Parenting Intervention Research Articles

A Digital Health Model for School-Based Implementation to Improve Parent and Child Outcomes: Comparison of Active Versus Light-Touch Coaching Effects.

Online or app-based parenting interventions have become more widely available in recent years. However, challenges related to poor engagement and high attrition have been noted in the literature, and there are important questions regarding ways to enhance parental engagement and improve treatment outcomes through digital health, including through the addition of therapeutic coaches. The current study evaluated differences in the effects of active versus "light-touch" coaching implementations of an enhanced version of Family Check-Up Online (FCU-O) on parent/family and child-level outcomes from pre-treatment to 2-month follow-up assessments. The enhanced version of the FCU-O was adapted to support families in coping with pandemic-related stressors to prevent youth behavioral and emotional problems during middle school and included app-based modules designed to support effective parenting practices as well as virtual coaching. In the "active-coach" condition, parenting coaches were active in efforts to arrange coaching sessions with parents as they worked through the app-based modules, while in the light-touch intervention, parent-coaches enrolled participants in the context of a one-time support session but did not actively pursue families to schedule additional sessions. Parents in the active-coach condition exhibited greater engagement with both the app and coaching sessions than parents in the light-touch condition. Further, stronger improvements in several aspects of parenting and child functioning were observed in the active-coach versus light-touch conditions. However, parents in the light-touch condition showed reductions in stress and comparable levels of dosage when using the app. Implications for prevention and accessibility of digital health interventions are discussed.

The Feasibility and Acceptability of Using a Digital Conversational Agent (Chatbot) for Delivering Parenting Interventions: Systematic Review.

Parenting interventions are crucial for promoting family well-being, reducing violence against children, and improving child development outcomes; however, scaling these programs remains a challenge. Prior reviews have characterized the feasibility, acceptability, and effectiveness of other more robust forms of digital parenting interventions (eg, via the web, mobile apps, and videoconferencing). Recently, chatbot technology has emerged as a possible mode for adapting and delivering parenting programs to larger populations (eg, Parenting for Lifelong Health, Incredible Years, and Triple P Parenting). This study aims to review the evidence of using chatbots to deliver parenting interventions and assess the feasibility of implementation, acceptability of these interventions, and preliminary outcomes. This review conducted a comprehensive search of databases, including Web of Science, MEDLINE, Scopus, ProQuest, and Cochrane Central Register of Controlled Trials. Cochrane Handbook for Systematic Review of Interventions and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used to conduct the search. Eligible studies targeted parents of children aged 0 to 18 years; used chatbots via digital platforms, such as the internet, mobile apps, or SMS text messaging; and targeted improving family well-being through parenting. Implementation measures, acceptability, and any reported preliminary measures of effectiveness were included. Of the 1766 initial results, 10 studies met the inclusion criteria. The included studies, primarily conducted in high-income countries (8/10, 80%), demonstrated a high mean retention rate (72.8%) and reported high acceptability (10/10, 100%). However, significant heterogeneity in interventions, measurement methods, and study quality necessitate cautious interpretation. Reporting bias, lack of clarity in the operationalization of engagement measures, and platform limitations were identified as limiting factors in interpreting findings. This is the first study to review the implementation feasibility and acceptability of chatbots for delivering parenting programs. While preliminary evidence suggests that chatbots can be used to deliver parenting programs, further research, standardization of reporting, and scaling up of effectiveness testing are critical to harness the full benefits of chatbots for promoting family well-being.

