Intervention For Parents Of Children Research Articles

The Nurturing Program: An Intervention for Parents of Children with Special Needs

Evidence-based psychosocial family interventions enhancing empathy and empowerment are particularly beneficial to families of children who have developmental disabilities. This study assessed the effectiveness of an intervention called the Nurturing Program for Parents and Their Children with Special Needs and Health Challenges (SNHC). Eighty-seven families were enrolled and randomly assigned to a control or treatment group. Forty-six families in the control group received individualized case management (CM) services and forty-one families in the treatment group were assigned to 12 sessions of the SNHC curriculum along with case management services. Before and after the intervention, participants in both conditions completed the Adult and Adolescent Parenting Index-2 assessing parents’ attitudes toward child rearing and the Family Empowerment Scale (FES) measuring family empowerment. Caregivers in the intervention condition improved in empathy towards children’s needs, F(1, 54) = 4.52, p = .04; and all families, both control group and treatment group, improved their attitudes towards the use of corporal punishment by posttest, F(1, 54) = 6.56, p = .013. Also, all caregivers increased in their empowerment over the course of the intervention, F(1, 50) = 13.28, p = .001. Attrition, 22–26% among CM and 51–56% among SNHC+CM, limited generalizability as did participants not completing all SNHC sessions. Despite these limitations, findings suggest that early interventions catering to families of children with developmental disabilities have a positive impact on parenting. To varying degrees, both conditions provided caregivers with tools that positively affected the quality of the parent–child relationships and promoted empowerment.

Adding "Circle of Security - Parenting" to treatment as usual in three Swedish infant mental health clinics. Effects on parents' internal representations and quality of parent-infant interaction.

This study presents effects of adding Circle of Security-Parenting (COS-P) to an already established comprehensive therapeutic model for early parent-child intervention in three Swedish infant mental health (IMH) clinics. Parents' internal representations and quality of parent-infant interaction were studied in a clinical sample comprised of 52 parent-infant dyads randomly allocated to two comparable groups. One group consisted of 28 dyads receiving treatment as usual (TAU) supplemented with COS-P in a small group format, and another group of 24 dyads receiving TAU only. Assessments were made at baseline (T1), 6 months after inclusion (T2) and 12 months after inclusion (T3). Changes over time were explored in 42 dyads. In the COS-P group, the proportion of balanced representations, as assessed with Working Model of the Child Interview (WMCI), significantly increased between T1 and T3. Further, the proportion of emotionally available interactions, as assessed with Emotional Availability scales (EA), significantly increased over time in the COS-P group. Improvements in the TAU-group were close to significant. Limitations of the study are mainly related to the small sample size. Strength is the real world character of the study, where COS-P was implemented in a clinical context not otherwise adapted to research. We conclude by discussing the value of supplementing TAU with COS-P in IMH treatment.

Evaluation of Acceptance and Commitment Therapy (ACT) for Mothers of Children and Youth with Autism SpectrumDisorder

Mothers of children with autism spectrum disorder (ASD) often face high levels of stress. While there have been interventions for parents of children with ASD targeting their parenting skills, there have been fewer studies that aim to target the psychological or physical well-being of the mothers themselves. This study included mothers of children with ASD to cofacilitate acceptance and commitment therapy (ACT) to other mothers of children with ASD. The intervention consisted of one evening session and a full-day workshop, followed by a refresher session 1 month later. Of the 33 mothers that enrolled in the study, 29 attended all three sessions and completed the outcome measures. Significant changes were observed over time in terms of depression, stress, social isolation and physical health scores. Post hoc analyses showed reductions in stress and depression and improvements in physical health which were maintained at follow-up. Results suggest that a brief parent-facilitated ACT group intervention may be effective in improving the mental and physical health of mothers of children with ASD.

Moving the field forward: Developing online interventions for children of parents with a mental illness

Parental mental illness has the potential to affect children adversely. These children report a higher risk of developing a mental illness than other children. At the same time, some young people are resilient in the face of adverse situations arising from their parent's illness, especially when appropriate interventions are provided. While there are several interventions available to support young people with parents with a mental illness, there are few online interventions. Additionally, much of the previous work in this area, including intervention development and evaluation, has not included the child's point of view about what they want. Clearly, there is a gap in current research regarding the development of interventions that are available online and are informed by children. This research note aims to further the argument for developing online interventions for children of parents with a mental illness.

Regular exercise improves the well-being of parents of children with cancer.

