Rethinking evidence-based practice and two-generation programs to create the future of early childhood policy

Applying the Family Stress Model to responsive feeding and early obesity prevention

Rapid weight gain during infancy and obesity during early childhood may lead to adverse health outcomes during later childhood and into adulthood, especially in families experiencing economic hardship. Families experiencing economic hardship may also experience food insecurity, which can impact child development and responsive feeding, an important target for obesity prevention in early life. The Family Stress Model suggests that stress, particularly economic hardship, can negatively impact parents' mental health, parenting, and quality of family relationships. This review proposes a conceptual model that expands upon the original Family Stress Model by including parent-child dyadic interactions during feeding (i.e., responsive feeding) as well as the coparenting relationship around feeding. Our conceptual model integrates responsive feeding into the Family Stress Model and includes the impact of food insecurity on feeding and child health outcomes. Such models that consider multiple influences on child development have implications for the design of effective interventions to promote healthy growth for entire families. Future directions in this research will empirically test the model and explore early intervention strategies that aim to promote responsive feeding, nutrition security, and health within families. Continuing interdisciplinary research between the fields of nutrition and family development will be key to addressing the complex interplay of family stressors, parent responsiveness, and childhood obesity.

Parent-child relationship, parenting behaviors, and adolescents' depressive symptoms after an earthquake: unraveling within-adolescent associations from between-adolescent differences

This study assessed temporal associations between parent-child relationship, parenting behaviors (i.e., warmth, rejection, and overprotection), and adolescents' depressive symptoms after trauma, using random-intercept cross-lagged panel models to distinguish between- and within-adolescent differences. We surveyed Chinese adolescents 12 (Aug 2018; T1), 21 (May 2019; T2), 27 (Nov 2019; T3) months after the Jiuzhaigou earthquake that occurred in August 2017. Of the 585 adolescents who participated in at least two waves of the study, mean age at T1 was 15.50 years old (SD = 1.58 years) and 57.8% were girls. Controlling adolescents' gender, age, ethnicity, trauma exposure at T1, and parents' marital status, between-adolescent results showed that parent-child relationship and parenting behaviors, parent-child relationship and depressive symptoms were correlated across models of parental warmth, rejection, and overprotection, whereas depressive symptoms were only correlated with parental rejection and overprotection. Within-adolescent results indicated that parent-child relationship and adolescents' depressive symptoms had bidirectional associations via the mediation of parental warmth from T1 to T3. Over the longer term following the earthquake, we found that parental rejection was bidirectionally associated with adolescents' depressive symptoms, whereas parental overprotection was unidirectionally influenced by adolescents' depressive symptoms from T2 to T3. In addition, more depressive symptoms in adolescents were associated with worsening parent-child relationship from T2 to T3. In conclusion, shortly after trauma, interventions should focus on improving parent-child relationship and relieving adolescents' depressive symptoms. Over the longer term after trauma, relieving adolescents' depressive symptoms should be prioritized to avoid its eroding effects on parent-child relationship and parenting behaviors, and to break the "vicious cycle".

Maternal Emotional and Behavioral Regulation/Dysregulation and Parenting Practices: A Systematic Review

Emotional and behavioral regulations are crucial for the development of perceptive, responsive, and flexible parenting. Moreover, maternal emotional dysregulation constitutes a risk for maltreatment behaviors. The present study aimed to conduct a systematic review of empirical studies on the associations between mothers' emotional and behavioral regulations and parenting practices with their children or adolescents. A systematic review was conducted, including papers that addressed these variables, analyzing the direct effects, and moderation or mediation effects of maternal emotional and behavioral regulation on parenting practices, targeting child and adolescent samples. We identified 35 studies for analysis. Most of the studies (86%) showed significant associations between maternal emotional and behavioral regulation and parenting practices. Mothers' emotional dysregulation was related to a high risk of maltreatment and negative parenting, such as unsupportive reactions and harsh discipline. High maternal emotional dysregulation and negative parenting, in turn, were associated with children's aggressive behaviors. Conversely, when mothers exhibited high emotional regulation, they engaged in more positive and supportive parenting. Additionally, maternal behavioral regulation with inhibitory control and effortful control led to supportive and warm parenting. Individual and contextual factors, such as maternal victimization history and symptoms of inattention and hyperactivity, had effects on maternal emotional dysregulation, which, in turn, impacted their parenting practices. Consequently, emotional and behavioral regulation played a crucial role in mothers' parenting practices with their children and adolescents. The findings of the current review could contribute to planning parenting interventions, including maternal emotional and behavioral regulation skills, aimed at preventing maltreatment of their children.

Home-visiting Parenting Programs to Improve Mother-Infant Interactions at Early Ages: A Systematic Review

Objective: To systematically review studies examining the effects of home-visiting preventive parenting programs (HV-PPs) on improving the quality of mother-child interactions in early childhood. Method: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol, we identified 3,586 studies published between 2018 and 2022 by searching the following databases: PubMed, Web of Science, BVS/LILACS, SciELO, and PsycNET/PsycINFO. After applying the eligibility criteria, 17 articles were selected for review. Results: Most studies were conducted in high-income countries (53%) and the remainder were conducted in upper-middle-income countries, predominantly using a randomized controlled trial design and with strong methodological quality. The 17 studies applied 13 different HV-PPs, predominantly using video feedback, based on various dosages and schedules. Most studies (77%) showed significant positive effects on mother-child interactions by improving mainly positive maternal behaviors (e.g., sensitivity and responsiveness). Positive effects occurred independent of the study design, sample characteristics, measures, and constructs assessed. However, the findings suggest that the combination of fewer than six sessions, durations shorter than three months, and a very early start did not impact mother-child interactions, as expected. Few studies have explored negative maternal behaviors, children's behaviors, and dyadic interactions such as mutuality and synchrony. Conclusions: HV-PPs positively impacted mother-child interactions in early childhood despite the large heterogeneity across program designs, outcome measures, and overlapping constructs. Based on the results, we discuss the practical and economic implications of using parenting programs as a preventive approach.

Investing in family-centered early childhood education: A conceptual model for preventing firearm homicide among Black male youth in the United States

INTRODUCTION

Firearms are now the number one killer of children and adolescents in the United States. Firearm homicides among Black male youth are the driver of this increase. Prevention requires a multi-faceted life course approach. Academic achievement has been identified as a protective factor. Early childhood education, which is linked to later achievement, is thus an intervention area of interest. Conceptualizing the potential links between early childhood education and reduced risk for youth firearm homicide is important for guiding policy advocacy and informing future research.

METHODS

This paper presents a conceptual model linking early childhood education to reduced risk for firearm homicide. Each link in the model is discussed, and a corresponding review of the literature is presented. The need for anti-racist policies to strengthen the impact of early childhood education is highlighted.

RESULTS

Early education and firearm homicide research are each well-established but largely disconnected. There are clear immediate benefits of early childhood education; however, these effects wane with time, particularly for youth of color. At the same time, juvenile delinquency-a major risk factor for firearm homicide-is influenced by educational inequities.

CONCLUSIONS

Effective interventions to reduce firearm homicides among Black male youth in the United States are needed. Early childhood education shows promise as an intervention. However, to have an impact, this education needs to be accessible and affordable for all, particularly families of color and low income. Societal structures and policies must also better support the positive gains seen through early childhood education to avoid dissipation.

Personalized Mobile Health-Enhanced Cognitive Behavioral Intervention for Maternal Distress: Examining the Moderating Role of Adverse Childhood Experiences

BACKGROUND

Maternal history of trauma is a risk factor for distress during pregnancy. The purpose of this paper was to examine the theorized differential impact of a cognitive behavioral intervention (Mothers and Babies Personalized; MB-P) on maternal distress and emotional regulation for those with ≥ 1 adverse childhood experiences (ACEs; vs no ACEs) from pregnancy to 3 months postpartum.

METHODS

Between August 2019 and August 2021, eligible pregnant individuals aged ≥ 18 years, < 22 weeks' gestation, and English-speaking were recruited from 6 university-affiliated prenatal clinics. Participants (N = 100) were randomized to MB-P (n = 49) or control (n = 51). Analyzable data were collected for 95 participants. Analyses tested progression of change (slope) and at individual timepoints (panel analysis) for perinatal mental health outcomes.

