Improving Child Peer Adjustment in Military Families through Parent Training: The Mediational Role of Parental Locus of Control

The Effectiveness of GenerationPMTO During Sustained Implementation in the Public Mental Health System: A Single-Arm Open Trial Evaluation

To support families and reduce the burden of child mental, emotional, and behavioral problems, evidence-based parenting interventions must remain effective in real-world service delivery contexts. The purpose of the current study was to evaluate the effectiveness of the GenerationPMTO (GenPMTO) intervention during sustained implementation in the Michigan public mental health system using a single-arm open trial (pre-post) design. We also examined potential predictors of treatment response. A multilevel analysis framework was utilized to evaluate data from 365 caregivers who completed GenPMTO treatment. Results revealed significant positive improvements from pretest to posttest in all four outcome domains (i.e., parenting confidence, parenting practices, caregiver depressive symptoms, child behavior problems). When compared to group-based GenPMTO delivery, the individual delivery format was associated with significantly greater improvements in overall effective parenting practices, as well as in the subdomain of skill encouragement. Caregiver gender, caregiver educational level, and child age were all implicated as predictors of GenPMTO outcomes. These findings add to the literature by supporting the effectiveness of the GenPMTO intervention when fully integrated into mental health care practice and can inform continued efforts to provide families with evidence-based services in community settings.

Parental perceptions of social and emotional well-being of young children from Australian military families

INTRODUCTION

Many Australian Defence Force (ADF) and Veteran families are affected by the stressors of Defence family life, including frequent and prolonged parental deployments, and frequent relocations.

OBJECTIVE

To address a gap in information about Defence and Veteran (hereafter Defence) parents' knowledge, confidence and resources to support their young children's well-being and build their resilience.

DESIGN

This study used a mixed methods design to explore Defence parent's perceptions of their young children's (aged 2-8 years) social and emotional well-being and understanding of their children's responses to unique stressors as well as their confidence in providing support. Data from 41 parents were available.

FINDINGS

Overall, parents reported positive well-being evaluation of their children. However, just over a third of parents also reported that their children rarely cope well on two indicators combined (adapting to new situations and sharing negative emotions with others). Significantly, more than half of the parents (61%) were only partially confident in their ability to assist their children to cope with unique stressors in military families. Qualitative data provided further insights into children's struggle with relocations and parental absence and the challenges parents face in supporting them. Parents reported having limited access to effective age- and culturally appropriate resources to support their young children.

DISCUSSION

In a first-of-its kind study, we found that Australian Defence parents reported their young children were coping on most of the key well-being indicators. However, awareness of currently available supports for children remains a barrier as well as access to contextualised, age- and culturally appropriate resources are lacking.

CONCLUSION

There is a need for access to free, quality, online, research-based Australian resources to support young children from Defence families, especially for those living in regional and rural locations and are less likely to have access to mental health and other specialist supports.

Parental efficacy after a military parenting program: A dyadic latent growth model

Parental efficacy is an important aspect of parenting and a key outcome in many parenting programs. However, most studies focus on mothers, and less is known about the relationship between coparents' parental efficacy over time following intervention, and how parental distress can impact parental efficacy. The current study (N = 271 heterosexual couples; 162 intervention and 109 control) used a dyadic latent growth model to explore the dependence structure of parental efficacy between couples 2 years after assignment to a military parenting program, After Deployment, Adaptive Parenting Tools or a control condition. Results revealed a significant intervention effect, with both mothers and fathers in the intervention group exhibiting quadratic changes over 2 years, while the control group remained relatively stable. Notably, mothers' baseline emotional distress and fathers' deployment length emerged as predictors in understanding parental efficacy improvement over time. This research underscores the importance of adopting a family systems perspective and considering emotional distress and environmental stressors in designing targeted interventions to support military families and enhance overall well-being.

