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Barton EE, Winchester C, Velez MS, Todt M, Locchetta BM, Skiba E. Field Testing the Family Behavior Support Mobile Application (FBSApp) During a Global Pandemic. J Autism Dev Disord 2024:10.1007/s10803-024-06373-8. [PMID: 38773034 DOI: 10.1007/s10803-024-06373-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 05/23/2024]
Abstract
We developed and tested an evidence-based mobile application designed to support families in using functional assessment-based intervention strategies with their young children with disabilities and challenging behaviors in home settings. Five families participated in the study. We utilized a multiple-probe across participants design to examine the effects of the FBSApp on parents' use of intervention strategies and childrens' use of challenging behaviors and replacement behaviors. We adapted our procedures to include individualized coaching to provide meaningful and effective support after the onset of the COVID-19 pandemic. A functional relation was not identified between access to FBSApp and caregiver use of strategies; however, the addition of coaching did lead to increased strategy use for two of four caregivers. A functional relation was identified between the use of the FBSApp plus coaching and CB. Families reported the app and coaching procedures favorably. We found that responsive, family-centered research CAN be conducted in spite of significant history events, and that mobile apps and virtual meeting platforms can be an accessible and efficient method for supporting families. The use of single case design allowed for flexible, yet methodologically sound procedures. More work is needed examining effective and efficient virtual supports for families.
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Affiliation(s)
| | | | - Marina S Velez
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mollie Todt
- Department of Special Education, Peabody College, Vanderbilt University, Nashville, TN, USA
| | | | - Emma Skiba
- , Williamson County School District, Williamson County, TN, USA
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McGuire A, Amaro CM, Singh MN, Brown S. Targeting Caregiver Psychopathology in Parent Management Training for Adolescents: A Scoping Review of Commercially Available Treatment Resources. CHILD & YOUTH CARE FORUM 2024; 53:269-291. [PMID: 38601299 PMCID: PMC11003757 DOI: 10.1007/s10566-023-09754-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2023] [Indexed: 04/12/2024]
Abstract
Background While parent management training (PMT) has been shown to be an effective treatment for adolescents with externalizing concerns, evidence suggests that effectiveness is not equitable across all types of families. Research suggests that caregiver psychopathology may adversely affect PMT success for adolescents. However, it remains unclear whether research on caregiver psychopathology is integrated within adolescent PMT resources (e.g., treatment manuals). Objective A scoping review of commercially available, clinician focused PMT resources was conducted to assess for information on caregiver psychopathology and clinical guidance for addressing caregiver psychopathology. Methods A search for commercially available resources was conducted among national treatment databases and book resource websites. Information on caregiver psychopathology was extracted from individual sessions of the PMT resources. Results Seven treatment resources met inclusion criteria. The majority of the treatment resources made at least one explicit comment that caregiver psychopathology may impact the course of treatment. There was very limited mention of caregiver psychopathology in skill building sections of the resources. Conclusions While most resources mentioned caregiver psychopathology, these comments lacked breadth and depth in providing clinicians with recommendations on how to tailor treatment to caregivers' needs. Recommendations are provided for how PMT programs might be improved in the future to support clinicians when faced with caregiver psychopathology by recognizing inequities and lack of diversity in resource development, using a transdiagnostic perspective (including a transdiagnostic approach to assessment of care-giver psychopathology), and integrating caregiver skill development.
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Affiliation(s)
- Austen McGuire
- Clinical Child Psychology Program, 2015 Dole Human Development Center, University of Kansas, 1000 Sunnyside Avenue, Lawrence, KS 66045-7556, USA
| | - Christina M. Amaro
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, Boston, MA 02215, USA
- Division of Behavioral Health and Center for Healthcare Delivery Science, Nemours Children’s Hospital, 1600 Rockland Road, Delaware, Wilmington, DE 19803, USA
| | - Mehar N. Singh
- Clinical Child Psychology Program, 2015 Dole Human Development Center, University of Kansas, 1000 Sunnyside Avenue, Lawrence, KS 66045-7556, USA
| | - Shaquanna Brown
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Box G-BH, Providence, RI 02912, USA
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI 02906, USA
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Pinto R, Canário C, Leijten P, Rodrigo MJ, Cruz O. Implementation of Parenting Programs in Real-World Community Settings: A Scoping Review. Clin Child Fam Psychol Rev 2024; 27:74-90. [PMID: 38062309 PMCID: PMC10920434 DOI: 10.1007/s10567-023-00465-0] [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: 11/06/2023] [Indexed: 03/08/2024]
Abstract
Implementing parenting programs in real-world community settings is fundamental to making effective programs widely available and consequently improving the lives of children and their families. Despite the literature acknowledging that the high-quality implementation of parenting programs is particularly challenging in real-world community settings, little is known about how the programs are implemented in these settings. This scoping review followed the methodological framework described by the Joanna Briggs Institute to map evidence on how evidence-based parenting programs have been implemented under real-world conditions. A systematic search of 12 scientific databases, gray literature, and the reference lists of the included studies identified 1918 records, of which 145 were included in the review. Fifty-three parenting programs were identified in studies documenting implementation in real-world community settings worldwide. Most studies included families in psychosocial risk engaged with family-support agencies. The qualitative synthesis identified several implementation outcomes, adaptations, barriers, and facilitators. Most studies reported a maximum of two implementation outcomes, mainly fidelity and acceptability. Providers frequently made adaptations, mainly to bring down barriers and to tailor the program to improve its fit. Findings highlight the need for a more detailed description of the implementation of programs, with greater consistency in terminology, operationalization, and measurement of implementation outcomes across studies. This will promote a more transparent, consistent, and accurate evaluation and reporting of implementation and increase the public health impact of parenting programs. Future studies should also assess the impact of adaptations and the cost-effectiveness and sustainability of programs in real-world community settings.
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Affiliation(s)
- Rita Pinto
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal.
| | - Catarina Canário
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Patty Leijten
- Research Institute for Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
| | - Maria José Rodrigo
- Department of Developmental Psychology and Education, Faculty of Psychology, University of La Laguna, Santa Cruz de Tenerife, Spain
| | - Orlanda Cruz
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
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Holtrop K, Piehler TF, Miller D, Young D, Tseng CF, Gray LJ. The Effectiveness of GenerationPMTO During Sustained Implementation in the Public Mental Health System: A Single-Arm Open Trial Evaluation. Behav Ther 2024; 55:248-262. [PMID: 38418038 DOI: 10.1016/j.beth.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 05/05/2023] [Accepted: 06/27/2023] [Indexed: 03/01/2024]
Abstract
To support families and reduce the burden of child mental, emotional, and behavioral problems, evidence-based parenting interventions must remain effective in real-world service delivery contexts. The purpose of the current study was to evaluate the effectiveness of the GenerationPMTO (GenPMTO) intervention during sustained implementation in the Michigan public mental health system using a single-arm open trial (pre-post) design. We also examined potential predictors of treatment response. A multilevel analysis framework was utilized to evaluate data from 365 caregivers who completed GenPMTO treatment. Results revealed significant positive improvements from pretest to posttest in all four outcome domains (i.e., parenting confidence, parenting practices, caregiver depressive symptoms, child behavior problems). When compared to group-based GenPMTO delivery, the individual delivery format was associated with significantly greater improvements in overall effective parenting practices, as well as in the subdomain of skill encouragement. Caregiver gender, caregiver educational level, and child age were all implicated as predictors of GenPMTO outcomes. These findings add to the literature by supporting the effectiveness of the GenPMTO intervention when fully integrated into mental health care practice and can inform continued efforts to provide families with evidence-based services in community settings.
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van Leuven L, Engelbrektsson J, Forster M. Reach and predictors of effects during nation-wide dissemination of the universal parenting program All Children in Focus. BMC Public Health 2023; 23:2027. [PMID: 37853429 PMCID: PMC10583325 DOI: 10.1186/s12889-023-16823-0] [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] [Received: 03/29/2023] [Accepted: 09/23/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Parenting programs have the potential to improve population health, if widely disseminated. However, wide-scale dissemination is challenging. Also, more knowledge is needed of whether parenting programs are effective for the variability of families in the general population. METHODS This study aimed to investigate who the universal parenting program All Children in Focus (ABC) reaches when offered in routine care in Sweden. A second aim was to investigate if the outcomes were predicted by factors related to family background, group leader experience, and homework completion. Questionnaires were collected before and after ABC from 1420 parents. Hierarchical regression analyses were performed to examine predictors of disruptive child behavior, parenting practices, and satisfaction. RESULTS ABC was available in about 40% of Swedish municipalities and reached a fairly representative population sample, with the exception that fewer fathers than mothers participated. The examined predictors explained a small proportion of the variance in the outcomes (2.5, 3.5 and 14.7%, respectively). Still, the effect on disruptive child behavior was statistically significantly larger for parents born in Sweden, with higher education, and older children. The effect on parenting practices was also larger for parents born in Sweden, for mothers, and for those practicing homework more frequently. Most examined predictors showed no statistically significant association with child and parenting outcomes. Parents were generally satisfied with ABC and the significant predictors of satisfaction had little practical meaning. CONCLUSIONS A fairly representative group of parents across Sweden were reached by ABC. Background variables, homework completion, and group leaders' experience explained a small proportion of variance in the outcomes. Meanwhile, the slightly lower intervention effects found for preschool children and parents born abroad calls for further investigation, since even small differences in effects can have an impact at a population level. The study also points to the importance of stressing homework completion and to increase the reach of universal parenting interventions to some underrepresented groups.
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Affiliation(s)
- Livia van Leuven
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels Väg 9, 171 65, Solna, Sweden.
| | - Johanna Engelbrektsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels Väg 9, 171 65, Solna, Sweden
| | - Martin Forster
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels Väg 9, 171 65, Solna, Sweden
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Lundgren JS, Ryding J, Ghaderi A, Bernhardsson S. Swedish parents' satisfaction and experience of facilitators and barriers with Family Check-up: A mixed methods study. Scand J Psychol 2023; 64:618-631. [PMID: 36891962 DOI: 10.1111/sjop.12913] [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] [Received: 08/23/2022] [Revised: 02/04/2023] [Accepted: 02/06/2023] [Indexed: 03/10/2023]
Abstract
Family Check-up (FCU) was introduced in Sweden more than a decade ago. Little is known about what parents experience as FCU's key mechanisms leading to changes in parenting. The aim of this study was to investigate Swedish parents' satisfaction with FCU, and their experiences of facilitators and barriers for making changes in their parenting. A mixed methods approach was employed using a parent satisfaction questionnaire (n = 77) and focus groups (n = 15). General satisfaction with FCU was adequate, with an average rating of 4 on a five-point scale (range 3.1-4.6). The analysis of quantitative and qualitative data resulted in eight themes representing facilitators and four themes representing barriers, organized into three categories: (1) access and engagement; (2) therapeutic process; and (3) program components. Ease of access to FCU facilitated initial engagement. Individual tailoring and access to FCU during different phases of change facilitated sustained engagement and change. Therapeutic process facilitators were a meaningful, supportive relationship with the provider, psychological benefits for parents and benefits for the whole family. Program components that facilitated change in parenting were new learning of parenting strategies and use of helpful techniques such as videotaping and home practice. Negative experiences with service systems prior to starting FCU, parent psychological barriers, and parent-provider mismatch were described as potential barriers. Some parents desired other program formats that were not offered, and some felt that new learning was insufficient to improve child behavior. Understanding the parent perspective can contribute to successful future work with implementing FCU.
