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Access to quality sexual assault (SA) care in rural communities is limited by challenges surrounding building and sustaining a skilled SA nurse examiner workforce. Telehealth can facilitate access to expert care while cultivating a local sexual assault response. The Sexual Assault Forensic Examination Telehealth (SAFE-T) Center aims to decrease disparities in SA care by providing expert, live, interactive mentoring, quality assurance, and evidence-based training via telehealth. This study examines multidisciplinary perceptions of pre-implementation barriers and SAFE-T program impact using qualitative methods. Implications for the implementation of telehealth programs to support access to quality SA care are considered. [ABSTRACT FROM AUTHOR]

This study examined how veteran social engagement predicted post-secondary school attainment. Nearly 10,000 post-9/11 veterans, who separated from military service in 2016, were surveyed on the programs/services they used over 4 years following separation. More than half of veterans had obtained a degree within 4 years of separation. A higher proportion of veterans of color and female veterans reported attending only some higher education than White non-Hispanic male veterans. Positive predictors of educational attainment included participating in veterans' centers and veteran-student organizations, while negative predictors included financial and mental health problems. Implications for veteran-serving programs of post-secondary institutions are discussed. [ABSTRACT FROM AUTHOR]

The COVID‐19 pandemic has led to economic turndowns, social restrictions, and family life alterations. The stress induced by the public health crisis and its consequences are beginning to be explored. This study examined stress experiences since the pandemic'sonset in work, financial, social, and health domainsamong a large sample of post‐9/11, United States military veterans. The sample, who separated from active‐duty service or deactivated from active status in a reserve component in 2016, completed an online survey (n = 3180) in 2020. Participants were 70% White non‐Hispanic, 81% male, and had an average age of 38 years. Frequencies and descriptive statistics were calculated. Female veterans and veterans of colour reported significantly higher levels of stress across most life domains. The results suggest White, male, post‐9/11 veterans may be somewhat protected from COVID‐19 stress, but that the pandemic is exacerbatinghealth and social disparities experienced by post‐9/11 veterans of colour and female veterans. Supports and comprehensive care, particularly targeted towardsat‐risk populations, are likely needed to provide sufficient resources for resiliency during and after the pandemic. [ABSTRACT FROM AUTHOR]

Early identification of children and youth who engage in problematic sexual behavior is important for all parties involved, such as children who exhibit and are impacted by the behavior. There are several reliable and valid identification tools that can be used to recognize problematic sexual behavior in children and youth (PSB-CY) in clinical practice; however, professionals who work with children in non-clinical settings (i.e., child development centers, youth programs, and schools) often have limited resources and tools when they encounter PSB-CY. This paper describes the development, content, and user feedback of a referral tool (RT) that was designed to help identify incidents of PSB-CY for use with military agencies and schools. Specifically, the RT was designed to help professionals, who may have observed or who may have been made aware of sexual behaviors in children and youth, organize their observations of the behavior in alignment with evidence-based information about PSB-CY and consistently document these occurrences. The RT guides users in determining if the observed behavior is normative, cautionary, or problematic and promotes informed decisions about whether the behavior needs to be referred to those who have experience using clinical tools for further review and the identification of next steps for supporting the children and families involved. Early adopters provided feedback on the use of the RT. The feedback suggested that the tool was user-friendly, understandable, and helpful as they made objective decisions about how to identify and handle referrals of PSB-CY. [ABSTRACT FROM AUTHOR]

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Two studies examined the impact of the implementation of the Field-tested Assessment, Intervention-planning, and Response (FAIR) system, a system-level intervention for determining whether allegations of family maltreatment meet threshold for abuse or neglect, on alleged recidivism. Data were collected at the 10 U.S. Army installations with the largest family maltreatment caseloads. Participants were family members who had an allegation of family maltreatment (i.e., child maltreatment or partner abuse) during one of the two study periods. Data were collected when Family Advocacy Program staff used the then-in-place system (Case Review Committee) and later the FAIR system. In Study 1, cases were followed for 6 months following the initial maltreatment allegation to measure the occurrence of subsequent allegations of any type. Additionally, at five installations, alleged victims of partner abuse were recruited into a study (Study 2) in which they anonymously reported on intimate partner violence via telephone. In Study 1, the advantage for the FAIR condition was concentrated in cases with unsubstantiated initial determinations; the mean relative risk reduction for recidivism was 0.48. In Study 2, FAIR extended median time to recidivism by approximately 170%. These results replicate and extend earlier findings that employing the FAIR system can result in decreased family maltreatment re-offense. [ABSTRACT FROM AUTHOR]

Military sexual trauma (MST) is a pervasive problem; this study examined the relationship of the precursory traumas of adverse childhood experiences (ACEs) and warfare exposure with MST. Post-9/11 veterans were surveyed at 3 months and at 24 to 30 months post-military separation. Female veterans who experienced at least 1 ACE but no warfare exposure were significantly more likely to receive unwanted sexual attention. Veterans (males and females) experiencing three or more ACEs but no warfare exposure were significantly more likely to receive unwanted sexual attention and contact. Experiencing only warfare exposure was not related to unwanted sexual attention or contact for females; however, a significant interaction was found between combined warfare exposure, ACEs, and MST for males and females. Veterans who reported warfare exposure and one to two or three or more ACEs were more likely to report unwanted sexual attention and/or contact. Exploration of individual ACEs revealed a significant relationship between childhood sexual abuse and unwanted sexual contact. For females, witnessing domestic violence predicted unwanted sexual contact. There was also a significant interaction between childhood sexual abuse and warfare exposure. Females who experienced both childhood sexual abuse and warfare exposure were significantly more likely to receive unwanted sexual attention and unwanted sexual contact. Albeit a small sample, males who experienced both were also significantly more likely to receive unwanted sexual attention. The findings reveal that precursory traumatic experiences in childhood and the interaction of ACEs and warfare exposure during military service can increase the likelihood of unwanted sexual attention and contact. This research further substantiates the need for screening efforts. It also demonstrates the importance of practitioners engaging in trauma-informed care principles and practices to address the residual effects of previous experiences during sexual trauma or mental health treatment efforts. [ABSTRACT FROM AUTHOR]

