Potentially Violent Disagreements and Parenting Stress Among American Indian/Alaska Native Families: Analysis Across Seven States

Objectives We examined the prevalence and correlates of potentially violent disagreements among AI/AN families with children. Methods We conducted a cross-sectional examination of data from the 2003 National Survey of Children’s Health, limited to seven states for which AI/AN race/ethnicity was available in public use files (Alaska, Arizona, Montana, New Mexico, North Dakota, Oklahoma, and South Dakota). Disagreements were classified based on how the family deals with conflict. If disagreements involved actual (hitting) or symbolic (throwing) violence, even rarely, the household was categorized as having “potentially violent disagreements,” with heated argument and shouting being classified as “heated disagreement.” Parenting stress and demographic characteristics were included as potential correlates. Results Potentially violent disagreements were reported by 8.4% of AI/AN and 8.4% of white families. The odds for potentially violent disagreements were markedly higher among parents reporting high parenting stress, in both AI/AN (OR 7.20; CI 3.45–15.00) and white (3.59, CI 2.71–4.75) families. High parenting stress had similar effects on the odds for heated discussion. Having a child with special health care needs was associated with parenting stress. Conclusions Questions about disagreement style may be useful as potential screens for domestic violence.     

Qualitative Investigation of Factors Contributing to Effective Nutrition Education for Navajo Families

Objectives Obesity rates in American Indian and Alaskan Native children are a major health threat, yet effective ways to address this remain elusive. Building on an earlier dietary assessment of Navajo Head Start families which indicated a gap in parental nutrition awareness despite a strong program emphasis, the aim of this project was to identify culturally relevant nutrition education strategies for Navajo parents and educators of young children. Methods Eight focus group interviews were conducted with 41 parents and early childhood education paraprofessionals to identify contributors to both healthful and unhealthy food ways of Navajo preschoolers. Results were presented in two community venues to verify the themes and discuss implications. Results Barriers to healthful eating included availability/cost, parenting/control, preferences/habits, time pressures, and knowledge/education. Enablers to healthful eating included the categories of schools/education, and support/modeling. Reactions to these findings during community forums suggested (1) the need for stronger parenting and parental control over the food environment; (2) community-level action to address these barriers; and (3) the need for knowledge and culturally relevant educational strategies for caregivers and children. Conclusions Implications for interventions include building upon existing community resources to enhance culturally relevant and respectful parental, family, and community support for affordable and acceptable food experiences and choices for young children and their families.     

Baseline Targeted Moderation in a Trial of the Family Check-Up 4 Health: Potential Explanations for Finding Few Practical Effects

Not all participants will benefit equally from even well-established, evidence-based prevention programs. For this reason, the field of prevention science is beginning to embrace individual tailoring of interventions. The Family Check-Up was among the first prevention programs to tailor at the family level as opposed to the more prevalent focus on adapting programs for different cultures, genders, and other immutable participant characteristics. Despite tailoring, families with lower levels of stress and parental mental health issues, children with lower baseline conduct problems, and families living in an extremely deprived neighborhood benefitted less from the Family Check-Up. This study examined baseline targeted moderation (BTM) within a trial of the Family Check-Up 4 Health (FCU4Health) program, an adaptation of the Family Check-Up for primary care delivery and explicit targeting of obesogenic behaviors. Ethnically diverse, low-income families (N?=?240) with children ages 5.5 to 12 years identified in pediatric primary care with elevated body mass index (BMI) were enrolled and randomized to FCU4Health or usual care. Few BTM effects were found using single-variable-as-moderator and latent-class-as-moderator analytic approaches across the primary (child BMI, body composition) and secondary outcomes (family health routines; child eating behaviors, food choices, emotional problems, problem behaviors, quality of life; caregiver BMI and body composition), as well as hypothesized mediators (child self-regulation, parenting skills). The high-risk nature of the sample and the FCU4Health being individually tailored might have mitigated finding BTM effects. This trial was prospectively registered (NCT03013309 ClinicalTrials.gov).

