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Panel information
Panel 16. Prevention and Interventions

Paper #1
Randomized Controlled Trial of the Community Navigation Universal Family Support Program: Preliminary Impact at Birth
Author information	Role
W. Benjamin Goodman, Ph.D., Center for Child and Family Policy, Duke University, United States	Presenting author
Kenneth A. Dodge, Sanford School of Public Policy, Duke University, United States	Non-presenting author
Helen M. Milojevich, Center for Child and Family Policy, Duke University, United States	Non-presenting author
Debra L. Best, Department of Pediatrics, Duke University, United States	Non-presenting author
Abstract
Background. Families with young children in the United States are in great peril. Maternal and infant mortality are among the highest in the developed world, over one-third of children experience a maltreatment investigation in their lifetime, and less than half of children are fully kindergarten ready at school entry. The MIECHV-approved Family Connects (FC) program was created as a universal postpartum home-visiting approach to promoting population rates of child and family well-being. Although results from multiple RCTs demonstrate FC improved postpartum mental health and reduced child maltreatment investigations, FC does not serve families prenatally and has not demonstrated positive impact on child behavioral outcomes. To improve population outcomes for pregnancy and for child behavioral development, Community Navigation (CN) was developed through piloting as a universal psychosocial system of primary care across early life. Trained navigators reach women during pregnancy, continue with FC at birth, and complete well-family visits at 12, 24, and 36 months of child age to provide support, assess family-specific needs for both parents and the child, deliver brief interventions, and connect families with community resources for ongoing needs. Objective. To evaluate preliminary implementation and impact of prenatal CN among a subsample of families participating in ongoing randomized controlled trial (RCT). Method. Participants included 376 families who have completed the prenatal phase of the trial, including a post-birth outcome evaluation survey. All participants were enrolled prenatally (prior to 28 weeks of gestation) and randomly assigned to receive either CN (treatment; n=185) or education materials (Control; n=191). CN participants completed a 1-2 hour guided conversation with a trained Navigator who assessed family-specific needs, delivered brief interventions, and connected families with community resources for ongoing support. Follow up contacts 4 weeks after the initial conversation and in the third trimester of pregnancy were completed to ensure families received needed services and to address new, emerging needs. All RCT families completed a two-hour survey post birth assessing CN impact on community service use and parent and child health and well-being. Results. Of the 185 families assigned to CN, 67% completed the prenatal guided conversation; 66% of those families completed at least one follow-up. 91% of completing families reported at least one need for support; 60% reported at least one significant need best addressed by a connection to a community resource. Post-birth impact evaluation results from intent-to-treat OLS regression models indicated that, relative to control group families, CN families reported significantly more connections to community resources (MI=4.35, MC=3.49, p<.05), fewer dysfunctional parent-infant interactions (MI=1.51, MC=1.66, p<.01), and greater satisfaction with their child’s healthcare (MI=9.41, MC=9.21, p<.05). Conclusion. The high rates of participation and need identification indicate CN can be implemented successfully in the prenatal period. Further, CN-eligibility predicted greater post-birth connections to community resources, higher quality parent-child relationships, and greater parent satisfaction with their child’s healthcare. Collectively, findings suggest CN holds promise as a backbone system of care support for families throughout early childhood.

