Nemours wants to train doctors to better support children who care for veteran parents

More than 2 million children live with a parent who was wounded during military service and many help care for them, a responsibility that can increase stress, depression, and feelings of isolation from friends who are often unaware of their caregiver role.

Now Nemours Children’s Health in Delaware wants to train health-care providers to better support these so-called “hidden heroes.” The Delaware-based health system is launching a free online training program to teach providers about the caregiver role children often play in military families, how to work with patients whose families have experienced trauma, and how to establish trust with youth who may be reluctant to talk about their experience.

The three-part program was developed by Nemours and the Elizabeth Dole Foundation, a nonprofit that supports families caring for injured or ill veterans founded by Elizabeth Dole, a former Republican senator from North Carolina. It is intended for primary, specialty, and behavioral health-care providers, as well as social workers and other medical professionals.

“Our nation is letting down our military and veteran families by allowing the struggles of our wounded veterans and their caregivers to be inherited by the next generation,” Steve Schwab, the foundation’s CEO, said in a statement. Nemours’ new training program is “an opportunity to change the outlook for these incredible young people,” he said.

The foundation’s Hidden Heroes campaign aims to raise awareness about the needs of military families, especially children, who often take on additional responsibilities. Some help care for an injured or sick veteran family member. Others take care of younger siblings who would otherwise have been cared for by the other adults in their home.

About 2.3 million children live with a veteran who is disabled, according to a 2021 study by the Elizabeth Dole Foundation and Mathematica, a research consulting firm, that analyzed Census data. Nemours was not involved in the study.

Focus groups of children and young adults from military families told researchers they often feel their needs are overshadowed by the needs of the family member receiving the care.

“People would ask how our dad was. Nobody would ask how we were,” one young adult told researchers.

Researchers found that children in these roles experienced higher levels of stress, burnout, fatigue, and depression compared to their peers. They are often reluctant to talk about their caregiver role, for fear of being judged by friends or schoolmates, which can lead to feelings of isolation.

“I don’t have a lot of friends who have dads with PTSD and anxiety. I’ll talk to my sister about it sometimes, or I won’t say anything,” a child told researchers. “Most of the time, I keep it inside.”

The goal of the new training program is to help providers establish a more trusting relationship with caregiver children, said Allison Gertel-Rosenberg, a vice president and chief policy and prevention officer at Nemours. This will help doctors better understand their patients’ needs and connect them with support services.

The training program emphasizes trauma-informed care, an approach that takes into consideration how the dangers and traumas someone has been exposed to affects their overall health and their relationship with health-care providers.

“We want to make sure we’re letting the families take the lead,” said Gertel-Rosenberg.

Though designed for military families, the training could one day be expanded to help children who are caregivers in their family for other reasons, for instance a parent who was injured by gun violence or who is experiencing addiction.