Parental Confidence Research Articles

Enhancing Connections-Palliative Care: A Quasi-Experimental Pilot Feasibility Study of a Cancer Parenting Program.

Background: In 2018, >75,000 children were newly affected by the diagnosis of advanced cancer in a parent. Unfortunately, few programs exist to help parents and their children manage the impact of advanced disease together as a family. The Enhancing Connections-Palliative Care (EC-PC) parenting program was developed in response to this gap. Objective: (1) Assess the feasibility of the EC-PC parenting program (recruitment, enrollment, and retention); (2) test the short-term impact of the program on changes in parent and child outcomes; and (3) explore the relationship between parents' physical and psychological symptoms with program outcomes. Design: Quasi-experimental two-group design employing both within- and between-subjects analyses to examine change over time and change relative to historical controls. Parents participated in five telephone-delivered and fully manualized behavioral intervention sessions at two-week intervals, delivered by trained nurses. Behavioral assessments were obtained at baseline and at three months on parents' depressed mood, anxiety, parenting skills, parenting self-efficacy, and symptom distress as well as children's behavioral-emotional adjustment (internalizing, externalizing, and anxiety/depression). Subjects: Parents diagnosed with advanced or metastatic cancer and receiving noncurative treatment were eligible for the trial provided they had one or more children aged 5-17 living at home, were able to read, write, and speak English, and were not enrolled in a hospice program. Results: Of those enrolled, 62% completed all intervention sessions and post-intervention assessments. Within-group analyses showed significant improvements in parents' self-efficacy in helping their children manage pressures from the parent's cancer; parents' skills to elicit children's cancer-related concerns; and parents' skills to help their children cope with the cancer. Between-group analyses revealed comparable improvements with historical controls on parents' anxiety, depressed mood, self-efficacy, parenting skills, and children's behavioral-emotional adjustment. Conclusion: The EC-PC parenting program shows promise in significantly improving parents' skills and confidence in supporting their child about the cancer. Further testing of the program is warranted.

Statutory Assessment for Special Educational Needs and the Warnock Report; the First 40 Years

The Warnock report ‘Special Educational Needs’ (Warnock 1978) provided the catalyst for an enduring framework of individual statutory assessment in England for children and young people (CYP) with Special Educational Needs (SEN). . Through its implementation in the Education Act 1981, consolidated in the Education Act 1966, the report established the overall SEN framework in England for last 40 years; laying the foundation for statements of SEN and more recently Education Health and Care Plans (EHCPs). The underlying legal structure created by Warnock has been reinforced rather than changed with the introduction of the Children and Families Act 2014. However by establishing rights to specified levels of resources, at the level of individual provision, the Warnock framework has risked undermining adequate provision and parental confidence in Special Educational Needs and Disability (SEND) provision overall-a central paradox of the SEND framework. This paper considers the consequences of an over reliance on statutory assessment to secure provision, the extent to which it skews resources within the system to one group of children and is therefore in danger of undermining the overall objectives of the current SEND reforms. However it is difficult to reform the statutory system without creating greater parental confidence in the non-statutory offer. While additional legislation to strengthen the SEND framework is desirable the Government could address the overreliance on statutory assessment by a more rigorous implementation of current legislation linked to reforms in funding, accountability and a renewed focus on the Equality Act 2010 provisions on SEND. This would entail the Government being willing to support a more rights based and less market led approach in schools and other settings and introduce strategies to reduce the reliance on statutory assessment in favor of ensuring the education system could routinely meet more CYPs needs. The conclusions are focused on the English system of SEND but the solutions are of relevance for other SEND assessment and funding models which are also considered.

“Now I Know I’m Not the Only one”: A Group Therapy Approach for Adoptive Parents

ABSTRACT Many children who enter the care system and are subsequently adopted have had exposure to a range of potentially traumatising experiences including domestic violence, abuse, neglect and loss of key caregivers. There are also an increasingly high number of adopted children presenting with the impact of intrauterine exposure to alcohol, drugs and stress. They are often adopted by adults with their own experiences of loss and fertility difficulties. Despite the low overall level of adoption disruption, it is becoming clear that some adoptive parents may face difficulties in terms of forming and maintaining secure attachments across time with their children. A 9-week therapeutic group intervention was delivered to a group of 15 adoptive parents in Northern Ireland. This incorporated psychoeducation on a range of topics including attachment theory, trauma and the impact on brain development. It also incorporated theory and practical strategies for parenting therapeutically with traumatised children, and those with foetal alcohol and drug-related difficulties. The main focus of the group was on developing the capacity for mind-mindedness in the parents, through the more reflective focus of the second half of each group. The results from the evaluation indicated the positive impact of this intervention on parents' understanding of their children, increased confidence in parenting, and increased sense of competence in coping with challenging behaviour. It also indicated a positive change in the children's behaviour and in the parent-child relationships.

