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I Serve 2: Identifying and caring for military-connected kids in a clinical setting

By Dr. Alicia Gill Rossiter and Dr. Peggy Wilmoth

“My daddy taught me how to walk when I was a little girl.  Now I am going to be like my daddy and help him learn to walk.”

Of the 1.3 million service members currently serving in the armed forces, approximately 55 percent are married and 43 percent have at least one child. Since the onset of military action in Iraq and Afghanistan in the early 2000s, more than 2 million military-connected children have had at least one parent deploy. Military-connected children can experience unique stressors that impact their health, yet their physical, psychological, and behavioral healthcare needs have often gone unrecognized outside of military health care settings.

Unlike the children of active-duty service members, whose parents serve full time in the military and typically move every two to four years, children of National Guard or Reserve Component service members typically live in civilian communities and rarely move due to their parents’ military career. As a result, National Guard and Reserve–connected children can experience barriers to culturally competent health care and behavioral health resources where they live. Civilian healthcare providers unfamiliar with the military lifestyle may lack the knowledge or expertise to identify and treat military-connected children, the specific needs and struggles of these children may go unnoticed.

To help providers gain a better understanding of this population, the Military and Veterans Health Expert Panel of the American Academy of Nursing created “I Serve 2: A Pocket Card for Healthcare Providers Caring for Military Children.” The pocket card aims to equip providers with the information they need to better identify physical, psychological, and behavioral health risk factors in military-connected children as it relates to their parent’s military service.

Biden Foundation staff met with Dr. Rossiter, Dr. Wilmoth, and other advocates for military-connected kids in the healthcare space last October to learn more about the “I Serve 2” pocket card.

Katie is a five-year-old whose father deployed to Afghanistan — she is the only child in her school with a parent in the military. During the deployment, her father was injured and survived an improvised explosive device (IED) blast. In addition to having bilateral below-the-knee amputations, he was also diagnosed with PTSD and a traumatic brain injury. Her father will be returning to their small rural hometown in the Midwest after he completes his initial care post-injury in Washington, D.C. Over the next several months to years, Katie and her family will rely on the support of their community to ensure their successful transition.

After her father was wounded, Katie started having nightmares and wetting the bed. She refused to go to school because she was worried about her mom. When she was in school she made frequent trips to the school nurse complaining about stomachaches and headaches. The school nurse had recently attended an in-service on “I Serve 2,” and by using the “I Serve 2” pocket card, the nurse discovered that Katie was worried that her dad may die and that something might happen to her mom.

The school nurse organized a meeting with Katie, her mother, and the school health team — the psychologist, social worker, and nurse — to work on a plan to support Katie and her family during this transition, which Katie described this way:

“He’s not my same daddy that went away to the war but mommy said I need to be a big girl now and help take care of him. My daddy taught me how to walk when I was a little girl.  Now I am going to be like my daddy and help him learn to walk.”

The “I Serve 2” pocket card provides prompts for identification and assessment of military children along with resources for care. The card includes the ICARE Support Strategy — Identify, Correlate, Ask, Ready Resources, and Encourage/Educate. Utilization of pocket cards arms the healthcare provider with specific questions regarding parents’ military service aimed at building resilience and developing healthy problem solving critical to the mission of building healthy military families, while mitigating the impact of parental military service on military-connected children.

As Katie’s story demonstrates, healthcare providers and support staff can play an important role in identifying the needs and challenges faced by military-connected youth. With “I Serve 2,” providers can make sure they’re meeting the needs of every child and family who walks through their doors.

Click here for a downloadable PDF of “I Serve 2: A Pocket Card for Healthcare Providers Caring for Military Children.”

Dr. Alicia Gill Rossiter, Lieutenant Colonel (retired), DNP, FNP, PPCNP-BC, FAANP, FAAN is a board certified pediatric and family nurse practitioner who retired after 25 years of combined active (US Army) and reserve (US Air Force) military service.  Her military experience combined with her selection as a Jonas Veteran Healthcare Scholar and American Academy of Nursing Policy Scholar was the impetus behind her research and scholarly work which includes women veterans and military sexual trauma, the effects of parental military service on military connected children, and transitioning needs of medics and corpsmen into the professional role of nursing. 

Dr. Peggy Wilmoth, Major General, U.S. Army (retired), Ph.D., MSS, RN, FAAN, is a nurse educator who had a concurrent 35-year career in the Army Reserve, culminating her service as the Deputy Surgeon General for the Army Reserve. Her experience as a parent of children who deployed coupled with her experience as a Robert Wood Johnson Health Policy Fellow and her research related to women’s health and military-connected children drive her engagement on these policy issues.