Objective: Risk and protective factors associated with parental functioning (i.e., meeting child's emotional needs) and satisfaction (i.e., closeness) were examined among post‐9/11 veteran mothers during their civilian transition. Background: Post–military‐separation stressors (e.g., relocation, benefit changes) can strain well‐being and familial relationships. Stress, particularly in the presence of unresolved trauma from military‐specific risks, can impinge upon parental functioning and satisfaction, negatively influencing child outcomes (e.g., social–emotional, academic, behavioral). Method: A prospective cohort was identified from all active duty service members who separated in May–September 2016. Logistic regression analyses of surveys completed by post‐9/11 veteran mothers (n = 711) assessed effects of protective (i.e., resilience) and military‐specific risk factors (i.e., deployments) on parental functioning and satisfaction. Interactions between protective factors and deployments and combat (patrols and corollaries) were explored. Results: Coping characteristics (e.g., healthy behaviors), absence of mental health conditions, and social supports were positively associated with parental functioning and satisfaction. Household financial security was not. Mothers who had deployed reported higher parental functioning and satisfaction. Mothers experiencing combat patrols were less likely to report high parental functioning. Conclusion: Malleable protective factors positively influence parenting but do not buffer against combat exposure. Implications: Interventions bolstering protective factors for veteran mothers can foster coping, reintegration, and positive child outcomes. [ABSTRACT FROM AUTHOR]

Background: Although research has shown that exposure to potentially traumatic and morally injurious events is associated with psychological symptoms among veterans, knowledge regarding functioning impacts remains limited. Methods: A population-based sample of post-9/11 veterans completed measures of intimate relationship, health, and work functioning at approximately 9, 15, 21, and 27 months after leaving service. Moral injury, posttraumatic stress, and depression were assessed at ~9 months post-separation. We used Latent Growth Mixture Models to identify discrete classes characterized by unique trajectories of change in functioning over time and to examine predictors of class membership. Results: Veterans were assigned to one of four functioning trajectories: high and stable, high and decreasing, moderate and increasing, and moderate and stable. Whereas posttraumatic stress, depression, and moral injury associated with perpetration and betrayal predicted worse outcomes at baseline across multiple functioning domains, moral injury associated with perpetration and depression most reliably predicted assignment to trajectories characterized by relatively poor or declining functioning. Conclusions: Moral injury contributes to functional problems beyond what is explained by posttraumatic stress and depression, and moral injury due to perpetration and depression most reliably predicted assignment to trajectories characterized by functional impairment over time. [ABSTRACT FROM AUTHOR]

Background: Evidence-based program resources (EBPR) websites for behavioral health are a potentially useful tool to assist decision-makers and practitioners in deciding which behavioral health interventions to implement. EBPR websites apply rigorous research standards to assess the effectiveness of behavioral healthcare programs, models, and clinical practices. Method: Visitors to a convenience sample of six EBPR websites (N=369, excluding students) were recruited for telephone interviews primarily by means of a pop-up invitation on the sites. Results: The visitors view the EBPR sites as important sources of information to support the identification and adoption of evidence-based programs/practices (EBPs) in behavioral healthcare, which aligns with the primary mission of EBPRs. For repeat visitors, there was some indication that the information obtained helped effect certain changes in their agencies' programs and policies. However, increased or improved guidance on EBP implementation was also requested. Conclusion: EBPR websites should be better publicized to the behavioral healthcare field. [ABSTRACT FROM AUTHOR]

Guided by social learning theory, this longitudinal study examined whether parent–child recurring conflict mediated the association between parental anger management, an understudied antecedent to parent–child recurring conflict, and adolescent deviant and problem‐solving behaviors in 415 rural families. Parental use of anger management in 6th grade was associated with less parent–child recurring conflict in 9th grade, which was associated with more adolescent problem‐solving behavior in 11th grade. Family practitioners seeking to promote adolescent problem‐solving behaviors may consider teaching families strategies for reducing parent–child recurring conflict and fostering parental anger management. [ABSTRACT FROM AUTHOR]

This study assessed the Moral Injury Symptoms Scale – Military Version – Short Form's (MISS-M-SF) factor structure and construct validity. Participants included 3650 combat-deployed U.S. veterans who answered all 10 MISS-M-SF items from the sixth wave of The Veterans Metric Initiative (TVMI). EFA results suggested a two-factor solution, based on item wording, fit best. CFA results indicated a bifactor model (one general factor and two method factors, based on item wording) fit best. Further investigation revealed that a one-factor model could be used despite the data's multidimensionality. Item-level analyses revealed four items represented the general factor exceptionally well, potentially simplifying assessment in research and clinical applications. Construct validity was also demonstrated through moderate to high correlations with conceptually related measures. [ABSTRACT FROM AUTHOR]

The Army Family Advocacy Program (Army FAP) strives to prevent family violence and intervene to reduce the deleterious effects of exposure to family violence. This paper examines the individual, family, community, and treatment factors associated with family violence revictimization. Case files of 134 families with substantiated child maltreatment and associated Army FAP interventions that closed in 2013 were coded across risk and protective factors and intervention characteristics and were matched to Army Central Registry files to identify revictimization rates through 2017. Revictimization, experienced by 23% of families, was predicted by community risk and reduced by intervention dose. With the high rates of relocations, housing or neighborhood issues, and the isolation military families experience and the relationship of these concerns to repeated family violence, identifying the impact of community risk is particularly important. Similarly, research that elucidates the effective treatment components is needed. [ABSTRACT FROM AUTHOR]

BACKGROUND: Underemployment is a challenge for the civilian workforce and a particular risk for veterans as they transition from military service to civilian employment. Workers' economic and demographic characteristics factor into underemployment risk. Veterans may be at greater risk due to specific economic and demographic factors, transitional factors (e.g., geographic relocation), and characteristics of their military service (e.g., military skill alignment with civilian jobs). OBJECTIVES: Describe underemployment experiences in employed post-9/11 veterans three years after their military transition to the civilian workforce. METHODS: The current study uses self-reported underemployment experience data from a longitudinal study of transitioning veterans. This study compares average perceptions of veteran underemployment experiences by specific groups (e.g., by race, gender, and paygrade) using analysis of variance and logistic regression. RESULTS: Veterans reported underemployment in their current jobs based on a perceived mismatch between the skills, education, and/or leadership experience they gained during military service. CONCLUSIONS: Veterans who were enlisted rank, identified as non-White, completed a bachelor's degree, and indicated PTSD symptoms reported higher pervasive underemployment. Intervention implications for the results, such as employer and veteran employment supports, are discussed. [ABSTRACT FROM AUTHOR]

