DEPARTMENT OF DEFENSE - CONGRESSIONALLY DIRECTED MEDICAL RESEARCH PROGRAMS

ADAPT and Marriage Checkup Together are Strengthening Military Families

Posted October 26, 2021

Abigail Gewirtz, Ph.D., University of Minnesota, Twin Cities
Jeffery Cigrang, Ph.D., Wright University
James V. Cordova, Ph.D., Clark University

Military families, like civilian families, have their fair share of challenges, which can be exacerbated by unique situations such as deployment and post-traumatic stress disorder (PTSD). Decades of research on parent training show that strengthening parenting improves resilience and readiness among children and parents.1 Families fortified with strong marriage and/or parenting skills support strong Service Members, yet few evidence-based programs are available to better improve military family readiness. Through the Psychological Health and Traumatic Brain Injury Research Program (PHTBIRP) aligned under the Military Operational Medicine Research Program (MOMRP), After Deployment Adaptive Parenting Tools (ADAPT) and Marriage Checkup, two evidence-based programs initially funded by the National Institutes of Health (NIH), have been advanced to help military families.

Abigail Gewirtz, Ph.D., University of Minnesota, Twin Cities Abigail Gewirtz, Ph.D.,
University of Minnesota,
Twin Cities

The ADAPT program provides simple but powerful tools to reduce parental stress, improve parenting skills and efficacy, and strengthen children’s cooperation.2,3,4,5 Dr. Abigail Gewirtz, hypothesized that after returning from war to the “new normal” parents might find family life – particularly in dealing with their children’s “big emotions” (e.g., fear, anger, sadness) ‒ to be stressful. A well-validated parent training program, specifically, the Oregon parent management training model, was modified by adding components to strengthen parents’ abilities to respond to their own and their children’s big emotions.6,7 With funding from the NIH in 2010 and 2011 as well as Fiscal Year 2014 (FY14) PHTBIRP Prevention and Health Promotion Interventions to Prevent Alcohol and Other Drug Abuse and Associated Physical and Psychological Health Problems in U.S. Military Personnel, Veterans and their Families and FY15 PHTBIRP Comprehensive Universal Prevention/Health Promotion Interventions Awards from MOMRP, Dr. Gewirtz tailored the Oregon parent management training model specifically to military families and tested ADAPT in four randomized controlled trials with over a thousand Reserve Component, National Guard, and active-duty families.8 Findings indicated that not only did parents enjoy the program and gain support from learning the skills and interacting with the other families, but the ADAPT program also resulted in improvements in observed parenting skills, and reductions in both child and parent mental health problems over 18 months following the end of the program.2,4,5,9,10

Dr. Gewirtz’s work used multiple ways of examining change in families, most notably by observing and videotaping interactions between children and their parents, in addition to using surveys and other tools. Parents and children are asked to engage in structured interaction tasks (e.g., to discuss a difficult issue related to deployment, and household conflicts) through interviews conducted exclusively in families’ homes. As an example, watching fathers engage with their children has helped the team explain how PTSD symptoms may interfere with interactions in the moment, and how ADAPT can help normalize those interactions. Dads with PTSD symptoms of avoidance were observed to have a particularly difficult time dealing with children’s big negative emotions. The intervention’s focus on helping parents deal with emotions helped those fathers to be more present and available to their children, which, in turn, increased their skills in other areas of parenting. Based on results from these studies, the Department of Defense’s Office of Military Community and Family Policy will implement ADAPT in several installations across the United States. Training and coaching will be provided to Military and Family Life Counselors (MFLC) to deliver the program in multiple formats.

James V. Cordova, Ph.D., Clark University James V. Cordova, Ph.D.,
Clark University
Jeffery Cigrang, Ph.D., Wright University Jeffery Cigrang, Ph.D.,
Wright University

Marriage Checkup, another effort to strengthen military families, is an evidence-based program developed by Dr. James Cordova to be the relationship health equivalent of annual physical and dental health checkups.11 With PHTBIRP funding from MOMRP, through a FY15 Broad Agency Announcement for Extramural Medical Research Award, Dr. Jeffrey Cigrang with the help of Dr. Cordova conducted two pilot implementation projects to validate the program with military couples.

