Search Results (298)

Caregiver self-regulation may be a critical component of caregivers’ effective delivery of caregiver-mediated interventions (CMIs). CMIs are a highly evidence-based group of interventions that target a broad range of challenges, including social communication, emotion regulation, and externalizing behaviors, for autistic and neurotypical children. CMIs teach caregivers to be “coaches” to help their children learn and practice skills in daily life. However, being a good “coach” likely requires caregivers to optimally self-regulate their emotions, thoughts, and behaviors when working with their children in moments that are often emotionally heightened. Caregiver self-regulation is a set of skills that promote parenting autonomy and confidence: self-sufficiency, self-efficacy, self-management, personal agency, and problem solving. This conceptual paper will briefly discuss the literature on the role of caregiver self-regulation in CMIs and argue that future implementation research on CMIs should measure caregiver self-regulation because, in line with recent expansion of the theory of planned behavior, caregiver self-regulation may predict more effective implementation of CMIs. We also argue, in line with CFIR 2.0, that supporting caregiver self-regulation could ultimately improve the implementation of CMIs with regard to each implementation outcome in the Implementation Outcomes Framework. For example, enhancing caregiver self-regulation may improve CMI appropriateness (by increasing alignment with each caregiver’s values and culture), adoption (by increasing engagement to finish the full CMI protocol), and even CMI sustainability (by increasing caregivers’ ability to problem-solve and generalize to new child challenges independently, freeing up provider time to work with new caregivers and allowing the agency to provide the CMI for a reduced relative cost). Should future research demonstrate that caregiver self-regulation is an implementation determinant, future implementation strategies may need to include support for caregiver self-regulation, because it may explain or enhance the implementation of CMIs across early intervention and community mental health systems. Full article

Families in rural communities face a constellation of challenges that significantly hinder their ability to support adolescents. Our study aimed to explore family functioning as a protective factor for adolescent mental health from the perspective of parents in rural communities of southern Ecuador, using Photovoice as a participatory research tool. The research design corresponds to Participatory Action Research. Five Focus Group Discussions (FGDs) were conducted. A total of 29 parents of adolescents participated in the study. The research team employed qualitative content analysis for the interpretation phase. Through photographs and focus groups, parents commented on aspects of family life that they perceived as necessary for supporting adolescents, such as effective communication, cohesion, supervision, and expressions of care. The main conclusion indicated that the implementation of Photovoice converted participants from subjects to collaborators, allowing them to critically reflect on their behaviors while aiding or reinforcing in the co-creation of strategies. Full article

Background/Objectives: School-based universal mental health interventions offer an inclusive and scalable approach to promote mental health and well-being among children. This study evaluates the Let’s Learn About Emotions (Opitaan tunteista in Finnish) program, an evidence-based, teacher-led universal school-based intervention originally developed in Japan and culturally adapted for Finnish primary schools. Methods: A total of 512 fourth-grade students from 14 schools participated in the 12-week program during spring 2023. Using a mixed-methods design, we assessed (1) the program’s acceptability among students, parents, teachers, and school principals, (2) fidelity of implementation, and (3) changes in students’ mental well-being pre- to post-intervention. Quantitative data included standardized questionnaires with valid responses collected from 233 students at baseline and 209 students at post-intervention, as well as parents and teachers. Qualitative data were collected through focus group discussions involving parents, teachers, and school principals during spring 2024. Results: Acceptability was high across all respondent groups. Teachers adhered closely to the teaching manual, as confirmed by self-reports and direct classroom observations. Statistically significant improvements were observed in parent-reported conduct problems, hyperactivity, and peer problems, though student self-reports did not show similar benefits. Conclusions: The program was found to be both acceptable and culturally appropriate in the Finnish context. Findings from this study provide valuable insights for refining and improving the program for future implementation. To more rigorously examine its effectiveness, future studies should employ a randomized controlled trial design. Full article

