Top

Published in:

01-05-2018

After Deployment, Adaptive Parenting Tools: 1-Year Outcomes of an Evidence-Based Parenting Program for Military Families Following Deployment

Authors: Abigail H. Gewirtz, David S. DeGarmo, Osnat Zamir

Published in: Prevention Science | Issue 4/2018

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.

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.

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.CrossRefPubMed

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.CrossRefPubMedPubMedCentral

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.CrossRefPubMed

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.CrossRefPubMedPubMedCentral

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.CrossRefPubMedPubMedCentral

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.CrossRefPubMedPubMedCentral

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.CrossRefPubMed

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.CrossRefPubMed

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.CrossRefPubMedPubMedCentral

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.CrossRefPubMed

Forgatch, M. S., & DeGarmo, D. S. (2011). Sustaining fidelity following the nationwide PMTO™ implementation in Norway. Prevention Science, 12, 235–246.CrossRefPubMedPubMedCentral

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.CrossRefPubMedPubMedCentral

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.CrossRefPubMed

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.CrossRefPubMedPubMedCentral

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.CrossRefPubMed

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.CrossRef

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.CrossRef

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.CrossRefPubMed

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.CrossRefPubMed

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.PubMedPubMedCentral

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.CrossRef

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.CrossRefPubMed

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.CrossRefPubMed

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.CrossRefPubMedPubMedCentral

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.CrossRefPubMedPubMedCentral

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.CrossRefPubMedPubMedCentral

Shrout, P. E., & Bolger, N. (2002). Mediation in experimental and nonexperimental studies: New procedures and recommendations. Psychological Methods, 7, 422–445.CrossRefPubMed

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.CrossRefPubMed

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.CrossRef

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.CrossRefPubMed

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.CrossRefPubMedPubMedCentral

Title: After Deployment, Adaptive Parenting Tools: 1-Year Outcomes of an Evidence-Based Parenting Program for Military Families Following Deployment
Authors: Abigail H. Gewirtz
David S. DeGarmo
Osnat Zamir
Publication date: 01-05-2018
Publisher: Springer US
Published in: Prevention Science / Issue 4/2018
Print ISSN: 1389-4986
Electronic ISSN: 1573-6695
DOI: https://doi.org/10.1007/s11121-017-0839-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

After Deployment, Adaptive Parenting Tools: 1-Year Outcomes of an Evidence-Based Parenting Program for Military Families Following Deployment

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 4/2018

Effectiveness of School-Based Teen Pregnancy Prevention Programs in the USA: a Systematic Review and Meta-Analysis

Using Facebook to Recruit Parents to Participate in a Family Program to Prevent Teen Drug Use

Can a Parenting Intervention to Prevent Early Conduct Problems Interrupt Girls’ Risk for Intimate Partner Violence 10 Years Later?

Predicting the Emergence of Sexual Violence in Adolescence

Visit Attendance Patterns in Nurse-Family Partnership Community Sites

Longitudinal Predictors of Behavioral Intentions and HIV Service Use Among Men Who Have Sex with Men