Building the skills and confidence of early childhood educators to work with parents: study protocol for the Partnering with Parents cluster randomised controlled trial.

BACKGROUND: In the early years of life, the benefits of parental engagement in children's learning are well documented. Early childhood educators are a potentially effective source of support, having opportunity to engage with parents on key issues related to children's learning and development. Educators report a need for more practical strategies for building positive partnerships with the parents of children in their care. To address this need, we have developed a practice support system, Partnering with Parents, to guide educators in Early Childhood Education and Care (ECEC) through practical strategies for working with parents. Partnering with Parents is designed to be embedded in everyday service delivery. METHODS: Using a cluster randomised controlled trial (cRCT) with intervention and wait-list control groups, we aim to evaluate the effectiveness of the Partnering with Parents practice support system under normal service conditions. The intervention is being trialled in ECEC services across Victoria, Australia. Services in the intervention group implemented the 10-week intervention before the control group commenced the intervention. Educators and parents of children attending the participating services are taking part in evaluating the intervention by completing questionnaires online at three time points (before, immediately after, and 3 months after the intervention group received the intervention). RESULTS: One hundred eighteen educators and 302 parents recruited from 19 participating ECEC services have consented to take part in the trial. CONCLUSIONS: There is considerable potential for ECEC services to improve everyday interactions with parents and potentially child outcomes, by implementing this practice support model. Future research in this field can examine long-term effects of improving the parent-educator relationship. The intervention has potential to be widely embedded in educator training or professional development. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12619000488101 . Prospectively registered 25 March 2019.

What Influences Parental Engagement in Early Intervention? Parent, Program and Community Predictors of Enrolment, Retention and Involvement.

Poor participant engagement undermines individual and public health benefits of early intervention programs. This study assessed the extent to which three types of engagement (participant enrolment, retention and involvement) were influenced by individual, program and contextual factors. Data were from a cluster randomised controlled trial (N = 1447) of a community-based parenting program, delivered at two levels of intensity (group sessions with and without individualised home coaching) conducted in Victoria, Australia. Individual (parent and family) factors and program factors were assessed by parent report and administrative records, and contextual factors by area-level population statistics. Data were analysed using multilevel logistic or linear regression models. Individual and contextual factors predicted enrolment, while family and program factors were more influential on program retention and parents' active involvement. Provision of individualised support was important to all forms of engagement, particularly for families experiencing the greatest barriers to participation. These findings indicate that different strategies are required to effectively support families in the processes of enrolling, continuing to attend and actively participating in early intervention programs.

Enhancing the early home learning environment through a brief group parenting intervention: study protocol for a cluster randomised controlled trial.

BACKGROUND: The quality of the home learning environment has a significant influence on children's language and communication skills during the early years with children from disadvantaged families disproportionately affected. This paper describes the protocol and participant baseline characteristics of a community-based effectiveness study. It evaluates the effects of 'smalltalk', a brief group parenting intervention (with or without home coaching) on the quality of the early childhood home learning environment. METHODS/DESIGN: The study comprises two cluster randomised controlled superiority trials (one for infants and one for toddlers) designed and conducted in parallel. In 20 local government areas (LGAs) in Victoria, Australia, six locations (clusters) were randomised to one of three conditions: standard care (control); smalltalk group-only program; or smalltalk plus (group program plus home coaching). Programs were delivered to parents experiencing socioeconomic disadvantage through two existing age-based services, the maternal and child health service (infant program, ages 6-12 months), and facilitated playgroups (toddler program, ages 12-36 months). Outcomes were assessed by parent report and direct observation at baseline (0 weeks), post-intervention (12 weeks) and follow-up (32 weeks). Primary outcomes were parent verbal responsivity and home activities with child at 32 weeks. Secondary outcomes included parenting confidence, parent wellbeing and children's communication, socio-emotional and general development skills. Analyses will use intention-to-treat random effects ("multilevel") models to account for clustering. RECRUITMENT AND BASELINE DATA: Across the 20 LGAs, 986 parents of infants and 1200 parents of toddlers enrolled and completed baseline measures. Eighty four percent of families demonstrated one or more of the targeted risk factors for poor child development (low income; receives government benefits; single, socially isolated or young parent; culturally or linguistically diverse background). DISCUSSION: This study will provide unique data on the effectiveness of a brief group parenting intervention for enhancing the early home learning environment of young children from disadvantaged families. It will also provide evidence of the extent to which additional one-on-one support is required to achieve change and whether there are greater benefits when delivered in the 1st year of life or later. The program has been designed for scale-up across existing early childhood services if proven effective. TRIAL REGISTRATION: 8 September 2011; ACTRN12611000965909 .

