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Group-based parent training programmes for improving emotional and behavioural adjustment in young children
Abstract
Background:
Emotional and behavioural problems in children are common. Research suggests that parenting has an important role to play in helping children to become well-adjusted, and that the first few months and years are especially important. Parenting programmes may have a role to play in improving the emotional and behavioural adjustment of infants and toddlers, and this review examined their effectiveness with parents and carers of young children.
Objectives:
1. To establish whether group-based parenting programmes are effective in improving the emotional and behavioural adjustment of young children (maximum mean age of three years and 11 months); and2. To assess whether parenting programmes are effective in the primary prevention of emotional and behavioural problems.
Search methods:
In July 2015 we searched CENTRAL (the Cochrane Library), Ovid MEDLINE, Embase (Ovid), and 10 other databases. We also searched two trial registers and handsearched reference lists of included studies and relevant systematic reviews.
Selection criteria:
Two reviewers independently assessed the records retrieved by the search. We included randomised controlled trials (RCTs) and quasi-RCTs of group-based parenting programmes that had used at least one standardised instrument to measure emotional and behavioural adjustment in children.
Data collection and analysis:
One reviewer extracted data and a second reviewer checked the extracted data. We presented the results for each outcome in each study as standardised mean differences (SMDs) with 95% confidence intervals (CIs). Where appropriate, we combined the results in a meta-analysis using a random-effects model. We used the GRADE (Grades of Recommendations, Assessment, Development, and Evaluation) approach to assess the overall quality of the body of evidence for each outcome.
Main results:
We identified 22 RCTs and two quasi-RCTs evaluating the effectiveness of group-based parenting programmes in improving the emotional and behavioural adjustment of children aged up to three years and 11 months (maximum mean age three years 11 months).The total number of participants in the studies were 3161 parents and their young children. Eight studies were conducted in the USA, five in the UK, four in Canada, five in Australia, one in Mexico, and one in Peru. All of the included studies were of behavioural, cognitive-behavioural or videotape modelling parenting programmes.We judged 50% (or more) of the included studies to be at low risk for selection bias, detection bias (observer-reported outcomes), attrition bias, selective reporting bias, and other bias. As it is not possible to blind participants and personnel to the type of intervention in these trials, we judged all studies to have high risk of performance bias. Also, there was a high risk of detection bias in the 20 studies that included parent-reported outcomes.The results provide evidence that group-based parenting programmes reduce overall emotional and behavioural problems (SMD -0.81, 95% CI -1.37 to -0.25; 5 studies, 280 participants, low quality evidence) based on total parent-reported data assessed at postintervention. This result was not, however, maintained when two quasi-RCTs were removed as part of a sensitivity analysis (SMD -0.67, 95% CI -1.43 to 0.09; 3 studies, 221 participants). The results of data from subscales show evidence of reduced total externalising problems (SMD -0.23, 95% CI -0.46 to -0.01; 8 studies, 989 participants, moderate quality evidence). Single study results show very low quality evidence of reductions in externalising problems hyperactivity-inattention subscale (SMD -1.34; 95% CI -2.37 to -0.31; 19 participants), low quality evidence of no effect on total internalising problems (SMD 0.34; 95% CI -0.12 to 0.81; 73 participants), and very low quality evidence of an increase in social skills (SMD 3.59; 95% CI 2.42 to 4.76; 32 participants), based on parent-reported data assessed at postintervention. Results for secondary outcomes, which were also measured using subscales, show an impact on parent-child interaction in terms of reduced negative behaviour (SMD -0.22, 95% CI -0.39 to -0.06; 7 studies, 941 participants, moderate quality evidence), and improved positive behaviour (SMD 0.48, 95% CI 0.17 to 0.79; 4 studies, 173 participants, moderate quality evidence) as rated by independent observers postintervention. No further meta-analyses were possible. Results of subgroup analyses show no evidence for treatment duration (seven weeks or less versus more than eight weeks) and inconclusive evidence for prevention versus treatment interventions.
Authors' conclusions:
The findings of this review, which relate to the broad group of universal and at-risk (targeted) children and parents, provide tentative support for the use of group-based parenting programmes to improve the overall emotional and behavioural adjustment of children with a maximum mean age of three years and 11 months, in the short-term. There is, however, a need for more research regarding the role that these programmes might play in the primary prevention of both emotional and behavioural problems, and their long-term effectiveness.
... Parenting interventions are usually short-term programs that seek to help parents improve their parenting practices in one or more specific domains using standardized curricula and are often developed to help prevent or treat a range of child emotional and behavioral problems (Barlow, Bergman, Kornør, Wei, and Bennett, 2016). Traditionally, parenting programs were based on behavioral modification techniques and used parent training as a modifier of children's difficult behaviors (Sanders and James, 1983), but many new theoretical frameworks have emerged (e.g., Family Systems, Attachment). ...
... Traditionally, parenting programs were based on behavioral modification techniques and used parent training as a modifier of children's difficult behaviors (Sanders and James, 1983), but many new theoretical frameworks have emerged (e.g., Family Systems, Attachment). Typically, parenting programs are delivered to groups of parents or on a one-on-one basis (e.g., in therapeutic relationships), use a range of techniques (e.g., discussion, role play, video vignettes, homework assignments), are provided in a number of healthcare or community-based settings (e.g., clinics, schools, homes, etc.), and generally occur over the course of 8-12 weeks for 1-2 hours each week (Barlow, Smailagic, Ferriter, Bennett, and Jones, 2010;Barlow et al., 2016). It is important to note that many parenting interventions incorporate multiple components, and thus may be considered 'behavioral' (e.g., focused on behavior modification techniques such as positive reinforcement), 'emotional' (e.g., focused on emotion socialization practices such as emotion coaching), or both; however, a distinction can be made based on interventions' theory of change models (i.e., how the intervention is thought to bring about change in parent and/or child outcomes). ...
... The implementation and evaluation of emotion socialization parenting interventions appears to be in the earlier stages, at least compared to the extant literature examining the effects of behavioral parenting training interventions (Barlow et al., 2016;Barlow, Smailagic, Huband, Roloff, and Bennett, 2014;Forehand, Jones, and Parent, 2013;Sanders, Kirby, Tellegen, and Day, 2014; van Aar, Leijten, Orobio de Castro, and Overbeek, 2017), and more basic information is needed. Our results indicated that emotion socialization parenting interventions effectively improve emotion socialization parenting practices, parenting behaviors, parent psychological well-being, child emotional competence, and child behavioral adjustment. ...
Background:
Although emotion socialization parenting interventions are supported by a growing body of literature, their effects have yet to be systematically examined. The present systematic review and meta-analysis assesses the evidence for emotion socialization parenting interventions for parents of young children.
Methods:
Six electronic databases were systematically searched from inception to October 5th, 2022. We conducted random effects meta-analyses of randomized controlled trials of emotion socialization interventions delivered to parents of children aged 18 months to 6 years 11 months.
Results:
Twenty-six studies which reported data from 15 individual trials met the inclusion criteria. Interventions had a positive effect on positive and negative emotion socialization parenting practices (g's = 0.50) and child emotional competence (g = 0.44). Interventions also had a positive effect on positive (g = 0.74) and negative parenting behaviors (g = 0.25), parent psychological well-being (g = 0.28), and child behavioral adjustment (g = 0.34). Findings remained significant after considering potential publication bias and conducting sensitivity analyses. Two significant moderating factors emerged.
Conclusions:
Emotion socialization parenting interventions are effective for improving emotion socialization parenting practices and child emotional competence. Additional methodologically rigorous trials are needed to buttress the current evidence and provide evidence for additional moderating factors.
... Several international systematic reviews and meta-analyses have evaluated universally offered early childhood interventions and have found significant improvements in mental health and/or parenting outcomes (e.g., [26][27][28][29][30][31][32][33][34][35]). The early childhood interventions can be conducted with individual families in their homes (e.g., [32,35]), can be group-based, and delivered at community facilities such as hospitals, social work clinics, preschools, or churches (e.g., [27,29,31]), or be online-based (e.g., [29]). ...
... Several international systematic reviews and meta-analyses have evaluated universally offered early childhood interventions and have found significant improvements in mental health and/or parenting outcomes (e.g., [26][27][28][29][30][31][32][33][34][35]). The early childhood interventions can be conducted with individual families in their homes (e.g., [32,35]), can be group-based, and delivered at community facilities such as hospitals, social work clinics, preschools, or churches (e.g., [27,29,31]), or be online-based (e.g., [29]). What all these interventions have in common is the aim to improve children's and parents' mental health by supporting the parent-child attachment or interaction, focusing on e.g., the parents' knowledge, attitudes, and understanding [26,28,29,[32][33][34][35]. ...
... When it comes to children's mental health and development, previous review studies have come to different conclusions. For instance, Barlow et al. [27] and Jeong et al. ...
... Another recent review that examined the impact of 14 different parenting programmes showed positive changes in both parenting and child behaviour outcomes after participating in the programmes (Branco et al., 2021). Other systematic reviews have shown that parenting programmes improve emotional and behavioural adjustment in children as well as the psychosocial well-being of parents (Barlow et al., 2016;Barlow & Coren, 2017). ...
... Despite increased evidence on the effects of parenting programmes, there is still a need for more studies examining the long-term effectiveness of group-based parenting programmes (Barlow et al., 2016;Barlow & Coren, 2017) and more studies using more rigorous methodological designs such as RCT design with long-term follow-up (Branco et al., 2021). ...
... effects of ICDP. The study showed a trend towards fewer child difficulties after 6 months; however, the sample was small and not ran- (Barlow et al., 2016) concluded that parental guidance programmes appear to have a positive effect on children's emotional difficulties and behavioural problems in the short term, but the authors of the study emphasized that more research is needed to gain further knowledge about the possible longterm effects of these programmes. ...
This study aimed to evaluate the effectiveness of the International Child Development Programme (ICDP), a group‐based parenting programme used internationally and implemented nationally in Norway. We used a cluster randomized controlled trial in which 81 groups were randomly assigned to either the intervention or waitlist control condition after the baseline data collection. A total of 590 parents completed at least one of three questionnaires (administrated before and after ICDP and 4 months after completing the intervention). Primary outcomes included parental self‐efficacy, parental emotion sensitivity and positive involvement with their child. Secondary outcomes included parents' perceptions of their relationship with the child, child‐rearing conflicts and the child's psychosocial health. We found significant effects favouring the intervention arm following the intervention and at follow‐up on two primary outcomes (parental self‐efficacy and emotion sensitivity). For the secondary outcomes, we found a significant reduction in child‐rearing conflict at the 4‐month follow‐up, increased closeness to the child, reduced child internalizing difficulties and increased prosocial behaviour immediately following the intervention. However, ICDP seems to have limited effects on parent‐reported changes in children. We conclude that ICDP as a universal preventive programme offered to parents in groups can be effective in strengthening parental self‐efficacy and improving parental emotion sensitivity.
... This fact also explains that, in the review conducted by Barlow and Coren (2018) only six systematic reviews of the effectiveness of parenting programmes published in the Campbell Library were identified. In most cases, the evaluation studies included in the reviews and meta-analyses refer to a few internationally widespread programmes (e.g., "Incredible Years" or "Triple P") implemented in high-income countries (Asmussen et al., 2017;Barlow et al., 2016;Jeong et al., 2021). ...
... In most cases, evaluation processes were labelled as non-rigorous, consisting of reports on client satisfaction or coverage analyses (Jiménez et al., 2019). According to available data, quality standards less commonly met in family programme evaluations include RCT designs, follow-up measures, cost-benefit evaluations, and outcome assessment related to children's well-being (Barlow et al., 2016;Jeong et al., 2021;Van Assen et al., 2020). ...
... interventions; EBPs must have demonstrated long-term benefits on certain family and child outcomes (Barlow et al., 2016;Gottfredson et al., 2015). To this respect, follow-up evaluations are needed to better understand the short-, medium-, and long-term effects of parenting and family support programmes, and to inform about the design of improved interventions that can maximise and sustain initial benefits over time (Jeong et al., 2021;Özdemir, 2015). ...
... Flere vitenskapelige oversiktsartikler (review-artikler) som har gått gjennom RCT-studier og kvasieksperimentelle studier viser at gruppeintervensjoner for foreldre kan bedre foreldrenes psykososiale helse og fungering (28,29), foreldreferdigheter og foreldre-barnsamspill (19,27,30) samt barns emosjonelle og atferdsmessige fungering (19,27,(30)(31)(32). Resultatene fra en systematisk gjennomgang av kvalitative studier peker mot at gruppeintervensjoner gir foreldre økt kunnskap og forståelse og bedre ferdigheter, samt en følelse av aksept og støtte fra andre deltakere i gruppen. ...
... Flere vitenskapelige oversiktsartikler (review-artikler) som har gått gjennom RCT-studier og kvasieksperimentelle studier viser at gruppeintervensjoner for foreldre kan bedre foreldrenes psykososiale helse og fungering (28,29), foreldreferdigheter og foreldre-barnsamspill (19,27,30) samt barns emosjonelle og atferdsmessige fungering (19,27,(30)(31)(32). Resultatene fra en systematisk gjennomgang av kvalitative studier peker mot at gruppeintervensjoner gir foreldre økt kunnskap og forståelse og bedre ferdigheter, samt en følelse av aksept og støtte fra andre deltakere i gruppen. ...
... Til tross for at foreldreveiledningsprogrammer er utbredt i Norge, vet vi for lite om effekten av disse tiltakene, spesielt på lang sikt (30). I det forebyggende arbeidet er det viktig å bruke tiltak som har vist gode resultater i kontrollerte evalueringer (34), og det er en relativt bred enighet blant praktikere, forskere og politikere om at tiltak rettet mot barn og unges psykiske helse burde ha best mulig dokumentasjon av effekt (35). ...
... Negative parenting practices have been consistently documented as being related to externalizing problems but less frequently examined as predictors of internalizing problems in preschool children [25]. Furthermore, parenting interventions were effective for improving emotional and behavioral problems in children and adolescents [36,37]. Thus, maternal social isolation may affect behavioral problems in children through parenting, although the present study was unable to examine this possible mechanism because of a lack of data on parenting. ...
... These studies indicate that parental factors were somewhat differentially associated with internalizing and externalizing problems. In fact, a systematic review on the effectiveness of group-based parent training programs provided moderatequality evidence for an improvement in externalizing problems but low-quality evidence for no effect on internalizing problems in young children (maximum mean age: 3 years and 11 months) [36]. However, a meta-analysis found that attachment-and emotion-focused parenting interventions for children at 0-18 years of age supported the potential of these interventions to reduce both internalizing and externalizing behavioral problems [37]. ...
