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Yu X, Roman LA, Raffo JE, Meng R, Vander Meulen P, Lloyd CS, Meghea CI. Neighborhood Racialized Economic Polarization, Home Visiting Coverage, and Adverse Birth Outcomes in a Medicaid-eligible Population. Womens Health Issues 2024; 34:340-349. [PMID: 38845232 DOI: 10.1016/j.whi.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 04/19/2024] [Accepted: 05/02/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Residential polarization shaped by racial segregation and concentrations of wealth (hereafter neighborhood racialized economic polarization) results in both highly deprived and highly privileged neighborhoods. Numerous studies have found a negative relationship between neighborhood racialized economic polarization and birth outcomes. We investigated whether community-informed home visiting programs achieve high rates of service coverage in highly deprived neighborhoods and can attenuate the deleterious effect of neighborhood polarization on birth outcomes. METHODS We used 2016-2019 data from Michigan's statewide database that links birth records, Medicaid claims, and program participation (N = 211,412). We evaluated whether 1) home visiting programs achieved high rates of service coverage in highly deprived neighborhoods, 2) participation in home visiting may help to mitigate the negative relationship between neighborhood polarization and birth outcomes, and 3) the reductions in preterm birth and low birthweight were larger among Black birthing individuals. Data were examined using multilevel generalized linear models and mediation analysis. RESULTS The statewide home visiting program achieved higher rates of coverage in the most deprived neighborhoods (21.0% statewide, 28.3% in the most deprived vs. 10.4% in the most privileged neighborhoods). For all, home visiting participation was associated with a decrease in the relationship between neighborhood polarization and preterm birth by 6.8% (mean indirect effect, -0.008; 95% confidence interval, -0.011 to -0.005), and by 5.2% (mean indirect effect, -0.013; 95% confidence interval, -0.017 to -0.009) for low birthweight, adjusting for individual-level risk factors. The decrease was larger among Black individuals. CONCLUSIONS A statewide Medicaid-sponsored home visiting program achieved high rates of service coverage in highly deprived neighborhoods. Program participation may help to mitigate the negative relationship between neighborhood polarization and birth outcomes, and more so among Black individuals. Continued support for home visiting services is required to better engage birthing individuals in neighborhoods with concentrated deprivation and to decrease disparities.
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Affiliation(s)
- Xiao Yu
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine, Grand Rapids and East Lansing, Michigan.
| | - Lee Anne Roman
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine, Grand Rapids and East Lansing, Michigan
| | - Jennifer E Raffo
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine, Grand Rapids and East Lansing, Michigan
| | - Ran Meng
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine, Grand Rapids and East Lansing, Michigan
| | - Peggy Vander Meulen
- Corewell Health, Healthier Communities Department, Strong Beginnings, Grand Rapids, Michigan
| | - Celeste Sanchez Lloyd
- Corewell Health, Healthier Communities Department, Strong Beginnings, Grand Rapids, Michigan
| | - Cristian I Meghea
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine, Grand Rapids and East Lansing, Michigan
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Kenny M, Raos R, Ahmad F, Gonzalez A. Assessing Health Equity in Partnership with Children's Mental Health Organizations: Considerations Before the Implementation of Parenting Programs. Health Equity 2024; 8:419-425. [PMID: 39015219 PMCID: PMC11250835 DOI: 10.1089/heq.2023.0143] [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: 04/17/2024] [Indexed: 07/18/2024] Open
Abstract
Objectives Understanding and addressing how an individual's social, political, economic, and cultural context affects their ability to achieve optimal health is essential to designing and implementing interventions. Before evaluating two parenting programs, in partnership with four children's mental health organizations, we used the Health Equity Impact Assessment tool (HEIA) to identify groups that may experience unintended health impacts, as well as generated mitigation strategies to address these impacts. Methods HEIA activities included a review of the published literature, a review of organizational documents, key informant interviews with staff (n = 12) and other related community service providers (n = 7), and a geographic information systems analysis. All sources of evidence were considered and analyzed using reflective thematic analysis. Summary reports were shared with all partners. Results A range of groups were identified as at risk of experiencing unintended health impacts, including caregivers who are racialized, immigrants, Indigenous, living with mental health issues or addictions, dealing with intellectual challenges and/or low literacy levels, survivors of childhood trauma, single parent families, or families experiencing financial difficulties. Unintended health impacts were sorted into 6 main themes which fell under the overarching themes of accessibility of the programs and cultural appropriateness. Mitigation strategies as well as innovative strategies already being applied by participating organizations are discussed. Conclusion Although this HEIA focused on parenting programs, the findings address equity issues applicable to the provision of a wide spectrum of children's mental health services.
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Affiliation(s)
- Meghan Kenny
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada
| | - Rob Raos
- Geographic Information Systems Analyst, McMaster University, Hamilton, Canada
| | - Fatima Ahmad
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
- Offord Centre for Child Studies, Hamilton, Canada
| | - Andrea Gonzalez
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
- Offord Centre for Child Studies, Hamilton, Canada
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Durepos P, MacLean R, Ricketts N, Boamah SA, Witherspoon R, Gould O, Olthuis JV, Totton K, Tucker K, Boulay I, Robitaille A, Aquino-Russell C, Kaasalainen S. Engaging care partners of persons living with dementia in acceptance and commitment therapy (ACT) programs: a scoping review. Aging Ment Health 2024; 28:725-737. [PMID: 38100551 DOI: 10.1080/13607863.2023.2288864] [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] [Received: 01/09/2023] [Accepted: 11/17/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVES Acceptance and commitment therapy (ACT) is a relatively new type of psychotherapy effective for treating depression and anxiety amongst family care partners of persons living with dementia [PLWD]. However, care partner engagement in mental health services is low and specific guidelines for designing ACT programs for care partners of PLWD do not exist. The purpose of this scoping review was to examine patterns in care partner engagement in ACT programs to identify program factors potentially influencing engagement. METHODS A comprehensive scoping review according to Arksey and O'Malley's framework was followed. Databases and grey literature were searched for primary studies of ACT programs with care partners of PLWD. Data were charted and synthesized. RESULTS Ten studies met inclusion criteria and were analyzed. Amongst these, engagement was highest in three ACT programs that were delivered individually, remotely and were therapist-led or supported. Conversely, engagement was the lowest in two ACT programs that were self-directed, web-based and had minimal or no care partner-therapist interaction. Program factors perceived as influencing engagement included tailoring and personalization, mode of delivery and format, therapeutic support and connectedness, program duration and pace. CONCLUSION Findings from this review suggest that care partners engagement may be promoted by designing ACT programs that focus on the therapeutic client-therapist relationship, are delivered remotely and individually. Future research should focus on evaluation of best implementation practices for engagement and effectiveness.
