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1.
Brain Injury ; 36(SUPPL 1):77, 2022.
Article in English | EMBASE | ID: covidwho-1815751

ABSTRACT

Objective: Despite the high prevalence of pediatric traumatic brain injury (TBI) in children under 5 years of age, there has been limited research about early family support and interventions for this age group. Given that TBI can disrupt parent-child interactions and parent-child interactions are central for child development, we developed an online parenting skills intervention (Gaining Real Life Skills over the Web;GROW) to improve TBI recovery. The online parenting skills program aims to improve caregiver functioning and increase positive parenting behaviors. The purpose of this pilot study was to examine feasibility, acceptability, and preliminary efficacy of the program. Methods: Parents learned strategies for responsive parenting while integrating stress management and self-care techniques by reviewing online content and videos and practicing parenting skills with therapist feedback over 8 weeks. The online content consisted of 5 core modules with the option for 1 supplemental session. Primary study outcomes were feasibility, acceptability, and efficacy of the GROW program to improve caregiver functioning and positive parenting behaviors. Qualitative interviews and satisfaction questionnaires will be analyzed to identify common themes and suggestions across participants. Results: To date, of 63 potentially eligible parents: 23 agreed to participate (36.5%), 19 declined (30.2%), and 21 are currently being recruited (33.3%). Of the 23 who agreed to participate: 10 completed baseline visits (43.5%), 5 are scheduled (21.7%), and 8 are being rescheduled (34.7%). Four parents have completed the program thus far and rated the program as both helpful and enjoyable, finding the coaching to be particularly valuable. Preliminary findings also trend toward an increase in caregiver functioning and positive parenting behaviors. Suggestions for improving the program were oriented towards shortening the program length. Families acknowledged the difficulty in dedicating time to review web content, complete homework, and meet with the therapist weekly. Families with very young children are busy;a challenge made even more difficult amid the influence of COVID and its added stressors. Final pilot data will be presented at the time of the conference. Conclusion: Despite promising feedback about the value of the program, low rates of participation underscore the challenges of engaging parents of very young children. Disruptions due to the COVID-19 pandemic likely made uptake even lower. Assuming that preliminary evidence for acceptability and efficacy are confirmed, next steps include working with stakeholders to preserve key content while redesigning the program to minimize barriers (e.g., shorten modules) and increase engagement. Efforts to identify and target the unique stressors associated with parenting a very young child will be essential to promote uptake. Ultimately, a larger-scale randomized control trial is needed in order to examine the relative efficacy of the program in relation to a comparison group.

2.
Brain Injury ; 36(SUPPL 1):98, 2022.
Article in English | EMBASE | ID: covidwho-1815738

ABSTRACT

Background: It is known that health of youth and caregivers are dynamically interconnected. Approximately 30% of youth experience persistent post-concussion symptoms (PPCS), which continue beyond four weeks post injury. Prolonged youth recovery is found to affect caregiver's mental health and family functioning. Parental stress also adversely affects youth with PPCS, suggesting that addressing caregiver needs can minimize negative health outcomes among their children. Despite the critical role that caregivers play in concussion recovery, there are no empiricallyvalidated interventions tailored to the specific needs of caregivers of youth with PPCS. Objective: To describe Move&Connect-Caregivers, a virtual group-based intervention for caregivers of youth with PPCS, using the Intervention Mapping (IM) approach. Methods: The six-step IM approach was utilized to guide the development of the novel intervention. First, a focus group with caregivers of youth with PPCS (n = 5) was held to understand their requirements [Needs Assessment step]. The collected data guided the development of program objectives which include psychoeducation, advocacy, and tools to promote positive family and health outcomes [Objectives]. Next, concerns and educational topics suggested by caregivers and supplemented with the theoretical framework of FAB (family-directed approach to brain injury) helped in designing content and methods of the intervention [Design]. Multiple iterative meetings were held with a clinical neuropsychologist and a social worker to develop intervention components and reference material. Further, consultations with stakeholders and a family leader were integrated into the creation process [Production]. The last two steps of IM [Implementation and Evaluation] are planned to assess program feasibility (Summer 2021) and program effectiveness will be established in a future pilot trial. Results: Move&Connect-Caregivers is a virtual group-based intervention that focuses on support strategies to address caregivers' health needs. It is comprised of six sessions titled as follows: Concussion Ripple Effect, School Advocacy, Child's Well-being, Family & You, Parenting is Hard, and Stress & Daily Challenges. This intervention will be delivered weekly by a clinical neuropsychologist and a social worker using the Zoom Health Care platform. Each session is one hour in length, and includes a psychoeducational topic and a group activity followed by discussions and reflections. Handouts and additional resources like websites and flyers will be provided to participants. Conclusion: This novel intervention will shed light on meaningful strategies to improve the well-being of families dealing with concussion. The IM approach is used as a guiding framework to systematically develop an evidence-based intervention for caregivers of youth with PPCS. Virtual interventions are important to enhance accessibility, convenience and social support, especially in current circumstances of COVID-19.

