A Digital Health Model for School-Based Implementation to Improve Parent and Child Outcomes: Comparison of Active Versus Light-Touch Coaching Effects.

Online or app-based parenting interventions have become more widely available in recent years. However, challenges related to poor engagement and high attrition have been noted in the literature, and there are important questions regarding ways to enhance parental engagement and improve treatment outcomes through digital health, including through the addition of therapeutic coaches. The current study evaluated differences in the effects of active versus "light-touch" coaching implementations of an enhanced version of Family Check-Up Online (FCU-O) on parent/family and child-level outcomes from pre-treatment to 2-month follow-up assessments. The enhanced version of the FCU-O was adapted to support families in coping with pandemic-related stressors to prevent youth behavioral and emotional problems during middle school and included app-based modules designed to support effective parenting practices as well as virtual coaching. In the "active-coach" condition, parenting coaches were active in efforts to arrange coaching sessions with parents as they worked through the app-based modules, while in the light-touch intervention, parent-coaches enrolled participants in the context of a one-time support session but did not actively pursue families to schedule additional sessions. Parents in the active-coach condition exhibited greater engagement with both the app and coaching sessions than parents in the light-touch condition. Further, stronger improvements in several aspects of parenting and child functioning were observed in the active-coach versus light-touch conditions. However, parents in the light-touch condition showed reductions in stress and comparable levels of dosage when using the app. Implications for prevention and accessibility of digital health interventions are discussed.

Family Check-Up Online: Effects of a Virtual Randomized Trial on Parent Stress, Parenting, and Child Outcomes in Early Adolescence.

We adapted the Family Check-Up Online (FCU-O) (1) to support families coping with pandemic-related stressors to prevent behavioral and emotional problems among middle school youth and (2) for smartphone delivery to increase access and reach during the COVID-19 pandemic. This study evaluated the direct and indirect effects of the adapted FCU-O at 4-months post-baseline. The FCU-O combines online parenting support with telephone coaching. Participants were primary caregivers of children ages 10 to 14 years. Eligibility included endorsing depression on the PHQ-2 or significant stress on a 4-item version of the Perceived Stress Scale. We randomly assigned participants to the adapted FCU-O (N = 74) or a waitlist control condition (N = 87). Participants predominantly self-identified as female (95%), 42.77 years old on average, and White (84.6%). Outcomes included caregiver reports of perceived stress and parenting, and youth conduct problems and depressive symptoms. Using a multilevel modeling approach, we tested intent-to-treat intervention effects at 4-months, with time points nested within participants. The FCU-O reduced caregiver stress and improved proactive parenting and limit setting but had no effects on youth outcomes. Effect sizes were small to moderate (Cohen's d ranged from .37 to .57). We examined indirect effects on youth outcomes at 4-months via changes in caregiver stress and parenting at 2-months. Mediation analyses suggested indirect effects on youth depressive symptoms via reductions in caregiver stress and increases in proactive parenting. Results indicate the FCU-O has potential as a public health intervention for families facing extreme stressors such as those during the COVID-19 pandemic. ClinicalTrials.gov Identifier: NCT05117099.

The reliability and validity of the Coder Impressions Questionnaire-Kindergarten for parenting and child behaviors.

Reliable and valid assessment of parenting and child behaviors is critical for clinicians and researchers alike, and observational measures of parenting behaviors are often considered the gold standard for assessing parenting and parent-child interaction quality. The present study sought to evaluate the reliability and validity of the Coder Impressions Questionnaire-Kindergarten (COIMP-K) measure. The present study was a secondary analysis of 274 parents and their children participating in a randomized control trial testing a brief parenting intervention for parents of children entering kindergarten. Families participated in baseline and follow-up assessments and videotaped observational tasks. Graduate and undergraduate coders completed the COIMP-K after achieving reliability. The aims of the present study were to assess COIMP-K's (a) internal consistency using intercorrelations among COIMP-K subscales, (b) construct validity, (c) convergent validity by comparing the COIMP-K subscales to parents' self-report of similar behaviors, (d) discriminant validity by comparing subscales to a parent-teacher communication measure as it is unrelated to parenting or child behaviors, and (e) congruence across time. The authors hypothesized that the COIMP-K would demonstrate adequate internal consistency (Cortina, 1993), adequate construct, convergent, and discriminant validity and find congruence of the measure across time. The results demonstrated that the factors had adequate internal consistency, construct, convergent, and discriminant validity, as well as longitudinal replicability and congruence over time. The study demonstrates that the COIMP-K is a reliable and valid tool for assessing observed family behaviors. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Adolescent-onset cannabis use and parenting young children: an investigation of differential effectiveness of a digital parenting intervention.

