Parenting Skills Training Research Articles

Design of the FRESH-DOSE study: A randomized controlled noninferiority trial evaluating a guided self-help family-based treatment program for children with overweight or obesity

Overweight and obesity affect 45% of children and increases the risk for several negative health sequelae. Family-Based Behavioral Treatment (FBT) is the most efficacious treatment for child weight management and consists of nutrition and physical activity education, behavior change skills and parenting skills training. FBT is time and staff intensive and can include 20, 60-min separate groups for parents and children, as well as 20-min behavior coaching sessions to help problem solve barriers to implementing the skills learned and individualize the program. Guided self-help (GSH) therapies involve providing families a manual to review independently and brief coaching sessions by an interventionist to facilitate adherence. We developed a GSH version of FBT (gshFBT) which provides a manual to both parents and children and includes 14, 20-min coaching sessions over 6-months. The current study randomized 150 children (mean age = 10.1 years (SD = 1.38); mean BMI% = 97.3% (SD = 2.84); mean BMIz = 2.09 (SD = 0.40); 49% female; 43% Hispanic) and one of their parents (mean age = 41.8 years (SD = 6.52); mean BMI = 32.0 (SD = 7.24); 87.3% female; 43% Hispanic) to either a group-based FBT program or a gshFBT program. Assessments are conducted at baseline, post-treatment (6 months), 6-month follow-up (12 months) and 12-month follow-up (18 months). Primary outcomes are child weight change (BMIz) and cost effectiveness. Recruitment occurred between May 2017 and October 2021 and follow-up assessments are underway. Given the public health concern for children with obesity and the low level of access to FBT, gshFBT could prove extremely useful to provide intervention to a greater proportion of the population.

The effect of parenting style on anxiety and depression in adolescent girls aged 12–16 years

BackgroundMany personality traits of adolescents are influenced by the personality traits and parenting styles of parents; Parents grow their children in different ways based on their cultural patterns and ideals; due to the importance of anxiety and depression in adolescents and considering the vital role of parents in growing children, the present study was designed and conducted to investigate the effect of parenting skills training on anxiety and depression in adolescent girls aged 12–16 years in Mahshahr city, Khuzestan province, Iran. Materials and methodsThis experimental study was performed on adolescent girls aged 12–16 years in Mahshahr city, Khuzestan province, Iran, in 2020. We chose both groups of our study using a multistage cluster sampling method. Mean anxiety and depression before, two, and six months after the intervention was measured by the test and control groups using parenting style, anxiety, and depression questionnaires. The educational intervention program for the training group was like a WhatsApp group, and sending messages were in the form of audio files, text messages, photos with captions, video messages, and PowerPoint presentations. Data analysis was performed using SPSS software version 24 and using independent t-test, paired t-test, repeated measures analysis of variance, and ANOVA. ResultsThe mean and standard deviation of the age were 14.03 ± 1.41 in the experimental group and 14.06 ± 1.38 in the control group. Before the educational intervention, the mean scores of anxiety and depression were not significantly different between the experimental and control groups. In contrast two months and six months after the educational intervention, there was a significant difference in the mean scores of anxiety and depression between the experimental and control groups (P < 0.05). ConclusionThe findings of the present study showed that an educational intervention on a group of mothers regarding their parenting styles has helped their adolescent daughters to handle their anxiety and depression and also led to a decrease in their anxiety and depression scores.

Measuring and Enhancing Initial Parent Engagement in Parenting Education: Experiment and Psychometric Analysis.

