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Jones KA, Freijah I, Brennan SE, McKenzie JE, Bright TM, Fiolet R, Kamitsis I, Reid C, Davis E, Andrews S, Muzik M, Segal L, Herrman H, Chamberlain C. Interventions from pregnancy to two years after birth for parents experiencing complex post-traumatic stress disorder and/or with childhood experience of maltreatment. Cochrane Database Syst Rev 2023; 5:CD014874. [PMID: 37146219 PMCID: PMC10162699 DOI: 10.1002/14651858.cd014874.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Acceptable, effective and feasible support strategies (interventions) for parents experiencing complex post-traumatic stress disorder (CPTSD) symptoms or with a history of childhood maltreatment may offer an opportunity to support parental recovery, reduce the risk of intergenerational transmission of trauma and improve life-course trajectories for children and future generations. However, evidence relating to the effect of interventions has not been synthesised to provide a comprehensive review of available support strategies. This evidence synthesis is critical to inform further research, practice and policy approaches in this emerging area. OBJECTIVES To assess the effects of interventions provided to support parents who were experiencing CPTSD symptoms or who had experienced childhood maltreatment (or both), on parenting capacity and parental psychological or socio-emotional wellbeing. SEARCH METHODS In October 2021 we searched CENTRAL, MEDLINE, Embase, six other databases and two trials registers, together with checking references and contacting experts to identify additional studies. SELECTION CRITERIA All variants of randomised controlled trials (RCTs) comparing any intervention delivered in the perinatal period designed to support parents experiencing CPTSD symptoms or with a history of childhood maltreatment (or both), to any active or inactive control. Primary outcomes were parental psychological or socio-emotional wellbeing and parenting capacity between pregnancy and up to two years postpartum. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the eligibility of trials for inclusion, extracted data using a pre-designed data extraction form, and assessed risk of bias and certainty of evidence. We contacted study authors for additional information as required. We analysed continuous data using mean difference (MD) for outcomes using a single measure, and standardised mean difference (SMD) for outcomes using multiple measures, and risk ratios (RR) for dichotomous data. All data are presented with 95% confidence intervals (CIs). We undertook meta-analyses using random-effects models. MAIN RESULTS We included evidence from 1925 participants in 15 RCTs that investigated the effect of 17 interventions. All included studies were published after 2005. Interventions included seven parenting interventions, eight psychological interventions and two service system approaches. The studies were funded by major research councils, government departments and philanthropic/charitable organisations. All evidence was of low or very low certainty. Parenting interventions Evidence was very uncertain from a study (33 participants) assessing the effects of a parenting intervention compared to attention control on trauma-related symptoms, and psychological wellbeing symptoms (postpartum depression), in mothers who had experienced childhood maltreatment and were experiencing current parenting risk factors. Evidence suggested that parenting interventions may improve parent-child relationships slightly compared to usual service provision (SMD 0.45, 95% CI -0.06 to 0.96; I2 = 60%; 2 studies, 153 participants; low-certainty evidence). There may be little or no difference between parenting interventions and usual perinatal service in parenting skills including nurturance, supportive presence and reciprocity (SMD 0.25, 95% CI -0.07 to 0.58; I2 = 0%; 4 studies, 149 participants; low-certainty evidence). No studies assessed the effects of parenting interventions on parents' substance use, relationship quality or self-harm. Psychological interventions Psychological interventions may result in little or no difference in trauma-related symptoms compared to usual care (SMD -0.05, 95% CI -0.40 to 0.31; I2 = 39%; 4 studies, 247 participants; low-certainty evidence). Psychological interventions may make little or no difference compared to usual care to depression symptom severity (8 studies, 507 participants, low-certainty evidence, SMD -0.34, 95% CI -0.66 to -0.03; I2 = 63%). An interpersonally focused cognitive behavioural analysis system of psychotherapy may slightly increase the number of pregnant women who quit smoking compared to usual smoking cessation therapy and prenatal care (189 participants, low-certainty evidence). A psychological intervention may slightly improve parents' relationship quality compared to usual care (1 study, 67 participants, low-certainty evidence). Benefits for parent-child relationships were very uncertain (26 participants, very low-certainty evidence), while there may be a slight improvement in parenting skills compared to usual care (66 participants, low-certainty evidence). No studies assessed the effects of psychological interventions on parents' self-harm. Service system approaches One service system approach assessed the effect of a financial empowerment education programme, with and without trauma-informed peer support, compared to usual care for parents with low incomes. The interventions increased depression slightly (52 participants, low-certainty evidence). No studies assessed the effects of service system interventions on parents' trauma-related symptoms, substance use, relationship quality, self-harm, parent-child relationships or parenting skills. AUTHORS' CONCLUSIONS There is currently a lack of high-quality evidence regarding the effectiveness of interventions to improve parenting capacity or parental psychological or socio-emotional wellbeing in parents experiencing CPTSD symptoms or who have experienced childhood maltreatment (or both). This lack of methodological rigour and high risk of bias made it difficult to interpret the findings of this review. Overall, results suggest that parenting interventions may slightly improve parent-child relationships but have a small, unimportant effect on parenting skills. Psychological interventions may help some women stop smoking in pregnancy, and may have small benefits on parents' relationships and parenting skills. A financial empowerment programme may slightly worsen depression symptoms. While potential beneficial effects were small, the importance of a positive effect in a small number of parents must be considered when making treatment and care decisions. There is a need for further high-quality research into effective strategies for this population.