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Affiliation(s)
- Julie S Lundgren
- Child and Youth Health Specialty Services, Center for Progress in Children's Mental Health, Regionhälsan, Region Västra Götaland, Gothenburg, Sweden
| | - Jennie Ryding
- Department of Social and Behavioural Studies, University West, Trollhättan, Sweden
| | - Ata Ghaderi
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Susanne Bernhardsson
- Research, Education, Development and Innovation Primary Health Care, Regionhälsan, Region Västra Götaland, Gothenburg, Sweden
- Department of Health and Rehabilitation, University of Gothenburg, The Sahlgrenska Academy, Institute of Neuroscience and Physiology, Gothenburg, Sweden
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Engelbrektsson J, Salomonsson S, Högström J, Sorjonen K, Sundell K, Forster M. Parent Training via Internet or in Group for Disruptive Behaviors: A Randomized Clinical Noninferiority Trial. J Am Acad Child Adolesc Psychiatry 2023; 62:987-997. [PMID: 36863414 DOI: 10.1016/j.jaac.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 01/01/2023] [Accepted: 02/21/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVE To evaluate if an internet-delivered parent training program is noninferior to its group-delivered counterpart in reducing child disruptive behavior problems (DBP). METHOD This noninferiority randomized clinical trial enrolled families seeking treatment in primary care in Stockholm, Sweden, for DBP in a child 3-11 years of age. Participants were randomized to internet-delivered (iComet) or group-delivered (gComet) parent training. The primary outcome was parent-rated DBP. Assessments were made at baseline and 3, 6, and 12 months. Secondary outcomes included child and parent behaviors and well-being and treatment satisfaction. The noninferiority analysis was determined by a one-sided 95% CI of the mean difference between gComet and iComet using multilevel modeling. RESULTS This trial included 161 children (mean age 8.0); 102 (63%) were boys. In both intention-to-treat and per-protocol analyses, iComet was noninferior to gComet. There were small differences in between-group effect sizes (d = -0.02 to 0.13) on the primary outcome with the upper limit of the one-sided 95% CI below the noninferiority margin at 3-, 6-, and 12-month follow-up. Parents were more satisfied with gComet (d = 0.49, 95% CI [0.26, 0.71]). At 3-month follow-up, there were also significant differences in treatment effect on attention-deficit/hyperactivity disorder symptoms (d = 0.34, 95% CI [0.07, 0.61]) and parenting behavior (d = 0.41, 95% CI [0.17, 0.65]) favoring gComet. At 12-month follow-up, there were no differences in any outcomes. CONCLUSION Internet-delivered parent training was noninferior to group-delivered parent training in reducing child DBP. The results were maintained at 12-month follow-up. This study supports internet-delivered parent training being used as an alternative to group-delivered parent training in clinical settings. CLINICAL TRIAL REGISTRATION INFORMATION Randomized Controlled Trial of Comet via the Internet or in Group Format; https://www. CLINICALTRIALS gov/; NCT03465384.
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Affiliation(s)
| | - Sigrid Salomonsson
- Centre for Psychiatry Research, Karolinska Institutet and Region Stockholm, Sweden
| | - Jens Högström
- Centre for Psychiatry Research, Karolinska Institutet and Region Stockholm, Sweden
| | | | - Knut Sundell
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
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Bado P, da Costa R, Bernardes C, Tripp G, Mattos P, Furukawa E. Needs assessment for behavioral parent training for ADHD in Brazil. Front Psychiatry 2023; 14:1191289. [PMID: 37575579 PMCID: PMC10415012 DOI: 10.3389/fpsyt.2023.1191289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/10/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction Attention-Deficit/Hyperactivity Disorder (ADHD) is a debilitating condition affecting children and their families worldwide. Behavioral parent training is a recommended form of empirically supported non-pharmacological intervention for young children with mild to moderate ADHD. However, access to such treatment is limited in many countries. Here we identify the treatment needs of Brazilian families with children demonstrating symptoms of ADHD, and the barriers families face in accessing behavioral treatment. Methods A qualitative needs assessment was undertaken with parents (n = 23), educators (n = 15), and healthcare providers (n = 16). Semi-structured telephone interviews were conducted, and common themes were identified through inductive coding of participants' responses. Results Participants reported a lack of accessible behavioral treatment, and delays in accessing treatment when available. The majority of parents had not received behavioral parent training, despite it being a recommended form of treatment. Parents, educators and healthcare providers strongly endorsed a need for practical tools to manage the behavior of children with ADHD. Conclusion Existing services might not meet the needs of children with ADHD and their families in Brazil. Easily accessed behavioral parent training programs are recommended to address the identified treatment gap for Brazilian children with ADHD and their families.
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Affiliation(s)
- Patricia Bado
- D’Or Institute for Research and Education, Rio de Janeiro, Brazil
- Department of Psychology, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Raquel da Costa
- D’Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Camila Bernardes
- D’Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Gail Tripp
- Okinawa Institute of Science and Technology Graduate University, Okinawa, Japan
| | - Paulo Mattos
- D’Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Emi Furukawa
- Okinawa Institute of Science and Technology Graduate University, Okinawa, Japan
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Sigmarsdóttir M, Rodríguez MMD, Gewirtz A, Rains L, Tjaden J, Forgatch MS. Five-year fidelity assessment of an evidence-based parenting program (GenerationPMTO): inter-rater reliability following international implementation. BMC Health Serv Res 2023; 23:576. [PMID: 37277856 DOI: 10.1186/s12913-023-09611-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 05/24/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Implementing evidence-based programs in community service settings introduces the challenge of ensuring sustained fidelity to the original program. We employ a fidelity measure based on direct observation of practitioners' competence and adherence to the evidence-based parenting program (EBPP) GenerationPMTO following installation in national and international sites. Fidelity monitoring is crucial, especially when the program purveyor transfers administration of the program to the community as was done in this case. In previous studies, the Fidelity of Implementation rating system (FIMP) was used to evaluate practitioners' fidelity to the GenerationPMTO intervention in six countries following implementation showing high levels of adherence up to 17 years post certification. Other studies showed FIMP to have predictive validity. The present study provides inter-rater reliability data for this fidelity tool across teams of the purveyor, Implementation Sciences International, Inc./ISII, and national and international sites over a five-year period. METHODS Data assess inter-rater reliability in terms of percent agreement and intraclass correlation (ICC) for the purveyor's two fidelity teams and the fidelity teams in seven implementation sites. RESULTS Results report stable good to excellent levels of inter-rater reliability and ICCs as well as good attendance at fidelity meetings for all fidelity teams. CONCLUSIONS This observational method of assessing fidelity post implementation is a promising approach to enable EBPPs to be transferred safely from purveyors to communities while maintaining reliable fidelity to the intervention.
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Affiliation(s)
| | | | - Abigail Gewirtz
- Department of Psychology, Arizona State University, Tempe, USA
| | - Laura Rains
- Implementation Sciences International, Inc., Eugene, USA
| | | | - Marion S Forgatch
- Implementation Sciences International, Inc., Eugene, USA
- Oregon Social Learning Center, Eugene, USA
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Casaburo GM, Asiimwe R, Yzaguirre MM, Fang M, Holtrop K. Identifying Beneficial Training Elements: Clinician Perceptions of Learning the Evidence-Based GenerationPMTO Intervention. JOURNAL OF CHILD AND FAMILY STUDIES 2023; 32:1-16. [PMID: 37362625 PMCID: PMC10224656 DOI: 10.1007/s10826-023-02600-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/28/2023]
Abstract
Improving the process through which mental health professionals are trained in evidence-based practices (EBPs) represents an important opportunity for extending the implementation of EBPs in community settings. In this study, we used a qualitative approach to examine the specific training elements that were beneficial to clinicians' experiences learning an evidence-based intervention. Individual, semi-structured interviews were conducted with mental health professionals completing training in the GenerationPMTO parenting intervention. Data were analyzed using the tenets of thematic analysis. Overall, participants reported positive experiences in the training and growth in their attitudes, knowledge, and confidence in GenerationPMTO. The qualitative findings also suggested seven specific training elements that participants perceived as beneficial: support, role plays, engagement, structure, writing/visuals, working with training families, and experiencing the GenPMTO model. These results are discussed within the context of the existing literature on EBP training and more broadly as they relate to expanding the implementation of evidence-based interventions. We also suggest implications for practice meant to enhance future EBP training efforts.
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Affiliation(s)
- Gianna M. Casaburo
- Department of Human Development and Family Studies, Michigan State University, 552 W. Circle Drive, East Lansing, MI 48824 USA
| | - Ronald Asiimwe
- Department of Human Development and Family Studies, Michigan State University, 552 W. Circle Drive, East Lansing, MI 48824 USA
| | - Melissa M. Yzaguirre
- Department of Human Development and Family Studies, Michigan State University, 552 W. Circle Drive, East Lansing, MI 48824 USA
| | - Meng Fang
- Department of Human Development and Family Studies, Michigan State University, 552 W. Circle Drive, East Lansing, MI 48824 USA
| | - Kendal Holtrop
- Department of Human Development and Family Studies, Michigan State University, 552 W. Circle Drive, East Lansing, MI 48824 USA
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Parra-Cardona R, Vanderziel A, Fuentes-Balderrama J. The impact of a parent-based prevention intervention on Mexican-descent youths' perceptions of harm associated with drug use: Differential intervention effects for male and female youths. JOURNAL OF MARITAL AND FAMILY THERAPY 2023; 49:370-393. [PMID: 36617375 DOI: 10.1111/jmft.12627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 12/08/2022] [Accepted: 12/15/2022] [Indexed: 06/17/2023]
Abstract
Parent training (PT) interventions reduce the likelihood of youth problematic behaviors, including drug use. However, the dissemination of culturally adapted PT interventions in low-income Latina/o immigrant communities remains scarce. In this selective prevention study, we examined the extent to which exposure to CAPAS-Youth, a culturally adapted version of the PT intervention known as GenerationPMTO© , resulted in increased adolescent perception of harm associated with use of alcohol and other drugs. In a randomized controlled trial with 71 Latina/o immigrant families (95% of parents self-identified as Mexican origin, n = 98), 37 families were allocated to the CAPAS-Youth intervention condition versus wait-list control (n = 34 families). According to adolescents' reports at intervention completion, significant increased levels of perceived harm associated with drug use were found for female youths, but not for males. Differential results indicate the importance of tailoring PT prevention interventions according to youths' sex differences (i.e., males vs. females).
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Affiliation(s)
- Rubén Parra-Cardona
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, Texas, USA
| | - Alyssa Vanderziel
- Department of Epidemiology & Biostatistics, Michigan State University, East Lansing, Michigan, USA
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Connor C, Yap MBH, Warwick J, Birchwood M, De Valliere N, Madan J, Melvin GA, Padfield E, Patterson P, Petrou S, Raynes K, Stewart-Brown S, Thompson A. An online parenting intervention to prevent affective disorders in high-risk adolescents: the PIPA trial protocol. Trials 2022; 23:655. [PMID: 35971178 PMCID: PMC9376903 DOI: 10.1186/s13063-022-06563-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescent depression can place a young person at high risk of recurrence and a range of psychosocial and vocational impairments in adult life, highlighting the importance of early recognition and prevention. Parents/carers are well placed to notice changes in their child's emotional wellbeing which may indicate risk, and there is increasing evidence that modifiable factors exist within the family system that may help reduce the risk of depression and anxiety in an adolescent. A randomised controlled trial (RCT) of the online personalised 'Partners in Parenting' programme developed in Australia, focused on improving parenting skills, knowledge and awareness, showed that it helped reduce depressive symptoms in adolescents who had elevated symptom levels at baseline. We have adapted this programme and will conduct an RCT in a UK setting. METHODS In total, 433 family dyads (parents/carers and children aged 11-15) will be recruited through schools, social media and parenting/family groups in the UK. Following completion of screening measures of their adolescent's depressive symptoms, parents/carers of those with elevated scores will be randomised to receive either the online personalised parenting programme or a series of online factsheets about adolescent development and wellbeing. The primary objective will be to test whether the personalised parenting intervention reduces depressive symptoms in adolescents deemed at high risk, using the parent-reported Short Mood & Feelings Questionnaire. Follow-up assessments will be undertaken at 6 and 15 months and a process evaluation will examine context, implementation and impact of the intervention. An economic evaluation will also be incorporated with cost-effectiveness of the parenting intervention expressed in terms of incremental cost per quality-adjusted life year gained. DISCUSSION Half of mental health problems emerge before mid-adolescence and approximately three-quarters by mid-20s, highlighting the need for effective preventative strategies. However, few early interventions are family focused and delivered online. We aim to conduct a National Institute for Health and Care Research (NIHR) funded RCT of the online personalised 'Partners in Parenting' programme, proven effective in Australia, targeting adolescents at risk of depression to evaluate its effectiveness, cost-effectiveness and usability in a UK setting. TRIAL REGISTRATION {2A}: ISRCTN63358736 . Registered 18 September 2019.
