For National Nurses Week, we are honoring the contributions and sacrifices made by all nurses in the medical community who are instrumental in enhancing the health of their patients. Nurses are the healthcare professionals who perform some of the most challenging and essential healthcare tasks and serve as the first and last point of contact for most patients as well as being a crucial link between patients and doctors. Nurses have a versatile career with dozens of specialties that require extreme focus and dedication. We’re spotlighting two of Magellan Health’s nurses who each explain why they chose to become nurses, and who describe what are some of the most rewarding and challenging aspects of working in this field:

• Tracy McClain, RN, BSN, Care Coordinator, Employer Center of Excellence
• Jacqueline Rigby Siomos, RN, senior care manager, Cambria County Clinical

Continue reading to learn more from Jacqueline and Tracy on their experience as nurses:

Why did you become a nurse and what are the most rewarding aspects of working in this field?

Jacqueline: I really wanted to help people and becoming a nurse was the best fit for me. I knew nursing had a lot of different opportunities available and I would always be guaranteed to have a fulfilling career. I enjoy that I learn something new each day, whether it’s a new medication, a new treatment modality, or a new data system.

Tracy: I always knew since a very young age that I wanted to work in a career that allows me to help people. Helping and supporting people in their time of need by bringing them care, comfort, and compassion does as much for me as it does the people I help.

What are some challenges you face being a nurse? How do you overcome those challenges?

Jacqueline: One of the biggest challenges is stress and burnout. It is very important to have healthy self-care rituals to be refreshed and rejuvenated for the next workday. You must commit to be a lifelong learner if you want to be a nurse since healthcare is an ever-changing field. 

Tracy: Not being able to help or make a positive difference in someone’s life, but I just always remind myself that I can’t save the whole world, so I stay focused on the people I can impact and never give up on anyone.

Is there anything you’d like to highlight about working in this field and National Nurses Week?

Jacqueline: Nursing is a challenging field, but the rewards of helping others outweigh all the challenges. I have always been blessed to work with a wonderful group of nurses and other professionals who always make the workday go smoothly. The nursing profession offers tremendous amounts of flexibility in scheduling, clinical specialties, and employment locations. Celebrating National Nurses Week is a great way to recognize the hard work and dedication of all my colleagues in the field. We are all in this together.

Tracy: Working in this field and with my team at Magellan has helped me gain knowledge and grow as a person. I have worked here for 25 years and can honestly say I am a more patient, compassionate, and educated nurse. It’s nice to know that nurses are being recognized for what they do and made to feel proud of being a nurse, especially when burn out tends to be high in this field.

Hard work, dedication, love, and resilience weave together an extraordinary tapestry that is the military spouse. We are strong, independent women and men fiercely supportive of each other. We care wholeheartedly about all associated with the military and work tirelessly to support those who support us through serving our country.

Military Spouse Appreciation Month recognizes the spouse’s contributions to the military and the community. Those in the military took an oath to serve our country and receive medals, salutes, and commendations for their commitment. The sacrifices of the families, while not as evident, should also be applauded and recognized for their commitment to the service of our country through their support of the service member. Often these sacrifices go unnoticed and can create challenges, such as maintaining a job or career.

The Struggle of Finding Employment as a Military Spouse

On many military installations, spouses volunteer thousands of hours for the cause of the community and the military services. One can find a spouse volunteering at thrift stores, schools, Community Action Centers, Military Spouse Clubs, and the American Red Cross, to name a few. The spouse’s work is visible and needed. When the service member knows that the family is stable and receiving the required support within the community, they can focus on serving their mission without hesitation.

Along with the usual marital stresses, most non-military spouses are near support systems of family, lifelong friends, and resources known to them. We learn to make friends quickly, and those people become our family. The resentment and loneliness this lifestyle brings can be hard to understand. The sacrifice, commitment, and the stress of many domestic roles can be lonely and isolating at times. We can sometimes lose our identity – known only as someone’s spouse or someone’s parent. Many opportunities present themselves, such as worldwide travel, educational benefits, and excellent schools, but with these opportunities there can be just as many, if not more, sacrifices.

So much of our military lifestyle is beyond our control. Affordable childcare options are a major concern for military spouses. It is a primary family expense and the main reason many spouses choose not to work outside the home. At one point in my career, I worked 40 hours a week and cleared less than $600 monthly after childcare expenses, transportation, lunch, hair, nails, etc. I was exhausted and felt enormous guilt for allowing my children to be cared for by strangers while I earned a mere pittance.

Military spouses sometimes “Suffer in Silence,” fearing that speaking up may impact our service member’s career.

Qualities of a Military Spouse

We cover family milestones, holidays, and events alone, often finding ways to make up for the missing service member. In many cases, giving birth is a prime example. Thanks to my husband’s battalion chaplain (and his wife who made him do it), Gary was able to sneak away for a couple of hours (in full camouflage paint and an odor to match!) from field exercises to visit our newborn son and me in the neonatal intensive care unit in Fayetteville, NC.

Charlene Austin, the wife of Secretary of Defense General Lloyd Austin, has always been a working military spouse. She gave me this advice years ago when I became despondent during my job search. “This [military] experience is guaranteed to be like no other. Remain open to options and alternatives. Grow to be happy with yourself and work to realize your needs and goals.” That is good advice, but so much easier said than done.

Military spouses often sacrifice a stable career with their active-duty partner. The constant moving makes it hard to have career progression since you are not in any position long enough to have forward momentum. For example, my dear friend, Ivy, has multiple graduate degrees. Yet, she decided not to work for nearly twenty years because it was difficult to secure positions with growth and one that would work with her schedule of raising children and supporting her military service member.

Military spouses are adaptable, flexible, punctual finance managers, organizational managers, schedule managers, and residential physician assistants. They serve as Girl Scout leaders, Boy Scout leaders, piano teachers, sports coaches, and tutors. We are located in an area for 12-36 months. Within the first two weeks of arrival, the spouse has unpacked and arranged the house, registered students in new schools (who is my emergency contact when I don’t know anyone?!), obtained new doctors and a dentist, scheduled sporting activities and other extra-curriculum activities, and planned the summer vacation with fun activities.

Why Companies Should Hire Military Spouses

Securing positions and establishing a career have changed within the last 10 years for military spouses; however, it can sometimes still be difficult for a spouse to secure a position if they are not a teacher or working within the medical field. Many employers hesitate to hire a military spouse because they focused on the spouse leaving and not the skills the person was contributing to the overall mission.

An organization would benefit from having a military spouse who can work independently and collaboratively to complete tasks without supervision. A military spouse has likely managed a household and children and settled conflicts—from submitting damage claims to advocating for the best classes for their child. Military spouses are often highly educated and experienced; therefore, they meet the requirements for many positions. They should not be discounted simply because they may be at a temporary station. There are a lot of remote work options these days that may result in continuity beyond service location.

