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Daily Routines Mediates the Impact of a Family's Adequacy of Resources on the Quality of the Caregiving Environment.
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The present study examined proximal variables in families of children prenatally exposed to cocaine and enrolled in a large-scale intervention program. Fifty-six high-risk families of children enrolled in the center-based (n = 30) or home-based (n = 26) intervention of the Linda Ray Intervention Program were interviewed. Four proximal variables wer...
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Background: Limited research has explored father–child interactions during feeding in dyads where fathers use cocaine, despite the critical role these interactions play in infant development. Methods: This study aimed to evaluate whether paternal cocaine use, psychopathology (measured via the SCL-90/R), and difficult child temperament (assessed usi...
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... The cut-off values varied, with some studies using very low limits (any positive response) and others using high limits (multiple instances of physical or verbal assault in the past year). Nine studies also included parenting attitude/stress either as a predictor of well-being outcomes or as the outcome that early childhood programs aimed to improve (Butz et al., 2001;Dinehart et al., 2006;Duggan et al., 2004;Frank et al., 2002;Hanlon-Dearman et al., 2017;Jones Harden et al., 2010;Lanier and Jonson-Reid, 2014;Pruner et al., 2020;Tandon et al., 2005). These studies used seven different assessments to measure indicators related to caregiver perceptions, attitudes, and experiences. ...
... Studies that assessed child well-being outcomes tended to focus on one domain of that concept, which was further conceptualized into a variety of measurable indicators. In other papers, the outcomes related to caregiving behaviors or the caregiving environment; among those studies, about half used selfreport questionnaires, while the rest used scored observations of caregiver-child interactions (Dinehart et al., 2006;Frank et al., 2002;Hanlon-Dearman et al., 2017;Schuler et al., 2002). In several papers, the authors measured changes in child behavior or temperament, either in terms of emotional expression, social behaviors, or attitudes (Bono & Sheinberg, 2009;Butz et al., 2001;Claussen et al., 2004;Hanlon-Dearman et al., 2017;Leitschuh and Dunn, 2001;Rotheram-Borus et al., 2019). ...
... Another factor contributing to low utilization of these programs is that families have other unmet needs that they feel are more pressing. When basic needs-such as food and housingare unmet, families may be less engaged in programs, less able to implement the skills from the intervention, and less likely to experience benefits from participation (Claussen et al., 2004;Dinehart et al., 2006;Frank et al., 2002;Hanlon-Dearman et al., 2017;Jones Harden et al., 2010;Lanier & Jonson-Reid, 2014;LeCroy & Whitaker, 2005;Pruner et al., 2020;Schuler et al., 2002;Tandon et al., 2008). Unmet needs related to mental and physical wellbeing-including SUD and safety from IPV-are elevated in families served by early childhood programs, and may play a role in program engagement and benefit (Duggan et al., 2004;Hanlon-Dearman et al., 2017;LeCroy & Whitaker, 2005;Palmer Molina et al., 2020;Peacock-Chambers et al., 2019;Rangmar et al., 2019;Rotheram-Borus et al., 2019;Schuler et al., 2002;Tandon et al., 2007;Tandon et al., 2005). ...
The rate of Neonatal Abstinence Syndrome (NAS) secondary to Prenatal Substance Exposure (PSE) has been rapidly increasing in the United States (U.S.); as these children age, they are interacting with public health systems such as in-home programs to promote early childhood development. These programs have been studied extensively in the context of their intended primary audiences, but less is known about their implementation or effectiveness relating to this specific subpopulation. Understanding the current literature on this topic can help program planning and service delivery. The purpose of this critical review is to assess trends in research and evaluation of home-based early childhood programs serving children with NAS and associated PSE. To conduct this review, the researcher searched for key phrases and topics in four databases and used a PRISMA diagram to structure the review process. The thirty-two studies that met the inclusion criteria were either formative evaluations of program implementation or summative evaluations that focused on outcomes for families. Areas of focus, definitions, and assessments varied greatly between the studies, making it difficult to generalize findings. From this review, three themes emerged: unmet basic needs threaten well-being and limit the effectiveness of interventions; existing programs are poorly equipped to help the families of children with NAS; and biases at all levels of the public health system may cause families to leave services. These findings are timely and relevant to the many service organizations that are experiencing an influx of potential clients with a history of PSE or NAS.
