Evaluation of a Community-Based Peer-to-Peer Support Program for Parents of At-Risk Youth with Emotional and Behavioral Difficulties

Parents of children with emotional and behavioral needs frequently experience difficulty navigating community-based services for their child, as well as experience increased stress and parental strain. Peer-to-peer support programs are an emerging approach to assist these parents, and evidence suggests that they are effective in increasing parents’ perceptions of social support, self-efficacy, and well-being. However, these programs often focus on parents of youth with diagnosed mental health disorders, despite the potential benefit for parents of youth who are at-risk for significant emotional and behavioral problems. In the current study, we used a pre-post design to evaluate a community-based, peer-to-peer support prevention program delivered via telephone to parents (N = 139) of youth with emerging behavioral and emotional difficulties. We evaluated (1) whether the intervention was delivered as designed, (2) the pre- and post-intervention gains in social support and concrete support, and (3) whether parents’ level of participation in the intervention and program adherence predicted outcomes. Results indicated that the intervention was delivered as intended and resulted in increased parental perceived social support and concrete support over time. Furthermore, higher levels of parental participation and intervention adherence were associated with increases in perceived social support. Thus, findings suggest that it may be beneficial for parents of at-risk youth with significant emotional and behavioral difficulties to engage in a peer-to-peer phone support prevention program.     

Development of a Family-based Program to Reduce Risk and Promote Resilience Among Families Affected by Maternal Depression: Theoretical Basis and Program Description

Depression is a family matter. It not only diminishes the quality-of-life of the depressed person, but also strains the resources of the family unit and increases the children's risk of developing significant problems that start early and persist into adulthood. Although treatment of a parent's depression is critical, many families also need professional intervention to reduce children's risk. This article reviews the evidence on needs of these families and shows that the theoretical and clinical evidence exists to support the design of interventions for families affected by maternal depression. A preventive intervention developed from this foundation is described, the Keeping Families Strong (KFS) program, that is designed to promote resilience and reduce the risk for psychological disorders in children of parents with depression. The pilot study on the KFS program, conducted in adult mental health outpatient settings, is described. Families participate in 10 meetings 90 min each, with a group for parents and for children (10 years and older) conducted concurrently. The program structure and content are described, the challenges of implementing a family preventive intervention in actual clinical settings are discussed, and a case example is provided, as well as preliminary outcome data on ten families. In sum, we provide a strong rationale for the potential of preventive interventions for families affected by maternal depression.     

An evaluation of parents as behavior change agents in the Preschool Life Skills program

Parental involvement in intervention can support intervention efficacy, improve generalization, and increase accessibility. The Preschool Life Skills (PLS) program is designed to teach 13 preschool life skills and prevent problem behavior. The current study explores the utility of the PLS program as delivered by parents. In Experiment 1, 6 parents were taught to use the PLS program at home with their typically developing children (3 years 3 months to 4 years 11 months). This application of the PLS program led to an increase in preschool life skills and a decrease in problem behavior and supported some generalization of the target preschool life skills from the home to preschool settings. In Experiment 2, 7 parents were taught to use the PLS program with their children with autism spectrum disorder (ASD; 3 years 11 months to 6 years 9 months). Results overall supported the parent implementation of the program and highlighted modifications required to support positive outcomes for children with ASD.     

Social Validity of a Training and Coaching Program for Parents of Children With Autism Spectrum Disorder on a Waiting List for Early Behavioral Intervention

Due to limited public resources, many children with autism spectrum disorder and their families must wait several months, if not years, to access early behavioral intervention (EBI) services. Service providers must thus develop alternative support models to assist families placed on waiting lists. The present study assessed the social validity of one such initiative, a training and coaching program for parents whose children had been put on a waiting list for EBI services. This program consisted of group training sessions on strategies to cope with their child’s disorder based on applied behavioral analysis and on one-hour, weekly follow-up meetings to support parents’ interventions with their child over the course of 12 months. Social validity was assessed through parental satisfaction with this program and their perception of its effects on themselves, the family, the child, and parental stress. The 94 participants were generally satisfied with the program overall, although they wished for more frequent and intensive interventions. They reported that the program had positive effects on their psychological well-being, their family’s quality of life, and their child’s behavior. However, parenting stress levels were found to have increased over the 12-month period. These results demonstrate that training and individually supporting parents can be beneficial for families of children with ASD who cannot have access to early behavioral intervention immediately upon receiving a diagnosis. Importantly, however, these lower-cost, parent-focused programs cannot be considered a substitute for more intensive and children-driven services.     

