Integrating a parenting intervention into pediatric primary care: A qualitative pilot study of stakeholders’ perspectives

Background In the U.S., children as early as two years old are being diagnosed with depression and other mental health problems. Children with chronic diseases also struggle with mental health problems. Evidence-based parent interventions can support these families by improving parenting practices. Pediatric primary care practices are ideal settings to provide parent interventions, as they can have broader reach, decrease stigma and improve health and mental health outcomes. There is currently no clear guidance as to how to integrate these interventions.Methods With the scientific premise that primary care settings can be a powerful place to reach families, this study examined barriers and facilitators of implementing an evidence-based parenting intervention within a primary care practice-based network.Results Semi-structured interviews were conducted with 16 community pediatricians in a Midwestern Practice-Based Research Network. The interview guide was developed based on the Consolidated Framework for Implementation Research (CFIR), with a particular emphasis on intervention characteristics and the organization’s inner setting. A codebook was developed using CFIR. Interview transcripts were coded by two independent raters (kappa = 0.93). Data were analyzed using directed content analysis.Conclusions Themes at the outer and inner setting were identified as determinants. Using theory and stakeholder input will help adapt the intervention as well as its strategies to implement parent interventions in primary care settings.

Child and parent outcomes following parent interventions for child emotional and behavioral problems in autism spectrum disorders: A systematic review and meta-analysis

There is growing interest in the development of behavioral parent interventions targeting emotional and behavioral problems in children with autism spectrum disorders. Such interventions have potential to improve a number of child and parental well-being outcomes beyond disruptive child behavior. This systematic review and meta-analysis assesses evidence for the efficacy of behavioral parent interventions for disruptive and hyperactive child behavior in autism spectrum disorders, as well as parenting efficacy and stress. A total of 11 articles from nine randomized controlled trials were included. Sufficient data were available to calculate standardized mean difference and show favorable effects of behavioral parent interventions on parent-reported measures of child disruptive behavior (standardized mean difference = 0.67), hyperactivity (standardized mean difference = 0.31) and parent stress (standardized mean difference = 0.37); effects on parent efficacy are less clear (standardized mean difference = 0.39, p = 0.17). There were insufficient data to explore intervention effects on internalizing behavior in autism spectrum disorders, parenting behaviors, or observational and teacher-reported outcomes, providing important avenues for future research. This review adds to growing evidence of the efficacy of behavioral parent interventions for child behavior and parental well-being in autism spectrum disorders (Prospero: CRD42016033979).

Facets of Parenting a Child with Hypoplastic Left Heart Syndrome

The purpose of the study was to conceptualize the needs of parents of young children with hypoplastic left heart syndrome (HLHS) to provide a theoretical framework to inform the development of future parent interventions. Participants were parents and grandparents (n=53) of 15 young children who had undergone the Sano surgical approach for HLHS. Analysis of recorded and transcribed single interviews with each participant was done as directed by interpretive description methodology. A model of five facets of parenting was conceptualized. These included survival parenting, “hands-off” parenting, expert parenting, uncertain parenting, and supported parenting. The facets of parenting delineated through this study provide a theoretical framework that can be used to guide the development and evaluation of interventions for parents of children with complex congenital heart disease and potentially other life-threatening conditions. Each facet constitutes a critical component for educational or psychosocial intervention for parents.