Strength At Home- Parents Pilot

Symptoms of posttraumatic stress disorder (PTSD) after deployment have been shown to
adversely impact family and close relationship functioning, including parent-child
relationships. About 31% of U.S. Veterans are parents to children under the age of 18. In
addition, a study of over 100,000 records of Iraq and Afghanistan Veterans indicated those
with dependent children were 40% more likely to carry a diagnosis of PTSD compared to those
without children. Despite these large numbers and the known association between PTSD and
parenting problems, there are no empirically validated parenting interventions within the VHA
that address the unique needs of Veteran parents with PTSD, nor is there evidence that
existing treatments for PTSD improve family functioning. This gap in both research and
practice is significant given that parent-child functioning is a large component of recovery
and reintegration into the community. Difficulties with parenting and the parent-child
relationship are a vital influence on overall family functioning and quality of life. It
follows logically that an intervention that improves parenting will have a significant
downstream impact on overall family and close relationship functioning and the Veteran's
quality of life.

This proposal will conduct the research necessary to adapt, refine, and conduct an open trial
of Strength at Home - Parents (SAHP) - the new intervention incorporates the core clinical
components of the empirically validated Strength at Home (SAH) interventions for improved
family functioning among Veterans and targets key parenting behaviors and interpersonal
relationship skills that can be impaired when a parent suffers from PTSD.

Given that parenting challenges are not typically addressed within VHA, one reason prior
national pilot efforts may have had trouble with enrollment and retention is a failure to
address motivation and goal setting at the outset. It can be difficult for clients to be
ready to change a problem when few resources have historically been available to address it.
Therefore this proposal will pilot the feasibility of including a pre-treatment Motivational
Interviewing Assessment (MIA15) to assist Veterans with PTSD in strengthening and building
motivation to change their parenting behaviors. The MIA can result in higher rates of
treatment retention during the first 4 weeks of treatment compared to treatment as usual.
Assessment approaches such as MIA that are personalized and collaborative have been shown to
have a positive and clinically meaningful impact on treatment.

Inclusion Criteria:

- English speaking and able to provide written informed consent

- Current parent to a child between the ages of 3 and 12.

- If the parent has more than one child within the target group, they will choose
one of their children to be the index child for the purposes of SAHP

- Though we expect skills learned will translate to other children in the family

- The child must reside with the Veteran or spend at least an average of two days
per week with the Veteran

- Screen positive for elevated PTSD symptoms on the PTSD checklist for DSM 5 (PCL-5)

- The PCL-5 is a 20 item self-report measure of PTSD symptoms in the past month.
Items are rated on a 5 point Likert scale (0 = not at all, 4= extremely) and
participants endorse symptoms based on "a very stressful experience."

- Items are summed with higher scores reflecting greater symptomatology. The
measure evidences good reliability (Internal consistency = .96; test-retest =
.84), discriminant and convergent validity and takes 5-10 min. to complete

- Screen positive (above the 85th percentile) for parent-child functioning problems
based on Parenting Stress Index- Short Form; PSI-SF

- All three subscales and the total stress scale on the short-form are highly
correlated with those on the long-form (.97-.99), and is expected to take
respondents about 10 minutes to complete

- The total stress scale can successfully differentiate between different levels of
risk for parent-child functioning problems and has strong convergent validity.
High Cronbach's alpha scores have been reported across all scales, ranging from
.88 to .9584

Exclusion Criteria:

- Major neurocognitive disorder, including due to TBI

- The adapted Ohio State Traumatic Brain Injury Identification Method (OSU TBI-ID),
is a 3-5 min. clinician administered interview for lifetime history of TBI

- The OSU TBI-ID is a recommended common data element by NIH and evidences good-
excellent reliability and validity

- The OSU TBI-ID will be used to identify severe TBI as defined as a score of 5

- The participant's medical record may also be used for secondary verification in
the case of TBI

- For those scoring a 5, further referral and screening for comprehension ability
will be recommended to determine exclusion (as the intent is to identify
individuals who may not understand or comprehend study materials)

- Untreated/poorly managed psychosis or substance dependence

- The Mini-International Diagnostic Interview (MINI), is a structured diagnostic
interview that can be completed in less than 10 minutes

- It is one of the most widely used diagnostic interviews and evidences
psychometric properties that are like more complex and lengthier measures

- The psychotic disorders and substance dependence subscales of the MINI will be
used to screen for DSM-V criteria for current psychosis and substance dependence

- Participants meeting the diagnostic criteria above will be asked about their
current treatment and if needed, the PI (licensed clinical psychologist) will
speak with them regarding their current treatment plan and interest in referrals

- Those not engaged in treatment (diagnosis without ongoing medication management
or psychotherapy) and/or evidencing need for referral to detox (e.g. symptoms of
withdrawal), and/or evidencing symptoms that interfere with the intake assessment
will be excluded and referred for treatment. Where possible, a warm handoff will
always be provided

- Participants will be welcomed back to the study once stabilized

- Current suicide risk

- The Beck Depression Inventory-II (BDI-II), a 21-item self-report measure of
depression symptoms (5 min. to complete), will be used to assess for suicide risk
as defined as a score of 2 or more on the BDI-II suicide item

- The BDI-II suicide item evidences a moderate correlation with the other scales of
suicidal ideation in clinical samples, and has predictive validity

- Follow-up risk-assessment will be provided by the PI who is a licensed clinical
psychologist

- Individuals will be eligible after crisis intervention has been received