Group‐based parent‐training (PT) is one of the most common and well‐established approaches for strengthening parenting skills and reducing child behavior problems. When offered in school settings, ...the social connections formed among participants may generate additional benefits for parents, schools, and children. However, to date there has been limited research on the potential benefits or harms associated with social connectedness (SC) in group‐based PT. This paper describes the study protocol for an ongoing National Institute of Nursing Research‐funded mixed‐methods study that aims to examine the extent to which group‐based PT, delivered in elementary schools serving families from predominantly low‐resource communities, generates SC among parents and if SC is associated with greater (a) reduction in child behavior problems and (b) engagement in their child's education. Using a prospective descriptive design, the study is nested within an ongoing quasi‐experimental parent study evaluating the group‐based PT intervention, the Chicago Parent Program (CPP) in Baltimore City schools. Challenges for this study include recruitment and retention of parents with constraints caused by the COVID‐19 pandemic. The study uses multiple methods and informants to understand the potential mechanisms underlying PT group effects and results have the potential to serve as an important foundation for future studies focused on SC, its impacts on parent‐child outcomes in low‐resource settings, and strategies for strengthening SC in health promotion interventions.
Patient or Public Contribution
Chicago Parent Program was developed with input from an advisory board of parents. Additionally, the parent study protocol was written and is co‐led in partnership with a community organization.
Group-based parent training (PT) is an evidence-based approach for strengthening parenting skills and reducing child behavior problems. However, there has been little research on the social ...connectedness (SC) formed among PT participants, particularly in low-income communities where parents may be more socially isolated. This study describes SC formed among parents in a group-based PT program implemented in their children's school and its association with changes in child behavior. Using a convergent mixed-methods design, data collection occurred between 2020 and 2022. Parents (n = 97) completed measures of their SC to other parents in their PT group and their child's behavior. Qualitative interviews with a representative subsample of parents (n = 17) were also conducted to understand parents' perceptions and experiences of SC within their PT group. Parents reported high levels of SC (M = 4.45 range = 3.04-5 on scale of 1-5; SD = 0.4). From baseline to postintervention, the number of children with child behavior problems significantly decreased (32.12%, 37.5% behavior intensity and problems, respectively). The magnitude of decline in child behavior problems was significantly related to parents' SC (b = −11.52, p = .02, SE = 4.99). Qualitative data confirmed high levels of SC, which parents linked to improvements in their parenting and children's behavior. Themes focused on the building of connections, committing to a safe space with parents who share similar goals, supporting one another, and gaining connections within the school environment and during the COVID-19 pandemic. Results highlight the potential synergistic effects of SC formed in the context of group-based PT with implications for strengthening parenting skills and children's well-being.
Public Policy Relevance Statement
Social connectedness is an important construct that has been linked to improved mental and physical health outcomes. Findings from this study highlight the importance of investing in school-based preventive parenting interventions that improve young children's behavioral health and build socially connected parent communities. These investments are particularly needed in low-income, underresourced communities where parents may experience more psychosocial adversity and isolation.
Social isolation has been linked to numerous health risks, including depression and mortality. Parents raising children in low‐income and under‐resourced communities are at an increased risk for ...experiencing social isolation and its negative effects. Social connectedness (SC), one's sense of belongingness and connection to other people, or a community, has been linked to reduced social isolation and improved health outcomes in the general population, yet little is known about the impact SC has on parents with low incomes. This integrative review aims to describe the current state of the science surrounding SC in parents with low incomes, summarize how SC is being defined and measured, evaluate the quality of the science, and identify gaps in the literature to guide future research. Five electronic databases were searched, yielding 15 articles for inclusion. Empirical studies meeting the following criteria were included: population focused on parents who have low incomes or live in low‐income communities and have dependent children, outcomes were parent‐centered, SC was a study variable or a qualitative finding, and publication date was before March 2021. Findings emphasize SC as a promising construct that may be protective in the health and well‐being of parents and children living in low‐income communities. However, a lack of consensus on definitions and measures of SC makes it difficult to build a strong science base for understanding these potential benefits. Future research should focus on understanding the mechanisms by which SC works to benefit parents and their children.
There is a well-documented gap between the need for and availability of mental health services for children nationwide. To address this gap, over 30 regional Child Psychiatry Access Programs (CPAPs) ...provide psychiatric consultation and other services to primary care providers.
Summarize the methods used to evaluate CPAPs in the United States.
PubMed, PsychInfo, CINAHL, and reference checking.
A systematic literature review was conducted searching 3 databases. The search produced 307 unique articles, 278 were excluded for irrelevance, leaving 29 for data extraction. Data extracted included author(s), publication year, provider types, CPAP formats, study sample, design, outcomes examined, results, and limitations. Articles were also appraised for quality using the Johns Hopkins Nursing Evidence-Based Practice Evidence Level and Quality Guide.
The 29 articles evaluated 13 unique CPAPs. Most evaluations used nonexperimental observational designs (68.9%), 6.9% used quasi-experimental designs, and none used true experimental designs. Evaluations examined the following outcomes: usage of program services (82.8%), provider satisfaction (48.3%), provider comfort/confidence with managing mental health concerns (31.0%), provider practice change (24.1%), patient outcomes (13.7%), and family satisfaction (6.9%). Outcomes were measured using surveys, qualitative interviews, or insurance claims data.
Review was limited to articles published in English in 3 databases or identified by reference checking.
Evaluations of CPAPs have largely been descriptive in nature, focusing primarily on program usage and provider satisfaction. Few studies have examined the impact of CPAPs on patients, families, or health systems. Future studies should evaluate the broader impacts of CPAPs.
This study examined associations between four indicators of social determinants of health (SDOH; parent education, poverty, material hardships, and child health problems), chronic school absence, and ...teachers’ ratings of parents’ engagement in their children's education. Surveys were collected from 304 parents and 26 teachers from eight Baltimore City Public Schools. Results revealed that teachers’ ratings of parent engagement were consistently lower among families experiencing adverse SDOH and/or whose children were chronically absent; however, there was no significant relationship between teachers’ ratings of parent engagement and child health problems. Additionally, chronic absence partially mediated the relationship between three SDOH indicators (total material hardships, parent education level, and child health problems) and teacher-rated parent engagement. Poverty was excluded from mediation analysis due to evidence of multicollinearity suppressive effects. Addressing the SDOH assessed in this study may be an effective strategy to reduce chronic absence, promote parent engagement, and foster equity in education.
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