Background/Objectives: As an independent research group, we examined parent and child outcomes of three different parenting programs delivered at scale. The programs were implemented in Bhutan, Serbia and Zambia by different organizations. Methods: Mixed methods included a caregiver interview using the HOME Inventory, a direct child assessment using the Global Scales of Early Development (GSED) and focus group discussions with caregivers (FGD). Sampled mothers and children were randomly selected for the HOME/GSED: Bhutan n = 432, Serbia n = 636, Zambia n = 1024. Over 40 mothers and fathers of children under 3 years were purposively selected for FGD. Intention-to-treat and secondary regression analyses of attendees and non-attendees were conducted on the HOME and GSED; FGDs were subject to content analysis. Results: Parenting practices were found to be minimally (Bhutan) or modestly (Zambia) higher for caregivers who attended group sessions. Caregivers in Serbia who recalled receiving play messages had higher HOME scores. Child outcomes showed small (Bhutan) or no differences (Serbia, Zambia) associated with participation. Conclusions: Explanations focused on limits to program participation in scaled programs, the need for pilot evaluations to ensure that the program design is effective, and the need to monitor delivery quality and other implementation processes. Full article

Adverse childhood experiences (ACEs) are associated with profound long-term health and developmental consequences. However, current identification strategies are largely reactive, often missing opportunities for early intervention. Therefore, the potential of machine learning to proactively identify children at risk of ACE exposure needs to be explored. Using nationally representative data from 63,239 children in the 2018–2020 National Survey of Children’s Health (NSCH) after listwise deletion, we trained and validated multiple machine learning models to predict ACE exposure categorized as none, one, or two or more ACEs. Model performance was assessed using accuracy, precision, recall, F1 scores, and area under the curve (AUC) metrics with 5-fold cross-validation. The Random Forest model achieved the highest predictive accuracy (82%) and demonstrated strong performance across ACE categories. Key predictive features included child sex (female), food insufficiency, school absenteeism, quality of parent–child communication, and experiences of bullying. The model yielded high performance in identifying children with no ACEs (F1 = 0.89) and moderate performance for those with multiple ACEs (F1 = 0.64). However, performance for the single ACE category was notably lower (F1 = 0.55), indicating challenges in predicting this intermediate group. These findings suggest that family environment factors can be leveraged to predict ACE exposure with clinically meaningful accuracy, offering a foundation for proactive screening protocols. However, implementation must carefully address systematic selection bias, clinical utility limitations, and ethical considerations regarding predictive modeling of vulnerable children. Full article

Background/Objectives: The child and adolescent mental health service (CAMHS) hand-over to adult mental health service (AMHS) remains an ongoing shortfall in eating disorder (ED) treatment, typically in tandem with diagnostic drift, heightened suicide risk, and carer burn-out. We created one 14-to-25 Transition—ED track within our own unit, where a single multidisciplinary team continuously follows each patient and family across the CAMHS–AMHS boundary (via weekly joint paediatric and adult clinician meeting) without changing the individual psychotherapist, family therapist, or dietitian at the age 18 transition. We investigated the manner in which patients and parents perceive this model. Methods: A survey of two naturalistic parent cohorts—CAMHS (n = 16) and Transition—Adult arm (n = 15)—also joined, alongside the original group of young adults who had entered the programme during its set-up phase (n = 9). Here, the 14–25 pathway denotes one unified route of care across adolescence and young adulthood; the Transition—Adult arm is its ≥ 18-years component. All index patients had a primary DSM-5-TR diagnosis of restricting-type anorexia nervosa. Participants completed the Client Satisfaction Questionnaire-8 (CSQ-8; range 8–32) and four bespoke Continuity-of-Care items (1–4 Likert). Results: Overall, the caregivers in both cohorts were pleased (median CSQ-8 = 28.5 [CAMHS] vs. 27.0 [Transition]; p = 0.75). Continuity items were universally well rated across cohorts. Cohort parents reported a median of two unchanged core clinicians (i.e., the individual psychotherapist, the family therapist, or the dietitian), which was nonsignificantly positively correlated with CSQ-8 scores (ρ = 0.22). Early-group patients mirrored caregiver impressions (mean CSQ-8 = 27.0 ± 3.9). Conclusions: It is feasible and highly acceptable to both caregivers and anorexia nervosa young adults to have the same key staff and family-centred sessions over the 14-to-25 age span. Constrained by single-site study and small sample size, these preliminary data provide a rationale for wider implementation and controlled follow-up studies. Full article