RESULTS

The majority of participants (n = 68, 71%) reported experiencing > 1 ACE (median = 1, range: 0-11). Participants demonstrated significant differential effects for depressive symptoms in absence of ACEs (standardized mean differences [SMD] = 0.82; 95% confidence interval [CI] = [0.13-1.51]) vs in presence of ACEs (SMD = 0.39; 95% CI = [-0.20 to 0.97]) and perceived stress in absence of ACEs (SMD = 0.92; 95% CI = [0.23-1.62]) vs in presence of ACEs (SMD = -0.05; 95% CI = [-0.63 to 0.53]). A panel analysis showed significantly reduced depressive symptoms postintervention and increased negative mood regulation at 3 months postpartum for individuals with ACEs.

CONCLUSIONS

Findings support effectiveness of the MB-P intervention to reduce prenatal distress for all pregnant individuals. Preliminary exploration suggests the possibility that individuals with ACEs may benefit from enhanced trauma-informed content to optimize the effects of a perinatal intervention.

Family-Focused Universal Substance Use Prevention in Primary Care: Advancing a Pragmatic National Healthcare Agenda

This article advances ideas presented at a National Academies of Sciences, Engineering, and Medicine workshop in 2022 that highlighted clinical practice and policy recommendations for delivering universal, family-focused substance use preventive interventions in pediatric primary care. Pediatric primary care is a natural setting in which to offer families universal anticipatory guidance and links to systematic prevention programming; also, several studies have shown that offering effective parenting programs in primary care is feasible. The article describes a blueprint for designing a pragmatic national agenda for universal substance use prevention in primary care that builds on prior work. Blueprint practice schematics leverage efficacious family-focused prevention programs, identify key program implementation challenges and resources, and emphasize adopting a core element approach and utilizing digital interventions. Blueprint policy schematics specify avenues for improving cross-sector policy and resource alignment and collaboration; expanding, diversifying, and strengthening the prevention workforce; and enhancing financing for family-focused prevention approaches. The article then draws from these schematics to assemble a candidate universal prevention toolkit tailored for adolescent patients that contains four interlocking components: education in positive parenting practices, parent and youth education in substance use risks, a parent-youth structured interaction task, and parent and youth linkage to in-person and web-based prevention resources.

Joint developmental trajectories of internalizing and externalizing problems from mid-childhood to late adolescence and childhood risk factors: Findings from a prospective pre-birth cohort

There is limited evidence on heterogenous co-developmental trajectories of internalizing (INT) and externalizing (EXT) problems from childhood to adolescence and predictors of these joint trajectories. We utilized longitudinal data from Raine Study participants (n = 2393) to identify these joint trajectories from 5 to 17 years using parallel-process latent class growth analysis and analyze childhood individual and family risk factors predicting these joint trajectories using multinomial logistic regression. Five trajectory classes were identified: Low-problems (Low-INT/Low-EXT, 29%), Moderate Externalizing (Moderate-EXT/Low-INT, 26.5%), Primary Internalizing (Moderate High-INT/Low-EXT, 17.5%), Co-occurring (High-INT/High-EXT, 17%), High Co-occurring (Very High-EXT/High-INT, 10%). Children classified in Co-occurring and High Co-occurring trajectories (27% of the sample) exhibited clinically meaningful co-occurring problem behaviors and experienced more adverse childhood risk-factors than other three trajectories. Compared with Low-problems: parental marital problems, low family income, and absent father predicted Co-occurring and High Co-occurring trajectories; maternal mental health problems commonly predicted Primary Internalizing, Co-occurring, and High Co-occurring trajectories; male sex and parental tobacco-smoking uniquely predicted High Co-occurring membership; other substance smoking uniquely predicted Co-occurring membership; speech difficulty uniquely predicted Primary Internalizing membership; child's temper-tantrums predicted all four trajectories, with increased odds ratios for High Co-occurring (OR = 8.95) and Co-occurring (OR = 6.07). Finding two co-occurring trajectories emphasizes the importance of early childhood interventions addressing comorbidity.

Integrating Treatment for Maternal Depression and Young Children's Behavior Problems

It is important to consider reciprocal associations between maternal and offspring mental health problems during early childhood. Existing interventions often focus narrowly on either adult or child mental health, missing the opportunity for holistic care. We describe the rationale and development of a pilot randomized clinical trial that explores their integration, combining an evidence-based parenting intervention with depression treatment to improve both maternal and child outcomes. Our approach is part of a growing field of two-generation interventions that offer a promising approach to enhance mental health support for caregivers and their young children.

Advancing early relational health: a collaborative exploration of a research agenda

Here, we introduce the Early Relational Health (ERH) Learning Community's bold, large-scale, collaborative, data-driven and practice-informed research agenda focused on furthering our mechanistic understanding of ERH and identifying feasible and effective practices for making ERH promotion a routine and integrated component of pediatric primary care. The ERH Learning Community, formed by a team of parent/caregiver leaders, pediatric care clinicians, researchers, and early childhood development specialists, is a workgroup of Nurture Connection-a hub geared toward promoting ERH, i.e., the positive and nurturing relationship between young children and their parent(s)/caregiver(s), in families and communities nationwide. In response to the current child mental health crisis and the American Academy of Pediatrics (AAP) policy statement promoting ERH, the ERH Learning Community held an in-person meeting at the AAP national headquarters in December 2022 where members collaboratively designed an integrated research agenda to advance ERH. This agenda weaves together community partners, clinicians, and academics, melding the principles of participatory engagement and human-centered design, such as early engagement, co-design, iterative feedback, and cultural humility. Here, we present gaps in the ERH literature that prompted this initiative and the co-design activity that led to this novel and iterative community-focused research agenda, with parents/caregivers at the core, and in close collaboration with pediatric clinicians for real-world promotion of ERH in the pediatric primary care setting.

Intergenerational Transmission of Parental Adverse Childhood Experiences and Children's Outcomes: A Scoping Review

Adverse childhood experiences (ACEs) are among the leading environmental causes of morbidity and mortality. Extending research on within-generation effects, more recent scholarship has explored between-generation consequences of ACEs. Despite growing interest in the intergenerational effects of parents' ACEs on children's outcomes, this line of scholarship has yet to be coalesced into a comprehensive review. The current study is a scoping review on the intergenerational transmission of parental ACEs and children's outcomes. Ten databases such as PubMed, APA PsycArticles, and Social Work Abstracts were searched. To be included, empirical studies must have been published in English and analyzed associations between a cumulative measure of at least four parental ACEs and children's outcomes. Sixty-eight studies qualified for the review and, among these, 60 were published in the most recent 5 years (2018-2022). Fifty-one studies had sample sizes smaller than 500, and 55 focused on the effect of maternal ACEs. Nearly all studies demonstrated that parental ACEs could affect children's outcomes directly or indirectly via mechanisms like maternal mental health problems or parenting-related factors. By scoping the extant literature, this review advances the knowledge base regarding the intergenerational impacts of parental childhood trauma and children's outcomes. It also reveals methodological limitations that should be addressed in future research to strengthen causal inferences along with practical implications for interventions that aim to interrupt the intergenerational transmission of trauma.

Partner Cooperation, Conflict, Maternal Mental Health, and Parenting Behaviors in Rural Kenya: Towards a Two-Generational Understanding of Gender Transformation Benefits

Increasing partner cooperation is an established approach to reducing intimate partner violence. This strategy, known in the literature as "gender transformation," benefits mental and physical health of women and men. Less is known about the potential for gender transformation strategies to improve the nurturing context for children. We hypothesize that increasing partner cooperation, a common benefit of community-based empowerment programs, would decrease child maltreatment through reducing intimate partner conflict and improving maternal mental health. This study utilizes cohort data from women (n = 400) participating in a combined group-based microfinance program to assess potential mechanisms by which partner cooperation at T1 (June 2018) predicts less children maltreatment at T2 (June 2019). As hypothesized, partner cooperation predicts less subsequent child maltreatment-frequency of neglect, corporal punishment, physical assault, and psychological abuse in the past month. This association is mediated completely by subsequent more partner cooperation and less intimate partner conflict, maternal loneliness, and depression. Implications of this study include potential for combining multiple development areas-women's empowerment, intimate partner cooperation, mental health, and child nurturing contexts. Future study should assess these pathways in a cluster-based randomized trial, and explore how findings may inform policy and practice where these domains are less integrated.

