Parenting STAIR: Adapting a Trauma-Focused Parenting Intervention for Military-Connected Mothers and Their Children

The goal of this study is to assess Parenting STAIR Modular (PSTAIR-M), a promising and innovative intervention for military-connected mothers (MCM) who have experienced trauma and their young children (ages 2-10). PSTAIR-M aims to help mothers manage the strong feelings that sometimes happen after experiencing something scary or stressful, as well as to better connect with their children and manage their behavior effectively.

The main questions the study aims to answer are: 1) Does PSTAIR-M reduce maternal PTSD and/or depression symptoms?, and 2) Does PSTAIR-M improve parental functioning?

Researchers will compare PSTAIR-M to treatment as usual (TAU) - other EBTs offered at participating study sites - to determine if PSTAIR-M is more effective in improving mental health and parenting.

Participants will: 1) attend 12-16 weekly, 1-hour online treatment sessions with their assigned clinicians, 2) complete three 1-hour online assessments administered by research staff, 3) engage with their child in three 15-30-minute online, observed play sessions, and 4) have assessments audio and video recorded.

Study Overview

• Status: Recruiting
• Conditions: Depression; PTSD; Parent-Child Relations
• Intervention / Treatment: Behavioral: Parenting-STAIR Modular (PSTAIR-M); Behavioral: Treatment as Usual (TAU)

Detailed Description

The present study is a two-arm randomized controlled trial (RCT) conducted in a community mental health setting comparing Parenting STAIR Modular (PSTAIR-M), and treatment as usual (TAU). This study will enroll N=120 military-connected mothers (MCM) and one index child (aged 2-10) at three Cohen Veterans Network (CVN) clinics (Family Endeavors Clinics in El Paso, Killeen, and San Antonio, TX). Participants will be trauma-exposed MCM who screen positive for PSTD and/or depression and/or demonstrate low parenting self-efficacy, and one identified child (ages 2-10). MCM will be randomly assigned to either PSTAIR-M (N=60 mothers; 60 children) or treatment-as-usual (TAU; N=60 mothers; 60 children). PSTAIR-M and TAU will be delivered virtually by CVN clinicians.

Parenting STAIR (PSTAIR) combines two existing evidence-based treatments (EBT), Skills Training in Affective and Interpersonal Regulation (STAIR) and Parent-Child Care (PC-CARE). PSTAIR-M involves a compact version of PSTAIR in Module 1 and tailored options for Module 2, focusing on skills development (Module 2a), narrative exposure (Module 2b), or parental functioning (Module 2c), implemented based on response to Module 1.

Assessments will occur at three timepoints: pre-treatment (baseline), mid-treatment (after session 11, approximately 11 weeks after baseline), and post-treatment (approximately 17 weeks after baseline). Assessments will include self-report instruments and dyadic parenting observations.

• Study Type: Interventional
• Enrollment (Estimated): 120
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Kathrine S Sullivan, PhD; Phone Number: 3235526056; Email: ks5313@nyu.edu
• Study Contact Backup: Name: Gina M Angelotti, MPH; Phone Number: 6462671807; Email: ga2208@nyu.edu

Study Locations

• United States
  • Texas
    • El Paso, Texas, United States, 79936
      • Recruiting
      • Steven A. Cohen Military Family Clinic at Endeavors, El Paso
      • Contact: Gina Angelotti, MPH; Phone Number: 915-213-6653; Email: ga2208@nyu.edu
      • Contact: Kathrine Sullivan, PhD, MSW; Phone Number: 915-213-6653; Email: ks5313@nyu.edu
    • Killeen, Texas, United States, 76549
      • Recruiting
      • Steven A. Cohen Military Family Clinic at Endeavors, Killeen
      • Contact: Gina Angelotti, MPH; Phone Number: 915-213-6653; Email: ga2208@nyu.edu
      • Contact: Kathrine Sullivan, PhD, MSW; Phone Number: 915-213-6653; Email: ks5313@nyu.edu
    • San Antonio, Texas, United States, 78249
      • Recruiting
      • Steven A. Cohen Military Family Clinic at Endeavors, San Antonio
      • Contact: Gina Angelotti, MPH; Phone Number: 915-213-6653; Email: ga2208@nyu.edu
      • Contact: Kathrine Sullivan, PhD, MSW; Phone Number: 915-213-6653; Email: ks5313@nyu.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Military-connected mother, defined as a mother who is either a female service member or veteran or female spouse of a service member or veteran;
2. Has a child aged 2-10;
3. Legal guardian of index child with legal and physical custody;
4. Lifetime trauma exposure (Life Events Checklist (LEC-5); Adverse Childhood Experiences Questionnaire (ACE-Q));
5. Screen positive for PTSD (defined as a PCL-5 score ≥32 or meeting ≥3 out of 4 DSM-5 symptom criteria [B, C, D, E] on the PCL-5), and/or depression (PHQ-9 score ≥8), and/or low parenting self-efficacy (PSOC score <59);
6. Able to speak and understand English or Spanish;
7. Eligible to receive services at a Steven A. Cohen Military Family Clinic at Endeavors.

