most definitive study to date that examined personnel records of 560,000 service members who married between 2002 and 2005 found divorce was less common among people who had been deployed longer. except for active duty air force folks. apparently they are doing something different. . .

>> military's family support programs really work. all of the things that had been presented to these folks in terms of challenges have been offset by the very hard work that happens on installations every day around the country and in communities around the country to try to prevent the negative impact of deployment on these families. it's also important to remember that stability, just because you stay married does not mean you are happy about being married. lots of unhappy people stay in their marriages. i know a very large study has been launched by the people at the rand corp. he did this

research and i expect the family component added to the millennium cohort study and the suicide study that are getting going will probably answer many of these questions. but it is a little confusing right now to try to understand what is the impact. there is good data from multiple wars and conflicts to combat stress, not just combat deployment, but combat stress. it does appear to be bad for relationships. many studies in multiple countries of veterans of conflict around the world have shown symptoms of post-traumatic stress syndrome and combat stress are related to problems in family relationships. there is some indication that certain symptoms of combat

stress and posttraumatic stress disorder are related to certain elements of relationships. for example, the raw also cluster appears to be related not surprisingly to anger, hostility, irritability, emotional mumming appears to relate to loss of intimacy and sharing. you can imagine how these kinds of behaviors corrode relationships with your wife or husband or children or close friends. studies on the symptoms have been carried out ever since world war two on both service members and holocaust victims as well as in armed forces around the world. in this country, there are two small studies that i find interesting that are consistent with these findings. one that i want to bring to your attention focuses on the degree to which a spouse can connect up

a service member's system with their understanding of the service member's experiences during deployment. to the extent there is a disconnected, either the service member seems to be reporting symptoms more severe than they would expect given their experiences during deployment or less, it's harder for the spouse to figure out how to react and it can generate tension in the relationship. this is an interesting window into intra-couple process these that may help us to create ways to help spouses and service members deal together with the trauma they have both experienced in their relationships. even though it is a small study, i think it is worth noting. a couple of other things i would like to bring to your attention about relationships. overall, divorce rates in the

military population are lower than the civilian sector. that was true before the war and is little unclear exactly where it is now. there are many reasons why marriages something you will see a lot of in the military. the military is highly selective and many things in the civilian population with like people out of marriage or prevent them from getting married or not the case in the military. everyone in the military has a job with benefits, some education, and those are things that reduce marriage ability in the civilian population. the military works hard to keep people married by supporting them and providing financial incentives. these findings are not surprising, but one of the wonderful things about the military is some of the discrepancies that appear in the civilian population disappear in the military. for example, the marriage prospects of black men in the

military are better than in the civilian world. that is a testament to what the military has done to level the playing field across ethnic minority groups. i do want to point out that because most of the policies and research on in the relationships in the military focus primarily on marital relationships, we do not know a lot about the formation of a quality, or stability of intimate relationships. half of the forces of married and presumably most of those people would like to get married. we do not know a lot about the implications on the prospects for people of establishing, sustaining, and making wonderful the relationships that they want to form. also, the marriages of female service members appear to be fragile. there twice as likely to end in divorce and they probably weren't greater attention than they have been getting. i don't know about you, but the

average family readiness group meeting does not signal is open or welcoming or designed to attract the male spouses of female service members of him in many groups that would only be won anyway who would feel like a museum exhibit if he walked in. this is a challenge for us to deal with. another headline i would like to bring to you is the emotional cycle or spiral of deployment is a well valued model of deployment or typical family experience. it is used in many domains to teach families what to expect. many families resonate with what this cycle says to them. it has a great deal of validity and makes a lot of sense. it has been written about a number of times over the years. those of you familiar with it knows that it typically includes five or seven stages

tied to the operational structure of deployment. but there are limitations in our knowledge about this. this is where the ivory tower bit comes in where i can track back and try to look and said what it was the database for what someone wrote. let me look at the data base and keep going back. i ended up in 1946 with the study of iowa families reunited after world war two which is actually wonderful. he was instrumental in the field of study in which i engaged. however, this is not world war two. i started looking more and one of the things i see is that almost all the data we have about the experiences of individuals and families following return from deployment a cross sectional

snapshot is not -- and not a longitudinal movie of their experience. i know you have heard this many times before and you can pull a string on researchers back and they will say longitudinal. i apologize for being repetitious. the consequences we don't know how reintegration unfolds. how does it happen over time? the problem with stage models is that they can be more rigid and imply things are more universal than they really are. this is a place mfri has been trying to focus its attention for a while. we have developed studies were we're able to talk with people in real time about their experience. we have also been working on larger, quantitative studies where we can ask people to recall their experiences. recollection is not as good a method, but it's difficult to

get real-time longitudinal data from service members. so we do what we can within the constraints that we have. i don't want to go through this in detail, but i want to point out two things to you. last is a depiction of some patterns i would call it essentially flat or small variations over time of what service members report in the months prior to the current month as they are recalling their first year home from deployment. you can see the fluctuations are relatively small. you can also see there are some folks at the very highest level of well-being and report themselves being there, starting their and staying there. on the right, you can see patterns or there's a great deal of variation. people who start high and fall quite a bit. people who start low and rise quite a bit. only a couple of these patterns are consistent with the

emotional cycle of the plan and what it would lead someone to expect, though it depends on how narrow or generous you make your inclusion criteria. the bottom line is about 70% were reporting either flat or very small variations in their well-being over the first your home. what i take away from this is that we have some preliminary evidence to suggest there may be more stability than we would have expected and there is more variability across people that we might have expected. our task for the future might be to think about how we predict what kind of pass someone is going to have based on where they started out? if they start out heading in the wrong direction, how can we help them reach iraq quickly? we have been thinking about a number of things. -- how do we help them quickly?

