Presentation on theme: "Copyright restrictions may apply JAMA Pediatrics Journal Club Slides: Improving Parenting Skills Perrin EC, Sheldrick RC, McMenamy JM, Henson BS, Carter."— Presentation transcript:
Copyright restrictions may apply 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.
Copyright restrictions may apply 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
Copyright restrictions may apply 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
Copyright restrictions may apply 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
Copyright restrictions may apply 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.
Copyright restrictions may apply 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.
Copyright restrictions may apply 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).
Copyright restrictions may apply 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.
Copyright restrictions may apply 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.
Copyright restrictions may apply 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.
Copyright restrictions may apply 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 (firstname.lastname@example.org). Funding/Support This study was funded by the National Institute of Mental Health R01 grant MH076244-01. Conflict of Interest Disclosures None reported. Contact Information