A Factorial Randomized Controlled Trial to Optimize User Engagement With a Chatbot-Led Parenting Intervention: Protocol for the ParentText Optimisation Trial

BACKGROUND

Violence against children (VAC) is a serious public health concern with long-lasting adverse effects. Evidence-based parenting programs are one effective means to prevent VAC; however, these interventions are not scalable in their typical in-person group format, especially in low- and middle-income countries where the need is greatest. While digital delivery, including via chatbots, offers a scalable and cost-effective means to scale up parenting programs within these settings, it is crucial to understand the key pillars of user engagement to ensure their effective implementation.

OBJECTIVE

This study aims to investigate the most effective and cost-effective combination of external components to optimize user engagement with ParentText, an open-source chatbot-led parenting intervention to prevent VAC in Mpumalanga, South Africa.

METHODS

This study will use a mixed methods design incorporating a 2 × 2 factorial cluster-randomized controlled trial and qualitative interviews. Parents of adolescent girls (32 clusters, 120 participants [60 parents and 60 girls aged 10 to 17 years] per cluster; N=3840 total participants) will be recruited from the Ehlanzeni and Nkangala districts of Mpumalanga. Clusters will be randomly assigned to receive 1 of the 4 engagement packages that include ParentText alone or combined with in-person sessions and a facilitated WhatsApp support group. Quantitative data collected will include pretest-posttest parent- and adolescent-reported surveys, facilitator-reported implementation data, and digitally tracked engagement data. Qualitative data will be collected from parents and facilitators through in-person or over-the-phone individual semistructured interviews and used to expand the interpretation and understanding of the quantitative findings.

RESULTS

Recruitment and data collection started in August 2023 and were finalized in November 2023. The total number of participants enrolled in the study is 1009, with 744 caregivers having completed onboarding to the chatbot-led intervention. Female participants represent 92.96% (938/1009) of the sample population, whereas male participants represent 7.03% (71/1009). The average participant age is 43 (SD 9) years.

CONCLUSIONS

The ParentText Optimisation Trial is the first study to rigorously test engagement with a chatbot-led parenting intervention in a low- or middle-income country. The results of this study will inform the final selection of external delivery components to support engagement with ParentText in preparation for further evaluation in a randomized controlled trial in 2024.

TRIAL REGISTRATION

Open Science Framework (OSF); https://doi.org/10.17605/OSF.IO/WFXNE.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/52145.

A Randomized Controlled Trial of Two Parenting Interventions on Enhancing Parental Resilience Resources and Reducing Children's Problem Behaviors in Chinese Cross-Boundary Families: Positive Benefits and Moderation Effects

Daily cross-boundary schooling between Shenzhen and Hong Kong constitutes a constant challenge for Chinese cross-boundary families in terms of parenting burden. To address their most urgent parenting needs, we adapted and evaluated two intervention approaches-improving emotional regulation and providing knowledge about Hong Kong. A cluster randomized controlled trial with repeated assessments (pre-, post-intervention, and one-month follow-up) was adopted to evaluate the intervention effects on the increases of parental resilience resources and reduction of children's problem behaviors. We further conducted moderation analyses to investigate whether parents with more increases in parental resilience resources would report a greater reduction in children's problem behaviors. A total of 214 mothers of cross-boundary families were randomly assigned to the emotional regulation arm (ER, n = 120) or the information provision arm (IP, n = 94). Both intervention arms showed positive effects on emotional regulation strategies, and the IP arm outperformed the ER arm in knowledge acquisition. Both arms showed significant and comparable improvements in parental self-efficacy and children's problem behaviors. Moreover, participants in the IP arm who reported more improvements in parental resilience resources showed a greater reduction in children's problem behaviors. By adapting two interventions to a new population of cross-boundary families, this trial extended the benefits from parents to children and demonstrated that the improvement of parental resilience resources makes a difference in reducing children's problem behaviors in the IP arm. Future studies are suggested to focus on parental resilience resources and maximize the benefits on children's outcomes.

A Hybrid Digital Parenting Program Delivered Within the Malaysian Preschool System: Protocol for a Feasibility Study of a Small-Scale Factorial Cluster Randomized Trial

BACKGROUND

The United Nations' Sustainable Development Goal 4, and particularly target 4.2, which seeks to ensure that, by 2030, all children have access to quality early childhood development, care, and preprimary education so that they are ready for primary education, is far from being achieved. The COVID-19 pandemic compromised progress by disrupting education, reducing access to well-being resources, and increasing family violence. Evidence from low- and middle-income countries suggests that in-person parenting interventions are effective at improving child learning and preventing family violence. However, scaling up these programs is challenging because of resource constraints. Integrating digital and human-delivered intervention components is a potential solution to these challenges. There is a need to understand the feasibility and effectiveness of such interventions in low-resource settings.

OBJECTIVE

This study aims to determine the feasibility and effectiveness of a digital parenting program (called Naungan Kasih in Bahasa Melayu [Protection through Love]) delivered in Malaysia, with varying combinations of 2 components included to encourage engagement. The study is framed around the following objectives: (1) to determine the recruitment, retention, and engagement rates in each intervention condition; (2) to document implementation fidelity; (3) to explore program acceptability among key stakeholders; (4) to estimate intervention costs; and (5) to provide indications of the effectiveness of the 2 components.

METHODS

This 10-week factorial cluster randomized trial compares ParentText, a chatbot that delivers parenting and family violence prevention content to caregivers of preschool-aged children in combination with 2 engagement components: (1) a WhatsApp support group and (2) either 1 or 2 in-person sessions. The trial aims to recruit 160 primary and 160 secondary caregivers of children aged 4-6 years from 8 schools split equally across 2 locations: Kuala Lumpur and Negeri Sembilan. The primary outcomes concern the feasibility and acceptability of the intervention and its components, including recruitment, retention, and engagement. The effectiveness outcomes include caregiver parenting practices, mental health and relationship quality, and child development. The evaluation involves mixed methods: quantitative caregiver surveys, digitally tracked engagement data of caregivers' use of the digital intervention components, direct assessments of children, and focus group discussions with caregivers and key stakeholders.

RESULTS

Overall, 208 parents were recruited at baseline December 2023: 151 (72.6%) primary caregivers and 57 (27.4%) secondary caregivers. In January 2024, of these 208 parents, 168 (80.8%) enrolled in the program, which was completed in February. Postintervention data collection was completed in March 2024. Findings will be reported in the second half of 2024.

CONCLUSIONS

This is the first factorial cluster randomized trial to assess the feasibility of a hybrid human-digital playful parenting program in Southeast Asia. The results will inform a large-scale optimization trial to establish the most effective, cost-effective, and scalable version of the intervention.

TRIAL REGISTRATION

OSF Registries; https://osf.io/f32ky.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/55491.

Young mother risk-taking moderates doula home visiting impacts on parenting and toddler social-emotional development

This longitudinal randomized controlled trial examined the impact of a doula home visiting intervention for young, low-income mothers on parenting and toddler social-emotional development and tested whether intervention effects were moderated by maternal emotional and behavioral health characteristics. 156 mothers were offered home visits from a home visitor starting in mid-pregnancy through several years postpartum, with a community doula also working with the mother during pregnancy and after the birth. 156 received case management. Interviews, video recordings of mother-child interactions, and toddler assessments were conducted at 3 weeks, 3 months, 13 months, and 30 months of age. Intent-to-treat analyses conducted with the full sample showed some intervention effects. Moderation analyses, however, showed that most effects were concentrated among mothers engaged in high levels of risk-taking (delinquent behaviors, school suspensions, smoking, alcohol use, sexual risk-taking). Among higher risk-taking mothers, the intervention was related to less intrusiveness during early infancy, less psychological and physical aggression during toddlerhood, more sensitive parenting attitudes, and greater toddler social relatedness. Maternal depressive symptoms were only a moderator for toddler behavior problems. These findings suggest that doula home visiting may be a particularly effective model for enhancing sensitive, non-aggressive parenting among young mothers with a history of risk-taking behavior.

Behavioral Parent Training for School-Aged Children With ADHD: A Systematic Review of Randomized Control Trials

BACKGROUND

All guidelines for the treatment of ADHD in children include behavioral parent training in combination with other strategies. In the past, several systematic reviews have been carried out that were either outdated or not sufficiently specific to ADHD. We wanted to conduct a new review focusing on a specific ADHD population of school age (4-12 years) and on behavioral and cognitive programs. We aimed to test our hypothesis that behavioral parent training would improve parents' difficulties, children's symptomatology, and the quality of life of families with ADHD.

METHODS

PUBMED, PsychInfo, Web of Science, ERIC, and Cochrane databases were searched for original articles on randomized control trials on behavioral parent training group for children with ADHD aged from 4 to 12 years until July 2023.

