Safe Kids Program Research Articles

Effectiveness of Remote Implementation of the ACT Raising Safe Kids Program: A Pilot Study

The objective of the study was to evaluate the effectiveness of remote implementation of the ACT Raising Safe Kids (ACT-RSK) program. The ACT-RSK program is an evidence-based group parenting program designed to promote positive parenting. The COVID-19 pandemic precipitated the creation of a remote implementation guide to deliver the program via telehealth. A small (N = 21) sample of caregivers of children aged 1 to 10 living in the USA participated in the 9-week program and completed pre- and post-intervention questionnaires. ACT Facilitators provided feasibility and fidelity feedback through a focus group and questionnaires. There was a significant improvement in positive parenting skills and a decrease in verbal and physical punishment. There were no improvements in parental nurturing or limiting and monitoring children’s media use. Facilitators and participants found remote implementation to be feasible and acceptable. Facilitators were able to maintain high fidelity to the model. The remote implementation of the ACT-RSK program has benefits to positive parental behaviors and discipline, but possibly not limiting and monitoring of children’s media use and nurturing behavior. However, characteristics of families’ experiences during the COVID-19 pandemic may have influenced these results. Remote implementation of the ACT-RSK program can be useful for promoting positive parental behaviors and discipline.

Feasibility and acceptability study of the online ACT-Raising Safe Kids program

This study aimed to examine the feasibility and acceptability of the online version of the ACT-Raising Safe Kids Parenting Program, and the effect of improving parenting practices in the coronavirus pandemic context. The sample comprised 20 mothers of two-to-six-year-old children. The mothers answered the ACT, PAFAS, and PSOC scales in the pre- and post-intervention assessments. In addition, the acceptability questionnaire and the ACE scale were administered at post-intervention. A within-group comparison analysis was performed. The results showed that the mothers reported a significant increase in emotional/behavioral regulation and parental sense of competence, and a decrease in coercive practices in the post-intervention period compared to the pre-intervention period. The mothers reported great acceptance of the ACT online version. In conclusion, the ACT online version was feasible, acceptable, and effective in improving parenting practices.

ACT Raising Safe Kids Program improves parenting practices, beliefs about physical punishment, management of anger, and mental health: Initial evidence from a study in Brazil

The exposure to child maltreatment has negative consequences for children’s health and development. These serious consequences demonstrate how important it is to develop and implement effective prevention strategies. The ACT Raising Safe Kids Program was developed to prevent child maltreatment and teach positive parenting skills to parents and caregivers. The aim of the present study was to evaluate initial evidence of effectiveness of the ACT Program in Porto Alegre, capital of the Brazilian state of Rio Grande do Sul. The study is based on an intervention with one-group pretest-protest design. The sample comprised 47 mothers and 5 fathers with a mean age of 38.73 years (SD = 6.81). Parenting meetings were implemented over nine weeks with groups, on average, composed of nine participants. Parenting practices, physical punishment beliefs, anger, and mental health outcomes were assessed through self-report measures before and after participation in the ACT Program. Measures included sociodemographic data, ACT Evaluation Questionnaire, Physical Punishment Beliefs Scale, State-Trait Anger Expression Inventory (STAXI-2), and Depression, Anxiety and Stress Scale (DASS-21). Within-group comparisons were analyzed through paired samples t-test. The results indicated that parenting practices (emotional and behavioral regulation, communication, and positive discipline), physical punishment beliefs, levels of anger (angry temperament, angry reaction, anger expression-out, and anger control-in), and mental health outcomes (depression and stress) improved significantly from pretest to posttest. The findings indicate the messages were enacted by parents. Further evaluation is required to determine the impact on parenting of the ACT Program in this context employing a randomized controlled design.

A Multi-Site Study of the ACT Raising Safe Kids Program in Portugal

ABSTRACT The present study examined outcomes of the ACT-Raising Safe Kids (ACT-RSK) program in central Portugal. ACT-RSK is a family violence and child abuse prevention program for parents and caregivers of young children. Forty-one parents of children aged three to nine years completed the ACT-RSK group program and the research measures. The study took place at three community based agencies, one school, and one shelter in central Portugal. Pre/post-program comparisons indicated that, following completion of the ACT-RSK program, ACT completers had improved parenting behaviors, improved responding to perceived child misbehavior, improved monitoring and limit-setting on children’s media use, and improved knowledge of child development.

