The Impact of Parental Deployment to War on Children

CHAPTER FOUR

The Impact of Parental Deployment to War on Children: The Crucial Role of Parenting Abigail H. Gewirtz*,1, Osnat Zamir†

*Department of Family Social Science & Institute of Child Development, University of Minnesota, St. Paul, Minnesota, USA † Department of Family Social Science, University of Minnesota, St. Paul, Minnesota, USA 1 Corresponding author: e-mail address: [email protected]

Contents 1. 2. 3. 4. 5. 6.

Introduction Why Is It Important to Know About the Impact of Deployment on Children? Resilience in Military Families Conceptual Framework Deployment as a Risk to Children's Adjustment Associations of Children's Socioemotional and Academic Adjustment with Parental Deployment to War by Developmental Stage 6.1 The Moderating Role of Child Gender 7. Associations of Child Adjustment, Family Stress, and Parenting Across the Deployment Cycle 8. Parenting Practices Mediate the Impact of Deployment Stress on Children 9. Empirically Supported Interventions to Address Parenting in Military Families 10. A Future Research Agenda References

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Abstract It is estimated that approximately 2 million children have been affected by military deployment, yet much of what is known about the adjustment of children experiencing a parent's combat deployment has emerged only within the past 5–10 years. The extant literature on associations of parental deployment and children's adjustment is briefly reviewed by child's developmental stage. Applying a family stress model to the literature, we propose that the impact of parental deployment and reintegration on children's adjustment is largely mediated by parenting practices. Extensive developmental literature has demonstrated the importance of parenting for children's resilience in adverse contexts more generally, but not specifically in deployment contexts. We review the sparse literature on parenting in deployed families as well as emerging data on empirically supported parenting interventions for military families. An agenda for future research in this area is proffered.

Advances in Child Development and Behavior, Volume 46 ISSN 0065-2407 http://dx.doi.org/10.1016/B978-0-12-800285-8.00004-2

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1. INTRODUCTION For much of the first decade of the twenty-first century, the United States was engaged in two wars simultaneously—in Iraq and Afghanistan. Operations Iraqi Freedom (OIF; 2003–2011), Enduring Freedom (OEF; 2001–2011), and New Dawn (OND; 2010–2011) involved the largest call-up ever of US Military troops. These included unprecedented numbers of women, and also of National Guard and Reserve (NG/R) troops, known as “civilian soldiers” or “weekend warriors.” These NG/R troops live in civilian communities and hold civilian jobs. Prior to 2001, few NG/R had ever anticipated the 12-month or longer combat deployments of the recent conflicts (Browne et al., 2007). US military personnel comprise 1% of the population of the United States of America, and almost half of these individuals have dependent children (Department of Defense, 2012). It is estimated that approximately 2 million children have been affected by military deployment, yet much of what is known about the adjustment of children whose parents are in a combat zone has emerged only within the past 5–10 years. In this chapter, we review what is known about the impact of parental deployment on children, using a developmental–ecological and family stress framework that provides a rationale for the importance of parenting for children’s resilience. Despite many years of developmental research demonstrating the crucial role of parenting in children’s development (Collins, Maccoby, Steinberg, Hetherington, & Bornstein, 2000) and particularly during times of stress (Masten, 2001), there is very little research on parenting in military families. We review what is known about the impact of military deployment on children, how parenting might mediate the impact of deployment stress on children’s adjustment, and programs to buffer parenting for military families. Finally, we proffer an agenda for future research.

2. WHY IS IT IMPORTANT TO KNOW ABOUT THE IMPACT OF DEPLOYMENT ON CHILDREN? More than 2 million US children are living with a parent who has deployed to OEF, OIF, and/or OND (Department of Defense, 2012). For children of active-duty service members living on military installations, deployment may be a part of life for the base community. For Reserve Component families, deployment may be a new disruption of family life.

