Toward a population-level public health approach to support families living under continuous traumatic stress
Abstract
Since October 2023, families across Israel have been living under conditions of continuous traumatic stress (CTS): ongoing, unresolved threat due to repeated rounds of regional conflict. Demand for mental health support has far outstripped the capacity of clinician-delivered services, leaving many families without evidence-based help. This community case study describes the development and early implementation of ADAPT-Israel. To our knowledge, this is likely to be the first population-level, parenting-centered public health approach designed for families living under CTS. The initiative uses a tiered model to provide parenting support across layers of care: (i) a universal layer of brief, trauma-informed public health messages and a self-directed, interactive online parenting program (with an optional AI avatar guide); (ii) a selective layer of facilitator-delivered ADAPT groups for live higher-risk families, beginning with families of long-serving military reservists; and (iii) an indicated layer of individual telehealth support for families experiencing clinical levels of difficulty. The approach adapts Adaptive Parenting Tools/ADAPT, an evidence-based program grounded in Social Interaction Learning theory and validated in a different context – for military families in the United States across three randomized controlled trials with nearly 1,000 military families. We describe the rationale, the methodology used to develop each tier, and early implementation experience. Feasibility and acceptability indicators from initial pilot groups are promising, including high group completion and positive participant reports of improved parenting and family relationships, though these are small-sample, self-report, early-stage findings rather than effectiveness evidence. We discuss practical implications, lessons learned, and the model’s potential utility in settings of protracted conflict and chronic threat.