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As you arrive in the webinar room, please answer this question in the chat pod -

What family stresses related to deployment and reintegration do you see in your work with military

families?

https://learn.extension.org/events/2400

This material is based upon work supported by the National Institute of Food and Agriculture, U.S. Department of Agriculture, and the Office of Family Readiness Policy, U.S. Department of Defense under Award Numbers 2014-48770-22587 and 2015-48770-24368.

Parenting During Times of Transition (Part 2) –Promoting Effective Parenting During

Deployment & Reintegration

Connecting military family service providers to research and to each other

through innovative online programming

www.extension.org/militaryfamilies

MFLN Intro

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MFLN Family Transitions

MFLN Family Transitions @MFLNFT

Military Families Learning Network

MFLN Family Transitions

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MFLN Group https://www.linkedin.com/groups/8409844

Dr. Abigail Gewirtz, Ph.D., L.P.Lindahl Leadership Professor

• Institute for Translational Research in Children’s Mental Health at the University of Minnesota

• Professor in the Department of Family Social Science and the Institute of Child Development

Today’s Presenter

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Research focuses on the development, effectiveness testing, and implementation of targeted prevention programs that promote child resilience among highly stressed families including those affected by military deployment and war

Learner Objectives:

• Identify key elements of effective parenting programs

• Describe family stresses of deployment and reintegration

• Describe what makes a program evidence-based• Describe why ADAPT is an evidence-based

program

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Healthy families, healthy service members

• Mission readiness requires an uncluttered mind- Concerns about family associated with poorer wellbeing during and

after deployment

• Much past research on influence of family members on each other’s wellness– Parents with psychological or parenting challenges have children

with more problems

• The good news: improving parenting skills leads to improvements in other family domains…..– Using evidence-based family programming

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After Deployment Adaptive Parenting Tools

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What is ADAPT?

• First federally funded randomized study of a parenting program for military families with school-aged children, and the first parenting study of National Guard families

• Tests a parenting program (ADAPT) designed specifically for military families via a randomized controlled trial, and at the same time aims to learn about how families navigate deployment and reintegration

• 14-week group-based parenting program that is now also available in 2 versions online-only individual tele-health

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Why did we start ADAPT?

• We wanted to learn about family resilience– How do parents reconnect with children after deployment?– How do mothers and fathers parent in the wake of deployment?– How can we support families after deployment?

• No research-based parenting programs for deployed families with school-aged children

• Fewer resources for the NGR than active-duty service members

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ADAPT’s theoretical framework: Parenting practices mediate impact of family stressors on child adjustment

• Deployment is a family stressor• Separations from family and children

(MacDermid, 2006)• Combat related stressors (Cozza et al.,

2005)

• Reintegration is a key transition point• Transitions offer special prevention

opportunities

• Parenting practices mediate the impact of deployment stress on child outcomes (Patterson, 1982)

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The study: Effectiveness of a web-enhanced parenting program for military families

• 2010-2016

• 336 NG/R families recruited; each family followed for two years

– Random assignment to a parenting program (ADAPT; 60%) or parenting services-as-usual (web and print resources; 40%)

– Parents and teachers complete online questionnaires, and observational, self-report, and physiological data are gathered from families (parents & children) at baseline, 6, 12, and 24 months.

– Outcomes: parenting practices, couple adjustment, child adjustment (behavior and emotional problems, substance use, peer adjustment), parent emotion regulation, parent emotion socialization

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Modifications to parent training model for military families: ADAPT• ADAPT is a 14-week long, web-enhanced, group-based

program for troops returning from deployment who have at least one child aged 5-12yrs– Weekly, provided in the community, 2hrs long, groups began Sept 2011– Online ADAPT is available to participants for 12 months

• Modifications include: attention to emotion regulation in family communication (emotion socialization)– Mindfulness training (to address experiential avoidance associated with

combat stress symptoms)– Emotion coaching (esp. responding to children’s anxiety)

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Modifications continued…

• Attention to military culture and values (in group process, in tailored video material, role plays, etc)

• Emphasis on united parenting front (for two-parent families)

