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The present study examined the effectiveness of a personalized remote video feedback parenting program to improve mother-child interactions and child behavior outcomes among mothers of children with behavior problems in comparison to counterparts with no behavior problems. The sample comprised 60 mothers and their 2-to-6-year-old children, including children with behavior problems (BP = 19) and children without behavior problems (NoBP = 41). The Strengthening Bonds program included one in-person group session and remote personalized video feedback about their mother-child interactions in a play situation via smartphone for six weeks. Mother-child interactions were the primary outcome, and children's behaviors were the secondary outcome. Pre- and post-intervention assessments were performed. The mother-child interactions were recorded during free- and structured-play situations and were then analyzed by the Parenting Interactions with Children: Checklist of Observations Linked to Outcomes (PICCOLO) and the Dynamics of the dyad activity coding system. Additionally, the mothers answered the Strengths and Difficulties Questionnaire. The results showed that, in the post-intervention, the mother-child interaction pattern improved in the BP group, especially in the teaching dimension of the PICCOLO. Also, after the program, more children with normal classification were in the BP group.
RESUMO
The randomized controlled trial examined the efficacy of a personalized remote video feedback parenting program to improve parenting and child behavior outcomes. Ninety-two mothers of 2-6-year-old children were randomly allocated into the intervention group (n = 50) and waiting-list control group (n = 42). The Strengthening Bonds preventive program was performed to improve positive parenting. The mothers participated in one in-person group session. During six weeks, the mothers received, via smartphone, remote personalized video feedback about their mother-child interactions in a play situation. Parenting was the primary outcome, and child behavior was the secondary one. Pre- and post-intervention assessments were performed. The generalized estimating equation analysis showed no significant results in the intention-to-treat (ITT). In the treatment-on-the-treated (TOT), there were statistically significant effects of the intervention decreasing mothers' coercive parenting practices and child behavior problems. The structural equation model analysis showed that the intervention-induced reductions in children's behavior problems were mediated by improvements in coercive practices. There was a direct effect of the intervention to improve the parental sense of competence. Despite the null findings in the ITT analysis, the TOT analysis showed promising results to strengthen positive parenting behaviors and beliefs and reduce child behavior problems.
El ensayo controlado aleatorizado analizó la eficacia de un un programa personalizado de parentalidad a distancia mediante feedback por vídeo dirigido a mejorar la parentalidad y el comportamiento de los niños. Se distribuyó aleatoriamente a 92 madres de niños de entre 2 y 6 años de edad en el grupo de intervención (n = 50) y un grupo control de lista de espera (n = 42). Para mejorar la parentalidad positiva se utilizó el programa preventivo Strengthening Bonds, en el que las madres participaron en una sesión de grupo presencial. Durante seis semanas recibieron por teléfono móvil feedback en vídeo personalizado sobre su interacción madre-hijo durante el juego. El resultado primario fue la conducta parental, y el resultado secundario la conducta del niño. Se llevaron a cabo mediciones preintervención y posintervención. El análisis de ecuaciones de estimación general no tuvo resultados significativos en los análisis por intención de tratar (AIT). En los análisis por protocolo (APP) hubo efectos significativos, reduciendo las prácticas parentales coercitivas de las madres y los problemas de conducta de los niños. El análisis de modelos de ecuaciones estructurales reveló que la disminución de los problemas de conducta de los niños producida por la intervención era mediada por la mejora en las prácticas coercitivas. La intervención tenía un efecto directo en la mejora del sentimiento de competencia parental. A pesar de la falta de resultados del AIT, el APP dio resultados prometedores en cuanto a la mejora de las conductas y creencias parentales positivas y en la reducción de los problemas de conducta de los niños.