Maternal History of Childhood Violence in the Context of a Parenting Program

The present study aimed to evaluate the effectiveness of a universal parenting program of violence prevention against children to improve the parenting practices in groups of mothers differentiated by the presence or not of a history of adverse childhood experiences. The study also aimed to characterize the types of violence experienced by the participants. A mixed-methods approach was used with qualitative and quantitative analyzes. The study sample consisted of 125 mothers of 3- to 8-year-old children. Mothers participated in the ACT-Raising Safe Kids Program with pre- and post-intervention evaluations. A self-report questionnaire was used to assess mothers’ parenting practices (emotional and behavioral regulation, communication, and positive discipline). After the intervention, an individual interview was carried out, including open-ended questions about the participants’ history of relationship with their parents and violence and maltreatment situations in their childhood. For the analysis, the mothers were divided into two groups, with a history of violence in childhood (VG; n = 103) and without violence in childhood (CG; n = 24). Results showed a high prevalence (81%) of mothers who reported violent episodes in their childhood, predominantly physical abuse. In the ACT post-intervention, both groups of mothers reported improvements in all dimensions of their parenting practices. In conclusion, the mothers improved their parenting practices after participation in a preventive program, regardless of their history of violence in childhood.

Impacto de um programa de competências parentais no stress e competências de atenção plena

Resumo Objetivo: Analisar o impacto da frequência do Adults and Children Together Raising Safe Kids (ACT-RSK) Programe nas competências parentais, no stress parental e nas competências de atenção plena, de um grupo de pais de crianças. Métodos: Realizou-se uma investigação-ação, utilizando um pré e pós-teste, tendo por referência a implementação do programa ACT-RSK, em 8 sessões de 90 minutos com periodicidade semanal, numa amostra de 22 pais da região Centro de Portugal. Utilizaram-se os questionários do Programa ACT-RSK, o Índice [...]

Feasibility study of a preventive parenting program with mothers of children born preterm

Preterm infants constitute a high-risk population for presenting emotional and behavioral problems and developmental dysregulation. Parenting preventive interventions can support mothers to act as co-regulators and prevent child behavior problems. The ACT – Raising Safe Kids Program is recommended to strengthen positive parenting practices. The present study aimed to examine the feasibility of the ACT Program in a target sample of mothers of children born preterm, comparing parenting practices and child behavior problems at pre- and post-intervention. The sample consisted of 30 mothers of 1- to 7- year - old children born preterm. The mothers answered the ACT and Parenting and Family Adjustment scales, and the Strengthen and Difficulties Questionnaire, in the pre- and post-intervention. The within-group comparison was performed. The results showed that, after the intervention, there was a significant improvement in parenting practices dimensions of communication, emotional/behavioral regulation, monitoring of electronic media, positive encouragement, and parental consistency and adjustment. Also, the coercive practices decreased in the post-intervention. Furthermore, there was a decrease in child behavior problems and improvement in the pro-social behavior, from pre- to post-intervention. In conclusion, the ACT showed the feasibility to improve positive parenting practices, enabling mothers to act as a co-regulator of the behavior of children born preterm.

Parents’ perspectives about their experience in the ACT-Raising Safe Kids program: A qualitative study

A presente investigação teve como principal objetivo compreender a perspetiva dos pais acerca da sua experiência e participação no ACT-Raising Safe Kids (RSK), um programa parental universal que visa prevenir a violência na infância. Realizaram-se entrevistas semiestruturadas presenciais a 10 pais (9 mães e 1 pai) de crianças entre os 3 e os 8 anos. Recorreu-se à análise de conteúdo e a procedimentos de estatística descritiva para analisar os dados obtidos. Os resultados indicaram que os pais decidiram participar no programa porque necessitavam de resolver problemas específicos e pretendiam aumentar conhecimentos, melhorar competências parentais e partilhar experiências. Após a participação no ACT-RSK, os pais reportaram uma maior consciência do seu comportamento, adequação das suas expetativas e aquisição de informação. Os participantes percecionaram um aumento da capacidade de autorregulação e autoeficácia e do uso de práticas parentais positivas. A mudança parental resultou na melhoria da capacidade de autorregulação, consciência das regras e redução dos problemas de comportamento dos filhos. Relativamente à implementação do ACT-RSK, os pais valorizaram os conteúdos abordados e a pertença ao grupo. Contudo, os participantes identificaram barreiras pessoais e do programa, tais como a falta de disponibilidade e o facto de considerarem algumas sessões menos úteis. Neste estudo, são discutidas as implicações dos resultados e apresentadas futuras linhas de investigação.

