Evidence-based Parenting Programs Research Articles

Policies are Needed to Increase the Reach and Impact of Evidence-Based Parenting Supports: A Call for a Population-Based Approach to Supporting Parents, Children, and Families.

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.

Pediatric residents’ parenting guidance after exposure to Incredible Years

Background: The Incredible Years® (IY) is an evidence-based group parenting program that provides parenting guidance to parents of children with disruptive behavior. Pediatric residents are expected to provide parenting guidance to families, but often express discomfort with doing so. Little is known whether exposure to the IY curriculum may impact pediatric resident parenting guidance. Methods: A pilot study was developed to determine whether pediatric residents exposed to the IY Program demonstrate better knowledge of positive parenting practices, higher comfort levels with providing parenting guidance and increased confidence in demonstrating parenting skills. Residents were exposed to an on-going IY Preschool Parenting Program during their Developmental-Behavioral Pediatrics rotation in 2017 - 2018. They completed pre and post surveys with questions about demographics, resident knowledge, comfort, and confidence with parenting guidance, as well as satisfaction with the program. Results: Eleven interns participated in the intervention, and 8 completed post-intervention surveys (64% response). All residents reported higher comfort in discussing parenting strategies with families (W = 0, p < .05) and providing referrals for mental health services (W = 0, p < .05). Residents reported more confidence with demonstrating specific parenting skills in the office (W = 0, p < .05). All interns reported that exposure to IY was “useful” or “somewhat useful” to their training, and all recommended that others be exposed to the program. Conclusions: Results support the value of exposure to IY for pediatric residents. Exposure to IY may be an effective way to educate residents about parenting guidance.

The Development of an Adapted Coparenting Program: Tuning in to Kids Together

ABSTRACT Group-based parenting programs can effectively improve parenting and child wellbeing; however, these programs are predominantly attended by mothers. Actively involving both parents has the potential to maximize program outcomes, as it allows the coparenting relationship to be targeted alongside parenting practices. Researchers suggest that one way of achieving this is to integrate coparenting content into existing, evidence-based parenting programs. Tuning in to Kids is an emotion-focused parenting program that provides an effective foundation for adaptation, given the benefits of the program and the nature of the content (i.e., parents learn the skill of emotion coaching that may also benefit the coparenting relationship). This paper outlines the process of adapting Tuning in to Kids through the integration of coparenting content and increased focus on the family system. The process was guided by the Medical Research Council framework for complex intervention development (i.e., identifying the evidence, developing a theoretical model, modeling the intervention process) and resulted in the development of Tuning in to Kids Together (TIK-Together). The program adaptation was designed to target Australian coparents and was informed by Australian evidence. TIK-Together aims to improve the coparenting relationship, in addition to supporting parenting practices and child emotional development.

Delivering evidence-based parenting support in educational settings

Parent-child relationships influence learning throughout a child’s formal schooling and beyond. The quality of parenting children receive has a major influence on their learning and developmental capabilities. Parental influence is important in the early years of life and extends throughout a child’s schooling. Parenting has a pervasive influence on children’s language and communication, executive functions and self-regulation, social and peer relationships, academic attainment, general behaviour and enjoyment of school. Schools can further enhance educational outcomes for students by developing the resources and expertise needed to engage parents as partners in learning. This can be achieved by delivering and facilitating access to a comprehensive system of high-quality, culturally informed, evidence-based parenting support programs. In this article, recent developments in the Triple P system of parenting support are used to illustrate how schools can develop a low-cost, comprehensive, high-quality parenting support strategy that blends universal components with targeted components for more vulnerable children. We identify potential organisational and logistical barriers to implementing parenting support programs and ways to address these.

COVID-19-Associated Orphanhood andCaregiver Death in the UnitedStates.