Introduction: There is scant empirical work on associations between current and past cannabis use and parenting skills in parents of young children. As recreational cannabis use is now legal in nearly half of states in the U.S., cannabis use is becoming more ubiquitous. Methods: In the current study, parents of toddler and pre-school age children were randomly assigned to participate in an app-based parenting skills program that included telehealth coaching (Family Check-Up Online; FCU-O), with a focus on parenting in the context of substance use. We aimed to test associations between adolescent-onset and current cannabis use and parent mental health and parenting skills, as well as whether effects of the FCU-O on parent mental health outcomes varied as a function of past cannabis use. Participants were 356 parents of children ages 1.5-5 participating in a randomized controlled trial of the FCU-O. Parents screened into the study if they reported current or past substance misuse or current depressive symptoms. After completing a baseline assessment, parents were randomly assigned to the FCU-O or control group and completed a follow-up assessment 3 months later. Parents retrospectively reported on the age when they initially used substances, as well as their current use. Results: After accounting for current cannabis use, adolescent-onset cannabis use was significantly associated with higher symptoms of anxiety and depression, but not with parenting skills. Adolescent-onset cannabis use was found to significantly moderate the effect of the FCU-O on parents' anxiety symptoms. Specifically, the FCU-O was particularly effective in reducing anxiety symptoms for parents with adolescent-onset regular cannabis use, after accounting for current cannabis use. Discussion: Adolescent-onset regular cannabis use may be a risk factor for later mental health challenges in parents of children under 5. An app-based parenting intervention may be particularly helpful in reducing symptoms of anxiety for parents who used cannabis regularly as adolescents. The findings have significant implications for the prevention of multigenerational risk for substance use and mental health challenges.

Parenting self-efficacy in relation to the family check-up's effect on elementary school children's behavior.

Prior research points to the promotion of parenting self-efficacy (PSE) as an important component of parenting interventions; however, few studies have tested PSE as a mediator or moderator of the effects of parenting programs on child behavior. In the present study, we examined the efficacy of the family check-up (FCU), a brief, strengths-based parenting intervention adapted for kindergarten school entry. We tested the FCU's effects on reducing growth in parent-reported child conduct problems (CP) from kindergarten to fifth grade and whether PSE functioned as a mediator or moderator of intervention effects, using a latent growth curve model and intent-to-treat approach. Participants were parents of 321 children from five elementary schools in a northwestern U.S. city. Although we did not find a main effect of the FCU in reducing growth in CP from kindergarten through fifth grade, we found a significant indirect effect of the FCU on reducing CP growth via improving PSE in second grade and that the indirect effect was moderated by baseline levels of PSE. Together, our findings suggest that the FCU is effective in promoting PSE, which is subsequently associated with reduced CP growth, particularly for parents with initially low PSE. Our findings bolster existing work on the relationship between PSE and child CP in the context of a preventive parenting intervention and emphasize the importance of PSE as an agent of change. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Differential impact of the school context on ethnic and racial identity and depression for monoracial and multiracial early adolescents.