BackgroundPrevention efforts focused on parenting can prevent and reduce the rates of child internalizing and externalizing problems, and positive changes in parenting skills have been shown to mediate improvements in child behavioral problems. However, parent skills training programs remain underused, with estimates that under half of eligible parents complete treatment and even lower rates engage in preventive interventions. Moreover, there is no validated measure to assess initial engagement in parent education or skills training, which is an understudied stage of parent engagement.ObjectiveWe aimed to test a novel engagement strategy, exploring whether including information pertaining to the neuroscience of child development and parent skills training enhanced parental intent to enroll. In addition, a novel self-report measure, the 18-item Parenting Resources Acceptability Measure (PRAM), was developed and validated.MethodsIn a group of 166 parents of children aged 5 to 12 years, using an engagement strategy based on the Seductive Allure of Neuroscience Explanations, we conducted a web-based experiment to assess whether the inclusion of neuroscience information related to higher levels of engagement via self-report and behavioral measures. The PRAM was subjected to an exploratory factor analysis and examined against relevant validity measures and acceptability measurement criteria.ResultsThree PRAM factors emerged (“Acceptability of Parenting Resources,” “Interest in Learning Parenting Strategies,” and “Acceptability of Parenting Websites”), which explained 68.4% of the total variance. Internal consistency among the factors and the total score ranged from good to excellent. The PRAM was correlated with other relevant measures (Parental Locus of Control, Parenting Sense of Competence, Strengths and Difficulties Questionnaire, Parent Engagement in Evidence-Based Services, and behavioral outcomes) and demonstrated good criterion validity and responsiveness. Regarding the engagement manipulation, parents who did not receive the neuroscience explanation self-reported lower interest in learning new parenting skills after watching an informational video compared with parents who did receive a neuroscience explanation. However, there were no significant differences between conditions in behavioral measures of intent to enroll, including the number of mouse clicks, amount of time spent on a page of parenting resources, and requests to receive parenting resources. The effects did not persist at the 1-month follow-up, suggesting that the effects on engagement may be time-limited.ConclusionsThe findings provide preliminary evidence for the utility of theory-driven strategies to enhance initial parental engagement in parent skills training, specifically parental interest in learning new parenting skills. In addition, the study findings demonstrate the good initial psychometric properties of the PRAM, a tool to assess parental intent to enroll, which is an early stage of engagement.

Technology-assisted task-sharing to bridge the treatment gap for childhood developmental disorders in rural Pakistan: an implementation science case study

BackgroundAs in many low-income countries, the treatment gap for developmental disorders in Pakistan is nearly 100%. The World Health Organization (WHO) has developed the mental Health Gap Intervention guide (mhGAP-IG) to train non-specialists in the delivery of evidence-based mental health interventions in low-resource settings. However, a key challenge to scale-up of non-specialist-delivered interventions is designing training programs that promote fidelity at scale in low-resource settings. In this case study, we report the experience of using a tablet device-based application to train non-specialist, female family volunteers in leading a group parent skills training program, culturally adapted from the mhGAP-IG, with fidelity at scale in rural community settings of Pakistan.MethodsThe implementation evaluation was conducted as a part of the mhGAP-IG implementation in the pilot sub-district of Gujar Khan. Family volunteers used a technology-assisted approach to deliver the parent skills training in 15 rural Union Councils (UCs). We used the Proctor and RE-AIM frameworks in a mixed-methods design to evaluate the volunteers’ competency and fidelity to the intervention. The outcome was measured with the ENhancing Assessment of Common Therapeutic factors (ENACT), during training and program implementation. Data on other implementation outcomes including intervention dosage, acceptability, feasibility, appropriateness, and reach was collected from program trainers, family volunteers, and caregivers of children 6 months post-program implementation. Qualitative and quantitative data were analyzed using the framework and descriptive analysis, respectively.ResultsWe trained 36 volunteers in delivering the program using technology. All volunteers were female with a mean age of 39 (± 4.38) years. The volunteers delivered the program to 270 caregivers in group sessions with good fidelity (scored 2.5 out of 4 on each domain of the fidelity measure). More than 85% of the caregivers attended 6 or more of 9 sessions. Quantitative analysis showed high levels of acceptability, feasibility, appropriateness, and reach of the program. Qualitative results indicated that the use of tablet device-based applications, and the cultural appropriateness of the adapted intervention content, contributed to the successful implementation of the program. However, barriers faced by family volunteers like community norms and family commitments potentially limited their mobility to deliver the program and impacted the program’ reach.ConclusionsTechnology can be used to train non-specialist family volunteers in delivering evidence-based intervention at scale with fidelity in low-resource settings of Pakistan. However, cultural and gender norms should be considered while involving females as volunteer lay health workers for the implementation of mental health programs in low-resource settings.

