Accessibility Statement

The development of the report from IVMF (to be published in full later in 2021) included interviews with subject matter experts representing the following roles: researcher, program director, creative arts therapist, and community-based arts provider.

Primary themes and findings from the interviews are presented below by population category and include recommendations pertaining to providing arts programming for military-connected populations, including the identification of challenges and stressors, needs, and factors that contribute to resilience for veterans and military personnel, military and veteran families, military and veteran children, and military caregivers. 

Many of the recommendations for community-based arts providers have broad applications that may also apply to creative arts therapists or service providers more generally. An asterisk (*) has been used to identify recommendations with broad applications. Interviews were considered for inclusion in multiple population categories when the expert or the organization the interviewee represented provided services to more than one population category and/or when the expert discussed information relevant to the needs of multiple populations during the interview.

Veterans and Military Personnel

The research team conducted four interviews with experts working with veterans and military personnel. In addition, three more interviews were included with experts working with military children, military families, or military caregivers. Experts in the following categories were represented: researcher (1), program director (4), creative arts therapist (2), and community-based arts provider (2).  

LEARN MORE

Recommendations for Creative Arts Therapists

1. Use engagement with creative arts therapies to help break barriers to healing. Engagement with creative arts therapies can help veterans and military personnel begin to talk about their experiences. “It was a way for therapists in our organization to get to know the people we were serving on their own terms—through their artwork.” “Most of life’s problems are quasi-clinical or not clinical at all.” Creative arts-based interventions can provide an approach to therapy that reduces barriers to engagement.

2. Work from a strengths-focused approach when working with veterans and military personnel. Engaging people in a strengths-focused approach can help to build upon existing successes and strengths.

3. Involve the full family whenever possible. Participants identified several reasons for full family engagement, citing that the entire family is affected when a service member is preparing for deployment, is deployed, or transitions out of the military.

4. Create opportunities for veterans to mentor other veterans by giving back through advocacy, volunteering, and engaging in programming in support of other transitioning veterans.

Recommendations for Community-Based Arts Providers

1. *“Become a learning organization, collect knowledge, curate it, and put it in motion so that we have a learning community of providers who are open to moving beyond their own boundaries, believing that what they’re actually contributing to is not only their individual body of work but a collective community of work.”

2. *Do research and develop an understanding of the needs and resources in your community. Build your programming around these needs and in a way that complements existing resources.

3. *Integrate and collaborate with other programs in your community. Collaboration among programs supports veterans and military personnel in accessing additional resources and experiencing their community of providers as connected and centered on a common goal.

4. *Develop programs that bring veterans or military personnel together with one another around meaningful activities. Experts identified that arts making in groups involves a social component that can help to reduce isolation and promote a sense of community and belonging. The arts provide a range of opportunities for bringing groups of veterans or military personnel together.

Challenges and Stressors

1. Co-occurrence of needs: Many veterans and military personnel present with more than one need at a time (e.g., housing and employment). There is a need for providers to work across silos to coordinate care and better serve the population. Services to address basic needs such as finding stable employment, securing safe and permanent housing, and accessing transportation to and from work are commonly needed. Co-occurring needs that complicate these circumstances can include the need for legal and/or financial assistance.

2. Idealizing and disparaging of military experience: Perceiving and portraying veterans and military personnel as either heroes or victims contributes to a disconnect between veterans/military personnel and civilian citizens. One expert said there is a tendency to “aggrandize or pathologize” veterans and military personnel, adding that both responses contribute to a military-civilian divide.

3. Military/civilian gap: There is a contrast in values between military and civilian culture. Military culture places emphasis on group cohesion and a common mission and civilian culture puts emphasis on the needs and goals of the individual. This contrast can cause challenges for transitioning veterans. Misconceptions and stereotypes also exist and deepen the military/civilian gap. Some misconceptions identified by interviewees included assumptions about combat experience, personal and political values, mental health and PTSD, and tendency toward violence.

4. Stigma: Experts identified that more work needs to be done “at the ground level to overcome stigma and normalize challenges associated with transitions in the life cycle of service members and their families.”