RESULTS

A total of 20 studies were included in the systematic review. The results were divided into four categories: parent data, child data collected by parents, teachers, or researchers. A qualitative analysis revealed for parents, effects on parental stress, feelings of parental efficacy, and negative parental educational behavior. As regard children, only effects are noted for parental assessment, on ADHD symptomatology, externalized disorders, and social skills.

CONCLUSION

Despite the heterogeneity or small number of studies in some categories, BPTs have positive effects on both parents and children. There are no convincing results to support the generalization of progress. This would seem to indicate that it remains essential to consider actions specific to each problematic environment for the child.

Different perceptual worlds: Parent and youth perspectives on parenting outcome trajectories from a Latino family-based program

Discrepancies between parent and youth perceptions of their relationship are a common aspect of generational acculturation gaps influencing immigrant families. Programs designed to strengthen parenting practices among immigrant Latino families commonly address immigration stresses, including differences between parent and youth perceptions, but little is known about discrepancies in their appraisals of program effects on parenting behavior. A randomized trial was conducted examining effects on parent behavior of a program for immigrant families with youth aged 10-14, developed through community-based participatory research principles. Families (346 parents and youth) were recruited by organizations serving Latino families in a Midwestern metropolitan area and randomly assigned to the eight-session psychoeducation and skill-building program or a waitlist control. Parents and youth completed self-report measures at pre-intervention, post-intervention (4 months), and a 6-month follow-up regarding parents' expression of acceptance, efforts to solicit information about the child's experiences, and consistency of discipline, key foci of the program. Based on social cognition theory, the study focused on possible differences in parents' and youths' perceptions of change in parenting behavior. Parents in the treatment group reported pre-post improved acceptance, consistent discipline, and solicitation, whereas youth reported improvement only in parental solicitation, a pattern maintained at follow-up. In the control group, the only change was youth-reported reduction in parental acceptance. Parents' perceptions of improvement are encouraging, but overall lack of improvements from the youth perspective poses a potential problem for impact on parent-child relations. Interventions may need to target both parent and youth cognitions about behavior changes directly.

A Pilot Trial of a Home-Based Parenting Intervention for High-Risk Infants: Effects on and Moderating Role of Effortful Control

Despite the important developmental outcomes associated with effortful control (EC), there is limited research demonstrating the efficacy of early interventions for improving EC and assessing the extent to which a child's level of baseline EC impacts the outcome of intervention on externalizing problems. This study aims to fill these gaps in the literature by assessing the efficacy of the Infant Behavior Program (IBP), a parenting intervention for infants with elevated levels of behavior problems, in improving infant EC and the moderating effect of baseline infant EC on intervention outcomes. Participants included 60 high-risk 12- to 15-month-old infants and their mothers. Families were randomized to receive the IBP or standard pediatric primary care. Parent-report measures of infant behavior and compliance were examined at baseline, post-intervention, and 3- and 6-month follow-up assessments. Results showed infants who received the IBP displayed significantly higher levels of EC at the post-intervention assessment compared to infants in the control group. Additionally, moderation analyses showed initial levels of EC moderated the effect of the IBP on externalizing problems and compliance, such that infants with higher levels of baseline EC displayed greater decreases in externalizing problems at post-intervention and greater increases in compliance at the 6-month follow-up. While these findings did not survive a false discovery rate correction, they offer preliminary support for the efficacy of the IBP in improving infants' EC and highlight the importance of considering EC as a factor associated with early intervention outcomes for externalizing problems.

Feasibility and acceptability of an online parenting intervention to address behaviour problems in moderately to extremely preterm pre-school and school-age children

BACKGROUND

Preterm birth is associated with adverse mental health outcomes, including internalizing problems, social difficulties and inattention. Interventions are needed beyond infancy and toddlerhood to support children and their families. We examined the feasibility and acceptability of the I-InTERACT Preterm pilot study, an online parenting intervention for preterm children ages 3-8.

METHOD

Families participated in a weekly intervention comprised of seven sessions with online modules followed by videoconference coaching sessions with a therapist. Following completion of the study, caregivers completed a survey to assess their satisfaction and were asked to participate in a voluntary semi-structured interview to provide feedback. We anticipated greater than a 50% participation rate (enrollment feasibility) and 75% completion rate (adherence feasibility). We also hypothesized that at least 80% of participants would be satisfied with the intervention (acceptability).

RESULTS

Nineteen of 32 families (59%) enrolled in the study, suggesting adequate enrollment feasibility. Feasibility of programme completion (adherence) was lower than anticipated (59%). Regarding satisfaction, all caregivers agreed that the programme's information was relevant to them and their family. Nearly all participants (92%) indicated that they had a better understanding of the effects of preterm birth on behaviour, that they enjoyed the programme, that it met their expectations and that they recommend the programme to others. In qualitative interviews, caregivers expressed satisfaction with the content, skills they learned, and receiving direct coaching. Caregivers suggested improvements to increase intervention feasibility and skill implementation, including offering biweekly sessions and more hands-on coaching.

CONCLUSION

Our largely satisfactory acceptability rates suggest the value of and need for a parenting intervention for children born preterm past the initial period of early development. Future directions include modifying the intervention in response to caregiver feedback to improve recruitment, engagement and adherence.

Parenting Interventions That Promote Child Protection and Development for Preschool-Age Children with Developmental Disabilities: A Global Systematic Review and Meta-Analysis

Global guidelines emphasize the critical role of responsive caregiving in terms of reducing violence against children and promoting early childhood development. However, there is an absence of global evidence synthesis on the effects of early childhood parenting programs for children with developmental disabilities. This systematic review and meta-analysis aims to investigate the effectiveness of parenting interventions delivered for preschool-age children with developmental disabilities in reducing violence against children, altering violence-related factors, and promoting child development. We searched for randomized controlled trials with inactive control. Estimates were pooled using robust variance estimations. Meta-regressions were conducted to explore sources of heterogeneity. In all, 33 studies met the inclusion criteria. The results showed that parenting programs improved child behavior, parental mental health, parenting practices, parental self-efficacy, parent-child interaction, child language skills, and child social skills post-intervention. No studies provided data on the actual occurrence of violence against children. Effects might vary by diagnosis, delivery modality, and world region. The findings supported the delivery of parenting programs to alter factors associated with violence against children and promote child language and social skills for families of young children with developmental disabilities, especially attention deficit hyperactivity disorder, autism, intellectual disability, and language disorders. More research using rigorous methods, long-term follow-ups, and transparent reporting is needed, particularly within more low- and middle-income countries.

Remote Recruitment Strategy and Structured E-Parenting Support (STEPS) App: Feasibility and Usability Study

BACKGROUND

The Structured E-Parenting Support (STEPS) app provides support for parents of children with elevated hyperactivity, impulsivity, inattention, and conduct problems who are awaiting clinical assessment. STEPS will be evaluated in a randomized controlled trial (RCT) within the Online Parent Training for the Initial Management of ADHD Referrals (OPTIMA) research program in the United Kingdom. Phase 1 of the OPTIMA tested the feasibility of participants' recruitment and the app's usability.

OBJECTIVE

This study aimed to adapt a digital routine clinical monitoring system, myHealthE, for research purposes to facilitate waitlist recruitment; test using remote methods to screen and identify participants quickly and systematically; pilot the acceptability of the recruitment and assessment protocol; and explore the usability of STEPS.

METHODS

myHealthE was adapted to screen patients' data. Parents' and clinicians' feedback on myHealthE was collected, and information governance reviews were conducted in clinical services planning to host the RCT. Potential participants for the observational feasibility study were identified from new referrals using myHealthE and non-myHealthE methods. Descriptive statistics were used to summarize the demographic and outcome variables. We estimated whether the recruitment rate would meet the planned RCT sample size requirement (n=352). In addition to the feasibility study participants, another group of parents was recruited to assess the STEPS usability. They completed the adapted System Usability Scale and responded to open-ended questions about the app, which were coded using the Enlight quality construct template.

RESULTS

Overall, 124 potential participants were identified as eligible: 121 (97.6%) via myHealthE and 3 (2.4%) via non-myHealthE methods. In total, 107 parents were contacted, and 48 (44.9%) consented and were asked if, hypothetically, they would be willing to participate in the OPTIMA RCT. Of the 28 feasibility study participants who provided demographic data, 21 (75%) identified as White. Their children had an average age of 8.4 (SD 1.7) years and 65% (31/48) were male. During the primary recruitment period (June to July 2021) when 45 participants had consented, 38 (84%) participants agreed hypothetically to take part in the RCT (rate of 19/mo, 95% CI 13.5-26.1), meeting the stop-go criterion of 18 participants per month to proceed with the RCT. All parents were satisfied or very satisfied with the study procedures. Parents (n=12) recruited to assess STEPS' usability described it as easy to navigate and use and as having an attractive combination of colors and visual design. They described the content as useful, pitched at the right level, and sensitively presented. Suggested improvements included adding captions to videos or making the recorded reflections editable.