• Addressing common barriers to participation– Web-component to increase involvement in group program by other

caregivers, spouses, etc.– Stand alone online ADAPT is under development (Marquez, Gewirtz, &

DeGarmo, 2013-2015)

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ADAPT program content

6 key parenting skills– Teaching through encouragement– Emotion socialization (added)– Positive involvement with children– Family problem-solving– Monitoring and supervision– Effective discipline

Groups augmented with online materials for midweek– Skill and practice videos– Mindfulness practices downloadable to MP3/smartphones– Home practice and information handouts– Short quizzes/ knowledge checks

Taught via:– Role play– Discussion– Practice

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Time to Chat

Questions? Thoughts? Share with us in the chat pod!

Who are the families in ADAPT?• 608 adults and 336 children in 336 families in Minnesota

National Guard, and in Army, Navy, Air Force, Marines, and Coast Guard Reserve Units

• 57 deployed mothers; 282 deployed fathers

• Married: 9.8 years on average (SD = 5.3)

• Mean number of marriages: 1.2

• Average number of children: 2.39 (SD = 1)

• Mean family income: $71,281 (SD = $34,761) 17

Who are the families continued…

• Number of deployments (ever): 1-13 for men, 1-5 for women

• Number of deployments since 2001: 1-6 for men, 1-5 for women (mean = 1.96 for men, 1.4 for women)

• Deployment status by family– Male deployed = 282– Female deployed = 31– Both deployed = 26

• For more information on baseline data, and intervention process, see Gewirtz et al., 2013, 2014, in press (moms, dads, overall parenting)

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Who are the military and deployed mothers in ADAPT?

80 military mothers– 52 in dual partner military families– 28 just mothers in military– 44 Army NG; 11 Air NG; 16 reserves, 9 other

57 mothers have deployed to OIF or OEF; 51 were gone 6-24 months; 44 deployed once

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Deployed vs. non-deployed mothers in ADAPT

• We analyzed data from 181 mothers who completed baseline data collection

• 34 deployed, 147 never deployed

• Controlling for marital status, deployed mothers reported significantly higher distress (PTSD and depression symptoms) and difficulties in emotion regulation than never deployed mothers

• Deployed mothers had more adverse past year life events

• But no differences in reports of couple or child adjustment (Gewirtz et al, 2014, Professional Psychology, Research and Practice)

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Interviews with deployed mothers

• At completion of ADAPT study, I invite all deployed mothers to an individual interview

– Coffee shop or woman’s choice of location– No longer than 45-60 mins– Videotaped, with a copy given to the woman to keep

• We have conducted 6 interviews to-date

• About ¼-1/3 of eligible women decline to participate– ‘this was a traumatic time and I don’t want to talk about it’

• Majority report that this is a good opportunity to share their experiences

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Interview questions

Chronological approach: life as a mother and a spouse– Prior to the first deployment– From knowing you were to deploy until the actual leaving

• Telling kids about deployment

– During deployment• Communication with the family• Safety and feeling threatened

– After returning to the family• Reunification with children and spouse

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Interview findings/themes• Deployment is something you train for

– Service and sacrifice/call of duty– Ambivalence – service vs. leaving kids

• Attitudes of friends, family and community members towards deployed mothers– Different attitudes towards men who deployed vs. women

• Feeling threatened– Danger is on-base

• Reintegration– Jumping right back into parenting– No transition time

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Time to Chat

Randomization• 60% families (N=207) randomly assigned to

ADAPT condition

• 40% families (N=129) to ‘services as usual’ –web and print materials about parenting

• Families assigned in cohorts based on in-home assessment date

• Families in the intervention/ADAPT condition were invited to the next group to start that matched their schedule and location– 7 cohorts, 29 groups delivered

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ADAPT groups• Held in churches,

community centers, colleges across Minnesota typically within a 45-60 minute drive for participants

• Childcare activities and pizza dinner provided

• Families reimbursed for travel ($10/family)

• Drawings to encourage on-time attendance and homework completion

• Groups lasted 2 hrs, usually on a weekday evening

• Group facilitators were National Guard or military-related individuals (e.g. VA, spouses, etc) and civilian human service professionals