Introduction: This study examined the direct and indirect effects of school context (negative peer relationships, school environment) on ethnic and racial identity (ERI) development in middle school and later depression symptoms in high school. Differences by racial group were examined for non-Hispanic White (NHW) early adolescents, monoracial adolescents, and multiracial adolescents. Methods: This study used existing data from a large, multiwave, longitudinal study that included 593 racial/ethnically diverse adolescents from sixth grade through ninth grade across three public middle schools in the Pacific Northwest. Results: Using multigroup path analysis in structural equation modeling, the findings indicated differences by racial group-school environment was associated with positive ERI development in middle school for NHW and monoracial adolescents but not for multiracial adolescents. For multiracial adolescents, ERI predicted later depression symptoms. Discussion: These findings demonstrated the importance of examining school context and peer relationships in relation to ERI development and psychological wellbeing.

Preschool Programs that Help Families Promote Child Social-Emotional School Readiness: Promising New Strategies.

Parents play a central role in supporting the early learning that positions young children for success when they enter formal schooling. For this reason, efforts to engage families in meaningful collaboration is a long-standing goal of high-quality early childhood education (ECE). Family-school engagement can take multiple forms; in this review, we focus on universal preschool-based outreach strategies that help parents support growth in child social-emotional and self-regulation competencies and prepare them for the transition into formal schooling. Recent research has expanded understanding of the neurodevelopmental processes that underlie child school readiness, and the impact of parenting (and the social ecology affecting parenting) on those processes. These new insights have fueled innovation in preschool-based efforts to partner with and support parents, expanding and shifting the focus of that programming. In addition, new approaches to intervention design and delivery are emerging to address the pervasive challenges of reaching and engaging families, especially those representing diverse racial, ethnic, cultural, and socioeconomic backgrounds. This paper reviews developmental research that underscores the importance of prioritizing child social-emotional learning (with attention to self-regulation and approaches to learning) in universal preschool-based parenting programs targeting young children. We highlight the intervention strategies used in programs with strong evidence of impact on child readiness and school adjustment based on randomized controlled trials (RCTs). New directions in intervention design and delivery strategies are highlighted, with the hope of extending intervention reach and improving family engagement and benefit.

Multidisciplinary Strategies for Preventing Opioid Misuse and Escalation by Targeting Mental Health Symptoms and Conditions.

We aim to review the association between childhood-onset mental health conditions and increased risk for early substance use including opioid misuse and opioid use disorders (OUD). The association between mental health conditions and opioid misuse suggests youth with mental health conditions may benefit from opioid prevention efforts that concurrently address mental health. To aid in the identification of youth with mental health conditions who could benefit from interventions, we will review opportunities and challenges associated with screening for mental health symptoms or substance use in settings where youth at high risk for mental health conditions present. We will also review how research projects within the National Institutes of Health's Helping to End Addiction Long-term (HEAL) Prevention Cooperative are addressing mental health within opioid misuse and OUD prevention interventions for youth.

A longitudinal study of home-based involvement and dyadic adjustment during the transition to early elementary school.

Home-based involvement refers to caregivers' active efforts to create learning opportunities for their children at home and in the community. Across child development, home-based involvement is a positive influence on children's social-emotional and academic functioning. Findings have suggested that home-based involvement tends to decline during elementary and middle school, but the extent to which home-based involvement changes over time during the transition to early elementary school is less clear. Dyadic adjustment is the quality of the relationship between two partners. Grounded in family systems theory, the spillover hypothesis suggests that dyadic adjustment is an important influence on home-based involvement. However, there is limited research on the extent to which dyadic adjustment predicts home-based involvement. The present study used latent growth curve analysis to examine the trajectory of home-based involvement during the transition to early elementary school, as well as the extent to which dyadic adjustment predicts home-based involvement during this transition. Participants were 157 primary caregivers of children in kindergarten through second grade. Results suggest that home-based involvement has a negative, linear trajectory between kindergarten and second grade, and that dyadic adjustment predicts higher levels of home-based involvement at kindergarten, first grade, and second grade. Implications of study findings for research and practice are discussed, with a focus on preventive interventions that aim to promote dyadic adjustment and home-based involvement during the transition to early elementary school. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Evaluating the Efficacy of the Family Check-Up Online to Improve Parent Mental Health and Family Functioning in Response to the COVID-19 Pandemic: A Randomized Clinical Trial.

