Enhancing the early home learning environment through a brief group parenting intervention: study protocol for a cluster randomised controlled trial.

BACKGROUND: The quality of the home learning environment has a significant influence on children's language and communication skills during the early years with children from disadvantaged families disproportionately affected. This paper describes the protocol and participant baseline characteristics of a community-based effectiveness study. It evaluates the effects of 'smalltalk', a brief group parenting intervention (with or without home coaching) on the quality of the early childhood home learning environment. METHODS/DESIGN: The study comprises two cluster randomised controlled superiority trials (one for infants and one for toddlers) designed and conducted in parallel. In 20 local government areas (LGAs) in Victoria, Australia, six locations (clusters) were randomised to one of three conditions: standard care (control); smalltalk group-only program; or smalltalk plus (group program plus home coaching). Programs were delivered to parents experiencing socioeconomic disadvantage through two existing age-based services, the maternal and child health service (infant program, ages 6-12 months), and facilitated playgroups (toddler program, ages 12-36 months). Outcomes were assessed by parent report and direct observation at baseline (0 weeks), post-intervention (12 weeks) and follow-up (32 weeks). Primary outcomes were parent verbal responsivity and home activities with child at 32 weeks. Secondary outcomes included parenting confidence, parent wellbeing and children's communication, socio-emotional and general development skills. Analyses will use intention-to-treat random effects ("multilevel") models to account for clustering. RECRUITMENT AND BASELINE DATA: Across the 20 LGAs, 986 parents of infants and 1200 parents of toddlers enrolled and completed baseline measures. Eighty four percent of families demonstrated one or more of the targeted risk factors for poor child development (low income; receives government benefits; single, socially isolated or young parent; culturally or linguistically diverse background). DISCUSSION: This study will provide unique data on the effectiveness of a brief group parenting intervention for enhancing the early home learning environment of young children from disadvantaged families. It will also provide evidence of the extent to which additional one-on-one support is required to achieve change and whether there are greater benefits when delivered in the 1st year of life or later. The program has been designed for scale-up across existing early childhood services if proven effective. TRIAL REGISTRATION: 8 September 2011; ACTRN12611000965909 .This research was commissioned and funded by the Victorian Government Department of Education and Early Childhood (now the Department of Education and Training, DET). JN, MT, SB, TH, VH, EW and NH were employees of the Parenting Research Centre when this study was designed and conducted. JN, SB, EW & NH are currently supported by the Australian Communities Foundation through the Roberta Holmes Transition to Contemporary Parenthood Program (Coronella sub-fund); EW was part-funded by the Centre for Research Excellence in Child Language at Murdoch Children’s Research Institute (NHMRC grant 1023493). OU is funded by the UK National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsula at the Royal Devon and Exeter NHS Foundation Trust. The views expressed in this publication are those of the authors and not necessarily those of the funding bodies

Impact of a brief group intervention to enhance parenting and the home learning environment for children aged 6-36 months: A cluster randomised controlled trial

