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Parenting strategies such as communicating clear expectations, providing calm directions, and teaching specific skills can strengthen young children’s social-emotional development. Parenting programs for children with disruptive behavior often emphasize gaining compliance via effective directives, and less on how to facilitate child skill acquisition or on effective parenting for differing situations and task demands. We aimed to study how parenting strategies and associated child behavior vary by situational contexts. Specifically, we focused on the differential use of directives and guidance during different tasks. This observation study utilized a microsocial coding system, the Parent–Child Play Task Observation System (PCPTOS), to closely examine parent and child interactions in multiple analogue task situations. The study drew on pre-intervention data for 224 parent–child dyads who participated in a parenting-focused intervention trial for children ages 3–7 who presented elevated levels of disruptive behaviors. Interrater reliabilities were very good to excellent. Parents used directives more frequently during the clean-up task and guidance more frequently during the teaching task compared to the other tasks. Associations of parent use of directives and guidance with child behavior and affect differed by task. Observed parent directives were associated with child disruptive behavior during each task, whereas parent guidance was negatively associated with child disruptive behavior and positively associated with child positive affect during the teaching task. Parenting strategies that are well matched to the situational context and proactively consider task demands are more likely to facilitate children’s social-emotional development.

Background High-prevalence childhood mental health problems like early-onset disruptive behavior problems (DBPs) pose a significant public health challenge and necessitate interventions with adequate population reach. The treatment approach of choice for childhood DBPs, namely evidence-based parenting intervention, has not been sufficiently disseminated when relying solely on staff-delivered services. Online-delivered parenting intervention is a promising strategy, but the cost minimization of this delivery model for reducing child DBPs is unknown compared with the more traditional staff-delivered modality. Objective This study aimed to examine the cost-minimization of an online parenting intervention for childhood disruptive behavior problems compared with the staff-delivered version of the same content. This objective, pursued in the context of a randomized trial, made use of cost data collected from parents and service providers. Methods A cost-minimization analysis (CMA) was conducted comparing the online and staff-delivered parenting interventions. Families (N=334) with children 3-7 years old, who exhibited clinically elevated disruptive behavior problems, were randomly assigned to the two parenting interventions. Participants, delivery staff, and administrators provided data for the CMA concerning family participation time and expenses, program delivery time (direct and nondirect), and nonpersonnel resources (eg, space, materials, and access fee). The CMA was conducted using both intent-to-treat and per-protocol analytic approaches. Results For the intent-to-treat analyses, the online parenting intervention reflected significantly lower program costs (t168=23.2; P Conclusions The online-delivered parenting intervention in this randomized study produced substantial cost minimization compared with the staff-delivered intervention providing the same content. Cost minimization was driven primarily by personnel time and, to a lesser extent, by facilities costs and family travel time. The CMA was accomplished with three critical conditions in place: (1) the two intervention delivery modalities (ie, online and staff) held intervention content constant; (2) families were randomized to the two parenting interventions; and (3) the online-delivered intervention was previously confirmed to be non-inferior to the staff-delivered intervention in significantly reducing the primary outcome, child disruptive behavior problems. Given those conditions, cost minimization for the online parenting intervention was unequivocal. Trial Registration ClinicalTrials.gov NCT02121431; https://clinicaltrials.gov/ct2/show/NCT02121431

