A systematic review of community-based parenting interventions for adolescents with challenging behaviours

Parenting in African American families: Profiles of general and culturally specific dimensions of parent-adolescent relationships during late adolescence

Developmental and parenting frameworks suggest that factors at the individual-level and multiple levels of adolescents' contexts are important determinants of how African American parents prepare their children to live in a racially stratified society. Using a person-centered approach, this study explored heterogeneity in profiles of African American parent-adolescent relationships (PARs) using indicators of parent-reported ethnic-racial socialization (cultural socialization, preparation for bias), general parenting practices (autonomy support, monitoring, behavioral control), and relationship quality (warmth, communication, conflict). We also examined how adolescents' characteristics, parents' personal and psychological resources, and contextual sources of stress and support contributed to profile membership. Data were from the Maryland Adolescent Development in Context Study (1991-2000) and consisted of 589 African American caregiver-adolescent dyads (caregivers: 89% female; 57.2% married; adolescents: 50.7% female; Mage = 17, SD = 0.64, range = 15-19 years old). Latent profile analysis revealed four profiles: (a) No-Nonsense High Socializers, (b) Indulgent Average Socializers, (c) Unengaged Silent Socializers, and (d) Authoritative Cultural Socializers. Adolescent characteristics (gender, depression, and problem behavior), parents' personal and psychological resources (parenting self-efficacy, centrality, private regard, and depression), and contextual sources of stress and support (stress: economic hardship, family stress, neighborhood disadvantage and support: marital status, family cohesion, family organization) were correlated with profile membership. Findings suggest that variability in African American PARs is shaped by an extensive set of individual and contextual factors related to adolescents and the family and neighborhood context. These findings have important implications for future research and how to target multiple potential levers for change in African American parenting practice.

A Meta-Analysis of Parenting Interventions for Immigrants

In light of increasing migration rates and the unique experiences of immigrants, this meta-analysis examined the effects of parenting interventions for immigrants. Specifically, we described the characteristics of parenting interventions for immigrants, examined cultural and/or linguistic adaptations made to the interventions, analyzed intervention effects, and examined potential moderating variables. Four electronic databases were searched in February 2021 for peer-reviewed articles published in English. Studies that involved immigrant parents, used an experimental design, and investigated an intervention targeting skills that parents could use directly with their children were included. Sixteen group design and two single-case design studies met inclusion criteria. The risk of publication bias was examined using funnel plots and found to be low. Overall, most parenting interventions for immigrants focused on young children and were delivered in groups. Interventions produced small to moderate effects on parent and child outcomes, which is comparable to those for the general population. All studies made cultural adaptations, with the most common being language. Moderator analyses indicate that the effects of interventions with surface structure adaptations were similar to those with deep structure adaptations. Limitations included the low methodological rigor of included studies and the exclusion of grey literature. More works of research on the relative effects of specific adaptations, such as ethnicity matching, are needed to better serve this population.

Policies are Needed to Increase the Reach and Impact of Evidence-Based Parenting Supports: A Call for a Population-Based Approach to Supporting Parents, Children, and Families

Parents can be essential change-agents in their children's lives. To support parents in their parenting role, a range of programs have been developed and evaluated. In this paper, we provide an overview of the evidence for the effectiveness of parenting interventions for parents and children across a range of outcomes, including child and adolescent mental and physical health, child and adolescent competencies and academic outcomes, parental skills and competencies, parental wellbeing and mental health, and prevention of child maltreatment and family violence. Although there is extensive research showing the effectiveness of evidence-based parenting programs, these are not yet widely available at a population level and many parents are unable to access support. We outline how to achieve increased reach of evidence-based parenting supports, highlighting the policy imperative to adequately support the use of these supports as a way to address high priority mental health, physical health, and social problems.

Lest We Forget the Parent in the Parent-Adolescent Dance!

Adolescence is a developmental stage with rapid, and dynamic, biological and social changes in an individual. These changes add to the vulnerabilities for mental health morbidity. Adolescents today live and grow at the center of a layered, globalized, hyper-connected world where proximate and distal environments constantly influence each other. Parenting is part of the most proximate of the environmental layers, and is purported to have a protective and supportive role for adolescents. This editorial reflects upon challenges in parenting adolescents, and the need for nuanced re-examinations of the role of parenting in today’s globalized, hyper-connected, yet isolating, constantly changing environments.