Military veterans have greater exposure to adverse childhood experiences (ACEs) than civilians and many also encounter warfare exposures, which can increase the likelihood of mental health problems. The purpose of this study was to test an interaction between childhood traumas and warfare exposures on the mental health of a sample of nearly 10,000 new post‐9/11 veterans. Results revealed that male veterans exposed to one or two ACEs, but no warfare, were more likely to experience anxiety, depression, suicidal thinking, and angry outbursts than the reference group (i.e., no ACEs and no warfare exposure). Female veterans exposed to one or two ACEs, but no warfare, were only more likely to experience suicidal thinking. Male and female veterans exposed to three or more ACEs and no warfare were more likely to experience probable posttraumatic stress disorder (PTSD), anxiety, depression, suicidality, and angry outbursts. Among those veterans who experienced corollaries of combat only (e.g., seeing someone killed or seriously wounded), male, but not female veterans were more likely to have probable PTSD, anxiety, and depression. Veterans exposed to warfare (i.e., combat and the corollaries of combat), irrespective of ACEs exposure, were the most likely to report mental health symptoms. Implications for community‐based mental health services are discussed. [ABSTRACT FROM AUTHOR]

Employing a strengths-based perspective, this study examined protective factors related to fathers' positive parenting behaviors and parenting satisfaction. The sample included 3,810 active duty veteran fathers who separated from the active component and had at least one child 18 years and younger. Logistic regression analyses indicated that financial status, health functioning, resilience, social support, positive social functioning with community and friends, and positive social functioning with relatives were all associated with parenting functioning. The interaction of the number of deployments and resilience was related to parenting functioning. Furthermore, health functioning, resilience, social support, positive social functioning with community and friends, and positive social functioning with relatives were associated with parenting satisfaction. Among fathers in a romantic relationship, the interaction of the number of deployments and romantic relationship functioning and the interaction of the number of deployments and romantic relationship satisfaction were both related to parenting functioning and parenting satisfaction. [ABSTRACT FROM AUTHOR]

Assessment that accurately categorizes families' risk for family violence (i.e., intimate partner violence and child maltreatment) and identifies areas of family need is essential for prevention program planning, practice, and resource allocation. The Family Needs Screener (FNS) assesses risk for intimate partner violence and child maltreatment. It is used as a tool to prioritize those who are in the greatest need of services as well as plan prevention efforts in selected prevention services offered to military families. To date, no peer-reviewed studies examine the factor structure of the FNS. In this study, we examined measurement aspects of the FNS as an assessment tool in identifying risk of family violence. Data were drawn from Army families (N = 18,159) who were screened between 2009 and 2013 and matched to substantiated cases of family violence. Exploratory structural equation modeling (ESEM) was used to examine the factor structure, measurement invariance, and predictive validity of the FNS. Results supported a shortened measure with a five-factor structure and full gender invariance. In particular, relationship issues were predictive of both intimate partner violence and child maltreatment. In addition, family of origin/history of family violence was predictive of substantiated cases of child maltreatment. Findings support the use of the FNS to assess risk, allocate, and plan for services in an Army population. Implications for scale modifications and use, as well as prevention efforts, are discussed. [ABSTRACT FROM AUTHOR]

Prior research has examined the independent effects of demographic and military characteristics, trauma history, and coping resources on military veterans' health. However, there is limited knowledge of how these factors intersect with one another and with veterans' health to impact their broader well‐being as they readjust to civilian life. Data for this study were drawn from a longitudinal investigation of the health and broader well‐being of U.S. veterans (N = 7150) who had recently left military service. Machine learning analyses (random forests of regression trees) were used to examine how factors assessed shortly after military separation were associated with veterans' well‐being approximately a year later. Veterans who endorsed the combination of low depression, high social support, and high psychological resilience were most likely to report high well‐being a year later. Neither demographic and military characteristics nor trauma history emerged as strong predictors of veterans' well‐being when considered in the context of other factors. Although most predictors were similar for women and men, depression was a stronger predictor of women's well‐being. Results highlight the importance of screening for and intervening with veterans who report high depression, low social support, and low psychological resilience when leaving military service. These findings can inform efforts to promote veterans' post‐military well‐being. [ABSTRACT FROM AUTHOR]

Background: Rural and underserved communities often struggle to provide access to specialized health care, including sexual assault care. Telehealth is an effective solution for providing access to an array of specialized health care services. Prior sexual assault telehealth programs have provided evidence that telehealth is a feasible and acceptable solution. However, there is scant information about program development and considerations in the literature to guide those who may seek to implement a sexual assault telehealth program in their communities. Purpose: The purpose of this paper is to describe the Sexual Assault Forensic Examination Telehealth (SAFE‐T) Center—a nurse‐led model for providing comprehensive, high‐quality sexual assault care in rural and underserved communities recently implemented at 3 hospitals in rural Pennsylvania. Methods: Using the program's logic model, we present our community‐engaged approach to the development and implementation phases of the SAFE‐T Center. Findings: We first describe how academic researchers partnered with multiple stakeholders to form a statewide advisory board and articulated a vision and mission for the SAFE‐T Center that meets the needs of local communities. We then describe the overall design of the model, how it was informed by this academic‐community partnership, and how each element relates to anticipated outcomes. We also present our plans for program evaluation, expansion, and sustainability. Conclusion: This detailed description of collaborative partnership, coalition‐building, program design and implementation can serve as a guide for hospitals and health systems seeking to implement telehealth programs to improve the care provided to survivors of sexual assault. [ABSTRACT FROM AUTHOR]

