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Cinà IV, Lindberg L, Enebrink P. "All Children in Focus": Effects of a Universal Parenting Program at a 6-Month Follow-Up in a Randomized Controlled Trial in Sweden. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:673-684. [PMID: 38748316 PMCID: PMC11111508 DOI: 10.1007/s11121-024-01681-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2024] [Indexed: 05/23/2024]
Abstract
Parenting programs have been shown to empower parents and prevent mental health problems in children. However, few programs are designed to promote wellbeing, which led to the development of the Swedish-promotive universal program, "All Children in Focus" (ACF). This study aimed to understand the effects of parents' participation in the ACF program on parents' emotion regulation and parenting practices over a 6-month follow-up and if intervention-produced changes predict child wellbeing (CW). Parental self-efficacy (PSE) was also included to assess the relation with parental outcomes and CW. This is an evaluation of a multicenter randomized waitlisted control trial conducted in Stockholm County, Sweden, with parents of children aged 3 to 12 years (n = 621) in 2012. Parents were randomized 1:1 to enter the program or to a waitlist. Questionnaires were completed by parents at baseline, post-intervention, and 6 months post-baseline. We used generalized mixed modeling to test effects on parental outcomes over time and regression analyses to study the predictive role of parental outcomes on CW. From baseline to the post- and to the 6-month follow-ups, parents in the intervention group reported greater levels of emotion regulation skills, cognitive reappraisal, and positive parenting than did parents in the control group. A decrease in negative and harsh parenting was evident in both groups, although it was greater in the intervention group. An increase in PSE was associated with high negative parenting at baseline in the intervention group. Child gender moderated positive parenting, suggesting that parents of girls in the intervention group had more favorable development of positive strategies. The findings indicate that a change in PSE predicts a change in CW at 6 months. The ACF program can be used to strengthen and develop parenting. This study advances our knowledge about the potential advantages of using a health-promoting approach to strengthen the wellbeing of families in the general population. Clinical trial registration: ISRCTN70202532 Current Controlled Trials.
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Affiliation(s)
| | - Lene Lindberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
- Center for Epidemiology and Community Medicine Region Stockholm, Box 45436, S-104 31, Stockholm, Sweden.
| | - Pia Enebrink
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Sampaio F, Nystrand C, Feldman I, Mihalopoulos C. Evidence for investing in parenting interventions aiming to improve child health: a systematic review of economic evaluations. Eur Child Adolesc Psychiatry 2024; 33:323-355. [PMID: 35304645 PMCID: PMC10869412 DOI: 10.1007/s00787-022-01969-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 03/03/2022] [Indexed: 12/01/2022]
Abstract
A comprehensive review of the economic evidence on parenting interventions targeting different aspects of child health is lacking to support decision-making. The aim of this review is to provide an up to date synthesis of the available health economic evidence for parenting interventions aiming to improve child health. A systematic review was conducted with articles identified through Econlit, Medline, PsychINFO, and ERIC databases. Only full economic evaluations comparing two or more options, considering both costs and outcomes were included. We assessed the quality of the studies using the Drummond checklist. We identified 44 studies of varying quality that met inclusion criteria; 22 targeting externalizing behaviors, five targeting internalizing problems, and five targeting other mental health problems including autism and alcohol abuse. The remaining studies targeted child abuse (n = 5), obesity (n = 3), and general health (n = 4). Studies varied considerably and many suffered from methodological limitations, such as limited costing perspectives, challenges with outcome measurement and short-time horizons. Parenting interventions showed good value for money in particular for preventing child externalizing and internalizing behaviors. For the prevention of child abuse, some programs had the potential of being cost-saving over the longer-term. Interventions were not cost-effective for the treatment of autism and obesity. Future research should include a broader spectrum of societal costs and quality-of-life impacts on both children and their caregivers.
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Affiliation(s)
- Filipa Sampaio
- Department of Public Health and Caring Sciences, Uppsala University, BMC, Husargatan 3 (Entry A11), 751 22, Uppsala, Sweden.