Translation and validation of the evidence-based practice attitude scale (EBPAS-15) to Brazilian Portuguese: Examining providers' perspective about evidence-based parent intervention

BACKGROUND

Few existing evidence-based parent interventions (EBPIs) for prevention and treatment of child and youth mental health disorders are implemented in low-middle-income countries. This study aimed to translate and confirm the factor structure of the Evidence-Based Practice Attitude Scale (EBPAS-15) survey in Brazilian Portuguese with the goal of examining providers' perspective about EBPIs.

METHODS

We translated and back translated the EBPAS-15 from English to Brazilian Portuguese. Participants were recruited via snowball sampling and data were collected using an online survey from July of 2018 through January of 2020. A confirmatory factor analysis was conducted to determine if the scale retained its original structure. Open-ended questions about providers' perspectives of their own clinical practice were coded using the Theoretical Domains Framework (TDF). Analyses included data from 362 clinicians (318 women, 41 men) from 20 of the 27 states of Brazil. Participants on average were 26.7 years old, held specialist degrees in the field of psychology, actively worked as therapists, and practiced in private clinics.

RESULTS

The translation of the EBPAS to Brazilian Portuguese retained the same four-factor structure as the English version except for dropping one item from the Divergence domain. When asked about the challenges in their practices, providers generally referred to parents as clients with little skills to discipline their children and lacking knowledge about child development.

DISCUSSION

The Brazilian version of the EBPAS-15 is promising, but future research should consider using quantitative data alongside qualitative information to better understand providers' attitudes about evidence-based interventions to inform implementation efforts.

TRIAL REGISTRATION

N/A.

Mental Health and Positive Development Prevention Interventions: Overview of Systematic Reviews

CONTEXT

Previous reviews of mental health interventions have focused on adolescents (10-19 years), with a paucity of comprehensive evidence syntheses on preventive interventions for school-aged children (5-10 years).

OBJECTIVE

To summarize and synthesize the available evidence from systematic reviews of mental health and positive development interventions for children aged 5-14.9 years in both high-income (HIC) and low- and middle-income countries (LMIC), with a focus on preventive and promotive strategies.

DATA SOURCES

This overview includes all relevant reviews from OVID Medline, The Cochrane Library, and Campbell Systematic Reviews through December 2020.

STUDY SELECTION

We included systematic reviews that synthesized empirical studies using experimental or quasi-experimental designs to evaluate the effectiveness of interventions in children aged 5-14.9 years.

DATA EXTRACTION

Data extraction and quality assessment were completed independently and in duplicate by two review authors. The AMSTAR2 tool was used to assess methodological quality.

RESULTS

We included 162 reviews. The greatest evidence was found in support of school-based universal and anti-bullying interventions in predominantly HIC. Moderate evidence was found for the use of substance abuse prevention, and early learning and positive development interventions in mixed settings. In LMIC-only contexts, the most promising evidence was found for positive youth development programs.

LIMITATIONS

The review was primarily limited by paucity of high-quality research due to methodological issues and high heterogeneity.

CONCLUSIONS

This overview of reviews highlights the need for further research to consolidate findings and understand the specific criteria involved in creating positive mental health and development outcomes from the various interventions considered.

Outpatient- or community-based interventions to prevent SIDS and sleep-related deaths

PURPOSE

To determine the state of science of outpatient- or community-based interventions for sudden infant death syndrome prevention in the United States, an integrative review was completed and studies identified through the application of inclusion and exclusion criteria.

CONCLUSIONS

Of the nine studies identified, three were randomized controlled trials. There was a wide range of measurement tools and variables measured. The timing of interventions also varied. There was a focus on mothers and African Americans. Lastly, study design and approach have not changed significantly over time.

PRACTICE IMPLICATIONS

Findings highlight recommendations for future research: expanding the target population, addressing culture in the development of the intervention or program, including additional providers, such as nurses, in the intervention or program, advancing innovation, and increasing rigor of study design.

An intervention for parents with severe personality difficulties whose children have mental health problems: a feasibility RCT

BACKGROUND

The children of parents with severe personality difficulties have greater risk of significant mental health problems. Existing care is poorly co-ordinated, with limited effectiveness. A specialised parenting intervention may improve child and parenting outcomes, reduce family morbidity and lower the service costs.

OBJECTIVES

To develop a specialised parenting intervention for parents affected by severe personality difficulties who have children with mental health problems and to conduct a feasibility trial.

DESIGN

A pragmatic, mixed-methods design to develop and pilot a specialised parenting intervention, Helping Families Programme-Modified, and to conduct a randomised feasibility trial with process evaluation. Initial cost-effectiveness was assessed using UK NHS/Personal Social Services and societal perspectives, generating quality-adjusted life-years. Researchers collecting quantitative data were masked to participant allocation.