In these pilot sessions, 85% of couples in the treatment condition completed all three Checkups. More than half (57%) of the couples who participated had never sought marriage counseling before. Close to half (43%) of the active-duty participants reported that they “definitely”, “probably”, or “might” not have sought marriage counseling services from somewhere else if Marriage Checkup had not been available in primary care. Finally, the percentages of enlisted personnel (79%) and officer (21%) participants in the study compared very favorably to the percentages in the U.S Air Force population (81% and 19%).12 The results of the investigating team’s work are also noteworthy for demonstrating an ability to reach a diverse sample of the population of married military couples with an effective “dose” of relationship assistance. These abbreviated versions of Marriage Checkup, adapted for use by behavioral health providers in primary care clinics with military couples, were shown to significantly improve marital health when compared to control group couples who had access to standard military community resources.13 Following these successful pilots, the Office of Military Community and Family Policy requested that all adult MFLCs be trained and certified to conduct regular Marriage Checkups at military installations around the world.

The successes achieved from these research projects are due to military families volunteering their time to participate in the research, support from military leadership, and funding from the NIH and PHTBIRP through MOMRP. Together, the ADAPT and Marriage Checkup programs are poised to fortify military families and assist them with parental and marriage issues unique to military families.

Links:

Public and Technical Abstracts: Comparing Web, Group, and Telehealth Formats of a Military Parenting Program

Public and Technical Abstracts: SMART Optimization of a Parenting Program for Active-Duty Families

Public and Technical Abstracts: Evaluation of a Brief Marriage Intervention for Internal Behavioral Health Consultants in Primary Care

Publications:

1Sandler IN, Schoenfelder EN, Wolchik SA, and MacKinnon DP. 2011. Long-term impact of prevention programs to promote effective parenting: Lasting effects but uncertain processes. Annual Review of Psychology 62:299-329. https://doi.org/10.1146/annurev.psych.121208.131619

2Gewirtz AH, DeGarmo D, and Zamir O. 2018. After Deployment, Adaptive Parenting Tools: One-year outcomes of a parenting program for military families. Prevention Science 19(4):589-599. https://doi.org/10.1007/s11121-017-0839-4

3Doty JL, Rudi JH, Pinna KLM, Hanson SK, and Gewirtz AH. 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):e169.https://doi.org/10.2196/jmir.4445

4Gewirtz AH, DeGarmo DS, and Zamir O. 2016. Effects of a military parenting program on parental distress and suicidal ideation: After Deployment Adaptive Parenting Tools. Suicide and Life Threatening Behavior 46(Suppl 1):S23-31. https://doi.org/10.1111/sltb.12255

5DeGarmo DS and Gewirtz AH. 2018. A recovery capital and stress-buffering model for post-deployed military parents. Frontiers in Psychology 9:1832. https://doi.org/10.3389/fpsyg.2018.01832

6Gewirtz AH, Erbes CR, Polusny MA, Forgatch MS, and DeGarmo DS. 2011. Helping military families through the deployment process: Strategies to support parenting. Professional Psychology: Research and Practice 42(1):56-62. https://doi.org/10.1037/a0022345

7Gewirtz AH, Pinna KL, Hanson SK, and Brockberg D. 2014. Promoting parenting to support reintegrating military families: After deployment, adaptive parenting tools. Psychological Services 11(1):31-40. https://doi.org/10.1037/a0034134

8Regents of the University of Minnesota. 2021. ADAPT: Adaptive Parenting Tools. https://www.adaptparenting.org

9Zhang N, Lee SK, Zhang J, Piehler T, and Gewirtz A. 2020. Growth trajectories of parental emotion socialization and child adjustment following a military parenting intervention: A randomized controlled trial. Developmental Psychology 56(3):652-663. https://doi.org/10.1037/dev0000837

10Piehler TF, Ausherbauer K, Gewirtz A, and Gliske K. 2018. Improving child peer adjustment in military families through parent training: The mediational role of parental locus of control. The Journal of Early Adolescence 38(9):1322-1343. https://doi.org/10.1177/0272431616678990

11Cordova JV, Fleming CJE, Morrill MI, et al. 2014. The Marriage Checkup: A randomized controlled trial of annual relationship health checkups. Journal of Consulting and Clinical Psychology 82(4):592-604. https://psycnet.apa.org/doi/10.1037/a0037097

12Cigrang JA, Cordova JV, Gray TD, et al. 2016. The Marriage Checkup: Adapting and implementing a brief relationship intervention for military couples. Cognitive and Behavioral Practice 23(4):561-570. https://doi.org/10.1016/j.cbpra.2016.01.002

13Cordova JV, Cigrang JA, Gray TD, et al. 2017. Addressing relationship health needs in primary care: Adapting the Marriage Checkup for use in medical settings with military couples. The Journal of Clinical Psychology in Medical Settings 24(3-4):259-269. https://doi.org/10.1007/s10880-017-9517-8

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Last updated Monday, January 3, 2022