Implementation Evaluation of the Mother-Child Education Program Among Refugee and Other Vulnerable Communities in Lebanon.

Despite the knowledge that quality early childhood development programs, including those that target parental knowledge and behaviors, are essential for ameliorating the negative effects of early-life adversity, robust analyses of their implementation and impact in highly vulnerable settings are scarce. To address this knowledge gap, we conducted a pilot wait-list randomized controlled trial (RCT) to assess the impact and the process of implementing and evaluating the Mother-Child Education Program (MOCEP) among refugee families and one low-income community in Beirut, Lebanon. This paper focuses on the analysis of MOCEP's implementation (i.e., key enablers of and barriers to the application and evaluation of the program). Our analysis suggests that, despite multiple challenges, implementation and robust evaluations of early childhood parenting programs in fragile contexts are feasible and urgently needed. This study illustrates how implementation evaluations are a key component of RCTs and crucial to identifying strategies to optimize program uptake and maximize impact.

A qualitative study of parents' and facilitators' experiences of Group Stepping Stones Triple P for parents of children with disabilities.

In this qualitative study, we evaluated parents' and facilitators' experiences of the Group Stepping Stones Triple P (GSSTP) programme for parents of children with disabilities. The study was embedded in a randomized controlled trial (RCT) of GSSTP and carried out in the Irish public health service. Eight parents and three psychologists participated in the study. We used a semi-structured interview schedule to collect data and conducted a thematic content analysis of interview transcripts to identify particularly useful and less helpful aspects of the programme and ways that its future delivery may be improved. We conducted separate analyses on parent and psychologist data. The main findings were that parents considered the GSSTP to have helped them develop better self-regulation and behaviour management skills, which contributed to improved family relations. Negative aspects of the programme included the use of dated videos, the volume of programme content, the attrition rate and the shortcomings of the programme in meeting the complex needs of vulnerable families. Improvement suggestions included increasing flexibility of manualised content, providing follow-up support to vulnerable parents, incentivizing parents to attend and updating videos.

Exploring antenatal education content for couples in Blantyre, Malawi.

BACKGROUND: Despite advocating for male involvement in antenatal education, there is unmet need for antenatal education information for expectant couples. The objective of this study was to gain a deeper understanding of the education content for couples during antenatal education sessions in Malawi. This is needed for the development of a tailor-made curriculum for couple antenatal education in the country, later to be tested for acceptability, feasibility and effectiveness. METHODS: An exploratory cross sectional descriptive study using a qualitative approach was conducted in semi-urban areas of Blantyre District in Malawi from February to August 2016. We conducted four focus group discussions (FGDs) among men and women independently. We also conducted one focus group discussion with nurses/ midwives, 13 key informant interviews whose participants were drawn from both health-related and non-health related institutions; 10 in-depth interviews with couples and 10 separate in-depth interviews with men who had attended antenatal clinics before with their spouses. All the interviews were audiotaped, transcribed verbatim and translated from Chichewa, the local language, into English. We managed data with NVivo 10.0 and used the thematic content approach as a guide for analysis. RESULTS: We identified one overarching theme: couple antenatal education information needs. The theme had three subthemes which were identified based on the three domains of the maternity cycle which are pregnancy, labour and delivery and postpartum period. Preferred topics were; description of pregnancy, care of pregnant women, role of men during perinatal period, family life birth preparedness and complication readiness plan, coitus during pregnancy and after delivery, childbirth and baby care. CONCLUSION: Antenatal education is a potential platform to disseminate information and discuss with male partners the childbearing period and early parenting. Hence, if both men and women were to participate in antenatal education, their information needs should be prioritized. Men and women had similar choices of topics to be taught during couple antenatal education, with some minor variations.

Do Parents Benefit From Help When Completing a Self-Guided Parenting Program Online? A Randomized Controlled Trial Comparing Triple P Online With and Without Telephone Support.

