FO RU M O N H E A LT H AN D NATI O NAL SE CURI TY

Military Families in Transition:
Stress, Resilience, and Well-being
Executive Summary
and Recommendations

Edited byRobert J. Ursano, MD
Frances H. Gabbay, PhD
Carol S. Fullerton, PhD

A Conference Sponsored by:Center for the Study of Traumatic Stress
Department of Psychiatry
Uniformed Services University of the Health Sciences

From the Conference Series:

FORUM ON HEALTH AND NATIONAL SECURITY

Military Families in Transition:
Stress, Resilience, and Well-being
Editor’s Note: This transcript has been edited, however, as in most transcripts some errors may
have been missed. The editors are responsible for any errors of content or editing that remain.

IPD 2014 by Center for the Study of Traumatic Stress
Department of Psychiatry
Uniformed Services University of the Health Sciences
4301 Jones Bridge Road
Bethesda, MD 20814-4712
First Edition

iPanelists
David M. Benedek, MD
COL, MC, USA
Professor and Deputy Chair, Department of
Psychiatry
Associate Director, Center for the Study ofTraumatic Stress
Uniformed Services University

Richard E. Heyman, PhD
Professor
Family Translational Research Group
Department of Cariology and Comprehensive
Care
New York University

Stephen J. Cozza, MD
COL(R), USA
Professor, Department of Psychiatry
Associate Director, Center for the Study ofTraumatic Stress
Uniformed Services University

Brian D. Leidy, PhD
Senior Extension Associate
Bronfenbrenner Center for Translational
Research
Beebe HallNYS College of Human Ecology
Cornell University

Eric B. Elbogen, PhD, ABPP
Associate Professor of Psychiatry
Forensic Psychiatry Program and Clinic
School of Medicine
University of North Carolina, Chapel Hill

Patricia Lester, MD
Jane and Marc Nathanson Family Professor of
Psychiatry
Semel Institute
University of California, Los Angeles

Wanda L. Finch, LICSW, CAS
CAPT, USPHSFamily and Community Resilience Program
Manager
Department of Defense Centers of Excellence

Shelley M. MacDermid Wadsworth, PhD
Director, Center for Families
Director, Military Family Research Institute
Professor, Human Development and Family
Studies
Purdue University

Abigail H. Gewirtz, PhD, LP
Associate Professor
Department of Family Social Science
Institute of Child Development
University of Minnesota
Mark N. Glauser, PhD
Professor, Department of Mechanical andAerospace Engineering; Associate Dean for
Research and Doctoral Programs
L.C. Smith College of Engineering andComputer Science
Professor, Department of Physics, College ofArts and Sciences
Fellow: AIAA, ASME, APS, Institute of Physics(UK)
Syracuse University

Stephen A. Maisto, PhD
Professor
Department of Psychology
Syracuse University
Ann S. Masten, PhD, LP
Irving B. Harris Professor of Child Psychology
Institute of Child Development
University of Minnesota
James E. McCarroll, PhD, MPH
Research Professor, Department of Psychiatry
Center for the Study of Traumatic Stress
Uniformed Services University

ii

Lynn L. McCollum, LCSW
Director, Family Programs, US Army
Installation
Management Command, Family and Morale,
Welfare and Recreation Programs
San Antonio, TX

Anthony J. Stamilio, MBA
Deputy Assistant Secretary of the Army
Manpower and Reserve Affairs
Civilian Personnel/Quality of Life
U.S. Department of the Army
Washington, DC

William R. Saltzman, PhD
Professor, Advanced Studies in Education andCounseling
Faculty, Marriage and Family Therapy
Program
Associate Director, Nathanson Family
Resilience Center
Semel Institute
University of California, Los Angeles

Robert J. Ursano, MD
Professor and Chair, Department of Psychiatry
Director, Center for the Study of TraumaticStress
Uniformed Services University

James L. Schmeling, JD
Managing Director, Co-FounderInstitute for Veterans and Military Families
Syracuse University

Douglas F. Zatzick, MD
Professor and Associate Vice Chair for HealthServices
Department of Psychiatry and Behavioral
Sciences
School of Medicine
University of Washington

Richard L. Spoth, PhD
F. Wendell Miller Senior Prevention Scientist
Director, Partnerships in Prevention Science
Institute
Iowa State University

Conference Planning Committee

Editing Committee

Frances H. Gabbay, PhD
K. Nikki Benevides, MA
Mary Lee Dichtel, RNJames E. McCarroll, PhD
Carol S. Fullerton, PhD
Robert J. Ursano, MD