BACKGROUND High-prevalence childhood mental health problems like early-onset disruptive behavior problems (DBPs) pose a significant public health challenge and necessitate interventions with adequate population reach. The treatment approach of choice for childhood DBPs, namely evidence-based parenting intervention, has not been sufficiently disseminated when relying solely on staff-delivered services. Online-delivered parenting intervention is a promising strategy, but the cost minimization of this delivery model for reducing child DBPs is unknown compared with the more traditional staff-delivered modality. OBJECTIVE This study aimed to examine the cost-minimization of an online parenting intervention for childhood disruptive behavior problems compared with the staff-delivered version of the same content. This objective, pursued in the context of a randomized trial, made use of cost data collected from parents and service providers. METHODS A cost-minimization analysis (CMA) was conducted comparing the online and staff-delivered parenting interventions. Families (N=334) with children 3-7 years old, who exhibited clinically elevated disruptive behavior problems, were randomly assigned to the two parenting interventions. Participants, delivery staff, and administrators provided data for the CMA concerning family participation time and expenses, program delivery time (direct and nondirect), and nonpersonnel resources (eg, space, materials, and access fee). The CMA was conducted using both intent-to-treat and per-protocol analytic approaches. RESULTS For the intent-to-treat analyses, the online parenting intervention reflected significantly lower program costs (t168=23.2; P<.001), family costs (t185=9.2; P<.001), and total costs (t171=19.1; P<.001) compared to the staff-delivered intervention. The mean incremental cost difference between the interventions was $1164 total costs per case. The same pattern of significant differences was confirmed in the per-protocol analysis based on the families who completed their respective intervention, with a mean incremental cost difference of $1483 per case. All costs were valued or adjusted in 2017 US dollars. CONCLUSIONS The online-delivered parenting intervention in this randomized study produced substantial cost minimization compared with the staff-delivered intervention providing the same content. Cost minimization was driven primarily by personnel time and, to a lesser extent, by facilities costs and family travel time. The CMA was accomplished with three critical conditions in place: (1) the two intervention delivery modalities (ie, online and staff) held intervention content constant; (2) families were randomized to the two parenting interventions; and (3) the online-delivered intervention was previously confirmed to be non-inferior to the staff-delivered intervention in significantly reducing the primary outcome, child disruptive behavior problems. Given those conditions, cost minimization for the online parenting intervention was unequivocal. CLINICALTRIAL ClinicalTrials.gov NCT02121431; https://clinicaltrials.gov/ct2/show/NCT02121431

An individual's capacity to self-regulate their cognitions, emotions and actions is an important life skill and emergent developmental competency for both children and parents. Individuals with better self-regulation achieve more positive life course outcomes and are less likely to develop significant mental health, social, and relationship problems. Parenting support programs that promote positive, nurturing parent-child relationships provide a unique multigenerational context to promote the self-regulatory capacity of both parents and children. Such programs provide a meaningful context and many opportunities for parents to enhance their self-regulation capacities, including skills such as goal setting, self-monitoring, self-evaluation, self-efficacy, personal agency, and thought and emotion regulation that, in turn, enable independent problem solving and responsive parenting. Parenting programs based on social learning theory, cognitive behavioral principles, and developmental theory typically include structured session activities and homework tasks that can be optimized to promote parental self-regulation. These include enhancing executive functions such as anticipating, planning ahead, following a plan, and problem solving, so that parents acquire greater cognitive flexibility, better impulse control, and are better able to generalize and apply learned parenting principles and skills beyond their immediate concerns to a broader range of child problems and challenging parenting and family situations. We illustrate how positive parenting principles and strategies can promote enhanced self-regulation, and discuss implications for research and practice.

Family-focused prevention programs have been shown to effectively reduce a range of negative behavioral health outcomes but have had limited reach. Three key barriers must be overcome to expand the reach of family-focused prevention programs and thereby achieve a significant public health impact. These barriers are (1) current social norms and perceptions of parenting programs; (2) concerns about the expertise and legitimacy of sponsoring organizations to offer parenting advice; and (3) a paucity of stable, sustainable funding mechanisms. Primary healthcare settings are well positioned to overcome these barriers. Recent changes within health care make primary care settings an increasingly favorable home for family-focused prevention and suggest possibilities for sustainable funding of family-focused prevention programs. This paper discusses the existing advantages of primary care settings and lays out a plan to move toward realizing the potential public health impact of family-focused prevention through widespread implementation in primary healthcare settings.