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Affiliation(s)
- Pamela Durepos
- Faculty of Nursing, University of New Brunswick, Fredericton, Canada
| | - Rachel MacLean
- Faculty of Nursing, University of New Brunswick, Fredericton, Canada
| | | | | | | | - Odette Gould
- Department of Psychology, Mount Allison University, Sackville, Canada
| | - Janine V Olthuis
- Department of Psychology, University of New Brunswick, Fredericton, Canada
| | - Karen Totton
- Faculty of Nursing, University of New Brunswick, Fredericton, Canada
| | - Kate Tucker
- Master of Applied Health Services Research, University of New Brunswick, Fredericton, Canada
| | | | - Annie Robitaille
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada
- Centre of Excellence in Frailty-Informed Care, The Perley and Rideau Veterans' Health Centre, Ottawa, Canada
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Berry V, Melendez-Torres GJ, Axford N, Axberg U, de Castro BO, Gardner F, Gaspar MF, Handegård BH, Hutchings J, Menting A, McGilloway S, Scott S, Leijten P. Does Social and Economic Disadvantage Predict Lower Engagement with Parenting Interventions? An Integrative Analysis Using Individual Participant Data. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:1447-1458. [PMID: 35870094 PMCID: PMC10678811 DOI: 10.1007/s11121-022-01404-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2022] [Indexed: 11/26/2022]
Abstract
There is a social gradient to the determinants of health; low socioeconomic status (SES) has been linked to reduced educational attainment and employment prospects, which in turn affect physical and mental wellbeing. One goal of preventive interventions, such as parenting programs, is to reduce these health inequalities by supporting families with difficulties that are often patterned by SES. Despite these intentions, a recent individual participant data (IPD) meta-analysis of the Incredible Years (IY) parenting program found no evidence for differential benefit by socioeconomic disadvantage (Gardner et al. in Public Health Resesearch 5, 1-144, 2017). However, it did not examine whether this was influenced by engagement in the intervention. Using intervention arm data from this pooled dataset (13 trials; N = 1078), we examined whether there was an SES gradient to intervention attendance (an indicator of engagement). We ran mixed-effects Poisson regression models to estimate incidence rate ratios (IRRs) for program attendance for each of five (binary) markers of SES: low income; unemployment; low education status; teen parent; and lone parent status. The multilevel structure of the data allowed for comparison of within-trial and between-trial effects, including tests for contextual effects. We found evidence that low SES was associated with reduced attendance at parenting programs-an 8-19% reduction depending on the SES marker. However, there was no evidence that this association is impacted by differences in SES composition between trials or by the attendance levels of higher-SES families. The findings underscore the importance of developing and prioritizing strategies that enable engagement in parenting interventions and encourage program attendance by low-SES families.
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Affiliation(s)
| | | | | | - Ulf Axberg
- VID Specialized University, Oslo, Norway
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5
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Crompton C, Wan MW, Dewan S, Wittkowski A. Navigating their child's attachment-related difficulties: Parents' journey from shame into awareness. Clin Child Psychol Psychiatry 2023; 28:1463-1479. [PMID: 36349510 PMCID: PMC10540477 DOI: 10.1177/13591045221135993] [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: 11/11/2022]
Abstract
Attachment-related difficulties frequently present in child and adolescent clinical services. Yet how parents engage with being informed of their child's attachment-related difficulties is little understood. In this qualitative study, ten parents with a birth child with attachment-related difficulties, as informed by a relevant service, and six healthcare professionals, were interviewed. The aim was to explore both perspectives on how parents experienced and engaged with this process, of their understanding of the child's difficulties and the supports they engaged with. Using grounded theory, the parental journey from shame to awareness is described, based around four main themes: failing as a parent, the process of making sense, a call to action, and awareness of attachment and interrelated difficulties. The intensity of shame and defensive processes felt by parents came through strongly in narratives, forming a key barrier to sense-making and action, while specific clinical, personal and support/resource characteristics facilitated progress. The findings highlight how parents can be better supported into a space of attachment-related awareness and understanding, which may in turn facilitate more positive outcomes for the child. The study also raises wide ranging implications relevant to all involved in the investment, planning and delivery of care for this client group.
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Affiliation(s)
- Chloe Crompton
- School of Health Sciences, The University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Ming W Wan
- School of Health Sciences, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | | | - Anja Wittkowski
- School of Health Sciences, The University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
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Woodruff-Gautherin TA, Cienkowski KM. Modeling Lost to Intervention in Early Hearing Detection and Intervention: A Modified eDelphi Study. Am J Audiol 2023; 32:543-559. [PMID: 37486804 DOI: 10.1044/2023_aja-22-00046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Abstract
PURPOSE The purpose of this study was to develop a functional model of the drivers behind why families may decline early intervention services following the identification of a child as D/deaf or hard of hearing. METHOD This model was developed using a modified eDelphi method. Invited experts (N = 155) were provided proposed models of why families may decline early intervention services in accordance with current literature. In the first phase of feedback, participants (n = 23) provided changes they would make to the model to be more in line with their perceptions of lost to intervention. These changes were implemented, and a second phase of feedback with participants (n = 25) moved to accept the model as presented. RESULTS Agreement was reached on five main barriers to early intervention access for children who have been identified as D/deaf or hard of hearing (family experience, family culture, perceived vulnerability, perceived benefits, and perceived barriers). Each of these main barriers has associated examples of how they may manifest across different early intervention programs and situations. CONCLUSIONS This is the first theoretical model of why loss to intervention happens within early hearing detection and intervention. Having a model provides the opportunity for future work to implement novel approaches to support families during the early intervention enrollment process.
