Improving Outcomes for Military Families with Young Children: Effects of a Novel Dyadic Coaching-Based Parenting Intervention in Two Exploratory Case Studies

Abstract

This article presents an intervention model for military families with young children reintegrating after deployment that aims to strengthen parent-child relationships and improve family outcomes. The Coaching and Parent Emotion Support (CaPES) program integrates emotion and behavioural regulation principles, within an intensive, dyadic, coaching-based delivery format. We outline the application and outcomes of CaPES in two case studies of Australian Defence Force (ADF) families. The results offer preliminary evidence of the efficacy of CaPES in improving parent-child relationship quality, parental mental health and wellbeing, and children’s behavioural and emotional outcomes in military families with young children.

Keywords:

• Coaching and parent emotion support (CaPES) program
• intervention
• reintegration
• military families

Military families are resilient, but a growing body of literature has documented the psychosocial impact of deployment and reintegration on military children, spouses and serving members. Systematic reviews have highlighted the pervasive and negative impact of deployment and reintegration on parental and child mental health, parenting, and parent-child relationships (Creech et al., 2014; Trautmann et al., 2015). Military deployment is associated with elevated emotional and behavioural problems in children, increased stress and mental health problems in parents, and a greater likelihood of child maltreatment (Chartrand et al., 2008; Siebler & Goddard, 2014; Trautmann et al., 2015). Unfortunately, the challenges faced by military families do not appear to simply resolve when the service member returns home.

Reintegration brings new and enduring challenges for all members of a family (Risi et al., 2023). Parents report that children cope less well during reintegration than deployment periods (Orthner & Rose, 2005) and that the emotional and behavioural difficulties that began during deployment can endure for years post-deployment (Barker & Berry, 2009). For both service members and non-deployed parents, reintegration brings challenges associated with rebuilding parent-child relationships, parenting, role shifts, re-establishing routines, and navigating the aftermath of trauma exposure (DeVoe & Ross, 2012; Gewirtz et al., 2014a; Risi et al., 2023, Walsh et al., 2014). Increased levels of stress are frequently reported by parents during reintegration (Risi et al., 2023; Walsh et al., 2014), which impacts parenting practices (Gliske et al., 2019). Stress makes it difficult for any parent to provide consistent quality caregiving and effective parenting practices, as evidenced by well-documented associations between parental stress and less sensitive caregiving (Evans et al., 2008; Feldman et al., 2004), maladaptive parenting practices (Guajardo et al., 2009) and authoritarian discipline (Deater-Deckard & Scarr, 1996).

Young children, those five years of age and under, are disproportionately represented in military families internationally (Australian Institute of Family Studies, 1993; Department of Defense, 2020). The rapid and profound development that occurs during the first five years of a child’s life, notably the establishment of attachment relationships with primary caregiver/s (Bowlby, 1982), leaves military families with young children particularly vulnerable to psychological and relational challenges during deployment and reintegration (Louie & Cromer, 2014). Indeed, disruptions in parent-child relationships during reintegration have been reported by military families with young children (Risi et al., 2023), as deployment appears to interfere with children’s opportunities to develop and maintain relationships with their deployed parent (Paris et al., 2010). Since the early relationships children have with their caregivers are essential for cognitive, social, emotional, and physical development (Bowlby, 1982), supporting families post-deployment to rebuild parent-child relationships and reconnect as a family is imperative for the life-long functioning of military children.

Despite an abundance of evidence-based parenting programs in the civilian world, there is a lack of empirically supported interventions tailored for military families reintegrating after deployment (Gewirtz, McMorris, et al., 2014). The Families OverComing Under Stress program (FOCUS; Lester et al., 2012) and the After Deployment, Adaptive Parenting Tools program (ADAPT; Gewirtz, Pinna, et al., 2014) are perhaps the most established interventions designed for military families. Although they have demonstrated positive outcomes for families with children as young as three (Gewirtz et al., 2018; Lester et al., 2012, 2016), they were not designed to specifically target families with young preschool-aged children and therefore may not optimally address the challenges most salient for this key developmental period (Julian et al., 2018). They also rely heavily on behavioural parent training (BPT). BPT is derived from social learning theory, which posits that child behaviours are strengthened and weakened through parent reinforcers (Kazdin, 1997). BPT interventions have a large evidence base supporting their effectiveness in increasing parenting skills and reducing problematic child behaviours (Lee et al., 2012; Maughan et al., 2005), however an estimated 30 to 40% of families who complete these programs do not experience clinically significant improvement (Forehand et al., 1984; Ollendick et al., 2016; Webster-Stratton, 1990a, 1990b). A range of factors that may impact treatment success have been identified, with parents’ own mental health representing a critical factor moderating the effectiveness of BPT interventions (Maliken & Katz, 2013). While addressing parental psychopathology more directly may be a way to enhance the effectiveness of BPT, evidence suggests it may be more parsimonious to use a transdiagnostic approach in informing treatment development (Maliken & Katz, 2013). The transdiagnostic model of psychopathology theorises that disruptions in emotions and emotion regulation processes underlie multiple forms of psychopathology (Barlow et al., 2004; Nolen-Hoeksema & Watkins, 2011). Thus, explicitly addressing and improving parents’ emotion regulation capacities may help more families benefit from BPT (Maliken & Katz, 2013).

Specifically developed interventions for military families with young children include the Strong Families Strong Forces program (SFSF; DeVoe et al., 2017) and the Strong Military Families program (SMF; Julian et al., 2018). SFSF is an 8-module program that aims to mitigate the effects of deployment-related stressors by targeting parental reflective functioning as a mechanism to enhance parents’ awareness of and sensitivity toward their child (DeVoe et al., 2017). Sessions are delivered to individual families in their home, although children are not actively involved. Results from a US Department of Defense funded randomised control trial (RCT), consisting of 115 service members and their children as well as 103 civilian partners, demonstrated service member who participated in SFSF reported greater reductions in parenting stress and mental health distress (DeVoe et al., 2017). There were no significant program effects on parenting stress or depression for civilian partners who participated in SFSF, however a meaningful reduction in anxiety was observed (Ross et al., 2020). SMF, on the other hand, is a 13-session parenting and self-care skills group that aims to promote military family protective factors and resilience across deployment and reintegration (Julian et al., 2018). The program is held in the format of a weekly parent psychoeducation group and a concurrent children’s group that focuses on child-led play. Although limited in its outcome data, participation in SMF has demonstrated improvements in parenting reflectivity in both the service member and civilian parent of military families (Julian et al., 2018).

