Randomized Control Trials with Schools: Handling Real-World Practicalities and Problems

There is a need for more evidence-based research in education and research involving the use of randomized control trials (RCTs) to examine the efficacy of interventions. However, the difficulty of conducting interventional research in educational settings is often less acknowledged. This article provides practical examples of the issues encountered when implementing a cognitive science informed intervention and the solutions that were successfully implemented. This article will also highlight the importance of designing a multifaceted intervention while considering the cost of the intervention itself, especially when working with hard-to-reach families. It is helpful to make use of existing classroom resources in the intervention to lower costs. Additionally, being consistent and attentive to the developmental stage of the children and supporting parental engagement are two aspects that are crucial to the implementation of the intervention. Researchers would benefit from conducting workshops and public engagement events and can use these opportunities to provide practical strategies about how to support the development of children’s skills in the home environment. In-person interactions are key as parents can ask any questions that they may have, and it can help to dispel any mistrust that they may have with the research process. The article also provides suggestions for building the researcher-practitioner relationship from study onset, including being flexible and accommodating towards the changes in the school context and communicating effectively with teachers. Lastly, the article outlines the benefit of using scaffolding, positive reinforcement, and play-based learning over the course of the intervention to support child outcomes.

Maternal internal migration and child growth and nutritional health in Peru: an analysis of the demographic and health surveys from 1991 to 2017

Background Peru has historically experienced high rural-to-urban migration. Despite large reductions in undernutrition, overweight is increasing. Elsewhere, internal migration has been associated with differences in children’s growth and nutritional health. We investigated how child growth and nutritional status in Peru varied over time and in association with maternal internal migration. Methods Using data from Demographic & Health Surveys from 1991 to 2017, we assessed trends in child growth (height-for-age [HAZ], weight-for-age [WAZ], weight-for-height [WHZ] z scores) and nutritional health (stunting, underweight, overweight) by maternal adult internal migration (urban [UNM] or rural non-migrant [RNM], or urban-urban [UUM], rural-urban [RUM], rural-rural [RRM], or urban-rural migrant [URM]). Using 2017 data, we ran regression analyses, adjusting for confounders, to investigate associations of maternal migration with child outcomes and the maternal and child double burden of malnutrition. We further stratified by timing of migration, child timing of birth and, for urban residents, type of area of residence. Results are given as adjusted predictive margins (mean z score or %) and associated regression p-values [p]. Results In 1991–2017, child growth improved, and undernutrition decreased, but large differences by maternal migration persisted. In 2017, within urban areas, being the child of a migrant woman was associated with lower WHZ (UUM = 0.6/RUM = 0.5 vs UNM = 0.7; p = 0.009 and p < 0.001 respectively) and overweight prevalence ((RUM 7% vs UNM = 11% [p = 0.002]). Results however varied both by child timing of birth (birth after migration meant greater overweight prevalence) and type of area of residence (better linear growth in children of migrants [vs non-migrants] in capital/large cities and towns but not small cities). In rural areas, compared to RNM, children of URM had higher HAZ (− 1.0 vs − 1.2; p < 0.001) and WAZ (− 0.3 vs − 0.4; p = 0.001) and lower stunting (14% vs 21%; [p < 0.001]). There were no differences by timing of birth in rural children, nor by time since migration across all children. The mother and child double burden of malnutrition was higher in rural than urban areas but no differences were found by maternal internal migration. Conclusions Migration creates a unique profile of child nutritional health that is not explained by maternal ethnic and early life factors, but which varies depending on the pathway of migration, the child timing of birth in relation to migration and, for urban dwellers, the size of the place of destination. Interventions to improve child nutritional health should take into consideration maternal health and migration history.

Feasibility of delivering parent-implemented NDBI interventions in low-resource regions: a pilot randomized controlled study