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Affiliation(s)
- Torri Ann Woodruff-Gautherin
- Department of Public Health Sciences, University of Connecticut Center for Excellence in Developmental Disabilities Education, Research, and Service, Farmington
| | - Kathleen M Cienkowski
- Department of Speech, Language and Hearing Sciences, University of Connecticut, Storrs
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Mooney KE, Bywater T, Dickerson J, Richardson G, Hou B, Wright J, Blower S. Protocol for the effectiveness evaluation of an antenatal, universally offered, and remotely delivered parenting programme 'Baby Steps' on maternal outcomes: a Born in Bradford's Better Start (BiBBS) study. BMC Public Health 2023; 23:190. [PMID: 36709270 PMCID: PMC9884130 DOI: 10.1186/s12889-023-15111-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 01/20/2023] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Poor perinatal mental health and maternal sensitivity towards a child in the early years can carry a long-term cost to individuals and to society, and result in negative child outcomes such as poor mental health and social emotional issues. Despite the recognition of early intervention and prevention, there is mixed evidence regarding antenatal parenting interventions that aim to enhance perinatal mental health and maternal sensitivity to prevent negative child outcomes. 'Baby Steps' is a relationship-based antenatal and postnatal parenting programme. The service evaluated in this study is delivered in a low-income and ethnically diverse community via Better Start Bradford. This study aims to assess whether the universally, and remotely delivered Baby Steps programme is effective in improving postnatal maternal sensitivity (primary outcome) and postnatal maternal mental health (secondary outcome) when compared to services as usual 6-10 weeks post-birth. It will also assess differences in birth outcomes, and differences in the prevalence of poor perinatal mental ill health through routine data. The feasibility of collecting cost and health related resource use data for a future economic evaluation will be explored. METHODS The study is a quasi-experimental evaluation in a single centre. All participants are drawn from Born in Bradford's Better Start (BiBBS) interventional family cohort study. Intervention participants will be matched to a demographically comparable control group using propensity score matching. The required minimum sample is n = 130 (ratio 1:1) to detect a medium effect (± 2.35, d = .50) on the primary outcome-maternal-child sensitivity, using the Mothers Object Relations Scale Short Form (MORS-SF). Secondary outcomes include the Patient Health Questionnaire (PHQ-8), Generalised Anxiety Disorder assessment 7 (GAD-7), identification of poor perinatal mental health through routine data, and birth outcomes (delivery method, gestation period, low birth weight). Service delivery costs and health resource use will be gathered from routine data. DISCUSSION This study will evaluate the effectiveness of Baby Steps for enhancing maternal-child sensitivity and maternal mental health when delivered universally and remotely. The findings regarding programme effectiveness, process, and costs will be relevant for researchers, service commissioners, and service staff. TRIAL REGISTRATION This study was prospectively registered with ISRCTN (22/04/2022, ISRCTN12196131).
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Affiliation(s)
- Kate E. Mooney
- grid.5685.e0000 0004 1936 9668Department of Health Sciences, University of York, York, UK ,grid.418449.40000 0004 0379 5398Bradford Institute for Health Research, Bradford, UK
| | - Tracey Bywater
- grid.5685.e0000 0004 1936 9668Department of Health Sciences, University of York, York, UK
| | - Josie Dickerson
- grid.418449.40000 0004 0379 5398Bradford Institute for Health Research, Bradford, UK
| | - Gerry Richardson
- grid.5685.e0000 0004 1936 9668Centre for Health Economics, University of York, York, UK
| | - Bo Hou
- grid.418449.40000 0004 0379 5398Bradford Institute for Health Research, Bradford, UK
| | - John Wright
- grid.418449.40000 0004 0379 5398Bradford Institute for Health Research, Bradford, UK
| | - Sarah Blower
- grid.5685.e0000 0004 1936 9668Department of Health Sciences, University of York, York, UK
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Fang Z, Lachman JM, Zhang C, Qiao D, Barlow J. A virtuous circle: Stakeholder perspectives of a short-term intensive parent training programme delivered within the context of routine services for autism in China. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:1973-1986. [PMID: 35068174 PMCID: PMC9597148 DOI: 10.1177/13623613211070869] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
While much knowledge about autism derives from high-income countries, most people diagnosed with autism reside in low- and middle-income countries, where little is documented in terms of local interventions. This is also true for parent training programmes for families of autistic children. An evaluation was conducted to understand the effects of a short-term intensive parent training programme delivered in routine services for families of autistic children in China. This study reported results from the in-depth interviews with 14 participating caregivers and group discussions with eight group leaders. The interviews and discussions were aimed at learning (1) to what extent the programme components were deemed acceptable, (2) what affected caregivers' attendance and engagement in the programme and (3) what affected group leaders' delivery of the programme. Findings suggested that future parent training programmes provide adequate opportunities for caregivers to practice and receive feedback; group support; coaching experience tailored to individual challenges; more autism-related knowledge, resources and activities for children and extended family members; and organisational support to group leaders. This study highlights the value of qualitative research and points to the need for more empirical studies to address the recommendations, so that research findings can be better utilised to promote practices.
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Ramos A, Matos F, Soares H. Parenting Programme Structure, Potential Barriers, and Facilitators: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13655. [PMID: 36294249 PMCID: PMC9603259 DOI: 10.3390/ijerph192013655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 06/16/2023]
Abstract
Becoming a parent is a challenging transition, and stress factors may arise. This scoping review aims to map, from the literature, the structure, potential barriers, and facilitators to be considered when conducting a parenting programme for parents of children up to 3 years old. It followed the JBI methodology and included studies with parents of children up to 3 years old (Participants), studies about parenting programme structure, its potential barriers, and facilitators (Concept) in the healthcare or community setting (Context). Qualitative and/or quantitative study designs and grey literature publications between 2016 and 2021 were eligible. The search was performed in three stages in CINAHL Plus with Full Text, MEDLINE with Full Text, and PubMed databases. It was also conducted in OpenGrey, ProQuest, Portuguese Open Access Scientific Repository, and Google Scholar. Fourteen articles were selected. The following aspects were identified regarding parenting programmes: benefits; structuring elements to be considered; facilitating factors and possible barriers to its development, and measurement instruments to assess the programme. Parenting programmes are important ways to contribute to a healthy, sustainable, and resilient society. It should be adapted to individuals, groups, and communities. They add value to parents, children, and society and should be carefully adapted to the group's needs.