A Systematic Literature Review of the ACT Raising Safe Kids Parenting Program

The ACT Raising Safe Kids Program is a research-based parenting intervention developed by the American Psychological Association to teach caregivers positive parenting skills and prevent violence. It has been implemented and evaluated in several countries. This study conducted a systematic review of the literature evaluating the ACT Program to identify its current state of the art. Reporting follows PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines. Searches were conducted from 2000 to October 2018 in the following databases: CAPES, PsycINFO, SciELO, Scopus and Web of Science. Thirteen empirical studies evaluating the program were found: 3 evaluated workshops for facilitators and 10 evaluated caregiver-training programs. All studies reported positive effects of the ACT program on knowledge held by both facilitators and caregivers, such as significant increase of positive parenting and decrease of corporal punishment. Overall 10 studies demonstrated the effectiveness of the program, 4 of these using quasi-experimental research designs and 6 studies through pre-experimental research designs. Three assessed the program’s efficacy by using experimental group designs with randomized controlled trials (RCT). Retention rates of the interventions are compared and research strategies to foster retention are listed. The authors of the studies identified the data collected exclusively on self-reports as one of the main limitations, and suggested the use of third-party information and/or observational measures to evaluate direct behavior changes. The ACT Program’s current state of the art is promising, and further RCT studies are needed to consolidate it as an evidence-based parenting program.

The effects of two early parenting interventions on child aggression and risk for violence in Brazil (The PI\xc1 Trial): protocol for a randomised controlled trial

BackgroundChildren in many low- and middle-income countries (LMICs) are at high risk for exposure to violence and later violent behaviour. The World Health Organization has declared an urgent need for the evaluation and implementation of low-cost parenting interventions in LMICs to prevent violence. Two areas of significant early risk are harsh parenting and poor child cognitive and socio-emotional development. Parenting interventions suitable for LMIC contexts have been developed targeting these risk factors and have been shown to have promising effects. However, their impact on child aggression, a key precursor of violence, has yet to be determined. The Pelotas Trial of Parenting Interventions for Aggression (PIÁ) has been designed to address this issue.MethodsWe are conducting a randomised controlled trial to evaluate two early parenting interventions for mothers of children aged between 30 and 42 months in a Brazilian city. The first of these, dialogic book-sharing (DBS), aims to promote child cognitive and socio-emotional development; and the second, the ACT Raising Safe Kids Program (ACT), is designed to reduce harsh parenting. These interventions are being compared with a control group receiving neither intervention. Three hundred and sixty-nine families in a birth cohort are being randomly allocated to one of the three groups (DBS, ACT, Control). Facilitators deliver the interventions to groups of five to 10 mothers at weekly sessions for 8 weeks in DBS and 9 weeks in ACT. Independent assessments of parenting and child development are being made before the interventions, shortly afterwards, and at follow-up 6 months later. The primary outcome is child aggression, and the two main secondary outcomes are: (1) child cognitive and socio-emotional development and (2) harsh parenting. Longer-term outcomes will be investigated as the birth cohort is followed into late childhood, adolescence, and adulthood.DiscussionThe Pelotas Trial of Parenting Interventions for Aggression (PIÁ) aims to evaluate the impact of two early parenting interventions on child aggression and several other key risk factors for the development of violence, including aspects of parenting and child cognition and socio-emotional functioning. The study is being carried out in a LMIC context where violence constitutes a major social and health burden. Since the two interventions are brief and, with modest levels of training, readily deliverable in LMIC settings, a demonstration that they benefit parenting and reduce risk factors for violence would be of major significance.Trial registrationBrazilian Ministry of Health Register of Clinical Trials, ID: RBR-2kwfsk. Registered on 6 June 2018.

The role of Aboriginal family workers in delivering a child safety-focused home visiting program for Aboriginal families in an urban region of New South Wales.

Aboriginal Australian children experience higher rates of injury than other Australian children. However, few culturally acceptable programs have been developed or evaluated. The Illawarra Aboriginal Medical Service (IAMS) developed the Safe Homes Safe Kids program as an injury prevention program targeting disadvantaged Aboriginal families with children aged 0-5 in an urban region of New South Wales. Delivered by Aboriginal Family Workers (AFWs), the program aims to reduce childhood injury by raising awareness of safety in the home. A program evaluation was conducted to determine the effectiveness of the home visiting model as an injury prevention program. This study reports on the qualitative interviews which explored the ways in which clients, IAMS staff and external service providers experienced the program and assessed its delivery by the AFWs. A qualitative program evaluation was conducted between January 2014 and June 2015. We report here on the semi-structured interviews undertaken with 34 individuals. The results show increased client engagement in the program; improved child safety knowledge and skills; increased access to services; improved attitudes to home and community safety; and changes in the home safety environment. Safe Homes Safe Kids provides a culturally appropriate child safety program delivered by AFWs to vulnerable families. Clients, IAMS staff and external service were satisfied with the family workers' delivery of the program and the holistic model of service provision. This promising program could be replicated in other Aboriginal health services to address unintentional injury to vulnerable Aboriginal children.