     

A Toddler Parenting Intervention in Primary Care for Caregivers With Depression Symptoms

Caregiver depression impacts parenting behaviors and has deleterious effects on child behavior. Evidence-based interventions to address parenting have not been adapted for use with depressed caregivers in pediatric primary care settings. Our study examined the feasibility and explored outcomes of an evidence-based parenting program implemented in primary care and adapted for caregivers with depressive symptoms caring for toddlers. We conducted a randomized controlled trial with a wait-list control. Participants were caregivers who screened positive for depressive symptoms in pediatric settings with a toddler. Our study was implemented from July 2011 to June 2012. We adapted the Incredible Years Parents, Babies and Toddlers program with the addition of depression psychoeducation (12 weekly sessions), and assessed caregivers at baseline and immediately post-intervention. We assessed participation rates, depressive symptoms, parenting discipline practices, social support, and parenting stress. Our results revealed that 32 caregivers participating in the intervention group had significantly greater improvement in self-reported parenting discipline practices compared to the 29 wait-list control group caregivers. We found no differences between groups in depressive symptoms, social support, or parenting stress. Our study demonstrated that the average attendance was poor (mean attendance = 3.7 sessions). We adapted an evidence-based parenting intervention for caregivers with depressive symptoms and toddlers in primary care; however, participation was challenging. Alternative intervention strategies are needed to reach and retain low-income caregivers with depression symptoms as they face multiple barriers to participation in groups within center-based services. Trial Registration Clinical Trials.gov identifier NCT01464619.     

Do Maternal Caregiver Perceptions of Childhood Obesity Risk Factors and Obesity Complications Predict Support for Prevention Initiatives Among African Americans?

Objectives African American maternal caregiver support for prevention of childhood obesity may be a factor in implementing, monitoring, and sustaining children’s positive health behaviors. However, little is known about how perceptions of childhood obesity risk factors and health complications influence caregivers’ support of childhood obesity prevention strategies. The objective of this study was to determine if childhood obesity risk factors and health complications were associated with maternal caregivers’ support for prevention initiatives. Methods A convenience sample of maternal caregivers (N?=?129, ages 22–65 years) completed the childhood obesity perceptions (COP) survey. A linear regression was conducted to determine whether perceptions about childhood obesity risk factors and subsequent health complications influenced caregivers’ support for prevention strategies. Results Caregivers’ perceptions of childhood obesity risk factors were moderate (M?=?3.4; SD?=?0.64), as were their perceptions of obesity-related health complications (M?=?3.3; SD?=?0.75); however, they perceived a high level of support for prevention strategies (M?=?4.2; SD?=?0.74). In the regression model, only health complications were significantly associated with caregiver support (β?=?0.348; p?<?0.004). Conclusions Childhood obesity prevention efforts should emphasize health complications by providing education and strategies that promote self-efficacy and outcome expectations among maternal caregivers.     

What’s Happening During Home Visits? Exploring the Relationship of Home Visiting Content and Dosage to Parenting Outcomes

Introduction Research has documented modest positive impacts of early childhood home visiting programs. However, understanding more about what home visitors do during visits and how much time they spend on specific topics may provide insight into the variability in effectiveness of services. Methods Outcome data were collected via parent survey at program enrollment and 12 months from 123 women in three MIECHV-funded home visiting models. Home visitors completed weekly home visit content and activity logs. Results Families received an average of 28 visits during the study (3.1 visits per month). Of ten content areas, the three most often discussed were early childhood development, physical care of children, and the parent–child-relationship. Multivariate regression models were used to explore the association of home visit dosage, home visit content and cumulative risk factors on parenting outcomes. Women whose visits were focused more on parenting topics reported lower parenting-related stress at follow-up compared to those whose visits had less parenting content. Additionally, higher-risk women who received greater numbers of home visits showed larger reductions in their attitudes about harsh punishment over time, compared to high-risk women with fewer home visits. Discussion Receiving home visits that emphasize parenting content may contribute to reduced parenting-related stress. For high-risk women in particular, receiving more visits overall may be important to achieving positive outcomes. Implications for practice include working to engage and retain high-risk families. Future home visiting research calls for improved methods for collecting data on content/activity during visits, the necessity for long-term follow-up, and testing for the effectiveness of varied and flexible visit schedules/content focus for women and families with trauma exposure.     

