Changes in daily life created by the novel coronavirus (COVID-19) pandemic have resulted in a largely unprecedented situation for millions of families worldwide. Families are under considerable ...stress, and parents may experience greater psychological distress and disruptions in the parent-child relationship. Some parents may be particularly vulnerable to recent stressors, including those with preexisting psychological disorders and family dysfunction. In the United States, military veterans are one such at-risk population. Recent challenges may exacerbate preexisting conditions and heighten parenting stress, thereby negatively impacting child and family functioning. In this article, we share our experiences developing and piloting a telepsychotherapy parenting skills program for military veterans. The intervention, Online Parenting Pro-Tips (OPPT), combined web-based educational modules addressing child development and positive parenting with live coaching (via videoconferencing link) of parenting skills. Forty-one veterans with a child between the ages of 3 and 9 years enrolled in this trial and 22 completed the 6-session intervention. Veterans who completed the intervention experienced significant reductions in depression, parenting stress, and family dysfunction, with medium to large effect sizes (Cohen's d ranged from .53 to .98). Veterans also reported significant improvements in their child's behaviors. These findings have important implications pertaining to the feasibility and effectiveness of telepsychotherapy interventions to support at-risk families and promote positive parent-child interactions and family functioning during the COVID-19 crisis and beyond. At a practical level, OPPT and similar telepsychotherapy interventions for families could be modified to be delivered via smartphone to increase accessibility and cost-effectiveness for families worldwide.
Prueba piloto de una intervención de habilidades de crianza por telepsicoterapia para familias veteranas: Implicaciones para el manejo de estrés parental durante COVID-19
Los cambios en la vida diaria creados por la nueva pandemia del virus corona (COVID-19) han resultado en una situación en gran medida sin precedentes para millones de familias en todo el mundo. Familias están bajo un estrés considerable y los padres pueden experimentar mayor angustia psicológica e rupturas en la relación padre-hijo. Algunos padres pueden ser particularmente vulnerable a estresores recientes, incluidos aquellos con preexistencia de trastornos psicológicos y disfunción familiar. En los Estados Unidos, veteranos militares son una de esas poblaciones en riesgo. Los desafíos recientes pueden exacerbar condiciones preexistentes y aumentar el estrés de los padres, lo que afecta negativamente al niño y funciones familiares. En este artículo, compartimos nuestras experiencias desarrollando y poniendo a prueba un programa de habilidades para padres de telepsicoterapia para veteranos militares. La intervención, consejos para padres en línea (OPPT), combinaron módulos educativos basados en la web que abordandan el desarrollo infantil y la crianza positiva, con coaching en vivo (a través de enlace de videoconferencia) de habilidades parentales. Cuarenta y un veteranos con un niño entre las edades de 3 y 9 años se inscribieron en este ensayo y 22 completaron la intervención de 6 sesiones. Los veteranos que completaron la intervención experimentaron reducciones significativas en depresión, estrés parental y disfunción familiar con efectos de tamaño medio a grande (El valor de Cohen oscilaba entre .53 y .98). Los veteranos también reportaron mejoras significativas en los comportamientos de sus hijos. Estos hallazgos tienen implicaciones importantes relacionadas con la viabilidad y efectividad de las intervenciones de telepsicoterapia para apoyar a familias en riesgo y promover interacciones positivas entre padres e hijos y el funcionamiento familiar durante la COVID-19 crisis y más allá. A nivel práctico, OPPT e intervenciones similares de telepsicoterapia para las familias podrían modificarse para ser entregadas a través de teléfonos inteligentes para aumentar accesibilidad y rentabilidad para familias de todo el mundo.