The ADAPT Parenting Intervention Benefits Combat Exposed Fathers Genetically Susceptible to Problem Drinking

Testing a vantage sensitivity model from differential susceptibility theory (DST), we examined a G × E × I hypothesis; that is, whether a military parenting intervention program (I) might buffer a G × E susceptibility for military deployed fathers exposed to deployment combat stress and trauma. We hypothesized that combat stress (E, referring to the natural environmental factor) would lead to increases in problem drinking, and that the effect of problem drinking would be amplified by genetic predisposition (G) for drinking reward systems, substance use, and addictive behaviors (i.e., differential vulnerability). Providing a preventive intervention designed to improve post-deployment family environments (I, vantage sensitivity) is hypothesized to buffer the negative impacts of combat exposure and genetic susceptibility. The sample included 185 post-deployed military fathers who consented to genotyping, from a larger sample of 294 fathers enrolled in a randomized effectiveness trial of the After Deployment Adaptive Parenting Tools (ADAPT) intervention. Trauma-exposed military fathers at genetic susceptibility for problem drinking assigned to the ADAPT intervention reported significantly more reductions in risky drinking compared with fathers at genetic susceptibility assigned to the control group, with a small effect size for the G × E × I interaction (d = .2). Trial Registration. The ADAPT trial is registered at the US National Institutes of Health ( ClinicalTrials.gov ) # NCT03522610.

Effectiveness of GenerationPMTO to Promote Parenting and Child Adjustment: A Meta-Analytic Review

GenerationPMTO is a theory- and evidence-based behavioral parenting program widely implemented in the past three decades. This systematic review and meta-analysis examined the effectiveness of twenty GenerationPMTO studies on parenting and child adjustment among 3893 families in six countries. Hedges' g from studies with pretest-posttest-controlled designs were computed and robust variance estimation (RVE) was used to deal with the effect size dependency. Results showed that GenerationPMTO significantly promoted parenting and child adjustment with moderate to high levels of heterogeneity. Specifically, GenerationPMTO improved parental discipline, parenting monitoring, skill encouragement, child externalizing problems, and child internalizing problems. Subgroup analyses revealed several important moderators, including type of comparison group, measurement, informant, risk of bias, etc. Intervention effects were quite robust across countries and multiple demographic characteristics. No publication bias across studies for parenting and child adjustment was detected. The revised Cochrane risk of bias for randomized trials (RoB 2) procedure was used to assess risk of bias within the included studies. Some studies showed a higher level of risk due to problems with the randomization process, missing data, low measurement quality, and reporting bias. Due to lack of data, we did not examine intervention effects on parental mental health or couple relationship quality. Future studies should test mediation models to understand the mechanisms of change and to identify moderators in order to understand the high levels of heterogeneity in GenerationPMTO studies.

Effects of the After Deployment: Adaptive Parenting Tools (ADAPT) intervention on fathers and their children: A moderated mediation model

Deployment to war is associated with disruptions to emotion regulation and parenting. Using data from a randomized controlled trial, we examined whether fathers with poorer emotion regulation would differentially benefit from the After Deployment, Adaptive Parenting Tools program, a 14-session group-based parenting intervention. Prior analyses of the intervention demonstrated benefits to observed couple parenting and children's adjustment, but not to fathers’ observed parenting. In this study we examined whether intervention effects on fathers’ observed distress avoidance were moderated by baseline emotion regulation, and whether reduced distress avoidance was associated with improved observed parenting and reduced children's internalizing symptoms. A subset of the full randomized controlled trial sample (181 families with a father who had returned from deployment to war in Iraq or Afghanistan, a nondeployed mother, and a target child aged 4–13) completed measures at baseline, 12-months, and 24-months postbaseline. Results indicated that fathers high in baseline emotion regulation difficulties assigned to the intervention group showed reductions in observed distress avoidance at 12 months compared to controls, which were subsequently associated with improvements in observed parenting practices and reductions in children's internalizing symptoms at 24 months. The results suggest a role for personalizing parenting programs for fathers high in emotion dysregulation.

Los contenidos de la formación parental y sus implicaciones en el comportamiento de los adolescentes: elementos desde una revisión

Resumen Los padres buscan apoyo para enfrentar los desafíos que sus hijos tienen en la adolescencia. El objetivo de este trabajo es analizar los tópicos abordados en la formación de padres con hijos adolescentes y su relación con las tendencias comportamentales de estos. Para ello, se llevó a cabo una revisión cualitativa de intervenciones y programas centrados en fortalecer el proceso de crianza, estableciéndose una concentración en los aspectos regulatorios, comunicativos y emocionales de la relación padre-hijo. Por medio de un análisis cuantitativo, también se pudo establecer que los tópicos abordados tienen efectos significativos sobre los adolescentes, como la reducción en problemas de comportamiento, manejo adecuado de la sexualidad y disminución en la tendencia al consumo de sustancias. Teniendo en cuenta la información registrada, es posible plantear que la formación parental puede abordarse en diferentes formatos de acuerdo con los objetivos y condiciones disponibles, lo que puede representar beneficios importantes para el desarrollo saludable de los adolescentes.

