Changes in daily life created by the novel coronavirus (COVID-19) pandemic have resulted in a largely unprecedented situation for millions of families worldwide. Families are under considerable ...stress, and parents may experience greater psychological distress and disruptions in the parent-child relationship. Some parents may be particularly vulnerable to recent stressors, including those with preexisting psychological disorders and family dysfunction. In the United States, military veterans are one such at-risk population. Recent challenges may exacerbate preexisting conditions and heighten parenting stress, thereby negatively impacting child and family functioning. In this article, we share our experiences developing and piloting a telepsychotherapy parenting skills program for military veterans. The intervention, Online Parenting Pro-Tips (OPPT), combined web-based educational modules addressing child development and positive parenting with live coaching (via videoconferencing link) of parenting skills. Forty-one veterans with a child between the ages of 3 and 9 years enrolled in this trial and 22 completed the 6-session intervention. Veterans who completed the intervention experienced significant reductions in depression, parenting stress, and family dysfunction, with medium to large effect sizes (Cohen's d ranged from .53 to .98). Veterans also reported significant improvements in their child's behaviors. These findings have important implications pertaining to the feasibility and effectiveness of telepsychotherapy interventions to support at-risk families and promote positive parent-child interactions and family functioning during the COVID-19 crisis and beyond. At a practical level, OPPT and similar telepsychotherapy interventions for families could be modified to be delivered via smartphone to increase accessibility and cost-effectiveness for families worldwide.
Prueba piloto de una intervención de habilidades de crianza por telepsicoterapia para familias veteranas: Implicaciones para el manejo de estrés parental durante COVID-19
Los cambios en la vida diaria creados por la nueva pandemia del virus corona (COVID-19) han resultado en una situación en gran medida sin precedentes para millones de familias en todo el mundo. Familias están bajo un estrés considerable y los padres pueden experimentar mayor angustia psicológica e rupturas en la relación padre-hijo. Algunos padres pueden ser particularmente vulnerable a estresores recientes, incluidos aquellos con preexistencia de trastornos psicológicos y disfunción familiar. En los Estados Unidos, veteranos militares son una de esas poblaciones en riesgo. Los desafíos recientes pueden exacerbar condiciones preexistentes y aumentar el estrés de los padres, lo que afecta negativamente al niño y funciones familiares. En este artículo, compartimos nuestras experiencias desarrollando y poniendo a prueba un programa de habilidades para padres de telepsicoterapia para veteranos militares. La intervención, consejos para padres en línea (OPPT), combinaron módulos educativos basados en la web que abordandan el desarrollo infantil y la crianza positiva, con coaching en vivo (a través de enlace de videoconferencia) de habilidades parentales. Cuarenta y un veteranos con un niño entre las edades de 3 y 9 años se inscribieron en este ensayo y 22 completaron la intervención de 6 sesiones. Los veteranos que completaron la intervención experimentaron reducciones significativas en depresión, estrés parental y disfunción familiar con efectos de tamaño medio a grande (El valor de Cohen oscilaba entre .53 y .98). Los veteranos también reportaron mejoras significativas en los comportamientos de sus hijos. Estos hallazgos tienen implicaciones importantes relacionadas con la viabilidad y efectividad de las intervenciones de telepsicoterapia para apoyar a familias en riesgo y promover interacciones positivas entre padres e hijos y el funcionamiento familiar durante la COVID-19 crisis y más allá. A nivel práctico, OPPT e intervenciones similares de telepsicoterapia para las familias podrían modificarse para ser entregadas a través de teléfonos inteligentes para aumentar accesibilidad y rentabilidad para familias de todo el mundo.