CONCLUSIONS

Remote recruitment and study procedures for testing a parenting intervention app are feasible and acceptable for parents. The parents felt that STEPS was a useful and easy-to-use digital parenting support tool.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s40814-021-00959-0.

Diet Outcomes from a Randomized Controlled Trial Assessing a Parenting Intervention Simultaneously Targeting Healthy Eating and Substance Use Prevention among Hispanic Middle-School Adolescents

Parents play a significant role in adolescent health behaviors; however, few nutrition interventions for Hispanic adolescents involve parents. This study assessed the effects of a 10-week parenting intervention simultaneously targeting nutrition and substance use prevention. Hispanic parent/6th-8th-grade adolescent dyads (n = 239) were randomized to Families Preparing the New Generation Plus (FPNG+; nutrition/substance use prevention), FPNG (substance use prevention only), or Realizing the American Dream (RAD; academic success control). Surveys assessed diet, alcohol use, substance use intentions, and substance use norms at baseline (T1), immediately post-intervention (T2), and at 16 weeks post-intervention (T3). Latent change modeling assessed diet changes; adolescent substance use outcomes were assessed using effect sizes. Among adolescents, those in FPNG+ increased fruit (+0.32 cup equivalents, p = 0.022) and fiber intake (+1.06 g, p = 0.048) and did not change added sugars intake at T2; those in FPNG and RAD reduced their intake of fruit and fiber (p < 0.05 for both). FPNG+ parents marginally increased fruit/vegetable intake (+0.17 cup equivalents, p = 0.054) and increased whole grains intake (+0.25-ounce equivalents, p < 0.05), in contrast to the reduction among RAD and FPNG parents (p < 0.05). Reductions in added sugar intake at T2 were greater among FPNG and FPNG+ parents relative to RAD parents (p < 0.05). FPNG+ and FPNG had comparable substance use outcomes (i.e., both had lower alcohol use and intentions to use substances relative to RAD). Engaging parents in a nutrition and substance use prevention parenting intervention yielded positive changes in dietary intake and maintained substance use prevention outcomes among their adolescent children.

Scaling the Moments That Matter® early childhood development model: how communities' monitoring for change contributes to sustainable impact

This paper presents a community case study of how the Moments That Matter^® (MTM) Program community-led monitoring, evaluation and learning (MEL) system contributes to a scalable model with quality and sustainable impact. With a faith-based approach, MTM is an early childhood development program partnership of Episcopal Relief & Development which is rooted in parenting empowerment and community ownership. MTM empowers Primary Caregivers, strengthening nurturing care of some 60,000 children aged under three since 2012. Launched in Zambia, MTM has expanded to five other countries. Based on MTM Zambia and Kenya, this paper examines how an innovative, community-led MEL system functions to drive sustainable impacts and scaling. Measurement for change has been critical to the community MEL system. MTM is people-centered with community leaders, early childhood development service providers, volunteers and Primary Caregivers all setting their specific goals. The program is inclusive with all stakeholders engaged in monitoring and making adjustments; interactive with relationship-based social and behavior change strategies; informative with continuous data gathering used for decisions and problem-solving; and dynamic with built-in flexibility and an adaptation process. The community-led MEL propels scaling up through two channels: (1) New communities for MTM program start up: As MTM communities graduate to community ownership, program staff and budget are then invested in new marginalized and underserved rural areas. (2) Deepening reach within MTM communities: Over the first two cycles, communities transition to community ownership, then continue independently of staff and budget. They identify a new set of vulnerable Primary Caregivers of children under three and carry out the caregiver parenting support and learning activities. The success of the program's community-led MEL in achieving sustainable change and fueling the program scale up hinges on three factors: (1) Initiating the community-led MEL dimension at project start, gradually increasing the community role while reducing the staff role. (2) Provision of Community MEL capacity-building and effective, user-friendly tools to be tailored locally. (3) Three program stakeholder types leading MEL and collaborating closely with each other: ECD Committees with MTM-trained faith leaders, ECD Promoters, and Primary Caregivers of children under three.

From seeing difficult behaviour to recognizing legitimate needs - A qualitative study of mothers' experiences of participating in a Circle of Security Parenting program in a public mental health setting

OBJECTIVE

Mental health challenges can interfere with caregivers' self-efficacy and their ability to engage with their children in developmentally appropriate ways. The goal of this study was to explore whether the intervention Circle of Security Parenting (COS-P) was experienced as a meaningful adjunct to psychological treatment.

METHOD

Individual qualitative semi-structured interviews were conducted with twelve female COS-P participants, exploring how taking part in COS-P had changed the way they related to themselves and others. Data were analyzed using a team-based, reflexive thematic analysis.

RESULTS

The analysis resulted in three main themes: (i) Connecting dots: A new perspective on one's past, (ii) Seeing oneself more clearly: Increased capacity to recognize and tend to own needs, and (iii) Gaining a map: Becoming a more competent parent.

CONCLUSION

Taking part in COS-P as an adjunct to psychological treatment positively impacted participants' sense of competence as mothers. They used the COS-P framework to make sense of their interaction with their child, enabling them to understand the child's behaviour and communication as expressing legitimate attachment needs. They also experienced that the course strengthened central psychological capacities, such as insight into their own developmental histories as well as increased self-awareness and self-care. Implications are discussed.

Effectiveness of Group Parent-Child Interaction Therapy on Problem Behaviors in Chinese Kindergartners

Problem behaviors in early childhood may put young children at risk for negative behavioral and psychosocial problems. This study examined the effectiveness of group PCIT on Chinese young children's externalizing and internalizing problems. The participants were 58 mothers with their children aged 2-3 years (M = 2.95 years, SD = 0.22), assigned to an immediate treatment (n = 26) group or to a waitlist (n = 32) control group. The program involved comprehensive group intervention and featured weekly 60-90-min sessions, totaling ten sessions over three months. Results indicate that group PCIT not only significantly improved teacher-reported problem behaviors in children, but also improved observed maternal parenting behavior. These findings support the use of group PCIT in Chinese children and provide mothers with an evidence-based tool to address problem behaviors in a non-clinical population.

Impacts of the Attachment and Child Health (ATTACHTM) Parenting Program on Mothers and Their Children at Risk of Maltreatment: Phase 2 Results

Early adversity (e.g., family violence, parental depression, low income) places children at risk for maltreatment and negatively impacts developmental outcomes. Optimal parental reflective function (RF), defined as the parent's ability to think about and identify thoughts, feelings, and mental states in themselves and in their children, is linked to secure attachment and may protect against suboptimal outcomes. We present the results of Phase 2 randomized control trials (RCTs) and quasi-experimental studies (QES) of the Attachment and Child Health (ATTACHTM) parental RF intervention for families with children at risk for maltreatment. Phase 2 parents experiencing adversity, along with their children aged 0-5 years (n = 45), received the 10-12-week ATTACHTM intervention. Building on completed Phase 1 pilot data, Phase 2 examined outcomes of long-standing interest, including parental RF and child development, as well as new outcomes, including parental perceived social support and executive function, and children's behavior, sleep, and executive function. RCTs and QES revealed significant improvements in parents' RF, perception of social support, and executive function, children's development (i.e., communication, problem-solving, personal-social, and fine motor skills), and a decrease in children's sleep and behavioral problems (i.e., anxiety/depression, attention problems, aggressive behavior, and externalizing problems), post-intervention. ATTACH™ positively impacts parental RF to prevent negative impacts on children at risk of maltreatment.

Engage, Develop, Learn: a pilot randomized clinical trial to test if a mobile application can enhance home support for early cognitive development among children living in poverty

BACKGROUND

Mobile applications (apps) exist to promote early child development; however, few studies have examined use of these apps among low-income families. Our objectives were to measure engagement with the Engage, Develop, Learn (EDL) app and determine if it promoted engagement and behavior change among low-income caregivers.

METHODS

We conducted a pilot study among English and Spanish-speaking, low-income families with children ages 12 to 15 months who received either the EDL app or injury prevention text messages. Baseline data were collected and interventions delivered over two home visits. App engagement was measured using messages opened. Caregiver development-promoting behaviors were measured with STIMQ score changes from baseline to follow-up at child age 2 years. We conducted key informant interviews among families randomized to receive the EDL app to identify barriers and facilitators to app use.

RESULTS

A total of 100 caregivers were recruited at their children's preventive care visit with 50 randomized to receive the EDL app and 50 to receive the injury prevention text messages; however, only 25 in the development app and 34 in the injury prevention group completed both home visits. Follow-up data were collected from 14 in the development app group and 30 in the injury prevention group. Over 10 weeks, 24% (6/25) remained engaged with the development app. STIMQ scores did not differ between groups. Barriers included technical difficulties accessing the app, social stressors, and 'forgetting' to use it.

CONCLUSIONS

Our pilot randomized trial of a child development app suggests that it may not be effective for promoting behavior change among low-income caregivers due to low engagement.

