A pilot feasibility study of Conexiones, a telephone-delivered cancer parenting education program for Hispanic mothers.

OBJECTIVE: To test the short-term impact of Conexiones, a culturally adapted cancer parenting education program for diagnosed child-rearing Hispanic mothers. DESIGN: Single group, pre-post-test design. SAMPLE: 18 U.S. Hispanic mothers diagnosed within 2 years with early-stage cancer (0-III) raising a child (5-17 years). METHODS: Participants completed consent, baseline measures, and five telephone-delivered Conexiones sessions at 2-week intervals from trained patient educators in English or Spanish. Outcomes were assessed at baseline and at 3 months. RESULTS: Maternal depressed mood, parenting self-efficacy, and parenting quality significantly improved. Children's anxious/depressed mood tended to significantly improve. Outcomes did not co-vary with mothers' level of acculturation. CONCLUSIONS: Conexiones appears to positively improve Hispanic mothers' distress and parenting competencies; efficacy testing is warranted within a larger randomized control trial. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS: A brief, culturally adapted cancer parenting education program has potential to enhance Hispanic mothers' and children's behavioral-emotional adjustment to a mother's cancer.

The Effects of the Parenting Education Performed through Whatsapp on the Level of Maternal-Paternal and Infant Attachment in Turkey.

PURPOSE: This study aimed to identify the effects of parenting education with online WhatsApp messages on the level of maternal-paternal and infant attachment. DESIGN AND METHODS: The study adopted a randomized-controlled experimental design. The sample of the study was 32 couples. The experimental group was provided with online parenting education in the WhatsApp groups. Data were collected through the Socio-Demographic Form, the Maternal Attachment Inventory, and the Paternal Postnatal Attachment Questionnaire. Data were analyzed using the Chi-square test, Wilcoxon test, Paired t-test, Independent sample t-test, Mann Whitney U test, and Wald type statistics test. RESULTS: Intra-group comparisons showed that there was a statistical significance between the Maternal Attachment Inventory total scores (p < 0.001). There was a significant difference between group time interactions (p < 0.001), and these differences had a high effect size. When the intra-group comparisons were performed in terms of the Paternal Postnatal Attachment Questionnaire, there were significant differences between the total score differences (p = 0.001). An analysis of the group time interactions indicated no statistically significant differences (p = 0.653). CONCLUSIONS: The results of this study showed that the parenting education intervention increased maternal attachment levels in a significant way.

What Parents Know Matters: Parental Knowledge at Birth Predicts Caregiving Behaviors at 9 Months.

OBJECTIVE: To examine the mediating role of socioeconomically disadvantaged parents' knowledge of early cognitive and language development at the first postpartum visit in the relation between education and caregiving behaviors at 9 months. STUDY DESIGN: Parental knowledge was assessed at the 1-week newborn visit (n = 468); anticipatory guidance received and desired at 1-month (n = 212) and 6-month (n = 191) visits were reported; and caregiving behaviors toward infants during a teaching task were observed at 9-month visit (n = 173). RESULTS: We found substantial variation in knowledge and caregiving behaviors. Parents who had more knowledge of infant development at 1 week were more likely to respond to cues (r = 0.18; P < .05) and foster social-emotional (r = 0.17; P < .05) and cognitive growth (r = 0.20; P < .05) at 9 months. Importantly, the indirect effect of education on cognitive growth fostering at 9 months through knowledge at 1 week was significant, controlling for primary language and number of other children in the home (infancy: ß = 0.06; B = 0.07; SE = 0.04; 95% CI, 0.007-0.165; early childhood: ß = 0.04; B = 0.06; SE = 0.03; 95% CI, 0.008-0.152). Open-ended responses indicated that anticipatory guidance in the first 6 months focused on infant physical growth; however, parents did not request additional anticipatory guidance from their pediatricians. CONCLUSIONS: This study sheds light on the importance of promoting parental knowledge about cognitive and language development to foster parental cognitive stimulations and language inputs during the first year of life. This study highlights the important role of anticipatory guidance on cognitive and language development during the earliest well-child visits and the need to better understand parental baseline knowledge to tailor anticipatory guidance to the family strengths and needs.

The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) Responsive Parenting Intervention for Firstborns Affects Dietary Intake of Secondborn Infants.

BACKGROUND: Although previous work has shown that children with older siblings tend to have poorer diet quality, no study has directly compared diets of infant siblings. OBJECTIVE: The goals of this analysis were to examine birth-order differences in dietary intake between firstborn (FB) and secondborn (SB) siblings, and to determine whether a responsive parenting (RP) intervention modified birth-order effects on diet. METHODS: The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) study randomly assigned first-time mothers to an RP intervention, which included guidance on feeding, sleep, soothing, and interactive play, or control. INSIGHT mothers who delivered a second child enrolled in an observation-only study of their SB infant (SIBSIGHT). Mothers completed FFQs for both children at ages 6 (n = 97 sibling pairs) and 12 (n = 100) mo. FB compared with SB intake of food groups of interest were compared, and the moderating effect of the RP intervention on birth-order differences was tested using generalized linear mixed models. RESULTS: Though FBs and SBs had similar diets, more FBs than SBs consumed 100% fruit juice at both 6 (13.8 compared with 3.2%, P = 0.006) and 12 mo (46.0 compared with 32.0%, P = 0.01). SBs consumed fruit more frequently (FB 2.8 compared with SB 3.2 times/d, P = 0.01), and were more likely to consume fried potatoes (FB 38.4 compared with SB 57.6%, P = 0.0009) and processed meats (FB 43.0 compared with SB 58.0%, P = 0.02) than FBs at 12 mo. There were no differences by birth order in intake of sweets, snacks, or sugar-sweetened beverages at 12 mo. At 12 mo, RP-group SBs ate vegetables more times per day (3.2) than control SBs (2.2, P = 0.01). RP-SBs also consumed a greater variety of vegetables (10.2) than control-SBs (7.9, P = 0.01). CONCLUSIONS: Birth order is not consistently associated with healthy or unhealthy infant dietary intake. However, an RP intervention delivered to first-time mothers may benefit subsequent infants' vegetable intake. This trial was registered at clinicaltrials.gov as NCT01167270.