针对退役老兵家庭之育儿技巧干预远程咨询的试行：关于冠状病毒流行期间管理育儿压力的暗示
由新冠病毒流行病所导致的日常生活变化应激导致全世界百万家庭陷入几乎前所未有的境况。 家庭们正在经受着巨大的压力, 而且家长们可能经受着更大的心理痛苦和来自亲子关系中的扰乱。 部分家长可能更易受近期压力源影响，其中包括那些已经遭受先前存在心理障碍和家庭不协调的家长。在美国, 退役老兵就属于这类处于危险中的群体。最近的挑战可能会恶化已经存在的境况并且增加了育儿压力, 因此会对孩子与家庭的运作产生消极影响。在本文中, 关于发展和测试一个针对退役老兵家庭育儿技巧远程心理咨询项目, 我们分享了的经验。这个干预项目, 名为在线家教专业贴士 （OPPT), 将以网络为基础并以儿童发展和积极正面育儿为任务的教育模块与通过视频会议进行的在线育儿技巧辅导结合起来。41个老兵以及他们3-9岁间的孩子参与了此次试运行试验, 其中22人完成了时长为6期的干预治疗。那些完成了干预治疗的老兵感受到了抑郁，育儿的精神压力, 和家庭失衡方面的显著性降低以及中等到较大的效应值（科恩维处于0.53 到0.98). 老兵们也报道孩子的行为有了显著的改善。这些发现, 在关于在疫情期间支持高危家庭并且推进积极的亲子互动以及家庭运转的远程心理治疗干预的可行性和有效性, 有着重要的借鉴意义。在现实操作的层面, OPPT和针对家庭的其他远程心理治疗干预可以被改进从而可以通过智能手机传达来增加对全世界家庭的可及性和成本效益。
Full text
Available for:
CEKLJ, FFLJ, NUK, ODKLJ, PEFLJ, UPUK
Purpose: Technological advances have made the delivery of psychological interventions via web-based platforms increasingly feasible. In recent years, there has been growth in the delivery of ...psychological interventions through web-based modalities, that is, telepsychology. Although there is evidence supporting the usability and feasibility of telepsychology for a range of populations, there is limited literature on clinician perceptions delivering telepsychology, particularly to pediatric rehabilitation populations. In this mixed-methods study, we report on clinician perspectives and experiences delivering telepsychology to children/families impacted by pediatric traumatic brain injury. Method: Seventeen clinicians (psychologists and advanced psychology doctoral students) who delivered telepsychology interventions to children/families impacted by pediatric brain injuries completed surveys and interviews. Results: Overall, clinicians reported that telepsychology was equivalent to face-to-face treatment in many regards (e.g., therapeutic alliance, weekly progress, child/family engagement, and establishing rapport). Clinicians reported a number of advantages of telepsychology over face-to-face interventions for this pediatric population including greater ease of scheduling, increased understanding of the family and home environments, and less caregiver stigma of behavioral health care. Disadvantages of telepsychology included difficulties reading nonverbal cues, logistical/technological issues, and greater disruptions during sessions. Conclusions: Findings provide an important foundation for future investigations examining the merits of telepsychology versus traditional treatment for both pediatric rehabilitation populations.
Impact and Implications
This study elucidates several advantages and disadvantages of utilizing telepsychology in comparison with face-to-face therapy for family-centered treatment of pediatric traumatic brain injury from a clinician perspective. Overall, clinicians reported that telepsychology was superior to face-to-face therapy in terms of scheduling/attendance, understanding the family and home environments, and reducing behavioral health stigma. Clinicians reported several challenges with utilizing telepsychology; the most prominent including distractions and reading nonverbal cues. Findings from this study provide an important foundation for future investigations examining the merits of telepsychology versus traditional treatment for pediatric populations.
Full text
Available for:
CEKLJ, FFLJ, NUK, ODKLJ, PEFLJ, UPUK
•Opinions about race range from color-blind ideology to racial equality.•Some view race as divisive, whereas others consider race as providing community.•Race may be salient aspect of identity for ...some but insignificant to others.•The topic of race elicits contrasting emotions from pride to apprehension.