International child abuse prevention: insights from ACT Raising Safe Kids

Evidence-based practices are often viewed as lofty goals endorsed by wealthy academics in developed nations, but impossible to implement in other contexts. This article will provide evidence suggesting that, to the contrary, we can indeed scale up western-developed parenting interventions that can be both effective and warmly received by parents in diverse cultural and economic contexts. This paper gives a brief overview of the ACT Raising Safe Kids Program and summarizes the results of evaluation studies done with parents around the world. It discusses specific strategies facilitators use to modify the program as necessary to fit cultural contexts while also maintaining fidelity, implementing the manualized curriculum under varied, and complex circumstances. It is hoped that the lessons learned from our work will inspire practitioners to adapt ACT or other programs to diverse contexts, evaluate those programs, and thereby improve the mental health and life trajectories of children and families around the world.

ACT Raising Safe Kids Program to promote positive maternal parenting practices in different socioeconomic contexts

The present study aimed to evaluate the effectiveness of the ACT – Raising Safe Kids Program in different socioeconomic contexts. The sample included 64 mothers of children aged 3–8 years, and 64 other caregivers, divided into three groups according to family socioeconomic level and type of school of the children (C-Public, B-Public and B-Private). The maternal parenting practices and behavior of the children were evaluated pre- and post-intervention with the ACT Program in group. Regardless of the socioeconomic level of the families and the type of school of the children, the ACT Program was effective in improving maternal parenting practices and behavior of the children, according to the perception of the mothers and other caregivers. The findings demonstrate the validity of the ACT Program in Brazilian context for socioeconomic levels B and C and public and private schools.

Um Estudo de caso com o programa parental ACT para educar crianças em ambientes seguros

The aim of this paper is to describe a case study of an intervention conducted with a Brazilian mother using the ACT Raising Safe Kids Program – a universal program to prevent violence against children. This study evaluated behavioral aspects of a mother, and her six-year old son in pre-post intervention measures, and follow-up. The mother fi lled the Brazilian instrument Parental Style Inventory (IEP), as well as the ASEBA (CBCL, ASR and ABCL) prior and after the intervention, and at follow-up; in addition to the ACT Program Assessment Questionnaire after the intervention. The husband fi lled the CBCL and the ABCL in all the study’s phases. Results pointed to a change in parental style after intervention (from “High Average” to “Excellent”). There was agreement between informants about their

A Case Study with the ACT Raising Safe Kids Parenting Program

The aim of this paper is to describe a case study of an intervention conducted with a Brazilian mother using the ACT Raising Safe Kids Program – a universal program to prevent violence against children. This study evaluated behavioral aspects of the mother and her six-year old son with pre-post intervention measures, and follow-up. The mother fi lled the Brazilian instrument Parental Style Inventory (IEP), as well as the ASEBA (CBCL, ASR and ABCL) prior and after the intervention, and at follow-up; in addition to the ACT Program Assessment Questionnaire after the intervention. The husband fi lled the CBCL and the ABCL in all the study’s phases. Results pointed to a change in parental style after inter

A multi-site study of the ACT Raising Safe Kids program: Predictors of outcomes and attrition

The present study examined the factors related to attrition and treatment outcomes in the ACT-Raising Safe Kids (ACT-RSK) program. ACT-RSK is a family violence and child abuse prevention program for parents and caregivers of young children. Sixty parents or caregivers of children aged 9years or younger completed the ACT-RSK group program and the research measures. The study took place at 7 community-based sites in the midwestern United States. Program completers were significantly older than noncompleters, suggesting that parent age relates to attrition from this program. Pre/post comparisons indicated increased nurturing behavior, decreased harsh parenting, and decreased negative discipline, as well as decreased child behavior problems following completion of the ACT-RSK program. Parent age predicted children's outcomes, indicating better results for the children of older parents/caregivers. In addition, pre-test harsh parenting scores predicted children's outcomes, suggesting that families with relatively higher initial levels of parental psychological aggression and corporal punishment had more robust child outcomes following completion of the program.