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NG/R troops may be leaving families in communities where there are few military families, and little is known about their needs. Regardless of the nature of a parent’s military affiliation, deployment involves an extended separation from a primary caregiver, and a separation that may be fraught with danger for the service member, and worry for his/her family. For those deployed, the physical transitions to and from home require moving from physically absent to present partnering and parenting, and moving between highly structured military operational contexts and informal family contexts with different rules for communication and emotional expression (Huebner, Mancini, Wilcox, Grass, & Grass, 2007). Deployment stressors include intense work conditions, infrequent breaks, and exposure to traumatic events such as death and injury (Hoge et al., 2004; Hosek, Kavanagh, Miller, & Miller, 2006; Tanielian & Jaycox, 2008). Negative sequelae: combat injuries, including traumatic brain injury, posttraumatic stress disorder (PTSD), depression, other anxiety disorders, and substance abuse, also may manifest (e.g., Hoge, Auchterlonie, & Milliken, 2006; Hoge et al., 2008; Milliken, Auchterlonie, & Hoge, 2007) and are associated with significant social/relationship challenges (Hoge et al., 2006; Vasterling et al., 2006). Nondeployed caregivers must cope with feelings of loss and fear over their partners’ safety, burdens of single parenting, renegotiating roles, decisions, and family tasks (Erbes, Polusny, MacDermid, & Compton, 2008). Different phases are associated with deployment and often referred to collectively as the “deployment cycle” (Pincus, House, Christenson, & Adler, 2007). Phases of the deployment cycle include preparation for deployment (e.g., training, predeployment, etc.), the deployment itself, and reintegration/reentry (MacDermid, 2006; Pincus et al., 2007). Stressors associated with each phase vary. During the predeployment phase, for example, children and parents alike face the uncertainty associated with a parent’s leaving. Parents may debate how long prior to a deployment to let a child know the parent is deploying based upon the child’s capacity to understand the concept as well as the child’s understanding of time. During the deployment, anxiety for both parents and children may rise with the uncertainties associated with lack of communication, and lack of knowledge about the service member’s safety. Ironically, it is during the reintegration stage that many families report the greatest challenges (Nelson Goff, Crow, Reisbig, & Hamilton, 2007), partly because the expectation that things will be “back to normal” with the service member’s return often is proved wrong. Instead, many refer to the “new normal”—particularly for those with psychological or physical injuries

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sustained during deployment. Emerging data (Gewirtz, Polusny, DeGarmo, Khaylis, & Erbes, 2010; MacDermid, 2006) indicate that the year following return from deployment may be a challenging transition year when the family adjusts to the deployed parent’s return, parents must reestablish a united parenting front, and children understand that their parent is here to stay (until the next deployment). For example, two longitudinal qualitative studies of reserve and active-duty OIF service members indicate that the process of reconciling family relationships during reintegration may be lengthier and more complex than previously documented (MacDermid, 2006).

3. RESILIENCE IN MILITARY FAMILIES While much of this chapter focuses on potentially negative correlates of deployment on children’s adjustment, it is important to note that living in a military family is not associated with increased risks. Military children typically function as well or even better than their civilian peers (Jensen et al., 1995; Jensen, Xenakis, Wolf, & Bain, 1991; Park, 2011). It is wartime deployment of parents, in particular, that appears to be a significant stressor for school-aged children (Barnes, Davis, & Treiber, 2007; Chandra et al., 2010; Flake, Davis, Johnson, & Middleton, 2009).

4. CONCEPTUAL FRAMEWORK A developmental–ecological framework (Bronfenbrenner, 1979; Caspi, Bolger, & Eckenrode, 1987) accounts for the cumulative and reciprocal influences of person and context on adjustment and development at multiple levels of influence. This framework is particularly relevant for understanding the impact of deployment on children because, in addition to developmental and family factors affecting children’s adjustment, the broader community context within which military families reside is particularly important. The community context—military installation, civilian community with a large military presence, or civilian community with little military presence—and the resources, support, and structure within those communities, may protect a family or exacerbate family stress (Huebner, Mancini, Bowen, & Orthner, 2009). Family stress models (Conger et al., 1992; Elder, Caspi, & Downey, 1986) have shown how challenging family contexts, such as socioeconomic stress, family transitions (divorce, remarriage, etc.), result in increased parental stress and psychopathology, and, in turn, impair parenting. We classify

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deployment as a family stressor. Below, we review the literature on deployment as a risk factor for children’s adjustment and subsequently examine what is known about associations among deployment stressors, child adjustment, and parenting in military families. In addition to reviewing research on the detrimental impact of deployment by children’s developmental stage, we note some strategies parents have utilized to buffer their children from the stress associated with deployment. These strategies were gathered in the course of a series of meetings with Minnesota NG/R families prior to their deployments from 2010 to 2012. There is no evidence for their effectiveness; rather, they are used here simply as examples of how some families have adapted to the stressful transitions inherent in deployment.