3.
Archives of Disease in Childhood ; 107(SUPPL 1):A1, 2022.
Article in English | EMBASE | ID: covidwho-1794527

ABSTRACT

The early years of life represent a critical window of opportunity for a child's development, a time when the brain is most sensitive to external influences. Early childhood is not only a period of special sensitivity to risk factors, but also a critical time when the benefits of early interventions are amplified, and the negative effects of risk can be reduced. This is underscored by the evidence from neuroscience1 which emphasizes the importance of nurturing care (adequate health, nutrition, responsive care, opportunities for learning and protection from harm and abuse) to all young children to enable them to reach their full potential. The first 1,000 days of life shape a child's future. Nurturing care plays a vital role in giving children the best possible start in life: the mantra 'Eat, Play, Love'2 summarizes the need for opportunities in the environment of the young child for adequate nutrition, opportunities for play and safety and security. This brain architecture is a critical foundation for all future learning, behaviour and health. And while neural connections continue into adulthood, how these early connections form determine whether later connections have strong or weak foundations. As demonstrated by Heckman,3 the smartest investments in human development are those done earliest in the lifespan, as returns to ECD investments are considerably higher compared to equivalent investments in the later years - primary school, secondary school and after. The healthy development of a baby's brain depends on nurturing care, which benefits children, but it also about the knowledge and resources their families and other caregivers require to provide it. It refers to the enabling conditions created by public policies, programmes and services to ensure children's good health and nutrition, protect them from threats and give them opportunities for early learning, through interactions that are responsive and emotionally supportive. To support the development of their children, parents need time, resources, and services. This is made available through a) enhanced enabling (policy) environments;b) integrated services (for example frontline workers including health, social work, education nutrition);c) knowledge and agency for caregivers and parents such as tools, guidance, masterclasses and information;d) financial support and resources including financial literacy, child benefits, cash transfers and e) amplification of caregivers' voices through social and digital media, parenting voices in community and policy platforms. While the Covid-19 pandemic exacerbated the crisis of care and learning, it has also provided an opportunity to elevate the needs for parenting and family support and care. To continue to promote ECD services and interventions and ensure that every child is enabled to not only survive but thrive we must strengthen formative research models and enhance implementation research on ECD;leverage existing routine touchpoints to elevate the importance of holistic ECD;invest in system strengthening and capacity building of frontline health workers through innovative tools;raise awareness and partners including with parents and caregivers themselves to ensure child health and development;enhance direct support to parents through community engagement initiatives;and, empower policy makers and key stakeholders with the latest evidence and advocate for enhanced investments in ECD and parenting support programmes.

