Parental Adherence Research Articles

8-OR: Depression and Diabetes Distress in African American and Latino Parents of Children with Type 1 Diabetes (T1D)

Introduction: Parents of young children experience high levels of depression and diabetes distress immediately post-diagnosis. However, there is a limited understanding of these factors later in the disease course, especially among parents from racial/ethnic minority groups who face management difficulties and persistent T1D health disparities (i.e., higher HA1c). This study described parental depressive symptoms, diabetes distress and adherence among African American and Latino parents of children with T1D duration > 1 year. Methods: African American (n = 39) and Latino (n = 26) parents of children age 5-10 years (M 9.0 ± 1.7 yrs; M HA1c = 9.0 ± 1.9; M T1D duration = 3.7±2.2 yrs) were enrolled in a behavioral intervention trial. At baseline they reported on demographics, treatment adherence (Diabetes Self-Management Questionnaire, DSMQ), diabetes distress (Problem Areas in Diabetes Revised for parents, PAID-PR), and depressive symptoms (Center for Epidemiological Studies-Depression, CES-D). HA1c was extracted from the medical record. Results: Over one-quarter (27%) of African American (M CES-D = 13.6 ± 9.5) and 42% of Latino (M CES-D = 14.1 ± 8.8) parents reported moderate/severe depressive symptoms. Nearly half (49%) of African American (M PAID-PR = 56.7 ± 19.7) and 38% of Latino (M PAID-PR = 50.2 ± 17.8) parents reported diabetes distress above a clinical cutoff. Both African American and Latino parents reported high levels of adherence (M DSMQ = 25.9 ± 4.7 and 26.7 ± 4.3, respectively, out of 35). Conclusions: Substantial proportions of African American and Latino parents of school-aged children who have been managing T1D for at least 1 year experience serious mood concerns, both diabetes-specific and general. High levels of T1D adherence indicate resilience in the face of such challenges. Supporting parental psychosocial functioning should be a high priority for diabetes care providers, especially among minority families who may be experiencing elevated challenges. Disclosure S. A. Carreon: None. J. N. Jones: None. A. Reyes garcia: None. K. S. Peters: None. K. K. Christopher: None. M. E. Hilliard: None. A. Butler: None. Funding National Institutes of Health (1DP3DK113236)

Implementation of preventivemeasures to prevent COVID-19: a national study of English primary schools in summer 2020.

We examined the feasibility of implementing preventive measures to prevent SARS-CoV-2 transmission across 105 English primary schools in summer 2020 via a survey and interviews with headteachers. High rates of implementation of most recommended measures were noted with the exception of requiring 2 m distance for students, fitting hand sanitizers in classrooms and introducing one-way systems in school corridors. Measures such as regular handwashing and stopping assemblies were considered easy to implement. Majorly challenging measures included distancing between individuals (for students: 51%, N = 99; for staff: 34%; N = 98; for parents: 26%, N = 100), spacing out desks (34%, N = 99), keeping same staff assigned to each student group (33%, N = 97) and staggering break times (25%, N = 99). Rapid implementation was facilitated by staff commitment and communication among stakeholders, but hampered by limitations with guidance received, physical environments, resources, parental adherence and balancing preventive measures with learning. Difficulties with distancing for younger children suggest that smaller bubbles with fewer distancing requirements within these may be a policy option. Schools require further financial, human resource and other support for effective implementation of preventive measures.

Parental Adherence to Home Activities in Early Intervention for Young Children With Delayed Motor Development.