Reducing the Biological and Psychological Toxicity of Poverty-related Stress: Initial Efficacy of the BaSICS Intervention for Early Adolescents

This proof-of-concept study tests the initial efficacy of the Building a Strong Identity and Coping Skills (BaSICS) intervention, a selective prevention of internalizing problems program for early adolescents exposed to high levels of poverty-related stress. Eighty-four early adolescents (M_age = 11.36 years) residing in very low-income neighborhoods were randomized to receive the 16-session intervention (n = 44) or to an assessment-only control condition (n = 40). BaSICS teaches coping skills, social identity development, and collective social action to empower youth with the ability to connect with members of their communities and cope with poverty-related stress in positive and collaborative ways. Pretest–posttest analyses showed that intervention adolescents acquired problem-solving and cognitive-restructuring skills and reduced their reliance on avoidant coping. In addition, HPA reactivity was significantly reduced in the intervention youth, but not controls. Finally, intervention youth's internalizing and somatic symptoms as reported by both youth and their parents, showed significant reductions over time, whereas control youth had no such changes. Results provide strong support for this approach to strength-building and symptom reduction in a population of early adolescents exposed to poverty-related stress.     

Math Intervention For Latino Parents and Kindergarteners Based on Food Routines

Family food routines are important contexts through which children develop math knowledge and skills. The Food For Thought (FFT) program teaches Latino parents strategies to develop their kindergarten children's math abilities during family food routines such as grocery shopping and cooking. We examined whether attendance to FFT was related to children's math outcomes at post-test (right after program completion). Sixty-eight low-income Latino parents and their kindergarten children (M?=?71 months) participated in the four-week program taking place in schools. Children's math skills (counting, numeral recognition and cardinal understanding) were assessed at pre- and post-test. The association between parents' attendance to FFT meetings and children′s math outcomes at post-test depended on children's initial levels of math skills (i.e., math skills at pre-test). Children with lower initial math skills whose parents attended more FFT meetings had more advanced math outcomes at post-test, than children with lower initial math skills whose parents attended fewer FFT meetings. The effect size of this interaction was moderate, d?=?0.46. Limitations and future directions of this early math intervention targeting Latino families are discussed.     

Dr. Susan W. Gray

While Susan W. Gray is known primarily for her work with the Early Training Project, a pioneering early intervention program with low-income black children, she has also influenced the development of school psychology and the creation of Early Childhood Education as a discipline. In addition, in her own quiet way, she has supported the career development of a number of professional women who have had impact on child development, early childhood education, and school psychology. Four major themes are used to present Susan Gray's biography: (1) being ahead of her time in terms of thinking which allowed her to take advantage of opportunities; (2) the role of serendipity versus long-range planning of career trajectories; (3) specific influences on her as a woman; and (4) a lifetime of courage and dedication. Examples of work which was in advance of psychology included work in early intervention with low-income children, an emphasis on the use of scientific experimental methodology in field research, an eclectic approach which crossed disciplinary boundaries, a consultative approach to school psychology, and the inclusion of affective and cognitive education in inter-     

The welcome baby program: A community-based volunteer prevention model of caring,sharing, and support for new parents

Primary prevention is one of the most important components of any community child abuse and neglect program. Welcome Baby is a community-based, volunteer primary prevention program that offers caring, sharing, and support to parents of newborns through hospital visitation and follow-up contacts during the adjustment period that surrounds the birth of a baby. Program goals include personal support for the new mother, prevention of child abuse and neglect by providing support and information for all parents, reinforcement of strengths and support for quality parenting, improving emotional preparation for parenthood, and early identification and intervention for families with the potential for maltreatment. Program rationale and conclusions agree with research findings that early and consistent support and intervention with high-risk families improve the quality of parent-child interaction and significantly reduce the risk of maltreatment. This article outlines the basic philosophy, goals, and operations of this community prevention program.     