It is essential to clarify factors associated with mental health and behavioral problems in early childhood, because children are critical stages of life for mental health. We aimed to prospectively examine the associations between maternal social isolation and behavioral problems in preschool children. We analyzed data from 5842 mother–child pairs who participated in the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study. The Lubben Social Network Scale-abbreviated version was used to assess social isolation (defined as scores < 12) one year after delivery. The Child Behavior Checklist 1½–5 was used to assess behavioral problems, and its subscales were used to assess internalizing and externalizing problems in children at 4 years of age. Multiple logistic regression analyses were conducted to examine the associations between social isolation and behavioral problems, after adjustment for age, education, income, work status, marital status, extraversion, neuroticism, depressive symptoms, child sex, and number of siblings. Multiple logistic regression analyses were also conducted for internalizing problems and externalizing problems. The prevalence of maternal social isolation was 25.4%. Maternal social isolation was associated with an increased risk of behavioral problems in children: the odds ratio (OR) was 1.37 (95% confidence interval [CI] 1.14–1.64). Maternal social isolation was also associated with increased risks of internalizing problems and externalizing problems in children: the ORs were 1.33 (95% CI, 1.12–1.59) and 1.40 (95% CI, 1.18–1.66), respectively. In conclusion, maternal social isolation one year after delivery was associated with behavioral problems in children at 4 years of age.
... Of the randomised and two-group quasiexperimental studies using direct measures of EFs, only one study-Nash (2012)-had clustering. The authors did not report the ICC, so we conducted sensitivity analyses as suggested by Deeks et al. (2020), which has been implemented in analogous reviews (Armstrong et al., 2018;Barlow et al., 2016). Barlow et al. (2016) located an ICC of 0.03 for one included group-based psychological intervention study. ...
... The authors did not report the ICC, so we conducted sensitivity analyses as suggested by Deeks et al. (2020), which has been implemented in analogous reviews (Armstrong et al., 2018;Barlow et al., 2016). Barlow et al. (2016) located an ICC of 0.03 for one included group-based psychological intervention study. An ICC of zero was used for meta-analyses, with accompanying sensitivity analyses to assess difference in meta-analysis results for ICCs of 0.02, 0.03 and 0.1. ...
Background:
The consequences for children born with birth defects and developmental disabilities encompassed by foetal alcohol spectrum disorder (FASD) are profound, affecting all areas of social, behavioural and cognitive functioning. Given the strong evidence for a core deficit in executive functioning, underpinned by impaired self-regulation skills, there has been a growing focus on the development of interventions that enhance or support the development of executive functions (EFs).
Objectives:
The primary objective of this review is to synthesise the evidence for structured psychological interventions that explicitly aim to improve EF in children. The review also sought to ascertain if the effectiveness of interventions were influenced by characteristics of the intervention, participants or type of EF targeted by the intervention.
Search methods:
Sixteen databases, 18 grey literature search locations and 9 trial registries were systematically searched to locate eligible studies (up to December 2020). These searches were supplemented with reference harvesting, forward citation searching, hand searches of topic-relevant journals and contact with experts.
Selection criteria:
Studies were included in the review if they reported on an impact evaluation of a psychological intervention aiming to improve EF in children 3-16 years who either had confirmed prenatal alcohol exposure or a formal diagnosis falling under the umbrella term of FASDs. Eligible study designs included randomised controlled trials (RCTs) and quasi-experimental designs with either no treatment, wait list control or an alternative treatment as a comparison condition. Single-group pre-post designs were also included.
Data collection and analysis:
Standard methodological procedures expected by the Campbell Collaboration were used at all stages of this review. Standardised mean differences (SMDs) were used to estimate intervention effects, which were combined with random effects meta-analysis (data permitting). Risk of bias was assessed using the Cochrane Risk of Bias Tool (RoB2) and Cochrane Risk of Bias in Non-Randomised Studies-Interventions tool (ROBINS-I).
Main results:
The systematic search identified 3820 unique records. After title/abstract and full-text screening, 11 eligible studies (reported in 21 eligible documents) were deemed eligible, with a combined 253 participants. Of the 11 studies, 6 were RCTs, 1 was a quasi-experiment and 4 were single-group pre-post intervention designs. All studies were rated as having an overall high or serious risk of bias, with some variation across domains for RCTs. For RCT and quasi-experimental studies, the overall effect of EF interventions on direct and indirect measures of EF generally favoured the experimental condition, but was not statistically significant. There was no difference between intervention and comparison groups on direct measures of auditory attention (k = 3; SMD = 0.06, 95% confidence interval [CI] = -1.06, 1.18), visual attention (k = 2; SMD = 0.90, 95% CI = -1.41, 3.21), cognitive flexibility (k = 2; SMD = 0.23, 95% CI = -0.40, 0.86), attentional inhibition (k = 2; SMD = 0.04, 95% CI = -0.58, 0.65), response inhibition (k = 3; SMD = 0.47, 95% CI = -0.04, 0.99), or verbal working memory (k = 1; d = 0.6827; 95% CI = -0.0196, 1.385). Significant heterogeneity was found across studies on measures of auditory attention and visual attention, but not for measures of cognitive flexibility, attentional inhibition or response inhibition. Available data prohibited further exploration of heterogeneity. There was no statistical difference between intervention and comparison groups on indirect measures of global executive functioning (k = 2; SMD = 0.21, 95% CI = -0.40, 0.82), behavioural regulation (k = 2; SMD = 0.18, 95% CI = -0.43, 0.79), or emotional control (k = 3; SMD = 0.01, 95% CI = -0.33, 0.36). Effect sizes were positive and not significant for meta-cognition (k = 1; SMD = 0.23, 95% CI = -0.72, 1.19), shifting (k = 2; SMD = 0.04, 95% CI = -0.35, 0.43), initiation (k = 1; SMD = 0.04, 95% CI = -0.40, 0.49), monitoring (k = 1; SMD = 0.25, 95% CI = -0.20, 0.70) and organisation of materials (k = 1; SMD = 0.25, 95% CI = -0.19, 0.70). Effect sizes were negative and not statistically different for effortful control (k = 1; SMD = -0.53, 95% CI = -1.50, 0.45), inhibition (k = 2; SMD = -0.08, 95% CI = -0.47, 0.31), working memory (k = 1; SMD = 0.00, 95% CI = -0.45, 0.44), and planning and organisation (k = 1; SMD = -0.10, 95% CI = -0.55, 0.34). No statistically significant heterogeneity was found for any of the syntheses of indirect measures of EF. Based on pre-post single-group designs, there was evidence for small to medium sized improvements in EF based on direct measures (cognitive flexibility, verbal working memory and visual working memory) and indirect measures (behavioural regulation, shifting, inhibition and meta-cognition). However, these results must be interpreted with caution due to high risk of bias.
Authors' conclusions:
This review found limited and uncertain evidence for the effectiveness of interventions for improving executive functioning in children with FASD across 8 direct and 13 indirect measures of EF. The findings are limited by the small number of high-quality studies that could be synthesised by meta-analysis and the very small sample sizes for the included studies.
... Of all the possible research designs, randomized controlled trials (RCTs) are considered to be the most reliable in determining the quality of impacts, since they minimize the risk of estimations being influenced by extraneous factors (Moher et al., 2010). Indeed, the scientific literature review that was conducted for this paper highlighted the fact that systematic reviews mainly include impact studies based on RCT evaluations (e.g., Barlow et al., 2016;Jeong, Franchett et al., 2021;MacArthur et al., 2018). Along with the research design, it is interesting to analyse outcomes by the type of data that is used (quantitative, qualitative, or mixed), since this data is based on different statistical procedures. ...
... Over half the programmes also analyse the data from a qualitative perspective. Systematic reviews of programmes focus on RCT quantitative analyses (e.g., Barlow et al., 2016;Jeong, Franchett et al., 2021;MacArthur et al., 2018). However, experts like Creswell (2014) recommend mixed methodological approaches (quantitative/ qualitative) to achieve better insights. ...
A description is made of the quality of Spanish family support programmes, based on their impact, dissemination, scaling
up in communities, and sustainability; 57 implemented programmes with informed evidence were selected by EurofamNet.
Most of the programmes were shown to make a positive impact, using quantitative methodologies, and they were
manualized, while about half of them defined the core contents and included professional training. From a cluster analysis
of programmes with scaling up, those with a high and moderate level of systematization were identified, based on the existence of defined core contents, implementation conditions, institutional support, professional training, and reports of findings. The highly systematized programmes were characterized by a greater use of mixed methodologies, their scientific dissemination through different means, and their inclusion in services. A programme quality analysis is proposed, taking an integrated approach that relates the programme’s impact with its design, implementation, and evaluation of sustainability.
... Several studies have shown that group-based support programs for parents can improve emotional and behavioral problems in preschool children [27]. Also, parental psychoeducation and counseling in communication skills and behavioral modification are important [28]. ...
... Results from previous studies with a similar approach have shown that the most effective intervention seems to be parent and preschool interventions starting at an early age, with a focus on communication [29,31,39]. Several studies have shown that group-based support programs for parents can improve emotional and behavioral problems in preschool children [27]. Unlike earlier studies, such interventions will be possible to evaluate long-term within the PLUSS model. ...
Background
Neurodevelopmental difficulties, such as problems in social inter-relatedness, communication, motor coordination, and attention, are frequent in preschoolers and constitute a risk for later negative consequences. This article describes the development of a multi-professional and multi-agency model, PLUSS, to facilitate care and interventions for preschoolers with neurodevelopmental difficulties.
Methods
The PLUSS model was developed for children aged 1.5–5 years with a need for a further assessment of neurodevelopmental symptoms. The model is evaluated using a quasi-experimental study design along with qualitative interviews that study preschool teacher, and parent experiences of PLUSS. Outcomes of interest are a) implementation, b) effectiveness related to processes and multi-agency collaboration, c) capacity building among professionals, d) child-related outcomes with a longitudinal follow-up as well as d) parental wellbeing and satisfaction.
Results
The model was launched in 2019 and so far, approximately 130 children have been assessed. Results from a pilot study with 62 children (27–72 months; boys: girls 2.65:1) show that the total mean SDQ score in parental rating was 15 ± 6 and in preschool teacher ratings 14 ± 7, exceeding the Swedish cut-off of 12. 54 parents have participated in parental training and rate high levels of satisfaction (mean score 4.5, max 5.0). In addition, 74 pre-school professionals have been trained in early signs of neurodevelopmental difficulties to facilitate early detection. Feedback from participants indicates high satisfaction with educational activities (mean score 4.2, max 5.0 = very satisfied).
Conclusions
The pilot study shows that the screening procedure can detect children with clinically significant problems. In addition, participant satisfaction is high in parent- and preschool teacher training. The longitudinal study approach enables both child follow-up and evaluation of interventions provided by the working model.
Trial registration
Clinical Trials 2021, PLUSS identifier, NCT04815889 . First registration 25/03/2021.
... Parenting programmes are effective in improving parenting skills and mental health [10,11], which appear to mediate improvements in child behaviour problems [12]. Several Cochrane reviews of universal and targeted group-based parenting programmes have demonstrated a variety of positive effects on both child and parental outcomes [10,[13][14][15]. Parenting programmes appear to be effective for parents regardless of trial setting and severity of problems at baseline, suggesting that a range of families can engage and benefit from these programmes [10,16]. ...
... However, to date no randomised controlled trials (RCTs) have been conducted. A trial evaluating SFSC will directly address the knowledge gaps identified in the Cochrane reviews of parenting interventions [10,[13][14][15] and will focus on families with older children, specifically targeting families from ethnically and socially diverse communities. The TOGETHER study aims to assess the effectiveness and cost effectiveness of the SFSC programme in enhancing parental mental well-being and children's social and emotional well-being up to 6-months post intervention across urban areas in England. ...
Background
Up to 20% of UK children experience socio-emotional difficulties which can have serious implications for themselves, their families and society. Stark socioeconomic and ethnic inequalities in children’s well-being exist. Supporting parents to develop effective parenting skills is an important preventive strategy in reducing inequalities. Parenting interventions have been developed, which aim to reduce the severity and impact of these difficulties. However, most parenting interventions in the UK focus on early childhood (0–10 years) and often fail to engage families from ethnic minority groups and those living in poverty. Strengthening Families, Strengthening Communities (SFSC) is a parenting programme designed by the Race Equality Foundation, which aims to address this gap. Evidence from preliminary studies is encouraging, but no randomised controlled trials have been undertaken so far.
Methods/design
The TOGETHER study is a multi-centre, waiting list controlled, randomised trial, which aims to test the effectiveness of SFSC in families with children aged 3–18 across seven urban areas in England with ethnically and socially diverse populations. The primary outcome is parental mental well-being (assessed by the Warwick-Edinburgh Mental Well-Being Scale). Secondary outcomes include child socio-emotional well-being, parenting practices, family relationships, self-efficacy, quality of life, and community engagement. Outcomes are assessed at baseline, post intervention, three- and six-months post intervention. Cost effectiveness will be estimated using a cost-utility analysis and cost-consequences analysis. The study is conducted in two stages. Stage 1 comprised a 6-month internal pilot to determine the feasibility of the trial. A set of progression criteria were developed to determine whether the stage 2 main trial should proceed. An embedded process evaluation will assess the fidelity and acceptability of the intervention.
Discussion
In this paper we provide details of the study protocol for this trial. We also describe challenges to implementing the protocol and how these were addressed. Once completed, if beneficial effects on both parental and child outcomes are found, the impact, both immediate and longer term, are potentially significant. As the intervention focuses on supporting families living in poverty and those from minority ethnic communities, the intervention should also ultimately have a beneficial impact on reducing health inequalities.
Trial registration
Prospectively registered Randomised Controlled Trial ISRCTN15194500 .
... Der var imidlertid ingen systematiske forskelle i de individuelle studiers effekt afhaengigt af laengden af interventionerne, opfølgningstidspunkt, studiet størrelse eller hvorvidt indsatserne var igangsat før eller efter fødslen. I en metaanalyse af de universelle og gruppebaserede indsatser (tre studier) fandt Barlow et al. (2016) ingen signifikant effekt på emotionelle og adfaerdsmaessige vanskeligheder hos 0-3-årige børn (18). På et metaniveau, hvor man sammenfatter den viden, man har fra eksisterende studier, er der således endnu begraenset viden om effekten af universelle foraeldreindsatser. ...
... Flere systematiske forskningsoversigter har vist, at selektive og i nogle tilfaelde også indikerede foraeldreindsatser overordnet set har potentiale til at forbedre foraeldre-barn-relationen og/eller spaed-og småbørns mentale helbred på kort sigt (18)(19)(20). Barlow et al. (2016) undersøgte i en forskningsoversigt af 23 randomiserede kontrollerede studier eller kvasirandomiserede kontrollerede studier effekten af gruppebaserede foraeldreindsatser udbudt fra en universel, selektiv eller indikativ tilgang til foraeldre til 0-3-årige (18). Uden at skelne mellem de tre forebyggelsesmaessige tilgange har en metaanalyse (ni studier) vist en positiv effekt på eksternaliserende symptomer samt på foraelder-barn-interaktion i form af en reduktion i negativ adfaerd (syv studier) og øget positiv adfaerd (fire studier). ...