In response to recent increases in the dissemination of Web-based parenting supports, an important consideration is whether the core benefits of self-directed participation in online parenting interventions are counterbalanced by issues such as high dropout and noncompletion rates commonly reported within the Internet intervention literature. This study outlines a randomized controlled trial of Triple P Online, a Web-based variant of the Triple P-Positive Parenting Program, delivered with varied levels of support scaffolding. Participants were 183 parents of children between 1 and 8 years of age with concerns about their child's behavior and at least one area of disadvantage or family difficulty. Participants were randomized to self-directed Triple P Online, telephone-supported Triple P Online, or a wait-list control. Primary outcomes measured at baseline, postintervention, and 5-month follow-up were negative parenting styles and child behavior problems. Secondary outcomes included parent confidence, anger, and adjustment; relationship quality; program engagement; and parent satisfaction. Self-directed participants showed short-term treatment effects, including reductions in overall negative parenting and frequency of child behavior problems, while practitioner support led to greater improvements in negative parenting and intensity of difficult child behaviors. Participants in the supported condition were also more likely to complete modules and reported greater program satisfaction. At follow-up, 50% of outcomes for the self-directed condition were significantly better than the control, while 94% of outcomes were significantly better than the control in the practitioner-supported condition. Although self-directed online approaches to parenting intervention are promising, this research highlights how minimal support can improve effective engagement and enhance outcomes for families.

Associations between childhood experiences of parental corporal punishment and neglectful parenting and undergraduate students' endorsement of corporal punishment as an acceptable parenting strategy.

This study evaluated the effects of childhood experiences of parental corporal punishment (CP) and neglectful parenting (NP) on Japanese university students' endorsement of parental CP (EPP) to discipline children, in relation to subjective happiness (SH). A total of 536 undergraduate students who showed no physical symptoms completed anonymous paper-based questionnaires addressing demographic characteristics, undergraduate classes, and recent health conditions on SF-8 (PCS, MCS). It was found that the proportions of participants who experienced pervasive CP and NP were larger in men than in women (36.5% vs. 19.4% for CP; 22.1% vs. 9.7% for NP). Multiple regression analyses (n = 346) revealed that the CP score was associated with positive EPP (ß = 0.310, p < 0.001). Further, students whose major was nursery education reported significantly lower level of EPP; however, neither SH nor good recent health conditions significantly reduced EPP. The NP score was inversely associated with the SH score (ß = -0.253, p < 0.001) (n = 346). In conclusion, childhood experiences of parental CP may affect adolescents' views related to their own parenting. Further investigation using internationally comparable methodologies, especially in prospective cohort studies, is warranted, not only in Japan but also in other Asian countries.

Behavioral Versus Nonbehavioral Guided Self-Help for Parents of Children With Externalizing Disorders in a Randomized Controlled Trial.

Self-help interventions for parents, which have a behavioral basis, are considered to be an effective treatment option for children with externalizing disorders. Nonbehavioral approaches are widely used but have little empirical evidence. The main objective of this trial was to compare the efficacy of a behavioral and a nonbehavioral guided self-help program for parents. Families of children (aged 4-11 years) diagnosed with attention-deficit/hyperactivity disorder (ADHD) or oppositional defiant disorder (ODD) were randomized to either a behavioral or a nonbehavioral guided self-help program including 8 parenting booklets and 10 counseling telephone calls. The analyses considered the ratings of 5 informants: blinded clinician, therapist, participant, (her or his) partner, and teacher. Of the 149 families randomized to treatment (intention-to-treat sample [ITT]), 110 parents completed the intervention (per-protocol sample [PP]). For the 4 primary outcome measures (blinded clinician- and participant-rated ADHD and ODD) at post-assessment, the analysis revealed a treatment advantage for the behavioral group in blinded clinician-rated ODD symptoms (ITT: d = 0.37; PP: d = 0.35). Further treatment differences, all in favor of the behavioral group (ITT and PP), were detected in therapist ratings (i.e., ODD) and participant ratings (e.g., parental self-efficacy [only PP], negative parenting behavior, parental stress). In both samples, no differences were found at post-assessment for ratings of the partner and the teacher, or at the 12-month follow-up (only participant ratings available). Behavioral guided self-help shows some treatment advantage in the short term. No superiority over nonbehavioral therapy was detected 12 months after treatment termination.

Effectiveness of the Neonatal Discharge Program for Very Low-Birth-Weight Infants on Parental Efficacy and Psychological Distress.