Informal Support among Low-Income Mothers Post Welfare Reform:A Systematic Review

The vulnerability and instability of low-income mothers situated in a context with a weak public safety net make informal social support one of few options many low-income mothers have to meet basic needs. This systematic review examines (a) social support as an empirical construct, (b) the restricted availability of one important aspect of social support—informal perceived support, hereafter informal support—among low-income mothers, (c) the role of informal support in maternal, economic, parenting, and child outcomes, (d) the aspects of informal support that influence its effects, and (e) directions for future research. Traditional systematic review methods resulted in an appraisal of 65 articles published between January 1996 and May 2017. Findings indicated that informal support is least available among mothers most in need. Informal support provides some protection from psychological distress, economic hardship, poor parenting practices, and poor child outcomes. To promote informal support and its benefits among low-income families, future research can advance knowledge by defining the quintessential characteristics of informal support, identifying instruments to capture these characteristics, and providing the circumstances in which support can be most beneficial to maternal and child well-being. Consistent measurement and increased understanding of informal support and its nuances can inform intervention design and delivery to strengthen vulnerable mothers’ informal support perceptions thereby improving individual and family outcomes.     

Community Involvement in Adapting and Testing a Prevention Program for Preschoolers Living in Urban Communities: ParentCorps

We describe a university-community collaborative effort to tailor and deliver a prevention program for families of preschoolers living in low-income, urban communities. ParentCorps, which builds on efficacious interventions with parents and young children, aims to promote child social competence and prevent conduct problems by strengthening parenting skills, enhancing support for parents, and empowering parents to access resources in their communities. Active community engagement and collaboration were viewed as critical to the development of the program and its feasibility testing. We present an overview of community involvement in the development of ParentCorps and approaches taken to involve community members during a feasibility study. Areas of success and lessons learned are discussed.     

Training Community Members to Serve as Paraprofessionals in an Evidence-Based,Prevention Program for Parents of Preschoolers

Widespread dissemination of evidence-based programs for underserved populations may require non-traditional means of service provision. Collaboration with paraprofessionals from communities that are targeted for intervention holds promise as a delivery strategy that may make programs more accessible and acceptable, especially to parents living in low-income, urban neighborhoods. We describe a paraprofessional training program for individuals living in a community targeted for preventive intervention based on high levels of poverty and community violence. The design and implementation of the training program are described in the context of issues related to the use of paraprofessionals in community-based, preventive interventions with parents of young children. We also provide insight into lessons learned from a feasibility study as well as general guidelines for the development of paraprofessional training programs for delivery of evidence-based programs.     

Promoting parent academic expectations predicts improved school outcomes for low-income children entering kindergarten

This study explored patterns of change in the REDI (Research-based Developmentally Informed) Parent program (REDI-P), designed to help parents support child learning at the transition into kindergarten. Participants were 200 prekindergarten children attending Head Start (55% European-American, 26% African American, 19% Latino, 56% male, M_age = 4.45 years, SD = 0.29) and their primary caregivers, who were randomized to a 16-session home-visiting intervention (REDI-P) or a control group. Extending beyond a prior study documenting intervention effects on parenting behaviors and child kindergarten outcomes, this study assessed the impact of REDI-P on parent academic expectations, and then explored the degree to which intervention gains in three areas of parenting (parent-child interactive reading, parent-child conversations, parent academic expectations) predicted child outcomes in kindergarten (controlling for baseline values and a set of child and family characteristics). Results showed that REDI-P promoted significant gains in parent academic expectations, which in turn mediated intervention gains in child emergent literacy skills and self-directed learning. Results suggest a need to attend to the beliefs parents hold about their child's academic potential, as well as their behavioral support for child learning, when designing interventions to enhance the school success of children in low-income families.     

