Risk factors for dropping out of a parenting education program

PREDICTING ATTENDANCE OF A PREVENTIVE PARENTING INTERVENTION FOR VERY PRETERM INFANTS

Preventive parenting interventions can experience challenges in maximizing dosage, or the amount of intervention received by parents. This study examined the associations of baseline mother, father, and very preterm infant (VPT; <32 weeks) characteristics with satisfactory intervention attendance of the family within a randomized controlled trial of Baby Triple P for Preterm Infants (Colditz et al., 2015). Mothers (n = 160) and fathers (n = 115) completed questionnaires prior to the randomization of family units (n = 160) to receive the intervention. Satisfactory session attendance (seven or eight sessions of eight in total) was achieved by 114 families (71.25%). In the logistic model for mothers, satisfactory attendance of the family was more likely when infants were extremely low birth weight (ELBW), odds ratio (OR) = 2.81, 95% confidence interval (CI) [1.16, 6.80], when the mother had a university, OR = 11.38, 95% CI [4.03, 32.19], or trade-certificate-level education, OR = 4.97, 95% CI [1.93, 12.84], or when she was not under financial stress, OR = 3.53, 95% CI [1.34, 9.28]. A similar pattern of results was found in the model for fathers. Session attendance of preventive parenting interventions for VPT infants may be improved by increasing the engagement of parents with infants not born ELBW, who have lower education, or are experiencing financial stress.

Barriers to Participation in Parenting Programs: The Relationship between Parenting Stress, Perceived Barriers, and Program Completion

Families experiencing child maltreatment or risk factors for child maltreatment often receive referrals to interventions focused on changing parenting practices. Compliance with specific parenting programs can be challenging as many of the stressors that place families at-risk may also interfere with program participation. Because families may receive limited benefit from programs they do not fully receive, it is critical to understand the relationship between parenting stress and barriers to program completion. We used structural equation modeling to examine the relationship among parenting stress, perceived barriers to program participation, and program completion in two datasets involving low-income parents. Data were collected at two time points from a sample of parents involved with child welfare services and a sample of parents considered at-risk of future involvement (total study n = 803). Direct paths from parenting stress at time 1 to barriers to participation and parenting stress at time 2, and from parenting stress at time 2 to program completion were significant. Interestingly, increased barriers to participation were related to increased parenting stress at time 2, and greater parenting stress was related to increased program completion. Results suggest that with increasing levels of parenting stress, parents have an increased likelihood of completing the program. Assessing and addressing the influence of perceived barriers and parenting stress on program participation may decrease the likelihood of treatment attrition.

Impact of Self-Help Schema Therapy on Psychological Distress and Early Maladaptive Schemas: A Randomised Controlled Trial

Self-help cognitive behaviour therapy has been found helpful in treating anxiety and depression. Recent evidence suggests that self-help schema therapy may represent another treatment alternative. The present study aimed to provide a preliminary assessment of the efficacy of self-help schema therapy on psychological distress and early maladaptive schemas (EMSs) using a 6-week treatment protocol with minimal email contact. Method: Participants were recruited from the general population and randomly assigned to self-help schema therapy (n = 32) or a waitlist (n = 32). Intent-to-treat analyses and study completer analyses were conducted using repeated-measures analyses of variance (time × group). Results: Intent-to-treat analyses revealed that treatment produced a marginal improvement in distress, but no change in EMSs. Among study completers (n = 34), self-help schema therapy yielded large reductions in distress scores on the Outcome Questionnaire-45.2 (partial eta squared = .16). Compared to the waitlist, self-help schema therapy also produced a moderate decrease in EMSs (partial eta squared = .10). The majority of study completers showed reliable clinical change in distress and reported high levels of satisfaction with the intervention. Conclusion: Self-help schema therapy may be an effective treatment for those individuals who persist in treatment. Self-help schema therapy has the potential to help a large number of individuals who may not otherwise have access to services. More research is needed to determine variables associated with treatment adherence and successful outcome.