... Most children in the cohort also had socioeconomic risk factors, including parents who were unmarried (75%), had less than a high school education (24%), or were uninsured (9%). These social risks could complicate the relationship between substance exposure, EI involvement, and child development (Dinehart et al., 2006;Leitschuh & Dunn, 2001). ...
... However, until more robust statewide systems are in place to monitor children with NAS and refer them to EI when appropriate, it is unknown how many children in this cohort fell through the gaps. Except for heroin, the substance of exposure was not associated with likelihood of referral, lending support to previous findings that PSE is just one factor in development for children with NAS (Bono & Sheinberg, 2009;Dinehart et al., 2006;Frank et al., 2002;Larson et al., 2019;Leitschuh & Dunn, 2001) and that biological factors, parental characteristics, agency practices, community supports, and public policies also have a role. The social stigma against using substances that are perceived as dangerous substance, including heroin, may result in higher rates of referral to services or more involvement with child welfare among children with those substance exposures (Prindle et al., 2018). ...
... Beyond the Kentucky perspective, many of the lessons learned in this project can apply globally to EI programs that currently serve or are considering serving children with NAS or PSE. First, EI programs should be aware of the co-occurring socioeconomic or biological risk factors that often accompany NAS and could affect child development and/or engagement in services (Bono & Sheinberg, 2009;Dinehart et al., 2006;Frank et al., 2002;Larson et al., 2019;Leitschuh & Dunn, 2001). Programs should also ensure that their data collection practices allow them to capture information about how often, and why, families do or do not engage in EI at each step of the intake and service delivery processes, in order to address gaps in care. ...
Neonatal abstinence syndrome (NAS) is a public health issue that affected more than 2% of live births in Kentucky in 2017. We analyzed data from Kentucky’s early intervention (EI) program and the mandatory statewide NAS registry to learn more about how families of children with NAS utilize EI services. Out of 1,113 children in the study, 32% were referred to EI and 9% enrolled. Gaps in the intake process include low referral rates, low screening rates among referred children (36%), and lag in the time from referral to enrollment. Because 79% of screened children qualified for EI and 95% of qualifying children enrolled, this sample demonstrated some need for and interest in services. We are using these findings to inform policy recommendations that could help EI agencies experiencing an influx of potential clients with a history of NAS.
... Limited family resources have been found to be negatively related to parental beliefs about parenting capabilities (e.g., Dunst et al, 1988). The lack of family resources has also been found to be related to an increased sense of parenting burden (e.g., Kilmer et al., 2010) and less time to engage children in parent-child interactions and learning opportunities (e.g., Dinehart et al., 2006). As Floyd and Saitzyk (1992) hypothesized, limited family resources would also be expected to be related to less effective parenting practices (see e.g., Macais et al., 2007). ...
This meta-analysis includes an evaluation of the relationships between the adequacy of family resources and four parenting measures (beliefs, burden, engagement, and practices). Adequacy of family resources was hypothesized to be positively related to parenting beliefs, engagement, and practices and negatively related to parenting burden. Studies were eligible for inclusion if the Family Resource Scale was used to measure family resources, the total scale score was used to index the adequacy of family resources, one or more parenting belief or practices measures were used as outcome measures, and the correlations between the adequacy of family resources and the parenting measures were reported. Twenty-eight studies (including 30 independent samples of study participants) conducted between 1986 and 2019 met the inclusion criteria. The 30 samples included 5,247 study participants. Results showed that the adequacy of family resources was related to each of the four parenting measures as hypothesized and that child risk condition (children with or without identified disabilities or medical conditions and the number of items for computing a total family resource scale score moderated the strength of the relationships between family resources and parenting beliefs and practices. The findings are discussed in terms of the contributions to family systems theory and research. Several limitations of the meta-analysis are described.
