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1.
Fam Syst Health ; 39(1): 7-18, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-34014726

RESUMO

OBJECTIVE: For implementation of an evidence-based program to be effective, efficient, and equitable across diverse populations, we propose that researchers adopt a systems approach that is often absent in efficacy studies. To this end, we describe how a computer-based monitoring system can support the delivery of the New Beginnings Program (NBP), a parent-focused evidence-based prevention program for divorcing parents. METHOD: We present NBP from a novel systems approach that incorporates social system informatics and engineering, both necessary when utilizing feedback loops, ubiquitous in implementation research and practice. Examples of two methodological challenges are presented: how to monitor implementation, and how to provide feedback by evaluating system-level changes due to implementation. RESULTS: We introduce and relate systems concepts to these two methodologic issues that are at the center of implementation methods. We explore how these system-level feedback loops address effectiveness, efficiency, and equity principles. These key principles are provided for designing an automated, low-burden, low-intrusive measurement system to aid fidelity monitoring and feedback that can be used in practice. DISCUSSION: As the COVID-19 pandemic now demands fewer face-to-face delivery systems, their replacement with more virtual systems for parent training interventions requires constructing new implementation measurement systems based on social system informatics approaches. These approaches include the automatic monitoring of quality and fidelity in parent training interventions. Finally, we present parallels of producing generalizable and local knowledge bridging systems science and engineering method. This comparison improves our understanding of system-level changes, facilitates a program's implementation, and produces knowledge for the field. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Informática Aplicada à Saúde dos Consumidores , Divórcio , Implementação de Plano de Saúde/métodos , Poder Familiar , Pais/educação , Adulto , COVID-19 , Criança , Saúde da Criança , Educação Infantil , Feminino , Humanos , Masculino , Relações Pais-Filho , Avaliação de Programas e Projetos de Saúde , SARS-CoV-2
2.
Child Dev ; 92(4): 1476-1493, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33432998

RESUMO

In a sample of 559 children (ages 9-18), researchers investigated whether: (a) fear of abandonment mediated the association between postdivorce interparental conflict (IPC) and mental health problems, and (b) parent-child relationship quality moderated the association between IPC and fear of abandonment. Mediation analyses indicated that pretest IPC predicted fear of abandonment 3 months later, which then predicted child- and teacher-reported mental health problems 10 months later. The hypothesized protective effect of a high-quality parent-child relationship was not observed. IPC predicted fear of abandonment for all children, except for those with low- and moderate-quality father-child relationships, for whom IPC was not significantly related to fear of abandonment. Findings highlight the need to optimize child coping programs and improve parenting-after-divorce programs to reduce IPC.

3.
Dev Psychopathol ; 33(1): 201-215, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-32308168

RESUMO

This 15-year longitudinal follow-up of a randomized controlled trial of a parenting-focused preventive intervention for divorced families examined cascade models of program effects on offsprings' competence. It was hypothesized that intervention-induced improvements in parenting would lead to better academic, work, peer, and romantic competence in emerging adulthood through effects on behavior problems and competencies during adolescence. Families (N = 240) participated in the 11-session program or literature control condition when children were ages 9-12. Data were drawn from assessments at pretest, posttest, and follow-ups at 3 and 6 months and 6 and 15 years. Results showed that initial intervention effects of parenting on externalizing problems in adolescence cascaded to work outcomes in adulthood. Parenting effects also directly impacted work success. For work outcomes and peer competence, intervention effects were moderated by initial risk level; the program had greater effects on youths with higher risk at program entry. In addition, intervention effects on parenting led to fewer externalizing problems that in turn cascaded to better academic outcomes, which showed continuity into emerging adulthood. Results highlight the potential for intervention effects of the New Beginnings Program to cascade over time to affect adult competence in multiple domains, particularly for high-risk youths.


