Couples Therapy for Domestic Violence: Finding Safe Solutions

BACKGROUND: Supportive parenting is critical for promoting healthy child development in the face of stressors, such as those occurring during COVID-19. Here, we address a knowledge gap regarding specific household risk factors associated with parenting quality during the pandemic and incorporate first-person accounts of family challenges and needs. METHODS: Mixed methods were applied to data collected between April 14th - 28th, 2020 from the "Parenting During the Pandemic" survey. Participants included 656 primary caregivers (e.g., mothers, fathers, foster parents) of least one child age 1.5-8 years of which 555 (84.6%) responded to at least one parenting questionnaire. Parenting quality was assessed across stressful, negative, and positive parenting dimensions. Household risk was examined across pandemic- linked (e.g., caregiver depression, unmet childcare needs) and stable factors (i.e., annual income, mental illness history). Significant correlates were examined with regressions in Mplus. Thematic analysis identified caregiver challenges and unmet needs from open-ended questions. FINDINGS: Caregiver depression, higher child parity, unmet childcare needs, and relationship distress predicted lower-quality parenting. Caregiver depression was the most significant predictor across every parenting dimension, with analyses indicating medium effect sizes, ds = .39 - .73. Qualitative findings highlighted severe strains on parent capacities including managing psychological distress, limited social supports, and too much unstructured time. INTERPRETATIONS: Lower quality parenting during COVID-19 is associated with multiple household and pandemic risk factors, with caregiver depression consistently linked to parent- child relationship disruptions. Focused efforts are needed to address caregiver mental health to protect child health as part of the pandemic response.

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Supporting families to protect child health: Parenting quality and household needs during the COVID-19 pandemic.

Online parenting programs can increase the accessibility of mental health services. This meta-analysis investigated the effectiveness of online parenting interventions in reducing children and adolescents behavior problems (primary outcome) and improving parenting behavior, parent distress, and parenting efficacy (secondary outcomes). A systematic search was conducted on PubMed, PsycInfo, Web of Science, SCOPUS, and ProQuest on June 28th, 2019. The meta-analysis was prior registered in PROSPERO. In total, 2160 records were identified and 15 Randomized Controlled Trials (RCTs) were included (N = 1668) in the systematic review and meta-analysis. The quality of each study was assessed by two independent evaluators. When compared to waitlist, online parenting interventions are effective in reducing behavior problems with a small effect size (Hedges’s g = 0.40). No significant differences were found between online and classical delivered parenting interventions in reducing behavior problems (g =  − 0.07). Compared to waitlist, the interventions are effective in improving parenting behavior (g = 0.34), parent distress (g = 0.30), and parenting efficacy (g = 0.41). The results appear to be stable at follow-up measures. The factors responsible for the effectiveness of the interventions were explored through moderation analyses. Online parenting interventions are promising for improving both behavior problems and parent outcomes. Future studies should focus on methods to increase their effectiveness and measure the outcomes more objectively.

The Efficacy of Internet-Based Parenting Programs for Children and Adolescents with Behavior Problems: A Meta-Analysis of Randomized Clinical Trials

Parents of children with autism spectrum disorder (ASD) experience numerous challenges caring for their children. Research shows that those parents, and specifically mothers, suffer from high levels of stress and poorer well-being compared to parents of children with other disabilities. Developing and evaluating interventions to help enhance their well-being and their interaction with their children is recommended (NICE, 2013). Parenting interventions have been shown to be efficacious for parents of children with ASD , yet practical barriers may have an impact on their widespread uptake (McConachie & Diggle, 2007). Self-help parenting interventions with minimal therapists’ support, which have the potential to overcome barriers to adherence, have been used with parents of children with other neurodevelopmental disorders. However, there is limited evidence evaluating these interventions and their effectiveness for parents of children with ASD. Moreover, most parenting interventions for parents of children with ASD focus on developing the parents’ abilities to enhance specific skills in their children, while only few include psychoeducation components addressing knowledge about ASD and parental well-being. The main aims of this thesis were to understand the impact of having a child with ASD on parental functioning both internationally and for Saudi Arabian mothers and to then develop and evaluate both quantitatively and qualitatively the effectiveness of a brief psychoeducation intervention for mothers of children with ASD in the Kingdom of Saudi Arabia (KSA). 
Chapter One provides an introduction to ASD including its current definition, diagnosis, co-morbidities, risk factors, and treatment options. In addition, it discusses the theoretical models related to parenting children with ASD, and autism within the context of KSA including gaps in current research there. Chapter Two (study one), presents a systematic review investigating the impact of having children with ASD on parental life. Autism was found to impact areas including response to ASD, parental well-being, relationships, positive perception, financial problems, and future worries. Differences in findings between mothers and fathers were identified. Chapter Three (study two) explores the unmet needs of Saudi mothers of children with ASD in KSA through a pilot qualitative study that used semi-structured interviews. Mothers expressed a range of issues and needs including feelings of lack of sufficient information about ASD, the need for parental training, shortage of quality ASD services, lack of fathers’ assistance, and stigma associated with having children with ASD. Moreover, mothers insisted that barriers such as lack of transportation add to their burden. Chapter Four (study three) presents a meta-analysis evaluating the effectiveness of parenting interventions on parental functioning of parents of children with ASD. Analyses revealed that parenting interventions are effective in enhancing parental well-being (stress, depression, and anxiety), parenting practices, and in increasing parents’ sense of competence SOC. Chapter Six (study four) delivers the findings from a small-scale randomised controlled trial (RCT) investigating the effectiveness of a self-help psychoeducation intervention with minimal therapists’ support, delivered via WhatsApp for mothers of children with ASD in KSA. The intervention was successful in reducing maternal reports of stress, depression, ASD symptoms, and child behaviour problems. Change of clinical significance was minimal and limited to maternal depression. Chapter Seven (study five) describes a qualitative study that evaluates the acceptability and views of mothers who participated in the trial in Chapter Six. Mothers had positive views of the intervention and many of them were actively engaged in the intervention and discussed new parenting skills and behaviours that they had acquired. Finally, Chapter Eight provides a general and overall discussion of the thesis findings, including a summary of the findings of all the studies within the thesis. In addition, methodological strengths and considerations, clinical implications, and direction for future research are discussed. Collectively, the studies within this thesis provided evidence for the effectiveness of self-help psychoeducation parenting intervention with minimal therapist support and delivered via a virtual medium for mothers of children with ASD in KSA indicating that such interventions may have a place in future routine care.