This is the final version of the article. Available from the publisher via the DOI in this record.This study evaluated the effectiveness of a group parenting intervention designed to strengthen the home learning environment of children from disadvantaged families. Two cluster randomised controlled superiority trials were conducted in parallel and delivered within existing services: a 6-week parenting group (51 locations randomised; 986 parents) for parents of infants (aged 6-12 months), and a 10-week facilitated playgroup (58 locations randomised; 1200 parents) for parents of toddlers (aged 12-36 months). Each trial had three conditions: intervention (smalltalk group-only); enhanced intervention with home coaching (smalltalk plus); and 'standard'/usual practice controls. Parent-report and observational measures were collected at baseline, 12 and 32 weeks follow-up. Primary outcomes were parent verbal responsivity and home learning activities at 32 weeks. In the infant trial, there were no differences by trial arm for the primary outcomes at 32 weeks. In the toddler trial at 32-weeks, participants in the smalltalk group-only trial showed improvement compared to the standard program for parent verbal responsivity (effect size (ES) = 0.16; 95% CI 0.01, 0.36) and home learning activities (ES = 0.17; 95% CI 0.01, 0.38) but smalltalk plus did not. For the secondary outcomes in the infant trial, several initial differences favouring smalltalk plus were evident at 12 weeks, but not maintained to 32 weeks. For the toddler trial, differences in secondary outcomes favouring smalltalk plus were evident at 12 weeks and maintained to 32 weeks. These trials provide some evidence of the benefits of a parenting intervention focused on the home learning environment for parents of toddlers but not infants. TRIAL REGISTRATION: 8 September 2011; ACTRN12611000965909 .This research was commissioned and funded by the Victorian Government Department of Education and Early Childhood Development (DEECD), and designed and conducted at the Parenting Research Centre. NH, EW, SB, AS, MT, MY and JN were employees of the Parenting Research Centre when this study was conducted. EW was part-funded by the Centre for Research Excellence in Child Language at Murdoch Childrens Research Institute (NHMRC grant 1023493). NH, EW, SB and JN are funded by the Australian Communities Foundation (Coronella sub-fund) at La Trobe University. OU is supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula at the Royal Devon and Exeter NHS Foundation Trust. Views expressed are those of the authors and not necessarily those of DEECD, NIHR, NHS or the Department of Health

Quantitative assessment of paravalvular regurgitation following transcatheter aortic valve replacement

Paravalvular aortic regurgitation (PAR) following transcatheter aortic valve implantation (TAVI) is well acknowledged. Despite improvements, echocardiographic measurement of PAR largely remains qualitative. Cardiovascular magnetic resonance (CMR) directly quantifies AR with accuracy and reproducibility. We compared CMR and transthoracic echocardiography (TTE) analysis of pre-operative and post-operative aortic regurgitation in patients undergoing both TAVI and surgical aortic valve replacement (AVR).Gareth Crouch, Phillip J Tully, Jayme Bennetts, Ajay Sinhal, Craig Bradbrook, Amy L Penhall, Carmine G De Pasquale, Robert A Baker, and Joseph B Selvanayaga

Protocol for the Adaptation of a Direct Observational Measure of Parent-Child Interaction for Use With 7–8-Year-Old Children

ObjectiveParenting sensitivity and mutual parent-child attunement are key features of environments that support children&rsquo;s learning and development. To-date, observational measures of these constructs have focused on children aged 2&ndash;6 years and are less relevant to the more sophisticated developmental skills of children aged 7&ndash;8 years, despite parenting being equally important at these ages. We undertook a rigorous process to adapt an existing observational measure for 7&ndash;8-year-old children and their parents. This paper aimed to: (i) describe a protocol for adapting an existing framework for rating parent-child interactions, (ii) determine variations in parents&rsquo; sensitive responding and parent-child mutual attunement (&lsquo;positive mutuality&rsquo;) by family demographics, and (iii) evaluate the psychometric properties of the newly developed measure (i.e., inter-rater reliability, construct validity).MethodParent-child dyads completed one home visit, including a free-play observation and parent questionnaire. Dyads were provided with three toy sets: LEGO&reg; Classic Box, Classic Jenga&reg;, and animal cards. The Coding of Attachment-Related Parenting (CARP) was adapted for use with 7&ndash;8-year-old children, and rating procedures were streamlined for reliable use by non-clinician/student raters, producing the SCARP:7&ndash;8 Years. Trained staff rated video-recorded observations on 11 behaviors across two domains (five for parents&rsquo; sensitive responding, six for parent-child positive mutuality).ResultsData were available for 596 dyads. Consistently strong inter-rater agreement on the 11 observed behaviors was achieved across the 10-week rating period (average: 87.6%, range: 71.7% to 96.7%). Average ICCs were 0.77 for sensitive responding and 0.84 for positive mutuality. These domains were found to be related but distinct constructs (r = 0.49, p &amp;lt; 0.001). For both domains, average ratings were strongly associated with the main toy used during the observation (p &amp;lt; 0.001, highest: cards, lowest: LEGO&reg;). Adjusted multivariate linear regression models (accounting for toy choice) revealed that less sensitive responding was associated with younger parent (p = 0.04), male parent (p = 0.03), non-English speaking background (p = 0.04), and greater neighborhood disadvantage (p = 0.02). Construct validity was demonstrated using six parent-reported psychosocial and parenting measures.ConclusionThe SCARP: 7&ndash;8 Years shows promise as a reliable and valid measure of parent-child interaction in the early school years. Toy selection for direct observation should be considered carefully in research and practice settings.</jats:sec

