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Trauma-Focused Cognitive Behavioral Treatment for Military Families

Introduction and background information

The number of military service members is over 2.7 million people (Lester, Aralis, Sinclair, Kiff, Lee, Mustillo & Wadsworth, 2016), there are nearly 2 million children living with a parent in the military and about 700,000 have had a parent deployed to Afghanistan or Iraq. Of those 700,000 at least 19,000 of those children have had a parent wounded in action and more than 2,200 have lost their parent to the war (Maholmes, 2012). Having a parent deployed not only puts the children at risk of psychosocial disturbances, emotional and behavioral difficulties, academic difficulties, and social and emotional adjustment; it also puts the families at risk (Friedberg & Brelsford, 2011). When one parent is at home taking care of the child(ren), there is an increased risk of child maltreatment. abuse, and neglect (Maholmes, 2012; Lincoln, Swift & Shorteno-Fraser, 2008). Having an increased risk of emotional and behavioral difficulties, psychosocial disturbances, academic difficulties, and social and emotional adjustment in military families of having a deployed parent when they are gone and when they return home, the input of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) should be implemented for treatment. TF-CBT is a “conjoint parent-child treatment that uses cognitive-behavioral principles and exposure techniques to prevent and treat posttraumatic stress, depression, and behavioral problems” (Ramirez de Arellano, Lyman, Jobe-Shields, George, Dougherty, Daniels, . . . Delphin-Rittmon, 2014). It is important to have this treatment in place for military families, so they can build resilience and, so they can learn the skills that will help them process thoughts and feelings related to the trauma they are experiencing with having a parent/spouse in the military. The core feature of TF-CBT is gradual exposure which includes 9 components to its acronym PRACTICE (Cohen & Mannarino, 2011). The acronym described by Cohen and Mannarino (2011) stands for:

P: Psychoeducation: information about grief and trauma, traumatic grief, and Post-Traumatic Stress Disorder (PTSD)

P: Parenting component: parents receive parenting and other PRACTICE skills

R: Relaxation skills: relaxation strategies in relation to trauma cues

A: Affect modulation: feeling expression and management skills in relation to trauma cues

C: Cognitive coping: cognitive triad and correcting maladaptive cognitions

T: Trauma narration and processing: develop narrative; process maladaptive trauma-related cognitions

I: In vivo mastery: overcome generalized trauma-related fears

C: Conjoint child-parent sessions: share child’s narrative and improve communication

E: Enhancing safety: acknowledge and address child’s fears about safety

The Department of Defense (DOD) Task Force indicated the inability of existing systems to provide adequate care for veterans returning home from the field and their families, making it clear that it is time to bring social work knowledge and methods to care and treat American veterans and their families (Wheeler & Bragin, 2007).

My interest in researching this topic is based on growing up in a military family and having friends whose parents served in the military. When parents would return home from the field there would be family problems. For example, when living in Germany and being friends with 4 children, difficulty began when one of their parents deployed. The children would act out to get attention from not only their remaining parent, but also at school. Problems involved poor academics, loss of friends, and disciplinary problems at home, school, and with law enforcement officials. Upon return, the parents argued, and the children continued to act out. However, that was not the case. The psychodynamic perspective is concerned with how internal processes such as needs, drives, and emotions motivate human behavior. It focuses on the roles of internal needs, drives and emotions on human behavior. The psychodynamic perspective would help military families and their children with explaining why they act the way they do because of their internal needs, drives, emotions and behaviors. Having a parent in the military, can put strain on the children and the family because emotions are overwhelming. Having a parent deployed in the time of war can be one of the most stressful events in a child’s life (Sogomonyan & Cooper, 2010). According to Sogomonyan and Cooper (2010), “evidence-based methods including Parent-Child Interactive Therapy and Trauma-Focused Cognitive Behavioral Therapy should be integrated for use with children of military families who experience trauma, distress, or other psychosocial symptoms.”

With children and families experiencing different types of emotional and behavioral problems TF-CBT would access the military trauma put onto the families and children. It’s not only the children experiencing these issues though, it is also the parent returning home. It has been reported that 38% of soldiers, 31% of Marines, and 49% of returning National Guard members report psychological symptoms (Wheeler & Bragin, 2007). With implementing TF-CBT social workers would be able to focus on the strengths instead of the negatives that result in having a parent/spouse that is in the military.