Do Less Mindful Mothers Show Better Parenting via Improvements in Trait Mindfulness Following a Military Parent Training Program?

Parental deployment to war poses risks to children's healthy adjustment. The After Deployment Adaptive Parenting Tools (ADAPT) program was developed for post-deployed military families to promote children's well-being through improving effective parenting. ADAPT combines behavior management with emotion socialization skills for parents, using brief mindfulness practices to strengthen emotion regulation. We used a three-wave longitudinal, experimental design to examine whether ADAPT improved parental trait mindfulness (PTM), and whether the effect was moderated by baseline PTM. We also investigated whether improved PTM was associated with behavioral, cognitive, and emotional aspects of parenting such as self-reported parental locus of control (PLOC), self-reported parental emotion socialization (PES), self-reported and observed behavioral parenting skills. We analyzed data from a randomized controlled trial (RCT) of the ADAPT, with a focus on mothers (n = 313) who were either deployed (17.9%) or non-deployed and partnered with a husband who had been recently deployed to Iraq and/or Afghanistan and returned (82.1%). Families identified a 4-13-year-old target child (Mean age = 8.34, SD = 2.48; 54.3% girls) and were randomized into ADAPT (a group-based 14-week program) or a control condition (services as usual). At baseline, 1-year, and 2-year follow-up, PTM, PLOC, PES, and parenting skills were self-reported, whereas home-based family interactions involving parents and the child were video-taped and assessed for observed behavioral parenting skills such as discipline and problem-solving using a theory-based coding system. Results showed that mothers with lower baseline PTM reported higher PTM at 1-year while mothers with higher baseline PTM reported lower PTM at 1-year. PTM at 1-year was associated with improved self-reported parenting skills and supportive PES at 2-year, as well as indirectly associated with improved PLOC and reduced nonsupportive PES at 2-year through PTM at 2-year. No associations between PTM and observed parenting skills were detected. We discuss the implications of these findings for incorporating mindfulness practices into behavioral parenting interventions and for personalized prevention considering parents' pre-existing levels of trait mindfulness as a predictor of intervention responsivity.

Improving parental emotion socialization in military families: Results of a randomized controlled trial

Prior research indicates that children of deployed parents are at risk for emotional problems, suggesting the utility of preventive efforts for military families. Effective parental socialization of children's emotions is protective for children's development, and parental experiential avoidance may impede parental emotion socialization, yet intervention studies in this area are lacking. This study examined the impact of a parenting program, After Deployment Adaptive Parenting Tools (ADAPT), on parental emotion socialization postintervention (6 months postbaseline) and whether intervention effects were moderated by parental experiential avoidance. The sample included 336 families (294 fathers and 313 mothers) with at least 1 deployed parent and a focal child aged 4-12. Families were randomized into either ADAPT (a 14-week group-based intervention) or control group. Self-reported data on parental emotion socialization and experiential avoidance were analyzed using structural equation modeling. Results showed that mothers who were assigned to the intervention had significant improved supportive emotion socialization and reduced nonsupportive emotion socialization at postintervention compared with controls. Mothers with higher levels of experiential avoidance assigned to the intervention group had higher levels of supportive emotion socialization at postintervention. No significant intervention effects were found in fathers. This study provides support for the effects of the ADAPT program on maternal emotion socialization at 6-month postbaseline, and the role of experiential avoidance as a moderator. We discuss findings in relation to the different parental roles that mothers and fathers play in postdeployed families, as well as implications for personalized intervention programming. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Intervention effects on reflectivity explain change in positive parenting in military families with young children

Military families with young children often experience stress related to the unique circumstances of military families (e.g., deployment), and there is a need for interventions that are specifically tailored to military families with young children. The Strong Military Families (SMF) intervention responds to this need, and consists of two versions: A Multifamily Group (N = 34), and a Homebased psychoeducational written material program (N = 42; treated as the comparison group in this report). The Multifamily Group utilized an attachment-based parenting education curriculum and in vivo support of separations and reunions, encouraged peer support among parents, and connected families to additional services. In the present nonrandomized trial, we examine intervention effects on observed parenting behavior and affect, and test whether changes in parenting reflectivity account for intervention-related changes in observed parenting. Observed parenting behavior and affect were coded from the Caregiver-Child Structured Interaction Procedure (Crowell & Fleischmann, 1993), and parenting reflectivity was coded from the Working Model of the Child Interview (Zeanah & Benoit, 1995). Results suggest that relative to Homebased participants, Multifamily Group participants showed pre- and post- improvements in aspects of positive parenting (Emotional Responsivity, Positive Affect), but no decreases in negative parenting. The efficacy of the SMF Multifamily Group intervention does not appear to depend on parent risk level or preintervention parent behavior and affect. Further, a mediation model demonstrated that the intervention effects on parents' observed positive affect in an interaction task with their child were partially accounted for by intervention-related changes in their parenting reflectivity. (PsycINFO Database Record

