Using consumer preference information to increase the reach and impact of media-based parenting interventions in a public health approach to parenting support

Within a public health approach to improving parenting, the mass media offer a potentially more efficient and affordable format for directly reaching a large number of parents with evidence-based parenting information than do traditional approaches to parenting interventions that require delivery by a practitioner. Little is known, however, about factors associated with parents' interest in and willingness to watch video messages about parenting. Knowledge of consumer preferences could inform the effective design of media interventions to maximize parental engagement in the parenting messages. This study examined parents' preferred formats for receiving parenting information, as well as family sociodemographic and child behavior factors that predict parents' ratings of acceptability of a media-based parenting intervention. An ethnically diverse sample of 162 parents of children ages 3-6 years reported their preferences for various delivery formats for parenting information and provided feedback on a prototype episode of a video-format parenting program based on the Triple P Positive Parenting Program. Parents reported the strongest preference for self-administered delivery formats such as television, online programs, and written materials; the least preferred formats were home visits, therapists, and multiweek parenting groups. Parents' ratings of engagement, watchability, and realism of the prototype parenting episode were quite strong. Parents whose children exhibited clinical levels of problem behaviors rated the episode as more watchable, engaging, and realistic. Mothers also rated the episodes as more engaging and realistic than did fathers. Lower income marginally predicted higher watchability ratings. Minority status and expectations of future problems did not predict acceptability ratings. The results suggest that the episode had broad appeal across groups.     

Triple P-Positive Parenting Program: Towards an Empirically Validated Multilevel Parenting and Family Support Strategy for the Prevention of Behavior and Emotional Problems in Children

This paper outlines the theoretical and empirical foundations of a unique multilevel parenting and family support strategy designed to reduce the prevalence of behavioral and emotional problems in preadolescent children. The program known as Triple P-Positive Parenting Program is a multilevel system of family intervention, which provides five levels of intervention of increasing strength. These interventions include a universal population-level media information campaign targeting all parents, two levels of brief primary care consultations targeting mild behavior problems, and two more intensive parent training and family intervention programs for children at risk for more severe behavioral problems. The program aims to determine the minimally sufficient intervention a parent requires in order to deflect a child away from a trajectory towards more serious problems. The self-regulation of parental skill is a central construct in the program. The program uses flexible delivery modalities (including individual face-to-face, group, telephone assisted, and self-directed programs) to tailor the strength of the intervention to the requirements of individual families. Its multidisciplinary, preventive and community-wide focus gives the program wide reach, permitting the targeting of destigmatized access points through primary care services for families who are reluctant to participate in parenting skills programs. The available empirical evidence supporting the efficacy of the program is discussed and its implications for research on dissemination are discussed.     

Population-Wide Parenting Intervention Training: Initial Feasibility

A population-level approach to deliver parenting and family support is a necessary but neglected approach needed to reduce the high prevalence of emotional/behavioral problems in children, decrease inadequate and potentially abusive parenting practices, and to provide improved parenting support to all parents within a specified population. We examined the initial feasibility of a large-scale professional training regimen to prepare existing service providers to implement an evidence-based preventive intervention in the realm of parenting and family support. Data from the U.S. Triple P System Population Trial are used to illustrate how a parenting and family support intervention can be successfully disseminated to a large, multidisciplinary workforce. We discuss lessons learned from this dissemination effort as well as implications for population-based approaches to child and family well-being.     

EARLY PARENTING SUPPORT AND INFORMATION: A CONSUMER PERSPECTIVE

The transition to parenthood is a period of both joy and challenge for most parents. There is a recognized need to support parents during this period, yet existing interventions have shown limited evidence of efficacy. This study takes a consumer‐focused approach to examine the needs and preferences of parents both prenatally (n = 77) and postnatally (n = 123) for parenting support. The study used a cross‐sectional design with a purpose‐built online survey. Parents were recruited via online forums, Facebook and parenting blogs, childcare centers, and playgroups. In general, all parents were satisfied with their current levels of both formal and informal support, and about one fourth of parents had accessed a parenting intervention. Parents expressed a moderate level of interest in additional parenting information, and parents expecting their first baby indicated preferences for information about basic baby care needs whereas postnatally, parents expressed more interest in topics around self‐care and behavior management. The implications for developing interventions and engaging families are discussed.     