Parents' knowledge and attitude and behavior toward autism: a survey of Chinese families having children with autism spectrum disorder.

BackgroundIn recent years, parent-mediated intervention for children with autism spectrum disorder (ASD) has increased. Therefore, implementing effective parent training programs for parents of children with autism is of paramount importance, particularly in low- and middle-income countries. However, little is known about the status of and gaps in parents’ knowledge on ASD, which may hinder the development of valid parental training programs. Herein, we aimed at exploring the status of Chinese parents’ knowledge, attitude and behavior toward ASD, and potential factors affecting the acquisition of correct knowledge.MethodsThis study used a self-designed parental knowledge questionnaire of autism (PKQA) comprising 20 questions alongside another questionnaire comprising additional 17 questions covering the aspects of family demographics, attitudes, and behaviors of parents. In total, we included 394 parents who visited the outpatient department of the Child’s Development and Behavior Center of the Third Affiliated Hospital of Sun Yat-Sen University between December 2018 and May 2019, with their children meeting the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria for ASD.ResultsThe median knowledge score in the PKQA was 15 [interquartile range (IQR), 13–17]. Advanced paternal age and longer time interval from diagnosis to enrolling into the parent training program were associated with a lower total knowledge score (all P<0.001). Higher maternal education attainment, higher family income, child being currently under intervention, and family members sharing a common perception of the diagnosis were associated with a higher total knowledge score (all P<0.01). Reading autism-related books (P<0.001) or attending professional lectures (P=0.019) were also associated with a higher total knowledge score.ConclusionsTaken together, this study revealed that family demographics and parents’ attitudes and behaviors toward ASD may significantly influence their knowledge about autism, suggesting the need for promoting more targeted parental skills training programs.

Effectiveness of emotion focused skills training for parents: study protocol for a randomized controlled trial in specialist mental health care

BackgroundEmotion-Focused Skills Training (EFST) is a newly developed manualized skill training program for parents to strengthen emotional bonds between parents and children and improve mental health outcomes in children. Results from several preliminary trials indicate that EFST can be quite effective, but more rigorous methods are needed to affirm the evidence of the program. The primary objective of this study is to compare the effectiveness of EFST to treatment as usual (TAU) in a Norwegian outpatient clinic for child and adolescent mental health. Additionally, the study will examine the basic theoretical assumption underlying EFST that increased parental emotional functioning predicts a decline in children’s mental health symptoms. Method 120 patients will be randomly assigned to either EFST or TAU. The main outcome measure is the semi-structured diagnostic interview Schedule for Affective Disorders and Schizophrenia, present and lifetime version (K-SADS-PL) scored by trained assessors administered at pretreatment and repeated after 3 months. The secondary outcome measure is the DSM-IV version of the Strength and Difficulties Questionnaire (SDQ) administered at pretreatment as well as 3, 6, and 12 months after the intervention. To examine the efficacy question, effect sizes and reliable change for each of the treatment arms will be assessed as well as symptom differences between the conditions. To examine the second aim of the study, we will examine (1) how parents relate to emotions in their children assessed by the Emotion-Related Parenting Styles (ERPS), (2) the parents’ emotion regulation capacity assessed by the Difficulties in Emotion Regulation Scale, short-form (DERS-SF), and (3) parents’ sense of self-efficacy and the strength of their relationship with the child will be assessed by the relationship with child scale (RWC) of the systemic inventory of change.DiscussionThis study will provide insights into the effectiveness of EFST in improving children’s mental health and the mechanisms of change responsible for the program’s effectiveness. Impotently, this study may provide information regarding whether children’s mental health issues can be alleviated through therapeutic work provided to the parents alone.Trial registrationClinical trials.gov Identifier: NCT04885036. First Posted on May 13, 2021. Trial status: In recruitment.

