Transportability of an Evidence-Based Early Childhood Intervention in a Low-Income African Country: Results of a Cluster Randomized Controlled Study.

Children in Sub-Saharan Africa (SSA) are burdened by significant unmet mental health needs. Despite the successes of numerous school-based interventions for promoting child mental health, most evidence-based interventions (EBIs) are not available in SSA. This study investigated the implementation quality and effectiveness of one component of an EBI from a developed country (USA) in a SSA country (Uganda). The EBI component, Professional Development, was provided by trained Ugandan mental health professionals to Ugandan primary school teachers. It included large-group experiential training and small-group coaching to introduce and support a range of evidence-based practices (EBPs) to create nurturing and predictable classroom experiences. The study was guided by the Consolidated Framework for Implementation Research, the Teacher Training Implementation Model, and the RE-AIM evaluation framework. Effectiveness outcomes were studied using a cluster randomized design, in which 10 schools were randomized to intervention and wait-list control conditions. A total of 79 early childhood teachers participated. Teacher knowledge and the use of EBPs were assessed at baseline and immediately post-intervention (4-5 months later). A sample of 154 parents was randomly selected to report on child behavior at baseline and post-intervention. Linear mixed effect modeling was applied to examine effectiveness outcomes. Findings support the feasibility of training Ugandan mental health professionals to provide Professional Development for Ugandan teachers. Professional Development was delivered with high levels of fidelity and resulted in improved teacher EBP knowledge and the use of EBPs in the classroom, and child social competence.

A population-level approach to promoting healthy child development and school success in low-income, urban neighborhoods: impact on parenting and child conduct problems.

Minority children living in disadvantaged neighborhoods are at high risk for school dropout, delinquency, and poor health, largely due to the negative impact of poverty and stress on parenting and child development. This study evaluated a population-level, family-centered, school-based intervention designed to promote learning, behavior, and health by strengthening parenting, classroom quality, and child self-regulation during early childhood. Ten schools in urban districts serving primarily low-income Black students were randomly assigned to intervention or a "pre-kindergarten education as usual" control condition. Intervention included a family program (a 13-week behavioral parenting intervention and concurrent group for children) and professional development for early childhood teachers. The majority (88 %) of the pre-kindergarten population (N = 1,050; age 4) enrolled in the trial, and nearly 60 % of parents in intervention schools participated in the family program. This study evaluated intervention impact on parenting (knowledge, positive behavior support, behavior management, involvement in early learning) and child conduct problems over a 2-year period (end of kindergarten). Intent-to-treat analyses found intervention effects on parenting knowledge, positive behavior support, and teacher-rated parent involvement. For the highest-risk families, intervention also resulted in increased parent-rated involvement in early learning and decreased harsh and inconsistent behavior management. Among boys at high risk for problems based on baseline behavioral dysregulation (age 4, 23 % of sample), intervention led to lower rates of conduct problems at age 6. Family-centered intervention at the transition to school has potential to improve population health and break the cycle of disadvantage for low-income, minority families.

Applying Public Health Frameworks to Advance the Promotion of Mental Health Among Asian American Children.

Asian American (ASA) children experience high rates of mental health problems. Although there is a pressing need to utilize population approaches, emerging frameworks from the fields of public and population health have not been applied to ASA children. This paper addresses this gap by first discussing applications of the National Prevention Strategy (NPS), a population strategy developed from the Social Determinants of Health perspective, to guide ASA prevention work. Next, we provide a practical example to illustrate how the NPS can be applied to prevention program design (using ParentCorps as an example) and dissemination and implementation processes to broadly address ASA children's mental health needs. Finally, we present preliminary data on the feasibility of applying this population strategy to ASA families and a framework for researchers who are considering disseminating and implementing evidence-based programs to ASA or ethnic minority pediatric populations.

The acceptability and representativeness of standardized parent-child interaction tasks.

Analogue behavioral observation of structured parent-child interactions has often been used to obtain a standardized, unbiased measure of child noncompliance and parenting behavior. However, for assessment information to be clinically relevant, it is essential that the behavior observed be similar to that which the child normally experiences and elicits. Furthermore, assessment procedures should be socially appropriate and acceptable to participants in order to facilitate investment in the assessment, and potentially treatment, process. Although analogue tasks have been shown to have reasonable psychometric properties, the social validity of these methods has not been evaluated. This study examined the acceptability and representativeness of 4 widely utilized, laboratory-based parent-child interaction tasks in a sample of 43 nonreferred, 3- to 6-year old children and their mothers, who were of European-American or African-American ethnicity. Mothers rated the acceptability of each task and the degree to which it was representative of "typical" interactions occurring with the child. Repeated-measures analyses of variance revealed high levels of acceptability and representativeness for all tasks, but consistent differences across tasks. These ratings were predominantly stable over a 2-week period. Additionally, social validity ratings were significantly associated with parenting self-esteem, maternal ethnicity, child gender, and child age, but not child behavior problems. Limitations and implications of these findings for the assessment of parent-child interaction are discussed.

Relation of adolescent mothers' history of antisocial behavior to child conduct problems and social competence.

We examined the extent to which maternal antisocial behavior (ASB) is directly related to child conduct problems and social competence and assessed the potential mediating role of negative parenting. The sample included 93 adolescent mothers and their children (44 boys, 49 girls). Mothers retrospectively reported about their ASB since the child's birth, through Grade 2. Negative parenting was coded during a parent-child interaction task (PCIT) at Grade 2. Teachers assessed child outcomes at Grade 3. Maternal ASB during the child's life was directly related to parenting and both child outcomes. In the overall sample, negative parenting partially mediated the relation between maternal ASB and child conduct problems. However, the pattern of relations differed by sex. For boys, maternal ASB was directly related to conduct problems, independent of parenting. For girls, maternal ASB was strongly related to parenting but not conduct problems. Negative parenting did not mediate the relation between maternal ASB and child social competence. Implications for intervention and future research are discussed.