Stop the Bleed: Effective Training in Need of Improvement.

BACKGROUND: The "Stop the Bleed" (StB) campaign aims to educate laypersons on performing bleeding control techniques in any setting that requires hemorrhage control, such as motor vehicle crashes or mass casualty incidents. Participants undergo a didactic and practical session, the latter incorporating a mannequin. We hypothesized that participants would increase content knowledge after StB participation and that the training could be improved by a more life-like bleeding modification of the mannequin. MATERIALS AND METHODS: From July 2017 to January 2018, hospital and community members from a major metropolitan area participated in StB training. Participants provided demographic data regarding prior emergency training and were asked pre- and post-test questions (five-point Likert scale) regarding their response to hemorrhage. Individuals also evaluated the mannequin on bleeding simulation. Scores were reported as means with standard deviation or medians with interquartile ranges (IQRs) with subset analysis stratified by experience. RESULTS: Of 402 participants, 310 provided complete data. On the composite, pre-test self-assessment, participants had a median score of 24 of 30 points (IQR 16-30). Post-testing demonstrated a statistically significant increase with a median score of 29 (IQR 25-30, P < 0.05). Subset analysis by prior emergency training (n = 102) demonstrated that both those with prior emergency training and those with no prior emergency training had significant improvement. On evaluation of the mannequin, participants reported that a more realistic model would increase their confidence in technique. Both subgroups reported that training would be enhanced if the mannequins were more realistic. CONCLUSIONS: StB is an effective education program. Those without prior experience or training in hemorrhage cessation demonstrated the most improvement. Regardless of background, participants reported overwhelmingly that the training would be more effective if it were more realistic. Future work to design and develop cost-effective mannequins demonstrating pulsatile blood flow and cessation of hemorrhage could enable learners to actually "Stop the Bleed".

The Challenge of Implementing the "Stop the Bleed" Campaign in Latin America.

BACKGROUND: Currently, several initiatives have emerged to empower the public to act as immediate responders in front of hemorrhaging victims. We aimed to evaluate the effectiveness of implementing the Stop the Bleed campaign and the association between the instructors' background and the theoretical and practical competences achieved by the participants in Latin America. METHODS: Medical students and general surgeons taught both allied health students and nonallied health students at a local university; the training had a master class followed by a practical component and a written test, as well as tourniquet placement was tested. RESULTS: 265 individuals received the training, and data were available for 243. Of these, 126 (52.07%) were women and the median age was 21 (IQR: 20-22) years. 121 (49.79%) were trained by general surgeons (group A) and 122 (50.21%) by medical students (group B). After the training, more than 98% of all participants perceived that they would most likely be capable of aiding correctly a bleeding victim by applying direct pressure and more than 90% of them felt confident in being able to apply a tourniquet. There were no statistically significant differences among both groups when comparing their post-training competence evaluations [Theoretical test score: group A = 5 (IQR: 4-5); group B = 5 (IQR: 4-5); P = 0.41] and [Practical competency of tourniquet deployment: group A = 119 (66.39%) versus group B = 120 (65.83%); P = 0.93]. CONCLUSIONS: The Stop the Bleed campaign can be effectively implemented in Latin America, and it can be taught by prequalified medical students without altering the learning objectives of the course.

Clinical and cost effectiveness of a parent mediated intervention to reduce challenging behaviour in pre-schoolers with moderate to severe intellectual disability (EPICC-ID) study protocol: a multi-centre, parallel-group randomised controlled trial.

BACKGROUND: Children with intellectual disabilities are likely to present with challenging behaviour. Parent mediated interventions have shown utility in influencing child behaviour, although there is a paucity of UK research into challenging behaviour interventions in this population. NICE guidelines favour Stepping Stones Triple P (SSTP) as a challenging behaviour intervention and this trial aims to evaluate its clinical and cost effectiveness in preschool children with moderate to severe intellectual disabilities. METHODS: This trial launched in 2017 at four sites across England, with the aim of recruiting 258 participants (aged 30-59 months). The Intervention Group receive nine weeks of SSTP parenting therapy (six group sessions and three individualised face to face or telephone sessions) in addition to Treatment as Usual, whilst the Treatment as Usual only group receive other available services in each location. Both study groups undergo the study measurements at baseline and at four and twelve months. Outcome measures include parent reports and structured observations of behaviour. Service use and health related quality of life data will also be collected to carry out a cost effectiveness and utility evaluation. DISCUSSION: Findings from this study will inform policy regarding interventions for challenging behaviour in young children with moderate to severe intellectual disabilities. TRIAL REGISTRATION NUMBER: Clinicaltrials.gov, NCT03086876. Registered 22nd March 2017, https://clinicaltrials.gov/ct2/show/NCT03086876.

Development of two instruments for assessing maternity health needs: protocol of a clinimetric study.