5. Personal/professional identity: Identity is commonly in flux when service members transition out of the military. Service members’ identity may have been tied to their military role and culture; during transition this identity needs to be reconciled in the context of new civilian roles and responsibilities. One expert talked about identity challenges of some women in the military, noting the pressure to fit into a largely male-dominated culture. Another expert indicated that identity challenges associated with transition may be further complicated for female veterans.

6. Sense of purpose: Lacking a sense of purpose can be tied to changes with identity upon transitioning from military to civilian life. Experts identified that developing a sense of purpose outside of one’s role in the military was an important aspect of transition.

7. Family transitions and relationships: Families undergo a transition when a service member separates from the military. Veterans/service members may feel like they lack a bond with their children or spouse. Roles often need to be renegotiated when a service member returns home.

Population Needs

1. Community connections: Veterans and service members benefit from services that help build a meaningful connection to their community of residence and/or connect them with other veterans, service members, and/or military families.

2. Navigation of benefits and services: There is a need to connect people to the right services quickly.

3. Coordination among providers: There is a need for providers to work across silos to coordinate care and better serve the population.

4. Mental health services: Veterans and military personnel may benefit from services that promote resilience and build on strengths. Some of the treatment approaches endorsed by interviewees included teaching grounding strategies, using guided imagery, teaching basic cognitive behavioral therapy skills like recognizing and tolerating emotions, and strategies, interventions, and programs that build community connections.

5. Narrative approaches to therapy: Services that explore dominant narratives can help veterans and military personnel examine strengths and resilience and build on those characteristics as they work to transition from military to civilian life. Narrative approaches to therapy also can support a shift from viewing circumstances through a deficit-focused lens to a strength-focused perspective, as veterans begin to tell their stories in a different light—moving toward a narrative that builds on feelings of being a strong, capable, and contributing citizen.

6. Communication: Veterans and military personnel benefit from programming that helps them to communicate their needs, feelings, and desires to the important people in their life.

7. Peer-to-peer support and/or mentorship: Services that center on peer relationships build on “the ethos crafted in the military of ‘leave nobody behind.’”

Factors That Contribute to or Promote Resilience

1. Mental and physical toughness: Interviewees identified that mental and physical toughness developed during a person’s military career can contribute to resilience.

2. Self-sacrifice: Veterans and service members often have a strong sense of self-sacrifice and selfless service. “An identity was formed by selflessly serving with others.”

3. Drive to be a productive and contributing citizen: “When we finish want to be as productive in civilian society as we were in service.”

Military and Veteran Families

Recommendations for serving military and veteran families are based on five interviews with experts working with service members, veterans, and their family members and caregivers. The research team conducted five interviews with experts working with family members of military personnel and veterans. Two additional interviews with experts working with caregivers, veterans, and service members also were included. Experts in the following categories were represented: researcher (4), program director (5), creative arts therapist (1), community-based arts provider (1), and other service provider (1). 

LEARN MORE

Recommendations for Creative Arts Therapists

1. Offer a holistic approach in serving the whole family. In addition to serving veterans and service members, include spouses, children, and other family members in the services offered. Consider treating the family as a system, because veterans and service members “don’t exist in a vacuum.”

2. Use a strengths-based approach. Operating from a strengths-based perspective puts the focus on building or enhancing skills, strengths, and relationships, which is often more engaging and more beneficial. “So often what we are trying to do is guided by the wrong narrative, like the broken veteran.”

3. Embed evidence-based practice and evaluation in programming. Researchers called for programs based in and informed by research. Additionally, they stressed the importance of evaluation. “Programs that sound good or feel good aren’t enough; they have to work.” Programs should be effective and engaging (“people have to like it and show up”).

4. Use a multidisciplinary approach. Multiple treatment options and providers address varying needs and issues (e.g., physical health, mental health, and community engagement) and promote collaboration and coordination among service providers.

Recommendations for Community-Based Arts Providers

1. *Develop training or education to enhance understanding of military culture. A very common theme among all interviewees was the need for military cultural competency and understanding of the military lifestyle. It is important to learn about military service and also recognize and unpack stereotypes.