Caregiver coaching is an essential component of caregiver-mediated interventions for young autistic children. Previous research evaluating usual practice in early intervention (EI) has found that EI providers often do not use caregiver coaching. Increasing the use of caregiver coaching strategies is critical to improving the outcomes of EI. We used a community-partnered process to develop a toolkit of implementation strategies to improve the use of caregiver coaching in EI. This study presents findings from a preliminary evaluation of the toolkit using a non-concurrent multiple-baseline design across groups of providers and caregiver–child dyads. The results indicate that providers’ caregiver coaching fidelity improved following the introduction of the toolkit. Caregivers demonstrated moderate growth in their use of supportive parenting techniques. All providers rated the toolkit as acceptable, appropriate, and feasible. The findings suggest that a toolkit of implementation strategies tailored to support the needs of community-based providers shows promise for improving caregiver coaching in EI. Full article

Background: Respiratory syncytial virus (RSV) bronchiolitis remains a leading cause of hospitalization in infants, particularly those with risk factors such as prematurity or chronic diseases. Nirsevimab, a long-acting monoclonal antibody, has recently been approved for RSV prevention. However, parental acceptance of this novel immunoprophylaxis is crucial for effective implementation. The aim of this study was to investigate parental acceptance of nirsevimab prophylaxis for RSV among eligible neonates in Emilia-Romagna, Italy, and to identify factors influencing decision making. Methods: A prospective, multicenter observational study enrolled 1042 parents of neonates eligible for nirsevimab prophylaxis according to regional criteria. Parents completed a semi-structured questionnaire during pre-immunization counseling, exploring knowledge, attitudes, perceived risks, information sources, and willingness to accept prophylaxis. Statistical analysis assessed associations between parental characteristics and acceptance rates. Results: Among the 1042 respondents, 87.0% (n = 907) expressed willingness to administer nirsevimab to their child, while 2.2% (n = 23) refused and 8.8% (n = 92) were undecided. Higher acceptance was significantly associated with awareness of RSV risks (72.1% vs. 41.7%, p < 0.01), belief in nirsevimab’s high efficacy (46.2% vs. 18.3%, p < 0.01), and lower concern over side effects (10.6% vs. 27.8%, p < 0.01). Trust in primary care pediatricians and the healthcare system was also notably higher among accepting parents (p < 0.001). Willingness to pay declined with a hypothetical EUR 250 cost but remained higher among the acceptance group (71.0% vs. 50.4%, p < 0.001). Conclusions: Parental acceptance of nirsevimab in Emilia-Romagna was high, though significant gaps in knowledge and concerns about safety persist. Targeted educational strategies that clarify the nature, efficacy, and safety of nirsevimab—alongside maintaining cost-free access—are essential to support the successful implementation of RSV prophylaxis programs. Full article

The recent reform of the preschool curriculum in Latvia signifies a paradigm shift with the objective of fostering holistic skill development. The success of this implementation is largely attributed to the pivotal role played by teacher perspectives. The present study investigates the views of pre-service early childhood teachers in Latvia on the transformation of the preschool mathematics education curriculum following the reform in 2019. A descriptive research design was employed, involving 54 focus group discussions with 271 part-time students from the University of Latvia and its regional branches. During the focus group discussions, participants analyzed and compared the changes in aims, content, assessment practices, and instructional strategies in mathematics education at the preschool level across mathematics curricula. The findings indicate an increasing appreciation for clarity in instruction, age-appropriate design, and the shift towards interactive, skills-based strategies. While prospective teachers generally support the aim of the reform, there are evident gaps in their understanding of formative assessment, integration of parental involvement, and promotion of higher-order thinking and real-life problem-solving. The study emphasizes the significance of enhancing teacher training, curriculum design, and educational policy to facilitate effective and meaningful implementation of the revised mathematics curriculum in preschool contexts. Full article

