Parenting-STAIR Modular: A randomized controlled trial of a trauma-focused parenting intervention for military-connected mothers and their children

Abstract: BACKGROUND: Military-connected mothers (MCM; mothers who are either service members or veterans or spouses of a service member or veteran) experience significant trauma exposure associated with post-traumatic stress symptoms and ultimately deficits in parental functioning. Maternal trauma and its mental health and functional sequelae can have significant consequences for children, including adverse mental health outcomes. Existing evidence-based treatments (EBT) available to MCM to address trauma have not been adapted for military culture and do not fully resolve symptoms or address the bidirectional relationship between symptoms and parental functioning. In this project, preliminary data will be collected on a newly adapted version of an innovative intervention: Parenting-STAIR Modular (PSTAIR-M), which addresses trauma symptoms and parenting among MCM. PSTAIR is a novel intervention, combining two existing EBTs: Skills Training in Affective and Interpersonal Regulation Narrative Therapy (STAIR), targeting maternal emotion dysregulation and mental health symptoms, and dyadic Parent-Child Care (PC-CARE), targeting parental functioning. METHODS: This study is a two-arm randomized controlled trial in which we will randomly assign N = 120 trauma-exposed MCM who exhibit elevated symptoms of PSTD or depression and/or low parenting self-efficacy, and one identified child (ages 2-10) to PSTAIR-M or treatment as usual. This trial will be conducted at three community mental health clinics operated by the Cohen Veterans Network. Assessments will occur at three timepoints: (1) Pretreatment, (2) mid-treatment (following session 11 in the treatment condition), and (3) posttreatment (following session 16 in the treatment condition). Assessments will include data on mental health and parenting outcomes as well as mechanisms which may account for observed effects of PSTAIR-M. Each assessment will also include a dyadic observation of mother and child, independently coded to capture parenting skills. DISCUSSION: Data collection will establish initial efficacy and will set the stage for further study of this intervention. Successful treatment with an efficient, personalized intervention has the potential to prevent adverse outcomes for MCM and their children and to interrupt the intergenerational cycle of trauma in military family systems. TRIAL REGISTRATION: ClinicalTrials.gov NCT06262178. Registered on February 15, 2024.