2. *Collaborate with existing community-based organizations. It is helpful to partner with existing organizations that already know how to deliver programs to and/or how to interact with and recruit the military community. It is also vital that all service providers be aware of other community organizations, so they can better direct or refer military families to the resources and support they need. One participant summarized this with the motto “support, do not supplant.”

3. *Do continuous outreach. There can be substantial turnover in military communities due to frequent relocations, promotions, and deployments. This means “you’re never done with outreach.”

Challenges and Stressors

1. Frequent transitions: Due to frequent moves and relocations, deployments, and the ultimate transition from military to veteran status, there can be a lack of stability and consistency in the lives of military families. For families, this can mean changes in employment status, needing to find new childcare, shifts in family roles and identity, and navigating new schools and communities.

2. Family separation: Active duty service members and National Guard and Reserve members are separated from their families due to trainings, schooling, and deployments. Deployments are typically associated with worry, fear, added stress, and changes in family roles. Family separations are more complicated for dual-service military couples and single-parent military families.

3. Community isolation and lack of support: Military families often report a lack of connection and belonging to their civilian communities and neighbors. Social isolation is particularly common in military spouses, families that live off-installation, and families of National Guard and Reserve members. It is likely that lack of community connection and lack of support are also problems for family members who are not recognized as dependents of service members or veterans (e.g., parents and unmarried partners).

4. Chronic daily stressors: Military families must deal with daily stressors or hassles that are specific to the military lifestyle. There are additional processes and paperwork involved in receiving medical care, moving, or enrolling in new schools and services. Additionally, there are long workdays for service members, and the unpredictable nature of military service can make it difficult to plan for the future of the family. One study participant added that stress can arise from conflicting identities and roles, reflecting, “the culture is fairly traditional but also requires nontraditional/flexible gender roles.”

5. Heightened risk: Certain factors can make military families more vulnerable to the stressors and challenges of military life. Military parents who are younger, have children at younger ages, are not wealthy, live away from extended family members and support systems, and have difficult or draining jobs are at a greater risk for negative outcomes.

6. Identity: Spouses of service members and veterans sometimes feel they lack an identity or that their identity is ignored, as the focus of attention or services is typically on the service member or veteran. Spouse unemployment and underemployment also can affect issues with identity. Identity challenges also can arise for spouses and children during separation for military service and the transition from being a military family to being a veteran family.

7. Spouse unemployment and underemployment: Many military spouses often struggle with unemployment and underemployment because of frequent moves, lack of childcare, and gaps in their resumes. The effects of spouse unemployment and underemployment are far-reaching and affect both military and veteran spouses. As with civilian families, military and veteran families are stronger with two incomes. Additionally, meaningful employment can serve as a buffer for social isolation for military and veteran spouses.

Population Needs

1. Programs created for and/or specific to military families: There are few programs that specifically cater to military families and their unique experiences, challenges, and strengths. A few experts commented on the gap in serving military families across community, clinic, and government programs. Programs that currently involve military family members often are created for service members and/or veterans, and then expanded to include military family members (e.g., parents, spouses, and children) without addressing the individual and varying needs and experiences of different family members. Interviewees stressed the benefit of programs that serve the whole family and treat the family as a system. Additionally, many programs for veteran families are aimed at helping veteran caregivers or families of a wounded, ill, or injured veteran. There is a lack of programs that address more common issues in veteran families, particularly those surrounding transition. Even fewer military family programs and organizations are evidence-based and evaluative.

2. Identification within the civilian community: Unless military family members self-disclose as such, community systems, programs, and creative arts therapists may be unaware of their military status. It is important for military family members to be identified so they may be connected with the appropriate services and resources and treated by military-sensitive providers. Most interviewees mentioned that these issues are exacerbated for families of National Guard and Reserve members, particularly because children of National Guard and Reserve members are not identified within school systems.

3. Social support, connection, and belonging: Like all families, military and veteran families should feel supported and experience a sense of connection and belonging within their local communities. However, many military families feel misunderstood by civilians and feel they don’t belong within their civilian communities. Such experiences can contribute to detrimental outcomes related to isolation, loneliness, and stress. Experts in the arts especially stressed the importance of programs that foster community connection, involvement, and belonging for military families. Again, some respondents indicated that the need for connection and belonging may be heightened for families of National Guard and Reserve members, families living off-installation, and veteran families, all of whom may be missing or lacking connection to their military community.