The family-centred Early Intervention model based on routines and natural environments has been widely supported by international evidence in recent decades. Within this framework, Family-Centred Practices (FCP) and their development in natural environments have emerged as an evidence-based intervention model of reference, promoting parental empowerment, shared decision-making, and functional intervention through daily routines. However, its effective implementation in real contexts presents multiple challenges, especially from the perspective of families receiving the service. Background/Objectives: This study explores the experiences, meanings, and assessments of Spanish families with children who have disabilities or developmental difficulties in relation to the application of these professional practices. This study is carried out in the Spanish context, since Campus Capacitas (Campus Capacitas—Catholic University of Valencia, Spain) has been implementing, in recent years, the family-centred model as a model of early intervention. Methods: A qualitative, descriptive, and interpretative methodology was used. Data collection was carried out through semi-structured interviews and discussion groups with 30 families from the 17 Spanish autonomous communities. Data analysis was carried out through thematic coding following criteria of qualitative rigour such as triangulation and theoretical saturation. Results: The findings show a significant gap between the theoretical model of family-centred practices and their practical application. Families who have experienced a clinical model criticise the absence of personalised intervention, unidirectional communication, as well as lack of participation in decision-making. In that sense, it is the different specialists of the early intervention team who are responsible for making intervention decisions. Therefore, these families demand more emotional and educational support. On the other hand, other families report positive experiences associated with collaborative, transdisciplinary, and home-based models based on a family-centred model. Conclusions: The results highlight the urgent need to move towards early intervention that strengthens the active role of families, promotes professional co-responsibility, and adapts to real child development environments, in line with international recommendations. Regarding future lines of research, we are committed to the development of longitudinal studies on the sustainable effects of interventions centred on families and on the global development of children and families. To carry out comparative studies between autonomous communities, to assess the influence of regulatory factors and regional resources on the practices implemented, as well as to carry out triangulation studies of the professional practices implemented, incorporating the perspectives of professionals and other intervention agents to enrich the analysis. Full article

Background: Human papillomavirus (HPV) infection is the leading cause of cervical cancer, which presents a significant health burden in low- and middle-income settings such as Kosovo^†, where it is the second leading cause of death among women. HPV vaccines are highly effective and integral to global cervical cancer elimination efforts. In 2024, Kosovo^† introduced the HPV vaccine into its immunisation schedule via a school-based program targeting sixth-grade girls. Rapid, theory-based insights supported development of a tailored communication and intervention plan ahead of the introduction. Methods: Over a two-week period, qualitative research was conducted with 102 participants, including healthcare professionals, parents, girls in the target age group, school staff, and community influencers. Data collection, analysis, and intervention development were carried out using the Behaviour Change Wheel (BCW) model, underpinned by the Capability, Opportunity, and Motivation for Behaviour change (COM-B) theoretical framework. Results: Trust in school-based immunisation and healthcare professionals emerged as key drivers, while a predominance of capability- and physical-opportunity-related barriers across target groups underscored the need for targeted communication and capacity-building efforts for all stakeholders. Using the BCW model, communication and intervention activities were developed for implementation by partners. Conclusions: Using rapid insight research grounded in the BCW model enabled the timely identification of behavioural drivers and barriers to HPV vaccine acceptance and supported development of a targeted intervention plan. The findings echoed global research on HPV vaccine introduction, highlighting context-specific needs and enablers and contributing to a successful rollout marked by high uptake within the first six months. Full article

This paper examines the importance of ‘education outside the classroom’ (EOtC) in an Australian secondary school. The primary aim was to develop a sense of belonging, build resilience, and enhance wellbeing in female students. This study investigated two cohorts of Year 9 students (aged 14–15 yrs) who participated in a four-week residential EOtC pilot program. The first cohort (Wave 1; N = 58) undertook the program alongside (N = 39) boys. The second cohort was single-sex girls (Wave 2; N = 28). A mixed-methods research design was implemented to inform experiences of students, parents, and staff and to triangulate inferences drawn from the data. Quantitative data was gained from pre- and post-program surveys with students and parents, whilst qualitative data was gathered from student focus groups, staff, and parents through semi-structured interviews to assess more nuanced impacts. School belonging was measured using the PISA six-item scale. Academic buoyancy was quantified using the four-item Academic Buoyancy Scale. Self-efficacy, peer relations, and resilience were evaluated by employing the 34-item Adolescent Girls’ Resilience Scale. The findings revealed significant improvements in students’ sense of belonging, including higher levels of school belonging than reported Australia-wide averages for 15-year-olds. Despite students’ mean academic buoyancy scores being more than a point lower than reported baseline scores for Australian high school students, it was promising to see a modest increase following the EOtC program. In conclusion, EOtC is a potent vehicle for developing a sense of belonging, enhancing resilience, and equipping students to deal with academic challenges. Full article