Moral injury (MI) may occur in the context of committing transgressions (i.e., self-directed MI reactions), witnessing transgressions, or being the victims of others' transgressions (i.e., other-directed MI reactions) that violate an individual's moral principles. Veterans with MI may experience impaired social well-being (SWB). Studies on MI and veterans' SWB have focused almost exclusively on social support and used cross-sectional data. The present study used growth curve analyses to examine the associations between self- and other-directed MI reactions and veterans' levels of social support, social functioning, social activities, and social satisfaction over the first 18 to 21 months of their transition to civilian life (N = 9,566). The results demonstrated declines in all SWB outcomes, with self- and other-directed MI reactions having differential effects. Higher versus lower levels of other-directed MI reactions were related to lower baseline scores on all SWB outcomes, βs = -.06 to -.20, and steeper declines over time in social functioning, β = -.09, and social satisfaction, β = -.10. Higher versus lower levels of self-directed MI reactions were related to lower baseline levels of social functioning, β = -.07, but higher baseline levels of social activity, β = .04. Higher versus lower levels of self-directed MI reactions were related to a steeper decline in social activity over time, β = -.10. These findings present a more nuanced picture than that depicted by current MI theoretical frameworks and support further research to uncover moderators of the associations between self- and other-directed MI reactions and SWB outcomes. [ABSTRACT FROM AUTHOR]

Objective: The Veterans Metrics Initiative is a longitudinal survey study examining the military-to-civilian transition of a cohort of new post-9/11 veterans. This study identified the programs and services used by new post-9/11 veterans who screened positive for mental health problems (N=3,295) and factors that predicted use.Methods: The population of veterans who separated from active duty service in the 90 days prior to August-November 2016 (N=48,965) was identified and invited to participate in the study. This study reports results from the first wave of data collected.Results: Complete data were provided by 9,566 veterans. Of these, 34% (N=3,295) screened positive for one or more probable mental health problems. A substantial majority of these veterans also reported having a general medical problem. Results revealed that veterans from junior enlisted ranks were significantly less likely than those from higher ranks to use programs and services. Use of programs and services by male and female veterans was similar. Several racial-ethnic differences also emerged. There was some evidence that veterans may underrecognize their own mental health problems. Veterans who were exposed to combat, had a medical discharge, or reported an ongoing general medical condition were all significantly more likely to report using U.S. Department of Veterans Affairs (VA) health care services.Conclusions: These findings suggest that veterans, particularly those from the junior enlisted ranks-who are most at risk for poor transitions-should be encouraged to use programs and services provided by both the VA and non-VA health care alternatives. [ABSTRACT FROM AUTHOR]

Background: Numerous programs exist to support veterans in their transitions to civilian life. Programs are offered by a host of governmental and non-governmental stakeholders. Veterans report encountering many barriers to program participation. This study identified barrier reduction strategies offered by programs that new post-9/11 veterans reported using, determined which strategies veterans use and value, and examined veteran characteristics that impact their odds of using programs that offer barrier reduction strategies.Method: This study reflects findings from the first wave of data collection of The Veterans Metrics Initiative (TVMI), a longitudinal study examining the military-to-civilian reintegration of new post-9/11 veterans. The websites of programs used by respondents were coded for barrier reduction components. Veterans also indicated which barrier reduction components they found most helpful in meeting their reintegration goals.Results: Of 9566 veterans who participated in Wave 1 data collection, 84% reported using a program that offered at least one barrier reduction component. Barrier reduction components included tangible supports (e.g., scholarships, cash), increased access to programs, decreased stigma, and encouraged motivation to change. Although only 4% of programs that were used by veterans focused on helping them obtain Veterans Administration benefits, nearly 60% of veterans reported that this component was helpful in reaching their goals. Access assistance to other resources and supports was also reported as a helpful barrier reduction component. For instance, approximately 20% of veterans nominated programs that offered transportation. The study also found evidence of a misalignment between the kinds of barrier reduction components veterans valued and those which programs offered. Veterans from the most junior enlisted ranks, who are at most risk, were less likely than those from other ranks to use barrier reduction components. Study limitations and ideas for future research are discussed.Conclusions: Despite the evidence that barrier reduction components enhance access to programs and contribute to program sustainability, many programs used by post-9/11 veterans do not offer them. There was also a misalignment between the barrier reduction strategies that veterans value and the strategies offered by programs. Veteran serving organizations should increasingly implement barrier reduction strategies valued by veterans. [ABSTRACT FROM AUTHOR]

Posttraumatic stress disorder (PTSD) has been found to lead to several adverse perinatal outcomes in the general population. Preliminary research has found that women veterans with PTSD have an increased prevalence of preterm birth, gestational diabetes, and preeclampsia. Less research has examined the role of moral injury (MI) in perinatal outcomes. This longitudinal survey study examined the impact of PTSD symptoms and MI on prospectively assessed adverse perinatal outcomes among women who became pregnant in the first 3 years after separating from U.S. military service (N = 318). The Moral Injury Events Scale was used to assess the degree to which individuals experienced distress related to transgressions of deeply held moral beliefs, and the Primary Care PTSD Screen for DSM-5 (PC-PTSD) was used to assess PTSD symptoms. Perinatal outcomes included experiencing an adverse pregnancy outcome (e.g., preterm birth, gestational diabetes), postpartum depression and/or anxiety, and perceived difficult pregnancy. Although both PTSD symptoms, adjusted odds ratio (aOR) = 1.16, 95% CI [1.00, 1.35]; and MI, aOR = 1.27, 95% CI [1.06, 1.41], emerged as significant predictors of adverse pregnancy outcomes, only PTSD symptoms were a significant predictor of postpartum depression and/or anxiety, aOR = 1.43, 95% CI [1.22, 1.68], and perception of a difficult pregnancy, β = .31, when controlling for lifetime trauma exposure, age, socioeconomic status, and ethnic/racial minority status. The results indicate that both PTSD symptoms and MI are associated with adverse perinatal outcomes, supporting the potential need to screen for both PTSD and MI during the perinatal period. [ABSTRACT FROM AUTHOR]