针对退役老兵家庭之育儿技巧干预远程咨询的试行：关于冠状病毒流行期间管理育儿压力的暗示
由新冠病毒流行病所导致的日常生活变化应激导致全世界百万家庭陷入几乎前所未有的境况。 家庭们正在经受着巨大的压力, 而且家长们可能经受着更大的心理痛苦和来自亲子关系中的扰乱。 部分家长可能更易受近期压力源影响，其中包括那些已经遭受先前存在心理障碍和家庭不协调的家长。在美国, 退役老兵就属于这类处于危险中的群体。最近的挑战可能会恶化已经存在的境况并且增加了育儿压力, 因此会对孩子与家庭的运作产生消极影响。在本文中, 关于发展和测试一个针对退役老兵家庭育儿技巧远程心理咨询项目, 我们分享了的经验。这个干预项目, 名为在线家教专业贴士 （OPPT), 将以网络为基础并以儿童发展和积极正面育儿为任务的教育模块与通过视频会议进行的在线育儿技巧辅导结合起来。41个老兵以及他们3-9岁间的孩子参与了此次试运行试验, 其中22人完成了时长为6期的干预治疗。那些完成了干预治疗的老兵感受到了抑郁，育儿的精神压力, 和家庭失衡方面的显著性降低以及中等到较大的效应值（科恩维处于0.53 到0.98). 老兵们也报道孩子的行为有了显著的改善。这些发现, 在关于在疫情期间支持高危家庭并且推进积极的亲子互动以及家庭运转的远程心理治疗干预的可行性和有效性, 有着重要的借鉴意义。在现实操作的层面, OPPT和针对家庭的其他远程心理治疗干预可以被改进从而可以通过智能手机传达来增加对全世界家庭的可及性和成本效益。
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CEKLJ, FFLJ, NUK, ODKLJ, PEFLJ, UPUK
We report findings from an intervention study using telehealth modalities to determine whether provision of telehealth services can improve access to care and increase adherence to cognitive therapy ...in veterans with mild traumatic brain injury (TBI) while matching traditional care in terms of outcomes.
Veterans who were initially non-adherent to clinic-based cognitive therapy were offered a newly developed treatment. The control participants were selected from patient records of veterans who had completed cognitive treatment and matched to MOPS-VI participants on the basis of age, marital or relationship status, and composite memory index score. Baseline and post-treatment cognitive functioning as assessed by the Test of Memory and Learning 2nd Edition (TOMAL-2) was obtained for all participants. The MOPS-VI modules were designed to increase understanding of TBI and elicit problem-solving skills for attention and memory impairment. Results Sixty-seven percent of veterans (who were assigned to the MOPS-VI treatment group because they were initially non-adherent with the clinic-based treatment) completed the MOPS-VI telemedicine treatment.
of a two-way analysis of Variance (ANOVA) comparing baseline and follow-up scores on the TOMAL-2 in the MOPS-VI and control groups revealed there was a significant pre-post assessment effect, indicating that participant's memory and learning improved after treatment for both MOPS-VI and standard treatment groups. There was no significant difference between clinic-based treatment and MOPS-VI therapy.
Preliminary evidence supports the efficacy of the treatment, defined as increased compliance in completing the treatment program, and improvements in standardized memory and learning test results comparable to those following clinic-based treatment.
The present study reports the phase I findings from an innovative web-based videophone treatment study designed to increase understanding of traumatic brain injury, and elicit problem solving skills ...for attention and memory impairment following mild TBI in returning veterans. The results support the feasibility of the approach and provide preliminary evidence of efficacy, defined as increased compliance and improvements in memory skills comparable to face-to-face treatment. The intervention utilized telehealth modalities to improve access to care and increase adherence to cognitive therapy. This is a matched pre/post design. The control group participants were veterans initially compliant with face-to-face cognitive therapy. The Military On-Line Problem Solving Videophone Intervention (MOPS-VI) participants were recruited from a group of veterans non-adherent to standard face-to-face cognitive therapy. Each MOPS-VI participant was provided a laptop computer, wireless internet and a videoconference phone for the duration of the intervention. Following baseline measures of executive dysfunction including: 1) The Test of Memory and Learning 2nd Edition, 2) The Test of Everyday Attention, 3) Behavioral Rating Inventory of Executive Function Adult Version, 4) Center of Epidemiological Depression Scale, and the 5) State/Trait Anxiety Inventory, veterans were trained how to access the on-line modules. Each module consisted of didactic information, veteran interviews providing personal accounts of struggles with executive dysfunction, and self-guided web exercises to help improve executive function skills. Upon completion of each of the six on-line modules, MOPS-VI participants participated in follow-up videophone sessions in an effort to generalize the content learned in the web-based modules. Results of a two way (pre vs. post assessments) × (standard vs. MOPS-VI) analysis of variance (ANOVA) indicated there was a significant pre-post assessment effect, F (1, 10) =50.38, p<.001, indicating that participants' memory improved after treatment for both MOPS-VI and standard treatment groups. There was no significant difference between face-to-face therapy and MOPS-VI therapy (F (1, 10) =0.39, p=.55) suggesting that MOPS-VI therapy is as effective as standard treatment and therefore is a strong alternative for face-to-face treatment. Although not statistically significant, the MOPS-VI intervention yielded similar results as standard therapy even when the MOPS-VI intervention was fewer months in duration. The results provide preliminary evidence that delivery of TBI telehealth intervention is feasible with this group and, for some patients, increase compliance. Further, the results suggest that the intervention is at least as effective as similarly organized face-to-face therapeutic intervention.
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