The aim of this study was to examine the feasibility (accessibility, engagement and impact) of adding social media and gaming features (e.g., social sharing with anonymity, badges to incentivize skills practice, an accredited facilitator for support) and access via smartphones to an evidenced-based parenting program, Triple P Online. The highly vulnerable population included 155 disadvantaged, high-risk parents (e.g., 76% had a family annual income of less than $15,000; 41% had been incarcerated; 38% were in drug/alcohol treatment; and 24% had had a child removed due to maltreatment). The ethnic groups most commonly identified were African American (24%) and Hispanic (66%). Respondents were primarily mothers (86%) from five community programs in Los Angeles. The study used a single group repeated measures design (pre, post, 6-month follow-up). Data collected included standardized self-report measures, post-intervention focus groups and interviews, website usage reports, and Google Analytics. Significant multivariate ANOVA time effects were found, demonstrating reductions in child behavioral problems, reduced lax/permissive and over-reactive parenting, and decreased parental stress. No effects were found for parental confidence, attributions, or depression and anxiety (which were in the normal range at baseline). Positive effects were maintained or improved at 6-month follow-up. The participants engaged in the online community and valued its flexibility, anonymity, and shared learning. This foundational implementation trial provides support for future rigorous evaluation of social media and gaming features as a medium for increasing parental engagement in evidence-based parenting programs online--a public health approach to protect and improve the development of vulnerable children.

Play tasks that use standardized procedures and materials are a practical way to assess parenting skills, child behaviors, and the ways in which parents and children interact. We describe a systematic process for developing the Parent–Child Play Task (PCPT) to assess mother–child interactions for a randomized controlled trial on a video-based parenting program. Participants are 307 mothers and their 3-through 6-year-old children who present oppositional and disruptive behavior challenges. The validity of the PCPT was investigated by testing (a) the extent to which the tasks elicit the specific parent and child behaviors of interest, (b) the consistency of individuals’ behavior across the play tasks, and (c) the concurrent associations of the PCPT observed child behaviors and mother reports of child behavior. The different tasks elicited the mother and child behaviors that they were designed to elicit. Behavior consistency across tasks for individual mothers and children was fair to good, with the exception of two task-specific behaviors. Mothers’ guidance (provision of instructions to foster a skill) during the teaching task and children’s interruptions while mother was busy during the questionnaire task were highly task specific. Modest associations were found between observed children’s noncompliance and inappropriate behaviors, and mother-reported conduct problems and oppositional behaviors. Implications for clinical and research assessments are discussed.

Primary care providers such as family doctors, pediatricians, and community child health nurses are a trusted first port of call for parents seeking advice on parenting issues, and routine well-child visits provide multiple opportunities for screening, support, and intervention. Pediatric practices and family-centered health settings are an ideal, nonstigmatized context for providing integrated care, including parenting support, as part of universal prevention and early intervention. This chapter describes how Triple P can be applied in brief interventions through the primary health care system to prevent and reduce social, emotional, and behavioral problems in children. Workforce development, clinic management support, and sustainable funding models are discussed as key implementation factors that require careful planning if there is to be widespread dissemination of evidence-based parenting support in pediatric primary care settings.

Mass media communication approaches have considerable potential for promoting positive parenting at a population level through their wide reach and powerful messaging. A media strategy can promote engagement in parenting programs, destigmatize parenting assistance, affect community norms, and directly impart parenting information to those who might not otherwise be reached. To reach parents with parenting messages, a broad range of media options can be utilized, including television, radio, audio and video streaming, social media, podcasts, and embedding parenting into news stories. Experimental studies of television, video, and radio programming have shown a strong capacity to engage parents and positive effects on parents’ parenting practices, children’s behavior, and family functioning. Important considerations include developing relationships with media outlets and knowing their requirements and interests, embedding the media strategy in a larger system of supports, and adapting flexibly to new media platforms and formats to stay current in a changing media environment.