Conversations around race have come to the forefront of public discourses in the United States with incidents of police brutality leading to movements such as Black Lives Matter and its opposition, All Lives Matter. Although there is substantial psychological literature focusing on racial attitudes and intergroup relations, much of this research is experimental, failing to capture diverse and evolving viewpoints of people in the United States. In the present study, our aim was to understand folk definitions and diverse perspectives about the role of race in the United States in participants’ own words. We thematically analyzed submissions to The Race Card Project (n = 913), a publicly available platform, and responses from a sample of college students describing perspectives on race (n = 1092). A total of 27 identified themes were organized in four domains: opinions about race, race-based interactions, race and identity, and emotions. Opinions about race ranged from color-blind ideology to racial equality, race as divisive or providing community, and excessive focus on race. References were made to historic and current race relations, assumptions based on skin color, prejudice and discrimination, White privilege, and “reverse racism.” These findings contribute to evolving scholarly understanding of race in the United States, with implications for informing initiatives to promote race relations and reduce experiences of discrimination for individuals of color.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Abstract This pilot study examined changes in parenting skills and child behavior following participation in an online positive parenting skills program designed for young children with traumatic ...brain injury (TBI). Thirty-seven families with a child between 3 and 9 years of age who sustained a moderate to severe TBI were randomly assigned to one of two interventions: online parenting skills training ( n = 20) or access to Internet resources on managing brain injury ( n = 17). Parent–child interaction observations and parent ratings of child behavior were collected pre- and post-treatment. Generalized estimating equations and mixed models were used to examine changes in parenting skills and child behavior problems as well as the moderating role of family income on treatment response. Participants in the parenting skills group displayed significant improvements in observed positive parenting skills relative to participants in the Internet resource group. Income moderated improvements in parent ratings of child behavior, with participants in the low-income parenting skills group and high-income Internet resource group reporting the greatest improvements in behavior. This is the first randomized controlled trial examining online parenting skills training for families of young children with TBI. Improvements in positive parenting skills and child behavior support the utility of this intervention, particularly for families from lower socioeconomic backgrounds.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Background
Although pediatric brain tumor survivors are at high risk for a variety of psychosocial and neurocognitive late effects, there are few evidence‐based interventions to address their needs. ...The purpose of this study was to test the efficacy of an online problem‐solving intervention on improving the quality of life and executive dysfunction among adolescent and young adult brain tumor survivors.
Procedure
A Survivor's Journey was adapted from a similar intervention for survivors of traumatic brain injuries, and involved self‐guided web modules providing training in problem‐solving as a tool for coping with everyday challenges, as well as weekly teleconferences with a trained therapist. Survivors (n = 19) between the ages of 13 and 25, and their caregivers, completed standardized measures of their emotional and behavioral functioning, executive functioning, and quality of life before and after the 12‐ to 16‐week intervention.
Results
Participation in the intervention led to significant improvements in self‐reported overall (Mpre = 62.03, SDpre = 17.67, Mpost = 71.97, SDpost = 16.75; d = 0.58, P = 0.01) and physical quality of life (Mpre = 63.13, SDpre = 21.88, Mpost = 75.00, SDpost = 21.33; d = 0.55, P < 0.01) as well as parent‐reported emotional quality of life (Mpre = 65.00, SDpre = 28.72, Mpost = 76.15, SDpost = 23.47; d = 0.43, P = 0.03). Greater improvement was noted in those who were diagnosed before the age of seven and those with average or above average estimated IQs. Current age did not moderate outcomes.
Conclusions
Online problem‐solving therapy may be efficacious in improving pediatric brain tumor survivors’ quality of life; however, further research with a comparison group is needed. Online interventions such as Survivor's Journey may decrease barriers to evidence‐based psychosocial care for brain tumor survivors.
Full text
Available for:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
To examine the effects of a Web-based parenting intervention (I-InTERACT), and an abbreviated version (Express), on caregiver depression, psychological distress, parenting stress, and parenting ...efficacy following pediatric traumatic brain injury (TBI).
Four children's hospitals and 1 general hospital in the United States.
148 caregivers of 113 children aged 3 to 9 years with a moderate to severe TBI.
Multicenter randomized controlled trial. Participants were randomly assigned to I-InTERACT, Express, or an active control condition. Caregiver data were collected at baseline and postintervention (6 months later).