SETTING

Two NHS mental health trusts and concomitant children's social care services.

PARTICIPANTS

Parents who met the following criteria: (1) the primary caregiver of the index child, (2) aged 18-65 years, (3) have severe personality difficulties, (4) proficient in English and (5) capable of providing informed consent. Index children who met the following criteria: (1) aged 3-11 years, (2) living with index parent and (3) have significant emotional/behavioural difficulties. Exclusion criteria were (1) having coexisting psychosis, (2) participating in another parenting intervention, (3) receiving inpatient care, (4) having insufficient language/cognitive abilities, (5) having child developmental disorder, (6) care proceedings and (7) index child not residing with index parent.

INTERVENTION

The Helping Families Programme-Modified - a 16-session intervention using structured, goal-orientated strategies and collaborative therapeutic methods to improve parenting, and child and parent functioning. Usual care - standard care augmented by a single psychoeducational session.

MAIN OUTCOME MEASURES

Trial feasibility - rates of recruitment, eligibility, allocation, retention, data completion and experience. Intervention acceptability - rates of acceptance, completion, alliance (Working Alliance Inventory-Short Revised) and experience. Outcomes - child (assessed via Concerns About My Child, Eyberg Child Behaviour Inventory, Child Behaviour Checklist-Internalising Scale), parenting (assessed via the Arnold-O'Leary Parenting Scale, Kansas Parental Satisfaction Scale), parent (assessed via the Symptom Checklist-27), and health economics (assessed via the Client Service Receipt Inventory, EuroQol-5 Dimensions).

RESULTS

The findings broadly supported trial feasibility using non-diagnostic screening criteria. Parents were mainly referred from one site (75.0%). Site and participant factors delayed recruitment. An estimate of eligible parents was not obtained. Of the 86 parents referred, 60 (69.7%) completed screening and 48 of these (80.0%) were recruited. Participants experienced significant disadvantage and multiple morbidity. The Helping Families Programme-Modified uptake (87.5%) was higher than usual-care uptake (62.5%). Trial retention (66.7%, 95% confidence interval 51.6% to 79.6%) exceeded the a priori rate. Process findings highlighted the impact of random allocation and the negative effects on retention. The Helping Families Programme-Modified was acceptable, with duration of delivery longer than planned, whereas the usual-care condition was less acceptable. At initial follow-up, effects on child and parenting outcomes were detected across both arms, with a potential outcome advantage for the Helping Families Programme-Modified (effect size range 0.0-1.3). For parental quality-adjusted life-years, the Helping Families Programme-Modified dominated usual care, and child quality-adjusted life-years resulted in higher costs and more quality-adjusted life-years. At second follow-up, the Helping Families Programme-Modified was associated with higher costs and more quality-adjusted life-years than usual care. For child quality-adjusted life-years, when controlled for baseline EuroQol-5 Dimensions, three-level version, usual care dominated the Helping Families Programme-Modified. No serious adverse events were reported.

CONCLUSION

The Helping Families Programme-Modified is an acceptable specialised parenting intervention. Trial methods using non-diagnostic criteria were largely supported. For future work, a definitive efficacy trial should consider site selection, recruitment methods, intervention efficiency and revised comparator condition.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN14573230.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 14. See the NIHR Journals Library website for further project information.

Concerns of Parents with or Raising Adolescent Children: a Qualitative Study of Iranian Families

Introduction: Adolescence is a challenging period and cultural background plays an important role in families with adolescent. So exploring parents’ concerns in the specific context of Iran may improves nurses' family-based services and helps to reduce conflicts Iranian families with respect to adolescents. In this paper we explore perceptions of Iranian parents’ concerns in the family with raising adolescent children.

Methods: Participants of this qualitative content analysis study were 23 parents with adolescents, who were recruited through purposive sampling. Data collection was done through semi structured in-depth interviews and analyzed based on Graneheim and Landman’s approach. Lincoln and Guba’s criteria were used to ensure the accuracy and strength of the study.

Results: The theme "rebellion against parents’ authority" was supported by two categories: (1) parent-teenage conflict, and (2) difficulty in controlling. As the offspring enter adolescence, parents feel that their child is going to leave their domain.

Conclusion: Findings from this study showed that the incongruity arises when traditional family norms fail to adapt to new patterns. Change of social and cultural norms in developing societies, has led to generational differences in families. This issue accompanied with adolescence, increases parents’ concern. So we recommend parental educational programs for learning effectively patterns for resisting internal challenges and communicate with adolescents.