The purpose of the study is to test and examine how TF-CBT can address and treat the problems listed above. The increased risk of problems in the children with a deployed parent in and out of home, warrants resources to help with TF-CBT and techniques related it to. Cognitive Behavioral Conjoint Therapy, Integrative Couples Therapy, Family Systems Therapy, Parent Management Training (Sensiba & Franklin, 2015), Conjoint child-parent sessions family, relaxation skills and psychoeducation are all techniques that help with implementing TF-CBT.  The children and families should be given appropriate treatment to resolve the problems that arise with having a parent deployed and with being deployed. Children being at all different ages, they experience the effects differently, which makes treatment and intervention plans different for each age group. Using TF-CBT with military families and their children would be an effective treatment with addressing traumatic grief, family relationships, psychosocial disturbances, and emotional and behavioral problems with having a parent that has been deployed.

  1. Literature Review

This literature review examines eight articles related to TF-CBT and how implementing this treatment would help military families and their children and the effects that the military can have on families and their children. The articles explore the benefits TF-CBT provides, the techniques and interventions that can be used and the importance that TF-CBT can have on military families and their children. This research supports the premise that TF-CBT is an important resource that can help mediate difficulties experienced by military families and their children.

Lester et al. (2016) examined the influence of parental deployments on family, children and parental adjustment’s in military families with young children between the ages of birth and 10 years of age.  The article focused on deployments and reintegration challenges that contributed to stress related factors for military families and to better understand the effects of military deployment. Lester et al. (2016) used data collected from phone interviews, web-based surveys, and Department of Defense archival data. To be eligible for the study, the families were required to live in the United States, currently have one parent serving in the military with a pay grade equal to or less than O-6 which is the highest rank below a general or admiral, and to have no parent that is currently deployed. Information about pay grade, US residence and deployment status was also obtained. Records of primary military parent deployments since September 11, 2001 that were obtained from databases maintained by the Defense Manpower Data Center (DMDC). The findings indicated parent and family risk and a risk for young children exposed to parental deployment. The study also indicated an association between impaired family and marital functioning with deployment exposure (Lester et al., 2016). Mothers and fathers from one and two parent military families with at least one child 10 years or younger were interviewed over the phone and completed web-based surveys. Questions were asked about their child’s development, child’s behavioral and emotional problems, and child’s anxiety. Questions were then asked of parental depression, if the parent possessed any posttraumatic stress symptoms, if the parent had alcohol or substance abuse problems, if there was any marital instability and if there were any family adjustment problems. The sample of the parents included 301 primary caregiving parents and 150 primary military parents. The data was then weighed so that the sample proportions accurately reflected the population of the military (Lester et al., 2016). Using this study done by Lester et al (2016), I would duplicate how to examine the possible influences of parental deployment on parental, family and child adjustment in military families. I would look at the primary caregiving and primary military parent characteristics and the impact of deployment with behavioral health, family adjustment and marital instability.

Brockman et al. (2015) examined 184 male National Guard or Reserve military service members, their intimate partner or spouse and their child that was between the ages of 4 and 13 years of age. The service members and their families participated in a larger trial of a behavioral parenting skills training intervention. The participants were recruited via presentations at mandatory predeployment and reintegration events for the National Guard and Reserve personnel in Minnesota, mailings from the Minneapolis Veterans Affrays Medical Center, family picnics for individual units, general community events for and by the military, announcements in fliers and the media, and social media; participation in the study was voluntary. Measures were used to assess combat-related trauma, PTSD symptoms, acceptance, and service members behavior during family interactions. Deployment Risk and Resilience Inventory scales, self-report scales, self-report questionnaire, and a 5-minute videotape showing problem solving, and conversations about deployment with their child and spouse were used to obtain results.