Parents of children with cancer describe impaired physical and social functioning, sleep disturbance and poor mental health. Exercise-related interventions impact positively on these quality of life domains, but have not been examined in this population. The aim of this longitudinal pilot study was to explore the feasibility of a 12-week pedometer-monitored walking intervention among parents of children with cancer, assessing adherence to a set activity target of 70,000 steps per week, and to explore the benefits of physical activity on mental and physical health. Parents were provided with a pedometer and requested to achieve a daily step count of 10,000 steps per day for 12 weeks. Mood, well-being and psychological distress were examined using validated questionnaires (Profile of Mood States 2nd edition [POMS-2], Distress Thermometer for Parents [DT-P] and Depression Anxiety Stress Scales [DASS-42]) at baseline, midpoint (6 weeks) and endpoint (12 weeks) to identify changes in these domains with increased activity. Fifteen parents were recruited. The majority increased their counts during the first 4 weeks of the study and maintained this to week 8 (n = 12). Time-dependent improvements were identified in the following psychometric test outcomes at week 12: DT-P score (likelihood ratio test [LRT] P= 0.02), POMS-2 total mood disturbance (LRT P = 0.03), fatigue inertia (LRT P = 0.009), tension anxiety (LRT P = 0.007) and vigour activity (LRT P = 0.001). Mental health benefits of a pedometer-based exercise intervention for parents of children with cancer were identified. Such programs should be included in a holistic approach to improve the psychological outcomes of parents whose children are receiving treatment for cancer.

Expert views of children's knowledge needs regarding parental mental illness

Children of parents with a mental illness are at significant risk of developing a mental illness. This risk may be reduced if appropriate interventions are provided that include information and knowledge about mental illness. While there are some interventions for children of parents with a mental illness, research is lacking about the type of mental health information children need and why they need that knowledge. This study presents the perspectives of a purposive sample of international research experts in the field of parental mental illness about the kind of mental health literacy information children with parents with a mental illness need. Twenty-three participants completed a self-constructed short answer questionnaire about the knowledge needs of children of parents with a mental illness. The qualitative data indicates that ‘identifying information’, ‘making sense of parents behaviour’, ‘coping better’ and ‘respecting safety’ are key knowledge needs of children. Given the views presented, these findings suggest that health care professionals should advocate for policies that support individual-, peer-, and family-focused programs driven by strong evaluation and rigorous research. If this is done, children of parents with mental illness may experience ‘myth busting’ of incorrect information about mental illness.

Effectiveness of a nurse-led preadmission intervention for parents of children with profound multiple disabilities undergoing hip-joint surgery: A quasi-experimental pilot study.

The aim of this study was to assess the effectiveness of a family-centered care (FCC) intervention provided by an advanced practice nurse (APN) for parents of children with profound disabilities undergoing surgery. In a quasi-experimental design, we used the MPOC-20 to assess satisfaction with FCC and interviews to identify potential mechanisms for improving satisfaction. There was a positive effect on the MPOC-20 domain "general information," albeit with a small effect size (Cohen's d = 0.35). The interviewed parents expected additional support. Emphasis should be placed on providing comprehensive care coordination by an experienced APN. Shared care management is crucial in improving FCC.

A randomized controlled trial of a telehealth parenting intervention: A mixed-disability trial

BackgroundThe quality of parenting a child receives has a major impact on development, wellbeing and future life opportunities. AimsThis study examined the efficacy of Triple P Online – Disability (TPOL-D) a telehealth intervention for parents of children with a disability. MethodsNinety-eight parents and carers of children aged 2–12 years diagnosed with a range of developmental, intellectual and physical disabilities were randomly assigned to either the intervention (51) or treatment-as-usual (47) control group. ResultsAt post-intervention parents receiving the TPOL-D intervention demonstrated significant improvements in parenting practices and parenting self-efficacy, however a significant change in parent-reported child behavioral and emotional problems was not detected. At 3-month follow up intervention gains were maintained and/or enhanced. A significant decrease in parent-reported child behavioral and emotional problems was also detected at this time. ConclusionsThe results indicate that TPOL-D is a promising telehealth intervention for a mixed-disability group.

Peer Coaching Interventions for Parents of Children with Type 1 Diabetes.

