Development and evaluation of a web-enhanced parenting program for reintegrating National Guard and Reserve families: After deployment, adaptive parenting tools/ADAPT
Authors: Sheila Hanson, PhD, Dustin Brockberg, BA, Abigail Gewirtz, PhD, LP
The conflicts in Iraq and Afghanistan have resulted in the largest deployment of U.S. troops since the Vietnam War, with over 2 million troops deployed since the 9/11 attacks (Tan, 2009). Among this group are significant numbers of National Guard and Reserve (NG/R) personnel, who are sometimes known as “weekend warriors” or “citizen soldiers.” Leading civilian lives except for when they are deployed or in training, NG/R personnel and their families tend to be very dispersed, living in civilian communities, where there may be few other NG/R personnel. Providing support to NG/R families may thus be challenging. Minnesota has one of the largest National Guard and Reserve forces in the United States with over 19,000 service members (U.S. Census Bureau, 2012). There have been few studies examining the impact of deployment on the children and families of these soldiers. After Deployment Adaptive Parenting Tools (ADAPT), a web-enhanced parenting program, was developed with the aim of improving adjustment for children in NG/R families by supporting and buffering parenting.
Military families are resilient, and the experience of growing up in a military family is not associated with children’s maladjustment (Jensen, Xenakis, Wolf, & Bain, 1991); however, wartime deployment of parents appears to be a significant stressor for school aged children (Chandra et al., 2010). Physical separation from children during deployment is often significant, with the average deployment lasting 12-15 months, and two or more deployments are common. Parent deployment to a combat zone is associated with child behavior problems, distress and transitions, (Jensen, Grogan, Xenakis, & Bain, 1989; Chartrand, Frank, White, & Shope, 2008; Chandra et al., 2010; Richardson et al., 2011) with greater distress associated with longer deployment (Chandra et al., 2010).
Deployment and reintegration for NG/R personnel have been associated with an array of transition-related stressors including relationship challenges, substance abuse and mental health difficulties, and these may be compounded by a lack of centralized services. Evidence suggests that the detrimental impact of a parent’s combat deployment on his/her children may be primarily mediated through its effects on parenting practices (Palmer, 2008). Both normative and severe family stressors and transitions (e.g., father absence, divorce, socioeconomic stress) have been shown to negatively affect parent and family functioning and lead to increased rates of coercive parent-child interactions, which in turn, impair child adjustment (e.g., Beardslee et al., 1983; Belsky, 1984; Capaldi, 1991; Conger et al., 2002; Dishion & Patterson, 2006; Patterson, DeBaryshe, & Ramsey, 1989). Furthermore, during deployment, parental stress of the at-home caregiver is a contributing factor to a child's psychosocial morbidity (Flake, Davis, Johnson, & Middleton, 2009).
Parent management training interventions have been shown to improve parenting practices among a variety of populations, reducing children’s risk for externalizing problems. Parent Management Training-Oregon Model (PMTO), a theory-based parenting intervention, has demonstrated both short-term positive effects on parenting and child behavior and longer-term cascading effects on family outcomes, including improvements in parenting, couple functioning, child functioning and parent wellbeing (Patterson & Forgatch, 2010).
After Deployment, Adaptive Parenting Tools/ADAPT is a modification of the empirically-supported PMTO model tailored to military families coping with the stress of deployment. A web-enhanced, 14-week group based intervention, ADAPT addresses the unique challenges of National Guard and Reserve families during reintegration. Core parenting practices of PMTO are taught: skill encouragement, positive involvement, limit setting, problem solving and monitoring, introduced in an active learning environment (Forgatch & DeGarmo, 1999). The program integrates behavioral management and emotion socialization skills to support families dealing with the challenges of deployment.
Combat stress symptoms are associated with challenges in emotional functioning, such as emotional regulation and experiential avoidance, which can interfere with parental functioning (Price, Monson, Callahan, & Rodriguez, 2006). To mitigate the impact of combat stress on parenting, parents are taught basic mindfulness techniques and emotion coaching practices designed to enhance parents’ emotion socialization skills. Improving their emotional regulation skills enables parents to focus on utilizing their core parenting skills to teach their children how to recognize and respond to emotions, and improve their self-regulatory skills.
A randomized effectiveness trial of the ADAPT program is funded by the National Institutes of Health (R01-DA030114). Over the past year, the study has recruited more than 250 reintegrating National Guard and Reserve families in Minnesota towards the goal of 400 participating families. Families are randomized to the ADAPT program or services-as-usual. In addition to the parenting groups, families participating in ADAPT have access to web-based supplements (video clips and review segments) prompted by weekly emails.
ADAPT addresses unique issues and challenges of deployment and the reintegration process. For example, parents learn to present a ‘united parenting front’ as they co-parent during and after deployment. Customized support is provided to each family within the parenting groups by a team of two to three trained facilitators at least one of whom is military connected.
Families participate in the study over a two-year time frame. Assessments including multi-method (observational, pen-and-paper and physiological measures) and multi-agent (parent, child, & teacher) measures at baseline, six, 12, and 24 months post-baseline will enable us to examine the effects of the intervention on parenting, and child and parent functioning.
The initial cohort of families has completed the first wave of ADAPT groups. Although the results evaluating the effectiveness of the intervention at posttest are very preliminary, they are promising. Data analysis of self-report measures at six-months post baseline, from the first 43 parents (23 controls, and 20 intervention participants in 27 families) indicates that participants in the intervention group reported significantly better discipline practices, stronger parenting self-efficacy and more satisfaction with their couple relationship than parents in the control group (medium effect sizes). Moreover, the improvements favoring the ADAPT intervention group occurred regardless of initial level of report. That is, both parents who reported initially low levels of couple satisfaction, parenting discipline and/or parenting efficacy, as well as those higher at baseline, tended to show improvements. This suggests that the intervention may be helpful in improving participants’ perceptions of their couple relationships, discipline and parenting efficacy, regardless of baseline risk or functioning.
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Sheila Hanson, PhD, the project manager for ADAPT in the Department of Family Social Science at the University of Minnesota, received her PhD from the College of Education and Human Development at the University of North Dakota. Dr. Hanson has a professional background in marketing and technology development. Her research interests include emotional regulation in families affected by traumatic and stressful events, consumer preference modeling for effective mental health services, and the development and delivery of technology-enhanced prevention and intervention programs. She has a personal interest in military families, as her husband was deployed to Iraq in 2005 with the Navy Reserves.
Dustin Brockberg received his BA in child psychology from University of Minnesota. Dustin is pursuing his MA in counseling at the University of Minnesota. He served in the United States Army for four years and deployed to Iraq and Korea. Brockberg’s research interests include traumatic brain injuries, post-traumatic stress disorder and emotion regulation in military children.
Abigail Gewirtz, PhD is associate professor in the Department of Family Social Science and the Institute of Child Development at the University of Minnesota. Dr. Gewirtz is the principal investigator of the ADAPT study, funded by the National Institute of Drug Abuse (R01 DA030114). Her research interests include the development, testing and implementation of interventions to promote resilience in highly-stressed children and parents. Gewirtz is the PI/director of Ambit Network, a SAMHSA/National Child Traumatic Stress Network center focusing on the implementation throughout Minnesota of evidence-based interventions for children exposed to traumatic events; she also is co-PI on an NIMH-funded Center for Personalized Prevention Research. Gewirtz has provided consultation to Federal and State government agencies, and non-profits, on ways to support traumatized children and highly stressed parents, and has written and presented widely on prevention and intervention for children under stress.