Three-generation model: A family systems framework for the assessment and treatment of veterans with posttraumatic stress disorder and related conditions.

Abstract

This article describes the three-generation family systems health care model developed at the Veteran and Family Clinic of the Home Base Program, a partnership between the Red Sox Foundation and Massachusetts General Hospital designed to improve treatment engagement of veterans with posttraumatic stress disorder (PTSD) and related conditions, and to provide care to the entire military-connected family. This clinical model was designed to address 3 interdependent facets of the PTSD-affected family system: (a) the multiple attachment relationships that are often strained; (b) the veteran's family roles, which may be impaired; and (c) the multiple pathways for treatment engagement and amelioration of the veteran's PTSD-related distress and behaviors within the family system. In addition, we describe the assessment system, designed to probe the interrelationships of individual veteran, couple, parenting, child, and family levels of functioning. Three cases illustrative of the three-generation model's clinical application, how it can address unmet needs, and its ability to overcome barriers to health care for military families are also discussed.

The provision of services in the UK for UK armed forces veterans with PTSD: a rapid evidence synthesis

“…The 20 remaining studies (24 articles) used designs typically regarded as less methodologically sound. These were primarily single-group designs, comprising the following: five observational studies (eight articles), 36,47,51,52,[58][59][60]64 five descriptive pieces, 48,49,53,57,61 four before-and-after studies (five articles), 50,54,55,62,63 two quasi-experimental studies, 46,56 a critical review/guideline, 44 a survey, 45 a service evaluation 35 and a non-randomised comparison. 65 Although these studies were not formally assessed for methodological quality, they were carefully considered and retained as important contributors to the evidence picture on models of care.…”

“…Across the total number of included studies (24 studies, 29 articles) in our review, publication years ranged from 1990 to 2016. Eighteen studies (23 articles) were conducted in the USA [37][38][39][40][41][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65] (17 of these were connected to the Veterans Health Administration, US Department of Veterans Affairs), three studies were conducted in Australia [44][45][46] and two studies (three articles) were carried out in the UK. 35,36,47…”

“…Fifteen studies reported in 18 articles were conducted in the USA [48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65] (13 of these were delivered in the context of the Veterans Health Administration, US Department of Veterans Affairs); three studies were carried out in Australia, [44][45][46] and two studies (three articles) were carried out in the UK. 35,36,47 The types of care models and an overview of the studies within each are summarised in the following sections.…”

Brief‐Systemic Programs for Promoting Mental Health and Relationship Functioning in Military Couples and Families

“…The primary assertion of the CATS model is that adaptation to traumatic stress, specifically in the context of couple relationships, is dependent on the integration of both individual and relational factors in treatment (see Nelson Goff & Smith, 2005;Oseland et al, 2016). Thus, not including other system members could actually undermine recovery from traumatic stress (see Ohye et al, 2015).…”

Integrative Intensive Retreats for Veteran Couples and Families: A Pilot Study Assessing Change in Relationship Adjustment, Posttraumatic Growth, and Trauma Symptoms

“…In fact, according to systems theory, feedback or change-back messages from system members who do not attend therapy or do not understand the treatment process may undermine progress. This disruption can occur because any change in treated individuals may bring about new reactionary patterns of interaction within their environment (see MacDermid Wadsworth et al, 2013;Ohye et al, 2015). In addition, others within the service members' environment often report desiring insight into their loved one's experiences postdeployment (e.g., Fischer et al, 2015), which creates added incentive to include other members from the veterans' support system (see also Sautter, Armelie, Glynn, & Wielt, 2011).…”