Adding Structured Components to Home Visitation to Reduce Mothers' Risk for Child Maltreatment: a Randomized Controlled Trial.

Purpose: Home visitation program effects are generally small, which may be caused by flexible intervention content leading to inconsistent outcomes. In this study we therefore examined whether the effectiveness of a Dutch home visitation program (i.e., Supportive Parenting) can be improved by adding structured intervention components targeting key risk factors for child maltreatment: parental sense of competence, perceived stress, parental anger, and PTSD symptoms. Method: Participants were randomly assigned to an experimental group (n = 74) that received four additional intervention components in two home visits, or a control group (n = 60) that received regular Supportive Parenting. Outcomes were assessed before (T1) and after (T2) the first, and before (T3) and after (T4) the second home visit. Effects were examined using ANCOVA for primary outcomes: parental sense of competence, perceived stress, parental anger, and PTSD symptoms, and secondary outcomes: risk of child maltreatment, parental warmth, and negative parenting. Moderation effects were examined for T1 scores, child temperament and life events. Results: Mothers who received the intervention components showed less stress compared to the control group at T3 and T4. There were no differences between groups on other outcomes and no moderation effects, although parental sense of competence reduced and anger increased within the experimental group specifically. Conclusion: The structured components may enhance the effectiveness of Supportive Parenting to reduce parenting stress. Future research into how other outcomes can be improved is needed. Supplementary Information: The online version contains supplementary material available at 10.1007/s10896-023-00509-7.

Group-based parent support during the transition to parenthood: Primary outcomes from a randomised controlled trial.

RATIONALE: Theory suggests that when parents believe in their ability to positively influence their children, the children are at lower risk of poor developmental outcome. For this reason, parents' sense of competence is a common target in early parenting interventions. OBJECTIVE: This study assessed effects on parents' sense of competence, parenting stress, and symptoms of depression from a widely implemented universal and group-based parenting program. METHODS: In total, 1701 families were enrolled and randomised to one of two conditions a) participation in Family Start up Program (FSP), currently implemented at large scale in Denmark, or b) Care as Usual (CAU). FSP aims to empower new parents through knowledge and network. CAU is the public pre- and post-natal care available to families in both conditions. Recruitment was conducted between November 24, 2014, and February 1, 2017 at Aarhus University Hospital, from all incoming pregnant women within one of the larger Danish municipalities. In total, 4313 families were assessed for eligibility. Data were analysed as intention-to-treat and with n = 1255 (74%) mothers and n = 984 (60%) partners who responded at 10 months postpartum. RESULTS: When randomised to the FSP, 92% of the mothers and 94% of the partners received the intervention attending an average of 8.4 [SD = 3∙4] and 7.9 [SD = 3∙3] group meetings, respectively. The program evaluation data indicated that parents were satisfied with the program. We found no mean differences between FSP and CAU in parental sense of competence, parental stress, or symptoms of depression at 10 months in mothers or partners. CONCLUSION: The intervention did not influence parents' sense of competence even if the parents attended and liked the group meetings. This highlights the need for refinement of either the intervention approach or the expectation to its outcome. ClinicalTrials.gov ID: NCT02294968.

Parental Reflectiveness, Posttraumatic Symptoms and Alcohol Use Disorder among Israeli Combat-Veteran Fathers.

Combat veterans are highly prone to develop Alcohol Use Disorder (AUD) following their release from duty, presumably due to high prevalence of prolonged aversive emotional symptoms such as Posttraumatic Stress Symptoms (PTSS). Parental Reflective Functions (PRF) and Parental Sense of Competence (PSOC) have been identified as key protective factors in predicting maternal functioning and well-being, yet little is known of its role among fathers, let alone combat veteran fathers. In this study we explored whether PRF and PSOC moderated the association between PTSS and AUD among 189 Israel Defense Forces (IDF) male combat veterans. Participants filled out validated measures assessing PTSS, PRF, PSOC and AUD. Results indicated that PTSS, as well as PRF's "interest and curiosity regarding the child's mental states" subscale, were positively correlated to AUD. In addition, PRF's "certainty about child mental states" subscale moderated the association between PTSS and AUD, so that PTSS and AUD were significantly correlated for participants who reported average or high levels of certainty about their child's mental states. This finding may imply that intrusive mentalizing ("hypermentalizing") by veteran fathers may facilitate the association between PTSS and AUD, presumably by constituting a maladaptive mechanism for coping with the stressful uncertainty embedded in the parent-child relationship.

Effectiveness of Structural⁻Strategic Family Therapy in the Treatment of Adolescents with Mental Health Problems and Their Families.

Mental health problems during adolescence constitute a major public health concern today for both families and stakeholders. Accordingly, different family-based interventions have emerged as an effective treatment for adolescents with certain disorders. Specifically, there is evidence of the effectiveness of concrete approaches of systemic family therapy on the symptoms of adolescents and family functioning in general. However, few studies have examined the effectiveness of other relevant approaches, such as structural and strategic family therapy, incorporating parent⁻child or parental dyadic measurement. The purpose of this study was to test the effectiveness of a structural⁻strategic family therapy with adolescents involved in mental health services and their families. For this purpose, 41 parents and adolescents who participated in this treatment were interviewed at pre-test and post-test, providing information on adolescent behavior problems, parental sense of competence, parental practices, parenting alliance, and family functioning. Regardless of participants' gender, adolescents exhibited fewer internalizing and externalizing problems after the treatment. Parents reported higher family cohesion, higher satisfaction and perceived efficacy as a parent, and healthier parental practices (less authoritarian and permissive practices, as well as more authoritative ones). An interaction effect between parenting alliance and gender was found, with more favorable results for the mothers. In conclusion, this paper provides evidence of the usefulness of structural⁻strategic family therapy for improving family, dyadic, and individual facets in families with adolescents exhibiting mental health problems.