Do Parents Benefit From Help When Completing a Self-Guided Parenting Program Online? A Randomized Controlled Trial Comparing Triple P Online With and Without Telephone Support

In response to recent increases in the dissemination of Web-based parenting supports, an important consideration is whether the core benefits of self-directed participation in online parenting interventions are counterbalanced by issues such as high dropout and noncompletion rates commonly reported within the Internet intervention literature. This study outlines a randomized controlled trial of Triple P Online, a Web-based variant of the Triple P—Positive Parenting Program, delivered with varied levels of support scaffolding. Participants were 183 parents of children between 1 and 8 years of age with concerns about their child’s behavior and at least one area of disadvantage or family difficulty. Participants were randomized to self-directed Triple P Online, telephone-supported Triple P Online, or a wait-list control. Primary outcomes measured at baseline, postintervention, and 5-month follow-up were negative parenting styles and child behavior problems. Secondary outcomes included parent confidence, anger, and adjustment; relationship quality; program engagement; and parent satisfaction. Self-directed participants showed short-term treatment effects, including reductions in overall negative parenting and frequency of child behavior problems, while practitioner support led to greater improvements in negative parenting and intensity of difficult child behaviors. Participants in the supported condition were also more likely to complete modules and reported greater program satisfaction. At follow-up, 50% of outcomes for the self-directed condition were significantly better than the control, while 94% of outcomes were significantly better than the control in the practitioner-supported condition. Although self-directed online approaches to parenting intervention are promising, this research highlights how minimal support can improve effective engagement and enhance outcomes for families.     

"Queremos Aprender": Latino Immigrants' Call to Integrate Cultural Adaptation with Best Practice Knowledge in a Parenting Intervention

Despite the unique and challenging circumstances confronting Latino immigrant families, debate still exists as to the need to culturally adapt evidence-based interventions for dissemination with this population. Following the grounded theory approach, the current qualitative investigation utilized focus group interviews with 83 Latino immigrant parents to explore the relevance of culturally adapting an evidence-based parenting intervention to be disseminated within this population. Findings from this study indicate that Latino immigrant parents want to participate in a culturally adapted parenting intervention as long as it is culturally relevant, respectful, and responsive to their life experiences. Research results also suggest that the parenting skills participants seek to enhance are among those commonly targeted by evidence-based parenting interventions. This study contributes to the cultural adaptation/fidelity balance debate by highlighting the necessity of exploring ways to develop culturally adapted interventions characterized by high cultural relevance, as well as high fidelity to the core components that have established efficacy for evidence-based parenting interventions.     

Intervention research: Integrating practice guidelines with dissemination strategies-A rejoinder to Paul, Stuve, and Cross

Paul, Stuve, and Cross (this issue) misunderstood the importance of the token economy described by Morisse et al. (1996) because they evaluated it solely from a clinical research perspective. Intervention research is a broader paradigm that describes the development of effective interventions via a series of research activities including basic psychological research, clinical research, and dissemination research. Given the wisdom of intervention research, we address three points made by our colleagues: (a) mental health staff should not adapt empirically validated practice guidelines to meet the needs of their program; (b) total-quality-management strategies like Interactive Staff Training should not drive dissemination efforts because they have little empirical support; and (c) user-friendly programs are inappropriate and unethical because they ignore consumer interests.     

Enhancing Initial Parental Engagement in Interventions for Parents of Young Children: A Systematic Review of Experimental Studies

Low rates of participation in parenting interventions may undermine their effectiveness. Although a wide range of strategies to engage parents in interventions are described in the literature, little is known about which engagement strategies are most effective in enhancing parental engagement. This systematic review explores effective engagement strategies to encourage initial parental engagement (recruitment, enrolment, and first attendance) in parenting interventions for parents of children aged 2–8 years old. This review was conducted based on the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions (Higgins and Green 2011) and the Preferred Reporting Items for Systematic Review and Meta-Analysis (Moher et al. 2009). Electronic systematic searches from January 1996 to August 2017 were conducted in PsycINFO, Scopus, ProQuest Social Sciences Journals, CINAHL, and PubMed databases. Eight studies met the inclusion criteria representing 1952 parents from four different countries. Of the engagement strategies tested in included studies (monetary incentive, setting, testimonial, advertisement, and engagement package), three strategies (advertisement, incentive, and engagement package) showed a significant effect on a stage of engagement, but none across stages. The low methodological quality of the selected studies limits their generalisability and thus provides limited evidence regarding effective engagement strategies to increase recruitment, enrolment, and first attendance rates in parenting interventions. There is a need for further, more methodologically rigorous, research evidence regarding how to engage parents more effectively in the early stages of parenting interventions.     