TRIAL REGISTRATION

This pilot trial was registered with ClinicalTrials.gov (ID NCT02717390).

Is Parents' ADHD Symptomatology Associated With the Clinical Feasibility or Effectiveness of a Psychoeducational Program Targeting Their Children's ADHD?

OBJECTIVE

To examine if the clinical feasibility and effectiveness of a psychoeducational program targeting children's ADHD differ between parents with varying ADHD symptom severities.

METHOD

An open trial analyzed data from 549 parents of children with ADHD aged 3 to 17 years, who participated in psychoeducation at an outpatient habilitation/disability clinic. In all analyses, parents were stratified into three symptom severity groups (low/middle/high) based on scores on an ADHD screening scale.

RESULTS

Parental ADHD symptom severity was not associated with results on any outcome, although the odds of having incomplete data were higher in parents reporting higher symptom severity. Across the entire sample, we observed high program completion rates, positive acceptability ratings and large increases in parental knowledge.

CONCLUSIONS

Psychoeducation may be beneficial regardless of the participating parent's ADHD symptomatology. Further research is needed to examine whether these results are generalizable to parents diagnosed with ADHD, an underrepresented group in our study.

Measuring and Enhancing Initial Parent Engagement in Parenting Education: Experiment and Psychometric Analysis

BACKGROUND

Prevention efforts focused on parenting can prevent and reduce the rates of child internalizing and externalizing problems, and positive changes in parenting skills have been shown to mediate improvements in child behavioral problems. However, parent skills training programs remain underused, with estimates that under half of eligible parents complete treatment and even lower rates engage in preventive interventions. Moreover, there is no validated measure to assess initial engagement in parent education or skills training, which is an understudied stage of parent engagement.

OBJECTIVE

We aimed to test a novel engagement strategy, exploring whether including information pertaining to the neuroscience of child development and parent skills training enhanced parental intent to enroll. In addition, a novel self-report measure, the 18-item Parenting Resources Acceptability Measure (PRAM), was developed and validated.

METHODS

In a group of 166 parents of children aged 5 to 12 years, using an engagement strategy based on the Seductive Allure of Neuroscience Explanations, we conducted a web-based experiment to assess whether the inclusion of neuroscience information related to higher levels of engagement via self-report and behavioral measures. The PRAM was subjected to an exploratory factor analysis and examined against relevant validity measures and acceptability measurement criteria.

RESULTS

Three PRAM factors emerged ("Acceptability of Parenting Resources," "Interest in Learning Parenting Strategies," and "Acceptability of Parenting Websites"), which explained 68.4% of the total variance. Internal consistency among the factors and the total score ranged from good to excellent. The PRAM was correlated with other relevant measures (Parental Locus of Control, Parenting Sense of Competence, Strengths and Difficulties Questionnaire, Parent Engagement in Evidence-Based Services, and behavioral outcomes) and demonstrated good criterion validity and responsiveness. Regarding the engagement manipulation, parents who did not receive the neuroscience explanation self-reported lower interest in learning new parenting skills after watching an informational video compared with parents who did receive a neuroscience explanation. However, there were no significant differences between conditions in behavioral measures of intent to enroll, including the number of mouse clicks, amount of time spent on a page of parenting resources, and requests to receive parenting resources. The effects did not persist at the 1-month follow-up, suggesting that the effects on engagement may be time-limited.

CONCLUSIONS

The findings provide preliminary evidence for the utility of theory-driven strategies to enhance initial parental engagement in parent skills training, specifically parental interest in learning new parenting skills. In addition, the study findings demonstrate the good initial psychometric properties of the PRAM, a tool to assess parental intent to enroll, which is an early stage of engagement.

Children in foster care with symptoms of reactive attachment disorder: feasibility randomised controlled trial of a modified video-feedback parenting intervention

BACKGROUND

Looked-after children are at risk of suboptimal attachment patterns and reactive attachment disorder (RAD). However, access to interventions varies widely, and there are no evidence-based interventions for RAD.

AIMS

To modify an existing parenting intervention for children with RAD in the UK foster care setting, and test the feasibility of conducting a randomised controlled trial (RCT) of the modified intervention.

METHOD

The intervention was modified with expert input and tested on a case series. A feasibility and pilot RCT compared the new intervention with usual care. Foster carers and children in their care aged ≤6 years were recruited across nine local authorities, with 1:1 allocation and blind post-treatment assessments. The modified intervention was delivered in-home by trained mental health professionals over 4-6 months. Children were assessed for RAD symptoms, attachment quality and emotional/behavioural difficulties, and foster carers were assessed for sensitivity and stress.

RESULTS

Minimal changes to the intervention programme were necessary, and focused on improving its suitability for the UK foster care context. Recruitment was challenging, and remained below target despite modifications to the protocol and the inclusion of additional sites. Thirty families were recruited to the RCT; 15 were allocated to each group. Most other feasibility outcomes were favourable, particularly high numbers of data and treatment completeness. The revised intervention was positively received by practitioners and foster carers.

CONCLUSIONS

A large-scale trial may be feasible, but only if recruitment barriers can be overcome. Dedicated resources to support recruitment within local authorities and wider inclusion criteria are recommended.

Effect of Attachment and Child Health (ATTACHTM) Parenting Program on Parent-Infant Attachment, Parental Reflective Function, and Parental Depression

High-risk families exposed to toxic stressors such as family violence, depression, addiction, and poverty, have shown greater difficulty in parenting young children. In this study, we examined the effectiveness of ATTACHTM, a 10−12 session manualized one-on-one parental Reflective Function (RF)-based parenting program designed for high-risk families. Outcomes of parent-child attachment and parental RF were assessed via the Strange Situation Procedure (SSP) and Reflective Function Scale (RFS), respectively. The protective role of ATTACHTM on parental depression was also assessed. Data were available from caregivers and their children < 6 years of age who participated in five pilot randomized control trials (RCTs) and quasi-experimental studies (QES; n = 40). Compared with the control group, caregivers who received the ATTACHTM-program demonstrated a greater likelihood of secure attachment with their children (p = 0.004) and higher parental RF [self (p = 0.004), child (p = 0.001), overall (p = 0.002)] in RCTs. A significant improvement in parental RF (p = 0.000) was also observed in the QES within ATTACHTM group analysis. As attachment security increased, receiving the ATTACHTM program may be protective for depressed caregivers. Results demonstrated the promise of ATTACHTM for high-risk parents and their young children.

Investigating active ingredients of the GenerationPMTO intervention: Predictors of postintervention change trajectories in parenting practices

Empirically determining the active ingredients of evidence-based parenting interventions is a promising means for strengthening interventions and enhancing their public health impact. This study aimed to determine which distinct ingredients of the GenerationPMTO (GenPMTO) intervention were associated with subsequent changes in parenting practices. Using a sample of 153 participants randomly assigned to the GenPMTO condition, we employed multilevel modeling to identify intervention ingredients empirically linked with change trajectories in parenting practices observed across the 2 years following intervention exposure. Coercive parenting and positive parenting outcomes were examined. Study results indicated that emotion regulation, effective communication, problem solving, and monitoring each demonstrated a significant pattern of findings for coercive parenting. Differential exposure to each of these ingredients significantly predicted the level of coercive parenting immediately postintervention and/or trajectories of change in coercive parenting across the subsequent 2-year period, controlling for coercive parenting at baseline. No significant predictors were found for positive parenting trajectories. Our findings suggest four components as active ingredients of the GenPMTO intervention for coercive parenting. Identification of these active ingredients may lead to strengthening future iterations of GenPMTO by expanding the set of core components specified in the model, which may further improve public health benefits. Implications for further understanding change stemming from evidence-based parenting interventions are also discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Building Resilience Against ViolencE (BRAVE): protocol of a parenting intervention for mothers and fathers with post-traumatic stress disorder in Pakistan

BACKGROUND

Prevalence of post-traumatic stress disorder (PTSD) is high in Pakistan both due to natural disasters and ongoing conflicts. Offspring of trauma survivors are at increased risk for mental and physical illnesses. Parental PTSD has been linked to troubled parent-child relationships, behaviour problems, trauma symptoms, and depression in children. This study aims to explore the acceptability, feasibility and indications of the effectiveness of group learning through play plus trauma-focused cognitive behaviour therapy (LTP Plus TF-CBT) for parents experiencing PTSD.

