As provider networks on military bases are overwhelmed with new cases, civilian clinicians are increasingly likely to treat military families.
Abstract In this paper, we report on the development and dissemination of a preventive intervention, Families OverComing Under Stress FOCUSan eight-session family-centered intervention for families facing the impact of wartime deployments. Specific attention is given to the challenges of rapidly deploying a prevention program across diverse sites, as well as to key elements of implementation success.
Data are presented to describe the range of services offered, as well as initial intervention outcomes. It proved possible to develop the intervention rapidly and to deploy it consistently and effectively. The sustained operational tempo in Iraq and Afghanistan created an urgent national need to support military readiness by enhancing family resilience and provided an opportunity to test a new model of intervention development and dissemination.
Throughout wartime deployments, these families face many stressors, including repeated relocation, parental absence, and fears and concerns Palmer ; Segal Several earlier studies suggest that military children typically exhibit resilience and well-being, despite these stressors Cozza et al.
However, more current studies indicate increased child distress during parental deployment Chartrand et al. Furthermore, across a variety of intervention strategies, there has been strong endorsement for structured manual-based programs that enhance parenting and parent—child relationships NRCIOM ; Sandler et al.
A central tenant of developmental research is that effective caregiver-child relationships provide an essential framework for building child adaptive skills, including emotional and behavioral self-regulation Nachmias et al.
Interventions that promote adaptive skills and behaviors in children and parents, particularly those that enhance parent—child communication, bonding, and family management, reduce problem behaviors and emotional distress in children throughout development Feinberg and Kan ; Spoth et al.
Given that military families have many existing strengths and that family factors play a central role in mediating childhood stress, it seemed prudent to design an intervention that built on these strengths, yet further enhanced protective family processes, particularly in light of the repeated deployments of the current conflicts.
FOCUS Families OverComing Under Stress was specifically developed as a family-centered preventive intervention strategy adapted for the needs of military families facing the stressors of multiple deployments.
Strength-based approaches with families have a particularly strong evidence base Beardslee and Knitzer ; NRCIOM ; therefore, the concept of resilience, which focuses on positive adaptation in the face of significant adversity, was central to FOCUS. Subsequent longitudinal studies that permitted more in-depth analyses of resilient processes highlighted the importance of attachment relationships as predictors of child resilience when exposed to hardship, trauma, or loss, the importance of families, and the need to understand the broader ecological context surrounding the child Sroufe ; Werner Chronology of Intervention Development Given the urgent national need for a rapid, scalable framework of preventive services for military families, our military partners requested that FOCUS be developed and implemented without first conducting a randomized trial.
Instead FOCUS was developed by adapting and consolidating key aspects of existing strength- and evidence-based interventions utilized in comparable contexts.
From the beginning, FOCUS was conceived to be a trauma-informed, skill-based, family-centered prevention selective and indicated intervention designed to promote family resiliency and to mitigate the sequelae of highly stressful deployment-related events on children and parents.
In order to meet the needs of the greatest number of military families, FOCUS was designed to be highly scalable.
Additionally, the intervention had to be straightforward to deliver; only approaches that could be taught to a wide range of providers in a variety of settings could be considered.
Finally, it needed to be highly portable and flexible so it could be quickly disseminated to a variety of very different communities, geographies, family types, and military service requirements. The three foundational programs from which FOCUS was developed all had a family-level, rather than an individual-level, perspective.
They were all directed toward children and parents who were at risk for mental disorders or serious life impairment, and yet none were conceived to provide treatment for a mental disorder. The first intervention, Project TALK Teens and Adults Learning to Communicateis a manualized, family-centered, prevention intervention developed to promote positive psychological adjustment in adolescents affected by parental illness Lester et al.
Project TALK contributed a proven model for a modularized prevention intervention, as well as the implementation of cognitive-behavioral skills delivered in a prevention framework across the family system.
The second preventive intervention strategy on which FOCUS was founded was the UCLA Trauma-Grief Intervention, a school-based, trauma-focused, cognitive-behavioral therapy program developed in post-war Bosnia for children and parents exposed to trauma and loss in war zones and other violent community settings Layne et al.
FOCUS incorporated from this intervention core elements of trauma-informed psychoeducation and skill-building techniques.
Family Talk, the third foundational component of FOCUS, is a brief, family-based preventive intervention that addresses obstacles to communication and the lack of attention to parenting common in families affected by parental depression Beardslee et al.
The Family Talk intervention contributed to FOCUS a systematic approach to sharing a family narrative, as well as practical strategies to building resilience. The central prevention and resiliency framework being developed in the U.
Navy USN and U. FOCUS incorporated the COSC Model into its assessment components, promoting a classification of family and family-member strengths and vulnerabilities according to their severity and relative need for interventions. An initial FOCUS manual integrating elements from the source interventions and the COSC model, as well as a set of key informant interviews, family focus groups, and environmental and systems assessment, was finalized in Saltzman et al.
During initial sessions, the Resiliency Trainers provide family members with education about the impact of combat operational stress and deployment in terms that are developmentally relevant to the family.
Throughout training, there is a focus on shared family-level skills across the deployment cycle:Purpose: This systematic review describes the impact of deployment since 9/11 on the mental health of military families with young children, evaluates evidence-based interventions for military parents with young children, and identiﬁes gaps in the science limiting our .
Systematic Approach to Military Families Essay Introduction to Unit 2 Unit 2 | Systemic Approach to Military Families In this unit we will review theories of family stress and explore risk and resilience factors as these pertain to military families.
Unit 2 | Systemic Approach to Military Families In this unit we will review theories of family stress and explore risk and resilience factors as these pertain to military families.
and systematic approach to EFMP standardization efforts, with a view to ensuring that program Communication and collaboration with military families with special needs, DoD stakeholders, national disability organizations, and military service organizations, and the provision of uniform.
Family-Centered Preventive Intervention for Military Families: Implications for Implementation Science strategy adapted for the needs of military families facing the Talk intervention contributed to FOCUS a systematic approach to sharing a family narrative, as well as practical.
Combat Deployment and the Military Family Combat deployment, in many ways, has affected every military family; the soldier, the spouse, and the child(ren). The spouses and child(ren) of the deployed soldier are often referred to as the “unsung heroes” of military families, at all times of a deployment.