The effectiveness of a psychoeducation intervention delivered via WhatsApp for mothers of children with autism spectrum disorder (ASD) in the Kingdom of Saudi Arabia

Background This study evaluated whether an evidence-based parenting intervention, when delivered online, could effectively address disruptive behavior problems in young children and yield outcomes comparable to in-person delivery of the same intervention. Methods Families (n = 334) of children (3-7 years; 63% White, 22% African American, 15% other races; 63% male) with disruptive behavior problems were randomized to online-delivered intervention (ODI) or staff-delivered intervention (SDI), resulting in baseline and demographic equivalence. Primary outcome measures for child disruptive behavior (independent observation, parent report) and secondary outcome measures of parenting and family impact were assessed at baseline, postintervention, and follow-up. Conducted using intent-to-treat (ITT) as well as per-protocol (PP) methods, noninferiority analyses, which drew on an HLM framework with repeat measures across three timepoints and on REML to provide unbiased estimates of model parameters, tested whether the outcome-difference CI did not exceed the a priori noninferiority margin. Results For ITT and PP analyses, the ODI was found to be noninferior to the SDI on the primary outcome: independently observed child disruptive behavior and parent-reported child behavior problems. The pattern for secondary outcomes was more varied: (a) noninferiority for observed positive and aversive parenting; (b) noninferiority for observed quality of parent-child relationship at post but not follow-up assessment; (c) noninferiority for parent-reported inappropriate/inconsistent discipline for PP but not ITT analyses; and (d) noninferiority not confirmed for parenting daily hassles and adverse family quality of life, despite large effect sizes for the ODI (Cohen's d .75-1.07). Finally, ODI noninferiority was found for teacher-reported child disruptive behavior. Conclusions The tested online-delivered parenting intervention demonstrated clear noninferiority with the corresponding staff-delivered parenting intervention on the primary outcome, child disruptive behavior problems, and reflected substantial though nonuniform noninferiority and meaningful effect sizes for secondary outcomes related to parenting and family. Future research will guide optimization of online interventions.

Online-delivered parenting intervention for young children with disruptive behavior problems: a noninferiority trial focused on child and parent outcomes

With online education and programs becoming increasingly common, it is necessary to examine their effectiveness. In this study, we conduct a meta-analysis of online parenting programs. In this meta-analysis, we included 28 studies yielding 127 effect sizes examining 15 outcome variables. We found that online parenting programs had the strongest effects on increasing positive parenting and parents' encouragement. We also found significant effects of reducing negative parent-child interactions, child problem behaviors, negative discipline strategies, parenting conflicts, parent stress, child anxiety, parent anger, and parent depression. Results also revealed programs' significant effects on increasing parent confidence, positive child behavior and parenting satisfaction. Comparisons of programs that included clinical support (meaning programs through which participants had access to content experts, therapists, or content specialists in conjunction with the online program) versus programs that only contained online components, revealed no significant differences in 6 program outcomes between programs with and without clinical support. Comparisons of programs provided to targeted populations versus general populations revealed no significant differences in four program outcomes between populations. Results suggest that online parenting programs can provide benefits for parents who may not be able to access in-person resources. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Do online parenting programs create change?: A meta-analysis

Purpose:During the COVID-19 pandemic, there has been an increase in cases of intimate partner violence (IPV) related to stay-at-home orders, as well as the financial and emotional stress many indiv...

Preventing Maltreatment at Home: A Meta-Analysis Examining Outcomes From Online Programs

Both media and academic reports have highlighted COVID-19's negative impacts on mental health and safety in the United States, yet care and service gaps persist. Evidence suggests that a default to in-person service delivery did not meet clients' needs before the pandemic, and that unmet needs have ballooned since COVID-19 spread throughout the United States due to a combination of increased stress, social isolation, and fewer available services during lockdowns. This article reviews literature on online interventions' utility and effectiveness in preventing and treating problems likely exacerbated under pandemic conditions, including mental health conditions, anger, couple dynamics, parenting, and alcohol misuse. The article also describes barriers to evidence-based e-interventions' wider and more consistent use, highlights some vulnerable populations' unique service needs, outlines service gaps that online programs might effectively mitigate, and offers a path by which social workers can lead an interdisciplinary charge in researching, developing, and implementing e-interventions during the current pandemic and beyond.

Erika L King

Papers

Do online parenting programs create change?: A meta-analysis

Preventing Maltreatment at Home: A Meta-Analysis Examining Outcomes From Online Programs

How the COVID-19 Pandemic Can and Must Expand Social Worker e-Interventions for Mental Health, Family Wellness, and Beyond.