Abstract
Despite significant stressors facing military families over the past 15 years of wars in Iraq and Afghanistan, no parenting programs adapted or developed for military families with school-aged children have been rigorously tested. We present outcome data from the first randomized controlled trial of a behavioral parent training program for families with a parent deployed to Iraq or Afghanistan. In the present study, 336 primarily National Guard and Reserve families with 4–12-year-old children were recruited from a Midwestern state. At least one parent in each family had deployed to the recent conflicts: Operations Iraqi or Enduring Freedom, or New Dawn (OIF/OEF/OND). Families were randomized to a group-based parenting program (After Deployment, Adaptive Parenting Tools (ADAPT)) or web and print resources-as-usual. Using a social interaction learning framework, we hypothesized an indirect effects model: that the intervention would improve parenting, which, in turn, would be associated with improvements in child outcomes. Applying intent-to-treat analyses, we examined the program’s effect on observed parenting, and children’s adjustment at 12-months post baseline. Controlling for demographic (marital status, length, child gender), deployment variables (number of deployments), and baseline values, families randomized to the ADAPT intervention showed significantly improved observed parenting compared to those in the comparison group. Observed parenting, in turn, was associated with significant improvements in child adjustment. These findings present the first evidence for the effectiveness of a parenting program for deployed military families with school-aged children.
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02 November 2017
The authors would like to indicate the corrections to Table 2 of the above referenced article, below. The note is missing, and the CACE indirect coefficients should be .18** and .16** instead of .16** and .15**. The corrected table is shown below.
Notes
We hypothesize indirect effects of change in parenting to improvements in child adjustment, rather than mediating effects because mediation is more robustly tested with the mediator as a temporal antecedent to a distal outcome. We also expected and tested replication of PMTO findings from Forgatch and DeGarmo (1999) who found that parenting, as target of the intervention, showed preliminary sensitivity to change with indirect associations to child outcomes at 12-month post baseline, demonstrating full mediation at later follow-ups.
It was for that reason—as well as consideration of participant burden—that we opted not to gather observational parenting data at posttest (T2). That is why the current report focuses on change from T1 to T3.
References
Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA School-Age Forms & Profiles. Burlington: University of Vermont, Research Center for Children, Youth, & Families.
Asher, S. R., & Wheeler, V. A. (1985). Children’s loneliness: A comparison of rejected and neglected peer status. Journal of Consulting and Clinical Psychology, 53(4), 500–505.
Brown, C. H., Wang, W., Kellam, S. G., Muthen, B. O., Petras, H., Toyinbo, P., et al. (2008). Methods for testing theory and evaluating impact in randomized filed trials: Intent-to-treat analysis for integrating the perspective of person, place and time. Drug and Alcohol Dependence, 95, S74–S104.
Byrne, B. M. (2013). Structural equation modeling with Mplus: Basic concepts, applications, and programming. Routledge.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale: Lawrence Earlbaum Associates.
Conger, R. D., Wallace, L. E., Sun, Y., Simons, R. L., McLoyd, V. C., & Brody, G. H. (2002). Economic pressure in African American families: A replication and extension of the family stress model. Developmental Psychology, 38, 179–193.
Creech, S. K., Hadley, W., & Borsari, B. (2014). The impact of military deployment and reintegration on children and parenting: A systematic review. Professional Psychology, Research and Practice, 45, 452–464.
Davis, L., Hanson, S. K., Zamir, O., Gewirtz, A. H., & DeGarmo, D. S. (2015). Associations of contextual risk and protective factors with fathers’ parenting practices in the postdeployment environment. Psychological Services, 12, 250–260.
Defense, D. of (2009). Profile of the Military Community. Washington D.C. Retrieved from http://download.militaryonesource.mil/12038/MOS/Reports/2009-Demographics-pdf.
Dishion, T., Peterson, J., Winter, C. E., Jabson, J. M., & Hogansen, J. M. (2007). Family assessment task coder impressions. Unpublished coding manual.
Dishion, T., Forgatch, M., Chamberlain, P., & Pelham III, W. E. (2015). The Oregon model of behavior family therapy: From intervention design to promoting large-scale system change. Behavior Therapy. https://doi.org/10.1016/j.beth.2016.02.002.