are there steps that they go through or sequences of issues and different patterns of that? what is the role of ambiguity? we talk a lot about ambiguity in relation to deployment. how about the additional challenge of returning to civilian deployment -- civilian employment? what happens when it goes well as opposed to badly? what about attempts to reestablish relationships with children? we do not talk so much about military fathers and their children. every media call seems to be focused on how bad is one mothers get deployed. but no one seems to be interested in talking to me about when fathers get deployed, which makes me want to go there. let me offer some cautionary notes. this is where i tried to take seriously my call to action mission. i don't think we know as much as we think we know. as i read this literature, i see

some findings get repeated and cited so often it seems as they are based on strong evidence when they are in fact not. it's one person repeating what another person said they thought they knew which that person was repeating from someone else said they thought they knew. when you track back, you find we're not quite so sure it is as true as we thought. most of what we know about military families comes from army families, which may mean army families can teach us about everyone else, but certainly my experience in working with military folks is they are hesitant to believe what happens to families in any one service can be easily generalize to happens in the other services. i do not assume it's not true and i don't assume it is. it is a research problem and we have to get the data tell us. our focus may be too narrow. like the work that goes on around the world about people who have experienced trauma, there is a tremendous amount of

focus on symptoms of distress and concerns and psychopathology. there is a lot of focus on partner symptoms with combat stress. there are a lot of other things we need to know about and sometimes the land is so narrow we might miss something important. we know far more about how much things happen and we do about why or how or under what conditions they happen. the military, as you know, is rife with survey data. large-scale survey data are really good for how much. much less satisfactory for how, why, or under what conditions. the method has to be so big that it's really difficult. we know very little about unmet needs and families who need help but do not, cannot, or will not seek it. our ability to get to those folks may be limited by the fact that all of the design innovations we're making we're

making based on the families who will do and can get treatment. sometimes we can be misled by the tyranny of the need or what i could call the distractions of the dashboard in the sense that as an administrator, when i see a big green circle, i think i don't need to worry about it and my intention was to hone in on the place where there is a red or yellow circle. as a researcher, i worry about that red circle and what it can teach me. i wonder if the people in the red circle are the harbingers, if they are or the green circle is going if we are not careful, or if they have an especially urgent need in their circle is a bit of small only because there are so few of them. we need to be careful we don't pay so much attention to the mean that we use good -- that we lose sight of the standard deviation. but the folks in the green

circle may also teaches about resilience and strength. before i move on, i will offer a couple of observations about resilience because i know it's a very popular concept in the military. i need your lot of credit to the co-chair of the mental health task force who was a very passionate and is very passionate about resilience and wanted to see it become something the military paid a lot of attention to. i think he would be very proud to see what has happened. i want to offer some cautionary notes based on telephone calls i have had, not with people like you, but people outside the military who are trying to sell you stuff. i had some strange conversations, so i want to tell you the same things i reminded them of so you can tell them when they call you. first, most people risk -- most people display resilience after

events. most people do not come back with posttraumatic stress or other diagnosable problems. the resilience is specific. they can be resilience of late -- it can be resolved in one area but not another. you can cope well in one area and fall apart in another. it is dynamic and not a trade. just because you display resilience at one time does not mean you will always and forever be. it is not any energy from the stress or mean brazilian people are impervious -- resilient people are impervious. it is not a vaccination. people say they would like to sell you a vaccination that will administer something and fix everything now and forever. resilience is a set of characteristics. some of which are inherited, i think. skills, some of which can be learned, and skill -- and resources, many of which can be provided to facilitate coping, recovery, and possibly even

growth. but it is not magic. some people act like it is. finally, a cautionary note -- many studies of deployment and family experiences are under way. literally hundreds. you have so far made all the way to publication in the scientific press which has a long lead time. in the next few years, our knowledge will grow considerably and there are studies we should just wait for as opposed to launching new ones and there are other places where we probably need to watch -- need to launch new ones. let me offer some provocative suggestions. this is a picture from one of the sesame street adds. i thought this cross such an adorable face, so it's a good weekend for provocative suggestions. i wonder if there are ways we could make more use of existing records to assess the effectiveness of policies, programs, and practices and publish the results in the

scientific press. there is so much data gathered on a day-to-day basis that some records in place that it is not clear we are fully utilizing those and making them available to researchers to have the time that expertise to help us figure out what they mean. but that work needs to get into the scientific press. there is too much work in the great literature their researchers never see. what happens is it never gets taken into account as a future work goes on. it disappears. if you have the experience of trying to track back to the program evaluations done at the end of the first gulf war, it is like trying to find a national treasure. because they are in the great literature, they are very hard to find. find ways to make use of more rigorous methods to assess effectiveness. sometimes when i say the most -- the gold standard for evaluation

is a random assignment to programs and pre and post data. it is so hard to think about doing it in these circumstances, but ultimately, we will have to find ways to tackle it if you want answers to these tough questions. i know that kind of work is happening. i don't mean to suggest it is not. but it could probably happen more. make sure we pay attention to how and why and for which people under which conditions in addition to just how much. i want to show you a quick example of that. this part of the evaluation of the sesame street program we have worked on. we split the samples and to mothers who tended to be less responsive to their kids and mothers who tended to be more responsive to this is a key dimension of parenting. this shows you the last response of moms. when they are less responsive, what mattered for kids markers of insecure attachment to the