Robert J. Ursano, MD
Mary Lee Dichtel, RN
Carol S. Fullerton, PhD
Frances H. Gabbay, PhD
James E. McCarroll, PhD
K. Nikki Benevides, MA

iii

Participants
Carolyn M. Aldwin, PhD
Professor, Human Development & Family
Sciences
Director, Gerontology Program
Oregon State University

Jill W. Chambers
COL(R), USA
This Able Vet®, LLC
Service Disabled Veteran Owned Small
Business

Patricia M. Barron
Director, Family Programs
Association of the United States Army
Arlington, VA

Kenneth R. Conner, PsyD, MPH
Acting Director, VA VISN 2 Center of
Excellence for Suicide Prevention
Associate Professor of Psychiatry
Co-Director, Center for the Study andPrevention of Suicide
University of Rochester Medical CenterPaul T. Bartone, PhD
COL(R), USA
Senior Research Fellow
Center for Technology and National Security
PolicyNational Defense University
Paul Bliese, PhD
COL, MSC, USA
Director, Center for Military Psychiatry and
Neuroscience
Walter Reed Army Institute of Research
Adrian Blow, PhD
Associate Professor and Program Director
Couple and Family Therapy Program
Department of Human Development andFamily Studies
Michigan State University
Debbie Bradbard, PhD, LCP
Deputy Director, Research and Policy
Blue Star Families, Inc.
Falls Church, VA
Teri S. Brister, PhD, LPC
Director, Content Integrity and NAMI Basics
NAMI Education, Training and Peer Support
CenterRory A. Cooper, PhD
FISA & Paralyzed Veterans of America Chair
Distinguished Professor, Department of
Rehabilitation Science and Technology
Co-Director, NSF Quality of Life Technology
Engineering Research Center
Human Engineering Laboratories
VA Pittsburgh Healthcare System
Anthony L. Cox, LCSW, DCSWCOL, USA
Director, US Army Family Advocacy Program
IMCOM, G9, Family and MWR Programs
Fort Sam Houston, TX
Delores Johnson Davis, MSW, LCSW
Office of the Assistant Secretary of the Army
Manpower and Reserve Affairs
Civilian Personnel/Quality of Life
Washington, DC
Peter J. Delany, PhD
RADM, USPHS
Director, Center for Behavioral Health
Statistics and Quality
Substance Abuse and Mental Health Services
Administration
Rockville, MD

iv

CPT Michael N. Dretsch, PhD
Chief, Neuroscience Applications
Comprehensive Soldier & Family Fitness
Program
Program Development, Analysis and Training
Integration Division
Headquarters Department of the Army
Arlington, VA
Cathy A. Flynn, PhD
Senior Program Analyst
Military Community & Family Policy
Office of the Under Secretary of Defense,
Personnel & ReadinessWashington, DC
Carol S. Fullerton, PhD
Research Professor, Department of Psychiatry
Scientific Director, Center for the Study ofTraumatic Stress
Uniformed Services University
Frances H. Gabbay, PhD
Research Associate Professor, Department of
Psychiatry
Director, Clinical Psychophysiology andPsychopharmacology Laboratory
Staff Scientist, Center for the Study ofTraumatic Stress
Uniformed Services University
J. Michael Haynie, PhD
Executive Director, Institute for Veterans andMilitary Families
Barnes Professor of Entrepreneurship
Whitman School of Management
Syracuse University
Kent E. Kester, MD
COL, MC, USA
Associate Dean for Clinical ResearchConsultant in Infectious Diseases to the Army
Surgeon General
Consultant in Medical Research &Development to the Army Surgeon General
Office of the Dean, School of Medicine
Uniformed Services University
Meredith Kleykamp, PhD
Assistant Professor, Department of Sociology
University of Maryland

Gina Lee-Glauser, PhD
Vice President for Research
Office of Research
Syracuse University
Catherine Mozden Lewis, RN, MSN, MPA
COL(R), USA
Deputy Director, Government Relations
Military Officers Association of America
Andrew London, PhD
Professor of Sociology
Faculty Associate, Aging Studies InstituteSenior Research Affiliate, Center for Policy
Research
Senior Fellow, Institute for Veterans andMilitary Families
Syracuse University
Trish Lowney, PhD
Assistant Vice President for Strategic Research
Development
Office of Research
Syracuse University
Jennifer Lundquist, PhD
Founder and Director of the Institute for Social
Science Research (ISSR)
Associate Professor, Department of Sociology
University of Massachusetts, Amherst
Harriet MacMillan, MD, MSc, FRCPC
Professor
Departments of Psychiatry and Behavioural
Neurosciences and of Pediatrics
Chedoke Health Chair in Child Psychiatry
Acting Director, Offord Centre for Child
Studies
McMaster University and McMaster Children’s
Hospital/Hamilton Health Sciences
Valerie Maholmes, PhD, CAS
Chief, Pediatric Trauma and Critical Illness
BranchEunice Kennedy Shriver National Institute ofChild Health and Human Development
National Institutes of Healthv

