Child Management Skills Research Articles

Behavioral and nutritional treatment for preschool-aged children with cystic fibrosis: a randomized clinical trial.

Evidence-based treatments that achieve optimal energy intake and improve growth in preschool-aged children with cystic fibrosis (CF) are a critical need. To test whether behavioral and nutritional treatment (intervention) was superior to an education and attention control treatment in increasing energy intake, weight z (WAZ) score, and height z (HAZ) score. This randomized clinical trial included 78 children aged 2 to 6 years (mean age, 3.8 years) with CF and pancreatic insufficiency (intervention, n = 36 and control, n = 42). The study was conducted at 7 CF centers between January 2006 and November 2012; all 78 participants who met intent-to-treat criteria completed through follow-up. Behavioral intervention combined individualized nutritional counseling targeting increased energy intake and training in behavioral child management skills. The control arm provided education and served as a behavioral placebo controlling for attention and contact frequency. Both treatments were delivered in person or telehealth (via telephone). Sessions occurred weekly for 8 weeks then monthly for 4 months (6 months). Participants then returned to standard care for 1 year, with 12-month follow-up thereafter. Changes in energy intake and WAZ score were examined from pretreatment to posttreatment (6 months) and change in HAZ score was assessed pretreatment to follow-up (18 months). Covariates included sex, Pseudomonas aeruginosa status at baseline, and treatment modality (in person vs telehealth). At baseline, mean (SD) energy intake was 1462 (329) kcals/d, WAZ score was -0.44 (0.81), and HAZ score was -0.55 (0.84). From pretreatment to posttreatment, the intervention increased daily energy intake by 485 calories vs 58 calories for the control group (adjusted difference, 431 calories; 95% CI, 282 to 581; P < .001) and increased the WAZ score by 0.12 units vs 0.06 for the control (adjusted difference, 0.09; 95% CI, -0.06 to 0.24; P = .25). From pretreatment to follow-up, the intervention increased the HAZ score by 0.09 units vs -0.02 for the control (adjusted difference, 0.14 units; 95% CI, 0.001 to 0.27; P = .049). Measured treatment integrity and credibility were high for both groups. Behavioral and nutritional intervention improved energy intake and HAZ score outcomes but not WAZ score outcomes. Our results provide evidence that behavioral and nutritional treatment may be efficacious as a nutritional intervention for preschoolers aged 2 to 6 years with CF and pancreatic insufficiency. clinicaltrials.gov Identifier:NCT00241969.

Advancing Family-Centred Care in Child and Adolescent Mental Health: A Critical Review of the Literature

Family-centred care (FCC) is a key factor in increasing health and related system responsiveness to the needs of children and families; unfortunately, it is an unfamiliar service model in children's mental health. This critical review of the literature addresses three key questions: What are the concepts, characteristics and principles of FCC in the context of delivering mental health services to children? What are the enablers, barriers and demonstrated benefits to using a family-centred approach to care in children's mental health? And how can we facilitate moving an FCC model forward in children's mental health? A range of databases was searched for the years 2000–2011, for children ages zero to 18 years. Articles were selected for inclusion if a family-centred approach to care was articulated and the context was the intervention and treatment side of the mental healthcare system. This literature review uncovered a multiplicity of terms and concepts, all closely related to FCC. Two of the most frequently used terms in children's mental health are family centred and family focused, which have important differences, particularly in regard to how the family is viewed. Initial benefits to FCC include improved child and family management skills and function, an increased stability of living situation, improved cost-effectiveness, increased consumer and family satisfaction and improved child and family health and well-being. Significant challenges exist in evaluating FCC because of varying interpretations of its core concepts and applications. Nonetheless, a shared understanding of FCC in a children's mental health context seems possible, and examples can be found of best practices, enablers and strategies, including opportunities for innovative policy change to overcome barriers.