Assuntos
Divórcio , Poder Familiar , Adolescente , Adulto , Criança , Humanos
4.
J Clin Child Adolesc Psychol ; 50(3): 385-399, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-31910050

RESUMO

Objective: A population-level, randomized controlled trial was conducted to test the effectiveness of a parent recruitment package for increasing initial engagement into a school-based parenting program and to identify strategies responsible for effects.Method: Participants were caregivers of kindergarten- to third-grade students (N = 1,276) attending one of five schools serving ethnically diverse families living in mostly low-income, urban conditions. First, families were randomly assigned to be recruited for research surveys or not, and then to a parenting program recruitment condition: 1) Engagement-as-usual (EAU) informational flyer; 2) EAU + testimonial booklet; 3) EAU + teacher endorsement; 4) EAU + recruitment call; or 5) all strategies (full package). Caregivers were offered a free parenting program at their child's school. Primary dependent variables were parenting program enrollment and attending at least one session (initiation). Exploratory analyses were conducted on program completion, attendance across sessions, homework completion, and in-session participation.Results: In the population-level sample, enrollment and initiation were higher for the full package compared to all other conditions except the recruitment call condition. Enrollment, initiation, and program completion were higher for the recruitment call and full package conditions compared to the EAU condition. In the subsample of initiators, parents in the full package condition attended fewer parenting sessions than in the EAU condition. Controlling for attendance across sessions, there were no condition effects on homework completion or in-session participation.Conclusions: The recruitment call can increase the public health impact of evidence-based parenting programs by improving enrollment, initiation, and program completion.

5.
Prev Sci ; 21(8): 1017-1027, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32720190

RESUMO

The Family Bereavement Program (FBP) is a family-based intervention for parentally bereaved children and surviving caregivers. Results are reported of a randomized controlled trial, examining intervention effects on emotional reactivity and regulation of young adults who participated in the program 15 years earlier. Participants (N = 152) completed four emotion challenge tasks: reactivity to negative images, detached reappraisal while viewing negative images, positive reappraisal while viewing negative images, and reengagement with positive images. Outcomes included cardiac interbeat interval (IBI), pre-ejection period (PEP), and respiratory sinus arrhythmia (RSA) as well as self-reported emotional experience and regulation effectiveness. Direct intervention effects and effects mediated through improved parenting were estimated. Several significant effects were observed in primary analyses; however, none remained significant after correction for familywise Type I error. Parenting mediated FBP effects on IBI during negative reactivity (b = 15.04), and on RSA during positive reengagement (b = 0.35); the latter effect was accounted for by changes in breathing. Intervention condition was a direct predictor of self-reported detached reappraisal effectiveness (b = 1.00). Intervention and gender interacted in predicting self-reported negative emotion during the negative reactivity (b = 1.04) and positive reappraisal tasks (b = 1.31) such that intervention-condition men reported more negative emotions during those tasks. Although these findings should be considered preliminary given the limited power of the corrected statistical tests, they suggest long-term effects of family intervention following the death of a parent on offspring's emotional reactivity and regulation ability that should be pursued further in future research.

6.
J Trauma Stress ; 33(5): 843-849, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32516471

RESUMO

The Active Inhibition Scale (AIS; Ayers, Sandler, & Twohey, 1998) is an 11-item, self-report measure of emotional suppression among children and adolescents. Previous research with the AIS has linked emotional suppression to several clinically significant outcomes, such as posttraumatic stress symptoms (PTSS) and suicide, among trauma-exposed and bereaved youth; however, there are no published evaluations of its psychometric properties. We examined the factor structure and criterion validity of the AIS in two samples. Sample 1 included youth (M = 12.22 years, SD = 2.96, range: 6-18 years; 55.4% female) referred to an outpatient psychology clinic specializing in childhood trauma and grief. Sample 2 included youth (M = 13.18 years, SD = 2.58, range: 8-18 years; 61.8% female) referred to a community grief counseling center. Confirmatory factor analytic results supported a one-factor solution, Cronbach's α = .94. Additionally, AIS scores correlated positively with PTSS, depression, and maladaptive grief, rs = .43-.64. Evidence of factorial invariance was found across gender, race/ethnicity, and age group. Emotional suppression scores were higher among girls compared to boys, Black and Hispanic youth compared to White youth, and older compared to younger age groups. The magnitude of correlations between AIS and symptom measure scores was comparable across groups. These results support the reliability and criterion validity of the AIS with diverse youth populations and underscore the role that emotional suppression may play in explaining group differences in mental health symptoms.

