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Allbaugh LJ, George G, Klengel T, Profetto A, Marinack L, O'Malley F, Ressler KJ. Children of trauma survivors: Influences of parental posttraumatic stress and child-perceived parenting. J Affect Disord 2024; 354:224-231. [PMID: 38490588 DOI: 10.1016/j.jad.2024.03.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/20/2024] [Accepted: 03/09/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Research has established a negative association between parental posttraumatic stress symptoms (PTSS), including subthreshold symptoms, and child physical and behavioral health outcomes. Such intergenerational transmission of risk has multiple possible mechanisms, including lack of positive parenting, increased negative parenting, shared environmental and contextual risks, and potential biological components such as shared genetics or even transmission of epigenetic risk. METHOD This study examined 93 parent-child dyads (n = 171 participants total) from a mixed Urban-Suburban US metropolitan area to investigate the relations between parental PTSS and child-perceived parenting and child PTSS. We sought to examine interactions between parental PTSS and parenting on child PTSS. RESULTS We found an association between parent and child PTSS, consistent with prior literature showing increased risk for children of trauma survivors. Interestingly, we found effects of positive parenting on diminished child PTSS symptoms only in parents without PTSS, whereas the effect of positive parenting on buffering child symptoms was absent in parents with PTSS. LIMITATIONS The present findings are tempered by the use of self-report data to assess parent and child PTSS, which is not as reliable as clinician assessment of symptoms. Further, the use of survey data limits what is known about the extent of trauma exposure in parents and children, and different measures were used to assess PTSS in parents and kids, which limits comparability of these reported symptoms. DISCUSSION Limitations notwithstanding, findings suggest joint attention paid to parenting practices and to a parent's recovery, even from subthreshold symptoms of PTSS, as two different but important ways to support trauma survivor parents in their efforts to most optimally parent and protect their children from intergenerational risk.
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Affiliation(s)
- Lucy J Allbaugh
- Department of Psychology, University of Dayton, Dayton, OH, United States of America.
| | - Grace George
- McLean Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Torsten Klengel
- McLean Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Alex Profetto
- McLean Hospital, Boston, MA, United States of America
| | - Lucas Marinack
- Department of Psychology, University of Wyoming, Laramie, WY, United States of America
| | - Fiona O'Malley
- Nationwide Children's Hospital, Columbus, OH, United States of America
| | - Kerry J Ressler
- McLean Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
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Lee H, Kim JY. Effectiveness of the TSL (Thank you, Sorry, and Love) program for adaptability of military children. MILITARY PSYCHOLOGY 2023:1-11. [PMID: 37956156 DOI: 10.1080/08995605.2023.2276638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 09/25/2023] [Indexed: 11/15/2023]
Abstract
This study aims to assess the effectiveness of the TSL (Thank you, Sorry, and Love) program in enhancing the adaptability of military children in the Republic of Korea. A total of 30 military children were selected as participants and assigned to three groups: an experimental group receiving the TSL program, a comparison group receiving a resilience program, and a control group. Measures of adaptability (including resilience, perceived stress, depression, family function, and school adaptation) were administered to the military children at pre, post, and follow-up stages. The results reveal significant differences in adaptability between the TSL program participants and the other groups' participants at the post-intervention and follow-up assessments. These findings suggest that the TSL program has the potential to effectively enhance the adaptability of military children and maintain their adaptive capacities across various domains in the long term.
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Affiliation(s)
- Hyun Lee
- Center for Social Welfare Research, Yonsei University, Seoul, Republic of Korea
| | - Jae Yop Kim
- Department of Social Welfare, Social Welfare, Yonsei University, Seoul, Republic of Korea
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Bufford T, Aralis H, Kataoka S, Lee SJ, Lavelle Trinh C, Lester P. Creating a Statistical Analysis Plan to Continually Evaluate Intervention Adaptations that Arise in Real-World Implementation. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:1302-1313. [PMID: 37243867 PMCID: PMC10220329 DOI: 10.1007/s11121-023-01513-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2023] [Indexed: 05/29/2023]
Abstract
Evidence-based health interventions are frequently translated into real-world settings where practical needs drive changes to intervention protocols. Due to logistical and resource constraints, these naturally arising adaptations are rarely assessed for comparative effectiveness using a randomized trial. Nevertheless, when observational data are available, it is still possible to identify beneficial adaptations using statistical methods that adjust for differences among intervention groups. As implementation continues and more data are collected and assessed, we also require analysis methods that ensure low statistical error rates as multiple comparisons are made over time. This paper describes how to create a statistical analysis plan for evaluating adaptations to an intervention during ongoing implementation. This can be done by combining methods commonly used in platform clinical trials with methods used for real-world data. We also demonstrate how to use simulations based on previous data to decide the frequency with which to conduct statistical analyses. The illustration uses data from large-scale implementation of a school-based resilience and skill-building preventive intervention to which several adaptations were made. The proposed statistical analysis plan for evaluating the school-based intervention has potential to improve population-level outcomes as implementation scales up further and additional adaptations are anticipated.
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Affiliation(s)
- Teresa Bufford
- Department of Biostatistics, UCLA Fielding School of Public Health, 650 Charles E. Young Dr. South, 51-254 CHS, Los Angeles, CA, 90095, USA.
