Parental Involvement In Treatment Research Articles

Transformative parents: Facilitating transformative experiences and interest with a parent involvement intervention

This study reports the implementation of a parental involvement intervention coupled with small group discussions aimed at facilitating transformative experiences (TEs) in science courses (biology and chemistry) in an all-girls middle and high school. Specifically, the goal was to generate parental involvement, TE, and interest. Analyses showed that the intervention was associated with more parent involvement and TE than a comparison condition. Furthermore, a high initial level of situational and individual interest was maintained in the treatment condition, whereas interest decreased in the comparison. A content analysis of journal entries suggested an association between parents showing value for science concepts and an increase in students’ perceived experiential value. The results provide evidence that a parent intervention may increase the likelihood of engagement in TE and maintaining girls’ interest in science, which has theoretical and practical implications.

On Protocols and Principles in the Case of Hiro

Dr. Jeremy Lichtman (2017, in this issue) presents a case of successful behavioral treatment of tics in "Hiro," a 10-year-old boy with Tourette Syndrome (TS) and attention-deficit/hyperactivity disorder (ADHD). This commentary discusses the case of Hiro from a principle-oriented approach, with particular focus on issues related to parental involvement in treatment, addressing comorbidity and therapy-interfering behavior, and planning for generalization and long-term maintenance.

Calm child programme: Parental programme for anxiety in children and young people with autism spectrum disorder and intellectual disabilities.

Children with autism spectrum disorder (ASD) and intellectual disabilities (IDs) are more vulnerable to experiencing anxiety disorders. Parental involvement in intervention is crucial for successful management of the interventions in the population of people with ASDs. This article describes the design and evaluation of parenting programme for anxiety disorders in children and young people with ASD and ID. In phase 1 semi-structured interviews were conducted to explore management strategies for anxiety at home and in school settings. A total of 34 participants (14 parents, 20 teachers) participated in the interviews. A Delphi process was conducted with health professionals to develop consensus on appropriate anxiety interventions. In phase 2 the intervention programme was implemented by seven parents who also participated in focus group to evaluate the developed programme. A parental programme, calm child programme (CCP), was developed, implemented and evaluated. The evaluations show significant decrease in children's anxiety as a result of implementing the programme. This study contributes further evidence to parental involvement in interventions for children and young people with ASD and IDs. The CCP is a useful and cost-effective approach in enabling parents to provide anxiety interventions in a home setting.

Parental involvement and association with adolescents' fruit and vegetable intake at follow-up: Process evaluation results from the multi-component school-based Boost intervention.

BackgroundBased on the assumption of parental influence on adolescent behavior, multicomponent school-based dietary interventions often include a parental component. The effect of this intervention component is seldom reported and the evidence is inconsistent. We conducted a systematic process evaluation of the parental component and examined whether the leveal of parental involvement in a large multi-component intervention: the Boost study was associated with adolescents’ fruit and vegetable (FV) intake at follow-up.MethodsThe Boost study was targeting FV intake among 1,175 Danish 7th graders (≈13- year-olds) in the school year 2010/11. The study included a school component: free FV in class and curricular activities; a local community component: fact sheets for sports- and youth clubs; and a parental component: presentation of Boost at a parent-school meeting, 6 newsletters to parents, 3 guided student-parent curricular activities, and a student-parent Boost event. Study population: Students whose parent replied to the follow-up survey (n = 347). Data: Questionnaire data from students, parents and teachers at 20 intervention schools. Process evaluation measures: dose delivered, dose received, appreciation and level of parental involvement. Parental involvement was trichotomized into: low/no (0–2 points), medium (3 points) and high (4–6 points). The association between level of parental involvement and self-reported FV intake (24-h recall), was analyzed using multilevel regression analyses.ResultsThe Boost study was presented at a parent-school meeting at all intervention schools. The dose delivered was low to moderate for the three other parental elements. Most parents appreciated the intervention and talked with their child about Boost (83.5 %). High, medium and low parental involvement was found among 30.5 %, 29.6 % and 39.4 % of the students respectively. Parental involvement was highest among women. More men agreed that the parental newsletters provided new information.Students with a medium and high level of parental involvement ate 47.5 and 95.2 g more FV per day compared to students with low level/no parental involvement (p = 0.02).ConclusionsStudents with a high level of parental involvement ate significantly more FV at follow-up compared to students with a low level/no parental involvement. Parental involvement in interventions may improve adolescents’ FV intake if challenges of implementation can be overcome.Trial registration ISRCTN11666034. Registered 06/01/2012. Retrospectively registered.