7.
J Clin Child Adolesc Psychol ; 49(1): 60-78, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30644774

RESUMO

This study presents findings from a randomized effectiveness trial of the New Beginnings Program (NBP), which has demonstrated efficacy in 2 prior randomized efficacy trials. Family courts in 4 counties facilitated recruitment of divorcing and separating parents, and providers in community agencies delivered the program. Participants were 830 parents of children ages 3-18 who were randomized to receive either the 10-session NBP or an active 2-session comparison condition in which parents learned about the same parenting skills but did not complete home practice of these skills. Parents were ethnically diverse (59.4% non-Hispanic White, 31.4% Hispanic, 9.2% other race or ethnicity). Multiple rater assessments of parenting, interparental conflict, and child mental health problems were conducted at pretest, posttest, and 10-month follow-up. The results indicated positive moderated effects of the NBP as compared with the active control condition to strengthen parenting at posttest and to reduce child mental health problems at posttest and 10 months. Many of these moderated effects showed positive benefits for non-Hispanic White families but not for Hispanic families. The findings indicate support for the effectiveness of the NBP when delivered by community-based agencies but also indicate the need for further adaptations to make the program effective for Hispanic parents.


Assuntos
Divórcio/psicologia , Adolescente , Criança , Feminino , Humanos , Masculino
8.
Dev Psychopathol ; 31(5): 1695-1713, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31535609

RESUMO

Exposure to high levels of postdivorce interparental conflict is a well-documented risk factor for the development of psychopathology, and there is strong evidence of a subpopulation of families for which conflict persists for many years after divorce. However, existing studies have not elucidated differential trajectories of conflict within families over time, nor have they assessed the risk posed by conflict trajectories for development of psychopathology or evaluated potential protective effects of children's coping to mitigate such risk. We used growth mixture modeling to identify longitudinal trajectories of child-reported conflict over a period of six to eight years following divorce in a sample of 240 children. We related the trajectories to children's mental health problems, substance use, and risky sexual behaviors and assessed how children's coping prospectively predicted psychopathology in the different conflict trajectories. We identified three distinct trajectories of conflict; youth in two high-conflict trajectories showed deleterious effects on measures of psychopathology at baseline and the six-year follow-up. We found both main effects of coping and coping by conflict trajectory interaction effects in predicting problem outcomes at the six-year follow-up. The study supports the notion that improving youth's general capacity to cope adaptively is a potentially modifiable protective factor for all children facing parental divorce and that children in families with high levels of postdivorce conflict are a particularly appropriate group to target for coping-focused preventive interventions.


Assuntos
Adaptação Psicológica/fisiologia , Divórcio/psicologia , Conflito Familiar/psicologia , Transtornos Mentais/psicologia , Adolescente , Criança , Feminino , Seguimentos , Humanos , Masculino , Pais/psicologia , Fatores de Proteção , Fatores de Risco
9.
J Fam Psychol ; 33(6): 690-703, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31318261

RESUMO

Despite widespread acknowledgment that "frequent, continuing, and meaningful" (Pruett & DiFonzo, 2014) time with both parents is beneficial for children from divorced or separated families, and that interparental conflict (IPC) is associated with increased child mental health problems, the joint effects of parenting time (PT), parenting quality (PQ), and IPC on children's mental health problems are less clear. The current study integrates two theoretical models in multiple mediator analyses to test indirect effects of mothers' and fathers' PQ and IPC to explain the association between PT and children's mental health problems within the same model. Participants were children aged 9-18 years (N = 141) who had one or both parents participate in a randomized comparative effectiveness trial of a court-based prevention program for high-conflict divorcing or separating families. Data were collected at pretest and 9-month follow-up. Analyses revealed an indirect effect in which fathers' PQ mediated the association between PT and child internalizing problems both concurrently and 9 months later. There were no significant indirect effects involving IPC. Analyses indicated a significant quadratic relation between PT and fathers' PQ, suggesting that although more PT is associated with better father-child relationships, there is a point beyond which more time is not related to a better relationship. We discuss the study findings, research limitations, and implications for public policy. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Divórcio/psicologia , Conflito Familiar/psicologia , Transtornos do Neurodesenvolvimento/psicologia , Relações Pais-Filho , Poder Familiar/psicologia , Pais/psicologia , Adolescente , Adulto , Criança , Divórcio/estatística & dados numéricos , Feminino , Humanos , Masculino , Tempo
11.
J Divorce Remarriage ; 60(4): 283-300, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31217674