A review of online and gamified psychoeducational interventions for children with neurodevelopmental disorders and their parents

Background. Children with neurodevelopmental disorders (NDD) are impacted in their emotional, cognitive, social, and/or motor development. They, along with their relatives, confront multifaceted challenges. Psychoeducation as an evidence-based intervention providing support and education, would play a crucial role to facilitate their daily live and disorders’ progress. In the emerging digital world, online and gamified psychoeducation has gained increasing traction since they offer a better engagement and accessibility. However, there is a discrepancy between the number of digital psychoeducation programs and those with clinical evidence-basis. The present work aims at reviewing evidence-based interventions for neurodevelopmental disorders, targeting both children and/or parents. Methods. A systematic search of PubMed, Web of Science, and Cochrane was conducted with keywords related to “neurodevelopmental disorders”, “psychoeducation”, “online and digital interventions”, and no publication date restrictions. Inclusion criteria involved studies on psychoeducation for parents or children using online platforms or gamified designs. Results. Out of the initial 70 articles, only 8 met inclusion criteria. Limited number of the publications showed that psychoeducation is a recent area of research for neurodevelopmental disorders. Reported results converged to support that technology and gamification in psychoeducational interventions stimulate children’s interest and improve outcomes for children with neurodevelopmental disorders and their parents. Discussion. While digital psychoeducational interventions are promising for children and parents, the existing literature highlights the need of a scientific validation of such technology-enhanced interventions before being translated in real life practice. Furthermore, such research topic should account for behavioral and cognitive skills along with quality of life, to consider the NDD comorbidities.

The effect of live-performed music therapy with physical contact in preterm infants on parental perceived stress and salivary cortisol levels.

Parents of preterm infants face a stressful life event which might have long term impact on the parent-child relation as well as on the infant's cognitive and socio-emotional development. Both music therapy (MT) and physical contact (PC) are stress-reducing interventions for parents and preterm infants on the neonatal intensive care unit (NICU). Meanwhile, especially close PC is considered as standard care (SC) in most NICUs. However, the effect of live performed MT with PC on parental perceived stress and cortisol levels has barely been investigated. We hypothesized that MT with PC leads to reduced stress levels and lower salivary cortisol concentrations compared to SC in parents of preterm infants during the first 4 weeks after birth. Randomized-controlled trial enrolling the parents of 99 preterm infants (MT n = 50, SC n = 49 infants). The infants received either MT with PC or SC only. Perceived stress was measured with the perceived stress questionnaire 20 (PSQ-20) after birth and 4 weeks later. Salivary cortisol levels were obtained and measured weekly after birth for 4 weeks. Forty-two mothers and eight fathers of the intervention group (MT with PC) as well as n = 43 mothers and n = 6 fathers of the control group (SC) were enrolled. For the intervention group, salivary cortisol was reduced 4 weeks after birth [mothers 5.5 nmol/l (confidence interval (CI) 3.6-7.5); fathers 8.3 (CI 7.2-9.4)] compared to the control group [mothers 10.3 nmol/l (CI 5.4-15.3); fathers 14.8 (CI 8.9-20.7)]. Overall perceived stress scores decreased in the intervention group (mothers -17.6; fathers -12.6) and increased in the control group (mothers +6.1; fathers +21.4) over 4 weeks. Live-performed MT with PC in preterm infants might be an effective, non-invasive intervention to reduce parental stress and cortisol levels. Future studies should investigate the long-term effects of this intervention on the parent-infant relation as well as on the infants' cognitive and socio-emotional development. https://drks.de/search/en/trial/DRKS00025755 identifier [DRKS00025755].

Mindfulness-Based Interventions for Parents: A Systematic Review of Target Groups, Effects, and Intervention Features

Abstract Objectives Mindfulness-based interventions (MBIs) have shown effectiveness in promoting parents’ and children’s well-being. The development of MBIs for parents has been growing worldwide, but varied curricula and overlapping contexts make it hard to grasp their core features. The aim of this study was to synthesize and summarize the target groups, effects, dissemination, format, and content features of MBIs for parents. Method A literature search for peer-reviewed articles published before December 2023 was conducted in PubMed, Scopus, and Web of Science following PRISMA guidelines. A quality appraisal was conducted for each included study. Only randomized controlled trials (RCTs) of MBIs for parents were included. Results After the eligibility assessment, 20 RCTs were identified. Most studies included only mothers and non-clinical target groups for both parents and children. Most of the interventions were derived from mindfulness-based cognitive therapy and mindfulness-based stress reduction. Several interventions demonstrated some evidence of effectiveness in reducing parenting stress. The majority of the interventions were delivered in a face-to-face format, and the length varied between four and nine sessions. Activities most commonly used were psychoeducation, group discussion, imagination exercises, and mindful parenting exercises. Conclusions The interventions included a variety of types of dissemination, format, and content, and various curricula applied to the same target groups. Mapping the target groups and the intervention features can help to develop more homogeneous and effective interventions that can be applied to other target groups for which MBIs have not yet been developed or adapted. Preregistration This study is not preregistered.