| | - Camilla Nystrand
- Department of Public Health and Caring Sciences, Uppsala University, BMC, Husargatan 3 (Entry A11), 751 22, Uppsala, Sweden
| | - Inna Feldman
- Department of Public Health and Caring Sciences, Uppsala University, BMC, Husargatan 3 (Entry A11), 751 22, Uppsala, Sweden
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Cathrine Mihalopoulos
- School of Health and Social Development, Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
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Sarkadi A, Thell M, Fängström K, Dahlberg A, Fäldt A, Pérez-Aronsson A, Warner G, Eriksson M. Are We Ready to Really Hear the Voices of Those Concerned? Lessons Learned from Listening to and Involving Children in Child and Family Psychology Research. Clin Child Fam Psychol Rev 2023; 26:994-1007. [PMID: 37700107 PMCID: PMC10640438 DOI: 10.1007/s10567-023-00453-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2023] [Indexed: 09/14/2023]
Abstract
A changing view of children, accelerated by the Convention of the Rights of the Child (UN in Convention on the rights of the child, UN Doc. A/RES/44/25, 1989, http://www2.ohchr.org/english/law/pdf/crc.pdf ) has shifted the landscape of child and family research over the last few decades. Once viewed with low credibility and operating outside the interpretive framework of adult researchers, the rights-bearing child is increasingly recognized not only as having the capacity but also the right to participate in research. More recently, this movement has transitioned from the direct engagement of children as research participants-now considered commonplace, although less so for those who are structurally vulnerable-to the involvement of children in research design, review, conduct, and dissemination. Yet, both practical and ethical challenges remain. While children have the right to participation, they also have the right to protection. In this commentary, we set out to: (i) lay forth epistemic, child rights, and child sociology arguments for doing research about, with and by children and youth; (ii) recount our own journey of including children and youth in research to demonstrate the unique knowledge and insights gained through these approaches; and (iii) offer lessons learned on how to engage children and youth in research, including the involvement of structurally vulnerable groups.
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Affiliation(s)
- Anna Sarkadi
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
| | - Maria Thell
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Karin Fängström
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Anton Dahlberg
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Anna Fäldt
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Anna Pérez-Aronsson
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Georgina Warner
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Maria Eriksson
- Department of Social Sciences, Marie Cederschiöld University, Stockholm, Sweden
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Korpilahti-Leino T, Luntamo T, Ristkari T, Hinkka-Yli-Salomäki S, Pulkki-Råback L, Waris O, Matinolli HM, Sinokki A, Mori Y, Fukaya M, Yamada Y, Sourander A. Single-Session, Internet-Based Cognitive Behavioral Therapy to Improve Parenting Skills to Help Children Cope With Anxiety During the COVID-19 Pandemic: Feasibility Study. J Med Internet Res 2022; 24:e26438. [PMID: 35138265 PMCID: PMC9009379 DOI: 10.2196/26438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/19/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background The COVID-19 pandemic has had a major impact on families’ daily routines and psychosocial well-being, and technology has played a key role in providing socially distanced health care services. Objective The first objective of this paper was to describe the content and delivery of a single-session, internet-based cognitive behavioral therapy (iCBT) intervention, which has been developed to help parents cope with children’s anxiety and manage daily situations with their children. The second objective was to report user adherence and satisfaction among the first participants who completed the intervention. Methods The Let’s Cope Together intervention has been developed by our research group. It combines evidence-based CBT elements, such as psychoeducation and skills to manage anxiety, with parent training programs that strengthen how parents interact with their child and handle daily situations. A pre-post design was used to examine user satisfaction and the skills the parents learned. Participants were recruited using advertisements, media activity, day care centers, and schools and asked about background characteristics, emotional symptoms, and parenting practices before they underwent the iCBT. After they completed the 7 themes, they were asked what new parenting skills they had learned from the iCBT and how satisfied they were with the program. Results Of the 602 participants who filled in the baseline survey, 196 (32.6%) completed the program’s 7 themes, and 189 (31.4%) completed the postintervention survey. Most (138/189, 73.0%) of the participants who completed the postintervention survey were satisfied with the program and had learned skills that eased both their anxiety (141/189, 74.6%) and their children’s anxiety (157/189, 83.1%). The majority (157/189, 83.1%) reported that they learned how to organize their daily routines better, and just over one-half (100/189, 53.0%) reported that the program improved how they planned each day with their children. Conclusions The single-session iCBT helped parents to face the psychological demands of the COVID-19 pandemic. Future studies should determine how the participation rate and adherence can be optimized in digital, universal interventions. This will help to determine what kinds of programs should be developed, including their content and delivery.