RESUMO

This study examined whether the New Beginnings Program (NBP), a parenting-focused preventive intervention designed to reduce children's post-divorce mental health problems, affected attitudes toward divorce and marriage in young adults whose mothers had participated 15 years earlier. Participants (M = 25.6 years; 50% female; 88% Caucasian) were from 240 families that had participated in a randomized experimental trial (NBP vs. literature control). Analyses of covariance showed that program effects on both types of attitudes were moderated by gender. Males in the NBP reported more positive attitudes toward marriage and less favorable attitudes toward divorce than males in the literature control.

12.
J Fam Psychol ; 33(5): 499-510, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30730180

RESUMO

Parenting time, interparental conflict, and the quality of parenting a child experiences in the postdivorce family environment have complex relations with child adjustment outcomes. Using person-centered latent profile analyses, the present study examined (a) separate profiles of mothers' (N = 472) and fathers' (N = 353) parenting time, interparental conflict, and quality of parenting following divorce; and (b) associations of mother and father profiles with concurrent child outcomes (48% female, 3- to 18-years-old) as well as child outcomes 3 and 10 months later. Mother and father profiles were primarily differentiated by levels of parenting time and quality of parenting, respectively. Mother and father profiles defined by greater parenting time and lower quality parenting were associated with the poorest child outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Adaptação Psicológica , Divórcio/psicologia , Conflito Familiar/psicologia , Relações Pais-Filho , Poder Familiar/psicologia , Adolescente , Adulto , Arizona , Criança , Pré-Escolar , Divórcio/estatística & dados numéricos , Feminino , Humanos , Masculino
13.
J Prim Prev ; 40(1): 111-127, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30656517

RESUMO

The field of prevention has established the potential to promote child adjustment across a wide array of outcomes. However, when evidence-based prevention programs have been delivered at scale in community settings, declines in implementation and outcomes have resulted. Maintaining high quality implementation is a critical challenge for the field. We describe steps towards the development of a practical system to monitor and support the high-quality implementation of evidence-based prevention programs in community settings. Research on the implementation of an evidence-based parenting program for divorcing families called the "New Beginnings Program" serves as an illustration of the promise of such a system. As a first step, we describe a multidimensional theoretical model of implementation that links aspects of program delivery with improvements in participant outcomes. We then describe research on the measurement of each of these implementation dimensions and test their relations to intended program outcomes. As a third step, we develop approaches to the assessment of these implementation constructs that are feasible to use in community settings and to establish their reliability and validity. We focus on the application of machine learning algorithms and web-based data collection systems to assess implementation and provide support for high quality delivery and positive outcomes. Examples are presented to demonstrate that valid and reliable measures can be collected using these methods. Finally, we envision how these measures can be used to develop an unobtrusive system to monitor implementation and provide feedback and support in real time to maintain high quality implementation and program outcomes.


Assuntos
Divórcio , Ciência da Implementação , Relações Pais-Filho , Melhoria de Qualidade , Adolescente , Adulto , Criança , Currículo , Coleta de Dados/métodos , Prática Clínica Baseada em Evidências , Feminino , Humanos , Aprendizado de Máquina , Masculino , Modelos Teóricos , Avaliação de Programas e Projetos de Saúde
14.
Psychoneuroendocrinology ; 100: 137-144, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30326461