Reducing Stress Among Mothers in Drug Treatment: A Description of a Mindfulness Based Parenting Intervention

Background Parenting women with substance use disorder could potentially benefit from interventions designed to decrease stress and improve overall psychosocial health. In this study we assessed whether a mindfulness based parenting (MBP) intervention could be successful in decreasing general and parenting stress in a population of women who are in treatment for substance use disorder and who have infants or young children. Methods MBP participants (N?=?59) attended a two-hour session once a week for 12 weeks. Within-group differences on stress outcome measures administered prior to the beginning of the MBP intervention and following the intervention period were investigated using mixed-effects linear regression models accounting for correlations arising from the repeated-measures. Scales assessed for pre-post change included the Perceived Stress Scale-10 (PSS) and the Parenting Stress Index-Short Form (PSI). Results General stress, as measured by the PSS, decreased significantly from baseline to post-intervention. Women with the highest baseline general stress level experienced the greatest change in total stress score. A significant change also occurred across the Parental Distress PSI subscale. Conclusions Findings from this innovative interventional study suggest that the addition of MBP within treatment programs for parenting women with substance use disorder is an effective strategy for reducing stress within this at risk population.     

The Closing Digital Divide: Delivery Modality and Family Attendance in the Pathways for African American Success (PAAS) Program

Although family-focused, evidence-based programs (EBPs) have the potential to reduce disparities in health and behavioral outcomes for youth, access to such programs is severely limited in the most affected areas, including African American communities in the rural South. As expanding the reach of EBPs is the primary goal of translational research, interest is growing in the potential of technology as a viable platform to disseminate services to areas with limited resources. To test whether African American families in the rural South would be willing to engage in a technology-based family-focused EBP to prevent adolescent risk behavior, we examined attendance using data from two arms of a three-arm community-based trial of the Pathways for African American Success (PAAS) program. In the overall study, sixth graders (N?=?412) and their primary caregivers were randomly assigned to the following conditions: (a) in-person, small group sessions led by facilitators; (b) self-directed, technology-based sessions; or (c) a literature control with home-mailed educational materials. Results indicated that attendance was higher in the technology condition than in the small group condition. Parental age, education, and socioeconomic status did not limit attendance in the technology condition. We conclude from these results that the use of technology can be an acceptable strategy for disseminating parenting EBPs to African American families in the rural South.     

Association of Maternal Depressive Symptoms and Offspring Physical Health in Low-Income Families

Objectives The present study sought to examine the association between maternal depressive symptoms and characteristics of offspring physical health, including health status, health behaviors, and healthcare utilization, among low-income families. Maternal engagement was explored as a mediator of observed effects. Methods Cross-sectional survey data from a community sample of 4589 low-income women and their preschool-age children participating in the WIC program in Los Angeles County were analyzed using logistic, Poisson, and zero-inflated negative binomial regression. Mediation was tested via conditional process analyses. Results After controlling for the effects of demographic characteristics including maternal health insurance coverage, employment status, education, and preferred language, children of depressed women (N?=?1025) were significantly more likely than children of non-depressed women (N?=?3564) to receive a “poor” or “fair” maternal rating of general health (OR 2.34), eat fewer vegetables (IRR: 0.94) more sweets (IRR: 1.20) and sugary drinks daily (IRR: 1.32), and consume fast food more often (OR 1.21). These children were also less likely to have health insurance (OR 1.59) and more likely to receive medical care from a public medical clinic or hospital emergency room (OR 1.30). Reduced maternal engagement partially mediated associations between maternal depressive symptoms and several child health outcomes including poor diet, health insurance coverage, and use of public medical services. Conclusions for Practice Maternal depressive symptoms are associated with poor health among preschool-age children in low-income families. Prevention, screening, and treatment efforts aimed at reducing the prevalence of maternal depression may positively affect young children’s health.     