Family-focused prevention programs have been shown to effectively reduce a range of negative behavioral health outcomes but have had limited reach. Three key barriers must be overcome to expand the reach of family-focused prevention programs and thereby achieve a significant public health impact. These barriers are: (1) current social norms and perceptions of parenting programs; (2) concerns about the expertise and legitimacy of sponsoring organizations to offer parenting advice; and (3) a paucity of stable, sustainable funding mechanisms. Primary healthcare settings are well positioned to overcome these barriers. Recent changes within health care make primary care settings an increasingly favorable home for family-focused prevention and suggest possibilities for sustainable funding of family-focused prevention programs. This paper discusses the existing advantages of primary care settings and lays out a plan to move toward realizing the potential public health impact of family-focused prevention through widespread implementation in primary healthcare settings.

Concurrent and predictive relationships between peer harassment and problem behavior were examined for middle and high school students as well as gender differences in these relationships. Students recruited in fifth through seventh grades (n = 223) and their parents provided quarterly questionnaire data and were followed up into high school. As hypothesized, experiencing frequent peer harassment in middle school was associated with greater problem behavior concurrently and prospectively into high school. Students experiencing frequent harassment exhibited more aggressive and antisocial behavior and were more likely to associate with deviant peers and use cigarettes during middle school than those experiencing some or no harassment. In regression analyses, frequent verbal harassment predicted antisocial behavior, alcohol use, and deviant peer association in high school, and frequent physical harassment predicted later antisocial behavior, aggression, deviant peer association, and multiple problem behavior. Gender interactions were found for prediction of later aggressive and antisocial behavior.

A five-session behavioral intervention to reduce risky sexual behavior was evaluated in a randomized controlled trial, in which 339 adolescents, ages 15 to 19 years, were recruited in public sexually transmitted disease clinics and randomly assigned to receive the intervention or usual care. The intervention targeted (a) decision-making about safer sex goals, (b) social skills for achieving safer sex, and (c) acceptance of negative thoughts and feelings. Compared to the control group at 6-months follow-up, treatment participants reported fewer sexual partners, fewer nonmonogamous partners, and fewer sexual contacts with strangers in the past 3 months, and less use of marijuana before or during sex. Treated adolescents also performed better on a taped situations test of skill in handling difficult sexual situations. Strongest intervention effects were for male and nonminority youth. Further research is needed to develop interventions with strong, durable effects across gender and ethnic groups that can be delivered cost-effectively within existing service systems.

The developmental model of adolescent antisocial behavior advanced by Patterson and colleagues (e.g., Patterson, Reid, & Dishion, 1992) appears to generalize the development of a diverse set of problem behaviors. Structural equation modeling methods were applied to 18-month longitudinal data from 523 adolescents. The problem behavior construct included substance use, antisocial behavior, academic failure, and risky sexual behavior. Families with high levels of conflict were less likely to have high levels of parent–child involvement. Such family conditions resulted in less adequate parental monitoring of adolescent behavior, making associations with deviant peers more likely. Poor parental monitoring and associations with deviant peers were strong predictors of engagement in problem behavior. These constructs accounted for 46% of the variance in problem behavior. Although association with deviant peers was the most proximal social influence on problem behavior, parental monitoring and family factors (conflict and involvement) were key parenting practices that influenced this developmental process.

This study provides evidence of the effectiveness of behaviorally based parenting skills classes provided by carefully trained and supervised group leaders who were not mental health clinicians. A program for parents of at-risk middle school students was evaluated in a randomized controlled trial in 8 small Oregon communities. Parents (N = 303) were randomly assigned to immediate treatment or a wait-list condition. Data were analyzed using latent growth modeling. Participation in the program led to significant improvements in problem-solving interactions as indicated by parent reports and a Taped Situations Test. Parents' over-reactivity and laxness toward their children's behavior were reduced and their feelings toward their children improved significantly as a function of treatment. Parent-reported child antisocial behavior was also reduced.