Carolyn Shelton, the spouse of General Hugh Shelton, former Chairman of the Joint Chiefs of Staff, shared an interesting story concerning her job search in the Washington, DC, area. She was submitting applications but had very little previous employment. She added her volunteer experience as a military spouse instead. A hiring manager reviewed her application and said, “Anyone who would volunteer this much at no pay has to be reliable. You’re hired!” Never discount the strength of your volunteer experience. You gain marketable skills needed in the business community.

When I met Carolyn, she had moved 24 times in 29 years. She humorously described her first experience as a military spouse (although I am sure humorously was not how she would have described it then).  They arrived at Ft. Benning, Georgia, where her husband was to attend Ranger School. He told her, “I’m going to sign in with the unit, then I’ll be back.” He didn’t make it back for two days! This happens more often than we care to admit.

It is past time that companies provide childcare assistance or subsidies. A flexible spending account should be one of many benefits companies offer employees. I hope the future holds affordable options for all companies that will foster a healthier work-life balance.

Companies like Magellan Federal have already taken giant steps in supporting military spouses in the workplace. Our Talent Acquisition team is superb at keeping the company recognized as a Military Friendly Top 10 Spouse Employer. Our President and CEO, Anna Sever, is the spouse of an active-duty military service member. I do not doubt that under her leadership, we will continue to build on the foundation the company was founded on – care for surviving spouses of the fallen. I applaud Magellan Federal for the emphasis placed on mental health and access to resources.

I encourage other corporations to provide more opportunities for military spouses. Hire them because they get the job done and allow them to manage at the highest positions!

On May 3, the U.S. Surgeon General issued an advisory calling attention to the public health crisis of loneliness, isolation, and lack of connection, calling it an “Epidemic of Loneliness and Isolation.”

Loneliness is the feeling of being isolated, or alone. It isn’t always tied to the amount of time you spend with other people but can come from a gap between the relationships you have and the ones you need or want.

There may not be a magic cure for loneliness, but there are healthy ways to cope and reconnect socially and regain a sense of belonging. Here are five steps to reduce loneliness:

1. Try helping someone else – Helping just one person at one time is a way to connect that improves the life of another, makes you feel better about yourself, and can be a great way to help people and meet others who share your interests. You can smile and be friendly, stop to help a neighbor, volunteer your time or donate food.
2. Think about getting a pet or finding a way to interact with animals – A pet can be a great companion, and source of comfort and may also lower stress and blood pressure. If you can’t have a pet, there are many volunteer opportunities to help animals in every community.
3. Take care of the relationships you already have – Reaching out to friends and family can help strengthen your sense of belonging. Set aside a few hours a week to connect. There doesn’t have to be a specific reason to call, and the call doesn’t have to be that long. A familiar look or a loving smile can change our experience instantly, even if we are far away or unable to see each other. You never know how reaching out to just one person may connect you to others.
4. Find new connections through activities you enjoy – Start or restart a hobby. Take a class to learn something new. Check out programs at the library or community center. You can invite friends or acquaintances you want to get to know better. Alternatively, you can go alone and meet people who share at least one interest of yours.
5. Talk with a counselor – It can be hard to make changes on your own and scary to think about being in social situations. If loneliness makes it hard for you to go about your day, a counselor can help.

As you think about taking small steps, remember the importance of self-care to help you feel better from the inside out. Exercise, healthy eating, proper sleep, sunshine and meditation are good ways to improve your emotional health.

Sources:

• Healthwise
• Surgeon General’s Advisory on Our Epidemic of Loneliness and Isolation – PDF

Evidence-based or evidence-informed treatment? Confused? You are not alone. Often used interchangeably, the terms “evidence-based” and “evidence-informed” in healthcare are two very different things. So, what do they really mean?

What is evidence-based treatment?

Evidence-based care is considered the gold standard in treating behavioral health conditions. Typically, “evidence-based” refers to an individual intervention that is based on quantitative research studies conducted in controlled, blinded settings and proven to be effective across a wide range of environments and people. Medications and other treatments that receive U.S. Food and Drug Administration (FDA) approval for a certain indication are also considered evidence-based.

What is evidence-informed treatment?  

 Evidence-informed care is an approach that shows promise but lacks enough proof of success to be viewed as a gold standard. Practitioners take bits and pieces from a variety of research, including evidence-based interventions and apply them to a condition. This produces something uniquely tailored to a certain need. Unlike evidence-based treatments, evidence-informed treatments don’t have results from research in controlled settings that demonstrate their effectiveness across a wide range of settings and people. When considering medication and other drug-like treatments, evidence-informed interventions have not received FDA approval for the condition they are treating. This is called “off-label” use.

Examples of evidence-based treatments

• Cognitive behavioral therapy (CBT) is a type of talk therapy that has proved effective in the treatment of anxiety, depression, addictions, phobias and certain physical health conditions. CBT focuses on changing automatic negative thoughts that can contribute to and worsen mental health and substance use symptoms. CBT has more evidence supporting it than any other psychological therapy.
• Acceptance and commitment therapy (ACT) is a type of mindful talk therapy that helps individuals stay focused on the present moment and accept thoughts and feelings without judgment. Over 200 randomized controlled trials have proven ACT is an effective treatment for depression, psychosis, chronic pain, substance use disorder, post-traumatic stress disorder, obsessive-compulsive disorder, panic disorder and social phobia.
• Dialectical behavior therapy (DBT) is a type of talk therapy based on CBT and specially adapted for people who experience emotions very intensely. Nine published randomized controlled trials and five controlled trials of DBT have proven its effectiveness for treating borderline personality disorder, including in highly suicidal women.
• Exposure and response prevention (ERP) therapy is a form of CBT that encourages individuals to engage with their obsessive thoughts without carrying out their associated compulsions. Treatment begins with placing individuals in situations which cause a tolerable level of anxiety and gradually build up to settings they find more difficult. ERP has been proven effective for treating obsessive-compulsive disorder in numerous clinical trials.
• Eye movement desensitization and reprocessing (EMDR) therapy is a mental health treatment technique that involves moving your eyes a specific way while you process traumatic memories. The goal of EMDR is to help individuals heal from trauma or other distressing life experiences. Since the first EMDR clinical trial in 1989, dozens of other clinical trials have proven this technique is effective and faster for the treatment of post-traumatic stress disorder.
• Transcranial magnetic stimulation (TMS) is a noninvasive treatment that was first used to treat depression in individuals who were nonresponsive to other treatments. TMS involves using a magnetic coil to influence the brain’s natural electrical activity and has full FDA approval for the treatment of major depressive disorder, obsessive-compulsive disorder, migraines and smoking cessation.
• Esketamine is an FDA-approved nasal spray used to treat severe treatment-resistant depression. Esketamine was found effective in a phase 3, double-blind, active-controlled study conducted at 39 outpatient centers from August 2015 to June 2017. The study involved nearly 200 adults with moderate to severe depression and a history of not responding to at least two antidepressants.
• Fluoextine is an antidepressant medication that is approved by the FDA to treat depression, obsessive-compulsive disorder, bulimia nervosa, premenstrual dysphoric disorder and panic disorder. It belongs to a group of medicines known as selective serotonin reuptake inhibitors (SSRIs) and works by increasing the activity of serotonin in the brain. Data based on a group of 9,087 patients who were included in 87 different randomized clinical trials confirms that fluoxetine is safe and effective in the treatment of depression from the first week of therapy.