Parent perspectives of engaging with a community paediatric clinic with linked child development supports in a disadvantaged area of Ireland

Parent experiences of child health services can be used to understand their value and optimise the support provision to families during critical developmental periods. A gap in the literature exists regarding parental perspectives of linked child development supports, particularly in disadvantaged areas. This study examined parent experiences of the impact and value of a community paediatric clinic (Kidscope) with linked, multi-agency supports in a disadvantaged area of Ireland. Using a qualitative analysis design, 10 parents participated in one-to-one interviews. A Community Advisory Group consulted on interview schedules. Data was thematically analysed in line with Braun & Clarke's Framework. Five themes and twenty-two sub-themes emerged. Kidscope's linked, multi-agency approach was valuable for engaging families, addressing developmental delay, supporting readiness for education, and developing parent-child relationships. Relational working and a child and family centred model of care empowered parents to become active agents in children's health. Coronavirus disease 2019, national deficits in healthcare, and staff turnover impeded service delivery. Kidscope and linked supports work in partnership to disrupt the impact exclusion from healthcare has on vulnerable children and families. This study provides evidence of an effective integrated paediatric service delivery model designed around vulnerable children and families and highlights areas for improvement.

Organizational change and evidence-based practices in support services for people with intellectual and developmental disabilities

The impact on support services for persons with intellectual and developmental disabilities of the socioeconomic movements and theoretical reformulations of the last decades has generated the necessity, in order to guarantee their sustainability, to carry out processes of profound change in their organizational culture, intervening in the elements that compose it. Among them are professional practices as the best way to intervene in culture, with the use of comparative analysis between an organization's current practices and those expected with culture change. In this line, the organizational self-assessment tool "Organizational Effectiveness and Efficiency Scale" (OEES) is applied in a study with 24 organizations, which uses a collaborative assessment approach in the service of a set of evidence-based practices identified as standards in key aspects that guide culture change, specifically, a person-centered approach, participative structures, use of information systems and data management, implementation of quality systems and participative and transformational leadership. The results obtained show that a large majority of organizations have significant discrepancies between their current practices and evidence-based practices. The descriptive analysis allows affirming the usefulness of the scale for an organizational diagnosis and identification of strategies to guide transformational change.

Protocol for a randomized control trial of the Building Regulation in Dual Generations Program (BRIDGE): preventing the intergenerational transmission of mental illness in at-risk preschool children

BACKGROUND

Since the onset of the COVID-19 pandemic, the worldwide prevalence of maternal depression has risen sharply; it is now estimated that one quarter of mothers experience clinically significant depression symptoms. Exposure to maternal depression during early childhood increases the risk for the development of childhood mental illness (MI) in offspring, with altered parenting practices mediating the association between maternal depression and child outcomes. Dual-generation interventions, which aim to simultaneously treat parent and child mental health, show promise for improving outcomes for mothers with depression and their young children. The Building Regulation in Dual Generations (BRIDGE) program combines Dialectical Behavior Therapy (DBT) and parenting skills training to concurrently treat maternal depression and improve parenting practices. In pilot within-group studies, BRIDGE has led to large reductions in maternal depression and child MI symptoms. The aim of the current study is to evaluate the efficacy of BRIDGE in reducing maternal depression and child MI symptoms (primary outcomes) as well as parenting stress and harsh parenting (secondary outcomes).

METHODS

A three-armed randomized control trial with equal group sizes will be conducted to compare the efficacy of (1) BRIDGE (DBT + parenting skills), (2) DBT skills training, and (3) services-as-usual. Participants (n = 180) will be mothers of 3- to 5-year-old children who report elevated depression symptoms. Those randomized to BRIDGE or DBT skills training will complete a 16-week group therapy intervention. Assessments will be administered at pre-intervention(T1) post-intervention (T2), and 6-month follow-up (T3).

DISCUSSION

Dual-generation programs offer an innovative approach to prevent the intergenerational transmission of mental illness. The current study will add to the evidence base for BRIDGE by comparing it to a stand-alone mental health intervention and a services-as-usual group. These comparisons will provide valuable information on the relative efficacy of including parenting support in a mental health intervention for parents. The results will contribute to our understanding of how maternal depression affects children's development and how intervening at both a mental health and parenting level may affect child and family outcomes.

TRIAL REGISTRATION

Name of registry: Clinical Trials Protocol Registration and Results System; trial registration number: NCT05959538; date of registry: July 24, 2023; available: https://classic.

CLINICALTRIALS

gov/ct2/show/NCT05959538.

Trends and forecasted rates of adverse childhood experiences among adults in the United States: an analysis of the Behavioral Risk Factor Surveillance System

CONTEXT

Many studies have shown increases in negative social aspects in the United States that may increase the likelihood of a child experiencing adversity. These rising trends include household dysfunction, poor mental health and substance use, crime rates, and incarceration. Additionally, the pathway of adverse childhood experiences (ACEs) may also perpetuate intergenerational trauma.

OBJECTIVES

Given these increased trends, our objective was to determine the mean ACEs reported among adults by year of birth to assess trends of ACEs over time.

METHODS

To assess ACEs trends in the United States, we utilized data from the 2020 Behavioral Risk Factor Surveillance System (BRFSS), a nationally representative survey. We summed individuals' reported ACEs and then calculated the mean ACE score within age cohorts (in 1-year increments) by year of birth. We utilized an auto-regressive integrated moving average (ARIMA) model to forecast mean ACEs through 2030.

RESULTS

Respondents to the ACEs module (n=116,378) represented 63,076,717 adults in the United States, with an average age cohort of 1715 individuals. The mean reported ACEs among individuals 80 years or older (born in or before 1940) was 0.79, while the highest mean ACEs (2.74) were reported among the cohort born in 1998-an average increase of 0.022 ACEs per year. The ARIMA model forecasted that individuals born in 2018 will, on average, surpass a cumulative of three ACEs.

CONCLUSIONS

Given the connection of ACEs to poor health outcomes and quality of life, this trend is alarming and provides evidence for the necessity of child maltreatment prevention. Multigenerational trauma-informed care and education are warranted for individuals with ACEs and may even prevent the cycle from recurring.

'Space to talk': a Portuguese focus group study of parents' experiences, needs and preferences in parenting support during prenatal and well-child care

OBJECTIVE

To explore the experiences, needs and preferences of a group of parents regarding the parenting support received during prenatal and well-child care in the Portuguese National Health Service.

DESIGN AND SETTING

We undertook descriptive-interpretive qualitative research running multiple focus groups in Porto, Northern Portugal.

PARTICIPANTS, DATA COLLECTION AND ANALYSIS

Purposive sampling was used between April and November 2018. Focus groups were conducted with 11 parents of a 0-3 years old with well-child visits done in primary care units. Thematic analysis was performed in a broadly inductive coding strategy and findings are reported in accordance with Consolidated Criteria for Reporting Qualitative Research guidelines.

RESULTS

Three main themes were identified to describe parents' experience when participating in their children's healthcare: (1) logistics/delivery matter, including accessibility, organisation and provision of healthcare activities, unit setting and available equipment; (2) prenatal and well-child care: a relational place to communicate, with parents valuing a tripartite space for the baby, the family and the parent himself, where an available and caring health provider plays a major role and (3) parenting is challenging and looks for support, based on key points for providers to watch for and ask about, carefully explained and consensual among health providers.

CONCLUSION

This study provides insight into parents' needs and healthcare practices that affect the parenting experience. To meet parents' preferences, sensitive health providers should guarantee a relational place to communicate and person-centredness, accounting for the whole family system to support healthy parenting collaboratively. Future studies are warranted to further strengthen the knowledge in the field of a population-based approach for parenting support.

The effects of a universal short-term home visiting program: Two-year impact on parenting behavior and parent mental health

BACKGROUND

At the time of childbirth, families face heightened levels of unmet need. These needs, if left unmet, can lead parents to engage in less positive parenting practices, which in turn, increase the risk of child maltreatment. Family Connects (FC) is a universal postnatal nurse home-visiting program designed to prevent child maltreatment by supporting all families in a community through one to three visits to improve parent mental health and parenting behaviors. A randomized controlled trial of FC demonstrated improving positive parenting and reducing postpartum depression through age 6 months.

OBJECTIVE

To determine sustained (2-year) impact of random assignment to FC on parenting behavior and parent mental health and identify heterogeneity of effects.

PARTICIPANTS AND SETTING

A representative subsample of 496 families that had been randomized to FC (255 treatment; 241 control) of infants born between July 1, 2009, and December 31, 2010, in Durham County, North Carolina.

METHODS

Demographic characteristics were collected through hospital discharge data. Treatment-blinded interviewers collected maternal reports of parenting behavior and mental health at infant age two years. Moderation and subgroup analyses were conducted to estimate heterogeneity in impact of FC.

RESULTS

Mothers assigned to FC engaged in more self-reported positive parenting relative to control mothers (B = 0.21; p < 0.05). Hispanic mothers assigned to FC reported greater sense of parenting competence (B = 1.28; p < 0.05). No significant main effect differences were identified for negative parenting, maternal depression, or father involvement.

