Home‐based intervention after discharge for Latino families of low‐birth‐weight infants

A home‐based intervention designed for impoverished Latino families of low‐birth‐weight infants was implemented, and the efficacy assessed for infants and mothers. Specially trained public health nurses visited the participants' homes for 4 months for the “short” and 12 months for the “extended” intervention groups. Mothers received support and training in infant care. A third group did not receive the intervention. Assessments were at 4‐ to 6‐month intervals from 1 to 24 months. Although the extended visitation group showed no benefits from the intervention, the short visitation group had higher scores on maternal confidence at one month, and on the Bayley Mental Scores at four months than the group receiving no intervention and extended intervention. The nonvisitation group scored significantly higher than both intervention groups on the HOME scores and on the Mother–Infant Interaction and Feeding scores at three different assessment periods. These data suggest that for poor Latino families home intervention is not beneficial across the board. Instead, efforts should be made to identify families that could benefit from intervention and to tailor the program to the specific needs of Latino families. © 2000 Michigan Association for Infant Mental Health.     

Parenting of low birth weight infants: A review of issues and interventions

Factors that may adversely affect parenting of low birth weight infants, including infant characteristics, parental emotional responses to premature birth, and patterns of parent-infant interaction, are reviewed. In addition, intervention studies designed to improve infant developmental outcomes through influencing parenting behaviors are examined. There was great diversity in theoretical frameworks, in timing of onset and frequency of interventions, and in measurement of outcomes. The interventions that were most effective in influencing behaviors and infant developmental outcomes were those in which there were multiple long-term contacts with parents and/or those that actively involved them in the intervention. The specific theoretical framework upon which the interventions were based appeared to be of less importance in influencing results. In order to increase our knowledge and ability to provide costeffective programs, there is a need to focus attention and data collection efforts on the process and intermediary steps of intervention as well as on outcome measures. There is also a need to improve our ability to recruit and retain those families who are most at risk for parenting and infant developmental problems including those with very low birth weight infants, those whose infants have serious perinatal complications, and those with indications of high social risk such as poverty-level incomes and problems of substance abuse.     

Increasing access to low‐intensity interventions for childhood anxiety: A pilot study of a guided self‐help program for Scandinavian parents

Cognitive Behavior Therapy (CBT) is an effective treatment for child anxiety. However, access to treatment is limited. It has been suggested that low‐intensity formats of parent‐delivered CBT may improve access to treatment. Our aim was to develop and pilot‐test the acceptability and effect of a low‐intensity therapist‐guided parent‐delivered group program for anxious children (age 7–12 years) adjusted to the Scandinavian culture. The program required 1.5 hours of therapist‐time per family. Mothers, fathers and children reported on revised child anxiety and depression scale (RCADS) at referral, pre‐ and post‐treatment. Mothers and fathers also gave a qualitative account of their experiences. Thirty‐one families were enrolled and only one family dropped out. Mean age of the children was 9 years. Intent‐to‐treat analyses revealed significant reductions in anxiety and depressive symptoms from pre‐ to post‐treatment for all informants. Large effect sizes were found for child anxiety symptoms as reported by mothers and fathers, and for child depressive symptoms as reported by mothers. Medium to large effect sizes was found for the self‐reported anxiety symptoms by the children, and for depressive symptoms reported by both children and fathers. More than 93% of the parents would recommend the program. Results suggest that our program may provide a new approach to improve access to treatment for anxious children in Scandinavia; however, further research must be conducted before firm conclusions can be drawn.     

A review of behavioral interventions to enhance sports performance

Research on applied behavior analysis and sports performance has become an increasingly popular subject. It involves using behavioral measures to assess the utility of numerous interventions to enhance athletic performance. We identified 101 studies published since the late 1960s focusing on behavioral interventions to enhance sports performance. To determine the breadth of the current research, we identified each sport and the different interventions used to improve performance. Of the studies included in this review, research has investigated 23 interventions with 21 sports. The purpose of this paper is to review the current literature regarding what procedures have been evaluated, the results of this research, some of the limitations, and future directions of behavioral research on sports performance enhancement. In doing so, this review will allow readers to easily browse the current literature by the sport or intervention of interest.     

