences, explained that the study aims to guide policy by creating a greater base of empirical data on how immediate family members are affected when a service member passes away.

In the interview, Cozza argued that basing policy on research is important for these families, whose needs vary based on relationship to the deceased, the type of death, geographic location, and other factors. By gathering data on these scenarios, Cozza hopes to better advise policy makers on how to help these families.

Even before the study began, Cozza established the importance of this research in his Future of Children article with Allison Holmes and Paula Rauch. A parent’s death in combat not only brings immediate grief, it can also mean that survivors lose their identity within the military community, especially if they have been living on base and need to leave. Additionally, sudden, violent deaths—such as suicides, accidents, and combat-related deaths—are more common among service members than in the general population, and such deaths have been shown to bring a greater risk of PTSD and other emotional issues for surviving loved ones.

Another Future of Children article suggested building communities of care for military families and pointed to a need for further research on how to best do so. In the article, communities of care are defined as complex systems that work across individual, parent/child, family, community, military, and national levels of organization to promote the health and development of military children and families. The authors highlighted the tensions that exist in creating these interdisciplinary care communities. When we attempt to create collaborative communities of care and run into conflicts between the training of clinicians and public health professionals, research evidence could create an objective common ground on which to base programs and policy. Cozza’s National Military Family Bereavement Study is an example of the evidence-based movement in action.

For more Future of Children articles on military families, see our Fall 2013 issue, Military Children and Families. For more on the evidence-based movement, check out this interview with Future of Children senior editor Ron Haskins.

One of the largest subcultures in America is also one of the least visible. Military children and families are everywhere–not just on or near installations. To illustrate, only a handful of counties across the continental United States had not sent Guard and Reserve members to Iraq or Afghanistan by 2011. Even though these families are everywhere, they often do not stand out. Military children do not wear uniforms. We need to develop a community-based model, to increase resilience and minimize health risks among military children.

In the Future of Children, Harold Kudler and Colonel Rebecca I. Porter (U.S. Army) explain that communities of care “extend the responsibility for developing [an] environment of respect and positive expectations from the clinic to the community.” With a shortage of mental health professionals, especially in rural areas, it is imperative to intervene at the community level. In order to make communities of care happen, the first step is identification–every clinical program should routinely ask everyone who enters its system, “Have you or has someone close to you served in the military?”, and all clinical staff should be taught about military culture and deployment mental health. A next step is to flag military family status in education, employment, and medical records so that it is not overlooked and tailored support can be offered across time. Also, health-care programs and insurance companies could offer incentives to providers to take military history as a way to improve health outcomes and perhaps reduce costs through better treatment. Additionally, clinical programs competent in working with military families should register their names and basic information in the National Resource Directory to help increase accessibility to community resources.

As Kudler and Porter note, perhaps “the secret of creating communities of care for military children is creating communities that care about military children.” To learn more see the Future of Children issue on Military Children and Families.

Given the sacrifices that military personnel make, children of military families deserve to have policies and support programs designed to fit their needs. Notable examples include subsidized childcare, deployment assistance, moving assistance, child development programs, and community awareness initiatives that train and support communities in their efforts to improve the lives of military infants and toddlers. Unfortunately, many current programs for military children were implemented quickly, at a time of pressing need; thus, few are based on scientific evidence of what works, and even fewer have been evaluated for their effectiveness.

In the newly released Military Children and Families issue of the Future of Children, an overarching theme is the need for better research about military families and the programs intended to help them. Despite the overall lack of evidence-based programs, there are important directions we can take to implement the principles of best practice to improve programming.

For example, Molly Clever and David R. Segal show that military families are diverse by factors such as age, race, ethnicity, and cultural background. Rather than compelling these families to fit into a fixed and rigidly structured set of programs, we should make support programs accessible to families of all backgrounds and at all stages of life. This is challenging, but programs designed for diverse non-military families have been well researched and evaluated, and this research should help in developing flexible and adaptive programs and policies.

We can also learn from the strengths of programs that appear to be working. Major Latosha Floyd and Deborah A. Phillips recount how the military’s child-care program went from a system in distress to a model for the nation, directly serving or subsidizing care for 200,000 children every day. They tell how the success of this program rests on four pillars–military certification, national accreditation, minimum standards in hiring, and a pay scale that reduces staff turnover.

As we learn from the strengths of good programs, and as we rigorously evaluate as many programs as we can, we will be able to better support military children and families by implementing the best services possible. For more information, see the Future of Children issue on Military Children and Families.