The aforementioned parenting programs for military families have all been developed and implemented in the US. Looking outside of the US, specifically developed interventions for military families is sparse. In Australia, the Australian Defence Force (ADF) offers the FamilySMART program (Australian Government, n.d.). The program is delivered by ADF social workers to small groups of military parents, and covers topics related to challenges of separation, maintaining relationships during the deployment cycle, stress management, and self-care (Australian Government, n.d.). A review of the literature, however, revealed a lack of peer-reviewed outcome studies into the FamilySMART program or any other parenting interventions for Australian military families with young children reintegrating after deployment.

Military families with young children evidently benefit from intervention programs aimed to support them. However, the need for the development of and research into additional interventions to strengthen parenting and parent-child relationships in military families with young children to mitigate the impacts of deployment and reintegration remains pronounced. The existing programs have shown promising results, however, they are limited by their emphasis on BPT, lack of child involvement, absence of real-time skill practice for parents, and reliance on self-report measures of parenting. With the transdiagnostic model of psychopathology in mind, CaPES was developed to support parent’s own emotion regulation by integrating emotion and behavioural regulation principles from mindful parenting, mentalisation-based therapy, emotion coaching, and Parent-Child Interaction Therapy (PCIT; Eyberg, 1988), with the aim to help parents better implement BPT skills.

The challenges military families with young children face during reintegration, such as managing stress and trauma exposure and the rapid socio-emotional development of young children, suggest interventions that focus on emotion regulation, like CaPES, would be advantageous. In particular, mindfulness has been suggested as a possible useful approach to help military parents as they cope with stress and challenges associated with deployment and reintegration (Gliske et al., 2019). Mindful parenting has been found to be positively correlated with high-quality, positive parent-child relationships and interactions (Duncan et al., 2015; Moreira et al., 2018). Gliske et al. (2019) suggested that mindfulness practices, such as listening with full attention, nonjudgmental acceptance, self-regulation, and emotional awareness, may increase military parents’ capacity for self-reflection while reducing parental reactivity in parent-child interactions. Broadly, mindfulness has been shown to be a helpful mechanism to moderate parents’ emotions and responses, with mindfulness-based parenting programs demonstrating positive effects on parental engagement, stress and distress, and parent and child psychopathology (Anand et al., 2023; Kil & Grusec, 2020; Meppelink et al., 2016).

Mentalising may also be important for military families. Mentalisation refers to an individual’s capacity to make sense of their own and others’ feelings and behaviours in terms of underlying mental states (Bateman & Fonagy, 2013). Since feeling misunderstood can cause distress and chronic parent-child relationship problems, difficulties in mentalising can have a pervasive effect on a family’s capacity to function effectively (Asen & Fonagy, 2012). Parents who have higher mentalising abilities have been shown to use more positive parenting skills, have better communication with their child, and better tolerate their child’s distress (Rostad & Whitaker, 2016; Rutherford et al., 2015). Stress, however, can impair mentalising, as it is difficult to think about the thoughts and feelings of others when operating in a fight-flight mode (Santelices & Cortés, 2022). Targeting mentalisation capacities in military family interventions may therefore be a useful way to improve the social and emotional functioning of all members, subsequently positively impacting parent-child relationships.

Parent mentalising may enable and support helpful emotion coaching for military families. Emotion coaching involves supporting parents to coach their child to increase their emotion recognition and regulation skills (Gottman et al., 1996). Positive emotion coaching skills for parents include holding an accepting attitude toward their child’s emotions, acknowledging their child’s emotions, and verbally coaching their child to understand, express, and manage their own emotions (Gottman et al., 1996). The principles of emotion coaching have been included in existing military family interventions, specifically the ADAPT program, with promising results. Among a sample of post-deployed military families with a child aged 4 to 13 years, Zhang et al. (2019) found that parents randomly assigned to the intervention showed greater improvements in parental emotion socialisation, which were in turn related to lower child internalising problems, than controls. The authors concluded that parent emotion socialisation, based on the same principles of emotion coaching, is a malleable skill that should be targeted in military family interventions because of the evidence that parent’s emotion coaching practices benefit children in various critical domains over the long term (Zhang et al., 2019).

Interventions that incorporate real-time parent coaching, like PCIT (Eyberg, 1988), have demonstrated the efficacy of therapists acting as parents’ emotion coaches. PCIT is a parent training program for families with young children that demonstrates robust positive outcomes across multiple parent-reported and observed parent-child interaction measures in diverse populations, including military families (Cooley et al., 2014; Gurwitch & Messer, 2018; Thomas et al., 2017). PCIT uses real-time, in-session parent coaching to facilitate parental self-regulation and skill acquisition during sessions (Eyberg & Funderburk, 2011). Real-time coaching serves as a source of real-time regulatory support, as therapists provide parents with intensive social regulation that encourages emotion regulation while they are actively practicing new parenting skills with their child (Skowron & Funderburk, 2022; Woodfield & Cartwright, 2020). Real time coaching of parents has been shown to improve parenting skills and treatment outcomes (Kaminski et al., 2008; Shanley & Niec, 2010).

Broadly speaking, by integrating BPT with modifiable transdiagnostic parenting factors to increase emotion regulation capacities within a more intensive, dyadic, coaching-based delivery format, CaPES seemingly addresses many of the limitations of the existing interventions targeting military families with young children.

The overarching aim of this study was to provide a preliminary exploration of CaPES as an intervention to strengthen parent-child relationships and support family’s post-deployment in military families with young children. Below, we report on the outcome data for two families from the Australian Defence Force (ADF) who completed a multi-time point case study design study examining the effects of CaPES on parent-child relationships, parental mental health and wellbeing (e.g., stress, mindfulness), and children’s behavioural and emotional outcomes.

Methods

Participants

Families were recruited from the Reintegration Experiences of ADF Families project, a survey study exploring the impacts of reintegration on ADF families with young children (see Risi et al., 2023 for further information about this study and cohort). Parents who elected to be contacted to participate in further research and who met the eligibility criteria for the study were contacted about participating in the current study. The eligibility criteria was defined as follows: (1) families with a child aged between two and five years who has experienced a parent’s deployment in their lifetime; and (2) parent/s who were fluent in English. Thirteen parents were contacted (two service members and 11 civilian partners of service members) via email, with two parents (both civilian partners) replying to indicate their family’s interest in participating. Both families went on to complete the intervention program.