Peer support is a promising model of providing psychosocial support to parents of children with type 1 diabetes. This review seeks to discuss the findings of the existing literature in peer coaching as it relates to parents and diabetes as well as to identify gaps in knowledge for future intervention development and implementation. Peer support programs vary widely with regard to recruitment, training, and delivery protocols. Across most programs, ongoing support and supervision are provided to peer coaches. Despite inconsistent effects on psychosocial and child health outcomes, parent coaching is consistently a highly acceptable and feasible intervention with parents of children with T1D. Current evidence supports use of parent coaching as part of a multicomponent intervention or program to increase patient satisfaction, but more research is needed to determine if it can stand alone as an active mechanism for behavior change. The use of peer coach interventions for parents of young children with diabetes is feasible to implement and highly acceptable. However, more research is needed to understand the enduring impact for target parents and peer coaches alike, as well as impact on child outcomes.

Pilot Evaluation of a Palliative and End-of-Life Communication Intervention for Parents of Children With a Brain Tumor.

Providing timely palliative and end-of-life care (PC/EOL) information to parents of children with a serious illness is a national health care priority. The goals of this study were to determine feasibility, acceptability, and parent responses related to a PC/EOL communication intervention, titled "Communication Plan: Early through End of Life (COMPLETE)" to parents of children with a brain tumor. The study was a 2-site prospective, single-group pilot study targeting parents' stress and coping outcomes. The sample included 13 parents of 11 children (ie, 11 families). During the first 6 months postdiagnosis, we evaluated parent outcomes at 4 time points (baseline and 3 post-sessions). Our findings included significant decline in decision regret ( P = .0089); strong, significantly increased hope ( P ≤ .0001); and significantly decreased uncertainty ( P = .04). Over time, more than half of the parents (61.5%) preferred to receive information about their child's current condition and PC/EOL options. Our findings provide evidence to suggest that the COMPLETE intervention is feasible and acceptable and produces promising effects on 3 parent outcomes (ie, decision regret, hope, and uncertainty) in parents of children with a brain tumor. Further research is indicated to evaluate COMPLETE with a larger sample of parents of children with cancer and with a control group.

Parent-child intervention decreases stress and increases maternal brain activity and connectivity during own baby-cry: An exploratory study.

Parental responses to their children are crucially influenced by stress. However, brain-based mechanistic understanding of the adverse effects of parenting stress and benefits of therapeutic interventions is lacking. We studied maternal brain responses to salient child signals as a function of Mom Power (MP), an attachment-based parenting intervention established to decrease maternal distress. Twenty-nine mothers underwent two functional magnetic resonance imaging brain scans during a baby-cry task designed to solicit maternal responses to child's or self's distress signals. Between scans, mothers were pseudorandomly assigned to either MP (n = 14) or control (n = 15) with groups balanced for depression. Compared to control, MP decreased parenting stress and increased child-focused responses in social brain areas highlighted by the precuneus and its functional connectivity with subgenual anterior cingulate cortex, which are key components of reflective self-awareness and decision-making neurocircuitry. Furthermore, over 13 weeks, reduction in parenting stress was related to increasing child- versus self-focused baby-cry responses in amygdala-temporal pole functional connectivity, which may mediate maternal ability to take her child's perspective. Although replication in larger samples is needed, the results of this first parental-brain intervention study demonstrate robust stress-related brain circuits for maternal care that can be modulated by psychotherapy.

Cognitive Behavior Therapy for Asian American Families of Children With Developmental Disabilities

Parents of children with developmental disabilities usually experience stress, grief, and isolation. Asian American parents may experience higher stress and other difficulties due to their cultural background, discrimination, and different acculturation status. Parental well-being also has an impact on the parent–child interaction and the child’s development. Psychological and educational intervention for parents of children with developmental disabilities has been studied from different approaches, such as family system and cognitive behavior therapy. The possibility of integrating cognitive behavior therapy and structural family therapy was also proposed.

Feasibility of standardized methods to specify behavioral pediatric obesity prevention interventions.

