Strong Families Strong Forces: Preliminary Efficacy Outcomes From a Randomized Clinical Trial of a Home-Based Intervention for Military Families

Background and Purpose:  Over 2 million children have experienced parental deployment to the wars in Afghanistan (OEF) and Iraq (OIF/OND). Very young children, age birth to five years, represent 40% of those affected. Over 42% of the Total Forces are parents. Although parent mental health problems have been linked to lower levels of child well-being and family functioning in a number of studies of military samples (e.g., Barker & Berry, 2009; Cozza, Chun & Polo, 2005), efficacy research on military-specific and developmentally-relevant programming for military families with very young children remains limited (Murphey, Darling-Churchill & Chrisler, 2011). In this presentation, we discuss the efficacy of a newly-developed home-based reintegration program for returning service members with very young children (Strong Families Strong Forces; SFSF) with a focus on parent mental health outcomes.  Developed specifically with and for military families, the aim of SFSF is to reduce the potentially negative impact of deployment-related experiences, including prolonged separation and service member combat stress, upon parenting stress, co-parenting processes, and the parent-child relationship, in military families with young children (birth to 5) during reintegration. Program elements are designed to enhance parental reflective functioning and support sensitivity in parental responses to child behavior and distress, and enhance family play and pleasure.  Because engagement and retention rates have been reported elsewhere (e.g., APA CYF Newsletter, January 2013), this presentation will focus primarily on parent mental health outcomes of the randomized clinical trial (RCT).

Methods: This three-phase project employed a community-based participatory approach to conduct a qualitative needs assessment (N=85 individual interviews with service member and at home parents), a feasibility study (N=9 completers), and a randomized clinical trial (SFSF vs. Waitlist Control; N=115 enrolled).  Self-report measures of mental health symptoms, parenting stress, parenting competence, child functioning, relationship satisfaction were completed by all adult participants at pretest, posttest, and 3-month follow up.  All parent mental health outcomes (e.g., posttraumatic stress, anxiety) were analyzed using ANCOVA with baseline scores as covariates.

Results: The majority of the study sample was National Guard/Reserve component (98.3%).  At baseline, approximately 11.8% of service members met criteria for DSM-IV PTSD.  Employing criteria revised by Bliese and colleagues (2008), approximately 37% of the sample met criteria for probably PTSD diagnosis, with no between-group differences at baseline on any measures.    Significant differences between treatment and comparison groups on measures of service member mental health were revealed at posttest, with moderate effect sizes (PTSD: f=8.6, p=.001, η2 =.08; anxiety: f=9.1, p=.00, η2=.09). 

Conclusion: Universal preventive interventions that are relationship-focused, military-specific and incorporate the family ecology may be viable mechanisms to reduce service member parent mental health symptoms during the reintegration phase of the deployment cycle.  In addition, the home-based service delivery modality appears to be an effective way to engage military populations.  Future directions and next steps, including effectiveness research, scalability, and adaptations for other populations, will also be discussed.