The overall goal of this work is to adapt, refine, and conduct an open trial of a parent-training intervention for Veterans with posttraumatic stress disorder (PTSD) using feedback from Veterans, VA clinicians, and expert consultants as key stakeholders. PTSD symptoms are associated with parent-child functioning difficulties, which are also an important determinant of quality of life and functional recovery. Unfortunately, existing treatments for PTSD do not appear to improve family functioning. Several parent-training interventions have been piloted within VHA, but none were developed specifically with Veterans as the target group of consumers, and none address the unique challenges presented by PTSD symptoms. Some interventions also presented feasibility challenges or they lacked studies attesting to their efficacy. To overcome these limitations, this project will examine the feasibility and acceptability of an evidence-based group intervention to improve parenting behaviors, parenting satisfaction, and family functioning in returning Veteran parents who are diagnosed with PTSD and who have children between the ages of 3 and 12. This intervention, labeled PTSD-Focused Parent Training (PFPT), is derived from an existing evidence- based intervention to improve Veteran relationship functioning (Strength at Home; SAH), and it is informed by the Cognitive Behavioral Theory of Interpersonal Functioning and the Military Family Attachment frameworks for the association between PTSD and family functioning problems. PFPT emphasizes the acquisition of parenting skills associated with positive child outcomes and healthy parent-child functioning (e.g., positive parenting, consistent discipline, parental monitoring). Integrated throughout the treatment is an emphasis on anger management, emotion regulation, and improved parent-child attachment. PFPT also includes a pre-treatment Motivational Interviewing Assessment (MIA) to assist Veterans with PTSD in strengthening and building motivation to change their parenting behaviors. The goals and change talk identified in the pre-treatment MIA are then referred to throughout the PFPT treatment. Groups are gender- specific, meaning that we will pilot the treatment in separate groups of women and men Veterans. This project will be carried out through 2 specific aims that will be accomplished in 36 months.
Aim 1 of the study is to obtain and incorporate expert clinician and Veteran feedback on the intervention. The PFPT manual will be reviewed and refined utilizing feedback from a panel of expert consultants and VA clinicians with extensive experience in treatments to improve Veteran family functioning. The treatment will then be piloted in two groups of Veterans (1 group of men, 1 group of women) for feedback on intervention content, acceptability, credibility, and satisfaction after each session. The expert consultants will convene a second time to review the Veteran feedback, the PFPT manual will be revised again, and the revised manual will be piloted in two more groups of Veterans for final feedback on intervention content, acceptability, credibility, and satisfaction after each session.
This aim will culminate in a final PFPT treatment manual.
Aim 2 of the study is to evaluate the feasibility of study recruitment, retention, MIA procedures, and proposed methods of the PFPT intervention and to conduct a preliminary examination of whether PFPT results in improvements in our target outcomes. This will be accomplished by an open trial of the revised treatment in 3 groups of women Veterans and 3 groups of men Veterans. Information collected on referral rates, enrollment, and retention will be used to evaluate the overall feasibility and acceptability of the PFPT intervention, MIA, and proposed methods. Pre- to post-treatment changes in the target outcomes of parenting behaviors, parenting satisfaction and overall family functioning will help evaluate whether PFPT has demonstrated sufficient promise to move toward an efficacy trial. We will also test the feasibility of obtaining collateral partner report of parent-child functioning throughout both aims.
Healthy family functioning, which includes parent-child functioning, is a key aspect of functional recovery after deployment that is negatively impacted by posttraumatic stress disorder (PTSD) symptoms. Parent-child functioning is often overlooked as a crucial component of family life that is impacted by PTSD, and can have a lasting impact on child risk for mental and physical health disorders. This risk can cascade back to influence Veteran quality of life. By improving parent-child functioning and parenting behaviors, this risk to Veterans and their children can be modified. Unfortunately, there is currently no empirically validated intervention available within Veterans Health Administration that was developed with and for Veterans diagnosed with PTSD to address parenting and parent-child functioning. This project will conduct the research necessary to address this need by refining, pilot testing, and conducting an open trial of PTSD-Focused Parent Training (PFPT).