... Another study on a smaller sample (n = 56) of the same population examined proximal variables and found that families of children enrolled in the center-based modality had more predictable daily routines than those in the home-based modality. Also, home caregiver education impacted the ability to establish or maintain daily routines where caregivers with lower education had less established routines than those with higher education levels (Bolzani Dinehart, Dice, Dobbins, Claussen, & Bono, 2006). Finally, another study on the same gestational cocaine exposure sample (n = 293) examined the moderating effect of low birth weight on the effectiveness of early intervention and found that children born with gestational cocaine exposure and who had low birth weight may benefit more from early intervention than children who are born with normal weight (Bono & Sheinberg, 2009). ...
This study examined the rates of special education placement during middle school grades (sixth through eighth) among children who participated in the Linda Ray Intervention Program (LRIP) center-based and home-based learning modalities. The study sample included 113 children in Miami Dade County Public Schools who had gestational cocaine exposure and received early intervention services due to developmental delays. This study found that children who participated in the center-based (25 hours per week) learning modality had a significantly lower rate of special education placement (14%) than the students in the home-based (three hours per week) learning modality (30%) in middle school. Also, results indicated that children who were socioeconomically disadvantaged (free/reduced lunch) and in the home-based learning modality were three to four times more likely to be in special education. This study provides evidence for the long-term impact of the LRIP center-based modality on special education outcomes.
(1) Background: Family systems theories include assertations that both personal and environmental factors are determinants of parents’ psychological health, well-being, and parenting quality. Applied family systems theories focus on determinants that can be operationalized as intervention practices. The analyses described in this paper focused on the direct and indirect effects of four family systems practices (family needs, resources, supports, and strengths), parents’ psychological health (depression, well-being, etc.), and parenting quality (parenting beliefs, involvement, and practices) in families of children with identified disabilities, medical conditions, or at-risk conditions for poor outcomes; (2) Methods: Data from previously completed meta-analyses of the relationships between family systems practices and parents’ psychological health outcomes and parenting quality outcomes were reanalyzed. Next, a meta-analysis of the relationships between parents’ psychological health and parenting quality was completed to identify which predictors were related to which parenting quality outcomes. Both main effects and mediated effects were examined; (3) Results: The four family systems practices were each related to six different psychological health measures and three parenting quality measures. The six different parental psychological health measures were also related to the three parenting quality measures. The relationships between family systems practices and parenting quality were partially mediated by parents’ psychological health; (4) Conclusions: The effects of family systems practices and parents’ psychological health on parenting quality were primarily direct and independent. The relationships between family systems practices and parenting quality were partially mediated by parents’ psychological health. Future research should focus on the identification of other mediator variables found to be important for explaining the indirect effects of family systems practices measures on parenting beliefs, behavior, and practices.
Children with prenatal substance exposure (PSE) often have behavior problems, but few studies have demonstrated that behavior therapy can be effective for these children. The current study evaluated the efficacy of Parent-Child Interaction Therapy (PCIT) for improving behavior problems in a sample of 116 children with PSE using archival data from a Midwestern PCIT clinic. Analyses included mean comparisons of pre- and post-treatment measures of child and parent behavior, prediction of drop-out from treatment, and evaluation of the potential complicating effects of PSE on treatment response. Results indicate that treatment effects of PCIT for children with PSE appear similar to the outcomes observed elsewhere in the PCIT literature. There was no indication that maternal polysubstance use alters child response to treatment. Attrition was high, but similar to other community trials of PCIT. The current study lends support to the use of PCIT for children with PSE who have behavior problems.
Substance-exposed newborns (SENs) are at increased risk of child maltreatment, out-of-home placement, and poor health and developmental outcomes. The purpose of this systematic review is to synthesize existing research on community- and home-based interventions designed to improve parenting and reduce risk of maltreatment for families with SENs, applying a program logic framework. The review includes studies that used preexperimental, quasi-experimental, and experimental designs. Twelve interventions were identified. Of the nine studies that used more rigorous experimental or quasi-experimental designs, five showed positive effects on at least one parenting or child maltreatment outcome, although some studies showed high risk of bias. Full coherence among the intended participants, theory of change, and program components was observed for only two interventions. The findings suggest a need for more rigorous research to develop and test interventions that are grounded in theory and prior research and that address the unique needs of families with SENs.