This pilot study aimed to (i) evaluate the effectiveness of a neonatal discharge program, (ii) identify relationships between parent and infant factors and parental efficacy and psychological distress, and (iii) identify ways to improve the neonatal discharge program. A quasiexperimental 1-group pretest/posttest design was used. Through consecutive sampling, 42 participants were recruited. Data were collected using self-report questionnaires. Self-administering instruments gathered data on parental efficacy and psychological distress as well as feedback and recommendations on the intervention. A significant increase in parental efficacy and a reduction in psychological distress were observed from pre- to postdischarge intervention. Significant relationships were found between parental efficacy and infants' gestational age, birth weight, gender, and participants' level of education, and a significant relationship was found between psychological distress and number of children from previous pregnancies. Moreover, an Internet-based program, in addition to the face-to-face teaching, was identified as a preferred option to aid in information retention. It is important to evaluate and enhance the neonatal discharge program to suit the parents of today while providing them with informational and emotional support. Future studies should explore parental coping and the long-term effects of their infant's birth and the intervention.

Is more better? Examining whether enhanced consultation/coaching improves implementation.

It is extremely challenging to implement evidence-based interventions in community-based agencies with sufficient quality, fidelity, and intensity to produce desired changes in practice and outcomes. This is particularly difficult to do within the confines of existing service providers' time, personnel, and resource constraints. Over the past 15 years, Together Facing the Challenge (TFTC) has been developed, tested, and disseminated in an effort to address this set of issues to improve treatment foster care (TFC). Data from the initial randomized trial showed improved practice and outcomes in TFTC compared to usual TFC. These initial results came from study-led training and follow-up consultation. Subsequent dissemination activities suggested potential need for more intensive support for TFTC supervisors to produce more consistent and sustained implementation of the model. The current randomized trial extends this work by comparing the previously tested standard consultation versus enhanced consultation that incorporated more of a coaching approach. Initial results suggest that enhanced coaching/consultation was associated with improvements in the small- to medium-effect size range. Results are promising, but require additional work to more fully understand how and whether to enhance supports as agencies implement new evidence-based approaches. (PsycINFO Database Record

Implementing Sustainable Evidence-Based Interventions in the Community: A Fidelity-Focused Training Framework for the Savvy Caregiver Program.

Evidence-based (EB) programs provide a tested means for addressing serious public health concerns. While establishing and maintaining fidelity to these programs is critical for high-quality outcomes, unfortunately, implementation reports rarely describe the strategies used to train and monitor fidelity in community-based implementations. Thus, an essential translational ingredient is a clearly articulated model for establishing a systemic, sustainable fidelity framework. This article provides a detailed description of the fidelity-focused framework developed for Michigan's statewide implementation of the Savvy Caregiver Program. This framework, titled Creating Confident Caregivers® (CCC), instilled conceptual understanding of fidelity, practice adherence, and competence via ongoing progressive practitioner training, peer observation, participant evaluation, and experiential assessments. Practitioners maintained very high evaluations from participants, and a select cadre of practitioners achieved master trainer status to monitor regional fidelity. This framework promotes sustainable fidelity to EB interventions and provides a replicable platform for other community-based implementations.

MIXED-METHODS EVALUATION OF PARTICIPANT RECRUITMENT AND RETENTION IN THE MOM POWER PARENTING INTERVENTION PROGRAM.

Parenting group success begins with attendance. Using archival pilot data from 99 mothers who enrolled in the Mom Power (MP) parenting intervention, this study sought to understand the factors that influenced participant engagement and retention. MP is a group-based, early intervention program grounded in attachment theory that utilizes motivational interviewing as a core component to enhance program engagement. Study aims were to qualitatively describe the reasons why mothers were interested in participating in the program, including what they hoped to gain from the experience, and to quantitatively examine the extent to which attendance was associated with demographic, experiential, and psychosocial factors. The qualitative analysis of intake interviews revealed that mothers expected the MP intervention to provide a warm environment for themselves and their children as well as to support and enhance their parenting, and 95% revealed their hopes that the intervention would help them grow and develop as women. Attendance rates were relatively high, with 62% of mothers missing less than one group session. Quantitative analyses using multiple regression to test associations of demographic, experiential, and psychosocial factors with attendance rates were not significant. Results suggest that motivational interviewing may be an important component in promoting participant engagement efforts in parenting interventions.

Effectiveness and experiences of families and support workers participating in peer-led parenting support programs delivered as home visiting programs: a comprehensive systematic review.