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Affiliation(s)
- C Connor
- University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK.
| | - M B H Yap
- Monash University, Melbourne, Australia
| | - J Warwick
- University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - M Birchwood
- University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - N De Valliere
- University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - J Madan
- University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | | | - E Padfield
- University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - P Patterson
- Birmingham Women's & Children's NHS Foundation Trust, Birmingham, UK
| | - S Petrou
- University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - K Raynes
- University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - S Stewart-Brown
- University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - A Thompson
- University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
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Greene MM, Schoeny ME, Berteletti J, Keim SA, Neel ML, Patra K, Smoske S, Breitenstein S. ezPreemie study protocol: a randomised controlled factorial trial testing web-based parent training and coaching with parents of children born very preterm. BMJ Open 2022; 12:e063706. [PMID: 35732380 PMCID: PMC9226920 DOI: 10.1136/bmjopen-2022-063706] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Children born very preterm (VPT; gestational age <32 weeks) are twice as likely to demonstrate behaviour problems such as aggression, non-compliance, temper tantrums and irritability compared with their term-born peers. While behavioural parent training (BPT), also referred to as behaviour therapy is a gold standard for prevention and treatment of childhood problem behaviours, there are limited accessible and effective BPT interventions for families with children born VPT. The purpose of this paper is to describe a multicentre, randomised controlled protocol for a factorial design trial evaluating the independent and combined effects of the ezParent BPT intervention plus brief, weekly coaching calls on parent and child outcomes for families with toddlers born VPT. METHODS AND ANALYSIS The study employs a 2×2 factorial randomised design. Parents (n=220) of children aged 20-30 months corrected age who were born VPT (<32 weeks) will be recruited from two large metropolitan Neonatal Intensive Care Units follow-up clinics and randomised to one of four conditions: (1) ezParent (2) ezParent +coach, (3) Active control or (4) Active Control +coach. Data on parenting and child behaviour outcomes will be obtained from all participants at baseline and 3, 6 and 12 months postbaseline. All analyses will use an intention-to-treat approach, independent of their actual dose of each intervention. ETHICS AND DISSEMINATION The study protocol has been approved by The Ohio State University Institutional Review Board (IRB) using a single IRB. Study results will be disseminated through presentations at regional and national conferences, publications in peer-reviewed journals, and sharing research reports with participating families and recruiting sites. TRIAL REGISTRATION NUMBER NCT05217615.
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Affiliation(s)
- Michelle M Greene
- Department of Pediatrics, Rush University Medical Center, Chicago, Illinois, USA
| | - M E Schoeny
- College of Nursing, Rush University, Chicago, Illinois, USA
| | | | - Sarah A Keim
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics and Division of Epidemiology, The Ohio State University, Columbus, Ohio, USA
| | - Mary Lauren Neel
- Division of Neonatology & Center for Perinatal Research, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Kousiki Patra
- Department of Pediatrics, Rush University Medical Center, Chicago, Illinois, USA
| | - Shea Smoske
- College of Nursing, The Ohio State University, Columbus, Ohio, USA
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Holtrop K, Durtschi JA, Forgatch MS. Investigating active ingredients of the GenerationPMTO intervention: Predictors of postintervention change trajectories in parenting practices. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2022; 36:212-224. [PMID: 34843323 PMCID: PMC9768796 DOI: 10.1037/fam0000925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Empirically determining the active ingredients of evidence-based parenting interventions is a promising means for strengthening interventions and enhancing their public health impact. This study aimed to determine which distinct ingredients of the GenerationPMTO (GenPMTO) intervention were associated with subsequent changes in parenting practices. Using a sample of 153 participants randomly assigned to the GenPMTO condition, we employed multilevel modeling to identify intervention ingredients empirically linked with change trajectories in parenting practices observed across the 2 years following intervention exposure. Coercive parenting and positive parenting outcomes were examined. Study results indicated that emotion regulation, effective communication, problem solving, and monitoring each demonstrated a significant pattern of findings for coercive parenting. Differential exposure to each of these ingredients significantly predicted the level of coercive parenting immediately postintervention and/or trajectories of change in coercive parenting across the subsequent 2-year period, controlling for coercive parenting at baseline. No significant predictors were found for positive parenting trajectories. Our findings suggest four components as active ingredients of the GenPMTO intervention for coercive parenting. Identification of these active ingredients may lead to strengthening future iterations of GenPMTO by expanding the set of core components specified in the model, which may further improve public health benefits. Implications for further understanding change stemming from evidence-based parenting interventions are also discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Kendal Holtrop
- Department of Human Development and Family Studies, Michigan State University
| | - Jared A. Durtschi
- School of Family Studies and Human Services, Kansas State University
| | - Marion S. Forgatch
- Implementation Sciences International, Inc., Eugene, Oregon
- Oregon Social Learning Center, Eugene, Oregon
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van Leuven L, Lalouni M, Enebrink P, Sorjonen K, Forster M. Feasibility and implementation of Safer Kids - A parenting program to reduce child abuse. CHILD ABUSE & NEGLECT 2022; 123:105434. [PMID: 34894587 DOI: 10.1016/j.chiabu.2021.105434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/19/2021] [Accepted: 12/02/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Child abuse is a world-wide problem causing long-term suffering for children and large costs to society. Parent-training programs have been shown to reduce harsh parenting but more research on parenting programs specifically addressing child abuse is needed. OBJECTIVE This study aimed at assessing the feasibility, implementation, and preliminary effectiveness of Safer Kids (SK); a structured parent-training program delivered immediately after parents are reported for child abuse. PARTICIPANTS AND SETTING Caregivers were eligible if they had been reported for child abuse to the Swedish social services and their child was 3-12 years old. METHODS Families were allocated to SK or intervention as usual (IAU) through a quasi-experimental design. Multilevel analyses and a Cox Proportional Hazard Model were used to assess between-group differences in risk factors for abuse and further child welfare reports. RESULTS In total, 67 families participated. SK was successfully implemented as an early-start intervention and most families completed the intervention. All agencies continued working with SK two years after the study, indicating sustainability of implementation. SK was more effective than IAU in reducing further child welfare reports up to 18 months from baseline. However, analyses of parent and child rated risk factors of re-abuse (abuse potential, wellbeing, and parent-child relationships) indicate none to small differences between conditions. CONCLUSIONS SK can be successfully implemented within the social services and may be effective in reducing occurrence of further child welfare reports. The effects of SK need to be further evaluated in a randomized controlled trial.
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Affiliation(s)
- Livia van Leuven
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels väg 9, 171 65 Solna, Sweden.
| | - Maria Lalouni
- Department of Clinical Neuroscience, Division of Neuro, Karolinska Institutet, Nobels väg 9, 171 65 Solna, Sweden, Sweden
| | - Pia Enebrink
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels väg 9, 171 65 Solna, Sweden
| | - Kimmo Sorjonen
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels väg 9, 171 65 Solna, Sweden
| | - Martin Forster
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels väg 9, 171 65 Solna, Sweden
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Woodfield MJ, Merry S, Hetrick SE. Clinician adoption of Parent-Child Interaction Therapy: A systematic review of implementation interventions. IMPLEMENTATION RESEARCH AND PRACTICE 2022; 3:26334895221082330. [PMID: 37091096 PMCID: PMC9924277 DOI: 10.1177/26334895221082330] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Parent-Child Interaction Therapy (PCIT) is a parent training intervention for childhood conduct problems, distinctive in its use of live clinician coaching of the parent-child dyad via a one-way mirror and discrete earpiece. However, despite a compelling evidence base, uptake of evidence-based parent training programmes such as PCIT by clinicians in routine care settings remains poor. This systematic review aimed to identify and synthesise implementation interventions that have sought to increase clinician adoption of PCIT in usual care settings. Methods We searched MEDLINE (Ovid), Embase (Ovid), PsycInfo (Ovid), CINAHL (EBSCO), Science Citation Index and Social Sciences Citation Index, and Web of Science Core Collection from inception to October 2020. Articles were included if they tested (by way of randomised controlled trials, controlled clinical trials, interrupted time series and controlled before and after trials) implementation interventions across any and all of the patient, clinician, clinic, system or policy domains. Two independent reviewers screened and selected studies, assessed risk of bias and extracted data - summarising implementation intervention components according to items from the Template for Intervention Description and Replication (TIDieR) checklist ( Hoffmann et al., 2014). Results Of the 769 articles identified once duplicates were removed, 13 papers relating to three studies met the inclusion criteria - all were quantitative or mixed-methods examinations of the effectiveness of different PCIT clinician training or training-related consultation methods. A narrative description of interventions was provided, as quantitative synthesis was not possible. Conclusions Research attention has to date been focussed on the establishment of an evidence-base for PCIT's effectiveness, with relatively little attention to the dissemination, implementation and sustainment of this treatment. Those studies that do exist have focused on training methods and training-related expert consultation. Research attention could usefully turn to both adoption and sustainment of this effective treatment in usual care settings. Plain language summary In this review, we aimed to summarise what is already known about how to implement PCIT in community settings after clinicians have received training in the approach. While research relating to the implementation of other parent training programmes is interesting and informative, implementation efforts are most effective when tailored to a specific programme in a specific context. As such, it was important to review published studies relating to PCIT specifically. We identified three relevant studies, one of which is yet to publish its main implementation findings. The three studies have focused on how best to train clinicians in PCIT, including how best to provide post-training support from expert trainers. We concluded that a fruitful line for future research would be to focus on the post-training period, particularly how best to support clinicians to adopt and sustain PCIT in their practice. Systematic review registration The study was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 01/10/2020 (CRD42020207118).
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Affiliation(s)
- Melanie J Woodfield
- The Werry Centre, Department of Psychological Medicine, University of Auckland, New Zealand
| | - Sally Merry
- The Werry Centre, Department of Psychological Medicine, University of Auckland, New Zealand
| | - Sarah E Hetrick
- The Werry Centre, Department of Psychological Medicine, University of Auckland, New Zealand
- Centre for Youth Mental Health, University of Melbourne,
Australia
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López-Zerón G, Parra-Cardona JR, Muñoz A, Sullivan CM. From Theory to Practice: On the Ground Cultural Adaption of a Parenting Intervention for Ethnic Minority Families Involved in the Child Welfare System. FAMILY PROCESS 2021; 60:1185-1201. [PMID: 33382100 PMCID: PMC10460544 DOI: 10.1111/famp.12627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Child maltreatment is a major public health issue in the United States. In the federal fiscal year 2017, approximately 7.5 million children were referred to child welfare services (CSW) in the nation. Developmental, emotional, behavioral, and cognitive problems are prevalent among children referred to CWS. For those in foster care, temporary or permanent placement frequently introduces additional instability into a child's already chaotic life, increasing their risk for deleterious physical and mental health outcomes. Limited research exists documenting the impact of efficacious culturally adapted parent training (PT) interventions aimed at serving low-income ethnic minority families involved in CWS. The objective of this study was twofold: to explicate how a culturally adapted PT intervention for diverse families involved in CWS was perceived by participants and to better understand how interventionists adapted to families' needs. In this study, we conducted in-depth interviews with 14 parents who had completed the adapted intervention, as well as all of the interventionists providing the intervention. A thematic analysis approach was used to analyze and interpret the data. Parents indicated the positive impact that the intervention had on enhancing their parenting skills, as well as their ability to cope with the challenges associated with having a child removed by CWS. Interventionists described the gradual adaptations they implemented, in an effort to increase its cultural and contextual relevance. Research findings are relevant to the family therapy field as they increase understanding about culturally adapted PT interventions for ethnic minority families within CWS contexts.