Effect of intervention delivered by frontline maternal care providers to improve outcome and parenting skills among adolescents with perinatal depression in Nigeria (the RAPiD study): A cluster randomized controlled trial

BackgroundPerinatal depression is more common and is associated with greater negative consequences among adolescents than adults. Psychosocial interventions designed for adults may be inadequate at addressing the unique features of adolescent perinatal depression. MethodsIn a two-arm parallel cluster randomized trial conducted in thirty primary maternal care clinics in Ibadan, Nigeria (15-intervention and 15-control) we compared age-appropriate intervention consisting of problem-solving therapy, behavioral activation, parenting skills training, and parenting support from a self-identified adult to care as usual. Pregnant adolescents (aged <20 years) at fetal gestational age16–36 weeks with moderate to severe depression were recruited. Primary outcomes were depression symptoms (Edinburgh Postnatal Depression Scale, EPDS) and parenting practices (Infant-Toddler version of the Home Inventory for Measurement of the Environment, HOME-IT) at six-months postnatal. ResultsThere were 242 participants (intervention arm: 141; Control arm: 101), with a mean age of 18∙0 (SD-1∙2). Baseline mean EPDS score was 14∙2 (SD-2.1); 80∙1 % completed the six-month postnatal follow-up. The intervention group had lower level of depressive symptoms than the control group, mean EPDS scores: 5∙5 (SD-3∙6) versus 7∙2 (SD-4∙0) (adjusted mean difference -1∙84 (95%CI- 3∙06 to −0∙62; p = 0∙003) and better parenting practices, mean total HOME-IT scores: 29∙8 (SD-4∙4) versus 26∙4 (SD-4∙2) (adjusted mean difference 3∙4 (95%Cl- 2∙12 to 4∙69, p = 0∙001). LimitationsThis study explored the effect of complex interventions making it difficult to know precisely what aspects produced the outcomes. ConclusionsAn age-appropriate psychosocial intervention package holds promise for scaling up care for adolescents with perinatal depression especially in resource-constrained settings. Trial registrationISRCTN16775958. Registered on 30 April 2019.

Group skills training for parents of adolescents with anorexia nervosa: a pilot evaluation

ABSTRACT Objective This pilot study evaluated group skills training for parents of adolescents with anorexia nervosa, an adjunct to family-based treatment (FBT). Method Training was provided in two formats (six weekly sessions or a two-day intensive) to 22 parents who were in any way engaged with FBT with their child and had been referred from public and private services providing eating disorder treatment to young people. Program feedback, perceived outcomes of the group, and parental wellbeing were assessed using self-report. Child height and weight were also collected. Data were collected at pre- and post-intervention and 3-month follow-up. Results The training was rated as being very helpful and relevant. It resulted in significant perceived improvements in understanding, knowledge, skills, and confidence in managing eating/the eating disorder. No changes in parent wellbeing or child body mass index were found. Conclusion Parent group skills training improves understanding, knowledge, skills, and confidence in managing eating/the eating disorder. An intensive format of delivery seems as feasible as the per protocol weekly sessions.

Effectiveness of caregiver-mediated intervention: a pilot study for children with neurodevelopmental disorders.

Caregiver-mediated intervention (CMI), based on parent skills training, is a family-mediated intervention model for children with neurodevelopmental disorders, in particular autism spectrum disorder. This study aimed to evaluate the effectiveness of CMI. Thirty-three children (aged 22-69 months from our department) and their caregivers participated in a two-week training course of ten 90-minute lessons. Caregivers were encouraged to try their best to apply intervention skills in both home routines and play routines to encourage the development of cognition, motion, social adaptability, and behavior of children. Demographic information, video-recorded data, and diagnostic scales were collected at two key time points: baseline and post-training (PT - within six months). Three aspects were assessed - primary variables, secondary variables, and correlation analyses. Results showed an improvement in PT in (1) Adult/Child Interaction Fidelity Rating (P < 0.01) and (2) adaptability of Gesell Developmental Scale and stereotyped behaviors and limited interests of Autism Diagnostic Observation Schedule (P < 0.05, P < 0.01). Moreover, a negative correlation occurred between caregiver skill improvement and parent education (P < 0.05), but without correlations with other demographics. As an efficacious family intervention for both children and their caregivers, CMI is worth being generalized widely.

Impact of the COVID-19 Pandemic on Research with American Indian and Alaska Native Populations.