parents was mother's distress and that combat. that really came into play. but when mothers were more responsive, financial resources and accumulated a plan of history were but -- or what mattered. i am not sharing this to say these are definitive findings or should guide programs, but when you dig down and begin to be for whom and under what conditions, you get different answers. it is market segmentation by research. this helps when you are trying to figure out who needs what. many of you are engaged in this every day and i applaud your efforts. a final cautionary notes -- i'm sorry, i final suggestion i will make is that we are paying sufficient attention to family diversity. this includes a diversity in structure, diversity in terms of having as they cultural or

ethnic minority member of including foreign spouses. the families of single female service members with or without children, many of our policies are not written what those families specifically in mind, and families with other divers for special needs. i was looking for images to use in this presentation on the defense links web site the other night. all the photographs come from there. i struggled and struggled and used 70 keywords to find photographs of service members with their parents. this is the only one i found. a mother receiving a flag. i know that you do not want to be the first occasion were a parent feels as though the military is reaching out to them, but i think it's telling that i have such a hard time finding those photographs. with that, i will thank you for your attention and sank all of the folks who provided me with the information i was able to share with you today. thank you.

[applause] >> thank you. our next keynote address will be provided by dr. beth allen davis, a pediatrician for [unintelligible] she retired in september 2009 after 21 years of exemplary service. dr. davis received her undergraduate degree at davidson college in north carolina where she is the first of all graduate of an rotc scholarship. she is commissioned into the u.s. army in 1982. she went on to obtain her and beat and pediatric training in the university of virginia or she developed a passion for the care of children with disabilities. she spent the first 10 years of her career as a general

pediatrician. this included a plan during desert storm, two months after the birth of her first child. -- is included deployed during desert storm, two months after the birth of her first child. she became the mayor -- she can medical student to the pediatric care. she went to madigan army medical center and completed a three- year fellowship and obtained a master's in public health at the university of washington. she holds a says the professor deployments at the uniformed services university health sciences -- there is debate what the proper pronunciation of the acronym is. i'm not sure which is better. as well as the university of washington. that's easier to pronounce. she became the chief of development services which made for the program director of the only development of behavior

pediatric scholarship in the department of defense. she served in this capacity and is chief of the exceptional family member program for the western region medical command until retirement from the army just a few weeks ago. dr. davis's advocacy extends beyond the limits of active duty and includes being the chair of section on uniform services representing over 900 military pediatricians at the american academy of pediatrics. through this forum and research endeavors, she has authored several journal articles and helped create educational beebe's for families. she has spearheaded -- educational dvds for families. she has been one of the founding members of the military child and adolescent center of excellence located in fort lewis, washington. please join me in welcoming dr. beth davis. [applause]

>> thank you very much for the vision of including medical personnel at this very important clubber to the event. i stand before you -- important collaborative event. i stand before you as a medical person with a very heavy heart today. but no less solemn and no less determined than president lincoln as he witnessed brother against brother on american soil. in his famous second inaugural address, something that resonates with all of us is my call to action to you, as he said -- let us strive on to finish the work we are in, to

bind up the nation's wounds, to care for him who shall have borne the battle, and for his widow and orphan to do all which may achieve and cherish a just and lasting peace among ourselves and with all nations. as we embark on this two-day journey, i really appreciate mr. thomas'invitation to bring candor and creativity along with our collaboration, so i have never been one that has not said what i thought. i hope in the short time now before this break, that i can shed some thoughts about who our military families. understanding the demographic and social makeup of military families as well as the demands and challenges they face

provides the background and contacts needed to interpret the information we collect. it is important to policy- makers, leaders, and other stakeholders to have an accurate picture of the demographic and social make about the population they lead and support. how our military children -- how are military children coping with wartime deployment? i have a bias toward children ages 0 to 5. not only because they are the most prevalent in the military, but because they are the most vulnerable. of the 24 million children in the united states between the ages of 025, about three- quarters of a million are in military families. there is no controversy about the science that early environment matters. the question today is not whether early experience matters, but how early childhood experience such as repeated

parental deployments shape individual development and which adaptations and support contribute movement along positive and brazilian pathways. -- resilient pathways. in my experience, from an army petersons viewpoint, there are constructs available in the medical community that i want to bring forward in this call to action, where we can look at perhaps a spectrum of risks, a spectrum of stress, and match it with these wonderful spectrums of support we have developed over the last not just eight years, but a lifetime of the department of defense to help integrate and support military families. i am going to bring today an idea about that approach. that approach seems like an

achievable goal, but i think it is a framework we can achieve that offers coordinated, comprehensive, continuous, preventive family-centered, culturally responsible, accessible, and indefensible services. -- and enhanceable services. having grown up in a military family and raised my own family in a military family, there are many rewards to military family life, but there can be many challenges as you well know. even more so, compared to past generations, there may be a reluctance among today's service members and families to accept uncritically many of the unwritten rules and expectations of being a military family, particularly those that affect the balance between work and

family. i have been very proud of the fact of the military has been a vehicle of social change for well over 50 years. to take on the contemporary society cost challenges that arise of the crossroads of the important work the military does and the balance of raising a family is not beyond our grasp to lead the nation in this area. this is a work in progress. i probably should have been a little more my son and started on the bottom half of the slide. i appreciate the work of reference to the 1983 army chief of staff general's paper that covered the army family because that was a turning point for the army and military.