A scoping review of randomized controlled trials of parenting and family-based interventions for 10 – 17 year-olds with severe and persistent conduct problems

ABSTRACT Purpose A scoping review of randomized controlled trials (RCTs) of parenting and family-based interventions that aim to reduce severe and persistent conduct problems among 10–17 year-olds. The review also examined feasibility for conducting a network meta-analysis of common therapy elements measured by RCTs. Materials and methods The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA- ScR). Searches were conducted in ERIC, PsycINFO, and MEDLINE without limits on publication year, language or publication country. Study methodological quality was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for RCTs. Results Twenty-five eligible RCTs were identified. The studies trialed nine interventions, with Multisystemic Therapy (MST) being the most evaluated (N = 10), followed by Functional Family Therapy (FFT, N = 4), and Treatment Foster Care Oregon (TFCO, N = 3). Only 10 of the 25 RCTs revealed treatment effect on conduct problems, including 6 of 9 MST, 1 of 4 FFT and all 3 TFCO trials. Discussion Surprisingly few RCTs of parenting and family-based interventions have been carried out exclusively with this population. Available data suggests that MST and FFT have uncertain effectiveness for reducing severe and persistent conduct problems. While the quality of the reviewed studies was generally high, only two reported substantive data on common therapy elements. Conclusion There is need for more RCTs of parenting and family-based interventions delivered for older children and adolescents with severe and persistent conduct problems. Future RCTs should systematically measure common therapy elements with a view to advancing intervention science.

Cascade effects of a parenting-focused program for divorced families on three health-related outcomes in emerging adulthood.

Using data from a 15-year longitudinal follow-up of a randomized controlled trial of a parenting-focused preventive intervention for divorced families (N = 240) with children aged 9-12, the current study examined alternative cascading pathways through which the intervention led to improvements in offspring's perceived health problems, BMI, and cigarette smoking in emerging adulthood. It was hypothesized that the program would lead to improvements in these health-related outcomes during emerging adulthood through progressive associations between program-induced changes in parenting and offspring outcomes, including mental health problems, substance use, and competencies. Intervention-induced improvements in positive parenting at posttest led to improvements in mental health problems in late childhood/early adolescence, which led to lower levels of mental health and substance use problems as well as higher levels of competencies in adolescence, which led to improvements in the health-related outcomes. Academic performance predicted all three health-related outcomes and other aspects of adolescent functioning showed different relations across outcomes. Results highlight the potential for intervention effects of preventive parenting interventions in childhood to cascade over time to affect health-related outcomes in emerging adulthood.