| | - Hilary Aralis
- Department of Biostatistics, UCLA Fielding School of Public Health, 650 Charles E. Young Dr. South, 51-254 CHS, Los Angeles, CA, 90095, USA
| | - Sheryl Kataoka
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, 90095, USA
| | - Sung-Jae Lee
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, 90095, USA
| | - Carla Lavelle Trinh
- Los Angeles Unified School District School Mental Health, 333 South Beaudry Avenue, Los Angeles, CA, 90017, USA
| | - Patricia Lester
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, 90095, USA
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Marlotte L, Klomhaus A, Ijadi-Maghsoodi R, Aralis H, Lester P, Griffin Esperon K, Kataoka S. Implementing depression care in under-resourced communities: a school-based family resilience skill-building pilot randomized controlled trial in the United States. Front Psychol 2023; 14:1233901. [PMID: 37790229 PMCID: PMC10542892 DOI: 10.3389/fpsyg.2023.1233901] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/11/2023] [Indexed: 10/05/2023] Open
Abstract
Introduction Youth in under-resourced communities are more likely to have greater social risk factors for mental health needs yet have less access to needed care. School-based mental health services are effective in treating common disorders such as adolescent depression; however, few have a family-centered approach, which may especially benefit specific populations. Methods Utilizing a community-partnered approach, we adapted an established, trauma-informed, resilience skill-building family intervention for adolescents with depression. We conducted a small randomized controlled feasibility pilot of an adapted intervention in a large school district that serves predominately low-income, Latinx students in the Southwest United States between 2014-2017. Youth between the ages of 12-18 years old with a Patient Health Questionnaire (PHQ-8) score of 10 or higher, who spoke English or Spanish, were recruited from 12 school mental health clinics. Twenty-five eligible adolescents with depression and their participating caregivers were enrolled and randomly assigned to receive either the adapted intervention, Families OverComing Under Stress for Families with Adolescent Depression (FOCUS-AD), or usual care, Cognitive Behavioral Therapy (CBT) only. Most of the sample was Latinx and female. We evaluated feasibility, acceptability, and preliminary effectiveness. Results Among participants who completed standardized assessments administered at baseline and approximately five months post-randomization (n = 10 FOCUS-AD, n = 11 CBT only), effectiveness was explored by identifying significant changes over time in adolescent mental health within the FOCUS-AD and CBT only groups and comparing the magnitude of these changes between groups. Nonparametric statistical tests were used. We found the FOCUS-AD intervention to be feasible and acceptable; participant retention was high. Adolescent symptoms of depression (measured by the PHQ-8) improved significantly from baseline to follow-up for youth in both FOCUS-AD (median decrease [MD] = 10, p = 0.02) and control (MD = 6, p = 0.01) groups, with no significant difference across the two groups. Results were similar for symptoms of PTSD (measured by the Child PTSD Symptom Scale; FOCUS-AD MD = 12.5, p = 0.01; CBT only MD = 7, p = 0.04; no significant difference between groups). Conclusion Family-centered approaches to depression treatment among adolescents living in under-resourced communities may lead to improved mental health, although further research is warranted.
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Affiliation(s)
- Lauren Marlotte
- Division of Population Behavioral Health, Jane and Terry Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | - Alexandra Klomhaus
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Roya Ijadi-Maghsoodi
- Division of Population Behavioral Health, Jane and Terry Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
- VA Health Service Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Hilary Aralis
- Division of Population Behavioral Health, Jane and Terry Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
| | - Patricia Lester
- Division of Population Behavioral Health, Jane and Terry Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | | | - Sheryl Kataoka
- Division of Population Behavioral Health, Jane and Terry Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
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Family-Based Prevention of Child Traumatic Stress. Pediatr Clin North Am 2022; 69:633-644. [PMID: 35934490 PMCID: PMC9554837 DOI: 10.1016/j.pcl.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Most children experience potentially traumatic events, and some develop significant emotional and behavioral difficulties in response. Although the field has mainly focused on treatment, a prevention framework provides an alternate approach to reducing the public health burden of trauma. Because parents and families can affect children's trauma exposure and reactions, family-based preventive interventions represent a unique opportunity to address child traumatic stress. This article discusses family-based programs that address child traumatic stress across 3 categories: preventing children's exposure to traumatic events, preventing traumatic stress reactions following exposure, and preventing negative long-term sequelae of trauma.
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6
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Chow TS, Tang CSK, Siu TSU, Kwok HSH. Family Resilience Scale Short Form (FRS16): Validation in the US and Chinese Samples. Front Psychiatry 2022; 13:845803. [PMID: 35633805 PMCID: PMC9136042 DOI: 10.3389/fpsyt.2022.845803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/23/2022] [Indexed: 12/02/2022] Open
Abstract
Family resilience, which refers to the processes through which a family adapts to and thrives from adversities, has growing importance in recent years. In response to the need for further research on family resilience, the present research aims to abbreviate and validate Sixbey's Family Resilience Assessment Scale (FRAS) into a 16-item version Family Resilience Scale Short Form in the US (FRS16) and Chinese (FRS16_C) samples. The samples included 1,236 (Study 1) and 1,135 (Study 2) participants from the US and China, respectively. Results of confirmatory factor analysis (CFA) supported the proposed three-factor structure of FRS16: Family Communication and Connectedness, Positive Framing, and External Support across two samples. Overall, the reliability and validity of full and subscales of FRS16 and FRS16_C were satisfactory. Multi-group CFA revealed that both configural and metric invariance are supported, suggesting that participants in the US and Chinese samples assign comparable meaning to the latent factors of FRS16. Results suggested that FRS16 and FRS16_C are valid instruments for family resilience in the US and Chinese samples.