METHODS/DESIGN

This is a two-arm pilot cluster randomised controlled trial (RCT). We aim to recruit 300 parents with a diagnosis of PTSD. The screening will be done using the Impact of Event Scale-Revised. Diagnosis of PTSD will be confirmed using the Clinician-Administered PTSD Scale-5 (CAPS-5). Union Councils from Peshawar and Karachi will be randomised into either group LTP Plus TF CBT arm or treatment as usual (TAU). The intervention includes 12 sessions of LTP Plus TF-CBT delivered weekly in the first 2 months and then fortnightly in a group setting by trained psychologists. The groups will be co-facilitated by the community health workers (CHWs). Parents will be assessed at baseline and 4th month (end of the intervention), using the Patient Health Questionnaire (PHQ-9), Generalised Anxiety Disorder (GAD-7) Scale, Client Service Receipt Inventory (CSRI), and Ages and Stages Questionnaire (ASQ-3).

DISCUSSION

This trial would help build an understanding of the acceptability, feasibility and indications of the effectiveness of a low-cost parenting intervention.

Does maternal inhibitory control mediate effects of a parenting intervention on maternal sensitive discipline? Evidence from a randomized-controlled trial

The quality of parenting greatly impacts child development, highlighting the importance of support programs that effectively improve parenting. Studies on successful intervention programs define their efficacy by gains in parenting and/or child development. However, much remains unknown about the internal processes that explain how parenting interventions bring about their effects. The aims of the current randomized‐controlled study were to test whether the Video‐feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP‐SD) improved maternal inhibitory control (1) and whether inhibitory control mediated any effects of VIPP‐SD on maternal sensitive discipline (2). In total, 66 mothers of whom a random 33% received the VIPP‐SD and the others a “dummy” intervention participated in pre‐ and post‐intervention assessments. Sensitive discipline was observed during a semi‐structured limit‐setting situation and inhibitory control was measured using a stop‐signal task. Contrary to expectations, inhibitory control improved over time in the control group and sensitive discipline did not show the expected increase in the intervention group. Results did not support mediation. We suggest that the intervention may have induced cognitive restructuring of parenting schemas, delaying improvements in post‐intervention inhibitory control and sensitive discipline. Factors that may be involved in parents’ susceptibility to interventions require attention in future work.

Adapting an Evidence-Based Home Visiting Intervention for Mothers With Opioid Dependence: Modified Attachment and Biobehavioral Catch-up

Infants born to mothers who are dependent on opioids often have difficulty regulating behavior and physiology at birth. Without sensitive maternal care, these infants are at risk for ongoing problems with self-regulation. Mothers who are dependent on opioids may experience challenges related to their substance use (e.g., unsupportive and/or risky environment, impulse control and reward system problems) that increase the likelihood of insensitive parenting in the absence of effective intervention. In this paper, we describe a home-visiting intervention we have adapted to enhance sensitive, responsive caregiving tailored to the specific needs of mothers with opioid dependence. The original intervention, Attachment and Biobehavioral Catch-up (ABC), was designed for mothers of infants aged 6-24 months who were exposed to early adversity. ABC has been shown to enhance sensitive parenting as well as children's behavioral and biological functioning, with positive outcomes extending into at least middle childhood. Mothers who are opioid dependent need earlier support than provided by ABC because opioid-exposed infants are often vulnerable at birth. The adapted intervention (modified ABC or mABC) includes one prenatal session and one early postnatal session, followed by 10 sessions every 2-3 weeks. In the initial two sessions in particular, mothers are helped to anticipate the challenges of caring for a baby who may be difficult to soothe while nonetheless providing sensitive care. mABC is intended to help mothers see the importance of responding sensitively so as to help infants overcome the developmental risks associated with opioid exposure. Additionally, mABC is structured to support mothers with the challenges of early parenting, especially if the mother herself was not parented sensitively. Throughout, the focus is on helping the mother nurture the distressed infant, attend to the infant's signals, and avoid behaving in overstimulating or intrusive ways. Case examples are presented that highlight both the challenges of working with this population as well as the gains made by mothers.

Supporting Child Development Through Parenting Interventions in Low- to Middle-Income Countries: An Updated Systematic Review

Background: Over 250 million children in low- and middle-income countries are at risk of not achieving their fullest developmental potential due to co-occurring risks such as poor nutrition and inadequate learning opportunities. Early intervention programs integrating the aspects of nurturing care, that is, good health, adequate nutrition, safety and security, responsive caregiving, and learning opportunities, may ameliorate against the negative impact of these adverse conditions. Methods: This meta-analytic review updates the evidence base of parenting interventions comprising stimulation and responsive caregiving components on developmental outcomes for children under age 2 years in low- and middle-income countries. It also describes and assesses the moderation effects of population characteristics and implementation features on the intervention effectiveness. Studies were identified based on previous systematic reviews and an updated literature search in eight databases and the gray literature up to December 2020. A random-effect model was used to explore the pooled effect sizes accounted for by the intervention for developmental outcome of cognition, language, motor, and social-emotional capacities. Exploratory moderation analyses were also conducted. Results: Twenty-one randomized controlled trials representing over 10,400 children from 12 low- and middle-income countries and regions across three continents (Africa, Latin America, and Asia) were identified. The interventions showed overall small-to-moderate effects on children's cognitive development (ES = 0.44; 95% CI = [0.30, 0.57]); language development (ES = 0.33; 95% CI = [0.18, 0.49]); and motor skills (ES = 0.21; 95% CI = [0.10, 0.32]). The overall effect on social-emotional development was non-significant (ES = 0.17; 95% CI = [-0.01, 0.34]). Effect sizes (ES) varied significantly across the studies. Parenting programs that targeted vulnerable groups, including rural communities and caregivers with lower education levels, had more significant effects on children's development. Group sessions (vs. individual visits) and high program dose (≥12 sessions) were also associated with stronger effects on child development. Further research is needed to determine the effectiveness of the workforce and training on programmatic outcomes. Conclusion: The findings indicate that parenting interventions that encourage nurturing care are effective in improving the early development of children, especially among vulnerable populations. We discuss opportunities to strengthen the implementation of research-based parenting interventions in such contexts.

An Implementation Evaluation of A Group-Based Parenting Intervention to Promote Early Childhood Development in Rural Kenya

Early childhood development (ECD) parenting interventions can improve child developmental outcomes in low-resource settings, but information about their implementation lags far behind evidence of their effectiveness, hindering their generalizability. This study presents results from an implementation evaluation of Msingi Bora ("Good Foundation" in Swahili), a group-based responsive stimulation and nutrition education intervention recently tested in a cluster randomized controlled trial across 60 villages in rural western Kenya. Msingi Bora successfully improved child cognitive, receptive language, and socioemotional outcomes, as well as parenting practices. We conducted a mixed methods implementation evaluation of the Msingi Bora trial between April 2018 and November 2019 following the Consolidated Advice for Reporting ECD implementation research (CARE) guidelines. We collected qualitative and quantitative data on program inputs, outputs, and outcomes, with a view to examining how aspects of the program's implementation, such as program acceptance and delivery fidelity, related to observed program impacts on parents and children. We found that study areas had initially very low levels of familiarity or knowledge of ECD among parents, community delivery agents, and even supervisory staff from our partner non-governmental organization (NGO). We increased training and supervision in response, and provided a structured manual to enable local delivery agents to successfully lead the sessions. There was a high level of parental compliance, with median attendance of 13 out of 16 fortnightly sessions over 8 months. For delivery agents, all measures of delivery performance and fidelity increased with program experience. Older, more knowledable delivery agents were associated with larger impacts on parental stimulation and child outcomes, and delivery agents with higher fidelity scores were also related to improved parenting practices. We conclude that a group-based parenting intervention delivered by local delivery agents can improve multiple child and parent outcomes. An upfront investment in training local trainers and delivery agents, and regular supervision of delivery of a manualized program, appear key to our documented success. Our results represent a promising avenue for scaling similar interventions in low-resource rural settings to serve families in need of ECD programming. This trial is registered at ClinicalTrials.gov, NCT03548558, June 7, 2018. https://clinicaltrials.gov/ct2/show/NCT03548558.

Parent and practitioner perspectives on Circle of Security Parenting (COS-P): A qualitative study

Circle of Security Parenting (COS-P) is an attachment-theory-informed program for parents of infants and young children. Designed for scalability, COS-P has been widely adopted internationally. Evidence for the program's effectiveness is limited, however, restricting capacity to make informed decisions about program allocation, and threatening ongoing program funding. To help address this evidence gap, this qualitative study explored the experiences and perceptions of 20 COS-P facilitators and 14 parent recipients in Australia, where COS-P uptake has been particularly widespread. Thematic analysis of combined interview and focus group data revealed a perception that COS-P primarily changes the lens through which parents view (a) their child, (b) themselves in the parenting role, and (c) the parent-child relationship, and that this was a pathway to increased empathy, compassion, and parenting confidence. Participants identified four components that underpinned program impact: key content, skills practice, group processes, and facilitator support. Although COS-P was considered suitable for broad application, limitations were noted. Findings can guide clinical application of COS-P and inform empirical research.