Association Between Caregiver Stress and Behavioral Problems in the Children of Incarcerated Fathers in Hong Kong

Objectives Caregivers of children with incarcerated parents have received little attention in the literature, though they face unique incarceration-related challenges. General caregiver research has highlighted associations between caregiver distress and children’s behavioral problems, even implying that the depressive tendencies of caregivers can be ‘transmitted’. The current study investigated the applicability of this notion to caregivers responsible for children of incarcerated fathers. Methods Fifty-four female caregivers of children with incarcerated parents were recruited via collaboration with a non-governmental organization. Their levels of stress and depression were measured using questionnaires, as were the behavioral problems of children under their care. The relationships between the variables were examined. Results The results firstly suggest that these caregivers are vulnerable to psychological distress, with around 57 % of them suffering from borderline to severe depression. Obtained socio-demographic characteristics were not found to have any bearing on the psychosocial functioning of caregivers or children—rather, all psychosocial variables were interlinked, and further analyses revealed that the depression of caregivers mediated the relationship between their perceived stress and internalizing/externalizing behavioral problems of the child (β = .628 and β = .468 respectively), implicating depression as a mechanism via which adversity can be transferred from a caregiver to a child. Conclusions Increasing the focus on a caregiver’s mental health may be an efficacious strategy in research and practice, perhaps by providing more support for caregivers and implementing joint caregiver-child interventions to more holistically alleviate problems in families affected by parental incarceration. Limitations of the current study and further recommendations are also discussed.     

Decreasing Substance use Risk among African American Youth: Parent-based Mechanisms of Change

African American couples (N?=?139; 67.7 % married; with children between the ages of 9 and 14) were randomly assigned to (a) a culturally sensitive, couple- and parenting-focused program designed to prevent stress-spillover (n?=?70) or (b) an information-only control condition in which couples received self-help materials (n?=?69). Eight months after baseline, youth whose parents participated in the program, compared with control youth, reported increased parental monitoring, positive racial socialization, and positive self-concept, as well as decreased conduct problems and self-reported substance use. Changes in youth-reported parenting behavior partially mediated the effect of the intervention on conduct problems and fully mediated its impact on positive self-concept, but did not mediate effects on lifetime substance use initiation. Results suggest the potential for a culturally sensitive family-based intervention targeting adults’ couple and parenting processes to enhance multiple parenting behaviors as well as decrease youths’ substance use onset and vulnerability.     

Redesigning the Maternal,Infant and Early Childhood Home Visiting Program Performance Measurement System

Objectives Statute for the Maternal, Infant and Early Childhood Home Visiting (MIECHV) Program requires that states and territories receiving Program funding assess improvements for participating families across six areas that address maternal and child well-being. In 2015, the MIECHV Program performance measurement system was redesigned to allow for national-level analyses and cross-grantee comparisons. The new measures were aligned with other federal performance measures to help ensure context for program analyses. The number of measures was also reduced to lessen reporting burden. This paper describes the redesign process and resulting national performance measures. Methods The redesign process included holding listening sessions with stakeholders and experts; reviewing the findings from other home visiting performance initiatives; consulting with experts; soliciting and responding to public comment on draft measures; seeking clearance from the Office of Management and Budget; and specifying each measure with detailed eligibility criteria, the timing and frequency of assessments, and the window for data collection. Results The redesign resulted in a set of 19 measures that all MIECHV-funded home visiting programs began collecting in 2016. This is nearly half the number of measures that MIECHV awardees had been reporting prior to the redesign. The measures are aligned with other federal measures, including those used in Healthy People 2020 and those used for other maternal and child health programs. Conclusions for Practice Data reported by MIECHV Program awardees will be used to assess their performance, identify areas for targeted technical assistance to support continuous improvement, and ensure meaningful impacts for at-risk families.     

Factors Associated with Ease of Using Community-Based Systems of Care for CSHCN in Hawai’i

Objectives: To study factors contributing to difficulty using community-based services by families of children with special health care needs (CSHCN) in Hawai’i. Methods: Data source was the 2001 National Survey of Children With Special Health Care Needs. The study population included the 449 respondents who were surveyed after additional items were added to the original questionnaire. Outcome of interest was “% of CSHCN whose families report community-based service systems are organized so they can use them easily.” Explanatory variables included child health conditions (functional limitation, degree of severity, types of service needs), child and family characteristics (child age, maternal education, poverty level), and health services characteristics (partnership of family in decision making, family-centered coordinated care, adequate health insurance). Results: Children with special health care needs comprised 11.0% of < 18 years old children. Overall, 69% of respondents reported that community-based services could be used easily. Logistic regression analysis showed that the odds of reporting difficulties in using community-based services were almost 5 times higher for families who did not partner in decision making, 2.9 times higher for families who did not receive family-centered coordinated care, and 2.7 times higher for families who did not have adequate health insurance compared with families who were satisfied with the care received. Need for services contributed independently to reporting difficulties in community-based service use. Contrary to the hypothesized associations, severe health conditions or limited functionality did not contribute significantly to reporting difficulties in service use. Conclusions: Families who reported difficulties in using community-based services were those who have children who need extensive and varied services. Lack of involvement in decision making, lack of coordinated care in a medical home, and insufficient health insurance were the main obstacles to their ability to use community-based services easily.     