A substantial minority of veterans struggle as they reintegrate into civilian life, reporting problems with vocational attainment, legal/financial/housing challenges, physical and mental health conditions, and social/interpersonal issues. While there are thousands of programs and services offered to veterans, little is known about which ones they use. In the current exploratory study, veterans separated from active duty in the prior three-months (48,965) were invited to complete a survey. Two primary questions were addressed: What programs/services did veterans use to assist in their reintegration to civilian life? What specific components/attributes of those programs did veterans report using? A total of 9566 veterans completed the survey. Approximately, two-thirds of veterans used at least one program to enhance their well-being, while one-third reported using multiple programs across multiple domains. Veterans primarily sought assistance for employment and educational advancement. Fewer veterans sought assistance for legal/financial/housing, health, and social functioning challenges. Social service providers and policy makers should be aware of the resources veterans use as they reintegrate into civilian life. Future research should examine factors that predict the use and nonuse of veteran reintegration programs, how use changes over time, and what factors predict program/service use, particularly among veterans at risk for poor transition outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Digitally delivered, parent-focused interventions (DD-PFIs) are viewed as an important method for supporting child well-being. Few DD-PFIs include health-promotion and general-parenting content, and only some are intended for a universal audience. The purpose of this paper is to focus on a preliminary evaluation of Grow Online, which was designed to address this gap. Design/methodology/approach: A mixed-methods design, including pretests and posttests and semi-structured interviews, was employed to evaluate program feasibility and demonstrate proof of concept. Findings: Feasibility findings were favorable, which indicates participants were satisfied with the program, liked the main program features, found the content helpful and had a positive experience using the website. Initial recruitment was strong, and engagement with the sessions was high; however, retention was poor with a 73.5 percent attrition rate. Significant pre- to post-changes were found on measures of over-reactive discipline, parenting efficacy, emotion coaching, coping socialization, child physical activity support, rewarding eating and child externalizing and internalizing behaviors. Research limitations/implications: Study design and high attrition limit the ability to infer causality and generalize beyond the sample. Practical implications: Providing support to parents through a universal health-promoting DD-PFI is viable, though issues involving retention need to be given full consideration. Originality/value: Parents use of technology to access child care information is increasing, but most information online is not evidence-informed. Grow Online fills an important gap in the research and practice of DD-PFIs, and this study's findings suggest a more rigorous evaluation is merited. [ABSTRACT FROM AUTHOR]

Transitioning from military to civilian life is challenging for a substantial number of veterans. Successful transitions require veterans to function well in various well-being domains including employment, education, financial, health, and social relationships. There are many programs and services designed to assist veterans transition to civilian life. However, veterans rarely avail themselves of supportive resources. This study examined veteran nonuse of programs and services within the first three months of their transition to civilian life. Results revealed that male veterans often reported that they did not need programs. Female veterans and veterans from the lowest enlisted ranks were more likely to report that they did not know if they were eligible for support programs. A small percentage of veterans indicated they had not found the right program or did not know where to go to get help. Veterans need clear information about available programs, eligibility requirements, where to locate them, and how to identify which programs will benefit them. Future research should focus on what predicts veteran use of programs and services, how use changes over time, and how programs and services should be advertised/marketed to different veteran populations, particularly those at risk for poor transition outcomes. [ABSTRACT FROM AUTHOR]

The negative effects of military work-related parental absences on military families and military children in particular have been detailed in the literature. Family adjustment to increased stress during deployment is influenced by the family's perceptions of the stressors. In the study reported in this article, military spouses (N = 79) were interviewed so researchers could gain an understanding of the spouses' perceptions of the effects (for example, concerns, unmet needs) of military work-related parental absences on the overall family system and could identify contextual risk and protective factors that contribute to the well-being of children in military families. Results are presented as percentages of spouses' theme responses and exemplary quotes. Unmet needs included individual child counseling, parental-absence support programs, age-specific programming for children, child care needs, availability of parenting programs, lack of awareness of programs for students and parents, and supports for exceptional family members. Recommendations for schools to meet these unmet needs are provided following a tiered support framework to better support military families during parental absences. [ABSTRACT FROM AUTHOR]

Background: We developed and validated the Well‐Being Inventory (WBI) to address the need for a tool that can provide a comprehensive assessment of key aspects of military veterans' lives. This multidimensional instrument assesses status, functioning, and satisfaction with regard to vocation, finances, health, and social relationships. Methods: Two large multi‐phase studies (Study 1 Ns = 301, 286; Study 2 Ns = 9,566, 7,342) were conducted to develop and validate this tool among military veterans. Results: Confirmatory factor analyses supported the proposed factor structure, with separate factors observed for all scales except the health functioning scale, which was best represented as three factors rather than a single factor. Cronbach's alphas were satisfactory, with an average alpha of 0.86. Most WBI measures discriminated among individuals with and without mental health conditions and demonstrated expected declines among those with a new mental health condition. Conclusions: This study provides initial evidence for the reliability, validity, and sensitivity to change of the WBI. This tool can be used to provide insight into areas in which military veterans would benefit from additional support and inform efforts to promote the well‐being of this population. Given its broad focus, it may also prove useful with other civilian populations. [ABSTRACT FROM AUTHOR]

Objective: Over the past few decades, women's roles in the United States military have expanded significantly. Currently women encounter more wartime experiences during deployment than in the past. Previous research with male service members has linked exposure to wartime events to subsequent development of post-traumatic stress disorder (PTSD) symptoms. However, because of the unique experiences of military women, research is needed to better understand the link between wartime experiences and mental health in female personnel. Methods: We examined the wartime experiences of deployed, active-duty female Airmen and their relations to PTSD. A large representative sample of active-duty female Air Force personnel, who responded to the U.S. Air Force Community Assessment Survey (CAS), was used to determine the relationships between wartime experiences and symptoms of PTSD. Previous research suggests the possibility that factors, including unit cohesion and self-efficacy, may mediate these relations. Results: Descriptive analyses indicate that the percentage of personnel experiencing PTSD symptoms increased as the number of wartime experiences increased. Logistic regression analyses revealed that wartime experiences were positively related to subsequent PTSD-related symptoms. Both unit cohesion and self-efficacy were negatively related to PTSD symptoms, but neither variable was found to moderate the relationship between wartime experiences and PTSD. Conclusions: Women are experiencing greater numbers of wartime experiences. Like men, as the number of wartime experiences increases, PTSD symptoms increase as well. Self-efficacy and unit cohesion were found to lower these symptoms, indicating that these factors may help decrease the negative impact of wartime experiences. [ABSTRACT FROM AUTHOR]

