Can Discipline Education be Culturally Sensitive?

Play Nicely: Evaluation of a Brief Intervention to Reduce Physical Punishment and the Beliefs That Justify It

The objective of this study was to assess the efficacy of the Play Nicely brief intervention in diminishing both the utilization of physical punishment and the beliefs that endorse such behavior among a sample of Colombian parents with children aged 2 to 6. Utilizing a quasi-experimental design, the research included pretest and posttest evaluations and involved both an intervention group (n = 37) and a control group (n = 29). The assessment tools used were a scale to measure beliefs about the positive impacts of physical punishment and the Physical Assault subscale of the Spanish version of the Conflict Tactics Scale Parent-Child (CTSPC). Parents participated in a single online session, which offered eight interactive options and lasted 10 min. The results highlighted a high prevalence of physical punishment within the sample (81.8%) and established statistically significant correlations between the justification of physical punishment and its actual use. Approximately one month following the intervention, there was a significant reduction in the employment of physical punishment among the intervention group (p = 0.009), and a notable decrease in the belief that "Punishment is the best alternative to control children's behavior" (p = 0.010) was observed. Consequently, the Play Nicely intervention proved effective in curtailing the use of physical punishment among parents of young children, demonstrating both efficacy and cost-effectiveness within a brief timeframe.

Examining the Use of a Brief Online Intervention in Primary Care for Changing Low-Income Caregivers' Attitudes Toward Spanking

There is a robust and growing literature base indicating that spanking is a common, but potentially problematic, discipline strategy. Goals: Using a randomized controlled trial design, this study examined whether participation in a brief online program, Play Nicely, would result in favorable changes in caregivers' attitudes toward spanking. The study also examined whether the intervention was equally effective for participants of color (POC) and White participants, and it assessed caregivers' perceptions of the program's cultural sensitivity. Methods: Participants were 52 caregivers from 1- to 5-year-old children who were visiting a pediatric clinic. Participants were enrolled and randomly assigned to either engage in the Play Nicely online program (n = 21) or view a control condition website (n = 31) in a clinic exam room. Results: There was not a statistically significant difference between the treatment and control groups' scores on attitudes toward spanking (ATS) at post-test (F (1, 49) = 1.515, p = 0.224), but a small between-group effect size was detected (d = 0.20). Within the treatment condition, desired changes in ATS scores were significantly higher among White participants than POC (t (17) = -2.125, p = 0.049), but there was not a significant difference in reported perceptions of Play Nicely's cultural acceptability between White participants and POC (t (19) = 0.469, p = 0.644). Conclusions: Findings suggest a need for further investigation of Play Nicely's impact on caregivers' ATS with a larger sample to clarify the program's utility as a potential population-based tool for parent education and violence prevention. Additional research is needed to identify sociocultural factors that may moderate the effects of spanking interventions for families across diverse racial backgrounds.

The Development, Preliminary Validation, and Clinical Application of the Quick Parenting Assessment

To prevent diseases, efforts are needed to determine how to address Adverse Childhood Experiences (ACEs), including parenting behaviors. The objective of this study, conducted in Nashville TN in 2017, was to initiate testing the psychometric properties of two new Adverse Childhood Experiences (ACEs) screening tools, the Quick Parenting Assessment (QPA) and Other Childhood Stressors (OCS). In a clinic serving low-income families, caregivers of children ages 2-10 completed assessments of parenting (QPA), other stressors (OCS), child behavior problems ((Strength and Difficulties Questionnaire (SDQ)), and Attitudes Toward Spanking (ATS). The QPA takes 1 min to complete and assesses for healthy and unhealthy parenting behaviors. Seventy-five percent of eligible participants completed the survey (N=558). A reduced 10-item QPA yielded a Cronbach's alpha of 0.79 and, in 4-10-year-olds, was associated with high SDQ conduct, hyperactivity, and total difficulties scores (r=0.44, 0.48, and 0.47; all p< 0.001). Children with QPAs of >4 were nine times more likely than those children with scores of ≤2 to have behavior problems (OR=8.93, 95% CI = 3.74-21.32). Elevated QPAs were associated with the ATS (r=0.47, p < .001). The OCS was also associated with high SDQ total difficulties scores (r=0.28, p< 0.001). Two pediatric ACEs screening tools, the QPA and the OCS, have promising psychometric properties. The findings suggest that parenting behaviors may play an outsized role in the pathogenesis of outcomes associated with ACEs. We discuss the clinical application of QPA at our institution and the theoretical potential for this instrument to reduce the rates of short- and long-term health problems.

Psychometric Evaluation of a Brief Assessment of Parents' Disciplinary Alternatives

OBJECTIVES

The majority of strategies designed to assess parental discipline practices typically focus on ineffective or adverse discipline options. When more comprehensive measures are utilized, parents are often expressly asked to report their use of nonphysical discipline options but such an approach signals to parents that they should report implementing such choices, thereby rendering it susceptible to social desirability.

METHODS

Rather than cueing parents with possible discipline options, the Production of Discipline Alternatives (PDA) is a very brief parent-report coding scheme of the discipline options parents freely generate to an open-ended question after reading a short vignette. The current study investigated the inter-rater reliability and stability as well as concurrent and predictive validity from the coding of this brief qualitative prompt using three waves of longitudinal data collected from mothers and fathers (prenatally, child age 6 months, and child age 18 months).