James D. McDonough, Jr.
COL(R), USA
Senior Director for Community Engagement
and Innovation
Syracuse University
Institute for Veterans and Military Families
Syracuse, NY
Deborah J. Monahan, PhD
Associate Dean for Research
Professor of Social WorkDavid B. Falk College
Syracuse University
Mike Monroe
VP of Military Initiatives
Points of Light
Washington, DC
Ruth Paris, PhD
Associate Professor and Director, Family
Therapy Certificate Program
School of Social Work
Boston University
Paul F. Pasquina, MD
COL(R), USA
Residency Director and Chair, Physical
Medicine & Rehabilitation
Uniformed Services University
Walter Reed National Military Medical Center
Eve E. Reider, PhD
Health Scientist Administrator
Prevention Research Branch
National Institute on Drug Abuse
National Institutes of HealthMartha Farnsworth Riche, PhD
Farnsworth Riche Associates
Trumansburg, NY
Lyndon A. Riviere, PhD
Research Psychologist, Military Psychiatry
BranchCenter for Military Psychiatry and
Neuroscience
Walter Reed Army Institute of Research

Rene J. Robichaux, PhD, LCSW
Social Work Programs Manager
Behavioral Health Division
U.S. Army Medical Command
Amy M. Smith Slep, PhD
Professor
Family Translational Research Group
Department of Cariology and Comprehensive
Care
New York University
Avron Spiro, PhD
Research Career Scientist
Massachusetts Veterans Epidemiology
Research and Information Center
VA Boston Healthcare System
Research Professor of Epidemiology andPsychiatry
Boston University
Marney Thomas, PhD
Senior Academic Staff
Military Projects
Bronfenbrenner Center for Translational
Research
Beebe Hall
College of Human Ecology
Cornell University
Froma Walsh, PhD
Co-Director, Chicago Center for Family Health
Mose & Sylvia Firestone Professor Emerita
School of Social Administration
Department of Psychiatry
The University of Chicago

viPreface
The health and well-being of military families is a key part of sustaining thehealth and readiness of our military forces. The Forum on Health and National
Security, sponsored by the Center for the Study of Traumatic Stress, addressedinterventions to mitigate the effects of stressors confronted by military families
and strategies to enhance the resilience and well-being of these families, as wartime
transitions to peace, garrison, and small group deployments. Participants represented
military and civilian leaders, and health care and family services educators,
researchers, planners, and providers. The goal of the Forum was to share knowledge
across disciplinary boundaries, and to develop new perspectives and vantage points,
in order to better understand the needs of military families.
Participants considered the challenges as well as potential solutions at different
levels, from the individual to the family to the larger systems in which soldiers andfamilies are embedded, including both military and civilian communities. In the
coming years, additional transitions, and new challenges, will confront militaryfamilies. Fewer resources will be available to mitigate the effects of the challenges,
requiring even greater consideration of cost-effective solutions. To facilitate difficult
decisions by leadership in a challenging transitional time, the group developed aset of recommendations addressing: (1) leadership; (2) training and education;(3) programs and interventions; and (4) research.

The health andwell-being of militaryfamilies is a key partof sustaining thehealth and readinessof our military forces.

