Improving parenting skills for families of young children in pediatric settings: a randomized clinical trial.

Article link available at:
http://archpedi.jamanetwork.com/article.aspx?articleid=1766496

Powerpoint slides available at:
http://archpedi.jamanetwork.com/data/Journals/PEDS/929547/POI130050slidea_prod.ppt

Transcript

1. 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.
2. 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
3. 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
4. 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
5. 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.
6. Copyright restrictions may apply 830 Consented To Contact 290 Provided time 1 data & assigned to conditions 485 did not enroll 345 Enrolled 55 Dropped out 150 Randomized 123 Assigned directly to PTG 89 PTG 61 WL 18 < 3 PTG sessions 50 F/U 11 D/O 71 ≥ 3 PTG sessions 67 F/U 5 F/U 4 D/O 13 D/O 73 ≥ 3 PTG sessions 50 < 3 PTG sessions 7 F/U 65 F/U 8 D/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.
7. Copyright restrictions may apply 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).
8. Copyright restrictions may apply 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.
9. Copyright restrictions may apply 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.
10. 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.
11. 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 (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. Contact Information