Randomized trial of Promoting First Relationships: Effects on maltreated toddlers' separation distress and sleep regulation after reunification

Oxford, Monica L.; Fleming, Charles B.; Nelson, Elizabeth M.; Kelly, Janice R.; Spieker, Susan J.

doi:10.1016/j.childyouth.2013.09.021

Cited by 26 publications

(15 citation statements)

References 23 publications

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“…For those birth parents who were enrolled in the study and randomized to PFR, many factors not addressed by PFR, such as substance abuse, mental illness, homelessness, and domestic violence, would affect their ability to achieve permanency with their children. These risk factors likely overwhelmed the moderate impacts on parenting outcomes we did find for birth families through six months post-intervention (Oxford, Fleming, Nelson, Kelly, & Spieker, 2013). For example, despite the small size of the birth parent sample available for follow up (43 out of 56) the effect sizes for a measure of child externalizing problems trended toward significance, and an observed measure of parenting support was significant, controlling for baseline score, child age, time since baseline, and whether or not there had been more than one removal from the birth home prior to enrollment.…”

Section: Discussionmentioning

confidence: 98%

Permanency outcomes for toddlers in child welfare two years after a randomized trial of a parenting intervention

Spieker

Oxford

Fleming

2014

Children and Youth Services Review

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This study reports on child welfare outcomes of a community based, randomized control trial of Promoting First Relationships® (PFR; Kelly, Sandoval, Zuckerman, & Buehlman, 2008), a 10-week relationship-based home visiting program, on stability of children’s placements and permanency status two years after enrollment into the study. Toddlers 10 – 24 months (N = 210) with a recent placement disruption were randomized, along with their birth or foster/kin parents, to PFR (n = 105) or a comparison condition (n = 105). A stable placement had no interruptions or disruptions. A permanent placement was a stable placement ending with a legal discharge to the study caregiver. Logistic regression models predicting the dichotomous stability and permanency variables, controlling for caregiver type, child welfare variables, and caregiver commitment, were conducted. There was no difference by intervention group on stability or permanency, but there was a significant interaction between caregiver type (birth parent vs. foster/kin) and intervention group. More foster/kin caregivers who received the PFR intervention provided stable, uninterrupted care and eventually adopted or became the legal guardians of the toddlers in their care, compared to foster/kin caregivers randomized to the comparison condition.

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Section: Discussionmentioning

confidence: 98%

Permanency outcomes for toddlers in child welfare two years after a randomized trial of a parenting intervention

Spieker

Oxford

Fleming

2014

Children and Youth Services Review

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“…130,781,782 It has also been associated with a disturbed hypothalamic-pituitary-adrenal axis, which is important for self-regulation and stress management. 124 Disorganised attachment styles develop when children are emotionally and physically depending on someone who is also a source of fear and anxiety.…”