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Affiliation(s)
- Kimberley A Jones
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Isabella Freijah
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Sue E Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Joanne E McKenzie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Tess M Bright
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Renee Fiolet
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Ilias Kamitsis
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Carol Reid
- Judith Lumley Centre, La Trobe University, Bundoora, Australia
| | - Elise Davis
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Shawana Andrews
- Poche Centre for Indigenous Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Carlton, Australia
| | - Maria Muzik
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Leonie Segal
- Health Economics and Social Policy, Australian Centre for Precision Health, University of South Australia, North Terrace, Australia
| | - Helen Herrman
- Orygen, National Centre of Excellenece in Youth Mental Health, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Catherine Chamberlain
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
- Judith Lumley Centre, La Trobe University, Bundoora, Australia
- NGANGK YIRA Murdoch University Research Centre for Aboriginal Health and Social Equity, Murdoch University, Perth, Australia
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Booth-LaForce C, Oxford ML, O’Leary R, Rees J, Petras A, Buchwald DS. Implementation fidelity of the Promoting First Relationships intervention program in a Native community. Transl Behav Med 2023; 13:34-41. [PMID: 36227860 PMCID: PMC9853091 DOI: 10.1093/tbm/ibac060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Promoting First Relationship (PFR) is an evidence-based intervention designed to promote positive, supportive relationships between primary caregivers and their young children. Implementing and testing the efficacy of PFR in a remote Native community is especially challenging and requires methods and tools for ensuring implementation fidelity. Tribal members of a Native community were successfully trained and certified to deliver PFR by university-based personnel. During PFR delivery, they achieved very high scores on adherence to intervention content (M = 0.99, SD = 0.02), and their quality of delivery uniformly exceeded established criteria. High attrition occurred before PFR was delivered. However, participants who remained in the study completed all 10 sessions of PFR content. Participants' satisfaction with the program was very high (M = 3.90 [of 4 points], SD = 0.19). High implementation fidelity was attained in the face of many inherent challenges. The suite of methods and tools used for training, monitoring, and evaluating implementation fidelity in this study provides an example that may be useful in the evaluation of evidence-based programs more generally.
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Affiliation(s)
- Cathryn Booth-LaForce
- Department of Child, Family, and Population Health Nursing, University of Washington, Barnard Center for Infant Mental Health and Development, Box 357231, Seattle, WA 98195-7231, USA
| | - Monica L Oxford
- Department of Child, Family, and Population Health Nursing, University of Washington, Barnard Center for Infant Mental Health and Development, Box 357231, Seattle, WA 98195-7231, USA
| | - Rae O’Leary
- Missouri Breaks Industries Research Inc., Eagle Butte, SD 57625, USA
| | - Jennifer Rees
- Department of Child, Family, and Population Health Nursing, University of Washington, Barnard Center for Infant Mental Health and Development, Box 357231, Seattle, WA 98195-7231, USA
| | - Anthippy Petras
- Elson S. Floyd College of Medicine, Institute for Research and Education to Advance Community Health, Washington State University, 1100 Olive Way, Ste 1200, Seattle, WA 98101, USA
| | - Dedra S Buchwald
- Elson S. Floyd College of Medicine, Institute for Research and Education to Advance Community Health, Washington State University, 1100 Olive Way, Ste 1200, Seattle, WA 98101, USA
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Promoting First Relationships ® for Primary Caregivers and Toddlers in a Native Community: a Randomized Controlled Trial. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:39-49. [PMID: 35997845 DOI: 10.1007/s11121-022-01415-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 02/03/2023]
Abstract
This study tested the effectiveness of Promoting First Relationships® (PFR), a preventive intervention program aimed at fostering positive caregiver-child relationships in Native families living on a rural reservation. Participants were 162 primary caregivers (96% Native; 93% female) and their Native toddlers (10-31 months old; 50% female). Families were randomized to a PFR group (n = 81) or Resource and Referral (RR) control group (n = 81), after baseline data collection (Time 1) to assess the quality of caregiver-child interaction, caregiver knowledge about children's social-emotional needs, caregiver depressive symptoms, and child externalizing behavior. After delivery of the PFR intervention or the RR service, follow-up assessments were repeated immediately post-intervention (Time 2) and 3 months later (Time 3). After controlling for baseline assessments, multivariate analyses of covariance revealed that caregivers in the PFR group had significantly higher scores on knowledge about children's social-emotional needs at Time 2 (p < .01, η2 = .06) and Time 3 (p < .05, η2 = .04) and less severe depressive symptoms at Times 2 and 3 (both p < .05, η2 = .04). At Time 3, the quality of caregiver-child interaction was better in the PFR group (p < .01, η2 = .06), an effect that was moderated by severity of depressive symptoms (p = .05, η2 = .06), with PFR having the greatest impact at low levels of initial symptoms (p = .02). Results support the positive impact of PFR in a Native community and suggest conditions under which the intervention may be most effective.