vii

Executive Summary and Recommendations

1

Executive Summary andRecommendations
Our nation’s recent conflicts have brought unparalleled challenges for militaryfamilies. The high operational tempo of a decade of conflict has required frequent
deployments, with limited recovery, reset, and restoration time for service members
and their families. Many returning service members and veterans suffer the effects ofinvisible wounds such as posttraumatic stress and concussions with resulting mild tomoderate traumatic brain injury. These wartime wounds can greatly impact families:
injured soldier, injured family. Further, the recent conflict has relied heavily on Guard
and Reserve troops, for whom the unpredictability of military service imposes additional and unique challenges. Amplifying the effects of these circumstances, the recent
period of conflict has overlapped substantially with a significant economic downturn.
Against this backdrop, military families face new challenges going forward, as theforce adapts to the changing circumstances.
The military is committed to ensuring the well-being of the soldier and the soldier’s family, and members of the force depend on this commitment. How individuals
transition into, within, and out of service, and more broadly, how they feel about theirmilitary experience, impacts the future of the force. A service member’s evaluationof their service experience, and that of her or his family, affects the likelihood of reenlistment and even how the military is conveyed to the next generation. To sustain
a promise and to promote national security, the military maintains a sharp focus on
the families of its members. In the coming years, fewer resources will be available tomitigate the effects of challenges faced by these families, requiring leaders to identify
cost-effective interventions.
To facilitate difficult decisions in a challenging transitional time, the Center for the
Study of Traumatic Stress (CSTS) of the Department of Psychiatry at the Uniformed
Services University convened a two-day forum, Military Families in Transition: Stress,
Resilience, and Well-being. Participants in the forum, the most recent in a series on
health and national security sponsored by the CSTS, included nationally recognized
military and civilian leaders, educators, researchers, and health care planners and providers. In confronting challenges that will be faced by military families in the coming
decades, the forum addressed Strategic Goal 2 in the FY 2012-2016 Strategic Plan:
To strengthen individual and mission readiness and family support, and promote
well-being.
The discussion identified a broad spectrum of challenges faced by military

The military iscommitted to ensuring
the well-being of thesoldier and the soldier’s
family, and membersof the force depend on
this commitment.

2

Capitalizing on existing
interventions withdemonstrated efficacy,
the effects of which areoften cascading, canfacilitate cost-effective
and sustainable
solutions.

Military Families in Transition: Stress, Resilience, and Well-being

families, including deployment-related burdens on spouses and children, economic
concerns, finding services for family members wounded in service, inadequacies inthe dissemination of information necessary to navigate existing services, and unpredictability. These challenges may be exacerbated as the force changes.
These stresses and challenges notwithstanding, most military families are coping
well and even thriving. The families are resilient and, like all families, are capable ofbecoming more resilient as they face future challenges. Sustaining and enhancing thiscapacity for resilience is a priority, and is accomplished by reducing specific stressand exposure to risk when possible, providing access to positive assets, and harnessing the power of human adaptive systems, including the family and the militaryand civilian community. Capitalizing on existing interventions with demonstrated
efficacy, the effects of which are often cascading, can facilitate cost-effective andsustainable solutions.
The forum developed four areas of recommendations that serve these overarchinggoals. These recommendations relate to: (1) leadership considerations to facilitate thewell-being of the soldiers and their families; (2) training and education; (3) design,
implementation, and evaluation of cost-effective programs and interventions to address
the challenges facing military families; and (4) research to provide action-oriented
knowledge on stress and resilience in military families to aid decision-making by theleadership.
Leadership••

Recognize the changing characteristics of military (and civilian) families. For
the military of 2025, it is important to utilize a flexible definition of the family. Whereas families are diverse and evolving, the functions families serve are
relatively constant. However, how those functions are implemented may changeover time. Defining the family in a flexible way facilitates efforts to apply a wide
range of knowledge about families as well as those to harness the adaptive powerof families.

••

During the downsizing, maximize predictability for service members and theirfamilies. Knowing what is up ahead is extremely valuable to families, reducing
their stress level and increasing their capacity for resilience.

••

Identifying family risk and resilience factors can inform policy and direct
research, training, education, and programs to prepare for unknown future
engagements.

••

As is well known, and remains critical to future planning, identifying andimplementing the optimal frequency and duration of deployments and dwell
time substantially impacts service member and family function. To the extent
that the nature and character of deployments change, the issues of frequency,
length, and recovery time need to be reconsidered.

••

Implement programs by first integrating existing capabilities, as this is costeffective and associated with greater sustainability. Partnering with civilian
communities to provide services to Reserve as well as Active components may
provide additional advantages.

••

When allocating resources, determine the most important problems, and how
resources can be used to impact the greatest number of people.

Executive Summary and Recommendations

••

••

••

••

3

Consider cascading effects in cost-benefit analyses. Longer-term outcomes andcost-benefit considerations are often lost in the need to address downsizing andcost efficiency, but failure to take these into account can actually increase costsin the out years.