5. DEPLOYMENT AS A RISK TO CHILDREN'S ADJUSTMENT Deployment is a risk factor for children’s adjustment for two primary reasons: (i) the separation from a primary caregiver and (ii) the danger associated with the deployment to a war zone. The danger may be associated with the increased child and at-home caregiver anxiety prior to and during deployment; during reintegration, war exposure may manifest via combat stress symptoms in the returning military parent. Although there is a robust developmental literature on the impact of separations on children, much of this literature has focused on separations that are associated with very different risk conditions, such as maltreatment, foster care, death of a parent, and incarceration. Until the recent conflicts, little research had focused on separation due to deployment. While the separation itself is a stressor, there are nonetheless significant differences between deployment and other types of separations. For example, deployment may be associated with pride in a parent’s service and sacrifice for the nation. To the extent that this pride can be nurtured and reinforced, a child can gain meaning from the parent’s deployment. Research has begun to uncover the impact of length and number of deployments (i.e., separations) on children (White, De Burgh, Fear, & Iversen, 2011). Consistent with the broader developmental literature on separation, the length of the separation (e.g., number of months deployed) appears to be a stronger predictor of children’s adjustment difficulties (e.g., Chandra et al., 2011; Esposito-Smythers et al., 2011) than the number of times a parent has deployed (Richardson et al., 2011). For example, mental

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health diagnoses in children associated with parental deployment (greatest for acute stress reaction, adjustment, depressive, and pediatric behavioral disorders) increased with total months of parental deployment (Mansfield, Kaufman, Engel, & Gaynes, 2011). Less research has focused on the impact of parent or child perceptions of danger associated with children’s adjustment. Not surprisingly, studies primarily have focused on older children and youth, who are more able to articulate their concerns for a parent’s safety (Huebner et al., 2007; Lester et al., 2010; Pfefferbaum, Houston, Sherman, & Melson, 2011).

6. ASSOCIATIONS OF CHILDREN'S SOCIOEMOTIONAL AND ACADEMIC ADJUSTMENT WITH PARENTAL DEPLOYMENT TO WAR BY DEVELOPMENTAL STAGE Consistent with the dynamic nature of development, children’s reactions to parental deployment vary as a function of their development. Few studies have examined the differential impact of deployment as a function of age. A recent review suggests that young preschool children express anxiety through externalizing behaviors, whereas older children, who are more aware of the reasons and danger involved in deployment, may become anxious or depressed (White et al., 2011). Mansfield et al. (2011) found more psychiatric diagnoses in older youth; others have reported that older teens had more problems than younger children (Chandra et al., 2011), both during deployment and following reintegration (Richardson et al., 2011). Below, we summarize the literature related to deployment by the developmental stage of the child as well as what is known about the moderating effect of child gender. Very young children represent the single largest age bracket (42%) of children in active-duty military families (Department of Defense, 2012). For infants and toddlers, the challenges associated with deployment separation are inextricably linked with the attachment relationship—a crucial developmental task of this phase. While little is known about the effects of different deployment operational tempos (i.e., the frequency and length of deployments) on very young children, the intermittent and/or prolonged absence of a primary caregiver may affect the child’s attachment bonds with that caregiver (e.g., Stroufe, 2005). For example, Barker and Berry (2009) found that attachment problems at reintegration became increasingly severe with each subsequent deployment, in a sample of 57 military families. Relationships may be particularly disrupted when a parent is deployed for an extended period immediately prior, during, or following a child’s birth

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(Maholmes, 2012). Upon returning from deployment, children and their parents may not recognize one another and very young children may show fear or confusion in the presence of the deployed parent (Cozza & Lieberman, 2007; Saltzman et al., 2011). Parents report innovative ways to increase familiarity across the deployment divide: pasting pictures of the deployed parent in and around the baby’s crib, placing clothes or blankets with the smell of the deployed parent in the crib, and playing recordings of the absent caregiver for the baby (ADAPT Project, 2012). For preschoolers, the absence of a deployed parent and their sudden reappearance may also be confusing and even frightening (Barker & Berry, 2009). Preschoolers’ rapidly burgeoning language capacity and increasing independence (and separation–individuation) provide both challenges and opportunities with regard to deployment. Barker and Berry (2009) found increases in parent reports of behavior problems, anxiety, clinginess, and attention-seeking in young children among families with a parent deployed compared to those without a recent deployment. Similarly, Chartrand, Frank, White, and Shope (2008) gathering data from 169 families on a Marine Base, reported increased behavior problems in preschoolers (3–5 year olds) of deployed, compared with nondeployed parents. Although there is very little literature on efforts to ameliorate or reduce preschoolers’ distress in response to deployment, anecdotal reports of deployed families revealed creative efforts to communicate with preschoolers during deployment, including through videotapes of the deployed parent reading to the child, life-sized “flat daddy” dolls with the parent’s photograph, and rituals such as deployed parent and child agreeing to eat the same food for a particular meal and then comparing notes on the phone or Skype (ADAPT Project, 2012). During the school years, children become more independent, behavioral expectations increase, and social and academic achievement galvanizes the mastery-motivational system. As children’s cognitive capacities expand, understanding the danger of the combat deployment context increases. It is not surprising, then, that studies indicate that school-aged children with deployed parents report increased anxiety and behavioral symptoms (Lester et al., 2010; Morris & Age, 2009) with the period immediately prior to deployment—a time of heightened anticipatory anxiety (Pfefferbaum et al., 2011). Engel, Gallagher, and Lyle (2010) reported associations between length and timing of deployments and standardized achievement scores in Department of Defense schools; poorer achievement scores were associated with concurrent deployment of a parent. Potentially compounding challenges for school-aged children in active-duty families are the frequent relocations often inherent in active-duty military life.