The purpose of this study was to investigate the relationship between characteristics of home activities and coaching practices with the adherence of parents of children with motor delays to home activities provided by physical therapists and occupational therapists in early intervention. An online survey study was developed and distributed to physical therapists and occupational therapists across the United States. A survey flier was posted online in parent support groups, physical and occupational therapy groups, newsletters, and organizations supporting parents of children with disabilities. A total of 720 respondents participated in the survey, and 446 participants from 49 states met the inclusion criteria and were included in the analysis. Parents indicated that physical therapists and occupational therapists applied the 5 coaching practices (joint planning, observation, practice, reflection, and feedback). However, parents (63%) reported more time was needed on coaching. Parents stated that therapists' modeling the activities was the most helpful teaching technique that enhanced their adherence to home activities. Coaching practices, appropriateness of the home activities to daily routines and home environment, provision of home activities enjoyed by the child, and parent self-efficacy were all significantly associated with adherence to home activities. Parents' adherence to home activities is affected not only by the type of coaching used by the therapists but also by the characteristics of the home activities provided for young children with delayed motor development. The results of this study provide additional evidence supporting individualization of home activities to promote parents' continuous provision of learning opportunities to promote their children's development. There was also support of the therapists' use of the 5 coaching practices in early intervention to support the parent's application of home activities when the therapists are not present. This study explored the use of home activities from the parents' perspective and provided valuable recommendations to therapists to improve parents' adherence to the recommended home activities in early intervention.

Developing and Enhancing Adherence to a Telehealth ABA Parent Training Curriculum for Caregivers of Children with Autism.

The current COVID-19 pandemic poses unique challenges to the delivery of applied behavior analysis (ABA) services, and there has been a growing demand for evidence-based practices on how to develop a telehealth ABA service model. The current article provides a detailed technological guide on how to develop a telehealth ABA parent training curriculum. Our model also includes a series of brief acceptance and commitment training (ACT) protocols to enhance parental adherence. We provide the details for replicating our telehealth model and also demonstrate its effectiveness. To begin, a step-by-step guide on how to develop this curriculum is presented, as well as protocols used in a 60-day telehealth ABA parent training program. Afterward, we describe a randomized controlled trial design to examine the effectiveness of this protocol. Thirteen families from the southern Illinois region participated in the curriculum before the COVID-19 outbreak. Obtained data indicated training was effective to teach skills, and parents with supplemental ACT material made significantly more progress than those in the control group, t(11) = 2.36, p = .038. Halfway through the training, the outbreak of COVID-19 occurred, and parents in the ACT group were more likely to continue the program, whereas parents in the control group were significantly more likely to postpone their participation, χ2 = 6.96, p = .008. Social validity measures indicated that parents rated the curriculum favorably. Limitations and suggestions for practitioners are discussed.

Patterns of Parental Adherence and the Association to Child and Parenting Outcomes Following a Multicomponent School-Home Intervention for Youth With ADHD

The goal of the present study was to evaluate the role of parent adherence in the Collaborative Life Skills (CLS) program, a multicomponent school-home intervention, for predicting child and parenting outcomes. A sample of 129 children (63% male; M age = 8.22, SD = 1.10; grades 2–5) with attention-deficit/hyperactivity disorder (ADHD) and their parents participated in CLS, which included 10 weekly behavioral parent training group sessions. Each week, parents provided information on their CLS skill use between sessions (at home) as part of the intervention. Outcome measures included parent and teacher ratings of child behavior and parenting at post-intervention and 6 months follow-up. Growth mixture models examining weekly parent skill use trajectories throughout the intervention significantly predicted parent- and teacher-reported outcomes including parent-rated child behavior, teacher-rated academic competence, and positive parenting behaviors. Fifty-two percent of parents displayed moderate skill use throughout the intervention, whereas the remaining parents had either low (20%) or high (28%) initial levels of use but demonstrated high skill utilization by the middle of the intervention. Results highlight the importance of examining individual differences in parents between session strategy use for behavioral parent training interventions targeting child and parenting outcomes.

