This study evaluates the longitudinal outcomes of Families OverComing Under Stress (FOCUS), a family-centered preventive intervention implemented to enhance resilience and to reduce psychological ...health risk in military families and children who have high levels of stress related to parental wartime military service.
We performed a secondary analysis of evaluation data from a large-scale service implementation of the FOCUS intervention collected between July 2008 and December 2013 at 15 military installations in the United States and Japan. We present data for 2,615 unique families (3,499 parents and 3,810 children) with completed intake and at least 1 postintervention assessment. Longitudinal regression models with family-level random effects were used to assess the patterns of change in child and parent (civilian and military) psychological health outcomes over time.
Improvement in psychological health outcomes occurred in both service member and civilian parents. Relative to intake, parental anxiety and depression symptoms were significantly reduced postintervention, and these reductions were maintained at 2 subsequent follow-up assessments. In addition, we identified an improvement over time in emotional and behavioral symptoms and in prosocial behaviors for both boys and girls. We observed reductions in the prevalence of unhealthy family functioning and child anxiety symptoms, as well as parental depression, anxiety, and posttraumatic stress symptoms from intake to follow-up.
Longitudinal program evaluation data show sustained trajectories of reduced psychological health risk symptoms and improved indices of resilience in children, civilian, and active duty military parents participating in a strength-based, family-centered preventive intervention.
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.
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.
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 < .001).
Evaluation data provided preliminary support for a strength-based, trauma-informed military family prevention program to promote resiliency and mitigate the impact of wartime deployment stress.
Recent studies have confirmed that repeated wartime deployment of a parent exacts a toll on military children and families and that the quality and functionality of familial relations is linked to ...force preservation and readiness. As a result, family-centered care has increasingly become a priority across the military health system. FOCUS (Families OverComing Under Stress), a family-centered, resilience-enhancing program developed by a team at UCLA and Harvard Schools of Medicine, is a primary initiative in this movement. In a large-scale implementation project initiated by the Bureau of Navy Medicine, FOCUS has been delivered to thousands of Navy, Marine, Navy Special Warfare, Army, and Air Force families since 2008. This article describes the theoretical and empirical foundation and rationale for FOCUS, which is rooted in a broad conception of family resilience. We review the literature on family resilience, noting that an important next step in building a clinically useful theory of family resilience is to move beyond developing broad “shopping lists” of risk indicators by proposing specific mechanisms of risk and resilience. Based on the literature, we propose five primary risk mechanisms for military families and common negative “chain reaction” pathways through which they undermine the resilience of families contending with wartime deployments and parental injury. In addition, we propose specific mechanisms that mobilize and enhance resilience in military families and that comprise central features of the FOCUS Program. We describe these resilience-enhancing mechanisms in detail, followed by a discussion of the ways in which evaluation data from the program’s first 2 years of operation supports the proposed model and the specified mechanisms of action.
Over the past decade, studies into the impact of wartime deployment and related adversities on service members and their families have offered empirical support for systemic models of family ...functioning and a more nuanced understanding of the mechanisms by which stress and trauma reverberate across family and partner relationships. They have also advanced our understanding of the ways in which families may contribute to the resilience of children and parents contending with the stressors of serial deployments and parental physical and psychological injuries. This study is the latest in a series designed to further clarify the systemic functioning of military families and to explicate the role of resilient family processes in reducing symptoms of distress and poor adaptation among family members. Drawing upon the implementation of the Families Overcoming Under Stress (FOCUS) Family Resilience Program at 14 active‐duty military installations across the United States, structural equation modeling was conducted with data from 434 marine and navy active‐duty families who participated in the FOCUS program. The goal was to better understand the ways in which parental distress reverberates across military family systems and, through longitudinal path analytic modeling, determine the pathways of program impact on parental distress. The findings indicated significant cross‐influence of distress between the military and civilian parents within families, families with more distressed military parents were more likely to sustain participation in the program, and reductions in distress among both military and civilian parents were significantly mediated by improvements in resilient family processes. These results are consistent with family systemic and resilient models that support preventive interventions designed to enhance family resilient processes as an important part of comprehensive services for distressed military families.
Durante la última década, los estudios sobre el efecto que tiene la movilización militar en tiempos de guerra y las adversidades relacionadas con dicha movilización en los militares y en sus familias, han servido como respaldo empírico para modelos sistémicos de funcionamiento familiar y para comprender más sutilmente los mecanismos mediante los cuales el estrés y el trauma repercuten en las relaciones con la familia y la pareja. También han potenciado nuestra opinión sobre las maneras en las cuales las familias pueden contribuir a la resiliencia de los niños y los padres que luchan contra los factores de estrés producidos por las movilizaciones militares en serie y los daños psicológicos y físicos de los padres. El presente estudio es el último en una serie diseñada para aclarar mejor el funcionamiento sistémico de las familias de militares y para explicar la función que cumplen los procesos familiares resilientes a la hora de disminuir los síntomas de angustia y de una adaptación deficiente entre los miembros de la familia. Sobre la base de la implementación del “Programa FOCUS de Resiliencia Familiar” (FOCUS Family Resilience Program) en 14 instalaciones militares en servicio activo en distintos puntos de Estados Unidos, se realizaron modelos de ecuaciones estructurales con datos de 434 familias de infantes de marina de la armada en servicio activo que participaron en el programa FOCUS. El objetivo era comprender mejor las maneras en las cuales la angustia de los padres repercute en los sistemas familiares de los militares y, a través del modelado analítico de trayectoria longitudinal, determinar las vías del efecto del programa en la angustia de los padres. Los resultados indicaron una influencia cruzada significativa de la angustia entre los padres militares y los civiles dentro de las familias; las familias con padres militares más angustiados fueron más propensas a mantener su participación en el programa; y las reducciones de la angustia entre los padres militares y los civiles estuvieron mediadas considerablemente por mejoras en los procesos familiares resilientes. Estos resultados coinciden con los modelos familiares resilientes y sistémicos que fomentan las intervenciones preventivas diseñadas para mejorar los procesos familiares resilientes como una parte importante de los servicios integrales para familias militares angustiadas.
