Adaptation, Refinement, and Open Trial of Parent Training for Veterans with PTSD

这项工作的总体目标是适应，完善，并进行家长培训干预的公开试验 对于患有创伤后应激障碍（PTSD）的退伍军人，使用退伍军人，VA临床医生和 专家顾问是主要利益攸关方。PTSD症状与亲子功能有关 困难，这也是生活质量和功能恢复的一个重要决定因素。不幸的是， 现有的创伤后应激障碍治疗似乎并不能改善家庭功能。几次家长培训 干预措施已在VHA内部试行，但没有一项是专门针对退伍军人制定的， 目标消费者群体，没有解决创伤后应激障碍症状提出的独特挑战。一些 干预措施也存在可行性挑战，或者缺乏证明其有效性的研究。到 为了克服这些局限性，本项目将研究循证医学的可行性和可接受性。 团体干预，以改善父母的行为，父母的满意度和家庭功能，在返回 被诊断患有创伤后应激障碍并且有3至12岁孩子的退伍军人父母。 这种干预，标记PTSD为重点的家长培训（PFPT），是来自现有的证据- 基于干预，以改善退伍军人的关系功能（在家里的力量; SAH），并告知 人际功能认知行为理论与军人家庭依恋 PTSD和家庭功能问题之间的关联框架。PFPT强调， 获得与积极的儿童结果和健康的亲子功能相关的育儿技能 (e.g.,积极的父母教育，始终如一的纪律，父母的监督）。在整个治疗过程中， 强调愤怒管理、情绪调节和改善亲子依恋。PFPT也 包括治疗前动机访谈评估（MIA），以帮助患有PTSD的退伍军人， 加强和建立动机，以改变他们的养育行为。目标和改变谈话 然后在整个PFPT治疗过程中参考治疗前MIA中确定的所有参数。团体是性别- 具体来说，这意味着我们将在男女退伍军人的不同群体中试点治疗。 该项目将通过两个具体目标进行，将在36个月内完成。目标1 该研究旨在获得并整合专家临床医生和退伍军人对干预的反馈。PFPT 将利用专家顾问小组和VA临床医生的反馈对手册进行审查和完善 具有丰富的治疗经验，以改善退伍军人家庭功能。治疗将是 在两组退伍军人（1组男性，1组女性）中进行试点，以获得对干预内容的反馈， 可接受性、可信度和满意度。专家顾问将召开第二次会议， 在审查退伍军人反馈的时间，PFPT手册将再次修订，修订后的手册将 在另外两组退伍军人中进行试点，以获得关于干预内容、可接受性、可信度 每次会议后的满意度。这一目标将最终形成最终的PFPT治疗手册。 本研究的目的2是评价研究招募、保留、MIA程序和 建议的PFPT干预方法，并进行初步检查， 从而改善我们的目标结果。这将通过修改后的公开审判来实现 3组女性退伍军人和3组男性退伍军人的治疗。转介时收集的资料 将使用比率、入学率和保留率来评估PFPT的总体可行性和可接受性 干预，MIA和建议的方法。治疗前后目标结局的变化 父母教养行为、父母教养满意度和整体家庭功能有助于评估PFPT是否 已经证明了足够的承诺走向疗效试验。我们亦会测试 获得关于父母-子女在两个目标中发挥作用的附属伙伴报告。

The overall goal of this work is to adapt, refine, and conduct an open trial of a parent-training intervention for Veterans with posttraumatic stress disorder (PTSD) using feedback from Veterans, VA clinicians, and expert consultants as key stakeholders. PTSD symptoms are associated with parent-child functioning difficulties, which are also an important determinant of quality of life and functional recovery. Unfortunately, existing treatments for PTSD do not appear to improve family functioning. Several parent-training interventions have been piloted within VHA, but none were developed specifically with Veterans as the target group of consumers, and none address the unique challenges presented by PTSD symptoms. Some interventions also presented feasibility challenges or they lacked studies attesting to their efficacy. To overcome these limitations, this project will examine the feasibility and acceptability of an evidence-based group intervention to improve parenting behaviors, parenting satisfaction, and family functioning in returning Veteran parents who are diagnosed with PTSD and who have children between the ages of 3 and 12. This intervention, labeled PTSD-Focused Parent Training (PFPT), is derived from an existing evidence- based intervention to improve Veteran relationship functioning (Strength at Home; SAH), and it is informed by the Cognitive Behavioral Theory of Interpersonal Functioning and the Military Family Attachment frameworks for the association between PTSD and family functioning problems. PFPT emphasizes the acquisition of parenting skills associated with positive child outcomes and healthy parent-child functioning (e.g., positive parenting, consistent discipline, parental monitoring). Integrated throughout the treatment is an emphasis on anger management, emotion regulation, and improved parent-child attachment. PFPT also includes a pre-treatment Motivational Interviewing Assessment (MIA) to assist Veterans with PTSD in strengthening and building motivation to change their parenting behaviors. The goals and change talk identified in the pre-treatment MIA are then referred to throughout the PFPT treatment. Groups are gender- specific, meaning that we will pilot the treatment in separate groups of women and men Veterans. This project will be carried out through 2 specific aims that will be accomplished in 36 months. Aim 1 of the study is to obtain and incorporate expert clinician and Veteran feedback on the intervention. The PFPT manual will be reviewed and refined utilizing feedback from a panel of expert consultants and VA clinicians with extensive experience in treatments to improve Veteran family functioning. The treatment will then be piloted in two groups of Veterans (1 group of men, 1 group of women) for feedback on intervention content, acceptability, credibility, and satisfaction after each session. The expert consultants will convene a second time to review the Veteran feedback, the PFPT manual will be revised again, and the revised manual will be piloted in two more groups of Veterans for final feedback on intervention content, acceptability, credibility, and satisfaction after each session. This aim will culminate in a final PFPT treatment manual. Aim 2 of the study is to evaluate the feasibility of study recruitment, retention, MIA procedures, and proposed methods of the PFPT intervention and to conduct a preliminary examination of whether PFPT results in improvements in our target outcomes. This will be accomplished by an open trial of the revised treatment in 3 groups of women Veterans and 3 groups of men Veterans. Information collected on referral rates, enrollment, and retention will be used to evaluate the overall feasibility and acceptability of the PFPT intervention, MIA, and proposed methods. Pre- to post-treatment changes in the target outcomes of parenting behaviors, parenting satisfaction and overall family functioning will help evaluate whether PFPT has demonstrated sufficient promise to move toward an efficacy trial. We will also test the feasibility of obtaining collateral partner report of parent-child functioning throughout both aims.