he and others formerly articulate the army's philosophy towards family, including the idea that a mutually enforcing partnership exist between the army and its family members and strong families make stronger, more brilliant army communities. -- more resilient army communities. you can see on the right-hand side, there's a lot of the support and formal structure of the military and in the right, lower side. honda left hand side, where family function and family resiliency is, i put a circle round because it has been more of an informal structure and support as was previously mentioned. perhaps we have not adequately reinforce this partnership. that is where an idea of that approach, it's lithification of

-- as a lithification of organization around our support could bridge the partnership between our yet ready s and our family function. i would ask you is this an organizational question or is this an ethical question? does the department of defense have an obligation to provide for health and well-being of our families for the present in and of itself regardless of future organizational potential? should our outcomes have direct measure of child outcome and family function, not only as indirect measures of mission readiness, but as one of our essential components as an organization? how can we nurture, protect, and insurer the well-being of all military families, not just to weather the storms of deployment, not just for reenlistment numbers, but

because it is what we do to honor the men and women and families who serve our nation? i think it is time and fitting that this summit is here, in this time of our history to make a formal commitment to understanding military families as we have been doing. their risks and of their resilience. in the national military family association survey from 2005, one of the most important factors for families dealing with lengthy deployment was the active support of their military leadership. i'm just going to share these numbers -- they are pretty ubiquitous. they helped me visually when i start thinking about the different studies out there and the tiny snapshots that we have.

similar to the general population of the u.s., family patterns in the military, both aff -- both active duty and reserve, have experienced significant changes since the 1970's. during the vietnam era, 85% of military service members were drafted, there were not planning a military career, and they were unmarried. currently, 100% of service members volunteer for service. 50% plan on military careers and 60% of active-duty service members have family responsibilities. likewise, family structures have shifted. in the military, traditional family, which is the working mail and the stay at home female spouse, have evolved into 40% working couples 15% active-duty mothers and wives, 7% or 8% dual active duty parents, and almost 10% of active duty single parent.

this is just to remind ourselves how our active duty branches there. we were talking about the army as were many of the studies are coming from. that would be true and would also be true that they represent the largest proportion of the current active duty. that's just an observation. it does not mean that's where we should put our efforts necessarily. when i think about the selective reserve personnel by reserve components, i think one of the things we will commonly see as limitations to comments made in the studies we have very little knowledge about the families of national guard and reserve. i do think one of the best sources of demographic information about families and children of reserves and national guard is the document

from the army in 2007 and what we know about army families. while it is exclusive to army, reserve, and national guard, it paints a wonderful and rich demographic picture of the vast majority of families who are currently reserve and national guard families that are experiencing deployment. we need to use documents like this to foster our understanding and develop coordinated support for these service members and their families in an orderly, accountable way. i am not going to go over all of these slides, but this is a snapshot from the 2007 demographics report which, they are now my second favorite document. i love reading these reports. i hope they continue to shed

light on the families that we serve. i'm embarrassed to say my first favorite document is the united states at less. it is very interesting to gather information as well. i want to highlight the families were talking about in active duty. they are under 55, married, with children, and with very young children. i think this will help us to find some of the service members who potentially would have increased risk with deployment or other mission-related stresses. for example, 83 percent cited tool active-duty marriages are among active duty jr. and midlevel enlisted soldiers. charing high tempos, the parents i have worked with the often do not even see each other. it is one parent dropped off

from the lemon and the other parent takes the child up. as these deployments have turned into two and three deployments of back-to-back for each of the parents, they have started to think maybe we could coordinate deployment and vote together which leaves family plans for the children without mentor ship and support. one dual active family came to me and one of the families i see with three young children. their question was not that they did not have a family plan since both parents with the play together, but when the paternal grandmother got to fort lewis, how could she be held to fill her oxygen tank while she was there for a year taking care of the three young grandchildren? we started problem-solving around that choice.

to be honest, they had considered a lot of other options. i don't know what the final outcome was, but that's the environment many of these young dueled marriages are in. 5% to 8% are single parents. that is considerably less than the u.s. population of single- parent, which is 17%. however, the doctor was recommended, what did deeper. the majority of these single parents are young, and listed, minority-identified women who need child care. they need flexible child care. a child care that supports them during their pt time and the child care for sick children. this demographic information and help inform us about some of those needs.

the third group of service members who i think potentially would have increased risk and could be supported and the outset with any military resources would be children with special health care needs. i am the first to tell you, having spent eight years as the chief of the medical [unintelligible] when you have to assets and try to have them talk to each other at a level of individual soldier assignment, there is a daily feeding and weeding that goes on to keep the priorities of the proponent act. i know the being coordinated among multiple after is

difficult we all have our priorities and we are here for a reason. but we are ready and we need to start coordinating our efforts at the individual military service member. i will say that as far as the reserve and national guard does, if memory is that reserve families are older, they have been married longer, and we know relative maturity of marriage is a known asset for coping with separation and deployment and other stresses. three-quarters of the spouses are employed outside the home which augmenting come. but it also provides a source of social and -- social support for stress and not your land only on the soldier for day-to-day issues that may be coming up. they typically have not relocated in the last year. however, there usually at a

