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Program Profile: After Deployment, Adaptive Parenting Tools (ADAPT)

Evidence Rating: No Effects - One study No Effects - One study

Date: This profile was posted on December 03, 2019

Program Summary

This is a behavioral parent-training program designed specifically for military families with school-aged children. The program is rated No Effects. ADAPT children reported fewer school problems and ADAPT parents demonstrated more positive involvement and problem-solving skills, compared with the control group. However, there were no statistically significant differences in measures of child loneliness and adaptive skills, parental discipline, skill encouragement, or monitoring.

This program’s rating is based on evidence that includes at least one high-quality randomized controlled trial.

Program Description

Program Goals/Target Population
After Deployment, Adaptive Parenting Tools (ADAPT) is a behavioral parent-training program designed specifically for military families with school-aged children. ADAPT is targeted at families with children between the ages of 4 and 12, where at least one parent has been deployed to Operations Iraqi or Enduring Freedom, or New Dawn. The program aims to improve five main positive parenting practices: 1) family problem-solving, 2) effective discipline, 3) positive involvement, 4) skill encouragement, and 5) monitoring.

Using information from empirical data, focus groups, and informant interviews, this training was based on the Parent Management Training–Oregon Model (PMTO) and tailored for military families (Gewirtz, DeGarmo, and Zamir 2018). These adaptations addressed common struggles from military families such as how combat stress reactions might influence parenting and reintegration following military culture.

Program Components
ADAPT is conducted as a group therapy session, consisting of 6 to 15 parents per group. Each session is 2 hours per week, and the program lasts for 14 weeks. Each week, the facilitators focus on a new topic while using active teaching methods, including discussion, role play, and practice.

Session 1 involves discussions on coping skills regarding deployment-related stressors and reintegration following deployment. Session 2 focuses on the use of effective parental direction to promote child cooperation. Session 3 emphasizes parents as children’s most important teachers and instructs parents on contingent positive encouragement of their children. Session 4 centers on recognizing difficult emotions following deployment, and Session 5 then deals with how to respond to those emotions, as well as the re-negotiation of familial roles after returning home.

Session 6 involves discussions on setting limits and effective discipline of children, and Session 7 covers following through with these limits by establishing family rules and strategies for negative sanctions. Session 8 focuses on family meetings and active listening skills and introduces parents to emotion coaching. Session 9 aims to help parents anticipate problems and stressors and discusses how to plan positive family activities. Session 10 builds upon Sessions 4, 5, 8, and 9, and involves instruction on how to manage conflicts and how to address children’s potential deployment-related stressors.

Session 11 discusses keeping children safe by monitoring them and their activities and peers, followed by Session 12, which encourages positive involvement in children’s academic advancement. Session 13 focuses on problem-solving communication between home and school. Session 14, the final session, centers on potential future deployments and planning for work and play between the family.

Key Personnel
Facilitators of the ADAPT Program are both military (i.e., National Guard and veterans) and non-military service providers (such as social workers and counselors), who receive 11 days of training and biweekly coaching from other staff certified in the PMTO model.

Program Theory
The ADAPT Program was built upon the social interaction learning (SIL) model, developed by Patterson and colleagues (Patterson, 2005), which examined how children’s adjustment was affected by parenting in stressful family contexts (Gewirtz, DeGarmo, and Zamir 2018). The SIL model suggests that parenting during stressful family contexts affects a child’s adjustment due to an increase in the frequency and/or rate of harsh discipline. The SIL model forms the basis of the PMTO program, which targets the reduction of coercive discipline by improving positive parenting skills. The PMTO model was then modified specifically for military families to create the ADAPT Program.

Evaluation Outcomes

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Study 1
Gewirtz and colleagues (2018) found the After Deployment, Adaptive Parenting Tools (ADAPT) intervention to have mixed results with regard to child adjustment and parent behaviors. In the ADAPT treatment group, children reported fewer school problems, and parents demonstrated higher positive involvement and a greater number of problem-solving skills, compared with the control group children and parents; these differences were statistically significant. However, there were no statistically significant differences between the treatment and control groups in measures of child-reported loneliness, teacher- and parent-reported adaptive skills in the child, parent discipline, parent skill encouragement, or parental monitoring of children. Overall, the preponderance of evidence suggests the program did not have the intended effects on parental behaviors or child outcomes.

Child Outcomes
Child-Report School Problems
The children in the treatment group reported a statistically significant lower number of school problems, compared with children in the control group, at the 12-month follow up.

Child-Report Loneliness
There was no statistically significant difference between the treatment and control groups in child self-reported loneliness at the 12-month follow up.

Teacher-Report Adaptive Skills
There was no statistically significant difference between children in the treatment and control groups in teacher-reported adaptive skills at the 12-month follow up.

Parent-Report Adaptive Skills
There was no statistically significant difference between children in the treatment and control groups in parent-reported adaptive skills at the 12-month follow up.

Parent Outcomes
Problem Solving
The parents in the treatment group displayed a statistically significant greater number of problem-solving behaviors, compared with parents in the control group, at the 12-month follow up.

Coercive Discipline
There was no statistically significant difference between the treatment and control groups in parental coercive discipline at the 12-month follow up.

Positive Involvement
The parents in the treatment group displayed statistically significant higher positive involvement, compared with the parents in the control group, at the 12-month follow up.

Skill Encouragement
There was no statistically significant difference between parents in the treatment and control groups in skill encouragement at the 12-month follow up.