Doty, J. L., Rudi, J., Pinna, K., Hanson, S. K., & Gewirtz, A. H. (2016). If you build it, will they come? Patterns of internet-based and face-to-face participation in a parenting program for military families. Journal of Medical Internet Research, 18, e169.
Durlak, J. A., & Wells, A. M. (1997). Primary prevention mental health programs for children and adolescents: A meta-analytic review. American Journal of Community Psychology, 25, 115–152.
Flay, B. R., Biglan, A., Boruch, R. F., Castro, F. G., Gottfredson, D., Kellam, S., et al. (2005). Standards of evidence: Criteria for efficacy, effectiveness and dissemination. Prevention Science, 6, 151–175.
Forehand, R., Lafko, N., Parent, J., & Burt, K. B. (2014). Is parenting the mediator of change in behavioral parent training for externalizing problems of youth? Clinical Psychology Review, 34, 608–619.
Forgatch, M., Patterson, G., Degarmo, D., & Beldavs, Z. (2009). Testing the Oregon delinquency model with 9-year follow-up of the Oregon Divorce Study. Development and Psychopathology, 21, 637-660. https://doi.org/10.1017/S0954579409000340.
Forgatch, M. S., & DeGarmo, D. S. (1999). Parenting through change: An effective prevention program for single mothers. Journal of Consulting and Clinical Psychology, 67, 711–724.
Forgatch, M. S., & DeGarmo, D. S. (2011). Sustaining fidelity following the nationwide PMTO™ implementation in Norway. Prevention Science, 12, 235–246.
Forgatch, M. S., & Patterson, G. R. (2010). Parent management training—Oregon model: An intervention for antisocial behavior in children. In J. R. Weisz & A. E. Kazdin (Eds.), Evidence-based psychotherapies for children and adolescents. New York: Guilford.
Forgatch, M. S., Knutson, N. M., & Mayne, T. (1992). Coder impressions of ODS lab tasks. Eugene: Oregon Social Learning Center.
Forgatch, M. S., Patterson, G. R., & Gewirtz, A. H. (2013). Looking forward: The promise of widespread implementation of parent training programs. Perspectives on Psychological Science, 8, 682–694.
Gewirtz, A. H., & Youssef, A. M. (2016). Parenting and children’s resilience in military families. New York: Springer.
Gewirtz, A. H., Forgatch, M., & Wieling, E. (2008). Parenting practices as potential mechanisms for child adjustment following mass trauma. Journal of Marital and Family Therapy, 34, 177–192.
Gewirtz, A. H., Pinna, K. L. M., Hanson, S. K., & Brockberg, D. (2014). Promoting parenting to support reintegrating military families: After deployment, adaptive parenting tools. Psychological Services, 11, 31–40.
Gewirtz, A. H., DeGarmo, D. S., Lee, S., Morrell, N., & August, G. (2015). Two-year outcomes of the early risers prevention trial with formerly homeless families residing in supportive housing. Journal of Family Psychology, 29, 242–252.
Gewirtz, A.H., DeGarmo, D.S., Plowman, E., August, G.J., & Realmuto, G. (2009). Parenting, parental mental health, and child functioning in families residing in supportive housing. American Journal of Orthopsychiatry, 79, 336-347.
Gewirtz, A. H., DeGarmo, D. S., & Zamir, O. (2016). Effects of a military parenting program on parental distress and suicide ideation: After deployment adaptive parenting tools. Suicide and Life Threatening Behavior (Special Issue), 46, S23–S31.
Gewirtz, A. H., DeGarmo, D. S., & Zamir, O. (2017). Testing a military family stress model. Family Process. https://doi.org/10.1111/famp.12282.
Griffith, J. (2009). After 9/11, what kind of reserve soldier? Considerations given to emerging demands, organizational orientation, and individual commitment. Armed Forces and Society, 35, 214-240. https://doi.org/10.1177/0095327X07312490.
Jo, B. (2002). Estimation of intervention effects with noncompliance: Alternative model specifications. Journal of Educational & Behavioral Statistics, 27(4), 385–409.
Kelley, M. L., & Jouriles, E. N. (2011). An introduction to the special section on U.S. military operations: Effects on military members’ partners and children. Journal of Family Psychology, 25, 459–460.