Standardized methods are needed to evaluate what occurs within the 'black box' of behavioral interventions to prevent pediatric obesity. The purpose of this research is to evaluate methods to specify the behavior change techniques used and the amount of time spent discussing target weight-related behaviors in an intervention for parents of children at risk for becoming overweight or obese. Independent coders were trained to identify behavior change techniques and time spent discussing weight-related behaviors in audio recordings and transcripts of intervention sessions from 100 randomly selected participants. The behavior change technique taxonomy (BCTTv1) was used to code techniques present in sessions. A newly-developed tool was used to code time spent discussing each target weight-related behavior (e.g., physical activity, screen time). Sessions from a subset of these participants (N=20) were double coded to evaluate inter-rater reliability. After revisions to coding protocols, coders reliably coded behavior change techniques used and time spent discussing target weight-related behaviors in sessions from the subset of 20 participants. The most commonly discussed target weight-related behavior was physical activity followed by energy intake and fruit and vegetable intake. On average, 13.9 (SD=2.8) unique behavior change techniques were present across sessions for a given participant. These results offer reliable methods for systematically identifying behavior change techniques used and time spent discussing weight-related behaviors in a pediatric obesity prevention intervention. This work paves the way for future research to identify which specific target behaviors and techniques are most associated with the prevention of unhealthy weight gain in children.

Effects of a brief problem-solving intervention for parents of children with cancer

ABSTRACTThis study examines a problem-solving intervention for parents of children with cancer. It was hypothesized that the intervention would improve problem-solving ability and decrease symptoms of caregiving stress and posttraumatic stress compared controls. 39 parents were assessed at baseline, one month, and three months post-intervention. No significant results were found. This study adds to research on problem-solving interventions for parents of children with cancer. Future studies should consider timing of interventions and target parents under the highest levels of distress.

Treatment of Pediatric Obesity: An Umbrella Systematic Review.

Multiple interventions are available to reduce excess body weight in children. We appraised the quality of evidence supporting each intervention and assessed the effectiveness on different obesity-related outcomes. We conducted a systematic search for systematic reviews of randomized controlled trials evaluating pediatric obesity interventions applied for ≥6 months. We assessed the quality of evidence for each intervention using GRADE (Grading of Recommendation, Assessment, Development, and Evaluation) approach. From 16 systematic reviews, we identified 133 eligible randomized controlled trials. Physical activity interventions reduced systolic blood pressure and fasting glucose (low to moderate quality of evidence). Dietary interventions with low-carbohydrate diets had a similar effect to low-fat diets in terms of body mass index (BMI) reduction (moderate quality of evidence). Educational interventions reduced waist circumference, BMI, and diastolic blood pressure (low quality of evidence). Pharmacological interventions reduced BMI (metformin, sibutramine, orlistat) and waist circumference (sibutramine, orlistat) and increased high-density lipoprotein cholesterol (sibutramine) but also raised systolic and diastolic blood pressure (sibutramine). Surgical interventions (laparoscopic adjustable gastric banding, Roux-en-Y gastric bypass, sleeve gastrectomy) resulted in the largest BMI reduction (moderate quality of evidence). Combined interventions consisting of dietary modification, physical activity, behavioral therapy, and education significantly reduced systolic and diastolic blood pressure, BMI, and triglycerides. Combined parent-child interventions and parent-only interventions had similar effects on BMI (low quality of evidence). Several childhood obesity interventions are effective in improving metabolic and anthropometric measures. A comprehensive multicomponent intervention, however, appears to have the best overall outcomes.

Using Intervention Mapping to develop the Parents as Agents of Change (PAC\xa9) intervention for managing pediatric obesity

BackgroundPediatric obesity has become increasingly prevalent over recent decades. In view of the psychosocial and physical health risks, and the high likelihood that children with obesity will grow to become adults with obesity, there is a clear need to develop evidence-based interventions that can be delivered in the health care system to optimize the health and well-being of children with obesity and their families. The aim of this paper is to describe the development, implementation, and planned evaluation of a parent-based weight management intervention designed for parents of 8–12 year olds with obesity.Methods/resultsThe principles of Intervention Mapping (IM) were used to develop an intervention called Parents as Agents of Change (PAC©). From 2006 to 2009, an environmental scan plus qualitative (individual interviews with parents and children), quantitative (medical record reviews), and literature review data were collected to gain broad insight into family factors related to pediatric obesity and its management. Theoretical frameworks and empirical evidence guided curriculum development, which was founded primarily on the tenets of family systems theory and cognitive behavioral theory. PAC was developed as a manualized, 16-session, group-based, health care professional-led intervention for parents to address individual, family, and environmental factors related to the management of pediatric obesity. The intervention was refined based on feedback from local and international experts, and has been implemented successfully in a multi-disciplinary weight management centre in a children’s hospital.ConclusionIM provided a practical framework to guide the systematic development of a pediatric weight management intervention for parents of children with obesity. This logical, step-by-step process blends theory and practice and is broadly applicable in the context of obesity management intervention development and evaluation. Following intervention development, the PAC intervention was evaluated within a randomized clinical trial.Trial registration NCT01267097; clinicaltrials.gov