The Role of Parenting Programmes in the Prevention of Child Maltreatment

Child maltreatment is a major worldwide concern and continuing high rates of abuse demand action. This article examines the role of parenting programmes as a strategy to prevent child maltreatment in the population as a whole and also as a targeted intervention for parents who have abused, or are at risk of abusing, their children. We argue that a blend of universal and targeted interventions is needed to reduce the prevalence of child maltreatment. Parenting interventions that concurrently target positive parenting and effective child management skills, dysfunctional parental attributions, and increasing parents' capacity to regulate their emotions are particularly useful. A variant of the Triple P—Positive Parenting Program, known as Pathways Triple P, is discussed to illustrate the value of this approach. Contextual factors that need to be addressed in working with child protection cases are also discussed. The role of training and supervision is discussed in the context of disseminating evidence‐based parenting programmes, and future directions for research are presented.

Treatment of Concurrent Substance Dependence, Child Neglect and Domestic Violence: A Single Case Examination Involving Family Behavior Therapy

Although child neglect and substance abuse co-occur in greater than 60% of child protective service cases, intervention outcome studies are deplorably lacking. Therefore, a home-based Family Behavior Therapy is described in the treatment of a woman evidencing child neglect, substance dependence, domestic violence and other co-occurring problems. Treatment included contingency management, self control, stimulus control, communication and child management skills training exercises, and financial management components. Results indicated improvements in child abuse potential, home hazards, domestic violence, and drug use, which were substantiated by objective urinalysis testing, and tours of her home. Validity checks indicated the participant was being truthful in her responses to standardized questionnaires, and assessors were "blind" to study intent. Limitations (i.e., lack of experimental control and follow-up data collection) of this case example are discussed in light of these results.

Changing Parent’s Mindfulness, Child Management Skills and Relationship Quality With Their Youth: Results From a Randomized Pilot Intervention Trial

We evaluated the efficacy of a mindful parenting program for changing parents' mindfulness, child management practices, and relationships with their early adolescent youth and tested whether changes in parents' mindfulness mediated changes in other domains. We conducted a pilot randomized trial with 65 families and tested an adapted version of the Strengthening Families Program: For Parent and Youth 10-14 that infused mindfulness principles and practices against the original program and a delayed intervention control group. Results of pre-post analyses of mother and youth-report data showed that the mindful parenting program generally demonstrated comparable effects to the original program on measures of child management practices and stronger effects on measures of mindful parenting and parent-youth relationship qualities. Moreover, mediation analyses indicated that the mindful parenting program operated indirectly on the quality of parent-youth relationships through changes in mindful parenting. Overall, the findings suggest that infusing mindful parenting activities into existing empirically validated parenting programs can enhance their effects on family risk and protection during the transition to adolescence.

Reducing conduct problems among children exposed to intimate partner violence: A randomized clinical trial examining effects of Project Support.

This study was a randomized clinical trial of Project Support, an intervention designed to reduce conduct problems among children exposed to intimate partner violence. Participants were 66 families (mothers and children) with at least 1 child exhibiting clinical levels of conduct problems. Families were recruited from domestic violence shelters. The Project Support intervention involves (a) teaching mothers child management skills and (b) providing instrumental and emotional support to mothers. Families were randomly assigned to the Project Support intervention condition or to an existing services comparison condition. They were assessed on 6 occasions over 20 months, following their departure from the shelter. Children in families in the Project Support condition, compared with those in the comparison condition, exhibited greater reductions in conduct problems. Mothers in the Project Support condition, compared with those in the comparison condition, displayed greater reductions in inconsistent and harsh parenting behaviors and psychiatric symptoms. Changes in mothers' parenting and psychiatric symptoms accounted for a sizable proportion of Project Support's effects on child conduct problems at the end of treatment. Clinical and policy implications are discussed.