Paper #2
Promoting Positive Parenting Through a Mobile app Intervention: A Pilot Test of Feasibility and Effectiveness
Author information	Role
Helen Milojevich, Center for Child and Family Policy, Duke University, United States	Presenting author
Kathryn Bigelow, The University of Kansas, United States	Non-presenting author
Sixia Chen, University of Oklahoma Health Sciences Center, United States	Non-presenting author
Andrew Peters, University of Oklahoma Health Sciences Center, United States	Non-presenting author
David Bard, University of Oklahoma Health Sciences Center, United States	Non-presenting author
Abstract
Background. Early adversity profoundly influences child development and long-term risk for mental and physical illness. Rates of adverse childhood experiences (ACEs) in the United States remain high, with 1 in 6 adults experiencing 4 or more ACEs. Importantly, despite widespread consequences of adversity, some individuals demonstrate resilience and experience healthy functioning. One robust predictor of resilience is parenting. As such, numerous efforts have been initiated to prevent early adversity by promoting positive parenting practices. One such effort is home visiting (HV), which provides one-on-one coaching to help parents learn safety, health, and parenting skills to promote child well-being and improve family functioning. Although HV improves parenting outcomes and reduces childhood adversity, these programs reach less than 4% of the population in need of such intervention. Furthermore, families participating in HV may benefit from additional support between home visits and after services have ended. To address these needs, service providers and researchers alike are increasingly turning to technology, including mobile apps, to deliver widespread, low-cost support. Objective. To develop and test the feasibility and effectiveness of a mobile app intervention designed to enhance HV and improve parenting skills by providing in-the-moment parenting tips to increase healthy parent-child interactions. Method. Participants included 24 parents receiving HV services with their child (ages 0-5 years). We conducted a 2-arm, randomized, controlled crossover trial and utilized ecological momentary assessments (EMA) to examine the impact of the app on positive parenting practices. Participants were counterbalanced to receive either 2 weeks of the app intervention (i.e., in-the-moment parenting tips) + EMA data collection followed by 2 weeks of only EMA data collection or to receive 2 weeks of only EMA data collection followed by 2 weeks of app intervention + EMA data collection. EMA surveys asked parents about their emotional state, current stressors, recent parent-child interactions, and their child’s emotions and behavior. Parents also completed a feedback survey on the feasibility and acceptability of the app. Results. Parents indicated strong endorsement of the app. Nearly 80% reported that the app helped them be more aware of their thoughts and behaviors, as well as helped them engage in more positive interactions with their child. Additionally, 65% indicated that they would highly recommend the app to a friend. Finally, over 45% were very interested in using the app in the future. EMA data suggested that app use did not lead to significant changes in parent-reported parenting behaviors (i.e., punitive, inconsistent, or positive parenting; ts(21) < .69, ps > .5); however, parents were significantly less emotionally reactive after receiving the parenting tips relative to at the start of the study, t(41) = 3.30, p < .01. Conclusions. The present study was a first step in creating and testing a positive parenting mobile app. Findings suggest that parents were receptive to the app and found merit in using it. However, parent surveys indicated the impact of the app on parenting was limited. We will discuss future directions, including efforts to improve the app and to implement it with other populations.

Paper #3
Attachment and Biobehavioral Catch-up Effects on Sensitivity Among Mothers Using Opioids
Author information	Role
Mary Dozier, Ph.D., Department of Psychological and Brain Sciences, University of Delaware, United States	Presenting author
Danielle Katz, Department of Psychological and Brain Sciences, University of Delaware, United States	Non-presenting author
Abstract
Introduction. Opioid and other substance use has increased dramatically in recent years. Maternal substance use renders children highly vulnerable to a host of short- and long-term challenges developing self-regulatory capabilities. Early intervention is needed that helps mothers provide sensitive care despite the challenges of substance use. Attachment and Biobehavioral Catch-up (ABC) is a 10-session home visiting program with a strong evidence base in enhancing parental sensitivity with other high-risk parents of older infants and preschoolers (e.g., Raby et al., 2017). Parental sensitivity has been identified as the intervention mechanism of ABC, with sensitivity mediating intervention effects on child outcomes such as inhibitory control and cortisol production (Garnett et al., 2020; Lind et al., 2017). Prior to the current study, ABC had not been used specifically among substance using mothers and had not been used with children younger than 2 months of age. For the current study population, we adapted ABC to begin shortly before birth and continue in the early infancy period. Adaptations included adding two sessions (a prenatal session and an immediate postnatal session) and attention to the subtle infant cues and parent responses specific to the newborn period. In the current study, we assessed the efficacy of the adapted version of ABC (ABC for Newborns) in enhancing parental sensitivity among mothers using substances (mostly opioids) through a randomized controlled trial. Methods. A total of 69 mothers using substances were randomized to receive ABC-Newborn (n=37) or a control condition (Developmental Education for Families or DEF).All but one mother reported using opioids and one reported using other substances. In both experimental and control conditions, mothers received 12 in-home sessions involving mothers and infants. At pre-intervention, mothers participated in a sensitivity assessment with a crying infant simulator programmed to cry (Voorthuis et al., 2013). At infant age of 6 months, mothers participated in a 10-minute play interaction with their infants in which sensitivity and intrusiveness were assessed, using an adapted version of NICHD Study of Early Child Care and Youth Development coding system (Brady-Smith et al., 1999). Results. At pre-intervention, groups did not differ significantly in responsiveness to the infant simulator, F(1, 60)=.04, p =.845. At child age of 6 months, mothers in the ABC-Newborn group behaved significantly more sensitively than mothers in the DEF group, F(1, 67)=4.57, p =.036. See Figure 1. Discussion. The findings of increased sensitivity for mothers in the ABC-Newborn are consistent with findings seen for ABC for older infants and preschoolers (e.g., Bick & Dozier, 2013; Raby et al., 2017). These findings are especially exciting because 1) the adapted version of ABC for mothers of newborns had not previously been tested and 2) a high-need and challenging population showed positive effects. As data collection continues, we will examine ABC-Newborn effects on later parental and child outcomes.