A Group Parenting Intervention for Male Postpartum Depression

Male postpartum depression is prevalent across populations; however, there is limited evidence on strategies to address it, particularly in low-income settings. To evaluate the effectiveness of Learning Through Play Plus Dads (LTP + Dads), a nonspecialist-delivered psychosocial intervention, in improving symptoms of male postpartum depression compared to treatment as usual. This cluster randomized clinical trial was conducted in Karachi, Pakistan, between June 2018 and November 2019. Assessors were blind to treatment allocation. Participants were recruited from 2 large towns in the city of Karachi via basic health units. Fathers aged 18 years and older with a DSM-5 diagnosis of major depressive episode and a child younger than 30 months were recruited. Of 1582 fathers approached, 1527 were screened and 357 were randomized in a 1:1 ratio to either the intervention or treatment as usual; 328 were included in the final analysis. Data were analyzed from April to June 2022. LTP + Dads is a manualized intervention combining parenting skills training, play therapy, and cognitive behavior therapy. The intervention was delivered by community health workers via 12 group sessions over 4 months. The primary outcome was change in 17-item Hamilton Depression Rating Scale score at 4 months. Secondary outcomes included anxiety symptoms; parenting stress; intimate partner violence; functioning; quality of life; and child social, emotional, and physical health outcomes. Assessments were completed at baseline and 4 and 6 months postrandomization. Of the 357 fathers included (mean [SD] age, 31.44 [7.24] years), 171 were randomized to the intervention and 186 to treatment as usual. Participants randomized to the intervention demonstrated significantly greater improvements in depression (group difference ratio [GDR], 0.66; 95% CI, 0.47 to 0.91; P < .001), anxiety (GDR, 0.62; 95% CI, 0.48 to 0.81; P < .001), parenting stress (GDR, -12.5; 95% CI, -19.1 to -6.0; P < .001), intimate partner violence (GDR, 0.89; 95% CI, 0.80 to 1.00; P = .05), disability (GDR, 0.77; 95% CI, 0.61 to 0.97; P = .03), and health-related quality of life (GDR, 12.7; 95% CI, 0.17 to 0.34; P < .001) at 4 months. The difference in depression and parenting stress was sustained at 6 months. Children of fathers randomized to the parenting intervention had significantly greater improvements in social-emotional development scores (mean difference, -20.8; 95% CI, -28.8 to -12.9; P < .001) at 6 months. The psychosocial parenting intervention in this study has the potential to improve paternal mental health and child development in Pakistan. Further studies in other populations and with longer follow-up are warranted. ClinicalTrials.gov Identifier: NCT03564847.

An early parenting intervention focused on enriched parent-child interactions improves effortful control in the early years of school.

This study examined long-term mediating effects of the smalltalk parenting intervention on children's effortful control at school age (7.5 years; 2016-2018). In 2010-2012, parents (96% female) of toddlers (N = 1201; aged 12-36 months; 52% female) were randomly assigned to either: standard playgroup, smalltalk playgroup (group-only), or smalltalk playgroup with additional home coaching (smalltalk plus). Multi-informant data indicated that smalltalk plus had unique indirect effects on children's effortful control, through parents' capacity to 'maintain and extend' children's focus during joint interactions. Possible mediating pathways via parent verbal responsivity, home learning activities, and descriptive language use were not supported. When parents received a structured playgroup program with additional home coaching, sustainable benefits were evident in children's self-regulation, assessed in the early school years.

Cognitive Stimulation and Maternal Feeding Styles in Families with Low Incomes: Impacts from a Randomized Clinical Trial

ObjectiveTo examine associations between cognitive stimulation in the home at 6 months and maternal feeding styles at 24 months, direct intervention effects of Smart Beginnings (SB) on feeding styles, and potential indirect effects of SB on feeding styles via earlier intervention effects on cognitive stimulation. Study DesignSingle-blind, two-site randomized clinical trial (RCT) of the SB intervention. SB integrates PlayReadVIP, a universal, pediatric primary care-based program, and Family Check-Up (FCU), a targeted secondary home-based parenting intervention. Mother-infant dyads (N=327) were randomized at birth to standard pediatric care or the SB intervention. Linear regression analyses determined associations between cognitive stimulation at 6 months and maternal feeding styles at 24 months, a secondary data analysis. Direct intervention impacts on feeding styles, a secondary RCT outcome, were also assessed and mediation analyses explored intervention effects on feeding styles via earlier intervention impacts on cognitive stimulation. ResultsCognitive stimulation was significantly associated with higher responsive and lower indulgent feeding styles. SB mothers were less likely to exhibit pressuring styles compared with controls (Effect Size [ES]=-0.12, p=0.02). Although no direct intervention effects were found on responsive or indulgent feeding styles, indirect effects of SB were evident on these feeding styles through intervention-induced increases in cognitive stimulation in the SB group. ConclusionThis study found positive linkages between cognitive stimulation in the home and later feeding styles. Additionally, the SB intervention was associated with less pressured feeding and indirect pathways mediated by intervention effects on cognitive stimulation. Implications for early childhood parenting interventions are discussed.

