Youth's Sibling Relationships Across the Course of a Parent's Military Deployment: Trajectories and Implications.

The present exploratory study explored the trajectories and implications of at-home (military unaffiliated) parents' perceptions of youth's sibling relationships across the course of a parent's military deployment. Participants included 109 families with at least two siblings (older sibling and younger siblings age: M = 10.85, SD = 3.92 and M = 7.89, SD = 3.58, respectively) and one parent serving in the National Guard. Data were collected via in-home interviews, at six time points across the deployment cycle. A series of multilevel models revealed increases in sibling disharmony during the months a deployed parent was away, but showed signs of recovery in the year after they returned. Increases in sibling disharmony were positively associated with increases in youth's externalizing behaviors above and beyond the effects of parenting.

Military Interprofessional Healthcare Teams: Identifying the Characteristics That Support Success.

Military interprofessional healthcare teams (MIHTs) are foundational to the care provided to military members and their families. However, to date, very little research has investigated MIHTs. Notably, we have few insights into what distinguishes successful MIHTs. This manuscript presents findings from a program of research that was carried out to address this gap. We review what is known about MIHTs to date and the Uniformed Services University's (USU) focused efforts to ensure that greater understanding of MIHTs was developed. We provide an overview of the USU-supported research and of the findings that were generated by that inquiry. After summarizing the manuscripts included in this special edition of Military Medicine, we close by acknowledging and thanking key members of the U.S. military healthcare system who supported this research.

New Insights About Military Interprofessional Healthcare Teams: Lessons Learned and New Directions From a Program of Research.

The success of the military is significantly supported by highly effective collaborative teams. While much is known about successful military teams outside the context of healthcare delivery, considerably less attention has been paid to teams working in patient care. Thus, this supplement has explored the features of successful military interprofessional healthcare teams (MIHTs). In this summary paper, the authors discuss what this supplement's investigations have taught us about MIHTs and offer a series of proposed future investigations of MIHTs and their role in military healthcare.

Associations of Embeddedness and Posttraumatic Stress Disorder among 9/11 Survivors.

Following exposures to traumatic events on 9/11, survivors have reported heightened levels of posttraumatic stress disorder (PTSD). Multiple factors contribute to both the exacerbation and amelioration of PTSD symptoms, including social integration and support. This cross-sectional study aimed to understand and identify associations of embeddedness and psychosocial risk factors by PTSD status for survivors and first responders of 9/11. Results indicate that those with chronic PTSD had the lowest prevalence of both social and emotional embeddedness and many who reported no PTSD symptoms following 9/11 reported moderate levels of social and emotional embeddedness. Overall, our findings suggest those individuals who reported little to no PTSD also reported the most social/emotional embeddedness; whereas those individuals who report greater or chronic PTSD report the least social/emotional embeddedness. As such, it may be beneficial for clinicians across multiple care disciplines and contexts to consider and address the social lives and needs of those individuals experiencing symptoms of PTSD to ensure their emotional and physical needs are truly being met.

Post-Traumatic Stress Disorder among Survivors of the September 11, 2001 World Trade Center Attacks: A Review of the Literature.

Prior reviews of 9/11-related post-traumatic stress disorder (PTSD) have not focused on the civilian survivors most directly exposed to the attacks. Survivors include those individuals who were occupants of buildings in or near the World Trade Center (WTC) towers, those whose primary residence or workplace was in the vicinity, and persons who were on the street passing through the area. This review reports published information on the prevalence of and risk factors for PTSD, as well as comorbidities associated with PTSD among 9/11 survivors. Articles selected for inclusion met the following criteria: (1) full-length, original peer-reviewed empirical articles; (2) published in English from 2002-2019; (3) collected data from persons directly exposed; (4) adult populations; and (5) focused on non-rescue or recovery workers (i.e., survivors). Data were extracted with focus on study design, sample size, time frame of data collection post-9/11, PTSD assessment instrument, and PTSD prevalence, risk factors, and comorbidities. Our review identified the use of cross-sectional and longitudinal designs, finding multiple direct comorbidities with PTSD, as well as the prevalence and persistence of PTSD. Future research would benefit from incorporating more mixed methods designs, and exploring the mediating mechanisms and protective factors of the known associations of PTSD among the 9/11 survivor population.

Interprofessional Healthcare Teams in the Military: A Scoping Literature Review.

Introduction: Research into healthcare delivered via interprofessional healthcare teams (IHTs) has uncovered that IHTs can improve patient satisfaction, enhance collaborative behaviors, reduce clinical error rates, and streamline management of care delivery. Importantly, these achievements are attained by IHTs that have been trained via interprofessional education (IPE). Research indicates that IHT training must be contextualized to suit the demands of each care context. However, research into the unique demands required of military IHTs has yet to be explored. For any form of IPE to be successfully implemented in the military, we need a clear understanding of how IHT competencies must be tailored to suit military care contexts. Specifically, we must know: (1) What evidence is currently available regarding IHTs in the military?; and (2) What gaps in the evidence need to be addressed for IPE to be customized to meet the needs of military healthcare delivery? Method: A scoping review of the literature was conducted to identify the breadth of knowledge currently available regarding military interprofessional healthcare teams (MIHTs). A search of PubMed, EMBASE, PsycInfo, ERIC, DTIC.mil, and NYAM Gray Literature databases was conducted without date restrictions. The search terms were: (interprofessional* OR inter-professional*) AND (military OR Army OR Navy OR Naval OR Marines OR "Air Force" OR "Public Health Service") AND (health OR medicine). Of the 675 articles identified via the initial search, only 21 articles met inclusion criteria (i.e., involved military personnel, included teams that were medically focused, comprised at least two professional disciplines, and had at least two people). Results: The manuscripts included: seven original research studies, six commentaries, five reviews, one letter, one annual report, and one innovation report. Analyses identified three themes (i.e., effective communication, supportive team environments, shared role understanding, and equity among team members) related to successful MIHT collaborations and five related to unsuccessful MIHT collaborations (i.e., inability to develop team cohesion, lack of trust, ineffective communication and communication breakdowns, unaddressed or unresolved conflicts, and rank conflicts). These manuscripts highlighted contextual factors that shape MIHTs. For example, MIHTs often work and live together for extended periods of time when deployed. Also, military rank can facilitate collaboration by establishing clear lines of reporting but can problematize collaboration when inexperienced care providers (e.g., early career physicians) outrank other team members (e.g., medics) who have more experience providing care in deployment contexts. Discussion: Given that the experiences of military personnel can be perilous and unpredictable, the military has an obligation to study the unique contexts of care where MIHTs are employed. In doing so, educational interventions can be tailored to better aid our service men and women, as well as their families.