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BACKGROUND: During child psychiatry hospitalization, working with the families or attachment figures is a challenge, most of the children who are admitted to these units come from multi-problem families, with limited research in this area. Video feedback (VF) interventions have proved to be a powerful resource to promote parental and child well-being in small children and has been used with parents with a psychiatric condition. Parental Reflective Functioning (PRF) is one of the parental abilities that can be improved with VF and could be especially important in coping with conflict and negative emotions in older children. The aim of this study is to implement Video Intervention Therapy (VIT) to enhance PRF in primary caregivers of inpatient psychiatric children. As there is no published research using VF with parents of children with severe psychopathology in a hospitalized context. This report, then, becomes a much needed pilot study providing evidence for a larger randomized control trial (RCT). METHODS: The study is a single-center, two-arm feasibility randomized control trial with a qualitative component. Block randomization was done to generate a 2:1 allocation, leaving more participants in the intervention group. The intervention comprises four modules; every module has both one video-recorded play session and one VIT session (in a group setting) per week. Evaluation of the caregivers included assessments of PRF and well-being, and child assessment included parent-ratings and clinician-ratings of symptomatology and general functioning. RESULTS: Thirty participants were randomized; eligibility and recruitment rate were 70.6% and 83.3%, respectively. The compliance-to-intervention rate was 85% in the VIT group and 90% in the control group. All participants completed entry evaluation and 90% at the 3-month follow-up. The intervention was acceptable to participants and feasible for therapists to deliver. Outcome data must be treated with caution due to the small numbers involved, yet indicate that the VIT may have a positive effect in improving parental and child mental health outcomes. CONCLUSIONS: VIT for primary caregivers of child inpatient children was feasible to deliver and acceptable for participants, therapist, and the staff unit involved; there is sufficient evidence to undertake a full-scale effectiveness RCT. TRIAL REGISTRATION: ClinicalTrials.gov NCT03374904 . Registered on 14 December 2017.
Assuntos
Psiquiatria Infantil , Transtornos Mentais , Cuidadores , Criança , Estudos de Viabilidade , Humanos , PaisRESUMO
This study evaluated the effects of a short video feedback intervention aimed at enhancing maternal sensitivity and the development of infants from low-income families in a randomized controlled trial. Forty-four mother-infant dyads living in low-income communities from Salvador, Brazil were randomly assigned between intervention and control groups. Maternal sensitivity was assessed during free-play and infant development was evaluated with a standardized scale. Intervention took place in eight home visits between the infant's third and tenth month. Results showed mothers in the intervention group interpreted the meaning of their infants' behavior more often (r = 0.33), asked babies more questions (r = 0.39), and were less intrusive (r = 0.47) when compared to controls on posttest. The absence of significant intervention effects on infant development suggests the need for additional intervention strategies and a greater time lag between maternal sensitivity and infant development assessments to detect possible delayed effects.
Assuntos
Desenvolvimento Infantil , Mães/educação , Mães/psicologia , Pobreza , Adulto , Brasil , Depressão/epidemiologia , Feminino , Nível de Saúde , Humanos , Lactente , Recém-Nascido , Comportamento Materno , Saúde Mental , Relações Mãe-Filho , Apego ao Objeto , Poder Familiar , Gravidez , Fatores SocioeconômicosRESUMO
BACKGROUND: Children requiring hospitalization for psychiatric care have serious disorders, high use of psychotropic medication, and frequent readmissions. The development and implementation of therapies focused on incorporating primary caregivers or attachment figures is necessary for working with children with severe psychiatric disorders. Mentalization or parental reflective functioning (PRF) is the ability of parents to understand their children's behaviors as an expression of internal emotional states and act accordingly to help them regulate their emotions; in this way mentalizing is a key component of sensitive parenting. Video-assisted therapies have proven to be effective in promoting change in parent-child relationships. The majority of studies have been carried out with mothers of pre-school children and in an outpatient setting. Video intervention therapy (VIT) is a flexible manualized therapy, which allows the intervention to be individualized to the context where it is applied, according to the needs and resources of the people who participate in it. The objective of the study is to evaluate the feasibility and acceptability of applying VIT to improve the PRF of the parents as primary carers of children hospitalized in a psychiatric service. METHODS: This is a pilot randomized, single-masked (outcome assessor) study with a qualitative component. It will involve a block randomization procedure to generate a 2:1 allocation (with more people allocated to the intervention arm). The intervention consists of four modules; every module has both one video-recorded play session and one VIT session per week. People assigned to the control group will receive treatment as usual plus weekly play sessions. Feasibility and acceptability of the study will be quantitatively and qualitatively assessed. Evaluation of the caregivers will include assessments of PRF, wellbeing and personality structure; assessments of children will include parent-ratings and clinician-ratings of symptomatology and general functioning. After every video feedback (VF) session, PRF, the caregiver's wellbeing and children's general functioning will be reassessed. DISCUSSION: This study will contribute to the currently scarce evidence on how to provide family attachment-based interventions in a child inpatient psychiatric unit. It will also inform the design and implementation of a future randomized clinical trial. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03374904 . Registered on 14 December 2017 (retrospectively registered).
