Mothering very young children after wartime deployment: A case report.

Parenting very young children in the context of military service, deployment separations, and war-related trauma can be challenging for many families. Female active duty personnel represent one of the fastest growing segments of the military, and recent policy changes have led women to pursue serving in combat positions at much higher rates. While not much is known about service member mothers, some studies have shown that they experience significant symptoms of distress, depression, and anxiety during the deployment cycle, feelings of disconnection from family during reintegration, and higher rates of childhood trauma histories than their male counterparts. Service member mothers who experience the combined stressors of deployment separation, combat exposure, and adverse childhood experiences-a triple threat-may be at serious risk of posttraumatic stress and depressive symptomatology, which can negatively influence the quality and nature of their parenting and parent-child relationships. This case report describes the participation of a young single service member mother and her preschool-aged daughter in a home-based, reintegration program designed for military families with very young children (ages 0-5). The paper illustrates how this relationship-based, reflective parenting intervention was effective in increasing the mother's sense of competence in her parenting and strengthening the parent-child relationship.

Criar a niños muy pequeños en el contexto del servicio militar, las separaciones debido a asignaciones militares de trabajo y el trauma relacionado con la guerra pueden representar un reto para muchas familias. Las mujeres, como miembros del personal activo con asignaciones militares, representan uno de los segmentos que aumentan más rápidamente dentro del campo militar, y los cambios recientes en las regulaciones han llevado a las mujeres a dedicarse al servicio en posiciones de combate en porcentajes mucho más altos. Aunque no mucho se sabe acerca de las madres que son miembros del servicio militar, algunos estudios han mostrado que ellas experimentan síntomas significativos de angustia, depresión y ansiedad durante el ciclo de asignación militar de trabajo, sentimientos de desconexión de la familia durante la reintegración, y más altos porcentajes de historias de trauma en la niñez que sus compañeros varones. Las mujeres en el servicio militar que experimentan la combinación de factores de estrés por la separación debido a la asignación de trabajo, el estar expuestas al combate, y las adversas experiencias de la niñez - una triple amenaza - pudieran encontrarse bajo un serio riesgo de estrés postraumático y sintomatología depresiva lo cual puede influir negativamente la calidad y naturaleza de la crianza y las relaciones progenitor-niño. Este reporte de caso describe la participación de una madre joven soltera miembro del servicio militar y su hija de edad prescolar dentro de un programa de reintegración con base en el hogar diseñado para familias militares con niños muy pequeños (edad 0-5). El ensayo ilustra cómo esta intervención de crianza con reflexión con base en la relación afectiva fue eficaz en lograr aumentar el sentido de competencia de la madre en cuanto a la crianza y fortalecer la relación progenitor-niño.

Le parentage de très jeunes enfants dans le contexte du service militaire, des séparations de déploiement et du trauma lié à la guerre peut s'avérer difficile pour bien des familles. Les femmes des forces armées représentent l'une des segments à la croissance la plus rapide des forces armées américaines et des changements politiques récents aux Etats-Unis ont amené les femmes à s'intéresser aux positions de combat à des taux beaucoup plus élevés qu'auparavant. Bien qu'on sache peu de choses sur les mères dans les forces armées, certaines études ont montré qu'elles font l'expérience de symptômes importants de détresse, de dépression et d'anxiété durant leur cycle de déploiement ainsi que de sentiments de déconnexion de la famille durant leur réintégration, et font preuve d'une incidence d'histoire de trauma de l'enfance bien plus élevée que leurs contreparties hommes. Les mères dans les forces armées qui font l'expérience d'une combinaison de facteurs de stress comme la séparation du déploiement, l'exposition au combat, et des expériences adverses de l'enfance - une triple menace - peut être à risque sérieux de stress post traumatique et d'une symptomatologie dépressive qui peut influencer la qualité et la nature de leur parentage et des relations parent-enfant de manière négative. Cette étude de cas décrit la participation d'une mère des forces armées jeune et célibataire et sa fille d'âge préscolaire dans un programme de réintégration à domicile pour les familles de militaires avec de très jeunes enfants (âges 0-5). Cet article illustre la manière dont cette intervention réflective, basée sur le parentage, était efficace pour l'augmentation du sens de compétence et confiance en son parentage de la part de la mère ainsi que pour le renforcement de la relation parent-enfant.

A randomized clinical trial of a postdeployment parenting intervention for service members and their families with very young children.