 Examples of evidence-informed treatments   

Response Disequilibrium Therapy (RDx)—Based on the response disequilibrium model, RDx puts patients in charge of implementing their own treatment procedure outside of therapy sessions in the same environments that trigger their symptoms so they can learn new behaviors to replace and control their previous responses to distressing situations.

While preliminary findings from case studies involving 19 participants with OCD suggest RDx may be a promising alternative to traditional OCD treatments, future research is needed to determine its effectiveness across a wide range of settings, people and problems to classify it as an evidence-based intervention.

• Pregabalin (an FDA-approved anticonvulsant medication and fibromyalgia treatment) has been used off-label to treat generalized anxiety disorder, social anxiety disorder, bipolar disorder, insomnia and chronic pain conditions other than fibromyalgia. For pregabalin to be used for these conditions in an evidence-based manner, the FDA would have to approve their use for each specific condition.
• Risperidone (an atypical antipsychotic medication approved by the FDA for the treatment of schizophrenia, bipolar disorder and autism-associated irritability) has been used in a variety of off-label ways, including to treat borderline personality disorder, post-traumatic stress disorder (PTSD) and bipolar disorder. To date, the FDA has not approved risperidone to treat these three conditions.

Are mental health and wellness apps evidence-based or evidence-informed?

These days, you can’t browse the web or use most apps on your phone without seeing an ad for a wellbeing or therapy program or app. Used alone or to supplement traditional treatment and promote wellbeing, not all mental health, substance use and wellbeing apps use evidence-based practices, nor have they been extensively researched in treating specific conditions. Wellbeing and therapy apps are typically considered:

• Evidence-based when evidence-based interventions are fully implemented on the platform and followed by users in the same manner they would be if they were being delivered during face-to-face treatment. For example, the original evidence-based model below is used in a wellbeing app that delivers CBT digitally and all steps are followed as listed.
  1. Identify troubling situations or conditions in your life.
  2. Become aware of your thoughts, emotions and beliefs about these problems.
  3. Identify negative or inaccurate thinking.
  4. Reshape negative or inaccurate thinking.
• Evidence-informed when only certain components of evidence-based interventions are implemented on the platform, and/or the app only fully implements or uses components of evidence-informed interventions. For instance, if a wellbeing app provides CBT and only asks users to identify troubling thoughts and become aware of their thoughts, emotions and beliefs about these problems, it is evidence-informed because it does not ask users to identify and reshape negative or inaccurate thinking.

When considering using an app for yourself, your patients, your employees or your members, ask yourself these questions:

• Are the treatments used in the app based on quantitative research?
  • Were the studies conducted in controlled, blinded settings?
  • Are the treatments proven to be effective across a wide range of environments and people?
• Are all treatment steps included in the process, or has the process been watered down?
• Have the treatments used in the app received FDA approval for a certain indication, if FDA approval is possible?

Magellan’s approach to evidence-based versus evidence-informed treatments and mental health, wellbeing and substance use apps

The American Psychiatric Association and the American Psychological Association both consider evidence-based interventions preferred approaches for the treatment of psychological conditions.

At Magellan, we are leading the way in providing innovative, impactful behavioral healthcare solutions. When developing new and enhancing existing offerings , like our digital cognitive behavioral therapy (DCBT) programs, we always start with evidence-based treatments and adhere fully to all tenets. Magellan Healthcare’s DCBTs have been heavily researched in the studies below:

• FearFighter® for anxiety, panic and phobia (now available online in Spanish)
  • Computer-aided CBT self-help for anxiety and depressive disorders: Experience of a London clinic and future directions. L. Gega, I. Marks, D. Mataix-Cols. Journal of Clinical Psychology: In Session (2004), Vol. 60 (2), 147-157.
  • Computer-aided vs. tutor-delivered teaching of exposure therapy for phobia/panic: Randomized controlled trial with pre-registration nursing students. L. Gega, I.J. Norman and I.M. Marks. International Journal of Nursing Studies 44 (2007) 397-405.
  • The feasibility and effectiveness of computer-guided (CBT) (FearFighter) in a rural area. L. Hayward, A.D. MacGregor, D.F. Peck, P. Wilkes. Behavioural and Cognitive Psychotherapy (2007) 35, 409-419.
• MoodCalmer for depression (now available online in Spanish)
  • Saving clinician’s time by delegating routine aspects of therapy to a computer: A randomized controlled trial in phobia/panic. I.M. Marks, M. Kenwright, M. McDonough, M. Whitaker and D. Mataix-Cols (2004).
  • Technology-based advances in the management of depression: Focus on the COPE program. Disease Management and Health Outcomes. J.H. Greist, D.J. Osgood-Hynes, L. Baer and I.M. Marks (2000) 7, 4.
• RESTORE® for insomnia and other sleep difficulties (now available online in Spanish)
  • Implementing computer-based psychotherapy among veterans in outpatient treatment for substance use disorders. E.D.A. Hermes and R.A. Rosenheck. Psychiatric Services 67:2, February 2016, 176-183.
  • Cognitive behavioral therapy for insomnia enhances depression outcomes in patients with comorbid major depressive disorder and insomnia. R. Manber, J.D. Edinger, J.L. Gress, M.G. San Pedro-Salcedo, T.F. Kuo, T. Kalista. SLEEP, Vol. 31, No. 4, 2008, 489-495.
  • Logging on for better sleep: RCT of the effectiveness of online treatment for insomnia. N. Vincent and S. Lewycky. SLEEP, Vol. 32, No. 6, 2009, 807-815.
  • Sleep locus of control and computerized cognitive-behavioral therapy (cCBT). N. Vincent, K. Walsh, and S. Lewycky. Behaviour Research and Therapy, 48 (2010), 779-783.
• SHADE for substance use disorder
  • Randomized controlled trial of cognitive-behavioural therapy for coexisting depression and alcohol problems: Short-term outcome. A.L. Baker, D.J. Kavanagh, F.J. Kay-Lambkin, S.A. Hunt, T.J. Lewin, V.J. Carr and J. Connolly. Addiction, 105, (2009) 87-99.
  • Clinician-assisted computerised versus therapist-delivered treatment for depressive and addictive disorders: A randomised controlled trial. F.J. Kay-Lambkin, A.L. Baker, B. Kelly and T.J. Lewin. Medical Journal Australia, 195, 3, 1 August 2011.
  • Computer-based psychological treatment for comorbid depression and problematic alcohol and/or cannabis use: A randomized controlled trial of clinical efficacy. F.J. Kay-Lambkin, A.L. Baker, T.J. Lewin and V.J. Carr. Addiction, 104, 278-388 (2009).
• ComfortAble® for chronic pain
  • Cognitive-behavioral therapy for individuals with chronic pain: Efficacy, innovations, and directions for research. D.M. Ehde, T.M. Dillworth and J.A. Turner. American Psychologist (2014), Vol. 69, No. 2, 153-166.

