Dr. Katherine Sullivan on How We Can Better Serve Veteran-Connected Children and Families

Assistant Professor Kathrine Sullivan joined the NYU Silver Faculty in September 2018 after earning her PhD from the University of Southern California. Dr. Sullivan's primary research interest is the impact of trauma on the children and families of military service members, and she recently completed a study funded by the National Institute of Child Health and Human Development entitled “Mental Health Outcomes Associated with Profiles of Risk and Resilience Among Military-Connected Youth.”

With Veteran’s Day approaching, we spoke to Dr. Sullivan about her research and how we can better meet the mental health needs of children and families of Veterans.

NYU Silver:
While the nation’s attention is focused on our Veterans, is there something you would like us to know about the particular challenges their children and families face?

Dr. Sullivan:
It is important to stress that data show most Veteran-connected families -– and families of active-duty military -– are doing fine. We tend to sensationalize the subset that are struggling and lose sight of the fact that they are the minority. That said, this small set of families, who are exposed to more risk factors (such as combat exposure) and have fewer protective factors (such as social support) need services and supports.

One of the things that is a big challenge working with the Veteran population as opposed to active duty military is we often don't know where these families are. Once service members separate from the military, the Department of Defense (DOD) no longer follows them. The Department of Veterans Affairs (VA) has a much harder time keeping track of Veterans. We know that children in Veteran families are exposed to a particular set of stressors and there are potentially pretty easy things that we can do to ameliorate some of those stressors, but we have to be able to find them.

NYU Silver:
What are some of those easy things that could be done to help Veteran-connected youth?

Dr. Sullivan:
Some large school districts around the country have recently started asking about military or Veteran connections when students enroll so that these students, who may be experiencing increased stress, could more easily be identified and referred to supportive services either within the school or in the community if needed.

Access to supports is a key concern. Veteran-connected kids experience some of the same stressors as military families but not at quite as a high a level. On the other hand, Veteran-connected kids tend to receive fewer supports from the military community than kids in military families, so they are in a grey area.

NYU Silver:
Are there other challenges in delivering mental health services to Veteran-connected children and families?

Dr. Sullivan:
Whereas there is a mechanism to deliver interventions to active duty families through the DOD structure, the mechanism to deliver interventions to Veteran-connected families is much less clear. The VA is starting to provide some couples treatment but, for the most part, the VA does not provide any services to family members or children; their mandate is treating the Veteran.

NYU Silver
Are there unique contributions that social workers bring to work with Veterans and their families?

Dr. Sullivan:
First, I should note that there is a lot of work being done in the area of Veterans’ families’ mental health. It may seem like a niche area, but anybody who is doing work around trauma or around stress in family systems is doing work relevant to military populations. And, as is often the case in fields of inquiry in which social workers are involved, there are psychologists, psychiatrists, and other disciplines triangulating around the topic.

What is unique about social workers is that we are trained to think in more systemic terms and to bring a strengths perspective – a focus on protective factors rather than just risk exposure.

Risk in the military population is a given. People know when they enlist that they and their families are going to be exposed to factors that increase the possibility of negative outcomes, such as behavioral health problems. And while large-scale epidemiological studies have established higher rates of mental health challenges in the military population vs. civilians, as I noted earlier, the majority of the military population is doing fine. My suspicion is that what accounts for the difference between the majority and the small subset that is struggling isn't so much that the latter is exposed to a dramatically increased risk – although that plays a role – but rather that they have less access to protective factors.

You can bring protective factors into a system at multiple ecological levels. For example, we could work on building supports for individual families or strengthen the family readiness groups that are supposed to be an engine for social support across DOD (although research shows that some families do not access them or find them supportive).

NYU Silver:
What is next in your research?

Dr. Sullivan:
I am interested in the mechanism that underlies the disparity between those military-connected families who are fine vs. those who are struggling, with a focus on family processes. There is more work to do to understand from a causal perspective how risk and protective factors play out in mental health outcomes among the spouses and children of service members.

While the potential for trauma to occur in a military family is high, particularly in our current operational climate, I suspect that many service members and their spouses have had higher exposure to traumatic events before they come into the service. In fact, research has shown that service members have higher rates of Adverse Childhood Experiences (ACEs) than the general population and many of them enlist because they are escaping challenges at home. Then once they enlist, they may be sent into combat. Even basic training is a stressful experience. So it speaks to their resilience in a lot of ways that so many service members and their families are doing fine.

While some people define resilience as a trait people have inherently, I recognize it as a process by which they overcome adversity, and that is what I am looking at in my research. I am seeking to understand the sum total of risk and protection that military-connected families experience and how that balance is associated with outcomes. That knowledge will ultimately help us design and implement effective interventions to help military-connected families who are struggling to cope with and rapidly recover from the stressors and trauma of their circumstances.