Moderators of treatment response to trauma-focused cognitive behavioral therapy among youth in Zambia.

The effectiveness of mental health interventions such as trauma-focused cognitive behavioral therapy (TF-CBT) may vary by client, caregiver, and intervention-level variables, but few randomized trials in low- and middle-income countries (LMIC) have conducted moderation analyses to investigate these characteristics. This study explores moderating factors to TF-CBT treatment response among a sample of orphans and vulnerable children (OVC) in Zambia. Data were obtained from a completed randomized trial of TF-CBT among 257 OVC in Zambia. Trauma symptoms and functioning were measured at baseline and following the end of treatment. Mixed effects regression models were estimated for each moderator of interest: gender, age, number of trauma types experienced, history of sexual abuse, orphan status, primary caretaker, school status, and parental involvement in treatment. Treatment effectiveness was moderated by history of sexual abuse with greater reductions in both outcomes (trauma, p<.05; functioning, p<.01) for those that experienced sexual abuse. Primary caretaker was also a moderator with greater trauma reductions in those who identified their mother as the primary caretaker (p<.01), and better functioning in those that identified their father as the primary caretaker (p<.05). Nonorphans and single orphans (mother alive) showed greater reduction in functional impairment (p<.01) compared with double orphans. There was no significant moderator effect found by gender, age, number of trauma types, school status, or caregiver participation in treatment. This study suggests that TF-CBT was effective in reducing trauma symptoms and functional impairment among trauma-affected youth overall and that it may be particularly effective for survivors of child sexual abuse and children whose primary caretaker is a biological parent. Scale-up of TF-CBTiswarranted given the wide range of effectiveness and prevalence of child sexual abuse. Future randomized trials of interventions in LMIC should power for moderation analyses in the study design phase when feasible.

Parent-Focused Childhood and Adolescent Overweight and Obesity eHealth Interventions: A Systematic Review and Meta-Analysis.

BackgroundEffective broad-reach interventions to reduce childhood obesity are needed, but there is currently little consensus on the most effective approach. Parental involvement in interventions appears to be important. The use of eHealth modalities in interventions also seems to be promising. To our knowledge, there have been no previous reviews that have specifically investigated the effectiveness of parent-focused eHealth obesity interventions, a gap that this systematic review and meta-analysis intends to address.ObjectiveThe objective of this study was to review the evidence for body mass index (BMI)/BMI z-score improvements in eHealth overweight and obesity randomized controlled trials for children and adolescents, where parents or carers were an agent of change.MethodsA systematic review and meta-analysis was conducted, which conforms to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Seven databases were searched for the period January 1995 to April 2015. Primary outcome measures were BMI and/or BMI z-score at baseline and post-intervention. Secondary outcomes included diet, physical activity, and screen time. Interventions were included if they targeted parents of children and adolescents aged 0-18 years of age and used an eHealth medium such as the Internet, interactive voice response (IVR), email, social media, telemedicine, or e-learning.ResultsEight studies were included, involving 1487 parent and child or adolescent dyads. A total of 3 studies were obesity prevention trials, and 5 were obesity treatment trials. None of the studies found a statistically significant difference in BMI or BMI z-score between the intervention and control groups at post-intervention, and a meta-analysis demonstrated no significant difference in the effects of parent-focused eHealth obesity interventions compared with a control on BMI/BMI z-score (Standardized Mean Difference −0.15, 95% CI −0.45 to 0.16, Z=0.94, P=.35). Four of seven studies that reported on dietary outcomes demonstrated significant improvements in at least 1 dietary measurement, and 1 of 6 studies that reported on physical activity outcomes demonstrated significant improvements compared with the control. The quality of the interventions was generally not high; therefore, these results should be interpreted with caution.ConclusionIt is recommended that larger, longer duration, high-quality parent-focused eHealth studies are conducted, which transform successful components from face-to-face interventions into an eHealth format and target younger age groups in particular.Trial RegistrationPROSPERO International Prospective Register of Systematic Reviews: CRD42015019837; http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42015019837 (Archived by WebCite at http://www.webcitation.org/6ivBHvBhq)