We further validate this research with outcomes from practical application of our solutions. By doing this, we ensure our clients and members receive only high-quality products and services that work in the real world—where it really matters.

SOURCES:

• ACT is an Empirically-Supported Therapy: Background and Clinical Evidence
• Act Theory: Acceptance and Commitment Therapy Explained
• CBT Explained: An Overview & Summary of CBT
• Dialectical Behavior Therapy
• EDMR Therapy
• Exposure and Response Prevention in the Treatment of Obsessive-Compulsive Disorder: Current Perspectives – PMC
• The Evidence for Cognitive Behavioural Therapy in any Condition, Population or Context: A Meta-review of Systematic Reviews and Panoramic Meta-analysis
• Fluoxetine: a review on evidence-based medicine
• National Library of Medicine: Pregabalin
• National Library of Medicine: Risperidone
• New Therapy Shows Promise for Swift Treatment of Obsessive Compulsive Disorder – Association for Psychological Science – APS
• Psychiatry.org – Study Supports Effectiveness of New Fast-Acting Antidepressant, Esketamine Nasal Spray
• Transcranial Magnetic Stimulation
• VR therapy for OCD Can Enhance the Delivery of Exposure Response Prevention
• What is Evidence-Based Therapy: 3 EBT Interventions

Since joining Magellan Behavioral Health of Pennsylvania (Magellan) two years ago, Stephanie Cassanese, stays busy in Cambria County supporting many different aspects of Magellan’s business in the Pennsylvania counties served by Magellan. In her role as supervisor of Recovery and Resiliency Services, Cassanese first and foremost leads the recovery and resiliency team and leads MY LIFE for Pennsylvania, where she oversees all aspects of the youth and young adult program for all Magellan counties.

“I do many things and every day here is different which is one of the reasons I love the job. It’s never the same day twice,” said Cassanese. Continue reading to learn more about the many innovative initiatives Cassanese and her team are working on at Magellan:

What project have you recently worked on that is impactful?

My team completed a project at the end of 2022 called the Peer Professional Employment Guide. It’s a workbook that we provide to new certified peer support (CPS) professionals with the goal of providing a source of advice and inspiration. This was a part of our Workforce Development Project that we’re continuing into 2023 post-COVID. There have been staffing shortages in every industry, but particularly in mental health. We’ve struggled to find and retain workers, so this is a part of our hope to retain newly trained peer professionals. There are a lot of individuals that get into peer support and don’t know what they’re getting into. The workbook shares information on everything from getting hired, interviewing, ethics, boundaries, and self-care. We also include testimonials from working peer professionals, so that individuals coming into peer support know what to expect.

Why is Magellan Behavioral Health of Pennsylvania the best place to work on creative projects?

Magellan is more than just a managed care organization; we really want to collaborate with the counties that we serve. I think Magellan encourages relationship building and that’s really the core tenet of my job, just building relationships with our county and provider partners and reassuring them that if they have questions or need any peer support related information, they can come to me. That’s something that Magellan really promotes collaboration and the idea of going above and beyond.

What are your thoughts on the culture at Magellan Behavioral Health of Pennsylvania? How has that culture impacted your team?

The culture here is really to be collaborators with our counties and providers. I think what differentiates us from other managed care organizations is that we’re not just the people that pay the claims. More than that, we try to be present at different events together with other stakeholders. Leadership is supportive; they want us to be out there in Pennsylvania communities, and leadership is always looking to help make that happen. We always strive to do better than we did the day before, that’s the culture here.

What exciting trends in the healthcare industry have you noticed? In what direction do you see healthcare going in? What lessons are there to learn from other industries that can be applied to healthcare?

The biggest one that comes to mind is the focus that the state and federal government is putting on suicide prevention and education. Since COVID, suicide rates have skyrocketed, and people are feeling more isolated and lonelier than they ever have before. This can also be related to another research push I’ve seen recently, which is on the impact of social media on youth and young adults on FOMO (the fear of missing out), self-esteem, and body image issues. I think that focusing on both, post-COVID, is going to be important.  Self-care has become common, and I think it is important that we encourage people to focus on caring for themselves, both physically and mentally. Magellan has also implemented a suicide risk assessment plan to identify members who may need additional support or treatment.

The healthcare industry also continues to conduct research focusing on things that are significantly impacting mental health, post-COVID. This is also more of a focus because our physical health and our mental health are one. When you’re struggling with your mental health, then your physical health will suffer and vice versa. I hope we continue with that direction because they are not two separate things. We’re one body, soul, spirit, and mind and it’s all connected.

A certain amount of ambiguity surrounds the term autism and often suggests a stereotypical image, but autism affects individuals uniquely. Over the years, professional theories about autism and other childhood disorders shifted to try to better capture what is now known as Autism Spectrum Disorders (ASD). Causes and treatments continue to be put forth to capture pieces of the mysterious puzzle. Though commonalities persist, each person with ASD experiences a unique level of impact on skills, intelligence, and capability and even the characteristics of siblings with ASD can vary widely. A few unique thinkers and accomplished artists that fall into this population are Albert Einstein, Thomas Edison, Emily Dickinson, Sir Isaac Newton, Beethoven, Mozart, de Vinci, Anthony Hopkins, and Jerry Seinfeld.

Early Warning Signs

Currently, one in forty-four children are diagnosed with ASD, with over 1 million reported to be in active-duty military families, according to 2021 CDC data (7) and Operation Autism (11). The American Autism Association offers some early signs and symptoms to be aware of for parents raising young children. (1):

Communication

• Delays in language development.
• Quirky repetitive language or sounds.
• Inability to initiate or maintain speech.
• Responds by repeating a question, rather than answering it.
• Difficulty communicating needs or desires.

Social Interactions

• Lack of appropriate verbal and nonverbal behavior.
• Lack of ability to develop peer friendships.
• Social and emotional exchange challenges, including maintaining eye contract.
• Minimal tolerance to being touched, held, or cuddled.
• Trouble perceiving or talking about feelings.
• Trouble sharing interests or successes with others (art, playthings).

Patterns of Behavior

• Restricted, repetitive and stereotyped behaviors.
• Difficulty in motor control
• Peculiar connection to objects.
• Distress with change in routine.
• Lining up toys.
• Head banging or rocking back and forth.