Safety, Feasibility, Fidelity, and Perceived Benefits of an Intervention for Parents with Mood Disorders and Their Children — “Let’s Talk About Children” in Japan

ABSTRACTIn Japan, there is no evidence-based intervention for parents with mental illness that is designed to support the patient in parenting and to prevent disorders in their children. The aim of this study was to evaluate the safety, feasibility and perceived benefits of using the Let’s Talk About Children program from Finland for parents with mood disorders in Japan before carrying out a more formal clinical trial. Nine parents with mood disorders whose children were aged 8–16 years old without a history of mental illness participated in the program. The Let’s Talk About Children program was carried out between a researcher/practitioner and participants during a preliminary discussion and two discussions. The program was conducted with a 1-week to 1-month interval between discussion one and discussion two. All participants completed the intervention, and interventions were conducted with fidelity. In terms of intervention safety, no one reported a harmful experience, and the participants reported considerable benefits from the intervention. Most parents reported that their well-being and self-acceptance changed positively. Parents reported more confidence in parenting and fewer worries about their children. All participants reported that their treatment motivation was positively changed and that they had experienced the intervention as very helpful or useful. The results are consistent with those in a corresponding Finnish study. The results suggest that the Let’s Talk About Children program is feasible for use with Japanese parents with mood disorders, and a clinical trial can be recommended.

Characterizing the Learning-to-Drive Period for Teens with Attention Deficits.

Motor vehicle collisions are the leading cause of death among teenagers, accounting for approximately 1 in 3 deaths for this age group. A number of factors increase crash risk for teen drivers, including vulnerability to distraction, poor judgment, propensity to engage in risky driving behaviors, and inexperience. These factors may be of particular concern and exacerbated among teens learning to drive with attention deficits. To our knowledge, our study is among the first to systematically investigate the experiences of novice adolescent drivers with attention deficits during the learner period of a Graduated Drivers Licensing program. Survey and on-road driving assessment (ODA) data were used to examine parent and teen confidence in the teens' driving ability, driving practice frequency, diversity of driving practice environments, and driving errors among teens with attention deficits as defined by attention-deficit/hyperactivity disorder (ADHD) diagnosis or parent-reported trouble staying focused (TSF). When teens' driving skill was evaluated at the conclusion of the learner period, teens with ADHD exhibited more driving errors than their typically developing (TD) counterparts (p = 0.034). Teens with TSF were more likely to have their ODA terminated (p = 0.019), had marginally lower overall driving scores (p = 0.098), and exhibited more critical driving errors (p = 0.01) compared with TD teens. These findings may have implications on the learning-to-drive period for adolescents with attention deficits. Adjustments may need to be made to the learner period for teens with attention deficits to account for attention impairments and to better instill safe driving behavior.

Prenatal Attachment, Parental Confidence, and Mental Health in Expecting Parents: The Role of Childhood Trauma.

Exposure to childhood abuse or neglect may lead to negative outcomes during pregnancy in expecting parents, which may contribute to a negative experience of childbearing and have consequences for the developing fetus. This study examined the associations between exposure to childhood abuse or neglect, psychological symptoms, prenatal attachment, and perception of parental competence in expectant parents. Individuals at low sociodemographic risk were recruited in community perinatal care settings and completed self-report assessment measures of depression, posttraumatic stress disorder, dissociation, personality disorders, perception of parental competence, and prenatal attachment. There were 322 participants (78% women), including 91 adults with a history of childhood abuse or neglect, Participants who were exposed to childhood abuse or neglect reported significantly higher levels of symptoms on all indices of mental health than nonexposed adults, even when controlling for sociodemographic risks. However, both groups reported similar levels of prenatal attachment and parental confidence. The impact of childhood maltreatment was similar in men and women. Structural equation modeling showed that childhood abuse or neglect leads to poor mental health and that poor mental health, but not childhood maltreatment, is associated with low parental confidence and prenatal attachment. Psychological symptoms are frequent in expectant parents who experienced maltreatment during their childhood. However, childhood abuse or neglect is not associated with their attitude regarding parenthood and the child in the absence of psychopathology. Supporting mental health may be an important target of parental programs offered during pregnancy to women and men with a history of childhood abuse or neglect.