Exclusion Criteria:

1. High risk for suicide (Ask Suicide-Screening Questions (ASQ));
2. Current psychotic symptoms (DSM-5-TR Self-Rated Level 1 Cross-Cutting Symptom Measure Domain VII);
3. Disability affecting communication, such as deafness;
4. Index child with severe developmental disability;
5. Severe substance or alcohol use (The Alcohol, Smoking and Substance Involvement Screening Test - Lite (ASSIST-Lite); Cannabis Use Disorder Identification Test-Short Form (CUDIT-SF)).

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Parenting STAIR Modular (PSTAIR-M); PSTAIR-M is a culturally adapted, 12-16-session modular intervention which combines elements of two existing EBTs: Skills Training in Affective and Interpersonal Regulation (STAIR), targeting maternal trauma and emotion dysregulation, and dyadic Parent-Child Care (PC-CARE), targeting parenting.	Behavioral: Parenting-STAIR Modular (PSTAIR-M); 12-16 PSTAIR-M treatment sessions (approximately 12-16 weeks).
Active Comparator: Treatment as Usual (TAU); Treatment as usual (TAU) is defined as an established EBT that is already being delivered at the study sites on an ongoing basis. Possible EBTs include prolonged exposure, cognitive processing therapy, cognitive behavioral therapy, and emotion-focused therapy. Clinicians treating participants randomly assigned to TAU will determine the most appropriate course of treatment based on established clinic protocols for treatment assignment.	Behavioral: Treatment as Usual (TAU); Weekly treatment sessions of an established EBT. The total number of sessions/weeks will be determined by the EBT and clinic protocols.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Post-traumatic stress disorder (PTSD) Checklist 5	The PCL-5 will be used to assess severity and change in PTSD symptoms. The PCL-5 is a 20-item self-report measure with strong evidence of reliability and convergent validity. Participants indicate the degree to which they have been bothered by problems related to a traumatic experience in the past month (e.g., "repeated, disturbing dreams of the stressful experience"; "feeling very upset when something reminded you of the stressful experience") on a 5-point Likert scale (0=not at all; 1=a little bit; 2=moderately; 3=quite a bit; 4=extremely). Summed responses yield a continuous score ranging from 0 to 80; higher scores indicate greater symptom severity.	PCL-5 will be administered at three assessment timepoints: pre-treatment (baseline), mid-treatment (after session 11, approximately 11 weeks after baseline), and post-treatment (approximately 17 weeks after baseline).
Patient Health Questionnaire-9 (PHQ-9)	The PHQ-9 will be used to assess severity and change in depressive symptoms. The PHQ-9 is a 9-item self-report measure with strong evidence of reliability and predictive and convergent validity. Participants indicate how often they have been bothered by particular problems within the past two weeks (e.g., "feeling down, depressed, or hopeless"; "poor appetite or overeating") on a 4-point Likert scale (0=not at all; 1=several days; 2=more than half the days; 3=nearly every day). Summed responses yield a continuous score ranging from 0 to 27; higher scores indicate greater symptom severity.	PHQ-9 will be administered at three assessment timepoints: pre-treatment (baseline), mid-treatment (after session 11, approximately 11 weeks after baseline), and post-treatment (approximately 17 weeks after baseline).
Parenting Sense of Competence Scale (PSOC)	The PSOC will be used to assess parental functioning as reflected by parenting self-efficacy. The PSOC is a 17-item self-report measure with strong evidence of reliability and validity. Participants indicate how much they agree or disagree with statements related to parenting (e.g., "Being a parent is manageable, and any problems are easily solved"; "My mother/father was better prepared than I am to be a good parent") on a 6-point Likert scale (1=strongly disagree; 2=disagree; 3=somewhat disagree; 4=somewhat agree; 5=agree; 6=strongly agree). Summed responses yield a continuous score ranging from 17 to 102; higher scores indicate greater parenting competency.	PSOC will be administered at three assessment timepoints: pre-treatment (baseline), mid-treatment (after session 11, approximately 11 weeks after baseline), and post-treatment (approximately 17 weeks after baseline).