Most coronavirus disease 2019 (COVID-19) deaths occur among adults, not children, and attention has focused on mitigating COVID-19 burden among adults. However, a tragic consequence of adult deaths is that high numbers of children might lose their parents and caregivers to COVID-19-associated deaths. We quantified COVID-19-associated caregiver loss and orphanhood in the United States and for each state using fertility and excess and COVID-19 mortality data. We assessed burden and rates of COVID-19-associated orphanhood and deaths of custodial and coresiding grandparents, overall and by race and ethnicity. We further examined variations in COVID-19-associated orphanhood by race and ethnicity for each state. We found that from April 1, 2020, through June 30, 2021, >140 000 children in the United States experienced the death of a parent or grandparent caregiver. The risk of such loss was 1.1 to 4.5 times higher among children of racial and ethnic minority groups compared with non-Hispanic White children. The highest burden of COVID-19-associated death of parents and caregivers occurred in Southern border states for Hispanic children, in Southeastern states for Black children, and in states with tribal areas for American Indian and/or Alaska Native populations. We found substantial disparities in distributions of COVID-19-associated death of parents and caregivers across racial and ethnic groups. Children losing caregivers to COVID-19 need care and safe, stable, and nurturing families with economic support, quality child care, and evidence-based parenting support programs. There is an urgent need to mount an evidence-based comprehensive response focused on those children at greatest risk in the states most affected.

Navigating the international dissemination of an evidence-based intervention: Scaling with fidelity and cultural-specificity

Attachment and Biobehavioral Catch-up (ABC), an evidence-based parenting program, monitors intervention fidelity and provides fidelity-focused supervision to providers, or “parent coaches,“ across one year of training. Recently, ABC dissemination has grown internationally, providing the opportunity for the ABC developer team to consider how to support intervention fidelity in an international context. The current manuscript describes early international dissemination efforts with local supervisors in Russia, Germany, and Norway. As part of ABC implementation, supervisors were trained in the in-the-moment commenting and coding system, a microanalytic behavioral coding system that measures fidelity to ABC. Local supervisors were also trained to provide fidelity-focused supervision. The present study found that supervisors were able to achieve coding reliability after engaging in an intensive week-long training, with reliability scores similar to supervisors who had gone through coding training in the United States. Supervisors were then able to deliver fidelity-focused supervision in the parent coaches’ native language, without the need to include an ABC staff member during the supervision meetings or provide translation of their behavioral coding. At the end of their training year, on average, parent coaches in the Russian, German, and Norwegian cohorts all met the fidelity requirements to gain certification in ABC, with fidelity data similar to those of parent coaches delivering ABC in the United States. Results from this evaluation demonstrate that an evidence-based parenting program with rigorous fidelity monitoring can be successfully transported from the United States to international contexts, with ongoing communication and collaboration between the developer site and international partners around language, culture, and fidelity-focused consultation as a key component of this dissemination.

A Pilot Study of a Parent Emotion Socialization Intervention: Impact on Parent Behavior, Child Self-Regulation, and Adjustment.

Adequate emotion regulation in children is crucial for healthy development and is influenced by parent emotion socialization. The current pilot study aimed to test, for the first time in a Scandinavian population, whether an emotion-focused intervention, Tuning in to Kids (TIK), had positive effects on parent emotion-related socialization behaviors (ERSBs), and children's self-regulation, anxiety, and externalizing behavior problems. We conducted a controlled trial of the 6-week evidence-based TIK parenting program with 20 parents of preschool children aged 5–6 years and 19 wait-list controls. Assessments at baseline and 6 months after the intervention included parent-report questionnaires on parent ERSBs and child adjustment, as well as aspects of children's self-regulation assessed with two behavioral tasks, the Emotional Go/No-Go task (EGNG) and the AX-Continuous Performance Task (AX-CPT). Results showed a significant increase in reported parent emotion coaching behavior and an uncorrected significant decrease in parents' report of child externalizing problems in intervention participants compared to controls. The behavioral data showed an uncorrected significant improvement in child emotion discrimination in the control condition compared to the intervention condition, while measures of children's executive control improved from baseline to follow-up for both conditions but were not significantly different between conditions. These findings suggest that this emotion-focused parenting intervention contributed to improvement in parents' emotion coaching and their appraisal of child externalizing problems, while children's self-regulation showed mainly normative developmental improvements. Further research with a larger sample will be the next step to determine if these pilot findings are seen in an adequately powered study.

