Dissemination of Family-Centered Prevention for Military and Veteran Families: Adaptations and Adoption within Community and Military Systems of Care

Boston Children's Hospital, Harvard Medical School, Boston, MA, USA, .
Clinical Child and Family Psychology Review (Impact Factor: 4.75). 10/2013; 16(4). DOI: 10.1007/s10567-013-0154-y
Source: PubMed


In response to the needs of military families confronting the challenges of prolonged war, we developed Families OverComing Under Stress (FOCUS), a multi-session intervention for families facing multiple deployments and combat stress injuries adapted from existing evidence-based family prevention interventions (Lester et al. in Mil Med 176(1): 19-25, 2011). In an implementation of this intervention contracted by the US Navy Bureau of Medicine and Surgery (BUMED), FOCUS teams were deployed to military bases in the United States and the Pacific Rim to deliver a suite of family-centered preventive services based on the FOCUS model (Beardslee et al. in Prev Sci 12(4): 339-348, 2011). Given the number of families affected by wartime service and the changing circumstances they faced in active duty and veteran settings, it rapidly became evident that adaptations of this approach for families in other contexts were needed. We identified the core elements of FOCUS that are essential across all adaptations: (1) Family Psychological Health Check-in; (2) family-specific psychoeducation; (3) family narrative timeline; and (4) family-level resilience skills (e.g., problem solving). In this report, we describe the iterative process of adapting the intervention for different groups of families: wounded, ill, and injured warriors, families with young children, couples, and parents. We also describe the process of adopting this intervention for use in different ecological contexts to serve National Guard, Reserve and veterans, and utilization of technology-enhanced platforms to reach geographically dispersed families. We highlight the lessons learned when faced with the need to rapidly deploy interventions, adapt them to the changing, growing needs of families under real-world circumstances, and conduct rigorous evaluation procedures when long-term, randomized trial designs are not feasible to meet an emergent public health need.

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    • "Young children are often not able to create a visual chronology of their experiences; thus, parents are encouraged to draw upon their perceptions of their child's understanding of the key events and plot those reflections onto their timeline. In addition, FOCUS-EC incorporates parent–child sessions to build the young child's emotional awareness skills including talking about and managing feelings (Beardslee et al. 2013). Preliminary results from the early childhood adaptation with active duty families included 637 families with children aged 3–5 years old yielded positive findings, including: a reduction in child psychopathology symptoms (p \ 0.001) and concurrent increases in prosocial behaviors (p \ 0.001). "
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    ABSTRACT: The risk for mental health problems and relational difficulties in military service members, spouses, and children is well-established. Yet, few services are available for families, particularly during the formative preschool years, when healthy parent-child relationships are crucial to the attainment of major socio-emotional milestones that form the foundation for later development. This paper describes the adaptation of a previously established military and trauma-informed preventive intervention, Families OverComing Under Stress (FOCUS) for use with families with a preschool-aged child (FOCUS for Early Childhood; FOCUS-EC). Grounded in theory and research on family resilience, FOCUS-EC aims to support parents as leaders of the family by providing developmental guidance and psychoeducation on deployment and reintegration, facilitate the construction of a family narrative, and enhance parenting strategies and the parent-child relationship. Furthermore, FOCUS-EC was adapted for use in a telehealth platform, enabling clinicians to reach military and veteran families in their homes, which is particularly useful for high-risk civilian-dwelling military families (including Reserve and National Guard). Pilot work and ongoing data collection as part of a randomized control trial suggest that FOCUS-EC is acceptable and feasible for military and veteran families with preschoolers.
    Full-text · Article · Feb 2015 · Contemporary Family Therapy
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    Full-text · Article · Aug 2013 · Clinical Child and Family Psychology Review
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    ABSTRACT: The papers in this section focus on public health responses and implementation considerations in addressing the challenges military families confront when parents go to war. While many military families show resilience, the challenges resulting from a decade of war with multiple deployments are detailed, as are innovative military and civilian programs designed to help service members and their families reintegrate successfully into the community. As more and more service members leave active duty, the burden of meeting military families' psychological needs will transition from the Department of Defense (DoD) and into the Veterans Administration (VA) and civilian arenas. While many strategies to support successful readjustment are offered, in this time of dwindling mental health resources and competing needs, it is unclear what priority the broader society places on meeting the needs of returning service members and their families. A growing emphasis on family-centered care in the Veterans Administration may help meet this gap.
    No preview · Article · Sep 2013 · Clinical Child and Family Psychology Review
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