One bias highlighted is that the results obtained were of a “single source measurement methodology” (Brockman et al., 2015). Having just one source of measurements leaves you with little information. Multiple forms of measurements are better. Observation of family interaction did provide information about behavioral problems and avoidance with many statistical tests being made. The data provided, suggests that military service members experiential avoidance may play a role in how they and their families adapt to challenges faced during postdeployment reintegrating. The article is useful to my study because it addresses family resiliency, family relationships, family roles and responsibilities, renewal of family bonds, effective parent-child and marital communication, and problem solving. The data suggested that a behavioral parenting intervention could help focus on reducing family members avoidance and relationship skills. The information provided by Brockman et al. (2015) on behavioral parenting intervention could help create opportunities for the social work practice as far as developing programs for parents, specifically military parents with children. In my study, I would use the results and information obtained from the service members that associate with having PTSD symptoms and their behavior interactions with their spouses and children.

Ramirez de Arellano et al. (2014) considers the effectiveness of TF-CBT and if it should be considered for inclusion as a covered service in public and private health plans. The research team examined literature that examined TF-CBT that evaluated the psychoeducation, coping strategies such as relaxation, identification of feelings, cognitive coping, and cognitive processing such as parent training and conjoint sessions. The team evaluated TF-CBT over a broad range of traumatic events, rather than focusing on a specific type of trauma. Their research was limited to U.S and international studies done in English. Results indicated that TF-CBT has been associated with improved outcomes. Unlike most of the other studies done, data was obtained from other research studies that were conducted by other research teams. The research team found that TF-CBT presents as a viable treatment approach for children, adolescents, and families who have experienced trauma. Addressing supporting data regarding depression, anxiety, behavior problems associated with having a control group and a non-control group gives me reliable information that I can use in my research study. Ramirez de Arellano et al. (2014) explored the implementation of TF-CBT through a broad range of traumas, sample sizes, control groups, symptoms, ages and if the implementation of TF-CBT was effective.

Gerlock et al. (2014) saw that social support from your spouse or intimate partner helped in counteracting or reducing some of the symptoms related to war-zone PTSD. The research team conducted a Relationships and PTSD study where they obtained informed consent for each research participant. Qualitative data was obtained through audio recordings and transcripts from previous interviews and this data was drawn from for the overall random sample of participants. The sample consisted of military veterans no longer on active duty and their spouse or partner. Research questionnaires, behavioral interview and team consensus were used throughout the study. Couples were interviewed separately which allowed them to describe relationship behaviors in their own voice.

The article provides a detailed examination of PTSD and how it effects the family system. The research found helps with informing clinical interventions for providers that are working with veterans with war-zone related PTSD. Though the article is limited to the clinical sample being assessed, it does highlight the importance of screening and assessing for patterns related to psychological abuse and physical violence when working with couples dealing with war-zone related PTSD (Gerlock et al., 2014). Gerlock et al. (2014) educates partners about PTSD symptoms and coaches them about their caregiving roles as a spouse and parent. The research team “specifically” addressed couple’s issues for veterans in PTSD treatment at VA locations in the Northwestern U.S. The article is useful for my overall review of TF-CBT for military families because it addresses the symptoms related to war-zone PTSD. It examined intimate relationships related to physical and psychological behaviors and focused on violence and abuse. Though the article focused on a limited sample and Northwestern U.S, I still find it useful in examining the effects that contribute to having a family member in the military. In my research study I would use the information obtained on how couples can approach their relationship with communication strategies and resolve conflicts.

S. Schneider & J. Schneider (2013) review advances of psychotherapeutic treatments for children and adolescents experiencing trauma and they provide available interventions and how they can be implemented. The researchers suggested that TF-CBT and Child Parent Psychotherapy (CPP) have the strongest empirical support. Along with Parent-Child Cognitive-Behavioral Therapy (CPC-CBT) with Pre-School PTSD Treatment (PPT), both which are adapted from TF-CBT, are important therapies. They studied the different effects of TF-CBT, CPP, CPC-CBT, PPT, prolonged exposure therapy for adolescents, trauma adaptive recovery group education and treatment, risk reduction through family therapy, strengthening family coping resources, trauma symptoms therapy, grief and trauma intervention for children, cognitive-behavioral intervention for trauma in schools, and trauma and grief component therapy for adolescents. The research team examined different age groups, trauma types and did different lengths of sessions which included individual and group. S. Schneider & J. Schneider (2013) concluded that TF-CBT is effective and serves as a front-line for child trauma. They also found that TF-CBT is a good for helping parents and children demonstrating PTSD, depression, anxiety, and child behavioral problems.  Research found that TF-CBT is helpful with helping military children experiencing trauma and grief.