A Meta-Analysis of Parenting Practices and Child Psychosocial Outcomes in Trauma-Informed Parenting Interventions after Violence Exposure

Over half of all youth are exposed to violence, which a growing body of literature suggests is associated with a broad range of negative developmental outcomes over the life course. However, best practices for supporting parenting are not widely applied to parents with children exposed to violence-related trauma. This meta-analyses seeks to synthesize the literature base of trauma-informed parenting interventions to better understand their potential impact on parenting and child outcomes. Specifically, 21 trauma-informed parenting interventions were identified that quantitatively assessed intervention effects on parenting and child outcomes. Six meta-analyses were conducted to assess intervention effects on (1) positive parenting practices, (2) negative parenting practices, (3) parenting stress, (4) children’s internalizing problems, (5) children’s externalizing problems, and (6) trauma symptoms, respectively. Moderate to large effect sizes were found for positive parenting practices (d?=?0.62) as well as child internalizing problems, externalizing problems, and trauma symptoms (d?=?0.48–0.59). Validity tests indicated robust findings for positive parenting and for all child outcomes. Additional moderator analyses support the importance of informed intervention design, showing differential findings by trauma type as well as by duration of the intervention. These findings indicate the value of evidence-based parenting interventions for violence-related trauma and support models of trauma-informed care that situate treatment in the broader social context, particularly the family. Results are discussed with respect to which parenting practices hold the most promise for supporting children exposed to violence-related trauma.     

Improving Mental Health Outcomes of Burmese Migrant and Displaced Children in Thailand: a Community-Based Randomized Controlled Trial of a Parenting and Family Skills Intervention

The negative effects of displacement and poverty on child mental health are well-known, yet research on prevention interventions in low- and middle-income countries, especially fragile states, remains limited. We examined the effectiveness of a parenting skills intervention on mental health outcomes among Burmese migrant and displaced children living in 20 communities in Thailand. Participants were primary caregivers and children aged 7 to 15 years (n?=?479 families). Families were randomly assigned to receive an adapted version of the Strengthening Families Program (n?=?240) or a wait-list control condition (n?=?239). Assessments were conducted at baseline and 1-month post-intervention for both conditions and at 6 months for treatment group only. One month after the program, children in the treatment condition showed significant reductions in externalizing problems (caregiver effect size (ES) ?0.22, p?=?0.02; child report ES ?0.11, p?=?0.02) and child attention problems compared with controls (caregiver report ES ?0.23, p?=?0.03). There was no significant treatment effect on children’s internalizing problems (ES ?0.06; p?=?0.31). Children reported a significant increase in prosocial protective factors relative to controls (ES 0.20, p?<?0.01). Results suggest that an evidence-based parenting skills intervention adapted for a displaced and migrant Burmese population facing high levels of adversity can have positive effects on children’s externalizing symptoms and protective psychosocial factors.Trial Registration. Clinicaltrials.gov: https://clinicaltrials.gov/show/NCT01829815     

Evaluation of a Childhood Obesity Prevention Online Training Certificate Program for Community Family Educators

Community family educators have the opportunity to incorporate childhood obesity prevention concepts in their programming with families of young children, but often lack formal health and nutrition education. The purpose of this feasibility study was to create an online training certificate program for community family educators and assess the program’s effectiveness at improving participant’s knowledge, attitudes, and intended and actual behaviors related to healthy lifestyles. Community family educators (n = 68) completed an online pretest, viewed 13 brief videos (8–15 min) focused on childhood obesity related topics and took mini-knowledge self-checks after each video followed by an online posttest. At posttest, paired t tests showed participants’ childhood obesity prevention related knowledge (i.e., nutrition, physical activity, screen time and sleep) improved significantly (p < 0.001). Participants’ attitudes toward parenting behaviors related to feeding practices, family meals, physical activity, screen time control and parent modeling significantly (p < 0.05) improved. Improvements also were seen in participants’ intentions to promote obesity prevention behaviors (i.e., age appropriate portions sizes, adequate physically active, and parental role modeling). Furthermore, changes in personal health behaviors at posttest revealed participants had significantly (p < 0.05) greater dietary restraint, improvements in sleep quality, and reductions of use of electronic devices during meals and snacks. Overall, participants were very satisfied with the training program, felt comfortable with skills acquired, and enjoyed the program. Findings suggest this online training program is a feasible and effective method for improving community family educators’ knowledge, attitudes, and intentions for obesity-prevention related parenting practices.     