Background This implementation feasibility study was conducted to determine whether an evidence-based parent-implemented distance-learning intervention model for young children at high likelihood of having ASD could be implemented at fidelity by Part C community providers and by parents in low-resource communities. Methods The study used a community-academic partnership model to adapt an evidence-based intervention tested in the current pilot trial involving randomization by agency in four states and enrollment of 35 coaches and 34 parent-family dyads. After baseline data were gathered, providers in the experimental group received 12–15 h of training while control providers received six webinars on early development. Providers delivered 6 months of intervention with children-families, concluding with data collection. Regression analyses were used to model outcomes of the coach behaviors, the parent fidelity ratings, and child outcomes. Results A block design model-building approach was used to test the null model followed by the inclusion of group as a predictor, and finally the inclusion of the planned covariates. Model fit was examined using changes in R2 and F-statistic. As hypothesized, results demonstrated significant gains in (1) experimental provider fidelity of coaching implementation compared to the control group; and (2) experimental parent fidelity of implementation compared to the control group. There were no significant differences between groups on child developmental scores. Conclusions Even though the experimental parent group averaged less than 30 min of intervention weekly with providers in the 6 months, both providers and parents demonstrated statistically significant gains on the fidelity of implementation scores with moderate effect sizes compared to control groups. Since child changes in parent-mediated models are dependent upon the parents’ ability to deliver the intervention, and since parent delivery is dependent upon providers who are coaching the parents, these results demonstrated that two of these three links of the chain were positively affected by the experimental implementation model. However, a lack of significant differences in child group gains suggests that further work is needed on this model. Factors to consider include the amount of contact with the provider, the amount of practice children experience, the amount of contact both providers and parents spend on training materials, and motivational strategies for parents, among others. Trial registration Registry of Efficacy and Effectiveness Studies: #4360, registered 1xx, October, 2020 – Retrospectively registered, https://sreereg.icpsr.umich.edu/sreereg/

Provider perspectives and reach of an evidence-based intervention in community services for toddlers

Best-practice recommendations for young children at high likelihood of autism include active involvement of caregivers in intervention. However, the use of evidence-based parent-mediated interventions in community practice remains limited. Preliminary evidence suggests that Project ImPACT for Toddlers demonstrates positive parent and child outcomes in community settings. Project ImPACT for Toddlers was adapted specifically for toddlers and teaches parents of young children strategies to build their child’s social, communication, and play skills in daily routines. This study reports implementation outcomes from the initial community rollout of Project ImPACT for Toddlers and examines the system-wide intervention reach, with the goal of informing continued community sustainment and scale-up. Participants include 38 community providers who participated in a Project ImPACT for Toddlers’ training study who completed an implementation survey and semi-structured interviews after approximately 3 months of community implementation. Participants perceived the training model as acceptable and appropriate, and identified several strengths of the approach. Interview themes also supported the feasibility, acceptability, and utility of the intervention in community settings. Quantitative findings complemented the thematic results from interviews. Intervention reach data indicate an increasing number of agencies delivering and families receiving Project ImPACT for Toddlers. Efforts to scale-up evidence-based interventions in early intervention should continue to build upon the model of the Bond, Regulate, Interact, Develop, Guide, and Engage Collaborative. Lay abstract Expert recommendations for toddlers who are likely to develop autism include caregivers being actively involved in the services children receive. However, many services available in the community may not follow these recommendations. Evidence suggests that an intervention named Project ImPACT for Toddlers demonstrates positive parent and child outcomes for families in the community. Project ImPACT for Toddlers was designed specifically for toddlers by a group of parents, clinicians, researchers, and funders. It teaches parents of young children strategies to support their child’s development in daily routines. This study reports the perspectives of early intervention providers who learned to use Project ImPACT for Toddlers on whether the intervention was a good fit for their practice and easy to use. The study also examines how many agencies are using Project ImPACT for Toddlers and how many families have received the intervention in the community. The goal of the study is to inform the continued use of Project ImPACT for Toddlers in the community and support offering the intervention in other regions. Participants include 38 community providers who participated in a training study of Project ImPACT for Toddlers and completed a survey and semi-structured interview after approximately 3 months of using Project ImPACT for Toddlers with families. Participants perceived the training model as acceptable and appropriate, and identified the group-based model of training, comprehensive materials, and agency support as strengths of the approach. Survey findings complemented the results from the interviews. Data indicate an increasing number of agencies and families accessing Project ImPACT for Toddlers. Efforts to expand evidence-based intervention in early intervention should continue to build upon the model used for Project ImPACT for Toddlers.

A study of knowledge, awareness, and acceptance of contraception among reproductive age women at tertiary care hospital, Ahmedabad

Background: India is projected to be the most populous country according to United Nations’ report; therefore, the knowledge and awareness of contraceptive methods is of utmost important for small family norms and to increase inter-pregnancy interval, so that we can achieve optimum maternal and child outcomes. This study was conducted to assess knowledge, awareness, and acceptance of contraceptive methods among reproductive-age women during Corona pandemic.Methods: A prospective observational questionnaire-based study involving 513 women belonging to the 15-49 years of age group were interviewed with consent. This was a knowledge, attitude and practice (KAP) study regarding socio-demographic profile, knowledge, awareness, and acceptance of the contraceptive method.Results: Statistical analysis of data was done by using chi-square and percentage. Out of 513 participants, 63 participants were not using any method of contraception. Barrier method is the most commonly preferred method of contraception. There was significant association of education of women and husband, occupation with usage of contraception (p<0.001, p=0.016 and p<0.001). During corona pandemic acceptance of tubal ligation had taken a hit.Conclusions: During corona pandemic barrier method and oral contraceptive pills were preferred methods. In comparison with pre-COVID era data, tubal ligation was least preferred method. Acceptance of IUCD and Injectable contraception remained same. Higher education level and better financial status had correlation with increased awareness and acceptance of contraceptive methods.