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Affiliation(s)
- Ana Ramos
- Instituto Politécnico de Setúbal, Escola Superior de Saúde. NURSE’IN-UIESI, Campus do IPS, Estefanilha, 2910-761 Setúbal, Portugal
| | - Filomena Matos
- University of Algarve, Health School. UICISA: E. NURSE’IN-UIESI, University of Algarve, Campus de Gambelas, 8005-139 Faro, Portugal
| | - Hélia Soares
- University of Azores, Health School. NURSE’IN-UIESI, University of Azores, 9700-042 Angra do Heroísmo, Portugal
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Mirzadegan IA, Blanton AC, Meyer A. Measuring and Enhancing Initial Parent Engagement in Parenting Education: Experiment and Psychometric Analysis. JMIR Pediatr Parent 2022; 5:e37449. [PMID: 36178725 PMCID: PMC9568823 DOI: 10.2196/37449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 08/12/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Isaac A Mirzadegan
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Amelia C Blanton
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Alexandria Meyer
- Department of Psychology, Florida State University, Tallahassee, FL, United States
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Sterrett K, Magaña MT, Gulsrud A, Paparella T, Kasari C. Predictors of Attrition in a Randomized Trial of a Social Communication Intervention for Infant-Toddlers at Risk for Autism. J Autism Dev Disord 2022:10.1007/s10803-022-05616-w. [PMID: 35678946 DOI: 10.1007/s10803-022-05616-w] [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: 05/12/2022] [Indexed: 10/18/2022]
Abstract
Addressing factors that make it more likely for families to attrite from early intervention trials will allow researchers to ensure that families reap the full benefits of participation. This study was an analysis of 78 children (Mage = 18.38 months, SD = 5.78) at risk for autism participating in a university-based randomized controlled trial of two 8-week long early intervention programs. Overall, attrition through 8-weeks was low, approximately 13%, however by the one-year follow-up attrition rates were approximately 50%. The most consistent predictor of attrition was the distance that families had to travel to the university. These data highlight the importance of providing services and support (e.g., financial and logistic) during follow-up to families to maximize their participation. Clincaltrials.gov Identifier: NCT01874327, 6/11/2013.
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Affiliation(s)
- Kyle Sterrett
- Department of Psychiatry and Bio-behavioral Sciences, University of California, Los Angeles, 90024, Los Angeles, CA, United States. .,Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, 760 Westwood Plaza 68-262B, 90024, Los Angeles, CA, United States.
| | - Maira Tafolla Magaña
- Department of Psychiatry and Bio-behavioral Sciences, University of California, Los Angeles, 90024, Los Angeles, CA, United States
| | - Amanda Gulsrud
- Department of Psychiatry and Bio-behavioral Sciences, University of California, Los Angeles, 90024, Los Angeles, CA, United States
| | - Tanya Paparella
- Department of Psychiatry and Bio-behavioral Sciences, University of California, Los Angeles, 90024, Los Angeles, CA, United States
| | - Connie Kasari
- Department of Psychiatry and Bio-behavioral Sciences, University of California, Los Angeles, 90024, Los Angeles, CA, United States
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Fynn WI, Runacres J. Dogs at school: a quantitative analysis of parental perceptions of canine-assisted activities in schools mediated by child anxiety score and use case. INTERNATIONAL JOURNAL OF CHILD CARE AND EDUCATION POLICY 2022; 16:4. [PMID: 35300319 PMCID: PMC8897139 DOI: 10.1186/s40723-022-00097-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/07/2022] [Indexed: 06/14/2023]
Abstract
Canine-assisted activities in schools can benefit students' educational, emotional, and social needs. Furthermore, they could be an effective form of non-clinical mental health treatment for children and adolescents. In the United Kingdom, school dogs are growing in popularity, however, little is known about how parents perceive canine-assisted activities as a treatment option. This is important as parental perceptions can influence engagement, whilst lack of awareness can become a barrier to treatment. This study uses a cross-sectional design to quantitatively explore the acceptability of canine-assisted activities amongst UK-based parents (n = 318) of children aged six to 16 (M = 10.12, SD = 3.22). An online survey used a treatment evaluation to determine acceptability across three use-cases. These included a child reading to dogs to improve literacy skills, a child interacting one-to-one to foster greater self-esteem and social skills, and a classroom dog to improve student behaviour and motivation. Additionally, the scale for generalised anxiety disorder was used to rank child anxiety as high or low, where high was a score equal to or above the UK clinical borderline threshold. The results found canine-assisted activities were less acceptable for the behavioural than the reading and social use-cases. Furthermore, parents of children with high anxiety had higher acceptability scores than parents of children with low anxiety for the reading and social use-cases but not for the behavioural use case. These findings suggest that UK parents' acceptability of canine-assisted activities in schools is mediated by child anxiety score. Furthermore, that parents may be less aware of the benefits of classroom dogs than other types of school-based canine-assisted activities.
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Affiliation(s)
- Wendy Irene Fynn
- University of Derby, Enterprise Centre, Bridge Street, Derby, DE1 3LA UK
| | - Jessica Runacres
- University of Derby, Enterprise Centre, Bridge Street, Derby, DE1 3LA UK
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Feasibility and effect of adding a concurrent parental component to a school-based wellness program using two modes of mobile-based technology - mixed methods evaluation of RCT. BMC Public Health 2022; 22:297. [PMID: 35164721 PMCID: PMC8842894 DOI: 10.1186/s12889-022-12581-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 01/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study assessed the feasibility and effect of two mobile modes (WhatsApp vs. a specially designed app) in their delivery of updates and assignments to parents. METHODS Two three-armed, randomized, controlled feasibility studies were conducted. In each trial, four schools with a total of 418 students in grade 5th, mean age 10.1 years, were randomly allocated to the control arm, youth-only arm, or youth & parental component arm. Only the data of those that completed all three assessments (pre, post and 3 months post program) were analyzed: 133 in the first trial and 137 in the second. In the youth-only arm, students participated in an interactive age-tailored prevention program delivered in 10 weekly, 90-min sessions on self-care behaviors, media literacy, self-esteem, and positive body image. The control groups in both studies received three health- and nutrition-related sessions. In the parental arm, in addition to the 'Favoring-Myself-Young's ten sessions program, parents received updates and were requested to complete shared assignments with their children. In the first year, the assignments were sent via WhatsApp, and in the following year via "Favoring Myself" smartphone application. Facilitators were third year undergraduate students. They used a detailed semi-structured guide and received 4-weekly hours of didactic and group dynamic supervision. Mixed-methods assessments were performed using semi-structured interviews with ten parents and five school staff members each year, as well as a computerized self-report questionnaire. RESULTS Feasibility of parent-adolescent shared assignments in both digital modes was lower than expected. The use of WhatsApp had higher feasibility and uptake than the use of the special application. The addition of the concurrent parental component via WhatsApp was associated with superior improvement in self-esteem and identification of advertisement strategies, compared with the youth-only program. However, adolescents in the youth-only program delivered via the smartphone application demonstrated superior improvement compared to those in the youth and parental component arm. CONCLUSIONS Although the addition of the concurrent parenting component was praised by the actively participating parents, overall, under the chosen structure and population, it did not prove to add statistically significant value to the youth-only arm. TRIAL REGISTRATIONS NCT03216018 (12.7.2017) and NCT03540277 (26.4.2018).