Child-Centred child management in a changing world

There is a need to "re-think" child management, as the completion of a procedure is not the only dental goal. Short versus long-term goals and the behavioural and pharmacologic repertoire will influence outcomes. A child-centred approach is described, with a specific protocol for the dental waiting room. The changing attitudes of society need to be taken into account in the use of behaviour management techniques by paediatric dentists. The goal of managing children in the dental environment requires some thought: the welfare of the child depends on attention by a clinician to long term goals. The contemporary child-centred clinician has a wide range of child management skills. It is not optional for the clinician to develop his/her behavioural expertise to a high level; clinician skills have long-term consequences. These days behaviour management begins in the waiting room where initial contact provides the opportunity to shape subsequent behaviours.

The Effects of the Nobody’s Perfect Program on Parenting Resourcefulness and Competency

We conducted an evaluation of Nobody’s Perfect Program involving 71 participants from Peterborough County, Canada. Prior to the program, parents completed demographic information, along with self-report measures assessing the types of interactions with their children, parent resourcefulness, knowledge and use of resources, parent competency and self-efficacy, which were completed again after the program and at a two month follow-up testing. In comparison to parents not earning certificates, parents earning certificates were younger and more likely to have completed previous parenting programs. As well, parents earning certificates demonstrated and maintained an increase in parenting resourcefulness, warm/positive parent-child interactions, sense of parenting competency and satisfaction, and use of community resources. The more sessions parents attended, the better their parenting resourcefulness and warm/positive parent-child interactions on completion and at follow-up, and the less their angry and punitive parenting at follow-up. Parents who had attended parenting programs before had higher parenting resourcefulness scores at entry. They left the program with increased levels of parenting resourcefulness, better parent-child interactions, and more effective child management skills. A number of recommendations are suggested to help facilitators of the program enhance service delivery and improve parental outcomes.

Investigating the Effectiveness of Behavioral Parent Training With Involuntary Clients in Child Welfare Settings

Objective: Whether parents could be taught to use behavior-analytic child-management skills. Method: Eleven parents typically labeled as difficult to train participated in one of two experimental parent-training programs at child-welfare agencies within the city of Chicago. Four classes of desirable parenting skills were recorded by observers during parent-child interactions in diverse settings, and the data were analyzed in single-subject designs. Results: Training produced improvements in the parenting skills observed. Follow-up observations occurring up to 6 months after training revealed that the parents continued to use these skills, sometimes at levels better than during their training. Conclusions: Behavioral parent training is an effective strategy for teaching parents with deficient parenting skills. Recommendations for conducting parent training with this population are discussed.

Mothers' Self- Evaluation, Attribution in Parenting and Coping Strategies on Child Externalizing Behaviour in Ibadan, Nigeria.

This study investigated the influence of mother's self- evaluation, attribution in parenting and coping strategies on children's (age 2-6 years) externalizing behaviour. Two hundred (200) nursing mothers with a mean age of 30.25, (SD 10.67) years were randomly selected for the study. Data was collected using self-administered questionnaires. Independent t-test and multiple regression analyses were used to test the hypotheses. The result indicates that children whose mothers report low self-evaluation showed significantly higher externalizing behaviour than children whose mothers reported high self-evaluation (t 198=18.581, p It was concluded that mothers should have a better understanding of their roles as parents to reduce tendency for externalizing behaviour in children. There is a need for individuals going into parenthood to have basic knowledge of child development and child management skills through appropriate parenting programmes to ensure positive future adult lives for their children. Ife Psychologia Vol.13(1) 2005: 101-112

Reducing conduct problems among children of battered women.

This study was an experimental evaluation of an intervention designed to reduce conduct problems among children of battered women. Participants were 36 families (mothers and children) in which the mother had sought shelter because of relationship violence and had at least 1 child (4-9 years old) with clinical levels of conduct problems. The intervention consisted of 2 primary components: (a) providing instrumental and emotional support and (b) teaching child management skills to mothers. Families were randomly assigned to either the intervention condition or the existing services comparison condition and were assessed on 5 occasions over 16 months after shelter departure. Compared with families receiving existing services, children in the intervention condition improved at a faster rate, the proportion of children displaying clinical levels of conduct problems was greatly diminished, and mothers displayed greater improvements in child management skills.