Interdisciplinary Community-Based Oral Health Program for Women and Children at WIC

Objectives To evaluate the women, infants, and children (WIC) Oral Health Program in a county in Florida. Methods The non-traditional interdisciplinary program of the current study was designed to reach at-risk populations with untreated dental diseases and limited access to care; it provides oral health education, dental screenings, preventive dental services, and referrals for women, children, and families at WIC offices. We evaluated the health status of patients enrolled in the program and the services provided. Results From 2013 to 2016, the program provided dental screenings for 576 children and 180 women. Caries prevalence for 3–5 year olds was 46.0%. Only 6.6% (12/114) of pregnant women were eligible for comprehensive dental care under Medicaid (<?21 years). Further, 71.2% (47/66) of all pregnant women had unmet dental care needs. Conclusions for Practice Our results suggested that many children and women had untreated dental diseases and need preventive services and dental care. Also, many pregnant women were not covered by Medicaid. This program demonstrates that collaboration with the WIC program can improve access to oral health services for underserved populations.     

Web-Based Prevention of Parenting Difficulties in Young,Urban Mothers Enrolled in Post-Secondary Education

Research consistently indicates that young mothers are at elevated risk for adverse social and economic risks. Recent attention has been paid to the value of maternal educational attainment for their children’s economic and social outcomes. Pursuit of post-secondary education requires mothers to balance multiple roles, potentially stressing the parent–child relationship. Yet, almost no studies have addressed parenting and associated stress in young mothers enrolled in post-secondary education, and no preventive intervention trials have been conducted. We screened young mothers (<25 years at child’s birth) pursuing post-secondary education in an urban, inner city college for study inclusion based on elevated parenting stress, and participated in a randomized controlled trial to assess the efficacy of a web-based parenting intervention (Triple P Online) in reducing parenting stress and dysfunctional discipline (N = 52). Mothers were randomly assigned to the web-based parenting program condition or to a waitlist control condition. Mothers who completed at least the first four core modules of the online program had lower scores on the Parenting Scale’s subscales (Overreactivity, Verbosity, and Laxness), compared to those who did not complete four or more modules. No intervention effects were obtained for parenting stress. The current study provides preliminary evidence of the efficacy of this online parenting program for reducing risk for dysfunctional discipline in student mothers. Future research is warranted to replicate these findings, and to test whether provision of supplemental support for implementation, or briefer program formats may promote both program compliance and outcomes related to reducing parenting stress.     

Enhancing Early Childhood Mental Health Primary Care Services: Evaluation of MA Project LAUNCH

Objectives The purpose of this study was to evaluate the efficacy of an innovative early childhood mental health intervention, Massachusetts Project LAUNCH. Early childhood mental health clinicians and family partners (paraprofessionals with lived experience) were embedded within community pediatric medical homes. Methods A longitudinal study design was used to test the hypotheses that (1) children who received services would experience decreased social, emotional and behavioral problems over time and (2) caregivers’ stress and depressive symptoms would decrease over time. Families who were enrolled in services and who consented to participate in the evaluation study were included in analyses (N?=?225). Individual growth models were used to test longitudinal effects among MA LAUNCH participants (children and caregivers) over three time points using screening tools. Results Analyses showed that LAUNCH children who scored in age-specific clinically significant ranges of social, emotional and behavioral problems at Time 1 scored in the normal range on average by Time 3. Caregivers’ stress and depressive symptoms also declined across the three time points. Results support hypotheses that the LAUNCH intervention improved social and emotional health for children and caregivers. Conclusions for Practice This study led to sustainability efforts, an expansion of the model to three additional communities across the state and development of an online toolkit for other communities interested in implementation.