The stability and validity of early adolescents' reports of 6 parenting constructs were examined: parent-child conflict, positive family relations, parental monitoring, parents' rule making, consistent enforcement of rules, and use of positive reinforcement. Hierarchical confirmatory factor analysis (CFA; H. W. Marsh & D. Hocevar, 1988) on questionnaire data from 3 quarterly assessments of 174 5th-7th grade youth was used to test a multitrait-multimethod (MTMM) model containing 6 parenting constructs as trait factors and 3 assessment occasions as method factors. Youths' reports of these parenting constructs were stable over time, and the CFA approach to MTMM data demonstrated convergent and discriminant validity of the constructs. Each parenting construct was significantly correlated with youths' reports of deviant peer associations, antisocial behavior, and substance use, providing evidence of criterion validity.

The goal of a public health approach to improving parenting is to increase the prevalence of effective parenting practices in a population. Achieving this goal requires that a large proportion of the population be reached with a spectrum of effective parenting supports, widely accessible in the community, and delivered in a variety of formats, through a variety of settings, and at different levels of intensity. Similarly, measuring the effectiveness of such a public health approach to improving parenting requires a spectrum of measurement tools at multiple levels so that child and family outcomes can be assessed at multiple levels of intervention. The levels of measurement include: (1) micro-focused observational measures, (2) easy-to-administer parent survey measures, (3) population-level prevalence indicators, and (4) program implementation measures. This chapter discusses these four levels of measurement, providing examples of each and exploring the contribution that each makes to a public health strategy.

11 focus groups (N = 160) of high-risk parents in Los Angeles County were asked to assess the value of social media to deliver an evidence-based parenting program, Triple P-Positive Parenting Program, to reduce child maltreatment. For feasibility, (N = 238) parents were surveyed regarding their internet use. Parents responded enthusiastically to the online program, and expressed the importance of a sense of community and learning through the experiences of others. 78% of the young, high-poverty, minority parents used the internet. An online evidence-based parenting program delivered in social media could enhance accessibility and engagement of high-risk parents - a powerful tool to reduce child maltreatment.

Sexual coercion and its relationship to high-risk sexual behavior were examined in five samples of young women. Sample 1 (N = 22) consisted of sexually active adolescents aged 15 to 19. Samples 2 (N = 206) and 3 (N = 70) were recruited from among patients at three sexually transmitted disease clinics. Sample 4 (N = 51) consisted of young homeless women living on the street in a large city. Sample 5 (N = 51) was recruited from among young women on a college campus. Across all samples, 44.4% of women indicated that they had been forced into some form of sexual activity against their will. Self-reports of sexually coercive experiences were consistently related to risky sexual behavior. It appears that many young women are coerced into engaging in high-risk sexual behavior. This implies the need for greater attention to male coercive sexual behavior and women's skills for coping with such behavior.

This study supports a model of adolescents' risky sexual behavior in which this behavior is seen as a product of the same peer and family factors which influence a wide range of problem behaviors. The Patterson et al. (1992) model of peer and parental factors associated with adolescents' sexual risk-taking behavior was tested on three independent samples of adolescents, ages 14 through 18. Adolescents whose peers were reported to engage in diverse problem behaviors were more likely to engage in risky sexual behavior. Poor parental monitoring and parent-child coercive interactions were associated having deviant peers, and poor parental monitoring also had a direct relationship to risky sexual behavior. Family involvement was associated with fewer parent-child coercive interactions. Less availability of parental figures in the family was directly associated with risky sexual behavior and was also associated with poorer parental monitoring.