BACKGROUND: There is an unquestionable need to adapt health care to the needs of each woman, to foster her self-confidence and provide her with the autonomy to manage her own maternity. This involves empowering her to choose and face her model of childbirth and childcare responsibly. The range of self-management health needs tests offered by the scientific community at this stage of life is practically non-existent. In this project, we intend to develop and evaluate the validity, reliability and ease of use of two self-administered analysis instruments for: 1.- Needs of women preparing for childbirth and 2.- Identification of alarm symptoms in the puerperium. METHODS: This is a descriptive study of the clinimetric characteristics and usability of two developed self-applied digital instruments for measuring needs in childbirth and postpartum based on the recommendations made in the consensus-based standards for the selection of health measurement instruments (COSMIN) and by the International Test Commission (ITC). The study consists of two phases: 1 - Evaluation of the clinimetric properties of the two instruments, which were developed and then altered, based on their comprehensibility and global usability estimated from a pilot study and 2 - Pre-implementation study. DISCUSSION: The final product will be two valid, reliable, usable instruments for self-assessment of health needs that are highly acceptable to young couples and the professionals who serve them. They will be a valuable resource for meeting the needs of the population more efficiently and guiding decision-making, and they will contribute to the greater sustainability of the health system.

Are Malaysian Type 2 Diabetes patients willing to be trained to speak to their offspring about risk of diabetes and preventive measures?

BACKGROUND: Offspring of type 2 diabetes patients have an absolute risk of 20-40% of developing the condition. Type 2 diabetes patients should be encouraged to speak to their offspring regarding diabetes risk and prevention strategies. The Health Belief Model conceptualises that the higher the perceived risk, the more likely an individual will modify their behaviour. The objectives of this study were to i) determine the distribution of type 2 diabetes patients regarding their willingness to accept training to speak to their offspring, ii) determine the distribution of type 2 diabetes patients regarding their willingness to accept training based on the HBM and iii) to determine the factors associated with their willingness to accept training. METHODS: This was a cross-sectional study amongst type 2 diabetes patients attending two primary care clinics in Malaysia. Sociodemographic data and knowledge of diabetes risk factors were collected. The adapted, translated and validated Diabetes Mellitus in the Offspring Questionnaire-Malay version (DMOQ-Malay) was self-administered. Statistical analysis included descriptive statistics, univariate and multiple logistic regression (MLogR). RESULTS: A total of 425 participants were recruited. Of these, 61.6% were willing to accept training. In MLogR, six variables were found to be significantly associated with willingness to accept training. These were i) positive family history [Adj. OR 2.06 (95% CI: 1.27, 3.35)], ii) having the correct knowledge that being overweight is a risk factor [Adj. OR 1.49 (95%CI: 1.01, 2.29)], iii) correctly identifying age ≥ 40 years old as a risk factor [Adj. OR 1.88 (95%CI: 1.22, 2.90)], iv) agreeing that speaking to their offspring would help them to prevent type 2 diabetes [Adj. OR 4.34 (95%: 1.07, 17.73)], v) being neutral with the statement 'I do not have much contact with my offspring' [Adj. OR: 0.31 (95% CI: 0.12, 0.810] and vi) being neutral with the statement 'my offspring are not open to advice from me' [Adj. OR: 0.63 (95% CI: 0.31, 0.84]. CONCLUSION: The majority of type 2 diabetes patients were willing to accept training to speak to their offspring to prevent diabetes. A training module should be designed to enhance their knowledge, attitude and skills to become family health educators.

A randomised clinical pilot trial to test the effectiveness of parent training with video modelling to improve functioning and symptoms in children with autism spectrum disorders and intellectual disability.

BACKGROUND: Poor eye contact and joint attention are early signs of autism spectrum disorder (ASD) and important prerequisites for developing other socio-communicative skills. Teaching parents evidence-based techniques to improve these skills can impact the overall functioning of children with ASD. We aimed to analyse the impact of conducting a group parent-training intervention with video modelling to improve the intelligent quotient (IQ), social and communication functioning and to minimise symptoms in children with ASD and intellectual disability (ID). METHODS: Study design: A multicentre, single-blinded, randomised clinical pilot trial of parent training using video modelling was conducted. SAMPLE: Sixty-seven parents of children with ASD, aged between 3 and 6 years and with IQs between 50 and 70, were randomised: 34 to the intervention group and 33 to the control group. Intervention program: The intervention group received parent training over 22 sessions, and the control group received the standard community treatment. INSTRUMENTS: Pre-evaluation and post-evaluation (week 28), the following were used: Autism Diagnostic Interview, Vineland Adaptive Behaviour Scale I, Snijders-Oomen Nonverbal Intelligence Test, Autism Behaviour Checklist and Hamilton Depression Rating Scale. DATA ANALYSIS: Intention to treat and complier-average causal effect (CACE) were used to estimate the effects of the intervention. RESULTS: There was a statistically significant improvement in the Vineland standardized communication scores in CACE (Cohen's d = 0.260). There was a non-statistically significant decrease in autism symptomatology (Autism Behaviour Checklist total scores) and a significant increase in the non-verbal IQ in the intervention group. After the false discovery rate correction was applied, IQ remained statistically significant under both paradigms. The effect size for this adjusted outcome under the intention-to-treat paradigm was close to 0.4, and when considering adherence (CACE), the effect sizes were more robust (IQ's Cohen's d = 0.433). CONCLUSIONS: Parent training delivered by video modelling can be a useful technique for improving the care given to children with ASD and ID, particularly in countries that lack specialists.