4.
Pakistan Paediatric Journal ; 46(1):67-74, 2022.
Article in English | EMBASE | ID: covidwho-1790130

ABSTRACT

Objective: The current study intends to look at how COVID-19 pandemic affected parenting practices during COVID-19 in Pakistan and if the children were exposed to more abuse and neglect at home. Study Design: A quantitative design survey. Place and Duration of the Study: Data was collected from parents visiting outpatient departments (OPDs) in four hospitals of Lahore, Peshawar, and Karachi in three months from July to September 2020. Material and Methods: A quantitative design survey was used, and data (N=923) were collected using a self-administered COVID-19 Parenting Response Scale (α = 0.74). Results: The primary responsibility of taking care of children rested with mothers in most of the cases. Ratio of severe disciplinary practices like shouting, yelling, cursing, and slapping children was increased significantly during the lock down as the anger and frustration in the parents also mounted. This effect was more pronounced in families from lower socioeconomic groups as well as for those who suffered income loss during COVID-19. Conclusion: Financial and emotional stress caused by COVID-19 exacerbated the already difficult parenting practices. Ultimately children suffered more violence at the hands of parents. In Pakistani society there is little awareness on building one‟s capacity on good parenting and little availability of such trainings. There is a need to understand implications for good parenting and create awareness of positive parenting methods.

5.
Journal of Men's Health ; 18(2), 2022.
Article in English | EMBASE | ID: covidwho-1737560

ABSTRACT

Background and objective: In early 2020, the novel COVID-19 virus arrived in the United States and resulted in broad, sweeping changes to safety procedures within healthcare settings, including prenatal care settings. While implemented to protect both providers and patients, this protocol limited fathers' ability to attend prenatal care appointments. At this time, limited research has been published on the effects of COVID-19 healthcare protocols on fathers' experiences and perceptions of prenatal care and parenting. This study aimed to understand how COVID-19 affected expectant fathers and fathers with newborns perceptions and experiences during pregnancy, prenatal care, and early parenting. Materials and methods: Structured interviews were completed with fathers expecting a child and fathers with children born after March 2020. Interviews were completed by video conference and recorded. Audio from each interview was transcribed. Content and thematic analysis was performed. Results: In total, 34 fathers were interviewed. Three broad themes were identified from the data including changing prenatal care policies that did not consider fathers, unique stressors associated with COVID-19, and isolation's negative impact on connecting to the pregnancy and support. Fathers reported limited engagement with the prenatal care system due to pandemic-related organizational and systematic changes in healthcare delivery. Results also suggest that fathers experienced elevated feelings of both stress and isolation from the pregnancy and prenatal care. Conclusions: Ultimately, this study highlights the need for providers and organizations to develop strategies for transforming prenatal healthcare delivery into inclusive, family centered care during emergency situations, as well as use this opportunity to build family centered care into normal prenatal care operations.

6.
Cancer Epidemiology Biomarkers and Prevention ; 31(1 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1677426

ABSTRACT

Statement of the problem: Unconscious bias and systemic racism is evident in published reports that describe persistent asymmetric outcomes in our entire health care system including oncology. Framework of the solution: There already is a very large set of publications that describe the extent and outcomes of health disparities. An extensive data set also describes mitigation strategies. Changing the outcomes includes policy changes within the health care system but also with regulatory agencies and the legislative branch of government. It is critical that these different systems are armed with the totality of available information in a manner that can be leveraged to improve the health care of all. We have developed a system of describing large sets of data manually extracted from published articles. These results are aggregated together independent of the framework of the manuscript so that similar outcomes can be placed side by side. This system can provide the necessary comprehensive data that is available today to begin to implement changes. Results to date: We have used COVID-19 publications as a prototype topic that has so many articles no single person can comprehend or manage. We extracted data from 1000 COVID-19 manuscripts that presented new data. This rendered 26,000 note fields arranged in a parent child relationship. The data base described 12,000 individual observations. A read only version is available at COVIDpublications.org. We are now applying this system to bias and stigma of the health care profession to persons who use drugs, and a demo of this project is available at (https://app.refbin.com/app/embed?m=1188). We have now established the rules to manually extract data from any clinical article that presents new data. This involves 4 types of note fields per observation arranged in parent child relationships. 1) The observation, 2) description of the observation, 3) the population, and 4) the topic. This system allows the observations from an unlimited number of studies to share parents. This results in about a 5-fold reduction in the total number of note fields. It also allows grouping of information so that a user can scan the data base and access the entirety of information without specifically knowing what they are looking for. Conclusions: We are expanding this data base bias and systemic racism of the health care system on persons with substance use disorder to include the broader range of patients. By capturing all of the data that is known we hope to influence implementation of improved health care to patients including those with cancer. These results will be presented in October.