P55 Improving parental knowledge and confidence in managing a child with JIA

Abstract Background An MDT-led educational class for parents of children newly diagnosed with JIA was developed with the aims of improving parental knowledge and confidence in managing a child with JIA. Our clinical observations were that a number of our patients had inaccurate ideas of what JIA was, three to six months into treatment. This is in-line with studies indicating that memory for medical information is often poor and inaccurate especially when the patient is anxious. Research also indicates the importance of patients developing an understanding of the condition and treatment which can aid in a number of improved outcomes including adherence. Our aim was to provide parents with an opportunity to increase their knowledge regarding JIA, addressing the medical and psychological management in a relaxed environment separate from a clinic appointment, without their children present. Several families had also requested to meet other parents for peer support and practical advice. Methods Parents of children newly diagnosed with JIA were invited to attend a session held in the evening at the NOC. Sessions were also conducted by the team at outreach clinics throughout the region. The programme was tailored to the child’s developmental stage and included information about JIA and its management from the advanced nurse specialist, physiotherapist, occupational therapist, paediatric psychologist and an experienced parent. Prior to the session, parents completed a short questionnaire to assess their confidence in managing their child’s condition and their understanding of JIA and treatment. Responses were measured on a ten point VAS scale. This was then repeated on completion of the session. Qualitative data regarding parent experience was also captured. Results Due to the large geographical area, attendance was approximately 50%. Parents’ understanding about JIA and treatment on average increased 2.6 points on VAS scale, parent’s confidence in managing their child increased on average 2.9 points. Parents reported the sessions were useful to explore what support is available, information regarding future management, importance of exercise, the emotional and psychological impact of JIA and how to manage it. 100% of parents reported their pre session aims were met. Conclusion Parental knowledge and confidence in managing their child’s condition was shown to increase in all those who attended, demonstrated by increases in VAS scores. Sessions allowed parents to access information from specialist paediatric rheumatology professionals and meet with peers in a relaxed environment. Consideration is currently being given to the use of social media to boost attendance through a virtual session. We are planning to follow-up parents to see if the increase in VAS scores is maintained Conflicts of Interest The authors declare no conflicts of interest.

Increase in Parental Knowledge and Confidence Following Communication of Dental Imaging Risks versus Benefits

Increase in Parental Knowledge and Confidence Following Communication of Dental Imaging Risks versus Benefits

Evaluating the efficacy of the Family Check-Up Online: A school-based, eHealth model for the prevention of problem behavior during the middle school years.

This study evaluated the efficacy of a family-centered preventive intervention, the Family Check-Up (FCU), delivered as an online, eHealth model to middle school families. To increase accessibility of family-centered prevention in schools, we adapted the evidence-based FCU to an online format, with the goal of providing a model of service delivery that is feasible, given limited staffing and resources in many schools. Building on prior research, we randomly assigned participants to waitlist control (n = 105), FCU Online as a web-based intervention (n = 109), and FCU Online with coaching support (n = 108). We tested the effects of the intervention on multiple outcomes, including parental self-efficacy, child self-regulation, and child behavior, in this registered clinical trial (NCT03060291). Families engaged in the intervention at a high rate (72% completed the FCU assessment) and completed 3-month posttest assessments with good retention (94% retained). Random assignment to the FCU Online with coaching support was associated with reduced emotional problems for children (p = .003, d = -0.32) and improved parental confidence and self-efficacy (p = .018, d = 0.25) when compared with waitlist controls. Risk moderated effects: at-risk youth showed stronger effects than did those with minimal risk. The results have implications for online delivery of family-centered interventions in schools.

Validity and reliability of the Karitane Parenting Confidence Scale among Japanese mothers.