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Affiliation(s)
- Tak Sang Chow
- Department of Counselling and Psychology, Hong Kong Shue Yan University, North Point, Hong Kong SAR, China.,Wan Chow Yuk Fan Centre for Interdisciplinary Evidence-based Practice and Research, Hong Kong Shue Yan University, North Point, Hong Kong SAR, China
| | - Catherine So Kum Tang
- Department of Counselling and Psychology, Hong Kong Shue Yan University, North Point, Hong Kong SAR, China.,Wan Chow Yuk Fan Centre for Interdisciplinary Evidence-based Practice and Research, Hong Kong Shue Yan University, North Point, Hong Kong SAR, China
| | - Tiffany Sok U Siu
- Wan Chow Yuk Fan Centre for Interdisciplinary Evidence-based Practice and Research, Hong Kong Shue Yan University, North Point, Hong Kong SAR, China
| | - Helen Sin Hang Kwok
- Department of Counselling and Psychology, Hong Kong Shue Yan University, North Point, Hong Kong SAR, China
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Short P, Burklow CS, Nylund CM, Susi A, Hisle-Gorman E. Impact of Parental Illness and Injury on Pediatric Disorders of Gut-Brain Interaction. J Pediatr 2021; 236:148-156.e3. [PMID: 33991543 DOI: 10.1016/j.jpeds.2021.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/02/2021] [Accepted: 05/07/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the relationship between parental injury and illness and disorders of gut-brain interaction (DGBI) in children. STUDY DESIGN A self-controlled case series using data from the Military Health System Data Repository compared International Classification of Diseases, Ninth Revision-identified DGBI-related outpatient visits and prescriptions in 442 651 children aged 3-16 years in the 2 years before and the 2 years after the injury and/or illness of their military parent. Negative binomial regression was used to compare visit rates for constipation, fecal incontinence, abdominal pain, irritable bowel syndrome, and a composite of these before and after parental injury and/or illness. Logistic regression, clustered by child, compared the odds of stooling agent and antispasmodic prescription before and after parental injury and/or illness. RESULTS In the 2 years following parental injury and/or illness, children had increased visits for DGBIs (adjusted incidence rate ratio [aIRR] 1.09; 95% CI 1.07-1.10), constipation (aIRR 1.07; 95% CI 1.04-1.10), abdominal pain (aIRR 1.09; 95% CI 1.07-1.12), and irritable bowel syndrome (aIRR 1.37; 95% CI 1.19-1.58). Following parental injury and/or illness, the odds of stooling agent prescription decreased (aOR 0.95; 95% CI 0.93-0.97) and the odds of antispasmodic prescription increased (aOR 1.26; 95% CI 1.18-1.36). CONCLUSIONS Parental injury and/or illness is associated with increased healthcare use for DGBIs. Parental health should be considered by clinicians when assessing DGBIs, counseling patients, and formulating treatment plans.
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Affiliation(s)
- Patrick Short
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD; Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Carolyn Sullivan Burklow
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD; Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Cade M Nylund
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD; Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Apryl Susi
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Elizabeth Hisle-Gorman
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
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8
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Rosenthal E, Franklin Gillette S, DuPaul GJ. Pediatric siblings of children with special health care needs: Well-being outcomes and the role of family resilience. CHILDRENS HEALTH CARE 2021. [DOI: 10.1080/02739615.2021.1933985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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9
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Kremkow JMD, Finke EH. Peer Experiences of Military Spouses with Children with Autism in a Distance Peer Mentoring Program: A Pilot Study. J Autism Dev Disord 2021; 52:189-202. [PMID: 33656623 DOI: 10.1007/s10803-021-04937-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 11/24/2022]
Abstract
Previous research has indicated military families with children with autism reported significant difficulties when relocating with their child with autism. One possible relocation support for these families is an online peer mentorship program with another military spouse with a child with autism who has more relocation experience. The purpose of this pilot investigation was to determine the feasibility, acceptability, and collect initial outcome data for an online peer mentorship program for military spouses with children with autism. Results from this study indicated an online peer mentorship program is feasible, and may be a helpful program to support military spouses with children with autism before relocations.
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Affiliation(s)
- Jennifer M D Kremkow
- Department of Communication Sciences and Disorders, Elmhurst University, 190 S Prospect Ave, Elmhurst, IL, 60126, USA.
| | - Erinn H Finke
- Department of Audiology and Speech Pathology, University of Tennessee Health Science Center, 578 South Stadium Hall, Knoxville, TNTN, 37996, USA
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10
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Dombrowsky AR, Kirchner G, Isbell J, Brabston EW, Ponce BA, Tokish J, Momaya AM. Resilience correlates with patient reported outcomes after reverse total shoulder arthroplasty. Orthop Traumatol Surg Res 2021; 107:102777. [PMID: 33321240 DOI: 10.1016/j.otsr.2020.102777] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 07/10/2020] [Accepted: 10/20/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Personal and social factors may account for much of the variation in patient reported outcome scores, yet little evidence exists on how psychological properties affect patient outcomes following reverse total shoulder arthroplasty (rTSA). The objective of this study is to determine if resilience, characterised by the ability to return to a healthy level of function after experiencing stress, correlates with patient reported outcome scores after rTSA. HYPOTHESIS Resilience score will correlate positively with patient reported outcomes after rTSA. METHODS Seventy-three patients were identified that had undergone primary rTSA with minimum 2-year follow-up (4.7±1.8). These patients completed a phone survey that included the Brief Resilience Scale (BRS), a measure of general resilience in all aspects of life, along with American Shoulder and Elbow Surgeon (ASES), Penn, and Single Assessment Numerical Evaluation (SANE) scores. Mean outcome scores were calculated to identify any correlation between resilience and clinical outcomes. RESULTS The mean BRS score was 23.8±4.8 (range 12.0-30.0), with 41 patients classified as normal resilience (NR), 17 patients as low resilience (LR), and 15 as high resilience (HR). Postoperative BRS scores correlated with ASES (r=0.31, p=0.008), Penn (r=0.25, p=0.03), and SANE score (r=0.32, p=0.007). The mean ASES score was 14.0 points lower in the LR group (77.0 points), compared to the HR group (91.0 points; p=0.04). Similarly, the LR group had a mean SANE score that was 18.6 points lower than the HR group (73.4 and 91.9 points, respectively; p=0.021). DISCUSSION The observation that greater general life resilience correlates with lower pain intensity, lesser magnitude of limitations, and perception of greater normality of the shoulder after reverse total shoulder arthroplasty emphasises the importance of addressing personal and social health opportunities along with the physical in musculoskeletal care. Resilience may be a useful predictor of outcomes following rTSA. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Alex R Dombrowsky
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 35233 Birmingham, AL, United States
| | - Graham Kirchner
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 35233 Birmingham, AL, United States
| | - Jonathan Isbell
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 35233 Birmingham, AL, United States
| | - Eugene W Brabston
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 35233 Birmingham, AL, United States
| | - Brent A Ponce
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 35233 Birmingham, AL, United States
| | - John Tokish
- Orthopaedic surgery, Orthopaedic sports medicine, Mayo Clinic, Phoenix, AZ, United States
| | - Amit M Momaya
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 35233 Birmingham, AL, United States.