Improving mental health of adolescents with Type 1 diabetes: protocol for a randomized controlled trial of the Nothing Ventured Nothing Gained online adolescent and parenting support intervention.

BACKGROUND: Management of Type 1 diabetes comes with substantial personal and psychological demands particularly during adolescence, placing young people at significant risk for mental health problems. Supportive parenting can mitigate these risks, however the challenges associated with parenting a child with a chronic illness can interfere with a parent's capacity to parent effectively. Interventions that provide support for both the adolescent and their parents are needed to prevent mental health problems in adolescents; to support positive parent-adolescent relationships; and to empower young people to better self-manage their illness. This paper presents the research protocol for a study evaluating the efficacy of the Nothing Ventured Nothing Gained online adolescent and parenting intervention which aims to improve the mental health outcomes of adolescents with Type 1 diabetes. METHOD/DESIGN: A randomized controlled trial using repeated measures with two arms (intervention and wait-list control) will be used to evaluate the efficacy and acceptability of the online intervention. Approximately 120 adolescents with Type 1 diabetes, aged 13-18 years and one of their parents/guardians will be recruited from pediatric diabetes clinics across Victoria, Australia. Participants will be randomized to receive the intervention immediately or to wait 6 months before accessing the intervention. Adolescent, parent and family outcomes will be assessed via self-report questionnaires at three time points (baseline, 6 weeks and 6 months). The primary outcome is improved adolescent mental health (depression and anxiety). Secondary outcomes include adolescent behavioral (diabetes self-management and risk taking behavior), psychosocial (diabetes relevant quality of life, parent reported child well-being, self-efficacy, resilience, and perceived illness benefits and burdens); metabolic (HbA1c) outcomes; parent psychosocial outcomes (negative affect and fatigue, self-efficacy, and parent experience of child illness); and family outcomes (parent and adolescent reported parent-adolescent communication, responsibility for diabetes care, diabetes related conflict). Process variables including recruitment, retention, intervention completion and intervention satisfaction will also be assessed. DISCUSSION: The results of this study will provide valuable information about the efficacy, acceptability and therefore the viability of delivering online interventions to families affected by chronic illnesses such as Type 1 diabetes. TRIAL REGISTRATION: Australian New Zealand clinical trials registry (ANZCTR); ACTRN12610000170022.

Father participation with mothers in the Signposts program: an initial investigation.

BACKGROUND: The Signposts program is an evidence-based intervention system for parents of children with intellectual disability and problem behaviours. This study provided an initial investigation of the outcomes for mothers associated with father participation in Signposts, using data collected from the Signposts Statewide project, conducted in Victoria, Australia. METHOD: Data from Signposts Statewide were analysed, with the effect size Cohen's d and 95% confidence interval around d calculated for pre- to post-program changes for 134 mothers who participated in Signposts with fathers and 483 mothers who participated without fathers. RESULTS: Although mothers in both groups benefitted from the program, as evidenced by pre- to post-program improvements across all measures, the mean effect size was notably larger for mothers who participated in Signposts with fathers. CONCLUSIONS: These results highlight possible further program benefits for mothers who participate in Signposts with fathers, and are of particular significance in light of research describing the increased stress experienced by mothers of children with a disability.

Changes in the content of children's school lunches across the school week.

