When Threat Never Ends: A Tiered Parenting Model Reaches Families Under Continuous Traumatic Stress

When an entire population lives under threat that never fully resolves, the mental health playbook built around one-on-one therapy starts to break down. Researchers at the Hebrew University of Jerusalem and the University of Haifa argue that this is precisely the situation facing Israeli families since October 2023, and they have now described what they believe is the first population-level, parenting-centered public health system designed for conditions of continuous traumatic stress. The initiative, called ADAPT-Israel, is detailed in a community case study published in Frontiers in Psychiatry, and its central proposition is provocative: when danger is chronic and community-wide, protecting children may depend less on scaling up individual treatment than on strengthening the caregiving relationships that surround them.

Continuous traumatic stress, a concept developed by psychologists Gery Eagle and Debra Kaminer, describes the experience of large populations exposed to ongoing wars, armed conflict, terrorism, or chronic community violence, in which individuals face repeated traumatic events and persistent uncertainty about future safety. Unlike a single discrete trauma, the stressor never ends, and neither does the physiological and psychological adaptation it demands. Children are particularly vulnerable. Studies of youth exposed to ongoing threat show elevated rates of posttraumatic stress symptoms, anxiety, sleep disturbances, and impairments in emotion regulation and executive functioning, both in the short term and over longer developmental horizons.

The scale of need in Israel illustrates why conventional services cannot keep pace. By mid-2024, roughly six months after the outbreak of the war, an estimated one in three Israeli adults, more than three million people, were experiencing significant mental health difficulties, including over 600,000 individuals in severe psychological distress. Referrals to child mental health services rose by nearly 20 percent during the first year of the war, while public-sector waiting times stretched from months to a year. The research team, led by Abigail Gewirtz of the Paul Baerwald School of Social Work and Social Welfare, reasoned that when large segments of a population are affected simultaneously, clinician-delivered services alone are structurally incapable of meeting demand, and that a coherent public health architecture is needed before difficulties escalate to specialist care.

The theoretical foundation of the approach is the wartime family stress model, which holds that war-related stressors affect children both directly and indirectly, through their impact on parents’ mental health and parenting. Across diverse contexts of war, disaster, and political violence, the caregiving environment has emerged as one of the most consistent predictors of children’s adjustment after adversity. Parents scaffold children’s emotional responses to threat, maintain routines and a sense of safety, interpret stressful events, and connect families to resources. Supportive parenting can therefore buffer the impact of trauma exposure on children’s emotional and behavioral functioning, and because parenting support is generally non-stigmatizing, can be delivered in varied formats and intensities, and benefits parents and children simultaneously, the researchers identified it as the most promising lever for population-level intervention.

ADAPT-Israel adapts an evidence-based program called Adaptive Parenting Tools, originally developed for United States military families experiencing deployment-related stress. ADAPT is grounded in Social Interaction Learning theory, developed by Gerald Patterson, which holds that coercive parenting practices are a key mechanism through which environmental stress negatively shapes children’s adjustment, making positive parenting skills the natural target for intervention. The program teaches core practices including skill encouragement, effective non-corporal limit setting, emotion coaching, family problem-solving, monitoring, and positive involvement, and infuses each with mindfulness and emotion-regulation content designed to help parents manage their own distress. Across three randomized controlled trials involving nearly 900 military families, ADAPT consistently improved parenting practices, parental wellbeing, and child adjustment across group, individual, telehealth, and self-directed online formats.

The Israeli adaptation reorganizes this evidence base into a tiered public health framework with four products at three levels of intensity. The universal layer consists of brief, trauma-informed public health messages and a self-directed interactive online parenting program, with an optional AI avatar guide. The selective layer provides facilitator-delivered ADAPT groups for higher-risk families, beginning with families of long-serving military reservists. The indicated layer offers individual telehealth support for families experiencing clinical levels of difficulty. All tiers share a common theoretical foundation and parenting principles, so that families can move between levels of intensity as their needs change, an approach modeled in part on Australia’s nationally implemented Triple P Positive Parenting Program.