Clinical case descriptions

Family 1

Noah (note, all names throughout are pseudonyms to protect anonymity), a 4-year-old boy, and his servicemember father (Nathan) and civilian mother (Naomi) participated in the intervention. Noah also had an infant-aged sibling, who was not directly involved in the intervention. At the time of the study, Noah’s father was a current serving member of the ADF, and had been for the entirety of Noah’s life. Nathan had been deployed or separated from his family because of his employment with the ADF over a dozen times in Noah’s life. The majority of these separations lasted, on average, one week. The longest separation occurred when Noah was 20 months-old and his father was deployed to a war-like operation for six months. Nathan’s last deployment occurred 9 months prior to the family’s participation in the intervention and lasted 7 weeks. Short, repeated separations as well as longer deployments are typical for ADF members because of the range of peacekeeping and war-like operations, humanitarian missions, and routine and training exercises that the ADF participate in both overseas and within Australia (Australian Government, 2020). According the ADF Census, almost 85% of permanent members had spent at least one night away from home on Defence service in the previous 12 months, with the median nights spent away being 33 (Australian Government, 2020).

Noah’s mother remained his primary caregiver throughout all of his father’s deployments. Naomi and Nathan described reintegration challenges associated with parenting and co-parenting, re-distributing roles and responsibilities, and managing developmental changes. Noah was described as resilient and able to adapt quickly to his father’s returns. However, he was also reported to experience difficulties with emotion regulation. Noah was described as anxious and easily overwhelmed, particularly when his expectations were not met, and as often having emotional responses that were out of proportion for the situation. Noah’s parents’ goals for participating in the intervention were to increase their parenting skills and effective discipline practices and ‘get back on the same page’ with parenting. Noah’s mother also expressed concern that Noah’s continued separations from his father may impact their attachment. She hoped the intervention would strengthen Noah and Nathan’s relationship as a way to mitigate future impacts of deployment and reintegration on their relationship.

Family 2

Willow (pseudonym), a 2-year-old girl, and her civilian mother (Whitney) participated in the intervention. At the time of the study, Willow’s father (Whitney’s husband) was a current serving member of the ADF, and had been for the entirety of her life. Willow also had an infant sibling, who was not involved in the intervention. Willow’s father was deployed for almost the entire gestational period and the first three months of her life, with the exception of a three week return for her birth. As reported by Whitney, her father ‘didn’t know how to parent’ and struggled to develop his relationship with Willow following his return. Willow’s mother and father engaged in 12-months of integration therapy with an ADF support service to assist them at this time, with positive outcomes. Willow’s father’s first and second deployment since the aforementioned deployment occurred during the current intervention period, and he was therefore unable to participate in the study. Willow’s father was deployed for two weeks at the beginning of the intervention. He then returned home for approximately four weeks before being deployed for a further seven weeks. Willow’s mother remained her primary caregiver throughout these times. During the pre-intervention interview, Whitney reported feeling nervous for her husband’s upcoming deployments and the impacts it may have on Willow. Willow was described as an emotional child, who struggled with anxiety and frequent tantrums. Whitney’s primary goal for participating in the intervention was to learn strategies to manage upcoming separations and reunions. She also hoped to gain more parenting confidence and learn strategies to manage Willow’s challenging behaviour.

Procedure

This study used a case study design adhering to the Journal Article Reporting Standards (JARS) and following the Single-Case Reporting in BEhavioural interventions (SCRIBE) guidelines (Tate et al., 2016, 2017). The study protocol was approved by the Australian Departments of Defence and Veterans’ Affairs Human Research Ethics Committee (363-21) and a university Human Research Ethics committee (2021/421). The current study was not conducted in collaboration or affiliation with the Australian Departments of Defence and Veterans’ Affairs (DDVA) or the ADF. At the time of writing, the authors were not members of or associated with the ADF.

Each family completed a pre-intervention interview and two baseline assessments (survey and parent-child play observation session), followed by 12 weekly 1-hour CaPES treatment sessions. Parents were provided with weekly session handouts to reinforce skills. Each family rescheduled two to three sessions at different points in treatment due to illness and family emergencies. Approximately one to two weeks after the completion of the intervention sessions, each family participated in a post-intervention interview and survey. Finally, each family participated in a follow-up interview and survey eight weeks after the completion of the intervention sessions. All sessions and interviews were conducted online via Zoom. For transcription and analysis purposes, interviews were audio recorded and parent-child play observations were video recorded. Parents provided written consent for their own and their child’s participation and recording for all components of the study at the commencement of the pre-intervention interview. The first author (a registered psychologist and clinical psychology registrar) served as the therapist for both families. The therapist followed a structured treatment manual tailored to the needs of military families and was provided with fortnightly supervision by the second and third author (both registered clinical psychologists).

Intervention

CaPES is an evidence-informed 12-week parenting program developed by the second and third author. The overarching aim of CaPES is to improve the quality of the parent-child relationship and reduce child emotional and behavioural difficulties. CaPES was designed for families with children aged two to seven years. It is considered an adaptive program as the live coaching component allows the program to be tailored specifically to unique family presentations or specific populations. A session-by-session overview of the CaPES program is provided in Table 1. Broadly speaking, CaPES integrates well-established interventions from (1) mindful parenting (Duncan et al., 2009), (2) mentalisation-based therapy (Asen & Fonagy, 2012), (3) emotion coaching (Gottman et al., 1996; Havighurst et al., 2013; Luby et al., 2012), (4) PCIT (Eyberg, 1988), and (5) BPT (Kazdin, 1997).

Table 1. Overview of treatment components, by session.