Practical Resources for Effective Postpartum Parenting (PREPP): a randomized controlled trial of a novel parent-infant dyadic intervention to reduce symptoms of postpartum depression: RCT of the PREPP intervention for postpartum depression

BackgroundThere is little known about the effectiveness of psychological interventions to prevent postpartum depression that focus on the birthing parent and infant dyad. Risk factors for PPD include depression during pregnancy, low parenting self-efficacy, and disrupted parental nocturnal sleep. The brief Practical Resources for Effective Postpartum Parenting (PREPP) intervention is designed for pregnant individuals at-risk for postpartum depression, providing them with 1) caregiving strategies aimed at reducing infant fuss and cry behavior and increasing infant sleep, 2) self-reflection and mindfulness skills and 3) psychoeducation about the postpartum period and infant behavior. The aims are to set more realistic postpartum expectations, enhance parenting confidence and sleep via supporting infant regulatory behavior, improve parental affect regulation and ultimately reduce the risk of postpartum depression. ObjectivesAssess the effectiveness of PREPP compared to enhanced treatment as usual in reducing symptoms of depression and anxiety and episodes of infant fuss and cry behavior and improving parental and infant sleep in the early postpartum. Study designA randomized controlled trial was conducted of 175 pregnant individuals. Inclusion criteria were standard prenatal care for a singleton pregnancy, aged 18 to 45 and at increased risk of PPD as determined by a score of ≥19 on the Predictive Index of Postnatal Depression or ≥7 on the Edinburgh Postnatal Depression Scale. Participants assigned to the PREPP group (n=88) received three coaching sessions and two phone check-ins. Participants assigned to the enhanced treatment as usual group (n=87) received three sessions which included psychoeducation, mood assessments, and clinical referral and follow-up as indicated. Assessments were conducted at 28 to 32 weeks and 34 to 39 weeks gestation, and at six, 12 and 16 weeks postpartum and included measures of parental depression, anxiety and sleep (Edinburgh Postnatal Depression Scale, Patient Health Questionnaire (PHQ-9), Hamilton Rating Scales of Depression and Anxiety and Pittsburgh Sleep Quality Index) and infant sleep and fuss and cry behavior (Baby Day Diary). ResultsCompared to enhanced treatment as usual, PREPP significantly reduced depressive symptoms at six, 12 and 16 weeks postpartum with medium to large effect sizes (d=0.7-0.98). Compared to enhanced treatment as usual, participants receiving PREPP reported less of a decline in sleep quality at six weeks postpartum (p=0.035) and the effect size was large (d=0.83). Moreover, parents receiving the PREPP intervention reported less infant fussing and crying, with the largest effect for morning crying (p<0.001; d=-1.48). ConclusionsThe results provide evidence that PREPP, initiated during pregnancy, reduced symptoms of parental depression and infant fuss and cry behavior in the early postpartum, compared to enhanced treatment as usual, in a sample at-risk for postpartum depression.

Navigating treatment trajectories for families with young children after domestic violence: A Delphi-study exploring the priorities in terms of trauma-therapy and attachment-based intervention

BackgroundIn families with young children who have experienced domestic violence, both parents and children are at risk to develop post-traumatic stress disorder (PTSD) symptoms, and there is a risk for disrupted parent-child interactions. ObjectiveTo identify the factors on which expert-clinicians agree that they should be considered when deciding on the order of trauma therapy for the parent, trauma therapy for the child, and attachment-based intervention. Participantsand settings: Participants were 16 experienced clinicians, trained in attachment-based intervention for parents and their young children, trauma therapy for adults, and trauma therapy for young children. MethodsA classic three-round Delphi approach was used. Anonymous online surveys were filled out by the participants. Consensus was defined as agreement among 70% of the participants. ResultsAfter the third survey round, there were eleven factors for which there was consensus. These included the preference of the parent for one of the three individual therapies, impaired parental mentalizing capacity, insensitive/disrupted parenting, a problematic attachment history between parent and child, a high level of child PTSD symptoms, a high level of parental PTSD symptoms, severe risks for the development of the child, a very young age of the child, and exposure of the child to one or more traumatic events. ConclusionsAgreement was found on which factors to consider in planning the order of treatments for families who have experienced domestic violence. These factors can provide a starting point from where clinicians can design a treatment plan with a specific family.