Review of scientific evidence on 1) the prevalence of mental health problems and mental disorders among 0-9-year-olds, 2) risk factors and protective factors, 3) the role of family, daycare, school and other societal arenas, 4) early identification of mental health problems, and 5) preventive interventions used in Denmark and their scientific documentation
... The Code of Practice (Kwok, Gu, and Kit, 2016) demonstrates that educational psychologists (EPs) play a significant role in the assessment of SEBD, despite the lack of clarity in this area. However, the Code of Practice (Barlow et al., 2016) does not specify the elements which may be relevant to an individual child's issues, or which methods of evaluation should be used. This may facilitate more subjective identification of problems, depending on how EPs personally interpret a child's issues and demands; this means that SEBD theories may follow either a medical model or be attributed to social causes. ...
Emotional, social, behavioral, and mental health disorders in young children are increasingly prevalent and may have long-term effects, persisting from preschool into primary school (Carroll & Hurry, 2018). Such challenges can significantly impact children's ability to adapt to the classroom and access learning opportunities. To address these challenges, Boxall (2002) developed the concept of nurture groups, where a small group of students is removed from their regular classes for a limited period during the school year to model positive attachment relationships, develop emotional literacy, and provide opportunities for social learning while maintaining access to education (Loinaz, 2015). This literature review aims to explore the effectiveness of nurture groups in improving outcomes for young children with emotional, behavioral, and social difficulties in primary schools. The study reviews existing literature, examining the positive effects of nurture groups on children's well-being, while also critiquing current research. The results suggest that children with a broad spectrum of social, emotional, and behavioral difficulties may benefit from nurture groups, thereby making a strong case for creating nurturing schools. However, one potential concern is that some students who thrive in nurturing schools may struggle when they return to mainstream classes. Therefore, further comparable studies on a larger scale are required.
... High reports of watching the weekly videos on average in this TIKOL study parallel TIK literature Wilson et al., 2014Wilson et al., , 2016. Most parenting program research examines the impact of group-based service delivery (Barlow et al., 2016;Barlow & Parsons, 2003;Olofsson et al., 2016;Ruma et al., 1996;Wymbs et al., 2016). However, recent research suggests that adapting parenting programs to an online, self-guided format can be just as effective and engaging for parents who do not have access to inperson resources (Spencer et al., 2020). ...
This study explored the engagement, effectiveness, and acceptability of an unstudied online version of an evidence-based emotion-focused intervention-Tuning in to Kids Online (TIKOL)-within a sample of parents of at-risk preschoolers. Risk was measured using the Devereux Early Childhood Assessment for Preschoolers, Second Edition (LeBuffe & Naglieri, 2012). This pilot study within a small Head Start sample demonstrated that parents watched, on average, 97% of the ten modules across the program duration, and all reported using "quite a few" of the parenting skills taught. Outcome data revealed significant improvements in employing an emotion coaching parenting style. Distressing reactions and parent-reported child conduct problems both decreased. There were no significant reductions in emotion dismissing beliefs. High levels of treatment acceptability were reported. Treatment engagement, effectiveness, and acceptability findings from this pilot TIKOL intervention study support the need to study this accessible, online version of a well-supported parenting program approach.
... There is also strong empirical support for family-focused interventions for children with emotional, behavioral and relationship problems [70][71][72]. Nonetheless, the data must be interpreted with caution due to the small sample size and the reduced quality of one of the two selected studies. ...
Children born preterm (<37 weeks of gestation) are at increased risk of socio-emotional difficulties. This study aims to determine the effects of rehabilitation intervention on the emotional regulation of children born preterm through a systematic review. We conducted a systematic review according to PRISMA guidelines. The literature screening was carried out on PUBMED, SCOPUS and WEB OF SCIENCE in August 2022. An author identified eligible studies based on predefined inclusion criteria and extracted the data. RCT quality was assessed using the JADAD and PEDro scales. We selected five RCTs for qualitative synthesis, having the common objective of evaluating the changes in emotional regulation after a rehabilitation intervention. Evidence of benefits was found after parent training intervention (PCIT; p < 0.05). Moreover, there was an improvement in day-to-day executive life and fewer behavioral problems after mindfulness intervention. Clinical, but not statistical, efficacy was found for the group-based physiotherapy intervention. In conclusion, parent training and mindfulness interventions can be helpful rehabilitation techniques, but the relatively small sample limited statistical power, so the discovery needs to be interpreted cautiously. Further research on these aspects is recommended.
... Current research on the effectiveness of group-based parenting interventions is mainly available for families with middle-to-high socioeconomic status and motherchild dyads (Barlow et al., 2016;Jones et al., 2016;Wilson et al., 2012). Therefore, the generalizability of groupbased intervention benefits is limited by a high drop-out rate of at-risk families (Smokowski et al., 2018;Utting et al., 2007) and a generally low participation of fathers, similar to home-based interventions (Panter-Brick et al., 2014;Pinquart & Teubert, 2010). ...
It is recognized that parenthood in the context of psychosocial adversity can have negative implications for infant development. Parenting programs are the first line of intervention to improve outcomes for families; however, evidence for the effectiveness of group-based, targeted early interventions is still scarce. Preliminary findings indicate Mellow Babies (MB) as a promising group-based parenting program for families at risk for parenting difficulties. Using thematic analysis, we aimed to understand: (i) the aspects of the intervention that enabled parents to complete the program and (ii) the relational and behavioral changes perceived as valuable for parents and their babies post-intervention. In total, 68 parents residing in the United Kingdom were interviewed after completing MB (49 mothers and 19 fathers; 88% self-identified as British). Three themes and six subthemes were generated from the data. Parents identified several intervention components as beneficial, including the facilitators' interpersonal skills and multi-dimensional, group-based approach. Participant reflections highlighted three underlying mechanisms that enabled positive change: (i) the sense of community cultivated within the group, (ii) the process of formulating and re-conceptualizing one's difficulties, and (iii) the opportunity to reshape inter-personal interactions. Findings are discussed within the context of perinatal and infant mental health.
... Despite these limitations, this study has focused on children's behavior during infancy and early childhood. Most parenting programs for behavioral development to date have been commonly delivered to preschool-aged children rather than young children during the earliest years of life and our information on early childhood was scarce [18,[41][42][43]. Moreover, we represented the child's socio-emotional behavior through a valid and reliable tool, while several previous studies reported no details regarding the reliability or validity of the measurement tool for behavioral problems [19]. ...
Background
Several studies showed that parenting intervention programs play a core component in early child development. Considering the limited healthcare resources in developing countries, group-session intervention based on care for child development (CCD) guideline might be cost-effective.
Methods
This randomized controlled trial was conducted at an outpatient public Pediatrics clinic in Isfahan, Iran. We included 210 pregnant women aged 18–45 years in their third trimester and followed their children for 18 months. The intervention group underwent 5 educational group sessions, each lasting for almost 45 minutes. The main outcomes were the children’s development and socio-emotional behavior problems based on Bayley Scales of Infant and Toddler Development-III (BSID-III) at 12 months and the Children Behavior Checklist (CBCL) at 18 months.
Results
Overall, data of 181 children were included in the current study, including 80 in the intervention group and 101 controls. The adjusted median/mean differences between intervention and control groups using median/linear regression were not significant for all BSID-III domains except for median differences for cognitive score based on BSID-III (β (SE): − 4.98(2.31), p:0.032) and mean differences for anxiety/depression score based on CBCL (β (SE): − 2.54(1.27), p:0.046).
Conclusion
In this study, parenting interventions through CCD group sessions were significantly effective on just one subscale of children’s socio-emotional behavior domains based on CBCL and one domain of children’s development based on BSID-III. There might be a ceiling or floor effects for the BSID-III and CBCL assessment, respectively, leaving little room for improvement as almost all children have achieved their full developmental potential in our study.
Trial registration
IRCT20190128042533N2, Date of registration: 16/01/2020, www.irct.ir
... Parenting style is determined by the mother's and father's behavior, with internalizing problems such as sleep and mood and externalizing problems such as social stress and job difficulty. Individual adolescent characteristics like temperament and personality also play an essential role in parenting [19,25,29]. ...
Various studies have been done on subjects such as parenting, parent-child relationships, parenting style, effortful parenting, the concept of parenting, the cognitive development of children, and the cognition of parents. This research is mainly based on parenting practice, child development, and maturation. Children's cognitive development starts in the first year of life and then progresses gradually. Children require positive parenting in painful and different situations. Parenting gives a child the confidence to face crucial, challenging problems. Sensitive parenting and caregiving are required for the child's maturity and cognitive development. Media has been observed to be essential in improving parenting practices. Children exhibit internalizing and externalizing symptoms as a result of harsh, aggressive, and intrusive parenting. According to the data, it is seen that the risk of depression increases in adolescence. The main reason for the rise in depression in children is the non-cooperation and support of mothers and fathers. The risk of depression decreases in children whose mothers and fathers are cooperative and supportive. While family and social stress increase the chances of depression in children, a negative parenting style means children face family and social anxiety. Due to the high level of hostile parenting and low level of positive parenting, they experience stress, peer pressure, and social and family relationship problems. Another excellent term for effortful control parenting is required for children's cognitive development. Parenting is necessary for the regulation of emotions and behavior. There are many problems seen in infancy, early childhood, and late childhood. There are four types of parenting styles seen: authoritative parenting, authoritarian parenting/controlling parenting, permissive parenting/indulgent parenting, and uninvolved parenting/neglecting to parent. Good parenting requires one to know the concept of good parenting, the idea of parenting, the importance of parenting and children's needs, the components of parenting, and the consequences of parenting.
... They have certain success in integrating migrants into the host community and sometimes even reduce the intensity of this process, reducing the risk of criminalization of migrant communities. Since adaptation experience of first-generation migrants is also important for socialization of their children, researchers have focused on studying ways to include parents and children in the culture of the host country (Barlow et al. 2016;Newland 2015;Eisenberg et al. 2001;Tsoukalas et al. 2010). Despite the experience of adaptation of migrants and refugees in various regions of the former Soviet Union, there are practically no studies on adaptation factors of the second and subsequent generations. ...
The experience of experiencing a new culture for first-generation migrants is usually quite an intense occurrence, one that has become the subject of numerous studies. However, the question of what happens later, at the level of the second and subsequent generations, is still under-investigated. The purpose of this study was to analyze the predictors of positive and negative affect of the second generation of migrants and representatives of the host (indigenous) population in Kazakhstan and Russia. The study involved 300 people selected on the basis of the principle of proportionality (quota selection). Survey methods and mathematical methods of data processing, including SEM (structural equation modeling), were used. The research model included comparative analysis of averages, regression analysis, and path analysis. The results testified in favor of the similarity of positive and negative affect indicators and their ratios in representatives of the host community and the second generation of migrants. Cultural attitudes of the host community representatives were characterized by higher certainty and rigidity than those of the representatives of the second generation of migrants. As a result of structural modeling, it was found that 20% of the positive affect dispersion in the representatives of the host community and 17% in the representatives of the second generation of migrants were conditioned by values, identity, and cultural attitudes. Positive affect in the representatives of the host community was associated with the values of self-overcoming, ethno-nihilism-based identity, and participation in cultural life of other peoples. Positive affect in representatives of the second generation of migrants was associated with the values of openness, attitude towards changing one’s ethnic identity, positive attitude towards cultural borrowings, and a tendency to observe the traditions of one’s ethnic group. Proposals have been formulated that contribute to reducing the cultural disunity of second-generation migrants and the host population.
... 18 Parenting interventions that promote positive, consistent and effective parenting behaviours have been widely evaluated and are the treatment of choice for child behaviour problems. [19][20][21][22] While most of these interventions have focused on child emotional and behavioural problems, 23 24 there is emerging evidence to suggest that such interventions can impact parenting practices related to children's health, for example, in the context of obesity, asthma, eczema and other chronic illnesses. 25 26 Many of these interventions are lengthy and delivered face-to-face, and barriers that can prevent parents from attending and benefitting from these interventions include time constraints, caregiving demands, transport or other logistics. ...
Introduction:
Dental decay is a major problem among Australian children. It can be prevented through good self-care and limiting sugar intake, but many parents/caregivers lack the skills and confidence to help their children adopt these practices. This trial will evaluate the efficacy of Healthy Habits Triple P - Oral health, a web-based online programme, in improving children's oral health-related behaviours (toothbrushing, snacking practices and dental visits) and related parenting practices, thereby preventing dental caries.
Methods and analysis:
This is a cluster, parallel-group, single-blinded, randomised controlled trial of an online intervention for parents/caregivers of children aged 2-6 years. From the City of Gold Coast (Australia), 18 childcare centres will be randomly selected, with equal numbers randomised into intervention and control arms. Intervention arm parents/caregivers will receive access to a web-based parenting intervention while those in the control arm will be directed to oral health-related information published by Australian oral health agencies. After the completion of the study, the Healthy Habits Triple P - Oral health intervention will be offered to parents/caregivers in the control arm. The primary outcome of this trial is toothbrushing frequency, which will be assessed via Bluetooth supported smart toothbrushes and parent/caregiver report. Data on other outcomes: parenting practices and child behaviour during toothbrushing, consumption of sugar rich foods and parents' confidence in dealing with children's demands for sugar rich food, and dental visiting practices, will be collected through a self-administered questionnaire at baseline (before randomisation), and 6 weeks (primary endpoint), 6 months and 12 months after randomisation. Data on dental caries will be collected at baseline, 12 and 18 months post-randomisation.
Ethics and dissemination:
Ethical approval has been obtained from Human Research Ethics Committees of Griffith University (2020/700) and the University of Queensland (2020002839). Findings will be submitted for publication in leading international peer-reviewed journals.
Trial registration number:
ACTRN12621000566831.
... The majority of the available evidence relates to physical abuse and neglect often in HICs [55]. Barlow et al. [64] found there was good evidence of modest benefits in improving outcomes associated with physical abuse and neglect, such as parent and family functioning and child development -In a review of the evidence on EBPSs in LMICs at preventing and reducing maltreatment and family violence, it was shown that EBPSs can be effective in reducing violence (physical and emotional) and neglect of adolescents, and increasing parental capacity to protect children from sexual violence [89] -In a rare study of population-level effects, Prinz et al. [32] used randomisation of the intervention (a tiered, multi-level approach to parenting support) compared to usual services. They found that provision of EBPSs led to significant reductions in rates of confirmed child maltreatment cases in the statutory child protection service, out-ofhome care placements, and hospital-treated child maltreatment injuries -Despite the theoretical alignment, there is a lack of studies examining the role of EBPSs on preventing domestic violence [90,91] and the documented impact of interparental conflict, domestic and family violence on parenting and parent-child relationships [92]. ...