Sibling, Peer, and Cyber Bullying Among Children and Adolescents: Co-occurrence and Implications for Their Adjustment

Bullying across the sibling, peer, and cyber context has consistently been associated with a range of long-term health and well-being consequences for children and adolescents. Although research examining different bullying forms simultaneously in the same study are emerging, it remains unclear to what extend sibling, peer, and cyber bullying co-occur and in what ways they are associated. Moreover, previous work has demonstrated that children and adolescents who experience multiple forms of victimization are at a particular risk of adverse outcomes. However, whether different constellations of co-occurring bullying forms have differential impacts has not yet been investigated sufficiently. The aim of the present study was to examine the frequencies of isolated and co-occurring sibling, peer, and cyber bullying as well as to explore their independent and cumulative relationships with child adjustment. This study was based on a sample of 329 children and adolescents aged between 9 and 15. Bullying experiences across the sibling, peer, and cyber context in the previous 6 months were assessed via self-report. Youth further reported on emotional problems, conduct problems, sleep problems, and academic achievement via an online questionnaire. Sibling, peer, and cyber bullying were uniquely associated with child outcomes. A cumulative relationship between bullying victimization across contexts and emotional problems, conduct problems, and sleep problems could be identified, while bullying perpetration across contexts was only linked to more conduct problems in a cumulative manner. The findings have important practical implications arguing for the adoption of a holistic approach toward bullying in prevention and intervention.

Achieving effective interprofessional practice between speech and language therapists and teachers: An epistemological perspective

Interprofessional practice between speech and language therapists and teachers involve sharing knowledge and experiences to achieve a common goal of improving child outcomes. Although interprofessional practice has widespread support from both disciplines, it is not always easily implemented in day-to-day practice and numerous challenges have been documented. This study attempts to address these challenges through an epistemological perspective of interprofessional practice between teachers and speech and language therapists. Action research methodology was employed for this inquiry that spanned the duration of a school year. Data analysis placed an explicit focus on the experiences of interprofessional practice between the speech and language therapist and teachers, including an examination of how action was agreed and the processes underpinning collaborative working. An epistemological lens facilitated a more in-depth consideration of the diverse ways of knowing implicit in interprofessional practice and provided guidance on how to overcome the barriers, and realise the potential, of collaboration between speech and language therapists and teachers in daily practice. Four factors, rooted in an epistemological perspective, were generated from the analyses as core tenets of effective interprofessional practice. These included securing a participatory space; actively facilitating power-sharing; balancing the status of practical knowing with propositional knowing and anchoring interprofessional practice in collaboratively designed, practical activities that integrate ways of knowing. The former four factors, and their implications, offer concrete and practical direction for practitioners and educators on how to achieve effective interprofessional practice to help improve child outcomes collaboratively.

A Coaching Model to Promote Economic Mobility and Child Developmental Outcomes

OBJECTIVES: Children growing up in poverty experience worse developmental outcomes than their more economically advantaged peers. Whether Mobility Mentoring, a program focused on building parent executive function to promote economic mobility, results in improved child developmental outcomes is not known. METHODS: This study population was drawn from children enrolled in Washington State’s public, income-qualified prekindergarten program and their families. We used a quasi-experimental, preintervention-postintervention design with 2 contemporaneous comparison groups: children in the same settings whose families did not receive the intervention and children in settings in which the intervention was not offered. Primary outcomes are improvement in each of the 6 dimensions of the Teaching Strategies GOLD (TSG) measure (social-emotional, physical, cognitive, language, literacy, and mathematics) and meeting or exceeding “widely held expectations” in all of these 6 dimensions. RESULTS: Within sites that offered the coaching program, children whose parents received the program (n = 2609) showed gains in 2 of 6 TSG dimensions compared with children (n = 440) whose parents did not, and also met or exceeded widely held expectations. TSG outcomes of all children in sites offering the intervention (n = 3049) did not differ from those of children in sites that did not (n = 7216). CONCLUSIONS: Findings provide sufficient evidence of a positive impact of Mobility Mentoring on child development to merit further study. If substantiated, building parental executive function may improve child outcomes as well as enhance progress toward economic self-sufficiency, and potentially be more engaging than traditional family support programs.