The impact of a mother-infant intervention on parenting and infant response to challenge: A pilot randomized controlled trial with adolescent mothers in El Salvador

A pilot randomized controlled trial (RCT) was conducted in El Salvador of an intervention ('Thula Sana') previously shown to enhance maternal sensitivity and infant security of attachment in a South African sample. In El Salvador, trained community workers delivered the intervention from late pregnancy to 6 months postpartum as part of a home-visiting programme. The sample comprised 64 pregnant adolescent women, aged 14-19 years, living in predominantly rural settings. They were randomised to receive either the intervention or normal care. Demographic information was collected at baseline and, immediately post-intervention, blind assessments were made of parental sensitivity and infant emotion regulation. The intervention was found to have a substantial positive impact on maternal sensitivity. Further, compared to control group, infants in the intervention group showed more regulated behaviour: in a social challenge task they showed more attempts to restore communication, and in a non-social challenge task they showed more social and goal-directed behaviour. This replication and extension of the South African findings in a small El Salvador sample shows promise and justifies the conduct of a large-scale RCT in a Central or South American context.

Therapeutic alliance as a predictor of behavioral outcomes in a relationally focused, family-centered telehealth intervention

This study evaluates therapeutic alliance as a mediator of the relationship between dosage and clinical outcomes for the Family Check-Up (FCU) Online, a telehealth adaptation of an evidence-based parenting intervention for parents of middle school youth. The sample consisted of N = 111 parents with children in middle school who received the FCU Online as part of an ongoing clinical trial. They were randomly assigned to receive telehealth coaching and participated in the intervention and follow-up assessment 12 months later. Data was collected using parent and child questionnaires as well as engagement data collected as part of the online intervention, using both parents and children as reporters of parent behavioral change. Using parent report measures, there was clear support for a mediation model, with parent report of alliance predicting parent self-report ratings of clinical progress (parent behavior change) at 12-month follow-up. However, for the child-report data, there was no clear relationship between dosage or therapeutic alliance with child reports of parenting. Clinical implications and future research directions are discussed.

Does Setting Goals Enhance Parenting Intervention Effects? A Field Experiment

People who pursue approach goals (i.e., desired outcomes to be reached) tend to be more likely to achieve their goals than people who pursue avoidance goals (i.e., undesired outcomes to be prevented). We tested this premise in a brief preventive parenting intervention targeting parental praise to reduce disruptive child behavior. We also tested whether goal setting effects depend on behavior change phase (initiation versus maintenance) and parents' regulatory focus (high versus low promotion and prevention focus). Parents (N = 224; child age 4-8) were randomized to one of four conditions: an approach goal-enhanced or an avoidance goal-enhanced intervention condition, a no-goal intervention condition, or a waitlist control condition. Outcomes were parent-reported and audio-recorded positive parenting and disruptive child behavior. Results show that goal setting had very limited effects. Setting avoidance goals, not approach goals, improved self-reported positive parenting. However, goal setting did not enhance effects of parenting intervention on observed (i.e., audio-recorded) positive parenting and disruptive child behavior. Furthermore, goal setting effects depended neither on the phase of change, nor on parents' regulatory focus. This field experiment suggests that setting approach goals does not enhance the brief parenting intervention to improve parent-child interactions.

Family Minds: A randomized controlled trial of a group intervention to improve foster parents' reflective functioning

Family Minds is a brief group psychoeducational parenting intervention designed to increase the reflective functioning (RF) and mentalization skills of foster parents. RF is important for foster parents who have to build relationships with children whose adverse experiences increase their risk for psychosocial challenges. A randomized controlled trial (RCT) for Family Minds was conducted in Texas with 89 foster parents. The main aims of this study were to examine whether the intervention could significantly increase the RF/mentalization skills of the foster parents and decrease their parenting stress. After 6 weeks, compared with the control group, intervention foster parents improved their RF via a lowering of pre-mentalizing and also significantly decreased parenting stress related to parent-child dysfunctional interactions. Other measures of RF and parenting stress showed no significant differences between groups. Foster child behavior was not significantly different between groups, although data at 6 months showed a possible lowering of internalizing symptoms for children of intervention parents. This RCT provides some encouraging evidence that Family Minds may increase RF in foster parents, improve parental sensitivity and their ability to emotionally regulate, decrease parenting stress related to challenging interactions with their foster children, and possibly decrease children's internalizing behavior.

The Family Check-Up: Ecological Family-Based Assessments in the Context of Potential Child Abuse or Chaotic Home Environments

One percent of all children in the United States are estimated to be abused or neglected each year, equating to about 700,000 children per year. Limited parenting skills are one of the most robust risk factors for child abuse and neglect. The present paper describes the Family Check-Up (FCU), a trauma-informed, strengths-based and comprehensive family management intervention aimed at promoting positive parenting skills, reducing child maladaptive behaviors, and optimizing child and family outcomes. By evaluating various ecological and contextual factors, the FCU targets a range of parenting and child behavior difficulties to prevent child abuse/neglect, while improving long-term child and family outcomes.

'Every day is hard, being outside, but you have to do it for your child': Mixed-methods formative evaluation of a peer-led parenting intervention for homeless families

We conducted a mixed-methods, formative evaluation of a peer-led parenting intervention for homeless families. Participants were parents living in temporary accommodation with self-identified difficulties related to parenting an index child aged 2-11 years. An evidence-based programme ('Empowering Parents, Empowering Communities') was adapted for delivery with the target population in London, UK. We assessed feasibility in terms of session attendance rate, intervention completion rate and potential for impact on a range of parent-reported outcomes measures. Acceptability and appropriateness were examined by a user satisfaction measure and qualitative interviews. The intervention was delivered across three group cohorts (N = 15). Thirteen parents completed the programme (including one parent who required two attempts). We found improvements in child behavioural difficulties, parenting knowledge and practices, while parental well-being and social support were unchanged. Participants were highly satisfied overall, with indications that the peer-led model mitigated negative expectancies of services and normalized experiences of parenting in challenging conditions. Parental self-care and 'the good enough parent' were strongly endorsed topics, although some content (e.g. timeout) was deemed impractical. These promising findings warrant further testing under controlled conditions.

Punitive Violence against Children: A Psychoeducational Parenting Program to Reduce Harsh Disciplining Practices and Child Beating in the Home

While parental harsh disciplining of children is a global concern, children living in Nigeria often experience particularly high levels of harsh discipline. Constrained by the lack of parenting skills to effectively manage children, most Nigerian parents rely too heavily on the use of violent methods in the disciplining of their children, which poses a huge threat to their well-being and development. Given the high levels of harsh parenting and the lack of understanding of its harms, we set out to develop a program of intervention called Psychoeducational parenting program to prevent violence against children (PEPVAC), guided by psychological principles of social learning theory, to help parents reverse the trend. We tested the effectiveness of the program using a quasi-experimental design with questionnaire and observation as data collection tools. Participants were 300 parents of children age 3-12 years, who endorsed using harsh discipline. Parents (n = 150) who received the 8-week intervention were compared with parents in the control group (n = 150). A mixed-model ANOVA revealed that the PEPVAC parents demonstrated a reduced use of harsh disciplinary tactics and a decreased incidence of parents beating their children compared to parents in the control group who continued with business-as-usual. Findings suggest that PEPVAC can be a useful intervention tool in the prevention of punitive violence against children, especially in a culturally-oriented country like Nigeria with over 91 million population of children who are at risk of disciplinary violence in the home.

Novel Service Delivery Approach to Address Reproductive Health Disparities within Immigrant Latino Communities in Geographic Hot Spots: An Implementation Study

Latinx youths continue to have the highest rates of teenage births in the United States and are at increased risk of acquiring sexually transmitted infections, including HIV/AIDS. A community-based research partnership piloted Families Talking Together, a brief, parent-based sexual risk reduction program using a novel and culturally relevant approach. This mixed-methods study examined the feasibility and acceptability of Spanish-speaking promotoras de salud (that is, community health workers) as implementers of an evidence-based intervention (EBI) to reach underserved immigrant communities. Findings suggest that promotoras are capable of implementing the EBI with positive organizational, client, and implementation outcomes. Furthermore, promotoras hold particular promise for addressing reproductive health disparities as they are indigenous and trusted members of the community who can reach members of marginalized Latino populations.

Establishing a Parenting Program for Transnationally Separated Chinese Immigrant Families: Community-Based Pilot Program

Children who experience transnational separation (TS) from their parents, often referred to as "satellite babies," endure a relatively common but underdiscussed experience. To date, no evaluations of clinical interventions to specifically support transnationally separated families have been described. This column describes implementation of a group therapy pilot program for parents to address parenting and emotional concerns related to TS at a social services agency in Boston's Chinatown. Parent and therapist interviews indicated increased skills in negotiating parental feelings of guilt, shame, and regret caused by TS. These insights can guide practitioners and researchers who wish to address family separation in their communities.