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For example, Lyle (2006) found that relocations and parental absence had their strongest negative effects on children of single parents and those with mothers in the army. School-aged children in NG/R families face somewhat different stressors; their residence in civilian communities may isolate them from other military families and result in a lack of educational and psychosocial support resources regarding deployment. Indeed, anecdotal reports from parents suggest that school personnel often are unaware of the challenges facing children during deployment. This, combined with some parents’ reluctance to reveal that a spouse is deployed (for privacy or safety reasons), may result in children being transferred to less challenging classes, or labeled as having behavior problems, rather than a recognition of the transitional challenges associated with deployment. One deployed National Guard mother, a single parent of a school-aged child, arranged for a weekly update on her child’s progress in school from the teacher. When the mother was unable to make the weekly call, the teacher would record a brief update and e-mail it to the mother. In this way, the mother did not need to rely on her child’s report of progress in school. During deployment, parents of school-aged children report that Webbased communication (e.g., Skype, Google hangout) is an effective strategy for connecting with children, as are family meetings (Gewirtz, Erbes, Polusny, Forgatch, & DeGarmo, 2011). School-aged children and adolescents may want to communicate with a deployed parent in a more spontaneous way than prearranged Skype or phone calls; modifying parent expectations may help to reduce disappointment and guilt on the part of the parent and the child. Parents have reported age-appropriate strategies to address the developmental needs of their youth including games played over the phone or Internet between the deployed parent and the child (e.g., battleships), and “taking” the deployed parent (via webcam) to be a spectator at a child’s sporting event (ADAPT Project, 2012). Adolescents are well aware of the dangers associated with deployment, the impact of deployment on the nondeployed parent, and opinions toward war and deployment (Huebner & Mancini, 2005; Huebner et al., 2007). Exposure to unlimited media reports of war, coupled with adolescent knowledge of the dangers of combat, may erode coping and adaptive capacities (Chartrand & Seigel, 2007; Reed, Bell, & Edwards, 2011). Stability of family routines and maintenance of family rituals may protect youth from the uncertainties of deployment (Gewirtz et al., 2011; Riggs & Riggs, 2011). Families report that tasking adolescents with some of the physical responsibilities that would normally be carried out by the deployed parent (e.g., shoveling the snow, mowing the lawn) provides youth with an opportunity to contribute to household functions (potentially increasing pride and

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independence). Offering formal and informal opportunities to communicate e.g., (through family meetings, or at-home parents simply letting youth know they are available to listen) provides an outlet for resolving conflicts in the absence of the deployed parent. During adolescence, a time when youth may be particularly sensitive to peer attitudes, deployment may differentially impact those in active-duty families living on military installations compared with those in NG/R families living in civilian communities. Living in communities with a strong military identity (e.g. on an installation or in a community with large numbers of military families) may reduce youth stress (Chapin, 2011); conversely, youth in civilian communities with few other military families may feel isolated in their experiences of a parent’s deployment. Monitoring adolescents’ behavior is crucial for preventing and reducing conduct problems (Dishion & Andrews, 1995), and an obvious challenge for deployed families is the absence of a monitoring parent. For example, Reed et al. (2011) reported higher levels of binge drinking among 8th grade girls with deployed, compared to nondeployed military parents. Data from the California Healthy Kids survey of over 14,000 youth indicated that an increase in the number of deployments was associated with a higher likelihood of lifetime and recent substance use, with the exception of lifetime smoking (Gilreath et al., 2013).

6.1. The Moderating Role of Child Gender There is some evidence that different periods of the deployment cycle differentially affect boys and girls, with girls showing more problems during the deployment absence while boys show more problems during the reintegration phase (Johnson & Ling, 2013). Some studies have found overall greater problems in girls, compared with boys (Chandra et al., 2011; Swedean et al., 2013) although attachment distress is more likely to be displayed by young boys of deployed parents (White et al., 2011). Consistent with what is known about the manifestation of psychopathology by gender, at least one study has shown that girls demonstrate more internalizing problems while boys present with more externalizing problems and school challenges (Waliski, Bokony, Edlund, & Kirchner, 2012).

