Parent-focused child maltreatment prevention: improving assessment, intervention, and dissemination with technology

Technology-Assisted Parenting Interventions for Families Experiencing Social Disadvantage: a Meta-Analysis

Technology-assisted interventions have been identified as a means to increase accessibility and enhance engagement of parenting programs. The current meta-analytic review examines the effectiveness of these interventions in families experiencing social disadvantage. A literature search was conducted spanning March 2007-June 2019. Nine studies met inclusion criteria (total of 864 participants) which included an evaluation of a parenting intervention for families with at least one of the following demographic challenges, low socioeconomic status, single parenthood, and/or young parenthood. Interventions (or a component of the intervention) were delivered by computer, cell phone, smartphone, and/or tablet. Data were organized into three categories: parental psychological well-being (e.g., self-esteem, social support), parenting (e.g., observed or self-reported parenting behavior), and child behavior (e.g., disruptive behavior). Effect sizes (Hedges' g) were calculated and moderators (i.e., contact with an interventionist, intervention length, publication year, % female parents, mean parent age, parental education, % minority, and child age) were examined through Q-statistics and meta-regression, as appropriate. Intervention showed a near-significant impact on parental psychological well-being (g = .35, p = .051). Furthermore, interventions that did not include direct contact with an interventionist showed no evidence of effectiveness (g = - .02); interventions that incorporated contact were significantly more effective (g = .68). In addition, intervention length moderated intervention effectiveness; shorter interventions yielded greater improvements in well-being, compared with longer interventions. Interventions were also associated with significant improvements in parenting (g = .38) and child behavior (g = .39). These findings provide support for the use of technology-assisted parenting interventions in populations experiencing social disadvantage.

[Cost and potential savings generated by a paediatrics e-Health web site for parents]

INTRODUCTION

There are few studies on e-Health interventions directed at parents that analyse their costs and any potential savings that may occur. The aims of this study consisted of calculating the costs of the development and maintenance of paediatric web site for parents, including the costs per visit and per visitor, and the potentially savings made as regards medical visits avoided as a result of its use.

METHODS

The technology costs as well as the work of the professionals were considered as costs of the web site. The calculation of the cost of the professionals and the potential savings were based on the official fees and public prices of the Andalusian Public Health Service.

RESULTS

During 5years and 6months of the study, the total cost of the web site was €45,201.56. The cost per visit received was €0.0155€, and €0.0186 for each single visitor. Among the 516 users that took part in the study, face-to-face visits to Primary Care paediatric clinics were avoided, as well as those to Paediatric Emergency Department, at a savings of €22,263.89.

CONCLUSIONS

The costs of developing a paediatric e-Health website for parents written in Spanish, using existing and free technologies, are low compared to other forms of e-Health development. Furthermore, the costs are considerably low if they are divided by the total number of visits or the number of visitors. There is also a considerable potential financial saving on contributing to avoid face-to-face visits.

Engagement and Adherence With ezPARENT, an mHealth Parent-Training Program Promoting Child Well-Being

Mobile health (mHealth) interventions use mobile technology (tablets and smartphones) delivery platforms for interventions to improve health outcomes. Despite growing acceptance, there is little understanding of how consumers engage with and adhere to mHealth interventions. This study analyzes usage data from the intervention arm ( n = 42) of a randomized clinical trial testing the efficacy of the ezPARENT program and provides recommendations for using engagement and adherence metrics. Engagement was measured by parent usage (duration, frequency, and activity) of ezPARENT and adherence using an adherence index (the sum of individual modules completed, number of visits to ezPARENT, and maximum time between visits). Parents spent M = 37.15 min per module and had M = 13.55 program visits in the 3-month intervention period. Parents visited the program over a period of M = 69.5 days and completed 82% of the modules. These data provide support that parents will use intervention programs delivered digitally; engagement and adherence metrics are useful in evaluating program uptake.