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Pinto R, Canário C, Cruz O, Rodrigo MJ. Implementation of evidence-based parenting programs under real-world conditions: Protocol for a scoping review. PLoS One 2021; 16:e0256392. [PMID: 34411197 PMCID: PMC8376025 DOI: 10.1371/journal.pone.0256392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/06/2021] [Indexed: 11/21/2022] Open
Abstract
Protecting children is recognized as a public health priority and supporting parents through the implementation of evidence-based programs is a well-known strategy to achieve this. However, researchers highlight that these programs remain insufficiently implemented in real-world contexts. A knowledge gap exists between the intended implementation of evidence-based parenting programs and their actual implementation on real-world dynamics. This scoping review aims to provide a comprehensive understanding of how evidence-based parenting programs have been implemented under real-world conditions by providing a map of available evidence and identifying knowledge gaps. The overall research question is: "How have evidence-based parenting programs been implemented under real-world conditions?". The proposed scoping review follows the framework originally described by Arksey and O'Malley, Levac and colleagues, and the Joanna Briggs Institute: (1) identifying the research questions; (2) identifying the relevant studies; (3) study selection; (4) charting the data; (5) collating, summarizing, and reporting the results; (6) consultation. The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) will inform the search strategy. The results will be described in relation to the research questions and in the context of the purpose of the review. This scoping review will help to bridge the implementation gap between research evidence and its translation into practice.
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Affiliation(s)
- Rita Pinto
- Faculty of Psychology and Education Science, University of Porto, Porto, Portugal
| | - Catarina Canário
- Faculty of Psychology and Education Science, University of Porto, Porto, Portugal
| | - Orlanda Cruz
- Faculty of Psychology and Education Science, University of Porto, Porto, Portugal
| | - Maria José Rodrigo
- Faculty of Psychology, University of La Laguna, San Cristóbal de La Laguna, Spain
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Anis L, Benzies KM, Ewashen C, Hart MJ, Letourneau N. Fidelity Assessment Checklist Development for Community Nursing Research in Early Childhood. Front Public Health 2021; 9:582950. [PMID: 34055705 PMCID: PMC8160096 DOI: 10.3389/fpubh.2021.582950] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/08/2021] [Indexed: 11/13/2022] Open
Abstract
Nurses play an important role in promoting positive childhood development via early interventions intended to support parenting. Despite recognizing the need to deliver vital parenting programs, monitoring fidelity has largely been ignored. Fidelity refers to the degree to which healthcare programs follow a well-defined set of criteria specifically designed for a particular program model. With increasing demands for early intervention programs to be delivered by non-specialists, rigorous yet pragmatic strategies for maintaining fidelity are needed. This paper describes the step-by-step development and evaluation of a program fidelity measure, using the Attachment and Child Health (ATTACH™) parenting program as an exemplar. The overall quality index for program delivery varied between "very good" to "excellent," with a mean of 4.3/5. Development of checklists like the ATTACH™ fidelity assessment checklist enables the systematic evaluation of program delivery and identification of therapeutic components that enable targeted efforts at improvement. In future, research should examine links between program fidelity and targeted outcomes to ascertain if increased fidelity scores yield more favorable effects of parenting programs.
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Affiliation(s)
- Lubna Anis
- Department of Pediatrics, Faculty of Nursing, Owerko Centre, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Karen M. Benzies
- Department of Pediatrics, Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Carol Ewashen
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Martha J. Hart
- Department of Pediatrics, Faculty of Nursing, Owerko Centre, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Faculty of Nursing, Owerko Centre, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Nicole Letourneau
- Department of Pediatrics, Faculty of Nursing, Owerko Centre, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Faculty of Nursing, Owerko Centre, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
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Wood JN, Kratchman D, Scribano PV, Berkowitz S, Schilling S. Improving Child Behaviors and Parental Stress: A Randomized Trial of Child Adult Relationship Enhancement in Primary Care. Acad Pediatr 2021; 21:629-637. [PMID: 32791318 DOI: 10.1016/j.acap.2020.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 07/23/2020] [Accepted: 08/06/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Prior single-site evaluations of Child Adult Relationship Enhancement in Primary Care (PriCARE), a 6-session group parent training, demonstrated reductions in child behavioral problems and improvements in positive parenting attitudes. OBJECTIVE To measure the impact of PriCARE on disruptive child behaviors, parenting stress, and parenting attitudes in a multisite study. METHODS Caregivers of children 2- to 6-year-old with behavior concerns recruited from 4 pediatric primary care practices were randomized 2:1 to PriCARE intervention (n = 119) or waitlist control (n = 55). Seventy-nine percent of caregivers identified as Black and 59% had annual household incomes under $22,000. Child behavior, parenting stress, and parenting attitudes were measured at baseline and 2 to 3 months after intervention using the Eyberg Child Behavior Inventory, Parenting Stress Index, and Adult-Adolescent Parenting Inventory-2. Marginal standardization implemented in a linear regression compared mean change scores from baseline to follow-up by treatment arm while accounting for clustering by site. RESULTS Mean change scores from baseline to follow-up demonstrated greater improvements (decreases) in Eyberg Child Behavior Inventory problem scores but not intensity scores in the PriCARE arm compared to control, (problem: -4.4 [-7.5, -1.2] vs -1.8 [-4.1, 0.4], P= .004; intensity: -17.6 [-28.3, -6.9] vs -10.4 [-18.1, -2.6], P= .255). Decreases in parenting stress were greater in the PriCARE arm compared to control (-3.3 [-4.3, -2.3] vs 0 [-2.5, 2.5], P= .025). Parenting attitudes showed no significant changes (all P> .10). CONCLUSIONS PriCARE showed promise in improving parental perceptions of the severity of child behaviors and decreasing parenting stress but did not have an observed impact on parenting attitudes.
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Affiliation(s)
- Joanne N Wood
- Division of General Pediatrics, The Children's Hospital of Philadelphia (JN Wood and PV Scribano), Philadelphia, Pa; PolicyLab, The Children's Hospital of Philadelphia (JN Wood and D Kratchman), Philadelphia, Pa; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania (JN Wood, PV Scribano, and S Berkowitz), Philadelphia, Pa.
| | - Devon Kratchman
- PolicyLab, The Children's Hospital of Philadelphia (JN Wood and D Kratchman), Philadelphia, Pa
| | - Philip V Scribano
- Division of General Pediatrics, The Children's Hospital of Philadelphia (JN Wood and PV Scribano), Philadelphia, Pa; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania (JN Wood, PV Scribano, and S Berkowitz), Philadelphia, Pa
| | - Steven Berkowitz
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania (JN Wood, PV Scribano, and S Berkowitz), Philadelphia, Pa
| | - Samantha Schilling
- Department of Pediatrics, University of North Carolina (S Schilling), Chapel Hill, NC. Dr Berkowitz is now with Department of Psychiatry, University of Colorado, School of Medicine, Aurora, Colo
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An Exploratory Study of a Training Team-Coordinated Approach to Implementation. GLOBAL IMPLEMENTATION RESEARCH AND APPLICATIONS 2021; 1:17-29. [PMID: 36032522 DOI: 10.1007/s43477-020-00003-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background It is now widely understood that successful implementation of evidence-based treatments is facilitated by several favorable conditions (e.g., community buy-in, invested agency leadership). However, strategies for supporting agencies in promoting these conditions have been examined to a lesser extent. In this exploratory study, the implementation support procedures of Parenting with Love and Limits (PLL), an evidence-informed family treatment for child/adolescent behavior problems in which the training team follows structured procedures to help coordinate implementation support activities, are illustrated, and their preliminary effectiveness examined. Methods PLL documents and communication records between PLL and n = 23 sites across the U.S. that initiated PLL pre-implementation activities were reviewed. In addition, implementation activities completed for each agency were entered into the Stages of Implementation Completion (SIC) dashboard. Results The prescriptive nature of the PLL implementation support protocol was illustrated through descriptions of procedural documents and case examples. Quantitative analyses revealed that, among the 23 sites that began pre-implementation, 9 discontinued, with a trend toward sites in metropolitan areas being more likely to discontinue than those in less populous areas. In addition, the 14 sites that launched PLL demonstrated a high amount of consistency in activities, with sites in the sustainability phase completing an average of 86% of implementation behaviors. Conclusions Training team-coordination of implementation activities may be one promising approach for supporting agencies in completing tasks to facilitate successful uptake of evidence-supported interventions. In turn, sustained implementation of evidence-supported treatments could allow communities to benefit from practice innovations to a greater extent.
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Prguda E, Burke K, Antrobus E, Bennett S. Accessibility of evidence‐based parenting programs in the community: Parents who are involved in the Criminal Justice System encounter barriers to program access. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Emina Prguda
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, Brisbane, Queensland, Australia,
| | - Kylie Burke
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, Brisbane, Queensland, Australia,
| | - Emma Antrobus
- School of Social Science, The University of Queensland, Brisbane, Queensland, Australia,
| | - Sarah Bennett
- School of Social Science, The University of Queensland, Brisbane, Queensland, Australia,
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Biglan A, Johansson M, Van Ryzin M, Embry D. Scaling up and scaling out: Consilience and the evolution of more nurturing societies. Clin Psychol Rev 2020; 81:101893. [PMID: 32858377 PMCID: PMC7403031 DOI: 10.1016/j.cpr.2020.101893] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 07/24/2020] [Accepted: 07/29/2020] [Indexed: 01/13/2023]
Abstract
This paper argues that diverse disciplines within the human sciences have converged in identifying the conditions that human beings need to thrive and the programs, policies, and practices that are needed to foster well-being. In the interest of promoting this view, we suggest that this convergence might usefully be labeled "The Nurture Consilience." We review evidence from evolutionary biology, developmental, clinical, and social psychology, as well as public health and prevention science indicating that, for evolutionary reasons, coercive environments promote a "fast" life strategy that favors limited self-regulation, immediate gratification, and early childbearing. However, this trajectory can be prevented through programs, practices, and policies that (a) minimize toxic social and biological conditions, (b) limit opportunities and influences for problem behavior, (c) richly reinforce prosocial behavior, and (d) promote psychological flexibility. The recognition of these facts has prompted research on the adoption, implementation, and maintenance of evidence-based interventions. To fully realize the fruits of this consilience, it is necessary to reform every sector of society. We review evidence that free-market advocacy has promoted the view that if individuals simply pursue their own economic well-being it will benefit everyone, and trace how that view led business, health care, education, criminal justice, and government to adopt practices that have benefited a small segment of the population but harmed the majority. We argue that the first step in reforming each sector of society would be to promote the value of ensuring everyone's well-being. The second step will be to create contingencies that select beneficial practices and minimizes harmful ones.