BACKGROUND: Designing child and family health services to meet the diverse needs of contemporary families is intended to minimize impacts of early disadvantage and subsequent lifelong health and social issues. Innovative programs to engage families with child and family support services have led to interest in the potential value of peer-led home visiting from parents in local communities. There is a range of benefits and challenges identified in a limited number of studies associated with home visiting peer support. OBJECTIVES: The objective of the review is to identify: INCLUSION CRITERIA PARTICIPANTS: Families/parents with one or more children aged zero to four years, peer support workers and their supervisors. INTERVENTION AND PHENOMENON OF INTEREST: Peer-led home visiting parenting support programs that use volunteer or paraprofessional home visitors from the local community compared to standard community maternal-child care. The phenomenon of interest will be the relationships between participants in the program. TYPES OF STUDIES: Quantitative studies: randomized control trials (RCTs). Qualitative studies: grounded theory and qualitative descriptive studies. OUTCOMES: Parental attitudes and beliefs, coping skills and confidence in parenting, parental stress, compliance with child health checks/links with primary healthcare services, satisfaction with peer support and services and the nature of the relationship between parents and home visitors. SEARCH STRATEGY: The search strategy will include both published and unpublished studies. Seven journal databases and five other sources will be searched. Only studies published in the English language from 2000 to 2015 will be considered. METHODOLOGICAL QUALITY: Studies were assessed by two independent reviewers using standardized critical appraisal tools from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) and the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) as appropriate. DATA EXTRACTION: Both quantitative and qualitative data were independently extracted by two reviewers using standardized data extraction tools from the JBI-MAStARI and the JBI-QARI, respectively, including qualitative and quantitative details about setting of interventions, phenomena of interest, participants, study methods and outcomes or findings. DATA SYNTHESIS: For quantitative findings, statistical pooling was not possible due to differences in interventions and outcome measures. Findings were presented in narrative form. Qualitative findings were aggregated into categories based on similarity of meaning from which synthesized findings were generated. RESULTS: Quantitative results from two RCTs demonstrated positive impacts of peer-led home visiting parent support programs including more positive parenting attitudes and beliefs, and more child preventative health care visits.Fifteen qualitative findings from two studies were aggregated into five categories from which two synthesized findings emerged. Parents and home visitors identified similar components as contributing to their program's success, these being quality of relationships between parents and home visitors with elements being mutual respect, trust and being valued within the partnership. In addition, home visitors identified importance of enabling strategies to develop relationships. They also needed supportive working environments with clinical staff and management. CONCLUSION: The current review indicates a positive impact of peer-led home visiting parent support programs, incorporating a framework of partnership between parents and home visitors, on mother-infant dyads. Positive changes in parenting attitudes and beliefs, and increased number of child preventative healthcare visits are supported by the quality of the relationship between parent and home visitor, and home visitors' working environments. IMPLICATIONS FOR PRACTICE: The essential characteristics of an effective parent support program are strategies for relationship building between parents and home visitors; ongoing staff and home visitor education to enhance communication, collaboration and working in partnership; supervision by team leaders; and continuous quality improvement. IMPLICATIONS FOR RESEARCH: The focus of further research should be on confirmatory studies using an action research methodology and the cost-effectiveness of these models.

Assessing Feedback in a Mobile Videogame.

BACKGROUND: Player feedback is an important part of serious games, although there is no consensus regarding its delivery or optimal content. "Mommio" is a serious game designed to help mothers motivate their preschoolers to eat vegetables. The purpose of this study was to assess optimal format and content of player feedback for use in "Mommio." MATERIALS AND METHODS: The current study posed 36 potential "Mommio" gameplay feedback statements to 20 mothers using a Web survey and interview. Mothers were asked about the meaning and helpfulness of each feedback statement. RESULTS: Several themes emerged upon thematic analysis, including identifying an effective alternative in the case of corrective feedback, avoiding vague wording, using succinct and correct grammar, avoiding provocation of guilt, and clearly identifying why players' game choice was correct or incorrect. CONCLUSIONS: Guidelines are proposed for future feedback statements.

The short Working Alliance Inventory in parent training: Factor structure and longitudinal invariance.