RESUMO

Adolescence is a sensitive developmental period in which substance use can exert long-term effects on important biological systems. Emerging cross-sectional research indicates that problematic alcohol consumption may be associated with dysregulated neuroendocrine system functioning. The current study evaluated the prospective effects of binge drinking in adolescence on cortisol stress reactivity in young adulthood among individuals who had experienced parental divorce in childhood (N = 160; Mean age = 25.55, SD = 1.22; 46.9% Female; 88.8% White Non-Hispanic). Youth completed validated measures of problematic drinking during adolescence (aged 15-19) and participated in a standardized social stress task nine years later in young adulthood. Latent growth modeling was conducted within a structural equation modeling framework. Greater binge drinking during adolescence was associated with a significantly lower cortisol stress response in young adulthood, controlling for young adult drinking, sex, childhood externalizing problems, and socioeconomic status. Findings suggest problematic alcohol consumption during mid-to-late adolescence may have important effects on the neuroendocrine stress response system at subsequent developmental stages.


Assuntos
Consumo Excessivo de Bebidas Alcoólicas/epidemiologia , Hidrocortisona/metabolismo , Estresse Psicológico/diagnóstico , Estresse Psicológico/epidemiologia , Consumo de Álcool por Menores , Adolescente , Comportamento do Adolescente/fisiologia , Adulto , Idade de Início , Consumo Excessivo de Bebidas Alcoólicas/complicações , Consumo Excessivo de Bebidas Alcoólicas/diagnóstico , Consumo Excessivo de Bebidas Alcoólicas/fisiopatologia , Estudos Transversais , Doenças do Sistema Endócrino/diagnóstico , Doenças do Sistema Endócrino/epidemiologia , Doenças do Sistema Endócrino/etiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Prognóstico , Estresse Fisiológico/fisiologia , Estresse Psicológico/metabolismo , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/etiologia , Transtornos Relacionados ao Uso de Substâncias/metabolismo , Consumo de Álcool por Menores/psicologia , Consumo de Álcool por Menores/estatística & dados numéricos , Adulto Jovem
15.
J Consult Clin Psychol ; 86(10): 845-855, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30265043

RESUMO

OBJECTIVE: Effects are reported of the Family Bereavement Program (FBP) on the mental health of bereaved youth and their surviving parent 15 years following the program. METHOD: On-hundred and 56 families (244 children ages 8-16; 54% male; 67% Non-Hispanic White) were randomly assigned to receive either the FBP (N = 90) or a literature control condition (N = 66). At the 15-year follow-up 80% of the youth and 76% of the bereaved parents were reinterviewed. Mental health problems and service use were self-reported by young adults and their parents. Key informants reported on mental health problems of young adults. RESULTS: Young adults in the FBP reported significantly less use of mental health services and of psychiatric medication than controls. Key informants reported significantly lower mental health problems for young adults who were in FBP as compared with controls and for those who were younger lower internalizing and externalizing problems for those in the FBP as compared with controls. Bereaved parents reported a significantly lower rate of alcoholism and less use of support groups than controls. CONCLUSIONS: The results provided evidence that FBP led to lower mental health problems and less service use by bereaved young adults and their parents as compared with controls. (PsycINFO Database Record (c) 2018 APA, all rights reserved).


Assuntos
Luto , Transtornos Mentais/psicologia , Serviços de Saúde Mental/estatística & dados numéricos , Morte Parental/psicologia , Pais/psicologia , Avaliação de Programas e Projetos de Saúde , Psicoterapia/métodos , Adolescente , Adulto , Criança , Feminino , Seguimentos , Humanos , Masculino , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Adulto Jovem
17.
Prev Sci ; 19(7): 853-865, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29936579