Stakeholder perspectives on a toolkit to enhance caregiver participation in community-based child mental health services

Client engagement in services is a critical element of effective community-based child and family mental health service delivery. Caregiver engagement is particularly important, as caregivers often serve as gatekeepers to child mental health care and typically must consent for services, facilitate service attendance, and are often the target of intervention themselves. Unfortunately, caregiver engagement has been identified as a significant challenge in community-based child mental health services. To address this gap, the Parent And Caregiver Active Participation Toolkit (PACT), which includes therapist training and participation tools for caregivers and therapists, was developed. Stakeholders' perspectives regarding the delivery of interventions designed to improve the quality and effectiveness of community-based care are essential to understanding the implementation of such interventions in routine service settings. As such, this mixed methods study examined the perspectives of 12 therapists, 8 caregivers, and 6 program managers who participated in a community-based randomized pilot study of PACT. Therapists, caregivers, and program managers agreed that PACT was acceptable, appropriate, and feasible to use in community settings and that both changes in therapist practices and caregiver participation resulted from implementing PACT. Some variable perceptions in the utility of the therapist training components were identified, as well as barriers and facilitators of PACT implementation. Results expand the parent pilot study's findings as well as complement and expand the literature on training community providers in evidence-based practices. (PsycINFO Database Record

Randomized Trial of the Parent And Caregiver Active Participation Toolkit for Child Mental Health Treatment

The purpose of this pilot study was to examine preliminary feasibility, acceptability, and effectiveness of a toolkit (Parent And Caregiver Active Participation Toolkit) to increase parent participation in community-based child mental health services. Study participants included 29 therapists (93% female; M age = 34.1 years; 38% Latino) and 20 parent/child dyads (children 80% female; M age = 8.6 years; parents 40% Latino) in 6 diverse community mental health clinics. Therapists were randomly assigned to standard care or the toolkit with standard care. Therapist and parent survey data and observational coding of treatment sessions were utilized. Mean comparisons and repeated measures analyses were used to test differences between study conditions over 4 months. Results supported preliminary feasibility and acceptability of the toolkit, with therapists assigned to the toolkit participating in ongoing training, adhering to toolkit use, and perceiving the toolkit as feasible and acceptable within their setting. Results preliminarily demonstrated improvement in therapists' job attitudes, as well as actual use of parent engagement strategies. Results also preliminarily demonstrated increases in parent participation in child therapy sessions and more regular attendance, as well as some indication of support for perceived treatment effectiveness. Overall, results suggest the feasibility, acceptability, and potential effectiveness of the toolkit to enhance therapist job attitudes; practices that support parent engagement, parent engagement itself, and consumer perspectives on treatment outcomes; and the potential promise of future research in the area of parent participation interventions in child mental health services.

Let's get technical: Enhancing program evaluation through the use and integration of internet and mobile technologies

Program evaluation has become increasingly important, and information on program performance often drives funding decisions. Technology use and integration can help ease the burdens associated with program evaluation by reducing the resources needed (e.g., time, money, staff) and increasing evaluation efficiency. This paper reviews how program evaluators, across disciplines, can apply internet and mobile technologies to key aspects of program evaluation, which consist of participant registration, participant tracking and retention, process evaluation (e.g., fidelity, assignment completion), and outcome evaluation (e.g., behavior change, knowledge gain). In addition, the paper focuses on the ease of use, relative cost, and fit with populations. An examination on how these tools can be integrated to enhance data collection and program evaluation is discussed. Important limitations of and considerations for technology integration, including the level of technical skill, cost needed to integrate various technologies, data management strategies, and ethical considerations, are highlighted. Lastly, a case study of technology use in an evaluation conducted by the Clearinghouse for Military Family Readiness at Penn State is presented and illustrates how technology integration can enhance program evaluation.

Technology-assisted Interventions for Parents of Young Children: Emerging Practices, Current Research, and Future Directions

Technology can potentially expand the reach and cut the costs of providing effective, evidence-based interventions. This paper reviews existing publications that describe the application and evaluation of technology-assisted interventions for parents of young children. A broad review of the early childhood literature revealed 48 studies describing technology-assisted parent education and interventions. Across these studies, multiple forms of technology were used, including web-based platforms, discussion forums, mobile devices, and video conferencing. Results are described moving from feasibility and acceptability of technology-based delivery systems to more rigorous evaluations examining their impact on parent and child outcomes. Potential exists for technology to deliver interventions to parents. Limitations are discussed including differential acceptability and elevated attrition associated with internet-only intervention delivery.