Session/s	Attendees	Focus
1	Parent/s	Orientation to program Psychoeducation about mindfulness, mindful parenting, and emotion regulation Introduce steps in helping child to regulate emotions using NODD skill (Notice, Observe, Describe, Defuse). Homework: Complete daily mindfulness activity
2	Parent/s	Review of homework activities Introduce and teach mindful and mentalisation-based play skills using SKIP acronym. SKIP stands for specific praise (e.g., ‘I love how gentle you’re being with the toys), kid-focused (i.e., reflecting back the child’s verbalisations and describing their behaviour), internal states (e.g., acknowledging, labelling and validating emotions), and present moment (e.g., letting the child lead the play, avoiding questions, commands and negative talk). Role-play SKIP skills and provide corrective feedback Homework: Daily 5-minute parent-child play sessions, aiming for at least four per week
3-4	Parent/s and child	Review of homework activities Orient parent/s and child to play session with in vivo coaching Code parent and child play for five minutes Provide parent brief feedback on skills and set goals for coaching Coach parent to use SKIP and NODD skills during play with child Repeat coding and coaching if two parents participating Homework: Daily 5-minute parent-child play sessions, aiming for at least four per week
5	Parent/s	Review of homework activities Psychoeducation about mentalising Show video clips of recorded parent-child play and/or alternative clips (e.g., cartoon excerpts) Encourage parent/s to wonder about the child’s internal experience, with an emphasis on curiosity about rather than knowing or ‘mind-reading’, with the goal of increasing parental mentalising Homework: Daily 5-minute parent-child play sessions, aiming for at least four per week – emphasis on parental curiosity about child’s internal states (I in SKIP skill) to further develop mentalising stance
6	Parent/s and child	As per sessions 3 and 4, with an additional mentalising focus during live coaching
7	Parent/s	Review of homework activities Psychoeducation about managing children’s challenging behaviour to improve the parent-child relationship and increase positive/desired behaviours Teach strategies to manage challenging behaviour (e.g., giving effective commands, use of positive attention, effective use of reward systems and time out) Homework: Daily 5-minute parent-child play sessions, aiming for at least four per week. Incorporate strategies to manage challenging behaviour
8	Parent/s	Review of homework activities Psychoeducation about emotion coaching Introduce and teach skills for supporting child’s emotion regulation during play (e.g., recognising triggers, labelling emotions, coaching use of emotion regulation skills such as breathing) Homework: Daily 5-minute parent-child mindful play sessions, aiming for at least four per week, to reinforce skill development in mindful parenting skills. Practice emotion coaching during interactions with child
9	Parent/s and child	As per sessions 3, 4 and 6, with an additional focus on emotion coaching.
10	Parent/s	Review of homework activities Psychoeducation about emotion coaching during conversations (e.g., talking about past events) Introduce and teach skills for supporting parents to talk about challenging situations that occurred in the past using ONCE skills (Open-ended questions, New information, Confirming and validating child’s responses and emotions, and Emotion labelling, explanation and resolution) Homework: Daily past event conversation (practising ONCE skill) with child and 5-minute parent-child play sessions, aiming for at least four per week
11	Parent/s and child	Review of homework activities Orient parent/s and child to emotion coaching conversation activity Coach parents to use emotion coaching skills during past event conversations with their child Code parent and child play for five minutes Provide parent brief feedback on skills and set goals for coaching Coach parent to use mindful play skills and emotion regulation strategies during play with child Repeat conversation task, coding and coaching if two parents participating Homework: Daily 5-minute parent-child play sessions, aiming for at least four per week
12	Parent/s and child	Review of homework activities Graduation session Review and rehearse skills learned throughout treatment Review progress/changes family has made Discuss ‘relapse prevention’ and how to plan for future stressors (e.g., upcoming deployments, relocations) Conduct final 5-minute parent and child play observation Provide certificates of completion and celebrate family’s success

Measures

Table 2 includes a list of measures completed at baseline, over the course of the intervention, post-treatment, and at a 2-month follow-up. These measures were selected because they measure constructs that CaPES was specifically designed to target, and have been used in other family-based interventions (e.g., Eyberg & Funderburk, 2011; Havighurst et al., 2013; Potharst et al., 2021; Zimmer-Gembeck et al., 2019) and interventions for military families (e.g., DeVoe et al., 2017, Ross et al., 2020).

Table 2. Assessment measures and timeline.

Measure	Baseline	Treatment (weekly)	Post-treatment	Follow-up
Parenting/parent-child relationship
Dyadic Parent Child Interaction Coding System (DPICS) - observation measure of parent-child interaction quality	X	X
Brief Parental Self-Efficacy Scale (BPSES)	X	X	X	X
Parent mental health and wellbeing
Depression, Anxiety and Stress Scale-21 (DASS-21)	X		X
Self-Compassion Scale-Short Form (SCS-SF)	X		X
Difficulties with Emotion Regulation Scale (DERS)	X		X
Parental Reflective Functioning Questionnaire	X		X
Five Facets of Mindfulness Questionnaire-Short Form (FFMQ-SF)	X		X
Parental Stress Scale	X		X
Child emotions and behaviour
Eyberg Child Behavior Inventory (ECBI)	X	X	X	X
Child Behavior Checklist (CBCL)	X		X
Qualitative data
Semi-structured interview	X		X	X

Depression Anxiety Stress Scale-21 (DASS-21; Lovibond & Lovibond, 1995)

The DASS is a 21-item scale measuring levels of depression, anxiety, and stress over the previous week. The DASS-21 is commonly used in intervention studies to assess change (Gamble et al., 2005; Gharaati Sotoudeh et al., 2020).

Self-Compassion Scale – Short Form (SCS-SF; Raes et al., 2011)

The SCS-SF is a 12-item measure of self-compassion that has demonstrated good internal consistency (Cronbach α > .86), and a near-perfect correlation with the long form Self-Compassion Scale (Raes et al., 2011).

Difficulties with Emotion Regulation Scale (DERS; Gratz & Roemer, 2004)

The DERS is a 36-item measure of emotion awareness and regulation difficulties. The measure is reported to have high internal consistency (α =.93), good test-retest reliability and Cronbach alpha coefficients of .80 for each subscale (Gratz & Roemer, 2004).

The Parental Reflective Functioning Questionnaire (PRFQ; Luyten, Mayes, et al., 2017)

The PRFQ is an 18-item measure that assesses parental curiosity regarding their child’s mental state. It contains three subscales: pre-mentalising, certainty about mental states. and interest and curiosity. The PRFQ is reported to have good internal consistency across the subscales, ranging from α = .70 to .82.

Five Facets Mindfulness Questionnaire – Short Form (FFMQ-SF; Bohlmeijer et al., 2011)

The FFMQ-SF is a 24-item measure of mindfulness that comprises five subscales: Nonreactivity to Inner Experience, Observing, Acting with Awareness, Describing/Labeling with Words, and Nonjudging. The FFMQ-SF displays adequate internal consistency, demonstrated by alpha coefficients greater than .70 (Bohlmeijer et al., 2011; Oñate & Calvete, 2018).

Parental Stress Scale (Berry & Jones, 1995)

The Parental Stress Scale is an 18-item measure that assesses parents’ feelings about their parenting role. The measure has been found to be highly reliable, both internally and overtime, and demonstrates satisfactory convergent and discriminant validity (Berry & Jones, 1995).

Brief Parental Self-Efficacy Scale (BPSES; Woolgar et al., 2013)

The BPSES is a five-item measure of parental self-efficacy. Psychometric evidence is limited (Woolgar et al., 2013), however the measure has been used successfully in a number of intervention studies (Midgley et al., 2018; Selwyn et al., 2016).

