The report is a product of the VA/HSR Evidence Synthesis Program.

The Effectiveness of Parenting Skills Training Programs for Parents with Histories of Sexual Trauma, Serious Mental Illness, or Military Service: A Systematic Review

Takeaway: Parenting skills training programs may improve some parent, child, and family system outcomes among families in which parents have a history of serious mental illness (SMI) or military service. Most available studies took a family-system perspective and included other family members in the intervention. While parenting skills training programs show promise, it is important to consider both the feasibility and scalability of implementation across VA when evaluating these programs.

Evidence-based parenting programs have demonstrated effectiveness for increasing parenting confidence, minimizing family stress, and improving parent-child relationships. Yet, most parenting programs have centered on the child’s presentation, including their behavioral or emotional challenges. Given that military Veterans are more likely to have histories of trauma exposure (including sexual trauma) and mental health problems that may impact parenting behaviors, some Veterans may benefit from parenting skills training programs. Yet, it is unknown if parenting programs are effective among populations that have family stressors like those in VA’s patient population.

In response to a request from VA’s Office of Mental Health and Suicide Prevention, HSR&D’s Evidence Synthesis Program (ESP) Center located in Durham, NC, conducted a systematic review to:

• Understand whether, and in what ways, parenting skills training programs can effectively support parents who are at increased risk for stress due to sexual trauma and/or serious mental illness (SMI), including posttraumatic stress disorder (PTSD), as well as parents with histories of military service.
• Clarify characteristics of effective parenting skills training programs.

Investigators identified 14 studies on parenting skills training interventions, half of which were randomized controlled trials. Nine available studies focused on parents with a history of SMI and 5 focused on military-connected families. Studies tested 5 major intervention types (multi-family groups, individual family therapy, home visitation with live coaching, chat-based virtual groups, and self-directed programs), and just over half of interventions were delivered in-person. Most studies took a family-system perspective that involved more than one family member, and 8 studies directly involved children in the intervention.

Summary of Findings

• Of the 9 studies (904 families) that assessed parenting skills training programs among parents with SMI, most were conducted among parents with a history of major depressive disorder.
• Behavioral parenting programs resulted in statistically significant improvements in the majority (69%) of parent-centered outcomes in families with at least 1 parent with SMI.
• Improvements were significant for fewer of the prioritized family-centered outcomes (40%) and child-centered outcomes (57%), and effect sizes were generally modest.
• Of the 5 studies (3,268 families) conducted among parents with a history of military service, only 1 study was conducted exclusively among military Veterans.
• Overall, results trended toward positive changes in key parent, family, and child outcomes, though not all improvements were significant and effect sizes were generally modest.
• Eight of 14 studies reported on the uptake of parenting skills and most demonstrated significant improvements in these skills.
• Common features of effective programs were in-person delivery and group-based formats.
• Adherence was high for the interventions delivered in person.
• One study explored the use of a military-connected facilitator and found that this implementation feature led to greater program participation.

Limitations

Limitations of the evidence include study design weaknesses, which contributed to low or very low certainty of evidence ratings for most outcomes. Further, investigators observed no clear pattern of effectiveness by intervention type, in part because outcome assessment differed across studies. 

Future Research

This comprehensive review of the literature identified several gaps in the current evidence that warrant future investigation. First, additional high-quality studies of parenting skills training are needed, especially among parents with histories of sexual trauma and PTSD and among Veterans. There is also a dearth of interventions designed to address the parenting problems associated with parental PTSD. A scan of studies published since this review started identified only two recent publications exploring novel trauma-informed interventions for parents with PTSD.

The field would also benefit from studies that directly test different intervention modalities (group vs individual, in-person vs videoconferencing) and examine whether including direct child engagement approaches enhances effectiveness. Lastly, there is a need for future research that examines the long-term impact of parenting skills training programs on the sustainment of gains in parenting skills, parental emotion regulation and stress, family functioning, and longitudinal child outcomes.

Implications

While parenting skills training programs show promise, it is important to consider the feasibility and scalability of implementation across VA when evaluating parenting programs.

Waldrop JB, Schechter JC, Davis NO, et al. The Effectiveness of Parenting Skills Training Programs for Parents with Histories of Sexual Trauma, Serious Mental Illness, or Military Service: A Systematic Review. Washington, DC: Evidence Synthesis Program, Health Services Research and Development Service, Office of Research and Development, Department of Veterans Affairs. VA ESP Project #09-010; 2023.

To view the full report, go to: vaww.hsrd.research.va.gov/publications/esp/parenting-skills-training.cfm (Intranet only).

ESP is currently soliciting review topics from the broader VA community. Nominations will be accepted electronically using the online Topic Submission Form. If your topic is selected for a synthesis, you will be contacted by an ESP Center to refine the questions and determine a timeline for the report.

This Management e-Brief is provided to inform you about recent HSR&D findings that may be of interest. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. If you have any questions or comments about this Brief, please email CIDER. The Center for Information Dissemination and Education Resources (CIDER) is a VA HSR&D Resource Center charged with disseminating important HSR&D findings and information to policy makers, managers, clinicians, and researchers working to improve the health and care of Veterans.

This report is a product of VA/HSR&D's Evidence Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers –; and to disseminate these reports throughout VA.

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