Technology-Based Innovations in Child Maltreatment Prevention Programs: Examples from SafeCare®

Each year, hundreds of thousands of children in the U.S. are victims of child maltreatment. Experts recommend behavioral, skill-based parent training programs as a strategy for the prevention of child abuse and neglect. These programs can be enhanced using innovative technology strategies. This paper presents a brief history of the use of technology in SafeCare®, a home visiting program shown to prevent child neglect and physical abuse, and highlights current work that takes a technology-based hybrid approach to SafeCare delivery. With this unique approach, the provider brings a tablet computer to each session, and the parent interacts with the software to receive psychoeducation and modeling of target skills. The provider and parent then work together to practice the targeted skills until mastery is achieved. Initial findings from ongoing research of both of these strategies indicate that they show potential for improving engagement and use of positive parenting skills for parents and ease of implementation for providers. Future directions for technology enhancements in SafeCare are also presented.

Can social networking be used to promote engagement in child maltreatment prevention programs? Two pilot studies

Introduction:

Child maltreatment is one of the United States' most significant public health problems. In efforts to prevent maltreatment experts recommend use of Behavioral Parent Training Programs (BPTs), which focus on teaching skills that will replace and prevent maltreating behavior. While there is research to support the effectiveness of BPTs in maltreatment prevention, the reach of such programs is still limited by several barriers, including poor retention of families in services. Recently, new technologies have emerged that offer innovative opportunities to improve family engagement. These technologies include smartphones and social networking; however, very little is known about the potential of these to aid in maltreatment prevention. The primary goal of this study was to conduct 2 pilot exploratory projects.

Methods:

The first project administered a survey to parents and providers to gather data about at-risk parents' use of smartphones and online social networking technologies. The second project tested a social networking-enhanced brief parenting program with 3 intervention participants and evaluated parental responses.

Results:

Seventy-five percent of parents surveyed reported owning a computer that worked. Eighty-nine percent of parents reported that they had reliable Internet access at home, and 67% said they used the Internet daily. Three parents participated in the intervention with all reporting improvement in parent-child interaction skills and a positive experience participating in the social networking-enhanced SafeCare components.

Conclusion:

In general, findings suggest that smartphones, social networking, and Facebook, in particular, are now being used by individuals who show risk factors for maltreatment. Further, the majority of parents surveyed in this study said that they like Facebook, and all parents surveyed said that they use Facebook and have a Facebook account. As well, all saw it as a potentially beneficial supplement for future parents enrolling in parenting programs.

Computer-assisted therapies: examination of therapist-level barriers to their use

Despite enthusiasm in the field for their potential ease of dissemination, little work has examined whether practicing clinicians are willing and able to use computer-assisted therapies (i.e., computerized treatments designed to be administered with therapist support). For therapists to use these tools, they require access to computer equipment, the skills needed to use the equipment, and willingness to adopt the technology in treatment. This study examined these three factors using survey data from a national sample of mental health clinicians (N=1,067). Respondents reported on their access to technology and computer fluency, in addition to completing the Computer-Assisted Therapy Attitudes Scale (CATAS), a measure of therapist attitudes designed for this study. Overall, the majority of therapists (90.7%) reported access to at least one computer at work and self-reported computer fluency levels were high. On average, therapists held positive attitudes towards computer-assisted therapies, although expressed concern that these technologies might damage rapport and did not feel that these technologies would improve treatment outcomes. Predictors of positive attitudes included greater general openness toward new treatments, greater comfort with computers, and easier access to technology at work (all ps<.01). Results suggested that, on the whole, therapists may be likely to integrate computer-assisted therapies into their clinical practice. However, therapists vary both in their ability and willingness to use these tools. Implications for the dissemination of computer-assisted therapies are discussed.

Web-based delivery of a preventive parent training intervention: a feasibility study

PROBLEM

Low enrollment and participation are common in face-to-face parenting interventions. Developing innovative delivery methods is one way to address participation barriers. The purpose of this study was to test the feasibility of a Web-based delivery model for an evidence-based behavioral parent training program.