This study evaluated the effects of an enhanced version of the Family Check-Up Online (FCU-O), adapted to address parent and family functioning in response to the COVID-19 pandemic. In order to increase accessibility, the FCU-O was delivered as a web-based application coupled with online coaching support, a service delivery model that is consistent with pandemic-related limitations for in-person intervention, as well as the limited staffing and resources available in many schools and health care settings despite the increased need for mental health services driven by the pandemic. This registered clinical trial (blinded) tested the effects of the intervention on parental mental health, parenting behaviors, and family functioning from pre-treatment to 2-month follow-up. Families were randomly assigned to receive the FCU-O (N = 74) or to a wait-list control condition (N = 87). Random assignment to the FCU-O was associated with significant improvements in parental well-being, including reduced anxiety, depression, and perceived stress. Further, the FCU-O predicted significant improvements in adaptive parenting skills (e.g. less negative/coercive parenting, greater proactive parenting), and enhancements in family-relational functioning (e.g. improved coparenting). Effect sizes were small to moderate in magnitude (partial eta squared values between 0.03 and 0.11). The results indicate that online delivery of a family-centered intervention may represent a promising approach for addressing pandemic-related impacts on parent and family functioning.

Family-centered prevention to enhance proactive parenting and parental self-efficacy during early elementary school.

The purpose of this study was to examine the effect of a family-centered intervention delivered during early elementary school, the Family Check-Up (FCU), in supporting parents' use of proactive parenting skills and the role that parental self-efficacy (PSE) has in promoting proactive parenting. We predicted both direct and mediated effects of the FCU on changes in proactive parenting. Participants were the primary caregivers of 321 kindergarten children and were randomly assigned to either the FCU or to a school-as-usual control group (n = 164 assigned to intervention). Results indicated that the FCU initiated during kindergarten enhanced proactive parenting skills directly and was mediated by PSE. These results highlight the FCU as an efficacious intervention in early elementary school in promoting proactive parenting skills and PSE and underscore the role of PSE as a primary pathway toward improved proactive parenting. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Engagement in a brief preventive parenting intervention during the transition to kindergarten: Effects of parent stress and child behavior concerns.

Although school-based preventive parenting interventions have been found to promote children's social-emotional skill development and behavioral functioning, it is important to understand potential barriers to engagement in such programs to ensure that intervention access is equitable and likely to reach those who could most benefit. In the present study, we tested independent and interactive associations between parents' concerns about their child's hyperactivity behavior and their perceived stress in relation to their participation in a preventive parenting intervention, the Family Check-Up (FCU), delivered when children were in kindergarten. Participants were parents of 164 children who were randomized to the intervention group of a randomized controlled trial that took place at five elementary schools. Results indicated that parents who reported higher levels of hyperactivity in their children and high levels of perceived stress were less likely to initially engage in the FCU, but if they did engage, they were more likely to participate more intensively as measured by total treatment time. Parents' motivation to change mediated the association between high parent stress and child hyperactivity in relation to total treatment time. This study has important implications for the use of motivational interviewing strategies to engage parents in school-based, family-centered interventions.

Examining links between parental monitoring and school engagement among middle school students with and without elevated behavior ratings.

The purpose of this study was to examine whether seventh-grade positive peer affiliation and conduct problems mediated the relationship between sixth-grade parental monitoring of behavior and eighth-grade school participation and grades among students with elevated behavior ratings (EBR; n = 821) and students with unelevated behavior ratings (UBR; n = 3,779). Conduct problems and peer affiliation mediated the relationship between parental monitoring and school participation as well as grades in the overall sample (n = 4,600). A multiple-group mediation model suggested that these effects did not significantly differ across students with EBR and UBR, though the mediation estimates were smaller in magnitude and not statistically significant among students with EBR. Implications for the role of parental monitoring as an intervention target within a multitiered system of support for social and behavioral skills in middle school, as well as limitations and future directions are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Parental influences on marijuana use in emerging adulthood.