Implementation of evidence-based parenting programs under real-world conditions: Protocol for a scoping review.

Protecting children is recognized as a public health priority and supporting parents through the implementation of evidence-based programs is a well-known strategy to achieve this. However, researchers highlight that these programs remain insufficiently implemented in real-world contexts. A knowledge gap exists between the intended implementation of evidence-based parenting programs and their actual implementation on real-world dynamics. This scoping review aims to provide a comprehensive understanding of how evidence-based parenting programs have been implemented under real-world conditions by providing a map of available evidence and identifying knowledge gaps. The overall research question is: "How have evidence-based parenting programs been implemented under real-world conditions?". The proposed scoping review follows the framework originally described by Arksey and O’Malley, Levac and colleagues, and the Joanna Briggs Institute: (1) identifying the research questions; (2) identifying the relevant studies; (3) study selection; (4) charting the data; (5) collating, summarizing, and reporting the results; (6) consultation. The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) will inform the search strategy. The results will be described in relation to the research questions and in the context of the purpose of the review. This scoping review will help to bridge the implementation gap between research evidence and its translation into practice.

The utility of the Positive Parenting Program (Triple P) for refugee background parents

ABSTRACT Parenting effectively after resettlement is a significant challenge faced by many former refugees. This study considers experiences of the Positive Parenting Programme (Triple P), an evidence-based parenting program; specifically, its perceived utility in assisting refugee background parents. This includes identifying amendments to better meet these parents’ needs. This New Zealand-based study involved interviewing seven refugee background mothers following their attendance of the Triple P Discussion Group Series. Analysis of accounts has participants describing this series as useful in addressing parenting needs, but also identifying amendments which would render the program more effective and relevant, including addressing changes in family dynamics, parental mental health concerns, and single parenting.

Feasibility pilot of an adapted parenting program embedded within the Thai public health system

BackgroundThis feasibility pilot of the Parenting for Lifelong Health for Young Children program in Thailand aimed to: 1) explore the feasibility of study evaluation approaches; 2) assess the feasibility of delivering an adapted program; 3) report indicative effects on child maltreatment and related outcomes; and 4) examine intervention content associated with key mechanisms of change perceived by caregivers and facilitators.MethodSixty primary caregivers of children aged 2–9 years were recruited for an 8-week parenting program embedded within the local health system. Mixed-methods approaches included quantitative caregiver-report and observational data from standardized instruments, and qualitative data from individual and group interviews with caregivers and program facilitators. Analyses involved Wilcoxon signed-rank tests, paired t-tests, Friedman’s ANOVA, and thematic analysis.ResultsParticipants reported that most (65%) were grandparents or great-grandparents. Study retention and response rates were high, and enrolled caregivers attended an average of 93% of sessions. Primary outcomes showed caregiver-reported pre-post reductions in overall child maltreatment (d = − 0.58, p < 0.001), as well as reductions in physical (d = − 0.58, p < 0.001) and emotional abuse (d = − 0.40, p < 0.001). Combined caregiver report and observational assessments using the HOME Inventory showed reductions in abusive and harsh parenting (d = − 0.52, p < 0.001). Secondary outcomes demonstrated decreases in child neglect; dysfunctional parenting; poor child monitoring and supervision; parental sense of inefficacy; child behavior problems; daily report on child problem behavior; parent overall depression, anxiety, and stress; and attitudes supporting physical punishment and harsh discipline. There were increases in overall positive parenting, daily positive parenting behavior, as well as HOME Inventory assessments on parent-child relationships. Thematic analyses from interviews and focus group data identified six key program themes associated with strengthened parent-child relationships, reduced child behavior problems, improved attitudes and strategies toward discipline, and improved management of parental stress.ConclusionsThis study represents one of few evaluations to test the feasibility of an evidence-based parenting program embedded within routine public health service delivery in a low- or middle-income country. Findings show preliminary effectiveness in reducing child maltreatment, improvements on 22 of 24 secondary outcomes, and perceived mechanisms of change that support quantitative findings. Prospects are promising for program scalability, pending randomized controlled trial results.Trial registration11/01/2019, ClinicalTrials.gov, ID# NCT03539341.