The Karitane Parenting Confidence Scale is a valid and reliable measure used to assess perceived parental self-efficacy, which is a critical component in facilitating adaptation to parenthood. In the current study, we translated the original version of the scale, developed in Australia, into Japanese and examined the validity and reliability of the translation, including its factor structure. A Web-based survey was administered to 316 mothers of children aged 0-12 months between May and June 2016. The results revealed that the Japanese version had a two factor structure: "self-efficacy for infant care" and "self-efficacy for parental role". The concurrent/convergent validity of the Japanese version was examined with an acceptable Cronbach's alpha coefficient for each subscale. The present findings indicate that the Japanese version of the Karitane Parenting Confidence Scale is a valid and reliable measure to assess parenting self-efficacy among Japanese mothers of infants. The results suggest further assessment of parental self-efficacy by using each subscale. Additionally, future studies should replicate the factor structures across varied or large populations.

A Mixed-methods Study Examining Inhaler Carry and Use among Children at School

Objective: Asthma self-management depends partly on access to inhalers; for children, this includes independent inhaler carry and use at school (“self-carry”). Although laws and policies support self-carry, little is known about practices within schools. This study aimed to identify factors associated with inhaler self-carry among children and examine barriers and facilitators to self-carry.Methods: This mixed-methods observational study included child-parent dyads and nurses from four Chicago schools. Children and parents answered questions about asthma care and morbidity, confidence in self-carry skills, and facilitators and barriers to self-carry. Nurses reported asthma documentation on file and their confidence in children’s self-carry skills. Analysis utilized logistic regression. Thematic analysis was performed for open-ended questions.Results: Of 65 children enrolled (mean = 10.66 years), 45 (69.2%) reported having quick-relief medication at school, primarily inhalers, and 35 (53.8%) reported self-carry. Inhaler self-carry was associated with controller medication use and parent confidence in child’s self-carry skills. Children and parents identified several facilitators to self-carry: child’s asthma knowledge, inhaler characteristics, and need for easy inhaler access. Barriers included child’s limited understanding of asthma and inhalers, perception that inhaler is not needed, and limited inhaler access. Children also emphasized social relationships as facilitators and barriers, while parents described children’s responsibility as a facilitator and inconsistent policy implementation as a barrier.Conclusions: Efforts to improve inhaler self-carry at school should focus on educating children about asthma and inhaler use, creating supportive environments for self-carry among peers and teachers, and fostering consistent implementation and communication about asthma policy among schools and families.

From Diagnoses to Ongoing Journey: Parent Experiences Following Congenital Heart Disease Diagnoses

Using qualitative and quantitative methods, the current cross-sectional study examined parents' experiences at the time of their child's diagnosis, what they thought helped their child recover, barriers to support, and identified needs for future models of care. The sample included 26 parents (22 mothers, 3 fathers, and 1 mother/father pair) of children with CHD, ranging in age between 6 months and 4 years with a mean age of 2 years. Qualitative results were organized around five themes: (a) They (medical team) saved my child's life, (b) My child is going to be okay, (c) Not out of the woods, (d) Optimizing support for my child and myself, and (e) What still gets in the way. Parents uniformly expressed a need for greater mental health support for their children as well as programs to improve parents' skill and confidence, with no difference between age groups (< 2 years and > 2 years of age). Common barriers to service included distance and time off work. Parents' experiences informed both acute and long term implications following CHD diagnoses, and highlight current gaps in mental health care. Direction for clinical care and improved intervention opportunities are discussed.

What impact does the child development assessment process have on parental self-efficacy?

ABSTRACTObjective: Parental self-efficacy has been linked to overall parental competence, resilience and capacity to respond to adversity. It is therefore a desirable skill to promote in vulnerable parents, and in particular, parents of children with developmental disabilities. This study examines the relationship between parental self-efficacy and the experience of engaging in a contemporary child development assessment process.Method: This evaluation study utilised a pre and post design to measure the change in parental self-efficacy using the Parental Self-Agency Measure (PSAM). Parents of children undergoing developmental diagnostic assessments were asked to complete these measures at the commencement and completion of their assessment journey, as well as a short demographic survey for exploration of family characteristics. A sample of 43 parents participated in this study.Results: Results suggest that the majority of parents who engage in a child development diagnostic process leave the service with increased parental self-efficacy. An analysis of demographic characteristics also demonstrated that vulnerable populations, such as parents with a mental illness, enter the service with much lower self-efficacy scores; yet experience an increase in self-efficacy during their child’s diagnostic assessment process.Discussion: The Child Development assessment process can be understood as an intervention strategy at a parent level, addressing parental understanding, confidence and management approaches which are foundational if children’s developmental outcomes are to be optimised post assessment. This study explores psychosocial barriers to PSE and provides recommendations of inclusive models of Child Development assessment that may help to address these barriers.