Feasibility of a psychoeducational group intervention to improve parental reflective functioning and bonding in pregnancy: a randomised trial

OBJECTIVE

To develop and evaluate Baby CHAT, a single-session psychoeducational intervention for expectant parents. Baby CHAT aims to improve parental reflective functioning (RF) and bonding.

BACKGROUND

The early years of a child's life, including pregnancy, are vital for healthy physical and emotional development. Caregivers who provide responsive parenting, enhanced through strong bonds and good RF, can aid healthy development.. However, limited interventions exist to enhance RF and bonding in expectant parents.

METHODS

Feasibility of Baby CHAT was assessed using a mixed methods randomised controlled trial design. It evaluated uptake and retention of participants, effect size calculations, and acceptability and satisfaction with Baby CHAT.

RESULTS

Participants (N = 20) were aged 30-39 years (n = 17) in their third trimester of pregnancy (n = 12). Nine males and 11 females were recruited. Content analysis of qualitative feedback after the intervention resulted in four themes; positive group aspects, group improvements, 4D scan footage and relating content to my baby.

CONCLUSIONS

Baby CHAT can help expectant parents think about their baby as a separate person and has potential to improve prenatal RF and bonding. However, further research is required to assess the effectiveness of Baby CHAT to improve bonding and RF.

Promoting parent-infant responsiveness in families experiencing homelessness

My Baby's First Teacher is an intervention designed specifically for parents with infants staying in emergency homeless shelters. Infants are overrepresented in shelter populations and face considerable risk to their development, including mental health. We utilized a randomized controlled design across three family shelters to evaluate the program's effectiveness with 24 dyads assigned to the intervention compared to 21 dyads in care-as-usual. Dyads were randomized by round at each site to account for shelter effects. We used path analysis to illustrate change over time and in relation to intervention assignment.

Pride-Based Self-Affirmations and Parenting Programs

We newly apply the concept of self-affirmation typically used in the domain of health and education to the domain of parenting. Recruiting parents of children age 13 or younger (n = 1,044), we test how eliciting positive self-concept affects interest in receiving parenting materials and participating in a parenting program. We find that an adapted, pride-based written self-affirmation exercise increased parents' positive self-concept and their interest in parenting programs and resources, particularly among parents with a high baseline fear of judgment associated with seeking help. Implications for applying insights from psychology as a strategy to mitigate fear of judgment to optimize participation in an evidence-based parenting program at scale are discussed.

Supporting LGBTQ+ Foster Teens: Development of a Relationship-Focused, Self-Guided Curriculum for Foster Families

LGBTQ+ youth are over-represented in the foster care system. Child welfare systems across the country have been struggling with how to make their systems work better for the LGBTQ+ youth they serve. One strategy is developing foster caregiver trainings that bolster caregivers' knowledge and support of LGBTQ+ youth in their care. This study has three aims: (1) to provide an overview of a module designed to support relationship building between LGBTQ+ youth in foster care and their caregivers, (2) to describe the theater testing procedure used to assess usability of the developed module with foster caregivers and adults, and (3) to share the results of the theater test. Overall, participants provided positive usability feedback about the module activities, as well as a wide variety of recommendations for strengthening the content for widespread use. Participants felt the module should be directed specifically toward caregiver skill development rather than toward both caregiver and youth support. This module represents one example of how materials focused on building foster caregivers' knowledge and support have the potential to help LGBTQ+ teens who are overrepresented in the foster care system.

Complementary Parent Components for Pediatric Pain Families: Innovations in Treatment

For families with a child with chronic pain, the home environment is the context in which adaptive or maladaptive illness behaviors are developed. Supporting families to effectively cope with their child’s chronic pain is a critical need. This work analyzes intervention approaches from emerging treatment programs to support families coping with pediatric pain that diverge from traditional treatment models by specifically targeting parents. Two novel parent intervention programs are presented that consider caregiver needs in both outpatient and inpatient pain treatment settings: Parents as Coping Coaches and Putting Parents FIRST. These programs are evaluated through comparing parental training components across different stages of treatment. Additionally, the efficacy of Putting Parents FIRST in promoting maintenance of children’s functional gains achieved in intensive interdisciplinary pain treatment is presented, and compared to previous results of the efficacy of Putting Parents FIRST. Specifically, outcomes of 36 children whose parents received the intervention in Putting Parents FIRST were compared to a matched control sample of children whose parents did not receive the parent intervention. Similar to the findings from Parents as Coping Coaches, results indicated that patients whose parents received the intervention maintained/improved program gains in disability, coping, and pain significantly more than patients whose parents did not receive the intervention. Implications for parent-focused intervention development efforts targeting parent and youth functioning in the context of pediatric chronic pain are considered.

Potential Neural Mediators of Mom Power Parenting Intervention Effects on Maternal Intersubjectivity and Stress Resilience

Stress resilience in parenting depends on the parent's capacity to understand subjective experiences in self and child, namely intersubjectivity, which is intimately related to mimicking other's affective expressions (i. e., mirroring). Stress can worsen parenting by potentiating problems that can impair intersubjectivity, e.g., problems of "over-mentalizing" (misattribution of the child's behaviors) and "under-coupling" (inadequate child-oriented mirroring). Previously we have developed Mom Power (MP) parenting intervention to promote maternal intersubjectivity and reduce parenting stress. This study aimed to elucidate neural mechanisms underlying the effects of MP with a novel Child Face Mirroring Task (CFMT) in functional magnetic-resonance-imaging settings. In CFMT, the participants responded to own and other's child's facial pictures in three task conditions: (1) empathic mirroring (Join), (2) non-mirroring observing (Observe), and (3) voluntary responding (React). In each condition, each child's neutral, ambiguous, distressed, and joyful expressions were repeatedly displayed. We examined the CFMT-related neural responses in a sample of healthy mothers (n = 45) in Study 1, and MP effects on CFMT with a pre-intervention (T1) and post-intervention (T2) design in two groups, MP (n = 19) and Control (n = 17), in Study 2. We found that, from T1 to T2, MP (vs. Control) decreased parenting stress, decreased dorsomedial prefrontal cortex (dmPFC) during own-child-specific voluntary responding (React to Own vs. Other's Child), and increased activity in the frontoparietal cortices, midbrain, nucleus accumbens, and amygdala during own-child-specific empathic mirroring (Join vs. Observe of Own vs. Other's Child). We identified that MP effects on parenting stress were potentially mediated by T1-to-T2 changes in: (1) the left superior-temporal-gyrus differential responses in the contrast of Join vs. Observe of own (vs. other's) child, (2) the dmPFC-PAG (periaqueductal gray) differential functional connectivity in the same contrast, and (3) the left amygdala differential responses in the contrast of Join vs. Observe of own (vs. other's) child's joyful vs. distressed expressions. We discussed these results in support of the notion that MP reduces parenting stress via changing neural activities related to the problems of "over-mentalizing" and "under-coupling." Additionally, we discussed theoretical relationships between parenting stress and intersubjectivity in a novel dyadic active inference framework in a two-agent system to guide future research.

Families Who Benefit and Families Who Do Not: Integrating Person- and Variable-Centered Analyses of Parenting Intervention Responses

OBJECTIVE

Families with disruptive child behavior are typically referred to services based on children's behavior alone, rather than on underlying mechanisms of disruptive behavior. Yet, the presence of the precise mechanisms targeted by services might be essential for intervention success. We integrated person- and variable-centered approaches to test whether families with combined disruptive child behavior and harsh/inconsistent parenting indeed benefit most from a behavioral parenting intervention in indicated prevention context, compared to families with disruptive child behavior but less harsh/inconsistent parenting, and families with less severe disruptive behavior.

METHOD

Families (N = 387) of children aged 4 to 8 years (disruptive behavior >75^th percentile) participated in a randomized trial of the Incredible Years parenting intervention (Trial NTR3594, www.trialregister.nl). We identified different response trajectories and tested whether families with combined child and parenting difficulties had a higher probability of responding well, compared to families with only child difficulties or less severe difficulties.

RESULTS

Most intervention group families (82%) showed a nonresponse trajectory. A minority (18%) showed a response trajectory with strong reductions in disruptive behavior (Cohen's d =1.45). As expected, families with both child and parenting difficulties were most likely to respond: 20% more than families with only child difficulties, and 40% more than families with less severe difficulties.

CONCLUSION

Incredible Years, as an indicated prevention program, benefits mainly families in which the mechanisms targeted by the intervention (ie, harsh/inconsistent parenting) is actually present, rather than all families. Careful matching of children to services based on assessments of both child and parenting behavior seems critical for intervention success.

CLINICAL TRIAL REGISTRATION INFORMATION

ORCHIDS: Study on Children's Genetic Susceptibility to Their Environment; https://www.trialregister.nl; 3594.