Enrollment and attendance in a parent training prevention program for conduct problems

Low levels of enrollment and attendance in parent training programs present major problems for researchers and clinicians. The literature on enrollment and attendance in prevention programs is especially limited, and these constructs may be particularly difficult to address in this context. Further, most previous research has not made the distinction between enrollment and attendance. This study describes predictors of enrollment and attendance in a behavioral parent training program intended to prevent conduct problems in preschoolers. Information was gathered from 106 preschoolers, their parents, and their teachers. Parent socioeconomic status (SES), single parent status, ethnicity, child externalizing behavior, parent depressive symptoms, and parent social support were investigated as possible predictors of families' enrollment and attendance. Only 48% of the families that had already provided informed consent and completed demographic questionnaires actually enrolled in the parent training program; parents with lower incomes and lower levels of social support were less likely to enroll. In addition, African-American and Puerto Rican families were less likely to enroll than Caucasian families. The average attendance rate for enrolled parents was 61%; dual parents and parents with children evidencing externalizing behavior problems attended more parent training sessions. Parent depression was not associated with enrollment or attendance. Significant relationships were maintained when controlling for other predictors including SES and when accounting for center-level variance. In addition, three distinct patterns of attendance were observed, which may have practical implications related to retention strategies.

Predictors of enrollment and retention in a preventive parenting intervention for divorced families

Participation rates in parenting programs are typically low, severely limiting the public health significance of these interventions. We examined predictors of parenting program enrollment and retention in a sample of 325 divorced mothers. Predictors included intervention timing and maternal reports of child, parent, family, and sociocultural risk factors. In multivariate analyses, child maladjustment and family income-to-needs positively predicted enrollment, and higher maternal education and recruitment near the time of the divorce predicted retention. Findings have implications for the optimal timing of preventive parenting programs for divorcing families and point to the importance of examining predictors of enrollment and retention simultaneously. Editors' Strategic Implications: parent education researchers and practitioners may find the authors' application of the Health Belief Model to be a useful organizing framework for improving engagement and retention.

Characteristics of primiparous women who are not reached by parental education classes after childbirth in Sweden

BACKGROUND

Parental education classes are part of the national child health promotion programme of the Swedish Child Health Clinics (CHC).

AIM

To investigate attendance at parental education classes during the infant's first year, and to identify factors associated with non-attendance in primiparous women.

METHODS

Swedish-speaking women were recruited from 97% of all antenatal clinics in Sweden during 3 wk, evenly spread over 1 y from 1999 to 2000. Questionnaires were mailed in early pregnancy, and at 2 mo and 1 y after the birth. Two thousand, four hundred and forty women answered the main outcome question about class attendance asked in the third questionnaire, and 1076 of these were first-time mothers.

RESULTS

Seventy-eight per cent of the primiparas attended classes and 31% of the multiparas. Factors associated with non-attendance in primiparas were: native language other than Swedish, a low level of education, smoking during pregnancy, inconvenient timing of pregnancy, feelings of loneliness and isolation, maternal hospital admission, and infant health problems. Three per cent of the primiparas did not attend classes either during pregnancy or after the birth, and this group seemed to constitute an even less privileged group.

CONCLUSION

Parental education classes organized by the CHCs did not reach women who were more disadvantaged in terms of socio-demographic background, and maternal and infant health.

The effectiveness of individual and group-based parenting programmes in improving outcomes for teenage mothers and their children: a systematic review

There is evidence from a range of studies showing adverse child outcomes for the children of teenage parents. Parenting programmes are increasingly being used to promote the well-being of parents and children, and this review aims to establish whether they can improve outcomes for teenage parents and their children. The findings of the review are based on 14 studies that used varying study designs, and are therefore limited. The results suggest, however, that parenting programmes can be effective in improving a range of psychosocial and developmental outcomes for teenage mothers and their children. Further research is needed.

Evaluation of an intervention programme to support mothers and babies at psychosocial risk: assessment of mother/child interaction and mother's perceptions of benefit

The outcome of a short-term intervention programme for mothers at psychosocial risk was evaluated. The study included 63 mothers and their 0-6-month-old babies who participated in a 6-week intensive treatment programme. Mother-child interaction was assessed in the beginning and at the end of treatment by two independent staff members based on direct observation, and by two control raters who observed video recordings which were arranged in blind order. The mothers were interviewed about the treatment retrospectively. A positive change in several aspects of mother-child interaction, according to the assessments made by the raters and according to the mothers themselves. The number of mothers who were positive toward the treatment rose from 34 in the beginning of the treatment to 56 at the end. In conclusion, a short but intensive intervention seems to have a positive outcome on mother-child interaction, and was in most cases linked to a positive attitude.