대학생 자녀가 지각한 부모의 심리적 통제와 대인관계 문제의 관계: 사회 부과적 완벽주의와 자기 자비의 순차 매개효과

Objectives: This study aimed to examine the sequential mediating effects of socially prescribed perfectionism and self-compassion on the relationship between parental psychological control and interpersonal problems among college students. Methods: To achieve this, an online self-report survey was conducted with 320 male and female college students from universities located in Seoul and the surrounding metropolitan area. The data were analyzed using SPSS 26 and PROCESS Macro 4.2 for SPSS. Results: The main findings of this study are as follows. First, correlation analysis revealed significant positive correlations between parental psychological control, interpersonal problems, and socially prescribed perfectionism; while significant negative correlations were found between these three variables and self-compassion. Second, the sequential mediating effects of socially prescribed perfectionism and self-compassion on the relationship between parental psychological control and interpersonal problems, as perceived by college students, were found to be significant. Conclusions: The study suggests implications for parental coaching, family counseling, and intervention strategies aimed at addressing interpersonal issues among college students.

Satisfaction and Effectiveness of Telepractice for Parents of Young Children with Language Delay

Objectives: This study aims to provide parent teaching techniques to mothers of 2-3-yearold children with language developmental delays via telepractice and to analyze the effectiveness and participant satisfaction. The training focuses on techniques to promote language development in their children.Methods: The study involved training and coaching seven mothers in parallel talk, self-talk, mand-model and time delay techniques via telepractice. The interactions between mothers and children were recorded at home and analyzed to observe changes in mothers’ use of the techniques and the characteristics of children’s speech. After completing the training-coaching procedure, a satisfaction survey was conducted among the participants.Results: Most participants showed improvement in the production rate per utterance and the total frequency of the techniques after the telelpractice for parent training and coaching. The children also exhibited more diverse types of utterances and increased production rates and frequencies following their mothers’ improvements. The satisfaction with remote parent training was reported to be high.Conclusion: The results of this study suggest that for parent intervention, training and coaching via telepractice can be an effective alternative for educating parents of young children with language developmental delays, enabling them to engage in interactions that promote their children’s language development.

Promoting children’s achievement in mathematics using literacy strategies:

This study provides a model of a school-based, parent intervention to support parents in building children’s mathematics understanding at home. Participating parents received instruction in how to support elementary children’s mathematical homework, using literacy strategies. The researchers designed and implemented a five-week model with the goal to improve students’ mathematics performance through support that parents provided at home. The goal of the study was to investigate the effects of a literacy-focused, parent intervention on participating families’ ability to support their children’s school-based mathematical needs. Data collection included parent interviews, pre- and post-intervention, and audio recordings of parent-child work sessions in the home. This study contributes to the literature by providing a model for parents to utilize literacy skills to facilitate students’ mathematical understanding.

INSIGHT responsive parenting intervention effects on child self-regulation at ages 3 and 6 years.