significant distance from active duty resources. active-duty military children are -- 40% of active duty military children are in the birth to five-year range. 74 million individuals are less than 18 years old. of the 1.2 million active-duty children, 40% r 025 and 96% of that group, about a million, are under 18 years of age. if you look at the selective reserves, 65% of children are in the k-12 school age. school-age children benefit from stable school experiences, peer groups, and extended families. this is shown to be true in many situations, even in the civilian

community with the loss of apparent in the face of natural disasters, during marital conflict, and even with their own physical illness like cancer. perhaps the reserves and natural -- national guard families have inherent protection for the majority of the military children from the stress of parental wartime deployment. having community's stability has been repeatedly identified as a pretty -- i priority -- a priority for coping with stress in a military life. for military families in 2005, compared to military families, only one-third of reserve families relocated in the past year. the vast majority of reserve and national guard families have been established longer than four years in the residence compared to 15% of active duty families. the research we did that for louis on deployed families, one of the side questions was about

moving. 47% reported having moving three or more times in the last five years. these were only families with school-age children. while we should be cognizant of the various differences, we need to understand and reinforce the possible inherent demographic strengths of the various services. for example, young, active duty parents with young children should be encouraged to set up home, to be on post, where organized housing, child care, and medical care is available. perhaps more mature and older reserve families with school-age children who are in settings where their protective structure of school and community for the children are ready established should be -- the emphasis should be on finding civilian try care

health services in that community rather than making them drive or relocate closer to a military community plan activation occurs. in summary, the majority of military children are young, a journalist -- junior enlisted active military families primarily in the navy and army. 50% of spouses work outside the home, 93% are female. any reliable, safe child care during service member to plummet. there are about 125 million single parents in the military who are typically young, and listed, minority females in need affordable, flexible child care. over one-third of military debt by themselves of minority. this necessitates an understanding of cultural family issues. compared to the average u.s. family, the military family is younger, more educated, more likely to have health care, more likely to be a minority, less likely to be a single parent,

and more likely to live outside the u.s. territory. i hope this helps to inform us as we consider what data we need to gather, where the gaps are. i want to take a moment as a bridge what we know about military families starve -- demographically, to what we know about military children, but first i want to say as a pediatrician, a developmental pediatrician, i do not believe there are service members, spouses, children -- is a military family. i never looked at a child outside of the context of their military family. studying military children in themselves or studying children that only come to certain clinics, i think we're missing the boat. children's early development than on health and well-being of

their parents. children grow and thrive on clothes and dependable relationships that provide love and nurturing, security, response of interaction, and encouragement for exploration. without at least one such relationship, development is disrupted and the consequences can be severe and long-lasting. we know this. we do not need to reinvent this just for military families, we know this. provided or restored, a sensitive, caregiving relationship can foster a remarkable recovery and resilience. my colleagues at new parent support group to go to the homes and visit catch me and say don't be too judgmental about these young families. they have a lot to offer because what i hear is every one of these children have televisions in their room and they're not

sleeping and they're missing school. i say get the television out of the room. which i think is an appropriate screech, but the new parent support group has opened my eyes to the strength of the generation y and the ones who are our young parents in the military who place a high value on family and social life. they are resilient in the face of adversity. this is where one ever came up. i see what ever as disrespect because i hear it from my college-age children, but it really started with this generation as you are telling me something that might get in the way of what i'm trying to accomplish, so i say "whenever." is it -- what ever. this is a generation addicted to media.

the coverage of war in the family room, but every room, where the tv star, is a concerning and we need to understand the effects of this new stressor and young children. these are technologically savvy individuals who skype with their spouses and have cameras so they can pass information between the wars own home. how helpful or beneficial is it for the service member to be living the trials of daily life of home as well as how beneficial is it for the home members to be living the life of the war zone? we do not know this. they do prefer team approach since and desire flexible hours and appreciate input from

mentors. i have started in the last few years being a little more candid. in my recommendations to young families, to help them reframe some of their priorities. when i make a new diagnosis of autism in 82 1/2 year-old at fort wainwright, and the family tells me they're getting to put in for assignments, i ask them what are their priorities for the assignment? i help them refrain that one of the properties needs to be autism-specific services for their child and not merely i want to go here because it's the next place in my career progression. i think the families take that into consideration as part of their decision making. initially, i thought was getting

into people's business, but now i have refrained for myself and that i am providing mentors ship to young generation nexters. to a child, wartime deployment is parental absence, increased sense of danger, and a change in roles and routines. non-military experience can help us informed about each of these, single parenting, children of divorce, children of incarcerated parents, emotionally unavailable children. but exactly what is it about the untimely departure of a parent to a war zone that is the same or different to military children and families than the other experiences? if we're going to read purpose materials and support to serve military families, we need clear outcome measures of their effectiveness or we need to endorse military-unique

resources. we need to understand the interventions we are providing to these families and what they're doing for the families. when a spouse is deployed, we know from crete and post desert storm work that mothers and wives have more symptoms of depression and increased stress and there is less family cohesion and structure. although these are often snapshot use, one time studies, when a parent is deployed, children have more behavior problems based on a small snapshot study from desert storm. they have more symptoms of depression and anxiety. i want to share with you a couple of studies we have done in the military with

developmental pediatrics their small snapshot studies, but they help inform us about military children in this war. the first is an air force developmental pediatrics fellow at boston. we all got together and said who is going to do something with preschool kids? who was going to do something with school-age children. who is going to do something with use or adolescence? -- with youth or adolescents. these are the studies that came out of that. one study looked at marine family preschool children. young children ages 3-5 have