Individual and group-based parenting programmes for improving psychosocial outcomes for teenage parents and their children

BACKGROUND

Rates of births to teenage parents are high and there is also a high incidence of poor outcomes among the children of teenage parents including developmental and learning problems, and child maltreatment. Parenting programmes may have an important role to play in improving outcomes for both teenage parents and their children.

OBJECTIVES

The aim of this review was to examine the effectiveness of individual and/or group based parenting programmes in improving psychosocial and developmental outcomes in teenage mothers and their children.

SEARCH STRATEGY

A range of biomedical and social science databases were searched including MEDLINE, EMBASE, CINAHL, PsychLIT, Sociofile, Social Science Citation Index, ASSIA, the Cochrane Library including SPECTR, CENTRAL, National Research Register (NRR) and ERIC.

SELECTION CRITERIA

Only randomised controlled trials were included in which participants had been randomly allocated to an experimental and a control group, the latter being a waiting-list, no-treatment or a placebo control group. Studies had to include at least one standardised instrument measuring maternal psychosocial health or infant health and development.

DATA COLLECTION AND ANALYSIS

The included studies were critically appraised using a number of criteria including the method of allocation concealment. The treatment effect for each outcome in each study was standardised by dividing the mean difference in post-intervention scores for the intervention and treatment group, by the pooled standard deviation, to produce an effect size. Due to the presence of significant heterogeneity it was not possible to combine the results in a meta-analysis.

MAIN RESULTS

The results of the review are based on data from four studies. These showed that both individual and group-based parenting programmes produced results favouring the intervention group on a range of maternal and infant measures of outcome including mother-infant interaction, language development, parental attitudes, parental knowledge, maternal mealtime communication, maternal self-confidence and maternal identity.

REVIEWER'S CONCLUSIONS

The conclusions which can be drawn from this review are limited due to the small number of included studies, and the use of a restricted number of outcomes measures. The conclusions are also limited by some of the methodological deficiencies of the included studies. Despite these problems the findings of the included studies suggest that parenting programmes may be effective in improving outcomes for both teenage mothers and their infants. There is, however, a need for further research into the effectiveness of parenting programmes for teenage parents.

A time to be born

OBJECTIVES

This study used a large, population-based data set (n = 619,455) to establish reference standards of the timing of spontaneous vaginal births.

METHODS

Low-risk births in Massachusetts from 1989 to 1995 were studied. This group comprised 242,276 births that met the following criteria: singleton, vertex, vaginal births with a birthweight of between 2500 and 4000 g; gestation between 37 and 42 weeks; a 5-minute Apgar score greater than 6, and no induction or stimulation.

RESULTS

Low-risk births displayed a mild circadian pattern, with a peak between 11:00 AM and 1:00 PM and a trough between 11:00 PM and 1:00 AM. Subgroup analysis showed no clear differences except for parity.

CONCLUSIONS

Reference standards should be developed and used as comparative norms for hospital and practice-based perinatal studies of diurnal patterns of birthing.

Factors predicting completion of a home visitation program by high-risk pregnant women: the North Carolina Maternal Outreach Worker Program

OBJECTIVES

This study sought to identify characteristics of high-risk pregnant women that predicted long-term participation in a home visitation program.

METHODS

Data regarding sociodemographic characteristics, perceived needs, psychological functioning, substance use, and informal social support were collected prospectively from 152 short-term and 221 long-term program participants.

RESULTS

In comparison with short-term participants, long-term participants were more likely to have been African American, married, nonsmokers, and enrolled in the program during their second trimester of pregnancy, and they were more likely to have had emotional and instrumental support needs.

CONCLUSIONS

Women with greater social support needs and healthier behaviors were more receptive to long-term home visitation than other women.

Sources of prenatal care data and their association with birth outcomes of HIV-infected women

OBJECTIVES

Different sources of prenatal care data were used to examine the association between birth outcomes of HIV-infected women and the Adequacy of Prenatal Care Utilization (APNCU) index.

METHODS

Adjusted odds ratios of birth outcomes for 1858 HIV-positive mothers were calculated for APNCU indexes on the basis of birth certificate data or 3 types of physician visits on Medicaid claims.