ISSUE ADDRESSED: the school setting is an important context for the development of children's eating behaviours. As most Australian children (86%) bring their lunch from home, knowledge of what parents provide in home-prepared school lunches can inform efforts to improve their nutritional quality. This study investigated the content of children's home-prepared school lunches, considered variation across the school week, and explored gender and grade level differences. METHODS: this observational analysis of children's home-prepared school lunches was conducted in children attending the first three years of school at one of five northern Melbourne metropolitan schools. One hundred and seventy parents (response rate 12%) gave consent for their child's lunch to be audited up to five times (minimum of three) across a one-month period. The food and beverage items of students' school lunches were audited using the School Food Checklist. RESULTS: the average home-prepared school lunch contained a sandwich, a piece of fruit and one and a half servings of extras (low nutritional value and/or high in added fat, salt or sugar). Servings of bread declined (Wilks' Λ=0.82, p=0.01) from Monday to Friday and there were more servings of extras (Wilks' Λ=0.79, p<0.01) on Monday than Wednesday. Younger children's lunches contained fewer servings of fruit (F(2,71.93)=4.84, p=0.03), vegetables (F(2,78.97)=3.86, p<0.05) and bread (F(2,140)=4.36, p=0.02) than those of older children. Girls' lunches contained significantly more vegetables than boys' lunches, (t(154.51)=-2.21, p=0.03). CONCLUSIONS: lunches were high in extras and low in servings of vegetables and other healthy snacks with minor variations in the quantity of bread and extras across the school week.

Maternal factors and experiences associated with observed parenting behavior in mothers attending a residential parenting program.

Parents experiencing early parenting difficulties often seek support through parenting programs. Characteristics of mothers seeking parenting support and information at an early parenting center in Victoria, Australia and the relationships between these factors and parenting behavior were explored using an observational measure of parent-child interaction. Participants were 43 mothers and children attending a 5-day residential parenting program at the Queen Elizabeth Centre. Maternal and sociodemographic data as well as an observational mother-child interaction task from the Nursing Child Assessment Satellite Training Parent Child Interaction Teaching scale were completed and scored on the first day of the program. Certain maternal factors and experiences were associated with observed parenting behavior. Poorer maternal sleeping quality, unplanned pregnancy and preterm birth were all associated with less optimal parenting behavior in certain domains. Findings are discussed with reference to the impact of past experiences around pregnancy and birth as well as the current context and well-being of mothers attending early parenting centers.

Effects of child characteristics on the outcomes of a parent support program.

BACKGROUND: Previous research has reported on the effectiveness of the Signposts program for supporting families of children with an intellectual disability and difficult behaviour (Hudson et al., 2003; Hudson, Cameron, & Matthews, 2008). This paper reports on an investigation of the extent to which child characteristics moderate the effectiveness of the program. METHOD: Data collected from 689 participants in the Signposts program were analysed to examine if the child characteristics of gender, age, or associated disability impacted on outcomes. RESULTS: The gender analyses produced mean effect sizes of 0.39 for boys and 0.42 for girls; however, this difference was not statistically significant. The age analyses produced mean effect sizes of 0.38 for children aged 2-5 years, 0.42 for children aged 6-12 years, and 0.30 for children aged 13-18 years; however, these differences among the age groups were not statistically significant. The associated disability analyses across 7 groups produced mean effect sizes ranging from 0.31 to 0.75; however, the differences among these groups were not statistically significant. CONCLUSIONS: First, gender was not a moderating variable. Second, while the effect size for the older age group seemed to be marginally lower than that of the other two groups, age was not found to be a moderating variable. Finally, type of associated disability was not found to be a moderating variable. Methodological limitations of the study necessitate care in interpreting the findings.

Outcomes following an early parenting center residential parenting program.

Outcomes for maternal well-being and behavior as well as difficult child behavior following participation in a 5-day early parenting center residential parenting program were explored. Participants were 44 mothers and their children, the majority presenting with child sleeping difficulties. Data were collected at four stages: intake (2-4 weeks prior to the program), the first day of the program, the last day of the program, and 4 weeks after the program. Measures included questionnaires, monitoring sheets, and videotaped observations of parent- child interactions. Improvements were seen in mothers' behavior during parent-child interaction over the week they attended the program. Maternal symptoms of depression, anxiety, and stress were lower after the program. The perceived frequency and seriousness of maternal reported difficult child behavior decreased over the measurement period, and 52% of parents had achieved 80% or more of their behavioral goal for their children. Implications for future research in early parenting centers are discussed.