• Families completed satisfaction surveys at the end of each group session (anonymous, IDs only, in sealed envelope)

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ADAPT group participation(Gewirtz, Pinna, Hanson, & Brockberg, 2014)

• Of the 207 families in the ADAPT condition, 70% showed up at least once

• An additional 7% families accessed online components only

• Almost half of the families attended at least seven sessions

• Slightly greater mother (53%) than father (47%) participation

• Of the 145 families who attended at least one session, 71% came to seven or more sessions

• 48% completed at least one home practice assignment; 52% used online tools

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Average General Satisfaction

Mean: 3.85 - men

3.97 - women

0 1 2 3 4

Some Very Little Some Quite a Lot Very Much

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“Giving Effective Directions”

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• Watch this 5-minute clip from ADAPT -https://youtu.be/jM_q5yD6KNY

• Join us back here once you’re finished and raise your hand to indicate you ready for discussion.

In the chat pod, please share your thoughts

about the video.

Time to Chat

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Preliminary follow-up dataWe evaluated the effectiveness of the ADAPT program at 6 and 12 months post-baseline

Examined the program’s effect on several dimensions of parenting:

– Parenting self-efficacy (T2)– Parent reports of ineffective discipline (T3)– Observed parenting (T3)

Recently examined program effects on child outcomes (T3)

- Behavior problems and adaptive skills (parent report)

And on parents’ PTSD symptoms33

Findings

Results indicate that, at posttest, the ADAPT intervention significantly improved parents’:

– Parenting self-efficacy (mothers and fathers)

– Reports of ineffective discipline (mothers and fathers)

– Observed parenting in mothers and in higher-risk fathers

– PTSD symptoms in mothers and in higher-risk fathers

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Findings continued…• At one year post baseline, improvements in parenting

efficacy as a result of the program led to:

– Reductions in mothers’ and fathers’ PTSD and depression symptoms, and reductions in suicidal ideation (Gewirtz, DeGarmo, & Zamir, in press)

– Improvements in children’s peer adjustment (Piehler, Ausherman, Gliske, & Gewirtz, under review)

• Preliminary child behavior data indicate behavior improvements in children in the ADAPT condition at one year post-baseline

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Time to Chat

What is one significant thing you learned today?

ADAPT4UNew study funded by the Dept of Defense

(Military Operational Medical Research Program/MOMRP) to evaluate different formats

of the ADAPT programOnline only

Group-basedTele health

Recruiting now!Families with 5-12 year olds, where at least one parent has deployed in service of OIF or OEF MN Metro area, Duluth, and Michigan (Grand Rapids, Kalamazoo, Battle Creek)Go to www.adapt4u.umn.edu

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Acknowledgements• ADAPT study funded by NIDA (R01 DA 030114; 2010-2015

(associated funding from SAMHSA’s National Child Traumatic Stress Network (SM56177); & NICHD R43 HD 066896)

• Program officers: Eve Reider and Belinda Sims

• Hundreds of National Guard and Reserve (NG/R) families

• National Guard command and communication staff

• Co-investigators: Drs. Melissa Polusny, Marion Forgatch, Dave DeGarmo

• Research staff and facilitators39

Thank you

Abi Gewirtz: agewirtz@umn.edu

ADAPT’s website:Adapt4u.umn.edu

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Evaluation and Certificate of Completion

MFLN Family Transitions is offering a certificate of completion for today’s webinar.

To receive a certificate of completion, please complete the evaluation and post-test at: https://vte.co1.qualtrics.com/SE/?SID=SV_9Gl6TWHJMhX9jX7

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Family Transitions Upcoming Event

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Building Community Partnerships to Meet Transitioning Service Members & Family Needs

• March 31, 2016 • Time: 11AM Eastern• Location: https://learn.extension.org/events/2410

For more information on MFLN Family Transitions go to: http://blog/.extension.org/militaryfamilies/life-cycle-transition-support

www.extension.org/62581

43This material is based upon work supported by the National Institute of Food and Agriculture, U.S. Department of Agriculture, and the Office of Family Readiness Policy, U.S. Department of Defense under Award Numbers 2014-48770-22587 and 2015-48770-24368.