CONCLUSIONS

Assignment to FC was associated with improvements in population-level self-reported scores of positive parenting 2 years post-intervention.

Strengthening mother-child interactions among mothers and children with behavior problems at early development

The present study examined the effectiveness of a personalized remote video feedback parenting program to improve mother-child interactions and child behavior outcomes among mothers of children with behavior problems in comparison to counterparts with no behavior problems. The sample comprised 60 mothers and their 2-to-6-year-old children, including children with behavior problems (BP = 19) and children without behavior problems (NoBP = 41). The Strengthening Bonds program included one in-person group session and remote personalized video feedback about their mother-child interactions in a play situation via smartphone for six weeks. Mother-child interactions were the primary outcome, and children's behaviors were the secondary outcome. Pre- and post-intervention assessments were performed. The mother-child interactions were recorded during free- and structured-play situations and were then analyzed by the Parenting Interactions with Children: Checklist of Observations Linked to Outcomes (PICCOLO) and the Dynamics of the dyad activity coding system. Additionally, the mothers answered the Strengths and Difficulties Questionnaire. The results showed that, in the post-intervention, the mother-child interaction pattern improved in the BP group, especially in the teaching dimension of the PICCOLO. Also, after the program, more children with normal classification were in the BP group.

Maternal History of Childhood Adversities and Later Negative Parenting: A Systematic Review

Adverse childhood experiences negatively impact future violence, victimization, perpetration, health, and lifelong development. The aim of the present study was to systematically review the scientific evidence of empirical studies on the association between maternal childhood adversity in a familial context, including maltreatment, household challenges, and later maternal negative parenting. A search was performed in the PubMed, PsycINFO, Web of Science, SciELO, and LILACS databases, using the combination of the following keywords: (neglect OR abuse OR maltreatment OR harsh parenting OR punishment OR discipline OR negative parenting practices) AND (adverse childhood experiences OR early adversity OR cycle of violence OR cycle of maltreatment OR history of maltreatment) AND (mother OR maternal). The results of 29 studies showed predominantly significant direct associations between maternal childhood adversities and negative parenting with their children (83%). Parental stress was also significantly associated with a maternal history of childhood adversities. Focusing on the type of maltreatment practices, there were similar intergenerational transmission types: homotypic and heterotypic. Few studies have examined the protective factors that could buffer the negative impact of a maternal childhood history of adversities on later negative parenting.

Developmental referrals of pre-school children in a diverse community in England: The importance of parental migration for referral rates

BACKGROUND

Children born to migrant parents have higher rates of language difficulties, intellectual disability and autism. This study explores the relationship between migration, ethnicity and reasons for early years referrals to community paediatrics in a diverse multi-cultural population in a city in south west England.

METHODS

Observational retrospective study from a community paediatric service serving a multi-cultural urban population from June 2012 to February 2016. We tested associations of ethnicity and parental birth origin with reason for referral (developmental or non-developmental) for children under 5 years old and estimated crude rate ratios for referrals using population census data.

RESULTS

Data were available for 514 children (52% white or mixed race, 16% Asian, 21% African diaspora, and 11.5% Somali); 53% had two UK-born parents while 22% had two migrant (non-UK-born) parents. Referrals were for developmental reasons in 307 (60%) including 86 for possible autism. Parental birth origin and ethnicity were associated with reason for referral (p < 0.001). Children from African diaspora, Asian or Somali backgrounds had more than twice the rate (rate ratio [RR] 2.37, 95% CI 1.88-2.99, p < 0.001) of developmental referrals compared with white or mixed-race children. Children of Somali or African diaspora ethnicity were, respectively, six-times (RR 5.99, 95% CI 3.24-10.8, p < 0.001) and four times (RR 4.23, 95% CI 2.44-7.29, p < 0.001) more likely to be referred for possible autism spectrum than their white or mixed-race peers. Developmental referral as a proportion of all referrals was twice as high among children with one migrant parent (20.4%) and three times as high among children with two migrant parents (29.5%), compared with children whose parents were both UK-born (10.7%).

CONCLUSIONS

This study supports the importance of ethnicity and parental migration as factors in young children experiencing developmental difficulties, especially concerns about social communication or autism.

Building Emotional Awareness and Mental Health (BEAM): an open-pilot and feasibility study of a digital mental health and parenting intervention for mothers of infants

BACKGROUND

Maternal mental health concerns and parenting stress in the first few years following childbirth are common and pose significant risks to maternal and child well-being. The COVID-19 pandemic has led to increases in maternal depression and anxiety and has presented unique parenting stressors. Although early intervention is crucial, there are significant barriers to accessing care.

METHODS

To inform a larger randomized controlled trial, the current open-pilot trial investigated initial evidence for the feasibility, acceptability, and efficacy of a newly developed online group therapy and app-based mental health and parenting program (BEAM) for mothers of infants. Forty-six mothers 18 years or older with clinically elevated depression scores, with an infant aged 6-17 months old, and who lived in Manitoba or Alberta were enrolled in the 10-week program (starting in July 2021) and completed self-report surveys.

RESULTS

The majority of participants engaged in each of the program components at least once and participants indicated relatively high levels of app satisfaction, ease of use, and usefulness. However, there was a high level of attrition (46%). Paired-sample t-tests indicated significant pre- to post-intervention change in maternal depression, anxiety, and parenting stress, and in child internalizing, but not externalizing symptoms. Effect sizes were in the medium to high range, with the largest effect size observed for depressive symptoms (Cohen's d = .93).

DISCUSSION

This study shows moderate levels of feasibility and strong preliminary efficacy of the BEAM program. Limitations to program design and delivery are being addressed for testing in adequately powered follow-up trials of the BEAM program for mothers of infants.

TRIAL REGISTRATION

NCT04772677 . Registered on February 26 2021.

The Building Regulation in Dual-Generations Program (BRIDGE): A Mixed-Methods Feasibility Pilot of a Parenting Program for Depressed Mothers of Preschoolers, Matched with Dialectical Behavior Therapy Skills

Early exposure to maternal depression is a key risk factor for child mental illness (MI), but there are limited programs that interrupt intergenerational transmission. The BRIDGE "Building Regulation in Dual Generations" Program treats maternal MI using Dialectical Behavior Therapy Skills with a paired curriculum that promotes non-reactive and emotionally validating parenting designed to improve child mental health and ultimately prevent MI. The pilot feasibility trial (n = 28 dyads) included mothers and their preschool-aged children. The 20-week program was completed in a group-based format using mixed methods questionnaires and interviews. Results indicate high feasibility and acceptability (86% retention). Consistent improvements were seen across program targets and outcomes including maternal depression (d = 1.02) and child mental health (d = 1.08), with clinically significant symptom reductions for 85% of clients. Mothers with higher adversity exhibited greater reductions in parenting stress. Qualitative results highlighted efficacy in promoting positive parent-child relationships, rewarding parenting experiences, competence, and child development. Evidence suggests high feasibility and accessibility for BRIDGE in addressing intergenerational mental health needs. There was strong satisfaction with the program material and efficacy across key outcomes. BRIDGE holds promise for offering a transdiagnostic approach to preventing child MI in families of at-risk preschool aged children.

Parenting practices during early childhood: validity evidence of a Brazilian scale

OBJECTIVE

The present study aims to analyze the validity of evidence and internal consistency of an inventory for assessing parenting practices during early childhood.

METHOD

Participants were 857 mothers of one-to-42-months children recruited in three cities in the Southeast region and one city in the Midwest region of Brazil. The participants answered a sociodemographic questionnaire with maternal and child data, and the Parenting Styles Inventory for Mothers of Babies (IEPMB). The IEPMB includes 25 questions about positive and negative parenting practices that mothers use to raise their children. An exploratory and confirmatory factor analysis was conducted using the following criteria to indicate adequate model fit: root-mean-square error of approximation (RMSEA) < .08; standardized root mean square residual (SRMR) < .09; comparative fit index (CFI) > 0.90. For the hypothesis-testing method, a comparison between groups using a student's t-test based on the child's age (infants vs. toddlers) and mother's age (adolescents vs. adults) was carried out.

RESULTS

The final 11 items model of the measure revealed an adequate overall model fit (RMSEA = 0.04; SRMR = 0.04; CFI = 0.94). The items were grouped into three constructs: Aggressiveness and Emotional Dysregulation, Relaxed Discipline, and Positive Monitoring. Adolescent mothers reported less positive monitoring than adult mothers (p < 0.001). Mothers of toddlers reported more aggressiveness/emotional dysregulation (p < 0.001) and relaxed discipline (p = 0.05) than mothers of infants.