Looking Closer

Concerned parents are encouraged to speak to their child’s medical provider. Most communities offer free screenings to assess developmental progress and check for school readiness. The earlier an ASD screening occurs, the better, as this is the first step toward diagnoses which leads to important early interventions. Siblings of children with ASD screened, since ASD can present families. Military treatment facilities can assist through Educational and Developmental Intervention Services (EDIS). Once a screening determines risk factors and signs of ASD, a formal diagnostic evaluation is conducted to identify areas that may be addressed in treatment, such as challenges in social communication, behaviors, sensory issues, and the level of impact on daily functioning is assessed. (1)

Children on the autism disorder spectrum experience a unique combination of impacts on brain functions (i.e., thinking, memory) that may reflect some strong skills in one functioning area and low abilities in other areas. For example, a strong math aptitude may be coupled with a slow processing speed that appears as laziness to observers. Social issues may surface as peer conflict and loss of friends due to errors in interpreting social cues and sensory discomfort felt when looking others in the eye. A perceived lack of empathy may result from a child experiencing intense feelings of empathy, but not knowing how to identify or act on them, and then responding inappropriately. Inadequate verbal skills and meltdowns may occur when emotional or sensory stimulation floods the child, maxing their coping skills (as with loud noises or unexpected changes).

Easily knocked out of balance, these children struggle to identify and communicate their needs. Sensory sensitivity, such as the feel or fit of clothing fabric, food texture or taste, odors, certain sounds, temperature variations, and light levels can flood the brain at unbearable levels. Food refusals can make it difficult for them to receive adequate nutrition, complicating healthy development. Nearly half will run or wander off without warning and many struggle with physical tasks like writing or riding a bike. With 40% of ASD children lacking verbal skills, it can be stressful for both caregivers and child to understand each other despite access to communication assistance devices. (4)

Diving Deep

The five major types of disorders falling under the ASD umbrella are Asperger’s, Rett’s, Kanner’s syndrome, Childhood Disintegrative Disorder, and Pervasive Developmental Disorder. It is very common to see other disorders accompanying ASD like Attention Deficit Hyperactivity Disorder (ADHD), Dyslexia, and Dysgraphia which can complicate the individual’s learning processes. Other concerns affecting this population in higher numbers are bullying, self-injurious behavior, anxiety, depression, schizophrenia, various health issues and physical disabilities.

Boys are four times more likely to be diagnosed with ASD than girls. (7) Professional theories have asserted that girls may be more likely to compensate by masking their symptoms resulting in a missed diagnosis or being misdiagnosed. (11). Girls may have subtle symptoms or higher functioning and do not always exhibit characteristics according to traditional ASD testing markers.

High functioning autism, (Asperger’s, ‘Aspie’), is seen in individuals with high levels of intelligence in some areas and deficits in others. The terms ‘camouflaging’ or ‘masking’ refer to sophisticated compensation skills where one notices, studies, and mimics the social skills of others, to compensate for natural tendencies. This can trigger remarks about them being too outgoing to have autism and undermine their self-awareness and identity. (5) ‘The invisible edge’ coined by Autism specialist Tony Attwood, describes these persons as flying under the radar resulting in either a late diagnosis or a missed diagnosis. (2) Delays in confirming the diagnosis hinder crucial access to early services and lead to the child facing expectations outside their abilities.

Compassionate Responding

Caring for a child with ASD can be quite physically and emotionally exhausting. Finding support can make a big difference. When a parent is stressed, it can be hard to be their best self for their special needs child and the rest of the family. Self-care for the caregiver is a necessary survival skill. Military installations offer respite care to help the caregivers and some states will offer pay for respite caregivers.

Emotional outbursts are common for children with ASD and challenging for parents to handle. It is helpful if the caregiver remains calm and models good coping skills from which the child can then draw to self-soothe. Using a distraction or special interest of the child (reading or playing with cars) can help calm the child. Raising voices and increasing tension can inadvertently prolong periods of challenging behaviors. Attuning regularly to the nuances of the child offers a parent greater ability to notice and appropriately respond to symptom escalation.

The American Autism Association identifies common interventions to include speech and language therapy; occupational therapy to address motor skills, sensory issues, and functional living; play therapy and floor time to aid in emotional and cognitive development; and social skills/ communication therapy to assist with socialization and emotional management. (1) Building a team of professionals around the child supports growth. It is vital to keep in mind that individuals with ASD can be quite gifted in areas of aptitude, enjoy life, and lead productive careers.

Military Families

Military lifestyle challenges are already difficult for the average family but for the family dealing with autism, essential care can be complicated. The process of confirming an ASD diagnosis can take up to 18 months to complete due to long wait times for testing. For the military family, duties, and permanent changes of station (PCS) moves can not only complicate this timeline but also delay the feedback process from providers and teachers who may have less opportunity to consistently observe and work with a child. Additionally, remote installations may not be able to offer access to all the necessary services, making participation in the Exceptional Family Member Program (EFMP), a significant benefit to the military child, less feasible. Operation Autism offers an in-depth resource Guide for Military Families and an interactive geographical map of resources. (11)

Many ASD symptoms can be intensified by stress and frequent changes that come with the military lifestyle as these children benefit most from a predictable routine and steady environment. Frequent relocations, changing homes, schools/ teachers, and making new friends, are especially difficult for children on the spectrum. With social skills already elusive, the ASD child may find these changes unbearable. Frequent social rejections and bullying can further frustrate attempts at making even a single real friend. Higher stress can lead to more health issues with these children who do not read their body cues well and even a loss of previously gained skills.

Magellan Federal Solutions

Magellan Federal provides counselors for many programs like the Military Family Life Counseling Program (MFLC) located on many installations within the US and overseas. The MFLC program is available to service members and their families for non-medical support. Although the medical nature of the ASD diagnosis causes the child to be out of scope for direct MFLC services, family members can be supported with counseling, resources, and referrals. The MFLC program offers a variety of including Healthy Steps Specialists working with parents of children 0-3 in pediatric clinics; Child and Youth Behavior Counselors working in the Child and Youth Program in CDCs/ school age services, and schools; and Adult MFLCs located in the family readiness centers. Other resources an MFLC might make referral to are Exceptional Family Member Program (EFMP), New Parent Support Program (NPSP), Tricare, and Military OneSource. Each of these assist parents with specific concerns related to their children.

EFMP is an installation-based program (offered by the Magellan Federal family in some locations) serving the military family with special needs members and is the best first stop for the family with a child newly diagnosed; offering support, resources, and information on assistance like respite care for parents. NPSP, also provided by Magellan Federal family at some locations, offers military families in home support to assist families with children under age five with visits by a nurse or social worker.

Regardless of when in the journey an ASD diagnosis is received, the military family does not have to travel the road alone. Magellan Federal is committed to providing support and guidance along the way.

This article was originally published on MFed Inform.