A review of behavioral approaches to weight control

Forty case reports and experimental studies of behavioral approaches to weight control were reviewed. The treatments, categorized as: aversive conditioning, covert sensitization, coverant conditioning, therapist controlled reinforcement and self-control of eating, were evaluated in terms of their empirical support. It was suggested that self-control procedures may be the most promising treatment, particularly when used in conjunction with therapist controlled reinforcement. Methodological difficulties and implications for future research were discussed.     

Adolescent vulnerability: A framework for behavioral interventions

A general framework is offered for characterizing behavioral risks in a way that might help coordinate behavioral interventions. It is demonstrated in terms of adolescents' vulnerability, arising from the life situations confronting teens, from teens' understanding of those situations, and from the beliefs of those entrusted with helping them (parents, educators, psychologists, etc.). The framework provides a rationale for identifying opportunities to reduce adolescent vulnerability, based on research regarding the genesis and control of risks. It provides a common language for characterizing alternative theoretical approachs to these issues and a systematic way to integrate their results. It is illustrated with results from research on the role of information in determining adolescent vulnerability.     

Informal social support characteristics and utilization of parenting support services among low‐income African American mothers of premature infants

Service delivery efforts to attenuate the risks associated with parenting premature infants in poverty often are compromised because those at greatest risk do not use available parenting support services. Yet, relatively little is known about the networks of support surrounding these parents. This study investigated both the characteristics of informal social support within a sample of 31 low‐income, African American mothers of premature infants at high risk for parenting difficulties and their use of community parenting support services. The findings suggest that mothers had small (M = 4.97, SD = 1.80), but highly mobilized, social support networks consisting primarily of family members. Among six different types of support, informational guidance and parenting support were available from the fewest people in participants' networks. Only 32.3% of the sample was aware of and 16.1% of the sample had ever used formal parenting support services. Participants who had received informal support from more than five people in the last month were significantly more likely to have knowledge about existing community parenting support services than those receiving support from smaller social networks. Patterns of knowledge about and utilization of services were examined with regard to network characteristics, perceived maternal desire for more parenting support opportunities than were available, and presence of special needs in the child. The implications of these findings for parenting support programs are discussed. ©2002 Michigan Association for Infant Mental Health.     

Disorganized infant attachment and preventive interventions: A review and meta‐analysis

Infant disorganized attachment is a major risk factor for problematic stress management and later problem behavior. Can the emergence of attachment disorganization be prevented? The current narrative review and quantitative meta‐analysis involves 15 preventive interventions (N = 842) that included infant disorganized attachment as an outcome measure. The effectiveness of the interventions ranged from negative to positive, with an overall effect size of d = 0.05 (ns). Effective interventions started after 6 months of the infant's age (d = 0.23). Interventions that focused on sensitivity only were significantly more effective in reducing attachment disorganization (d = 0.24) than interventions that (also) focused on support and parent's mental representations (d = ?0.04). Most sample characteristics were not associated with differences in effect sizes, but studies with children at risk were more successful (d = 0.29) than studies with at‐risk parents (d = ?0.10), and studies on samples with higher percentages of disorganized attachment in the control groups were more effective (d = 0.31) than studies with lower percentages of disorganized children in the control group (d = ?0.18). The meta‐analysis shows that disorganized attachments may change as a side effect of sensitivity‐focused interventions, but it also illustrates the need for interventions specifically focusing on the prevention of disorganization.     