The purpose of this study was to gain a clearer understanding of the relation between parental relationship qualities and overall emerging adulthood (EA) marijuana use processes. The present study drew from an ethnically and socioeconomially diverse sample of EAs (ages 19-22) and their parents (n = 470) from the Pacific Northwest region. This study used parent-report and child-report data to capture measures of parenting and EA marijuana use outcomes. Latent Class Growth Analysis (LCGA) was used to model trajectories of marijuana use and risk factor analyses were used to examine how marijuana group membership varied by covariates and parental relationship qualities. Results revealed that lower levels of family cohesion and quality of parent-child communication were more likely to predict membership in the high-using groups and moderate-decreasing user groups in comparison to low-to-non users. Results also indicated that lower levels of frequency of parent-child communication were more likely to predict membership in the high-users group compared to the low-to-non users. Regarding parent knowledge of marijuana use, trends toward congruence and underestimation of EA marijuana use predicted membership in the high-using and moderate-decreasing groups compared to the low-to-non users. Study results indicate EAs in their early 20s may be more likely to engage in healthy decision-making regarding marijuana use in an environment that includes warm, supportive parent-child relationships where parents are aware of their EAs use without focusing on their EA's perceptions of risk. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Family Check-Up Online: A Telehealth Model for Delivery of Parenting Skills to High-Risk Families With Opioid Use Histories.

Growing opioid misuse in the United States has resulted in more children living with an adult with an opioid use history. Although an abundance of research has demonstrated a link between opioid misuse and negative parenting behaviors, few intervention efforts have been made to target this underserved population. The Family Check-Up (FCU) has been tested in more than 25 years of research, across multiple settings, and is an evidence-based program for reducing risk behavior, enhancing parenting skills, and preventing the onset of substance use. It is designed to motivate parents to engage in positive parenting practices and to change problematic parenting and has been tested across a variety of ages including early childhood and adolescence. It is highlighted in NIDA's Principles of Substance Use Prevention for Early Childhood: A research-based guide as one of only three effective selective prevention programs for substance abuse among families with young children. Recently, we developed an online version of the FCU that has now been adapted for early childhood and families with opioid use histories. The online platform and telehealth model allow for wide-scale dissemination, ease of training with community providers, and increased public health reach for families in remote, rural areas. This is particularly important when targeting families with opioid misuse and addiction because there are high rates of addiction in remote areas, yet few services available. In this article, we describe the FCU Online and review new content in the model that targets a population of young adult parents with substance abuse histories, including opioid use. New modules include content focused on harm reduction for this high-risk population of parents, such as safety in the home, substance use while parenting, and managing conflict with partners and friends.

Therapeutic alliance as a predictor of behavioral outcomes in a relationally focused, family-centered telehealth intervention.

This study evaluates therapeutic alliance as a mediator of the relationship between dosage and clinical outcomes for the Family Check-Up (FCU) Online, a telehealth adaptation of an evidence-based parenting intervention for parents of middle school youth. The sample consisted of N = 111 parents with children in middle school who received the FCU Online as part of an ongoing clinical trial. They were randomly assigned to receive telehealth coaching and participated in the intervention and follow-up assessment 12 months later. Data was collected using parent and child questionnaires as well as engagement data collected as part of the online intervention, using both parents and children as reporters of parent behavioral change. Using parent report measures, there was clear support for a mediation model, with parent report of alliance predicting parent self-report ratings of clinical progress (parent behavior change) at 12-month follow-up. However, for the child-report data, there was no clear relationship between dosage or therapeutic alliance with child reports of parenting. Clinical implications and future research directions are discussed.

Adolescent measures of family socioeconomic status: Reliability, validity, and effects on substance use behaviors in adolescence and young adulthood.