OBJECTIVE: Parenting through the deployment cycle presents unique stressors for military families. To date, few evidence-based and military-specific parenting programs are available to support parenting through cycles of deployment separation and reintegration, especially for National Guard/Reserve members. The purpose of this research was to test the efficacy of a parenting program developed specifically to support military families during reintegration. METHOD: Within 1 year of returning from deployment to Afghanistan or Iraq, 115 service members with very young children were randomly assigned to receive either the Strong Families Strong Forces Parenting Program at baseline or after a 12-week waiting period. Using a home-based modality, service members, at-home parents, and their young child were assessed at baseline, 3 months posttreatment/wait period, and 6 months from baseline. RESULTS: Service member parents in Strong Families evidenced greater reductions in parenting stress and mental health distress relative to those in the waitlist comparison group. Service members with more posttraumatic stress symptoms reported higher levels of perceived parental efficacy in the intervention group than service members in the comparison group. Intervention also resulted in enhanced parental reflective capacity, including increased curiosity and interest in the young child among those in the intervention group relative to comparison. CONCLUSION: Service member parents and their spouses demonstrated high interest in participating in a postdeployment parenting program targeting families with very young children. Findings point to the feasibility, appeal, and efficacy of Strong Families in this initial trial and suggest promise for implementation in broader military and community service systems. (PsycINFO Database Record

IMPLEMENTATION AND SUSTAINABILITY OF CHILD-PARENT PSYCHOTHERAPY: THE ROLE OF REFLECTIVE CONSULTATION IN THE LEARNING COLLABORATIVE MODEL.

Recent implementation science in mental health has focused on identifying the most effective strategies to disseminate and implement evidence-based treatments (EBTs) into real-world practice settings. The learning collaborative training methodology and its use of expert trainers/consultants have become increasingly popular as one of these approaches. Moreover, there is preliminary evidence that ongoing expert consultation may increase the adoption, learning, and sustainability of EBTs by an already practicing workforce and, consequently, help trainers, practitioners, and organizations address implementation barriers. This article describes the authors' experiences in facilitating Child-Parent Psychotherapy (CPP) training and explores the role of reflective clinical consultation as an active process that supports the implementation of a rich, but complex, model that requires sophisticated knowledge and skills from practitioners. It examines the intricate range of the CPP consultant's functions, which ultimately support clinicians' reflective practice as they learn and adopt this EBT. Reflective consultation is proposed as an essential component for the integration of knowledge, experience, and emotions in practitioners and as a catalyst for organizational change. Using their voices as trainers-consultants and those of their trainees, the authors discuss the implications of reflective consultation for the effective implementation and sustainability of CPP. Reflections are offered on lessons learned.

Circulating TGF-ß1 and VEGF and risk of cancer among liver transplant recipients.

Transplant recipients have elevated cancer risk, perhaps partly due to direct carcinogenic effects of immunosuppressive medications. Experimental evidence indicates that calcineurin inhibitors given to transplant recipients increase cellular expression of transforming growth factor ß1 (TGF-ß1) and vascular endothelial growth factor (VEGF), which could promote cancer. To assess the potential role of these pathways in the transplantation setting, we conducted a case-control study nested in a cohort of liver recipients. Cases had nonmelanoma skin cancer (N = 84), cancer of the lung (N = 29), kidney (N = 20), or colorectum (N = 17), or melanoma (N = 3). We selected N = 463 recipients without cancer as controls. TGF-ß1 and VEGF levels were measured in sera obtained, on average, approximately 3 years before case diagnosis/control selection. We also measured platelet factor 4 (PF4), a marker of ex vivo platelet degranulation, because TGF-ß1 and VEGF can be released from platelets, and we developed a statistical model to isolate the platelet-derived fraction from the remaining circulating component. Compared with controls, lung cancer cases had higher levels of TGF-ß1 (median 22.8 vs. 19.4 ng/mL, P = 0.02) and VEGF (277 vs. 186 pg/mL, P = 0.02). However, lung cancer cases also had higher platelet counts (P = 0.08) and PF4 levels (P = 0.02), while residual serum levels of TGF-ß1 and VEGF, after accounting for PF4, were unassociated with lung cancer (P = 0.40 and P = 0.15, respectively). Associations were not seen for other cancers. In conclusion, TGF-ß1 and VEGF levels were increased in association with lung cancer among transplant recipients, which may be explained by increased platelet counts and platelet degranulation in lung cancer cases.

When a parent goes to war: effects of parental deployment on very young children and implications for intervention.

Young children (birth through 5 years of age) are disproportionately represented in U.S. military families with a deployed parent. Because of their developmental capacity to deal with prolonged separation, young children can be especially vulnerable to stressors of parental deployment. Despite the resiliency of many military families, this type of separation can constitute a developmental crisis for a young child. Thus, the experience may compromise optimal child growth and development. This article reviews what is known about the effects of the military deployment cycle on young children, including attachment patterns, intense emotions, and behavioral changes and suggests an ecological approach for supporting military families with infants, toddlers, and preschoolers. Specifically, home-based family focused interventions seem to warrant the most serious consideration.