Parents can be essential change-agents in their children’s lives. To support parents in their parenting role, a range of programs have been developed and evaluated. In this paper, we provide an overview of the evidence for the effectiveness of parenting interventions for parents and children across a range of outcomes, including child and adolescent mental and physical health, child and adolescent competencies and academic outcomes, parental skills and competencies, parental wellbeing and mental health, and prevention of child maltreatment and family violence. Although there is extensive research showing the effectiveness of evidence-based parenting programs, these are not yet widely available at a population level and many parents are unable to access support. We outline how to achieve increased reach of evidence-based parenting supports, highlighting the policy imperative to adequately support the use of these supports as a way to address high priority mental health, physical health, and social problems.
... Evidence for the use of group parenting programmes using similar methods and formats during infancy is less strong (Barlow et al, 2010). For example, Barlow et al (2016) conclude that universal and selective parenting programmes may be effective in improving the emotional and behavioural adjustment of infants and toddlers but further evidence is required about the specific benefits and longer term effects. ...
Infancy is a critical period during which major developmental transformations occur. Early parenting is one of the strongest influences on infants’ immediate and longer-term outcomes. The transition to parenting can be demanding and stressful for mothers and fathers. This paper reports results from a feasibility study of the Empowering Parents Empowering Communities Baby and Us programme, an 8-week, universal, peer-led parenting programme for new parents living in socially disadvantaged communities. This study is a quasi-experimental, one arm, no control group study, assessing the feasibility and acceptability of Baby and Us. Programme participants (n = 158) completed standardised self-report measures of parent goal attainment, self-efficacy, knowledge about parenting, mental wellbeing, parental confidence, and programme acceptability. We found that recruiting parents from disadvantaged backgrounds was feasible (96% of programmes recruited sufficient parents to proceed, mean = 6.6 parents per programme); parent goals closely matched the aims of the programme; programme completion was high (74%), and self-report measurement completion rates were in line with other large scale community delivered parenting programmes; parents rated the programme as highly satisfactory; and they reported significant improvements in their mental wellbeing, confidence, parenting skills, self-efficacy, and goal attainment. These results provide important data to conduct a full-scale trial of Baby and Us.
... Recently, attachment-based parenting interventions have been developed to support the development of sensitive and secure attachment relationships between parents and infants. Studies find that parental sensitivity, parent-child interactions, and parent-child attachment can be improved through early intervention [37,39,[49][50][51][52][53][54][55][56]. This is found especially in interventions that focus clearly on maternal sensitive behavior [57]. ...
Background
Inequality in health can have profound effects on a child’s opportunities later in life. To prevent these downstream effects in families at increased risk of adversity, programs are needed to provide support and improve well-being across several domains. The present trial is aimed at assessing the effectiveness of the Minding the Baby® (MTB) home visiting intervention in improving the mother-child relationship, parental reflective functioning, well-being, and mental health, as well as child development and well-being in families at known risk of adverse health, relational, and developmental outcomes.
Methods
The study is a pragmatic, prospective, quasi-cluster-randomized controlled trial in which seven Danish municipalities were randomized to MTB training in either 2018 or 2019. A total of 250 pregnant women at increased risk of adversity will be recruited (75 care as usual families and 175 intervention families). Care as usual families will be recruited before and after the MTB training. The MTB intervention is an attachment-based, interdisciplinary home visiting intervention offered from the third trimester of pregnancy until the child is 2 years old. The participants are assessed at baseline, and when the infant is 3, 12, and 24 months old. The primary outcome is maternal sensitivity measured by the Coding Interactive Behavior scale applied to video recordings of mother-infant interactions. Secondary outcomes include parent-child interaction, parental reflective functioning, parental mental health, maternal satisfaction, parental stress, and child development and well-being. The treatment effect is estimated as a fixed effect using a binary indicator of MTB treatment, and cluster-robust standard errors based on wild bootstrap are used for inference.
Discussion
This is the first trial of MTB in a Scandinavian context and will include the largest sample yet in a trial of MTB. The trial is expected to contribute to knowledge about the effect of early support for pregnant women, their infants, and their families at increased risk of adversity.
Trial registration
ClinicalTrials.gov NCT03495895. The study was registered on April 12, 2018.
... This effect size is reasonable given effect sizes in general population of online BPT approximating 0.30 38 ; effect size estimates in referred populations from meta-analysis for parent-reported child externalising behaviour outcomes range from 0.23 to 0.81. 18 We will recruit 220 participants to account for 10% attrition. ...
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 ez Parent 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) ez Parent (2) ez Parent +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 .
... Supporting parents in developing and applying sensitive parenting skills can stimulate healthy child development and prevent future problems (20,25,(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37).To support the development of flexible, loving and secure attachment relationships between parents and infants, many parenting interventions have been designed and implemented. Studies find that both parental sensitivity and parentchild interactions can be improved through early intervention (27,(38)(39)(40)(41)(42)(43)(44). This is found especially in interventions that focus clearly on maternal sensitive behavior and a modest number of sessions (45). ...
Background
A warm, sensitive, and responsive relationship to a caregiver is essential for healthy child development.
Objective
This paper examines the effects of the Incredible Years Parents and Babies (IYPB) program on the parent-child relationship at post-intervention when offered as a universal parenting intervention to parents with newborn infants.
Method
We conducted a pragmatic, two-arm, parallel pilot randomized controlled trial; 112 families with newborns were randomized to IYPB intervention (76) or usual care (36). The IYPB program is a group intervention with eight two-hour sessions. In addition to parent-reported questionnaires, we collected a six-minute-long video at post-intervention from 97 families to assess the parent-child relationship, which was then coded with the Coding Interactive Behavior system.
Results
There were no significant intervention effects on either the total score or any of the seven subscales at post-intervention when the children were around 5.5 months old. For parental sensitivity, results were significant at the 10% level, favoring the IYPB group. When examining the lowest-functioning mothers in moderator analyses, we also found no significant differences between the two groups.
Conclusion
In line with parent-report outcomes, we did not find any statistically significant differences between the IYPB program and usual care on parent-child relationship when offered as a universal intervention for a relatively well-functioning group of parents with infants in a setting with a high standard of usual care. However, there was a positive trend for the total score, parental sensitivity and reciprocity with effect sizes in the range of .41-.51. It is possible that a larger sample would have resulted in significant differences for these outcomes.
Trial registration
ClinicalTrials.gov NCT01931917 (registration date August 27, 2013)
... In addition, several studies have shown that group-based parent support programs can improve emotional and behavioral problems among preschool children. However, the long-term efficacy of these programs is uncertain, as are their primary prevention effects [18]. ...
Background:
Neurodevelopmental difficulties with various emotional and behavioral symptoms increase the risk of mental health problems later in life. Although we know that early detection and interventions are effective, there is a lack of intersectoral, integrative, and evidence-based working models to provide these services for preschool children and their parents. PLUSS (Psykisk hälsa Lärande Utveckling Samverkan kring Små barn; English translation: mental health, learning, development, collaboration around preschool children) is a collaborative "one way in" model involving parents, health care providers, preschools, social services, and researchers. PLUSS provides coordinated services to screen, evaluate, and support toddlers with neurodevelopmental problems. It also offers parental interventions and education for preschool teachers.
Objective:
The model will be studied in a research project that aims to investigate (1) using a quasi-experimental study on longitudinal trajectories of neurodevelopmental difficulties and ability to function among participating preschoolers, (2) user satisfaction, and (3) implementation of the model and its effectiveness. The long-term goal is to provide evidence-based, coordinated services to reduce problems related to neurodevelopmental difficulties among preschool children and promote well-being and functioning in everyday life.
Methods:
The population of interest is children aged 1.5-5 years, whom the child health care nurse refers for further assessment due to suspected neurodevelopmental problems. Data are collected using questionnaires and semistructured interviews. Measures include sociodemographic data, longitudinal data on neurodevelopmental problems, parental well-being and satisfaction, the effectiveness of parental and preschool teacher training and implementation of the model, and fostered multisectoral collaborations. Data will be analyzed with qualitative and quantitative methods.
Results:
The PLUSS model has been approved by the National Ethics Review Board (2019-04839). This study was supported by FUTURUM grants 910161 and 910441. Data collection started in April 2019, with the data collection period planned to end in May 2024.
Conclusions:
PLUSS is an integrative working model with multiprofessional competence and intersectoral collaboration capacity to help preschool children with neurodevelopmental problems and their parents. It will be studied using quasi-experimental cross-sectional and longitudinal study designs. Data will be collected from parents, health care providers, and preschool teachers, and will be analyzed using quantitative and qualitative methods. The study will run in one Swedish county, and generalizability needs to be studied separately. Loss of follow-up could impact the longitudinal analysis.
Trial registration:
ClinicalTrials.gov NCT04815889; https://clinicaltrials.gov/ct2/show/NCT04815889.
International registered report identifier (irrid):
DERR1-10.2196/34969.
... Interventions which promote positive, caring and consistent parenting practices are repeatedly reported as critical in attempts to reduce the incidence of adverse childhood experiences (ACEs) and consequent poor health outcomes (Barth, 2009;Chen & Chan, 2016;Havighurst, Harley & Prior, 2004;National Scientific Council on the Developing Child, 2007;Sanders, 2012;Sanders & Turner, 2005). Population-wide dissemination and implementation of effective parenting support interventions may therefore offer a means to improve both immediate and long-term child mental health outcomes (Barlow, Bergman, Kornor, Wei & Bennett, 2016;Barth, 2009;Delawarde, Briffault, Usubelli & Saias, 2014;Kaminski, Valle, Filene & Boyle, 2008;Sanders, 2012;Stewart-Brown & Schrader-McMillan, 2011). Efficacy trial evidence indicates that parenting program interventions can change parenting practices, consequently helping to improve behaviour, mental health and wellbeing in children (Butler, Gregg, Calam & Wittkowski, 2019;Chen & Chan, 2016;Sanders, Kirby, Tellegen & Day, 2014;Sandler, Ingram, Wolchik, Tein & Winslow, 2015.;Sandler, ...
Research indicates that healthy development of children and young people is directly related to the nature and quality of parenting/ caregiving they receive. Parenting support interventions have potential to support healthy child development and mental health. While many parenting programs, in controlled research settings, have demonstrated efficacy in improving child mental health outcomes, there are numerous challenges in translating these programs to real-world settings.
The aim of this review was to systematically identify and synthesise existing qualitative research on the barriers and facilitators that influence the implementation of parenting programs in real-world settings.
Four key electronic databases (PsycInfo, Medline, Family and Society Studies Worldwide and CINAHL) were searched. A modified population, intervention, control, and outcome (PICO) inclusion/ exclusion criteria framework determined the inclusion of fourteen articles in the review. All identified studies were double-screened, and data were extracted independently by two authors. Included studies were synthesised using framework synthesis methods and were quality appraised.
The results from the synthesis revealed six themes and sixteen subthemes related to implementation barriers and facilitators. The overarching themes were: system level factors, provider characteristics, program characteristics, organisational characteristics, prevention support system factors, and client factors. Provider, program, and organisational characteristics were the most frequently reported.
The findings highlight the importance of considering these factors from the initial stages of development and implementation of parenting programs into real-world settings.
... Despite these limitations, this study has focused on children's behavior during infancy and early childhood. Most parenting programs for behavioral development to date have been commonly delivered to preschool-aged children rather than young children during the earliest years of life and our information in early childhood was scarce (15,(35)(36)(37). Moreover, we represented the child's behavior through a valid and reliable tool, while several previous studies reported no details regarding the reliability or validity of the measurement tool for behavioral problems (31). ...
Background
Several studies showed that parenting intervention programs play a core component in early child development. Considering the limited healthcare resources in developing countries, a group design intervention might be cost-effective.
Methods
This randomized controlled trial was conducted from February 2020 to February 2021 at an outpatient public Pediatrics clinic in Isfahan, Iran. We included 210 pregnant women aged 18-45 years in their third trimester and followed their children for 18 months. The intervention group underwent 5 educational group sessions, each lasting for almost 45 minutes. The main outcomes were the children's development and behaviors based on Bayley Scales of Infant and Toddler Development-III (BSCID-III) at 12 months and Children Behavior Checklist (CBCL) at 18-month of age.
Results
Overall, data of 181 children were included in the current study, including 80 in the intervention group and 101 controls. The adjusted median differences were significantly lower in the intervention group than in controls for attention problems (-3.38; SE=1.59; P=0.035), anxiety problems (-2.28; SE=1.03; P=0.007) and pervasive developmental problems (-5; SE= 1.16; P<0.001) based on CBCL results. However, the difference of proportions was not significant in none of the BSCID-III domains in the intervention and control groups.
Conclusion
In this study, parenting interventions through CCD group sessions were significantly effective on several child’s behavior domains, but not on children’s development. Although CCD is known to improve children’s development and behaviors, the feasible method of its delivery to a large population, especially in developing countries, remains to be determined.
Trial Registration
IRCT20190128042533N2, Date of registration: 16/01/2020, www.irct.ir
... Parents are the key mediators of healthy development in their child [23,27,30,46,56,62,63] and interventions that improve parents' sensitivity to the child's developmental needs are viable means to optimize child mental health [30,[83][84][85] and probably also a healthy weight development [56,57]. ...
Background
Child mental health problems are a major public health concern associated with poor mental and physical health later in development. The study evaluates a new community-based intervention to promote sensitive parenting and reduce enduring mental health problems and unhealthy weight among vulnerable infants aged 9-24 months.
Methods
We use a step-wedge cluster randomized controlled trial design conducted within a home visiting program offered by community health nurses to infant families in Denmark. Sixteen municipalities are randomly allocated to implement the intervention starting at three successive time points from May 1, 2022 to January 1, 2023. A total of 900-1000 families will be included. A standardized program, Psykisk Udvikling og Funktion (PUF), is used to identify infants with major problems of eating, sleep, emotional or behavioral regulation or developmental problems. The intervention builds on the Video-Feedback Intervention to Promote Positive Parenting (VIPP) program, adapted to the PUF-context and named the VIPP-PUF. Children will be followed up at ages 18 and 24 months. Primary outcome measure is the Strengths and Difficulties Questionnaire (SDQ) at child age 24 months. The other outcome measures include body mass index z-scores, the Ages and Stages Questionnaire Social-Emotional (ASQ:SE2); the Child Behavior Checklist (CBCL 1½ -5); Eating behavior Questionnaires; the Being a Mother-questionnaire (BaM13); the Parental Stress Scale (PSS); and the WHO-5 well-being index (WHO-5). Data on child and family factors are obtained from National registries and the Child Health Database.
Quantitative measures are applied to examine the effectiveness of the VIPP-PUF intervention and the implementation process. Qualitative measures include interviews with CHNs, parents and municipality stakeholders to explore factors that may influence the adherence and effectiveness of the intervention.
Discussion
The study examines a service-setting based intervention building on the promotion of sensitive parenting to vulnerable infants. We use a mixed methods approach to evaluate the intervention, taking into account the influences of COVID-19 pandemic running since March 2020. Overall, the study has potential to add to the knowledge on the possibilities of prevention within the municipality child health care to reduce the risk of mental health problems and unhealthy weight in early childhood.