4. Connection to local programs and resources: Some experts identified the need to connect military and veteran family members with existing programs and resources within their community. There may be a lack of awareness of certain programs or program administrators may be uncertain of how to reach military families and encourage participation.

5. Access to quality mental health services: Each member of the family needs access to quality mental health care. Needs vary across and within families, so military and veteran family members require care that will adapt to those needs.

6. Childcare services: As is the case with civilian families, military families often require childcare. Military family members are often living away from extended family and lack community connections, which can complicate finding suitable childcare.

7. Military spouse employment: Military spouses are often highly educated and motivated, yet often struggle to find employment due to frequent moves and gaps in their resumes. Military families benefit from two incomes, especially during periods of transition, and military spouses often benefit from meaningful employment.

The most common thematic response regarding the needs of military families was that military families are incredibly diverse and heterogeneous, making it difficult to identify primary needs. One expert said it was like “asking ‘what are the most pressing needs of American families?’” Another respondent said, “The veteran and military experience is as diverse as our country’s experience.”

Factors That Contribute to or Promote Resilience

1. Bonds of military community: Generally, military and veteran families are skilled at forming communal bonds and are often seeking to make tight connections, build camaraderie, and share a sense of belonging. Seeking out and forming these bonds and relationships within and outside of the military community can promote resilience in military family members.

2. Effective and healthy communication: Effective communication aids in building resilience and allows families to process experiences, negotiate, and problem solve. In particular, creative arts therapies and community-based arts programming can promote shared understanding and meaning and improve communication skills. “Art is really powerful because it is a form of nonverbal communication and is non-threatening . . . it can provide a place for all of them to sit down and be able to see or hear what each member of the family has to say.”

3. Desire to learn and master new skills: Military families are often motivated, engaged, and eager to develop new skills. Subject matter experts in the arts highlighted the desire to learn and master new skills as a strength of military family members.

4. Enhanced family connections and relationships: Military families encounter challenges and experiences together that can enhance their family relationships and build a stronger family system. Similarly, building relationship skills can improve family connection. Resilience in children is more likely when parents set limits, are competent caregivers, and are loving and involved in their children’s lives.

5. Military lifestyle: “Adaptability is our greatest skill.” Many subject matter experts reported that resilience is ubiquitous among military families (“most military families are resilient”) and is a necessary part of the military life.

6. Individual characteristics: As is the case with all families, individual traits (e.g., personality traits, genetic traits, etc.) can foster resilience. Intelligence, social competence, and kindness are all related to resilience.

Military and Veteran Children

The research team conducted five interviews with experts working with the children of military personnel and veterans. Two additional interviews with experts working with military and veteran families, caregivers, veterans, and service members also were included. Experts in the following categories were represented: program director (6), creative arts therapist (1), community-based arts provider (1), and other service provider (1).

LEARN MORE

Recommendations for Creative Arts Therapists

1. Offer a holistic approach in serving the whole family. In addition to serving the children of service members and veterans, include parents, grandparents, siblings, and other family members in activities, services, or events. Creative arts therapists should consider treating the family as a system in order to address and enhance parenting skills, parent-child relationships, sibling relationships, family dynamics, and other variables within the family context.

2. Use a strengths-based approach. Programs that focus on building or enhancing skills, strengths, and relationships are often more engaging and more beneficial. Creative arts therapies fit very well within a strengths-based approach. “Art can give voice to kids, give children a chance to express themselves and even make friends.” Children and youth may not be able to talk about or express certain emotions or thoughts they are experiencing, and “music and art therapy can encourage processing and help kids learn to trust.” A few experts encouraged a greater focus on positive youth development.

3. Use a multidisciplinary approach. Multiple treatment options and providers address varying needs and issues (e.g., physical health, mental health, and community engagement) and promote collaboration and coordination among service providers. Additionally, a multidisciplinary approach is beneficial because it is not always clear which creative arts therapy will resonate with a particular child. A few study participants indicated that music and art therapy are popular with many children, but others prefer creative writing. In taking a multidisciplinary approach, creative arts therapists can determine what works best for each military child.

