Families of service members with traumatic injuries, wounds or long-term illness may not anticipate all they will face when rushing to meet their loved one admitted as an inpatient. When difficulties arise, some families must search for help, but a preventive care program called Operation BRAVE Families (OBF) at Walter Reed National Military Medical Center offers a proactive hand before troubles appear.

A 2013 literature review published in Military Medicine said the impact of traumatic injuries and wounds on the warrior family are often devastating. Families have little time to prepare for sudden combat injuries, and decisions are made at a time of crisis, uncertainty and intense emotional distress. Combat injuries, such as amputation and PTSD, affect complex developmental needs of children.

Dr. Ryo Sook Chun, a child and adolescent psychiatrist at WRNMMC, serves as director of OBF, also known as Operation Building Resilience and Valuing Empowered Families. She explained the collaborative program started in 2001, soon after 9/11.

“We had a family assistance center right next to the Pentagon to assist the families and children of the deceased, [as well as] those directly impacted by 9/11,” she said. 

The Child and Adolescent Psychiatry Service developed the working partnership with families of wounded warrior parents from the war in Iraq and Afghanistan.

“After 2003, when we started having a large number of injured service members, their children and families arrive to [the former Walter Reed Army Medical Center] and they needed the [psychological] service,” which was the main issue, she explained.

Families were uprooted from where they had been living for some time. Children were pulled away from their schools and friends, the second reason for developing OBF, Chun said.

“They were all trying to carry on their daily life [without] knowing what’s happening to their loved one who is injured. So OBF reached out to their children and families as a team, and became part of their medical care,” the psychiatrist explained.

As a part of the injured service member’s care team, OBF receives information about who arrives to the hospital, and whether they have children, how many, and if the children were at WRNMMC with the parent, or not.

“We’re able to get connected with those children who are for instance, in Hawaii, Alaska, and we’re able to assist the [hospitalized] parent to maintain contact with those children,” Chun said. “We contact the schools [and] contact the local resources so the children will be supported.”

The collaborative, non-traditional behavioral health service joins the teams of other specialty care clinics to work with both patients and their families. For example, when a child has an illness, the child may receive treatment in pediatric oncology.

“We are an outreach, preventive program that provides different levels of service: from preventive service to the treatment, along with the follow-up care.  Another important part is that we are a one-stop-shop that connects the family to the resources in the community or in the hospital,” she explained.

“First of all, we have different levels of care, so we will do more outreach and help stabilize education for the child and family, [as well as] provide psychiatric and psychological assessment. We’ll help the child’s specific symptoms—nightmares, sleep problems, or behavior problems at school – we’ll address those,” the psychiatrist said.

According to Chun, the program is very inclusive, working with not only immediate family but cousins and other extended family members.

“When they come in, we’ll include them in our interviews and educations,” she said.

Comprised of an interdisciplinary team, Chun takes the lead of the group that also includes a psychologist and social workers who are dedicated to continue to work with the family as long as they are reachable.

“Some of the families we follow used to live here on [the WRNMMC medical] campus, now they’re in the community and we stay connected,” Chun said, but it’s the family’s choice whether they want this or not.

Now, mostly kids whose parents have traumatic or terminal illness are seen now, with a slow-down of traumatic injury from the battlefield, she said. Operation Brave Family takes a different approach in the case of traumatic illness than a case of war trauma/injury.

“Patients with illnesses like terminal cancer are referred to OBF so when they do reunite with their spouse and children, we will see the child and family as more of a psychological first-aid aspect,” Chun explained. “Then we will make the assessment, [and] meet the child’s needs.”

She said OBF works with other departments in the medical center including physical medicine and rehabilitation, occupational therapy, orthopedics, the department of behavioral health, warrior clinic, obstetrics and gynecology as well as the surgical intensive care unit.

“We may have gotten involved with that family because another arm of our service is collaborative care. Collaborative care is that piece that [works with families] that are dealing with severe injuries and illness, whether the family needs the service, or not, the family was dealing with this severe illness. We get them through referral,” the pediatric psychiatrist explained.

Chun said OBF makes those families aware that the collaborative care program is available to help them, but the program doesn’t go to the family’s home.

“We make them aware of the service that they can receive but they have to come to our clinic for that,” the director said.

Broad range of services include therapeutic art and play sessions, psychoeducation, individual and family therapies, school-related services, assistance in case management and referrals as needed.

Families involved with OBF during the inpatient stay of their loved one have the option to continue working with the program; some remain nearby. The pediatric psychologist said some are seen for three or four years – as long as the family accepts the service.

“We don’t have any families who’ve stayed with us since 2003 but they come and go, so sometimes they come back but many of the families move back to where they’re from,” Chun explained. “When the service member comes back for a follow-up visitor second treatment, then sometimes the kids come along.”