A mixed methods evaluation of the large-scale implementation of a school- and community-based parenting program to reduce violence against children in Tanzania: a study protocol

BackgroundDespite the rapid dissemination of parenting programs aiming to reduce and prevent violence against children (VAC) worldwide, there is limited knowledge about and evidence of the implementation of these programs at scale. This study addresses this gap by assessing the quality of delivery and impact of an evidence-based parenting program for parents/caregivers and their adolescent girls aged 9 to 14—Parenting for Lifelong Health Teens (PLH-Teens), known locally as Furaha Teens—on reducing VAC at scale in Tanzania. The study will explore participating family and staff perspectives on program implementation and examine factors associated with implementation and how implementation quality is associated with intervention outcomes when the program is delivered to approximately 50,000 parent-child dyads (N = 100,000) in schools and community centers across eight districts of Tanzania.MethodsThis mixed-methods study will answer the following research questions: (1) what is the implementation quality and fidelity of PLH-Teens at scale in Tanzania; (2) what factors are associated with the quality of delivery and implementation fidelity of PLH-Teens; (3) how are implementation quality and fidelity associated with intervention outcomes; (4) what are participant and implementing staff perspectives on the acceptability, appropriateness, feasibility, benefits, and challenges of delivering PLH-Teens in their schools and communities; (5) what is the impact of PLH-Teens on VAC and participant well-being; and (6) how much does it cost to deliver PLH-Teens at scale? Qualitative and quantitative data will be collected directly from implementers, parents/caregivers, and adolescents using pre-post questionnaires, observational assessments, cost surveys, focus groups, and interviews. Qualitative data will be analyzed thematically with the aid of NVIVO software. Quantitative data will be cleaned and analyzed using methods such as correlation, regression, and structural equation models using Stata and R. COREQ and TREND guidelines will be used, where appropriate.DiscussionFindings will provide vital insights into some of the factors related to quality implementation at scale. Lessons learned regarding the implementation of PLH-Teens at scale will be applied in Tanzania, and also in the delivery of PLH parenting programs globally.

It takes a whole village?

It takes a whole village?

Predicting child outcomes in Bhutan: Contributions of parenting support and early childhood education programmes

The Royal Government of Bhutan has increasingly emphasised Early Childhood Care and Development (ECCD). The Ministries of Education and Health provide services to support child development, including health care, Care for Child Development (C4CD) and centre-based ECCD programmes. C4CD is an evidence-based parenting programme for children younger than 36 months, while centre-based programmes are provided for children aged 3–5 years. This study examined the association of participation in C4CD and ECCD programmes with child development. A list of 54 randomly selected ECCD centres from nine districts in Bhutan was generated. We surveyed 232 parents of 3–5-year-olds from the 54 centres and another 245 parents from nearby areas whose 3–5-year-old children were not attending ECCD programmes. Parents reported on home-based activities and early childhood development. Controlling for sociodemographic variables, we found that both ECCD attendance and C4CD participation were positively associated with child developmental outcomes, particularly in the Learning and Psychosocial Well-being domains. Children who were attending ECCD programmes had higher developmental outcomes than non-attenders, and the gap between the two groups was greatest among older children. Parents who participated in C4CD provided more stimulating home learning environments than other parents, with most variability within home learning environments observed within subsample of parents whose children did not attend ECCD programmes. In addition, the frequency of home-based activities fully mediated the relationship between C4CD participation and child developmental outcomes. The findings support the scaling up of both ECCD and C4CD programmes.