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Family resilience and flourishment: Well‐being among children with mental, emotional, and behavioral disorders. Res Nurs Health 2020; 43:465-477. [DOI: 10.1002/nur.22066] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 08/07/2020] [Indexed: 12/13/2022]
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Guastaferro K, Self-Brown S, Shanley JR, Whitaker DJ, Lutzker JR. Engagement in home visiting: An overview of the problem and how a coalition of researchers worked to address this cross-model concern. JOURNAL OF CHILD AND FAMILY STUDIES 2020; 29:4-10. [PMID: 32292264 PMCID: PMC7156135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Home visiting is a widely supported intervention strategy for parents of young children who are in need of parenting skill improvement. However, parental engagement limits the potential public health impact of home visiting, as these programs often have low enrollment rates, as well as high attrition and low completion rates for those who enroll in these programs. The Coalition for Research on Engagement and Well-being (CREW) provided support for three pilot projects representing different home visiting models and aspects of engagement. The results of these pilot projects are presented in this special section. The purpose of this commentary is to introduce CREW and highlight the importance of a cross-model project to improve engagement among home visiting programs.
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Breitenstein SM, Laurent S, Pabalan L, Risser HJ, Roper P, Saba MT, Schoeny M. Implementation findings from an effectiveness-implementation trial of tablet-based parent training in pediatric primary care. FAMILIES, SYSTEMS & HEALTH : THE JOURNAL OF COLLABORATIVE FAMILY HEALTHCARE 2019; 37:282-290. [PMID: 31621349 PMCID: PMC6901710 DOI: 10.1037/fsh0000447] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
INTRODUCTION The use of mobile delivery to deliver parent training can address barriers to access and improve the translation of interventions in existing settings like pediatric primary care. Studying implementation provides critical information to identify and address barriers and facilitators and inform sustainability efforts. METHOD This study was a descriptive evaluation using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework as part of a Hybrid Type I Effectiveness-Implementation trial of the ezParent Program within 4 pediatric primary care clinics. We collected data before, during, and after implementation to evaluate provider implementation and their perspectives on program benefits and barriers to implementation. RESULTS On average, 14% of eligible parents were introduced to the study. Of these parents, 78% expressed interest in participating and 37% enrolled in the study. Seventy-eight percent of staff providers (n = 36) implemented the procedures at least once, and among those who implemented 3 or more times (n = 24), 79% maintained implementation for 6 months. Barriers to implementation include limited time, lack of information, and full practice buy-in and engagement. DISCUSSION Implementation fidelity may improve with additional education and training of the interdisciplinary team, clear messaging regarding the purpose and content of the ezParent program, defining roles within the care team, identifying practice champions, and use of the electronic health record. Findings from this evaluation, including data from the randomized controlled trial and literature to support intervention effectiveness and implementation, will be used to develop an implementation toolkit to include specific strategies for implementation and ideas for local adaptations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Scheier LM, Kumpfer KL, Brown JL, Hu Q. Formative Evaluation to Build an Online Parenting Skills and Youth Drug Prevention Program: Mixed Methods Study. JMIR Form Res 2019; 3:e14906. [PMID: 31687934 PMCID: PMC6914279 DOI: 10.2196/14906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 09/09/2019] [Accepted: 09/24/2019] [Indexed: 12/02/2022] Open
Abstract
Background Family-based drug prevention programs that use group-based formats with trained facilitators, such as the Strengthening Families Program (SFP), are effective in preventing underage drinking and youth drug use. However, these programs are resource-intensive and have high costs and logistical demands. Tailoring them for Web-based delivery is more cost-effective and makes it easier to scale these programs for widespread dissemination. This requires the active involvement of all key stakeholders to determine content and delivery format. Objective The aim was to obtain consumer, agency stakeholder, and expert input into the design of a Web-based parenting skills training and youth drug prevention program. Methods We conducted 10 focus groups with 85 adults (range 4-10, average 8 per group), 20 stakeholder interviews with family services agency staff, and discussed critical design considerations with 10 prevention scientists and e-learning experts to determine the optimal program content and technology features for SFP Online. Focus group participants also answered survey questions on perceived barriers to use, desired navigational features, preferred course format, desired content, preferred reward structures, course length, interactive components, computer efficacy, and technology use. Descriptive statistics were used to examine consumer characteristics; linear regression was used to examine relations between SFP exposure and four continuous outcome measures, including desired program content, interactive technology, and concerns that may inhibit future use of SFP Online. Logistic regression was used as a binary measure of whether consumers desired fun games in the SFP Online program. Results Three broad thematic categories emerged from the qualitative interviews enumerating the importance of (1) lesson content, (2) logistics for program delivery, and (3) multimedia interactivity. Among the many significant relations, parents who viewed more SFP lessons reported more reasons to use an online program (beta=1.48, P=.03) and also wanted more interactivity (6 lessons: beta=3.72, P=.01; >6 lessons: beta=2.39, P=.01), parents with less interest in a mixed delivery format (class and online) reported fewer reasons to use the online program (beta=−3.93, P=.01), comfort using computers was negatively associated with concerns about the program (beta=−1.83, P=.01), having mobile phone access was related to fewer concerns about online programs (beta=−1.63, P=.02), willingness to view an online program using a mobile phone was positively associated with wanting more online components (beta=1.95, P=.02), and parents who wanted fun games wanted more interactivity (beta=2.28, P=.01). Conclusions Formative evaluation based on user-centered approaches can provide rich information that fuels development of an online program. The user-centered strategies in this study lay the foundation for improving SFP Online and provide a means to accommodate user interests and ensure the product serves as an effective prevention tool that is attractive to consumers, engaging, and can overcome some of the barriers to recruitment and retention that have previously affected program outcomes in family-based prevention.
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Affiliation(s)
| | - Karol L Kumpfer
- University of Utah, Salt Lake City, UT, United States.,Strengthening Families Program, LLC, Salt Lake City, UT, United States
| | | | - QingQing Hu
- Division of Public Health, University of Utah, Salt Lake City, UT, United States
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Askeland E, Forgatch MS, Apeland A, Reer M, Grønlie AA. Scaling up an Empirically Supported Intervention with Long-Term Outcomes: the Nationwide Implementation of GenerationPMTO in Norway. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2019; 20:1189-1199. [PMID: 31440944 PMCID: PMC6881263 DOI: 10.1007/s11121-019-01047-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Effective implementation outcomes are necessary preconditions for effective service and positive treatment outcomes for children with behavioral problems. The aim of this study is to assess outcomes of the transfer of the empirically supported intervention GenerationPMTO from the developer in the USA to a nationwide implementation in Norway. Adoption, sustainability, reach, and fidelity are tested across seven generations of therapists in Norway. Participants in the study were 521 therapists who began training in the program. The developer's team trained the first generation (G1) and the Norwegian team trained the next six generations (G2-G7). The mean rate of certification was 94.2% (n = 491). Intervention fidelity was assessed from 1964 video recordings of intervention sessions submitted for certification evaluation using the observation-based measure Fidelity of Implementation Rating System (FIMP). A small but significant drop in fidelity scores was previously observed from G1 to G2; however, fidelity scores recovered at or above G1 scores for G3 Forgatch and DeGarmo (Prevention Science 12, 235-246, 2011). Twenty years since the inception of implementation, 314 certified therapists practice the model today, a retention rate of 64%. The outcomes show sustained fidelity scores across seven generations, increasing heterogeneity among therapists trained, and a shift of focus in the target population from clinical to primary services. The present study contributes to the field with the systematic evaluation of outcomes for the full transfer implementation approach with continuing adoption and sustainability, increasing reach and sustained intervention fidelity across several generations of practitioners.
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Affiliation(s)
- Elisabeth Askeland
- The Norwegian Center for Child Behavioral Development, NUBU, Postbox 7053 Majorstuen, 0306, Oslo, Norway.
| | - Marion S Forgatch
- Implementation Sciences International, Inc. & Oregon Social Learning Center, Eugene, OR, 97401, USA
| | - Anett Apeland
- The Norwegian Center for Child Behavioral Development, NUBU, Postbox 7053 Majorstuen, 0306, Oslo, Norway
| | - Marit Reer
- The Norwegian Center for Child Behavioral Development, NUBU, Postbox 7053 Majorstuen, 0306, Oslo, Norway
| | - Anette A Grønlie
- The Norwegian Center for Child Behavioral Development, NUBU, Postbox 7053 Majorstuen, 0306, Oslo, Norway
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de Matos MG, Wainwright T, Brebels L, Craciun B, Gabrhelík R, Schjodt BH, Plantade-Gipch A, Poštuvan V, Stojadinovic I, Richards J. Looking Ahead. EUROPEAN PSYCHOLOGIST 2019. [DOI: 10.1027/1016-9040/a000362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Across many domains of health and welfare, there have been remarkable advances in prevention where public-health models have had a significant impact. Psychology has much to offer in building on these successes and we describe some excellent examples, but in general, it has not been fully engaged with prevention science and implementation. We set out some of the key challenges and opportunities for psychology and prevention science in contemporary practice, recognizing that often the rhetoric from governments to support prevention interventions do not match up to making the necessary resources available. We argue that psychology must prioritize this area of practice as there is evidence that the gains of recent decades may be under threat without concerted efforts.
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Affiliation(s)
| | | | - Lieven Brebels
- Work and Organization Studies, Faculty of Economics and Business, KU Leuven, Belgium
| | - Barbara Craciun
- Faculty of Psychology, Titu Maiorescu University, Bucharest, Romania
| | - Roman Gabrhelík
- Department of Addictology, Charles University, Prague, Czech Republic
| | | | | | - Vita Poštuvan
- Department of Psychology (FAMNIT), Slovene Centre for Suicide Research (UP IAM), Andrej Marusic Institute, University of Primorska, Slovenia
| | | | - Jennifer Richards
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, The Netherlands
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Morales-Castillo M, Aguirre-Dávila E, Durán-Urrea L. Los contenidos de la formación parental y sus implicaciones en el comportamiento de los adolescentes: elementos desde una revisión. SAUDE E SOCIEDADE 2019. [DOI: 10.1590/s0104-12902019181111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Resumen Los padres buscan apoyo para enfrentar los desafíos que sus hijos tienen en la adolescencia. El objetivo de este trabajo es analizar los tópicos abordados en la formación de padres con hijos adolescentes y su relación con las tendencias comportamentales de estos. Para ello, se llevó a cabo una revisión cualitativa de intervenciones y programas centrados en fortalecer el proceso de crianza, estableciéndose una concentración en los aspectos regulatorios, comunicativos y emocionales de la relación padre-hijo. Por medio de un análisis cuantitativo, también se pudo establecer que los tópicos abordados tienen efectos significativos sobre los adolescentes, como la reducción en problemas de comportamiento, manejo adecuado de la sexualidad y disminución en la tendencia al consumo de sustancias. Teniendo en cuenta la información registrada, es posible plantear que la formación parental puede abordarse en diferentes formatos de acuerdo con los objetivos y condiciones disponibles, lo que puede representar beneficios importantes para el desarrollo saludable de los adolescentes.
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Biglan A, Van Ryzin MJ. Behavioral Science and the Prevention of Adolescent Substance Abuse. Perspect Behav Sci 2019; 42:547-563. [PMID: 31976449 PMCID: PMC6769129 DOI: 10.1007/s40614-019-00217-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
This article reviews the evidence regarding behavioral science approaches to the prevention of substance use disorders. Prevention science grew out of research on family and school-based interventions that were designed to treat common behavioral problems of children and adolescents. That research showed that the amelioration of problems such as aggressive behavior could prevent the development of later problems including substance use, depression, and academic failure. We begin by reviewing evidence regarding the risk factors that contribute to the development of substance use disorders, as well as the protective factors that can reduce their likelihood. We then describe a variety of family, school, and community prevention programs that have been shown to prevent youthful use and abuse of substances. We conclude by describing the progress that has been made in getting these programs widely and effectively implemented, and the challenges we face in getting to the point where most communities are achieving considerable success in prevent substance use and the other common and costly behavioral and psychological problems of children and adolescents.