在过去的十年中,关于战时部署和其相关的困难对于服役军人及其家庭影响的研究为家庭功能系统模型提供了实证支持,并对压力和创伤在家庭和伴侣关系中的传递机制提出了更细微的理解。这些研究还促进了我们对于家庭是如何帮助那些与一系列部署和家长身体,心理伤害抗衡的儿童和家长增强韧性的理解。该研究是一系列针对进一步阐明军人家庭系统功能以及解释韧性家庭过程在减轻压力和家庭成员适应不良现象中的作用的研究中最新的一个。根据在全美国14个现役军队设施中实施的FOCUS家庭韧性项目,我们使用从434个参与FOCUS项目的海军以及海军陆战队家庭中得出的数据,构建了结构方程式模型。其目的是更好的理解家长困扰如何在军人家庭系统中传递,并通过纵向途径分析模型,决定该项目对家长困扰影响的途径。研究发现表明家庭内部军人家长和平民家长之间存在明显困扰相互影响。有受困扰军人家长的家庭更有可能持续参与项目;军人和平民家长中困扰减轻明显受到韧性家庭过程的影响。这些结果与支持旨在将提升家庭韧性过程作为针对受困扰军人家庭全面服务的一个重要部分的家庭系统和韧性模型一致。
Video
Family-centered preventive interventions have been proposed as relevant to mitigating psychological health risk and promoting resilience in military families facing wartime deployment and ...reintegration. This study evaluates the impact of a family-centered prevention program, Families OverComing Under Stress Family Resilience Training (FOCUS), on the psychological adjustment of military children. Two primary goals include (1) understanding the relationships of distress among family members using a longitudinal path model to assess relations at the child and family level and (2) determining pathways of program impact on child adjustment. Multilevel data analysis using structural equation modeling was conducted with deidentified service delivery data from 280 families (505 children aged 3-17) in two follow-up assessments. Standardized measures included service member and civilian parental distress (Brief Symptom Inventory, PTSD Checklist-Military), child adjustment (Strengths and Difficulties Questionnaire), and family functioning (McMaster Family Assessment Device). Distress was significantly related among the service member parent, civilian parent, and children. FOCUS improved family functioning, which in turn significantly reduced child distress at follow-up. Salient components of improved family functioning in reducing child distress mirrored resilience processes targeted by FOCUS. These findings underscore the public health potential of family-centered prevention for military families and suggest areas for future research.
In this paper, we report on the development and dissemination of a preventive intervention, Families OverComing Under Stress (FOCUS), an 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. FOCUS, developed by a UCLA-Harvard team, was disseminated through a large-scale demonstration project funded by the United States Bureau of Navy Medicine and Surgery (BUMED) beginning in 2008 at 7 installations and expanding to 14 installations by 2010. 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 toll of multiple and prolonged deployments on families has become clearer in recent years as military families have seen an increase in childhood anxiety, parental psychological distress, and ...marital discord. Families overcoming under stress (FOCUS), a family-centered evidence-informed resiliency training program developed at University of California, Los Angeles and Harvard Medical School, is being implemented at military installations through an initiative from Navy Bureau of Medicine and Surgery. The research foundation for FOCUS includes evidence-based preventive interventions that were adapted to meet the specific needs of military families facing combat operational stress associated with wartime deployments. Using a family narrative approach, FOCUS includes a customized approach utilizing core intervention components, including psychoeducation, emotional regulation skills, goal setting and problem solving skills, traumatic stress reminder management techniques, and family communication skills. The purpose of this study is to describe the development and implementation of FOCUS for military families. A case example is also presented.
Aim
To review systematically studies examining the development of social competence in children born very preterm (VPT) (gestation <33wks) and identify neonatal and family predictors.
Method
...Peer‐reviewed original articles were extracted from PubMed and PsycINFO following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Selection criteria included children born VPT and comparison children born at term, sample born after 1990, and children assessed between 0 and 17 years on at least one measure of social competence spanning social adjustment, performance, and/or social skills.
Results
Twenty‐three studies were included. Seven focused on social competence and another 16 examined social competence within a range of outcomes. Study quality was low. Limitations included reliance on single informant data, cross‐sectional measurement, use of brief screening tools, absence of child or peer report, and no conceptual model. In terms of social adjustment, 16 out of 21 studies found children born VPT had more peer problems and social withdrawal. Findings of social performance were mixed, with some studies suggesting differences in prosocial behavior (4/14) and others not. Social skills were assessed in four studies and showed children born VPT had poorer skills than children born at term. Predictors of social competence included gestational age, neonatal brain abnormalities, and family socio‐economic status.
Interpretation
Children born VPT have poorer social competence. These difficulties emerge early and persist throughout childhood.
What this paper adds
Two out of seven primary social competence studies and three out of 16 with a more general focus were considered to have high quality methodology.
Children born very preterm are at increased risk of social competence difficulties.
These difficulties emerge early and persist throughout childhood.
Social difficulties include more peer problems and social skill deficits.
Predictors include extremely preterm birth, neonatal cerebral abnormalities and lower socio‐economic status.
This article is commented on by Johnson on page 890 of this issue.
PDF