CONCLUSIONS

The instrument named from this study as the Parenting Practices Inventory for Mothers of Babies showed evidence for measuring mothers' parenting practices in early childhood and allows the identification of parents who need support.

Building Emotional Awareness and Mental Health (BEAM): study protocol for a phase III randomized controlled trial of the BEAM app-based program for mothers of children 18-36 months

Background

The prevalence of maternal depression and anxiety has increased during the COVID-19 pandemic, and pregnant individuals are experiencing concerningly elevated levels of mental health symptoms worldwide. Many individuals may now be at heightened risk of postpartum mental health disorders. There are significant concerns that a cohort of children may be at-risk for impaired self-regulation and mental illness due to elevated exposure to perinatal mental illness. With both an increased prevalence of depression and limited availability of services due to the pandemic, there is an urgent need for accessible eHealth interventions for mothers of young children. The aims of this trial are to evaluate the efficacy of the Building Emotion Awareness and Mental Health (BEAM) app-based program for reducing maternal depression symptoms (primary outcome) and improve anxiety symptoms, parenting stress, family relationships, and mother and child functioning (secondary outcomes) compared to treatment as usual (TAU).

Methods

A two-arm randomized controlled trial (RCT) with repeated measures will be used to evaluate the efficacy of the BEAM intervention compared to TAU among a sample of 140 mothers with children aged 18 to 36 months, who self-report moderate-to-severe symptoms of depression and/or anxiety. Individuals will be recruited online, and those randomized to the treatment group will participate in 10 weeks of psychoeducation modules, an online social support forum, and weekly group teletherapy sessions. Assessments will occur at 18–36 months postpartum (pre-test, T1), immediately after the last week of the BEAM intervention (post-test, T2), and at 3 months after the intervention (follow-up, T3).

Discussion

eHealth interventions have the potential to address elevated maternal mental health symptoms, parenting stress, and child functioning concerns during and after the COVID-19 pandemic and to provide accessible programming to mothers who are in need of support. This RCT will build on an open pilot trial of the BEAM program and provide further evaluation of this evidence-based intervention. Findings will increase our understanding of depression in mothers with young children and reveal the potential for long-term improvements in maternal and child health and family well-being.

Trial registration

ClinicalTrials.govNCT05306626. Registered on April 1, 2022

"It brought my family more together": Mixed-methods study of low-income U.S. mothers during the pandemic

Objective

We sought to understand challenges and positive experiences of low-income families during the pandemic.

Background

Strength-based perspectives of economically disadvantaged mothers are missing from literature on the impact of the COVID-19 pandemic. Although it is imperative to recognize disparities that were highlighted by the pandemic, strengths-based approaches and a resilience framework can help professionals build upon and learn from ways families manage during those times.

Method

We used a mixed-method approach to gain understanding of the unique experiences of 15 low-income mothers at the height of the pandemic. We administered a brief COVID-19 stress screener, the Five-Minute Speech Sample measure, and an open-ended question about potential positive experiences during the pandemic.

Results

We learned that strength and resilience supersede the liabilities brought on by COVID-19 that are so often focused on. We found highly divergent experiences across mothers in terms of stress; even mothers with high levels of stress readily identified positive aspects of life during the pandemic. Mothers' responses were indicative of greater feelings of warmth and tenderness than negativity about their children.

Conclusion and Implications

We discuss findings in terms of strengths-based practices and policies for mothers receiving public assistance and provide suggestions for continued research on resilience of mothers during the pandemic.

Building Emotional Awareness and Mental Health (BEAM): A Pilot Randomized Controlled Trial of an App-Based Program for Mothers of Toddlers

Background

Families have faced unprecedented challenges during the COVID-19 pandemic, leading to increased maternal mental health problems and barriers to accessing care. Innovative programs are needed to support both maternal mental health and parenting, and to buffer the long-term impacts of stress on young children. Using a patient-oriented approach, our research team aimed to co-develop and pilot test an App-based psychoeducation and social-connection platform: Building Emotional Awareness and Mental Health (BEAM).

Methods

The co-development process involved a parent advisory board from conceptualization and design, through to direct participation in the program delivery. The BEAM program includes weekly videos and activities based on Unified Protocol therapy modules and emotion-focused parenting strategies, a weekly telehealth group review session, and access to a private online forum for support from other mothers and clinical coaches. A parallel randomized control trial was conducted across two provinces in Canada. Mothers of preschool children (aged 18-36 months old), with moderate-to-severe depression (Patient Health Questionaire-9 ≥ 10), were recruited online and randomized to either the 10-week BEAM intervention or treatment as usual (TAU) control group. Online surveys (ensuring researcher blinding) included questions about feasibility and acceptability of the program and pre/post self-report measures of mental health, parenting, positive coping and child behavior outcomes. The primary outcome measures were symptoms of depression and parenting stress. Data were analyzed using mixed models and an intention-to-treat approach.

Results

65 participants were randomized, by an online allocation tool, to the BEAM (n = 33) and TAU (n = 32) groups. Engagement was relatively high at the beginning of the program, with 78.8% starting the BEAM App and 70.6% attending ≥1 telehealth session. Most respondents felt socially supported, satisfied with the App, and found it easy to use. Pre-post results indicated interaction effects with greater reductions in overall mental health problems, and specifically anxiety and sleep symptoms, among BEAM vs. control participants. There were also time effects with reductions in depression symptoms across both groups. No significant treatment effects emerged for the other mental health symptoms, parenting problems, positive coping, or child behavior outcomes. Descriptive data are included to highlight possible areas of promise for future large efficacy trials. Technological difficulties and other challenges that may have led to attrition and impacted outcomes are discussed. There were no adverse events related to study participation.

Conclusions

The BEAM program has promise as a novel, feasible and acceptable intervention for improving mental health among mothers of young children.

Clinical Trial Registration

[www.ClinicalTrials.gov], identifier [NCT04772677].

Development of evidence-informed bridge programming to support an increased need for eating disorder services during the COVID-19 pandemic

Over the course of the COVID-19 pandemic, rates of eating disorders have increased, further straining systems of care that were already overburdened. The current paper describes novel interventions, largely informed by Family-Based Treatment (FBT), that were implemented by a tertiary specialist adolescent eating disorders service. In response to the pandemic, programming was designed to bridge access to care while waiting for availability of evidence-based therapy. The Brief Psychology Consultation Clinic provides several sessions to patients and families, focused on psychoeducation and problem-solving informed by FBT and other evidence-based therapies. Two groups, the FBT Caregiver Workshop Series and FBT Caregiver Support Group, provide psychoeducation and support for caregivers of youth with eating disorders. Perceived strengths and benefits of these services, as well as barriers to implementation and future research directions are discussed.

The context and development of the early relational health screen

Early relational experiences are key drivers for developing social emotional capacities, educational achievement, mental health, physical health, and overall wellbeing. The child health sectors are committed to promotion, prevention, and early intervention that optimize children's health and development, often employing evidence-based screening as foundational practices. Despite a variety of validated parent-infant observational assessment tools, few are practical within busy practice settings, acceptable with all racial and ethnic groups and ready for universal adoption. In response to this need, a team of clinicians, early childhood educators, researchers and infant mental health specialists collaborated to develop and test a novel video-based, dyadic relational screening and monitoring tool, the Early Relational Health Screen (ERHS). This tool uniquely focuses on the early parent-child relationship (6-24 months), within the construct of early relational health (ERH). Initial testing demonstrated that the ERHS is a valid, reliable, feasible, and useful screening and monitoring tool for clinical applications. The ERHS was further developed within a population-based, prospective research study and adapted with brief video feedback for parents in the home visiting and child health sectors. The ERHS and its adaptations appear to advance ERH and equity within the transforming child health and public health care systems of today.

["Frühe Hilfen": what must pediatricians know?]

In early childhood, essential foundations are laid for healthy growing up and long-term quality of life and health. Stressful life situations can disrupt good early childhood development, therefore early support is essential. Early childhood interventions like "Frühe Hilfen" provide support systems with coordinated services for parents and children during early childhood. They are particularly aimed at families in stressful life situations and thus counteract the long-term consequences of negative childhood experiences and promote healthy growing up. Pediatricians are important cooperation partners of "Frühe Hilfen", especially with respect to access to the services. Early life care is an interdisciplinary and integrative concept that aims to promote optimal conditions for families around the desire to have children, pregnancy, birth and early childhood, among other things, with a view to risk situations.