The COVID-19 pandemic forced health research programs across the world to close or pause, threatening the progress of basic science, clinical and social science research, and research careers. Impacts of the pandemic on research occurring with American Indian and Alaska Native (AI/AN) peoples, which is often conducted using community-based and -engaged approaches, offer an opportunity to understand how community-research partnerships shaped decision-making and facilitated adaptations to study design, recruitment, data collection, program implementation, and analyses. The COVID-19 pandemic disproportionately impacted AI/AN peoples, exacerbating many of the health and social inequities already being examined in community-based and -engaged research projects. The nine articles in this special issue share insights from research focused on a variety of topics from food security to diabetes prevention and parenting skills training. In the face of the pandemic, the research teams drew on experience and skills garnered by engaging the perspectives and wisdom of community partners and rooted in the principles of community-based participatory research to respond to shifting research priorities, new processes for remote consent and data collection, and increased needs for clear communication, connection, and support. Lessons from these research teams challenge us to think about how we can carry forward beneficial adaptations to best serve community needs, especially as the pandemic continues and the potential for similar global crises increases.

The effect of parenting skills training on attitudes toward child abuse in mothers referring to health centers of Shahid Beheshti University of Medical Sciences in Tehran in 2019

The effect of parenting skills training on attitudes toward child abuse in mothers referring to health centers of Shahid Beheshti University of Medical Sciences in Tehran in 2019

The role of parents in adolescent obesity treatment: Results of the TEENS+ randomized clinical pilot trial.

The optimal role for involving parents in adolescent obesity treatment is unknown. To demonstrate that two parent approaches within adolescent obesity treatment are distinct, as evidenced by differential parent outcomes, and determine the preliminary efficacy of each approach on adolescent weight loss. Adolescent/parent dyads (N=82; mean adolescent age=13.7 ± 1.2 years) participated in TEENS+, a 4-month behavioural weight loss treatment. Participants were randomized to: (1) TEENS+parents as coaches (PAC; parent skills training), or (2) TEENS+parent weight loss (PWL; adult behavioural weight loss). Assessments occurred at 0, 4 (post-treatment), and 7-months. Within- and between-group repeated measures general linear mixed models examined change in parent weight (∆kg; primary outcome); parenting, feeding, weight control strategies, home environment, and adolescent body mass index (∆BMI; secondary outcomes). PWL parents had greater 4-month weight losses (∆kg0-4m =-5.14 ± 4.87 kg) compared to PAC (-2.07 ± 3.89 kg; between-group p < 0.01). Key constructs differed between groups as expected. Both groups yielded significant within-group adolescent ∆BMI0-4m (PWL: -0.97 ± 1.38 kg/m2 vs. PAC: -0.93 ± 1.42 kg/m2 ; ps < 0.01); during maintenance, adolescents in PWL had ∆BMI4-7m increases (+0.41 ± 1.07 kg/m2 ; p=0.02) while PAC did not (+0.05 ± 1.31 kg/m2 ; p=0.82). Parent treatments were distinct in implementation and both yielded significant 4-month adolescent weight loss. Differential weight patterns were observed during maintenance, favouring PAC, warranting further exploration.

A comparison of the effectiveness of Clark and ACT parenting training on improving the emotional-behavioral problems of the child with divorced single mothers

The main purpose of this study was to compare the effectiveness of Clark and Acceptance and Commitment Therapy parenting training on improving the emotional-behavioral problems of the child with divorced single mothers. The present study was a semi-experimental, pre-test, post-test, and control group. The research population included divorced mothers referred to the psychology and counseling organization centers of the Mashhad, Iran, during May-July 2019. Among them, 66 parents with their children were selected and randomly assigned into two experimental and control groups. Parents with their children in all groups responded to the Achenbach Children's emotional-behavioral problems Questionnaire before intervention (pretest) and immediately after the intervention (posttest). The results showed that there was a significant difference in anxious/depressed and attention problems between parenting skills training based on the Clark approach and Parent-Child Relationship Training based on Acceptance and Commitment approach. The results indicated that training the mothers in two parenting skills training and Parent-Child Relationship Training approaches can improve the emotional-behavioral problems of the child with divorced single mothers. The parenting skills training approach was more effective than control and Parent-Child Relationship Training groups in anxious/depressed and attention problems variables. Finally, it’s possible to conclude that both parenting skills training and Parent-Child Relationship Training are useful interventions in improving the children's negative feelings and beliefs about their parents' divorce and their emotional-behavioral problems, and can also increase positive feelings and attitudes toward parents and their resilience, ultimately leading to increase their compatibility with parental divorce.