4. Use developmentally appropriate practice. The needs and experiences of military children vary widely by age and maturity of the child. Older children may display more emotional symptoms, while younger children may act out behaviorally. Creative arts therapists must “meet children where they are” and remember, “not one size fits all kids.” Programs must take a developmental and contextual approach to caring for military-connected children and youth.

Recommendations for Community-Based Arts Providers

1. Develop training or education to enhance understanding of military culture. A common theme among all interviewees was the need for military cultural competency and understanding of the military lifestyle. It is important for all service providers and even civilian community members to learn about military service, unpack stereotypes, and improve understanding of the experiences of military children.

2. Focus on local community needs and individual family needs. Both creative arts therapists and community-based arts providers can customize services and programs to the specific and individual needs of the local community. Needs differ so much across different age groups, branches of service, service member rank, geographical location, and so on that it is better to address needs at the lower systems level. It is vital that all service providers “meet people where they are.” It is also important that all service providers be aware of other community organizations, so they can better direct or refer military and veteran families and children to the resources and support they need.

3. Provide flexibility and choice for children. Create an environment for military children where they are able to make choices and feel in control, even “if it’s just picking their art materials.” Military children often feel as though they have little control of their life (due to moving schools, separation from parents, etc.). Additionally, being flexible in terms of the services and activities offered can accommodate children at varying levels of development and maintain and encourage engagement. “Maybe you have to get them moving, maybe you switch to writing, or use imagery . . . sometimes we sit under the table!”

4. Consider incorporating a team or group element. Group settings work well for military children, because the military culture is focused on teamwork and selflessness. Additionally, groups or teams can foster trust, reliance, and support among children. Military children also benefit from participating in groups with other military families who have shared experiences and understand the military lifestyle. This is particularly significant for military children of veterans or service members who are wounded, ill, or injured. Peer relationships are highly important for teenagers and preteenagers and team building can develop or solidify relationships.

Challenges and Stressors

1. Frequent transitions and school changes: Military children often experience a lack of stability and consistency as a result of frequent moves and relocations, deployments, and other transitions. There are many transition challenges related to education and community engagement for military children. These challenges and stressors can be particularly difficult for military and veteran children with special needs.

2. Family separation: Most military and veteran children have experienced separation from their service member parent. During deployments, children must cope with the stress and anxiety of having their parent in danger. One subject matter expert said, “During deployment or separation, from a young child’s perspective, that person is gone.”

3. Shifts in family dynamics: During transitions, and particularly during times of family separation, there can be a change in family roles. Children may have to take on more chores or responsibilities. Sometimes there is a risk of parentification of children, and parents may rely on children in ways that surpass their developmental capacities. There also can be shifts in family dynamics when the family separates from the military or a service member or veteran returns home with a mental or physical injury.

4. Community isolation and lack of support: Military children sometimes feel lonely or singled out, especially if they are not in a community with other military kids or families. Lack of connection, belonging, and support, as well as social isolation, are of particular concern for children in military families that live off-installation, families of National Guard and Reserve members, and veteran families. One study participant commented on the absence of services and resources targeting and available to children of veterans.

5. Secondary trauma: Post-traumatic stress disorder in service members and veterans can be transmitted to their children. Even if children do not experience secondary traumatic stress, the effects of trauma experienced by a parent can greatly affect parenting, parent-child relationships, and family dynamics. “Trauma from war and deployment is different from civilian trauma . . . [service members are] not really able to talk about military trauma, but civilians can talk about the pain and fear of a car accident. Many parents try to shield their children from war, but then children know stuff is going on in home and family, but don’t understand why.”

6. Deficit approach: Much of the literature and programming targeting military children and youth concentrates on deficits. This can have a negative impact on the confidence, self-esteem, and resilience of military and veteran children. Programs tend to be developed around problems rather than strengths

Population Needs

1. Recognition and awareness of military children needs: Several respondents expressed concern that civilians, service providers, schools, and so forth don’t consider or aren’t aware of the needs and experiences of military children. One interviewee stated the following was a pressing need: “Keeping people aware that we have an all-volunteer force that is married with children.” It’s important that programs, research, and schools focus on and further investigate how children are affected by military service. “So often when we say ‘military family,’ we are really just referring to the adults in the family; we must focus on the children.” “I know their parents are serving, but they’re serving too.”