Assessing resiliency in Canadians experiencing social vulnerability: Psychometric properties of the CUPS Resiliency Interview Schedule and Resiliency Questionnaire

Deficit models of care for clients experiencing social vulnerability have become increasingly unsustainable; and there is a shift towards models of care that promote and protect resiliency for lifelong health. We defined clients as socially vulnerable if they were living with poverty, mental health problems and addictions, disability, and social isolation. Scales to measure outcomes of resiliency-focused programming have limited reliability and have not been validated with vulnerable populations. The aim of this study was to develop and conduct preliminary psychometric assessment of two measures: CUPS (formerly Calgary Urban Project Society) Resiliency Interview Schedule (RIS) and Resiliency Questionnaire (RQ) for adults experiencing social vulnerability. To engage clients who were seeking integrated services at a social services agency, we developed the RIS and accessed data collected between April 2017 and December 2018. In a structured intake interview, the client and staff prioritised goals and identified resiliency in three domains: (a) economic, (b) social-emotional, and (c) health. On average, clients (N = 545) who completed the CUPS-RIS were 45.9 years old (SD = 12.62). For the CUPS-RIS, Cronbach's alphas at intake and outcome assessments were 0.80. Exploratory factor analysis demonstrated a four-factor solution with two unexpected results: executive functioning/self-regulation loaded with mental and physical health, and client education failed to load on any factor. We found significant improvements between client intake and outcome measurement points on eight of 12 sub-domains. As a brief self-report measure of resiliency, we developed the CUPS-RQ and accessed data collected between November 2018 and May 2019. Clients (N = 29) who completed the CUPS-RQ concurrently with the Resilience Research Centre-Adult Resilience Measure (RRC-ARM) were, on average, 42.46 years old (SD = 12.87). The CUPS-RQ was correlated with RRC-ARM, r = 0.819. In preliminary psychometric assessment, the CUPS-RIS and CUPS-RQ demonstrated satisfactory reliability and validity and show promise as measures of resiliency for agencies serving clients experiencing social vulnerability.

Family Factors Associated with Hands-On Play and Screen Time During the COVID-19 Pandemic

Background

Parent–child interactions are crucial for child development. The COVID-19 pandemic has negatively affected mental health and increased parenting challenges impacting parent–child functioning.

Objective

This study examined parent factors related to more and less enriching child activities during the pandemic through Bronfenbrenner’s Ecological Systems framework.

Methods

A convenience sample of parents (N = 708), primarily mothers (n = 610; 87.4%) aged 35.59 years old (SD = 5.59; range = 21–72), with children ages 2–8 years completed an online questionnaire between April 14-June 1, 2020. Participants mostly resided in Canada, had an income of > $100,000, and identified as White (82.4%). Parent–child activities were measured as total weekly time and combined time across activities within two categories: hands-on play and screen time. Bivariate correlations informed blockwise linear regression models.

Results

For families with childcare needs, parental anxiety was associated with higher total hands-on play, combined hands-on play, and combined screen time. Families without childcare needs indicated parenting stress was associated with lower total hands-on play and combined hands-on play, and higher supervised screen time. Family structure and indices of socioeconomic status were also predictive of activities across childcare needs and child ages.

Conclusions

To promote high-quality parent–child interactions and positive developmental outcomes during the pandemic, childcare needs and parent wellbeing should be supported, while evidence-based guidelines for child screen time should be further researched in this context.

Advancing Antiracism in Community-Based Research Practices in Early Childhood and Family Mental Health

Structural racism-the ways that institutional policies, practices, and other norms operate to create and sustain race-based inequities¹-has historically been foundational to the operations of academic medical centers and research institutions. Since its inception, academic medicine has depended on the exploitation of vulnerable communities to achieve medical, educational, and research goals.² Research practices have long ignored or taken advantage of the individuals purportedly benefiting from the research, a dynamic most manifestly true for Black, Indigenous, and People of Color (BIPOC) communities in the United States. Reflecting current practices in racial justice work, we intentionally use the term "BIPOC" to highlight shared experiences within racially and ethnically minoritized communities, given the history of White supremacy in the United States. We acknowledge limitations of this term, which collapses myriad unique communities and histories into one construct. Specifically, child and adolescent psychiatry has historically been driven by Eurocentric approaches, paradigms, and methodology. These nonparticipatory dominant research practices have contributed to a lack of culturally responsive interventions for BIPOC communities, a paucity of evidence-based practices with demonstrated effectiveness within BIPOC communities, and disparities in access and quality of care.³ Mental health research involving BIPOC communities has been replete with exploitation and inequality.².

Dyadic Effects of Pokémon GO on Physical Activity and Sedentary Behavior in Mothers and Children

Family-based mobile health applications may be an opportunity to increase children's physical activity (PA) levels. Researchers have highlighted Pokémon GO as a potential model for future PA interventions as it integrates PA with social gamification. This study provides descriptive data on Pokémon GO usage among mothers and their children and examines differences in moderate to vigorous PA (MVPA) over time among individuals playing Pokémon GO compared to non-players using a dyadic subsample from a three-year longitudinal study. After the release of Pokémon Go in July 2016, 156 mother-child dyads completed questionnaires about Pokémon Go usage and wore accelerometers continuously for seven days at baseline (Sep 2016), six months, and twelve months. Independent sample t-tests and chi-square tests were used to investigate differences in demographics and daily MVPA by player status cross-sectionally at each time point. At baseline, six mothers and 21 children reported playing Pokémon Go. Baseline demographic characteristics were not associated with player status. Across time, mothers engaged in an average of 21.12 minutes of daily MVPA (SD = 19.7) and children in 29.35 minutes (SD = 18.88). Children's daily MVPA did not differ by player status, but mothers who reported playing engaged in higher daily MVPA (M = 46.84, SD = 38.07) compared to non-players (M = 21.40, SD = 23.31). This naturalistic study lacked power to further analyze changes in MVPA after the release of the game due to lack of engagement with Pokémon GO. Understanding how to design a family-oriented game to bring together gamification, physical activity, and family-based interventions will be important for future public health efforts.

Promoting the Quality of Teacher-Toddler Interactions: A Randomized Controlled Trial of "Thrive by Three" In-Service Professional Development in 187 Norwegian Toddler Classrooms

The effectiveness of the Thrive by Three intervention, a 10-month, multicomponent, in-service professional development model to promote the quality of caregiver-toddler interactions (i.e., process quality), was tested utilizing a clustered randomized controlled design. Eighty childcare centers with 187 toddler classrooms in Norway were randomly assigned to either the Thrive by Three intervention group (n=87) or a usual-activity wait list control group (n=100). Interactional quality was assessed with the Toddler version of the Classroom Assessment Scoring System (CLASS-Toddler) at three timepoints: pre-, mid-, and post-intervention. There were significant group differences in change in quality during the intervention period in both CLASS domains, Emotional and Behavioral Support (EBS), and Engaged Support for Learning (ESL), with greater overall differences in the ESL domain. Quality increased in the intervention groups, but quality decreased in the control group from baseline to post-intervention. There were significant group differences in quality at baseline. The Thrive by Three intervention had a positive effect on teacher-toddler interactions in both the EBS and ESL domains. Results need to be replicated preferably in more diverse samples.

Clinical Trial Registration:ClinicalTrials.gov #NCT03879733.

An online family-based self-monitoring and goal-setting intervention to improve children’s physical activity: the FRESH feasibility trial and three-arm pilot RCT

Background

Family-based physical activity promotion presents a promising avenue for promoting whole-family physical activity, but high-quality research is lacking.

Objectives

To assess the feasibility, acceptability and preliminary effectiveness of FRESH (Families Reporting Every Step to Health), a child-led online family-based physical activity intervention; and to identify effective and resource-efficient family recruitment strategies.

Design

The project consisted of (1) a randomised feasibility trial, (2) a randomised controlled pilot trial and (3) a systematic review and Delphi study.

Setting

Norfolk/Suffolk counties, UK.

Participants

Families, recruited from schools, workplaces and community settings, were eligible to participate if one child aged 7–11 years and one adult responsible for their care provided written consent; all family members could participate.

Interventions

The FRESH intervention, guided by self-determination theory, targeted whole families and was delivered via an online platform. All family members received pedometers and were given website access to select family step challenges to ‘travel’ to target cities around the world, log steps, and track progress as they virtually globetrotted. Families were randomised to FRESH intervention, pedometer-only or control arm.

Main outcome measures

Physical (e.g. blood pressure), psychosocial (e.g. family functioning) and behavioural (e.g. device-measured family physical activity) measures were collected at baseline and at 8- and 52-week follow-up. A mixed-methods process evaluation assessed the acceptability of the intervention and evaluation.

Data sources review

Systematic search of four databases (Cochrane Library, PubMed, PsycINFO and SCOPUS).

