Citizen soldiers (National Guard and Reserves) represent approximately 40% of the two million armed forces deployed to Afghanistan and Iraq. Twenty-five to forty percent of them develop PTSD, clinical depression, sleep disturbances, or suicidal thoughts. Upon returning home, many encounter additional stresses and hurdles to obtaining care: specifically, many civilian communities lack military medical/psychiatric facilities; financial, job, home, and relationship stresses have evolved or have been exacerbated during deployment; uncertainty has increased related to future deployment; there is loss of contact with military peers; and there is reluctance to recognize and acknowledge mental health needs that interfere with treatment entry and adherence. Approximately half of those needing help are not receiving it. To address this constellation of issues, a private-public partnership was formed under the auspices of the Welcome Back Veterans Initiative. In Michigan, the Army National Guard teamed with the University of Michigan and Michigan State University to develop innovative peer-to-peer programs for soldiers (Buddy-to-Buddy) and augmented programs for military families. Goals are to improve treatment entry, adherence, clinical outcomes, and to reduce suicides. This manuscript describes training approaches, preliminary results, and explores future national dissemination.

A motivational orientation intervention designed to improve parenting program retention was field tested versus standard orientation across two parenting programs, Parent-Child Interaction Therapy (PCIT) and a standard didactic parent training group. Both interventions were implemented within a frontline child welfare parenting center by center staff. Participants had an average of six prior child welfare referrals, primarily for neglect. A double-randomized design was used to test main and interaction effects. The motivational intervention improved retention only when combined with PCIT (cumulative survival = 85% vs. around 61% for the three other design cells). Benefits were robust across demographic characteristics and participation barriers but were concentrated among participants whose initial level of motivation was low to moderate. There were negative effects for participants with relatively high initial motivation. The findings suggest that using a motivational intervention combined with PCIT can improve retention when used selectively with relatively low to moderately motivated child welfare clients.

The current study examined rates of alcohol misuse among National Guard (NG) service members and their spouses/partners, concordance of drinking behaviors among couples, and the effects of alcohol misuse, depression, and posttraumatic stress disorder (PTSD) on three measures of family functioning. This study is important because it addresses the topics of heavy drinking and family functioning in an at-risk population-NG service members returning from a combat zone deployment. We surveyed NG service members (1,143) and their partners (674) 45-90 days after returning from a military deployment. Service member rates of hazardous drinking were 29.2% and spouses/partners 10.7%. Of the 661 linked couples, 26.2% were discrepant where only one member met the criteria for hazardous drinking and 5.4% were congruent for alcohol misuse where both members met hazardous drinking criteria. Service members belonging to either congruent or discrepant drinking groups were more distressed in their marriages/relationships than those in the nonhazardous group. In dyadic analyses, an unexpected partner effect was found for parenting outcomes; that is, when service members drink more, their spouses/partners are less stressed when it comes to parenting. Importantly, both service member and spouse/partner depression was significantly associated with negative family outcomes. Results from this study suggest that when working with these families, it is important to understand the drinking status of both soldier and spouse and to treat depression in addition to alcohol misuse.

Abbreviations: WMD = weapons of mass destruction DSR = disaster somatization reaction TDB = Terrorism and Disaster Branch NCTSN = National Child Traumatic Stress Network AbstractWhen a disaster strikes, parents are quick to seek out the medical advice and reassurance of their primary care physician, pediatrician, or in the case of an emergency, an emergency department physician. As physicians often are the first line of responders following a disaster, it is important that they have a thorough understanding of children's responses to trauma and disaster and of recommended practices for screening and intervention. In collaboration with mental health professionals, the needs of children and families can be addressed. Policy-makers and systems of care hold great responsibility for resource allocation, and also are well-placed to understand the impact of trauma and disaster on children and children's unique needs in such situations. Gurwitch RH, KeesM, Becker SM, Schreiber M, Pfefferbaum B, Diamond D: When disaster strikes: Responding to the needs of children. Prehosp Disast M«/2004;19(l):21-28. IntroductionEmergency medicine is a relatively new specialization dating only from the early 1960s. In fact, the American Medical Association rejected the initial application for emergency medicine as a medical specialty, citing no need for organization and certification. Finally, in 1979, the American Board of Emergency Medicine was recognized as a conjoint specialty 1 with the charge to assess and to stabilize all individuals presenting to an emergency department. Since its inception, the responsibilities of emergency medicine physicians have continued to evolve. At the beginning of the 20th century, medical personnel were involved in the treatment of several large-scale, medical epidemics affecting physical health, such as poliomyelitis, rubella, and diphtheria. With the dawn of the 21st century, new threats to the health and safety of children have emerged. In the United States, the domestic terrorist attack in Oklahoma City and the large-scale, coordinated, terrorist attacks of 11 September 2001 have added a new facet to all areas of medicine, including disaster mental health. The ongoing threats of chemical, biological, radiological, and nuclear attacks (weapons of mass destruction (WMD)), as well as conventional weapons (e.g., explosives) have underlined the need for disaster planning and preparedness. As physicians and other health professionals design and modify disaster and crisis plans, the inclusion of plans for disaster mental health issues, particularly related to children, also must be incorporated.Medical professionals are an important point of contact for children and families during or following a catastrophic event. Immediately after an event, children may be seen in triage or emergency department settings. Later, parents may bring their children to pediatricians or consult with the family physi-

The military community and its partners have made vigorous efforts to address treatment barriers and increase appropriate mental health services use among returning National Guard soldiers. We assessed whether there were differences in reports of treatment barriers in 3 categories (stigma, logistics, or negative beliefs about treatment) in sequential cross-sectional samples of U.S. soldiers from a Midwestern Army National Guard Organization who were returning from overseas deployments. Data were collected during 3 time periods: September 2007-August 2008 (n = 333), March 2009-March 2010 (n = 884), and August 2011-August 2012 (n = 737). In analyses using discretized time periods and in trend analyses, the percentages of soldiers endorsing negative beliefs about treatment declined significantly across the 3 sequential samples (19.1%, 13.9%, and 11.1%). The percentages endorsing stigma barriers (37.8%, 35.2%, 31.8%) decreased significantly only in trend analyses. Within the stigma category, endorsement of individual barriers regarding negative reactions to a soldier seeking treatment declined, but barriers related to concerns about career advancement did not. Negative treatment beliefs were associated with reduced services use (OR = 0.57; 95% CI [0.33, 0.97]).