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Novilla LK, Broadbent E, Glade R, Crandall A. Supporting and Engaging Families: An Examination of Publicly-Funded Health Promotion Programs in the Intermountain West, USA. Front Public Health 2020; 8:573003. [PMID: 33178662 PMCID: PMC7593609 DOI: 10.3389/fpubh.2020.573003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/28/2020] [Indexed: 11/24/2022] Open
Abstract
Public health programming efforts have traditionally focused on either an individualistic or population approach, neglecting the family as a setting for or partner in health promotion efforts. Due to the multi-faceted influence of families on individual health, family-focused, and family-friendly public health interventions are important to making lasting changes for individual and community health. The purpose of this study was to examine the degree to which health promotion programs in a state in the US Intermountain West involve and support families across four family impact principles: family engagement, family stability, family responsibility, and family diversity. A survey was completed by 67 health promotion administrators and practitioners from 12 out of 13 county health departments with additional responses from public health practitioners at the State Health Department. The results of the survey indicated that health promotion efforts were best at supporting family responsibility and a diverse group of families but were weaker in family engagement and family stability. Applying a more family-centered and family-focused approach to health promotion efforts can be achieved by employing interdisciplinary efforts and by taking advantage of tools like the Public Health Family Impact Checklist to intentionally engage and support families in programs and interventions.
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Affiliation(s)
| | - Eliza Broadbent
- Department of Public Health, Brigham Young University, Provo, UT, United States
| | - Rozalyn Glade
- Department of Public Health, Brigham Young University, Provo, UT, United States
| | - AliceAnn Crandall
- Department of Public Health, Brigham Young University, Provo, UT, United States
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Skomorovsky A, McCuaig Edge HJ, Lee JE, Wan C, Dursun S. Military to civilian transition challenges, caregiving activities, and well-being among spouses of newly released Canadian Armed Forces Veterans. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2020. [DOI: 10.3138/jmvfh-2019-0026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: Transition to civilian life may not only be highly challenging for service members, but also for their spouses, especially following a medical release. Often, the families of ill or injured service members must confront unexpected responsibilities related to caring for the member, while having to adjust to civilian life. This study was conducted to examine military to civilian transition challenges and engagement in caregiving among spouses of newly released Canadian Armed Forces (CAF) Veterans and their associations with spousal well-being. Methods: The Canadian Armed Forces Transition and Well-Being Survey (CAFTWS) was administered to spouses of CAF Veterans released in 2016 ( N = 595). The survey assessed spouses’ experiences with a range of military to civilian transition challenges and engagement in caregiving, as well as various indicators of their well-being (e.g., daily stress and psychological distress). Regression analyses were conducted to assess the associations of transition challenges and caregiving with well-being. Results: Results revealed that challenges related to finding educational opportunities and health care providers, and loss of military identity, as well as more frequent engagement in caregiving, were significantly associated with elevated levels of daily stress and psychological distress among spouses of Veterans. Discussion: This study is among the first to examine transition experiences, caregiving and well-being in a representative sample of Veterans’ spouses. Findings outline key challenges experienced and underline important predictors of well-being. Recommendations on services that could help facilitate or improve the experiences of families during the transition process are discussed.
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Affiliation(s)
- Alla Skomorovsky
- Director General Military Personnel Research and Analysis, Department of National Defence, Ottawa, ON
| | - Heather J. McCuaig Edge
- Director General Military Personnel Research and Analysis, Department of National Defence, Ottawa, ON
- Canadian Forces Health Services Group, Department of National Defence, Ottawa, ON
| | - Jennifer E.C. Lee
- Director General Military Personnel Research and Analysis, Department of National Defence, Ottawa, ON
| | - Cynthia Wan
- Director General Military Personnel Research and Analysis, Department of National Defence, Ottawa, ON
| | - Sanela Dursun
- Director General Military Personnel Research and Analysis, Department of National Defence, Ottawa, ON
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Kaeppler C, Lucier-Greer M. Examining Impacts of Cumulative Risk on Military-Connected Youth and the Role of Family in Coping. CHILD & YOUTH CARE FORUM 2020. [DOI: 10.1007/s10566-020-09544-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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14
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Blamey H, Phillips A, Hess DC, Fear NT. The impact of parental military service on child well-being. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2019. [DOI: 10.3138/jmvfh.2019-0014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Introduction: The aim of this review is to evaluate the literature on the association between parental military-related factors and child well-being. Methods: We conducted a literature search for research published from 2000–2017 from NATO and Partnership for Peace (PfP) countries in the English language only. Eligible studies were those that included topics of military personnel and children’s well-being; papers that included child maltreatment/abuse were excluded. Search databases included Embase, Medline, PsycINFO, ScienceDirect, Web of Science, Google Scholar, and PubMed. Results: Thirty-six predominantly United States (US)-based studies were included in the review: 27 of cross-sectional study design, 4 longitudinal, and 5 retrospective cohort studies. Discussion: The parental military-specific factors that affect child well-being are cumulative deployment months, frequent relocation, and factors related to relocation such as expanded household responsibility, disrupted daily routines, academic interruption, and disruption to social networks. These factors are associated with military children having higher levels of emotional and behavioural difficulties – such as symptoms of depression – than their civilian counterparts. Limitations of the review include the large proportion of studies with a cross-sectional design, as well as studies with small sample sizes. Indications for future research include looking at children from dual military families and the use of longitudinal study designs.
