A self-paced online emotion socialization intervention for parents of children with challenging behavior: Tuning in to Kids OnLine.

Background: Evidence-based parenting programs delivered using online technology are an important way to enhance program uptake. To date, programs that address emotion socialization processes, such as Tuning in to Kids, have always been delivered in person, via group or one-to-one delivery. This study used a randomized control design to examine the efficacy of the self-paced Tuning in to Kids OnLine (TIKOL). Method: Participants were 150 parents of children aged 4-10 years old with challenging behaviors, randomized into intervention or 10-month waitlist control. Parents and teachers completed questionnaires at baseline and 6 months after the intervention (equivalent time points for controls) measuring parent wellbeing, parent emotion socialization, parent efficacy, child behavior, and anxiety. Results: Analyses, using mixed methods multilevel modeling, showed that intervention parents reported significantly reduced emotion dismissiveness and increased emotion coaching, empathy and efficacy compared to controls who did not. Parents participating in TIKOL also reported that their children's behavior problems and anxiety were significantly improved. Greater engagement (modules watched and duration of support calls) was associated with more significant improvements. Conclusion: Findings provide preliminary support for the efficacy of TIKOL in improving parents' emotion socialization and reducing child behavior problems and anxiety, especially when efforts to support online engagement are utilized. Further evaluation using independent observations and a sample representing a wider demographic would strengthen these findings. Clinical trial registration: Australian and New Zealand Clinical Trials Registry No. ACTRN12618000310268.

A Preliminary Evaluation of the Cultural Appropriateness of the Tuning in to Kids Parenting Program in Germany, Turkey, Iran and China.

Background: Parenting interventions based on emotion socialization (ES) theory offer an important theoretically driven approach to improve children's emotional competence and behavioral functioning. Whether such approaches are effective in different cultural contexts, and whether the methods of delivery used are appropriate and acceptable, is an important empirical question. This paper reports on the preliminary evaluation of an ES parenting intervention, Tuning in to Kids (TIK), in Germany, Turkey, Iran, and China. Pilot studies of TIK have been conducted in each country with mothers of 4-6-year-old children. Method: The current study used qualitative methods with thematic analysis to explore the cultural appropriateness of the program in each site. Results: Culture-specific challenges were found across all sites in changing parents' beliefs about the value of encouraging children's emotional expression and supportive emotion discussions. Emotion literacy of parents depended on their access to emotion terms in their language, but also to parents' experiences with emotions in their family of origin and culture-related beliefs about emotions. Adaptations were required to slow the speed of delivery, to address issues of trust with parents in seeking help, and to provide more opportunities to practice the skills and integrate different beliefs about parenting. Conclusion: While this ES parenting intervention has been developed in a Western cultural context, slight adaptations to the delivery methods (rather than change to the content) appeared to contribute to cultural appropriateness. The next step will be to quantitatively evaluate these adaptations of TIK in the different countries using randomized controlled studies.

A randomized controlled trial of an emotion socialization parenting program and its impact on parenting, children's behavior and parent and child stress cortisol: Tuning in to Toddlers.

This paper examines the efficacy of a universally-offered parenting program, Tuning in to Toddlers (TOTS), that aims to improve parent emotion socialization, reduce parent and toddler stress and improve social, emotional, and behavioral functioning in toddlers. Three hundred parents of an 18-36 month old toddler were cluster randomized into intervention or control. Parents in the intervention participated in 6 × 2 h group sessions of TOTS. Baseline and 12-months post-intervention measures were collected using parent-report questionnaires and hair samples from parents and toddlers of systemic cortisol stress. Compared to controls, intervention parents reported significantly greater reductions in difficulties in emotion regulation (difficulty remaining goal directed: 95% CI.10, 1.71, p = .028; lack of access to strategies: 95% CI 0.62, 2.42, p = .001), emotion dismissing (beliefs: 95% CI 2.33,4.82, p < .001; behaviors: 95% CI 0.32, 0.65, p = <.001), greater increase in empathy (95% CI -2.83, -1.50, p < .001), emotion coaching (beliefs: 95% CI -2.56, -0.27, p = .016; behaviors: 95% CI -0.58, -0.24, p = <.001), children's behavior (95% CI 0.19, 2.43, p = .022) and competence (95% CI -1.46, -0.22, p = .008). Significant greater reductions in systemic cortisol were found for intervention but not control children (95% CI 0.01, 0.35, p = .041). Findings provide preliminary support for the use of TOTS as a universal prevention program to improve parent emotion socialization and children's functioning. Trial Registration: Australian and New Zealand Clinical Trials Registry: ACTRN12615000962538.

Emotion-focused parenting interventions for prevention and treatment of child and adolescent mental health problems: a review of recent literature.

PURPOSE OF REVIEW: To review recent studies on emotion-focused parenting interventions to provide clinicians with knowledge about how these approaches might be used in prevention and treatment of mental health difficulties for children, adolescents and their families. RECENT FINDINGS: A number of emotion-focused parent interventions are reported in the literature, including emotion coaching/communication parenting programs, emotion-focused family therapy, attachment-focused parenting interventions (including those that address parental reflective functioning/mentalization), mindfulness parenting programs and behavioral programs with added emotion components. All target emotions or emotional communication to assist parents and children understand and work through emotional experiences so they are less likely to impede healthy functioning. These interventions target four main domains: exploring family of origin or early attachment/relational experiences with emotion, targeting parents' own emotion awareness and regulation, shifting parents responses to or communication with their children when emotions occur, and promoting parents' skills for assisting children to regulate emotions and behavior. This review from the last 18 months found 50 studies that evaluated programs addressing these domains. SUMMARY: Whilst the dominant approach in evidence-based parenting programs has been teaching behavioral strategies, it has been recognized that a focus on emotion-related processes is important. This is especially when working to improve the attachment relationship or when parents and children experience emotion dysregulation. This review demonstrates extensive evidence to support emotion-focused parenting interventions.

Does engagement with an intensive outreach service predict better treatment outcomes in 'high-risk' youth?

AIM: Engagement is critical in ensuring that the most 'at risk' clients receive care from psychiatric services, but the relationship between engagement and treatment outcomes remains unclear. This study investigated possible improvements in client engagement and the relationship between engagement and treatment outcomes in a group of difficult-to-engage, 'high-risk' young people seen by the Intensive Mobile Youth Outreach Service (IMYOS) in Western Metropolitan Melbourne, Australia. METHODS: Data from standardized outcome measures on client engagement, suicidality, hostility, well-being and functioning obtained at referral, after initial assessment and at discharge, were analysed retrospectively. RESULTS: Improved engagement was achieved after initial assessment and remained steady at discharge. All outcome measures showed significant improvement at discharge. Higher overall engagement following assessment was associated with decreased hostility risk and greater well-being and functioning at discharge. The engagement dimensions 'collaboration', 'perceived usefulness' and 'client-therapist interaction' were most consistently associated with better treatment outcomes. CONCLUSION: Engagement at an early stage of treatment can be a useful predictor for later hostility risk, well-being and functioning. To promote better outcomes for difficult-to-engage youth, service delivery needs to focus on collaborative client involvement, the development of a 'strong' therapeutic alliance and individualization of treatment in regard to client needs.