Eyberg Child Behavior Inventory (ECBI; Eyberg & Pincus, 1999)

The ECBI is a 36-item scale that measures behaviour problems exhibited by children aged 2 to 16 years. Caregivers indicate the frequency of behaviours along a 7-point scale from 1 (Never) to 7 (All the time) and whether they perceive the behaviour as a problem (0 = No, 1 = Yes). Results yield an Intensity Scale (i.e., the frequency of disruptive behaviours) and a Problem Scale (i.e., the number of behaviours that parents report as a problem to them). Higher scores reflect greater concern about the child’s behaviour, with Intensity scores ≥ 131 and Problem scores ≥ 15 in the clinical range. The ECBI facilitates longitudinal measurement of treatment progress (Eyberg & Pincus, 1999).

Child Behavior Checklist (CBCL; Achenbach, 1999)

The CBCL is a 113-item, caregiver-report measure assessing childhood capabilities and emotional and behavioural problems for children aged 1.5 to 18 years. A T-score higher than 65 is considered to be in the clinical range. The CBCL is a psychometrically sound instrument, demonstrated by strong validity and reliability estimates (Nakamura et al., 2009).

Dyadic Parent-Child Interaction Coding System, Fourth Edition (DPICS; (Eyberg et al., 2014)

The DPICS is a behavioural observation coding system that can be used to code parent-child interactions. In the current study, parent-child interactions were coded for a 5-minute interval to assess parents’ use of play skills (e.g., specific praise, reflections, behaviour descriptions) and their use of phrases to avoid (e.g., commands, critical comments, questions). Parents were instructed to let their child play with whatever they wanted and to follow their child’s lead. Each five-minute interaction was coded twice: first, live during the session and secondly, from verbatim transcriptions of the video-recorded interactions. All coding was done by the first author, a certified PCIT therapist. Certified PCIT therapists have received the training necessary to develop competence using the DPICS (PCIT International, n.d.). The DPICS has high inter-rater reliability, test-retest reliability, discriminant validity, and treatment sensitivity (Robinson & Eyberg, 1981).

Semi-structured interviews

Each family participated in three 60 to 90-minute semi-structured interviews throughout the course of the study (baseline/pre-treatment, post-treatment and follow-up). The pre-treatment interview was used to gather information about the family’s background, the child’s developmental history, the servicemember parent’s employment with the ADF, the family’s experiences of deployment and reintegration, and the family’s presenting concerns and goals for treatment. The post-intervention interview explored how the family engaged with the intervention, the progress made over the course of the intervention, and the family’s overall evaluation of the intervention for themselves and for other military families. The follow-up interview explored parent’s perspectives of the longer-term impact of participating in the intervention to provide insight into the durability of parent and child outcomes. Each interview was conducted online via Zoom and audio recorded.

Analyses

We examined descriptive statistics and the percent reduction in target symptoms and behaviours from pre-treatment to post-treatment wherever appropriate. To examine weekly changes in the outcome data, we used visual inspection criteria, including the level and trend of the data, to assess symptom and behaviour change from the baseline assessment, across the treatment phase to post-treatment (Kazdin, 1982, 2021). To provide an estimate of effect sizes for outcome measures, the percentage of nonoverlapping data (PND; Scruggs & Mastropieri, 1998) across the baseline and intervention phase was also calculated. To calculate PND, the most extreme baseline data point is identified. It is then determined how many intervention data points fall below this value. This number is divided by the total number of intervention data points to provide a percent of overlapping data. A PND of 70 and above is considered effective, while a PND of 90 or above is regarded as very effective (Scruggs & Mastropieri, 1998).

Semi-structured interview analyses

Post-intervention and follow-up interviews were transcribed verbatim by the first author. A thematic analysis, using a coding reliability approach, was conducted. In coding reliability thematic analysis, analysis begins with theme development (Braun & Clarke, 2019). Themes are conceptualised as data domains which are generally developed from data collection questions (Braun & Clarke, 2019). In the current study, themes were developed from the interview questions. Coding is then a process of identifying material relevant to each domain/theme. Coding was completed by the first author, and discussed with the second and third authors to establish coding consensus.

Results

In the following sections, quantitative results are grouped into three types of outcomes assessed in the current study: (a) parenting and parent-child relationship; (b) parent mental health and wellbeing; and (c) child emotions and behaviour. Qualitative data is discussed in the context of the themes developed from the thematic analysis: intervention outcomes and benefits; intervention acceptability and experiences; and intervention generalisability.

Parenting and parent-child relationship

Over the course of treatment, all three participating parents increased their use of the SKIP skills (e.g., specific praise, behaviour descriptions, reflections; see Figure 1) and decreased their use of phrases to avoid (e.g., questions, commands, critical statements; see Figure 2), as measured on the DPICS. Each parent’s results are described below.

Figure 1. Graphic displays of each parents’ specific praises, behaviour descriptions, and reflections.

Figure 2. Graphic displays of each parents’ questions, commands, and critical statements.

Naomi’s (Noah’s mother) average use of the play skills increased from baseline to the intervention phase: specific praise (baseline = 0, intervention M = 4.33), behaviour descriptions (baseline = 0, intervention M = 4), and reflections (baseline = 3, intervention M = 14.67). The PNDs from baseline to intervention for all three skills were 100% for Naomi, indicating a consistent large effect. Naomi’s average use of questions (baseline = 19, intervention M = 7.5) and commands (baseline = 4, intervention M = 0.33) decreased from baseline to the intervention phase. Her use of critical statements remained at zero across baseline and the intervention phase. The PNDs from baseline to intervention for questions and commands were 100%.

Nathan’s (Noah’s father) average use of each of the play skills increased from baseline to the intervention phase: specific praise (baseline = 1, intervention M = 2.83), behaviour descriptions (baseline = 0, intervention M = 4.44), and reflections (baseline = 4, intervention M = 19.33). The PNDs from baseline to intervention for Nathan’s behaviour descriptions and reflections were 100%, while the PND for specific praise was 83.33%, indicating large effects across all three skills. Nathan’s average use of questions decreased from baseline to the intervention phase (baseline = 23, intervention = M = 6.67). There were small increases in his average use of commands (baseline = 0, intervention M = 0.5) critical statements (baseline = 0, intervention M = .17). The PNDs from baseline to intervention for questions, commands, and critical comments were 100%, 50%, and 83.33% respectively.

