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, 4) have assessments and observed play sessions audio and video recorded.

Participants may also be invited to participate in an optional, 30-minute online one-on-one qualitative interview, which would be audio and video recorded and would cover participants' experiences with the intervention, the clinic sites, and their providers.

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.

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)).

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.

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.

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.

Assessors will be blind to treatment arm. Coders blind to treatment arm will also code 10% of dyadic parenting sessions.