Parent Training via CD-ROM: Using Technology to Disseminate Effective Prevention Practices

Family-based prevention programs have demonstrated effectiveness in reducing risk factors for substance abuse. The lack of efficient methods for training staff and insuring treatment integrity and the limited time that program progenitors have for dissemination impede the spread of these programs. Additionally, there are barriers to families who use these programs such as stigma associated with a parent education or mental health approach, transportation and access difficulties, and inability to commit to months of treatment sessions. New developments in technology can surmount most of these barriers. The author describes a video-based interactive CD-ROM for training parents and families in child management and relationship enhancement skills. The program's development was based on two premises which are well-supported in the literature. One premise is that interactive videodisk programs increase knowledge and performance more efficiently than do standard methods of instruction. The other is that videotaped modeling of parenting skills is as effective in producing improvements in child behavior as are parent education discussion groups and parent training with a therapist. The CD-ROM program is self-administered, highly interactive, and brief, requiring no trained staff for its delivery. Users receives feedback about their choices from the computer, not a person, thus minimizing defensiveness. Controlled evaluations show improvements in knowledge and parenting skills, and reductions in child behavior problems. Many teens moved from the clinical range of behavior problems to the normal range after their mothers used the program. Replication efforts by service providers and universities are underway due to the program's ease of implementation and evaluation. Gaps in knowledge about this approach include general long-term effects, and, more specifically, how the program will affect ethnically diverse populations, how repetition and use by other family members affects outcomes, and how to overcome mental health professionals' resistance to the technology. Prevention practice can be improved with this approach since it can be disseminated relatively quickly and inexpensively, with very high treatment integrity. The convenience and lack of stigma can increase participation by parents prior to their becoming distressed by their children's behavior problems. Existing programs can incorporate and evaluate CD-ROM parent training, while new efforts will be encouraged by such an inexpensive program. Program changes, based upon research feedback, can be incorporated rapidly without the difficulty of retraining program staff.

Facilitating Healthy Parenting Among Mothers with Substance Abuse or Dependence Problems:

More than one and one-half million children in the United States experience abuse or neglect. Research has identified parental substance abuse or dependence as one of the primary risk factors for child abuse. Along with this recognition, there are increased efforts to provide appropriate treatment to maltreating, substance-abusing or dependent parents. Parenting interventions may be required or recommended in conjunction with their treatment for substance abuse or dependence. However, current parenting programs, which tend to emphasize child management skills, may be less effective for parents with substance abuse or dependence issues. Traditional parenting programs may be rendered less potent for these parents with: multiple and chronic life problems, insufficient supports, poor coping skills, already damaged relationships with their children, and repetitive patterns of relating to their children sometimes based upon their past traumas. Parenting outcomes may be improved through comprehensive parenting p...

THE EFFECTIVENESS OF FAMILY THERAPIES FOR SELECTED BEHAVIORAL DISORDERS OF CHILDHOOD

This article reviews the scientific evidence for the effectiveness of family‐based aproaches in the treatment of selected childhood behavioral disorders. Although limitations certainly exist, family interventions have consitently improved child and, in some cases, parent functioning in families with children presenting with conduct disorder (CD) and autism. Parents and other family members also directly benefit from child‐focused interventions, gaining in knowledge, child management skills, and attitudinal improvements. Longh‐term follow‐ups indicate that CD and autistic children achieved lasting gains. Similarly, the research on attention‐deficit/hyperactivity disorder (ADHD) indicates that parent training improves child noncompliance and aggression yet does not consistently affect core symptoms of ADHD. There is no evidence that adding short‐term family interventions improves ADHD child functioning beyond improvements from the use of psychostimulant medications. Some tentative support for family involvement in the treatment of childhood anxieties and fears is reviewed, but clear conclusions await future investigations. Finally, several methodological limitations and needed areas of research are discussed.