Whitney’s (Willow’s mother) average use of each of the play skills increased from baseline to the intervention phase: specific praise (baseline = 1, intervention M = 5.8), behaviour descriptions (baseline = 0, intervention M = 3.8), and reflections (baseline = 8, intervention M = 8.2). The PND from baseline to intervention for Whitney’s specific praise and behaviour descriptions was 100%, while the PND for reflections was 50%. Whitney’s average use of negative communication approaches decreased from baseline to the intervention phase: questions (baseline = 11, intervention M = 7.83), commands (baseline = 11, intervention M = 3), and critical statements (baseline = 0, intervention M = 0.67). The PNDs from baseline to intervention for questions, commands, and critical comments were 83.33%, 100%, and 50% respectively.

Regarding parental self-efficacy, measured with the BPSES, all three parents demonstrated considerably variable scores from baseline and throughout the intervention to follow-up (Figure 3). While there are no guidelines for clinical cut-off ratings, the score is out of a possible 25, which suggests all parents were already reporting fairly high levels of parental efficacy before completing CaPES. When comparing BPSES scores at baseline and follow-up, Noah’s mother (baseline = 21, follow-up = 22) and Willow’s mother (baseline = 19, follow-up = 25) scores improved while Noah’s father’s scores decreased (baseline = 24, follow-up = 20). PND was 64.29% for Noah’s mother, 0% for Noah’s father, and 78.57% for Willow’s mother.

Figure 3. Graphic display of each parent’s BPSES scores.

Parent mental health and wellbeing

Table 3 shows the changes in parental mental health and wellbeing outcomes from pre-intervention to post-intervention for all three parents. Parental depression, anxiety and stress was measured by the DASS-21. Naomi’s responses indicated a decrease in symptoms of depression, anxiety, and stress from pre-intervention to post-intervention. Nathan’s responses indicated a decrease in symptoms of depression and stress and an increase in his level of anxiety from pre-intervention to post-intervention. Both Noah’s mother’s and father’s pre-intervention and post-intervention scores were all in the normal range and did not indicate clinically significant levels of depression, anxiety, or stress. Whitney’s responses indicated a decrease in symptoms of depression, anxiety, and stress from pre-intervention to post-intervention. Whitney’s responses fell in the Severe range for stress and anxiety pre-intervention. Post-intervention, her stress and anxiety scores were no longer elevated and considered to be in the normal range. Whitney’s pre-intervention and post-intervention depression scores were in the normal range.

Table 3. Parental mental health and wellbeing measure scores at pre-intervention and post-intervention, with percentage change.

Measure	Noah’s mother			Noah’s father			Willow’s mother
	Pre	Post	% change	Pre	Post	% change	Pre	Post	% change
DASS-21
Depression	2	1	50%↓	3	2	33.33%↓	3	0	100%↓
Anxiety	2	0	100%↓	0	1	100%↑	8	2	75%↓
Stress	6	3	50%↓	7	6	14.29%↓	13	3	79.92%↓
SCS-SF	3.25	3.42	5.23%↑	2.75	2.75	–	2.42	3.67	51.65%↑
DERS	71	65	8.45%↓	90	72	20%↓	71	75	5.64%↑
PRFQ
Pre-mentalising	2	1.5	25%↓	2.83	1.67	40.99%↓	3	1.33	55.67%↓
Certainty of mental states	4.33	4.33	–	3.5	4.33	23.71%↑	5.17	4.33	16.25%↓
Interest and curiosity	5	5.17	3.4%↑	5.5	6	9.09%↑	6.17	5.17	16.21%↓
FFMQ-SF
Full scale	3.25	3.5	7.69%↑	2.71	3.08	13.65%↑	3.58	3.63	1.4%↑
Describing with words	12	16	33.33%↑	18	21	16.67%↑	21	21	–
Nonreactivity to inner experience	21	21	–	12	12	–	18	19	5.56%↑
Nonjudging	18	10	80%↓	11	17	54.55↑	16	17	6.25↑
Observing	12	11	8.33↓	10	10	–	17	16	5.88↓
Acting with awareness	15	17	13.33↑	14	12	14.29↓	14	16	14.29↑
Parental Stress Scale	48	43	10.42%↓	33	30	9.09%↓	42	26	38.1%↓

Parental mentalising was measured using the PRFQ. All three parents demonstrated a considerable decrease in their Pre-Mentalising subscale score from pre-intervention to post-intervention, indicating that their reflective functioning ability increased over the course of the intervention. All three parents demonstrated average (i.e., neither very high nor very low) scores for the Certainty in Mental States and Interest and Curiosity subscales pre- and post-intervention. Average scores on these subscales are more optimal that low or very high levels, which indicate more dysfunction (Luyten, Mayes, et al., 2017). Average scores on the Certainty in Mental States subscale suggests an appropriate recognition of the opacity of mental states, as opposed to being either overly certain or uncertain about the mental states of the child (Luyten, Mayes, et al., 2017). Average scores on the Interest and Curiosity subscale reflect an active curiosity about and willingness to understand the mental states of the child, as opposed to hyper-mentalising or an absence of interest in the child’s mental states (Luyten, Nijssens, et al., 2017).

Mindfulness was measured using the FFMQ-SF. All three parents total FFMQ-SF score increased pre-intervention to post-intervention, indicating they each became more mindful in their everyday lives over the course of the intervention. Changes in the FFMQ-SF subscales can be observed in Table 3. Of note, Naomi and Nathan reported their ability to label their experiences and express them in words to themselves and others (Describing with words subscale) increased by 33.33% and 16.67% respectively from pre-intervention to post-intervention. Regarding the ability to be non-judgmental towards our inner experience (Nonjudging subscale), Nathan reported a 54.55% increase from pre- to post-intervention. Naomi and Whitney reported a 13.33% and 14.29% increase, respectively, in their ability to act with awareness after attending to information present at that moment (Acting with awareness subscale).

Naomi’s and Whitney’s SCS-SF score increased by 5.23% and 51.65% respectively from pre-intervention to post-intervention, indicating their level of self-compassion increased over the course of the intervention. Nathan’s SCS-SF score remained stable at pre-intervention and post-intervention. Naomi’s and Nathan’s DERS score decreased by 8.45% and 20% respectively from pre-intervention to post-intervention, indicating their difficulties with emotion regulation decreased over the course of the intervention. Whitney’s score increased by 5.64% from pre-intervention to post-intervention. All three parents reported a reduction in parenting stress, as measured by the Parental Stress Scale, from pre-intervention to post intervention.

Child emotions and behaviour

Child behaviour was measured weekly using the ECBI, as shown in Figure 4. Parents also completed the CBCL at pre-treatment and post-treatment. These results are displayed in Table 4.

Figure 4. ECBI intensity and problem T-scores for Noah and Willow.

Table 4. Child Behavior Checklist (CBCL) T-scores pre- and post-treatment.