Review methods

Articles were screened in duplicate, and data extraction was fully checked. Academic experts participated in the three-round Delphi study. Data were combined to identify effective and resource-efficient family recruitment strategies.

Inclusion criteria

Included generally healthy school-aged children and at least one adult; intervention attempted to change physical activity, sedentary behaviour, screen use, diet, or prevent overweight/obesity in multiple family members; presented relevant measure of effect in children and adults.

Results

The feasibility study (12 families, 32 participants; 100% retention at 8 weeks) demonstrated the feasibility and acceptability of FRESH, but highlighted that adaptations were required. Of 41 families recruited in the pilot study (149 participants), 98% and 88% were retained at the 8-week and 52-week follow-up, respectively. More children in the FRESH arm self-reported doing more family physical activity, and they thought that FRESH was fun. There were no notable between-group differences in children’s outcomes. Change in moderate to vigorous physical activity at 8 weeks favoured FRESH intervention adults [vs. control: 9.4 minutes/week (95% confidence interval 0.4 to 18.4) vs. pedometer only: 15.3 (95% confidence interval 6.0 to 24.5)], and was stronger in fathers, but this was not maintained. In 49 included studies, apart from recruitment settings and strategies used (reported in 84% and 73% of the studies, respectively), recruitment details were scarce. School-based recruitment was predominant. The Delphi study identified a wide range of recruitment settings and strategies.

Limitations

Recruitment was the main limitation of the FRESH studies; generalisability of the proposed recruitment strategies may be limited.

Conclusions

This study has demonstrated the feasibility and acceptability of the FRESH intervention. However, we failed to recruit the target sample size and were unable to demonstrate a signal of effectiveness. Future research should employ a multifaceted recruitment approach.

Future work

Further refinements to intervention delivery and recruitment methods should be investigated.

Study registration

Current Controlled Trials ISRCTN12789422 and PROSPERO CRD42019140042.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 9. See the NIHR Journals Library website for further project information.

Evaluating implementation of LEAPS, a youth-led early childhood care and education intervention in rural Pakistan: protocol for a stepped wedge cluster-randomized trial

Background

The Sustainable Development Goals (SDGs) highlight the importance of investments in early childhood care and education (ECCE) and youth development. Given Pakistan’s large young population, and gender and urban-rural inequalities in access to education, training, and employment, such investments offer opportunities. LEAPS is a youth-led ECCE program that trains female youth, 18–24 years, as Community Youth Leaders (CYLs) to deliver high-quality ECCE for children, 3.5–5.5 years, in rural Sindh, Pakistan.

Methods

We use a stepped wedge cluster-randomized trial to evaluate implementation of LEAPS. Ninety-nine clusters will be randomized to receive the intervention in one of three 7-month steps (33 clusters/step). The primary outcome is children’s school readiness (indexed by the total score on the International Development and Early Learning Assessment (IDELA)). Secondary child outcomes are children’s IDELA domain scores and executive functions. Data are collected in cross-sectional surveys of 1089 children (11 children/cluster from 99 clusters) aged 4.5–5.5 years at four timepoints (baseline and at the end of each step). Additionally, we will enroll three non-randomized youth participant open cohorts, one per step (33 CYLs: 66 comparison youth per cohort; 99:198 in total). Youth cohorts will be assessed at enrollment and every 7 months thereafter to measure secondary outcomes of youth personal and professional development, depressive symptoms, and executive functions. A non-randomized school cohort of 330 LEAPS students (10 students/cluster from 33 clusters) will also be enrolled and assessed during Step 1 after intervention rollout and at endline. The quality of the learning environment will be assessed in each LEAPS ECCE center and in a comparison center at two timepoints midway following rollout and at endline. A concurrent mixed-methods implementation evaluation will assess program fidelity and quality, and the extent to which a technical support strategy is successful in strengthening systems for program expansion. A cost evaluation will assess cost per beneficiary. Data collection for implementation and cost evaluations will occur in Step 3.

Discussion

Youth-led models for ECCE offer a promising approach to support young children and youth. This study will contribute to the evidence as a means to promote sustainable human development across multiple SDG targets.

Trial registration

ClinicalTrials.govNCT03764436. Registered on December 5, 2018.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05518-9.

Preventing Childhood Toxic Stress: Partnering With Families and Communities to Promote Relational Health

By focusing on the safe, stable, and nurturing relationships (SSNRs) that buffer adversity and build resilience, pediatric care is on the cusp of a paradigm shift that could reprioritize clinical activities, rewrite research agendas, and realign our collective advocacy. Driving this transformation are advances in developmental sciences as they inform a deeper understanding of how early life experiences, both nurturing and adverse, are biologically embedded and influence outcomes in health, education, and economic stability across the life span. This revised policy statement on childhood toxic stress acknowledges a spectrum of potential adversities and reaffirms the benefits of an ecobiodevelopmental model for understanding the childhood origins of adult-manifested disease and wellness. It also endorses a paradigm shift toward relational health because SSNRs not only buffer childhood adversity when it occurs but also promote the capacities needed to be resilient in the future. To translate this relational health framework into clinical practice, generative research, and public policy, the entire pediatric community needs to adopt a public health approach that builds relational health by partnering with families and communities. This public health approach to relational health needs to be integrated both vertically (by including primary, secondary, and tertiary preventions) and horizontally (by including public service sectors beyond health care). The American Academy of Pediatrics asserts that SSNRs are biological necessities for all children because they mitigate childhood toxic stress responses and proactively build resilience by fostering the adaptive skills needed to cope with future adversity in a healthy manner.

Health surveillance and development of children with congenital Zika Virus syndrome: an integrative literature review

Objective:

To identify scientific knowledge about the attention to health surveillance and development of Brazilian children under the age of three years involving the Congenital Zika virus (ZIKV) Syndrome.

Data sources:

This is an integrative literature review of primary studies with Brazilian children under three years of age from 2015 to 2019. The searches were carried out in the databases Latin American and Caribbean Literature in Health Sciences (LILACS), US National Library of Medicine (PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL), SCOPUS and Web of Science. It was carried out by crossing the keywords in English (child, child development and Zika virus) and in Portuguese (criança, desenvolvimento infantil e Zika vírus), with the combination of the Boolean operator “AND”.

Data synthesis:

The knowledge produced is related to the specific health and development problems of children affected by the Congenital ZIKV Syndrome, with clinical characteristics, care demands, multiprofessional performance, health monitoring and surveillance needs.

Conclusions:

This integrative review synthesized scientific knowledge by adding aspects that reinforce the relevance of appropriate approaches to assess and care for children, linked to the engagement of caregivers, the need to document, evaluate and track the situations of children in early childhood and long-term, management coordination of care and its challenges in the context of primary health care.

The influence of the quality in daycare environments on children’s motor development between six to 15 months old

Abstract Objectives: to analyze the influence of the quality in the environment on children’s motor development between six to 15 months old attending early childhood education centers. Methods: a cross-sectional and analytical study addressing children’s motor development between six to 15 months old, both sexes, enrolled in nursery (0-12 months) and preschoolers (12-24 months). The Affordances in the Home Environment for Motor Development-Infant Scale and Alberta Infant Motor Scale were used in the Brazilian versions Results: the sample was comprised of 104 children and 30 early childhood education centers: presenting a mean age of 9.15 months, 88% attended full-time and 12% part-time schooling (mornings or afternoons). One center was classified with a low Affordances, 26 were considered Sufficient, and three were Adequate. Of the participating children, 40% presented typical motor development. The higher levels of Affordances suggest better motor development, and lower levels of suspected delayed motor development. Conclusion: the environments of early childhood education centers influence children’s motor performance, especially daily activities and the use of toys. The lower the Affordances level, more likely children are suspected of delayed motor development.

Exploring Perinatal Indicators of Infant Social-Emotional Development: A Review of the Replicated Evidence

The importance of infant social-emotional development for outcomes across the lifecourse has been amply demonstrated. Despite this, most screening measures of social-emotional development are designed for children 18 months of age and over, with a clear gap in earlier infancy. No systematic review has yet harvested the evidence for candidate indicators in the perinatal window. This paper examines modifiable risk and protective factors for two seminal early markers of social-emotional development: attachment security and behavioral regulation mid-infancy. We searched meta-analytic and longitudinal studies of developmental relationships between modifiable exposures in the perinatal window (pregnancy to 10 months postpartum) and attachment and behavioral regulation status measured between 12 and 18 months. Six electronic databases were used: ERIC, PsycINFO, Medline Complete, Informit, Embase, and Scopus. Twelve meta-analytic reviews and 38 original studies found replicated evidence for 12 indicators across infant, caregiving, and contextual domains predictive of infant behavioral regulation and attachment status between 12 and 18 months. Key among these were caregiving responsiveness, maternal mental health, couple relationship, and SES as a contextual factor. Perinatal factors most proximal to the infant had the strongest associations with social-emotional status. Beyond very low birthweight and medical risk, evidence for infant-specific factors was weaker. Risk and protective relationships were related but not always inverse. Findings from this review have the potential to inform the development of reliable tools for early screening of infant social-emotional development for application in primary care and population health contexts.