Maternal confidence after birth in at-risk and not-at-risk mothers: internal and external validity of the Danish version of the Karitane Parenting Confidence Scale (KPCS)

BackgroundParenting confidence is a key factor in predicting a range of outcomes for both parents and children, such as parental depression, parental stress, and child health development. This study examines maternal confidence in at-risk and not-at-risk mothers and the psychometric properties of the Karitane Parenting Confidence Scale (KPCS).ResultsThe total sample consisted of 695 mothers (488 not-at-risk and 207 at-risk) from a community setting. Cronbach’s alpha ranged from 0.72 to 0.79, and item-rest correlations ranged from 0.17 to 0.57. Total score improved significantly from 41.75 at two months to 42.41 at six months for the not-at-risk group and increased significantly from 39.51 at two months to 41.12 at six months for the at-risk group. The differences between the two risk groups were significant at both times.ConclusionThe KPCS has acceptable internal consistency, but an overall ceiling effect, with many items characterized by low discrimination. Despite a significant difference in maternal confidence between at-risk and not-at-risk mothers at both two and six months, the total score did not predict risk status very well in this sample. A nine-item version may be equal to the original 15-item version.

Romantic attachment, dyadic coping, and parental adjustment across the transition to parenthood

AbstractThis study explored the mediating role of common dyadic coping (common DC) on the longitudinal associations between attachment‐related anxiety and avoidance and parental adjustment to the first year postpartum. A total of 92 Portuguese couples completed self‐report questionnaires of romantic attachment, common DC, parenting stress, and parental confidence. Results showed that more avoidant parents (at mid‐pregnancy) engaged less in common DC (at 6 weeks postpartum), which consequently increased their partner's parenting stress (only in mothers) and decreased their partner's parental confidence (in both parents) at 6–9 months postpartum. Anxious attachment did not predict parents' adjustment directly or indirectly. Interventions aimed at preventing adjustment difficulties to early parenthood in more avoidant parents should focus on enhancing their common DC strategies soon after childbirth.

Assistance for parents with unsettled infants in Central Vietnam: a qualitative investigation of health professionals\u2019 perspectives

BackgroundUnsettled infant behaviours are a common concern for parents internationally, and have been associated with maternal stress, reduced parenting confidence, and postnatal mental health problems among parents. Little information currently exists regarding available support for the parents of unsettled infants in low-and-middle income countries such as Vietnam. We aimed to describe how unsettled infant behaviour was understood and investigated by Vietnamese health professionals, and what health education was provided to parents regarding infant sleep and settling.MethodsThis qualitative study elicited the perspectives of Vietnamese health professionals working in Thua Thien Hue Province, Vietnam. A semi-structured interview guide included participant demographics, and questions about providing assistance to the parents of unsettled infants, understandings of unsettled infant behaviour, management of unsettled infant behaviour and health education. Individual interviews or small-group discussions were undertaken in Vietnamese, data were translated and analysed in English. The authors used a thematic approach to analysis, supported by Nvivo software.ResultsNine health professionals (four primary care doctors, one paediatrician and four nurses/midwives) working in urban and rural areas of Thua Thien Hue were interviewed. Four themes were created that reflected the responses to the literature-based interview questions. Health professionals described having received little formal training about infant sleep and settling, thus based their advice on personal experience. Information on infant sleep and settling was not included in health education for new mothers, which focused on breastfeeding and preventing malnutrition. Where advice was given, it was generally based on settling strategies involving high levels of caregiver intervention (holding, rocking, breastfeeding on demand and tolerating frequent overnight wakings) rather than behaviour management style strategies. Participants emphasised the importance of recognising and responding to infant behavioural cues (e.g infants cry when hungry).ConclusionsThere is an unmet need for information on infant sleep and settling for new parents and health professionals in Vietnam. Our findings suggest information for caregivers on how to respond sensitively to infant tired signs should be formally included in the training of health professionals in LALMI settings. Sleep and settling information should also be part of culturally appropriate multi-component maternal and child health interventions aimed at promoting early childhood development.

