The United States Public Health Service (USPHS) Commissioned Corps (Corps) dates back over 200 years and is a part of the U.S. Department of Health and Human Services (HHS). As one of seven uniformed services, the Corps is a cadre of over 6,100 diverse, highly qualified, public health professionals who, through public health promotion, disease prevention, and advancement of public health science, work to safeguard the health and safety of this nation. This section offers a brief overview to familiarize readers with the Corps.

Brief Overview of the Corps

Unlike the other uniformed services, the Corps is an all officer service organization...Unlike the other uniformed services, the Corps is an all officer service organization where uniformed officers operationally report to the United States Surgeon General and are assigned to HHS and non-HHS agencies. These uniformed officers constitute a well-trained, deployable force that is prepared to respond to urgent public health needs and threats both across this nation and globally (HHS, n.d.).

Corps officers are deployed to many areas impacted by natural disasters, disease outbreaks and public health emergencies. Beginning as a cadre of professionals within the U.S. Marine Hospital Service, Public Health Service officers combatted yellow fever, cholera, and plague outbreaks (HHS, n.d.). Today, Corps officers deploy to provide assistance during national public health emergencies (e.g., hurricanes, flooding, and wild fires), to combat the Ebola epidemic in West Africa, and to provide humanitarian assistance in Latin America and the Caribbean. Regardless of the uniformed service that is responding, deployments can be difficult.

Most of the literature on deployments focuses on military deployments. Although Corps officers are not in the military, they are part of a uniformed service and they do deploy. A critical assumption of this article is that Corps officers and their families experience similar impacts as their military counterparts. These impacts can be both negative and positive. This article will discuss how deployments impact families. Family resiliency and future implications for research and practice will also be examined.

Impact to Families

Family Reactions to Deployment
Deployments have the potential to contribute negatively and positively to the physical and psychological health of family members. Meadows and colleagues (Meadows, Tanielian, & Karney, 2016) asserted that, despite the length of deployments, families experienced mental health challenges, behavioral difficulties in children, greater risk for divorce, and higher rates of suicide. They found the greatest levels of stress for service members and their spouses were present during deployments (Meadows et al., 2016). Specifically, they asserted that when the service member experienced trauma, both the service member and their spouse may experience signs of depression, anxiety, post-traumatic stress disorder (PTSD), and binge drinking. Children of service members who experienced injury or trauma have also experienced prominent increases in psychological symptoms (Meadows et al., 2016).

Upon the service members’ return home, family relationships and other familial activities usually returned to former levels of normalcyDespite challenges experienced pre-, during and post- deployment, the literature review revealed that family members are generally resilient. Upon the service members’ return home, family relationships and other familial activities usually returned to former levels of normalcy (Meadows et al., 2016). Many family members were excited and elated for their service member to return safely home. Meadows et al (2016) opined that deployments contributed to decreases in physical and psychological hostility among partners, a better family environment with higher parenting satisfaction from the service member, and less binge drinking.

Spouses. Often, deployments are unpredictable, have unique requirements, and differ in the length of time required to complete the mission. Deployments Often, deployments are unpredictable, have unique requirements, and differ in the length of time required to complete the missionrequire officers to be away from their families for an extended period, which can result in increased levels of stress for spouses (Trautmann, Alhusen, & Gross, 2015).

Deployments create an emotional cycle that begins when the service member initially shares information with his or her spouse about the impending deployment (Department of Veterans Affairs [VA], 2019). The initial response garners strong emotions, such as anger and fear (VA, 2019). As the deployment date draws closer, the spouse may experience a period of withdrawal and social isolation or detachment from the relationship (VA, 2019; Verdeli et al., 2011).

The frequency and length of deployments are associated with increased levels of parental stress and depressive symptoms; a decline in couple functioning and general well-being; and increased use of mental health services by spouses, especially among individuals caring The initial response garners strong emotions, such as anger and fearfor young children and functioning as the sole caregiver during the deployment period (Trautmann, Alhusen, & Gross, 2015). Spouses experience higher rates of depression than the general population (Verdeli et al., 2011). In this regard, the mental health of the parent remaining at home plays a critical role in how children cope with deployment.

Negative marital functioning was significantly associated with PTSD (Karney & Trail, 2016). Specifically, lower marital satisfaction was significantly associated with the initial deployment and the cumulative months immediately after the deployment, as well as any traumatic experiences (Karney & Trail, 2016). Marital satisfaction was higher among couples who had not experienced any deployments as compared with those who did; however, there was no significant relationship between level of marital satisfaction and the number of additional deployments for those who experienced them (Karney & Trail, 2016). Negative marital functioning was significantly associated with PTSDThese findings are significant because they suggest that multiple deployments do not increase a service member’s risk for divorce.