I-InTERACT (10-14 sessions) and Express (7 sessions) combine live coaching of parenting skills and positive parenting strategies.
Center for Epidemiologic Studies Depression Scale (CES-D); Global Severity Index of the Symptom Checklist-90-R (GSI), Parenting Stress Index (PSI), and Caregiver Self-Efficacy Scale (CSES).
Analyses revealed no main effects of treatment on caregiver distress (GSI), parenting stress (PSI), or parenting efficacy (CSES). However, analyses examining baseline severity as a moderator found that caregivers with elevated levels of depression in I-InTERACT experienced significantly greater reductions in CES-D scores compared with caregivers in the active control condition.
I-InTERACT reduced caregiver depression but no other facets of caregiver psychological functioning. Modifications to the treatment content may be necessary to reduce parenting stress and improve caregiver efficacy.
To examine the moderating effects of parent marital status and participation on efficacy of an online family problem-solving intervention for pediatric traumatic brain injury (TBI).
Participants were ...132 adolescents (12-17 years) who had sustained a recent (<6 months) TBI and their parents. Participants were randomly assigned to the intervention (Counselor-Assisted Problem Solving, CAPS) or an Internet resource comparison (IRC) condition. CAPS was designed to support families in the initial phase following TBI, by teaching problem-solving skills and addressing common challenges. To examine the moderating effect of parent marital status, participants were divided into 4 groups (ie, CAPS married household, CAPS unmarried household, IRC married household, and IRC unmarried household). Family income and caregiver education were controlled in analyses.
Parent marital status moderated treatment effects on adolescent externalizing behavior problems. Adolescents from married households in CAPS displayed fewer behavior problems at 6 and 18 months postbaseline compared with adolescents from unmarried households in CAPS. Among married CAPS families, there were no differences in outcomes among families where 1 or 2 parents actively participated.
Web-based interventions for pediatric TBI, such as CAPS, are a viable option for some although not all families. Further research is needed to investigate factors that influence efficacy to match families to the most beneficial treatments.
Adolescents sustaining traumatic brain injury (TBI) show increased prevalence of behavior problems. This study investigated the associations of parent mental health, family functioning, and ...parent-adolescent interaction with adolescent externalizing behavior problems in the initial months after TBI, and examined whether injury severity moderated these associations.
117 parent-adolescent dyads completed measures of family functioning, adolescent behavior, and parent mental health an average of 108 days post-TBI. Dyads also engaged in a 10-min video-recorded problem-solving activity coded for parent behavior and tone of interaction.
Overall, higher ratings of effective parent communication were associated with fewer externalizing behavior problems, whereas poorer caregiver psychological functioning was associated with greater adolescent externalizing behaviors. Results failed to reveal moderating effects of TBI severity on the relationship between socio-environmental factors and behavior problems.
Interventions targeting parent communication and/or improving caregiver psychological health may ameliorate potential externalizing behavior problems after adolescent TBI.
To examine changes in parent depression, psychological distress, parenting stress, and self-efficacy among participants in a randomized trial of a Web-based parent training program for pediatric ...traumatic brain injury (TBI).
Primary caregivers of 37 children aged 3 to 9 years who sustained a moderate/complicated mild to severe TBI were randomly assigned to the intervention or control group, and both groups were equipped with home Internet access. The online parent training program was designed to increase positive parenting skills and improve caregiver stress management. It consisted of 10 core sessions and up to 4 supplemental sessions. Each session included self-guided Web content, followed by a videoconference call with a therapist to discuss content and practice parenting skills with live feedback. Families in the control group received links to TBI Web resources.
Parent income moderated treatment effects on parent functioning. Specifically, lower-income parents in the parenting skills group reported significant reductions in psychological distress compared with lower-income parents in the control group. No differences were found among higher-income parents for depression, parenting stress, or caregiver efficacy.
Parent training interventions post-TBI may be particularly valuable for lower-income parents who are vulnerable to both environmental and injury-related stresses.
PDF