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Difficulties in Emotion Regulation Scale (DERS)	DERS, which measures emotion regulation, will be evaluated as a potential mediator. DERS is a 36-item self-report measure with adequate reliability and construct and predictive validity. Participants indicate how true or untrue various statements about emotions are for them (e.g., "I have no idea how I am feeling"; "I know exactly how I am feeling") on a 5-point Likert scale (1=almost never; 2=sometimes; 3=about half the time; 4=most of the time; 5=almost always). Summed responses yield a continuous score ranging from 36 to 180; higher scores indicate greater emotion regulation difficulty.	DERS will be administered at three assessment timepoints: pre-treatment (baseline), mid-treatment (after session 11, approximately 11 weeks after baseline), and post-treatment (approximately 17 weeks after baseline).
Brief Cope	Brief Cope, which measures coping, will be evaluated as a potential mediator. Brief Cope is a 28-item self-report measure with adequate reliability and convergent and discriminant validity. Participants indicate how much or how often they have used various coping strategies (e.g., "I used alcohol or other drugs to make myself feel better"; "I took action to try to make the situation better") on a 4-point Likert scale (0=I didn't do this at all; 1=I did this a little bit; 2=I did this a medium amount; 3=I did this a lot). Summed responses within each of 14 subscales (e.g., substance use; active coping) yields a continuous score ranging from 0 to 6; higher scores indicate greater use of a particular coping strategy.	Brief Cope will be administered at three assessment timepoints: pre-treatment (baseline), mid-treatment (after session 11, approximately 11 weeks after baseline), and post-treatment (approximately 17 weeks after baseline).
Dyadic Parent-Child Interaction Coding System-IV (DPICS)	Parent interaction will be videotaped and coded by independent assessors. 10% of recordings will also be coded at UC Davis Parent-Child Interaction Therapy (PCIT) Training Center by expert coders unaware of treatment condition. Positive scores include the number of observed praises, reflections, and behavioral descriptions used during the play session, and negative scores include the number of observed questions, commands, and negative talk. DPICS is administered for 15-minutes in total with three 5-minute sessions focusing on child-directed play (CDI), parent-directed play (PDI), and clean-up.	DPICS-IV observation will occur at three time points: pre-treatment (baseline), mid-treatment (after session 11, approximately 11 weeks after baseline), and post-treatment (approximately 17 weeks after baseline).
Strengths and Difficulties Questionnaire (SDQ)	The SDQ will be used to assess child behaviors. The SDQ is a 25-item parent-report measure with good reliability, cross-informant correlation, and retest stability. Participant mothers indicate how true or untrue various statements about child behavior are relative to their participating child (e.g., "Shares readily with other children, for example toys, treats, pencils", "Often fights with other children or bullies them") on a 3-point Likert scale (0=not true; 1=somewhat true; 2=certainly true). Summed responses yield a continuous score ranging from 0 to 40; higher scores indicate greater behavioral difficulty.	SDQ will be administered at three assessment timepoints: pre-treatment (baseline), mid-treatment (after session 11, approximately 11 weeks after baseline), and post-treatment (approximately 17 weeks after baseline).
Military Stress of Life Survey	The Military Stress of Life Survey, a 14-item self-report measure adapted from the Department of Defense (DoD) Navy and Marine Stress of Life Survey, has been adapted for this study to assess lifetime and recent burden of military-related stressors. Participants indicate (0=no; 1=yes) whether they and their families have ever experienced various stressful situations associated with military life (e.g., "A combat-related injury"; "Difficulty balancing the demands of family life and military duties"), and if so, whether the experience occurred within the last 12 months. For every "yes" response, participants rate how stressful the particular experience was on a 4-point Likert scale (0=not stressful at all; 1=slightly stressful; 2=moderately stressful; 3=very stressful). Summed responses yield a continuous score ranging from 0 to 42; higher scores indicate a greater burden of military-related stressors.	Military Stress of Life Survey will be administered at two assessment timepoints: pre-treatment (baseline) and post-treatment (approximately 17 weeks after baseline).
Treatment Acceptability and Expectations (TAE)	TAE is a 5-item measure developed by study co-investigator Dr. Marylene Cloitre, will be used to assess acceptability and feasibility of the intervention. Participants are asked to appraise the intervention (e.g., "How logical does this type of treatment seem to you?"; "How successful do you think this treatment will be in reducing your trauma symptoms?") on an 8-point Likert scale (0=not at all; 2=very little; 4=somewhat; 6=moderate; 8=extremely). Summed responses yield a continuous score ranging from 0 to 40; higher scores indicate greater acceptability.	The TAE will be administered at two time points: mid-treatment (after session 11, approximately 11 weeks after baseline) and post-treatment (approximately 17 weeks after baseline).