Children. The mental health of the returning service member can influence not just the spouse, but the entire family, specifically children (VA, 2019). A child’s response to a parental deployment varies just as individual personalities vary. The child’s response to deployment is contingent upon age, developmental stage, and any mental or behavioral health difficulties the child may be experiencing (Creech, Hadley, & Borsan, 2014). Consistent with the influences of deployments on spouses, children also experience positive and negative outcomes. A favorable outcome in children would be an increase in their resiliency and increased levels of responsibility and maturity (Nicosia, Wong, Shier, Massachi & Datar, 2017). Conversely, deployments may also have a negative consequence on the child’s emotional growth. These influences are a result of the impact the service member’s deployment has on the care the child receives; disruption of daily Consistent with the influences of deployments on spouses, children also experience positive and negative outcomesroutines; and on how deployments affect service members’ physical and psychological health upon their return to home (Nicosia et al., 2017).

Deployments may be associated with increased emotional and behavioral difficulties across all age groups, including increased rates of medical visits for psychological challenges experienced during the deployment period (Creech et al., 2014). Children aged three to five experienced the highest rates of adjustment problems (e.g., internalization and externalization) and total psychiatric symptoms (Creech et al., 2014). Internalization may present as a depressed mood, anxiety, somatic complaints, fearfulness or withdrawn behaviors or other behaviors that could harm the child (Rooney et al., 2013; Novak & Mihić, 2018). Externalization may be exhibited as fighting or other aggressive or uncontrolled behaviors that harm others, such as bullying, destruction or damage to others’ personal property (Rooney et al., 2013). Children aged 6 to 12 experienced higher rates of anxiety and externalization. The collective length of deployment across the child’s life span served as a predictor of their depression and externalizing symptoms (Creech et al., 2014).

Deployments may be associated with increased emotional and behavioral difficulties across all age groups...Adolescents experienced significantly higher amounts of internalizing and externalizing and issues with school over any other age group (Creech et al., 2014). Further, adolescents voiced concern about the increased stress on the parent remaining at home, challenges with additional responsibilities, and concern about the welfare of the deployed parent (Creech et al., 2014). Among all age groups, adolescents, and especially males, experienced social and behavior maladjustments reflected as declines in academic performance, closeness to friends, independence, and personal Among all age groups, adolescents, and especially males, experienced social and behavior maladjustments...responsibility during the deployment periods (Nicosia et al., 2017).

Family Resiliency

Resiliency is the capability or aptitude to recover from or adjust effortlessly to misfortune or change (Merriam-Webster, 2019). Service members and their families experience a significant amount of change and adversity during deployments that may challenge the service member and families’ coping resources (Meredith et al., 2011). In this regard, a high level of resiliency may be beneficial to both the service member and families who are trying to cope with the stress of deployments. The RAND Corporation (RAND), in conjunction with the Center for Medical Policy Research, conducted a study to explore resiliency and to create a better appreciation of various approaches that could be beneficial to promote resilience among service members and their families (Meredith et al., 2011).

Resiliency is the capability or aptitude to recover from or adjust effortlessly to misfortune or changeRAND conducted a focused literature review and concluded that certain factors may contribute to individual and familial levels of resiliency. Individual factors such as positive coping, positive thinking, and behavioral control, which is a process of self-regulation and self-management contributed to resiliency. Additional key finding suggested that on the familial level, resiliency was impacted by emotional ties, communication, support, nurturing and adaptability (Meredith et al., 2011).

...on the familial level, resiliency was impacted by emotional ties, communication, support, nurturing and adaptabilityMeadows et al’s (2016) findings were consistent with the RAND study in that a family’s support system and communications were significant factors impacting a family’s level of resiliency during a stressful period such as deployments. Additionally, Meadows et al. (2016) found that a family’s belief system and organizational patterns (i.e., flexibility of the family, physical and psychological health and social and fiscal resources) of individual family members contributed to higher levels of resiliency. Familial-resilience resources available to the family prior to deployment play a critical role in how they respond to the stress associated with deployments. The complex dynamics related to resiliency of service members and their families are pivotal to effective coping during deployments or other stressful periods (Meadows et al., 2016). Studies suggested that extended and recurrent deployment, combined with other consequences of combat, may challenge the ability of everyone involved to cope with the stress of deployment.Familial-resilience resources available to the family prior to deployment play a critical role in how they respond to the stress associated with deployments