"My child will actually say 'I am upset' Before all they would do was scream": Teaching parents emotion validation in a social care setting.

BACKGROUND: Emotion validation by parents has positive outcomes for children's emotional development, particularly in vulnerable families, but there is a lack of research on supporting health workers to teach emotion validation to parents whose children are open to early help and children's social services. There is also a theoretical debate about how best to conceptualize emotion validation and why it is beneficial to children. The purpose of the study was to test the feasibility of teaching emotion validation skills to parents and family workers in a social care setting and to examine the effects of such teaching on children's emotion awareness and emotion regulation. METHODS: This small scale qualitative feasibility study involved 11 parents (with children aged 2-5 years) who were receiving early help social services and five family workers. All parents took part in a 4-week course teaching emotionally validating parenting: either in a group class (six parents) or one-one delivery at home via a family worker (five parents). Effects on parents, children, and family workers were assessed using semi-structured interviews. RESULTS: Six themes were identified in qualitative analysis: (1) parent became more validating, (2) parent's own vulnerability affected their ability to use the skills, (3) child became more aware of emotions, (4) child became calmer and more accepting of negative emotions, (5) child transferred emotion validation to others, and (6) family workers incorporated emotion validation techniques into their professional practice. CONCLUSION: Results demonstrated the feasibility of teaching emotional validation skills to parents via both delivery methods, with positive outcomes reported for parents and children and positive impact reported on family worker practice. Qualitative analysis suggested that parental acceptance of child's negative emotions may be linked with greater self-awareness of negative emotions in the child.

Parent Management Training Oregon Model and Family-Based Services as Usual for Behavioral Problems in Youth: A National Randomized Controlled Trial in Denmark.

This randomized control trial used intent-to-treat analyses to compare parent management training-Oregon model (PMTO) (N = 64) to family-based services as usual (SAU) (N = 62) in 3.5-13-year-old children and their families in Denmark. Outcomes were parent report of child internalizing and externalizing problems, parenting efficacy, parenting stress, parent sense of coherence, parent-report of life satisfaction, and parental depressive symptoms. Outcomes were measured at pretreatment, post-treatment, and 18-20 months post-treatment. Results demonstrated that both PMTO and family-based SAU resulted in significant improvements in child externalizing and internalizing problems, parenting efficacy, as well as parent-reported stress and depressive symptoms, life satisfaction, and aspects of sense of cohesion. Effect sizes at post-treatment and follow-up were in the small to moderate range, consistent with prior PMTO evaluations. However, there were no significant differences between PMTO and family-based SAU. Further research on the process and content of family-based SAU is needed to determine how this approach overlaps with and is distinct from PMTO.

Examining the Emotional Experience of Mothers Completing an Evidence-Based Parenting Intervention: A Grounded Theory Analysis.

Parenting interventions are a well-established treatment for addressing child behavior problems that have also been shown to improve parent psychosocial health. Yet, little is known about how caregiver emotional experiences change over time during treatment. In response, the purpose of this study was to explore the emotional experiences of mothers following their participation in an evidence-based parenting intervention. Researchers conducted a secondary analysis of existing qualitative data. The study sample included semi-structured interview data from 17 mothers who previously completed the GenerationPMTO parenting intervention. Data analysis followed the grounded theory approach and included a sequential process of open, axial, and selective coding using the constant comparative method. Findings indicate mothers progressed through three distinct, yet interrelated stages of emotional experience: Before PMTO, their experiences were characterized by parenting through crisis (Stage 1); during PMTO, they transitioned to crisis stabilization (Stage 2); and following PMTO, they described experiences of emerging recovery and resilience (Stage 3). Maternal emotional experiences in each stage occurred across three contextual realms: (a) the individual (intrapersonal) level, (b) the parent-child relationship level, and the broader systemic level. Results highlight the dynamic and evolving nature of maternal emotional experience throughout various stages of the intervention process and suggest how these experiences may be associated with promoting effective parenting practices and positive child outcomes.

Las intervenciones en la crianza son un tratamiento firmemente consolidado para abordar los problemas de comportamiento de los niños y, a su vez, se ha comprobado que mejoran la salud psicosocial de los padres. Sin embargo, poco se sabe acerca de cómo las experiencias emocionales de los cuidadores cambian con el tiempo durante el tratamiento. En respuesta a esto, el propósito de este estudio fue analizar las experiencias emocionales de las madres después de su participación en una intervención factual en la crianza. Los investigadores llevaron a cabo un análisis secundario de los datos cualitativos actuales. La muestra del estudio incluyó datos de entrevistas semiestructuradas de 17 madres que anteriormente completaron la intervención en la crianza denominada GenerationPMTO. Los análisis de los datos siguieron el enfoque de teoría fundamentada e incluyeron un proceso secuencial de codificación abierta, axial y selectiva utilizando el método comparativo constante. Los resultados indican que las madres pasaron por tres estapas diferentes, pero interrelacionadas, de experiencia emocional: antes de la PMTO, sus experiencias estuvieron caracterizadas por la crianza durante la crisis (etapa 1), durante la PMTO, pasaron a la estabilización de la crisis (etapa 2) y después de la PMTO, describieron experiencias de surgimiento de recuperación y resiliencia (etapa 3). Las experiencias emocionales maternas de cada etapa se produjeron en tres ámbitos contextuales: a) el nivel individual (intrapersonal), b) el nivel de la relación entre padres e hijos y el nivel sistémico más amplio. Los resultados destacan la índole dinámica y cambiante de la experiencia emocional materna durante varias etapas del proceso de intervención y sugieren cómo estas experiencias pueden estar asociadas con el fomento de prácticas de crianza eficaces y resultados positivos en los niños.