2. Improved school experiences and transitions: Changing schools is challenging for military children and their families. It is important that school professionals are educated about military children and develop military cultural competency. There is a lack of consistency during school transitions, and military parents and their children are left to navigate changes in expectations and requirements, receiving the appropriate services, continuing activities, making new friends, and so forth. Military parents also need help in guiding their children through these processes and gaining access to the necessary information.

3. Programs created for and/or specific to military children, particularly children of veterans: There are few programs that specifically cater to military children and their unique experiences, challenges, and strengths. A few experts commented on the gap in serving military families, especially military children, across community, clinic, and government programs. Programs that currently involve military family members often are created for service members and/or veterans and then expanded to include military family members (parents, spouses, and children) without addressing the individual and varying needs and experiences of different family members. Additionally, many programs for veteran families are aimed at helping veteran caregivers or families of wounded, ill, or injured veterans. There is a particular absence of programs that address issues relating to the transition from being a military family to being a veteran family. Children of veterans lose connection to the military and access to certain services, resources, and programs, and can face new challenges during transition, “yet there is almost no programming for them.”

4. Identification within the civilian community: Unless parents identify their children as military-connected or children self-disclose, community systems, programs, and providers may be unaware of their military status. It is important for military children and youth to be identified so they may be connected with appropriate services and resources and be treated by military-sensitive providers. Most study participants mentioned that these issues are exacerbated for families of National Guard and Reserve members, particularly because children of National Guard and Reserve members are not identified within school systems. Additionally, children of veterans are frequently not identified within the community. One interviewee recommended that the VA, health-care providers, and other service providers ask veterans if they have children, what ages their children are, and so forth.

5. Social support, connection, and belonging: Like all children, military children should feel supported and experience a sense of connection and belonging within their local communities. However, many military children feel they stand out and/or don’t belong within their civilian communities or schools. “If military parents are isolated, odds are children are isolated as well.” Such experiences can contribute to detrimental outcomes related to isolation, loneliness, and stress. Some experts indicated that the need for connection and belonging may be heightened for children of National Guard and Reserve service members, children living off-installation, and children of veterans, all of whom may be missing or lacking connection to their military community.

Factors That Contribute to or Promote Resilience

1. Military community bonds and peer support: Military families and military children are skilled at forming communal bonds. Seeking out and forming these bonds and relationships within and outside of the military community can promote resilience in military children. Support from peers (military and civilian) can greatly enhance resilience in military teens and preteens, in particular.

2. Enhanced family connections and relationships: Military families encounter challenges and experiences together that can enhance their family relationships and build a stronger family system. Similarly, building relationship skills can improve family connection. Resilience in children is more likely when parents set limits, are competent caregivers, and are loving and involved in their children’s lives.

3. Military lifestyle: “Adaptability is our greatest skill.” Many interviewees reported that resilience is ubiquitous among military families (“most military families are resilient”) and is a necessary part of the military life. Military children “learn to be flexible and roll with change.”

4. Military children see selfless sacrifice: Military children are often exposed to admirable qualities in military adults (including their parents), such as dedication to service, a sense of duty, and selfless sacrifice. Making meaning of challenges associated with the military lifestyle and focusing on positive strengths can both improve and foster resiliency in military-connected children and youth.

Military Caregivers

The Research Team conducted five interviews with experts working with military caregivers, family members or others who provide a broad range of unpaid care and assistance for service members or veterans with a disabling physical or mental injury or illness. One additional interview with an expert working with military families was also included. Experts in the following categories were represented: researcher (1), program director (3), creative arts therapist (2), and other service provider (1). 

LEARN MORE

Recommendations for Creative Arts Therapists

1. Offer a holistic approach to serving the military-connected population by serving caregivers, spouses, and children in addition to serving veterans and other military family members, when possible. Offering many services at one location makes the coordination of services and appointments easier for families and can promote the engagement of the whole family. Coordinating services at one location also can promote better collaboration among providers.