behavioral responses specifically externalizing symptoms or disruptive symptoms when children in families of deployed parents are compared to children in families of non- deployed parents. we need to caution ourselves that this is in a small cohort of families where children were being taken to child care, where the mothers were a little older, with more education and our typical young families, and they represented four month deployments rather than year- long deployments. if anything, this is an underestimate of preschool reaction to parental wartime deployment. we looked at 101 at home mothers of deployed soldiers of -- deployed school -- deployed

parents school age children. since i was the research manager for these projects come these all started out to be more than they were. our ability to recruit military families was very, very difficult. i don't know if their plates were so full or the idea of research is just, has so much other things attached to it, but we had a very difficult time gathering enough families with enough diversity to give us the power we wanted to get out of some of the studies. he did find that the parents reported a one in three of the school-age children -- the parents identified emotional behavior concerns. in 42% of these parenting stress was clinically significant, based on a tool that is used. 39% of parents identified

internalizing or mood problems specifically anxiety in their school age children, not externalizing problems or school function problems. these are kids that are having problems internally with sleek, worry, and anxiety about their deployed parent. mitigating issues that were found to be very positively affected -- effecting improve outcome or college-educated parents, a sense of military support, a sense of military support, or employed at home spouses. we have not published this -- youth who came in for physicals, let's find out what they think about deployment. they were very similar to their parents' responses. 22% of the children who have a deployed parent indicating they

had significant emotional and behavioral concerns about themselves. this is age 11-16 as opposed to 8% of children whose parents were not deployed. this nicely matched the parent responses. almost one in four kids self identified themselves as at risk. the nice thing about this study is that takes out of the mix, they are able to control for it in one, it takes out of the mix the effect of parental stress on parents reporting behavior of their children. we went straight to the children in this study. finally, i would be remiss if i did not mention the sophisticated work that has been done in child neglect and child abuse. i would refer you to an article

from 2007 where child maltreatment in in most army families was noted to be 42% higher during deployment. this is attributed to child neglect by the mother being three times higher during the deployment and non-deployment. i want to share with you this construct and helps explain the spectrum of reaction and it's resonates with pediatric providers. it comes from the book "from neurons to neighborhoods." he describes stress akin to that of a big exam. use time management and accomplish a task that may not get accomplished. it is usually moderate in nature, a little uncomfortable, short-lived, but necessary for

growth and development. many families describe this kind of stress with relocation and changes in duties dikes. if it is more prolonged than usual, they introduced the concept of tolerable stress. in this category, that stress may be problematic and require additional steps or intervention. the recovery is possible and equilibrium can be returned. this sense of control that return to normalcy is key to tolerable stress. .

the meaning of the stress, the context where it is experienced, including how the at home parent is coping. there is no question that stress is apparent. it is bewitched services that needs to be better understood. -- it is the services that need to be better understood. chronic stress has been shown to affect blood pressure, contribute to heart attacks, diminished the immune system, contributed to asthma and diabetes 80% of americans emetic

and expenditures are stress related. -- asthma and diabetes. 80% of americans expenditures are stress related. what we know, employment is stressful for most military families. during separation, the most important factor for children is the coping and resiliency of the at home apparent bid of 25% to 25 -- at home apparent. 20% to 25% of children find the stress tolerable.

we know that military children and all children do well if they can. military families take care of their children and their children's health. we have some of the highest child immunization rates in america in the military. most parents care about their children. most parents do not intentionally neglect them. i really appreciate what it is -- that to have little quantifiable data, that to have some population outcome data that is coming out. it'll include spouses and children information in 2010.

it to help inform us. we do not have any data about the effects of multiple deployment. we do not know very much about child abuse and child neglect. a call to action has been placed that we have to take care of that small percentage who are at risk for child abuse and child neglect but a that could have irreversible -- neglect. that could have irreversible consequences. the final slides are getting back to the idea of an approach and something that comes from pediatric literature and pediatric experiences. i like the idea of embracing a virtual community for our young technologically savvy families. i think it needs to be a single portal of entry and not just a

1800 number that we call. i think they need to be care coordination prevention. a needs to be accessible to all military families. it need to the family centered. it needs to be of reachable -- out-reachable. it needs to have a community based assets. it needs to have a message for data gathering that is longitudinal and full of outcome. this cannot be easy. some of the work that has been done here is phenomenal. i wanted to say that i think it is important on this issue that we do good and not just look a

good. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] >> we look at health care from a n stearns cos perspective. what is live thursday at 7:00 a.m. eastern -- watch it live thursday at 7:00 a.m. eastern. the supreme court -- and mr. cotter is a canadian citizen detained at guantanamo bay. what the canadian supreme court by friday at 9:00 eastern on c- span2. >> c-span's documentary of one of the most and the buildings in washington is now on dvd. "supreme court, home to america's highest court."

hear from the justices themselves. bonior own and dvd -- only your own dvd copy. -- own your own dvd copy. >> now i hearing on veterans cemeteries and burial services. we will hear from a senator who served in a vietnam. this is almost two hours. >> good morning. the veteran's disability affairs subcommittee hearing on honoring our fellow heros. are we meeting the needs of our veterans and their families?