Addressing Immigration-Related Stress in a Culturally Adapted Parenting Intervention for Mexican-Origin Immigrants: Initial Positive Effects and Key Areas of Improvement.

Culturally adapted evidence-based parenting interventions constitute a key strategy to reduce widespread mental health disparities experienced by Latinx populations throughout the United States. Most recently, the relevance of culturally adapted parenting interventions has become more prominent as vulnerable Latinx populations are exposed to considerable contextual stressors resulting from an increasingly anti-immigration climate in the country. The current study was embedded within a larger NIMH-funded investigation, aimed at contrasting the differential impact of two culturally adapted versions of the evidence-based parenting intervention known as GenerationPMTO©. Specifically, a sample of low-income Mexican-origin immigrants was exposed either to a culturally adapted version of GenerationPMTO primarily focused on parent training components, or to an enhanced culturally adapted version in which parenting components were complemented by sessions focused on immigration-related challenges. The sample for the study consisted of 103 Mexican-origin immigrant families (190 individual parents). Descriptive analysis and generalized estimating equations (GEEs) indicated that exposure to the enhanced intervention, which included context- and culture-specific sessions, resulted in specific benefits for parents. However, the magnitude of the impact was not uniform for mothers and fathers and differed according to the type of immigration-related stress being examined (i.e., intrafamilial vs. extrafamilial stress). Overall, findings indicate the relevance of overtly addressing contextual (e.g., discrimination) and cultural challenges in culturally adapted interventions, as well as the need to increase precision according to the extent to which immigration-related stressors impact immigrant mothers and fathers in common and contrasting ways. Implications for family therapy practice and research are discussed.

Las intervenciones basadas en evidencia, dirigidas a padres y adaptadas a la cultura son una estrategia clave para reducir las desigualdades en salud mental generalizadas que las poblaciones de latin@s experimentan en los Estados Unidos. Más recientemente, la relevancia de intervenciones dirigidas a padres adaptadas a la cultura ha adquirido más peso al estar las poblaciones de latin@s expuestas a factores estresantes contextuales considerables como resultado de un ambiente cada vez más contrario a la inmigración en el país. Este estudio fue incluido dentro de una investigación de mayor escala financiada por NIMH cuyo objetivo era contrastar el impacto diferencial de dos versiones adaptadas a la cultura de la intervención basada en evidencia y dirigida a padres conocida como GenerationPMTO© . En específico, se expuso una muestra de inmigrantes de origen mexicano de bajo ingreso, o a una versión de GenerationPMTO adaptada a la cultura y enfocada principalmente en elementos de entrenamiento de padres, o a una versión reforzada adaptada a la cultura en la cual los elementos de padres se complementaron con sesiones enfocadas en retos asociados a la inmigración. La muestra para el estudio consistió de 103 familias inmigrantes de origen mexicano (190 padres individuales). Análisis descriptivos y ecuaciones de estimación generalizadas indicaron que la exposición una intervención reforzada, que incluía sesiones contextual y culturalmente específicas, generaron beneficios específicos para los padres. Sin embargo, la magnitud del impacto no fue uniforme para madres y padres y fue distinta según el tipo de estrés por inmigración examinado (p.ej., estrés intrafamiliar versus estrés extrafamiliar). En general, los hallazgos indican la relevancia de enfrentar abiertamente retos contextuales (p.ej., discriminación) y culturales en intervenciones adaptadas a la cultura, así como la necesidad de aumentar la precisión conforme a cómo los factores estresantes asociados a la inmigración afectan a madres y padres inmigrantes de la misma y diferentes maneras. Se discuten las implicaciones para la práctica e investigación de terapia familiar.

Does knowing translate to doing? Practitioners' experiences of Circle of Security-Parenting (COS-P) training and implementation.

This study sought to understand how practitioners perceive and experience the Circle of Security-Parenting (COS-P) training, and further, how they integrate and implement it into practice, and how these experiences influence their use and understanding of the program and its underlying model. A thematic analysis of semistructured interviews at two time points (shortly after training and 3-6 months after training) was used to explore 12 practitioners' experiences of COS-P training and subsequent implementation. Three main themes were identified; clinical salience, personal salience, and partial use of the program. The findings reflected participants' common perception that the model is relevant and generalizable to a wide variety of contexts. It also highlighted potential barriers to implementation, particularly practitioners' experiences using only components of the COS-P program in isolation. The results suggest practitioners' assumptions about client complexities, vulnerabilities, and/or incapacities, can prompt practitioners to withhold the use of COS-P (in part or whole), thereby potentially neglecting key components required for client change. The only participants who implemented the COS-P training in full had additional training in Circle of Security.

Este estudio buscaba comprender cómo los profesionales de la práctica perciben y experimentan el entrenamiento Círculo de Seguridad-Crianza (COS-P), y aún más, cómo ellos lo integran e implementan en la práctica y cómo estas experiencias influyen en su uso y comprensión del programa y el modelo que el mismo enfatiza. Se usó un análisis temático de entrevistas semiestructuradas en dos momentos temporales (poco después del entrenamiento y 3-6 meses después del entrenamiento) para explorar doce experiencias de profesionales de la práctica en cuanto al entrenamiento de COS-P y la subsecuente implementación. Se identificaron tres temas principales; relevancia clínica, relevancia personal y el uso parcial del programa. Los resultados reflejan la percepción común de los participantes de que el modelo es relevante y se puede generalizar a una variedad amplia de contextos. También destacó barreras potenciales para la implementación, particularmente las experiencias de los profesionales de la práctica usando sólo componentes aislados del COS-P. Los resultados sugieren que las suposiciones de los profesionales de la práctica acerca de las complejidades, vulnerabilidades y/o incapacidades del cliente pueden dar pie para que tales profesionales no revelen el uso de COS-P (en parte o totalmente), de modo que potencialmente desatiendan componentes claves requeridos para el cambio en el cliente. Los únicos participantes que implementaron el entrenamiento de COS-P en su totalidad recibieron entrenamiento adicional en cuanto a Círculo de Seguridad.