A Group Visit for High-Risk Pediatric Asthma Patients: A Quality Improvement Initiative to Improve Asthma Care.

Asthma disproportionately affects poor and minority children. Limited parental knowledge and confidence in asthma management, as well as stress from chronic illness, may contribute to poor outcomes. Novel approaches for providing care are essential for this vulnerable population. Our objective was to evaluate the feasibility and impact of an asthma group visit for high-risk children. Our primary care practice cares for more than 2600 children with asthma. The majority have public insurance. Children classified as high risk (≥1 asthma-related emergency department visit/hospitalization in the preceding 2 years) were eligible. Children received brief physical examinations, medication review, and updated Asthma Action Plans. Educational sessions were held for children and parents. Pre and post surveys were used to assess parents' experience and changes in confidence in asthma management. Twenty children and their parents participated. Mean parent confidence scores (5-point Likert-type scale, 5 indicating greatest confidence) improved in managing their child's asthma symptoms (3.60, 4.40, P ≤ .005), managing their child's asthma medications (3.85, 4.30, P ≤ .005), using their child's Asthma Action Plan (3.79, 4.45, P ≤ .02), communicating with the school about their child's food allergies (4.32, 4.72, P ≤ .03), and helping their child relax to reduce emotional triggers of asthma (3.25, 4.47, P ≤ .01). All families reported that they would return to a group visit. Group visits are feasible for providing care, education, and peer support to a vulnerable population. Parents expressed satisfaction and improved confidence in aspects of asthma management. Group visits have the potential to improve asthma outcomes for high-risk families.

Improving interventions for parents of children and young people with autism spectrum disorder (ASD) in CAMHS

With ever increasing recognition and diagnosis of autism spectrum disorders (ASD) in children within mainstream schooling, there was a need for City and Hackney Child and Adolescent Mental Health Services...

Parenting self-efficacy in the context of poverty and HIV in Eastern Uganda: A qualitative study.

We sought to understand social representations of effective parenting and parenting self-efficacy among female HIV-affected caregivers in rural Eastern Uganda. We conducted in-depth interviews (n = 21) to describe parenting experiences and caregivers' perceptions of their own parenting abilities and to create vignettes for use in directed focus groups. We carried out open focus groups (n = 2) to gain social perspectives on parenting, and directed focus groups (n = 2) concentrated on parenting self-efficacy. Analysis involved memoing and inductive and deductive coding of transcripts. Caregivers' perceptions of their own parenting were grounded in parenting values such as providing children with basic needs, having well-behaved children, and having good relationships with children. Caregivers' perceptions were influenced by challenges, including single parenthood, living with HIV, limited family resources, and mental health problems. When facing challenges, caregivers relied on social support and faith as well as their own parenting confidence. Caregivers' perceptions of their parenting abilities were influenced by how they felt others perceived them, their satisfaction in the parenting role, their perseverance despite challenges, and the extent to which they had a vision for their family. Our findings contextualize parenting self-efficacy within parenting values, challenges, and social perceptions among HIV-affected caregivers in rural Uganda.

The Support for New Mums Project: A protocol for a pilot randomized controlled trial designed to test a postnatal psychoeducation smartphone application.

To report a pilot trial protocol for testing the effectiveness of the Support for New Mums smartphone application in a cohort of first-time mothers. A pilot/feasibility randomized controlled trial using a two-group pre-test and repeated post-test design. This protocol follows the Standard Protocol Items: Recommendations for Intervention Trials (SPIRIT) guidelines. The Intervention group will receive access to the smartphone application for 6weeks post birth. Both Intervention and control groups will receive standardized institutional postnatal care services. Trial funding was gained from respective grant sponsors in May and November 2016. The Support for New Mums smartphone application could be a novel method for addressing the gap in provision of postpartum care services providing psychoeducation and improving maternal parental self-efficacy for Australian childbearing women. Australian New Zealand Clinical Trials Registry ACTRN12618001580268.