The Impact of Parental Military Deployment on Children with Disabilities

描述（由申请人提供）：父母军事部署对残疾儿童的影响长期的战时任务给美国武装部队及其家庭带来了前所未有的压力。[虽然最近部署的步伐已经放缓，但了解部署的影响仍然至关重要，因为美国武装部队经常被要求参加地球仪的冲突。尽管军人家庭的复原力很高，但他们仍然面临与压力相关的后果的风险，相对于父母的部署，一些研究发现，儿童因抑郁症，睡眠障碍和焦虑而就诊的次数增加，并且更多地使用精神药物。虽然这些研究结果预示了部署对残疾儿童可能产生更大的负面影响，因为他们通常使用更多的服务，但尚未对这一群体进行单独研究。生活过程的转变往往是残疾儿童家庭的主要压力源， 与额外的负面儿童结果相关。拟议的R21研究是对PA-11-202 [军人家庭儿童研究：父母军事部署和重返社会对儿童和家庭功能的影响]的回应，具体目的是（1）分析纵向军事卫生系统数据，以描述严重残疾军人子女的卫生保健利用模式;（2）进行多变量差异中的差异分析，以评估部署对这些利用模式的关联;以及（3）测试部署期间家庭环境的各方面是否缓冲或加剧了部署对这些利用模式的影响。该研究将重点关注自闭症儿童、双相情感障碍儿童、运动障碍儿童以及通过医疗保健索赔中的诊断确定的智力和发育障碍儿童。拟议的研究是创新的方法来了解父母部署的影响。首先，我们将重点关注一个仔细界定的儿童群体， 具体残疾类型。其次，我们可以获得关于每个孩子的现有的、纵向的、异常全面的数据。第三，我们将建立一个广泛的离散的卫生保健利用的措施，其中一些将反映常规和预防性服务，一些反映特殊需要的服务，和其他可能是危机或紧急需求的指示。第四，尽管所有的部署研究必须基于观察而不是实验数据，我们将利用一个特别强大的，准实验设计的基础上的差异，两个非等效组的前后措施的差异多变量分析。最后，我们正在设计研究，并将根据一个概念模型来解释我们的结果，该模型评估了家庭环境和关键结果之间的关系，该模型由项目团队成员开发。调查结果将为国防部卫生系统TRICARE提供必要的信息，以评估有严重残疾儿童的军人家庭的独特需求，并就部署期间支持家庭和儿童所需的干预措施提出具体建议。

DESCRIPTION (provided by applicant): The Impact of Parental Military Deployment on Children with Disabilities Long wartime assignments put unprecedented pressures on the U.S. Armed Forces and their families. [Although the pace of deployments have been reduced recently, it remains critical to understand the impact of deployment as U.S. Armed Forces are routinely called to conflicts around the globe.] Despite high levels of resilience among military families, they remain at risk for stress-related outcomes and, relative to parental deployment, some research has found that children have experienced increases in visits for depressive disorders, sleep disorders, and anxiety, and greater use of psychotropic medications. Although these findings foreshadow possible greater negative consequences of deployment for children with disabilities who generally utilize more services, this group has not been separately studied. Life course transitions are often major stressors on families of children with disabilities and are associated with additional negative child outcomes. The proposed R21 study is in response to PA-11-202 [Research on Children in Military Families: The Impact of Parental Military Deployment and Reintegration on Child and Family Functioning] and the Specific Aims are to (1) analyze longitudinal military health system data to describe health care utilization patterns among children of military members with significant disabilities; (2) conduct multivariate difference-in-difference analysis to assess the association of deployment on these utilization patterns; and (3) test whether aspects of the family environment during deployment buffer or exacerbate the effect of deployment on these utilization patterns. The study will focus on children with autism, children with bipolar disorder, children with motor impairments and children with intellectual and developmental disabilities identified by diagnoses contained on healthcare claims. The proposed study is innovative in its approach to understanding the impact of parental deployment. First, we will focus on a carefully defined population of children with significant and specific types of disabilities. Second, we have access to existing, longitudinal, unusually comprehensive data on each child. Third, we will construct a wide range of discrete health care utilization measures, some of which will reflect routine and preventative services, some reflecting special need services, and others that may be indicative of crisis or emergency needs. Fourth, although by necessity all studies of deployment must be based on observational rather than experimental data, we will utilize a particularly strong, quasi-experimental design based on difference in difference multivariate analysis of pre-post measures of two non-equivalent groups. Finally, we are designing the study and will interpret our results based on a conceptual model that assesses the relation between aspects of the family environment and critical outcomes, a model developed by project team members. The findings will provide necessary information for TRICARE, the health system of the Department of Defense, to evaluate the unique needs of military families of children with significant disabilities and generate specific recommendations regarding needed interventions to support families and children during deployments.