The Influence of Adherence to the Mediterranean Diet among Children and Their Parents in Relation to Childhood Overweight/Obesity: A Cross-Sectional Study in Greece

Background: Childhood overweight/obesity constitutes a serious issue, as may cause several health problems. The main characteristics of the Mediterranean Diet have been acknowledged as the most appropriate shield mainly for obesity. Methods: The study was performed on 1728 primary students, during school years 2014-2016, in Greece. Children and their parents completed questionnaires which included dietary and lifestyle habits. The KIDMED score (range -4 to 12) was used to assess the level of childhood adherence to the Mediterranean diet and the MedDietScore (range 0 to 55) was used to assess parental adherence. For the purposes of this analysis, the examined sample was n = 875 of students (522 girls)-parents pairs whose level of adherence to the Mediterranean diet was able to be evaluated. Results: The prevalence of overweight and obesity in the Greek sample was 26.0%, according to International Obesity Task Force (IOTF) cutoff criteria for children. KIDMED Score was significantly lower in children with overweight/obesity compared with children with normal weight (4.65 ± 2.14 vs. 5.16 ± 2.05, p = 0.002). The multiadjusted analysis revealed that children close to the Mediterranean diet were less likely to be overweight/obese (p < 0.001), either parents are away from or close to the Mediterranean diet. Conclusions: This study revealed that children's adherence to the Mediterranean diet was inversely associated with weight status either parents are away from or close to this dietary pattern. Future interventions against childhood obesity have to take into consideration the crucial importance of familial aggregation of healthy food choices and interfamily influences in the home environment on children's weight status.

Early Cleft Lip Repair and Its Effect on Infant Weight Gain

Cleft lip and palate (CLP) is the most common congenital birth defect of the head and neck. Infants with CLP experience difficulties with feeding, leading to low weight gain and failure to thrive.1 At our institution, a paradigm shift has occurred where children with unilateral cleft lip defects are repaired in the late neonatal to early infantile period.2 Before the introduction of early cleft lip repair (ECLR), wide complete cleft lip defects were treated with adjuvant nasoalveolar molding (NAM) and repaired at the age of 3-6 months. The advantage of ECLR lies in the avoidance of the cumbersome and irritating NAM process that requires frequent biweekly dental clinic visits and parental adherence to an appliance protocol. Because little is known about the effects of ECLR on infantile feeding and weight gain, the purpose of this study is to compare the effect of ECLR on weight gain in contrast to NAM and standard timing of cleft repair.

Data driven decision making to characterize clinical personas of parents of children with cystic fibrosis: a mixed methods study

BackgroundBeginning at a young age, children with cystic fibrosis (CF) embark on demanding care regimens that pose challenges to parents. We examined the extent to which clinical, demographic and psychosocial features inform patterns of adherence to pulmonary therapies and how these patterns can be used to develop clinical personas, defined as aspects of adherence barriers that are presented by parents and/or perceived by clinicians, in order to enhance personalized CF care delivery.MethodsWe undertook an explanatory sequential mixed-methods study consisting of i) multivariate clustering to create clusters corresponding to parental adherence patterns (quantitative phase); ii) parental participant interviews to create clinical personas interpreted from clustering (qualitative phase). Clinical, demographic and psychosocial features were used in supervised clustering against clinical endpoints, which included adherence to airway clearance and aerosolized medications and self-efficacy score, which was used as a feature for modeling adherence. Clinical implications were developed for each persona by combing quantitative and qualitative data (integration phase).ResultsThe quantitative phase showed that the 87 parent participants were segmented into three distinct patterns of adherence based on use of aerosolized medication and practice of airway clearance. Patterns were primarily influenced by self-efficacy, distance to CF care center and child BMI percentile. The two key patterns that emerged for the self-efficacy model were most heavily influenced by distance to CF care center and child BMI percentile. Eight clinical personas were developed in the qualitative phase from parent and clinician participant feedback of latent components from these models. Findings from the integration phase include recommendations to overcome specific challenges with maintaining treatment regimens and increasing support from social networks.ConclusionsAdherence patterns from multivariate models and resulting parent personas with their corresponding clinical implications have utility as clinical decision support tools and capabilities for tailoring intervention study designs that promote adherence.