Trial registration
www.ClinicalTrials.gov; IDNCT04601779; Protocol ID 95-110-21307. Registered 25 June 2021.
... Intervening early in life through parenting interventions has increased markedly during the last decade. Systematic reviews and meta-analyses find positive results of parenting interventions on child emotional adjustment and behavior, parenting skills, parent mental health, parental sensitivity, and parent-child relationship [18][19][20][21][22][23][24]. Further, studies show that early interventions aimed at disadvantaged families are better economical investments than interventions later in life [25,26]. ...
Background
Inequality in health can have profound short- and long-term effects on a child’s life. Infants develop in a responsive environment, and the relationship between mother and infant begins to develop during pregnancy. The mother’s ability to bond with the fetus and newborn child may be challenged by mental health issues which can cause impaired functioning and poorer health outcomes. Families with complex problems need interdisciplinary interventions starting in early pregnancy to be prepared for motherhood and to ensure healthy child development. This study aims to examine the effects of an early and coordinated intervention (the Family Clinic and Municipality (FACAM) intervention) offered to vulnerable pregnant women during pregnancy and the child’s first year of life on the mother-child relationship, maternal social functioning, mental health, reflective functioning, well-being, parental stress, and the development and well-being of the child.
Methods
The study is a prospective randomized controlled trial where we will randomize 320 pregnant women enrolled to receive antenatal care at the family clinic at Odense University Hospital, to either FACAM intervention or usual care. The FACAM intervention consists of extra support by a health nurse or family therapist during pregnancy and until the child starts school. The intervention is most intensive in the first 12 months and also includes attachment-based support provided either individually or in groups. The participants are assessed at baseline, and when the infant is 3 and 12 months old. The primary outcome is maternal sensitivity measured by the Coding Interactive Behavior (CIB) instrument. Secondary outcomes include prenatal parental reflective functioning, mental well-being, depressive symptoms, breastfeeding duration, maternal satisfaction, child development, parent competence, parental stress, and activities with the child.
Discussion
The trial is expected to contribute knowledge about the effect of early coordinated support in antenatal and postnatal care for vulnerable pregnant women and their families.
Trial registration
ClinicalTrials.gov NCT03659721 . Registered on September 6, 2018
... In addi-tion, candidates for foster care must complete special training in parental competencies. Research suggests that parenting training may be very effective in improving the emotional and behavioural adjustment of young children, as well as addressing externalizing behavior problems in children (Barlow et al., 2016). Due to the stressful context of foster care provision and the relatively limited scope of research into potential ways of buffering stress or preparing foster parents for their roles, this study examined individual differences in EI and coping with stress as potential resources for foster care. ...
Although much research on emotional intelligence (EI) and coping with stress has been performed in recent years, little is known about these dimensions of individual differences in both foster and biological parents. The main purpose of this study is to examine emotional intelligence and coping styles in foster parents in comparison to biological parents. The study included 124 individual participants aged between 30 and 64 years old (M = 45.18, SD = 8.72), including foster parents (n = 63, 50.81%) and biological parents (n = 61, 49.19%). The cross-sectional survey study was conducted using the Schutte Self-Report Emotional Intelligence Test (SSEIT) and Coping Inventory for Stressful Situations (CISS). In comparison to biological parents, foster parents demonstrated significantly higher levels of emotional intelligence (EI), more frequently used task-oriented coping styles, and less often pursued emotional and avoidant coping strategies to deal with stress. EI was positively correlated with task-oriented coping and negatively so with emotional coping. Hierarchical regression analysis indicated that EI was a strong predictor of task-oriented coping. Training focused on the enhancement of both EI and coping with stress should be considered as an effective way to improve parents’ competence.
... We were unable to assess which families downloaded the "Radio Butiá" stories and songs. Barlow's et al. (2016) systematic review about the impact of group-based parenting programs on children's outcomes shows that positive parenting is strongly associated with children's achievements and wellbeing. Barlow's review identified a range of parental behaviors that are important for infant attachment security, such as parental 15 In our welcome SMS message to the program, we included our cellphone number and asked recipients to save our contact phone in order to keep receiving messages through this channel. ...
We study whether an e-messaging program rooted on behavioral economics insights and administered on top of a parenting workshop helps improve parental investment and commitment. Treated families received messages thrice a week for 24 weeks. The messages were designed to help parents reorient their attention towards positive parenting goals, simplify parental tasks, and reinforce positive identities. Using an RCT on 24 early childhood centers in Uruguay, we find incremental effects over the workshop on the frequency of parental involvement and parenting quality. Effects range around 0.3 standard deviations and are larger for families experiencing more negative shocks and lower negative identity at baseline, suggesting the program triggered the right channels.
... The majority of the available evidence relates to physical abuse and neglect often in HICs [55]. Barlow et al. [64] found there was good evidence of modest benefits in improving outcomes associated with physical abuse and neglect, such as parent and family functioning and child development -In a review of the evidence on EBPSs in LMICs at preventing and reducing maltreatment and family violence, it was shown that EBPSs can be effective in reducing violence (physical and emotional) and neglect of adolescents, and increasing parental capacity to protect children from sexual violence [89] -In a rare study of population-level effects, Prinz et al. ...
Parents can be essential change-agents in their children’s lives. To support parents in their parenting role, a range of programs have been developed and evaluated. In this paper, we provide an overview of the evidence for the effectiveness of parenting interventions for parents and children across a range of outcomes, including child and adolescent mental and physical health, child and adolescent competencies and academic outcomes, parental skills and competencies, parental wellbeing and mental health, and prevention of child maltreatment and family violence. Although there is extensive research showing the
effectiveness of evidence-based parenting programs, these are not yet widely available at a population level and many parents are unable to access support. We outline how to achieve increased reach of evidence-based parenting supports, highlighting the policy imperative to adequately support the use of these supports as a way to address high priority mental health, physical health, and social problems.
... Emotion focused parenting interventions that focus on assisting parents with regulating emotions, managing stress, and improving parenting are likely to be important for preventing emotional and behavioral problems during this time. Currently, there are few evidence-based programs for parents of toddlers (see Barlow et al., 2016), and those that have efficacy either use behavioral strategies (i.e., teach consistent discipline, consequences and rewards) with universal populations [i.e., Toddlers without tears (Hiscock et al., 2008), Triple P for Toddlers (Morawska & Sanders, 2006), and The Incredible Years Toddler Basic (Gross et al., 2003)] or aim to increase parental sensitivity/responsiveness when there are attachment difficulties in clinical populations (i.e., Circle of Security; Hoffman et al., 2006). While these approaches offer important contributions to parenting of young children, they do not target parents' ability to engage in adaptive emotion socialization, despite the important contribution of these aspects of parenting for toddler development. ...
This paper examines the efficacy of a universally-offered parenting program, Tuning in to Toddlers (TOTS), that aims to improve parent emotion socialization, reduce parent and toddler stress and improve social, emotional, and behavioral functioning in toddlers. Three hundred parents of an 18–36 month old toddler were cluster randomized into intervention or control. Parents in the intervention participated in 6 × 2 h group sessions of TOTS. Baseline and 12-months post-intervention measures were collected using parent-report questionnaires and hair samples from parents and toddlers of systemic cortisol stress. Compared to controls, intervention parents reported significantly greater reductions in difficulties in emotion regulation (difficulty remaining goal directed: 95% CI.10, 1.71, p = .028; lack of access to strategies: 95% CI .62, 2.42, p = .001), emotion dismissing (beliefs: 95% CI 2.33,4.82, p < .001; behaviors: 95% CI .32, .65, p = <.001), greater increase in empathy (95% CI −2.83, −1.50, p < .001), emotion coaching (beliefs: 95% CI −2.56, −0.27, p = .016; behaviors: 95% CI −.58, −0.24, p = <.001), children's behavior (95% CI .19, 2.43, p = .022) and competence (95% CI −1.46, −0.22, p = .008). Significant greater reductions in systemic cortisol were found for intervention but not control children (95% CI .01, .35, p = .041). Findings provide preliminary support for the use of TOTS as a universal prevention program to improve parent emotion socialization and children's functioning.
Trial Registration: Australian and New Zealand Clinical Trials Registry: ACTRN12615000962538.
... Does not mention specifically SW. Barlow et al., 2016 Group-based parent training programs for improving emotional and behavioral adjustment in young children. ...
This paper reports on the findings from a systematic review of parenting interventions used by social workers to support vulnerable children in the United Kingdom. The study focused on children from birth to 11 years and 11 months based on Munro's rationale for early intervention. From the 423 papers initially identified, twelve met the inclusion criteria for this review. Four common themes were identified: developing relationships, the effectiveness of parenting interventions, societal impact on families and health and psychological concerns. The importance of effective relationships between parents and social workers was identified as key to effective parental interventions but there was limited evidence of improved outcomes for children despite this. A common factor in the studies was the level of parental deprivation which in many cases was associated with a range of mental health issues frequently seen in association with drug and alcohol abuse and domestic violence. The review identified a number of successful outcomes across a range of parenting interventions. However, what was surprising was the limited input from the children themselves within this review. Applying our findings to practice, the authors recommend a number of ways to contribute to the development of parenting interventions.
... Many of these programs are informed by social learning theory and are based on the assumption that improvements in parenting behavior will lead to decreases in child problem behavior. Reviews have demonstrated that group-based parent training programs are among the most effective interventions for reducing child behavior problems [45][46][47]. Benefits of participating in a group with other parents can include gaining support and acceptance from other parents, and normalization of parent's experiences [48]. ...
The Exploring Together program is a group-based parent training program that comprises separate parent, child, and teacher components, and a combined parent–child interactive component. A cluster-randomized trial design was used to compare the Exploring Together program with (Exploring Together; ET) and without (Exploring Together-Adapted; ET-Adapted) the parent–child interactive component. One hundred and thirty-six parents and their children (aged 5–10 years) with externalizing and/or internalizing problems participated in the trial, recruited from primary schools. There was a significant reduction in negative parenting behavior across both treatment groups (ET and ET-Adapted) but no significant improvement in positive parenting behaviors. Parenting self-efficacy improved significantly across both treatment groups however there was no significant change in parenting satisfaction or parenting stress. There was no consistent evidence of superiority of one version of the Exploring Together program over the other. Further investigation regarding treatment dosage and mastery of parenting skills associated with the program is warranted.
... through training (Deković et al., 2012). Parenting education has a positive influence on parents and their children (Barlow et al., 2014;Barlow et al., 2016;Deković et al., 2012). However, most parents do not seek assistance until their child is having serious difficulties and requires time-consuming and expensive clinical interventions (Axford et al., 2012). ...
Prevention-focused parenting education programs (P-FPEPs) provide knowledge and support to parents to strengthen parent–child relationships, enhance parental and family well-being, and promote healthy child development. The positive impact of such programs on child health and development is well documented. Yet, how P-FPEPs influence parents remains unclear. The objective of this study was to explore parental perceptions of changes associated with participation in a P-FPEP. We analyzed data using interpretive description with qualitative responses from 459 parents who participated in nine different P-FPEPs in a large Canadian city. Participation in a P-FPEP changed parents’ relationships with themselves, their children, their partners, and their community. Participants’ relationship with themselves as parents changed as they recognized the value of self-care without guilt, gained knowledge of typical child development, and developed greater confidence in their parenting. Positive changes in participants’ relationships with their children were facilitated by better understanding the perspective of the child, improving communication, feeling more connected to their child, and changing parenting behavior. For many participants, the relationship with their partner improved when they learned about different parenting styles and began communicating more openly. Participants’ relationships with the larger community were strengthened as they experienced a sense of normalization of their parenting experiences, developed connections with other parents, and learned about community resources. Independent of any specific program curriculum or structure, change associated with P-FPEPs focused on how a shift in understanding and attitudes changed relationships and consequently changed parenting behavior.
... Historically, PFIs have predominately been delivered through in-person means (Corralejo & Domenech Rodríguez, 2018;McGoron & Ondersma, 2015), and have operated at the selective level or higher on the continuum of care (Salari & Enebrink, 2018). The evidence base for these programs indicate they can be an effective means for improving young children's behavioral and emotional health (Barlow et al., 2016a(Barlow et al., , 2016bGardner et al., 2019;Mihelic et al., 2017). ...
Parents influence their child’s positive development, and this is especially true during early childhood. In military families, the largest percentage of children are between 0 and 5 years old, and there is growing interest in developing and disseminating parent-focused interventions that target this age range for military parents. The present study examines the feasibility and proof-of-concept of the universal, web-based, Take Root parenting program, which was designed to empower military and civilian parents with a 0- to 3-year-old child in their parenting role and support positive child development. Seventy-nine participants were recruited from two Armed Services YMCA locations in fall 2019 and summer 2020. Results indicate that executing the research protocol and implementing the program among military families with young children were feasible. Further, significant pre- to post-changes in self-reports of parenting efficacy, mindful relaxation, and family functioning were found; however, when a Bonferroni-Holm correction was applied to account for multiple testing, only parenting efficacy remained significant. Collectively, the favorable results indicate the potential usefulness of Take Root for military families with young children and support the need for further, more rigorous evaluations of the program.
... Results from previous studies with a similar approach have shown that the most effective intervention seems to be parent and preschool interventions starting at an early age, with a focus on communication [29,31,39]. Several studies have shown that group-based support programs for parents can improve emotional and behavioural problems in preschool children [27]. Unlike earlier studies, such interventions will be possible to evaluate long-term within the PLUSS-model. ...
Background: Neurodevelopmental difficulties are frequent in preschoolers and constitute a risk for later negative consequences. This article describes the development of a multi-professional and multi-agency model, PLUSS, to facilitate care and interventions for preschoolers with neurodevelopmental difficulties.
Methods: The PLUSS-model was developed for children aged 1.5-5 years with a need for a further assessment of neurodevelopmental symptoms. The model is evaluated using a quasi-experimental study design along with qualitative interviews. Outcomes of interest are a) implementation, b) effectiveness related to processes and multi-agency collaboration, c) capacity building among professionals, d) child-related outcomes with a longitudinal follow-up as well as d) parental wellbeing and satisfaction.
Results: The model was launched in 2019 and so far, approximately 130 children have been assessed. Results from a pilot study with 62 children (27-72 months; boys: girls 2.65:1) show, using the strengths and difficulties questionnaire (SDQ), that the included children have clinically significant problems. The total mean SDQ score in parental rating was 15 +/- 6 and in preschool teacher ratings 14 +/- 7, exceeding the Swedish cut-off of 12. 54 parents have participated in parental training and rate high levels of satisfaction (mean score 4.5, max 5.0). In addition, 74 pre-school professionals have been trained in early signs of neurodevelopmental difficulties to facilitate early detection. Feedback from these educational activities is encouraging (mean score 4.2, max 5.0).
Conclusions: The PLUSS-model enables early detection and interventions for preschool children and their families, without a set diagnosis. The pilot study shows that the screening procedure can detect children with clinically significant problems. In addition, encouraging results have been obtained from both parent- and preschool teacher training. The longitudinal study approach enables both child follow-up and evaluation of interventions provided by the working model.