7. ASSOCIATIONS OF CHILD ADJUSTMENT, FAMILY STRESS, AND PARENTING ACROSS THE DEPLOYMENT CYCLE How might child adjustment difficulties associated with deployment be related to family stress and parenting? Deployment is associated with disrupted parent–child interactions for parents who go to war as well as

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for those at home (Gibbs, Martin, Kupper, & Johnson, 2007; Rosenheck & Fontana, 1998). We could find no research on the impact on families of stressors specifically associated with the predeployment period (Institute of Medicine, 2013). However, anecdotal data from hundreds of National Guard parents suggest that anticipatory anxiety about how to prepare the children and family for deployment are common (ADAPT Project, 2012). Data gathered during parental deployment show increased stress for at-home family members: among Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) deployed families, 32% of 5- to 12-year-old children assessed during parental deployment had Pediatric Symptom Checklist scores in the “high risk” range for psychosocial problems, approximately 2.5 times the national norm, and parental stress was the most significant predictor of poor child functioning (Flake et al., 2009). How frequently parents seek medical attention for their children and themselves may also be reflective of parental stress. For children aged 3–8 years, visits to the doctor for mental health issues increased 11%, visits for behavior problems increased 19%, and visits for stress-related disorders increased 18% during the period of a parent’s deployment (Waliski et al., 2012). Increased at-home caregiver stress may also account for the documented rise in child maltreatment during deployment, most frequently at the hands of a female at-home caregiver. For example, Rentz et al. (2007) found that child maltreatment rates rose by approximately 30% for every increase of 1% in operation-related deployment and reunion. Examining substantiated child maltreatment reports, Gibbs et al. (2007) found that overall maltreatment rates were significantly higher while a parent was deployed, particularly when the at-home caregiver was a female civilian, with neglect twice as frequent, but physical abuse less frequent than at other times. Reintegration is a particularly vulnerable time for military families and may be complicated by longer deployments, combat stress, redeployment, and newer marital relationships (MacDermid, 2006). A longitudinal screening of returning OIF soldiers revealed that 42.4% of NG/R and 20.3% of active-duty veterans required mental health treatment for PTSD or depression several months after reintegration (greater than at first screening; Milliken et al., 2007). In addition, 15% of NG/R soldiers and 11.8% of active-duty soldiers endorsed one or more of two alcohol abuse screening questions. Jacobson et al. (2008) found increased risk of new-onset binge drinking, heavy weekly drinking, and alcohol-related problems among combat troops and NG/R soldiers compared with active-duty personnel.

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There is a relatively robust literature on the impact of parents’ combat stress and related symptoms (i.e., posttraumatic stress symptoms, depression, and substance use) on children’s adjustment, particularly during reintegration. For example, Glenn et al. (2002) reported that veterans’ PTSD symptoms, aggressive behavior, and combat exposure were associated with child hostility and aggression. PTSD, depression, and substance abuse are associated with parent–child and family relationship impairments in interpersonal expressiveness, family cohesion, and effective problem-solving, as well as family conflict, and children’s behavioral and emotional problems (Gewirtz et al., 2010; Glenn et al., 2002; Jordan et al., 1992; Samper, Taft, King, & King, 2004). Moreover, the impact of parental substance use, PTSD, and depression on children is well documented in the civilian literature: parental stress and distress, and subsequent parenting impairments predict increases in behavior problems that are precursors for youth substance use (Beardslee, Bemporad, Keller, & Klerman, 1983; Patterson, Reid, & Dishion, 1998). For example, parental substance abuse was predictive of initiation and growth in youth substance use in a study of 351 community 5th–12th graders (DeGarmo, Reid, Leve, Chamberlain, & Knutson, 2010). In the face of stressful family transitions, longitudinal studies consistently find effective parenting protective for children (Masten, 2001). When parents monitor, set limits, teach, problem solve, and are positively involved, children show resilience in the face of stressful family transitions (Forgatch, Patterson, DeGarmo, & Beldavs, 2009; Gewirtz, Forgatch, & Wieling, 2008). Providing parents with effective parenting strategies has lasting positive outcomes for children and parents (Forgatch et al., 2009; Forgatch, Patterson, & Gewirtz, 2013).