The influence of parental compliance to treatment of chronic gastroduodenal pathology in children on patient’s quality of life

The effectiveness of the treatment of chronic gastroduodenal pathology associated with Helicobacter pylori infection consists not only in the successful eradication of the pathogenic microorganism, but also in eliminating dyspeptic and abdominal pain syndrome, as the main clinical criteria for this pathology. Among the main reasons that affect the successful outcome of therapy, it can be distinguished strict adherence to the prescribed drug regimens. The aim of the work was to assess the effect of parental adherence to their child suffering from chronic gastroduodenal pathology, treatment on the patient's quality of life. 80 children of high school age suffering from chronic gastroduodenal pathology associated with Helicobacter pylori were examined. Anti-Helicobacter therapy using clarithromycin, amoxicillin, omeprazole for 14 days was held in all patients. The training of parental compliance in relation to ongoing therapy for their child was conducted before therapy in patients of the comparison group. The special questionnaire developed by us was used to assess the level of parental compliance. In addition, in all patients, the quality of life indices were studied using the SF-36 questionnaire at baseline and one month after the start of therapy. It was revealed that in children with chronic gastroduodenal pathology the initial indicators on all scales of quality of life were significantly lower compared to the children of the control group. It was found that the greater compliance of parents to their child's prescribed therapy leads not only to the successful eradication of Helicobacter pylori infection, but also to positive dynamics, both physical and psychological aspects of health.

Modeling the Theory of Planned Behaviour to predict adherence to preventive dental visits in preschool children.

Dental caries is the most common chronic childhood disease that occurs in a continuum and can be prevented by children and their parents' adherence to recommended oral health behaviors. Theory-driven tools help practitioners to identify the causes for poor adherence and develop effective interventions. This study examined the Expanded Theory of Planned Behaviour (TPB) Model by adding the concept of Sense of Coherence (SOC) to predict parental adherence to preschooler's preventive dental visits. Data regarding socio-economic demographics were collected from parents of children aged 2-6 years. Constructs of TPB including parental attitudes, subjective norms (SN), Perceived Behavioural Control (PBC), and intention to attend preventive dental visits for their preschoolers were collected by questionnaire, alongside parents' sense of coherence (SOC). Dental attendance was measured by asking if the child had a regular dental visit during the last year. Structural Equation Modeling Analysis (SEMA) was carried out to identify significant direct and indirect (mediated) pathways in the extended TPB model. Three hundred and seventy-eight mothers (mean age = 34.41 years, range 22-48) participated in the study. The mean age of children was 3.92 years, range: 2-6), and 75.9% had dental insurance. Results of the final model showed that predisposing factors (child's birthplace and mother's birthplace) significantly predicted enabling resources (family monthly income and child's dental insurance status); both predicted the TPB components (PBC, SN, and attitude). TPB components, in turn, predicted behavioural intention. However, contrary to expectation, intention did not significantly predict dental attendance in the past 12 months. Parent's SOC significantly predicted TPB components and dental attendance. Overall, 56% of the variance in dental attendance was explained by the expanded TPB model. The expanded TPB model explained a great deal of variance in preschooler's dental attendance. These findings suggest that the expanded model could be used as the framework for designing interventions or strategies to enhance dental attendance among preschoolers; in particular, such strategies should focus specifically on enhancing parental SOC including empowerment.

A randomized control trial of hypothermia alert device in low birth weight newborns and the effect on kangaroo mother care and weight gain