Recruiting fathers for parenting research using online advertising campaigns: Evidence from an Australian study

BACKGROUND: Fathers are underrepresented in parenting and child health research. Given there is a strong link between fathers' parenting behaviour and children's well-being, there is a need to find ways to engage fathers more consistently. The current short report provides information and learnings about recruiting fathers online using social media. Results are drawn from an Australian study that aimed to recruit roughly equal numbers of mothers and fathers to participate in a survey about employment, parenting, and health, using online advertising. METHODS: First, a series of five Facebook advertising campaigns were run, aimed at "parents" generally (i.e., gender-neutral). A lack of recruited fathers prompted a second series of six Facebook campaigns aimed solely at fathers. All campaigns targeted employed adult parents of children (≤18 years) in Australia using Facebook's "Adverts Manager." RESULTS: The 11 campaigns recruited a total of 1,468 fathers. The vast majority of these fathers were recruited using the advertisements specifically aimed at fathers (n = 1,441). Gender-neutral campaigns inviting and selecting "parents" to participate in the study overwhelmingly yielded samples of mothers. Similarly, advertisements inviting both "mums and dads" resulted in very low recruitment of fathers. CONCLUSIONS: The extremely low numbers of fathers recruited using the gender-neutral "parent-focused" campaigns was unexpected. Potential reasons for this include low engagement with gender-neutral parenting terms, and/or that mothers were disproportionally exposed to the Facebook advertisements. These learnings suggest that father-focused recruitment is required to target and engage fathers in parenting research and services

The Agreement between Parent-Reported and Directly Measured Child Language and Parenting Behaviors

Parenting behaviors are commonly targeted in early interventions to improve children's language development. Accurate measurement of both parenting behaviors and children's language outcomes is thus crucial for sensitive assessment of intervention outcomes. To date, only a small number of studies have compared parent-reported and directly measured behaviors, and these have been hampered by small sample sizes and inaccurate statistical techniques, such as correlations. The Bland-Altman Method and Reduced Major Axis regression represent more reliable alternatives because they allow us to quantify fixed and proportional bias between measures. In this study, we draw on data from two Australian early childhood cohorts (N = 201 parents and slow-to-talk toddlers aged 24 months; and N = 218 parents and children aged 6-36 months experiencing social adversity) to (1) examine agreement and quantify bias between parent-reported and direct measures, and (2) to determine socio-demographic predictors of the differences between parent-reported and direct measures. Measures of child language and parenting behaviors were collected from parents and their children. Our findings support the utility of the Bland-Altman Method and Reduced Major Axis regression in comparing measurement methods. Results indicated stronger agreement between parent-reported and directly measured child language, and poorer agreement between measures of parenting behaviors. Child age was associated with difference scores for child language; however, the direction varied for each cohort. Parents who rated their child's temperament as more difficult tended to report lower language scores on the parent questionnaire, compared to the directly measured scores. Older parents tended to report lower parenting responsiveness on the parent questionnaire, compared to directly measured scores. Finally, speaking a language other than English was associated with less responsive parenting behaviors on the videotaped observation compared to the parent questionnaire. Variation in patterns of agreement across the distribution of scores highlighted the importance of assessing agreement comprehensively, providing strong evidence that simple correlations are grossly insufficient for method comparisons. We discuss implications for researchers and clinicians, including guidance for measurement selection, and the potential to reduce financial and time-related expenses and improve data quality. Further research is required to determine whether findings described here are reflected in more representative populations