8. PARENTING PRACTICES MEDIATE THE IMPACT OF DEPLOYMENT STRESS ON CHILDREN Parenting practices have been shown to mediate the impact of stressors on children’s functioning in multiple circumstances, including marital transitions, poverty, mental illness, substance abuse, and family violence (Belsky, 1984; Conger et al., 1992, 2002; Elder et al., 1986). Specifically, studies have shown that family stressors increase coercive and ineffective parenting, which, in turn, leads to impaired child adjustment (e.g., Beardslee et al., 1983; Belsky, 1984; Capaldi, 1991; Conger et al., 2002; Dishion & Patterson, 2006;

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Patterson, DeBaryshe, & Ramsey, 1989). Literature also highlights the importance of parents’ emotion socialization (i.e., teaching, responding to, and regulating emotions) for child adjustment (Chaplin, Cole, & Zahn-Waxler, 2005; Eisenberg, Cumberland, & Spinrad, 1998). Disrupted parenting associated with the deployment cycle may be due in part to the stresses of caregiving, fears of combat danger, feelings of loss during separation, and difficulties associated with reestablishing roles, relationships, and responsibilities. For the service member, work in combat zones requires sensitivity to danger, coping with extensive exposure to potentially traumatic events, and capacity for immediate reactivity and suppression of emotions that may impair emotion regulation capacities (Vujanovic, Niles, Pietrefesa, Schmertz, & Potter, 2011), and in extremely stressful situations—working memory capacity (Morgan, Doran, Steffian, Hazlett, & Southwick, 2006). Transitioning from war to home may require a recalibration of emotional responding (Ruscio, Weathers, King, & King, 2002). Consistent with this, reintegrating OIF/OND service members reported physical, psychological, and social challenges, including emotional withdrawal, hypervigilance, hyper-stimulation, and mood swings (MacDermid, 2006). The family environment is often home to family members’ most intense exchanges of emotions. Reintegrating service members may react to intense family interactions (e.g., those involving discipline, or conflict) by withdrawing, overreacting, or dismissing children’s emotion displays—modeling the use of emotion suppression as a tool to cope with negative emotions, thereby increasing children’s risk for psychological problems (Gewirtz & Davis, 2013; Tiwari et al., 2008). This problem is compounded for those with combat stress symptoms, where emotionally absent/numb or emotionally uncontrolled and coercive interactions may have become overlearned and automatic (i.e., mindless; Langer & Imber, 1979). Experiential avoidance (e.g., the avoidance of distressing emotions related to combat experiences) is associated with increased risk for psychiatric disorder and substance use, as well as deficits in family communication (Hayes, Wilson, Gifford, Follette, & Strosahl, 1996; Tull, Gratz, Salters, & Roemer, 2004). In combat-related PTSD, emotional numbing has been found to be a key predictor of relationship problems with partners and children (Riggs, Byrne, Weathers, & Litz, 1998; Ruscio et al., 2002). War-related injuries, PTSD, loss, and stress-related working memory impairments may exacerbate parenting challenges (Cozza, Chun, & Polo, 2005; Deater-Deckard, Sewell, Petrill, & Thompson, 2010; Gewirtz et al., 2010). Strengthening

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parenting and addressing emotion regulation can reduce the effects of stress and improve children’s adjustment.

9. EMPIRICALLY SUPPORTED INTERVENTIONS TO ADDRESS PARENTING IN MILITARY FAMILIES Despite indications that parenting may be a crucial mediator of the impact of deployment stress on children, there is a dearth of empirically supported parenting programs tailored specifically to military families (Gewirtz et al., 2011; Murphey, Darling-Churchill, & Chrisler, 2011). Parenting programs are available on some military installations but rarely for military families living in civilian communities. For example, the New Parent Support Program is available for parents of young children living on military installations. A process evaluation revealed the program to demonstrate high levels of satisfaction and perceived utility by participants (Kelley, Schwerin, Farrar, & Lane, 2006), but no evaluation of program outcomes, efficacy, or effectiveness has been published. The scale of the recent conflicts, media, and public policy attention to military families (e.g., Michelle Obama’s Joining Forces Initiative) have resulted in increased awareness of the needs of military families and a parallel increase in research attention. In the past 5 years, both the National Institutes of Health and research units of the Department of Defense have issued requests for proposals for research to further knowledge about military families, wartime deployment, and related stressors. Funded studies include the development and testing of theory-based, empirically supported programs to support military families—and among them military parenting programs. Below, we briefly review three such programs. Strong Families Strong Forces is an eight-module home-based parenting intervention developed specifically with and for military parents serving in OEF/OIF/OND who have very young children (ages 0–5) (DeVoe, Ross, Acker, & Paris, 2011; DeVoe, Ross, & Paris, 2012). The program targets parental reflective capacity (i.e., parents’ capacity to identify, monitor, and respond to their own and their child’s emotional states; Grienenberger, Kelly, & Slade, 2005), parent mental health, parenting stress, and coparenting (DeVoe & Ross, 2013; DeVoe, Ross, & Holt, 2013) within the context of deployment and reintegration (DeVoe & Ross, 2012). Findings from the first randomized clinical trial (N ¼ 128) funded by the Department of Defense and conducted primarily with NG/R families, demonstrate program efficacy for families who have returned from deployment within the