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Baumann AA, Domenech Rodríguez MM, Wieling E, Parra-Cardona JR, Rains LA, Forgatch MS. Teaching GenerationPMTO, an evidence-based parent intervention, in a university setting using a blended learning strategy. Pilot Feasibility Stud 2019; 5:91. [PMID: 31338206 PMCID: PMC6626357 DOI: 10.1186/s40814-019-0476-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 07/05/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite the large number of evidence-based practices (EBPs) ready for implementation, they are the exception in usual care, especially for ethnic minority patients, who may not have access to trained health professionals. Providing EBP training as part of a graduate curriculum could help build the pipeline of professionals to provide quality care. METHODS We conducted a before-after study to determine whether we could implement a blended learning strategy (BL; i.e., in vivo and online training) to teach an EBP in university settings. Feasibility in this pilot was operationalized as knowledge acquisition, satisfaction, fidelity, acceptability, and usability. Using GenerationPMTO as the EBP, our aim was to train graduate students enrolled in Psychology, Social Work, and Family Therapy programs in the EBP in one academic year. Two therapists from a community agency were also students in this pilot. A total of 13 students from five universities were trained in the intervention. Adaptations were made to the intervention and training strategy to optimize training fidelity. Focus groups were conducted with the students to capture their perspective about the training. RESULTS Students demonstrated significant knowledge acquisition from baseline (Mean = 61.79, SD = 11.18) to training completion (Mean = 85.27, SD = 5.08, mean difference = - 23.48, 95% CI = - 29.62, - 17.34). They also reported satisfaction with the BL format, as measured by teaching evaluations at the end of the course. Instructors received acceptable fidelity scores (range of 7-9 in a 9-point scale). Qualitative findings from focus groups showed support for acceptability and usability of BL training. CONCLUSIONS BL training in university settings can be conducted with fidelity when provided by appropriately trained instructors. BL that integrates EBP and adaptations may be uniquely applicable for training providers in low-resource and ethnically diverse settings. The BL enhanced knowledge of GenerationPMTO was acceptable and usable to students, and was delivered with high instructor fidelity to the training model.
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Affiliation(s)
- Ana A. Baumann
- George Warren Brown School of Social Work, Washington University, St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO 63130 USA
| | | | - Elizabeth Wieling
- Family Social Science, University of Minnesota, 290 McNeal Hall, 1985 Buford Circle, St. Paul, MN 55108 USA
| | - J. Rubén Parra-Cardona
- Steve Hicks School of Social Work, University of Texas at Austin, 1925 San Jacinto Blvd 3.130F. STOP D3500, Austin, TX 78712-0358 USA
| | - Laura A. Rains
- Implementation Sciences International, Inc., 10 Shelton-McMurphey Boulevard, Eugene, OR 97401 USA
| | - Marion S. Forgatch
- Implementation Sciences International, Inc., 10 Shelton-McMurphey Boulevard, Eugene, OR 97401 USA
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After Deployment, Adaptive Parenting Tools: 1-Year Outcomes of an Evidence-Based Parenting Program for Military Families Following Deployment. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2019; 19:589-599. [PMID: 28913717 DOI: 10.1007/s11121-017-0839-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Despite significant stressors facing military families over the past 15 years of wars in Iraq and Afghanistan, no parenting programs adapted or developed for military families with school-aged children have been rigorously tested. We present outcome data from the first randomized controlled trial of a behavioral parent training program for families with a parent deployed to Iraq or Afghanistan. In the present study, 336 primarily National Guard and Reserve families with 4-12-year-old children were recruited from a Midwestern state. At least one parent in each family had deployed to the recent conflicts: Operations Iraqi or Enduring Freedom, or New Dawn (OIF/OEF/OND). Families were randomized to a group-based parenting program (After Deployment, Adaptive Parenting Tools (ADAPT)) or web and print resources-as-usual. Using a social interaction learning framework, we hypothesized an indirect effects model: that the intervention would improve parenting, which, in turn, would be associated with improvements in child outcomes. Applying intent-to-treat analyses, we examined the program's effect on observed parenting, and children's adjustment at 12-months post baseline. Controlling for demographic (marital status, length, child gender), deployment variables (number of deployments), and baseline values, families randomized to the ADAPT intervention showed significantly improved observed parenting compared to those in the comparison group. Observed parenting, in turn, was associated with significant improvements in child adjustment. These findings present the first evidence for the effectiveness of a parenting program for deployed military families with school-aged children.
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Gewirtz AH, Lee SS, August GJ, He Y. Does Giving Parents Their Choice of Interventions for Child Behavior Problems Improve Child Outcomes? PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2019; 20:78-88. [PMID: 29352401 PMCID: PMC6054560 DOI: 10.1007/s11121-018-0865-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Empowering consumers to be active decision-makers in their own care is a core tenet of personalized, or precision medicine. Nonetheless, there is a dearth of research on intervention preferences in families seeking interventions for a child with behavior problems. Specifically, the evidence is inconclusive as to whether providing parents with choice of intervention improves child/youth outcomes (i.e., reduces externalizing problems). In this study, 129 families presenting to community mental health clinics for child conduct problems were enrolled in a doubly randomized preference study and initially randomized to choice or no-choice conditions. Families assigned to the choice condition were offered their choice of intervention from among three different formats of the Parent Management Training-Oregon Model/PMTO (group, individual clinic, home based) and services-as-usual (child-focused therapy). Those assigned to the no-choice condition were again randomized, to one of the four intervention conditions. Intent-to-treat analyses revealed partial support for the effect of parental choice on child intervention outcomes. Assignment to the choice condition predicted teacher-reported improved child hyperactivity/inattention outcomes at 6 months post-treatment completion. No main effect of choice on parent reported child outcomes was found. Moderation analyses indicated that among parents who selected PMTO, teacher report of hyperactivity/inattention was significantly improved compared with parents selecting SAU, and compared with those assigned to PMTO within the no-choice condition. Contrary to hypotheses, teacher report of hyperactivity/inattention was also significantly improved for families assigned to SAU within the no-choice condition, indicating that within the no-choice condition, SAU outperformed the parenting interventions. Implications for prevention research are discussed.
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Affiliation(s)
- Abigail H Gewirtz
- Department of Family Social Science & Institute of Child Development, University of Minnesota, 290 McNeal Hall, 1985 Buford Ave, St. Paul, MN, 55108, USA.
| | - Susanne S Lee
- Department of Psychiatry, University of Minnesota, 2312 S 6th St. Minneapolis, St. Paul, MN, 55454, USA
| | - Gerald J August
- Department of Family Social Science, University of Minnesota, 290 McNeal Hall, 1985 Buford Ave, St. Paul, MN, 55108, USA
| | - Yaliu He
- The Family Institute, Northwestern University, 618 Library Place, Evanston, IL, 60201, USA
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Zamir O, Gewirtz AH, Dekel R, Lavi T, Tangir G. Mothering under political violence: Post-traumatic symptoms, observed maternal parenting practices and child externalising behaviour. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2018; 55:123-132. [PMID: 30537100 DOI: 10.1002/ijop.12557] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 11/07/2018] [Indexed: 11/11/2022]
Abstract
Using the family stress model as our conceptual framework, we explored whether observed maternal parenting practices (positive and coercive) account for the associations between mothers' post-traumatic stress symptoms and children's externalising behaviours. Mothers' self-reported post-traumatic stress symptoms, observed maternal practices, and reports of children's externalising behaviour were collected from 123 Israeli mothers and their children, who were exposed to ongoing rocket attacks in southern Israel. A structural equation model revealed that mothers' post-traumatic stress symptoms were linked with greater maternal coercive parenting practices, which in turn were associated with more externalising behaviours in children. The study highlights the crucial role of maternal distress and mothers' parenting skills in the development of externalising behaviours in children exposed to chronic political violence. These results suggest that prevention interventions designed to promote parenting skills for mothers exposed to political violence may be beneficial for children's healthy development.
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Piehler TF, Ausherbauer K, Gewirtz A, Gliske K. Improving Child Peer Adjustment in Military Families through Parent Training: The Mediational Role of Parental Locus of Control. THE JOURNAL OF EARLY ADOLESCENCE 2018; 38:1322-1343. [PMID: 30555201 PMCID: PMC6289184 DOI: 10.1177/0272431616678990] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The current study investigated the mechanisms through which a parenting intervention for military families fosters positive peer adjustment in children. A sample of 336 families with a history of parental deployment enrolled in a randomized controlled trial of the After Deployment Adaptive Parenting Tools (ADAPT) preventive intervention. ADAPT is a 14-week preventive intervention designed to strengthen parenting in military families. The intervention was associated with improvements in mother's and father's parental locus of control (i.e., a more internal locus of control) at a 6-month follow-up assessment while controlling for baseline levels. Mothers' parental locus of control was positively associated with improvements in children's peer adjustment 12 months following the intervention while controlling for baseline peer adjustment. A significant indirect effect revealed that participation in ADAPT resulted in improved 12-month peer adjustment by improving mothers' parental locus of control. Implications for supporting youth resilience to stressors associated with deployment are discussed.
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Affiliation(s)
- Timothy F. Piehler
- Department of Family Social Science, University of Minnesota
- Institute for Translational Research in Children’s Mental Health, University of Minnesota
| | | | - Abigail Gewirtz
- Department of Family Social Science, University of Minnesota
- Institute for Translational Research in Children’s Mental Health, University of Minnesota
- Institute of Child Development, University of Minnesota
| | - Kate Gliske
- Department of Family Social Science, University of Minnesota
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He Y, Gewirtz AH, Lee S, August G. Do Parent Preferences for Child Conduct Problem Interventions Impact Parenting Outcomes? A Pilot Study in Community Children's Mental Health Settings. JOURNAL OF MARITAL AND FAMILY THERAPY 2018; 44:716-729. [PMID: 29425398 PMCID: PMC6085174 DOI: 10.1111/jmft.12310] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A pilot, doubly randomized preference trial was conducted to investigate the impact of providing parents preferences on parenting outcomes. Families with children having conduct problems were randomly assigned to a choice group in which they received their preferred treatment among the four intervention options or a no-choice group in which they were randomized assigned to one of the four options. Results of mixed-effects models showed that parents in the choice group who selected Parent Management Training-Oregon Model (PMTO) had better parenting outcomes over time compared to parents in the choice group who selected child therapy. It highlights the importance of incorporating parent preferences in the delivery of evidence-based treatments.
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Affiliation(s)
- Yaliu He
- The Family Institute at Northwestern University
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Smith JD, Egan KN, Montaño Z, Dawson-McClure S, Jake-Schoffman DE, Larson M, St. George SM. A developmental cascade perspective of paediatric obesity: a conceptual model and scoping review. Health Psychol Rev 2018; 12:271-293. [PMID: 29583070 PMCID: PMC6324843 DOI: 10.1080/17437199.2018.1457450] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 03/22/2018] [Indexed: 12/12/2022]
Abstract
Considering the immense challenge of preventing obesity, the time has come to reconceptualise the way we study the obesity development in childhood. The developmental cascade model offers a longitudinal framework to elucidate the way cumulative consequences and spreading effects of risk and protective factors, across and within biopsychosocial spheres and phases of development, can propel individuals towards obesity. In this article, we use a theory-driven model-building approach and a scoping review that included 310 published studies to propose a developmental cascade model of paediatric obesity. The proposed model provides a basis for testing hypothesised cascades with multiple intervening variables and complex longitudinal processes. Moreover, the model informs future research by resolving seemingly contradictory findings on pathways to obesity previously thought to be distinct (low self-esteem, consuming sugary foods, and poor sleep cause obesity) that are actually processes working together over time (low self-esteem causes consumption of sugary foods which disrupts sleep quality and contributes to obesity). The findings of such inquiries can aid in identifying the timing and specific targets of preventive interventions across and within developmental phases. The implications of such a cascade model of paediatric obesity for health psychology and developmental and prevention sciences are discussed.