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Comportamento do Adolescente , Cuidadores/psicologia , Comportamento Infantil , Retroalimentação Psicológica , Pacientes Internados/psicologia , Transtornos do Neurodesenvolvimento/terapia , Pais/psicologia , Gravação em Vídeo , Adolescente , Fatores Etários , Criança , Emoções , Estudos de Viabilidade , Feminino , Humanos , Masculino , Mentalização , Transtornos do Neurodesenvolvimento/diagnóstico , Transtornos do Neurodesenvolvimento/psicologia , Relações Pais-Filho , Poder Familiar , Projetos Piloto , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
Se presentan resultados de un estudio sobre la efectividad de una intervención con video-retroalimentación para familias vulnerables, llamada terapia de interacción guiada (IG). La muestra estuvo compuesta por 19 diadas -figura parental y niños entre 2 y 10 años-, participantes en programas sociales de intervención familiar. Se evaluó el nivel de ajuste conductual y socioemocional en los niños y adultos, mediante un diseño pre-post de grupo único. Se encontró diferencias estadísticamente significativas (p<0.05) con mejorías en los problemas de los niños, y en el bienestar general y sintomatología ansioso-depresiva del adulto, pero no en las variables de estrés contextual ni en las relaciones sociales del adulto; la IG parece funcionar mejor en niños menores de 6 años. Estos hallazgos indican que la IG sería efectiva para mejorar el bienestar y salud mental de díadas en riesgo psicosocial, requiriéndose más investigación para respaldar esta tendencia preliminar.
Outcomes of a study about the effectiveness of an intervention using video feedback for vulnerable families, called interaction guidance therapy (IG), are presented. The sample was composed by 19 dyads -parent and children between 2 and 10 years-, participants in social programs of family intervention. The level of behavior and emotional adjustment of children and adults was assessed, by means of a pre-post design with a single group. Statistical significant differences were found (p<0.05), with improvements in children problems, and in general wellbeing and anxious-depressive symptomatology of the adult, but not in the variables of contextual stress neither in the social relationships of the adult; IG seems to work better with children younger than 6 years of age. These results indicate that IG would be effective to improve the wellbeing and mental health of dyads in psychosocial risk requiring more research to support this preliminary trend.
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Humanos , Masculino , Adulto , Feminino , Criança , Pessoa de Meia-Idade , Comportamento Infantil , Gravação em Vídeo , Relações Interpessoais , Retroalimentação , Ajustamento Social , Saúde da Criança , Inquéritos e Questionários , Cuidadores , Avaliação de Resultado de Intervenções Terapêuticas , Família , Grupos de Risco , Inventário de Personalidade , Saúde MentalRESUMO
El artículo presenta una nueva forma de intervención terapéutica con familias multiproblemáticas, denominada Terapia de Interacción Guiada (IG) e ilustra su aplicación mediante un estudio de caso, llevado a cabo en un programa social de la Sociedad Protectora de la Infancia de Santiago de Chile. La IG es una terapia breve que, desde el enfoque sistémico y la teoría del apego, se focaliza en mejorar las interacciones cuidador(a)-niño(a). La IG intercala sesiones de juego familiar grabadas en video, con sesiones de observación de secuencias de interacción positivas y negativas escogidas por el terapeuta. Se discute su potencial beneficio con estas familias y los desafíos que implica adaptar e implementar este modelo al contexto chileno.
The paper present a new form of intervention with multiproblem families called Interaction Guidance Therapy (IG) and illustrate it's application trough a description of one therapy process developed on a social program of Sociedad Protectora de la Infancia. IG is a brief therapy that, from attachment and system theories, focuses on enhanced caregiver-child interaction. IG combines family play sessions recorded on video, with sessions of discussion about whose objective is to show and to discuss positive and negative interaction sequences chosen by the therapist. Potential benefits with this families and challenges that implied to adapt and to implement a model of this kind in social organizations and health services in Chile are discussed.