Section: Attachment-orientated Interventionsmentioning

confidence: 99%

The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: an evidence synthesis

Macdonald

Livingstone

Hanratty

et al. 2016

Health Technol Assess

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BackgroundChild maltreatment is a substantial social problem that affects large numbers of children and young people in the UK, resulting in a range of significant short- and long-term psychosocial problems.ObjectivesTo synthesise evidence of the effectiveness, cost-effectiveness and acceptability of interventions addressing the adverse consequences of child maltreatment.Study designFor effectiveness, we included any controlled study. Other study designs were considered for economic decision modelling. For acceptability, we included any study that asked participants for their views.ParticipantsChildren and young people up to 24 years 11 months, who had experienced maltreatment before the age of 17 years 11 months.InterventionsAny psychosocial intervention provided in any setting aiming to address the consequences of maltreatment.Main outcome measuresPsychological distress [particularly post-traumatic stress disorder (PTSD), depression and anxiety, and self-harm], behaviour, social functioning, quality of life and acceptability.MethodsYoung Persons and Professional Advisory Groups guided the project, which was conducted in accordance with Cochrane Collaboration and NHS Centre for Reviews and Dissemination guidance. Departures from the published protocol were recorded and explained. Meta-analyses and cost-effectiveness analyses of available data were undertaken where possible.ResultsWe identified 198 effectiveness studies (including 62 randomised trials); six economic evaluations (five using trial data and one decision-analytic model); and 73 studies investigating treatment acceptability. Pooled data on cognitive–behavioural therapy (CBT) for sexual abuse suggested post-treatment reductions in PTSD [standardised mean difference (SMD) –0.44 (95% CI –4.43 to –1.53)], depression [mean difference –2.83 (95% CI –4.53 to –1.13)] and anxiety [SMD –0.23 (95% CI –0.03 to –0.42)]. No differences were observed for post-treatment sexualised behaviour, externalising behaviour, behaviour management skills of parents, or parental support to the child. Findings from attachment-focused interventions suggested improvements in secure attachment [odds ratio 0.14 (95% CI 0.03 to 0.70)] and reductions in disorganised behaviour [SMD 0.23 (95% CI 0.13 to 0.42)], but no differences in avoidant attachment or externalising behaviour. Few studies addressed the role of caregivers, or the impact of the therapist–child relationship. Economic evaluations suffered methodological limitations and provided conflicting results. As a result, decision-analytic modelling was not possible, but cost-effectiveness analysis using effectiveness data from meta-analyses was undertaken for the most promising intervention: CBT for sexual abuse. Analyses of the cost-effectiveness of CBT were limited by the lack of cost data beyond the cost of CBT itself.ConclusionsIt is not possible to draw firm conclusions about which interventions are effective for children with different maltreatment profiles, which are of no benefit or are harmful, and which factors encourage people to seek therapy, accept the offer of therapy and actively engage with therapy. Little is known about the cost-effectiveness of alternative interventions.LimitationsStudies were largely conducted outside the UK. The heterogeneity of outcomes and measures seriously impacted on the ability to conduct meta-analyses.Future workStudies are needed that assess the effectiveness of interventions within a UK context, which address the wider effects of maltreatment, as well as specific clinical outcomes.Study registrationThis study is registered as PROSPERO CRD42013003889.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…The concept that synchrony of both sleep-related and foundational parent-child interactions, in addition to the individual parent and infant characteristics, shape infant sleep patterns is an essential premise of the proposed theory. Researchers evaluating interventions designed to optimize overall parent-child interactions have also noted significant improvements in parental ratings of child sleep disturbances (Oxford, Fleming, Nelson, Kelly, & Spieker, 2013; Treyvaud, Rogers, Matthews, & Allen, 2009). Thus, it may be beneficial to use broader conceptualizations of parent-infant interactions in a nursing theory pertaining to infant sleep, particularly those that capture synchrony of the family microsystem.…”

Section: Proposed Theorymentioning

confidence: 99%

A Proposed Nursing Theory: Infant Sleep and Development

Keys

Benzies

2018

Nurs Sci Q

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Although well positioned to work with families of young children, nurses do not yet have a theory that guides practice and research by relating infant sleep to child and family development. The authors of this paper describe a proposed theory that combines Bronfenbrenner's bioecological theory of human development with the Barnard model of parent-child interaction to inform nursing practice and research related to infant sleep and optimizing child and family development. The theory focuses on sustainability of change in family processes and infant sleep, with a goal of optimizing family wellness as the proximal environment for child development.

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Randomized trial of Promoting First Relationships: Effects on maltreated toddlers' separation distress and sleep regulation after reunification

Cited by 26 publications

References 23 publications

Permanency outcomes for toddlers in child welfare two years after a randomized trial of a parenting intervention

Permanency outcomes for toddlers in child welfare two years after a randomized trial of a parenting intervention

The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: an evidence synthesis

A Proposed Nursing Theory: Infant Sleep and Development

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