The sample of the research ranged from birth to 18 years of age, their caregiver and family. The length/format of each treatment was different in sessions with some being 4-12 in length and others 15-25 in length and some were conjoint, individual, family support, and group setting. Despite the size of the sample and other limitations of the study, the article provides factors and information relevant to TF-CBT and how it proves to be useful in addressing symptoms of PTSD, depression, and internalizing factors. Using this information in my research study would help with identifying TF-CBT and treatments that go along with that form of therapy. It would address that enhanced parent involvement, the inclusion of trauma-focused components in treatment and effective training in parent-child engagement can impact treatment for the family and child.

Herzog et al. (2011) view family members of individuals that are exposed to traumatic events are vulnerable to having secondary impacts of that stress that the initial family member has. The research team found that having a parent with PTSD negatively impacts not only the other adults in the family but the children as well.  Within the sample, introductory letters, sealed surveys, and reminder cards were provided to the participating National Guard Brigade Combat Team family program. The materials were sent to 1,011 households and to be eligible for the study, households had to have an Army National Guard Soldier, a spouse or partner that lives with them, and at least one child in the home between the ages of 2 and 18 (Herzog et al. 2011). Results of the study found that spouses of soldiers with posttraumatic stress are at an increased risk of secondary traumatic stress symptoms. The study also found that “internalizing problems were found to be symptomatic of secondary trauma stress in children” (Herzog et al. 2011).

Herzog et al. (2011) used a small sample size of seven families and the children of the soldiers that experienced high levels of posttraumatic stress were compared to the norms. The study was composed of well-educated high-ranking soldiers and their spouses. The results of the study were limited because it only examined Combat-Exposed National Guard Soldiers, but the article did support that symptoms are developed from secondary exposure for the children. Herzog et al. (2011) provides me with detailed information on how secondary trauma symptoms impacts the soldier’s family and their children. Herzog et al. further examines the need for preventive and treatment efforts targeted to all family members and their relationships to help lessen the effects of combat exposure. Families of war bear the stress of a having a member with combat related injuries to include PTSD, anxiety, and depression. The article is useful to my study because it addresses the unseen factors and symptoms that military families and their children face. Herzog et al. (2011) introduce children that are exposed to a parent with PTSD have higher levels of depression, anxiety and forms of PTSD symptoms. TF-CBT would treat posttraumatic stress, depression and anxiety that children and families are exposed to because of secondary trauma symptoms from their parent.

Cozza et al. (2010) developed a study that examined the relationship of injury primitiveness and family disruption postinjury to child distress in families of combat-injured serve members. The research team also examined preinjury deployment related family distress symptoms as an indicator of preexisting family risk of child distress development. Information was obtained from 41 spouses of combat-injured service members hospitalized at two tertiary care military medical centers. Interviews were conducted, and 7 main questions were asked regarding the child’s emotional status related to the injury, the child’s behavior change postinjury, preinjury deployment related family difficulties, disruptions related to child and family schedules, the impact of injury of parental discipline, and the impact related to the amount of time the noninjured parent spent with their child. The findings of the study indicated that there was high deployment related family distress prior to combat injury. Findings also indicated that families reported high child distress following combat injury could be related to schedule disruption, separation from parents, changed living arrangements, and the changes in parenting behavior (Cozza et al., 2010).

Cozza et al. (2010) recognizes that combat injury can cause family and child distress. Although, this study done by the research team has several limitations. First, the sample of spouses were not methodically recruited and second the time varied in injury which limited the “generalizability” of the results (S. Schneider & J. Schneider, 2013). The data obtained was derived from a clinical interview. The research team did not use standardized instruments to measure child distress, the impact of combat injury on the child and family, and family behavioral and emotional response. Using this article as part of my research study would help with examining the effects of having a parent in the military and how combat injuries not only impact the service member but also their families. It would address the disruption families and children face after a parent has been injured in combat and how it can be substantial to their wellbeing.

