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

这项工作的总体目标是适应、改进和实施家长培训干预的公开试验 针对患有创伤后应激障碍(PTSD)的退伍军人，使用退伍军人、退伍军人临床医生和 作为关键利益攸关方的专家顾问。创伤后应激障碍症状与亲子功能有关 困难，这也是生活质量和功能恢复的重要决定因素。不幸的是， 现有的治疗创伤后应激障碍的方法似乎并没有改善家庭功能。几个家长培训 在VHA内进行了干预试验，但没有一项是专门针对退伍军人制定的 目标消费者群体，没有人解决创伤后应激障碍症状带来的独特挑战。一些人 干预措施也带来了可行性挑战，或者缺乏证明其有效性的研究。至 克服这些限制，本项目将审查以证据为基础的 团体干预改善返乡儿童的育儿行为、育儿满意度和家庭功能 被诊断患有创伤后应激障碍且子女年龄在3至12岁之间的资深父母。 这项被称为专注于创伤后应激障碍的家长培训(PFPT)的干预措施源于现有的证据- 以改善退伍军人关系功能为基础的干预(家庭力量；SAH)，它被告知 人际功能的认知行为理论与军人家庭依恋 创伤后应激障碍与家庭功能问题之间的联系框架。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 (例如，积极的育儿、始终如一的管教、父母的监督)。整个治疗过程中整合的是 强调愤怒管理、情绪调节和改善亲子依恋。PFPT还 包括治疗前动机访谈评估(MIA)，以帮助患有创伤后应激障碍的退伍军人 加强和建立改变其育儿行为的动力。目标与变革之谈 在治疗前MIA中确定的，然后在整个PFPT治疗中提及。群体是性别的- 具体来说，这意味着我们将在不同的女性和男性退伍军人群体中试行这种治疗。 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 这项研究旨在获得并纳入专家、临床医生和资深医生对干预的反馈。PFPT 手册将利用专家顾问小组和退伍军人管理局临床医生的反馈进行审查和完善 在改善退伍军人家庭功能的治疗方面拥有丰富的经验。然后治疗将是 在两组退伍军人(一组男性，一组女性)中进行试点，以获得干预内容的反馈， 每次会议后的可接受性、可信度和满意度。专家顾问将召开第二次 是时候审查退伍军人的反馈了，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试行，以获得关于干预内容、可接受性、可信度、 以及每次治疗后的满足感。这一目标将最终形成一份PFPT治疗手册。 该研究的目标2是评估研究人员招募、保留、MIA程序和 提出了PFPT干预的方法，并对PFPT是否存在进行了初步审查 结果改善了我们的目标结果。这将通过对修订后的 治疗3组女性退伍军人和3组男性退伍军人。通过转介收集的信息 将使用费率、注册人数和保留率来评估PFPT的总体可行性和可接受性 干预、MIA和建议的方法。治疗前后目标结果的变化 父母养育行为、父母满意度和整体家庭功能将有助于评估PFPT 已经证明有足够的希望走向疗效试验。我们还将测试其可行性。 获取两个目标中亲子关系运作的附属合作伙伴报告。

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.