Parental involvement in exercise and diet interventions for childhood cancer survivors: a systematic review.

Childhood cancer survivors (CCS) are at risk of becoming overweight or obese due to treatment effects and/or post-treatment behaviors. Parents are key agents influencing child diet and physical activity (PA), which are modifiable risk factors for obesity. A systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was undertaken to evaluate current interventions that include diet and PA elements for CCS to determine if and to what extent parents were included, and whether parent involvement had a significant effect on behavioral outcomes or adiposity. A total of 2,386 potential articles were reviewed and 25 individual studies fulfilled inclusion criteria. Parental involvement was classified into three categories and varied across studies, although most had indirect or no parental involvement. The studies that included direct parental involvement showed positive outcomes on a variety of measures suggesting that increasing parental involvement in interventions for CCS may be one way to promote long-term lifestyle changes for pediatric cancer patients. However, additional research directly addressing parental involvement in obesity prevention and treatment among CCS is warranted.

Parent Involvement Intervention in Developing Weight Management Skills for both Parents and Overweight/Obese Children

The purpose of the study was to evaluate a parent involvement intervention for childhood obesity intended to increase parents' skills in managing children's weight-related behavior and to improve child-parent relationships. Many studies reported on parental influence on childhood obesity, emphasizing parent involvement in prevention and management of childhood obesity. A randomized controlled trial was conducted. Forty-two parents of overweight/obese children were recruited from four cities and randomized to the experimental group or control group. The parental intervention was provided only to parents in the experimental group and consisted of weekly newsletters and text messages for a period of 5 weeks. Exercise classes and nutrition education were provided to all children. Lifestyle Behaviour Checklist and the Child-Parent Relationship Scale (CPRS) were used for measurement of parent outcome. For the child outcome, dietary self-efficacy, exercise frequency, and body mass index were measured. A mixed-design analysis of variance was performed with city location entered as a random effect. After the intervention, CPRS of parents and dietary self-efficacy of children showed an increase in the experimental group (p < .05). Intervention effects differed significantly according to the city location regarding the control efficacy of parents and dietary self-efficacy of children (p < .05). The results support the effectiveness of the parent involvement intervention in promoting child-parent relationship and dietary self-efficacy of children. However, a 5-week parent involvement intervention was not sufficient to produce significant changes in children's body mass index. Further research is needed to investigate effects of parent involvement intervention with long-term evaluation.

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The benefits of antipsychotic medications for ASD‐related symptoms The importance of parental involvement in interventions for disruptive behaviors The progress in computer and online therapy for depression and anxiety

Phenomenology and clinical correlates of family accommodation in pediatric anxiety disorders

Despite evidence documenting high prevalence of family accommodation in pediatric obsessive–compulsive disorder, examination in other pediatric anxiety disorders is limited. Preliminary evidence suggests that family accommodation is common amongst children with anxiety disorders; however, the impact on clinical presentation and functional impairment has not been addressed. This study assessed the nature and clinical correlates of family accommodation in pediatric anxiety, as well as validating a mechanistic model. Participants included 112 anxious youth and their parents who were administered a diagnostic clinical interview and measure of anxiety severity, as well as questionnaires assessing internalizing and externalizing symptoms, family accommodation and functional impairment. Some form of accommodation was present in all families. Family accommodation was associated with increased anxiety severity and externalizing behaviors, having a diagnosis of separation anxiety, and increased functional impairment. Family accommodation partially mediated the relationship between anxiety severity and functional impairment, as well as externalizing behaviors and functional impairment. Family accommodation is common in pediatric anxiety disorders, and is associated with more severe clinical presentations and functional impairment. These findings highlight the importance of parental involvement in treatment and the need to specifically target accommodation practices during interventions to mitigate negative outcomes in anxious youth. Further studies utilizing longitudinal data are needed to validate mechanistic models.

