Surveying Early Intervention Providers to Identify Opportunities for Workforce Support to Strengthen Family-Centered Care.

Traditional provider-to-child models of early intervention (EI) service provision have been increasingly replaced by service guidelines that promote a broader family-centered approach to support improvement in the child's primary area of delay. These guidelines include working directly with caregivers and addressing needs of the family that might impact a caregivers' capacity to engage in developmentally supportive interactions with children (e.g., caregiver distress). Knowledge of provider skills, practices, and attitudes would inform efforts to broaden and enhance practice in line with these guidelines. Within an academic-community partnership to support EI, we surveyed 88 providers in Miami and Boston about their usual practice, perceptions of their skills, general attitudes towards evidence-based practices, and interest in specific training opportunities. Findings indicated that providers spent more time working directly with children than caregivers. Providers reported high interest in training to manage caregiver distress, support preschool readiness, and align work with family culture. Negative overall attitudes towards using evidence-based interventions and provider exhaustion were related to less interest in obtaining training in culturally-responsive practice. Exhaustion also related to less interest in training on other topics that represent a broadened scope of care, including building warm parent-child relationships. Findings are informing efforts to design EI training opportunities to improve parent-provider relations, enhance parent-child interactions, and reduce caregiver stress.

Feasibility and promise of community providers implementing home-based parent-child interaction therapy for families investigated for child abuse: A pilot randomized controlled trial.

BACKGROUND: Despite evidence supporting Parent-Child Interaction Therapy's (PCIT) effectiveness for maltreatment prevention, its integration in child welfare services (CWS) has been challenging. OBJECTIVE: Using a pilot randomized controlled trial design, we evaluated the (1) feasibility of training therapists from CWS providers to implement home-based PCIT (2) feasibility of retaining parent-child dyads at-risk for child abuse in voluntary PCIT services, and (3) promise of PCIT for improving parenting skills. PARTICIPANTS AND SETTING: Between 2015-2017, 23 therapists from CWS providers and 55 caregiver-child dyads who were determined to be at moderate-to-high risk for physical and/or emotional abuse, remained in the same home, and were referred for voluntary parenting services following a child protective investigation participated. METHODS: We trained 14 therapists in home-based PCIT and randomly assigned participating dyads to receive PCIT or services as usual (SAU). Dyads completed baseline and post-treatment assessments, including self-reported and observed parenting skills. RESULTS: All therapists successfully completed the PCIT training; none completed full certification requirements. Of all randomized dyads, 51 % completed at least one treatment session, and the mean number of treatment sessions was 10.83. Caregivers assigned to PCIT used more self-reported (d = .72) and observed (d = .59) positive parenting skills post-treatment than caregivers assigned to SAU. Negative, inconsistent, and punitive parenting strategies and parenting stress did not significantly differ between caregivers assigned to PCIT and SAU. CONCLUSIONS: Despite several challenges to feasibly implementing PCIT in community-based child welfare settings, even a small dose of PCIT improved positive parenting skills among at-risk parent-child dyads.

Racial/ethnic group differences in parenting attitudes among at-risk emerging adults: The roles of adversity, relationship quality, and caregiver involvement and attitudes.

BACKGROUND: Healthy parenting attitudes are foundational for positive parenting and child well-being. However, few studies explore their formation and mediators explaining racial/ethnic group differences. OBJECTIVE: The present study prospectively examines potential mediators for racial/ethnic group differences in parenting attitudes in a diverse sample of emerging adults (EA). PARTICIPANTS & SETTING: Participants are EA and their caregivers (N = 891) who participated in the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). METHODS: Adverse childhood experiences (ACEs), parenting attitudes, and caregiver-child relationship quality and involvement were assessed. Mediators of racial/ethnic group differences were tested using Structural Equation Modeling with bias-corrected confidence intervals based on 1000 bootstrapped samples. RESULTS: Black EA had less appropriate developmental expectations and perceptions of family roles, empathy toward children, and rejection of physical punishment, compared to White EA. Latinx EA also had less empathy toward children compared to White EA. Caregivers' parenting attitudes mediated group differences, beyond ACEs and relationship quality and involvement. Significant mediation effects include: appropriate developmental expectations, R2 = 0.08, p < .05; rejection of physical punishment, R2 = 0.06, p < .05; appropriate family roles, R2 = 0.16, p < .05; and empathy toward children, R2 = 0.15, p < .05, for Black relative to White EA, as well as, empathy toward children, R2 = 0.12, p < .05, for Latinx relative to White EA. CONCLUSION: Findings highlight the mediating role of intergenerational transmission of parenting attitudes for explaining racial-ethnic differences and supporting positive parenting practices in diverse communities.