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past 12 months. Military parents randomly assigned to the Strong Families Strong Forces program reported significant reductions in mental health symptoms, including posttraumatic stress, depression and anxiety, and parenting stress and improvements in parental reflective function compared to controls (DeVoe & Ross, 2013; DeVoe et al., 2013). In addition, 93% of families in the Strong Families treatment arm completed a minimum of seven of the eight home-based modules (DeVoe & Ross, 2013; DeVoe et al., 2013). Qualitative findings from exit interviews also reveal selfreported improvements in domains of couple communication, coparenting, and parental, self, and other reflective function (DeVoe & Ross, 2013). Strong Military Families (SMFs) is a 13-session multi-family group intervention for military service members, their parenting partners, and their young children (Rosenblum et al., in press). SMF targets include strengthening social support, providing parent education to enhance parent–child attachment relationships, teaching parents self-care and stress reduction, referring parents to community care resources, and increasing the use of family routines. The program is currently being evaluated in a randomized clinical trial funded by the National Institutes of Health (NIH); outcome data are not yet available. However, data from a small open trial pilot study with 21 parents indicate that the program was feasible and acceptable to both mothers and fathers. Participants self-reported increases in their knowledge, skills, and confidence regarding addressing their young children’s feelings about deployment and reunification, and decreases in feelings of helplessness and decreases in child behavior problems, and there was a reduction in the number of parents meeting clinical criteria for PTSD. There was no change in depression or PTSD symptoms (Rosenblum et al., in preparation). After Deployment, Adaptive Parenting Tools (ADAPT) is a program targeting families of children aged 5–12 with at least one parent who has deployed. ADAPT is based upon the Parent Management Training-Oregon model that targets the improvement of parenting skills that have been shown to strengthen children’s adjustment and reduce coercive parent–child interactions (Forgatch & DeGarmo, 1999; Forgatch, Patterson, & Gewirtz, 2013). ADAPT also includes additional components focused on improving parent emotion regulation via mindfulness training and emotion coaching of children. The program is Web-enhanced such that all skills taught in group are summarized in short video vignettes available online, together with home practice assignments, quizzes, skill summaries, and mindfulness exercises. The group-based program is delivered in 14 weekly multifamily

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sessions of 2 hours each. The program is currently being evaluated in an NIH-funded randomized controlled trial with 400 military families, primarily from the Reserve Components. Interim intent-to-treat outcome analyses with the first 89 mothers and fathers in 54 families demonstrated significant improvements in couple adjustment, and parenting self-efficacy, and reduced self-reported ineffective discipline among parents randomly assigned to the ADAPT program, compared with those assigned to services-as-usual (Gewirtz, 2013a, b). Moreover, the ADAPT program delivery model, which requires participants to travel to evening or weekend groups in community locations, appears to be feasible for both mothers and fathers, with early data showing 79% families attending at least 7 of the 14 group sessions (considered more than adequate dosage in earlier PMTO studies; Forgatch & DeGarmo, 1999), and one-half of participants using the online resources. Participants also reported very strong program satisfaction (Gewirtz, Pinna, Hanson, & Brockberg, in press), and mothers and fathers showed equal levels of participation and satisfaction.

10. A FUTURE RESEARCH AGENDA Research on parenting in military families is at an inchoate stage. Chief among the empirical questions yet to be answered are the details of how deployment and associated stressors affect parenting and children’s adjustment. The multifaceted nature of the deployment process (i.e., separation, family concerns for the service member’s safety, exposure to traumatic stressors) renders it a qualitatively different experience for families than most other family transitions. For example, how do families’ experiences in preparing for deployment, during deployment, and in reintegration, affect children’s adjustment throughout the deployment process? What are the key parenting buffers, or moderating factors, that might protect children, or enhance resilience in this process? While the drawdowns in both Iraq and Afghanistan have resulted in far fewer military personnel deployed overall, there remain small numbers of active-duty service members, such as those in Special Operations and the Marines, who continue to be deployed at a high operational tempo (i.e., frequency and intensity). Multiple deployments take a toll on service members, increasing rates of depression, anxiety, and PTSD (Hosek et al., 2006; MHAT-VII, 2011; Phillips, Leardmann, Gumbs, & Smith, 2010; Polusny et al., 2009; Tanielian & Jaycox, 2008). Multiple deployments also stress families, with multiple-deployed soldiers reporting significantly higher rates