Parental Involvement in Juvenile Sex Offender Treatment: Requiring a Role as Informed Supervisor

Sex offenses, particularly those against children, have always been viewed negatively in society. A large portion of these offenses are committed by children against children. Most state legislatures focus on punitive measures when dealing with juvenile sex offenses, yet few place treatment on equal ground. Treatment has been shown to be effective in reducing the rate of recidivism of juvenile sex offenders. Juvenile sex offenders that participate in treatment have shown lower recidivism rates than adult offenders or untreated juvenile sex offenders. This Note advocates that states adopt legislation based on a successful statute in Colorado that creates a sex offender management board consisting of a multidisciplinary treatment team for juvenile sex offenders' treatment while requiring parental involvement in treatment as “informed supervisors” when the team deems it appropriate. Key Points for the Family Court Community: Sex offender treatment on juveniles has been successful in reducing recidivism, as juveniles are more receptive to treatment than adults. Supervision and treatment of juvenile sex offenders would be more effective if parents or guardians are involved in the juvenile's sex offender treatment. States should adopt legislation based on the Colorado model that creates a sex offender management board and multidisciplinary team to supervise the treatment of juvenile sex offenders and requires appropriate parental involvement in the treatment as “informed supervisors”.

Psychoeducation as a Mediator of Treatment Approach on Parent Engagement in Child Psychotherapy for Disruptive Behavior

Parent engagement in treatment for child disruptive behavior has been associated with improved child outcomes in care. However, many families who enter care do not receive an adequate dose of treatment, and parents are often not involved. We examined therapists’ use of psychoeducation, a therapeutic practice used to present factual information about target problems and treatments, and its association with parent engagement in child psychotherapy. Participants were drawn from the Child System and Treatment Enhancement Projects’ multisite trial contrasting standard evidence-based treatments, modular treatment, or usual care. We included an ethnically diverse sample of 46 youth (ages 7–13) who received treatment for disruptive behavior in modular treatment or usual care. A reliable observational coding system was developed to assess therapists’ in-session use of psychoeducation strategies (e.g., discussing causes of misbehavior, describing and providing rationale for treatment, etc.), as well as other engagement strategies (e.g., collaborative goal setting, managing expectations, etc.), in the early phase of treatment. Findings revealed that modular treatment therapists provided more psychoeducation and other engagement strategies compared with usual care therapists. Furthermore, psychoeducation strategies employed by therapists early on uniquely predicted subsequent parent involvement in treatment, over and above the use of other engagement strategies. Finally, therapists’ use of the psychoeducation strategy of discussing causes of child's misbehavior mediated the effect of treatment condition on parent involvement in their child's therapy. These findings suggest that the implementation of psychoeducation strategies upon entry into care promotes parent involvement in child psychotherapy for disruptive behavior.

A transagency approach to enabling access to parent-based intervention for language delay in areas of social disadvantage: A service evaluation

Primary language delay remains one of the most prevalent developmental delays in early childhood, particularly in disadvantaged areas. Previous research has established language difficulties and social disadvantage being particular risk factors for adverse outcomes later in life. To help prevent low educational achievement and poorer outcomes, early treatment for any speech and language problems is vital. Early intervention and parental involvement in treatment has proven beneficial for pre-school children experiencing language development difficulties. In areas where there is social disadvantage, however, parents often do not engage with treatment. A local service project has evaluated a new, joint-working intervention, Enhanced Parent-Based Intervention (EPBI), which took place in Children’s Centres within areas of social disadvantage. This exploratory study compared the EPBI service with the existing standard parent-based intervention (PBI) and examined the effects on attendance, engagement with treatment and language outcomes for children. When the EPBI service was offered in the disadvantaged areas, take-up and attendance rates increased from 35% to 100% and from 50% to 80% respectively. Children made gains with their language development, and this progress was comparable with language gains made by children from standard PBI groups in areas without social disadvantage. The results of the service evaluation indicated that when parents engage with the intervention, EPBI resulted in positive outcomes for socially disadvantaged children, which could benefit society in the long-term with potential cost savings. Limitations and future developments are discussed.