Cette étude s'est donné pour but de comprendre comment les praticiens perçoivent et font l'expérience de la formation du Cercle de Sécurité-Parentage (COS-P en anglais), et ensuite comment ils l'intègrent et la mettent en place dans leur pratique, ainsi que la manière dont ces expériences influencent leur utilisation et compréhension du programme, tout comme son modèle sous-jacent. Une analyse thématique d'entretiens semi-structurés en deux temps (pas longtemps du Cercle de Sécurité-Parentage (COS-P) après la formation et 3 à 6 mois après la formation) a été utilisée afin d'explorer à la fois les expériences du COS-P faites par douze praticiens et leur mise en place subséquente. Trois thèmes principaux ont été identifiés, la saillance clinique, la saillance personnelle et l'utilisation partielle du programme. Les résultats ont reflété la perception commune des participants selon laquelle le modèle est pertinent et généralisable à une grande variété de contextes. L'étude a aussi mis en lumière les barrières potentielles pour la mise en place, en particulier les expériences des praticiens utilisant uniquement des composantes du programme COS-P en isolation. Les résultats suggèrent que les suppositions des praticiens sur les complexités des clients, leurs vulnérabilités et / ou leurs incapacités, peuvent pousser les praticiens à ne pas utiliser le COS-P (en partie ou totalement), négligeant ainsi potentiellement des composantes clés exigées pour que le client change. Les seuls participants qui ont mis en place la formation COS-P en totalité avaient la formation supplémentaire de Cercle de Sécurité.

Infant illness severity and family adjustment in the aftermath of NICU hospitalization.

Up to 15% of parents have an infant who will spend time in a neonatal intensive care unit (NICU). After discharge, parents may care for a medically fragile infant and worry about their development. The current study examined how infant illness severity is associated with family adjustment. Participants included parents with infants who had been discharged from the NICU 6 months to 3 years prior to study participation (N = 199). Via a Qualtrics online survey, parents reported their infants' medical history, parenting stress, family burden, couple functioning, and access to resources. Multivariable regression analyses revealed that more severe infant medical issues during hospitalization (e.g., longer length of stay and more medical devices) were associated with greater family burden, but not stress or couple functioning. Infant health issues following hospitalization (i.e., medical diagnosis and more medical specialists) were associated with greater stress, poorer couple functioning, and greater family burden. Less time for parents was associated with increased stress and poorer couple functioning. Surprisingly, parents of infants who were rehospitalized reported less stress and better couple functioning, but greater family burden. Family-focused interventions that incorporate psychoeducation about provider-patient communication, partner support, and self-care may be effective to prevent negative psychosocial sequelae among families.

Hasta un 15% de progenitores tiene un infante que pasará un tiempo en una Unidad de Cuidado Intensivo Neonatal (NICU). Después de la salida, los progenitores deben cuidar de un infante médicamente débil y preocuparse por su desarrollo. El presente estudio examinó cómo la severidad de la enfermedad del infante se asocia con la adaptabilidad familiar. Los participantes eran progenitores con infantes que habían salido de la Unidad de Cuidado Intensivo Neonatal entre 6 meses y 3 años antes de participar en el estudio (N = 199). Por medio de una encuesta electrónica tipo Qualtrics, los progenitores reportaron el historial médico de su infante, el estrés de la crianza, la carga familiar, el funcionamiento como pareja y el acceso a recursos. Los análisis de regresión de variables múltiples revelaron que asuntos médicos más severos del infante durante la hospitalización (v.g. período más largo de hospitalización, más aparatos médicos) se asociaban con mayor carga familiar, aunque no así con estrés o el funcionamiento como pareja. Los asuntos de salud infantil posteriores a la hospitalización (v.g. diagnóstico médico, más médicos especialistas) se asociaron con mayor estrés, un más pobre funcionamiento como pareja y mayor carga familiar. Menos tiempo para los progenitores se asoció con un aumento en el estrés y un más pobre funcionamiento como pareja. De modo sorprendente, los progenitores de infantes que habían sido hospitalizados otra vez reportaron menos estrés y mejor funcionamiento como pareja, pero mayor carga familiar. Las intervenciones con enfoque familiar que incorporan educación sicológica acerca de la comunicación entre proveedor y paciente, apoyo a la propia pareja y el cuidado propio pudieran ser eficaces para prevenir la secuela sicosocial entre familias.