RESULTS

Findings demonstrated strong inter-rater reliability (between independent coders) and stability of discipline alternatives provided by parents across nearly two years. Concurrent and predictive validity were also observed; specifically, mothers and fathers who generated proportionally more physical discipline options were more likely to approve of physical discipline, to be inclined to punish perceived misbehavior, to prefer authoritarian parenting approaches, to evidence greater child abuse risk, and to report more frequent use of physical discipline.

CONCLUSIONS

The current findings imply the PDA may have research utility as well as potential value in screenings at primary and integrated care settings relevant for prevention and intervention efforts.

Effective Discipline to Raise Healthy Children

Pediatricians are a source of advice for parents and guardians concerning the management of child behavior, including discipline strategies that are used to teach appropriate behavior and protect their children and others from the adverse effects of challenging behavior. Aversive disciplinary strategies, including all forms of corporal punishment and yelling at or shaming children, are minimally effective in the short-term and not effective in the long-term. With new evidence, researchers link corporal punishment to an increased risk of negative behavioral, cognitive, psychosocial, and emotional outcomes for children. In this Policy Statement, the American Academy of Pediatrics provides guidance for pediatricians and other child health care providers on educating parents about positive and effective parenting strategies of discipline for children at each stage of development as well as references to educational materials. This statement supports the need for adults to avoid physical punishment and verbal abuse of children.

How to Convince Parents to Stop Spanking Their Children

English- and Spanish-speaking parents of 1- to 5-year-old children were invited to view 5-10 minutes of parent training program, "Play Nicely," as part of the well-child checkup. Key measures were parents' plans to change how they discipline and, if they planned to use less spanking, how the program worked in their situation. Of 197 parents who participated, 128 (65.0%) planned to change how they discipline. Nineteen parents (9.6%) reported that they planned to spank less. The most common reasons for parents to plan to spank less were that the program taught other discipline options (12/19, 63.2%) and that the program taught that spanking was not recommended as a form of discipline (6/19, 31.6%). The majority of parents report that the program works because it offers alternatives to spanking. This study has implications for the development of parent training programs and the primary prevention of child abuse, violence, and other health problems.

Developing tailored positive parenting messages for a clinic-based communication programme

BACKGROUND

Health care providers fill a central role in the prevention of both child abuse and neglect (CA/N) and unintentional childhood injury. Health communication interventions hold promise for promoting attitudes and behaviours among parents that increase positive parenting practices, which may be linked to decreased rates of intentional and unintentional childhood injuries. This manuscript describes the development of 'RISE Up', an ambulatory clinic-based childhood injury prevention programme that provides tailored, injury prevention print materials to parents of children ages 0-5.

METHODS

Fifteen semi-structured key informant interviews were conducted with clinic healthcare providers and staff to develop communication strategies and materials for caregivers. Cognitive response testing was then conducted with 20 caregivers of the priority population to assess all materials. Interviews were recorded, transcribed and analyzed using thematic coding methods.

RESULTS

Formative research revealed that health care providers and caregivers were very responsive to messages and materials. Health care providers reported that abuse and neglect were particularly relevant to their patients and noted several benefits to implementing the RISE Up programme in a health care setting. Caregivers generally found messages on reducing the risks of injuries, as well as the graphics displayed in the RISE Up programme to be helpful.

CONCLUSIONS

Addressing the common determinants of both intentional and unintentional childhood injury through customized print materials may be a useful component of comprehensive prevention efforts to address childhood injury risk with greater impact. Providers and parents responded favourably to this communication strategy.

Parents' Primary Professional Sources of Parenting Advice Moderate Predictors of Parental Attitudes toward Corporal Punishment

Despite the risk it poses to children's mental and physical health, approval and use of corporal punishment (CP) remains high in the United States. Informed by the Theory of Planned Behavior, we examined potential predictors of attitudes supportive of CP while assessing the moderating effects of parents' (N=500) chosen primary professional source of advice regarding child discipline: pediatricians (47.8%), religious leaders (20.8%), mental health professionals (MHPs) (n=18.4%), or other identified professionals (13.0%). We conducted a random-digit-dial telephone survey among parents ages 18 and over within New Orleans, LA. The main outcome measure was derived from the Attitudes Toward Spanking scale (ATS). The main "predictors" were: perceived injunctive norms (i.e., perceived approval of CP by professionals; and by family and friends), perceived descriptive norms of family and friends regarding CP, and expected outcomes of CP use. We used multivariate OLS models to regress ATS scores on the predictor variables for each subset of parents based on their chosen professional source of advice. Perceived approval of CP by professionals was the strongest predictor of parental attitudes supportive of CP, except for those seeking advice from MHPs. Perceived injunctive and descriptive norms of family and friends were important, but only for those seeking advice from pediatricians or religious leaders. Positive expected outcomes of CP mattered, but only for those seeking advice from religious leaders or MHPs. In conclusion, the strength and relevance of variables predicting attitudes toward CP varied according to the professional from which the parent was most likely to seek advice.