Resources and Bibliography

1. American Autism Association: myautism.org, https://www.myautism.org/information-kits https://www.myautism.org/informational-kits/general-therapies-for-individuals-with-autism
2. Attwood, Tony. Asperger’s Syndrome: A Guide for Parents and Professionals. Jessica Kinglsey Publishers 1998.
3. Autism Society: https://autismsociety.org/
4. Autism Speaks: autismspeaks.org
5. Abilities Workshop: https://special.abilitiesworkshop.com/autism-resources?gclid=EAIaIQobChMIiPj53OG9_QIVGXxvBB3CQg1tEAAYASAAEgJgTPD_BwE
6. Bargiela, S., Steward, R. and Mandy, W. (2016) ‘The Experiences of Late-diagnosed Women with Autism Spectrum Conditions: An Investigation of the Female Autism Phenotype. Journal of Autism and Developmental Disorders 46, 3281-3294
7. Center for Disease Control https://www.cdc.gov/ncbddd/autism/index.html
8. Exceptional Family Member Program (EFMP), an installation-based program offered by the Magellan Federal family in some locations, serving the military family with special needs children, including autism and is the best first stop for the family with a child newly diagnosed with ASD; offering support, resources, and information on assistance opportunities like respite care for parents.
9. Military OneSource offers a special needs consultant at 888-342-9647, articles and information. militaryonesource.mil
10. National Professional Development Center on Autism Spectrum Disorder. (NPDC). https://autismpdc.fpg.unc.edu/national-professional-development-center-autism-spectrumdisorder. Develops free professional resources for teachers, therapists, and technical assistance Focused Intervention Resources and Modules (AFIRM), a series of free online modules.
11. Operation Autism website offers a resource Guide for Military Families including an interactive geographic guide to local resources at https://operationautism.org/autism-101/causes-and-prevalence-rates/. https://operationautism.org/resources/bases-map/.
12. Organization for Autism Research (OAR). https://researchautism.org/ Non-profit organization responsible for creating Operation Autism and guide and offers free resources either as a digital download or hard copy.
13. Tricare offers special needs liaisons and autism specific resources and information including providers and programs like Echo and Autism Care Demonstration.
14. Extended Health Care Option (ECHO) supplemental benefit for Active Military families with special needs. More information provided through Tricare.org
15. Autism Care Demonstration. https://www.tricare.mil/Plans/SpecialPrograms/ACD

It’s a commonly accepted perspective in the field of mental health that all behaviors have a goal. When it comes to understanding youth who are challenged with an autism spectrum disorder (ASD), the key is realizing that all behaviors represent efforts to communicate. Rigid expectations of social behaviors and decision-making based on age can interfere with supporting a person on the spectrum, especially when communication is expressed differently when compared to the general population. While the behaviors of someone on the spectrum may seem unusual or even at times disruptive, the best approach for understanding a person with autism, especially youth, is to determine the goal, how the goal is communicated through their behaviors, and the intersectionality of those behaviors with peer interaction, transitioning to adolescence and adulthood, and adapting to new environments due to a military permanent change of station (PCS) or sudden absence of a parent. Intentionally diversifying sources of support can improve outcomes for youth especially as they transition into adulthood.

Understanding Autism[1]^,[2]

Autism Spectrum Disorder (ASD) is defined as a neurological disorder that, because of its effects on brain functioning, can negatively impact daily interactions such as socializing, displaying affection, and communicating. This impact has far-reaching implications, spanning multiple domains and presenting in an unpredictable manner. The severity of the disorder is compounded by co-occurring conditions and adverse reactions to sensory stimuli, such as lighting and noise.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) provides further clarifying terms, using two identifying categories of symptoms to provide a basis for diagnosis of autism:

• Persistent deficits exist in social communication and social interaction across multiple contexts and restricted, repetitive patterns of behaviors, interests, or activities.
• Some of the characteristics include repetitive movements and speech, inflexibility, fixated interests, and hyper-/hypo-reactivity to sensory input.

Similarities With Other Youth[3]^,[4]

Youth with autism are prone to experience the same desires for friendships and intimacy as their peers. They share the same right to have educators and family educate them on this topic. These youth will also experience peer pressure and bullying, as all youth do. Kids with ASD crave same-aged allies just like others their age. They are vulnerable to missing non-verbal cues that mask sarcasm, teasing and even malicious intent. Peers who are not on the spectrum but have demonstrated healthy social skills are ideal for helping youth with autism to communicate and understand communication.

Differences From Other Youth[5]

Understanding autism in youth is more than a simple exercise in definitions and categorizing symptoms—a concerted and diligent effort for research is needed across disciplinary domains. The CDC’s Study to Explore Early Development (SEED) has provided the most comprehensive study of ASD in the United States, examining the health, functioning, risk factors, and signs present in preschool-aged children. Such a study empowers others to support the ability of a person with autism to effectively communicate. Amid a scarcity of research exploring ASD among pre-/teens, the SEED’s usefulness has been further expanded to survey the families of 800 children between the ages of 12-16 who were a part of the initial phase of SEED. Although similarities between neurodivergent youth and neurotypical youth can easily be identified, this study shines a necessary light on the differences between adolescent cohorts.

The findings in this report reveal that adolescents with autism experience a need for greater support in the areas of physical and mental health, as well as extending the use of healthcare beyond the stage of adolescence, in contrast to peers their age.

In comparison to adolescents in the control group of this study, children with autism were 90% more likely to have co-occurring mental or physical health conditions and at the same time more than three times likely to not access appropriate health care for those needs.

Being included in general education classrooms is a boon to social competence in youth with ASD, but not a fix. Social deficits create a need for interventions that coach social skills for them, such as initiating or inviting others to play and engage, while these skills naturally occur in typically developing youth.

A peer helper can assist with bridging the gap between these differences, offering the chance for youth from both cohorts to experience and engage in friendly behavior in a variety of environments, such as classrooms, recreational areas, or after-school events.

It may be difficult for a child from either cohort to articulate the differences, but the relational tension will be present, nonetheless. Interventions should assist both children, equipping them with clearly defined choices that improve the likelihood of forming a healthy social connection between them.

Challenges for Military Families

Military sources indicate that more than 13,000 military dependents, the majority being children, have some form of autism. No matter where they go, their families will always be the immediate support system, a system vulnerable to emotions and challenges related to the difficulties of military life: a permanent change of station, frequently absent or deployed parents, changing primary care managers and parental/marital stress.

A diagnosis of ASD means that every day a caregiver must plan every activity to prevent behaviors that will likely be misunderstood by those untouched by ASD. Even when connecting the youth with an organization that can provide care and interaction outside of the home, the caregiver will need to provide specifics about their child’s needs and determine if the environment they are entering is an adequate fit. The environment should include staff trained to intervene and redirect especially by understanding what behavior that seems disruptive is trying to convey on behalf of the child. Most parents and caregivers find themselves repeatedly having to explain to other professionals why their child reacted the way they did.

Another frustrating factor that families looking for support outside of the home encounter is simply a lack of affordable and competent sites. The emotional toll on a parent or caregiver from frequently reaching a dead end can exhaust even the most resilient. The chances of finding a great fit for a youth with ASD is generally cut in half by the lack of behavior management services, the expense of the programs, and the sad reality of untrained staff.

Military families also encounter increased hardship introduced by the search for evidence-based treatment services, especially when a new duty station proves to be a disruption to receiving quality care. Not all stations have ease of access to needed services.[6] Military children and their families move every few years. These frequent changes hinder the ability to maintain secure relationships in the school setting and with each move, the rigors of advocacy for individualized services are reborn. Any family who has dealt with a military move can vouch that the process is replete with paperwork. A family who has a child with autism has their work nearly doubled. Important documents and steps to take include, but are not limited to, the most recent copy of an IEP, a current behavior plan, medical documentation, connecting with the receiving school play son, a new therapist, and finding a neighborhood accessible to community-based services.