Self-regulation encompasses the ability to modulate behavior, cognition, and emotions. Parents can promote child self-regulation with responsive parenting (RP). RP shapes various components of self-regulation and is associated with numerous developmental outcomes. Here, we examine long-term effects of an early-life RP intervention designed for obesity prevention on later child self-regulation and temperament. Participants were from a randomized clinical trial comparing the RP intervention against a safety control (n = 279). RP intervention content in the domains of feeding, sleep, emotion regulation, and interactive play was delivered to primiparous mothers and infants at four home visits during the first year after birth, followed by clinical research center visits at ages 1 and 2 years and phone calls at 1.5 and 2.5 years. Child self-regulation and temperament were assessed with behavioral tasks and the Children's Behavior Questionnaire at child ages 3 and 6 years. A path model tested whether the RP intervention affected child self-regulation in comparison to the control group. At 6 years, children in the RP group had lower parent-reported negative affect (b = -0.34, SE = 0.15, p = .023) and better observed emotion regulation (b = 0.45, SE = 0.16, p = .007). Findings indicate that an RP intervention designed for early obesity prevention promoted emotional aspects of self-regulation in middle childhood, highlighting RP as a strategy for promoting healthy behavior across multiple domains. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Abstract B049: Building rapport in navigator-delivered health insurance literacy interventions: Engagement and tone used by parents of children with cancer and patient navigators

Abstract Purpose: To explore the linguistic elements of engagement and tone used by parents of children with cancer and a patient navigator (PN) during a pilot study of a health insurance literacy (HIL) intervention. Methods: A trained PN delivered a four-session Zoom-based HIL intervention for parents of children with cancer that contained content on: Session 1 (S1) health insurance terms, (S2) using health insurance, (S3) insurance appeals/legislation, and (S4) budgeting and financial strategies. We applied Linguistic Inquiry Word Count (LIWC-22) software to analyze transcriptions of each session regarding engagement and tone. We report, in aggregate, differences in language: analytical language (e.g., formal, logical), clout language (e.g., confidence, leadership), authenticity language (e.g., degree of self-monitoring), and emotional tone (e.g., positive and negative emotion words) (all range 1-99) between S1 and S4 using paired t-tests. We also analyzed language similarities between the PN and the parent using Language Style Matching, which represents the degree to which both speakers are engaged in the conversation. Results: Of 10 participants, 9 completed 4 sessions, and 1 parent completed 3 (39 sessions total); sessions were on average 35.1 (SD=6.4) minutes. Most participants were women (80%), married (90%), white (100%), and non-Hispanic (90%); half had a college degree. The PN spoke more than parents across all four sessions (90% PN vs 8.8% parent); however, parent engagement, as represented by word count, increased as the sessions went on (mean S1: 414 words, S4: 603.8 words, p=0.21). S1 contained the most language exchange between parents and the PN (median word count: 5,533.5). The discussions became increasingly authentic (mean by session: S1:24.2; S4:28.6; p=0.02), held more clout (S1:77.8, S4: 85.8; p=0.009), and increased in emotional tone (S1:49; S4:65, p=0.002). Analytical language decreased over time (S1:24.4; S4:19.8, p=0.05). Language style matching was consistently high and trending upward across sessions (S1:0.80; S4: 0.81, p=0.3). Conclusions: In a pilot test of a HIL intervention, we saw an increase in authentic language, emotional tone, and parent word count coupled with a decrease in analytical language, indicating increased rapport between the PN and parent over the sessions. This suggests there is emotional and supportive value in PN-led interventions as compared to self-directed interventions. PNs can build trust and promote equity by deconstructing and personalizing health insurance information. Future work should explore how rapport built between parents and PNs relates to health insurance literacy and financial toxicity outcomes. Citation Format: Mary K. Killela, Anne C. Kirchhoff, Perla Vaca Lopez, Amy Chevrier, Monique Stefanou, Katie Rogers, Douglas Fair, Echo L. Warner. Building rapport in navigator-delivered health insurance literacy interventions: Engagement and tone used by parents of children with cancer and patient navigators [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B049.

Mary Main’s contributions to our family systems approach to interventions with parents of young children

ABSTRACT In this paper we describe our Berkeley colleague Mary Main’s intellectual contributions to our program of creating and evaluating couples group interventions for parents of young children. The first section presents the theoretical model and the projects at the heart of our research program. The second section illustrates how the Adult Attachment Interview, a Couple Attachment Interview, or a questionnaire describing attachment styles helped us to understand how internal working models of both parent-child and couple relationships added to our observational measures of couple and parenting behavior to provide unique information. In a third section, we conclude that we did not have the kind of impact on Mary’s thinking that Mary had on ours, but we are heartened by seeing increasing attempts of some developmental attachment theorists to include fathers in their studies and others who focus on the effects of the quality of relationship between the parents on their children’s development.

