The Impact of Having a Child With Special Healthcare Needs on Length of Military Service

ABSTRACT Introduction In 2010, the National Survey of Children with Special Healthcare Needs revealed that parents of children with special healthcare needs (CSHCN) report employment decisions are influenced by healthcare coverage needs. The U.S. military healthcare system arguably offers service member parents of CSHCN with the most comprehensive, inexpensive, long-term healthcare in the country—potentially increasing their incentive to remain in the military. This study explored the effect of having a CSHCN on the length of parental military service. Materials and Methods A retrospective cohort was formed using the Military Health System database from 2008 to 2018. Included children were <10 years in 2010 and received ≥1 year of military healthcare between 2008 and 2010. The Pediatric Medical Complexity Algorithm categorized children as having special healthcare needs via ICD 9/10 codes as having complex chronic (C-CD), non-complex chronic (NC-CD), or no chronic disease (CD). Families were classified by the child with the most complex healthcare need. Duration of military healthcare eligibility measured parental length of service (LOS). ANOVA and linear regression analysis compared LOS by category. Logistic regression determined odds of parental LOS lasting the full 8-year study length. Adjusted analyses controlled for child age and sex, and military parent sex, rank, and marital status. Results Over 1.45 million children in 915,584 families were categorized as per the algorithm. Of individual children included, 292,050 (20.1%) were CSHCN including those with complex chronic and non-complex chronic conditions. After grouping by family, 80,909 (8.8%) families had a child/children with C-CD (mean LOS 6.39 years), 170,787 (18.7%) families had a child/children with NC-CD (mean LOS 6.41 years), and 663,888 (72.5%) families had children with no CD (mean LOS 5.7 years). In adjusted analysis, parents of children with C-CD and NC-CD served 0.4 [0.37-0.42] and 0.33 [0.31-0.34] years longer than parents of children with no CD; odds of parents serving for the full study period were increased 33% (1.33 [1.31-1.36]) in families of children with C-CD and 27% (1.27 [1.26-1.29]) in families of children with NC-CD. Conclusions Findings indicate that military parents of CSHCN serve longer military careers than parents of children with no chronic conditions. Continued provision of free, high-quality healthcare coverage for dependent children may be important for service member retention. Retaining trained and experienced service members is key to ensuring a ready and lethal U.S. military.

P111 Sleep disturbances are associated with poor neurobehavioural outcomes following traumatic brain injury: A study of military service members and veterans

Introduction Sleep disturbances are pervasively reported in military service members and veterans, especially following traumatic brain injury (TBI). The purpose of this study was to examine the association between sleep disturbances and neurobehavioural outcomes in a large group of U.S. military service members and veterans, with and without a history of TBI. Methods Participants were enrolled into the Defense and Veterans Brain Injury Center/Traumatic Brain Injury Center of Excellence, 15-Year Longitudinal TBI study (N = 606). Participants self-reported sleep disturbances (PROMIS 8A) and neurobehavioral symptoms. Data were analyzed using analysis of variance with post-hoc comparisons. Four groups were analyzed separately: uncomplicated mild TBI (MTBI; n=218); complicated mild, moderate, severe, or penetrating - combined TBI (CTBI; n=118); injured controls (IC, i.e., orthopedic or soft-tissue injury without TBI; n=162); and non-injured controls (NIC; n=108). Results Participants in the MTBI group reported the highest proportion of moderate-severe sleep disturbances (66.5%) compared to the IC (54.9%), CTBI (47.5%), and NIC groups (34.3%). Participants classified as having Poor Sleep reported significantly worse scores on almost all TBI-QOL scales compared to those classified as having Good Sleep, regardless of TBI severity or even the presence of TBI (ps<.05, Cohen’s ds>.3). Discussion This study demonstrates that sleep disturbances remain a prevalent and debilitating concern in service member and veteran populations. Regardless of group (injured or NIC), sleep disturbances were common and were associated with significantly worse neurobehavioral functioning. When assessing and treating neurobehavioural symptoms, it is important to assess sleep, especially in service member and veteran populations.