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Affiliation(s)
- Justin D. Smith
- Department of Psychiatry and Behavioral Sciences, Department of Preventive Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA, (312)503-4041.
| | - Kaitlyn N. Egan
- Department of Psychology and Neuroscience, Baylor University, Waco, Texas, USA, (619)733-3977.
| | - Zorash Montaño
- Children’s Hospital of Los Angeles, University of Southern California, Los Angeles, California, USA, (323)804-6666.
| | - Spring Dawson-McClure
- Center for Early Childhood Health & Development, New York University Langone Medical Center, New York, New York, USA, (919)930-7240.
| | - Danielle E. Jake-Schoffman
- Division of Preventive & Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA, (508)856-6517.
| | - Madeline Larson
- Department of Psychology and Neuroscience, Baylor University, Waco, Texas, USA, (253)225-0119.
| | - Sara M. St. George
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA, (305)243-0726.
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Gewirtz AH. A Call for Theoretically Informed and Empirically Validated Military Family Interventions. JOURNAL OF FAMILY THEORY & REVIEW 2018; 10:587-601. [PMID: 30416241 PMCID: PMC6219466 DOI: 10.1111/jftr.12278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 03/16/2018] [Indexed: 06/09/2023]
Abstract
Although multiple evidence-based family interventions exist, less than a handful have been developed or rigorously tested specifically for military families. Indeed, few interventions available to military families are theory based or empirically validated; most have good face validity but little data on efficacy or effectiveness. This article argues for an emphasis on the rigorous evaluation, via pragmatic randomized controlled trials, of theory-based family interventions to strengthen and support military families. Data are provided from a theory-based, empirically validated parenting program for families (After Deployment, Adaptive Parenting Tools, or ADAPT) to demonstrate the potential for randomized controlled trials to yield rich data about family functioning beyond program outcomes. Opportunities to generate theoretically informed, evidence-based family interventions for military families will contribute not only to testing theories about military families but also to advancing well-being for the next generation of service members and their families.
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Parra-Cardona R, Leijten P, Lachman JM, Mejía A, Baumann AA, Amador Buenabad NG, Cluver L, Doubt J, Gardner F, Hutchings J, Ward CL, Wessels IM, Calam R, Chavira V, Domenech Rodríguez MM. Strengthening a Culture of Prevention in Low- and Middle-Income Countries: Balancing Scientific Expectations and Contextual Realities. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2018; 22:7-17. [PMID: 30058025 DOI: 10.1007/s11121-018-0935-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Relevant initiatives are being implemented in low- and middle-income countries (LMICs) aimed at strengthening a culture of prevention. However, cumulative contextual factors constitute significant barriers for implementing rigorous prevention science in these contexts, as defined by guidelines from high-income countries (HICs). Specifically, disseminating a culture of prevention in LMICs can be impacted by political instability, limited health coverage, insecurity, limited rule of law, and scarcity of specialized professionals. This manuscript offers a contribution focused on strengthening a culture of prevention in LMICs. Specifically, four case studies are presented illustrating the gradual development of contrasting prevention initiatives in northern and central Mexico, Panamá, and Sub-Saharan Africa. The initiatives share the common goal of strengthening a culture of prevention in LMICs through the dissemination of efficacious parenting programs, aimed at reducing child maltreatment and improving parental and child mental health. Together, these initiatives illustrate the following: (a) the relevance of adopting a definition of culture of prevention characterized by national commitments with expected shared contributions by governments and civil society, (b) the need to carefully consider the impact of context when promoting prevention initiatives in LMICs, (c) the iterative, non-linear, and multi-faceted nature of promoting a culture of prevention in LMICs, and (d) the importance of committing to cultural competence and shared leadership with local communities for the advancement of prevention science in LMICs. Implications for expanding a culture of prevention in LMICs are discussed.
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Affiliation(s)
- Rubén Parra-Cardona
- Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Blvd., Stop, D3500, Austin, TX, 78712, USA.
| | - Patty Leijten
- Research Institute of Child Development and Education & Research Priority Area YIELD, University of Amsterdam, Amsterdam, Netherlands
| | - Jamie M Lachman
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Complexity in Health Improvement, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Anilena Mejía
- Instituto de Investigaciones Científicas y Servicios de Alta Tecnología, Panama City, Panama
| | - Ana A Baumann
- George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, USA
| | | | - Lucie Cluver
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Jenny Doubt
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Frances Gardner
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Judy Hutchings
- Centre for Evidence Based Early Intervention, Department of Psychology, Bangor University, Bangor, UK
| | - Catherine L Ward
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Inge M Wessels
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Rachel Calam
- Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
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Facilitators and Barriers in Cross-Country Transport of Evidence-based Preventive Interventions: a Case Study Using the Family Check-Up. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2018; 22:73-83. [PMID: 30032407 DOI: 10.1007/s11121-018-0929-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study is a qualitative analysis of facilitators and barriers in the dissemination of Family Check-Up (FCU), a U.S.-developed preventive intervention in Sweden. The FCU is inherently culturally flexible because it was designed to be tailored to each family's needs and context, including cultural norms and values. We present the FCU implementation framework (IF) as a conceptual framework for cross-country transport of the FCU and evidence-based programs (EBP) more generally. The FCU IF draws from implementation science literature and involves specifying barriers and facilitators related to implementation drivers (e.g., competency) at each implementation phase and applying these data to inform phase-specific, readiness-building activities for each driver. In addition to driver-related influences, barriers and facilitators specific to the FCU and the collaborative partnership between the U.S. and Swedish purveyors emerged in the data. The partnership's reliance on a hybrid bottom-up, top-down approach that balanced the Swedish purveyor's autonomy and cultural expertise with guidance from the U.S. purveyor facilitated adaptation of the FCU for Sweden. Relying on previously collected data, we also explored similarities and differences in barriers and facilitators to FCU scale-up in the United States versus Sweden. In general, across drivers, the same barriers and facilitators were salient. This study suggests that dissemination of culturally flexible EBPs guided by a dynamic implementation framework can facilitate cross-country transport of EBPs. This study promotes a culture of prevention by highlighting barriers, facilitators, and readiness-building strategies that influence the cross-cultural transportability of EBPs that prevent the onset and escalation of child problem behavior.
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Sterrett-Hong EM, Karam E, Kiaer L. Statewide Implementation of Parenting with Love and Limits Among Youth with Co-Existing Internalizing and Externalizing Functional Impairments Reduces Return to Service Rates and Treatment Costs. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 44:792-809. [PMID: 28120298 DOI: 10.1007/s10488-016-0788-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Many community mental health (CMH) systems contain inefficiencies, contributing to unmet need for services among youth. Using a quasi-experimental research design, we examined the implementation of an adapted structural-strategic family intervention, Parenting with Love and Limits, in a state CMH system to increase efficiency of services to youth with co-existing internalizing and externalizing functional impairments (PLL n = 296; Treatment-As-Usual n = 296; 54% male; 81% Caucasian). Youth receiving PLL experienced shorter treatment durations and returned to CMH services at significantly lower rates than youth receiving treatment-as-usual. They also demonstrated significant decreases in internalizing and externalizing symptoms over time. Findings lay the foundation for further examination of the role of an adapted structural-strategic family treatment in increasing the efficiency of CMH systems.
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Affiliation(s)
- Emma M Sterrett-Hong
- Couple and Family Therapy Program, Kent School of Social Work, University of Louisville, 310 N. Whittington Pkwy Burhans Hall 134, Louisville, KY, 40222, USA.
| | - Eli Karam
- Couple and Family Therapy Program, Kent School of Social Work, University of Louisville, 310 N. Whittington Pkwy Burhans Hall 134, Louisville, KY, 40222, USA
| | - Lynn Kiaer
- Hornby Zeller Associates, Inc., Troy, USA
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Vidal S, Connell CM. Treatment Effects of Parent-Child Focused Evidence-Based Programs on Problem Severity and Functioning among Children and Adolescents with Disruptive Behavior. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2018; 48:S326-S336. [PMID: 29883195 DOI: 10.1080/15374416.2018.1469092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This study examined the treatment effects of manualized parent-child focused evidence-based programs (EBPs), characterized by an emphasis on parental involvement and engagement, on functioning and problem severity among a statewide sample of children and adolescents referred to outpatient psychiatric clinic for serious and persistent disruptive behavior. Propensity score matching was employed to account for baseline differences between children and adolescents (Mage = 8.4 years; 26% girls; 42% White, 10% Black, 42% Hispanic, 5% other) who received parent-child focused EBPs (treatment group; n = 220) and treatment-as-usual (comparison group; n = 2,543). Children and adolescents who received parent-child focused EBPs showed significantly greater reduction in problem severity compared to the comparison group, indicative of a drop below the clinical threshold for problem behavior. However, the pattern of improvement in problem severity was not paralleled by differential improvement in ratings of child functioning across treatment and comparison conditions. Finally, there were significant differences between the treatment and comparison groups pertaining to certain child and case characteristics that have potential implications for reaching high-risk populations of children and families. These findings support the potential of taking parent-child focused EBPs into scale to promote positive behavioral changes among children and adolescents. Parent-child focused EBPs may serve as an effective remedy that is less restrictive and more conducive to the healthy development of children and adolescents.
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Sigmarsdóttir M, Forgatch MS, Guðmundsdóttir EV, Thorlacius Ö, Svendsen GT, Tjaden J, Gewirtz AH. Implementing an Evidence-Based Intervention for Children in Europe: Evaluating the Full-Transfer Approach. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2018; 48:S312-S325. [PMID: 29877721 DOI: 10.1080/15374416.2018.1466305] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
This study evaluated the implementation outcomes of GenerationPMTO, an evidence-based parenting intervention for child and adolescent behavior problems, in three European countries. The implementation approach was full transfer, in which purveyors train a first generation (G1) of practitioners; adopting sites assume oversight, training, certification, and fidelity assessment for subsequent generations (Forgatch & DeGarmo, 2011; Forgatch & Gewirtz, 2017). Three hundred therapists participated in trainings in GenerationPMTO in Iceland, Denmark, and the Netherlands. Data are from the implementation's initiation in each country through 2016, resulting in 6 generations in Iceland, 8 in Denmark, and 4 in the Netherlands. Therapist fidelity was measured at certification with an observation-based tool, the Fidelity of Implementation Rating System (Knutson, Forgatch, Rains, & Sigmarsdóttir, 2009). Candidates in all generations achieved fidelity scores at or above the required standard. Certification fidelity scores were evaluated for G1 candidates, who were trained by the purveyor, and subsequent generations trained by the adopting implementation site. In each country, certification fidelity scores declined for G2 candidates compared with G1 and recovered to G1 levels for subsequent generations, partially replicating findings from a previous Norwegian study (Forgatch & DeGarmo, 2011). Recovery to G1 levels of fidelity scores was obtained in Iceland and the Netherlands by G3; in Denmark, the recovery was obtained by G5. The mean percentage of certification in each country was more than 80%; approximately 70% of certified therapists remained active in 2017. Findings support full transfer as an effective implementation approach with long-term sustainability and fidelity.