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Ozernov-Palchik O, Olson HA, Arechiga XM, Kentala H, Solorio-Fielder JL, Wang KL, Torres YC, Gardino ND, Dieffenbach JR, Gabrieli JDE. Implementing Remote Developmental Research: A Case Study of a Randomized Controlled Trial Language Intervention During COVID-19. Front Psychol 2022; 12:734375. [PMID: 35069315 PMCID: PMC8782159 DOI: 10.3389/fpsyg.2021.734375] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022] Open
Abstract
Intervention studies with developmental samples are difficult to implement, in particular when targeting demographically diverse communities. Online studies have the potential to examine the efficacy of highly scalable interventions aimed at enhancing development, and to address some of the barriers faced by underrepresented communities for participating in developmental research. During the COVID-19 pandemic, we executed a fully remote randomized controlled trial (RCT) language intervention with third and fourth grade students (N = 255; age range 8.19-10.72 years, mean = 9.41, SD = 0.52) from diverse backgrounds across the United States. Using this as a case study, we discuss both challenges and solutions to conducting an intensive online intervention through the various phases of the study, including recruitment, data collection, and fidelity of intervention implementation. We provide comprehensive suggestions and takeaways, and conclude by summarizing some important tradeoffs for researchers interested in carrying out such studies.
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Affiliation(s)
- Ola Ozernov-Palchik
- Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, United States
- Harvard Graduate School of Education, Cambridge, MA, United States
| | - Halie A. Olson
- Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Xochitl M. Arechiga
- Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Hope Kentala
- Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, United States
| | | | - Kimberly L. Wang
- Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Yesi Camacho Torres
- Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Natalie D. Gardino
- Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Jeff R. Dieffenbach
- Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - John D. E. Gabrieli
- Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, United States
- Harvard Graduate School of Education, Cambridge, MA, United States
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Garnett R, Davidson B, Eadie P. Parent perceptions of a group telepractice communication intervention for autism. AUTISM & DEVELOPMENTAL LANGUAGE IMPAIRMENTS 2022; 7:23969415211070127. [PMID: 36382075 PMCID: PMC9620687 DOI: 10.1177/23969415211070127] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND & AIMS Estimates suggest that one in 59 children receive a diagnosis of autism and that early intervention can be effective if applied consistently and intensively. Parent implemented intervention can increase intervention consistency and intensity however, availability of providers, geographical factors, time constraints, and parental stress levels can all act as barriers to service access. Limitations in understanding elements that support family engagement can also impact participation in intervention. Telepractice can increase availability of intervention services and decrease the time and costs associated with face-to-face delivery. Research focused on children with autism has shown that telepractice is acceptable to parents. Despite positive findings for telepractice services with individual clients, limited research has been conducted on telepractice services for parent groups; parent perceptions and preferences regarding intervention; and service delivery methods. This research aimed to investigate parent perceptions of a group intervention programme for autism; the telepractice approach; parent and child outcomes; and parental stress. The purpose of the investigation was to build an understanding of parent's intervention preferences to inform future service offerings, increase choice, and support participation. METHODS Eleven parents of preschool children with autism participated in a telepractice delivered group training programme called Hanen More Than Words (HMTW). The intervention is traditionally delivered face to face and teaches strategies to facilitate social-communication development in young children.Quantitative and qualitative measures were used to evaluate parent perceptions of the telepractice HMTW intervention. Data were collected via the Parenting Stress Index, HMTW programme evaluation forms, and online parent survey.Quantitative data was analysed using descriptive statistics. Pre- and post-intervention comparisons of parenting stress were conducted using paired T-Tests. Open comment field responses were analysed qualitatively using a directed content analysis. RESULTS Parents reported high levels of satisfaction with telepractice delivered HMTW across intervention and post programme evaluations. Interactive learning opportunities, group participation, video coaching, individualisation of service, and programme facilitation were identified as key supports to learning.Parents perceived increased insight into the interaction, learning, and behaviour of themselves and their children. They reported positive changes in strategy implementation and confidence. Parents also perceived improvements in their children's communication, responsiveness, interaction, and play following intervention. Parental stress measurements from pre- to post intervention, were not significantly different. CONCLUSIONS Telepractice may reduce service barriers and improve access, particularly with the efficiency of a group delivery approach. Utilising technology to deliver group intervention was acceptable to parents and perceived to have positive outcomes for both parent and child. Further investigation into parent perceptions of intervention types and delivery approaches, could facilitate a broader understanding of family needs with respect to service access and engagement. IMPLICATIONS Expansion of telepractice offerings can increase efficiencies and service choice for families and providers. Limitations in service availability and barriers to service access and engagement, confirm the importance of pursuing ongoing service improvements and evaluating the preferences of service users. Development of standardised tools to measure and compare parent perceptions across intervention types and service delivery approaches would be beneficial.
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Affiliation(s)
- Robyn Garnett
- Robyn Garnett, Department of Audiology and
Speech Pathology, University of Melbourne, 550 Swanston Street Carlton, VIC
3053, Australia.
| | - Bronwyn Davidson
- Department of Audiology and Speech Pathology,
University of Melbourne, 550 Swanston Street Carlton, VIC 3053,
Australia
| | - Patricia Eadie
- Melbourne Graduate School of Education,
University of Melbourne, 234 Queensberry Street, Parkville VIC 3053,
Australia
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Caregiver Participation Engagement in Child Mental Health Prevention Programs: a Systematic Review. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 23:321-339. [PMID: 34936045 DOI: 10.1007/s11121-021-01303-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2021] [Indexed: 10/19/2022]
Abstract
Prevention programs are a key method to reduce the prevalence and impact of mental health disorders in childhood and adolescence. Caregiver participation engagement (CPE), which includes caregiver participation in sessions as well as follow-through with homework plans, is theorized to be an important component in the effectiveness of these programs. This systematic review aims to (1) describe the terms used to operationalize CPE and the measurement of CPE in prevention programs, (2) identify factors associated with CPE, (3) examine associations between CPE and outcomes, and (4) explore the effects of strategies used to enhance CPE. Thirty-nine articles representing 27 unique projects were reviewed. Articles were included if they examined CPE in a program that focused to some extent on preventing child mental health disorders. There was heterogeneity in both the terms used to describe CPE and the measurement of CPE. The majority of projects focused on assessment of caregiver home practice. There were no clear findings regarding determinants of CPE. With regard to the impact of CPE on program outcomes, higher levels of CPE predicted greater improvements in child and caregiver outcomes, as well as caregiver-child relationship quality. Finally, a small number of studies found that motivational and behavioral strategies (e.g., reinforcement, appointment reminders) were successful in promoting CPE. This review highlights the importance of considering CPE when developing, testing, and implementing prevention programs for child mental health disorders. Increased uniformity is needed in the measurement of CPE to facilitate a better understanding of determinants of CPE. In addition, the field would benefit from further evaluating strategies to increase CPE as a method of increasing the potency of prevention programs.