Psychological aspects of childbirth: Evidence for a birth‐related mindset

Psychological research on childbirth is rare, even though research from other scientific fields such as obstetrics or midwifery highlights the importance of psychological factors in childbirth. In this article, the theoretical construct of a birth‐related mindset and direct and indirect measures for assessing the mindset are proposed. It is assumed that childbirth can be mentally presented as a rather natural (natural mindset) or a rather medicalized (medicalized mindset) event. In three online studies (Study 1: N = 117, Study 2: N = 206, Study 3: N = 192), we aimed to explore whether the proposed birth‐related mindset is related to the retrospectively reported process of labor and birth (operationalized, e.g., by performed interventions, duration of birth, place of birth). For this, the relation between the mothers’ birth‐related decisions and outcomes of childbirth and the mothers' birth‐related mindsets were analyzed. Results indicated that (1) birth‐related criteria such as place of birth, epidural anesthesia, and C‐sections were associated with the birth‐related mindset, (2) these aspects of the delivery were related to the evaluation of the birth (birth experience), (3) the birth‐related mindset moderated the relationship between C‐section and birth experience, and (4) the indirect measures had little to no added explanatory value to the developed Mindset and Birth Questionnaire. Thus, the results indicate that the birth process experienced by the women and the mental representations of birth (birth‐related mindset) are closely related. Future studies need to investigate to what extend the experienced birth process influences the mindset of birth, or the mindset the experienced birth process, or both.     

Effectiveness of the home‐start parenting support program: Behavioral outcomes for parents and children

This study examined effectiveness of Home‐Start, a program designed to support parents with young children. The aims were (a) to examine whether Home‐Start improved maternal well‐being and (b) to examine whether Home‐Start led to changes in the behavior of mothers or children. Self‐reported and observational data were collected in two waves, using data from 54 mothers and their children between 1.5 and 3.5 years of age who participated in this intervention program for 6 months. These data were compared to 51 comparison families who reported need for parenting support. The results showed a significant improvement in perceived parenting competence, but no effects on maternal depressive moods. Mixed results were found for parenting behavior: Parental consistency and observed sensitivity improved significantly in the Home‐Start group whereas no effects were found on the other parenting variables. Child behavioral problems seemed to diminish at the second measurement in both groups, and therefore these changes cannot be attributed to Home‐Start.     

Parent‐selected interventions for infants at‐risk for autism spectrum disorders and their affected siblings

Infants with older siblings having Autism Spectrum Disorders (ASD) are at genetically increased risk for showing characteristics of ASD in the first 2 years of life. Parents, who already have at least one child with ASD, may closely monitor their later born children and implement interventions as soon as the children begin to show what the parents believe is aberrant behavior or development that may be early stages of ASD. To date, no study has examined the number and types of services and interventions these parents access for their at‐risk infants. Using a Service and Intervention Questionnaire developed for this study, we interviewed 23 parents involved in a larger prospective study of genetically at‐risk infants who reported developmental and/or behavior problems in their at‐risk infants. Parents reported utilizing a mean of 1.83 and 7.26 services and/or interventions for their at‐risk infants and older children with ASD, respectively. Two‐thirds of the interventions received by the infants were also given to their older affected siblings. The interventions included empirically validated approaches (e.g., early intensive behavioral intervention), professional services (speech–language therapy, occupational therapy), and non‐validated treatments (e.g., diet and vitamin therapies). Overall, 81 non‐validated and 18 validated interventions were used. On a Likert‐type rating scale, parents reported being involved and satisfied with what they generally thought were effective services. They felt more involved and satisfied with ABA, and felt it was more effective than non‐validated interventions. The findings suggest that parents with infants at‐risk for ASD and an older affected child will access a variety of autism services for both children, but the parents will implement primarily non‐validated interventions. Parent education is recommended to help parents make informed treatment decisions for their children. Copyright © 2009 John Wiley & Sons, Ltd.     