	Internalising		Externalising		Total
	Pre	Post	Pre	Post	Pre	Post
Noah	63	67	54	60	63	68
Willow	68	71	64	66	69	72

Noah’s parents completed the ECBI and CBCL together. Noah’s parents indicated similar levels of problem behaviour intensity from baseline (T-score = 57) to intervention phases (mean T-score during intervention = 56.83) to post-treatment and follow-up (mean T-score after treatment = 56.5). The PND for this scale was 71.43%. On the problem subscale, Noah’s parents indicated an overall decrease in problem behaviour from baseline (T-score = 51) to follow-up (T-score = 41), with some periods of elevation in the intervention phase (mean T-score during intervention = 49.6). The PND for this scale was 75%. Scores across both subscales were in the typical range and were not considered problematic. On the CBCL, Noah’s parents indicated similar scores on the internalising and externalising scales and the total measure at pre-treatment and post-treatment. Pre-treatment, Noah’s internalising score and total score were in the borderline clinical range. Post-treatment, they were both clinically elevated. Despite an increase in Noah’s externalising score from pre-treatment to post-treatment, it was not considered elevated (e.g., below 64^th percentile).

Willow’s mother indicated variable levels of problem behaviour intensity throughout the study, although an overall decrease from baseline (T-score = 64) to follow-up (T-score = 48) was reported. The mean T-score during the intervention phase was 59.17. On the problem subscale, Willow’s mother indicated an overall decrease in problem behaviour from baseline (T-score = 69) to follow-up (T-score = 45), with some periods of elevation in the intervention phase (mean T-score during intervention = 64.08) and post-treatment. The PND for each scale was 85.71%. For each the intensity scale and problem scale, Willow’s mother’s scores were above the threshold to be considered a concern at baseline and at various points throughout the intervention phase. At follow-up, her scores were below the 65^th percentile, meaning that her scores at the end of treatment were no longer clinically significant. On the CBCL, Willow’s mother indicated similar, clinically elevated scores on the internalising and externalising scales and the total measure at pre-treatment and post-treatment.

Qualitative data

Intervention outcomes and benefits

During the post-intervention and follow-up interviews, all parents talked about the gains their child made as a result of participating in the intervention. Naomi, Nathan, and Whitney each reported that their child’s behaviour, speech articulation and vocabulary, and emotion regulation capacity had improved. Noah’s mother reported that Noah is “a lot more confident and articulate. He’s able to express his feelings more.” Whitney explained that:

[Willow has] no more tantrums. It’s very far off from where she was. She doesn’t tantrum. There’s no hitting, there’s no kicking. She’s really coming along with how she communicates to others …. Her anxiety has decreased because she trusts me more.

As reflected in Whitney’s comment above, both families reported that participating in the intervention improved the quality of their parent-child relationship. Noah’s mother described a notable improvement for Noah and his father’s relationship:

I think [Noah’s] confidence with [his father] has gone up a lot. I feel like they now have like a friendship element that they didn’t have before … The [relationship] quality definitely has improved.

Nathan reported that finding a way to interact with Noah through the skills covered in CaPES vastly improved their relationship:

There’s a big difference between communicating with an adult [compared with a child] … In terms of actually having a conversation with a small child, that’s a gap where, I guess, I didn’t have the skill set to do effectively before. And I've noticed that that gap has been filled now. I feel much more comfortable having those sorts of conversations [with Noah] and for it to be meaningful.

When discussing their initial goal of ‘getting back on the same page’ with parenting, Nathan reflected that participating in the intervention has made him “feel that parenting is more of a partnership.” Naomi reiterated this sentiment and said “[participating in the intervention has] definitely made us better as a couple. We’re on the same parenting page now, which is really lovely, because we had been trying for a long time to get there.”

Intervention acceptability and experiences

The efficacy, adaptability, and projected long-term impacts of the intervention were discussed by Whitney in her follow-up interview:

[CaPES] empowers the adult, allows us to reflect on what we’re doing, allows the child to feel safe, which is what they need, and then is timeless. When Willow is a teenager, I know as long as I continue doing this and adapt it to as she ages, she will be able to come to me and talk to me about the hard things.

Noah’s parents identified the real-time coaching as a pivotal element of CaPES and attributed much of their gains in parenting skills and confidence to this component. This is highlighted by Nathan, who said:

We cover quite a bit in the parent-only sessions. And as much as we take our little notes and try remember it all … it’s good to get instantaneous feedback on what you’re doing. That way you can focus on improving it then and there instead of going away and having to try and remember.

Intervention generalisability

Whitney discussed the generalisability of CaPES. Despite not being able to participate in the intervention due to deployment commitments, Whitney reported that she had noticed a positive change in how Willow’s father interacted with her:

He picked up on a lot of the skills that I had spoken to him about them. So, like he would describe her behaviour … and she just loved it. She was like ‘you’re understanding what I'm doing, you’re validating me’ so it made her feel more comfortable in his presence.

Overall, both families discussed their belief that CaPES is a useful and efficacious intervention to support military families with young children, not just post-deployment but throughout the whole deployment cycle. As Naomi reflected:

I think [CaPES] will definitely be beneficial [for military families]. I think it will give the [service] member a lot more confidence … knowing I can make this better, I can improve our relationship will give them hope and a lot more attachment to their families … If you have happy and stable and collaborative parents, the kid’s going to benefit.

Discussion

The current study provided an exploration of CaPES as an intervention to strengthen parent-child relationships and improve family outcomes in military families with young children post-deployment. Findings from two case studies provide preliminary evidence of the efficacy of CaPES in improving parent-child relationship quality, parental mental health and wellbeing, and children’s behavioural and emotional outcomes for military families with young children.

Across the two case studies, the quality of both the servicemember and the civilian parent-child relationship improved, as evidenced by DPICS-coded increases in parents’ positive interaction responses (e.g., labelled praise, behaviour descriptions, reflections) and decreases in parents’ undesirable interaction responses (e.g., questions, commands, critical statements), and in qualitative reflections from parents. Healthy and resilient children and adults develop from early caregiver relationships that are secure and positive (Bowlby, 1982; Ranson & Urichuk, 2008), highlighting the importance of this finding for the long-term outcomes of military children. These results are particularly encouraging because they were derived from a combination of observational, self-report, quantitative, and qualitative data, all indicating improvements in parenting behaviour and relationship quality following the intervention.