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Affiliation(s)
- Helen Blamey
- King’s Centre for Military Health Research, and Academic Department of Military Mental Health, King’s College London, London, United Kingdom
| | - Ava Phillips
- King’s Centre for Military Health Research, and Academic Department of Military Mental Health, King’s College London, London, United Kingdom
| | - Donabelle C. Hess
- 470th Air Base Squadron, Department of the Air Force, Geilenkirchen NATO Air Base, Germany
| | - Nicola T. Fear
- King’s Centre for Military Health Research, and Academic Department of Military Mental Health, King’s College London, London, United Kingdom
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Kranke D, Barmak S, Weiss E, Dobalian A. The Application of a Self-Labeling Approach among Military-Connected Adolescents in a Public School Setting. HEALTH & SOCIAL WORK 2019; 44:193-201. [PMID: 30839058 DOI: 10.1093/hsw/hlz007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/15/2018] [Accepted: 10/11/2018] [Indexed: 06/09/2023]
Abstract
The contextual factors and individual responses to the labeling of military-connected adolescents as "being in a military family" is an understudied yet important phenomenon. Minimal research construes the experience of being in a military family as a label applied to military-connected populations by people in society. However, social environmental factors associated with school setting among military-connected adolescents being in a military family have common components to the process of self-labeling. This article seeks to explore the concept and application of self-labeling by (a) providing a literature review of self-labeling among military-connected adolescents and (b) relying on modified labeling theory to identify any consistencies or potential nuances. The analysis of the process is strictly hypothetical, but could help to account for widely varying responses, sequence of events, and underlying reasons for the behaviors among some military-connected adolescents identified in the literature review and in light of the U.S. protracted military involvement in Iraq and Afghanistan. Authors conclude by highlighting the need for future research to assess the adequacy of this self-labeling framework to ensure the healthy development of military-connected youths.
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Affiliation(s)
- Derrick Kranke
- Veterans Emergency Management Evaluation Center, U.S. Department of Veterans Affairs, Plummer Street, North Hills, CA
| | | | - Eugenia Weiss
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Aram Dobalian
- Veterans Emergency Management Evaluation Center, U.S. Department of Veterans Affairs, North Hills, CA
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Cunitz K, Bühler A, Willmund GD, Ziegenhain U, Fegert JM, Zimmermann P, Kölch MG. [Intervention programs for psychological stress in children of military personnel in the USA - Results of a systematic literature review with regard to transferability to Germany]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2019; 47:503-526. [PMID: 31269864 DOI: 10.1024/1422-4917/a000675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Intervention programs for psychological stress in children of military personnel in the USA - Results of a systematic literature review with regard to transferability to Germany Abstract. Military personnel who have been deployed in war zones or other unstable regions are at an increased risk to develop mental health disorders, including posttraumatic stress disorder. Likewise, their children are at high risk to develop mental health problems as well as emotional and behavioral difficulties. Most research on prevalence of mental health problems as well as on interventions within this group was conducted in the USA. In Germany, no systematic intervention for children of military members focusing on their experiences of deployment exist. The systematic literature review aimed to analyze existing intervention programs in the USA, in particular for children of military members regarding evidence, type and addressed target group (parents, children, both). Compared to the social welfare and health care systems in the USA, the German systems are different. Hence, a second aim was to examine the transferability of these programs to the specific needs of children of German military members (Bundeswehr). 27 intervention programs could be included in the review. Programs, directly or indirectly, are addressing the needs of children of a deployed parent. They are usually focusing on the "emotional cycle of deployment" (phase of preparation of deployment, separation phase of deployment and the return of the deployed parent). The programs mainly focused on parenting skills, family reactions to stress, coping strategies of families, and the feeling of coherence within the family. Only 20 % of the interventions could be assigned to the type of indicated prevention. Nine interventions have shown positive effects (either in RCT or non-experimental designs). Several elements of the programs are transferable to the German situation of children of military members. In particular, contents which address the specific situation of families with a military member are desperately needed in Germany. Transferability is limited by the non-comparability of health care and social welfare systems in the USA and in Germany.
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Affiliation(s)
- Katrin Cunitz
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universitätsklinikum Ulm
| | - Antje Bühler
- Psychotraumazentrum der Bundeswehr, Bundeswehrkrankenhaus, Berlin
| | | | - Ute Ziegenhain
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universitätsklinikum Ulm
| | - Jörg M Fegert
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universitätsklinikum Ulm
| | - Peter Zimmermann
- Psychotraumazentrum der Bundeswehr, Bundeswehrkrankenhaus, Berlin
| | - Michael G Kölch
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universitätsklinikum Ulm.,Klinik für Psychiatrie, Neurologie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Universitätsmedizin Rostock
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17
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Sinclair RR, Paulson AL, Riviere LA. The Resilient Spouse: Understanding Factors Associated With Dispositional Resilience Among Military Spouses. ACTA ACUST UNITED AC 2019. [DOI: 10.1080/21635781.2019.1608876] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Robert R. Sinclair
- Department of Military Psychiatry, Center for Military Psychiatry and Neurosciences, Silver Spring, Maryland
- Department of Psychology, Clemson University, Clemson, South Carolina
| | | | - Lyndon A. Riviere
- Department of Military Psychiatry, Center for Military Psychiatry and Neurosciences, Silver Spring, Maryland
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Building Resilience: The Conceptual Basis and Research Evidence for Resilience Training Programs. REVIEW OF GENERAL PSYCHOLOGY 2018. [DOI: 10.1037/gpr0000152] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The relationship between adverse experiences and later development has been explored by many researchers, leading to the conceptualization of resilience as a factor explaining the normal or optimal development of some individuals exposed to adversity. Today many different interventions exist aiming to improve the ability of individuals to respond to adversity. In this narrative literature review, we evaluate the literature surrounding resilience and resilience training, discussing the quality of the evidence supporting resilience training, theoretical and practical differences between types of training, and the impact of resilience and psychological training on outcome measures across a variety of settings. The results of our review show that the quality of the literature is mixed, resilience training is not well differentiated from other forms of training, and that the impact of psychological training on later functioning depends heavily on the type of outcome measured and the setting of the training. Further research must be conducted prior to the implementation of resilience training programs in order to assure their efficacy and effectiveness in proposed contexts.
