Digital Parent Training RCT Meta-Analysis and Systematic Review

Abstract

Telehealth interventions have the opportunity to scale evidenced-based therapeutics and increase service access to historically hard to reach populations, including rural, and minority groups. Behavior management parenting interventions are a best-practice intervention to treat a range of disruptive behavior disorders and family dysfunction concerns, which have traditionally occurred in person, but recently been trialed online due to growing demand and a need for remote delivery during COVID-19. There is limited and mixed information to date regarding evidence for online services and minimal research on client and therapeutic factors associated with better outcomes, which is critical for advancing efficacy in the rapidly-growing approach to treating child mental illness. Therefore, we conducted a systematic review and meta-analysis (k = 24, total number of intervention participants = 1469 and control participants = 800) of the impact of digital parent training interventions on parent skill, parent mental health, and child externalizing mental health outcomes from 2000 to 2020, among children 2-12 years old, across four databases. Exclusionary criteria include programs targeted for parents of children with intellectual disabilities, autism, brain injury, nutrition/health/dental needs or primary medical diagnosis. Across outcomes, there was a modest effect size of digital parent training interventions (g =.22-.30), compared to controls using random effect two-level and multi-level models. Study heterogeneity varied across outcomes (I² = 18.6% to 66.3%). Results of publication bias were mixed across tests, but they were suggestive of a slight inflation of the effects sizes across outcomes. We tested several moderators related to child demographics, family socioeconomic status, intervention design, and risk of bias. We found the effects of digital parent training on parent skills and child outcomes were stronger if the intervention used was evidence-based, combined hybrid interactive platforms with a therapist and was compared to an inactive control. Given the limitations from the existing literature assess moderating effects regarding population characteristics (i.e. SES, parent mental health), we call on future studies to provide standardized demographics to aide future knowledge synthesis work and provide templates for shared measurement. We preregistered our meta-analysis here, with datafile, code and supplementary: https://osf.io/e35bt/.

Building Emotional Awareness and Mental Health (BEAM): A Pilot Randomized Controlled Trial of an App-Based Program for Mothers of Toddlers

“…Their feedback included a request for online support that would allow for connection to other mothers via forums or brief (1 h or less) group discussions, contact with therapists, and access to evidenced-based mental health and parenting strategies delivered in short-informational videos. These requests aligned with our knowledge synthesis work highlighting the importance of therapist contact (vs. only didactic materials) to symptom improvement in digital programs (30). Similarly, our previous qualitative research on parenting forums (1,000 posts) during the pandemic highlighted requests for strategies to support family mental health and to feel less isolated (31).…”

Supporting families to protect child health: Parenting quality and household needs during the COVID-19 pandemic

“…Novel technologies providing digital delivery of psychological services for families are playing a crucial role during the pandemic [ 79 – 81 ], when in-person care has become less accessible. Particularly for families experiencing a range of household and psychosocial risk factors, providing evidenced-based telehealth services is critical for preventing coercive parent-child interactions and potentially more severe outcomes such as child abuse and maltreatment.…”

“…Novel technologies providing digital delivery of psychological services for families are playing a crucial role during the pandemic [79][80][81], when in-person care has become less "Managing uncertainty" "Self-care"…”

“…Particularly for families experiencing a range of household and psychosocial risk factors, providing evidenced-based telehealth services is critical for preventing coercive parent-child interactions and potentially more severe outcomes such as child abuse and maltreatment. Current digital parenting interventions hold promise for improving a range of family outcomes including parenting skills, parent and child mental health, and parenting stress [78][79][80][81]. Telehealth programs such as Triple P Online [82] and ezPARENT [83] are documented to have similar effect sizes to other evidenced-based parenting programs offered in-person [78] but may be able to maximize service accessibility and address family health needs now.…”

Digital Parenting Interventions for Fathers of Infants From Conception to the Age of 12 Months: Systematic Review of Mixed Methods Studies

“…During the COVID-19 pandemic, factors such as social and public health protections paired with additional childcare responsibilities for families and economic uncertainty contributed to increasingly challenging access to in-person services worldwide [29,30]. Parents often seek both information and support on the internet [31,32], and meta-analyses have shown that digital programs designed for parents are effective in improving parenting skills and child outcomes [33][34][35]. As such, complete or partial digital delivery of interventions has become increasingly beneficial during this time [36,37] and holds great potential for supporting fathers.…”