7.
Cogent Medicine ; 8, 2021.
Article in English | EMBASE | ID: covidwho-1617073

ABSTRACT

Background: The COVID-19 pandemic has inevitably affected children and their families. This study examines the impact of the COVID-19 measures in children with chronic somatic conditions (CSC) and their parents and compares them with a Dutch general population sample. Methods: We included a sample of children with CSC (0-18 years, n=326) and compared them with children (8-18 years, n=1,287) from the Dutch general population. Perceived stress, coping, social interaction with friends and family, physical activity, eating behavior, family support, and financial situation were assessed with the digitally administered COVID-19 child check questionnaire between November 2020 and May 2021. Results: During the COVID-19 pandemic, children with CSC engaged less in physical activity and social interaction with friends compared with children from the general population. Children with CSC and their parents experienced less stress than children and parents from the general population. Moreover, parents of children with CSC aged 0-7 years and children aged 8-18 years from the general population experienced less support and more financial deterioration than parents of children with CSC aged 8-18 years. In the parents from the general population only, this deteriorated financial situation was associated with more stress, worse family interaction and parenting perception, and less received support. Conclusions: The impact of COVID-19 measures in children with CSC and their parents differed from those in the general population. Addressing the collateral damage of COVID-19 measures in children and their families can give direction to policy and potentially prevent (long-term) negative consequences.

8.
Obesity ; 29(SUPPL 2):100, 2021.
Article in English | EMBASE | ID: covidwho-1616059

ABSTRACT

Background: Fathers play an important role in child development but are rarely included in research on the parental determinants of child eating behavior. This omission requires addressing, particularly in the context of the COVID-19 pandemic, during which families spent more time at home and thus more time together for meals and snacks. Previous research in mothers suggests providing structure around children's eating may be beneficial for child eating behavior. We aimed to investigate associations of fathers' reports of provision of structure around children's eating during the pandemic with child eating behavior and diet during the pandemic. Methods: Fathers (N = 112) of 2-12- year- old children completed an online survey in May/June 2020 including questions on structure-related food parenting practices (e.g. insist child eats at table, not allowing child to wander around during meal, father decides timing of meal), child eating behaviors (emotional overeating [EOE], food responsiveness [FR]), and child diet. Correlations and path models were used to examine individual and simultaneous relationships. Results: A third of the sample was more likely to eat meals together compared to before the pandemic. Structure-related food parenting practices were significantly negatively associated with EOE (β = -. 434, p = .004) but not FR (β = -. 227, p = .132). EOE was significantly positively correlated with children's sweet and savory snack intake (e.g. chocolate, cookies/cake, donuts, ice cream, low-fat chips, savory snacks;rho = .244 to .504) as well as fast food intake (rho = .432). Conclusions: Our results suggest that fathers' provision of structure around children's eating during the pandemic may be associated with lower levels of obesity-associated eating behaviors in their children, which could contribute to healthier profiles of food intake and body weight.

