Replication of the ADAPT Online Parent Training Program for Post-Deployed Military Families

Introduction: 

This paper reports a replication test of an online parent training program called ADAPT: After Deployment Adaptive Parenting Tools. The ADAPT was designed to address the unique needs of families of re-integrating service members. The cumulative research program on ADAPT is based on a military family stress model. The intervention was adapted from the PMTO evidence based program for at-risk families. It was hypothesized that improvements in parental efficacy would be associated with improvements in parent, couple, and child adjustment.

Methods:

Two RCTs were employed. ADAPT Online was an R44 funded by NIDA and was conducted by IRIS Educational Media. ADAPT Online was responsible for the translation of PMTO and the development of a 10 module online-only version of ADAPT. Study participants were 112 active-duty, Reserve Component and veteran families including 87 individual military parents and 25 military couples. The second ADAPT study was conducted at the University of Minnesota, a large multi-method R01 funded by NIDA. The larger randomized trial tested in-person plus online parent training. ADAPT involved 609 parents from 336 families of young children aged 4 to 12. Models were tested here specified with similar measures across both studies. Each study obtained the same self-report data on parental efficacy, dyadic adjustment, and effective parenting strategies. For child adjustment the ADAPT online employed the Strengths and Difficulties Questionnaire and the ADAPT employed the Behavioral Assessment Scale for Children.

Findings:

For both the ADAPT Online and ADAPT studies, intent-to-treat main effects for the proximal variable of parental efficacy was stronger for mothers. For the smaller online study, 2/3rds of participants were mothers and only ITT × Gender effects were supported for mothers. Models in the second study were ran separately for mothers and fathers and findings supported both parents. The effect size d for ADAPT online was .56 for mothers’ efficacy and was .47 and .29 for mothers and fathers, respectively in ADAPT. In both studies, structural equation path models specifying auto-regressive change effects demonstrated replication of hypothesized paths. Pre-post change in efficacy in turn was associated with significant increases in dyadic adjustment and effective parenting behaviors. Each of the parenting and marital domains across both studies independently predicted improvements in child behavioral functioning. R²for the changes in SDQ was .58 for mothers in ADAPT online, and was .52 and .44 for mothers and fathers respectively in ADAPT study.

Conclusions:

Parental efficacy was a proximal response indicator and potential mediator of improvements in family resilience (i.e., child, parent, parenting, and marital functioning outcomes) within military families. Implications for comparative delivery designs and adaptive designs using parental efficacy are discussed. A third RCT, recently funded by DoD, is a comparative effectiveness trial of three formats of ADAPT with Reserve Component families: the group-based program, an individual telehealth program (i.e., facilitator and participant family meet weekly over WebEx), and a self-directed online only program.