Over-chastisement, Child Non-compliance and Parenting Skills: A Behavioural Interventiaon by a Family Centre Social Worker

This single-case study describes a behavioural intervention by a Family Centre social worker with a family whose two eldest children had been registered on the Child Protection Register following an incident of over-chastisement by their mother. Working in partnership with the parents. a behavioural assessment and intervention was undertaken over a four month periood. The assessment suggested that child non-compliance was a central problem behaviour and that mother and child were caught in a trap where each negatively reinforced the other's aversive, coercive behaviour, since these behaviours were successful in terminating the other's unwanted or aversive behaviours. The intervention aimed to increase child compliance and reduce child defiance using a positive reinforcement programme, and to increase the mother's child management skills using a parent training programme. The results showed that child compliance with maternal instructions increased significantly and that this was maintained at eleven month follow-up. Also, mother's use of command negative decreased significantly; this improvement was also maintained at eleven month follow-up.

Prevention through parent training: Three preventive parent education programs

One route to preventing child behavior disorders and adjustment problems is the enhancement of parent competence. This paper reviews three preventive parent education programs conducted at a community mental health center. One program provides child behavior advice in pediatric practices, another is a class that teaches child management skills to parents of preschoolers, and a third is a more specialized behavior management class for parents of children with Attention Deficit-Hyperactivity Disorder (ADHD). Program evaluations indicate that the interventions improve parent skills, child behavior and parent-child interaction. The contribution to the prevention of serious behavior problems is highlighted.

A Family Focus approach to child abuse prevention

Family Focus is a child abuse prevention program established to assist families in the task of raising their children from birth through 3 years. Its goal is to prevent child abuse by reducing isolation, improving emotional support systems and increasing parental knowledge of child behavior and effective child management skills. It strives to be viewed by the community as a positive family resource center with its services available to any interested parent, not just those identified as being at high risk for child abuse. Family Focus provides playgroups, parent education classes and other resources. The "Infant Program" was added to the program to provide outreach and follow-up services to parents and their high risk infants birth to 2 years.

HELPING BANGLADESHI FAMILIES: Tower Hamlets Parent Adviser Scheme

This paper describes the problem facing Bangladeshi families of children with mental handicaps in the East End of London. It illustrates how comprehensive help has been provided by employing a full‐time Bangladeshi worker as a Parent Adviser, who was trained in counselling and child management skills before beginning regular home‐visiting. The enormous benefits that have occurred as a result of this work are documented with reference to one family.

What Is the Role of Group Parent Training in the Treatment of ADD Children?

Abstract The nature of the behavioral deficiencies in children with Attention Deficit Disorders and how these might lead to the development of noncompliance, oppositional behavior, and other conduct problems are briefly described. Since the majority of ADD children eventually display such conduct problems, it is important to train parents in behavior management skills so as to effectively treat these conduct problems. The abundance of ADD children referred to child guidance centers and the significant distress they create for their parents argue for the use of group parent training in child management skills as the most cost-effective method for managing this heavy case load. The rationale for a group parent training program, and the steps involved in it are briefly described. A case example is provided.

The Behavioural Treatment of Faeces Retention: An Expanded Case Study

The successful treatment of faeces retention in a 6-year-old boy is discussed in the light of recent findings in the literature which suggest the need to take both family and therapist variables into account when training parents in child management skills. Details are given of the family variables considered relevant to the presenting problem in this case: lack of paternal motivation to co-operate in treatment, maternal depression and social isolation, and problem behaviour in a sibling. The treatment plan designed to take account of these variables is described, as well as the problems (and their resolution) encountered in implementing it. Successful outcome was maintained at three and six month follow-up. It is argued that wider use of this model of an expanded case study would provide useful hypotheses for future research, as well as clinical relevance for other practitioners.