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O'Leary R, Oxford ML, Booth-LaForce C, London S, Buchwald DS. Experiences of Native Participants in the Promoting First Relationships® Intervention: Focus Group Findings. Matern Child Health J 2022; 26:2263-2270. [PMID: 36109420 PMCID: PMC10693919 DOI: 10.1007/s10995-022-03533-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVES We tested Promoting First Relationships® (PFR), an evidence-based preventive intervention program for caregivers promoting attachment and social and emotional development of infants and toddlers, in a randomized controlled trial in a Native community. Quantitative results yielded evidence of efficacy; but in this report, our objective was to assess the participants' real-life experiences, challenges, and suggested enhancements to further adapt the program. METHODS At the end of the study we conducted three focus groups (N = 17)-two groups for participants who completed the 10-week intervention and one group for those who did not. Focus groups were structured to generate discussion about (1) elements or activities of PFR they enjoyed and others that were challenging, (2) suggested solutions to participant challenges, (3) experiences with video recordings and handouts, and (4) aspects of the program that could be changed to make it more culturally-relevant. RESULTS Qualitative analysis of the focus group transcripts revealed five themes: (1) appreciation for PFR providers and program, (2) personal growth, (3) improved caregiver-child relationships, (4) participant challenges, and (5) participant suggestions to improve the program. CONCLUSIONS These qualitative results complement our quantitative assessment of the positive impact of the PFR program. Additionally, they provide importance guidance for future implementation of PFR in this, and other Native communities, as well as insight into broader issues to consider when adapting intervention programs for Native families.
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Affiliation(s)
- Rae O'Leary
- Missouri Breaks Industries Research, Inc., 118 S. Willow Street, PO Box 1824, Eagle Butte, SD, 57625, USA.
| | - Monica L Oxford
- Child, Family, and Population Health Nursing, University of Washington, Seattle, USA
| | - Cathryn Booth-LaForce
- Child, Family, and Population Health Nursing, University of Washington, Seattle, USA
| | - Sara London
- College of Education, University of Washington, Seattle, USA
| | - Dedra S Buchwald
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle and Spokane, USA
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Booth-LaForce C, Oxford ML, Barbosa-Leiker C, Burduli E, Buchwald DS. Randomized Controlled Trial of the Promoting First Relationships® Preventive Intervention for Primary Caregivers and Toddlers in an American Indian Community. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 21:98-108. [PMID: 31754964 DOI: 10.1007/s11121-019-01053-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Preventive intervention programs that address parenting practices and children's developmental needs early in life have led to positive changes in caregiving behavior and children's developmental outcomes. However, little is known about the efficacy of such programs among American Indian families. This study tested the efficacy of the strengths-based Promoting First Relationships® (PFR) program in American Indian families living on a rural reservation. Participants were 34 toddlers (10-30 months old) and their primary caregivers. Families were randomized to an Immediate (n = 17) or Waitlist (n = 17) group after a home visit for baseline data collection, which included assessment of observed caregiver-child interactions, caregiver perceptions, and child behavior. After randomization, we delivered the PFR intervention in 10 visits to the Immediate group, with some adaptations based on focus groups with community members and staff input. We analyzed follow-up assessments by implementing multiple regression analyses, controlling for baseline scores and using multiple imputation to handle missing data. Results supported our primary hypotheses: the Immediate group, compared with Waitlist, had significantly higher scores on the quality (p = .011, d = 1.02) and contingent responsiveness (p = .013, d = 1.21) of caregiver-child interactions, as well as on caregiver knowledge of toddlers' social and emotional needs and level of developmentally appropriate expectations (p = .000, d = 0.58). Caregiver stress and caregivers' reports of child behavior did not differ significantly. Our results hold promise for additional PFR research in other Native communities.