OBJECTIVE: The purposes of the present study were twofold: (a) to examine the factor structure of the Working Alliance Inventory, Short (WAI-S) and (b) to investigate if factor loadings and thresholds fulfilled properties of longitudinal measurement invariance across two waves of data. METHOD: The study sample consisted of 259 Norwegian parents receiving Parent Management Training, the Oregon model. Parents rated alliance at sessions 3 and 12 during the therapy. Confirmatory factor analyses to assess the fit of a one-, two-, and three-factor model were performed using robust weighted least squares estimation for categorical indicators. RESULTS: The results showed that data provided best fit for the three-factor solution with goal, task, and bond. Furthermore, results demonstrated satisfactory invariance for factor loadings and thresholds across time. CONCLUSIONS: Overall, the results indicate that the WAI-S three-factor solution has acceptable psychometric properties for longitudinal measurement comparisons.

[Anxious School Absenteeism: Cognitive-Behavioral Treatment of School Phobia at a Psychological Counseling Center]. / Angstbedingte Schulverweigerung: Verhaltenstherapeutisch orientiertes Vorgehen bei schulphobischem Verhalten an einer psychologischen Beratungsstelle.

Resulting from a shortage of possibilities in the ambulant treatment of school phobia behavior-therapeutic interventions were established at a psychological counseling center for families twenty years ago, which have been in existence to this day. The criteria of anxiety-based absenteeism as well as problems of terminology and classification will be presented with emphasis on school phobia as a combination of separation anxiety and social anxiety ("Schulphobie"). The multimodal treatment focuses on cognitive interventions, graduated exposition and close cooperation with teachers. The counselor is also in charge of the networking and cooperation of all people concerned. A short case study is used to illustrate the process. Measures such as training and information for teachers and school social workers and a manual for the comprehension and the treatment of school phobia, which was edited in cooperation with a psychological counseling center for schools complement the treatment.

Individual-Oriented Relationship Education: An Evaluation Study in Community-Based Settings.

The effects of relationship education aimed at individuals, rather than couples, have not yet been widely investigated. However, increasingly, relationship education is provided to large and diverse groups of individuals who may be in varying stages of relationships. Several programs have been developed to strengthen relationship competencies among single individuals as well as among partnered individuals who, for a variety of reasons, seek relationship education without their partners. The current study is an exploratory evaluation study that examined self-reported outcomes for 706 single and partnered individuals who attended Within My Reach classes delivered in community-based agencies. Participants were from diverse backgrounds and exhibited many of the risk factors for poor relationship outcomes including unemployment, low income, and childhood experience of abuse or neglect. Pre-post analyses indicated that the program was beneficial for both singles and partnered individuals. Singles reported increased belief in ability to obtain healthy relationships. Partnered individuals reported increased relationship quality, relationship confidence, and reduced conflict. Regardless of relationship status, participants also reported improvement in general relationship and communication skill. Results support the utility of individual-oriented relationship education for singles and partnered individuals with diverse background characteristics.

Effects of a Brief, Prevention-Focused Parenting Education Program for New Mothers.

We evaluated the effects of a parenting program, Baby and You, on parenting knowledge, parenting morale, and social support using a single-group, pre-test, and post-test design with 159 Canadian mothers of infants aged 2 to 9 months old. Baby and You is a prevention-focused parenting program (PFPP) to improve maternal and infant health through education and social support. The 4-week curriculum focuses on infant development and safety, parent-child relationships, maternal self-care, and community resources. We computed repeated-measures ANOVAs separately for scores on Parenting Knowledge Scale, Parenting Moral Index, and Family Support Scale. We found a significant increase between pre-test and post-test on parenting knowledge, but not parenting morale or social support. Parenting morale may be a stable construct that shows little change over time. It may take more than 4 weeks of programming for mothers to identify and integrate new sources of social support.