A randomized controlled trial of a mother-infant or toddler parenting program: demonstrating effectiveness in practice.

OBJECTIVE: Describes outcomes of an intervention aimed to improve infant or toddler care and reduce parental distress. METHODS: A randomized controlled trial method was used with 118 mothers. Participants were allocated to an intervention group (n = 65) or an enhanced waitlist group (n = 53). Measures were taken at pre-, post-, and 6-weeks follow-up. RESULTS: Results demonstrated that mothers who attended the program reported improvement in depression, anxiety, stress, parental satisfaction, and decreases in problematic child behavior. Improvements were maintained at the 6-week follow up. Intention-to-treat analysis replicated the results, although with smaller effect sizes. CONCLUSIONS: The results of this study demonstrate that delivery of a 1 day intervention for distressed mothers can contribute to lower levels of parental distress and child problem behavior. Given the importance of early mother-child relationships and the limited number of well-controlled studies on brief interventions this result is of significance to researchers and the service community.

The wide-scale implementation of a support program for parents of children with an intellectual disability and difficult behaviour.

BACKGROUND: While there have been several evaluations of programs to help parents manage difficult behaviour of their child with an intellectual disability, little research has focused on the evaluation of such programs when delivered to large populations. METHOD: The benchmarks recommended by Wiese, Stancliffe, and Hemsley (2005) were used to evaluate the wide-scale implementation of the Signposts for Building Better Behaviour program (Hudson et al., 2001). RESULTS: A total of 2,119 parents and carers participated in the program over an 18-month period. Following the program, participants reported that they were less depressed, less anxious, and less stressed, were more confident and satisfied with managing their child, and were less hassled by their child's behaviour. They also reported that their child exhibited fewer difficult behaviours. Effect sizes ranged from small to large, depending on mode of delivery of the program. Average cost of delivery was $1,304 per participant. CONCLUSION: When implemented on a wide-scale basis, the Signposts program was effective in assisting families to manage their child's difficult behaviour. Limitations of the study are discussed.

What Influences Parents' Fear about Children's Independent Mobility? Evidence from a State-Wide Survey of Australian Parents.

PURPOSE: To identify factors associated with generalized and stranger-specific parental fear (PF) about children's independent mobility (CIM), a critical aspect of physical activity. DESIGN: Cross-sectional survey; random sampling frame, minimum quotas of fathers, rural residents. SETTING: State of Victoria, Australia. SUBJECTS: Parents of children aged 9 to 15 years (n = 1779), 71% response rate. MEASURES: Validated measures of PF and fear of strangers (FoS); parent, child, social, and environmental factors. ANALYSIS: Unadjusted and adjusted linear regression stratified by child age (9-10; 11-13; 14-15). RESULTS: Adjusted models explained a substantial proportion of variance across all age groups (PF: 33.6%-36.7%; FoS: 39.1%-44.0%). Perceived disapproval from others was consistently associated with both outcomes (PF: ß =.11 to 23, p ≤ .05; FoS: ß =.17-.21, p ≤ .001) as was parents' perception of children's competence to travel safely (PF: ß = -.24 to -.11, p ≤ .05; FoS: ß = -.16 to -.13, p ≤ .01). Factors associated with FoS included having a female child (ß = -.21 to -.13, p ≤ .001), language other than English (ß = .09 to.11, p ≤ .01), and low levels of parent education (ß = -.14 to -08, p ≤ .05). CONCLUSION: The current study suggests that social norms, child competence, and perceptions about the benefits of CIM underpin PF. This evidence informs the development of interventions to reduce PF and promote CIM and children's physical activity.

Managing challenging behaviour in preschool children post-traumatic brain injury with online clinician support: protocol for a pilot study.