Collaborators and Investigators

• Sponsor: New York University
• Collaborators: University of California, Davis; Cohen Veterans Network
• Investigators: Principal Investigator: Kathrine S Sullivan, PhD, New York University

Publications and helpful links

General Publications

• Sullivan KS, Angelotti G, Zhang F, Kim S, Wortham W, Lindsey MA, Jaccard J, Cloitre M, Timmer S, Linkh DJ, Lancaster SL. Parenting-STAIR Modular: a randomized controlled trial of a trauma-focused parenting intervention for military-connected mothers and their children. Trials. 2026 Jan 13;27(1):118. doi: 10.1186/s13063-025-09369-6.

Study record dates

Study Major Dates

• Study Start (Actual): July 21, 2025
• Primary Completion (Estimated): May 31, 2026
• Study Completion (Estimated): September 30, 2026

Study Registration Dates

• First Submitted: January 22, 2024
• First Submitted That Met QC Criteria: February 8, 2024
• First Posted (Actual): February 15, 2024

Study Record Updates

• Last Update Posted (Actual): March 30, 2026
• Last Update Submitted That Met QC Criteria: March 24, 2026
• Last Verified: October 1, 2025

More Information

Terms related to this study

• Keywords: PTSD; Depression; Parenting; Parent-Child Relations; STAIR; PC-CARE; Military Family
• Additional Relevant MeSH Terms: Trauma and Stressor Related Disorders; Mental Disorders; Behavioral Symptoms; Stress Disorders, Traumatic; Behavior; Depression; Stress Disorders, Post-Traumatic; Therapeutics
• Other Study ID Numbers: 23-1393

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Data collected in the context of the proposed research will be highly sensitive as it involves information about mental health and parenting, collected from protected populations including actively serving members of the military, veterans, and children. Protecting the rights and privacy of all participants is paramount. Data sharing efforts will meet the standards established by the NIH for rigorous human subjects' protection. Based on ethical considerations, the raw data will not be shared to protect the identities of participants, as stated in the informed consent. Fully de-identified post-processed files will be deposited to the Qualitative Data Repository (QDR; https://qdr.syr.edu/) along with data dictionaries for these data.
• IPD Sharing Time Frame: The investigative team will publish final results at study completion. Deidentified data will be available to outside investigators through QDR after publication of final results from the trial.
• IPD Sharing Access Criteria: Data will be categorized as special access and, due to the sensitivity of the data, will require depositor approval to access. QDR Terms of Use will describe criteria for accessing data, privacy and confidentiality standards consistent with NIH requirements, and conditions for data use that are specific to the project for which data has been requested. Investigators requesting data are expected to demonstrate procedures to ensure data security and will be prohibited from manipulating data for the purposes of identifying research participants. In shared, de-identified data, participants will be assigned new ID numbers that bear no relationship to the original participant's ID numbers. Shared data will be stripped of all identifiers that could potentially lead to deductive disclosure of the participant's identity. Only data necessary to achieve the aims of the specific projects proposed will be shared.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No