Background/Objectives: Parenting stress, the emotional strain resulting from the demands of child-rearing, can profoundly affect both parental well-being and children’s emotional and behavioral development. This study examined the impact of maternal parenting stress during early childhood on the longitudinal progression of children’s internalizing, externalizing, and attention deficit hyperactivity disorder (ADHD) symptoms, from early childhood through adolescence. Methods: The study included 406 mother–child pairs from the Rhea mother–child cohort in Crete, Greece. Maternal parenting stress was assessed at age 4 using the Parental Stress Scale (PSS). Children’s symptoms were evaluated at ages 4 (Strengths and Difficulties Questionnaire, ADHD Test), 6, 11, and 15 years (Child Behavior Checklist, Conners’ Parent Rating Scale) through maternal reports. Multivariate mixed regression models, incorporating a random intercept for each child and a random slope for age at follow-up, were used to analyze the trajectories of symptoms from ages 4 to 15. Group-based trajectory modeling was applied to identify trajectory groups from 4 to 15 years, and multinomial logistic regression models were implemented to examine the associations between parental stress and group trajectories. Results: The results revealed that higher parental stress at age 4 was significantly associated with increased internalizing (b = 0.94, 95% CI: 0.68, 1.21), externalizing (b = 1.03, 95% CI: 0.75, 1.30), and ADHD symptoms (b = 0.86, 95% CI: 0.58, 1.14) over the study period. Notably, the impact of parenting stress on behavioral problems decreased with age (interaction with age, p = 0.032). Additionally, higher parenting stress at age 4 was linked to a greater likelihood of belonging to adverse symptom trajectories, including high decreasing, low increasing, and stable high trajectories for both internalizing and externalizing problems. Conclusions: These findings underscore the importance of early maternal parenting stress as a predictor of long-term emotional and behavioral difficulties in children, emphasizing the need for early intervention programs that support maternal mental health and children’s emotional development. Full article

Background/Objectives: Infants admitted to neonatal intensive care units (NICUs) face challenges in achieving successful oral feedings. During oral feedings, these infants commonly present with suck–swallow–breathe incoordination, with approximately 30% developing dysphagia, leading to feeding aversion, prolonged hospitalization, and increased parental stress. Cold liquid feeding has demonstrated benefits in improving feeding safety in adults with dysphagia; however, its application in neonates is relatively limited. This study aimed to examine global neonatal feeding practices, with a specific emphasis on cold milk feeding as an intervention for dysphagia. Methods: A cross-sectional global electronic survey was distributed via professional society listservs and closed online professional group forums targeting neonatal providers and feeding therapists from June 2023 to June 2024. The survey assessed institutional feeding protocols, oral feeding practices, and the use of cold milk for infants with dysphagia. Responses were analyzed descriptively. Results: A total of 210 complete responses were received from level IV (51%), level III (42%), and level II (5%) NICUs. While 30% of the respondents were aware of cold milk feeding as a dysphagia intervention, only 15% of the total respondents reported using it in practice. Among the 32 institutions implementing cold milk practices, only one had an established protocol. Additionally, 72% reported having a feeding protocol in place, often incorporating cue-based tools. Most respondents (87.5%) did not allow oral feeding during nasal continuous positive airway pressure (nCPAP), whereas 78% permitted it during high-flow nasal cannula (HFNC) support. Conclusions: Although the awareness of cold milk feeding in neonates is increasing, its implementation remains limited and lacks standardization. Significant variability exists in oral feeding practices, particularly regarding feeding during respiratory support. This underscores the need for further research and evidence-based guidelines to ensure safe and consistent care for preterm infants. Full article

To develop interventions and policies to promote healthy and sustainable diets during times of crisis, it is important to understand how populations respond to such situations based on real-life examples. Using the recent COVID-19 pandemic as a case study to identify risk and protective factors for such situations, we implemented the first longitudinal mixed-methods approach of this topic to date. Data were collected from a sample of UK parents (stratified for gender and socioeconomic status) through two surveys and a set of focus groups during the pandemic. The focus groups identified multifaceted drivers of change linked to capability (e.g., shielding), opportunity (e.g., time, food access and availability), and motivation (e.g., reflective motivation, stress and mental health challenges) barriers. High levels of COVID-19 stress were linked with less healthy and sustainable diets in the survey results, while higher social cohesion, reflective motivation to consume healthy foods, and positive coping scores were protective, and linked to healthier and more sustainable diets. A range of coping strategies were identified, including home cooking and meal planning, which could provide a basis for future intervention development to reduce stress, maintain wellbeing, and improve dietary outcomes in future crisis situations. Full article