A South-to-South Cultural Adaptation of an Evidence-Based Parenting Program for Families in the Philippines.

Rates of child maltreatment are higher in low‐ and middle‐income countries due to risk factors such as social inequities, economic adversity, and sociocultural norms. Given the evidence showing the effectiveness of parenting interventions to prevent child maltreatment, this study embarked on a cultural adaptation of an evidence‐based parenting program with the eventual goal of integrating it within a nationwide conditional cash transfer program for low‐income Filipino parents with children aged 2–6 years. We document the systematic adaptation of the Parenting for Lifelong Health for Young Children program that was developed and tested in South Africa, for low‐resource Filipino families using the heuristic framework for the cultural adaptation of interventions. We underscore the merits of conducting a multistage top‐down and bottom‐up process that uses a participatory approach among cultural insiders and outsiders to develop a parenting intervention that reflects the contextual realities and cultural values of end users. The adapted program, Masayang Pamilya Para sa Batang Pilipino, is the product of a delicate and deliberate effort to balance Filipino childrearing goals and values with the scientific evidence on components of parenting interventions known to promote positive parenting and prevent child maltreatment.

Social support dimensions predict parental outcomes in a Spanish early intervention program for positive parenting

Research has shown that social support influences parenting, and yet few studies have reported how different dimensions of social support influence outcomes in a group-based parenting intervention for parents with young children. We examined the influence of social support source, type, satisfaction, and access barriers on parental outcomes in the “Growing Up Happily in the Family” program targeting parents with children aged 0–5. The sample was 256 mainly at-risk (87.2%) and non-at-risk parents participating in 49 program groups in local social services in three Autonomous Communities of Spain. Social support variables were examined as predictors of pre-post change scores in parents’ child-rearing attitudes, sense of parental competence, and parenting stress using hierarchical linear regression analyses. Results showed significant contributions of social dimensions to lack of empathy, belief in corporal punishment, parental satisfaction, dysfunctional interaction, and perception of the child as difficult. The direction of the effects varied depending on the social support dimension considered. While formal support use was associated with positive changes in parenting stress, informal support predicted positive changes in child-rearing attitudes. Support involving tangible and positive social interaction and the cumulation of perceived barriers to service access were related to negative changes in child-rearing attitudes and satisfaction with the role. In conclusion, efforts should be made to promote the dimensions of support that are most useful in increasing the effectiveness of evidence-based parenting programs.

Multimethod adherence measurement in an evidence-based parenting program.

Multimethod adherence measurement in an evidence-based parenting program.

Changes in practitioners\u2019 attitudes, perceived training needs and self-efficacy over the implementation process of an evidence-based parenting program

BackgroundEvidence-based family support programs such as the Triple P – Positive Parenting Program have the potential to enhance the well-being of children and families. However, they cannot achieve their expected outcomes if insufficient attention is paid to the implementation process. It has been demonstrated that practitioners’ attitudes towards evidence-based programs (EBPs), perceived training needs and self-efficacy for working with parents influence implementation outcomes (e.g., program acceptability, adoption, adherence and sustainability). At the same time, the experience of being involved in the implementation process of an EBP could enhance practitioners’ perceptions of the initiative. This study aimed to assess changes in practitioner’s attitudes, perceived training needs and self-efficacy over a two-year EBP implementation process, in interaction with their appraisal of their organization’s capacity to implement the EPB.MethodsIn the province of Quebec, Canada, Triple P was implemented and evaluated in two communities. Ninety-nine practitioners from various organizations completed questionnaires shortly before their training in Triple P and two years later.ResultsFindings show that practitioners who displayed more initial skepticism regarding their organization’s capacity to implement the program reported greater improvements in attitudes over time, while practitioners who showed more optimism at baseline reported a greater decrease in their perceived training needs. Practitioners’ self-efficacy increased moderately regardless of perceived organizational capacity.ConclusionsThese results are encouraging given that more positive perceptions of EBPs could foster the systematic use of these programs in communities, for the potential benefit of a greater number of families.