Huebner et al. (2007) viewed their study on the ambiguous loss theory, that stated, “The premise is that ambiguity coupled with losscreates a powerful barrier to coping and grieving, and leads to symptoms such as depression and relational conflict that erode human relationships.” The research team derived their model from family context, risk, and resilience. The framework of the study revolved around ambiguous loss to organize responses from youth and their uncertainty associated with parental deployment (Huebner et al., 2007). The sample of the study consisted of 107 adolescent participants who attended camps sponsored by the National Military Family Association (NMFA). Data was collected from these participants through focus group interviews where they discussed emotional issues. Collecting data from focus groups allowed the research team to gather large amounts of data in limited amount of time. Results indicated the overall perceptions of uncertainty and loss, boundary ambiguity which relates to the changes in roles and responsibilities that occurred when their parent was deployed, the changes in mental health, and relationship conflict (Huebner et al., 2007).

One limitation that can be found in this study is the sample size and how it was limited to adolescents attending a camp. Although, the study did report on a range of outcomes among the adolescents who were experiencing parental deployment. With using the theory of ambiguous loss, the research team could interpret responses to loss, understand family system changes, and were able to chart a course of support for the adolescents and their families (Huebner et al., 2007).  The study conducted by Huebner et al. (2007) however is helpful for my study because it examines a range of emotions that are associated with deployment. With examining the effects of having a parent deployed, allows for the TF-CBT because it would allow for the treatment of depression and behavioral problems that adolescents possess when having a parent deployed.

The following discussion integrates the findings of the eight articles discussed in this review of the literature on TF-CBT and how implementing this treatment would help families and their children that are affected with having a parent or spouse in the military. TF-CBT is an intervention for children and families that experience or are exposed to trauma related symptoms (Ramirez de. Arellano et al., 2014). Ramirez de Arellano et al. (2014) reported that the primary goal of TF-CBT is to reduce PTSD symptoms among children, adolescents and their families and that using TF-CBT provides structure for cognitive-behavioral principles. S. Schneider et al. (2013) supports TF-CBT as an effective treatment for military children experiencing trauma. According to Herzog et al (2011), families and children experience secondary trauma symptoms related to having a parent injured in combat. The injured parent experiences PTSD which in return allowed for secondary trauma symptoms in their spouse/partner and children. Symptoms included higher levels of anxiety, depression and PTSD related symptoms. Cozza et al. (2010) reported that families with high preinjury deployment related family distress and high family disruption postinjury were more likely to report higher levels of child distress. Gerlock et al. (2014) saw that social support from your spouse or intimate partner helped in counteracting or reducing some of the symptoms related to war-zone PTSD.  Gerlock and his research team provided a detailed examination of PTSD and how it effects the family system. There is an increased risk for emotional, behavioral, and academic difficulties in school-aged and adolescent children affected by having a parent in the military (Lester et al., 2016). Having an increased risk of these TF-CBT would be a useful intervention and treatment because it would allow for the treatment of depression and behavioral problems that adolescents possess when a parent is deployed. Huebner et al. (2007) could interpret responses to loss, understand family system changes, and were able to chart a course of support for the adolescents and their families with understanding ambiguous loss. Ambiguous loss is a loss that occurs without closure or understanding, and having a parent in the military, many children face this loss. Understanding ambiguous loss, serves as an important component of TF-CBT because it serves as a background information of how and why a family or child is feeling; it allows for understanding and communication. Brockman et al. (2015) explored the negative impact of military service members combat related trauma. Brockman and the research team found that military service members deployment is clearly visible in family relationship problems.

TF-CBT is a conjoint child and parent psychotherapy approach for children and adolescents that experience emotional and behavioral difficulties related to having a traumatic even in their life. However, using TF-CBT with military children and families is useful because of its interventions with cognitive behavioral, family, and humanistic principles (Trauma Focused Cognitive, n.d.).  Using TF-CBT with military families and their children would help mediate the difficulties and challenges that the family and children experience with deployment, PTSD and having a parent injured in combat. Ramirez de Arellano (2014) describe that the central focus of TF-CBT is to ensure an approach that is appropriately developed for the needs of the children and the family. In doing so you would develop an assessment and coping strategies to help the children and the family better manage trauma related distress and emotional reactions.