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Hansen A, Brown SD, Yap MBH. Enhancing Engagement of Fathers in Web-Based Preventive Parenting Programs for Adolescent Mental Health: A Discrete Choice Experiment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12340. [PMID: 34886063 PMCID: PMC8656658 DOI: 10.3390/ijerph182312340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/11/2021] [Accepted: 11/20/2021] [Indexed: 11/22/2022]
Abstract
Few fathers enrol in web-based preventive parenting programs for adolescent mental health, despite the evidence of the benefits associated with their participation. To inform the development of father-inclusive programs, this study used a discrete choice experiment (DCE) design to determine (a) the relative influence of number of sessions, program benefits, program participants, and user control over program content on fathers' preferences for web-based preventive parenting programs; and (b) whether selected father characteristics were associated with their preferences. One hundred and seventy-one fathers completed the DCE survey, which comprised 25 choices between hypothetical programs. Programs that included the participant's adolescent child (z = 10.06, p < 0.0001), or parenting partner (z = 7.30, p < 0.001) were preferred over those designed for fathers only. Participants also preferred program content that was recommended for them by experts (z = -4.31, p < 0.0001) and programs with fewer sessions (z = -2.94, p < 0.01). Program benefits did not predict fathers' choice of program. Prior use of a parenting program, level of education, perceived role of parenting for adolescent mental health, and being part of a dual-working family were associated with preferences. Application of these findings may improve paternal enrolment in web-based preventive parenting programs.
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Affiliation(s)
- Ashlyn Hansen
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC 3800, Australia;
| | - Scott D. Brown
- School of Psychology, University of Newcastle, Callaghan, NSW 2308, Australia;
| | - Marie B. H. Yap
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC 3800, Australia;
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3000, Australia
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Lohse B, Cunningham-Sabo L. Quantifying parent engagement in the randomized Fuel for Fun impact study identified design considerations and BMI relationships. BMC Med Res Methodol 2021; 21:205. [PMID: 34627162 PMCID: PMC8502317 DOI: 10.1186/s12874-021-01398-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Parent participation in children's health interventions is insufficiently defined and measured. This project quantified parent participation to enable future examination with outcomes in an intervention focused on 4th graders, aged 9-11 years, and their families living in northern Colorado. METHODS Indices were developed to measure type (Parent Participation Profile; PPP) and intensity (Parent Engagement Intensity; PEI) of engagement in Fuel for Fun (FFF), an asymmetric school-and family-based intervention for 4th graders. Study arm-specific participation opportunities were catalogued and summed to calculate the PPP. An algorithm considered frequency, effort, convenience, and invasiveness of each activity to calculate PEI. Indices were standardized (0-100%) using study arm-specific divisors to address asymmetric engagement opportunities. Parents who completed ≥75% of the PPP were defined as Positive Deviants. Youth height and weight were measured. Youth BMI percentile change was compared with parent Positive Deviant status using general linear modeling with repeated measures that included the participation indices. RESULTS Of 1435 youth, 777 (54%) had parent participation in at least one activity. Standardized means were 41.5 ± 25.4% for PPP and 27.6 ± 20.9% for PEI. Demographics, behaviors or baseline FFF outcomes did not differ between the Positive Deviant parent (n = 105) and non-Positive Deviant parents (n = 672); but more Positive Deviant parents followed an indulgent feeding style (p = 0.015). Standardized intensity was greater for Positive Deviant parents; 66.9 ± 20.6% vs 21.5 ± 12.7% (p < 0.001) and differences with non-Positive Deviant parents were related to activity type (p ≤0.01 for six of eight activities). Standardized participation intensity was associated with engagement in a greater number of standardized activity types. Among participating parents, standardized intensity and breadth of activity were inversely related to the youth BMI percentile (n = 739; PEI r = -0.39, p < 0.001; PPP r = -0.34, p < 0.001). Parent engagement was not associated with parent BMI change. CONCLUSIONS An activity-specific intensity schema operationalized measurement of parent engagement in a complex, unbalanced research design and can serve as a template for more sensitive assessment of parent engagement. Positive deviance in parent engagement was not a function of personal, but rather activity characteristics. PPP and PEI increased with fewer requirements and convenient, novel, and personalized activities. Parent engagement indices affirmed lower engagement by parents of overweight/obese youth and concerns about target reach.
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Affiliation(s)
- Barbara Lohse
- Rochester Institute of Technology, Wegmans School of Health and Nutrition, 180 Lomb Memorial Drive 78-A622, Rochester, NY 14623 USA
| | - Leslie Cunningham-Sabo
- Department of Food Science and Human Nutrition, Colorado State University, 106 Gifford Building, Fort Collins, CO 80523-1571 USA
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Koldoff EA, Holtzclaw BJ, Kolobe THA. Parents of Preterm and Very Low Birthweight Infants and Their Childrearing Practices. West J Nurs Res 2021; 44:692-700. [PMID: 34010069 DOI: 10.1177/01939459211015670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Emerging research supports that early intervention leads to better health and higher functional status for infants with very low birthweight and/or low gestational age. Optimizing the transition from neonatal intensive care to early intervention programs relies heavily on parent engagement. The purpose of this descriptive correlational study was to investigate the relationship between parental characteristics, childrearing behaviors, and participation in early intervention. We used convenience sampling of 49 parents who participated in early intervention and the Parent Behavior Checklist to assess parent characteristics. Correlation coefficients between parenting behaviors, birthweight, and participation in early intervention were low. An important finding was that most parents in this study were within the "average" range for childrearing practices, despite the documented challenges associated with very low birthweight or gestational age. Despite documented challenges, parents of preterm infants with very low birthweight and parents of typical birthweight infants have similar parenting beliefs and behavior.