Kraemer, H. C., Wilson, G. T., Fairburn, C. G., & Agras, W. S. (2002). Mediators and moderators of treatment effects in randomized clinical trials. Archives of General Psychiatry, 59, 877–883.
Lester, P., Peterson, K., Reeves, J., Knauss, L., Glover, D., Mogil, C., et al. (2010). The long war and parental deployment: Effects on military children and at-home spouses. Journal of the American Academy of Child and Adolescent Psychiatry, 49, 310.
Little, R. J., & Yau, L. H. Y. (1998). Statistical techniques for analyzing data from prevention trials: Treatment of no-shows using Rubin’s causal model. Psychological Methods, 3, 147–159.
MacKinnon, D. P. (2008). Introduction to statistical mediation analysis. NY: Lawrence Earlbaum Associates.
McDonald, R. P., & Ho, M.-H. R. (2002). Principles and practice in reporting structural equation analyses. Psychological Methods, 7, 64–82.
Muthén, L. K., & Muthén, B. O. (1998–2015). Mplus: Statistical analysis with latent variables: user’s guide (7th ed.). Los Angeles: StatModel.
National Center for Veterans Analysis and Statistics. (2016). Profile of Post-911 Veterans: 2014. Department of Veteran’s Affairs, Office of Policy and Planning. Retrieved from http://www.va.gov/vetdata/docs/SpecialReports/Post_911_Veterans_Profile_2014.pdf.
Park, N. (2011). Military children and families. American Psychologist, 66, 65–72.
Patterson, G. R. (1982). Coercive family process. Eugene: Castalia.
Patterson, G. R. (2005). Next generation of PMTO models. Behavior Therapist, 28, 25–32.
Patterson, G. R., Forgatch, M. S., & Degarmo, D. S. (2010). Cascading effects following intervention. Development and Psychopathology, 22, 949–970.
Prinz, R., Foster, S., Kent, R., & O’Leary, K. (1979). Multivariate assessment of conflict in distressed and nondistressed mother-adolescent dyads. Journal of Applied Behavior Analysis, 12, 691–700.
Reynolds, C. R., & Kamphaus, R. W. (2004). Behavior assessment scale for children. Bloomington: Pearson Assessments.
Sandler, I. N., Schoenfelder, E. N., Wolchik, S. A., & MacKinnon, D. P. (2011). Long-term impact of prevention programs to promote effective parenting: Lasting effects but uncertain processes. Annual Review of Psychology, 62, 299–329.
Shrout, P. E., & Bolger, N. (2002). Mediation in experimental and nonexperimental studies: New procedures and recommendations. Psychological Methods, 7, 422–445.
Snyder, J., Reid, J., Stoolmiller, M., Howe, G., Brown, H., Dagne, G., & Cross, W. (2006). The role of behavior observation in measurement systems for randomized prevention trials. Prevention Science, 7, 43–56.
Spoth, R., Redmond, C., Haggerty, K., & Ward, T. (1995). A controlled parenting skills outcome study examining individual difference and attendance effects. Journal of Marriage and Family Counseling, 57, 449–464.
Sullivan, K., Capp, G., Gilreath, T. D., Benbenishty, R., Roziner, I., & Astor, R. A. (2015). Substance abuse and other adverse outcomes for military-connected youth in California. JAMA Pediatrics, 169, 922–928.
Wolchik, S. A., Sandler, I. N., Tein, J.-Y., Mahrer, N. E., Millsap, R. E., Winslow, E., et al. (2013). Fifteen-year follow-up of a randomized trial of a preventive intervention for divorced families: Effects on mental health and substance use outcomes in young adulthood. Journal of Consulting and Clinical Psychology, 81, 660–673.
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Funding was provided by the National Institute of Health, R01 DA 030114; 2010–2016.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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Gewirtz, A.H., DeGarmo, D.S. & Zamir, O. After Deployment, Adaptive Parenting Tools: 1-Year Outcomes of an Evidence-Based Parenting Program for Military Families Following Deployment. Prev Sci 19, 589–599 (2018). https://doi.org/10.1007/s11121-017-0839-4
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DOI: https://doi.org/10.1007/s11121-017-0839-4