i ask that you join me in the pledge of allegiance. >> i pledge allegiance to the united states -- to the flag of the united states of america. into the republic for which it stands one nation under god indivisible with liberty and justice for all. >> thank you. abraham lincoln created a system and dedicated it to the soldiers who shall die in the service of the country. his sentiments are as palpable today as they were in 1862. if insurers are veterans are

properly memorialize. we may be falling short of our intended goals. [unintelligible] these benefits were created decade ago. they have not kept pace with inflation. the value of the current burial of balance is $300 has diminished as funeral and burial costs have increased at a higher rate than inflation. i'm concerned about the current senator policies would lead a large number of veterans and served by better and options. national cemeteries are establishing areas for the uncertain population is 170,000 veterans within a radius. several areas with large numbers of veterans will remain

uncertain by a v.a bear. real option. their goal of reaching 90% would require 31 more cemeteries beyond those in operation. according to a steady, there are no locations in the u.s. that will meet the current requirements until 2015. only one community will reach the population threshold of 170,000 veterans. the changes to the standard may be in order. it negatively impact the survivors left behind. i want to further examine this critical aspect. the national shrine mandate --

they shall be considered national shrines. several factors will impact the ability to meet and maintain the national shrine mandate. mainly, the growing number of internments, change in burial preferences, and population migration. they should conduct a preemptive review of the obstacles in order to try to work toward new issues that may arise and insurer existing ones do not grow. i look forward to hearing from secretary -- the secretary on this. i believe that we can bring a continuous improvements to our system by insuring that their burial benefits and final resting places will be reflected

the debt of their service. i would like to acknowledge that we have been joined by the ranking member of the committee and deal to the ranking member of the said committee for the opening statement. >> -- and yield to the ranking member of the subcommittee for the opening statement. >> as thank you for the test and 80 and serving veterans and their families. a deceased veteran is one of our most solemn obligations. they have earned honor reposed in the national shrine. they are due the tributes and things of a grateful nation. as members of the greatest generation, we are seeing increased demand on all of our national cemeteries. interment in national cemeteries will rise from the current level of 2.9 million to 3.4 million by 2014.

i thank you for helping my efforts to patch -- past hr174 that i introduced earlier this year. it would establish a national cemetery in southern colorado and benefit those veterans and family is in this fast-growing area. one reason for the delay is that the southern colorado region does not need these objectives -- meet these objectives -- these subjective standards. there are many other factors that need to be taken into account including travel time to and from national cemeteries, access to public transportation in the area, and other factors that are more realistic in a large circle. i know this problem is not

limited to southern colorado. it extends to many rural and urban regions like nebraska, new york city, los angeles, new york, and other areas that are adversely affected by the arbitrary rules. passing this would be an important first step in addressing this problem and is identical to hr1660 that passed the committee and house last congress. i thank you for your continued support of this bill. i want to thank everyone again for being here today. i look forward to your testimony. >> thank you. i remind our panelists that your written statement have been made. you can edit them as you choose

to we will have submission -- sufficient time for follow-up questions. on their first panel is the hon. [inaudible] >> i wonder if it would be possible to allow the ranking member to make an opening statement if he has won. -- one. >> yes. ok. you are now recognized. >> thank you. i appreciate the opportunity to be here today. thank you. >> thank you. we are honored by your presence here today enter service to this country. -- and to all the people connected to our national

cemeteries from the people mowing the lawn to the superintendent of arlington national cemetery. we are grateful for your dedication. this is a subject of special importance. my mother is interred at one of our national cemeteries it has always been treated as sacred ground -- cemeteries. it had always been treated as a good ground. it is hard to describe the reverence that everyone treat our cemeteries with. we are in your debt. i look forward to your testimony. we are in your debt, mr. cleveland. >> thank you. mr. miller. >we will enter it into the record. >> thank you.

max, it is good to see. over our years together, we have done a lot and we have shared a lot. these issues -- i can reflect upon our days when we were in the committee. we had some personnel issues. so many of our forces would rely upon the active duty to provide honors. as we draw down, we learned about them not going beyond so many miles of the fort. we even adopted the protocol and procedures to do military honors we worked more so with thebso's out there to make sure -- military honors. we worked more so with the bso's

to make sure they had what they needed. it was all of our efforts to make sure that we set the course and gave the proper tone. i want to thank you for taking on this new position. you set the standards and pays for the world, and i think it helps define america as who we are as we cherish our heritage. you have accepted the role of responsibility. you are now the chief steward of so many souls. the they lie in graves far away

from their homeland. is disheartening to me is that we have poor standards in america. you set the pace. come second is arlington national cemetery. third are the va national cemetery. we should not have four standards. i have great pride in what we have been able to do. we have not completed that. years ago when i visited andersonville, i was stunned with what i had seen. i did not realize that we were still doing burials. it was an active cemetery run through the department of interior. i did not know that. when i looked up in the distance and saw that there are preparing

for a burial on that day, i began to look around and saw all the markers out of line. they were stained. in the wall was in poor condition. someone had mowed believes. grass was growing -- the leaves. grass was growing around the markers. i was stunned. i had threatened to take jurisdiction away from the department of interior. i had good conversations with secretary salazar who said he will conduct a read you. -- review. i hope we can have a national shrine program to raise their standards so that -- i wish we could all be it your standard.