Long-Term Treatment Outcomes for Parent-Assisted Social Skills Training for Adolescents With Autism Spectrum Disorders: The UCLA PEERS Program

Social deficits are a hallmark characteristic among adolescents with autism spectrum disorders (ASD), yet few evidence-based interventions exist aimed at improving social skills for this population, and none have examined the maintenance of treatment gains years after the intervention has ended. This study examines the durability of the Program for the Education and Enrichment of Relational Skills (PEERS), a manualized, parent-assisted social skills intervention for high-functioning adolescents with ASD. Targeted skills related to the development and maintenance of friendships were assessed 1–5 years following treatment for 53 adolescent participants and their parents. Results indicate that adolescents receiving PEERS maintained treatment gains at long-term follow-up on standardized measures of social functioning including the Social Skills Rating System and the Social Responsiveness Scale as well as in frequency of peer interactions and social skills knowledge. Perhaps due to parent involvement in treatment, results reveal additional improvements in social functioning at follow-up assessment.

Evaluating Parents and Adult Caregivers as “Agents of Change” for Treating Obese Children: Evidence for Parent Behavior Change Strategies and Research Gaps

This scientific statement addresses parents and adult caregivers (PACs) as "agents of change" for obese children, evaluating the strength of evidence that particular parenting strategies can leverage behavior change and reduce positive energy balance in obese youth. The statement has 3 specific aims. The first is to review core behavior change strategies for PACs as used in family-based treatment programs and to provide a resource list. The second is to evaluate the strength of evidence that greater parental "involvement" in treatment is associated with better reductions in child overweight. The third is to identify research gaps and new opportunities for the field. This review yielded limited and inconsistent evidence from randomized controlled clinical trials that greater PAC involvement necessarily is associated with better child outcomes. For example, only 17% of the intervention studies reported differential improvements in child overweight as a function of parental involvement in treatment. On the other hand, greater parental adherence with core behavior change strategies predicted better child weight outcomes after 2 and 5 years in some studies. Thus, the literature lacks conclusive evidence that one particular parenting strategy or approach causally is superior to others in which children have a greater focus in treatment. A number of research gaps were identified, including the assessment of refined parenting phenotypes, cultural tailoring of interventions, examination of family relationships, and incorporation of new technologies. A conceptual model is proposed to stimulate research identifying the determinants of PAC feeding and physical activity parenting practices, the results of which may inform new treatments. The statement addresses the need for innovative research to advance the scope and potency of PAC treatments for childhood obesity.

Nourishing Our Understanding of Role Modeling to Improve Support and Health (NOURISH): Design and methods

Pediatric overweight is associated with numerous physical and psychological health risks, and overweight children are at significant risk for obesity in adulthood. African-American children are at particularly high risk for obesity and related health complications. However, this racial group has traditionally had limited access to obesity treatment and relatively few studies have included sufficient numbers of lower-SES, African American participants. Further, although parental involvement in treatment for pediatric overweight has been found to be beneficial, few studies have examined the efficacy of offering treatment exclusively to parents, a potentially cost-effective approach which could benefit the entire family. This pilot project will evaluate the efficacy of an intensive parenting intervention, (NOURISH; NourishingOurUnderstanding ofRole modeling toImproveSupport andHealth), targeting racially diverse parents of overweight children (ages 6–11). NOURISH addresses several urgent research priorities by targeting the underserved and addressing the significant disparity in obesity treatment services. Parents meeting study criteria (having a child between the ages of 6 and 11 with a BMI≥the 85th percentile) will be offered participation in the randomized trial comparing NOURISH with a control group. We hypothesize that children whose parents participate in NOURISH will manifest greater decreases in BMI, and greater improvements in dietary intake, and quality of life compared to children whose parents do not participate. This study is designed explicitly to gather preliminary feasibility, acceptability, and effectiveness data to inform a subsequent larger randomized controlled trial.