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Zhang N, Rudi JH, Zamir O, Gewirtz AH. Parent Engagement in Online Mindfulness Exercises Within a Parent Training Program for Post-Deployed Military Families. Mindfulness (N Y) 2018; 9:725-736. [PMID: 29963214 PMCID: PMC6020143 DOI: 10.1007/s12671-017-0810-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Mindfulness has drawn increased attention in prevention programs targeting parents. Commonly, mindfulness-based programs are provided to reduce parental stress and improve child outcomes. Less often, researchers incorporate a mindfulness-informed approach, integrating a low dose of mindfulness exercises into an existing evidence-based parent training model. Little is known about participant engagement with mindfulness exercises in such programs. This non-experimental study focuses on families who are at risk for impaired parenting due to the unique stressor of a parent's deployment to war. The goal is to examine military parents' online engagement in mindfulness exercises and associations between engagement and dispositional mindfulness within a web-enhanced parent training program. Online tracking records and self-reported data were obtained from 370 military parents (207 families) who were assigned to the program; at 6-month follow-up, 68.6% of these parents were retained (at least one parent reported from 75.4% of families). Results showed that nearly half (44.6%) of the parents engaged with the exercises. Participants who attended face-to-face group sessions (i.e., attendees) engaged throughout the intervention period whereas participants who never attended group sessions (i.e., non-attendees) mostly engaged during the first month in the program. Attendees and mothers engaged more than non-attendees and fathers. While engaged parents self-reported increased dispositional mindfulness at 6-month follow-up compared to baseline, only mothers' engagement accounted for a significant proportion of the variance (3%) in dispositional mindfulness at 6-month follow-up, after controlling for covariates. Implications for incorporating online mindfulness exercises into parent training are discussed in the context of programming for military families.
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Gewirtz AH, DeGarmo DS, Zamir O. After Deployment, Adaptive Parenting Tools: 1-Year Outcomes of an Evidence-Based Parenting Program for Military Families Following Deployment. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2018; 19:589-599. [PMID: 28913717 DOI: 10.1007/s11121-017-0839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Despite significant stressors facing military families over the past 15 years of wars in Iraq and Afghanistan, no parenting programs adapted or developed for military families with school-aged children have been rigorously tested. We present outcome data from the first randomized controlled trial of a behavioral parent training program for families with a parent deployed to Iraq or Afghanistan. In the present study, 336 primarily National Guard and Reserve families with 4-12-year-old children were recruited from a Midwestern state. At least one parent in each family had deployed to the recent conflicts: Operations Iraqi or Enduring Freedom, or New Dawn (OIF/OEF/OND). Families were randomized to a group-based parenting program (After Deployment, Adaptive Parenting Tools (ADAPT)) or web and print resources-as-usual. Using a social interaction learning framework, we hypothesized an indirect effects model: that the intervention would improve parenting, which, in turn, would be associated with improvements in child outcomes. Applying intent-to-treat analyses, we examined the program's effect on observed parenting, and children's adjustment at 12-months post baseline. Controlling for demographic (marital status, length, child gender), deployment variables (number of deployments), and baseline values, families randomized to the ADAPT intervention showed significantly improved observed parenting compared to those in the comparison group. Observed parenting, in turn, was associated with significant improvements in child adjustment. These findings present the first evidence for the effectiveness of a parenting program for deployed military families with school-aged children.
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Affiliation(s)
| | | | - Osnat Zamir
- Hebrew University of Jerusalem, Jerusalem, Israel
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Dorsey S, Kerns SEU, Lucid L, Pullmann MD, Harrison JP, Berliner L, Thompson K, Deblinger E. Objective coding of content and techniques in workplace-based supervision of an EBT in public mental health. Implement Sci 2018; 13:19. [PMID: 29368656 PMCID: PMC5784597 DOI: 10.1186/s13012-017-0708-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 12/29/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Workplace-based clinical supervision as an implementation strategy to support evidence-based treatment (EBT) in public mental health has received limited research attention. A commonly provided infrastructure support, it may offer a relatively cost-neutral implementation strategy for organizations. However, research has not objectively examined workplace-based supervision of EBT and specifically how it might differ from EBT supervision provided in efficacy and effectiveness trials. METHODS Data come from a descriptive study of supervision in the context of a state-funded EBT implementation effort. Verbal interactions from audio recordings of 438 supervision sessions between 28 supervisors and 70 clinicians from 17 public mental health organizations (in 23 offices) were objectively coded for presence and intensity coverage of 29 supervision strategies (16 content and 13 technique items), duration, and temporal focus. Random effects mixed models estimated proportion of variance in content and techniques attributable to the supervisor and clinician levels. RESULTS Interrater reliability among coders was excellent. EBT cases averaged 12.4 min of supervision per session. Intensity of coverage for EBT content varied, with some discussed frequently at medium or high intensity (exposure) and others infrequently discussed or discussed only at low intensity (behavior management; assigning/reviewing client homework). Other than fidelity assessment, supervision techniques common in treatment trials (e.g., reviewing actual practice, behavioral rehearsal) were used rarely or primarily at low intensity. In general, EBT content clustered more at the clinician level; different techniques clustered at either the clinician or supervisor level. CONCLUSIONS Workplace-based clinical supervision may be a feasible implementation strategy for supporting EBT implementation, yet it differs from supervision in treatment trials. Time allotted per case is limited, compressing time for EBT coverage. Techniques that involve observation of clinician skills are rarely used. Workplace-based supervision content appears to be tailored to individual clinicians and driven to some degree by the individual supervisor. Our findings point to areas for intervention to enhance the potential of workplace-based supervision for implementation effectiveness. TRIAL REGISTRATION NCT01800266 , Clinical Trials, Retrospectively Registered (for this descriptive study; registration prior to any intervention [part of phase II RCT, this manuscript is only phase I descriptive results]).
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Affiliation(s)
- Shannon Dorsey
- Department of Psychology, University of Washington, Guthrie Hall, Box 351525, Seattle, WA 98195 USA
| | - Suzanne E. U. Kerns
- University of Denver, Graduate School of Social Work, Craig Hall, Room 471, 2148 S. High St, Denver, CO 80208 USA
| | - Leah Lucid
- Department of Psychology, University of Washington, Guthrie Hall, Box 351525, Seattle, WA 98195 USA
| | - Michael D. Pullmann
- Division of Public Behavioral Health and Justice Policy, University of Washington School of Medicine, 2815 Eastlake Ave E, Suite 200, Seattle, WA 98102 USA
| | - Julie P. Harrison
- Department of Psychology, University of Washington, Guthrie Hall, Box 351525, Seattle, WA 98195 USA
| | - Lucy Berliner
- Harborview Center for Sexual Assault and Traumatic Stress, University of Washington School of Medicine, 401 Broadway, Suite 2027, Seattle, WA 98122 USA
| | - Kelly Thompson
- Department of Psychology, University of Washington, Guthrie Hall, Box 351525, Seattle, WA 98195 USA
| | - Esther Deblinger
- CARES Institute, Rowan University School of Osteopathic Medicine, 42 E. Laurel Road, UDP, Suite 1100, Stratford, NJ 08084 USA
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Abstract
Oppositional defiant disorder (ODD) is diagnosed broadly on the basis of frequent and persistent angry or irritable mood, argumentativeness/defiance, and vindictiveness. Since its inception in the third Diagnostic and Statistical Manual of Mental Disorders, epidemiological and longitudinal studies have strongly suggested a distinct existence of ODD that is different from other closely related externalizing disorders, with different course and outcome and possibly discrete subtypes. However, several issues, such as symptom threshold, dimensional versus categorical conceptualization, and sex-specific symptoms, are yet to be addressed. Although ODD was found to be highly heritable, no genetic polymorphism has been identified with confidence. There has been a definite genetic overlap with other externalizing disorders. Studies have begun to explore its epigenetics and gene–environment interaction. Neuroimaging findings converge to implicate various parts of the prefrontal cortex, amygdala, and insula. Alteration in cortisol levels has also been demonstrated consistently. Although a range of environmental factors, both familial and extrafamilial, have been studied in the past, current research has combined these with other biological parameters. Psychosocial treatment continues to be time-tested and effective. These include parental management training, school-based training, functional family therapy/brief strategic family therapy, and cognitive behavior therapy. Management of severe aggression and treatment of co-morbid disorders are indications for pharmacotherapy. In line with previous conceptualization of chronic irritability as a bipolar spectrum abnormality, most studies have explored antipsychotics and mood stabilizers in the management of aggression, with limited effects.
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Affiliation(s)
- Abhishek Ghosh
- Drug De-addiction and Treatment Centre, Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh
| | - Anirban Ray
- Department of Psychiatry, Institute of Psychiatry, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Aniruddha Basu
- Drug De-addiction and Treatment Centre, Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh
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Aarons GA, Sklar M, Mustanski B, Benbow N, Brown CH. "Scaling-out" evidence-based interventions to new populations or new health care delivery systems. Implement Sci 2017; 12:111. [PMID: 28877746 PMCID: PMC5588712 DOI: 10.1186/s13012-017-0640-6] [Citation(s) in RCA: 208] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 08/18/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Implementing treatments and interventions with demonstrated effectiveness is critical for improving patient health outcomes at a reduced cost. When an evidence-based intervention (EBI) is implemented with fidelity in a setting that is very similar to the setting wherein it was previously found to be effective, it is reasonable to anticipate similar benefits of that EBI. However, one goal of implementation science is to expand the use of EBIs as broadly as is feasible and appropriate in order to foster the greatest public health impact. When implementing an EBI in a novel setting, or targeting novel populations, one must consider whether there is sufficient justification that the EBI would have similar benefits to those found in earlier trials. DISCUSSION In this paper, we introduce a new concept for implementation called "scaling-out" when EBIs are adapted either to new populations or new delivery systems, or both. Using existing external validity theories and multilevel mediation modeling, we provide a logical framework for determining what new empirical evidence is required for an intervention to retain its evidence-based standard in this new context. The motivating questions are whether scale-out can reasonably be expected to produce population-level effectiveness as found in previous studies, and what additional empirical evaluations would be necessary to test for this short of an entirely new effectiveness trial. We present evaluation options for assessing whether scaling-out results in the ultimate health outcome of interest. CONCLUSION In scaling to health or service delivery systems or population/community contexts that are different from the setting where the EBI was originally tested, there are situations where a shorter timeframe of translation is possible. We argue that implementation of an EBI in a moderately different setting or with a different population can sometimes "borrow strength" from evidence of impact in a prior effectiveness trial. The collection of additional empirical data is deemed necessary by the nature and degree of adaptations to the EBI and the context. Our argument in this paper is conceptual, and we propose formal empirical tests of mediational equivalence in a follow-up paper.
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Affiliation(s)
- Gregory A. Aarons
- Department of Psychiatry, University of California, San Diego, La Jolla, CA USA
- Child and Adolescent Services Research Center, San Diego, CA USA
| | - Marisa Sklar
- Department of Psychiatry and Human Behavior, Brown University, Box G-A1, Providence, RI USA
| | - Brian Mustanski
- Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Nanette Benbow
- Feinberg School of Medicine, Northwestern University, Chicago, IL USA
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Farley JL, Whipple EE. EXPANDING INFANT MENTAL HEALTH TREATMENT SERVICES TO AT-RISK PRESCHOOLERS AND THEIR FAMILIES THROUGH THE INTEGRATION OF RELATIONAL PLAY THERAPY. Infant Ment Health J 2017; 38:669-679. [PMID: 28833296 DOI: 10.1002/imhj.21663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The expansion of infant mental health (IMH) to at-risk preschoolers and their families has contributed to the integration of relational play therapy (RPT) into IMH treatment services for this population. Integrating RPT allows access to specialized play and expressive techniques specific to preschool and family development, which improves the clinical ability to meet the multiple and complex needs of at-risk parent-child dyads and their families. This article will examine the RPT literature and explore the similarities and differences between IMH and RPT. In addition, two case studies will highlight a five-phase, integrative clinical-treatment process and provide insight into how IMH clinicians are integrating RPT models and maintaining adherence to the IMH treatment approach.
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