Paper #4
Home Visiting Impacts on Child Kindergarten Readiness and Parent Mental Health: Findings From Family Connects
Author information	Role
Gayane Arturovna Baziyants, Sanford School of Public Policy, Duke University, United States	Presenting author
Kenneth A. Dodge, Sanford School of Public Policy, Duke University, United States	Non-presenting author
W. Benjamin Goodman, Center for Child and Family Policy, Duke University, United States	Non-presenting author
Abstract
Introduction. Children’s kindergarten readiness is an important predictor of later academic success (Sabol & Pianta, 2017; Whyte & Coburn, 2022). Parents and caregivers often serve as immediate touchpoints in the diverse ecosystem of children’s development (Bronfenbrenner, 1996). Supporting parents in their mental health, parenting practices, and parent-child interactions is essential for the promotion of children’s kindergarten readiness. Home visiting (HV) has been utilized as a method of service delivery for over a century, with positive impacts across parent and child outcomes (Duffee et al., 2017; Roben & Costello, 2022). Nonetheless, research is mixed on the impact of HV on children’s kindergarten readiness, and the mechanisms through which HV may influence these outcomes. Additionally, while some studies demonstrate short-term impacts on parent mental health, most do not demonstrate sustained positive effects (Ammerman et al., 2010; Chazan‐Cohen et al., 2007). Objective. To investigate the main effect of FC on measures of child kindergarten readiness and parent mental health, five years post intervention. A secondary objective is to investigate the indirect effect of FC on outcomes of children’s kindergarten readiness to identify mechanisms of FC effectiveness. Methods. A representative subsample of 549 families were randomly selected from the first RCT evaluation of FC. The RCT consisted of 4,777 families of infants born between July 1, 2009, and December 31, 2010, in Durham County, North Carolina. Families were assigned to treatment and control conditions based on infant birth date. Dependent variables at child age 5 years included average scores of children’s verbal knowledge, emotional regulation, attention problems, social problems, parent depression, and possible clinical depression. Mediator included previously documented improvements in outcomes of parent mental health and positive parenting. Main effects were measured through ordinary least squares regression models. General structural equation modeling was utilized for mediation analyses, with indirect effects estimated using the product-of-coefficients method with bootstrapped samples (Sim et al., 2022; Zhao et al., 2010). Results. Parents randomly assigned to FC were significantly less likely to be diagnosed with possible clinical depression (B= - 0.08; p<0.05) and less likely to report depressive symptoms (B = - 0.17; p<0.05). There were no significant impacts on children’s verbal knowledge, emotional regulation, attention problems, and social problem. Preliminary mediational models demonstrate an indirect effect of FC on children’s emotion regulation, such that 64% of the effect of FC on children’s emotion regulation is mediated by FC impact on parent mental health (B=0.05; p=0.05). Discussion. The universal, postnatal HV program has demonstrate sustained five-year impacts on parent mental health, with indirect effects on children’s emotion regulation. Findings make important contributions to child and family policy by demonstrating a cost-effective, short-term approach to supporting all parents and children.

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