The Implementation Science of Strong Families Strong Forces: A Community-Based Participatory Approach to Program Development and Study Design
Approximately 1.9 million U.S. troops have been deployed to Afghanistan (Operation Enduring Freedom; OEF) and Iraq (Operation Iraqi Freedom; OIF) since October, 2001 (Institute of Medicine, 2010). OEF/OIF deployments are more stressful than those in earlier wars in terms of frequency and length of deployment for service members and families (Chartrand & Siegel, 2007). Over 2 million children have been affected by parental OEF/OIF deployment, of whom 40% are younger than five years (DOD, 2008). Problematic mental health functioning in service members has been associated with lower levels of parent and family functioning during OEF/OIF deployment and reintegration (Barker & Berry, 2009; Chartrand, Frank, White, & Shope, 2008; Cozza, Chun, & Polo, 2005; Sayers, Farrow, Ross, & Oslin, 2009). Despite these substantial needs, little research and evidence-based programming are available for these families. This paper reviews the implementation science of a 4-year community-based participatory research (CBPR) study designed to develop and test Strong Families Strong Forces (SFSF), a home-based intervention for returning OEF/OIF service members with very young children and their families. The overarching goal of SFSF is to mitigate the impact of deployment experiences on military families with young children. This paper: 1) presents findings from initial exploratory phases 2) describes translation of findings to an evidence-informed reintegration program and 3) identifies critical CBP process outcomes integral to creating a program that is feasible, acceptable, and culturally responsive to the needs of National Guard/Reserve military components.
Methods: During the first phase of this mixed-methods project, standardized self-report measures assessing parenting and psychological distress (BSI) were completed by OEF/OIF service member parents (N= 39) and spouses (N= 31). Audiorecorded semi-structured interviews elicited parents’ experiences of reintegration, parenting, and utilization of resources/supports. Quantitative data were entered into SPSS for analysis. Qualitative interviews were transcribed verbatim and analyzed using grounded theory techniques (Charmaz, 2006). SFSF was piloted (Phase 2) with N=9 families to determine feasibility and safety of the intervention. Phase 3, a randomized clinical trial, is ongoing.
Findings: Overall, most families were coping well with deployment and reintegration. 14% of service members met criteria for PTSD, 22% reported clinically significant parenting stress, and 54% were struggling with depression or anxiety. Spouses reported higher levels of functioning, with only 12% struggling with clinically significant parenting stress, and 48% exhibiting depression or anxiety. Interview themes included parent mental health, perceived legacy of war-related experiences, recognizing and responding to young children's reactions to deployment separation, and barriers to access/utilization of resources and supports. Critical CBP process outcomes included the development of military-civilian partnerships, conversion of community member feedback to changes in research design, and translation of research findings to intervention development.
Conclusions: This collaborative approach to program-building is intended to maximize participant input regarding deployment-related experiences and family perceptions of need related to reintegration and parenting, ensuring that the resulting program has strong ecological validity and practical relevance for military families. Implications of building a consumer and evidence-informed family program for returning OIF/OEF service members with young children will be discussed.