The universal messaging component was built through an audience-centered process rather than top-down advice. The team conducted ten focus groups with 107 parents drawn from Jewish, Druze, and Muslim Arab communities, conducted in Hebrew or Arabic in locations ranging from a northern border town to Jerusalem and Tel Aviv. Preliminary thematic analysis has already informed six draft message scripts addressing tension between partners who respond differently to ongoing threat, community support as a coping resource, responding to children’s unexpected questions about death and loss, regression among older children, hypervigilance and trauma-related triggers, and children’s renewed requests to sleep with their parents out of fear. The scripts are being converted into animated videos in collaboration with the educational media company Compedia, and the team plans dissemination in Hebrew, Arabic, Russian, and Amharic through WhatsApp groups, social media, local radio, billboards, and school communications. The design assumption is that parents under continuous stress have limited cognitive and emotional bandwidth, so support must be easy to encounter, easy to understand, and easy to act on.

The online program reflects the same logic of low burden and high interactivity. Where the original ADAPT online program included twelve modules with videos of five to ten minutes each, the Israeli version uses two short clips of two to three minutes per module, interspersed with interactive exercises in which parents apply what they have learned to daily parenting situations, along with a digital diary for reflecting on skill practice at home. Parents can also enter a virtual family center where a video avatar presents and debriefs each module, answers questions, and troubleshoots challenges. The platform is complete and in beta testing, with rollout planned for late 2026.

Early implementation data from the selective tier are encouraging, though the researchers are careful to frame them as feasibility and acceptability findings rather than effectiveness evidence. Three 14-week parenting groups piloted in 2025 served 42 parents from 26 families, all with at least one parent who had completed more than 200 days of reserve military service since October 2023. Despite meetings being disrupted several times by missile sirens, 81.3 percent of families completed the program. Anonymous satisfaction ratings on the validated ADAPT Parent Evaluation Form, translated into Hebrew, were consistently high for group experience, with means ranging from 4.38 to 4.61 on a five-point scale. Post-intervention focus groups with eleven mothers, analyzed using quantitative content analysis with inter-rater agreement above 90 percent, showed that mothers particularly valued peer connection, normalization, and facilitator support, while finding some practices, such as incentive charts and structured home practice, harder to sustain. The indicated tier has so far been piloted with three families through 14 weekly telehealth sessions, with parents informally reporting calmer, more intentional responses and benefits for presenting a united parenting front.

The authors are explicit about the limitations. The pilot samples are small and self-selected, the satisfaction data rely on self-report without clinical or behavioral outcomes, and there is no comparison condition, so no effectiveness claims can yet be supported. The evidence base derives from American military families, and whether those benefits transport to the Israeli context remains to be demonstrated. The selective and indicated tiers have so far reached only a tiny proportion of reservist families, and other highly exposed groups, including evacuated, bereaved, and directly attacked families, have not yet been served. The team is now planning two rigorous evaluations: a three-group non-inferiority randomized controlled trial comparing the online program and groups against a message-only control, and a separate test of the messaging campaign across discrete populations. Six facilitators trained between January and March 2026 are delivering three additional groups with 24 families, and discussions are underway with NGOs and government agencies for full-scale implementation. The researchers argue the model’s relevance extends well beyond Israel, from Ukraine to other settings of protracted conflict, wherever mental health systems face the same mismatch between overwhelming need and limited specialist capacity.

Subject of Research: A tiered public health parenting program for families under continuous traumatic stress in Israel

Article Title: Toward a population-level public health approach to support families living under continuous traumatic stress

Article References: Gewirtz, A. H., Keleynikov, M., Eliash-Fizik, H., Lewis, N., Gale, J., Itzhaky-Wruble, S., Hoffnung-Assouline, A., & Viner, A. (2026). Toward a population-level public health approach to support families living under continuous traumatic stress. Frontiers in Psychiatry, 17, Article 1929102. https://doi.org/10.3389/fpsyt.2026.1929102

Image Credits: AI Generated

DOI: 10.3389/fpsyt.2026.1929102

Keywords: continuous traumatic stress, parenting intervention, public health, ADAPT-Israel, military reservist families, child mental health, prevention science, telehealth, trauma-informed care, Israel, randomized controlled trials, family resilience