promoting positive parenting practices through parenting education
Improving Parenting Skills for Families of Young Children in Pediatric Settings a Randomized...
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JAMA Pediatrics Journal Club Slides:Improving Parenting Skills
Perrin EC, Sheldrick RC, McMenamy JM, Henson BS, Carter AS. Improving parenting skills for families of young children in pediatric settings: a randomized clinical trial. JAMA Pediatr. Published online November 4, 2013. doi:10.1001/jamapediatrics.2013.2919.
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• Disruptive Behavior Disorders
– Symptoms evident as early as 1 to 3 years of age.
– Symptoms typically continue into adolescence.
– Often result in academic underachievement, reduced social competence, and various mental health disorders.
– Common but modifiable.
• BUT
– Infrequently identified early.
– Intervention based on mental health referral.
– Fewer than 25% treated.
Introduction
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Intervention
• Parent-training programs have been shown to be effective.
• The Incredible Years (IY) program in particular has received support in multiple randomized clinical trials.
However,
• Evidence-based parent-training programs are not widely available.
• Evidence for their feasibility and efficacy in primary care settings is limited.
Objective
• To test the efficacy of offering an evidence-based parenting program within pediatric practices to parents of 2- to 4-year-old children with early evidence of disruptive behaviors.
Introduction
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• Study Design– Routine screening for disruptive behavior at 2- and 3-year well-child
care visits.– Eligible parents were enrolled and assigned by random number to
immediate intervention (parent-training group [PTG]) or waiting list (WL) control group.
– PTG: 10-week version of the IY parent-training program (see http://www.incredibleyears.com).
– Leaders were study psychologists plus members of the pediatric staff (nurse, social worker, pediatrician).
• Setting and Sample– Four federally qualified health centers, 7 suburban pediatric practices.– Parents of 345 children enrolled.
• 29% Nonwhite/non-Hispanic• 26% With annual income less than $20 000.
Methods
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Methods• Outcomes
– Early Childhood Behavior Inventory (ECBI).– Parenting Scale.– Standardized observation of parent-child interaction (coded according to
Dyadic Parent-Child Interactive Coding System−Revised).– Assessments before intervention, immediately following intervention, 6
months later, and 12 months later.
• Limitations
– Slow recruitment resulted in the following:• Fewer participants in WL groups than intervention groups.• Intervention groups without control in 6 practices. These participants
were analyzed as a separate condition: nonrandomized PTG.
– Videotaped observations technically challenging.
– Only about half of parents who acknowledge disruptive behavior in their toddlers are able to participate fully in parent-training intervention.
– Research burden high; loss to follow-up.
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830Consented To Contact
290Provided time 1 data & assigned to conditions
485 did not enroll
345Enrolled
55Dropped out
150 Randomized
123Assigned directly to PTG
89PTG
61WL
18< 3 PTG sessions
50 F/U
11 D/O
71≥ 3 PTG sessions
67 F/U
5 F/U
4 D/O
13D/O
73≥ 3 PTG sessions
50< 3 PTG sessions
7F/U
65 F/U
8D/O
43 D/O
17 Dropped out
Note. PTG = parent training group; WL = waitlist; F/U = follow-up; D/O = dropped out
Results• Overall: 144 of 212 families
(68%) assigned to intervention completed at least 3 IY sessions.
• High fidelity to the IY protocol was maintained throughout the study.
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Waitlist Condition
Randomized PTG
Non-randomized PTG
5
7
9
11
13
15
17
Pre-Treatment
Post-Treatment
6-month follow-up
12-month follow-up
Results: ECBI Problem Scale
• In both parent-training conditions, parents’ reports of child disruptive behaviors were lower than baseline at all follow-up assessments.
• Both parent-training conditions were superior to WL at all follow-up assessments.• ECBI Intensity Scale followed same pattern with 1 exception (nonsignificant at 6-month
follow-up).
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Waitlist Condition
Randomized PTG
Non-randomized PTG
2.2
2.4
2.6
2.8
3
3.2
Pre-Treatment
Post-Treatment
6-month follow-up
12-month follow-up
Results: Parenting Scale
• In both parent-training conditions, self-reports of negative parenting behaviors were lower than baseline at all follow-up assessments.
• Both parent-training conditions were superior to WL at all follow-up assessments.
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Waitlist Condition
Randomized PTG
Non-randomized PTG
-0.1
0
0.1
0.2
0.3
0.4
0.5
Pre-Treatment
Post-Treatment
6-month follow-up
12-month follow-up
Results: Standardized Observation of Parent-Child Interaction
• In both parent-training conditions, observed negative parent-child interaction was lower than baseline at both follow-up assessments.
• Both parent-training conditions were superior to WL at both follow-up assessments.
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Comment
• Results support feasibility and effectiveness of parent training for young children in pediatric settings.
• For parents who are able to participate, the intervention is successful across a wide range of risk.
• Pediatric office staff can be trained to deliver the evidence-based parent-training intervention.
• Sustainability of parent training provided within pediatric practices is dependent on changes in health insurance policies.
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• If you have questions, please contact the corresponding author:– Ellen C. Perrin, MD, Division of Developmental-Behavioral Pediatrics,
Floating Hospital for Children, Tufts Medical Center, 800 Washington St, Ste 854, Boston, MA 02111 ([email protected]).
Funding/Support
• This study was funded by the National Institute of Mental Health R01 grant MH076244-01.
Conflict of Interest Disclosures
• None reported.
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