Socioeconomic status (SES) is a robust predictor of health disparities in adolescence and early adulthood, yet obtaining accurate and reliable measurements of family SES from younger participants remains a challenge. We evaluated the reliability and validity of a subjective SES measure, i.e., perceived family financial security (PFS), which assesses adolescents' perceptions of whether their family has enough money to meet their needs. We also examined the predictive associations of PFS and parental education (adolescent reports) with alcohol, marijuana, and tobacco use during adolescence and young adulthood. Longitudinal data were obtained from 593 parent-child dyads in the Pacific Northwest region of the United States, who were assessed eight times between 2005 and 2014. Present analyses included data from four annual assessments conducted when the participating children were adolescents (age range = 10.25-16.33 years) and a final follow-up in young adulthood (age range = 20-23.42 years). PFS had good test-retest reliability and convergent validity with other parent and adolescent reported SES measures. Adolescent-reported PFS significantly predicted tobacco use frequency in young adulthood, whereas adolescent-reported parental education predicted alcohol use frequency. PFS was not a significant predictor of alcohol or marijuana use. Findings suggest that PFS can be a psychometrically sound measure to assess a unique dimension of SES in adolescent samples, with differential predictive associations among substance use outcomes in young adulthood compared to more traditional measures like parental education. Future research should evaluate the psychometric properties and utility of PFS as a complementary SES measure.

The Family Check-Up: Ecological Family-Based Assessments in the Context of Potential Child Abuse or Chaotic Home Environments.

One percent of all children in the United States are estimated to be abused or neglected each year, equating to about 700,000 children per year. Limited parenting skills are one of the most robust risk factors for child abuse and neglect. The present paper describes the Family Check-Up (FCU), a trauma-informed, strengths-based and comprehensive family management intervention aimed at promoting positive parenting skills, reducing child maladaptive behaviors, and optimizing child and family outcomes. By evaluating various ecological and contextual factors, the FCU targets a range of parenting and child behavior difficulties to prevent child abuse/neglect, while improving long-term child and family outcomes.

Using Motivational Interviewing to Improve Parenting Skills and Prevent Problem Behavior During the Transition to Kindergarten.

In this study, we examined the efficacy of a version of the Family Check-Up (FCU) adapted for kindergarten school entry with regard to parenting skills during the transition to school. We also examined whether improvements in parenting skills would mediate improvements in parent- and teacher-rated child behavior problems from kindergarten to second grade. The FCU is a motivational interviewing (MI) intervention designed to engage parents in treatment to improve parenting skills. Participants were parents of 365 children enrolled in one of five elementary schools in the Pacific Northwestern United States. Main and indirect effects were tested with structural equation path modeling using an intent-to-treat approach. The FCU was associated with improved change in parenting skills, and changes in parenting skills, in turn, predicted reductions in child behavior problems. Implications for embedding MI in family-centered interventions at kindergarten school entry are discussed. Trial registration: NCT02289092.

Family-centered prevention to enhance parenting skills during the transition to elementary school: A randomized trial.

The objective of this study was to evaluate the effect of a family-centered preventive intervention, the Family Check-Up (FCU), on improving parenting skills during kindergarten and first grade, when children are challenged to engage in a variety of new behaviors, such as sustained attention and self-regulation of behavior in the classroom. Building on prior research and funded by the Department of Education, we tested the effect of the FCU on parenting skills during the transition to kindergarten. We predicted both direct and moderated effects of the FCU on changes in parenting, including positive parenting, monitoring/family routines, and negative parenting skills. In this registered clinical trial (NCT02289092; see Consolidated Standards of Reporting Trials diagram in Figure 1), participants were 321 families of kindergarten children recruited from 5 public elementary schools and randomly assigned to either the FCU or to a school-as-usual control group (n = 164 assigned to intervention). Families engaged in the intervention at a high rate (75%) and completed assessments about parenting skills from kindergarten to first grade. Results suggest that FCU effects on parenting skills were moderated by parenting contextual stress. As stress increased, so did positive effects of FCU on monitoring/family routines and negative parenting. No effects on positive parenting skills were observed. Results of this research suggest the effects of the FCU are more pronounced for high-stress families and contribute to the literature supporting adaptive, tailored approaches to intervention for high-risk children and their caregivers. (PsycINFO Database Record (c) 2020 APA, all rights reserved).