Influences on Patterns of Parents’ Engagement and Participation Behaviors in Family Prevention Programs
Some very interesting papers in this session. Ankie Menting presented research from a study examining engagement in a parent training intervention for mothers released from incarceration. The study looked at reasons for consent and retention, which these were associated with the extent of data provided by participants. Monetary compensation was found not to be that important – overall parents’ desire to learn new parenting skills and to contribute to science were the key reasons for consenting, though a number of other reasons were also described. For intervention group families, learning was most important for retention in the programme, and for control group families, contribution to science was linked to the provision of interview data during the trial.
Anne Mauricio suggested that whilst participation in parenting programmes was influenced by family characteristics and implementation aspects, there had been less research on programme and provider effects. In this study, group composition was linked to attendance, and there were also some links between participant characteristics and attendance. Overall higher fidelity was linked to lower levels of attendance, though this differed slightly according to the language which the programme had been delivered in. ‘Early terminators’ had mixed profiles, including those with a lower GPA and less externalising behavioural problems, but also those more educated and less depressed. Sessions staffed by providers who were skilled and experienced but least like participants (in terms of ethnicity) were linked to mid programme termination
Katy Bamberger’s paper looked at how parental engagement in programmes changed over time (during attendance). I was particularly interested in this work, since it addressed these issues in the context of SFP10-14. Her paper looked at the relationship between parent engagement and family conflict during the sessions. She suggested that engagement was a dynamic construct, which could be a target for enhancing programmes. Engagement could be thought to include the interaction of the participants with the curriculum/new skills/programme content, and also with staff and other participants. Engagement might include multiple forms of engagement – e.g. speaking, thinking and listening. Katy’s research sought to address whether engagement was as important, or more important than, attendance. This study used group leaders’ observation of parent sessions. Engagement was conceptualised as including participation, interest, positive affect to leaders and other parents, and a score was created. Over time there were differences in engagement levels between parents, and across time points. Family conflict was used as a predictor of engagement, and was observed in the family hour – it included family tension overall and session specific tension. Overall engagement increased over weeks 1-7, but tended to level off. Parents with high tension engaged less and vice versa. But both groups of parents maintained similar strategies (I think this referred to the skills and techniques they are asked to use at home between the sessions). There was also an interaction between chronic and session specific tension. In some sessions families with low stress overall have more engagement in sessions in with they have high stress levels (compared with families who had high stress overall). One of the issues raised by the talk concerned which aspects of engagement programme leaders were most likely to pick up on.
Early Childhood Prevention Strategies to Promote Health and Reduce Risk for Obesity
This session discussed the emotional health consequences of weight status, and the fact that patterns of eating develop early during childhood, making this an important time to intervene, as early childhood weight status tracks into adulthood. The first paper, by Kirsten Davison, discussed early childhood risk factors obesity. She pointed out that there were important mechanisms linking screen time and obesity, including curtailed sleep, sedentary activity, and food consumed. She also asked whether obesity issues could be linked to other constructs, such as family functioning. The second paper, by Julie Lumeng made the important point that addressing obesity was far more complex than simply telling people to eat less and exercise more, and that most parents are doing the best they can, and do not want their children to be obese. Her paper looked at ‘veracious’ eating by children in the Headstart scheme, the links between anxiety and hunger, and those between stress, cortisol and eating – stress increases emotional eating and can lead to obesity. She suggested that when children were suffering high levels of stress, the only substance which they can use to self-regulate this stress is food (whereas adults may use alcohol or other substances). Stress can produce abnormal cortisol levels which create changed dietary patterns. But over time continually high levels of stress may blunt cortisol and self-regulation, reducing satiety responsiveness, which may lead to overweight. The third paper, by Alexandra Adams looked at the prevention of obesity in tribal communities, and the importance of working with them and considering their health belief constructs.
Implementing Large Scale Interventions in Schools: Promoting Parent Engagement and School Support for Family-Centre Interventions
Andy Garbacz argued that meaningful family engagement in tiered service delivery frameworks in schools is feasible, and described the use of a ‘family zone’ or room in schools (what he described as antecedent/context building). Carl Sumi presented results from a programme called First Steps to Success, which is designed to reinforce good behaviour in the classroom. He stressed the need for interventions to make sure they address schools’ goals and missions – a point I heard being made at various points during the conference. Karen Bierman described a scheme to extend and enrich head start home visits with EBI components, specifically the REDI Parent programme. She argued that at the pre-school age stage, both cognitive skills and social readiness are important. In the research which she presented, changes in child outcomes were achieved, but without changes in general aspects of parenting. Skilled parents appeared to benefit children the most, but less skilled parents gained a lot (in terms of skills, etc.). The implication appeared to be that it was not always necessary to change global parenting to bring about changes via parents.