Parenting and Prematurity: Understanding Parent Experience and Preferences for Support

Infants born very preterm are at risk of developmental and behavioural problems and their parents are at risk of psychological distress and compromised parenting. This study has two key aims: (1) to identify, from the parents’ own perspective, the unique aspects of parenting an infant born very preterm and (2) to assess parent preferences for support including opinions of a new, tailored parenting intervention, Prem Baby Positive Parenting Program (Triple P). A qualitative approach was taken with focus groups of 18 parents of infants born preterm and a thematic analysis conducted. Parents identified several unique aspects of parenting an infant born preterm including: difficulty coping with the stress of hospitalisation; institutionalisation to the hospital environment; a lack of preparation for the transition to parenthood; grief; isolation; getting into “bad parenting habits” of overnurturance and a lack of certainty about developmental expectations. Parents preferred parenting support that is tailored to parents of infants born preterm, has flexible delivery, enhances coping skills and the spousal relationship and is sensitive to the emotional context of parenting an infant born preterm. Understanding the experiences and the preferences of parents of infants born preterm is an important step in tailoring parenting interventions to fit their needs.     

Little Children with Big Worries: Addressing the Needs of Young,Anxious Children and the Problem of Parent Engagement

Anxiety disorders in preschool-age children represent an important clinical problem due to high prevalence, substantial impairment, persistence, and associated risk for later emotional problems. Early intervention may mitigate these problems by capitalizing on a strategic developmental period. Elevated neuroplasticity, availability of screening tools, and the potential to modify parenting practices position anxiety as a good candidate for early intervention and preventive efforts. While some novel interventions show promise, the broad success of such programs will largely depend on parent engagement. Since parents are less likely to identify and seek help for anxiety problems compared to other childhood behavior problems, especially in a preventive manner, methods for understanding parents’ decisions to participate and enhancing levels of engagement are central to the success of early childhood anxiety prevention and intervention. Understanding these processes is particularly important for families characterized by sociodemographic adversity, which have been underrepresented in anxiety treatment research. This review summarizes the developmental phenomenology of early emerging anxiety symptoms, the rationale for early intervention, and the current state of research on interventions for young, anxious children. The roles of parent engagement and help-seeking processes are emphasized, especially among economically disadvantaged and ethnic minority communities who are acutely at risk. Evidence-based strategies to enhance parent engagement to facilitate the development and dissemination of efficacious programs are offered.     

Parent training with high-risk immigrant chinese families: a pilot group randomized trial yielding practice-based evidence

We studied the efficacy and implementation outcomes of a culturally responsive parent training (PT) program. Fifty-four Chinese American parents participated in a wait-list controlled group randomized trial (32 immediate treatment, 22 delayed treatment) of a 14-week intervention designed to address the needs of high-risk immigrant families. Parents were eligible for intervention if they were Chinese-speaking immigrants referred from schools, community clinics, or child protective services with concerns about parenting or child behavior problems. Retention and engagement were high with 83% of families attending 10 or more sessions. Results revealed that the treatment was efficacious in reducing negative discipline, increasing positive parenting, and decreasing child externalizing and internalizing problems. Treatment effects were larger among families with higher levels of baseline behavior problems and lower levels of parenting stress. Further augmentation of PT to address immigrant parent stress may be warranted. Qualitative impressions from group leaders suggested that slower pacing and increased rehearsal of skills may improve efficacy for immigrant parents unfamiliar with skills introduced in PT.     

Computer-based intervention with coaching: an example using the Incredible Years program

Increases in personal computer ownership and Internet use patterns provide a potential avenue for dissemination of evidence-based prevention and treatment interventions. The authors describe the implementation of a psychoeducational intervention (the Incredible Years parenting program, which is designed to promote behavioral change in parents and children) using a hybrid model combining computer- and web-based delivery with professional intervention via phone calls, electronic messages, and home visits. The model attempted to simulate many of the parent training methods shown to be successful in the original program. The intervention was implemented with 90 Head Start families who reported elevated levels of child behavior problems. Of the 45 families offered the intervention in the final year of the project, 37 (82%) completed at least half the program and 34 (76%) completed the entire intervention using procedures refined in light of the initial year's experience. These participants reported high achievement of their self-determined goals and were highly satisfied with the intervention. The combination of technology with professional coaching represents a potential model for adapting and disseminating evidence-based interventions.     