Trial registration: Clinical Trials 2021, PLUSS identifier, NCT04815889. First registration 25/03/2021.
Background:
Conduct problems are a range of disruptive behaviours in childhood that are associated with long-term adverse outcomes in adolescence and adulthood, including antisocial behaviour, substance misuse, and poor academic achievement. Children with conduct problems can vary according to age of onset, comorbidities, and environmental factors, and it has been suggested that certain groups of children may have different treatment outcomes. Therefore, it is important to assess the extent to which personalised interventions for different groups of children with conduct problems may affect outcomes. To our knowledge, this is the first review to systematically identify and appraise the effectiveness of personalised interventions, adapted, or developed, for prespecified subgroups of children with conduct problems.
Objectives:
To assess whether personalised interventions, adapted or developed for subgroups of children with conduct problems are effective in improving outcomes.
Search methods:
We used standard, extensive Cochrane search methods. The latest search was 1 February 2022.
Selection criteria:
We included randomised controlled trials (RCTs), in any setting, in children (aged two to 12 years) with conduct problems and within a prespecified subgroup, comparing a personalised intervention with a non-personalised intervention, waitlist control, or treatment as usual. Personalised interventions included adaptations to standard practice, such as parent-training programmes; other recommended interventions for children with conduct problems; or interventions developed specifically to target subgroups of children with conduct problems. We excluded non-personalised and non-psychological interventions (e.g. pharmacological or dietary intervention). Prespecified subgroups of children with conduct problems, however defined, were eligible for inclusion.
Data collection and analysis:
We used standard Cochrane methods. Our primary outcomes were 1. child conduct problems or disruptive behaviour and 2.
Adverse events:
Our secondary outcomes were 3. personalised treatment outcomes relevant to each subgroup, 4. parenting skills and knowledge, 5. family functioning, engagement and decreased dropout, and 6. educational outcomes. We used GRADE to assess the certainty of the evidence.
Main results:
We identified 13 RCTs (858 participants). Seven studies were conducted in the USA, five in Australia, and one in Germany. Eleven studies reported their source of funding, with five studies receiving grants from the National Institute of Mental Health. In total, 15 different funders supported the studies included in the review. We separated subgroups of children with conduct problems into three broad categories: children with co-occurring conditions (e.g. emotional difficulties), parent characteristics (e.g. conflict between parents), or familial/environmental circumstances (e.g. rural families). All studies delivered a personalised intervention that was adapted or developed for a prespecified subgroup of children with conduct problems. We rated all trials at unclear or high risk of bias in most domains. Below, we report the results of improvement in child conduct problems and disruptive behaviour, personalised treatment outcomes, and parenting skills and knowledge for our main comparison: personalised versus non-personalised interventions. Improvement in child conduct problems and disruptive behaviour Compared with a non-personalised intervention, a personalised intervention may result in a slight improvement in child conduct problems or disruptive behaviour measured using the Eyberg Child Behavior Inventory (ECBI) Problem subscale in the short term (mean difference (MD) -3.04, 95% confidence interval (CI) -6.06 to -0.02; 6 studies, 278 participants; P = 0.05), but may have little to no effect on improving child conduct problems or disruptive behaviour measured by the ECBI Intensity subscale (MD -6.25, 95% CI -16.66 to 4.15; 6 studies, 278 participants; P = 0.24), or the Externalising subscale of the Child Behaviour Checklist (CBCL) (MD -2.19, 95% CI -6.97 to 2.59; 3 studies, 189 participants, P = 0.37) in the short term. We graded the certainty of evidence as very low for all three outcomes, meaning any estimate of effect is very uncertain. Personalised treatment outcomes, relevant to each subgroup Although six studies reported personalised treatment outcomes, relevant to each subgroup, we were unable to pool the data due to differences between the measures used in the studies and the heterogeneity this would produce in analysis. The results for this outcome were inconclusive. Parenting skills and knowledge Although seven studies reported parenting skills and knowledge, we were unable to pool the data due to differences between the measures used in the studies and the heterogeneity this would produce in analysis. The results for this outcome were inconclusive. Adverse events None of the trials reported monitoring adverse events. Summary of results In summary, there is limited evidence that personalised intervention improves child conduct problems, personalised treatment outcomes, relevant to each subgroup, or parenting skills and knowledge compared with a non-personalised intervention.
Authors' conclusions:
There is limited evidence for the effectiveness of personalised interventions for subgroups of children with conduct problems. The certainty of evidence for all outcomes was very low, meaning that we have very little confidence in the estimated effects and the true effects may be different to our findings, which will limit the relevance of our findings to clinical decisions. To overcome the limitations of the evidence, large-scale RCTs are needed to determine whether personalised interventions, adapted or developed, for subgroups of children with conduct problems are effective in improving outcomes. Consensus on the most appropriate measures to use in these studies is needed in order to facilitate cross-study comparisons. Persistent conduct problems predict a range of adverse long-term outcomes, so future research should investigate the medium- and long-term effects of personalised treatments. Studies are needed in low- and middle-income countries as well as studies recruiting children aged between nine and 12 years, as they were under-represented in the studies.
Background:
Although there is some evidence that maternal perinatal mental disorders are associated with emotional/behavioral problems in children, the long-term impacts of postnatal bonding disorder remain unclear. We aimed to examine the associations between maternal postnatal bonding disorder and emotional/behavioral problems in preschool children.
Methods:
We analyzed data from 7220 mother-child pairs who participated in the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study. Maternal bonding disorder was defined as Mother-to-Infant Bonding Scale score ≥5 at 1 month after delivery. The Child Behavior Checklist 1½-5 was used to assess emotional/behavioral problems, and its subscales were used to assess internalizing and externalizing problems in children at 4 years of age. Multiple logistic regression analyses were conducted to examine the associations of postnatal bonding disorder with emotional/behavioral, internalizing, and externalizing problems after adjustment for age, education, income, parity, prenatal psychological distress, postnatal depressive symptoms, child's sex, preterm birth, and birth defects.
Results:
The prevalence of postnatal bonding disorder was 14.8 %. Postnatal bonding disorder was associated with an increased risk of emotional/behavioral problems in children: the odds ratio (OR) was 2.06 (95 % confidence interval [CI], 1.72-2.46). Postnatal bonding disorder was also associated with increased risks of internalizing problems and externalizing problems in children: the ORs were 1.69 (95 % CI, 1.42-2.02) and 1.90 (95 % CI, 1.59-2.26), respectively.
Limitations:
Bonding and problems were self-reported.
Conclusions:
Bonding disorder at 1 month after delivery was associated with an increased risk of emotional/behavioral problems in children at 4 years of age.
There are signs that the potential of developing skills to address child or family based concerns is not being realised. In this paper, we critically analyse work with children and families to (1) identify skills development as an under-theorised component of practice, (2) define skills development as a specific aim and form of practice, (3) outline a new social-systemic model of skills development, and (4) propose a new approach for practice that we call collaborative skills development (CSD). The paper details an action research project we set up that embedded this approach as the foundation for a new service that sought to help children in, or on the edge of, state care within an established UK based organisation. We then present an evaluation of this project to analyse how this model of working helped and how and what we can learn about the theory of CSD. These findings support the theory and practice of CSD as a new way of thinking about and working with children and families.
Although parenting programs have been supported as an effective family-based intervention for children’s behavioral problems, they are underutilized in developing countries. This randomized controlled study aims to determine the effectiveness of the Incredible Years parenting program (IYPP) in improving behavioral problems in children, parenting stress, and parental mental health. Seventy mother-child dyads from three tertiary hospitals in Malaysia were divided into the IYPP and waitlist control groups. Weekly parent training sessions were adjusted during the pandemic period. Child’s total difficulty scores of the Strength and Difficulty Questionnaire (SDQ-TDS), Parental Stress Scale (PSS) scores, and parental DASS-21 scores were measured at pre- and post-intervention, and follow-up, and analyzed using generalized estimating equation (GEE). Compared to the control group at baseline, the intervention group showed a 4.2- and a 3.5-point significantly lower SDQ-TDS at 2 weeks post-intervention and 3 months follow-up, respectively (B = -4.20, 95% CI: -6.68, -1.72, p = 0.001; B = -3.51, 95% CI :-6.37, -0.66, p = 0.016), a 5.0-point significantly lower PSS at 3 months follow-up (B = -5.03, 95% CI: -9.16, -0.90, p = 0.017), and a 4.1-point significantly lower general stress scores at 2 weeks post-intervention (B = -4.06, 95% CI: -7.20, -0.92, p = 0.011). Effect sizes were small (ds = 0.28 - 0.40). There was no significant intervention effect on maternal anxiety and depression scores. The modified parenting program was effective in improving children’s behavior, parenting stress, and general stress among mothers of children aged 6-12 years presented with borderline and abnormal levels of behavioral problems, with sustained effects demonstrated for child behavior. However, the interpretation of these findings requires careful consideration of potential pandemic-instigated challenges and implications.
The main purpose of the current study was to investigate the influence of group-based parenting education programs on protective factors that prevent child abuse and neglect. The group-based parenting education programs that were chosen in this study were a family literacy program, a parent-child interaction program, and a child safety and welfare education program. All participant families showed promising results in enhancing family functioning/resiliency, social support, concrete support, knowledge of parenting and child development, and nurturing and attachment and families attending different parenting education programs showed significantly different improvement in concrete support, social support, and knowledge of parenting and child development. In addition, families with different demographic characteristics showed significantly different improvement in all five protective factors. The presence of five protective factors can reduce the likelihood of abuse and neglect and group-based parenting education can help provide safe environments for children by supporting families.
Background
Mental disorders have become a public health crisis. Early prevention is key. Parenting programmes are effective for children aged ≥ 3 years; however, there is a lack of evidence of their effectiveness for children aged ≤ 2 years.
Objectives
To establish if the model named Enhancing Social–Emotional Health and Well-being in the Early Years (E-SEE) Steps can (1) enhance child social emotional well-being and establish whether or not it is cost-effective at 20 months of age when compared with services as usual; and (2) be delivered as a proportionate universal model with fidelity.
Design
A pragmatic two-arm randomised controlled trial and economic appraisal, with an embedded process evaluation to examine the outcomes, implementation and cost-effectiveness of the intervention, and intervention uptake, compared with services as usual. The study had an external pilot phase (which was originally planned as an internal pilot).
Setting
The intervention was delivered in community settings by early years children’s services and/or public health staff in four sites.
Participants
A total of 341 parents of infants aged ≤ 8 weeks were randomised in a ratio of 5 : 1 (intervention, n = 285; control, n = 56). The target sample was 606 parents.
Intervention
Two Incredible Years ® parenting programmes (i.e. infant and toddler) delivered in a proportionate universal model with three levels [one universal (book) and two targeted group-based parenting programmes].
Main outcome measures
Child social and emotional well-being (primary outcome) was assessed using the Ages and Stages Questionnaire: Social and Emotional, 2nd edition, at 2, 9 and 18 months after randomisation. Parent depression (secondary key outcome) was assessed using the Patient Health Questionnaire-9 items. Both questionnaires were eligibility screeners for targeted groups.
Results
The primary outcome analysis provided no evidence that the E-SEE Steps model was effective in enhancing child social and emotional well-being. The adjusted mean difference was 3.02 on the original Ages and Stages Questionnaire: Social and Emotional, 2nd edition, in favour of the control [95% confidence interval –0.03 to 6.08; p = 0.052; N = 321 (intervention, n = 268; control, n = 53)]. Analysis of the key secondary outcome (i.e. parent depression levels as assessed by the Patient Health Questionnaire-9 items) provided weak evidence on the Patient Health Questionnaire-9 items in favour of the intervention (adjusted mean difference –0.61, 95% confidence interval –1.34 to 0.12; p = 0.1). Other secondary outcomes did not differ between arms. The economic analysis showed that the E-SEE Steps model was associated with higher costs and was marginally more effective (0.031 quality-adjusted life-years gained from E-SEE Steps compared with SAU, 95% confidence interval –0.008 to 0.071) than services as usual, resulting in an incremental cost-effectiveness ratio of approximately £20,062 per quality-adjusted life-year compared with services as usual. Overall take-up of the targeted parenting programmes was low. Sites, although enthusiastic, identified barriers to delivering the intervention.
Limitations
The target sample size was not met and the study was not powered to explore the effectiveness of each level of intervention. Most parents in the sample were well educated and, therefore, the results are unlikely to be generalisable, particularly to those at greatest risk of poor social and emotional well-being.
Conclusions
The E-SEE Steps proportionate universal model did not enhance child social and emotional well-being, but generated non-significant improvements in parent health outcomes, resulting in considerable uncertainty around the cost-effectiveness of the intervention. The primary and key secondary outcome gave inconsistent signals. Although, with system changes, increased resources and adaptations to the intervention, the model could be implemented, evidence for positive outcomes from the E-SEE Steps model is poor.
Future work
The universal-level E-SEE Step data (i.e. the Incredible Years book) from the external pilot will be pooled with the main trial data for further exploration up to follow-up 1, which is the time point at which most change was seen.
Trial registration
This trial is registered as ISRCTN11079129.
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research ; Vol. 10, No. 8. See the NIHR Journals Library website for further project information.
This study served to conceptualize neurodisability (ND) navigation-building. Capacity-building toward wide-reaching ND navigation or help-seeking service lacks empirical evidence. Researchers widely agree that a system-wide framework is absent. While research emphasizes service-level findings, other jurisdiction- and policy-level insights are lacking. Using Collective Community Impact and Participatory Action Research, government and nongovernment organizations in three Canadian regions implemented novel cross-jurisdictional initiatives to improve navigation capacity. Family-partners and other stakeholders systematically engaged in discussions. Grounded in qualitative thematic design, we sought to unveil connections between emerging themes. These themes led to stakeholders co-constructing an intersectoral navigation-building conceptualization. A framework was essential for highlighting change-levers and potential replication in other jurisdictions/landscapes. Finally, practice and policy implications compatible with an ecosystem model are presented.
Background
The positive impact of parenting programs for youth mental health is undermined by difficulties engaging parents. Low engagement disproportionately impacts parents of lower-socioeconomic positions (SEPs). Internet- and mobile-based interventions hold potential for overcoming barriers to enrolment, but additional research is needed to understand how programs can appropriately meet the needs of parents across SEPs. Consumer preference methods such as discrete choice experiments may be valuable in this endeavour.
Method
A discrete choice experiment was used to determine the relative influence of modifiable program features on parents' intent to enrol. 329 Australian parents of children aged 0–18 repeatedly selected their preferred program from randomized sets of hypothetical programs in an online survey. Each hypothetical program was unique, varying across four program features: module duration, program platform, user control, and program cost. Cumulative link models were used to predict choices, with education, household income, and community advantage used as indicators of SEP.