9.
Journal of Medical Internet Research ; 23(12), 2021.
Article in English | EMBASE | ID: covidwho-1598077

ABSTRACT

Background: The transition to parenthood can be challenging, and parents are vulnerable to psychological disorders during the perinatal period. This may have adverse long-term consequences on a child's development. Given the rise in technology and parents' preferences for mobile health apps, a supportive mobile health intervention is optimal. However, there is a lack of a theoretical framework and technology-based perinatal educational intervention for couples with healthy infants. Objective: The aim of this study is to describe the Supportive Parenting App (SPA) development procedure and highlight the challenges and lessons learned. Methods: The SPA development procedure was guided by the information systems research framework, which emphasizes a nonlinear, iterative, and user-centered process involving 3 research cycles-the relevance cycle, design cycle, and rigor cycle. Treatment fidelity was ensured, and team cohesiveness was maintained using strategies from the Tuckman model of team development. Results: In the relevance cycle, end-user requirements were identified through focus groups and interviews. In the rigor cycle, the user engagement pyramid and well-established theories (social cognitive theory proposed by Bandura and attachment theory proposed by Bowlby) were used to inform and justify the features of the artifact. In the design cycle, the admin portal was developed using Microsoft Visual Studio 2017, whereas the SPA, which ran on both iOS and Android, was developed using hybrid development tools. The SPA featured knowledge-based content, informational videos and audio clips, a discussion forum, chat groups, and a frequently asked questions and expert advice section. The intervention underwent iterative testing by a small group of new parents and research team members. Qualitative feedback was obtained for further app enhancements before official implementation. Testing revealed user and technological issues, such as web browser and app incompatibility, a lack of notifications for both administrators and users, and limited search engine capability. Conclusions: The information systems research framework documented the technical details of the SPA but did not take into consideration the interpersonal and real-life challenges. Ineffective communication between the health care research team and the app developers, limited resources, and the COVID-19 pandemic were the main challenges faced during content development. Quick adaptability, team cohesion, and hindsight budgeting are crucial for intervention development. Although the effectiveness of the SPA in improving parental and infant outcomes is currently unknown, this detailed intervention development study highlights the key aspects that need to be considered for future app development.

10.
Paediatrics and Child Health (Canada) ; 26(SUPPL 1):e104, 2021.
Article in English | EMBASE | ID: covidwho-1584131

ABSTRACT

BACKGROUND: With more than 28 million individuals of refugee or asylum-seeking background globally, the current situation has been described as one of the largest humanitarian crises of all time. Families of refugee background have complex, multigenerational mental health and developmental needs that are not accounted for in current programming frameworks. Difficulties in resettlement have been further compounded by COVID-19-related lockdowns, straining parental mental health and placing children at an increased risk for developmental or behavioural problems. Providing appropriate support services and educational resources that address the multigenerational concerns of families of refugee background will address these challenges, allowing for improved parental mental health, family cohesion, and developmental outcomes for children. OBJECTIVES: To gather data about the experiences, resources, referral pathways and barriers that impact the experience of parents of refugee background in the Greater Toronto Area (GTA) and to develop a novel, multi-dimensional parenting program model using Community-Based Participatory Research (CBPR) principles. DESIGN/METHODS: This was a qualitative community-based participatory study using a formative research framework, in accordance with COREQ guidelines. In-depth interviews (IDIs) were conducted with parents of refugee background and care providers that work closely with this population. Data were recorded, transcribed, and coded using deductive and inductive coding methods by two independent coders. A peer debriefing strategy was used to verify the coding approach and interpretation of findings in accordance with the RATS (relevancy, appropriateness, transparency and soundness) guidelines for qualitative research. RESULTS: A total of 20 IDIs were conducted (7 parents and 13 care providers). The main topics that were identified to be incorporated into the program include features of child development, how to address resettlement issues, child advocacy, and parenting in the Canadian context. Participants felt that tackling the language barriers, addressing the overlapping responsibilities of the mothers attending the sessions, providing incentives, increasing awareness of the program, and using an anti-racist and anti-oppressive approach is key to the program's success. Participants emphasized the need for trauma-informed mental health support within the program model. CONCLUSION: This study describes the key considerations for a novel parenting program for families of refugee background, by engaging them as key stakeholders in the program design process. Future iteration of this project would involve a pilot and evaluation of the program.

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