2. Utilize a multidisciplinary approach that can include several different types of therapies (e.g., music therapy, art therapy, and mental health counseling) and services (e.g., peer-to-peer support groups, activities, and engagement in the community). Multiple services and treatment options can promote engagement.

3. Provide flexibility in appointment scheduling, hours of operation, and format of service delivery. All experts interviewed cited flexibility as important when serving military caregivers. Interviewees identified that flexibility in scheduling appointments and expanded hours of operation (e.g., evenings and weekends) can help reduce barriers to engagement. In addition, offering services remotely (via online engagement) was recommended, particularly when offering peer-to-peer support services, as it was easier for caregivers to participate. Other recommendations included offering caregiver groups that focus on wellness and offering these opportunities on an individual basis for caregivers who may not be able to make regularly scheduled group meetings. Finally,

providing services or care to children and care recipients while services are being provided for caregivers (e.g., childcare offered concurrent with caregiver group sessions) can support engagement.

4. Orient programming around opportunities for self-care, meaningful engagement, and connection to other caregivers. Creative arts therapy services can address needs associated with mental health, identity, stress management, and the caregiver/care recipient relationship.

Recommendations for Community-Based Arts Providers

1. Collaborate with other community-based organizations. Collaboration is important because there is a need for providers to be able to refer quickly and efficiently to other services that meet needs that fall outside of the scope of the initial or primary provider. Partnerships between arts and non-arts organizations can promote services that address a range of needs.

2. Develop a basic understanding of military culture. This is important for all providers working with the military-connected population. In addition, an understanding of the basic needs and challenges of caregivers is important. Caregivers may be sensitive to a lack of understanding and erroneous assumptions about their caregiver role or experiences.

Challenges and Stressors

1. Demands of the caregiving role: Caregiving can require around-the-clock care for some caregivers and caregiving can be burdensome at times. Caregivers may worry about the worsening health of their care recipient.

2. Worries about the future: Caregivers may worry about the long-term health of their care recipient and implications for the future that may include financial concerns (e.g., retirement) and personal concerns (e.g., isolation). “As the care recipient’s needs grow so do the needs of the caregiver”

3. Relationship issues: Relationship challenges and stressors may emerge in the relationship between the caregiver and care recipient, as roles and responsibilities often shift when a friend, family member, or spouse takes on the caregiver role.

4. Social issues: Social issues can include social isolation. Caregivers may not be able to leave their care recipient alone and other medical and behavioral health issues may prevent or complicate the caregiver’s ability to bring the care recipient to various places. Decreased socialization with friends and family may lead caregivers to feel isolated.

5. Complex systems of care or lack of services: Caregivers often express having a difficult time navigating systems of care or finding services to meet their needs. One expert talked about the lack of services available in some communities, noting that people sometimes travel long distances to receive specialized medical treatment.

6. Caregiver burnout: “We see a lot of caregivers who are burned out, not because of any one single thing but from a conglomeration of issues.”

7. Desire to leave the caregiver role: Caregiver fatigue, loss of independence associated with time spent on caregiving responsibilities, and relationship stressors in the relationship with the care recipient are among some of the stressors that may cause caregivers to want to leave their caregiving role.

8. Financial issues: One study participant talked about financial hardship and the influx of financial support that typically comes in when a service member is first injured. The expert noted that there were no services offered during that transition period to support long-term financial planning. Additionally, co-pays for services can create additional strain on families.

9. Mental health needs: Caregivers may develop mental health needs associated with depression, anxiety, caregiver fatigue, and stress.

10. Loss of personal identity: Several experts talked about caregivers’ personal identity being shadowed by their caregiver role. Caregivers have been identified as “hidden heroes,” because the focus of attention is often on the care recipient. The caregiver may experience grief over the loss associated with life changes.

11. Unpredictability: There is an unpredictability to a caregiver’s life that is often affected by the physical and emotional status of the care recipient. As one expert stated: “One day might be great, the next day might be terrible.”

Population Needs

1. Community-based resources: Military families need resources and support in their community. Military families can move a lot and so wherever they end up they need to have resources that help them to feel like they are part of the community. “Providing services to caregivers is a great way to serve veterans—by caring for caregivers we are caring for veterans.”