Helping parents of premature babies: A cognitive-behavioral approach

Having an infant in an intensive care setting is highly stressful for parents and may disrupt the bonding process. This article presents a cognitive-behavioral framework as a useful way of understanding and intervening with parents of normal, healthy, premature babies. Differences are shown between stimulus events experienced by parents of term and premature babies and the consequent differences in thoughts, feelings, and behaviors are discussed. Suggestions are made for helping parents of premature babies replace dysfunctional irrational cognitions with more appropriate and rational beliefs.     

Clinical research on behavioral activation as treatment for post‐traumatic stress disorder: A brief review and meta‐analysis

Behavioral activation (BA), an effective treatment for depression, has recently been receiving attention as a possible intervention for PTSD. BA interventions could be particularly useful in treating underserved populations (i.e., individuals with lower socioeconomic status). A literature search was conducted, which identified seven outcome studies that examined the effectiveness of stand‐alone BA treatment for individuals with PTSD. All studies identified for this brief review demonstrated clinically significant reductions in PTSD symptoms using BA as an intervention. A meta‐analysis of these few studies revealed a nonsignificant effect (Cohen's d = 0.713, p = .512) despite reporting an average symptom reduction of 25.8%. Other studies utilizing BA treatment for PTSD do so in tandem with other interventions and were excluded from analysis. This brief review summarizes the literature on the use of BA as a stand‐alone treatment for PTSD and suggests that future research seek to confirm the usefulness of BA as a potential treatment modality for mental health‐care providers treating individuals with PTSD.     

A clinical interview for parents of high-risk infants: Concept and applications

The birth and hospitalization of a preterm infant are stressful and emotionally demanding experiences for parents. The Clinical Interview for Parents of High-Risk Infants (CLIP) is a semistruc tured clinical interview that may be used as a one-time assessment or as a cornerstone for ongoing psychosocial work with parents. The interview assesses early parental adaptation and alerts the clinician to areas of concern as identified by the parents. The interview enables parents to consolidate emotionally their experiences relative to the infant's high-risk status. The CLIP has utility both for planning psychosocial care in the intensive care nursery, and for discharge preparation. The rationale underlying the design of the CLIP is presented, the interview is described, and clinical applications are discussed.     

A systematic review and meta‐analysis of tertiary interventions in clinical burnout

Clinical burnout is one of the leading causes of work absenteeism in high‐ and middle‐income countries. There is hence a great need for the identification of effective intervention strategies to increase return‐to‐work (RTW) in this population. This review aimed to assess the effectiveness of tertiary interventions for individuals with clinically significant burnout on RTW and psychological symptoms of exhaustion, depression and anxiety. Four electronic databases (Ovid MEDLINE, PsychINFO, PubMed and CINAHL Plus) were searched in April 2016 for randomized and non‐randomized controlled trials of tertiary interventions in clinical burnout. Article screening and data extraction were conducted independently by two reviewers. Pooled odds ratios (ORs) and hazard ratios (HRs) were estimated with random‐effects meta‐analyses. Eight articles met the inclusion criteria. There was some evidence of publication bias. Included trials were of variable methodological quality. A significant effect of tertiary interventions compared with treatment as usual or wait‐list controls on time until RTW was found, HR = 4.5, 95% confidence interval (CI) = 2.15–9.45; however, considerable heterogeneity was detected. The effect of tertiary interventions on full RTW was not significant, OR = 1.33, 95% CI = 0.59–2.98. No significant effects on psychological symptoms of exhaustion, depression or anxiety were observed. In conclusion, tertiary interventions for individuals with clinically significant burnout may be effective in facilitating RTW. Successful interventions incorporated advice from labor experts and enabled patients to initiate a workplace dialogue with their employers.     