Results
Overall, parents preferred cheaper programs and briefer modules. Parents' preferences differed based on their socioeconomic challenges. Lower-income parents preferred briefer modules, cheaper programs and application-based programs compared to higher-income parents. Parents with less education preferred briefer modules and a predefined module order. Parents living in areas of less advantage preferred website-based programs, user choice of module order, and more expensive programs.
Conclusions
This study offers program developers evidence-based strategies for tailoring internet- and mobile-based parenting interventions to increase lower-SEP parent enrolment. Findings also highlight the importance of considering parents' socioeconomic challenges to ensure programs do not perpetuate existing mental health inequalities, as “one-size-fits-all” approaches are likely insufficient for reaching lower-SEP parents.
Importance:
Most parenting programs target parents of children with severe behavioral problems. There is limited evidence on the effectiveness of universal parenting programs, especially for families with low income.
Objective:
To evaluate the effectiveness of the KeySteps@JC Parent-Child Interaction Program for low-income families in Hong Kong.
Design, setting, and participants:
A parallel, unblinded, cluster, randomized clinical trial was conducted from September 2018 to June 2019. Eight participating preschools in Hong Kong were randomly assigned (1:1) using an online randomization plan generator into intervention (immediate) and waiting list control (delayed) groups. Intervention participants included the parents of children in kindergarten grade 1. The results were processed by an intention-to-treat analysis.
Interventions:
KeySteps@JC Parent-Child Interaction program.
Main outcomes and measures:
The primary outcome was child behavioral problems, which were assessed using the Strength and Difficulties Questionnaire. Secondary outcomes were parental emotion coaching, involvement in child reading and play, and parent stress levels, which were assessed using Chinese-validated versions of the Parent Reading Belief Inventory, the Chinese Parent-Child Interaction Scale, the Emotion-Related Parenting Styles, and the Parental Stress Scale questionnaires. Parents in the intervention group participated in a training program consisting of 20 weekly 1.5-hour sessions on child behavior management, emotion coaching, dialogic reading, and interactive play. The primary hypothesis was that child behavior problems would be reduced after the intervention. The main analysis was a mixed-method regression with group status as the independent variable.
Results:
A total of 267 parents (mean age, intervention group: 33.8 years; 95% CI, 32.9-34.7 years; waiting list group: 35.7 years; 95% CI, 34.5-36.9 years) participated in the program. The intervention group included 153 participants (57.3%), and the waiting list group included 114 participants (42.7%). Among the target children (mean age, intervention group: 3.5 years; 95% CI, 3.4-3.5 years; waiting list group: 3.4 years; 95% CI, 3.4-3.5 years), there were 88 boys (57.5%) in the intervention group and 59 boys (51.8%) in the waiting list group. At postintervention, the intervention group reported a statistically significant improvement in children's behavior (Cohen d, 0.29; 95% CI, 0.04-0.53); parents' use of emotion-coaching strategies, including feelings of uncertainty or ineffectiveness in emotion socialization (Cohen d, 0.26; 95% CI, 0.01-0.50) and parental rejection of negative emotion (Cohen d, 0.33; 95% CI, 0.08-0.57); and involvement in child reading (Cohen d, 0.17; 95% CI, -0.07 to 0.41).
Conclusions and relevance:
The results of this randomized clinical trial provide promising evidence on the effectiveness of a multicomponent parenting intervention in preparing children from low-income families to be more socially and emotionally ready for school.
Trial registration:
ClinicalTrials.gov Identifier: NCT03615937.
Objectives
Previous studies have highlighted the need to offer targeted interventions to strengthen the wellbeing of family members in families with children with neurodevelopmental disorders (NDD). Interventions for this target group require research and development. The purpose of this study was to test a new family intervention: Dialogical Family Guidance (DFG).
Methods
Families of children with NDD were randomized into an intervention group that was delivered DFG and a comparison group provided with ordinary clinical treatment. The Family Functioning, Family Health and Social Support (FAFHES) and the DFG instrument were used to collect data at baseline and after 3 months. Repeated measure analysis of variance (ANOVA) was used as an analytical strategy.
Results
There was a significant within-subjects effect of time on family health and social support, indicating that family health and social support increased in both groups over time. There was also a significant between-subjects effect of group and interaction between time and group on social support, indicating that social support increased more in the intervention group than in the control group. Managing in daily life and the relationship between parents were associated with family functioning and family health.
Conclusion
DFG can strengthen parental experiences of social support. Managing in daily life, relationship between parents, practical guidance, psychoeducation, dialogue, and receiving positive feedback on parenting were strengthening factors during DFG. However, the results of this study must be considered as only preliminary, as they relate only to parental perceptions of the intervention effects.
Trial registration
ClinicalTrials.gov NCT04892992 (retrospectively registered).
The reference of choice for pediatricians, residents, and medical students, this revised and expanded sixth edition provides clear, practice-oriented guidance on the core knowledge in pediatrics. Edited by a leading primary care authority with more than 100 contributors, this edition provides comprehensive coverage of hundreds of topics ranging from asthma and urinary tract infections to toilet training and adolescent depression. View a message from Dr Berkowitz. Available for purchase at https://shop.aap.org/berkowitzs-pediatrics-6th-edition-paperback/ (NOTE: This book features a full text reading experience. Click a chapter title to access content.)
Objectives
Parenting is an integral component of obesity treatment in early childhood. However, the link between specific parenting practices and treatment effectiveness remains unclear. This paper introduces and validates a new parenting questionnaire and evaluates mothers’ and fathers’ parenting practices in relation to child weight status during a 12-month childhood obesity treatment trial.
Methods
First, a merged school/clinical sample (n = 558, 82% mothers) was used for the factorial and construct validation of the new parenting questionnaire. Second, changes in parenting were evaluated using clinical data from the More and Less Study, a randomized controlled trial (RCT) with 174 children (mean age = 5 years, mean Body Mass Index Standard Deviation Score (BMI SDS) = 3.0) comparing a parent support program (with and without booster sessions) and standard treatment. Data were collected at four time points over 12 months. We used linear mixed models and mediation models to investigate associations between changes in parenting practices and treatment effects.
Findings
The validation of the questionnaire (9 items; responses on a 5-point Likert scale) revealed two dimensions of parenting (Cronbach’s alpha ≥0.7): setting limits to the child and regulating one’s own emotions when interacting with the child, both of which correlated with feeding practices and parental self-efficacy. We administered the questionnaire to the RCT participants. Fathers in standard treatment increased their emotional regulation compared to fathers in the parenting program (p = 0.03). Mothers increased their limit-setting regardless of treatment allocation (p = 0.01). No treatment effect was found on child weight status through changes in parenting practices.
Conclusion
Taken together, the findings demonstrate that the new questionnaire assessing parenting practices proved valid in a 12-month childhood obesity trial. During treatment, paternal and maternal parenting practices followed different trajectories, though they did not mediate treatment effects on child weight status. Future research should address the pathways whereby maternal and paternal parenting practices affect treatment outcomes, such as child eating behaviors and weight status.
Early-onset child conduct problems are common and costly. A large number of studies and some previous reviews have focused on behavioural and cognitive-behavioural group-based parenting interventions, but methodological limitations are commonplace and evidence for the effectiveness and cost-effectiveness of these programmes has been unclear. To assess the effectiveness and cost-effectiveness of behavioural and cognitive-behavioural group-based parenting programmes for improving child conduct problems, parental mental health and parenting skills. We searched the following databases between 23 and 31 January 2011: CENTRAL (2011, Issue 1), MEDLINE (1950 to current), EMBASE (1980 to current), CINAHL (1982 to current), PsycINFO (1872 to current), Social Science Citation Index (1956 to current), ASSIA (1987 to current), ERIC (1966 to current), Sociological Abstracts (1963 to current), Academic Search Premier (1970 to current), Econlit (1969 to current), PEDE (1980 to current), Dissertations and Theses Abstracts (1980 to present), NHS EED (searched 31 January 2011), HEED (searched 31 January 2011), DARE (searched 31 January 2011), HTA (searched 31 January 2011), mRCT (searched 29 January 2011). We searched the following parent training websites on 31 January 2011: Triple P Library, Incredible Years Library and Parent Management Training. We also searched the reference lists of studies and reviews. We included studies if: (1) they involved randomised controlled trials (RCTs) or quasi-randomised controlled trials of behavioural and cognitive-behavioural group-based parenting interventions for parents of children aged 3 to 12 years with conduct problems, and (2) incorporated an intervention group versus a waiting list, no treatment or standard treatment control group. We only included studies that used at least one standardised instrument to measure child conduct problems. Two authors independently assessed the risk of bias in the trials and the methodological quality of health economic studies. Two authors also independently extracted data. We contacted study authors for additional information. This review includes 13 trials (10 RCTs and three quasi-randomised trials), as well as two economic evaluations based on two of the trials. Overall, there were 1078 participants (646 in the intervention group; 432 in the control group). The results indicate that parent training produced a statistically significant reduction in child conduct problems, whether assessed by parents (standardised mean difference (SMD) -0.53; 95% confidence interval (CI) -0.72 to -0.34) or independently assessed (SMD -0.44; 95% CI -0.77 to -0.11). The intervention led to statistically significant improvements in parental mental health (SMD -0.36; 95% CI -0.52 to -0.20) and positive parenting skills, based on both parent reports (SMD -0.53; 95% CI -0.90 to -0.16) and independent reports (SMD -0.47; 95% CI -0.65 to -0.29). Parent training also produced a statistically significant reduction in negative or harsh parenting practices according to both parent reports (SMD -0.77; 95% CI -0.96 to -0.59) and independent assessments (SMD -0.42; 95% CI -0.67 to -0.16). Moreover, the intervention demonstrated evidence of cost-effectiveness. When compared to a waiting list control group, there was a cost of approximately $2500 (GBP 1712; EUR 2217) per family to bring the average child with clinical levels of conduct problems into the non-clinical range. These costs of programme delivery are modest when compared with the long-term health, social, educational and legal costs associated with childhood conduct problems. Behavioural and cognitive-behavioural group-based parenting interventions are effective and cost-effective for improving child conduct problems, parental mental health and parenting skills in the short term. The cost of programme delivery was modest when compared with the long-term health, social, educational and legal costs associated with childhood conduct problems. Further research is needed on the long-term assessment of outcomes.
The main purpose of this study was to evaluate whether a research-based standardized parenting program could successfully improve the reciprocal interaction between parents and their young children. The program was implemented and evaluated with a 2-group (manualized parenting group; waitlist control group) repeated-measures design. It included pretest, post-test, and follow-up conditions, and a multi-measure assessment protocol. Thirty mothers and 10 fathers of children with behavior problems (ages = 3-5 years) participated in the parenting program. Results indicated a decrease in parental use of verbal and corporal punishment to their young children, and an increase of positive nurturing strategies, reduce parental stress, and improve parent perceptions of their child's behavior. Children's global pattern of behavior and psychosocial adaptation, as well as the observed parent-child interactions, also improved. Discussion focuses both on the effectiveness of using a manualized parenting intervention and on the relevance of parents' stress and anger-aggression to improve our understanding of the reciprocal interaction between parents and their young children.
Systematic reviews should build on a protocol that describes the rationale, hypothesis, and planned methods of the review; few reviews report whether a protocol exists. Detailed, well-described protocols can facilitate the understanding and appraisal of the review methods, as well as the detection of modifications to methods and selective reporting in completed reviews. We describe the development of a reporting guideline, the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols 2015 (PRISMA-P 2015). PRISMA-P consists of a 17-item checklist intended to facilitate the preparation and reporting of a robust protocol for the systematic review. Funders and those commissioning reviews might consider mandating the use of the checklist to facilitate the submission of relevant protocol information in funding applications. Similarly, peer reviewers and editors can use the guidance to gauge the completeness and transparency of a systematic review protocol submitted for publication in a journal or other medium.
Fast Track is a multisite, multicomponent preventive intervention for young children at high risk for long-term antisocial behavior. Based on a comprehensive developmental model, this intervention includes a universal-level classroom program plus social-skill training, academic tutoring, parent training, and home visiting to improve competencies and reduce problems in a high-risk group of children selected in kindergarten. The theoretical principles and clinical strategies utilized in the Fast Track Project are described to illustrate the interplay between basic developmental research, the understanding of risk and protective factors, and a research-based model of preventive intervention that integrates universal and indicated models of prevention. (C) 2000 Elsevier Science Ltd.
Inadequate parenting is an important public health problem with possible severe and long-term consequences related to child development. We have solid theoretical and political arguments in favor of efforts enhancing the quality of the early family environment in the population at large. However, little is known about effect of universal approaches to parenting support during the transition to parenthood. This protocol describes an experimental evaluation of group based parenting support, the Family Startup Program (FSP), currently implemented large scale in Denmark.
Participants will be approximately 2500 pregnant women and partners. Inclusion criteria are parental age above 18 and the mother expecting first child. Families are recruited when attending routine pregnancy scans provided as a part of the publicly available prenatal care program at Aarhus University Hospital, Skejby. Families are randomized within four geographically defined strata to one of two conditions a) participation in FSP or b) Treatment As Usual (TAU). FSP aims to prepare new families for their roles as parents and enhance parental access to informal sources of support, i.e. social network and community resources. The program consists of twelve group sessions, with nine families in each group, continuing from pregnancy until the child is 15 months old. TAU is the publicly available pre- and postnatal care available to families in both conditions. Analyses will employ survey data, administrative data from health visitors, and administrative register based data from Statistics Denmark. All data sources will be linked via the unique Danish Civil Registration Register (CPR) identifier. Data will be obtained at four time points, during pregnancy, when the child is nine months, 18 months and seven years. The primary study outcome is measured by the Parenting Sense of Competence scale (PSOC) J Clin Child Psychol 18:167-75, 1989. Other outcomes include parenting and couple relationship quality, utility of primary sector service and child physical health, socio-emotional and cognitive development.
The protocol describes an ambitious experimental evaluation of a universal group-based parenting support program; an evaluation that has not yet been made either in Denmark or internationally.
ClinicalTrials.gov ID: NCT02294968 . Registered November 14 2014.
The study was a randomized controlled trial evaluating the efficacy of a brief and preventatively-focused parenting discussion group for dealing with disobedient behavior in preschool-aged children. Eighty-five parents with children aged between 3 and 5 years who were concerned about the noncompliant behavior of their child were recruited from Auckland, New Zealand and Brisbane, Australia. Compared to the waitlist control group (n = 40), parents in the intervention group (n = 45) reported greater improvements in disruptive child behavior, ineffective parenting practices and parenting confidence, as well as clinically significant improvements in child behavior and parenting. All of these effects were maintained at 6-month follow up. No group differences were found for parental wellbeing, inter-parental conflict and general relationship quality, although intervention parents reported improvements in parental wellbeing and inter-parental conflict at 6-month follow-up. The findings are discussed in terms of the implications for making brief and effective parenting support available to parents.