Background: Lack of thermal protection is one of the major challenges faced by developing nations for newborn survival. Early detection and subsequent prevention of hypothermia through Kangaroo Care could lead to significant health outcomes for the newborn. Hypothermia alert device is a bracelet that monitors for early hypothermia by sensing the extremities and sounding an alarm for parents to take action.Methods: In a randomized controlled trial, the effect of the hypothermia alert device on KMC compliance at home and weight gain of newborns on 4th week follow-up was evaluated. New borns discharged from the neonatal intensive care unit at Indira Gandhi Institute of Child Health (IGICH). Neonates who were LBW (less than 2500 grams) were included in the study once they were stable and ready for discharge. Neonates were given a hypothermia alert device to monitor their temperatures for hypothermia for 4 weeks. Weekly follow-ups were held with parents and to record measurements of growth. Additionally, parents were given a KMC diary to track sessions of KMC. Neonates were given either a placebo bracelet or a BEMPU Bracelet. Bracelets were identical and both monitored for hypothermia, however only the BEMPU Bracelet gave an alarm when the newborn was hypothermic.Results: Statistically 44 neonates completed the 4-week trial; 23 were in the control group and 21 were in the BEMPU group; of these, 19 participants in the control group completed KMC diaries and 19 BEMPU group completed KMC diaries. The results of the clinical trial reveal that parents of neonates in the BEMPU group demonstrated better compliance to KMC. In the BEMPU group, the average daily time spent doing KMC was significantly higher in first (3.02 v 1.96 h, p=0.016) and fourth (3.04 v 2.38 h, p=0.094) week of discharge. There was an increase of weight gain in the BEMPU group after the first (25.7 v 20.7 g, p=0.1.85) and fourth (28.3 v 22.9 g, p=0.057) week of discharge.Conclusions: The hypothermia alert device was found to be an effective intervention to promote parent adherence to Kangaroo Care and weight gain.

Feasibility of Parent Coaching of Music Interventions for Children With Autism Spectrum Disorder

AbstractParent-mediated interventions for children with autism spectrum disorder (ASD) have elicited emerging interest among music therapists. A conceptual framework (reported elsewhere) delineated the incorporation of music to an established parent coaching model (Parent-Early Start Denver Model [P-ESDM];). The purpose of this study was to explore the feasibility of adapting the P-ESDM to a music-based parent coaching model. An alternating treatments design with a parent–child dyad was implemented, with music and non-music conditions in each treatment session. Behavioral video analysis of parental verbal and non-verbal responsiveness, child joint attention and verbal behaviors, and parent and therapist adherence to treatment provided quantitative data. A semi-structured follow-up interview with a parent addressed concerns, preferences, and suggestions for improvement. Parental verbal responsiveness seemed lower during the music condition, but non-verbal responsiveness increased notably during the music condition. Parent adherence to treatment was achieved in the sixth session. Child receptive joint attention increased in the music condition only, and initiating joint attention was higher in most sessions during the music condition. Parental comfort with the music did not seem ideal with the brief time allotted to training despite familiarity with the music. Music-based parent coaching to enhance social communication of preschoolers with ASD seems feasible. This study provides initial support to a conceptual framework of parent coaching of music interventions. Further research should investigate other methods to teach the music, alternative session schedules, and more precise measures of parental responsiveness.

BLOOD THICKER THAN WATER? STEPGAP IN INTERGENERATIONAL RELATIONSHIPS

The increasing prevalence of ageing stepfamilies and stepchildren’s potential to act as a source of support for older parents has prompted research about intergenerational cohesion in step-relationships. Previous research has hypothesized a qualitative gap (a step-gap) between step and biological relationships to the advantage of the latter. In this Swedish study we compare emotional closeness between older parents and adult children among parents (aged 66-79) who have had both biological and stepchildren, and children (aged X-Y) who have had both biological and stepparents. Qualitative interviews (n=24) of family histories including a hierarchical convoy model of family relationships were collected and analyzed. Results show that with few exceptions biological relationships are rated as emotionally closer than step-relationships, both by parents and adult children, supporting the step-gap hypothesis. While the older parents tend to deemphasize the importance of blood for their ratings, the adult children often emphasize the importance of blood. The difference is explained by a parental adherence to an ideology of equal treatment of children, while the adult children stress the importance of biology for their identity and belonging.

