Using a SMART Design to Optimize a Parenting Program for Military Families

Significance: While a relatively large number of evidence-based parenting prevention interventions have been developed and validated, relatively little data exist to help elucidate what formats, doses, and sequences of parenting interventions work for which types of parents. The present study aims to address this gap with an underserved population: military families affected by parental deployment to war.

Over two million children have been affected by the military deployment of a parent to the recent wars in Iraq and Afghanistan. Service member parents often face long separations from their children in dangerous environments, and may experience combat stress/PTSD symptoms, which can impair parenting, ultimately threatening children’s adjustment. After Deployment, Adaptive Parenting Tools is the first evidence-based parenting prevention program for military families, rigorously tested via RCTs. Data demonstrate the program to be effective in improving observed and reported parenting practices, leading to improvements in children’s emotional and behavioral adjustment and parent wellbeing. The program is available in multiple formats (online, telehealth, group, individual, etc.) but no data are available regarding what formats and sequences work best for which families.

Innovation: This presentation overviews a new sequential, multiple assignment, randomized trial/SMART to optimize ADAPT for elite and high operational tempo active-duty military families (i.e. those with a parent in the Army and Army Special Operations).

Approach: We describe the goal of this SMART, the first with families in elite US military units. Data to support the putative tailoring variable (parental locus of control) are presented, together with the program’s adaptive intervention strategies (i.e. doses and sequences of the program). The SMART is being tested in three military bases with 630 families across the USA. A key challenge is how to simply convey the complexity and value of a SMART design to military commanders and other stakeholders with little research experience.

Results/Implications for Optimizing Prevention Science: Data from SMART designs have strong practical implications as well as contributing research evidence to our understanding of personalized prevention science. The products of the current SMART will include clinician guidelines for format, sequence, and dosage of parenting programs for military families at different levels of risk and parenting skill/efficacy.