Jusqu'à 15% des parents ont un bébé qui passera du temps en Unité Néonatale de Soins Intensifs. A la sortie de l'hôpital les parents peuvent se retrouver à prendre soin d'un bébé fragile du point de vue médical et s'inquiéter de son développement. Cette étude a examiné comment la sévérité de la maladie du bébé est liée à l'ajustement de la famille. Les participants ont inclu des parents avec des bébés étant sortis de l'Unité Néonatale de Soins Intensifs 6 mois à trois ans avant la participation à l'étude (N = 199). Au travers d'un questionnaire Qualtrics en ligne, les parents ont fait état de l'histoire médicale des bébés, du stress de parentage, du poids sur la famille, du fonctionnement du couple et de l'accès aux ressources. Des analyses de régression multivariables ont révélé que les problèmes médicaux du bébé durant l'hospitalisation les plus graves (i.e. durée plus longue du séjour, plus de dispositifs médicaux) étaient liés à un poids sur la famille plus fort, mais pas au stress ni n'affectait le fonctionnement du couple. Les problèmes de santé du bébé après l'hospitalisation (soit un diagnostic médical, plus de spécialistes médicaux) étaient liés à un stress plus élevé, à un fonctionnement du couple moins bon, et à un poids sur la famille plus fort. Moins de temps pour les parents était lié à un stress supplémentaire et à un fonctionnement du couple moins bon. Avec surprise, les parents de bébés qui étaient réhospitalisés ont fait état de moins de stress et d'un meilleur fonctionnement de couple, mais d'un poids plus fort sur la famille. Les interventions centrées sur la famille qui incorporent une psychoéducation sur la communication médecin-parent, le soutien du partenaire et le soin de soi peut s'avérer efficace afin d'éviter des séquelles psychosociales négatives chez les familles.

Parent engagement in an original and culturally adapted evidence-based parenting program, Legacy for Children™.

Legacy for Children™ (Legacy) is an evidence-based program focused on promoting sensitive, responsive parenting for socioeconomically disadvantaged families. Legacy has recently been culturally and linguistically adapted for Spanish-monolingual Latino families and is being piloted in partnership with an early childhood education program. We conducted a mixed methods study to identify barriers and facilitators to engagement, using program monitoring data sources from both participant and group leader perspectives. We conducted qualitative analyses of open-ended data to identify distinct barriers (e.g., employment challenges, health-related challenges and appointments) and facilitators (e.g., other mothers in group, interest in program topics) to engagement that emerged across English and Spanish language curriculum versions; curriculum-specific barriers and facilitators were also documented. We interpret these findings in light of quantitative data on measures of engagement, showing that participants in the Spanish curriculum evidenced comparable levels of parent-group leader relationship quality relative to the English group, and higher levels of parent's group support/connectedness and overall satisfaction. These results offer promising considerations for optimizing families' engagement in parenting programs in the context of early care and education settings.

Legado para los Niños™ (Legado) es un programa basado en la evidencia que se centra en promover una crianza sensible y susceptible para familias con desventajas socioeconómicas. Recientemente, Legado se ha adaptado cultural y lingüísticamente para familias Latinas en las que sólo se habla español, y está siendo puesto en práctica experimental en asociación con un programa de educación en la temprana niñez. Llevamos a cabo un estudio con una variedad mixta de métodos para identificar obstáculos y promotores para ser incluidos usando recursos de información de la supervisión del programa provenientes de las perspectivas tanto de participantes como de líderes de grupo. Realizamos análisis cuantitativos de información no limitada de antemano para identificar diferentes obstáculos (v.g. dificultades de empleo, dificultades y citas relacionadas con la salud) y promotores (v.g. otras madres en el grupo, interés en los temas del programa) para ser incluidos los cuales surgieron a lo largo de las versiones curriculares del inglés y del español; también se documentaron los obstáculos y promotores relacionados con el currículo específico. Interpretamos estos resultados a la luz de la información cuantitativa sobre medidas de participación, mostrando que los participantes en el currículo en español demostraron comparables niveles de calidad de la relación progenitor-líder de grupo en relación con el grupo de inglés, y más altos niveles de apoyo del grupo a los progenitores y satisfacción en general. Estos resultados ofrecen consideraciones prometedoras para lograr una óptima participación de las familias en programas de crianza en el contexto de escenarios de cuidado y educación tempranos.

Le programme Legacy for ChildrenTM (Legacy) est un programme factuel se concentrant sur la promotion d'une parentage sensible et réactif pour des familles de milieu socioéconomique défavorisé. Legacy a récemment été culturellement et linguistiquement adapté aux familles Latino américaines, en espagnol, et se trouve testé en partenariat avec un programme éducatif de la petite enfance. Nous avons procédé à une étude au moyen de méthodes mixtes afin d'identifier les barrières qui existent et freinent l'engagement, ainsi que ce qui facilite l'engagement, en utilisant des sources de données d'évaluation du programme à la fois de la perspective des participants et du leader de groupe. Nous avons fait des analyses qualitatives de données ouvertes afin d'identifier des barrières précises (i.e. les défis du chômage, les défis liés à la santé et aux rendez-vous) et les aspects facilitateurs (i.e. autres mères dans le groupe, intérêt pour les sujets du programme) pour l'engagement qui ont émergé au travers des deux versions, la version en anglais et la version en espagnol. Les barrières tenant au curriculum et aux facilitateurs ont aussi été répertoriées. Nous avons interprété ces résultats à la lumière de données quantitatives sur des mesures d'engagement, montrant que les personnes participant au curriculum espagnol faisaient preuve de niveaux comparables de qualité de la relation parent-meneur de groupe que le groupe anglais, et de niveaux plus élevés de soutien/connexion et de satisfaction générale du groupe parent. Ces résultats offrent des considérations prometteuses pour l'optimisation de l'engagement des familles dans des programmes de parentage dans le contexte du soin précoce et de l'éducation de la petite enfance.

Cognitively-Based Compassion Training for parents reduces cortisol in infants and young children.