Identifying family

Now, and as a part of sustained operations in the future, invest in program
evaluation at the outset to more successfully identify cost-effective programs.

policy and direct

Support the development of historical reviews and leadership lessons learned inorder to capture the lessons on family support, family stressors, family resilience,and program operations. Manuals for family programs based on the experienceof the past ten years can facilitate the ramp-up to responding in the next conflict.
Consideration of where and how to house these lessons learned and how tosustain them is important to future engagements.

education, andInclude the Guard and Reserve when planning for transitions facing militaryfamilies, as they face unique challenges such as relative isolation and greater
unpredictability regarding their service.

Training and Education••

Maintain/enhance a leadership education group specifically at the Command andGeneral Staff College and at the War College, that teaches lessons learned fromthe recent and past conflicts on the soldier-family interrelationship to sustain thefighting force. Development of this curriculum should include specific leadershipquestions and tools for solutions in future conflict times.

••

Enhance methods and materials for communicating the issues of downsizing withmilitary families, in order to promote trust and manage expectations of the service
member and their family.

••

Train and maintain the core competency to deal with soldier and family issues inorder to be prepared and to sustain the force. In particular, train interventionists
to deal with posttraumatic stress disorder (PTSD), traumatic brain injury (TBI),
family violence, and child neglect, which are an ongoing part of service life andwhich will be an important part of future wars.

••

For family service providers, review and consider training in the followingintervention skills, which are now part of many family and individual interventions for stress-related exposures: emotion-regulation skills; problem-solving
skills; risk, safety, and motivational communication skills; goal-setting skills;
management of trauma and loss reminders; deployment separation reminders
management; collaborative parenting; and financial readiness/planning.

••

Train providers to: (1) recognize the effects of service member posttraumaticstress (PTS), PTSD, and other combat stress reactions on families; and (2) educate
families to recognize, monitor, and manage these stress responses as a team.

••Consider, where applicable, calling service providers trainers or coaches, in orderto reflect their role as strength builders, and thereby reduce stigma associatedwith care.

••

Sustain and further develop bridging education programs for civilian community
leaders, school personnel, health care providers, and others in the civilian com-risk and resilience
factors can informresearch, training,
programs to prepare
for unknown future
engagements.

4

Military Families in Transition: Stress, Resilience, and Well-being

munity, about military culture, PTSD, and TBI. The present knowledge base ishigher than in the past, but not historically high, considering World War II. Thisknowledge and sensitivity will decay over time. Continuing an active outreachto civilian communities will relieve soldiers and family members of being the
primary educators of their communities and maximize the ability of militaryfamilies to engage with communities. This is particularly true around smaller
installations and with Guard and Reserve service member units.

Programs musttarget multiple levels,
focusing on three
engines of resilience:(1) reduce the level ofstress and exposure torisk; (2) boost access••

When allocating limited resources, consider that cuts in training dollars areassociated with increased risks for lack of necessary skills in future times of rapid
mobilization/response, as was true in the present conflict.

••

Develop fellowships to enhance the skills and knowledge of military providers
and researchers in actionable research, program evaluation, and implementation
science.

to positive assets(e.g., good healthcare,money for food, andsafe communities); and(3) harness the powerof human adaptive

Programs and Interventions••

Programs must target multiple levels, focusing on three engines of resilience: (1)reduce the level of stress and exposure to risk; (2) boost access to positive assets(e.g., good healthcare, money for food, and safe communities); and (3) harness
the power of human adaptive systems, including families and the systems inwhich they reside. A focus on these engines of resilience — reducing risk, boosting assets, and harnessing human systems (RBH) — will promote sustainablechange.

••Aim to reduce risk factors and increase protective factors versus focusing
solely on reducing negative outcomes. It is important to proactively assess andaddress family risk and protective factors as well as risk and protective factorsof individuals.

••

Assess programs in order to determine if efforts to reduce risk and enhanceprotective factors are effective. Assessment requires more than process measures.
Measure both positive and negative outcomes of programs.

••

Develop programs that impact multiple outcomes, thus providing programs
that may be more cost-effective. Evaluate programs using multi-level analysis,
to assess their effects at various levels (i.e., community, family, and individual).

••

The strength of the community (both an installation and the surrounding
community) can sustain families and service members. Interventions that build
community strength and bridge to civilian communities are an important partof a programmatic approach.

••

Include a self-help strategy in programs, in order to empower families and build
their sense of efficacy. This approach helps families and individuals sustain theirown recovery.

