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JAMA Pediatrics Journal Club Slides: Improving Parenting Skills

JAMA Pediatrics Journal Club Slides: Improving Parenting Skills.

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JAMA Pediatrics Journal Club Slides: Improving Parenting Skills

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  1. 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.

  2. Introduction • 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.

  3. Introduction 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.

  4. Methods • 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.

  5. 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.

  6. 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.

  7. 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).

  8. 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.

  9. 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.

  10. 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.

  11. Contact Information • 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 (eperrin@tuftsmedicalcenter.org). 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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