This study tests a group-based secular contemplative practice intervention, Cognitively-Based Compassion Training (CBCT), with parents of young children. We report on a randomized controlled preliminary efficacy study. Certified teachers administered CBCT for 20 hr across 8 to 10 weeks in two cohorts of parents with infants and young children. The intervention group was compared to a waitlist control group. Thirty-nine parents and their children, who ranged in age from 4 months to 5 years, were evaluated at pre- and postintervention (n = 25 intervention, n = 14 waitlist control) on hair cortisol concentration. Parents also completed self-administered questionnaires at both time points regarding demographics, physical symptoms of stress, parenting stress, self-compassion, and mindfulness. Children of parents in the CBCT group experienced significant decreases in cortisol at the postintervention assessment, as compared with the control group. However, parent cortisol and self-report measures did not significantly change other than a small effect on clinical levels of parenting stress. CBCT may be a positive new way to intervene with parents to lower infants' and young children's cumulative physiological stress.

Este estudio puso a prueba una práctica de intervención contemplativa secular con base en un grupo, el Entrenamiento Compasivo con Base Cognitiva (CBCT), con padres de niños pequeños. Nosotros reportamos sobre un estudio de efectividad preliminar controlado al azar. Maestros titulados administraron el CBCT por 20 horas a lo largo de 8-10 semanas en dos grupos de padres con infantes y niños pequeños. El grupo de intervención fue comparado con un grupo de control en lista de espera. Treinta y nueve padres y sus niños, que oscilaban en edad de 4 meses a 5 años, fueron evaluados antes y después de la intervención (n=25 grupo de intervención, n=14 grupo de control en lista de espera) en cuanto a la concentración de cortisol en el cabello. Los padres también completaron cuestionarios auto-administrados en ambos momentos temporales con respecto a información demográfica, síntomas físicos de estrés, estrés de crianza, auto-compasión, así como plena conciencia. Los niños de padres en el grupo CBCT experimentaron una significativa disminución de cortisol al momento de la evaluación posterior a la intervención, tal como se les comparó con el grupo de control. Sin embargo, el cortisol de los padres y las medidas de auto-reporte no cambiaron significativamente. El CBCT pudiera ser una nueva manera positiva de intervenir con padres para reducir el estrés fisiológico cumulativo de infantes y niños pequeños.

Cette étude a testé une intervention de pratique contemplative séculaire et basée sur un groupe, la Formation de Compassion Cognitive (abrégé ici selon l'anglais CBCT), avec des parents de jeunes enfants. Cet article porte sur une étude d'efficacité préliminaire randomisée et contrôlée. Des formateurs certifiés ont procédé à une CBCT de 20 heures réparties sur 8-10 semaines chez deux cohortes de parents avec des nourrissons et des jeunes enfants. Le groupe d'intervention a été comparé à un groupe de contrôle en liste d'attente. Trente-neuf parents et leurs enfants, allant de 4 mois à 5 ans d'âge, ont été évalués avant et après l'intervention (n=25 intervention, n=14 contrôle de liste d'attente) sur la concentration de cortisol capillaire. Les parents ont également rempli des questionnaires auto-administrés aux deux temps d'évaluation, concernant des données démographiques, les symptômes physiques de stress, le stress de parentage, l'auto-compassion et la pleine conscience. Les enfants de parents du groupe CBCT ont fait preuve de baisses de niveau de cortisol importantes à l'évaluation post-intervention en comparaison au groupe de contrôle. Cependant le cortisol parental et les mesures auto-rapportées n'ont pas changé de manière importante. La CBCT peut être une nouvelle manière positive d'intervenir avec les parents afin de faire baisser le stress physiologique cumulatif des nourrissons et des jeunes enfants.

When mummy and daddy get under your skin: A new look at how parenting affects children's DNA methylation, stress reactivity, and disruptive behavior.

Child maltreatment is a global phenomenon that affects the lives of millions of children. Worldwide, as many as one in three to six children encounter physical, sexual, or emotional abuse from their caregivers. Children who experience abuse often show alterations in stress reactivity. Although this alteration may reflect a physiological survival response, it can nevertheless be harmful in the long run-increasing children's disruptive behavior and jeopardizing their development in multiple domains. But can we undo this process in at-risk children? Based on several lines of pioneering research, we hypothesize that we indeed can. Specifically, we hypothesize that highly dysfunctional parenting leads to an epigenetic pattern in children's glucocorticoid genes that contributes to stress dysregulation and disruptive behavior. However, we also hypothesize that it is possible to "flip the methylation switch" by improving parenting with known-effective parenting interventions in at-risk families. We predict that improved parenting will change methylation in genes in the glucocorticoid pathway, leading to improved stress reactivity and decreased disruptive behavior in children. Future research testing this theory may transform developmental and intervention science, demonstrating how parents can get under their children's skins-and how this mechanism can be reversed.

[Training programs in parental skills: A contribution to the prevention of the development of externalizing behaviors in preschool children]. / Programas de fortalecimiento de prácticas parentales: Un aporte a la prevención de conductas externalizantes en preescolares.

The presence of externalizing behaviors in childhood has significant degrees of future self-continuity and is a risk factor for school failure and drop-out, criminal behavior, substance abuse and depen dence, suicidal behaviors and other developmental psychopathological disorders. In this review, the main aspects related to parental practices strengthening programs are analyzed as useful instruments in the context of multi-component preventive work strategies. The evidence has shown that interven tion aimed at mothers and fathers is crucial in the modification of behavioral problems in children, where training in parental skills is one of the most studied strategies and considered of higher quality when preventing the development of externalizing behaviors.