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Huffman AH, Dunbar N, Broom TW, Castro CA. Soldiers’ perspectives of the Married Army Couples Program: A review of perceived problems and proposed solutions. MILITARY PSYCHOLOGY 2018. [DOI: 10.1080/08995605.2018.1478537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Ann Hergatt Huffman
- Department of Psychological Sciences and W. A. Franke College of Business, Northern Arizona University, Flagstaff, Arizona
| | - Nora Dunbar
- Department of Psychological Sciences, Northern Arizona University, Flagstaff, Arizona
| | - Timothy W. Broom
- Department of Psychological Sciences, Northern Arizona University, Flagstaff, Arizona
| | - Carl A. Castro
- Center for Innovation and Research on Veterans, Military Families (CIR), USC School of Social Work University of Southern California, Los Angeles, California
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20
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Isaacs SA, Roman NV, Savahl S. The development of a family resilience-strengthening programme for families in a South African rural community. JOURNAL OF COMMUNITY PSYCHOLOGY 2018; 46:616-635. [PMID: 31682289 DOI: 10.1002/jcop.21962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/25/2017] [Accepted: 01/21/2018] [Indexed: 06/10/2023]
Abstract
The aim of this study was to develop a contextually based family resilience program. Also presented here is a literature review of family resilience interventions suggesting that these 3 processes are the basis for effective family functioning. A close collaboration with the community ensured an adequate understanding of the presenting family challenges and this article describes the process in developing a program based on these challenges. A 3-round Delphi design was used for the study with international and local experts (n = 10) in the field of family and resilience studies and community stakeholders (n = 5). The program has three main aims: to increase family connectedness, family communication processes and social and economic resources. Based on the findings of this study, 4 modules will be presented to participants, "about family," "talking together," "close together," and "working together." A description is provided of the program content and decisions regarding logistical program concerns.
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21
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Fear NT, Reed RV, Rowe S, Burdett H, Pernet D, Mahar A, Iversen AC, Ramchandani P, Stein A, Wessely S. Impact of paternal deployment to the conflicts in Iraq and Afghanistan and paternal post-traumatic stress disorder on the children of military fathers. Br J Psychiatry 2018; 212:347-355. [PMID: 29665873 DOI: 10.1192/bjp.2017.16] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Little is known about the social and emotional well-being of children whose fathers have been deployed to the conflicts in Iraq/Afghanistan or who have post-traumatic stress disorder (PTSD).AimsTo examine the emotional and behavioural well-being of children whose fathers are or have been in the UK armed forces, in particular the effects of paternal deployment to the conflicts in Iraq or Afghanistan and paternal PTSD. METHOD Fathers who had taken part in a large tri-service cohort and had children aged 3-16 years were asked about the emotional and behavioural well-being of their child(ren) and assessed for symptoms of PTSD via online questionnaires and telephone interview. RESULTS In total, 621 (67%) fathers participated, providing data on 1044 children. Paternal deployment to Iraq or Afghanistan was not associated with childhood emotional and behavioural difficulties. Paternal probable PTSD were associated with child hyperactivity. This finding was limited to boys and those under 11 years of age. CONCLUSIONS This study showed that adverse childhood emotional and behavioural well-being was not associated with paternal deployment but was associated with paternal probable PTSD.Declaration of interestN.T.F. is a trustee of the Warrior Programme, a charity supporting ex-service personnel and their families. She is also a member of the Independent Group Advising on the Release of Data (IGARD). S.W. is a trustee of Combat Stress, a charity supporting ex-service personnel and their families, and President of the Royal Society of Medicine. S.W. is partially funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emergency Preparedness and Response at King's College London in partnership with Public Health England (PHE), in collaboration with the University of East Anglia and Newcastle University.
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Affiliation(s)
| | - Ruth V Reed
- University of Oxford Department of Psychiatry,Warneford Hospital,Oxford,UK
| | - Sarah Rowe
- University College London,Gower Street,London and King's College London,London,UK
| | | | | | | | | | | | - Alan Stein
- University of Oxford Department of Psychiatry,Warneford Hospital,Oxford,UK
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22
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Foote FO, Benson H, Berger A, Berman B, DeLeo J, Deuster PA, Lary DJ, Silverman MN, Sternberg EM. Advanced Metrics for Assessing Holistic Care: The "Epidaurus 2" Project. Glob Adv Health Med 2018; 7:2164957X18755981. [PMID: 29497586 PMCID: PMC5824899 DOI: 10.1177/2164957x18755981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 12/08/2017] [Indexed: 11/16/2022] Open
Abstract
In response to the challenge of military traumatic brain injury and posttraumatic stress disorder, the US military developed a wide range of holistic care modalities at the new Walter Reed National Military Medical Center, Bethesda, MD, from 2001 to 2017, guided by civilian expert consultation via the Epidaurus Project. These projects spanned a range from healing buildings to wellness initiatives and healing through nature, spirituality, and the arts. The next challenge was to develop whole-body metrics to guide the use of these therapies in clinical care. Under the "Epidaurus 2" Project, a national search produced 5 advanced metrics for measuring whole-body therapeutic effects: genomics, integrated stress biomarkers, language analysis, machine learning, and "Star Glyphs." This article describes the metrics, their current use in guiding holistic care at Walter Reed, and their potential for operationalizing personalized care, patient self-management, and the improvement of public health. Development of these metrics allows the scientific integration of holistic therapies with organ-system-based care, expanding the powers of medicine.
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Affiliation(s)
| | - Herbert Benson
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Ann Berger
- National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Brian Berman
- The Institute for Integrative Health, Baltimore, Maryland
- University of Maryland School of Medicine Center for Integrative Medicine, Baltimore, Maryland
| | - James DeLeo
- The NIH Clinical Center Department of Clinical Research Informatics, Bethesda, Maryland
| | | | - David J Lary
- The University of Texas at Dallas, Richardson, Texas
| | - Marni N. Silverman
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
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23
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Moore KD, Fairchild AJ, Wooten NR, Ng ZJ. Evaluating Behavioral Health Interventions for Military-Connected Youth: A Systematic Review. Mil Med 2017; 182:e1836-e1845. [PMID: 29087850 PMCID: PMC5728367 DOI: 10.7205/milmed-d-17-00060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
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.