Friday morning I chaired a session on ‘Promoting Positive Mental Health in Children and Young People’. It was interesting to note during Mia Köster’s session that depression scores for children increased (as measured by peers I think), possibly due to increased more awareness of depression issues.
The morning plenary focused on the prevention of HIV/AIDS, and the use of ‘treatment as prevention’. During the session the point was made that often the focus is on the prescription of anti-viral drugs, but it is important to remember the context in which these are delivered and received. Biomedical technologies often eventually ‘morph’ into behaviours (e.g. condoms).
The Effectiveness of Family Strengthening Programs for Prevention and Treatment
The first paper in this session reported on the effectiveness of the Strong African American Families Programme. Steve Kogan suggested that the programme – adapted from SFP10-14, had as its underlying theoretical basis the goal of enhancing self-regulation. The aim of the current study was to test the programme in ‘real world’ conditions. Challenges in such effectiveness evaluations include: achieving delivery as intended; recruitment, especially for normative universal prevention interventions; and attention to the needs of ethnic minority groups. This implementation used the Cooperative Extension system. Steve made the point that prevention programmes often borrow mechanisms from more ‘treatment’ focused interventions. SAAF was implemented in eight rural counties in Georgia through the Extension systems. State level specialists were involved in providing technical assistance. Adherence (delivery of the intervention) was high – at 86%. Intermediate outcomes for the intervention group were as predicted by the programme’s logic model.
David Collins described the cultural adaptation of a Family Strengthening Programme, targeted at parents who had been incarcerated.
Terje Gunnar Ogden presented findings from a study of Parent Management Training (PMTO) – based on the Oregon Model, focusing on the issue of treatment alliance. He distinguished between common factors (e.g. the characteristics of the therapist, and their alliance with participants)) and programme factors and their relative influence in shaping programme outcomes. Fidelity and alliance were not empirically correlated (even though they were theoretically), but both fidelity and alliance predicted outcomes. Fidelity predicted positive changes in outcomes, but alliance had the opposite effects. The more ‘difficult’ the children’s behaviour at T1, the poorer the fidelity at T1. There was no transfer from parent ratings to teacher ratings of child behaviour. One of the questions asked at the end of this paper was whether fidelity and alliance were truly independent.
Schools and Wellbeing: Social and Emotional learning Programs
Neil Humphrey presented findings from a trial of PATHS in the UK – a universal SEL curriculum programme for children aged 7-9. Overall, and using ITT, there were not many effects for the programme. In implementation there were issues of low dosage, with some classes behind where they should have been in relation to delivery. Fidelity and quality of delivery were high, but not that well correlated. There was a strong correlation between quality of delivery and participant responsiveness. The more SEL work that schools were doing (i.e. other programmes, etc.), the poorer the effects of PATHS, but where these other programmes comprised ‘targeted’ work, there was some positive moderation. Higher dosage either made no difference, or possibly had a negative effect on outcomes, and the same was true for pupil reports of fidelity. There were associations between quality of delivery and outcomes. I think the paper also suggested that where the programme had higher reach there were better outcomes. When sub group analyses were conducted it was identified that there were some treatment effects for some groups in relation to emotional symptoms, peer problems and pro –social behaviour (for those with initially higher levels of problems I think). For conduct problems there was some indication of iatrogenic effects, but it was possible that this was due to positive changes in the control group (linked to new interventions delivered in those schools).
The second paper in this session – by Michael Wigelsworth, reported findings from a meta-analysis, which compared effects (and their size) between: efficacy and effectiveness studies; those led by/involving/or not involving programme developers; and ‘home grown’ v ‘imported’ programmes. The findings appeared to be quite complex and mixed. Except for emotional competence, efficacy studies had bigger effects than effectiveness studies. In terms of programmes being culturally transferred between countries, it was sometimes the case that they were more effective when adapted for a new setting, but the small numbers of programmes involved made it more difficult to identify clear patterns. Some programmes might have a greater need for the involvement of the original developers – for instance where teachers needed to acquire new sets of skills. There was also an important temporal aspect in the involvement of developers – that is, they might be more likely to be involved in early (feasibility or efficacy trials) when programmes were still being ‘tweaked’.