Monitoring
There was no statistically significant difference between the parents in the treatment and control groups in child monitoring at the 12-month follow up.
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Evaluation Methodology

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Study 1
Gewirtz and colleagues (2018) conducted a randomized controlled trial to examine if parents who participated in the After Deployment, Adaptive Parenting Tools (ADAPT) program would improve parenting skills, specifically in teaching through encouragement, discipline, problem solving, child monitoring, positive involvement with children, and emotion socialization. It was hypothesized that improvement in these six core areas would also improve outcomes for the child.

Participants included 336 military families, consisting of 314 mothers and 294 fathers. Families were considered eligible for the study if 1) at least one parent had been deployed to recent conflicts such as Operation Iraqi Freedom, Operation Enduring Freedom, or Operation New Dawn; and 2) had one child residing in the home between the ages of 4 and 12. In 86.7 percent of the families, one parent had been deployed recently, and in 13.3 percent of the families, both parents had been deployed recently. In 95 percent of the families, the father was deployed, and in 18.2 percent, the mother was deployed. Age of the participants varied, with mothers ranging from 23 to 51 years and fathers ranging from 23 to 58 years. About 88.4 percent of the fathers and 92.7 percent of the mothers were white, while the remaining participants’ race/ethnicity was unspecified. Of the 336 families, 272 had both parents participating in the study, and the remaining 64 had one parent participant. Of the 272 two-parent families, 258 were married, 12 were not married, and two did not disclose marital status. Of the 64 one-parent participants, 23 were married and the partner declined to participate, 18 were divorced, 10 were single, nine were separated, one was widowed, and the remaining 3 did not disclose status. Families were randomized into the control (n = 129) or treatment groups (n = 207). The groups did not significantly differ on baseline characteristics. The treatment group received the ADAPT intervention, and the control group received web or print resources.

Observed parenting and child outcomes were examined at 12-months post-baseline using an intent-to-treat analysis. Data were collected for parenting practices and parent, teacher, and child reports at baseline (T1) and 12 months later post-intervention (T3). Overall outcomes were assessed for both child outcomes and for parenting skills. Child outcomes were assessed by both child self-report and teacher and parent reports. The first child self-report measure included the school problems composite T score from the Behavioral Assessment Scale for Children (BASC) which measured negative attitudes toward school and negative attitudes toward teachers (Reynolds and Kamphaus 2004). The second child self-report was measured by a 24-item scale of loneliness and dissatisfaction (Asher and Wheeler 1985). Teacher and parent scores for children were obtained by having the adults rate BASC items on a 4-point scale, consisting of 39 items. Scores for outcomes on parenting practices were collected by direct observation of structured family interaction tasks. These tasks involved identifying and solving everyday conflicts, discussing deployment-related problems, and planning family activities. The problem-solving outcome was scored by using a 9-item scale that evaluated the quality and extent of parents’ and children’s proposed solutions to everyday conflicts. Discipline was scored by an 8-item scale assessing various parenting practices. Positive involvement was scored on a 10-item scale that assessed parent encouragement and affection. Skill encouragement was scored by using an 8-item scale observing the parent’s ability to promote skill development. Monitoring was scored based on a 4-item scale regarding parents’ knowledge of their children’s activities and supervision. The study authors did not conduct subgroup analyses.
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Cost

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There is no cost information available for this program.
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Implementation Information

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Facilitators of the After Deployment, Adaptive Parenting Tools (ADAPT) intervention received 11 days of training and biweekly coaching from staff certified in the Parent Management Training–Oregon Model (Gewirtz, DeGarmo, and Zamir 2018).
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Evidence-Base (Studies Reviewed)

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These sources were used in the development of the program profile:

Study 1
Gewirtz, Abigail H., David S. DeGarmo, and Osnat Zamir. 2018."After Deployment, Adaptive Parenting Tools: 1-Year Outcomes of an Evidence-Based Parenting Program for Military Families Following Deployment." Prevention Science 19:589–99.
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Additional References

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These sources were used in the development of the program profile:

Asher, S.R., and V.A. Wheeler. 1985. “Children’s Loneliness: A Comparison of Rejected and Neglected Peer Status.” Journal of Consulting and Clinical Psychology 53(4):500–505.

Doty, Jennifer L., Jessie H. Rudi, Keri L. M. Pinna, Sheila K. Hanson, and Abigail H. Gewirtz. 2016. “If You Build It, Will They Come? Patterns of Internet-Based and Face-To-Face Participation in a Parenting Program for Military Families.” Journal of Medical Internet Research 18(6):1–15.

Gewirtz, Abigail H., Keri L. M. Pinna, Sheila K. Hanson, and Dustin Brockberg. 2014. “Promoting Parenting to Support Reintegrating Military Families: After Deployment, Adaptive Parenting Tools.” Psychological Services 11(1):31–40.

Gewirtz, Abigail H., David S. DeGarmo, and Osnat Zamir. 2016. “Effects of a Military Parenting Program on Parental Distress and Suicidal Ideation: After Deployment Adaptive Parenting Tools.” Suicide and Life-Threatening Behavior 46:23–32.

Patterson, G.R. 2005. “Next Generation of PMTO Models.” Behavior Therapist 28:25-32.

Reynolds, C.R., and R.W. Kamphaus. 2004. Behavior Assessment Scale for Children. Bloomington, Ind.: Pearson Assessments.
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Program Snapshot

Age: 4 - 12, 23 - 58

Gender: Both

Race/Ethnicity: White, Other

Setting (Delivery): Home, Other Community Setting

Program Type: Family Therapy, Group Therapy, Parent Training

Targeted Population: Military Personnel, Families

Current Program Status: Active