Parental Engagement and Barriers to Participation in a Community-Based Preventive Intervention

This study examined parent characteristics and barriers to participation in a community-based preventive intervention with a sample of 201 parents from low-income and predominantly ethnic minority backgrounds. Person-centered analyses revealed five subgroups of parents who demonstrated variability in their parent characteristics, which included psychological resources and level of parental involvement in education. Group membership was associated with differences in school involvement and use of the psychoeducational intervention at home, after accounting for the number of barriers to engagement. For the intervention attendance variable, greater number of barriers was associated with decreased attendance only for parents in the resilient subgroup and the psychologically distressed subgroup. Attendance remained constant across levels of barriers for the other three subgroups of parents. The results of the study inform theory and practice regarding how to tailor preventive interventions to accommodate subgroups of parents within populations that experience barriers to accessing mental health services.     

Parent perceptions of an integrated stuttering treatment and behavioral self-regulation program for early developmental stuttering

PurposeRecent research has identified approximately half of children who stutter present with self-regulation challenges. These manifest in elevated inattentive and/or impulsive behaviours, aligned with attention deficit hyperactivity disorder (ADHD) symptoms. These symptoms have been found to influence the child’s responsiveness to their stuttering treatment, and may exacerbate the psychosocial consequences of stuttering for them and their families. Early stuttering intervention identifies parents as key agents of change in the management of their children’s stuttering. This study sought feedback from parents regarding their experiences with an integrated stuttering treatment and behavioral self-regulation program for early developmental stuttering, addressing the child’s self-regulation challenges.MethodEight parents of children who stutter who had co-occurring self-regulation challenges completed the integrated program. This incorporated the Triple P--Positive Parenting Program adapted for the developmental stuttering population, and the Curtin University Stuttering Program (CUSP). Semi-structured qualitative interviews were conducted to capture parents’ reflections on, and experiences with, the integrated program.ResultsThematic analysis identified several major themes regarding the parents’ experiences with the integrated program: emotional impact on parents, child self-regulation, link between stuttering and behaviour, parent self-regulation, impact on family dynamics, and overall positive perceptions of the integrated program. All of the parents indicated they would recommend the program to future parents of children who stutter.ConclusionThis study provides insights into parents’ perceptions regarding an integrated intervention approach for early stuttering and behavior management. It also indicates how adopting a holistic approach to stuttering intervention is positive and has social validity.     

Parents as Partners: A U.K. Trial of a U.S. Couples‐Based Parenting Intervention For At‐Risk Low‐Income Families

Despite the well‐established links between couple relationship quality and healthy family functioning, and burgeoning evidence from the international intervention field, there is little or no evidence of the efficacy of couples‐based interventions from the United Kingdom (U.K.). This study explored whether the Parents as Partners (PasP) program, a group‐based intervention developed in the United States, brought about the same benefits in the U.K. The evaluation is based on 97 couples with children from communities with high levels of need, recruited to PasP because they are at high risk for parent and child psychopathology. Both mothers and fathers completed self‐report questionnaires assessing parents’ psychological distress, parenting stress, couple relationship quality and conflict, fathers’ involvement in child care and, importantly, children's adjustment. Multilevel modeling analysis comparing parents’ responses pre‐ and postintervention not only showed substantial improvements for both parents on multiple measures of couple relationship quality, but also improvements in parent and child psychopathology. Analyses also indicated most substantial benefits for couples displaying poorest functioning at baseline. The findings provide initial evidence for the successful implementation of PasP, an American‐origin program, in the U.K., and add support for the concept of the couple relationship as a resource by which to strengthen families.     

The transactional model of early home intervention

This article describes a developmental model for early home intervention and treatment of environmentally and biologically at-risk infants and their parents: The Transactional Model of Home Intervention. The model identifies the development of both infants and parents as targets of intervention and considers their ongoing interactions or transactions within the family context as the vehicle of intervention. The child and his physical/social environment are conceptualized as actively influencing one another in their reciprocal transactions. An early intervention program based on this transactional model is described. The intervention is tailored to suit the needs of both child and parents and, more generally, the needs of the family. The intervention process involves a problem-solving model of education by which parents acquire cognitive strategies that will enable them to assess the needs of their child and to design a program to fulfill these needs.     

