Evaluating Behavioral Health Interventions for Military-Connected Youth: A Systematic Review

Abstract

Introduction Military-connected youth are at increased risk for experiencing distinct psychosocial and behavioral health vulnerabilities. Although behavioral health interventions have been developed to treat vulnerabilities in military-connected youth, little is known about the methodological quality of studies evaluating these interventions. In this study, a systematic review of behavioral health interventions for military-connected youth was conducted to examine methodological quality and treatment outcomes. Materials and Methods Electronic databases were systematically searched for studies evaluating behavioral health interventions for military-connected youth which yielded 3,324 citations. Methodological quality was evaluated by 2 researchers with 3 measures that assessed scientific rigor, transparency, external and internal validity, and power for quantitative, qualitative, and mixed-method trials. Interrater reliability was strong (κ = 0.81). Sample characteristics and treatment outcomes were also assessed. Results Fourteen studies meeting full inclusion criteria evaluated 10 behavioral health interventions. Methodological quality scores for all studies were poor to fair, with limitations in reporting, external and internal validity, and power. Research designs were predominantly nonexperimental. Treatment effects for both psychosocial and behavioral health outcomes were consistently positive for all studies. In studies reporting effect sizes, treatment effects were small to moderate (d = 0.01–0.42, odds ratio = 0.04–0.47, b = −0.02–0.56). Demographic and military characteristics of samples were inconsistently reported. Conclusion Behavioral health interventions for military-connected youth have noteworthy methodological limitations, indicating a need to employ more rigorous research strategies. Positive treatment outcomes, however, suggest promising interventions for improving psychosocial and behavioral health problems in military-connected youth. Future research directions and implications for clinical-community practice are also discussed.

Purchased Behavioral Health Care Received by Military Health System Beneficiaries in Civilian Medical Facilities, 2000–2014

“…During OEF/OIF, military children, spouses, and service members experienced behavioral and emotional difficulties, anxiety, mood, suicidal ideation, and substance use problems 19,27,28,29–31 that increased need and demand for behavioral health care. 17,32 In this study, adolescents (12–17) and adults under age 60 were more likely to be treated for suicidal ideation and nondependent drug abuse than older adults, which is consistent with previous research, indicating military adolescents and service members experienced high rates of suicidal behaviors and unhealthy substance use during these wars. 33,29,34 Additionally, adult MHS beneficiaries under age 60 were more likely to be treated for opioid/combination opioid dependence compared with those age 60 and older.…”

Culturally responsive play therapy with military-connected children and families: Opportunities for rigorous research.

“…Among the limited number of clinical interventions empirically investigated with military children, Moore et al (2017) identified concerns in data analysis. We recommend researchers increase transparency in their analysis to improve rigor.…”

“…Importantly, they reported none of the programs they reviewed were the subject of empirical study (one program collected satisfaction survey data). In their review of behavioral health interventions for military-connected youth conducted between 1995 and 2016, Moore et al (2017) identified 14 studies for inclusion to assess participant characteristics, treatment outcomes, and methodological quality. Regarding participants, nine of the studies identified included a family component and ten studies included youth (ages 0-17); however, Moore et al did not report the age of youth participants, which may be a barrier to understanding the interventions in the context of participants' developmental needs.…”

“…Regarding treatment outcomes, 14 studies evaluated a total of 10 behavioral health interventions; 10 studies utilized pre-/post-designs with three longitudinal designs; two studies included qualitative designs; and two studies were mixed-methods (Moore et al, 2017). The authors noted positive treatment outcomes were reported, with small to moderate effects.…”

“…The authors noted positive treatment outcomes were reported, with small to moderate effects. However, Moore et al (2017) concluded that the methodological quality of the majority of studies was poor, citing particular weaknesses in treatment fidelity, low response rates, and attrition of participants. Further, studies were criticized for missing power analysis and utilization of analysis that did not account for sample weighting of missing data.…”