Center for the Study of Traumatic Stress
CSTS | Department of Psychiatry | Uniformed Services University | 4301 Jones Bridge Road, Bethesda, MD 20814-4799 | www.CSTSonline.org

Principles of Caring for Combat
Injured Families and their Children
Combat injury is a life-changing
medical treatment and rehabilitation
event that impacts a service member,over time. Often, adults do not
Injury to a parent is a major threat totheir children, and other family
know how to speak to children
children of all ages and a challenge for evenmembers and loved ones.
about the injury, or how much and
Military children are our nation’s
the most resilient of military families.
what kind of information to share.
children, and they represent a
As a result of parental combat
vulnerable population within theinjury, many family members may
injured family unit. Injury to a parent is a major threat
demonstrate initial distress that is likely to be temporary.
to children of all ages and a challenge for even the most
Most children will remain healthy in the face of this stress,
resilient of military families.
but some children may sustain life-changing trajectories
Parental injury disrupts the family system — its routines, in their emotional development and/or their interpersonalcohesion, and sense of safety. Importantly, parental injury
relationships. The use and study of the following principles
can alter the child’s view of the wounded parent, andof care for our combat injured families will foster evidenceundermine the child’s view of their own physical integrity.
based approaches that can support their healthy growth
Combat injury also affects existing patterns of parenting, asand recovery. These principles can be used by hospital
both injured and uninjured parents experience their own
and community-based professionals in military or civilian
emotional responses and face the complicated reality ofsettings.
■ Principles of psychological first aid (PFA) are central■ Injury communication is an essential component of

to supporting Injured Families. Care of injured service
members and families should incorporate key elementsof PFA: providing safety, comfort, information, practicalassistance, and connection to appropriate community
resources— all serving to support healthy family recovery.
■ Medical care for the combat injured must be family
focused. Care of combat injured service members must
attend to family needs and specifically should work
toward relieving family distress, sustaining parental
functioning, and fostering effective parent-childcommunication about the injury.
■■ Service providers should anticipate a range of
responses to combat injury. Serious injury will challenge
our healthiest families. Most service members and theirchildren and families will adjust to the injuries theysustain. However, others may struggle with the changes
that they face. Some may even develop problems that■
require treatment. Service providers should expect thisbroad range of responses and be prepared to meet familyneeds as they are identified.

injured family care. Effective injury communication
involves the timely, appropriate, and accurate sharing of
information with and among family members from themoment of notification of injury throughout treatment
and rehabilitation. Communication should be calibrated
to address patient and family anxiety and to sustain
hope. Because families may be uncertain how to sharedifficult information with their children, they may
benefit from professional guidance on what to say andhow to say it.
Injured Family programs must be developmentallysensitive and age appropriate. Services and programsmust address the unique developmental responses ofchildren of different ages and genders, and recognizethat distress, care needs, and communication ability willchange with children of different ages.
Injured Family care is longitudinal, extending
beyond immediate hospitalization. Services need tobe tailored to the changing needs of the combat injured
family throughout the treatment and rehabilitation
Continued

process. Interventions must meet the family where it isin the recovery process, recognizing a family’s uniquestrengths and challenges, as well as anticipate its futureneeds through transition to a new community or new
way-of-life.
■ Effective Injured Family care requires aninterconnected community of care. Effective
intervention requires collaboration and coordinationof services between the family, the health care system,
and military and civilian community resources. This
collaboration fosters a community of care that reaches
across traditional professional boundaries throughout
rehabilitation and recovery.
■ Care must be culturally competent. Healthcare andcommunity professionals who interact with combat
injured families need to possess the cultural andlanguage competence to engage families that may be
traditional or nontraditional in their composition andmay be of broad ethnic and religious backgrounds.
It is essential that all healthcare and community
service providers understand and respect the uniqueexperiences and traditions of military families.

■ Communities of care should address any barriers

to service. Barriers to intervention can complicate
the healthy recovery of combat injured service andfamily members. These barriers may include a family’s
difficulty in accessing health care or community
services. In addition, a community’s lack of awarenessor misunderstanding of the needs of a combat injured
family or a family’s reluctance to seek assistance (due tostigmatization) can also limit family intervention andrecovery■ Families, communities, and service providers must
be knowledgeable. Individuals, families, professionals,organizations and communities all have a need foraccess to quality educational materials to address thechallenges that confront combat injured families.
Effective education leads to the development of skills
in all parties, building empowerment in communities
and families. Development of new knowledge isfundamental to better meeting the needs of this uniquepopulation.

Center for the Study of Traumatic Stress
Department of Psychiatry
Uniformed Services University
4301 Jones Bridge Road, Bethesda, MD 20814-4799
www.CSTSonline.org