Deborah Gross

Parent Training of Toddlers in Day Care in Low-Income Urban Communities

The authors tested a 12-week parent training program with parents (n = 208) and teachers (n = 77) of 2-3-year-olds in day care centers serving low-income families of color in Chicago. Eleven centers were randomly assigned to 1 of 4 conditions: (a) parent and teacher training (PT + TT), (b) parent training (PT), (c) teacher training (TT), and (d) waiting list control (C). After controlling for parent stress, PT and PT + TT parents reported higher self-efficacy and less coercive discipline and were observed to have more positive behaviors than C and TT parents. Among toddlers in high-risk behavior problem groups, toddlers in the experimental conditions showed greater improvement than controls. Most effects were retained 1 year later. Benefits were greatest when parents directly received training.

Implementation fidelity in community-based interventions

Implementation fidelity is the degree to which an intervention is delivered as intended and is critical to successful translation of evidence-based interventions into practice. Diminished fidelity may be why interventions that work well in highly controlled trials may fail to yield the same outcomes when applied in real life contexts. The purpose of this paper is to define implementation fidelity and describe its importance for the larger science of implementation, discuss data collection methods and current efforts in measuring implementation fidelity in community-based prevention interventions, and present future research directions for measuring implementation fidelity that will advance implementation science.

The long-term efficacy of a behavioral parent training intervention for families with 2-year-olds.

The effectiveness of a behavioral parent training (BPT) intervention for improving maternal self-efficacy, maternal stress, and the quality of mother-toddler interactions has been demonstrated (Gross, Fogg, & Tucker, 1995). The 1-year follow-up of the 46 parents of toddlers (assigned to an intervention or comparison group) who participated in that study is reported. It was hypothesized that (a) BPT would lead to enduring positive changes in parenting self-efficacy, parenting stress, and parent-toddler interactions; and (b) the amount of parent participation in the intervention would be correlated with greater gains in parent-child outcomes at 1 year. All the families were retained and significant gains in maternal self-efficacy, maternal stress, and mother-child interactions were maintained. Minimal BPT effects were found for fathers. BPT dosage was related to reductions in mother critical statements and negative physical behaviors at 1-year postintervention. The findings are consistent with self-efficacy theory and support parenting self-efficacy as a target for BPT in families of young children.

The equivalence of the Child Behavior Checklist/11/2-5 across parent race/ethnicity, income level, and language

This study examined the equivalence of the Child Behavior Checklist/1 1/2-5 (CBCL/1 1/2-5) in 682 parents of 2- to 4-year-old children stratified by parent race/ethnicity (African American, Latino, and non-Latino White), family income (low vs. middle-upper), and language version (Spanish vs. English). Externalizing Scale means differed by income and child gender. Internalizing Scale means differed by income and parent race/ethnicity. Differential item analyses showed that few items functioned differently by racial/ethnic, language, and income group. A confirmatory factor analysis demonstrated that the Externalizing Scale provided a good fit with the data across racial/ethnic and income groups. However, model fit was improved for the Internalizing Scale when factor weights were allowed to vary. Findings support the equivalence of the CBCL/1 1/2-5 when used with parents of low-income preschool children from African American and Latino backgrounds, although further study of the factor structure for the Internalizing Scale is recommended.

Antipsychotic Medication Prescribing Trends in Children and Adolescents

The Food and Drug Administration has approved the use of antipsychotic medications in some children and adolescents with severe emotional and behavioral disorders. However, recent national data show a dramatic rise in off-label and Food and Drug Administration-approved uses of these medications. Of particular note is a twofold to fivefold increase in the use of antipsychotic medications in preschool children, despite little information on their long-term effects. This article describes the trend in pediatric antipsychotic medication use, possible explanations for the increase, implications for childrens health, and recommendations for pediatric providers who work with parents of children and adolescents who seek or receive antipsychotic medication treatments.

Maternal confidence in toddlerhood: Its measurement for clinical practice and research

There are currently no measures of maternal confidence specifically for the developmental issues that arise in children between 12 months and 36 months of age. Yet, maternal confidence has been correlated with indices of maternal and child competence. The purpose of this study was to assess the reliability and validity of the Toddler Care Questionnaire (TCQ), a measure of maternal confidence in toddlerhood, for use in clinical and research settings. The data provide strong evidence that the TCQ is a reliable instrument and has validity among middle-class mothers of toddlers. The data are discussed in terms of their clinical significance and directions for future research.

A critical analysis of the intent-to-treat principle in prevention research

Nonadherence to experimental protocols in randomized clinical trials (RCT) is a ubiquitous problem that can lead to erroneous estimations of treatment effects. The most widely advocated strategy for addressing the problem of nonadherence is based on the principle of intent-to-treat (ITT) in which all participants are analyzed according to their randomized condition regardless of actual adherence to the assigned protocol. However, there are numerous problems with using the ITT principle, all of which can be magnified in prevention RCTs. We describe the rationale underlying the use of the ITT principle and the potential problems it can create when interpreting results from prevention RCTs. Four alternative solutions for analyzing nonadherence to experimental protocols that would advance the science and practice of prevention are described. Editors’ Strategic Implications: This paper details a strategy that shows promise. This paper speaks to all research methods when treatment and comparisons are involved. The authors’ recommendations for analyzing nonadherence to protocols—in both experimental and control conditions—are sound; if followed, they would improve research practice and push the knowledge base forward about how to ensure translation from research to practice. The authors’ lessons may be just as relevant to researchers in applied settings as they are to those conducting clinical trials.

Threats to validity in randomized clinical trials

The purposes of this article are to present an overview of randomized clinical trials (RCTs) and describe some of the methodological problems inherent in using RCTs in nursing research. Many nursing intervention studies are fraught with problems that defy the stringent control criteria required for RCTs, leading to biased estimates of intervention efficacy. Five threats to validity in RCTs are presented, including problems related to (a) differential dropout, (b) random assignment, (c) identifying and maintaining an adequate control condition, (d) nonadherence to research protocols, and (e) assessment of clinically meaningful change. Three strategies are recommended for addressing some of the problems posed by RCTs and improving inference.

The Chicago Parent Program: Comparing 1-Year Outcomes for African American and Latino Parents of Young Children

Data were merged from two prevention randomized trials testing 1-year outcomes of a parenting skills program, the Chicago Parent Program (CPP) and comparing its effects for African-American (n = 291) versus Latino (n = 213) parents and their preschool children. Compared to controls, intervention parents had improved self-efficacy, used less corporal punishment and more consistent discipline, and demonstrated more positive parenting. Intervention children had greater reductions in behavior problems based on parent-report, teacher-report, and observation. Although improvements from the CPP were evident for parents in both racial/ethnic groups, Latino parents reported greater improvements in their childrens behavior and in parenting self-efficacy but exhibited greater decreases in praise. Findings support the efficacy of the CPP for African American and Latino parents and young children from low-income urban communities.

Intervention research in highly unstable environments

This article highlights issues and presents strategies for conducting intervention research in highly unstable environments such as schools, critical care units, and long-term care facilities. The authors draw on their own experiences to discuss the challenges that may be encountered in highly unstable settings. The concept of validity provides a framework for understanding the value of addressing the many methodological issues that can emerge in settings characterized by instability. We explain unstable environments by elaborating on knowable elements that contribute to instability. Strategies are provided for improving success of intervention research in unstable settings by carrying out an environmental assessment prior to beginning a study.