Telenursing Using SKEDit To Educate Parents with Thalassemia Children

&lt;p&gt;Background: Excess iron levels and low hemoglobin (Hb) levels are one of the complications of Beta-Thalassemia. The implementation of education using &lt;em&gt;WhatsApp&lt;/em&gt; is expected to increase parental knowledge of the illness and children to adhere to iron chelation therapy.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;&lt;p&gt;Objective: To identify the effect of the implementation of education using &lt;em&gt;WhatsApp&lt;/em&gt; through the SKEDit application compared to using booklets on parental knowledge and medication adherence in pediatric patients with thalassemia.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;&lt;p&gt;Method: The study was quasi-experimental using pre and post-test with control group. The total sample was 61 respondents with purposive sampling technique. Parental knowledge was measured using a Parental knowledge about Thalassemia questionnaire and the level of adherence was measured using an indirect method known as 'Pill Count'. The data were then analyzed using the Mann whitney and wilcoxon test.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;&lt;p&gt;Results: There was a significant difference in the level of knowledge in the pretest and posttest on the intervention group (p: 0.001) and the pretest and posttest in the control group (p: 0.001). There was a significant difference in the level of adherence of the pretest and posttest in the intervention group (p: 0.028). There was no significant difference in the level of adherence of the pretest and posttest in the control group (p: 0.214). There was no difference in the level of knowledge between the two groups (p: 0.994). There was no difference in the level of adherence between the two groups (p: 0.987).&lt;/p&gt;&lt;p&gt; &lt;/p&gt;&lt;p&gt;Conclusion: Providing education using WhatsApp through the SKEDit application and also booklets both effectively increase the level of parental knowledge and medication adherence of pediatric patients with thalassemia.&lt;/p&gt;

Family-Centered Care Enhanced Neonatal Neurophysiological Function in Preterm Infants: Randomized Controlled Trial.

Family-centered intervention for preterm infants has shown short- to medium-term developmental benefits; however, the neurological effects of intervention have rarely been explored. The objectives of this study were to examine the effect of a family-centered intervention program (FCIP) on neurophysiological functions in preterm infants with very low birth weight (VLBW; birth weight of < 1500g) in Taiwan, to compare the effect of the FCIP with that of a usual-care program (UCP), and to explore the FCIP-induced changes in neurobehavioral and neurophysiological functions. This was a multicenter, single-blind randomized controlled trial. The study took place in 3 medical centers in northern and southern Taiwan. Two hundred fifty-one preterm infants with VLBW were included. The FCIP group received a family-centered intervention and the UCP group received standard care during hospitalization. Infants were assessed in terms of neurobehavioral performance using the Neonatal Neurobehavioral Examination-Chinese version, and their neurophysiological function was assessed using electroencephalography/event-related potentials during sleep and during an auditory oddball task during the neonatal period. The FCIP promoted more mature neurophysiological function than the UCP, including greater negative mean amplitudes of mismatch negativities in the left frontal region in the oddball task in all infants, lower intrahemispheric prefrontal-central coherence during sleep in infants who were small for gestational age, and higher interhemispheric frontal coherence during sleep in those who were appropriate for gestational age. Furthermore, interhemispheric coherence was positively associated with the total neurobehavioral score in preterm infants who were appropriate for gestational age (r=0.20). The fact that more parental adherence strategies were used in the FCIP group than in the UCP group might have favored the intervention effect in this study. Family-centered intervention facilitates short-term neurophysiological maturation in preterm infants with VLBW in Taiwan.

Multi-level Intervention Program – A Quality Improvement Initiative to Decrease Central Line-Associated Bloodstream Infections in the Pediatric Acute and Hematology/Oncology Units