Resources for health: a primary-care-based diet and physical activity intervention targeting urban Latinos with multiple chronic conditions.

OBJECTIVE: The Resources for Health trial evaluates a social-ecologically based lifestyle (physical activity and diet) intervention targeting low-income, largely Spanish-speaking patients with multiple chronic conditions. DESIGN: A randomized controlled trial was conducted with 200 patients recruited from an urban community health center and assigned to intervention and usual care conditions. Intervention involved 2 face-to-face, self-management support and community linkage sessions with a health educator, 3 follow-up phone calls, and 3 tailored newsletters. MAIN OUTCOME MEASURES: Primary outcomes measured at 6-months were changes in dietary behavior and physical activity. Changes in multilevel support for healthy living were evaluated as a secondary outcome. RESULTS: After adjustment for age, sex, language, and number of chronic conditions, significant intervention effects were observed for dietary behavior and multilevel support for healthy lifestyles but not for physical activity. CONCLUSION: The Resources for Health intervention provides an effective and practical model for improving health behavior among low-income, Spanish-speaking patients with multiple chronic conditions.     

Parenting Intervention to Reduce Attention and Behavior Difficulties in Preschoolers: A CUIDAR Evaluation Study

In this study, we evaluated CUIDAR, a program that provides community-based 10-week parent training to reduce attention and behavior problems in preschool children. We recruited 154 predominantly low-income and Latino preschoolers and their parents to participate in this evaluation study. We collected data prior to and immediately following intervention and one year later. At the time of follow-up, we also recruited 15 parents who had initially enrolled, but never participated in the program to serve as a comparison group for a limited set of analyses. From pre to post intervention, we observed significant, positive changes in eight out of ten measured parenting behaviors. From pre intervention to follow-up, improvements in the use of transitional statements and planning ahead were significant. Children’s SDQ Total Difficulties scores significantly decreased from pre to post intervention (d = .36), and we observed significant, positive changes in all SDQ subscales. From pre intervention to follow-up, children’s SDQ Total Difficulties scores significantly decreased (d = .71) and all SDQ subscales reflected significant, positive changes. We observed no significant differences in reported barriers to participation between parents who participated in the program and those who enrolled, but never participated. Intervention gains were moderated by several factors, including history of out-of-home care and family structure. Our results should be interpreted cautiously because not all analyses included a comparison group, and a randomized trial of CUIDAR effectiveness is still needed.     

Parent and Staff Uncertainties Regarding the Philosophy of Early Intervention in a Preschool Autism Program

This study investigated the influences of dominant paradigms in the field of autism on the attitudes and beliefs of stakeholders in an early intervention (EI) program for children with autism. This EI program is based on a developmental approach with the premise that intensive intervention in young children (ages 2–6 years) can change their developmental trajectory given the brain's plasticity. This study was based on 48 interviews with parents and staff, as well as three focus groups with stakeholders at a program serving young children with autism. Qualitative data analysis revealed that parents and staff were most influenced by the curative aspect of the medical model while they did not commonly demonstrate adherence to the principles of EI. Parents also revealed conflicting attitudes simultaneously, as many of them expressed wishes for their children to be cured of autism while at the same time wanting that interventions would continue indefinitely.     

Effects of a televised smoking cessation intervention among low-income and minority smokers

In November 1985, a television smoking cessation program was broadcast for 20 days on the noon and 9 p.m. news. Smokers in West Garfield Park, an inner-city impoverished area of Chicago, were randomly assigned either to a comprehensive intervention or to a no-intervention control condition. Although 100,000 self-help manuals had been distributed throughout Chicago, none of the controls in this low-income area had obtained a manual. The intervention consisted of providing the smokers a self-help manual, the televised broadcast, weekly support meetings, and supportive phone calls. At a 4-month follow-up, 20% of treatment participants were abstinent compared to 9% of controls. The results indicated that intensive supplementary opportunities enhanced participation by low-income smokers in a media smoking cessation program.