Using TF-CBT allows for the treatment of PTSD, depression and anxiety experienced by military families and their children. Implementing this therapy would allow for the treatment of families and their children to fix family relationships and the family system. The literature reviews focus on symptoms that are experienced by military families and their children. It also focuses on service members experience while in deployment and in combat and how those symptoms can in a whole effect their family. This topic has relevance to the social work field and further research on the implantation of TF-CBT for military families and their children. Group therapy, individual therapy, conjoint parent therapy, relaxation skills, parenting lessons and psychoeducation initiative would be beneficial using TF-CBT.

  1. Methodology

Using TF-CBT with military families and their children would be an effective treatment with addressing traumatic grief, family relationships, psychosocial disturbances, and emotional and behavioral problems with having a parent that has been deployed. I will be using a mixed methods approach to address the problem identified in this study. Using a mixed method approach I will be combining aspects of interpretive and positivist research approaches within all or many of the methodological steps contained within my research study (Grinnell, Williams & Unrau, 2016).  The study will involve collecting, analyzing and integrating quantitative and qualitative research with using experiments, surveys, interviews and groups. In this study a multiple-baseline design will be used because more than one case, one setting and problem will be addressed. Using a multiple-baseline design I would select the sample in multiple stages. The first being geographical region, in this case the military, secondly a currently active military member, and lastly a military family with children that has experienced having a parent/spouse deployed. With the population chosen, I would then choose groups from that population that fall under the criteria for the study, and lastly focus on the individuals separately and then as a whole with their family.

With selecting a sample for the study, I would get in contact with the DOD and the DMDC to access the DOD archival databases and other databases containing military information pertaining to my study. With the information obtained from the databases, I would then find families that are eligible for the study and contact them via telephone and mail. I would send out questionnaires, surveys and scales. Using purposive sampling, which is a nonprobability sampling procedure (Grinnell, Williams & Unrau, 2016), I would select at least 30 research participants with certain characteristics and attributions for inclusion. Lester et al. (2016), factors that I would consider to be eligible for the study would be if a spouse has been deployed or not, having to have at least 1 child in the home, spouse living in the same home and currently having one family member serving in the military. Participants will be asked to provide age, gender, educational level and rank when asked to sign the consent forms prior to completing the surveys and questionnaires. The Independent Variable (IV) of the study is the military family, children and the military spouse and the Dependent Variable (DV) of the study is the TF-CBT. In the study, a Deployment Risk and Resilience Inventory (DRRI) scale, Posttraumatic Stress Disorder Checklist-Military (PCL-M), Acceptance and Action Questionnaire-II (AAQ-II) and a videotape will be used which allows for narrative data to be collected.

Mirroring the study done by Brockman et al. (2015) I will be using the DRRI scale which consists of 15 yes-no questions relating to combat experience, for example, “I personally witnessed someone from my unit seriously get wounded or killed.” The purpose and reliability of this scale is its association with PTSD symptoms and the onset of PTSD symptoms after being deployed. The PCL-M is a self-report scale, which allows service members to rate the how bothersome military-related PTSD symptoms are to them over a 30-day time frame. The scale will be rated one-five, with one being “none at all” and five being “extremely.” According to Brockman et al. (2015) “The PCL-M had been repeatedly demonstrated to have a good internal reliability and validity in prior research.”  The purpose of the PCL-M is used for its “ability to measure post-trauma symptoms in military service personnel” (Herzog et al., 2011) The AAQ-II is a self-report questionnaire that will consist of seven questions using the seven-point Likert scale. The AAQ-II is single factor, has internal consistency, test-retest reliability and shows the associations with depression and anxiety. The purpose of using videotapes is to show the interaction with service members and their spouses and children. The videotapes will last between five and ten minutes and will show problem-solving with the child, conversations with their child about deployment and problem-solving with their spouse about co-parenting. The videotapes will be rated using the Macro-Level Family Interaction Coding System (MFICS) which is comprised of a 55 Likert scale with items being rated 1-5, a face-valid approach that will assess the occurrence of behaviors reflecting positive engagement which will consist of 20 items, 18 items consisting of withdrawal and avoidance questions, and 17 questions consisting of reactivity-coercion. Mirroring the study done by Lester et al. (2016) the children’s social and emotional development will be measured using the Social-Emotional (ASQ-SE), which is a web-based survey, their anxiety will be measured using the Spence Preschool Anxiety Scale (PAS) which includes a telephone interview and their emotional and behavioral problems will be measured using the Strengths and Difficulties Questionnaire (SDQ). The ASQ-SE will consist of 30 items for all age groups, the PAS will consist of 28 items that will be a parent-report measuring their children’s anxiety if they are in preschool and will have five subscales: generalized anxiety, social anxiety, obsessive compulsive disorder, physical injury fears and separation anxiety. The SDQ is also a parent-report which consists of 25 questions that screens children between the ages of six-ten. A standardized score will be calculated and summed from all the participants to the seven scales disbursed with an alpha =.80.