CaPES appeared effective in its aim to increase parents’ own emotion regulation capacities by targeting transdiagnostic parenting and psychopathology factors. From pre- to post-intervention, parents reported a decrease in emotion regulation difficulties and increase in emotional awareness. Parents reportedly became more mindful and aware of the present moment, more self-compassionate, and better able to make sense of mental states that underlie their own and others’ feelings and behaviours. All three parents reported reductions in depression, general stress, and parenting stress following treatment, while two of the three parents reported reductions in anxiety. These improvements in emotion regulation, mindfulness, self-compassion, mentalisation, mental health symptoms, and stress likely speak to the parents improved ability to interact with child in a more attuned and responsive manner as a result of CaPES.

Both children in the current study showed improved emotional and behavioural functioning after participating in CaPES, when assessed using the ECBI. At follow-up, neither child’s ECBI behaviour intensity nor problem behaviour scores were clinically significant. Qualitative reflections from parents also highlighted both children’s improvements in behaviour, emotion regulation capacities, and speech articulation and vocabulary following treatment. When assessed using the CBCL, small increases in child emotional and behavioural difficulties were reported from baseline to post-intervention. Total scores on the CBCL were clinically elevated for both children post-treatment. Differences in the results of the ECBI and CBCL may be due to time of measurement, with the CBCL only completed post-intervention and not at follow-up. Reviews of BPT effects on child behaviour have consistently found greater improvements at follow-up than post-intervention (Donovan et al., 2022; Kaminski & Claussen, 2017), suggesting child behaviour change is gradual as parents continue to apply the intervention principles.

Implications for practice, policy, and future research

The results of this study suggest CaPES could serve as an effective and viable treatment for military families with young children who have experienced deployment, which has implications for practice and policy. Preliminary evidence of CaPES’ feasibility and acceptability as an intervention for military families with young children post-deployment was demonstrated in the current study. Other interventions targeted to military families with young children have demonstrated somewhat similar results to CaPES, including improvements in parenting stress, mental health distress, and mentalising (DeVoe et al., 2017; Julian et al., 2018). However, CaPES has several defining characteristics that may set it apart from existing interventions.

Firstly, CaPES explicitly works with parents to help them understand the importance of and develop skills in emotion regulation, emotional coaching, mindfulness, and mentalisation. Not only are parents taught the skills during psychoeducation sessions, but they are also supported to implement and develop the skills during the live coaching sessions. Coaching plays an influential role in facilitating change, skill acquisition, and parents’ own emotion regulation (Shanley & Niec, 2010; Woodfield & Cartwright, 2020), In CaPES, the role of the coach extends beyond simply prompting a particular skill in the moment to almost ‘parenting the parent’. The therapist/coach explicitly supports parents’ emotional regulation, mindful awareness, and mentalising capacities by modelling, prompting, and encouraging parents to be present, accept the child and self without judgement, be aware of and compassionate towards the emotional experiences of the self and child, understand the child’s behaviour in terms of mental states, and self-regulate during parent-child interactions. As such, parents develop the capacities to respond to their child more supportively, compassionately, and responsively. These are each parenting qualities important for promoting secure attachments and enhancing relationship quality (Allen et al., 2014).

Secondly, CaPES’ ability to be delivered remotely, via the internet, may improve military family engagement and accessibility to treatment. Military families live a mobile lifestyle, routinely relocating every few years (Australian Government, 2021). CaPES online delivery overcomes geographic barriers, allowing services to be provided to military families living in rural and remote areas, or regions characterised by limited local treatment options.

The current study was conducted in Australia which has a different military environment and deployment experiences compared to the United States (US). However, recent research has demonstrated that the reintegration experiences of military families with young children in the US and Australia share many commonalities (Risi et al., 2023). Such findings suggest that the challenges experienced by military families may not be so much influenced by country-specific environmental and contextual factors but instead largely shaped by the shared experience of the separation of the family unit. As such, the implementation of CaPES may be generalisable to US military families. Further research is needed, however, to endorse and extend the current findings and confirm the program’s generalisability. Future research efforts should focus on utilising a larger sample size of military families in and beyond Australia, including control groups, to meet this need. Research examining the efficacy of CaPES in other populations, such as community and clinical samples as well as families with young children who experience other types of parental separation such as incarceration and work-related absences, would be a beneficial extension of the current research to provide further information about CaPES’ efficacy, validity, and generalisability.

Rather than considering CaPES as a post-deployment ‘treatment’ program, it may be better considered as a prevention program that can be tailored to each family’s unique situation. The success of CaPES for Willow and her family, who experienced all phases of the deployment cycle throughout their participation, indicates engagement in CaPES may be beneficial at any state of the deployment cycle. Military families are typically a hard-to-reach population (Gewirtz, Pinna, et al., 2014). Framing CaPES as a prevention program may assist with the future engagement of military families and increase their willingness to participate.

Limitations

This study has several limitations that are common in the early stages of intervention development and evaluation, however, nonetheless should be considered when interpreting the results. Given the case-study design, the current study is limited in the conclusions that can be drawn about the effects of CaPES. The study, therefore, has internal and external validity limitations, such as the possibility that improvements from pre- to post-intervention were due to time, maturation, competing the same measures more than once, or other unrelated variables rather than a direct result of CaPES itself. Additionally, we cannot be certain if the families investigated in the current study are representative of the wider body of Australian military families with young children. This has implications for the generalisability and transferability of the conclusions. Finally, we recognise that the second and third author’s involvement in the development of CaPES could be considered a potential conflict of interest. However, they were not directly involved with the families or data collection in this study. They did not receive any personal financial benefit from the development of CaPES (other than their ordinary wages) and therefore have little reason to preference their own interests or obligations over their duties and responsibilities as researchers. Nonetheless, further research by researchers external to the original program development team would further strengthen the future examination of CaPES.

Conclusion

Military deployment and reintegration can pervasively and negatively impact all members of a military family (Chartrand et al., 2008; Creech et al., 2014; Trautmann et al., 2015). It is critical to identify effective interventions that can support military families with young children to mitigate these impacts. This study offers preliminary evidence that CaPES is an efficacious intervention for military families with young children, as demonstrated by improvements in parent-child relationship quality, parental mental health and wellbeing, and children’s behavioural and emotional outcomes. CaPES’ integration of transdiagnostic emotion and behavioural regulation principles within an intensive, dyadic, coaching-based delivery format is unique and valuable, and may result in enhanced treatment success.

Acknowledgements

The authors thank the families who participated in this study for their generosity, involvement, and time. We are very grateful for your participation without which this study could not have been possible.

Disclosure statement

The authors report there are no competing interests to declare.

Additional information

Funding

This project was conducted as part of a PhD at the University of Wollongong (New South Wales, Australia) that was funded through an Australian Government Research Training Program (AGRTP) Scholarship.