Emotion Regulation, Coercive Parenting, and Child Adjustment: A Serial Mediation Clinical Trial.

Objective: Prior intent to treat (ITT) evaluation of the Fathering Through Change (FTC) online interactive behavioral parent training program demonstrated a causal link from the FTC intervention to reductions in pre-post changes in fathers' coercive parenting, and in turn, reductions in pre-post changes in child behavioral problems (a moderate indirect effect size d = .30). The present study expands on this work by investigating mediational mechanisms. Methods: The present study employed a sample of 426 recently divorced or separated fathers who were each randomly assigned to either the FTC program or to the waitlist control. We tested a set of ITT serial mediation hypotheses positing effects of the FTC on fathers' reductions in coercive parenting would be mediated through reductions in emotion regulation problems. To be included in this intervention, fathers had been separated or divorced within the past two years and also had children between the ages of four and twelve. Results: The intervention obtained a significant total and set of unique pathways linking the FTC intervention to improved child adjustment. This supports a causal experimental link to reduced child behavior problems (d = .39). Emotion regulation did not fully mediate the intervention effect on parenting. Conclusions: Emotion regulation added both direct and indirect experimental explained variance over and above parenting alone. Clinical implications are discussed for the application of online training through pediatric settings.

Participation in the Fathering through Change intervention reduces substance use among divorced and separated fathers.

Recent evaluations of parent training programs have demonstrated beneficial crossover effects in reducing parental substance use. Because divorce is associated with substance use risk and substance use interferes with effective parenting, parent training programs are critically important for divorced fathers but there are few evidence-based programs tailored to fathers. We tested whether an evidence-based parenting program would exhibit beneficial impact on fathers' substance use and whether these changes were mediated by changes in parenting efficacy. We tested hypotheses in a sample of 426 divorced and separated fathers randomly assigned to the online Fathering through Change (FTC) program or the wait-listed control condition. Models specified as 3-month pre-post analyses of self-reported substance use. The FTC was associated with reductions in total substance use (d = 0.14) and drinking (d = 0.26) but not with reductions in tobacco smoking and marijuana use. Data also supported a significant indirect effect for FTC through pre-post changes in parenting efficacy (d = 0.36). We discuss clinical implications for the integration of parent training within substance use treatment.

Fathering Through Change (FTC) intervention for single fathers: Preventing coercive parenting and child problem behaviors.

Dishion and Patterson's work on the unique role of fathers in the coercive family process showed that fathers' coercion explained twice the variance of mothers' in predicting children's antisocial behavior and how treatment and prevention of coercion and promotion of prosocial parenting can mitigate children's problem behaviors. Using these ideas, we employed a sample of 426 divorced or separated fathers randomly assigned to Fathering Through Change (FTC), an interactive online behavioral parent training program or to a waitlist control. Participating fathers had been separated or divorced within the past 24 months with children ages 4 to 12 years. We tested an intent to treat (ITT) mediation hypothesis positing that intervention-induced changes in child problem behaviors would be mediated by changes in fathers' coercive parenting. We also tested complier average causal effects (CACE) models to estimate intervention effects, accounting for compliers and noncompliers in the treatment group and would-be compliers in the controls. Mediation was supported. ITT analyses showed the FTC obtained a small direct effect on father-reported pre-post changes in child adjustment problems (d = .20), a medium effect on pre-post changes in fathers' coercive parenting (d = .61), and a moderate indirect effect to changes in child adjustment (d = .30). Larger effects were observed in CACE analyses.

Factors influencing the use of clinical guidelines by general practitioners working in a setting of complex multimorbidity: a case study by interviews.

BACKGROUND: The Central Australian Remote Practitioners Association Standard Treatment Manual (CARPA) contains protocols for primary health care in remote Central Australia. This context stands in stark contrast to the mainstream settings in Australia and features an Aboriginal population with very poor health status, powerful social determinants of health, geographical isolation and high turnover of health practitioners. The manual consolidates the core elements of national guidelines, particularly as they pertain to Aboriginal health care, into a single document. The aim of this study is to explore factors that promote or impede the use of CARPA by general practitioners (GPs) in Central Australia, with a particular focus on chronic disease management. METHODS: In-depth interviews were conducted with GPs and GP registrars employed in the provision of Aboriginal health care in Central Australia. Interview transcripts were thematically analysed from a critical theory perspective. RESULTS: 11 GPs and 3 GP registrars from the two major Aboriginal primary health services in Central Australia were interviewed. The dominant theme in the data was that poor continuity of care impeded the use of CARPA. The second-most dominant theme was that electronic health record systems enhanced the use of CARPA in some ways, and impeded its use in others. Other factors influencing the use of CARPA included the culture of the health service organisation, GPs' first impressions of CARPA, the accessibility and usability of CARPA, and GPs' confidence practicing in such a unique environment. CONCLUSIONS: This study identifies factors from multiple domains that influence the use of best practice guidelines in the delivery of chronic disease care. It demonstrates that such factors may not be purely 'enablers' or 'barriers', but may be a mixture of both. It highlights the critical role of continuity of care and the potential benefits and pitfalls of using electronic health records in providing chronic disease care. This study provides empirical insights that can be used to improve chronic disease care.

Educating registrars in your practice.

BACKGROUND: Postgraduate general practice training is an apprenticeship of learning to be a general practitioner by working as a general practitioner under supervision. During this apprenticeship, registrars learn the art, craft and ethics of their vocation, and how to apply clinical knowledge and skills in different contexts. OBJECTIVE: This article summarises how registrars learn, and the role of general practice supervisors and training practices in supporting their education. DISCUSSION: General practice supervisors form educational alliances with registrars that provide the foundation for deep and broad learning. Overseeing patient safety requires supervisors to respond to registrars' queries and monitor them proactively. Registrars learn best in practices that include them in all their work and share their expertise. Specific issues raised by teams of part-time super-visors, and by rural and remote practice, are discussed. Finally, teaching practices are recommended to seek and implement feedback from registrars.