The UCLA Division of Population Behavioral Health trains clinical, non-clinical and peer professionals who are currently serving or interested in working with military-connected populations.
A Population Health Approach to Military Family Readiness, Well-being and Resilience
Since 2008, UCLA has provided the FOCUS (Families OverComing Under Stress) resilience enhancing program for Active Duty Service Members and their Families. The FOCUS team provides a suite of trauma-informed, family-centered services including real-time assessment, personalized education, skills development and family narrative tools to enhance adult, child and family well-being over time.
Consistent with Strengthening the Military Family Readiness System for a Changing American Society, the 2019 report of the National Academy of Science, Engineering and Medicine, FOCUS uses a population health framework to support military family readiness, well-being and resilience. Through screening, tiered promotion and prevention efforts grounded in prevention science and continuous quality monitoring, FOCUS outcomes are consistent with a “learning” Military Family Readiness System. The FOCUS suite of services is designed to support service members and their families across military and community ecosystems.
Figure: Continuum of coordinated support within the Military Family Readiness System.
SOURCE: Adapted from National Academies of Sciences Engineering and Medicine (2016, p. 180).
History of FOCUS Implementation for Military Families and Communities
Since 2008, FOCUS has been implemented for the Department of Defense at military installations in the United States, Japan and Germany. It uses an adaptive “learning system” approach to implementation with a focus on data-driven personalized delivery and continuous quality improvement.
The FOCUS intervention is grounded in developmental and preventive intervention research that identifies the mutual influences among individuals and relationships within families, and between families and broader social contexts. As a trauma-informed intervention, FOCUS has been designed to mitigate stress and enhance resilience in families and couples facing adversity. Using a community-participatory approach, the FOCUS intervention development team initially adapted existing evidence-based interventions for military-connected families to improve family functioning, parenting and adult and child outcomes. It has been implemented using a population health model as a suite of services from universal to selective and indicated prevention across ecosystems to reach military-connected families where they live, work and play—including though virtual platforms.
To promote implementation of FOCUS with fidelity and to support its ongoing customization to meet the evolving circumstances of military families, an adaptive approach is used to deliver the FOCUS core elements. Ongoing quality improvement and program evaluation have consistently demonstrated positive impact on adults and child well-being over time, as well as on parenting, family functioning and couples relationship outcomes aligned with military family readiness.
Core Elements of FOCUS:
FOCUS Resilience Check-in. This standardized psychological health and family functioning assessment utilizes an integrated web-based survey and feedback platform. Real-time results are used to tailor psychoeducation and customize skill building to guide program delivery and make timely referrals. The Check-in is completed by all family members at intake, upon program completion and periodically for one year.
Customized psychoeducation. Education is provided is based on individual and family specific strengths and needs. FOCUS providers provide personalized information on the impact of adversity and trauma on children and families, guidance about child development and support for navigating systems of care.
Resilience skill development. Learning and practicing skills including emotion regulation, problem solving, communication, goal setting and managing separation, trauma and loss reminders to enhance individual and family resilience processes.
A family narrative timeline. Adults and children develop individual and family narratives to understand shared key family transitions like deployments, moves or injuries/illness. This communication activity facilitates development of shared understanding, perspective taking and meaning-making particularly important in the context of adversity.
Two decades of war have presented military-connected families with unforeseen challenges: the duration of the war, prolonged family separation caused by multiple deployments, the impact of both visible and invisible injuries and young service members often with young dependent children. Supporting military-connected families through these unforeseen needs has created opportunities for the FOCUS program to support Service Members and their families in many new ways—identified through the use of an information infrastructure ensures ongoing quality monitoring, community engagement and partnership, and integration with emerging research trends.
To meet the needs of all types of families, FOCUS provides a range of programs and delivery platforms (in-person and telehealth):
- FOCUS for Families with Children and Teens
- FOCUS for Couples
- FOCUS for Early Childhood (In-person or Virtual Home Visiting)
- FOCUS-Wounded, Ill and Injured for both Couples and Family Programs
- School-based FOCUS Resilience Skills for Elementary, Middle and High School Students
- FOCUS Skills Groups for Parents, Couples, Teens and Children
- Resilience Skills for Peer Navigators and Non-Clinical Providers
- FOCUS On the Go! and FOCUS World
FOCUS services have been implemented for active duty families at active duty installations with consistently high levels of engagement and participation across the continuum of tiered services, as well as high adherence by families within the multisession models. Follow-up evaluations of the multi-session family intervention and its adaptations have demonstrated significant and sustained improvements in adult, child and family-level well-being outcomes up to 12 months later.
Training for Community Providers and Providers Working with Military-Connected Families