Participation in the Fathering through Change intervention reduces substance use among divorced and separated fathers

Recent evaluations of parent training programs have demonstrated beneficial crossover effects in reducing parental substance use. Because divorce is associated with substance use risk and substance use interferes with effective parenting, parent training programs are critically important for divorced fathers but there are few evidence-based programs tailored to fathers. We tested whether an evidence-based parenting program would exhibit beneficial impact on fathers' substance use and whether these changes were mediated by changes in parenting efficacy. We tested hypotheses in a sample of 426 divorced and separated fathers randomly assigned to the online Fathering through Change (FTC) program or the wait-listed control condition. Models specified as 3-month pre-post analyses of self-reported substance use. The FTC was associated with reductions in total substance use (d = 0.14) and drinking (d = 0.26) but not with reductions in tobacco smoking and marijuana use. Data also supported a significant indirect effect for FTC through pre-post changes in parenting efficacy (d = 0.36). We discuss clinical implications for the integration of parent training within substance use treatment.

Using a simple direct-to-consumer marketing strategy to increase participation in parenting programs

Abstract Low participation in evidence-based parenting programs not only presents a major challenge for population trials where a minimum level of intervention exposure is necessary to detect population-level impact, but also undermines the incorporation of these programs into routine practice settings. As part of a large population trial, we aimed to increase participation in a series of parenting seminars by using a simple direct-to-consumer marketing strategy, i.e., redesigning the program flyer. We captured parents' attention by affirming that “parenting is not always easy”, highlighted the potential benefits of participation, clarified what participation entailed, and addressed some of the common barriers such as the stigma associated with participation in parenting programs. Because fathers and mothers were shown to have different needs, we tailored the flyers to mothers and fathers separately. Testing the flyers on a small sample of parents showed that both mothers and fathers perceived the flyers as relevant. As expected, mothers were more likely to express interest in the program when they saw the flyer which focused on benefits related to dealing with child behavioural problems and featured a mother-child dyad, while fathers preferred the flyer which highlighted the benefits related to dealing with emotional problems, and featured a father-child dyad. Next, following the same procedure that was used to deliver the original flyers over the first 18 months of the project, we used the new flyers to inform parents about the upcoming seminars over the next 24 months. The preliminary results showed that although the average number of parents participating in each seminar had initially decreased from about seven to four, after the introduction of the new flyers, the number increased consistently and reached an average of nine parents during the last 6-month period. The results shows that program uptake can be increased using simple direct-to-consumer marketing strategies.

Emotion-focused parenting interventions for prevention and treatment of child and adolescent mental health problems: a review of recent literature.

To review recent studies on emotion-focused parenting interventions to provide clinicians with knowledge about how these approaches might be used in prevention and treatment of mental health difficulties for children, adolescents and their families. A number of emotion-focused parent interventions are reported in the literature, including emotion coaching/communication parenting programs, emotion-focused family therapy, attachment-focused parenting interventions (including those that address parental reflective functioning/mentalization), mindfulness parenting programs and behavioral programs with added emotion components. All target emotions or emotional communication to assist parents and children understand and work through emotional experiences so they are less likely to impede healthy functioning. These interventions target four main domains: exploring family of origin or early attachment/relational experiences with emotion, targeting parents' own emotion awareness and regulation, shifting parents responses to or communication with their children when emotions occur, and promoting parents' skills for assisting children to regulate emotions and behavior. This review from the last 18 months found 50 studies that evaluated programs addressing these domains. Whilst the dominant approach in evidence-based parenting programs has been teaching behavioral strategies, it has been recognized that a focus on emotion-related processes is important. This is especially when working to improve the attachment relationship or when parents and children experience emotion dysregulation. This review demonstrates extensive evidence to support emotion-focused parenting interventions.