SUPPORTING POSITIVE PARENTING IN COMMUNITY HEALTH CENTERS: THE ACT RAISING SAFE KIDS PROGRAM

The present study involves an evaluation of the effect of the American Psychological Association's ACT Raising Safe Kids (RSK) program on parenting outcomes for families served by Community Health Centers. The ACT‐RSK program is a primary family violence and child physical abuse prevention program for parents of young children. Parents were trained in effective parenting including nonviolent discipline, child development, anger management, social problem‐solving skills, effects of violent media on children, and methods to protect children from exposure to violence. Results indicate improved nurturing and positive parenting behaviors and lower rates of psychologically and physically aggressive behavior toward children. These improvements occurred independent of children's age and prior levels of aggression. Use of this model within healthcare settings has the potential to more effectively address parents’ needs for parenting guidance while reducing the likelihood of child maltreatment.

Pilot Evaluation of the ACT Raising Safe Kids Program on Children’s Bullying Behavior

Research documents that parents play a critical role in the development and maintenance of behavior problems in children. Few bullying prevention programs, however, target children in early childhood or include a parenting component in spite of experts recommending that parent training in behavior management be addressed. Based upon these recommendations, the present study examines the relationship among parent characteristics (hostility, depression, and overall parenting skills) and child bullying and the effects of the American Psychological Association’s ACT Raising Safe Kids program on reducing early childhood bullying. The ACT-RSK program is a primary family violence and child physical abuse prevention program for parents of young children. Fifty-two parents/caregivers, representing children ages 4–10, completed the Brief Symptom Inventory, the ACT Parents Raising Safe Kids Scale, and Early Childhood Bullying Questionnaire (derived from the Child Behavior Checklist and Strengths and Difficulties Questionnaire). Twenty-five of these parents/caregivers were trained in effective parenting including nonviolent discipline, child development, anger management, social problem-solving skills, effects of violent media on children, and methods to protect children from exposure to violence through the ACT-RSK program. The remaining 27 parents/caregivers received treatment as usual. Results indicate decreased bullying in children whose parents completed the ACT-RSK program. Furthermore, of the parent characteristics assessed, parental hostility is the only significant parent predictor for child bullying. These findings suggest the efficacy of this brief intervention for preventing bullying.

Effects of the ACT Raising Safe Kids Parenting Program on Children's Externalizing Problems

Eighty-seven parents and primary caregivers of children aged 10 years or younger participated in a study examining the effects of the ACT Raising Safe Kids program on children's behavior. It was hypothesized that children of caregivers who complete ACT-RSK would demonstrate reduced behavior problems compared to children of caregivers in a treatment-as-usual comparison group. Results indicated that the behavior of children of treated caregivers improved significantly more than comparisons on a measure of conduct problems. Although further research is needed, these results suggest that ACT-RSK may contribute to the prevention of behavior problems in early childhood.

Recognizing the Payoff for Investing in Prevention

Early in August, we had a major victory for prevention. The U.S. Department of Health and Human Services released requirements for new health insurance plans to cover eight preventive women’s health services at no cost for women (Institute of Medicine 2011). The recommended services are screenings for gestational diabetes, cervical cancer, HIV, and sexually transmitted infections; lactation counseling and breastfeeding support; screening and counseling for domestic violence; contraception; and yearly preventive care visits. These services were recommended by the Institute of Medicine Committee on Preventive Services for Women, who carefully considered the evidence upon which they based their recommendations. Major victories such as this one are the result of years of research from prevention scientists to understand modifiable risk factors; develop and test methods of screening and intervention; translate effective programs into practice; conduct effectiveness studies that also examine cost, dissemination, and adoption; and conduct methodological studies to strengthen the ways in which we research these topics. Manuscripts in this issue address important prevention topics such as drug use prevention in youth, the promotion of positive behaviors among young girls, an environmental intervention to increase access to fresh fruits and vegetables, the prevalence and emergence of cigar and cigarillo use among teens, suicide prevention, prevention of abuse, and ways Native American youth access health information. Studies in this issue reflect the prevention research continuum, from conducting needs assessments to more rigorous randomized designs. For example, the Rushing and Stephens article examines new technological avenues for reaching American Indian and Alaska Native youth, finding that as many as 75% of those youth reported searching online for health information. These data are already being used to design technology-based interventions for this high-risk population. At the other end of the research spectrum, Portwood and colleagues conducted a randomized trial to examine the impact of a primary prevention program, finding that the Adults and Children Together Against Violence Parents Raising Safe Kids program is a promising strategy to reduce child maltreatment in diverse communities. Another article by Cross and colleagues reminds us of the importance of training others to be agents of public health by examining approaches to better enhance and maintain suicide prevention gatekeeper skills over time. S. R. Tortolero (&) Health Promotion and Behavioral Sciences, The University of Texas School of Public Health, Houston, TX, USA e-mail: Susan.Tortolero@uth.tmc.edu