••

Consider gateways, pathways, and configurations: (1) Incorporate gateway
managers, considering what the gateways are and how entrée is managed. Thisis central to engaging individuals and families, in order to reduce attrition, as thesystem in which military families live is large and complex. Provide user-friendly
access, and recognize that multiple points of contact are crucial, especially for
those that feel isolated or depressed. (2) Evaluate the pathways between pro-systems, including
families and thesystems in which they
reside.

Executive Summary and Recommendations

5grams. (3) Consider the configuration of programs across the system, acrosscareer time, and across new and emerging types of military families, in order todetermine the matrix of programs that best serves the diverse elements of the
population at various and critical points in their careers. This matrix is a ramp
up — ready to fight — tool for future engagements.

Modularized••

Modularized programs have the advantage that they can be adapted for emerging needs: (1) Identify core elements of interventions that might be universallyeffective and adaptable to different situations. (2) Construct programs focusing
on these core components, incorporating degrees of freedom so that programs
can be adjusted while remaining faithful to the core components. (3) Design
programs that are adaptable up front, allowing families to see an early win andengage. (4) Build a resilience component into programs, to promote problem
solving. (5) Assess continuously and adjust programs as needed, to meet theneeds of different families and situations.

emerging needs.

••

Where possible adapt existing (civilian as well as military) evidence-based programs to serve military families.

••

During implementation, focus sharply on reach: impact is a function of effect size
and reach. A small effect that reaches a large group (i.e., has substantial reach)has a large impact.

••

Implementing new interventions in interdisciplinary teams that include representatives of policy, front-line family work, and intervention science can expedite
program development, evaluation, and adaptation.

••

For expanded reach to active duty service members and families, as well as Guard
and Reserve, leverage existing: (1) mentoring relationships of spouses and service
members within the Army community across active duty, Guard, and Reservefamilies; (2) trusted community supports of each family (e.g. church, school); and(3) technological systems, especially to support geographically dispersed soldiersand their families.

Research••

Leverage existing opportunities: (1) Develop cross-linked historical and current
administrative health and behavior databases on military families and soldiers, inorder to facilitate analyses using new large data-intensive approaches of criticalreal-time and historic family-soldier health and career outcome questions (e.g.,
Army STARRS historical data analyses). (2) Develop similar databases on civilian families, which share risk and protective factors in common with militaryfamilies, for comparison where possible. (3) Increase the use of existing mobile
and real-time technology (e.g., use mobile devices and cloud computing technology to collect and evaluate process and outcome data). (4) Identify and reduce
unnecessary barriers to research and the use of existing data, to facilitate effortsof researchers to contribute to problem solutions.

••Examine family functioning in studies of deployment and recovery, as it is a
critical variable in soldier recovery and reset. Studies to identify the effects oflength and frequency of deployment, characteristics of deployment, and dwell
time on family function can greatly assist in developing interventions to sustain
resilience and promote rapid recovery of deployed service members.

programs have theadvantage that they
can be adapted for6Balance the informative

Military Families in Transition: Stress, Resilience, and Well-being••

The leadership must be educated in the use of tools to recognize the effects ofcumulative stress on families and service members and in intervention strategies
to deal with those effects: Stress is cumulative, and high cumulative risk canoverload the capacity of any system.

••

Identify risk and protective factors, the most effective times to apply interventions,and opportunities to impact a range of negative outcomes for families and individuals. Negative family outcomes for potential intervention include: family violence,soldier and family legal problems, child school problems, soldier and family mental
health problems, family breakup, as well as others. The grouping of these outcomescan provide additional power to identify risk times and groups and interventions
which may work across negative outcomes. Such an approach can strengthen
actionable research that can be used by leadership in a cost-effective manner.

••

Encourage a life-course and career perspective in research: Following individuals
and families over time enables an understanding of change and outcomes over time.
Using current statistical techniques, one can model patterns of change, in order to
identify time points of risk, groups at risk, and times at which interventions may
have maximal impact and, therefore, are most cost-effective.

••

Balance the informative power of long-term research and the immediate need toassist families, utilizing designs that also facilitate ongoing knowledge (e.g., multifactorial, rollout designs). Incorporate multiple outcomes into study designs as a
cost-effective way to evaluate effects of interventions on more than one problem
or system. Given the increasing number of women in service and as heads ofhouseholds, including an evaluation of gender differences in studies of active-duty
and veteran populations will be of continuing importance.

••

Program evaluation is an ongoing need for research going forward and a criticalcomponent of planning for the next conflict time.

power of long-term
research and theimmediate need to assist
families, utilizing designs
that also facilitate
ongoing knowledge(e.g., multifactorial,
rollout designs).