The purpose of the study is to determine that using TF-CBT with military families and their children would be an effective treatment with addressing traumatic grief, family relationships, psychosocial disturbances, and emotional and behavioral problems with having a parent that has been deployed. Using a strengths-based approach will help reduce the impact of the deployment-related stressors which include separation, mental health concerns, parental combat stress, and child-parent relationships (Ross & DeVoe, 2014). The study will be explained to the participants when they are contacted by telephone and mail with the questionnaires, surveys and scales that will be sent out. I would explain to the participants that their information is confidential that their informed consent would be collected if they decided to participate in the study. I would notify them that I would administer the study to them with a few other researchers in the field of their scores from all seven scales had an alpha =.80 or better. The study would take place the first week of the new year at a facility where they would stay at for six weeks. The six-week program would require families, spouse and children to participate in group therapy sessions, individual sessions and family sessions where relationships, emotional and behavioral problems, anxiety, depression, PTSD symptoms, marital stability and family adjustment will be worked on. Confidentially will be explained to every participant, in terms of their treatment and results not being shared with anyone not pertaining to the study, unless the issue of harming of themselves or others comes up and if I or the other researchers expect child and or elder abuse. Addressing culture competence can be an issue at times in the study because there will be individuals of different cultures and backgrounds. Individuals and the research team must understand and be willing to work with one another (Samhsa, n.d.). Having cultural knowledge of the individuals in the study is important so you as an individual of as part of the research team don’t offend one another. Consultation and translation will be available upon request.

Using the ABC research design, data will be collected first through process of selection to establish a baseline, once selected for the program treatment to individuals will be put into place the first week, 3 weeks into the program participants will be evaluated again. If treatment hasn’t worked, another form of treatment will be put into place, and the last day of the of the program participants will be evaluated again to establish if treatment has been successful or not. Results and treatment methods will be collected and recorded by the research team to use for future research statistics. Data will be stored in a locked in a filing cabinet. Once all the data is collected from the six-week program, I would use descriptive statistics, allowing for the summarizing and describing of the participants and that variable related to the treatment. I would enter the nominal, ordinal and ratio data collected into a computer. Collecting data at these three intervals allows for each variable to be described to provide a picture of characteristics to the research team. The descriptive statistics that will be described and looked at include gender, the difference of symptoms to having a parent deployed in the military, and education referring to how parents react to changes in their children and what they do to make a change. The goal with using inferential statistics in this study is to rule out any chance for finding differences between the variables in the sample. Using a chi-square test would allow for gathering and testing variables at the nominal and or ordinal level. Using the chi-square test would allow for looking at specific values of one variable in association with another one of the variables.

In this study I hope to find relationships addressing traumatic grief, family relationships, psychosocial disturbances, and emotional and behavioral problems with having a parent that has been deployed. With introducing TF-CBT to military families I hope to find a change in how families interact with one another, communicate with each other, behavioral changes being made and the strength of the family coming together to work with one another. I do think that some of my findings may be similar with other research findings, but I also think that they may differ in some aspect because of using a six-week program with the families. With introducing TF-CBT to the military, I believe that it would be beneficial on all levels in accessing the military trauma put onto the families and children. If Social workers would implement TF-CBT with military families, they would be able to focus on the strengths instead of the negatives that result in having a parent/spouse that is in the military and they would also help the family grow as a whole by working with them individually and as a group.