Resilience-promoting policies and contexts for children of color in the United States: Existing research and future priorities

The health status of children in the United States varies by racial and ethnic, shaped by an interrelated set of systems that disadvantage children of color in the United States. In this article, we argue for a broad view of resilience, in both research and policy, that views resilience not just as a property of individuals but also as a characteristic of social contexts and policies. Accordingly, we describe the empirical evidence for policies and contexts as factors that can improve health among children and families that are deprived of equal opportunities and resources due to structural racism. We discuss the evidence and opportunities for policies and interventions across a variety of societal systems, including programs to promote economic and food security, early education, health care, and the neighborhood and community context. Based on this evidence and other research on racism and resilience, we conclude by outlining some directions for future research.

Supporting families to protect child health: Parenting quality and household needs during the COVID-19 pandemic

BACKGROUND

Supportive parenting is critical for promoting healthy child development in the face of stressors, such as those occurring during COVID-19. Here, we address a knowledge gap regarding specific household risk factors associated with parenting quality during the pandemic and incorporate first-person accounts of family challenges and needs.

METHODS

Mixed methods were applied to data collected between April 14th - 28th, 2020 from the "Parenting During the Pandemic" survey. Participants included 656 primary caregivers (e.g., mothers, fathers, foster parents) of least one child age 1.5-8 years of which 555 (84.6%) responded to at least one parenting questionnaire. Parenting quality was assessed across stressful, negative, and positive parenting dimensions. Household risk was examined across pandemic- linked (e.g., caregiver depression, unmet childcare needs) and stable factors (i.e., annual income, mental illness history). Significant correlates were examined with regressions in Mplus. Thematic analysis identified caregiver challenges and unmet needs from open-ended questions.

FINDINGS

Caregiver depression, higher child parity, unmet childcare needs, and relationship distress predicted lower-quality parenting. Caregiver depression was the most significant predictor across every parenting dimension, with analyses indicating medium effect sizes, ds = .39 - .73. Qualitative findings highlighted severe strains on parent capacities including managing psychological distress, limited social supports, and too much unstructured time.

INTERPRETATIONS

Lower quality parenting during COVID-19 is associated with multiple household and pandemic risk factors, with caregiver depression consistently linked to parent- child relationship disruptions. Focused efforts are needed to address caregiver mental health to protect child health as part of the pandemic response.

Supporting families to protect child health: Parenting quality and household needs during the COVID-19 pandemic

Background

Supportive parenting is critical for promoting healthy child development in the face of stressors, such as those occurring during COVID-19. Here, we address a knowledge gap regarding specific household risk factors associated with parenting quality during the pandemic and incorporate first-person accounts of family challenges and needs.

Methods

Mixed methods were applied to data collected between April 14th - 28th, 2020 from the “Parenting During the Pandemic” survey. Participants included 656 primary caregivers (e.g., mothers, fathers, foster parents) of least one child age 1.5–8 years of which 555 (84.6%) responded to at least one parenting questionnaire. Parenting quality was assessed across stressful, negative, and positive parenting dimensions. Household risk was examined across pandemic- linked (e.g., caregiver depression, unmet childcare needs) and stable factors (i.e., annual income, mental illness history). Significant correlates were examined with regressions in Mplus. Thematic analysis identified caregiver challenges and unmet needs from open-ended questions.

Findings

Caregiver depression, higher child parity, unmet childcare needs, and relationship distress predicted lower-quality parenting. Caregiver depression was the most significant predictor across every parenting dimension, with analyses indicating medium effect sizes, ds = .39 - .73. Qualitative findings highlighted severe strains on parent capacities including managing psychological distress, limited social supports, and too much unstructured time.

Interpretations

Lower quality parenting during COVID-19 is associated with multiple household and pandemic risk factors, with caregiver depression consistently linked to parent- child relationship disruptions. Focused efforts are needed to address caregiver mental health to protect child health as part of the pandemic response.

Building Healthy Children: A preventive intervention for high-risk young families

The Building Healthy Children (BHC) home-visiting preventive intervention was designed to provide concrete support and evidence-based intervention to young mothers and their infants who were at heightened risk for child maltreatment and poor developmental outcomes. This paper presents two studies examining the short- and long-term effectiveness of this program at promoting positive parenting and maternal mental health, while preventing child maltreatment and harsh parenting. It also examines the intervention's sustained effect on child symptomatology and self-regulation. At baseline, young mothers and their infants were randomly assigned to receive BHC or Enhanced Community Standard. Families were assessed longitudinally across four time points. Data were also collected from the child's teacher at follow-up. Mothers who received BHC evidenced significant reductions in depressive symptoms at mid-intervention, which was associated with improvements in parenting self-efficacy and stress as well as decreased child internalizing and externalizing symptoms at postintervention. The follow-up study found that BHC mothers exhibited less harsh and inconsistent parenting, and marginally less psychological aggression. BHC children also exhibited less externalizing behavior and self-regulatory difficulties across parent and teacher report. Following the impactful legacy of Dr. Edward Zigler, these findings underline the importance of early, evidence-based prevention to promote well-being in high-risk children and families.

A scoping review of parental roles in rehabilitation interventions for children with developmental delay, disability, or long-term health condition

The importance of parental roles in rehabilitation interventions (i.e. the tasks and responsibilities assigned to parents in intervention) is widely reported but there is a paucity of information regarding the tasks linked with specific parental roles. A rigorous scoping review was conducted to understand the various roles that parents of children with developmental delays, disabilities, and long-term health conditions perform in intervention and the tasks and responsibilities associated with each role. The results confirm that parents take on distinct intervention roles which can be placed on a continuum from passive to active responsibility. Some parental roles are clearly associated with tasks completed in-session, some are linked with out-of-session tasks while others entail a combination of in-and out-of-session tasks. The in-session tasks linked with the Learner role emerged as central to enabling parents to assume other in-and out-of-session roles. The results also highlight the influence of the parent-professional relationship on the type of roles parents take on in their child's intervention. The findings of the scoping review serve as the initial step in generating items for a tool to measure the type of roles that parents assume in intervention to empirically test the relationship between these roles and parental engagement.

Unpacking the Impacts of a Universal Parenting Program on Child Behavior

This study examined the theory of change of the ACT Raising Safe Kids parenting program, including whether intervention effects on children's behavior problems were explained by improvements in mothers' reported parenting practices, as well as whether baseline child behavior problems moderated these relations. Adult mothers of 3-to 8-year-old Brazilian children were assigned to the intervention (n = 97) or control (n = 46) groups. Results showed that the intervention improved mothers' perceptions of their parenting practices (positive discipline, emotional and behavioral regulation, and communication). Intervention-induced reductions in children's internalizing and externalizing behavior problems were mediated by improvements in mothers' emotional and behavioral regulation. Program effects were strongest for children with high levels of baseline behavior problems.

Frühgeburtlichkeit und langfristige Folgen bis ins Schulalter

Zusammenfassung. Theoretischer Hintergrund: Frühgeborene (FG) haben ein erhöhtes langfristiges Entwicklungsrisiko. Dennoch gibt es in Deutschland kein konzertiertes Vorgehen zur Nachsorge bis ins Schulalter. Die heutigen Erkenntnisse zu Entwicklungsstörungen sind Grundlage einer qualifizierten Förderung. Fragestellung: Wie hoch sind Schulrückstellungsraten bei FG? Wie wird den schulischen Bedürfnissen FG Rechnung getragen? Methode: Evaluation der Schulrückstellung in einer aktuellen Kohorte sehr kleiner FG und qualitative Befragung von Lehrer_innen. Ergebnisse: Das Risiko für Schulrückstellungen ist bei FG erhöht. Lehrer_innen haben ein limitiertes Wissen zu Bedürfnissen FG und gleichzeitig hilfreiche Vorschläge für spezifische Förderung im Unterricht. Diskussion und Schlussfolgerung: Langfristige entwicklungsneurologische Nachsorge für FG ist dringend empfohlen, um potenzielle Probleme früh zu identifizieren, Interventionen zu initiieren und eine optimale Entfaltung des Entwicklungspotentials zu fördern.