Objective: Using an ecological resilience model, we sought to identify protective factors that buffer against the effects of stressful deployment‐related experiences on symptoms of posttraumatic stress disorder (PTSD) among active duty U.S. Air Force personnel who were married or in a committed relationship. Background: Stressful deployment experiences are associated with PTSD symptoms among active duty military personnel. However, certain protective factors may buffer against negative effects of such experiences. Method: Analyses for the present study were active duty military personnel who completed the 2011 Air Force Community Assessment Survey, were married or in a committed relationship, and had completed at least one deployment at the time of the survey (N = 12,166). Results: Regression analyses indicated that stressful deployment experiences were statistically related to elevated PTSD symptoms but also that both personal and contextual factors moderated those symptoms. Furthermore, self‐efficacy, family coping, spouse/partner support, financial resources, and religious participation moderated the relation between stressful deployment experiences and PTSD symptoms. Conclusion: PTSD symptoms were positively associated with stressful deployment experiences, and symptoms were less likely to occur when service members experienced support from individual, family, and community sources. Implications: Interventions that promote self‐efficacy and social support from multiple ecological contexts may help reduce PTSD symptoms among combat‐exposed Air Force personnel. [ABSTRACT FROM AUTHOR]

Abstract: Fathering in the military context has been studied for decades. The general approach to this research has mirrored the way in which civilian fathering was studied, with an original emphasis on the deficiencies among fathers as parents, eventually giving way to examining the benefits of father involvement. Largely in the past decade, research has begun to examine the strengths of military fathers and how they can thrive as parents even as they live in a challenging work context. This review examines the literature on fathering in the military. In addition, the article encourages future research on military fathers to use more of a strengths‐based approach. Moreover, virtually nothing is known about civilian fathers who coparent with a service member. Future research should address this gap in understanding the full range of military family formations. [ABSTRACT FROM AUTHOR]

Purpose Parent-focused interventions (PFIs) are a promising method for supporting parents and promoting children’s well-being. Few PFIs in the USA, however, include physical health promotion content and are universal programs. The purpose of this paper is to describe a universal health-promoting PFI for parents of elementary school-aged children and demonstrate proof of concept.Design/methodology/approach The program emphasizes positive parenting practices, stress management skills and physical health promotion strategies and recommendations, and is part of a larger initiative that includes a continuum of universal, developmentally appropriate, health-promoting PFIs for civilian and military parents. The program was implemented at two community sites in rural Pennsylvania with 20 civilian parents completing pretests and posttests. Study measures assessed parenting, stress and stress management and physical health promotion related outcomes.Findings Parents reported decreases in suboptimal discipline and feeding practices, stress and child internalizing behavior. They also reported increases in their sense of control in managing child behavior, coping socialization, child’s outdoor playtime and health recommendations met.Research limitations/implications While these preliminary findings may not be generalizable, they serve as proof of concept, which suggests that more rigorous research on the program is warranted.Practical implications Implementing a universal, health-promoting PFI within the USA is viable and has the potential to impact multiple short-term outcomes.Originality/value Parents are among their child’s earliest and most influential educators, and this study lends further support to their role as health educators. Given the significant public health benefits of holistically promoting child health, the time has come for universal PFIs to begin including physical health promotion content. [ABSTRACT FROM AUTHOR]

Purpose Efforts to promote the health and well-being of military veterans have been criticised for being inadequately informed of veterans' most pressing needs as they separate from military service, as well as the programmes that are most likely to meet these needs. The current article summarises limitations of the current literature and introduces The Veterans Metrics Initiative (TVMI) study, a longitudinal assessment of US veterans' well-being and programme use in the first three years after they separate from military service. Veterans were assessed within 3 months of military separation and will complete five additional assessments at 6-month intervals during the subsequent period. Participants The TVMI study cohort consists of a national sample of 9566 newly separated US veterans that were recruited in the fall of 2016. Findings to date The TVMI sample includes representation from all branches of service, men and women, and officers and enlisted personnel. Although representative of the larger population on many characteristics, differential response rates were observed for some subgroups, necessitating the development of non-response bias weights. Comparisons between unweighed and weighted results suggest that the weighting procedure adequately adjusts for observed differences. Future plans Analyses are under way to examine veterans' well-being and programme use in the period following separation after military service, as well as factors associated with poor outcomes. We have also begun to decompose programmes into their core components to facilitate examination of how these components relate to well-being. Once our third data collection is complete, we will examine factors related to different patterns of readjustment over time. [ABSTRACT FROM AUTHOR]

The PROSPER model uses a three-tiered community partnership, university researcher, and Cooperative Extension-based technical assistance system to support the delivery of evidence-based interventions in communities. This study examines the trajectory and predictors of the collaborative relationship between technical assistance providers and community teams across the three phases of organization, implementation, and sustainability. Members of 14 PROmoting School-university-community Partnerships to Enhance Resilience (PROSPER) community teams and directors of local agencies rated communities' levels of readiness and adolescent substance use norms. Technical assistance providers rated their collaborative relationship with their teams at 14 occasions across 4.5 years. Results from mixed models show that levels of collaboration were stable until the sustainability phase, when they increased significantly. Team differences in change were significant during the implementation phase. Community readiness predicted levels of the collaborative relationship over time: high community readiness was associated with a high level of collaboration during organization, but a decline in collaboration during implementation. These results provide a more nuanced understanding of the relationship between technical assistance provision and community prevention teams and lead to recommendations to improve dissemination models to achieve a greater public health impact. [ABSTRACT FROM AUTHOR]

Violence in military families remains a vexing problem. Since the advent of the Global War on Terror, there is inconsistent evidence that the prevalence of family violence is increasing, particularly during and after military deployments. However, child neglect appears to increase significantly during military deployments. The military has developed family advocacy programs designed to keep families safe and intervene to reduce the deleterious effects of exposure to family violence. This is one of the first studies to examine the quality with which a family advocacy program is implemented and the degree to which families engage with the program. To conduct this study, the case files of 226 families who came in contact with the Army Family Advocacy Program (FAP) and whose cases were closed in 2013 were reviewed and coded across several implementation and service outcomes. These included involvement of qualified staff, whether or not appropriate victim and offender assessments were completed, degree of inter-agency communication, and appropriateness of referrals, among others. Soldier and family member participation in FAP and other Army-sponsored programs designed to reduce violence was also assessed. Generally speaking, the Army Family Advocacy Program was implemented with high quality, established processes and procedures for handling cases were largely followed, and FAP staff responded rapidly and thoroughly to reported abuse. However, family engagement with Army services and supports was low. Developing robust approaches to engaging families in family programming must be a high priority going forward. [ABSTRACT FROM AUTHOR]