Within a public health approach to improving parenting, the mass media offer a potentially more efficient and affordable format for directly reaching a large number of parents with evidence-based parenting information than do traditional approaches to parenting interventions that require delivery by a practitioner. Little is known, however, about factors associated with parents’ interest in and willingness to watch video messages about parenting. Knowledge of consumer preferences could inform the effective design of media interventions to maximize parental engagement in the parenting messages. This study examined parents’ preferred formats for receiving parenting information, as well as family sociodemographic and child behavior factors that predict parents’ ratings of acceptability of a media-based parenting intervention. An ethnically diverse sample of 162 parents of children ages 3–6 years reported their preferences for various delivery formats for parenting information and provided feedback on a prototype episode of a video-format parenting program based on the Triple P Positive Parenting Program. Parents reported the strongest preference for self-administered delivery formats such as television, online programs, and written materials; the least preferred formats were home visits, therapists, and multiweek parenting groups. Parents’ ratings of engagement, watchability, and realism of the prototype parenting episode were quite strong. Parents whose children exhibited clinical levels of problem behaviors rated the episode as more watchable, engaging, and realistic. Mothers also rated the episodes as more engaging and realistic than did fathers. Lower income marginally predicted higher watchability ratings. Minority status and expectations of future problems did not predict acceptability ratings. The results suggest that the episode had broad appeal across groups.

The potential spread of HIV infection into the adolescent population underscores the need for valid measures of high-risk sexual behavior in adolescents. This article reports on the development and construct validation of two measures of high-risk sexual behavior for heterosexual adolescents. Based on evidence that diverse problem behaviors are interrelated in adolescents, it was hypothesized that specific risky sexual behaviors, such as nonuse of condoms and multiple partners, would be interrelated, and that the cluster of high-risk sexual behaviors would be correlated with measures of other adolescent problem behaviors. The interrelationships among specific sexual behaviors were consistent across three independent samples, and the composite sexual behavior measures were correlated with measures of other problem behaviors. The results provide support for the validity of a construct of high-risk sexual behavior and point to the need for interventions that target diverse risky sexual behaviors.

Relationships among risky sexual behaviors, other problem behaviors, and the family and peer context were examined for two samples of adolescents. Many adolescents reported behaviors (e.g., promiscuity or nonuse of condoms) which risked HIV or other sexually transmitted disease infection. Such risky behaviors were significantly intercorrelated. Consistent condom use was rare among those whose behavior otherwise entailed the greatest risk of infection. In both samples, an index of high-risk sexual behavior was significantly related to antisocial behavior, cigarette smoking, and illicit drug or alcohol use. Social context variables, including family structure, parenting practices, and friends' engagement in problem behaviors, were associated with high-risk sexual behavior. Finally, for sexually active adolescents, problem behaviors and social context variables were predictive of nonuse of condoms. Results were consistent across the two studies and regression weights held up well under cross-validation.

This paper makes a case for research on community interventions on child rearing. Sufficient evidence has accumulated about the development of children’s problem behavior to justify evaluating efforts to reduce the prevalence of these problems in whole communities. The contextual risk factors for diverse child behavior problems are well understood, and interventions to ameliorate individual risk factors have been developed and evaluated. Because interventions with individual children have proven to be efficacious, it is now appropriate to direct energy toward reducing the prevalence of children with behavior problems. At the same time, existing interventions have limitations. Community interventions may be needed to modify the larger social context for families. This paper enumerates possible components of a community intervention to improve child-rearing outcomes. Existing evidence indicates that communities would benefit from making parent training and family support programs available to parents. Validated methods of identifying and remediating academic and behavioral problems in schools are available, but influencing schools to adopt them remains a problem. Community organizing could mobilize communities to allocate the resources necessary to support such parenting and schooling programs as well as encourage their adoption. Media campaigns could foster community support and directly influence parenting practices. Efforts to modify peer influences to use illicit substances have received empirical support; similar efforts may be relevant to preventing other problems. The development of a science of community interventions on child rearing is hampered by overreliance on randomized control trials. For this reason, two examples of time-series experimental evaluations of community intervention components are described here.