Lighthouse Parenting Programme: Description and pilot evaluation of mentalization-based treatment to address child maltreatment

This article introduces an innovative mentalization-based treatment (MBT) parenting intervention for families where children are at risk of maltreatment. The Lighthouse MBT Parenting Programme aims to prevent child maltreatment by promoting sensitive caregiving in parents. The programme is designed to enhance parents' capacity for curiosity about their child's inner world, to help parents 'see' (understand) their children clearly, to make sense of misunderstandings in their relationship with their child and to help parents inhibit harmful responses in those moments of misunderstanding and to repair the relationship when harmed. The programme is an adaptation of MBT for borderline and antisocial personality disorders, with a particular focus on attachment and child development. Its strength is in engaging hard to reach parents, who typically do not benefit from parenting programmes. The findings of the pilot evaluation suggest that the programme may be effective in improving parenting confidence and sensitivity and that parents valued the programme and the changes it had helped them to bring about.

A novel group parenting intervention to reduce emotional and behavioural difficulties in young autistic children: protocol for the Autism Spectrum Treatment and Resilience pilot randomised controlled trial

INTRODUCTION

The majority of young autistic children display impairing emotional and behavioural difficulties that contribute to family stress. There is some evidence that behavioural parenting interventions are effective for reducing behavioural difficulties in autistic children, with less evidence assessing change in emotional difficulties. Previous trials have tended to use unblinded parent-report measures as primary outcomes and many do not employ an active control, limiting the conclusions that can be drawn.

METHODS AND ANALYSIS

The Autism Spectrum Treatment and Resilience study is a pilot randomised controlled trial (RCT) testing the specific effect of a 12-week group parenting intervention (Predictive Parenting) on primary and secondary outcomes, in comparison to an attention control condition consisting of psychoeducation parent groups. Following a feasibility study to test research procedures and the interventions, the pilot RCT participants include 60 parents of autistic children aged 4-8 years who are randomised to Predictive Parenting versus the attention control. Measures are administered at baseline and post intervention to assess group differences in child and parent outcomes, costs and service use and adverse events. The primary outcome is an objective measure of child behaviours that challenge during interactions with their parent and a researcher. The trial aims to provide data on recruitment, retention, completion of measures and acceptability of the intervention and research protocol, in addition to providing a preliminary indication of potential efficacy and establishing an effect size that could be used to power a larger-scale efficacy trial. We will also provide preliminary estimates of the cost-effectiveness of the interventions.

ETHICS AND DISSEMINATION

Ethical approval was granted from NHS Camden and Kings Cross Research Ethics Committee (ref: 16/LO/1769) along with NHS R&D approval from South London and Maudsley, Guy's and St Thomas', and Croydon Health Services NHS Trusts. The findings will be disseminated through publication in peer-reviewed journals and presentations at conferences.

TRIAL REGISTRATION NUMBER

ISRCTN91411078.

The Effect of Mindfulness Interventions for Parents on Parenting Stress and Youth Psychological Outcomes: A Systematic Review and Meta-Analysis

Background: The psychological well-being of parents and children is compromised in families characterized by greater parenting stress. As parental mindfulness is associated with lower parenting stress, a growing number of studies have investigated whether mindfulness interventions can improve outcomes for families. This systematic review and meta-analysis evaluates the effectiveness of mindfulness interventions for parents, in reducing parenting stress and improving youth psychological outcomes. Methods: A literature search for peer-reviewed articles and dissertations was conducted in accordance with PRISMA guidelines in the PsycInfo, Medline, PubMed, CINAHL, Web of Science, Cochrane Central Register of Controlled Trials, and ProQuest Dissertations & Theses databases. Studies were included if they reported on a mindfulness-based intervention delivered in person to parents with the primary aim of reducing parenting stress or improving youth psychological outcomes. Results: Twenty-five independent studies were included in the review. Eighteen studies used a single group design and six were randomized controlled trials. Within-groups, meta-analysis indicated a small, post-intervention reduction in parenting stress (g = 0.34), growing to a moderate reduction at 2 month follow-up (g = 0.53). Overall, there was a small improvement in youth outcomes (g = 0.27). Neither youth age or clinical status, nor time in mindfulness training, moderated parenting stress or overall youth outcome effects. Youth outcomes were not moderated by intervention group attendees. Change in parenting stress predicted change in youth externalizing and cognitive effects, but not internalizing effects. In controlled studies, parenting stress reduced more in mindfulness groups than control groups (g = 0.44). Overall, risk of bias was assessed as serious. Conclusions: Mindfulness interventions for parents may reduce parenting stress and improve youth psychological functioning. While improvements in youth externalizing and cognitive outcomes may be explained by reductions in parenting stress, it appears that other parenting factors may contribute to improvements in youth internalizing outcomes. Methodological weaknesses in the reviewed literature prevent firm conclusions from being drawn regarding effectiveness. Future research should address these methodological issues before mindfulness interventions for parents are recommended as an effective treatment option for parents or their children.

Do Less Mindful Mothers Show Better Parenting via Improvements in Trait Mindfulness Following a Military Parent Training Program?

Parental deployment to war poses risks to children's healthy adjustment. The After Deployment Adaptive Parenting Tools (ADAPT) program was developed for post-deployed military families to promote children's well-being through improving effective parenting. ADAPT combines behavior management with emotion socialization skills for parents, using brief mindfulness practices to strengthen emotion regulation. We used a three-wave longitudinal, experimental design to examine whether ADAPT improved parental trait mindfulness (PTM), and whether the effect was moderated by baseline PTM. We also investigated whether improved PTM was associated with behavioral, cognitive, and emotional aspects of parenting such as self-reported parental locus of control (PLOC), self-reported parental emotion socialization (PES), self-reported and observed behavioral parenting skills. We analyzed data from a randomized controlled trial (RCT) of the ADAPT, with a focus on mothers (n = 313) who were either deployed (17.9%) or non-deployed and partnered with a husband who had been recently deployed to Iraq and/or Afghanistan and returned (82.1%). Families identified a 4-13-year-old target child (Mean age = 8.34, SD = 2.48; 54.3% girls) and were randomized into ADAPT (a group-based 14-week program) or a control condition (services as usual). At baseline, 1-year, and 2-year follow-up, PTM, PLOC, PES, and parenting skills were self-reported, whereas home-based family interactions involving parents and the child were video-taped and assessed for observed behavioral parenting skills such as discipline and problem-solving using a theory-based coding system. Results showed that mothers with lower baseline PTM reported higher PTM at 1-year while mothers with higher baseline PTM reported lower PTM at 1-year. PTM at 1-year was associated with improved self-reported parenting skills and supportive PES at 2-year, as well as indirectly associated with improved PLOC and reduced nonsupportive PES at 2-year through PTM at 2-year. No associations between PTM and observed parenting skills were detected. We discuss the implications of these findings for incorporating mindfulness practices into behavioral parenting interventions and for personalized prevention considering parents' pre-existing levels of trait mindfulness as a predictor of intervention responsivity.

Improving Child Peer Adjustment in Military Families through Parent Training: The Mediational Role of Parental Locus of Control

The current study investigated the mechanisms through which a parenting intervention for military families fosters positive peer adjustment in children. A sample of 336 families with a history of parental deployment enrolled in a randomized controlled trial of the After Deployment Adaptive Parenting Tools (ADAPT) preventive intervention. ADAPT is a 14-week preventive intervention designed to strengthen parenting in military families. The intervention was associated with improvements in mother's and father's parental locus of control (i.e., a more internal locus of control) at a 6-month follow-up assessment while controlling for baseline levels. Mothers' parental locus of control was positively associated with improvements in children's peer adjustment 12 months following the intervention while controlling for baseline peer adjustment. A significant indirect effect revealed that participation in ADAPT resulted in improved 12-month peer adjustment by improving mothers' parental locus of control. Implications for supporting youth resilience to stressors associated with deployment are discussed.

DOES A PERINATAL PARENTING INTERVENTION WORK FOR FATHERS? A RANDOMIZED CONTROLLED TRIAL

Fathers are increasingly expected to contribute to their parenting role at the transition to parenthood; however, many fathers experience mental health problems during this time. Parenting support for new fathers is limited, and research often only includes the mothers in intervention studies. Clear evidence for parenting programs for fathers has not yet been established. This study evaluated the effects of a parenting intervention (Baby Triple P) on fathers who were expecting their first baby. The design was a randomized controlled trial comparing Baby Triple P with care as usual over three time points (pregnancy, 10 weeks' postbirth, and 6 months' postbirth) for 112 fathers living in Brisbane, Australia. The primary outcomes included paternal psychological distress such as depression, anxiety, and stress and several secondary measures. No significant intervention effects for Baby Triple P were found at either post- or follow-up assessments. Fathers in both groups reported significant increases in their parenting confidence and self-efficacy. The results indicate no conclusive evidence for the effectiveness of Baby Triple P for new fathers. Future research using a sample with greater likelihood of experiencing problems at the transition to parenthood is needed as is offering more tailored need-based support to obtain substantial evidence for this preventative parenting program.