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Affiliation(s)
- Cathryn Booth-LaForce
- Department of Child, Family, & Population Health Nursing, University of Washington, CHDD 106 South Building, Box 357920, Seattle, WA, 98195-7920, USA.
| | - Monica L Oxford
- Department of Child, Family, & Population Health Nursing, University of Washington, CHDD 106 South Building, Box 357920, Seattle, WA, 98195-7920, USA
| | | | - Ekaterina Burduli
- College of Nursing, Washington State University, Spokane, WA, 99210-1495, USA
| | - Dedra S Buchwald
- Elson S. Floyd College of Medicine, Institute for Research and Education to Advance Community Health, Washington State University, 1100 Olive Way, Ste 1200, Seattle, WA, 98101, USA
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Kuklinski MR, Oxford ML, Spieker SJ, Lohr MJ, Fleming CB. Benefit-cost analysis of Promoting First Relationships®: Implications of victim benefits assumptions for return on investment. CHILD ABUSE & NEGLECT 2020; 106:104515. [PMID: 32454356 PMCID: PMC7359609 DOI: 10.1016/j.chiabu.2020.104515] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/11/2020] [Accepted: 04/22/2020] [Indexed: 05/08/2023]
Abstract
BACKGROUND Child abuse and neglect (CAN) cost United States society $136 billion to $428 billion annually. Preventive interventions that reduce CAN may improve people's lives and generate economic benefits to society, but their magnitude is likely to vary greatly with assumptions about victim costs avoided through intervention. OBJECTIVE We examined the implications of different assumptions about avoided victim costs in a benefit-cost analysis of Promoting First Relationships® (PFR), a 10-session attachment and strengths-based home visiting intervention. PARTICIPANTS AND SETTING Participants were 247 child protection-involved but intact families in Washington State randomized to receive PFR (n = 124) or resource and referral (n = 123). METHODS We monetized intervention effects on out-of-home placements and implicit effects on CAN and calculated net present values under three scenarios: (1) benefits from avoided system costs, (2) additional benefits from avoided tangible victim costs, and (3) additional benefits from avoided tangible and intangible quality-of-life victim costs. For scenarios 2 and 3, we varied the CAN effect size and estimated the effect size at which PFR was reliably cost beneficial. RESULTS PFR's societal net benefit ranged from $1 (scenario 1) to $5514 - $25,562 (scenario 2) and $7004 - $32,072 (scenario 3) (2014 USD). In scenarios 2 and 3, PFR was reliably cost beneficial at a CAN effect size of approximately -0.25. CONCLUSIONS PFR is cost beneficial assuming tangible victim costs are avoided by PFR. Research into the long-term health and economic consequences of reducing CAN in at-risk populations would contribute to comprehensive, accurate benefits models.
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Affiliation(s)
- Margaret R Kuklinski
- Social Development Research Group, School of Social Work, University of Washington, 9725 Third Ave. NE, Suite 401, Seattle, WA 98115, United States.
| | - Monica L Oxford
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, United States.
| | - Susan J Spieker
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, United States.
| | - Mary Jane Lohr
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, United States.
| | - Charles B Fleming
- Center for The Study of Health and Risk Behavior, Department of Psychiatry, University of Washington, United States.