Family-based interventions for pediatric obesity: Methodological and conceptual challenges from family psychology.

Family-based interventions for pediatric obesity are defined by active parent involvement in treatment. In the current review the authors examine 31 family-based interventions with published outcome data and distinguish 4 categories of family-based interventions: (a) Target a narrow range of parent behaviors related to eating/exercise and assess change only in terms of child eating, exercise, or weight; (b) target a similarly narrow range of parent behaviors but nevertheless assess program-related changes in general parenting skills or family functioning; (c) target a broad range of parent behaviors related to general parenting and family functioning but do not assess program-related changes in these areas; and (d) target general parenting or family functioning and also assess program-related changes in these areas. The authors highlight methodological and conceptual challenges facing researchers in this area and argue for an even broader family focus in family-based interventions for pediatric obesity.

Parental Influence on Child Change in Physical Activity During a Family-Based Intervention for Child Weight Gain Prevention

This study examined the association between parent and child change in physical activity during a family-based intervention for child weight gain prevention. Daily step counts were recorded for parents and children in 83 families given a goal to increase activity by 2000 steps per day above baseline. Linear mixed effects models were used to predict child change in daily step counts from parental change in step counts. Both maternal (P < .0001) and paternal (P < .0001) change in step counts for the current day strongly predicted child change in step counts for that day. On average, a child took an additional 2117.6 steps above baseline on days his or her mother met her goal versus 1175.2 additional steps when the mother did not meet her goal. The respective values were 1598.0 versus 1123.1 steps for fathers. Day of week moderated the maternal effect (P = .0019), with a larger impact on Saturday and Sunday compared with weekdays. A similar but nonsignificant pattern was observed for fathers. Encouraging parents to increase physical activity, particularly on weekends, may be a highly effective way to leverage parental involvement in interventions to increase children's physical activity.

Family-related predictors of body weight and weight-related behaviours among children and adolescents: a systematic umbrella review.

This umbrella review analysed the relationships between family variables and child/adolescent body weight, diet and physical activity. In line with theories of health behaviour change, it was assumed that behaviour-specific family variables (i.e. beliefs, perceptions and practices referring to food intake or physical activity) would have stronger support than more general family variables (i.e. socio-economic status or general parental practices). Data obtained from 18 systematic reviews (examining 375 quantitative studies) were analysed. Reviews of experimental trials generally supported the effectiveness of reward/positive reinforcement parental strategies, parental involvement in treatment or prevention programmes, and cognitive-behavioural treatment in reducing child/adolescent body mass and/or obesity. Results across reviews of correlational studies indicated that healthy nutrition of children/adolescents was related to only one parental practice (parental monitoring), but was associated with several behaviour-specific family variables (e.g. a lack of restrictive control over food choices, high intake of healthy foods and low intake of unhealthy foods by parents and siblings, low pressure to consume foods). With regard to adolescent physical activity, stronger support was also found for behaviour-specific variables (e.g. physical activity of siblings), and for certain socio-economic variables (e.g. parental education). Child and adolescent obesity prevention programmes should account for behaviour-specific family variables.

Parents' Involvement in ASD Treatment: What Is Their Role?

The rising prevalence of autism spectrum disorders (ASD) warrants a greater level of clinical attention to best treat those with ASD. The characteristics of ASD lead to impairment for both the child with the disorder and his/her family. To effectively treat children with ASD, parents need to be included in intervention efforts. Research suggests that parental involvement in treatment improves the generalizability of skills and increases the amount of intervention the child receives. Numerous benefits have been found in child and parent outcomes when parents are included in treatment. The purpose of this paper is to discuss the impact ASD can have on the parent-child relationship, the factors that influence treatment outcome, and the advantages of including parents in treatment. The different roles parents can have in treatment will also be discussed along with providing clinicians guidance on practical ways to involve parents in the treatment of children with ASD.