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Affiliation(s)
- Kendall D Moore
- Department of Psychology, University of South Carolina, Barnwell College, 1512 Pendleton Street, Columbia, SC 29208
| | - Amanda J Fairchild
- Department of Psychology, University of South Carolina, Barnwell College, 1512 Pendleton Street, Columbia, SC 29208
| | - Nikki R Wooten
- College of Social Work, University of South Carolina, Hamilton College, 1512 Pendleton Street, Columbia, SC 29208
| | - Zi Jia Ng
- Department of Psychology, University of South Carolina, Barnwell College, 1512 Pendleton Street, Columbia, SC 29208
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24
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Garcia E, Wijesekera K, Lester P. A Family-Centered Preventive Intervention Within Pediatric Oncology: Adapting the FOCUS Intervention for Latino Youth and Their Families. JOURNAL OF EDUCATIONAL AND PSYCHOLOGICAL CONSULTATION 2017. [DOI: 10.1080/10474412.2017.1323221] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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25
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Fear NT, Wessely S. Is it 'good to share'? Intergenerational transmission of post-traumatic stress disorder. Acta Psychiatr Scand 2017; 135:361-362. [PMID: 28369697 DOI: 10.1111/acps.12734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- N T Fear
- King's Centre for Military Health Research and Academic Department of Military Mental Health, King's College London, London, UK
| | - S Wessely
- King's Centre for Military Health Research and Academic Department of Military Mental Health, King's College London, London, UK
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26
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Finley EP, Pugh MJ, Palmer RF. Validation of a Measure of Family Resilience among Iraq and Afghanistan Veterans. MILITARY BEHAVIORAL HEALTH 2017; 4:205-219. [PMID: 28168094 DOI: 10.1080/21635781.2016.1153530] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Although interactions within veterans' families may support or inhibit resilient coping to stress and trauma across the deployment cycle, research on family resilience has been hampered by the lack of a brief assessment. Using a three-stage mixed-method study, we developed and conducted preliminary validation of a measure of family resilience tailored for Iraq and Afghanistan veterans (IAV), the Family Resilience Scale for Veterans (FRS-V), which was field-tested using a survey of 151 IAV. Our findings indicate the resulting 6-item measure shows strong initial reliability and validity and support the application of existing models of family resilience in this population.
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Affiliation(s)
- Erin P Finley
- South Texas Veterans Health Care System, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Mary Jo Pugh
- South Texas Veterans Health Care System, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Raymond F Palmer
- Department of Family and Community Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
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27
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Saltzman WR. The FOCUS Family Resilience Program: An Innovative Family Intervention for Trauma and Loss. FAMILY PROCESS 2016; 55:647-659. [PMID: 27734461 DOI: 10.1111/famp.12250] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
This article describes the core principles and components of the FOCUS Program, a brief intervention for families contending with single or multiple trauma or loss events. It has been administered nationally to thousands of military family members since 2008 and has been implemented in a wide range of civilian community, medical, clinical, and school settings. Developed by a team from the UCLA and Harvard Medical Schools, the FOCUS Program provides a structured approach for joining with traditional and nontraditional families, crafting shared goals, and then working with parents, children, and the entire family to build communication, make meaning out of traumatic experiences, and practice specific skills that support family resilience. Through a narrative sharing process, each family member tells his or her story and constructs a timeline that graphically captures the experience and provides a platform for family discussions on points of convergence and divergence. This narrative sharing process is first done with the parents and then the children and then the family as a whole. The aim is to build perspective-taking skills and mutual understanding, to reduce distortions and misattributions, and to bridge estrangement between family members. Previous studies have confirmed that families participating in this brief program report reductions in distress and symptomatic behaviors for both parents and children and increases in child pro-social behaviors and family resilient processes.
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Affiliation(s)
- William R Saltzman
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
- Advanced Studies in Education & Counseling, California State University, Long Beach, CA
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28
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van Ee E, Kleber RJ, Jongmans MJ. Relational Patterns Between Caregivers With PTSD and Their Nonexposed Children: A Review. TRAUMA, VIOLENCE & ABUSE 2016; 17:186-203. [PMID: 25964276 DOI: 10.1177/1524838015584355] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The question as to whether or not children can be affected by the traumatization of their parents has been the topic of a long-standing debate. This article provides a critical review of 72 research studies on traumatized parents with symptoms of posttraumatic stress disorder (PTSD), the parent-child interaction, and the impact on their nonexposed child (0-18 years). The evidence suggests that traumatization can cause parenting limitations, and these limitations can disrupt the development of the young child. From the studies reviewed several patterns emerged: Relational patterns of traumatized parents who are observed to be emotionally less available and who perceive their children more negatively than parents without symptoms of PTSD; relational patterns of children who at a young age are easily deregulated or distressed and at an older age are reported to face more difficulties in their psychosocial development than children of parents without symptoms of PTSD; and relational patterns that show remarkable similarities to relational patterns between depressed or anxious parents and their children. Mechanisms such as mentalization, attachment, physiological factors, and the cycle of abuse offer a valuable perspective to further our understanding of the relational patterns. This article builds on previous work by discussing the emerged patterns between traumatized parents and their nonexposed children from a relational and transactional perspective.
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Affiliation(s)
- Elisa van Ee
- Reinier van Arkel, Psychotraumacentrum Zuid Nederland, Den Bosch, the Netherlands
| | - Rolf J Kleber
- Clinical and Health Psychology, Utrecht University, Utrecht, the Netherlands
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Evaluation of a Family-Centered Preventive Intervention for Military Families: Parent and Child Longitudinal Outcomes. J Am Acad Child Adolesc Psychiatry 2016; 55:14-24. [PMID: 26703905 DOI: 10.1016/j.jaac.2015.10.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 09/23/2015] [Accepted: 10/23/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study evaluates the longitudinal outcomes of Families OverComing Under Stress (FOCUS), a family-centered preventive intervention implemented to enhance resilience and to reduce psychological health risk in military families and children who have high levels of stress related to parental wartime military service. METHOD We performed a secondary analysis of evaluation data from a large-scale service implementation of the FOCUS intervention collected between July 2008 and December 2013 at 15 military installations in the United States and Japan. We present data for 2,615 unique families (3,499 parents and 3,810 children) with completed intake and at least 1 postintervention assessment. Longitudinal regression models with family-level random effects were used to assess the patterns of change in child and parent (civilian and military) psychological health outcomes over time. RESULTS Improvement in psychological health outcomes occurred in both service member and civilian parents. Relative to intake, parental anxiety and depression symptoms were significantly reduced postintervention, and these reductions were maintained at 2 subsequent follow-up assessments. In addition, we identified an improvement over time in emotional and behavioral symptoms and in prosocial behaviors for both boys and girls. We observed reductions in the prevalence of unhealthy family functioning and child anxiety symptoms, as well as parental depression, anxiety, and posttraumatic stress symptoms from intake to follow-up. CONCLUSION Longitudinal program evaluation data show sustained trajectories of reduced psychological health risk symptoms and improved indices of resilience in children, civilian, and active duty military parents participating in a strength-based, family-centered preventive intervention.