Conclusion: Implications for Research and Practice

To mitigate the impact of deployments on families, systems must be in place to prepare the entire family...In conclusion, deployments have noteworthy implications for parents and children in the uniformed services, especially during extended or long-term deployments (Nicosia et al., 2017). To mitigate the impact of deployments on families, systems must be in place to prepare the entire family for deployment and ensure effective communication during deployments (Meadows, 2016). More specifically, addressing family stress within the context of the deployment cycle; offering programs to promote early intervention before and during the first deployment; and providing the support needed to improve parental and family relationships during the post-deployment stage are important (Gewirtz, Erbes, Polusny, Forgatch & DeGarmo, 2011; Meadows et al., 2016).

The literature is replete with deployment-related research that focuses on other uniformed services, specifically, the Army, Air Force, Navy and Marines; however, there has been limited deployment related research focused on the Corps. Additional research is needed about how deployments impact Corps officers and their families. This research should explore the similarities and differences between the Corps and the other military services.

Additional research is needed about how deployments impact Corps officers and their familiesConflict-of-Interest Disclosures: This article does not relate to official duties with HRSA or CMS, but relates to clinical and deployment roles in the U.S. Public Health Service Corps. There are no conflicts of interest associated with the article and no products are being promoted.

Disclaimer: The views expressed in the publication are solely the opinions of the authors and do not necessarily reflect the official policies of the U.S. Department of Health and Human Services, the Health Resources and Services Administration, or the Centers for Medicare and Medicaid Services nor does mention of the department or agency names imply endorsement by the U.S. Government. Questions or comments should be directed to the authors.

Corrigendum: This article was originally posted on September 30, 2019. The authors notified us of content in the article that required revision for additional clarity. This article is the amended version. The intent of the article is unchanged from the initial post.

Authors

Janice Marie Arceneaux, DNP, APRN, FNP-C, CMSRN
Email: Janice.Arceneaux@cms.hhs.gov

Commander (CDR) Janice M. Arceneaux began her uniformed services career in 1990 as an enlisted member of the United States (U.S.) Army. She began her career in the U.S. Public Health Service Commissioned Corps in 2007 as an O-3/Nurse Consultant detailed at the Centers for Medicare and Medicaid Services. She has over 23 years of diverse experience in health promotion, disease prevention, mental healthcare, program management, policy, and education/training. She holds a Bachelor’s of Science degree from George Mason University in Fairfax, VA; graduate degrees from the University of Maryland at Baltimore and the University of Texas at Tyler; and a Doctorate of Nursing Practice degree from Texas Tech University Health Sciences Center. CDR Arceneaux is a certified Family Nurse Practitioner with a research background in obesity prevention and implementing healthy weight loss through behavior modification.

James LaVelle Dickens, DNP, APRN, FNP-BC, FAANP
Email: James.Dickens1@cms.hhs.gov

CAPT James Dickens serves in the U.S. Department of Health and Human Services, Region VI-Dallas with the Centers for Medicare and Medicaid Services (CMS) as the Manager of the Survey Branch. Previously he served in the Office of the Secretary of Health as the Senior Program Manager for the Office of Minority Health in Region VI. He is an experienced Registered Nurse and Board Certified Family Nurse Practitioner with over thirty-one years of federal healthcare experience. CAPT Dickens is a Commissioned Officer in the United States Public Health Service (USPHS) Commissioned Corps. His medical deployments include participating as a clinical team member for the Afghanistan Health Initiative (AHI) in Kabul, Afghanistan. He served as a technical advisor as a member of a Commissioned Corps hospital assistance team in Saipan, Commonwealth of the Northern Mariana Islands and in St Croix, U.S. Virgin Islands. CAPT Dickens also served as the Officer in Charge of the Commissioned Corps Ebola Response, Team 2 serving at the Monrovia Medical Unit (MMU) Ebola Treatment Unit in Monrovia, Liberia-West Africa, leading all local MMU clinical response efforts.

Wanza Bacon, MBA, BSN, RN
Email: WBacon@hrsa.gov

Captain Wanza Bacon has worked for the Health Resources and Services Administration (HRSA) for 11 years. She currently serves as the Regional Supervisor of Atlanta’s Division of Regional Operations in the Bureau of Health Workforce. In this capacity, CAPT Bacon strategically directs HRSA programs in the largest of ten HHS Regional offices, strengthening the health workforce and improving health care access to an estimated 65.7 million in underserved, high needs areas. Concurrently, she is Rapid Deployment Force 3’s Deputy Operations Section Chief, where she provides operational oversight for all medical personnel.