Mandating the COVID-19 Vaccine for U.S. Service Members: An Exploration of Ethical Arguments

ABSTRACT As the COVID-19 pandemic continues across the globe, the advent of novel vaccines has created a possible path to prepandemic life for many. Still, many individuals, including those in the U.S. military, remain hesitant about getting vaccinated. The U.S. Food and Drug Administration recently granted full approval to the Pfizer-BioNTech mRNA vaccine (Comirnaty). Consistent with messaging from President Biden, the Department of Defense leadership has instructed the military to prepare for mandatory vaccination. While many have praised this declaration, others have raised concerns regarding the suppression of individual service member autonomy. This commentary explains the different ethical principles relevant to individual autonomy and how they are understood in a military context and then explores the ethical arguments both for and against mandating vaccination for all U.S. service members.

Counseling LGBT Military Clients Using the Multicultural and Social Justice Counseling Competencies Framework

When working with LGBT service member clients, counselors should use the Multicultural and Social Justice Counseling Competencies as a framework to guide their practice as they navigate the intersection between the military culture and LGBT culture. This framework addresses four domains that are foundational for multicultural and social justice competency: (a) counselor self-awareness, (b) the client worldview, (c) the counseling relationship, and (d) counseling and advocacy interventions. Included in the framework are the following aspirational competencies within each domain: attitudes and beliefs, knowledge, skills, and action. Best practices for culturally competent, social-justice-focused work with LGBT service members within each of these domains are discussed.

Impacts of a Resident Camp Experience on the Lives of Military-Connected Youth

Children and adolescents in U.S. military families experience several challenges such as multiple relocations, being separated from a service member parent, the deployment of a service member parent to a war zone, changing peer groups, and fear of death/injury of a service member parent. These unique attributes of being a military-connected child can be somewhat attenuated with programs specifically designed for this population. Using Positive Youth Development (PYD) as the theoretical underpinning, the purpose of this study was to explore the impacts of a week-long resident camp specifically designed for youth of injured, ill, or fallen service members—a much understudied group. An end-of-camp survey intended to determine if attending camp had an impact on three pre-conceived constructs (self-confidence, connections to others, positive coping skills) provided secondary data which were analyzed in this study. More than 3,000 youth ages 8 to 15 years old completed the questionnaire. Demographic information collected was limited to gender and age. Initially, an EFA was conducted to determine if the intended constructs were indeed measured. Following this, t-tests and ANOVAs were applied as appropriate to the data. The EFA determined that four constructs were measured by the survey (selfconfidence, peer connections, coping skills, and perceived counselor support [adult/child relationships])—all dimensions of PYD. Some age and gender differences were also found. The study findings suggest that military-related camp programs be implemented that target boys with active programming and intentional down-time activities (e.g., informal conversations and interactions) to help them create and develop friendships. In addition, by continuing to provide opportunities that are both novel and challenging to campers, staff can help young people to develop a sense of competence and confidence in their ability to take on new activities. As younger campers struggle with positive coping skills, staff have an opportunity to engage the youngsters in conversations and corrective actions to help them develop and practice positive coping strategies. Lastly, the data show that returning to camp for multiple years makes a difference in some aspects of PYD for campers. This suggests that camps may wish to encourage campers to return for several consecutive years; this may conflict with camps that have waiting lists of potential campers and wish to limit the number of times a child may return in an effort to serve more children.

Diagnostic Evaluation of Hypoglycemia Due To an Insulinoma in a Deployed Infantryman: Significance of Neuroglycopenia and the Role of the Military Health System

ABSTRACT Insulinoma, the prototype of endogenous hyperinsulinemic hypoglycemia, is a very rare condition, with an incidence of four cases per million person-years. Its rate of occurrence in the U.S. military population is unknown. Two cases of insulinomas involving active duty service members have been published. However, there has been no reported case of an insulinoma in a deployed service member. We report the case of a 21-year-old infantryman with clinical hypoglycemia of insidious onset, manifesting with overt neuroglycopenic symptoms during his deployment as a combatant soldier, and the ultimate diagnosis of an insulinoma as the underlying cause. The series of multiple clinical evaluations and the unique circumstances leading to the formal evaluation of the patient’s hypoglycemia and treatment are chronicled. The significance of neuroglycopenia and the diagnostic approach to any suspected case of hypoglycemia, the potential challenges and opportunities, and educational aspects of evaluation and management of the insulinoma are elaborated. The potential role of the Military Health System in facilitating the detection and treatment of this rare condition in the service member is discussed as well.