IntroductionCentral Venous Catheters (CVCs) are placed in pediatric patients that require frequent and/or long-term access for intravenous treatments and increase the risk for Central line-associated bloodstream infections (CLABSIs). The specific aims of the study were to evaluate adherence to the intervention components and rates of Central Line Associated Bloodstream Infections (CLABSIs) over five years. MethodsImplementation occurred on the acute care and hematology-oncology pediatric units of a quaternary health care setting in Southern California. Adherence rates were quantified using a CVC audit sheet and CLABSI rates were obtained quarterly before, and at year 1, 2, 3, 4, 5 of implementation. ResultsCLABSI rates for both pediatric units decreased over the five-year period. Adherence rates were 90% to 100% on the different features of the intervention; the lowest was adherence to Patient Protective Equipment (PPE). A total of 41 incidents of hospital-acquired CLABSIs were reported the year prior to the Bug Buster Committee, which decreased steadily to 9 incidents after implementation. The quarterly CLABSI rates in the Pediatric Acute Care ranged from 2.8 to 6.6/1,000 catheter days and in Pediatric Hematology-Oncology from 2.1 to 4.3/1,000 catheter days the year prior to implementation. ConclusionsWhile adherence for staff remains high, parent/family adherence was low. We recommend including in the multi-level intervention, procedures targeting parent adherence such as patient education handouts, reviewing content on admission, placing signs on doors indicating PPE requirements, and promptly providing PPE to non-adherent family members.

DHealth Solution for Improving Parent Adherence to Behavioral Treatment for ADHD

dHealth Solution for Improving Parent Adherence to Behavioral Treatment for ADHD

Engaging Children to Support Parental Weight Loss: A Randomized Trial.

Background. Despite evidence that social network members influence the eating behaviors of adults, no study to date has had the primary aim of examining children as support partners for parents in a weight loss intervention. Aim. To evaluate parent adherence with eating/exercise goals and weight loss in a 6-month study engaging children as support partners. Method. Adults with obesity (body mass index ≥ 30 kg/m2, n = 102) and at least one child ≥12 years were randomized to a child support or control group. In the child support group, children enrolled with their parent and engaged in a supportive behavior 2 days/week. In the control group, there was no enrolled child support. Parents in both groups selected a healthy eating strategy and daily step goal. Results. There was no difference in weight loss between the child support and control groups (-5.97 vs. -5.42 lbs, p = .81). In the child support group, 30% of children did not engage in the study. The majority of parents whose children did not engage withdrew from the study. In secondary analyses, parent adherence with eating/exercise goals increased with the days of child support (p < .001). For all participants, low chaos in the home environment (p < .04) and increased parent adherence with follow-ups (p < .008) predicted weight loss. Conclusions. We found no treatment effect of child support on weight loss. Active child support of eating/exercise goals appeared to facilitate goal adherence, while anticipated but unrealized child support may have had iatrogenic consequences. Further investigation of family-focused weight loss interventions is warranted.

스키 강습 서비스품질이 학부모 신뢰, 지속의도 및 추천의사에 미치는 영향

스키 강습 서비스품질이 학부모 신뢰, 지속의도 및 추천의사에 미치는 영향

Research to Practice: Implementation of Family School Success for Parents of Children With ADHD

“Family-School Success” (FSS) is an efficacious intervention improving the home and school functioning of children with ADHD in grades 2–6. An extension of this intervention designed for a younger population also showed positive effects for kindergarten and first grade students in a pilot study. Following the completion of these trials, FSS was implemented in a fee-for-service tertiary care ADHD center. The implementation process included adapting the manual and treatment procedures to be feasible outside the structure and support of a federally funded randomized control trial (RCT). The current study examines the process of adapting the treatment protocol and examines the acceptability and effectiveness of the adapted FSS, as well as predictors of family treatment response including parent engagement in treatment (as measured by attendance and homework adherence). A case study illustrates the adaptations to the intervention and its implementation in the clinic-based setting. In line with findings from clinical trials, families reported high satisfaction with the adapted FSS intervention and showed significant improvement in parental self-efficacy, child academic homework performance, and reduction in child impairment. Additionally, as in the initial FSS RCT, parental attendance in the adapted FSS program predicted child attention to academic homework, controlling for parental adherence to between-session homework. Furthermore, controlling for attendance at FSS sessions, parent adherence to between-session homework assignments predicted improvements in parent self-efficacy as well as child’s homework productivity. These results replicate those of the original RCT and confirm that both session attendance and between-session homework completed are important for improvement during the program. Overall, this study provides support for the acceptability and effectiveness of this treatment model and suggests that future work toward dissemination to community-based settings would be worthwhile.