Financial strain is another stressor faced by military families. Spousal unemployment can easily become a dynamic for a family with a child on the spectrum. It is often simpler and more cost effective to care for the child at home, especially when hours for paid time off become depleted due to frequent calls from the school for a parent to come deescalate the child.

Frequent moves, financial strain, and harried reintegration processes can mount into a tremendous pile of stress leading to feelings of isolation and marital discord in many cases. Finding and building a support system, albeit challenging, is not impossible and is worth its weight in gold. Despite all the barriers and challenges of a military lifestyle, friendships and systems that are built often turn out to be lifelong relationships. Military living means that a challenge posed for one is a challenge accepted by all.

How the MFLC Program Can Help with Communication

The Military and Family Life Counseling program supports service members, their families and survivors with confidential non-medical counseling where they are stationed. Recognizing behavior as a form of communication is a skill possessed by Military and Family Life Counselors (MFLC) counselors. MFLCs are in an excellent position to support families and schools by providing referrals and psychoeducation about the need for behavior to be interpreted rather than reacted to.

Anxiety for anyone is an emotion that disables executive functioning. MFLCs can equip staff and family with language that prevents and even deescalates anxiety in youth with autism. A person with ASD may look away for a moment or two before responding to directions. Rightly interpreting this behavior can prevent the wrong reaction and a misunderstanding. A pause in responding doesn’t necessarily mean unawareness or lack of intellect—for the person with ASD, looking away may mean, I need a quick break from stimuli.

MFLCs can also help by increasing awareness of incorrect assumptions, such as the aforementioned “pause” as a lack of emotionality, and biases built into labels such as low or high functioning. MFLCs can coach staff and family to ask, “what support do you need,” rather than assuming wrongly about the support needed at any point on the spectrum.

Effective communication is essential in at least two settings: school-based and healthcare. Data show a strong correlation between time spent in general education classrooms and increased academic skills and knowledge, receipt of a high school diploma, and/or increased access to typical peers, which promotes a primary desire for youth in general: healthy social relationships. The ultimate benefit is enhanced integration in the community. Youth participation in work opportunities, paid and unpaid, during high school is also connected to better outcomes in adulthood. To get started with the MFLC program contact your installation’s Military and Family Support center.

Tips for Preventative Healthcare

The single greatest external factor in fostering support for a teen preparing to enter adulthood is preventative healthcare. While under the care of their family, youth with autism benefit from services such as the Exceptional Family Member Program (EFMP), Extension for Community Healthcare Outcomes (a virtual interdisciplinary network for providers which includes parental feedback), Tricare, and Individualized Education Plans (IEP)/504 plans. However, as discussed, youth with autism are less likely to continue healthcare into adulthood. The goal for preventative healthcare is to equip the person receiving the healthcare with an awareness of what their health can and should look like and the right to receive that care.

An ideal strategy for improving health outcomes and reducing service gaps for youth with autism involves interdisciplinary training promoting the use of evidence-based interventions. Operation Autism lists several, including the most widely used, Applied Behavioral Analysis (ABA), Picture Exchange Communication Systems (PECS), and Speech and Language Therapy (SLT) across multiple contexts. At a minimum, as recommended by the CDC, care should be timely, coordinated, and family centered. Practitioners and school administrators should encourage parents and caregivers to enroll youth early in services, such as insurance plans and residential living, that support the transition to adulthood.

According to measures included in the Health Resources and Services Administration Maternal and Child Health Bureau National Performance as reported by the CDC SEED 2 study, practitioners should ensure three elements are met when establishing a wholesome health care transition:

• The youth should spend time alone with the primary care provider,
• The PCP should actively work with the child to understand healthy living, and
• The parent should know how the child will be insured when they reach adulthood.

Conclusion

The research-to-practice gap is steadily closing with studies such as SEED and the increase of evidence-based practices (along with the collective disapproval of ineffective and harmful treatment practices). Understanding the needs of youth with autism has been difficult but is no longer the apprehensive feat it once was, and while military families with ASD may have additional stressors, there is a system of support available to help navigate these challenges. Ultimately, communication is a gift for all human beings to use in the quest to understand one another, and establishing healthy communication with youth with autism is not simply a matter of teaching them what to say but it largely entails the ability to interpret what they are already saying.

This article was originally published on MFed Inform.

[1] Low Functioning to High Functioning Autism: A Prescriptive Model for Counselors Working With Children Across the Spectrum. Katherine Feather, 2016. https://www.counseling.org/docs/default-source/vistas/article_11d2bf24f16116603abcacff0000bee5e7.pdf?sfvrsn=4ca9442c_4

[2] Operation Autism. (n.d.). Life Journey through Autism: A Guide for Military Families

[3] Autism Speaks. 2013. Leading The Way: Autism Friendly Youth Organizations. https://www.autismspeaks.org/tool-kit/leading-way-autism-friendly-youth-organizations

[4] https://www.plannedparenthood.org/planned-parenthood-massachusetts/local-training-education/parent-buzz-newsletter/parent-buzz-e-newsletters/sexuality-education-youth-autism-spectrum

[5] Health Status and Health Care Use Among Adolescents Identified With and Without Autism in Early Childhood — Four U.S. Sites, 2018–2020. Powell PS, Pazol K, Wiggins LD, et al. https://www.cdc.gov/ncbddd/autism/autism-spectrum-disorder-in-teenagers-adults.html

[6] Toward Innovative, Cost-effective, and Systemic Solutions to Improve Outcomes and Well-being of Military Families Affected by Autism Spectrum Disorder. 2015. Klin et al. https://pubmed.ncbi.nlm.nih.gov/25745376/

“Oh my! It’s raining cats and dogs out there!” A second-grade girl remarked as she stared out of a classroom window. Another child, wide-eyed and twirling her braid, turned and stared in shock and disbelief at the raindrop scattered windowpane. “What do you mean, those poor puppies!?” she cried. “Nooooo….” scoffed another classmate, “There are NO ANIMALS. She means it’s raining REALLY HARD.” The concerned child saddened about the well-being of the possible tumbling animals outside, slumped down in her chair, trying to avoid the gaze of everyone. Her eyes welled with tears, and she remained silent throughout the rest of the class. She continued to twirl her hair with more vigor. Soon the sun began to shine via the droplets on the windowpane, and she stopped twirling her hair to stare at the beautiful array of light. “This is a prism, a spectrum of light.” She whispered to herself.