2. Comprehensive caregiver services: Experts recommended several types of programs and services to address caregiver needs, including:

a. Programs that help bolster the caregiver role and engage caregivers in providing care by learning caregiving interventions and how to adapt to the caregiver role.

b. Programs that reduce isolation. Caregivers value freedom from their care recipient and benefit from knowing they are not alone by connecting with others.

c. Case management services that help with service navigation and access. A key factor can be a caregiver support coordinator—a person who serves as a designee for a caregiver, conducts a needs assessment, and formulates a treatment plan

especially set up to meet the needs of that caregiver (available through the VA comprehensive caregiver support program).

d. Financial literacy and assistance. Often times there is a gap or decrease in income when a service member is injured and is medically retired. This occurs at the same time that families are often negotiating relocation and securing new housing. Additionally, spouses who become caregivers may leave employment in order to manage caregiving responsibilities.

3. Mental health services: Caregivers can be parents, spouses, or children and there are different challenges and needs associated with these different relationships. Each member of the family benefits from access to high-quality mental health providers when needed. Every family is different and has unique needs, and families need care that will adapt to those needs. Clinics that have a multidisciplinary environment (e.g., offering creative arts therapies, peer-to-peer support services, and mental health counseling) where people have access to different kinds of treatment and providers can be beneficial.

4. Childcare services: Many caregivers—particularly those who are the spouse of the care recipient— are also caring for dependent children in the home, and may have childcare needs.

5. Support with adjusting to change: The whole family often needs to adapt to changes in roles and dynamics within the family when a family member takes on a caregiving role. The whole family can benefit from psychoeducation to learn about the veteran or service member’s injury or trauma, to understand and to gain empathy for the injured family member, and to learn how to help the family member in the recovery process. The whole family also can benefit from the time and space to communicate with one another, to express how roles have changed, and to work through any conflicts. Individual family members’ responses and needs to stressors and trauma will be different. Each person’s distinct response will have an impact on the other family members and the family system as a whole. Supportive counseling can help to validate feelings; focus on developing and enhancing coping skills; and teach mindfulness, meditation, and relaxation techniques in order to promote self-care and enhance wellness.

6. Opportunities to engage in self-care: A military caregiver often has a bigger role to play in the family system (e.g., being a parent in addition to being a caregiver) that can result in additional stress. Caregivers may benefit from psychoeducation on burnout, opportunities to engage in self-care, and access to self-care services such as yoga, art therapy, and mental health counseling.

7. Social support: Caregivers benefit from supportive networks that include other caregivers. Caregivers can support and understand one another, which may help to reduce isolation. Peer mentoring programs are one way to address this need.

8. Spiritual support: Spiritual support can promote a sense of inner peace. Spiritual networks may also help to reduce isolation.

Factors That Contribute to or Promote Resilience

1. Ability to adapt to change: Military families can become stronger after having adjusted to multiple moves or deployments. Empathy and communication may become stronger as military families build an enhanced ability to adapt to change. The family system itself also can become stronger because of experiences adapting to change.

2. Enhanced family connections: Military families deal with challenges that civilians may not understand. There is a cultural connection that develops from shared experiences and a common mission, which builds a common connection among members of military families.

3. Advocacy: Caregivers can develop strong communication and advocacy skills from their caregiving role.

Research Methods

Interviews with subject matter experts were structured using four separate interview instruments (specific to each population group), a recruitment e-mail, and a verbal consent form. Prior to starting the research, the Syracuse University institutional review board approved the protocol. The IVMF team created a matrix of subject matter experts, categorized by population served, type of programming, and type of arts programming (if applicable). Populations served were organized using four categories: veterans and military personnel, military and veteran families, military and veteran children, and military caregivers. The team contacted approximately 30 subject matter experts and conducted 19 interviews in total. Experts were represented in the following professional roles: researcher, program director, creative arts therapist, and community-based arts provider. Some experts represented more than one professional role (e.g., program director and creative arts therapist).

Each interview included six to seven open-ended questions and lasted about one hour. The interviews were analyzed for themes and key findings. 

LEARN MORE

STAY CONNECTED

Stay updated on Creative Forces news and events.