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Affiliation(s)
- Elizabeth A Koldoff
- Fran and Earl Ziegler College of Nursing, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Barbara J Holtzclaw
- Fran and Earl Ziegler College of Nursing, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Thubi H A Kolobe
- Department of Rehabilitation Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Melvin K, Meyer C, Scarinci N. Exploring the complexity of how families are engaged in early speech-language pathology intervention using video-reflexive ethnography. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2021; 56:360-373. [PMID: 33577716 DOI: 10.1111/1460-6984.12609] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 12/14/2020] [Accepted: 12/18/2020] [Indexed: 05/23/2023]
Abstract
BACKGROUND Despite being an important aspect of effective early intervention service delivery, 'engagement' has been inconsistently defined in paediatric healthcare. Previous research has identified that engagement in early speech-language pathology intervention is complex and multifaceted. However, more research is needed to understand the ways that different families may engage with intervention in different settings. AIMS To explore the complexity of engagement in early speech-language pathology intervention from the perspectives of both families and their speech-language pathologists (SLPs). METHOD & PROCEDURES Video-reflexive ethnography was used to explore engagement with 21 matched SLP-family dyads in early intervention services. Up to three intervention appointments for each participating family were video recorded. Short video segments were selected and played to participants during individual semi-structured interviews where participants were invited to reflect on the interactions captured (i.e., 'video-reflexive sessions'). Interview data were analysed using thematic analysis. OUTCOMES & RESULTS Results from the interview data were organized into one overarching theme 'Families may have "different levels of engagement"', and four individual themes that reflected how families engage differently in various aspects of intervention, including (1) attending sessions and coming into the room; (2) actively participating in sessions; (3) continuing to actively participate outside sessions; and (4) having open and honest communication with their SLPs. CONCLUSIONS & IMPLICATIONS Families may have different levels of engagement in various aspects of intervention, which contribute to their unique profile of engagement. Findings of this study prompt SLPs to move beyond using blanket statements about whether or not families are engaged, to instead describing in detail how families are uniquely engaged. What this paper adds What is already known on the subject In early speech-language pathology intervention, the term 'engagement' refers to (1) a complex, multifaceted state of families 'being engaged' in intervention both inside and outside sessions; and (2) a relational, co-constructed process where many families 'become engaged' in intervention as they work together with SLPs. Although research has acknowledged engagement may look different for each parent and family, little is known about how families are uniquely engaged in early speech pathology intervention in different settings. What this paper adds to existing knowledge This study is the first to explore engagement from the perspectives of both families and SLPs working together in intervention. Both groups of participants described the complexity of engagement in this setting and acknowledged that families engage differently in different aspects of intervention, which contribute to their unique profile of engagement. What are the potential or actual clinical implications of this work? Being able to identify potential indicators of engagement, such as the ones described in this study, provide opportunities for SLPs to take a reflexive approach to engaging with individual families, in line with principles of family-centred care. Findings of this study therefore prompt SLPs to reflect on how the families they work with are engaged in intervention, and to consider their own role in facilitating engagement. In addition, results highlight the importance of SLPs initiating open conversations with families themselves about how they would like to be engaged in intervention, and what support would be most beneficial to them.
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Affiliation(s)
- Katelyn Melvin
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Carly Meyer
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Nerina Scarinci
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
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Masiran R, Ibrahim N, Awang H, Lim PY. Improving multicultural parenting program for children with emotional and behavioral problems: An integrated review. Asian J Psychiatr 2020; 51:101851. [PMID: 31711780 DOI: 10.1016/j.ajp.2019.101851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/16/2019] [Accepted: 10/16/2019] [Indexed: 01/13/2023]
Abstract
Children with emotional and behavioral problems are often managed using medications or behavioral therapy, but in some countries, there is no structured parenting intervention to equip parents from different cultural backgrounds with adequate parenting skills to help these children. This paper aims to synthesize key findings from previous research on multicultural parenting programs and produce a comprehensive integrated view by looking into three separate themes: effective multicultural parenting programs, ethnocultural groups and cultural adaptation process. Literature search through Scopus and Google Scholar from 1999 to 2019 was conducted using the terms "effective parenting program", "effective parenting intervention", "effective multicultural parenting program", "effective multicultural parenting intervention", "multicultural parenting program", "multicultural parenting intervention", "parenting program and ethnic groups", "parenting intervention and ethnic groups", "adapted parenting program", "adapted parenting intervention", "cultural adaptation of parenting program'' and "cultural adaptation of parenting intervention". By applying the "Literature Review Synthesis Process", authors conducted cross-analysis, integrated possibilities, and prioritized the synthesized information gearing towards highly probable solutions for improving multicultural parenting programs to manage emotional and behavioral problems in children better. Development of a culturally fit parenting intervention and its implications on existing parenting programs are also discussed. The findings highlight the need 1) to engage with ethnocultural groups of parents during development of a new multicultural parenting program, and 2) to incorporate specific measures for engaging with parents during multicultural parenting program implementation. This paper contributes in acknowledging cultural components in future parenting intervention programs. Finally, recommendations are made for future directions of research.
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Affiliation(s)
- Ruziana Masiran
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia.
| | - Normala Ibrahim
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia.
| | - Hamidin Awang
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia.
| | - Poh Ying Lim
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia.
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Peacock-Chambers E, Feinberg E, Senn-McNally M, Clark MC, Jurkowski B, Suchman NE, Byatt N, Friedmann PD. Engagement in Early Intervention Services Among Mothers in Recovery From Opioid Use Disorders. Pediatrics 2020; 145:peds.2019-1957. [PMID: 31992649 PMCID: PMC6993421 DOI: 10.1542/peds.2019-1957] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Opioid-exposed infants frequently qualify for early intervention (EI). However, many eligible families choose not to enroll in this voluntary service. This study aims to understand the perceptions and experiences that may impact engagement with, and the potential benefits of, EI services among mothers in recovery from opioid use disorders (OUDs). METHODS We conducted semistructured qualitative interviews (n = 22) and 1 focus group (n = 6) with mothers in recovery from OUDs in western Massachusetts. Transcripts were coded and analyzed by using a descriptive approach. RESULTS The mean participant age was 32 years, and 13 had a high school degree or less. Five major themes emerged revealing mothers' development through stages of engagement in EI services: (1) fear, guilt, and shame related to drug use (emotions acting as barriers to enrollment); (2) the question of whether it is "needed" (deciding whether there is value in EI for opioid-exposed infants); (3) starting with "judgment" (baseline level of perceived stigma that parents in recovery associate with EI); (4) breaking down the "wall" (how parents overcome the fear and perceived judgment to build partnerships with providers); and (5) "above and beyond" (need for a personal connection with mothers and concrete supports through EI in addition to the child-focused services provided). CONCLUSIONS Barriers to engagement in EI among mothers in recovery from OUDs include a range of emotions, perceived stigma, and ambivalence. An effort to purposefully listen to and care for mothers through a strengths-based, bigenerational approach may help establish greater connections and foster stronger EI engagement among families affected by OUDs.