METHODS

Parents (n = 9) completed two Web-based prototype sessions of the Chicago Parent Program delivered on an Android tablet over 2 weeks, and then participated in a post-intervention focus group. Quantitative and qualitative data were collected.

FINDINGS

The Web-based delivery adaptation was feasible and useful for low-income urban parents.

CONCLUSIONS

Our preliminary findings suggest that Web-based delivery is a feasible approach to integrating mental health prevention into systems of care. Translating interventions to alternative delivery platforms is promising for nursing to increase access to evidence-based interventions.

A randomized controlled trial evaluating the efficacy of Triple P Online with parents of children with early-onset conduct problems

OBJECTIVE

This study examined the efficacy of Triple P Online (TPOL), an eight-module intensive online positive parenting program for parents of children with early-onset disruptive behavior problems.

METHOD

One hundred and sixteen parents with 2-9-year-old children displaying early-onset disruptive behavior difficulties were randomly assigned to either the intervention condition (N = 60) or an internet-use-as-usual control group (N = 56).

RESULTS

At post-intervention assessment, parents receiving the internet intervention TPOL had significantly better outcomes on measures of problem child behavior, dysfunctional parenting styles, parents' confidence in their parenting role, and parental anger. At 6-month follow-up assessment intervention gains were generally maintained, and in some cases enhanced. Consumer satisfaction ratings for the program were high.

CONCLUSIONS

Internet-delivered self-help parenting programs appear to make a valuable contribution to a comprehensive public health approach to parenting support.

Using a Digital Frame and Pictorial Information to Enhance the SafeCare® Parent-Infant Interactions Module With a Mother with Intellectual Disabilities: Results of a Pilot Study

Parents with intellectual disabilities (ID) are disproportionately represented in the child welfare system. Parents with ID can be better served by developing curricula that support various modes of learning. Technology offers a potentially effective tool because it is visual, interactive, and self-instructional. SafeCare® is an evidence-based parenting program with flexibility to adapt its curricula while maintaining fidelity. This research presents the results of a pilot study that examined the effectiveness of an adaptation to the SafeCare® parent-infant interactions (PII) module for a mother with ID by using a digital picture frame with pictures of the mother and her infant engaged in skills that met the performance criteria for PII. A multiple-probe design across behaviors was used with the mother and her infant, showing a dramatic increase in PII skills that was maintained across 3 monthly follow-ups. Although further research is necessary, the preliminary data suggest the digital picture frame enhancement to the SafeCare® PII module may be a promising instructional tool for parents with ID.

Efficacy of child abuse and neglect prevention messages in the Florida Winds of Change campaign

Public awareness campaigns have been included in universal, communitywide, and programmatic approaches aimed at preventing child abuse and neglect. More evaluation of campaign effects is needed to identify their place on the continuum of evidence-based programs. This article reports on an efficacy study of the Florida Winds of Change campaign using a randomized experimental design. Investigators conducted an online survey of a web-based panel of Florida residents with children 18 years of age or younger living in the home. Six outcomes were measured at baseline and a 30-day follow-up. Three outcomes referred to knowledge of child development, child disciplinary techniques, and community resources for parents. Prevention attitudes or beliefs, motivation, and action were also assessed. Respondents were exposed to three public service announcements and a selection of parent resource material. Logistic regression models revealed that exposure to campaign messages was associated with significant increases in all but one of the campaign outcomes.

Commentary on using new technologies in the child maltreatment field

The articles in this special issue describe how different types of technology can be applied in the child maltreatment field to improve activities. This commentary suggests that though new technology does not necessarily make for better content, it does create exciting new possibilities that creative minds can use to advance the field. The projects described in this issue are examples of such creativity and give a glimpse of the future. However, advances in technology applications do not come without some cost and some loss. Technological approaches may reduce human interaction and result in the loss of its intangible benefits. The commentary suggests that the child maltreatment field appears ripe for broad-based application of technology in three areas: web-based professional training, self-directed interventions and prevention programs, and use of social networking technology. Finally, ideas are proposed for understanding the true cost of developing, implementing, and maintaining technological applications.