Desarrollo y validación de una escala sobre disciplina parental en contextos familiares en situación de riesgo psicosocial / No disponible

Este artículo describe el desarrollo de una escala para evaluar las creencias de padres y madres en situación de riesgo psicosocial sobre las estrategias disciplinarias durante la adolescencia. Se presentan los resultados psicométricos obtenidos en el proceso de construcción de la escala con una investigación en la que participaron 197 familias usuarias de los servicios sociales comunitarios de la ciudad de Sevilla. Los análisis factoriales realizados (exploratorio y confirmatorio) evidenciaron la existencia de dos factores con índices estadísticos adecuados: disciplina inductiva y disciplina coercitiva. Con objeto de aportar evidencias de validez, se relacionaron estos dos factores con otras dimensiones del funcionamiento familiar teóricamente relacionadas con las prácticas disciplinarias, obteniéndose resultados que apoyan la validez y fiabilidad del instrumento desarrollado para evaluar un ámbito fundamental de las prácticas educativas de las familias en situación de riesgo psicosocial

Development and validation of an instrument for measuring parents’ beliefs about behavioral control as educative practices with adolescents in psychosocial risk situations is presented. The development and dimensionality of the proposed scale was examined with a sample made of 197 families at psychosocial risk that benefited from preservation services in Seville (Andalusia, Spain). Both exploratory and confirmatory factor analyses evidenced two factors with adequate psychometric properties: inductive discipline and coercive discipline. Evidences for validity were probed through significant correlations with other family functioning measures. The scale developed led us to evaluate a critical aspect of parental discipline in families at psychosocial risk with psychometric guarantees

Estilos educativos parentales y su relación con la socialización en adolescentes / No disponible

En el presente artículo se analiza la importancia de la familia sobre el desarrollo social óptimo del hijo adolescente. Los objetivos de esta investigación son evaluar la socialización de 80 sujetos entre 11 y 14 años a través de su conducta social y sus habilidades sociales, estudiar el modelo de crianza de los padres y las madres y su relación con el nivel educativo de los mismos, y analizar la correlación entre el estilo de socialización utilizado por los padres y el ajuste social del hijo. Los instrumentos utilizados han sido la Batería de Socialización (BAS-3), la Escala de Habilidades Sociales (EHS) y la Escala de Socialización Parental en la Adolescencia (ESPA29). Los resultados muestran una relación significativa entre la competencia social del adolescente y muchas dimensiones que conforman el estilo educativo parental. Además se crean modelos predictores de diversas variables relacionadas con la conducta social y las habilidades sociales

The current article examines the influence of families on the optimum social development of adolescents. The objectives of this study include the assessment of socialization in 80 subjects from age 11 to 14 through their social behavior and skills, the research of parenting styles and its relation to educational attainment and the analysis of the correlation between the parents’ socialization and the children’s social adjustment. The instruments used were the Socialization Battery (BAS-3), the Social Skills Scale in Adolescents (EHS) and the Parental Socialization Scale in Adolescent (ESPA29). The results show a significant relationship between the children’s social competence and many dimensions of the parenting styles. Furthermore, some models are created to predict variances related to social behavior and skills

Implementation of Parent Management Training-Oregon Model (PMTO(TM) ) in Iceland: building sustained fidelity.

Bringing empirically supported treatments (ESTs) into community settings is a challenge because of threats to therapy adherence. The nationwide implementation of Parent Management Training-the Oregon Model (PMTO) in Iceland was studied by comparing therapists' competent adherence to PMTO across three generations of therapists. To assess therapists' competence and adherence to the PMTO method, the Fidelity of Implementation Rating System (FIMP) was used as the measuring device. Of 16 therapists across three generations who entered training, 12 completed with certification. As expected, each of the three generations obtained adequate FIMP scores. Generations 1 and 3 showed equivalent levels of performance on FIMP scores at certification. A small drop in FIMP scores for Generation 2 was explained in terms of translating and culturally adjusting materials and strengthening training procedures. Results are parallel to earlier findings from the nationwide PMTO implementation in Norway and support the idea that PMTO can be implemented in community settings with high fidelity even when resources are scarce.

Entre-Parents: initial outcome evaluation of a preventive-parenting program for French-speaking parents.

Entre-Parents is the French adaptation of Parenting Our Children to Excellence, an eight-session group-parenting program for parents of preschoolers. An evaluation conducted in the French-speaking part of Switzerland with 132 parents provides initial evidence for the community acceptability and efficacy of Entre-Parents. Program attendance was high (average of 6.6 out of the 8 sessions), and parents participated actively in sessions and expressed high levels of program satisfaction. Results indicate that, over time, the program contributed to more effective parenting practices, a reduction in parenting stress, an increase in family adaptability, and increases in children's social competence and reductions in their disruptive and anxious behaviors. Some of these benefits were stronger for parents who attended more sessions.