BACKGROUND: Traumatic brain injury (TBI) in children is associated with a range of poor long-term outcomes, including behavioural disturbances. Parents can experience high levels of stress and injury-related burden, and evidence suggests that distressed parents are less likely to adopt positive parenting styles to manage their child's behaviour. The 'Signposts for Building Better Behaviour' program is a parenting programme that was originally developed to assist parents of children with an intellectual disability in managing their child's behaviour. More recently, it has been adapted to include a TBI module, to assist parents in managing post-TBI behaviour. However, geographical and financial barriers remain, preventing many parents from accessing the programme in the standard face-to-face modality. This project aims to investigate the feasibility and acceptability of the programme when delivered with clinician support via videoconferencing. METHODS/DESIGN: The sample for this feasibility study will be recruited from the Royal Children's Hospital, Melbourne, and the Victorian Paediatric Rehabilitation Service. Participants will be the parents of a child who sustained a TBI between the ages of 2.0 and 6.11, within the previous 2 years. The parents of 15 children will complete the programme, with clinician support via videoconferencing, while the parents of a further 15 children will form a treatment as usual wait-list control group. Parents complete questionnaires assessing their child's behaviour, as well as assessing their own mental health, sense of parenting competency, disciplinary style, and family functioning. These will be completed upon enrolment in the study regarding their child's pre-injury behaviour and then again pre-intervention, immediately post-intervention, and 4 months post-intervention. Parents who complete the intervention will also complete questionnaires assessing their satisfaction with the programme and its delivery. Information will be collected on the feasibility, clinical practicality, and acceptability of the programme when delivered through this medium. DISCUSSION: This study is the first to investigate the feasibility of delivering post-child TBI behavioural intervention via videoconferencing in Australia. Preliminary findings from this study may support the development of a larger randomised controlled trial. It is hoped that programme delivery through this medium would facilitate better access to the programme, enabling improved long-term outcomes for families. TRIAL REGISTRATION: ANZCTR, ACTRN12616001574437.

Feasibility and consumer satisfaction ratings following an intervention for families who have a child with acquired brain injury.

OBJECTIVE: Our objective was to ascertain the feasibility and consumer satisfaction ratings of families who received an adapted pediatric acquired brain injury (ABI) 'Signposts for Building Better Behavior' program in either group- or telephone-support delivery formats. METHODS: Forty-eight families of children aged between 3 and 12 years with mild, moderate, and severe ABI completed Signposts in group (n=23) or telephone-support (n=25) format consisting of nine information booklets, a DVD, and Workbook. RESULTS: All parents approved of the skills taught and a majority felt the materials were helpful in both managing challenging behavior associated with brain injury, and teaching new skills to their brain injured child. All parents rated a high level of feasibility for all of the Signposts materials. CONCLUSION: The current research has provided preliminary evidence for the feasibility and satisfaction of a family-centered parent-based behavioral intervention program called Signposts to be used with a pediatric ABI population. It also provides evidence for a less costly option of intervention delivery via telephone-support.

Modeling contextual influences on parents with intellectual disability and their children.

Many parents with intellectual disability experience living conditions associated with risk for children and parents. This study used structural equation modeling to test a theoretical model of the relationships among parent, child, family, and contextual variables in 120 Australian families where a parent had an intellectual disability. Findings revealed that parenting practices had a direct effect on children's well being, that social support was associated with children's well being through the mediator of parenting practices, and that access to social support had a direct influence on parenting practices. Implications of the findings for research, intervention, and policy are explored, with the goal of promoting optimal well being for children who are raised by parents with intellectual disability.

Behavioural treatment to reduce sleep problems in children with autism or fragile X syndrome.

There are few well-controlled, published evaluations of sleep interventions for children with developmental disabilities. This paper evaluates a parent training programme using behavioural principles to reduce sleep problems in children with autism or fragile X syndrome (FXS). Training included bedtime routines, reinforcement, effective instructions, partner support, and extinction (removing reinforcement to reduce a behaviour). Programme efficacy was demonstrated by using a multiple baseline across-participant design. Social validity was also assessed. Five children with autism and one with Asperger syndrome (four males, two females; mean age 5y 6mo; age range 3y 5mo to 7y 4mo) and their parents; and seven children with FXS (six males, one female; mean age 4y 9mo; age range ly 11mo to 9y 1mo) and their parents participated. Ten families completed intervention within the multiple baseline design. Most parents' goals were achieved and visual analysis of the sleep data indicated improvement. Settling problems, night waking, and co-sleeping were effectively reduced. The programme had high social validity and outcomes were clinically significant and maintained at follow-up.