A Call for Theoretically Informed and Empirically Validated Military Family Interventions

Although multiple evidence-based family interventions exist, less than a handful have been developed or rigorously tested specifically for military families. Indeed, few interventions available to military families are theory based or empirically validated; most have good face validity but little data on efficacy or effectiveness. This article argues for an emphasis on the rigorous evaluation, via pragmatic randomized controlled trials, of theory-based family interventions to strengthen and support military families. Data are provided from a theory-based, empirically validated parenting program for families (After Deployment, Adaptive Parenting Tools, or ADAPT) to demonstrate the potential for randomized controlled trials to yield rich data about family functioning beyond program outcomes. Opportunities to generate theoretically informed, evidence-based family interventions for military families will contribute not only to testing theories about military families but also to advancing well-being for the next generation of service members and their families.

Parent Discrepancies in Ratings of Child Behaviors Following Wartime Deployment

Researchers have shown that parents often disagree in their ratings of their children's behavior, and that these discrepancies are typically related to child and family characteristics (e.g., child's age, parent psychopathology). Few studies, however, have examined discrepancies in how mothers and fathers rate child behavior during a stressful family context such as a parent's wartime deployment. The present study of 174 military families (children aged 6 to 11 years; 54.0% female) examined whether family factors (parental sense of control, marital satisfaction) and contextual risk factors related to a parent's wartime deployment (number and length of deployments, battle experiences, and posttraumatic stress disorder [PTSD] symptoms) were associated with discrepancies in how mothers and fathers rated internalizing and externalizing behaviors in their children. Using a latent congruency model, our results showed that when parents self-reported higher levels of PTSD symptoms, both mothers, β = -.33, p = .021, and fathers, β = .41, p = .026, tended to also report higher levels of internalizing symptoms in their child, relative to what their spouse reported. In comparison to mothers, fathers also tended to report higher levels of child externalizing symptoms, β = .44, p = .019. Our findings may help clinicians understand how parent mental health within a stressful family context relates and/or informs a parent's ratings on assessments of his or her child's internalizing and externalizing symptoms.

Evaluating Behavioral Health Interventions for Military-Connected Youth: A Systematic Review

INTRODUCTION

Military-connected youth are at increased risk for experiencing distinct psychosocial and behavioral health vulnerabilities. Although behavioral health interventions have been developed to treat vulnerabilities in military-connected youth, little is known about the methodological quality of studies evaluating these interventions. In this study, a systematic review of behavioral health interventions for military-connected youth was conducted to examine methodological quality and treatment outcomes.

MATERIALS AND METHODS

Electronic databases were systematically searched for studies evaluating behavioral health interventions for military-connected youth which yielded 3,324 citations. Methodological quality was evaluated by 2 researchers with 3 measures that assessed scientific rigor, transparency, external and internal validity, and power for quantitative, qualitative, and mixed-method trials. Interrater reliability was strong (κ = 0.81). Sample characteristics and treatment outcomes were also assessed.

RESULTS

Fourteen studies meeting full inclusion criteria evaluated 10 behavioral health interventions. Methodological quality scores for all studies were poor to fair, with limitations in reporting, external and internal validity, and power. Research designs were predominantly nonexperimental. Treatment effects for both psychosocial and behavioral health outcomes were consistently positive for all studies. In studies reporting effect sizes, treatment effects were small to moderate (d = 0.01-0.42, odds ratio = 0.04-0.47, b = -0.02-0.56). Demographic and military characteristics of samples were inconsistently reported.

CONCLUSION

Behavioral health interventions for military-connected youth have noteworthy methodological limitations, indicating a need to employ more rigorous research strategies. Positive treatment outcomes, however, suggest promising interventions for improving psychosocial and behavioral health problems in military-connected youth. Future research directions and implications for clinical-community practice are also discussed.