References

Brockman, C., Snyder, J., Gewirtz, A., Gird, S. R., Quattlebaum, J., Schmidt, N., Pauldine, M. R., Elish K., Schrepferman, L., Hayes, C., Zettle, R., Degarmo, D (2015). Relationship of service members’ deployment trauma, PTSD symptoms, and experiential avoidance to postdeployment family reengagement. Journal of Family Psychology, 30(1), 52-62. doi:10.1037/fam0000152

Cohen, J.A. & Mannarino, A.P. (2011) Trauma-Focused CBT for Traumatic Grief in Military Children. Journal of Contemporary Psychotherapy, 41(4), 219-227. doi:https://doi-org.ezproxy.lindenwood.edu/10.1007/s10879-011-9178-0

Cozza, S. J., Guimond, J. M., McKibben, J. A., Chun, R. S., Arata-Maiers, T. L., Schneider, B., & … Ursano, R. J. (2010). Combat-injured service members and their families: The relationship of child distress and spouse-perceived family distress and disruption. Journal of Traumatic Stress23(1), 112-115. doi:10.1002/jts.20488

Friedberg, R. D., & Brelsford, G. M. (2011). Using cognitive behavioral interventions to help children cope with parental military deployments. Journal of Contemporary Psychotherapy, 41(4), 229-236. doi: http://dx.doi.org/10.1007/s10879-011-9175-3

Gerlock, A. A., Grimesey, J., & Sayre, G. (2014). Military- Related Posttraumatic Stress Disorder and Intimate Relationship Behaviors: A Developing Dyadic Relationship Model. Journal of Marital and Family Therapy, 40(3), 344-56. Retrieved from http://ezproxy.lindenwood.edu:2048/login?url=https://search-proquest-com.ezproxy.lindenwood.edu/docview/1551133286?accountid=12104

Grinnell, R. M., Williams, M., & Unrau, Y. A. (2016). Research Methods for Social Workers: An Introduction. Kalamazoo: Pair Bond Publications.

Huebner, A. J., Mancini, J. A., Wilcox, R. M., Grass, S. R., & Grass, G. A. (2007). Parental deployment and youth in military families: Exploring uncertainty and ambiguous loss*. Family Relations, 56(2), 112-122. Retrieved from http://ezproxy.lindenwood.edu:2048/login?url=https://search-proquest-com.ezproxy.lindenwood.edu/docview/213933646?accountid=12104

Herzog, J. R., Everson, R. B., & Whitworth, J. D. (2011). Do Secondary Trauma Symptoms in Spouses of Combat-Exposed National Guard Soldiers Mediate Impacts of Soldiers’ Trauma Exposure on Their Children? Child and Adolescent Social Work Journal, 28(6), 459-473. doi:10.1007/s10560-011-0243-z

Lester, P., Aralis, H., Sinclair, M., Kiff, C., Lee, K., Mustillo, S., & Wadsworth, S. M. (2016). The Impact of Deployment on Parental, Family and Child Adjustment in Military Families. Child Psychiatry & Human Development, 47(6), 938-949. https://doi.org/10.1007/s10578-016-0624-9

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Ramirez de Arellano, M. A., Lyman, D. R., Jobe-Shields, L., George, P., Dougherty, R. H., Daniels, A. S., . . . Delphin-Rittmon, M. E. (2014). Trauma-Focused Cognitive-Behavioral Therapy for Children and Adolescents: Assessing the Evidence. Assessing the Evidence Base Series, 65(5), 591-602. Retrieved October 23, 2017, from http://ps.psychiatryonline.org/doi/pdf/10.1176/appi.ps.201300255

Ross, A. M., & DeVoe, E. R. (2014). Engaging Military Parents in a Home-Based Reintegration Program: A Consideration of Strategies. Health & Social Work39(1), 47-54.

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Sogomonyan, F., & Cooper, J. L. (2010, May 04). Trauma Faced by Children of Military Families What Every Policymaker Should Know. Retrieved October 02, 2017, from http://www.nccp.org/publications/pub_938.html

Trauma Focused Cognitive Behavioral Therapy (TF-CBT) for Military Families. (2017, May 22). Retrieved October 25, 2017, from https://www.eventbrite.com/e/trauma-focused-cognitive-behavioral-therapy-tf-cbt-for-military-families-tickets-33795627632#

Wheeler, D. P., & Bragin, M. (2007). Bringing it all back home: Social work and the challenge of returning veterans. Health & Social Work, 32(4), 297-300. Retrieved from http://gatekeeper2.lindenwood.edu/login?



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