Preliminary Findings from the Implementation of Behavioral Parent Training in a Partial Hospitalization Program

ABSTRACT There is limited research on outcomes of partial hospitalization programs (PHPs). Questions remain regarding necessary treatment components for favorable outcomes including how to involve parents. There is growing consensus regarding the importance of parent participation in youth mental health treatment. Behavioral parent training (BPT) is an evidenced-based approach based on operant conditioning to target youth behavior through active skills training for parents that has demonstrated benefits across a range of diagnoses. BPT is one of the most extensively studied and effective treatments for reducing oppositional and disruptive behavior in youth. Modifying BPT for use in a youth PHP is appealing given its effectiveness in outpatient settings and its impact across a range of diagnoses. The present study examines the impact of brief BPT within a PHP that serves patients 5–17 years of age. Results demonstrated that patients who received BPT were significantly less likely to visit the emergency department (ED), be admitted to the inpatient psychiatric unit, or be readmitted to the PHP within 1 month of discharge. The results held at six-month post-discharge from the PHP. These results suggest that the addition of BPT to a PHP provides targeted support to optimize parent involvement, which may reduce revisiting the ED and/or acute psychiatric care service utilization following discharge. These results may be particularly useful in revealing crucial treatment components when establishing best practices and/or standards of care for PHPs, though further investigation is required.

Meeting the Needs of Families Involved in the Child Welfare System for Parental Substance Abuse: Outcomes From an Effectiveness Trial of the Families Actively Improving Relationships Program.

Limited evidence-based practices exist to address the unique treatment needs of families involved in the child welfare system with parental substance abuse. Specifically, parental opioid and methamphetamine abuse have increased over the last decade, with associated increases of families reported to the child welfare system. The Families Actively Improving Relationships (FAIR) program was developed to address the complexities of these families. Evidence-based strategies to address the interrelated needs of parents—including substance abuse and mental health treatment, parent skills training, and supportive case management to improve access to ancillary needs—are integrated in an intensive community outpatient program. This study examined the clinical effectiveness of FAIR when delivered in a Medicaid billable outpatient clinic. Parents (n = 99) were randomized either to the immediate FAIR condition or to the Waitlist (WL) condition, using a dynamic wait-listed design, with all parents provided the opportunity to eventually receive FAIR. Outcomes show statistically and clinically significant reductions in parental opioid and methamphetamine use, mental health symptoms, and parenting risk, and improvements in stability in parents receiving FAIR. Providing services to families who require travel in excess of 20 miles for sessions has challenging implications for program costs under a Medicaid structure. Study outcomes highlight the need for policies to support funding of intensive family-based programs.

The Effect of Communication Skills Training for parents on Adolescent Female Students' Self-Esteem

The Effect of Communication Skills Training for parents on Adolescent Female Students' Self-Esteem

Benefits and cultural adaptations of psychosocial interventions for parents and their children with intellectual disabilities in low-and middle-income countries: A systematic review.

Evidence and awareness of the importance of culturally adapting psychosocial interventions is growing. The aim of this paper is to systematically review studies on cultural adaptations of psychosocial interventions for parents and their children with intellectual disabilities, in low- and middle-income countries. Studies were identified through electronic databases and searching bibliographies. The quality and cultural adaptations of thirteen studies focusing on parental trainings were analysed using standardised tools and frameworks. Findings suggest interventions reduce the risk of depression and stress and increase coping strategies and positive perceptions of family functioning. Parenting skills training may improve parent-child interactions and child development. However, these benefits should be interpreted cautiously due to methodological shortcomings. Most studies described efforts to make appropriate cultural adaptations to the interventions, but these adaptations were not comprehensive. High-quality cultural adaptations are crucial to providing meaningful interventions in different parts of the world.

