Leveraging Digital Technology to Support Pregnant and Early Parenting Women in Recovery from Addictive Substances: A Scoping Review.

Little is known about digital health interventions used to support treatment for pregnant and early parenting women (PEPW) with substance use disorders (SUD). METHODS: Guided by the Arksey and O'Malley's Scoping Review Framework, empirical studies were identified within the CINAHL, PsycInfo, PubMed, and ProQuest databases using subject headings and free-text keywords. Studies were selected based on a priori inclusion/exclusion criteria, and data extraction and descriptive analysis were performed. RESULTS: A total of 27 original studies and 30 articles were included. Varying study designs were used, including several feasibility and acceptability studies. However, efficacious findings on abstinence and other clinically important outcomes were reported in several studies. Most studies focused on digital interventions for pregnant women (89.7%), suggesting a dearth of research on how digital technologies may support early parenting women with SUD. No studies included PEPW family members or involved PEPW women in the intervention design. CONCLUSIONS: The science of digital interventions to support treatment for PEPW is in an early stage, but feasibility and efficacy results are promising. Future research should explore community-based participatory partnerships with PEPW to develop or tailor digital interventions and include family or external support systems to engage in the intervention alongside PEPW.

The Results of the Families Improving Together (FIT) for Weight Loss Randomized Trial in Overweight African American Adolescents.

BACKGROUND: Few intervention studies have integrated cultural tailoring, parenting, behavioral, and motivational strategies to address African American adolescent weight loss. PURPOSE: The Families Improving Together (FIT) for Weight Loss trial was a randomized group cohort study testing the efficacy of a cultural tailoring, positive parenting, and motivational intervention for weight loss in overweight African American adolescents (N = 241 adolescent/caregiver dyads). METHODS: The trial tested an 8-week face-to-face group motivational plus family weight loss program (M + FWL) compared with a comprehensive health education control program. Participants were then rerandomized to an 8-week tailored or control online program to test the added effects of the online intervention on reducing body mass index and improving physical activity (moderate-to-vigorous physical activity [MVPA], light physical activity [LPA]), and diet. RESULTS: There were no significant intervention effects for body mass index or diet. There was a significant effect of the group M + FWL intervention on parent LPA at 16 weeks (B = 33.017, SE = 13.115, p = .012). Parents in the group M + FWL intervention showed an increase in LPA, whereas parents in the comprehensive health education group showed a decrease in LPA. Secondary analyses using complier average causal effects showed a significant intervention effect at 16 weeks for parents on MVPA and a similar trend for adolescents. CONCLUSIONS: While the intervention showed some impact on physical activity, additional strategies are needed to impact weight loss among overweight African American adolescents.

Using community-based participatory methods to design a digital intervention for mothers with substance use disorders: Qualitative results from focus group discussions.

PURPOSE: This community-based participatory research project explored the feasibility of delivering parenting and recovery supports through digital technology for mothers recovering from addictive substances. DESIGN AND METHODS: A community advisory board of key stakeholders (n = 7) served as a focus group of advisors to discuss needed supports. Data were analyzed through qualitative descriptive analysis. FINDINGS: Results revealed themes about challenges and supports needed, and whether supports delivered through digital technology may improve recovery and parenting. PRACTICE IMPLICATIONS: Future exploration needs to examine the extent to which the use of community-guided, tailored digital support applications that supplement prescribed treatment can enhance parenting and recovery.

An overview of the Families Improving Together (FIT) for weight loss randomized controlled trial in African American families.

BACKGROUND: The Families Improving Together (FIT) randomized controlled trial tests the efficacy of integrating cultural tailoring, positive parenting, and motivational strategies into a comprehensive curriculum for weight loss in African American adolescents. The overall goal of the FIT trial is to test the effects of an integrated intervention curriculum and the added effects of a tailored web-based intervention on reducing z-BMI in overweight African American adolescents. DESIGN AND SETTING: The FIT trial is a randomized group cohort design the will involve 520 African American families with an overweight adolescent between the ages of 11-16 years. The trial tests the efficacy of an 8-week face-to-face group randomized program comparing M + FWL (Motivational Plus Family Weight Loss) to a comprehensive health education program (CHE) and re-randomizes participants to either an 8-week on-line tailored intervention or control on-line program resulting in a 2 (M + FWL vs. CHE group) × 2 (on-line intervention vs. control on-line program) factorial design to test the effects of the intervention on reducing z-BMI at post-treatment and at 6-month follow-up. INTERVENTION: The interventions for this trial are based on a theoretical framework that is novel and integrates elements from cultural tailoring, Family Systems Theory, Self-Determination Theory and Social Cognitive Theory. The intervention targets positive parenting skills (parenting style, monitoring, communication); cultural values; teaching parents to increase youth motivation by encouraging youth to have input and choice (autonomy-support); and provides a framework for building skills and self-efficacy through developing weight loss action plans that target goal setting, monitoring, and positive feedback.