Putting Words to the Experience: An Italian Group Intervention for Children of Separated Parents

ABSTRACTThis article presents an Italian group intervention for children of separated parents and describes preliminary findings about its efficacy. After briefly discussing the state of art for interventions of children of separated parents, the core characteristics of the group intervention are explained and each meeting is described. Then, pre–post research is presented to provide empirical support for this approach. Results reported that participation in the group strengthens the social and interpersonal self-concept dimension in the majority of children. Results are discussed considering both empirical and clinical implications.

Intervention Fidelity: Monitoring Drift, Providing Feedback, and Assessing the Control Condition.

Measurement of intervention fidelity is an essential component of any scientifically sound intervention trial. However, few papers have proposed ways to integrate intervention fidelity data into the execution of these trials. The purpose of this article is to describe the intervention fidelity process used in a randomized controlled trial of a human patient simulator intervention and how these data were used to monitor drift and provide feedback to improve the consistency of both intervention and control delivery over time in a multisite education intervention for parents of children with newly diagnosed Type 1 diabetes. Intervention fidelity was measured for both the intervention and control condition by direct observation, self-report of interventionist delivery, and parent participant receipt of educational information. Intervention fidelity data were analyzed after 50%, 75%, and 100% of the participants had been recruited and compared by group (treatment and control) and research site. The sample included 191 parents of young children newly diagnosed with Type 1 diabetes. Observations scores in both intervention and control groups indicated a high level of intervention fidelity. Treatment receipt was also high and did not differ by treatment group. The teaching session attendance rates by site and session were significantly different at Time Point 1 (50% enrollment); following study staff retraining and reinforcement, there were no significant differences at Time Point 3 (100% enrollment). Results demonstrate the importance of monitoring intervention fidelity in both the intervention and control condition over time and using these data to correct drift during the course of a multisite clinical trial.

An Investigation of Factors that Influence Acceptability of Parent Training

Parent training is an effective intervention for parents of children with a variety of childhood disorders, including conduct problems, and parents often view behavioral parent training as acceptable. Explanations and rationales for parent training are commonly provided at the beginning of treatment. The purpose of this study was to determine whether changing the description of a behavioral parenting intervention influenced parents’ acceptability ratings and whether mothers and fathers differed in their ratings. There were 78 participants (39 mother–father dyads) in this study. Participants viewed one of two descriptions of parent training that focused on either addressing deficits in parenting skills or enhancing existing parenting skills. Parents’ acceptability of the treatment descriptions was evaluated using the Treatment Evaluation Inventory—Short Form. Participants also completed the Eyberg Child Behavior Inventory and The Parental Locus of Control Scale. A multiple linear regression and a mixed factorial ANOVA were used to analyze the data. There was not a significant interaction between parent gender and parent training description type. There was also not a significant difference in the acceptability of the two parent training descriptions. However, mothers rated both treatment descriptions as more acceptable than did fathers. Results indicated that parental locus of control significantly predicted acceptability of the parent training descriptions. The results of the current study suggested that treatment acceptability was not influenced by the way that the interventions were described. Future research should focus on how to increase acceptability of parent training for fathers and parents with an external locus of control.

Breaking cycles of risk: The mitigating role of maternal working memory in associations among socioeconomic status, early caregiving, and children's working memory.

Previous research has documented socioeconomic-related disparities in children's working memory; however, the putative proximal caregiving mechanisms that underlie these effects are less known. The present study sought to examine whether the effects of early family socioeconomic status on children's working memory were mediated through experiences of caregiving, specifically maternal harsh discipline and responsiveness. Utilizing a psychobiological framework of parenting, the present study also tested whether maternal working memory moderated the initial paths between the family socioeconomic context and maternal harsh discipline and responsiveness in the mediation model. The sample included 185 socioeconomically diverse mother-child dyads assessed when children were 3.5 and 5 years old. Results demonstrated that maternal harsh discipline was a unique mediator of the relation between early experiences of family socioeconomic adversity and lower working memory outcomes in children. Individual differences in maternal working memory emerged as a potent individual difference factor that specifically moderated the mediating influence of harsh discipline within low socioeconomic contexts. The findings have implications for early risk processes underlying deficits in child working memory outcomes and potential targets for parent-child interventions.