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Hash JB, Oxford ML, Fleming CB, Ward TM, Spieker SJ, Lohr MJ. Impact of a home visiting program on sleep problems among young children experiencing adversity. CHILD ABUSE & NEGLECT 2019; 89:143-154. [PMID: 30665020 PMCID: PMC6526956 DOI: 10.1016/j.chiabu.2018.12.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/14/2018] [Accepted: 12/20/2018] [Indexed: 05/10/2023]
Abstract
BACKGROUND Adversity may negatively impact young children's sleep but receiving home visitation services could buffer children from this potential consequence of adversity. OBJECTIVE This study examined whether young children's adverse experiences increased their risk for sleep problems and if Promoting First Relationships® (PFR), a home visitation program, reduced children's risk for sleep problems both directly and indirectly through increased parenting sensitivity. PARTICIPANTS AND SETTING Participants were 247 parents and their 10- to 24-month-old child recruited from Child Protective Services offices. METHODS A secondary analysis of a randomized controlled trial comparing PFR to a resource and referral control condition was conducted. Four time points of data were collected from baseline to 6 months post-intervention. Parenting sensitivity was measured at all time points using a parent-child interaction tool. Children's adversities were measured at various time points using caregiver report tools and official state records. Children's sleep problems were reported by parents at 6 months post-intervention. RESULTS The likelihood of having a sleep problem increased as children's adversities increased (β = .23, SE = .08, p = .005). There was no effect (direct or indirect) of treatment assignment on children's sleep problems (ps > .05). Post hoc analyses showed a treatment assignment by adversity interaction such that children's odds of having a sleep problem increased as their adversities increased, but only among children in the control condition (b = -0.37, SE = 0.17, p = .030). CONCLUSIONS Experiencing more adversities associated with a greater risk for sleep problems, but PFR buffered children from this risk.
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Affiliation(s)
- Jonika B Hash
- Department of Biobehavioral Nursing & Health Informatics, University of Washington, Seattle, WA, 98195, USA.
| | - Monica L Oxford
- Department of Family & Child Nursing, University of Washington, Seattle, WA, 98195, USA
| | - Charles B Fleming
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, 98195, USA
| | - Teresa M Ward
- Department of Psychosocial & Community Health, University of Washington, Seattle, WA, 98195, USA
| | - Susan J Spieker
- Department of Family & Child Nursing, University of Washington, Seattle, WA, 98195, USA
| | - Mary Jane Lohr
- Department of Family & Child Nursing, University of Washington, Seattle, WA, 98195, USA
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Pasalich DS, Fleming CB, Spieker SJ, Lohr MJ, Oxford ML. Does Parents' Own History of Child Abuse Moderate the Effectiveness of the Promoting First Relationships® Intervention in Child Welfare? CHILD MALTREATMENT 2019; 24:56-65. [PMID: 30428707 DOI: 10.1177/1077559518809217] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
To better understand how and for whom parenting intervention may improve family outcomes in child welfare services, we examined whether parents' own history of child abuse moderated the indirect effects of the Promoting First Relationships® (PFR) intervention on toddlers' secure base behavior via parental sensitivity. Parents ( N = 247) and their toddlers (10-24 months) involved with child protective services were randomized to PFR or a control intervention. Results showed that the PFR group demonstrated greater parental sensitivity at postintervention than the control group, which in turn led to higher levels of toddler secure base behavior at 6-month follow-up. Findings from a moderated mediation model indicated that these intervention effects were only evident for parents who experienced physical abuse in their childhood. Parents' history of sexual or emotional abuse did not significantly moderate outcomes. These results provide evidence for a key mechanism of change in PFR informed by attachment theory and suggest that PFR intervention effects may be stronger in parents at higher risk of the intergenerational transmission of abuse.
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Oxford ML, Spieker SJ, Lohr MJ, Fleming CB. Promoting First Relationships ®: Randomized Trial of a 10-Week Home Visiting Program With Families Referred to Child Protective Services. CHILD MALTREATMENT 2016; 21:267-277. [PMID: 27646148 PMCID: PMC5357588 DOI: 10.1177/1077559516668274] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
We conducted a community-based randomized control trial with intent-to-treat analysis on Promoting First Relationships® (PFR), a 10-week home visiting program. The study included 247 families with 10- to 24-month-old children who had a recent, open child protective services investigation of child maltreatment. Families were randomly assigned to receive either the 10-week home visiting PFR service or a telephone-based, three-call resource and referral (R&R) service. Across postintervention time points, parents in the PFR condition scored higher than families in the R&R condition in parent understanding of toddlers' social emotional needs ( d = .35) and observed parental sensitivity ( d = .20). Children in the PFR condition scored lower than children in the comparison condition on an observational measure of atypical affective communication ( d = .19) and were less likely than children in the comparison group to be placed into foster care through 1-year postintervention (6% vs. 13%, p = .042). No significant differences were found on measures of parenting stress or child social-emotional competence, behavior problems, or secure base behavior. Overall, the results show support for the promise of PFR as an intervention for enhancing parent sensitivity and preventing child removals for families in the child welfare system.
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Affiliation(s)
- Monica L Oxford
- 1 Family & Child Nursing, University of Washington, Seattle, WA, USA
| | - Susan J Spieker
- 1 Family & Child Nursing, University of Washington, Seattle, WA, USA
| | - Mary Jane Lohr
- 1 Family & Child Nursing, University of Washington, Seattle, WA, USA
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