Feasibility and preliminary outcomes from a pilot study of an integrated health-mental health promotion program in school mental health services.

The prevalence of unmet health and mental health needs among youth has spurred the growing consensus to develop strategies that integrate services to promote overall well-being. This pilot study reports on the feasibility and outcomes of a theory-driven, family-focused, integrated health-mental health promotion program for underserved adolescents receiving school mental health services. Parent and adolescent assessments conducted prior to and following the brief, 6-session promotion program showed significant improvements in family support, youth self-efficacy, health behaviors, and mental health outcomes. Clinician reports contributed to a characterization of the feasibility, acceptability, and future recommendations for the integrated program.

The Children and Parents in Focus project: a population-based cluster-randomised controlled trial to prevent behavioural and emotional problems in children.

BACKGROUND: There is large body of knowledge to support the importance of early interventions to improve child health and development. Nonetheless, it is important to identify cost-effective blends of preventive interventions with adequate coverage and feasible delivery modes. The aim of the Children and Parents in Focus trial is to compare two levels of parenting programme intensity and rate of exposure, with a control condition to address impact and cost-effectiveness of a universally offered evidence-based parenting programme in the Swedish context. METHODS/DESIGN: The trial has a cluster randomised controlled design comprising three arms: Universal arm (with access to participation in Triple P - Positive Parenting Program, level 2); Universal Plus arm (with access to participation in Triple P - Positive Parenting Program, level 2 as well as level 3, and level 4 group); and Services as Usual arm. The sampling frame is Uppsala municipality in Sweden. Child health centres consecutively recruit parents of children aged 3 to 5 years before their yearly check-ups (during the years 2013-2017). Outcomes will be measured annually. The primary outcome will be children's behavioural and emotional problems as rated by three informants: fathers, mothers and preschool teachers. The other outcomes will be parents' behaviour and parents' general health. Health economic evaluations will analyse cost-effectiveness of the interventions versus care as usual by comparing the costs and consequences in terms of impact on children's mental health, parent's mental health and health-related quality of life. DISCUSSION: This study addresses the need for comprehensive evaluation of the long-term effects, costs and benefits of early parenting interventions embedded within existing systems. In addition, the study will generate population-based data on the mental health and well-being of preschool aged children in Sweden. TRIAL REGISTRATION ISRCTN: ISRCTN16513449.

Dissemination of a multilevel evidence-based system of parenting interventions with broad application to child welfare populations.

Parenting interventions are relevant to many touch points of the child welfare system. This paper describes a multilevel system of parenting interventions called "Triple P" that matches intervention intensities to families, builds on a strong scientific base, provides multiple access points for parents, and offers a de-stigmatized, cost-efficient approach. This population approach can simultaneously address child-maltreatment prevention and promotion of child mental health.

A developmental perspective of the relationship of racial-ethnic identity to self-construct, achievement, and behavior in African American children.

This longitudinal study examines the development of racial-ethnic identity among African American children. Racial preferences were assessed in early elementary school with the Racial Attitudes, Beliefs, and Stereotypes Measure-II, a projective technique using paired comparisons of pictures of African American, Asian, Latino, and Caucasian children. Racial-ethnic identity in 3rd grade was assessed using the Multi-Ethnic Identity Measure Ethnic Belonging subscale. Multilevel models indicated that own-group racial preferences increased with age. Second-grade own-group preferences were positively related to 3rd-grade racial-ethnic identity scores. Third-grade racial-ethnic identity was associated positively with self-esteem variables (scholastic, social, physical appearance, and behavioral) and with academic performance. Identity correlated negatively with parent-rated aggression and externalizing and internalizing behaviors. The findings suggest that children's racial-ethnic identity develops differentially by gender, with girls showing faster growth but lower initial ethnic identity. Racial-ethnic identity was shown to be modestly but statistically significantly associated with various important child outcomes.

"The Costs of a Public Health Infrastructure for Delivering Parenting and Family Support".

Objectives: To estimate the costs of building a public health infrastructure for delivering a population-wide evidence-based multi-level system of parenting interventions to strengthen parenting; reduce risk for child maltreatment and coercive parenting practices; and reduce the prevalence of early child behavioral and emotional problems. Methods: Using data from 9 South Carolina counties, this study examines the costs to service agencies of training a wide range of providers. Using data on the number of children and families served, the paper estimates the total costs of training providers sufficient to treat all children and families in a hypothetical community. Results: The costs of the universal media and communication component totaled less than $1.00 per child in the population. The costs of training service providers to deliver at other intervention levels were quite modest ($11.74 on a per child basis). Conclusions: This study shows that a population-wide system of efficacious parenting programs aimed at reducing child behavioral and emotional problems and promoting effective parenting is quite feasible. Rough estimates suggest that these costs could be recovered in a single year by as little as a 10% reduction in the rate of abuse and neglect.