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Affiliation(s)
- Tarja Korpilahti-Leino
- Research Centre for Child Psychiatry, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland.,INVEST Child Psychiatry, INVEST Research Flagship Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - Terhi Luntamo
- Research Centre for Child Psychiatry, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland.,INVEST Child Psychiatry, INVEST Research Flagship Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland.,Department of Child Psychiatry, Turku University Hospital, Turku, Finland
| | - Terja Ristkari
- Research Centre for Child Psychiatry, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland.,INVEST Child Psychiatry, INVEST Research Flagship Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - Susanna Hinkka-Yli-Salomäki
- Research Centre for Child Psychiatry, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland.,INVEST Child Psychiatry, INVEST Research Flagship Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - Laura Pulkki-Råback
- Research Centre for Child Psychiatry, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland.,INVEST Child Psychiatry, INVEST Research Flagship Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - Otto Waris
- Research Centre for Child Psychiatry, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland.,INVEST Child Psychiatry, INVEST Research Flagship Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - Hanna-Maria Matinolli
- Research Centre for Child Psychiatry, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland.,INVEST Child Psychiatry, INVEST Research Flagship Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - Atte Sinokki
- Research Centre for Child Psychiatry, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland.,INVEST Child Psychiatry, INVEST Research Flagship Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - Yuko Mori
- Research Centre for Child Psychiatry, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland.,INVEST Child Psychiatry, INVEST Research Flagship Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - Mami Fukaya
- Department of Psychology and Human Developmental Sciences, Graduate School of Education and Human Development, Nagoya University, Nagoya, Japan
| | - Yuko Yamada
- Section of Medical Care and Consultation, Nagoya City Central Care Center for Disabled Children, Nagoya, Japan
| | - Andre Sourander
- Research Centre for Child Psychiatry, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland.,INVEST Child Psychiatry, INVEST Research Flagship Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland.,Department of Child Psychiatry, Turku University Hospital, Turku, Finland
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Fält E, Salari R, Fabian H, Sarkadi A. Facilitating implementation of an evidence-based method to assess the mental health of 3-5-year-old children at Child Health Clinics: A mixed-methods process evaluation. PLoS One 2020; 15:e0234383. [PMID: 32520968 PMCID: PMC7286525 DOI: 10.1371/journal.pone.0234383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 05/26/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND A number of instruments for identifying mental health problems in children are available, but there is limited knowledge about how to successfully implement their use in routine practice. The Strengths and Difficulties Questionnaire (SDQ) is an instrument with sound psychometric properties. Because using multi-informant SDQs when assessing young children has been emphasized, parent- and preschool teacher reports on the SDQ were introduced at Child Health Clinics in a Swedish municipality. This paper aimed to describe a facilitation programme developed to support the introduction of SDQ in clinical practice and evaluate how nurses perceived the facilitation strategies used. Moreover, the dose (delivery) and reach (response rate and population coverage) of the questionnaires were assessed. METHODS The mixed-methods process evaluation was guided by Moore et al.'s framework. Process data were excerpted from monitoring data, the trial database, research group documents, study materials, group interviews with nurses, and a survey on nurses' opinions and experiences of the screening method and the implementation process. Data were analysed using descriptive statistics and qualitative content analysis. RESULTS Facilitation strategies used included: educational meetings, educational outreach visits, newsletters, facilitative administrative support, and adaptations made in procedures and materials when required. Although nurses described a variety of barriers at the organisational and individual level, they were in favour of using the SDQ in clinical practice and emphasised the importance of the facilitation strategies used for its implementation. While dose levels (77-91%) indicated that nurses essentially delivered the intervention as intended, parental response rates remained between 54 and 63% and population coverage at around 50%, throughout the intervention period. CONCLUSION The facilitation program was perceived to support the implementation of the SDQ at the yearly check-ups in the child healthcare setting, but further efforts are required to reach all families.
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Affiliation(s)
- Elisabet Fält
- Department of Public Health and Caring Sciences, Child Health and Parenting (CHAP), Uppsala University, Uppsala, Sweden
- * E-mail:
| | - Raziye Salari
- Department of Public Health and Caring Sciences, Child Health and Parenting (CHAP), Uppsala University, Uppsala, Sweden
| | - Helena Fabian
- Department of Public Health and Caring Sciences, Child Health and Parenting (CHAP), Uppsala University, Uppsala, Sweden
| | - Anna Sarkadi
- Department of Public Health and Caring Sciences, Child Health and Parenting (CHAP), Uppsala University, Uppsala, Sweden
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Social Factors Associated with the Effectiveness of a Spanish Parent Training Program-An Opportunity to Reduce Health Inequality Gap in Families. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072412. [PMID: 32252297 PMCID: PMC7177529 DOI: 10.3390/ijerph17072412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 11/16/2022]
Abstract
Parent training programs (PTPs) have been used extensively in Anglo-Saxon countries, but less so in Southern Europe. Several characteristics of families have been linked to effective parenting and positive development of children, but few studies have examined the social determinants of the effectiveness of PTPs. The Parenting Skills Program for families (PSP) is a PTP from Spain. This study aimed to identify the social characteristics (sex, age, country of birth, marital status, educational level, and employment status) of parents that determine the success of the PSP in relation to social support, parenting skills, parental stress, and negative behaviors among children. A quasi-experimental study with a prepost design with no control group was used. We conducted a survey before (T0) and after the intervention (T1). Sample size was 216. We fit multiple logistic regression models. Parenting skills increased more among parents with a lower educational level. Parents' stress decreased more among parents who had a lower educational level, were unemployed, and were men. Social support increased among parents who were younger, unemployed, or non-cohabiting. We found no significant differences in the effect on children's negative behaviors according to the social factors evaluated. The PSP is effective for socioeconomically diverse families, but the success differs according to the parents' social profile. Unlike most previous studies, the results were better among more socially disadvantaged people, highlighting the potential of this kind of intervention for reducing the social inequality gap between groups.
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