Enhanced gaze‐following behavior in Deaf infants of Deaf parents

Gaze following plays a role in parent–infant communication and is a key mechanism by which infants acquire information about the world from social input. Gaze following in Deaf infants has been understudied. Twelve Deaf infants of Deaf parents (DoD) who had native exposure to American Sign Language (ASL) were gender‐matched and age‐matched (±7 days) to 60 spoken‐language hearing control infants. Results showed that the DoD infants had significantly higher gaze‐following scores than the hearing infants. We hypothesize that in the absence of auditory input, and with support from ASL‐fluent Deaf parents, infants become attuned to visual‐communicative signals from other people, which engenders increased gaze following. These findings underscore the need to revise the ‘deficit model’ of deafness. Deaf infants immersed in natural sign language from birth are better at understanding the signals and identifying the referential meaning of adults’ gaze behavior compared to hearing infants not exposed to sign language. Broader implications for theories of social‐cognitive development are discussed. A video abstract of this article can be viewed at https://youtu.be/QXCDK_CUmAI     

A randomized study of the impact of a sensitizing intervention on the child‐rearing attitudes of parents of low birth weight preterm infants

Nordhov, S. M., Kaaresen, P. I., Rønning, J. A., Ulvund, S. E. & Dahl, L. B. (2010). A randomized study of the impact of a sensitizing intervention on the child‐rearing attitudes of parents of low birth weight preterm infants. Scandinavian Journal of Psychology, 51, 385–391. The background for this study was that nurturant child‐rearing attitudes are associated with positive development in low birth weight (LBW) infants. The objective was to study child‐rearing attitudes and early intervention (EI) in parents of LBW infants from 12–36 months corrected age. LBW infants (BW < 2000 g) were randomized to an intervention (IG) or a control group (CG). The EI consisted of seven in‐hospital sessions prior to discharge, then four home visits. A Child Rearing Practices Report was administered at 12 (mothers only), 24 and 36 months. A total of 146 infants were randomized. The mean BW in IG was 1396 (SD 429) g and 1381 (436) g in CG. The mean GA was 30.2 (3.1) weeks in IG and 29.9 (3.5) weeks in CG. Mothers in IG reported significantly more nurturant child‐rearing attitudes at 12 and 24 months. There was a significant change in restrictive and nurturant attitudes over time. It was concluded that EI may lead to more nurturant child‐rearing attitudes in mothers of preterms.     

Enhancing parental reflective functioning through early dyadic interventions: A systematic review and meta‐analysis

Parental reflective functioning (PRF) is an important predictor of infant attachment, and interventions that target parent–infant/toddler dyads who are experiencing significant problems have the potential to improve PRF. A range of dyadic interventions have been developed over the past two decades, some of which explicitly target PRF as part of their theory of change, and some that do not explicitly target PRF, but that have measured it as an outcome. However, no meta‐analytic review of the impact of these interventions has been carried out to date. The aim of this review was to evaluate the effectiveness of dyadic interventions targeting parents of infant and toddlers, in improving PRF and a number of secondary outcomes. A systematic review and meta‐analysis was conducted in which key electronic databases were searched up to October 2018. Eligible studies were identified and data extracted. Data were synthesised using meta‐analysis and expressed as both effect sizes and risk ratios. Six studies were identified providing a total of 521 participants. The results of six meta‐analyses showed a nonsignificant moderate improvement in PRF in the intervention group (standardised mean difference [SMD]: –0.46; 95% confidence interval [CI] [–0.97, 0.04]) and a significant reduction in disorganised attachment (risk ratio: 0.50; 95% CI [0.27, 0.90]). There was no evidence for intervention effects on attachment security (odds ratio: 0.71; 95% CI [0.19, 2.64]), parent–infant interaction (SMD: –0.10; 95% CI [–0.46, 0.26]), parental depression (SMD: –1.55; 95% CI [–3.74, 0.64]) or parental global distress (SMD: –0.19, 95% CI [–3.04, 22.65]). There were insufficient data to conduct subgroup analysis (i.e. to compare the effectiveness of mentalisation‐based treatment with non‐mentalization‐based treatment interventions). Relational early interventions may have important benefits in improving PRF and reducing the prevalence of attachment disorganisation. The implications for future research are discussed.