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30
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Cozza SJ. Meeting the intervention needs of military children and families. J Am Acad Child Adolesc Psychiatry 2015; 54:247-8. [PMID: 25791140 DOI: 10.1016/j.jaac.2015.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 01/28/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Stephen J Cozza
- Uniformed Services University of the Health Sciences, Bethesda, MD.
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31
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Dissemination of family-centered prevention for military and veteran families: adaptations and adoption within community and military systems of care. Clin Child Fam Psychol Rev 2014; 16:394-409. [PMID: 24129478 DOI: 10.1007/s10567-013-0154-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In response to the needs of military families confronting the challenges of prolonged war, we developed Families OverComing Under Stress (FOCUS), a multi-session intervention for families facing multiple deployments and combat stress injuries adapted from existing evidence-based family prevention interventions (Lester et al. in Mil Med 176(1): 19-25, 2011). In an implementation of this intervention contracted by the US Navy Bureau of Medicine and Surgery (BUMED), FOCUS teams were deployed to military bases in the United States and the Pacific Rim to deliver a suite of family-centered preventive services based on the FOCUS model (Beardslee et al. in Prev Sci 12(4): 339-348, 2011). Given the number of families affected by wartime service and the changing circumstances they faced in active duty and veteran settings, it rapidly became evident that adaptations of this approach for families in other contexts were needed. We identified the core elements of FOCUS that are essential across all adaptations: (1) Family Psychological Health Check-in; (2) family-specific psychoeducation; (3) family narrative timeline; and (4) family-level resilience skills (e.g., problem solving). In this report, we describe the iterative process of adapting the intervention for different groups of families: wounded, ill, and injured warriors, families with young children, couples, and parents. We also describe the process of adopting this intervention for use in different ecological contexts to serve National Guard, Reserve and veterans, and utilization of technology-enhanced platforms to reach geographically dispersed families. We highlight the lessons learned when faced with the need to rapidly deploy interventions, adapt them to the changing, growing needs of families under real-world circumstances, and conduct rigorous evaluation procedures when long-term, randomized trial designs are not feasible to meet an emergent public health need.
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32
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Paley B, Lester P, Mogil C. Family systems and ecological perspectives on the impact of deployment on military families. Clin Child Fam Psychol Rev 2014; 16:245-65. [PMID: 23760926 DOI: 10.1007/s10567-013-0138-y] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The scope of sustained military operations in Iraq and Afghanistan has placed great demands on the Armed Forces of the United States, and accordingly, military families have been faced with deployments in more rapid succession than ever before. When military parents fulfill occupational duties during wartime, military children and families face multiple challenges, including extended separations, disruptions in family routines, and potentially compromised parenting related to traumatic exposure and subsequent mental health problems. Such challenges can begin to exert a significant toll on the well-being of both individuals and relationships (e.g., marital, parent-child) within military families. In order to respond more effectively to the needs of military families, it is essential that mental health clinicians and researchers have a better understanding of the challenges faced by military families throughout the entire deployment experience and the ways in which these challenges may have a cumulative impact over multiple deployments. Moreover, the mental health field must become better prepared to support service members and families across a rapidly evolving landscape of military operations around the world, including those who are making the transition from active duty to Veteran status and navigating a return to civilian life and those families in which parents will continue to actively serve and deploy in combat zones. In this article, we utilize family systems and ecological perspectives to advance our understanding of how military families negotiate repeated deployment experiences and how such experiences impact the well-being and adjustment of families at the individual, dyadic, and whole family level.
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Affiliation(s)
- Blair Paley
- Department of Psychiatry and Biobehavioral Sciences, Nathanson Family Reslience Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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33
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Saltzman WR, Pynoos RS, Lester P, Layne CM, Beardslee WR. Enhancing family resilience through family narrative co-construction. Clin Child Fam Psychol Rev 2014; 16:294-310. [PMID: 23797387 DOI: 10.1007/s10567-013-0142-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We draw upon family resilience and narrative theory to describe an evidence-based method for intervening with military families who are impacted by multiple wartime deployments and psychological, stress-related, or physical parental injuries. Conceptual models of familial resilience provide a guide for understanding the mechanics of how families respond and recover from exposure to extreme events, and underscore the role of specific family processes and interaction patterns in promoting resilient capabilities. Leading family theorists propose that the family's ability to make meaning of stressful and traumatic events and nurture protective beliefs are critical aspects of resilient adaptation. We first review general theoretical and empirical research contributions to understanding family resilience, giving special attention to the circumstances, challenges, needs, and strengths of American military families. Therapeutic narrative studies illustrate the processes through which family members acquire meaning-making capacities, and point to the essential role of parents' in facilitating discussions of stressful experiences and co-constructing coherent and meaningful narratives. This helps children to make sense of these experiences and develop capacities for emotion regulation and coping. Family-based narrative approaches provide a structured opportunity to elicit parents' and children's individual narratives, assemble divergent storylines into a shared family narrative, and thereby enhance members' capacity to make meaning of stressful experiences and adopt beliefs that support adaptation and growth. We discuss how family narratives can help to bridge intra-familial estrangements and re-engage communication and support processes that have been undermined by stress, trauma, or loss. We conclude by describing a family-based narrative intervention currently in use with thousands of military children and families across the USA.
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Affiliation(s)
- William R Saltzman
- Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA.
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