Using Longitudinal Social Network Analysis to Evaluate a Community-Wide Parenting Intervention

Harsh parenting attitudes and behaviors negatively impact children’s behavior and development, and are linked to heightened levels of violence in children. Parent training programs are effective preventive interventions, but only reach caregivers who attend them. In this study, programs were implemented alongside a community mobilization process, intended to use caregivers’ social networks to disseminate new parenting skills community wide. We used social network analysis to explore whether this intervention, first, increased positive parenting, second, changed social networks of female caregivers (selection), and, third, influenced parenting behavior via connections (socialization), while controlling for psychiatric morbidity, parenting stress, alcohol misuse, and child’s age. “Colored” Afrikaans-speaking female caregivers (N = 235; mean age 35.92 years) in a rural community in South Africa, with children between 1½ and 18 years old, were included in the study; two waves of data were collected (January–April 2016 and June–October 2017). We detected community-wide increases in positive parenting behavior (involvement, supervision, consistent discipline, and reduced corporal punishment). Attending at least one session of a parenting skills training program (n = 51; 21.7%) significantly predicted increases in network centrality (i.e., outdegree and indegree). Caregivers appeared to use similar parenting behavior to other caregivers they were connected to within the network, especially when those others attended a parenting skills training program. Overall, the results suggest that the information in the intervention was spread throughout the community through social interactions with program attendees and the community mobilization process. The results also illustrate the value of social network analysis for ascertaining the processes by which the intervention achieved its impact.

Transdiagnostic feasibility trial of internet-based parenting intervention to reduce child behavioural difficulties associated with congenital and neonatal neurodevelopmental risk: introducing I-InTERACT-North

Objective We examined feasibility and acceptability of an adapted telepsychological parent-child intervention to improve parenting skills and reduce emotional and behavioural difficulties in Canadian families of children at-risk for poor neurodevelopment given congenital or neonatal conditions. Preliminary program efficacy outcomes are also described. Methods Twenty-two families of children between the ages of 3–8 years with histories of neonatal stroke, hypoxic ischemic encephalopathy (HIE) and serious congenital and neonatal conditions [(congenital heart disease (CHD) or prematurity)] consented to participate in an adapted telepsychological parenting skills training program (I-InTERACT-North). The program helps parents develop positive parenting skills to improve parenting competence and child behaviour through 7 online psychoeducational modules completed independently and 7 videoconference sessions with a therapist. Videoconference sessions include live coaching to support application of skills. Feasibility (i.e., number of participants eligible, consented, refused), adherence (i.e., completion time, retention rates), acceptability (i.e., website experience questionnaire, therapist and parent semi-structured interviews), and preliminary efficacy (i.e., observational coding of parenting skill, self-reported parent competence, parent-reported child behaviour) data were collected. Results Nineteen of the 22 families (86%) enrolled completed the program in an average of 10 weeks (range: 6-17 weeks). Parents and therapists reported high overall satisfaction with the program (100%), including acceptability of both the online modules (95%) and the videoconference sessions (95%). Parenting confidence (d = 0.45), parenting skill (d = 0 .64), and child behaviour (d = 0.50) significantly improved over the course of the intervention. Conclusions Findings provide preliminary evidence for the feasibility, acceptability, and efficacy of I-InTERACT-North for parents of children with neonatal brain injury.

Formative Design and Evaluation of a Responsive eHealth/mHealth Intervention for Positive Family Adaptation Following Pediatric Traumatic Brain Injury

This paper describes the formative design and evaluation of a self-guided online program called “Road to Recovery” to provide education, support, and skills training for parents and caregivers of children with traumatic brain injury (TBI) in the acute phase following injury. TBI is a leading cause of death and disability in childhood and can lead to substantial family stress and burden, particularly during the initial months post-injury. Road to Recovery directly addresses the need for resources to support families while adapting to this “new normal.” This online program was designed and developed using the Successive Approximation Model of instructional design. Formative evaluation was conducted across three phases of design, with improvements implemented following each phase. The result is a highly usable online program that is responsive to identified parent and caregiver needs.