The present study uses an ecological systems perspective to examine how parental involvement in school-related activities in sixth grade influences early adolescents’ school bonding and academic achievement in eighth grade. Results of multilevel models of multiple data sources (i.e., adolescents, parents, and principals) suggested that parents’ involvement in school, as reported by the adolescent in sixth grade, was a significant predictor of school bonding and academic grades in eighth grade. Furthermore, parent reports of guidance, support, and involvement in school and non-school activities were unrelated to their adolescents’ grades and school bonding. Finally, schools’ efforts to engage parents did not consistently predict an association between parental involvement and adolescent outcomes. [ABSTRACT FROM AUTHOR]

The increasing popularity of the Internet and social media is creating new and unique challenges for parents and adolescents regarding the boundaries between parental control and adolescent autonomy in virtual spaces. Drawing on developmental psychology and Communication Privacy Management ( CPM) theory, we conduct a qualitative study to examine the challenge between parental concern for adolescent online safety and teens' desire to independently regulate their own online experiences. Analysis of 12 parent-teen pairs revealed five distinct challenges: (a) increased teen autonomy and decreased parental control resulting from teens' direct and unmediated access to virtual spaces, (b) the shift in power to teens who are often more knowledgeable about online spaces and technology, (c) the use of physical boundaries by parents as a means to control virtual spaces, (d) an increase in indirect boundary control strategies such as covert monitoring, and (e) the blurring of lines in virtual spaces between parents' teens and teens' friends. [ABSTRACT FROM AUTHOR]

This study examined how participation in a universal family skills-building program may interact with community risks and resources to produce youth outcomes. Prior research has noted community-level variability in risk and protective factors, but thus far no study has examined the role that participation on a community-wide intervention may play in moderating the effects of community risks or resources. The study included 14 communities (seven in Iowa, seven in Pennsylvania) that implemented a family focused evidence-based program as part of the PROSPER project. Community level variables included both risk factors (percent of low income families, the availability of alcohol and tobacco, norms regarding adolescent substance use, incidence of drug-related crimes) and community resources (proactive school leadership, availability of youth-serving organizations, and student involvement in youth activities). The proximal youth and family outcomes included youth perceptions of their parents' management skills, parent-child activities, and family cohesion. Results indicated that the Strengthening Families Program:10-14 may have moderated the impact of the community risks and resources on community-level youth outcomes; risk levels meaningfully associated with community-level change in program participants, though these results varied somewhat by outcome. Generally, higher levels of resources also meaningfully associated with more positive change after participating in the family-focused intervention. These results suggest that the effect of some evidence-based programs may be even stronger in some communities than others; more research in this area is needed. [ABSTRACT FROM AUTHOR]

This study examined the relations among three different types of naturally occurring social support (from romantic partners, friends and neighbors, and unit leaders) and three indices of service member well-being (self reports of depressive symptoms, satisfaction with military life, and perceptions of unit readiness) for service members who did and did not report negative experiences associated with military deployment. Data were drawn from the 2011 Community Assessment completed anonymously by more than 63,000 USAF personnel. Regression analyses revealed that higher levels of social support was associated with better outcomes regardless of negative deployment experiences. Evidence of moderation was also noted, with all forms of social support moderating the impact of negative deployment experiences on depressive symptoms and support from unit leaders moderating the impact of negative deployment experience on satisfaction with military life. No moderation was found for perceptions of unit readiness. Subgroup analyses revealed slightly different patterns for male and female service members, with support providing fewer moderation effects for women. These findings may have value for military leaders and mental health professionals working to harness the power of naturally occurring relationships to maximize the positive adjustment of service members and their families. Implications for practices related to re-integration of post-deployment military personnel are discussed. [ABSTRACT FROM AUTHOR]

Purpose – Military-connected students experience a high rate of parental absence due to their parents’ military obligations. Military work-related parental absences can affect school-aged children’s emotional and behavioural health and overall academic functioning. The paper aims to discuss this issue. Design/methodology/approach – The current review identified research studies that explored the effects of military-connected parental absence on school-aged children. Specifically, quantitative and qualitative research studies that examine the impact of military parental absences on dependent variables related to internalising and externalising behaviours and academic functioning were of interest. In all, 26 studies were identified for inclusion in the review. Findings – Overall, military-connected students who experience a parental absence due to military service are more likely to exhibit an increase in problem behaviours and a decrease in academic functioning compared to civilian peers or military-connected peers who were not experiencing parental absence. Originality/value – The current review elucidates parental absence within the military context, highlighting key factors that may contribute to increased and decreased behavioural and academic functioning of military-connected students. Results from the review in relation to risk and protective factors for military-connected students, future research and school programming directions are discussed. [ABSTRACT FROM AUTHOR]

An emerging literature highlights the potential for broader dissemination of evidence-based prevention programs in communities through existing state systems, such as the land grant university Extension outreach system and departments of public education and health (DOE-DPH). This exploratory study entailed surveying representatives of the national Extension system and DOE-DPH, to evaluate dissemination readiness factors, as part of a larger project on an evidence-based program delivery model called PROSPER. In addition to assessing systems' readiness factors, differences among US regions and comparative levels of readiness between state systems were evaluated. The Extension web-based survey sample N was 958 and the DOE-DPH telephone survey N was 338, with response rates of 23 and 79 %, respectively. Extension survey results suggested only a moderate level of overall readiness nationally, with relatively higher perceived need for collaborative efforts and relatively lower perceived resource availability. There were significant regional differences on all factors, generally favoring the Northeast. Results from DOE-DPH surveys showed significantly higher levels for all readiness factors, compared with Extension systems. Overall, the findings present a mixed picture. Although there were clear challenges related to measuring readiness in complex systems, addressing currently limited dissemination resources, and devising strategies for optimizing readiness, all systems showed some readiness-related strengths. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND While demand for youth violence prevention programs increases, the ability of the school-day schedule to accommodate their time requirements has diminished. Viable school-based prevention programs must strike a balance between brevity and effectiveness. This article reports results from an effectiveness trial of a 12-session curriculum-based universal violence prevention program that promotes healthy conflict resolution skills among urban adolescents. METHODS Using a review of program record data and a multisite quasi-experimental study design, we examined the effectiveness of a New York City-based violence prevention program entitled the Violence Prevention project (VPP) optimized to meet school needs. We analyzed survey data from 1112 9th- and 10th-grade students in 13 New York City public high schools across 4 consecutive school years. Both participants and nonparticipants were surveyed. RESULTS Review of program record data indicated that the program was implemented with acceptable fidelity to the core component structure, and that participant responsiveness to the model was high. Multilevel modeling indicated that VPP participation was protective for academic self-concept and promoted conflict resolution skills. CONCLUSIONS Findings indicate that semester-long violence prevention programs optimized to meet the needs of a typical high school can be effective at promoting healthy conflict resolution skills in urban adolescents. [ABSTRACT FROM AUTHOR]