RESULTS

Claims- and birth certificate-based APNCU indexes agreed poorly (kappa < 0.3). Only the broadest claims-based APNCU index had lower adjusted odds ratios for low birthweight (0.64; 95% confidence interval [CI] = 0.49, 0.84) and preterm birth (0.70; 95% CI = 0.54, 0.91). The birth certificate-based index had a reduced adjusted odds ratio (0.73; 95% CI = 0.56, 0.95) only for preterm birth.

CONCLUSIONS

The association of birth outcomes and adequacy of prenatal care in this HIV-infected cohort differed significantly depending on the source of prenatal care data.

Continued risky behavior in HIV-infected youth

OBJECTIVES

The purpose of this study was to describe and compare risky behaviors in HIV-infected youths and adults.

METHODS

Records of HIV-infected outpatients were reviewed for the period January 1990 to February 1998. Youths (younger than 22 years at HIV diagnosis and younger than 25 years at study entry, n = 139) were compared with adults (22 years or older at HIV diagnosis or 25 years or older at study entry, n = 2880). Risky behaviors occurring after HIV diagnosis included unsafe sex and needle sharing.

RESULTS

Female and male youths were more than twice as likely as adults to engage in risky behavior (adjusted odds ratios of 2.6 and 2.3, respectively).

CONCLUSIONS

Both youths and adults continue to engage in risky behaviors after HIV diagnosis. Prospective studies are needed, along with targeted public health campaigns, for youths with HIV and for those at risk of infection.

Estimates of US children exposed to alcohol abuse and dependence in the family

OBJECTIVES

This study sought to provide direct estimates of the number of US children younger than 18 years who are exposed to alcohol abuse or alcohol dependence in the family.

METHODS

Data were derived from the National Longitudinal Alcohol Epidemiologic Survey.

RESULTS

Approximately 1 in 4 children younger than 18 years in the United States is exposed to alcohol abuse or alcohol dependence in the family.

CONCLUSIONS

There is a need for approaches that integrate systems of services to enhance the lives of these children.

A randomized controlled trial of group versus individual well child care for high-risk children: maternal-child interaction and developmental outcomes

OBJECTIVE

To determine if group well child care (GWCC) for high-risk children affects maternal-child interaction and development as compared to these outcomes in children receiving traditional individual well child care (IWCC).

STUDY DESIGN

Randomized controlled trial.

PARTICIPANTS

Infants less than 4 months old at the initiation of the study who came from high-risk families. Families were classified as high risk, and eligible for study participation, if the mother had one or more of the following characteristics: poverty, single marital status, less than a high school education, age less than 20 years at delivery, previous substance abuse, or a history of abuse as a child.

SETTING

Two urban, university pediatric clinics in Seattle, Washington.

INTERVENTIONS

Study children were randomized to receive GWCC or IWCC prior to the first study visit at the age of 4 months. Study health supervision visits were scheduled at 4, 5, 6, 8, 10, 12, and 15 months of age. For children randomized to receive GWCC, study visits consisted of an age-matched group discussion of child rearing issues, either preceding or following a brief physical examination. After the 15-month visit, development of study patients was assessed by the use of Bayley Scales of Infant Development (Bayley). Maternal-child interaction and the home environment were evaluated by the use of the Nursing Child Assessment Teaching Scale (NCATS) and the Home Observation for Measurement of the Environment (HOME), respectively.

RESULTS

At least one outcome measure was obtained on 114 children; 86 patients completed all three outcome measures. Bayley psychomotor mean scores were 103.6 +/- 11.5 for GWCC patients versus 100.0 +/- 12.4 for those receiving IWCC (P = .14); mean scores for the mental section were 99.3 +/- 14.8 and 100.4 +/- 14.3, respectively (P = .71). The prevalence of high-risk maternal-child interactions was 10% in both the GWCC and IWCC groups. A high-risk home environment was found in 16% of IWCC patients versus 4% of those randomized to GWCC (odds ratio comparing IWCC to GWCC 4.6, 95% confidence interval 0.78, 26.0, after controlling for confounding variables). Provider time was similar among groups (mean number of minutes/patient/study visit: 19.8 +/- 5.6 and 20.4 +/- 6.7 for GWCC and IWCC, respectively, P = .66).

CONCLUSION

GWCC is a viable alternative to IWCC for high-risk children. Developmental outcomes and maternal-child interaction are at least as good for children who received GWCC as compared to traditional IWCC, without any increase in provider time required.