Computer‐Based Intervention with Coaching: An Example Using the Incredible Years Program

Increases in personal computer ownership and Internet use patterns provide a potential avenue for dissemination of evidence‐based prevention and treatment interventions. The authors describe the implementation of a psychoeducational intervention (the Incredible Years parenting program, which is designed to promote behavioral change in parents and children) using a hybrid model combining computer‐ and web‐based delivery with professional intervention via phone calls, electronic messages, and home visits. The model attempted to simulate many of the parent training methods shown to be successful in the original program. The intervention was implemented with 90 Head Start families who reported elevated levels of child behavior problems. Of the 45 families offered the intervention in the final year of the project, 37 (82%) completed at least half the program and 34 (76%) completed the entire intervention using procedures refined in light of the initial year's experience. These participants reported high achievement of their self‐determined goals and were highly satisfied with the intervention. The combination of technology with professional coaching represents a potential model for adapting and disseminating evidence‐based interventions.     

Increasing parenting self-efficacy: The Fussy Baby Network® intervention

High levels of infant crying place families at risk for disrupted relationships, parenting stress, and even for child maltreatment. We conducted an evaluation of the Fussy Baby Network^® (FBN), a program supporting families struggling with infant crying and related concerns. The study contrasted 29 families who sought help from FBN with 27 families with excessively crying infants who did not seek services. Researchers measured parenting self-efficacy, depression, and stress in each group before and after the intervention. Results from hierarchical multiple regression analysis indicated greater improvements over time in parenting self-efficacy for parents receiving FBN services. Furthermore, the greater improvements in parenting self-efficacy in the intervention group were not directly attributable to reductions in infant crying. These findings provide preliminary evidence that the FBN approach may be effective at boosting the confidence of parents struggling with caring for their infants. Future research with larger samples with baseline equivalence and stronger research designs should explore this intervention further. This study also suggests that interventions for families with excessively crying infants should move beyond the focus of reducing infant crying to a broader strategy of supporting parents and strengthening relationships between parents and their infants to build parenting capacity.     

A Model of Intention to Participate in Parenting Interventions: The Role of Parent Cognitions and Behaviors

A wide range of factors, from perceived child behavior problems to sociocultural factors, have been identified as impacting the engagement of parents in parenting interventions. However, parents’ cognitions and behaviors have not been evaluated sufficiently to understand their role in initial parental engagement. The current study aimed to examine why some parents are more likely to want to participate in parenting programs and how their cognitions and behaviors are related to their intention to participate in future parenting interventions. We tested the hypothesised model of parental factors on intention to participate using structural equation modelling (SEM) in AMOS. This study (N = 6,733) analyzed existing data from the International Parenting Survey (IPS), a web-based tool developed to collect information about parents’ views on family and parenting at a population level in several countries. Results showed that parents’ coercive parenting, parental consistency, positive encouragement, relationship with their child, parental self-efficacy, psychological distress, and help-seeking behaviors were significantly related to their intention to participate in future parenting interventions. The structural model of parents’ cognitions and behaviors explained 16% of the variance in intention to participate. Although the current model explained a small but significant percentage of the variance, it expands existing understanding regarding parental cognitions and behaviors and their relationship to intention. Implications for further research and engagement practice are discussed.     

Reflective Parenting Programs: Theory and Development

Recent research has indicated that parental reflective functioning or mentalization plays a crucial role in the development of a range of healthy adaptations in both parent and child. While many parenting interventions developed over the course of the last 20 years have implicitly attempted to enhance mentalization in parents, this article describes an effort to directly intervene with parents to enhance or encourage the development of reflective capacities. In this article, the broad outlines of a reflective parenting approach are described. Two reflective parenting programs are then considered, one a group intervention designed for low-risk parents, the other a home visiting intervention designed for high-risk parents and children.     

Relating Engagement to Outcomes in Prevention: The Case of a Parenting Program for Couples

Analyses of program engagement can provide critical insight into how program involvement leads to outcomes. This study examines the relation between participant engagement and program outcomes in Family Foundations (FF), a universal preventive intervention designed to help couples manage the transition to parenthood by improving coparenting relationship quality. Previous intent-to-treat outcome analyses from a randomized trial indicate FF improves parental adjustment, interparental relationships, and parenting. Analyses for the current study use the same sample, and yield statistically reliable relations between participant engagement and interparental relationships but not parental adjustment or parenting. Discussion considers implications for FF and the difficulties researchers face when examining the relation between engagement and outcomes in preventive interventions.