Partner abuse (PA) is a public health problem that affects a significant number of families. Experiencing PA places victims at risk for a variety of negative outcomes, including substance use or abuse, depression, post-traumatic stress disorder, and, in extreme cases, permanent injury or death. Furthermore, children who are exposed to PA are at risk for problems in the areas of cognitive functioning, self-esteem, psychological and emotional well‐being, interpersonal relationships, and behavior. Most of what is known about PA has accrued through studies of civilian families. In this article, the authors report the results of an in depth review of the epidemiology of PA in each branch of the military. Results revealed that most studies of the military have been conducted with Army families. Rates of nonclinically significant PA are higher in military samples than civilian samples. Men and women connected to the military engage in rates of mild to moderate PA at similar rates. Males in the military engage in more violent PA than do women. These findings are discussed within a prevention and risk/resilience framework. Practical suggestions for clinicians working with military personnel and families and ideas for future research are provided. [ABSTRACT FROM AUTHOR]

Collective efficacy refers to a perceived sense of connectedness and willingness to intervene among youth, and is a potential aspect of positive youth development (Larson in Am Psychol 55:170-183, ; Lerner et al. in Child Dev 71:11-20, ; Sampson et al. in Science 277:918-924, ). Theoretically, those who feel connected to a group that is empowered to positively influence the behavior of their peers may demonstrate fewer problem behaviors. Few studies, however, have measured the impact of youth perceptions of collective efficacy. As a relatively new child-related research topic, there is much to be learned. One contribution to the foundation of this research agenda begins by evaluating the reliability and validity of a measure of collective efficacy with elementary children attending community-based afterschool programs. This paper describes the internal consistency reliability and various indicators of construct and concurrent validity of the Collective Efficacy Among Children Scale. The measure was found to have high internal consistency reliability. Construct validity was tested using exploratory factor analyses of collective efficacy including the dimensions of willingness to intervene and cohesion found in previous research (Sampson et al. in Science 277:918-924, ). Concurrent validity assessed relations between the scale and other measures in theoretically congruent ways. Using Hierarchical Linear Models to account for children's nestedness in after-school programs, connectedness was found to be more related to emotional adjustment, particularly children's prosocial attitudes (caring about others and sharing). Children's perception of the willingness of the group to intervene was found to be related to less problem behavior, (i.e. smoking tobacco, drinking alcohol, vandalism, and stealing). The implications suggest that future research should further explore children's collective efficacy, and ways to foster its development in youth-serving afterschool settings. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND While demand for youth violence prevention programs increases, the ability of the school-day schedule to accommodate their time requirements has diminished. Viable school-based prevention programs must strike a balance between brevity and effectiveness. This article reports results from an effectiveness trial of a 12-session curriculum-based universal violence prevention program that promotes healthy conflict resolution skills among urban adolescents. METHODS Using a review of program record data and a multisite quasi-experimental study design, we examined the effectiveness of a New York City-based violence prevention program entitled the Violence Prevention project (VPP) optimized to meet school needs. We analyzed survey data from 1112 9th- and 10th-grade students in 13 New York City public high schools across 4 consecutive school years. Both participants and nonparticipants were surveyed. RESULTS Review of program record data indicated that the program was implemented with acceptable fidelity to the core component structure, and that participant responsiveness to the model was high. Multilevel modeling indicated that VPP participation was protective for academic self-concept and promoted conflict resolution skills. CONCLUSIONS Findings indicate that semester-long violence prevention programs optimized to meet the needs of a typical high school can be effective at promoting healthy conflict resolution skills in urban adolescents. [ABSTRACT FROM AUTHOR]

Military families face a number of unique challenges, including frequent relocations and school transitions, as well as extended separations from loved ones. The military, schools, and communities have been working together to build the capacity of children, youth, and families to successfully cope with the stressors they encounter. Most branches of the military have instituted liaison programs within schools and communities to help military school-aged children make more seamless transitions from one school to another due to relocations. This study assessed the thoughts and perceptions of U.S. Marine Corps (USMC) school liaison professionals (SLs) regarding their work with a broad array of stakeholders, both on- and off-base. Generally, SLs expressed positive sentiments regarding the USMC liaison program. They also reported that they were working hard at developing stronger connections to various constituencies in position to assist military families. Unfortunately, there was some indication that SLs may be at risk for burnout. Given the needs of military children, youth, and families, SLs appear to be filling an important function that could enhance military-school-community partnerships. © 2011 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

This study combines research documenting the benefits of positive relationships between youth and caring adults on a young person’s positive development with studies on youth voice to examine the mechanisms through which participation in youth programs contributes to positive developmental outcomes. Specifically, the study explores whether youth’s perceived quality relationships with adults contribute to strengthening of youth voice and in turn how the two combine to affect youth’s perception of the benefits of program participation. The findings derived from survey data regarding 748 youth who participated in youth—adult partnership programs in 29 states suggest that young people who develop positive relationships with adults perceive they have more voice in the program and in turn perceive more benefits to program participation. Implications for research and practice are presented. [ABSTRACT FROM PUBLISHER]

This study examined factors associated with the predicted and actual post-funding sustainability of evidence-based interventions implemented as part of the Pennsylvania Commission on Crime and Delinquency’s Research-Based Delinquency and Violence Prevention Initiative. Correlates of predicted post-funding sustainability included program staff, overall school support, and school administrator support. Additionally, predicted post-funding sustainability was strongly associated with actual post-funding sustainability. Other correlates of actual post-funding sustainability included financial sustainability planning and aligning the intervention with the goals of the agency/school. Five years post-funding 33% of the interventions were no longer operating, 22% were operating at a reduced level, and 45% were operating at the same level or a higher level than the final year of funding. These findings are discussed in terms of implications for increasing intervention sustainability, as well as implications for future research on intervention sustainability. [ABSTRACT FROM AUTHOR]