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of considering divorce or separation compared with those deployed once (MHAT-VII, 2011). The selection and training of SO forces (Banks, 2006; Morgan, Southwick, Hazliett, & Dial-Ward, 2008) appears to be protective for individual service member functioning. For example, those selected for Special Forces groups tended to display fewer dissociative symptoms (a vulnerability factor for PTSD) than those not accepted (Morgan et al., 2008). However, no data are available to indicate whether these potentially protective effects extend to family functioning. For active-duty spouses, perceptions of the impact of deployment (on marital stress, family stability, and children) appear to be more important in influencing well-being and couple challenges than the actual number of separations (Burrell, Adams, Durand, & Castro, 2006). No studies have examined differences in parenting and children’s functioning by deployment operational tempo; the dearth of research in this area necessitates further investigation. In the mainstream developmental psychology literature, far more is known about the parenting of mothers than of fathers (Bornstein, 2002; Lamb, 2004), yet the vast majority of deployed parents are fathers. Understanding what promotes effective fathering that protects children in the wake of deployment is critical, but just a handful of studies address this question (e.g., Willerton, Schwarz, Wadsworth, & Oglesby, 2011). In parallel, almost no research has been conducted on military mothers, despite the fact that the conflicts in Iraq and Afghanistan have resulted in larger numbers of women deployed (and as a greater percentage of the overall force) than in any prior conflict (Institute of Medicine, 2013). Women account for approximately 14% of those deployed (Department of Defense, 2012), and 38% of female service members are mothers (Institute of Medicine, 2013). Military mothers face unique challenges, both as military service members and as parents; very little is known about how deployment affects mothers’ parenting and how deployed mothers’ parenting influences children’s adjustment (e.g., Kelley, Doane, & Pearson, 2011). We recently examined family adjustment in deployed and non-deployed mothers in 181 Reserve Component families who had experienced at least one deployment. Compared with non-deployed mothers, those who had deployed self-reported significantly higher levels of distress, and more difficulties in emotion regulation. However, no differences were found on maternal reports of children’s adjustment and relationship quality adjustment (Gewirtz, McMorris, Hanson, & Davis, in press). Recent changes in military policy admitting women into combat roles and thereby increasing their exposure to the dangers of combat only heighten the need to learn more about how combat

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affects women—their identity, roles, parenting—and their children’s development and resilience. Despite public policy attention to the needs of service members’ families, research lags far behind. We speculate that it is the urgency of the needs of our military families that might lead to impatience with the (relatively longterm) endeavor of the scientific process. What is needed is recognition both from scientists and practice and policy experts of a new paradigm that commits to getting data from the scientific process into the public arena as quickly as possible. There is reason for optimism. For example, several government agencies including the Department of Defense, National Institutes of Health (especially the National Institute on Drug Abuse and the National Institute of Child Health and Development), and the Department of Veterans’ Affairs have recently blended funding to solicit research proposals on behalf of military families. A challenge for researchers is to release research findings as soon as is feasible (even interim or preliminary findings), rather than waiting, say, 5–7 years from the start of a randomized control trial until all data are completely analyzed. A challenge for the practice and policy community is to go beyond the “comfort zone” of existing programs about which little outcome data exist to demand rigorous evaluation as a requirement for large-scale implementation and to increase the uptake of programs empirically supported with randomized controlled trials (the scientific gold standard for establishing efficacy and effectiveness; Flay et al., 2005). Indeed, the military practice and policy community has begun to increase the demand for family-based programs that are empirically supported, and to require positive outcome findings from randomized controlled trials for programs that are to be disseminated or implemented on a large scale. Many military family programs are currently in use but the effectiveness of those programs has not been established. The programs currently being tested (e.g., those described above) represent the first efforts to establish an evidence base for parenting programs for military families. In conclusion, while the past decade has seen a significant increase in our understanding of the needs and challenges of children affected by their parents’ wartime deployment, relatively little is known. Extant knowledge suggests that the needs of children affected by deployment are significant and cannot wait. Supporting the parenting of those who serve and sacrifice has the potential to strengthen military families and their children’s resilience—and invest in the next generation of military and civilian families.

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