Heterogeneity in Response during Multisystemic Therapy: Exploring Subgroups and Predictors.

Multiple studies have shown that Multisystemic Therapy (MST) is, at group level, an effective treatment for adolescents showing serious externalizing problem behavior. The current study expands previous research on MST by, first, examining whether subgroups of participants who respond differently to treatment could be identified. Second, we investigated if the different trajectories of change during MST could be predicted by individual (hostile attributions) and contextual (parental sense of parenting competence and deviant and prosocial peer involvement) pre-treatment factors. Participants were 147 adolescents (mean age = 15.91 years, 104 (71%) boys) and their parents who received MST. Pre-treatment assessment of the predictors and 5 monthly assessments of externalizing behavior during treatment took place using both adolescent and parents' self-reports. Six distinct subgroups, showing different trajectories of change in externalizing problem behavior during MST, were identified. Two of the 6 trajectories of change showed a poor treatment response, as one class did not change in externalizing problem behavior and the other class even increased. The remaining 4 trajectories displayed a positive effect of MST, by showing a decrease in externalizing behavior. Most of these trajectories could be predicted by parental sense of parenting competence. Additionally, lower involvement with prosocial peers was a predictor of the group that appeared to be resistant to MST. Adolescents do respond differently to MST, which indicates the importance of personalizing treatment. Protective factors, such as parental sense of parenting competence and prosocial peers, seem to require additional attention in the first phase of MST.

Predictores del estrés parental en madres de familias en riesgo psicosocial / Parenting Stress Predictors in Mothers of Families at Psychosocial Risk

En este estudio se han analizado las relaciones entre el estrés parental, las competencias parentales percibidas y la contribución de factores sociodemográficos y psicológicos para la explicación del estrés parental. Participaron 80 madres portuguesas usuarias de servicios de protección a menores en riesgo. Los resultados mostraron niveles muy elevados de estrés parental -especialmente en madres con hijos adolescentes y desempleadas- y relaciones significativas entre el estrés y las competencias percibidas como madre. La satisfacción con el rol maternal y el empleo fueron los factores más robustos a la hora de explicar el estrés parental, prediciendo un 37% de la varianza.

In this study we analyzed the associations between parenting stress, parental sense of competence and the contribution of socio-demographical and psychological factors to the explanation of parenting stress. Participants were 80 Portuguese mothers, recipients of the child protection services. Results showed high levels of parenting stress, especially in unemployed mothers with adolescent children, and significant associations between parenting stress and perceived parental competences. Maternal role satisfaction and employment were the most robust factors on the explanation of parenting stress, predicting 37% of the variance.

Estrés y competencia parental: un estudio con madres y padres trabajadores / Stress and parental competence: a study with working parents

El objetivo de este estudio es evaluar dimensiones relativas al contexto familiar y laboral, y examinar su contribución al nivel de estrés asociado a la paternidad. Se analizó el papel desempeñado por la percepción de competencia, tanto del padre como de la madre, una vez controladas algunas características de ambos contextos. Se realizaron análisis con la información obtenida de 74 progenitores que, en el momento de la evaluación, disponían de un puesto laboral y cuidaban al menos a un menor en edad escolar. Los resultados indicaron que la dedicaciónlaboral, el número de hijos y la percepción de dificultad en el cuidado del menor, fueron las variables más robustas para explicar el estrés parental. Asimismo, los análisis mostraron que una evaluación positiva y optimista del papel que la persona desempeña en la educación y el cuidado de sus hijos, tendió a atenuar la aparición de estrés parental.

The aim of this study is to explore the role of some dimensions related with labor and family context, and examine their influence to the stress level associated with parenthood. Special attention was given to the perceived competence as a parent after controlling different characteristics from both contexts. Several analyses were performed with the information obtained from 74 active-working parents responsible for at least one school-aged child. The results indicated that the work time, the number of children at home and the perception of difficulty about child caring were the most important variables for explaining the parental stress. Furthermore,analysis showed that a positive and optimistic perception of the parental role and child care helped to mitigate the appearance of parental stress.

Parenting Practices of Mothers of Children with ADHD: The Role of Maternal and Child Factors.

BACKGROUND: We examined the relationships among child behavioural and demographic characteristics and parent characteristics in understanding the effectiveness of parenting practices used by mothers of children diagnosed with ADHD. METHOD: One hundred and fifty Australian mothers of children diagnosed with ADHD were interviewed and asked to assess the severity of their child's disruptive behaviour, their own parenting sense of competence, perceptions of social isolation and parenting practices. The hypothesis was that severity of child disruptive behaviour, higher child age, 'only' child status, lower parental sense of competence and greater social isolation would be associated with the use of less effective parenting practices. RESULTS: The regression analysis indicated that the combination of these variables was significantly associated with parenting practices, accounting for 32% of the variance. Unique contributions were evident for severity of overall behavioural disturbance and parental sense of competence. CONCLUSIONS: Theoretical and clinical implications are discussed together with methodological limitations of the study.