RESUMO

Prevention science researchers and practitioners are increasingly engaged in a wide range of activities and roles to promote evidence-based prevention practices in the community. Ethical concerns invariably arise in these activities and roles that may not be explicitly addressed by university or professional guidelines for ethical conduct. In 2015, the Society for Prevention Research (SPR) Board of Directors commissioned Irwin Sandler and Tom Dishion to organize a series of roundtables and establish a task force to identify salient ethical issues encountered by prevention scientists and community-based practitioners as they collaborate to implement evidence-based prevention practices. This article documents the process and findings of the SPR Ethics Task Force and aims to inform continued efforts to articulate ethical practice. Specifically, the SPR membership and task force identified prevention activities that commonly stemmed from implementation and scale-up efforts. This article presents examples that illustrate typical ethical dilemmas. We present principles and concepts that can be used to frame the discussion of ethical concerns that may be encountered in implementation and scale-up efforts. We summarize value statements that stemmed from our discussion. We also conclude that the field of prevention science in general would benefit from standards and guidelines to promote ethical behavior and social justice in the process of implementing evidence-based prevention practices in community settings. It is our hope that this article serves as an educational resource for students, investigators, and Human Subjects Review Board members regarding some of the complexity of issues of fairness, equality, diversity, and personal rights for implementation of preventive interventions.


Assuntos
Ética , Pesquisa sobre Serviços de Saúde/organização & administração , Serviços Preventivos de Saúde/ética , Serviços Preventivos de Saúde/organização & administração , Comitês Consultivos , Prática Clínica Baseada em Evidências , Guias como Assunto , Humanos , Projetos de Pesquisa
18.
Eval Health Prof ; 41(2): 290-320, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29635949

RESUMO

We used a multigroup propensity score approach to evaluate a randomized effectiveness trial of the New Beginnings Program (NBP), an intervention targeting divorced or separated families. Two features of effectiveness trials, high nonattendance rates and inclusion of an active control, make program effects harder to detect. To estimate program effects based on actual intervention participation, we created a synthetic inactive control comprised of nonattenders and assessed the impact of attending the NBP or active control relative to no intervention (inactive control). We estimated propensity scores using generalized boosted models and applied inverse probability of treatment weighting for the comparisons. Relative to the inactive control, NBP strengthened parenting quality as well as reduced child exposure to interparental conflict, parent psychological distress, and child internalizing problems. Some effects were moderated by parent gender, parent ethnicity, or child age. On the other hand, the effects of active versus inactive control were minimal for parenting and in the unexpected direction for child internalizing problems. Findings from the propensity score approach complement and enhance the interpretation of findings from the intention-to-treat approach.


Assuntos
Divórcio , Poder Familiar , Pais/educação , Adolescente , Fatores Etários , Criança , Pré-Escolar , Grupos Étnicos , Humanos , Relações Pais-Filho , Pontuação de Propensão , Fatores Sexuais , Fatores Socioeconômicos , Estresse Psicológico/prevenção & controle
20.
Prev Sci ; 19(6): 782-794, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29243200

RESUMO

This study tests a theoretical cascade model in which multiple dimensions of facilitator delivery predict indicators of participant responsiveness, which in turn lead to improvements in targeted program outcomes. An effectiveness trial of the 10-session New Beginnings Program for divorcing families was implemented in partnership with four county-level family courts. This study included 366 families assigned to the intervention condition who attended at least one session. Independent observers provided ratings of program delivery (i.e., fidelity to the curriculum and process quality). Facilitators reported on parent attendance and parents' competence in home practice of program skills. At pretest and posttest, children reported on parenting and parents reported child mental health. We hypothesized effects of quality on attendance, fidelity and attendance on home practice, and home practice on improvements in parenting and child mental health. Structural Equation Modeling with mediation and moderation analyses were used to test these associations. Results indicated quality was significantly associated with attendance, and attendance moderated the effect of fidelity on home practice. Home practice was a significant mediator of the links between fidelity and improvements in parent-child relationship quality and child externalizing and internalizing problems. Findings provide support for fidelity to the curriculum, process quality, attendance, and home practice as valid predictors of program outcomes for mothers and fathers. Future directions for assessing implementation in community settings are discussed.


Assuntos
Comportamento Cooperativo , Promoção da Saúde/normas , Modelos Teóricos , Poder Familiar , Pais/educação , Avaliação de Programas e Projetos de Saúde/métodos , Adolescente , Criança , Feminino , Humanos , Entrevistas como Assunto , Masculino , Transtornos do Neurodesenvolvimento/prevenção & controle , Observação , Pesquisa Qualitativa
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