Children with Autism Spectrum Disorders have their own unique struggle. Like the spectrum of light, Autism diagnosis defines a broad range of conditions that demonstrate marked struggles with language (expressive/receptive), repetitive/restrictive behaviors, social skills, and nonverbal communication. This vignette of an interaction between three 8-year-old children provides an example of a receptive language issue. For this little girl, she struggled to understand an idiom likening the raindrops to “cats and dogs falling from the sky.” Dr. Stephen Shore stated, “If you met one person with Autism, you have met one person with Autism.” He is an author, a professor of Education, and a member of the board of Autism Speaks, an organization created to educate and advocate for those affected by Autism throughout their lifespan. His quote incites awareness that while a child may be diagnosed with autism, their presentation and needs will be unique. (APA, 2013)

Autism Speaks shares statistics and trends that have shown a steady increase in the diagnosis of autism spectrum disorders (ASD). Diagnosis has become more comprehensive in recent years. Awareness and early detection have been associated with an increase in the frequency of diagnosis. The Centers for Disease Control (CDC) reported in 2021 that 1 in 44 children was diagnosed with an autism spectrum disorder in the United States. Autism affects children across all socioeconomic statuses and minority groups. Minority groups are diagnosed at a later age and at a lesser frequency than other demographic groups. Families face multiple challenges after diagnosis. These include parents having difficulty maintaining ‘out of the home’ employment while becoming full-time advocates for their children. The additional cost of providing treatment and care per child with ASD is approximately $60,000 per year (Autism Speaks, 2017).

Risk Factors of Military Children with Autism

While 1 in 44 children in the general population is reported to be diagnosed with Autism, the statistics are not entirely clear for military children. In 2020, TRICARE reported that across all branches of service, 34,361 military children were diagnosed with an autism spectrum disorder, with about 60% being children of active-duty Service members. It is suspected that these numbers are underreported (Klin et al., 2015). Military children with Autism and their families face unique stressors and struggles compared to their civilian counterparts. Military families must secure a treatment provider and participate in testing, diagnosis, treatment, and educational support while remaining mission-focused.  Stress is escalated with uncertainties about deployment, war, and geographic separation from their support systems in permanent changes of duty station (PCS) (OAR, 2019).

Case Study/Expertise

Although there have been many systemic improvements in services for military children, there are still barriers that exist due to the high mobility nature of military life. Most military families move every 2-4 years, requiring parents to establish new care providers for their children once they arrive at their new location. For children who require specialized care, it is even more daunting. After months of treatment in their current duty station, they are required to “go back to the end of the line” once they locate a new service provider. High frustration levels were also reported due to a lack of satisfaction with the quality of the care their child receives at their new provider. Families not only geographically isolated from their previous providers, but military parents with children with autism reported higher stress levels and social isolation across qualitative research after relocation and during separation (Klin, et al, 2015).

Deployment cycles lead to increased behavioral and emotional issues for military children. Parents have reported that once their child’s problematic behaviors have stabilized after their parent has deployed, their behaviors may increase once again once the parent returns from deployment. Children exhibit increased emotional withdrawal and repetitive behaviors when their Service member parent is deployed. It has been reported that the parent left behind to manage the care of the entire household can experience feelings of guilt and worry about providing adequate parenting alone (Davis and Finke, 2015).

Permanent Change in Duty Station (PCS) also takes a unique toll on the military child with autism. Friendship and social interaction are protective factors and good for overall mental health. Military children move frequently and must make new friends in their new hometown and school. Autistic children innately struggle with making social connections, making it harder to establish new positive social connections with peers. Autistic children were reported to be lonelier and more withdrawn after relocating to their new location (Davis and Finke, 2015).

Magellan Federal Best Practices

As mission partners, Magellan Federal Military & Family Life Counselors (MFLCs) can become the help multiplier for these special families. MFLCs may serve as referral linkages, connecting families to the life-changing services locally or at their next duty station before moving. MFLCs may create an Autism Resource Connect (ARC)—a smooth connection to autism resources for military families from one base to the next. This proposed program component can partner with base resources to maintain an updated roster of local providers to ensure that before, during, and after the process of permanent changes of duty station (PCS), families can ensure a comprehensive and smooth transition to local support. Utilizing the current Military Family Life Counseling network of counselors, resource lists can be maintained locally and can be shared with their counterparts at other installations.

Although MFLCs do not provide direct support for the child diagnosed with autism, their families may benefit from the non-medical counseling support. MFLCs can provide support through individual, marriage, and family counseling. MFLCs can also connect with local Exceptional Family Members Programs (EFMPs) to provide MFLC briefings/presentations to families currently within the program advising of support that can be provided to the family unit. Although the child with exceptional needs is out of the MFLC program scope, the parents and siblings are not.

Another gap that appears to exist in care for these military families is the support of the siblings of children with autism. School MFLCs have particularly great advantages in identifying and serving these unique children. Siblings of children with autism, particularly older siblings, tend to externalize stress and frustration through negative behaviors. MFLCs situated in middle schools and high schools may be instrumental in providing support for these children. These siblings empirically have shown higher tendencies to experience loneliness, academic struggle, and aggression (Walton & Ingersoll, 2015).  MFLCs can create spaces of peer support in the groups.

In April, we celebrate the Month of the Military Child. We wear purple in support and solidarity-creating awareness of the unique challenges of the military child. Military children and families affected by autism experience these challenges compounded by navigating life’s daily routine challenges. While awareness is wonderful, awareness is the first step. Magellan Federal supports children diagnosed with an autism spectrum disorder and their families by bridging gaps in support and care. Specifically, MFLCs provide briefings and psychoeducation regarding available services to supportive base programs. Autism is a life-long disability. With support, every individual can reach their potential. The outcomes for children are exponentially better with early diagnosis and intervention. MFLCs can make a difference. One Team. One Mission.

Resources

OAR. A Guide for Military Families(2019) https://operationautism.org/wp-content/uploads/2019/12/A_Guide_for_Military_Families.pdf

Autism Speaks www.autismspeaks.org

Exceptional Family Member Program https://www.militaryonesource.mil/special-needs/efmp/

References

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.

Autism Speaks(2019). Autism and Health Report https://www.autismspeaks.org/sites/default/files/2018-09/autism-and-health-report.pdfb

Davis, J., & Finke, E. (2015). The Experience of Military Families with Children with Autism Spectrum Disorders During Relocation and Separation. Journal of Autism and Developmental Disorders, 45(7), 2019-2034.

Klin A, Wetherby AM, Woods J, Saulnier C, Stapel-Wax J, Klaiman C, Jones W, Rubin E, Scahill L, Call N, Bearss K, Gunter C, Courtemanche CJ, Lemieux A, Cox JC, Mandell DS, Van Decar JP, Miller RA, Shireman CL. Toward innovative, cost-effective, and systemic solutions to improve outcomes and well-being of military families affected by autism spectrum disorder. Yale J Biol Med. 2015 Mar 4;88(1):73-9. PMID: 25745376; PMCID: PMC4345541.

OAR. A Guide for Military Families(2019) https://operationautism.org/wp-content/uploads/2019/12/A_Guide_for_Military_Families.pdf

Walton, K.M &Ingersoll, B.R. (2015) Psychosocial Adjustment and Sibling Relationships in Siblings of Children with Autism Spectrum Disorder: Risk and Protector Factors.