Evaluation of a Family-Centered Prevention Intervention for Military Children and Families Facing Wartime Deployments

摘要

Objectives. We evaluated the Families OverComing Under Stress program, which provides resiliency training designed to enhance family psychological health in US military families affected by combat- and deployment-related stress. Methods. We performed a secondary analysis of Families OverComing Under Stress program evaluation data that was collected between July 2008 and February 2010 at 11 military installations in the United States and Japan. We present data at baseline for 488 unique families (742 parents and 873 children) and pre–post outcomes for 331 families. Results. Family members reported high levels of satisfaction with the program and positive impact on parent–child indicators. Psychological distress levels were elevated for service members, civilian parents, and children at program entry compared with community norms. Change scores showed significant improvements across all measures for service member and civilian parents and their children ( P 1 – 4 Deployed service members are often exposed to a landscape of chronic stressors, potential traumatic events, and harsh environmental risk factors during combat duty. Among those service members returning from deployment to Iraq, 16% to 17% meet criteria for depression, posttraumatic stress disorder (PTSD), or generalized anxiety. 5 Repeated deployments or exposure to adverse conditions have been associated with higher rates of combat-related psychological health problems, traumatic brain injury, substance abuse, and marital conflict. 6 – 15 Extended separations in the context of combat deployment may also affect psychological health for the at-home spouse and children. Recent evidence suggests that distress levels of at-home family members increase as the number of deployment months increases. 16 Military children may also be vulnerable to emotional and behavior disruptions, including heightened anxiety and academic difficulties. 1 , 17 – 21 Consistent with the larger literature on child distress, 22 psychological symptoms in military parents predict child adjustment problems. 16 , 23 , 24 Additionally, the cumulative length of parental deployments correlates with increased risk for depression and behavioral disruptions in school-aged children 16 and with increased distress in adolescents. 24 Interventions that target families facing adversity and build on family strengths to reduce psychological distress have been shown to have a positive effect on parent and child adjustment and to provide sustained benefits. 25 In randomized controlled trials involving families in challenging circumstances (i.e., parental medical illness, parental depression), targeted family interventions that strengthen parent–child relationships, promote effective parenting practices, and increase family understanding have consistently demonstrated positive outcomes in child development and psychological health over time. 25 – 28 Effective coping skills, particularly those that address traumatic stress reactions, are associated with enhanced stress management, 29 – 31 and effective caregiver–child relationships support the development of child adaptive skills such as emotional and behavioral regulation. 32 , 33 The FOCUS (Families OverComing Under Stress) project for military families emerged from foundational research on a previously described family-centered preventive intervention model and then was adapted and manualized by a University of California, Los Angeles (UCLA)–Harvard intervention development team at Marine Corps Base, Camp Pendleton. 34 , 35 The program was subsequently implemented as a large-scale demonstration program for the US Marine Corps and US Navy, funded by the US Navy's Bureau of Medicine and Surgery. Importantly, potential barriers to accessing mental health services have been addressed by a FOCUS implementation emphasis on being strength and skills based, practical, and easily accessible and applicable for military families. Implementation also includes strong military leadership involvement and community partnership to ensure active outreach and family engagement. FOCUS provides education and skills training for military parents and children. Training is designed to enhance coping with deployment-related experiences, including possible combat-related psychological or physical injury in the service member. Through a structured narrative approach, family members share their unique perspectives of deployment-related experiences, thereby enhancing understanding, bridging communication, and increasing family cohesion and support. This process mobilizes theoretically and empirically supported family resiliency processes. 36 , 37 FOCUS also integrates the US Navy and US Marine Corps stress continuum model, 38 which categorizes deployment stress into 4 color zones—green, yel