This study examines long-term effects of a transition to parenthood program, Family Foundations, designed to enhance child outcomes through a strategic focus on supporting the coparenting relationship. Roughly 5 to 7 years after baseline (pregnancy), parent and teacher reports of internalizing and externalizing problems and school adjustment were collected by mail for 98 children born to couples enrolled in the randomized trial. Teachers reported significantly lower levels of internalizing problems among children in the intervention group compared with children in the control group and, consistent with prior findings at age 3, lower levels of externalizing problems for boys in the intervention group. Baseline level of observed couple negative communication moderated intervention effects for parent and teacher report of child adjustment and teacher report of school adjustment and adaptation. Effect sizes ranged from 0.40 to 0.98. Results indicate that relatively brief preventive programs for couples at the transition to parenthood have the capacity to promote long-term positive benefits for children’s adjustment. Although we attended to missing data issues in several ways, high levels of attrition in this long-term follow-up study is a cause for caution. (PsycINFO Database Record (c) 2014 APA, all rights reserved)(journal abstract)
The Birmingham Brighter Futures strategy was informed by epidemiological data on child well-being and evidence on "what works," and included the implementation and evaluation of three evidence-based programmes in regular children's services systems, as well as an integrated prospective cost-effectiveness analysis (reported elsewhere). A randomised controlled trial (RCT) of the Incredible Years BASIC parenting programme involved 161 children aged three and four at risk of a social-emotional or behavioural disorder. An RCT of the universal PATHS social-emotional learning curriculum involved children aged four-six years in 56 primary schools. An RCT of the Level 4 Group Triple-P parenting programme involved parents of 146 children aged four-nine years with potential social-emotional or behavioural disorders. All three studies used validated standardised measures. Both parenting programme trials used parentcompleted measures of child and parenting behaviour. The school-based trial used teacher reports of children's behaviour, emotions, and social competence. Incredible Years yielded reductions in negative parenting behaviours among parents, reductions in child behaviour problems, and improvements in children's relationships. In the PATHS trial, modest improvements in emotional health and behavioural development after one year disappeared by the end of year two. There were no effects for Triple-P. Much can be learned from the strengths and limitations of the Birmingham experience.
The aim of this study was to assess the effectiveness of an intervention program with and without the mothers' training in the development of preterm infants. The participants were 08 preterm infants and their mothers who have been participating in the Intervention and Follow-up Service of Risk Infant in the city of São Carlos, SP. The participants were divided in two groups: 04 infants participated on the intervention group with mothers' orientation and training (experimental group - EG) and 04 infants participated of the intervention group without mothers' orientation and training (control group - CG). The preterm were assessed through Operational Portage Inventory for four months, considering the following areas: infant stimulation, social development, cognition, language, self-care and motor development. The data were then submitted to the regression analysis. The results demonstrated that the EG obtained a larger evolution of the appraised behaviors than the CG one.
Background:
The New Forest Parenting Programme (NFPP) is a home-delivered, evidence-based parenting programme to target symptoms of attention-deficit/hyperactivity disorder (ADHD) in preschool children. It has been adapted for use with 'hard-to-reach' or 'difficult-to-treat' children. This trial will compare the adapted-NFPP with a generic parenting group-based programme, Incredible Years (IY), which has been recommended for children with preschool-type ADHD symptoms.
Methods/design:
This multicentre randomized controlled trial comprises three arms: adapted-NFPP, IY and treatment as usual (TAU). A sample of 329 parents of preschool-aged children with a research diagnosis of ADHD enriched for hard-to-reach and potentially treatment-resistant children will be allocated to the arms in the ratio 3:3:1. Participants in the adapted-NFPP and IY arms receive an induction visit followed by 12 weekly parenting sessions of 1½ hours (adapted-NFPP) or 2½ hours (IY) over 2.5 years. Adapted-NFPP will be delivered as a one-to-one home-based intervention; IY, as a group-based intervention. TAU participants are offered a parenting programme at the end of the study. The primary objective is to test whether the adapted-NFPP produces beneficial effects in terms of core ADHD symptoms. Secondary objectives include examination of the treatment impact on secondary outcomes, a study of cost-effectiveness and examination of the mediating role of treatment-induced changes in parenting behaviour and neuropsychological function. The primary outcome is change in ADHD symptoms, as measured by the parent-completed version of the SNAP-IV questionnaire, adjusted for pretreatment SNAP-IV score. Secondary outcome measures are: a validated index of behaviour during child's solo play; teacher-reported SNAP-IV (ADHD scale); teacher and parent SNAP-IV (ODD) Scale; Eyberg Child Behaviour Inventory - Oppositional Defiant Disorder scale; Revised Client Service Receipt Inventory - Health Economics Costs measure and EuroQol (EQ5D) health-related quality-of-life measure. Follow-up measures will be collected 6 months after treatment for participants allocated to adapted-NFPP and IY.
Discussion:
This trial will provide evidence as to whether the adapted-NFPP is more effective and cost-effective than the recommended treatment and TAU. It will also provide information about mediating factors (improved parenting and neuropsychological function) and moderating factors (parent and child genetic factors) in any increased benefit.
Trial registration:
Current Controlled Trials, ISRCTN39288126.
Untreated behavioral and mental health problems beginning in early childhood are costly problems affecting the long-term health and wellbeing of children, their families, and society. Although parent training (PT) programs have been demonstrated to be a cost-effective intervention modality for treating childhood behavior problems, they have been less effective for children from low-income and underserved racial and ethnic populations. The purpose of this randomized trial is to compare the effectiveness, cost, and social validity of two manualized evidence-based PT programs that were developed and tested on different populations and employ different delivery models: (1) The Chicago Parent Program (CPP), a group-based program developed in collaboration with a community advisory board of African-American and Latino parents; and (2) Parent-Child Interaction Therapy (PCIT), an individualized parent-child coaching model considered to be 'the gold standard' for parents of children with externalizing behavior problems.
This trial uses an experimental design with randomization of parents seeking behavioral treatment for their 2- to 5-year-old children at a mental health clinic in Baltimore, MD (80% African-American or multi-racial; 97% receiving Medicaid). Using block randomization procedures, 262 parents are randomized to CPP or PCIT. Clinicians (n = 13) employed in the mental health clinic and trained in CPP or PCIT are also recruited to participate. Primary outcomes of interest are reductions in child behavior problems, improvements in parenting, perceived value of the interventions from the perspective of parents and clinicians, and cost. Parent distress and family social risk are assessed as modifiers of treatment effectiveness. We hypothesize that CPP will be at least as effective as PCIT for reducing child behavior problems and improving parenting but the programs will differ on cost and their social validity as perceived by parents and clinicians.
This is the first study to compare the effectiveness of a PT program originally designed with and for parents from underserved racial and ethnic populations (CPP) against a well-established program considered to be the 'the gold standard' (PCIT) with a high-risk population of parents. Challenges related to conducting a randomized trial in a fee-for-service mental health clinic serving urban, low-income families are discussed.Trial registration: NCT01517867.
Background:
Psychopathology in women after childbirth represents a significant risk factor for parenting and infant mental health. Regarding child development, these infants are at increased risk for developing unfavorable attachment strategies to their mothers and for subsequent behavioral, emotional and cognitive impairments throughout childhood. To date, the specific efficacy of an early attachment-based parenting group intervention under standard clinical outpatient conditions, and the moderators and mediators that promote attachment security in infants of mentally ill mothers, have been poorly evaluated.
Methods/design:
This randomized controlled clinical trial tests whether promoting attachment security in infancy with the Circle of Security (COS) Intervention will result in a higher rate of securely attached children compared to treatment as usual (TAU). Furthermore, we will determine whether the distributions of securely attached children are moderated or mediated by variations in maternal sensitivity, mentalizing, attachment representations, and psychopathology obtained at baseline and at follow-up. We plan to recruit 80 mother-infant dyads when infants are aged 4-9 months with 40 dyads being randomized to each treatment arm. Infants and mothers will be reassessed when the children are 16-18 months of age. Methodological aspects of the study are systematic recruitment and randomization, explicit inclusion and exclusion criteria, research assessors and coders blinded to treatment allocation, advanced statistical analysis, manualized treatment protocols and assessments of treatment adherence and integrity.
Discussion:
The aim of this clinical trial is to determine whether there are specific effects of an attachment-based intervention that promotes attachment security in infants. Additionally, we anticipate being able to utilize data on maternal and child outcome measures to obtain preliminary indications about potential moderators of the intervention and inform hypotheses about which intervention may be most suitable when offered in a clinical psychiatric outpatient context.
Trial registration:
Current Controlled Trials ISRCTN88988596.
Importance:
Disruptive behavior disorders, such as attention-deficient/hyperactivity disorder and oppositional defiant disorder, are common and stable throughout childhood. These disorders cause long-term morbidity but benefit from early intervention. While symptoms are often evident before preschool, few children receive appropriate treatment during this period. Group parent training, such as the Incredible Years program, has been shown to be effective in improving parenting strategies and reducing children's disruptive behaviors. Because they already monitor young children's behavior and development, primary care pediatricians are in a good position to intervene early when indicated.
Objective:
To investigate the feasibility and effectiveness of parent-training groups delivered to parents of toddlers in pediatric primary care settings.
Design, setting, and participants:
This randomized clinical trial was conducted at 11 diverse pediatric practices in the Greater Boston area. A total of 273 parents of children between 2 and 4 years old who acknowledged disruptive behaviors on a 20-item checklist were included.
Intervention:
A 10-week Incredible Years parent-training group co-led by a research clinician and a pediatric staff member.
Main outcomes and measures:
Self-reports and structured videotaped observations of parent and child behaviors conducted prior to, immediately after, and 12 months after the intervention.
Results:
A total of 150 parents were randomly assigned to the intervention or the waiting-list group. An additional 123 parents were assigned to receive intervention without a randomly selected comparison group. Compared with the waiting-list group, greater improvement was observed in both intervention groups (P < .05). No differences were observed between the randomized and the nonrandomized intervention groups.
Conclusions and relevance:
Self-reports and structured observations provided evidence of improvements in parenting practices and child disruptive behaviors that were attributable to participation in the Incredible Years groups. This study demonstrated the feasibility and effectiveness of parent-training groups conducted in pediatric office settings to reduce disruptive behavior in toddlers.
Trial registration:
clinicaltrials.gov Identifier: NCT00402857.
There is large body of knowledge to support the importance of early interventions to improve child health and development. Nonetheless, it is important to identify cost-effective blends of preventive interventions with adequate coverage and feasible delivery modes. The aim of the Children and Parents in Focus trial is to compare two levels of parenting programme intensity and rate of exposure, with a control condition to address impact and cost-effectiveness of a universally offered evidence-based parenting programme in the Swedish context.
The trial has a cluster randomised controlled design comprising three arms: Universal arm (with access to participation in Triple P - Positive Parenting Program, level 2); Universal Plus arm (with access to participation in Triple P - Positive Parenting Program, level 2 as well as level 3, and level 4 group); and Services as Usual arm. The sampling frame is Uppsala municipality in Sweden. Child health centres consecutively recruit parents of children aged 3 to 5 years before their yearly check-ups (during the years 2013--2017). Outcomes will be measured annually. The primary outcome will be children's behavioural and emotional problems as rated by three informants: fathers, mothers and preschool teachers. The other outcomes will be parents' behaviour and parents' general health. Health economic evaluations will analyse cost-effectiveness of the interventions versus care as usual by comparing the costs and consequences in terms of impact on children's mental health, parent's mental health and health-related quality of life.
This study addresses the need for comprehensive evaluation of the long-term effects, costs and benefits of early parenting interventions embedded within existing systems. In addition, the study will generate population-based data on the mental health and well-being of preschool aged children in Sweden.Trial registration: ISRCTN: ISRCTN16513449.
One in five Americans under age 18 lives in a family below the Federal poverty threshold. These more than 15 million children are at increased risk of a wide variety of adverse long-term health and developmental outcomes. The early years of life are critical to short- and long-term health and well-being. The Legacy for Children
TM
model was developed in response to this need and marries the perspectives of epidemiology and public health to developmental psychology theory in order to better address the needs of children at environmental risk for poor developmental outcomes.
The Legacy for Children
TM
group-based parenting intervention model was evaluated as a pair of randomized controlled trials among low-income families in Miami and Los Angeles. The study was designed to allow for site-stratified analysis in order to evaluate each model implementation separately. Evaluation domains include comprehensive assessments of family, maternal, and child characteristics, process outcomes, and prospective programmatic cost. Data collection began prenatally or at birth and continues into school-age.
The societal costs of poor developmental outcomes are substantial. A concerted effort from multiple sectors and disciplines, including public health, is necessary to address these societal concerns. Legacy uses a public health model to engage parents and promote overall child well-being in families in poverty through rigorous evaluation methodologies and evidence-based intervention strategies. This study collects rich and modular information on maternal and child outcomes, process, and cost that will enable a detailed understanding of how Legacy works, how it can be refined and improved, and how it can be translated and disseminated. Taken together, these results will inform public policy and help to address issues of health disparities among at-risk populations.
Trial registration
To evaluate the effectiveness and cost utility of a universally provided early years parenting programme.
Multicentre randomised controlled trial with cost-effectiveness analysis.
Early years centres in four deprived areas of South Wales.
Families with children aged between 2 and 4 years. 286 families were recruited and randomly allocated to the intervention or waiting list control.
The Family Links Nurturing Programme (FLNP), a 10-week course with weekly 2 h facilitated group sessions.
Negative and supportive parenting, child and parental well-being and costs assessed before the intervention, following the course (3 months) and at 9 months using standardised measures.
There were no significant differences in primary or secondary outcomes between trial arms at 3 or 9 months. With '+' indicating improvement, difference in change in negative parenting score at 9 months was +0.90 (95%CI -1.90 to 3.69); in supportive parenting, +0.17 (95%CI -0.61 to 0.94); and 12 of the 17 secondary outcomes showed a non-significant positive effect in the FLNP arm. Based on changes in parental well-being (SF-12), the cost per quality-adjusted life year (QALY) gained was estimated to be £34 913 (range 21 485-46 578) over 5 years and £18 954 (range 11 664-25 287) over 10 years. Probability of cost per QALY gained below £30 000 was 47% at 5 years and 57% at 10 years. Attendance was low: 34% of intervention families attended no sessions (n=48); only 47% completed the course (n=68). Also, 19% of control families attended a parenting programme before 9-month follow-up.
Our trial has not found evidence of clinical or cost utility for the FLNP in a universal setting. However, low levels of exposure and contamination mean that uncertainty remains.
The trial is registered with Current Controlled Trials ISRCTN13919732.
Recent research suggests that symptoms of attention deficit hyperactiv- ity disorder may begin to emerge in children at a very young age. Given that early onset is associated with more deleterious outcomes, early intervention is imper- ative. In the current study, we evaluated the effectiveness of two different interventions with children aged 3-5 years. A multicomponent intervention com- bined parent education and individualized assessment-based intervention in home and preschool or day care settings was compared with a parent education intervention consisting of parent education alone. Both interventions resulted in significant im- provements measured by standardized assessments of behavior and preacademic skills. There were no significant