-- at your standard. we are not there yet. let's raise that standard. i want to thank you for bringing the light not only to allow max cleveland to talk about the good things they do in arlington and the va, but a lot of the things they do well with their limited budgets. let as know what your needs are. we will work together, not only with in tthe appropriations committee, but secretary salazar to make it right. >> thank you. i would like to remind all panelists that your complete written statements have been made prior to record. you can change or limit your remarks so that we can have time

to follow up on questions with everyone. our first panel includes the hon. max cleveland. he has served this country in many capacities. congratulations on your position, sir. he is also a senator and a soldier, and all americans are grateful for your service. [unintelligible] department of the army u.s. defence. miss catherine stevenson, director for business services for the national park service s.

we go by the five minute rule. secretary cleveland, you are now recognized for five minutes. >> i will say that the kind words are welcome. i can take credit for none of that. the american battle monuments commission has been around since 1923 when the general led the efforts after the american expeditionary force in world war ii 1. he put together -- world war romai. he put it together. most americans never see an american cemetery abroad could .

we invite all of you to come. if you cannot come, see is on the internet. we are there. thank you for your comments. my mother is also interred at a national cemetery. my father served at pearl harbor. we thank you for those words. mr. chairman, coming to the palace is an interesting experience, because in the senate will run not limited by the five minute rule. i will try to control -- we were not limited by the five minute rule. i will try to control myself. the first time i came to this room i was 34 years of age. that was a time when i encountered all the issues that you are dealing with in terms of the va cemetery system. now i am much older, old enough to think that dance with me and

you are still the one are all these of but goodies. it is an honor -- are oldies but goodies. it is an honor to be here. we maintain an commemorate americans who come in many ways, it died in in place and are buried where they fell. we also run monuments. in more ways now that generations are succeeding world war generations who are buried in our cemeteries, our main mission becomes not only green grass and white crosses. we do that better than anybody in the world. our main mission now is to tell

that story for succeeding generations so that they will understand why there is a cemetery there in manila, hawaii, an imam -- in a pan a panama, and western europe. america has been all over the world. americans have lost their lives all over the world. we enter those who primarily lost their lives in world war i and world war ii. beginning with the end of world war ii, with the korean war, and technology made it possible for us to fly there remains home.

from the korean war on, we fly the remains home. in a certain way, it makes the loss of that loved one and that service man or woman even more and non[unintelligible] it is appropriate that we gather here today to think about how we can better honor the fallen and better take care of those who gave us the last full measure of devotion. for those who want to read of, each of you has the annual brochure. citizens can get it if they request it. this is an age-old problem. i have been looking at various quotes that i like very much.

one date from 2500 years ago. and oratory tried to describe his feelings about the loss of people from his community and his nation. it is the periclean oratory that we remember. "for the heroes had the whole earth it to them. inland's far from their own, there is enshrined in every breath, a record and written with no tablets except that of the heart." in so many ways we have the tablet and cemeteries. we have our hearts as well. for those left lost loved ones, their heart will take until

their death. for the rest of us, it too, there is a sense in which we all tried to make meaning out of suffering. we tried to make meaning out of war. the great american poet lost a brother, a younger brother, and world war i. he is buried in one of our cemeteries. he, in trying to do with the grief, wrote a poem. the last lines are very meaningful to me. "they say we leave you our death, and give them their meaning." i think that is what we are all about. thank you very much. >> thank you. next -- your statement is

entered in the hearing record. you are now recognized. >> thank you. i appreciated the opportunity to testify in support of arlington national cemetery. it is an honor to represent the cemetery. with me today is the deputy secretary of oversight. the management presents unique challenges among military cemeteries. arlington continues to serve as an active burial place for today's military men and women and serves as a heavy visited national shrine. in 2008, there were 4123

internments and 2780. in the current fiscal year, we estimate that it is more than 7000 funerals conducted at arlington national cemetery. 10 formal requests for the internment policy were received. seven were from extended family members to go into existing graves. they were approved at my level. three others were requested and not approved by the secretary of the army which would have required a new gravesite. since state funeral of president kennedy, arlington has become a major tourist attraction. during this past fiscal year, an arlington, dated 4 million visitors, making it one of the most visited historical sites. there will be conducted almost 3000 ceremonies this year. thousands of visitors have come

to arlington to participate in various convincevents. over 127 fallen service members serving in operation freedom and 445 fallen members serving in operation iraqi freedom have been laid to rest. for among them, another medal recipient is memorialized for his deeds. on january 1, 2009, it was authorized all service members who were killed in action or died as a result of wounds to receive a full military honors at arlington cemetery whether

they were injured or memorialize. this would include an escort platoon, colored team, firing party, a casket team, and chaplin. this concludes my remarks. >> thank you, sir. miss stevenson, you are now recognized the de >> thank you -- recognize. >> thank you. thank you for the opportunity to discuss the national cemetery. we considered a great honor to serve our victims and their families. we are committed to ensuring our committees are maintained at a standard worthy of those who fought for our country. we are pleased to tell you about the progress we have made to improve the condition of the cemetery's we manage since the

last testified in may of 2007. in 2007, all reported that $1 million in project funds were spent on repairs. in 2008 and 2009, the national park service has invested $4.5 million in cemetery repair projects. this is in addition to routine maintenance. another $1.9 million of flood relief funding is being spent on the visitors' center that is by the battlefield. in addition to the project money, at every park has had an increase in their operating funds for the last two fiscal years. some leasing concerns have been raised about the appearance of national cemeteries. i wish to assure you that the national park service takes these concerns seriously. it already follows the manuals

written by the national cemetery administration.