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Affiliation(s)
- Elizabeth Peacock-Chambers
- Institute for Healthcare Delivery and Population Science, .,University of Massachusetts Medical School-Baystate, Springfield, Massachusetts
| | - Emily Feinberg
- Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
| | - Molly Senn-McNally
- University of Massachusetts Medical School-Baystate, Springfield, Massachusetts
| | | | - Briana Jurkowski
- Institute for Healthcare Delivery and Population Science,,University of Massachusetts Amherst, Amherst, Massachusetts
| | - Nancy E. Suchman
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, Connecticut; and
| | - Nancy Byatt
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Peter D. Friedmann
- University of Massachusetts Medical School-Baystate, Springfield, Massachusetts
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Camden C, Dostie R, Heguy L, Gauvin C, Hudon C, Rivard L, Gaboury I. Understanding parental concerns related to their child's development and factors influencing their decisions to seek help from health care professionals: Results of a qualitative study. Child Care Health Dev 2020; 46:9-18. [PMID: 31797396 DOI: 10.1111/cch.12731] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 11/27/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Early identification of children at risk of developmental delay is crucial to promote healthy development. Assessing parental concerns about development is often part of identification processes. However, we currently do not understand well how and why parents become concerned and how and why they access early identification and intervention services. The purpose of this study was to explore parental perceptions about their child's development and the factors influencing their reported professional help-seeking behaviours. METHODS This exploratory study was part of a larger study describing child development in children aged 2-5 in a small Canadian city. We conducted semistructured interviews with 16 parents whose children were at risk of developmental delay to examine their perceptions of their child's development, their use of community services promoting development, and their recommendations to optimize those services. RESULTS Four themes were identified: (a) Vision of child development influencing help-seeking behaviours: Natural or Supported?, (b) Internal and external sources contributing to parents' level of developmental concern, (c) Using internal resources and struggling to access external resources, and (d) Satisfaction with services accessed and recommendations to access more support. Parents' vision of child development along with sources of parental concern appeared to influence the level of concern, enhancing our understanding of how parents become concerned. The level of concern and parents' knowledge and perceived access to resources seemed to influence their decision whether or not to consult health care professionals. Parents provided many suggestions to improve services to promote child development and support families. DISCUSSION Results highlight the importance of supporting parents in recognizing if their child is at risk of delay and increasing awareness of available resources. It appears particularly important to ensure that health care professionals and community-based support services are accessible to provide parents with the support they need, especially when they have concerns.
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Affiliation(s)
- Chantal Camden
- École de réadaptation, University of Sherbrooke, Sherbrooke, Canada
| | - Rosalie Dostie
- École de réadaptation, University of Sherbrooke, Sherbrooke, Canada
| | - Lea Heguy
- École de réadaptation, University of Sherbrooke, Sherbrooke, Canada
| | - Cheyenne Gauvin
- École de réadaptation, University of Sherbrooke, Sherbrooke, Canada
| | - Catherine Hudon
- École de réadaptation, University of Sherbrooke, Sherbrooke, Canada
| | - Lisa Rivard
- School of Rehabilitation Science, University of McMaster, Hamilton, Canada
| | - Isabelle Gaboury
- École de réadaptation, University of Sherbrooke, Sherbrooke, Canada
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Guastaferro K, Self-Brown S, Shanley JR, Whitaker DJ, Lutzker JR. Engagement in home visiting: An overview of the problem and how a coalition of researchers worked to address this cross-model concern. JOURNAL OF CHILD AND FAMILY STUDIES 2020; 29:4-10. [PMID: 32292264 PMCID: PMC7156135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Home visiting is a widely supported intervention strategy for parents of young children who are in need of parenting skill improvement. However, parental engagement limits the potential public health impact of home visiting, as these programs often have low enrollment rates, as well as high attrition and low completion rates for those who enroll in these programs. The Coalition for Research on Engagement and Well-being (CREW) provided support for three pilot projects representing different home visiting models and aspects of engagement. The results of these pilot projects are presented in this special section. The purpose of this commentary is to introduce CREW and highlight the importance of a cross-model project to improve engagement among home visiting programs.
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Fulgoni CM, Melvin GA, Jorm AF, Lawrence KA, Yap MB. The Therapist-assisted Online Parenting Strategies (TOPS) program for parents of adolescents with clinical anxiety or depression: Development and feasibility pilot. Internet Interv 2019; 18:100285. [PMID: 31890632 PMCID: PMC6926173 DOI: 10.1016/j.invent.2019.100285] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 09/30/2019] [Accepted: 10/05/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To develop a Therapist-assisted Online Parenting Strategies (TOPS) program that is acceptable to parents whose adolescents have anxiety and/or depressive disorders, using a consumer consultation approach. METHODS The TOPS intervention was developed via three linked studies. Study 1 involved content analysis of feedback from participants (N = 56) who received a web-based preventive parenting intervention called Partners in Parenting (PiP), as part of a randomised controlled trial. Study 2 involved stakeholder consultations with: (i) parents of adolescents aged 12-17 years (N = 6), and (ii) mental health professionals (N = 28), to identify adaptations to PiP that are required to make it appropriate for parents of adolescents with anxiety and depressive disorders. Study 3 was a pilot of the resulting TOPS program with professionals (N = 10) and a small sample of parents (N = 3) to assess the acceptability of the program content and format that involved online modules and videoconferencing coaching. RESULTS Study 1 indicated a need for an enhanced program for parents whose adolescents are experiencing anxiety and depressive disorders, while findings from Study 2 informed the content of the new TOPS program. In Study 3, mental health professionals endorsed the structure and content, while parents affirmed the acceptability of the TOPS program. Feedback from Studies 2 and 3 indicated that the therapist-coach was a valuable resource to (i) provide parents with strategies that are associated with the alleviation of adolescent anxiety and depression, (ii) discuss difficulties in implementing these strategies, (iii) assist parents with overcoming these difficulties; and (iv) support the development of a relapse prevention plan. Professionals felt that the TOPS program would broaden parental knowledge about how to recognise and respond to symptoms of clinical anxiety and depression in their adolescent. CONCLUSIONS This study provided preliminary support for the feasibility, acceptability and perceived usefulness of the TOPS program.
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Affiliation(s)
- Catherine M.F. Fulgoni
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Glenn A. Melvin
- School of Psychology, Deakin University, Burwood, VIC 3125, Australia,Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, UK
| | - Anthony F. Jorm
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Katherine A. Lawrence
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Marie B.H. Yap
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia,Corresponding author at: Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia.
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Yap MBH. Empowering Multiply Disadvantaged Parents: A Step Toward Breaking the Intergenerational Perpetuation of Health Inequalities. JAMA Psychiatry 2019; 76:233-234. [PMID: 30673065 DOI: 10.1001/jamapsychiatry.2018.3972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Marie B H Yap
- School of Psychological Sciences, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Parkville Victoria, Australia
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