Understanding levels of engagement and readiness for change in an eHealth sleep program for children with neurodevelopmental disorders

BackgroundChildren with neurodevelopmental disorders (NDD) experience high rates of sleep problems. The Better Nights, Better Days for Children with Neurodevelopmental DisordersTM(BNBD-NDDTM) program is an online intervention for parents of children with NDD who have insomnia/insomnia symptoms. The program has recently undergone a national implementation study (recruitment completed; data collection and analysis ongoing), where parental adherence and engagement are being evaluated. Preliminary results have shown that despite high levels of recruitment, there is less utilization of the program than the research team expected. Parental engagement may have been impacted by participants' motivation and readiness for change, as well as indirectly by the COVID-19 pandemic. The objective of the current study is to better understand engagement with the BNBD-NDDTM program concerning parental motivation and readiness for change, while considering the possible impacts of COVID-19.MethodsParents of children with NDD (n = 18) who were enrolled in the BNBD-NDDTM program for a minimum of 4 months completed exit interviews using a researcher-generated, semi-structured interview guide. During the interview, participants were asked about their engagement in the program, perspectives on their own readiness for changing their children's sleep, and the impact of COVID-19 on their engagement. Data were analyzed following an inductive content analysis approach.ResultsSeveral categories of data were generated that explain levels of engagement, including: (1) severity of sleep problems; (2) motivation for change; (3) previous strategies for sleep; (4) confidence in the program; (5) sacrifices made to change sleep; (6) maintenance of change; (7) experience with levels of support provided; and (8) impact of the COVID-19 pandemic.ConclusionParents identified several factors related to their readiness for change as contributors to their engagement level in the BNBD-NDDTM program. The COVID-19 pandemic had varied impacts on engagement for participants in this sample. Understanding parents' engagement levels within the BNBD-NDDTM eHealth program related to their motivation and readiness for change is crucial to optimize uptake and adherence to the program, improve the program's implementation and sustainability, and continue to help children with NDD to sleep better.

Feasibility of a Dutch post-discharge parenting intervention (TOP program) for moderate preterm born infants

Background and aimModerate preterm (MP) birth is associated with an increased risk of developmental problems. However, post-discharge support for this group is scarce. The aim of this study was to evaluate the feasibility of a post-discharge parenting program (TOP program) for MP infants. Three feasibility dimensions were evaluated (1) recruitment capability and compliance, (2) intervention acceptability, and (3) limited efficacy testing. MethodsA group of MP infants with a gestational age (GA) between 320/7‐346/7 weeks and their parents received six home visits by a TOP interventionist until 6 months corrected age (CA). A pre-posttest intervention design with quantitative and qualitative measures was used.Recruitment capability and compliance, acceptability, and satisfaction with the intervention were evaluated using a questionnaire, checklists, interviews, and a focus group. Infant socio-emotional development, parental distress, self-efficacy, and reflective functioning were measured with questionnaires. Observation measurements were used for infant motor development and parental sensitivity. ResultsThirty-two families completed the six home visits. The satisfaction rate (scale 0–10) was remarkably high (Mean 9.4, range: 8–10). Parents reported that the program was suitable, enhanced their understanding of their infants' developmental needs, and increased their self-efficacy. The infants showed age-appropriate motor and socio-emotional development post-intervention. Parental self-efficacy, reflective functioning, and sensitivity improved from pre to post intervention, with small to large effect sizes. ConclusionThe study demonstrated high compliance, acceptability, and satisfaction with the TOP program for MP infants with promising infant and parent outcomes. This study contributes to the preparatory work prior to a larger scale evaluation and dissemination.