Healthy Infants

Full project title: Translating Effective Maltreatment Research into the Community

Project timeline: 09/01/09-08/31/12

Funded by CDC grant #R18 CE001705-0, this research focuses on developing and testing the translatability of an evidence-based parenting intervention into a community-based program aimed at reducing child maltreatment.

Abstract

"Healthy Infants" seeks to develop and test the translatability of an evidence-based parenting intervention into a community-based program aimed at reducing child maltreatment. Specifically, we propose to translate the Play and Learning Strategies program (PALS; Landry & Smith, 1996; Smith et al., 2000; Landry et al., 2001), an evidence-based program demonstrated to increase responsive parenting and thereby promote healthy infant social emotional development. The PALS program has been demonstrated to operate with fidelity and effectiveness within an in-person, one-to-one, mother-coach relationship. However, within this effectiveness evidence, the role of coach has remained within the research context. Attempts to more broadly disseminate this program into the community have met with many barriers to effectiveness; particularly those related to the provision of training and support necessary for community-based coaches to serve families at the level that research coaches have previously demonstrated (Glasgow, Marcus, Bull, & Wilson, 2004). Through our prior work (Infant Net; Feil, Baggett, Davis, et al., 2008), we have developed an Internet-based delivery system for the PALS program, one that harnesses the power of the internet to facilitate efficient connections between the community parents and trained PALS coaches. By utilizing the Infant Net delivery platform, we have the opportunity to address critical dissemination barriers through linking home visitors within community
service organizations directly to professionally-trained PALS program consultants in order to provide the necessary training and ongoing support required for effective community-based program implementation. It is within this context, consistent with Healthy People 2010 goals pertaining to Healthy Infants and toddlers, that
we will pursue the following:

Objective 1) In preparation of community implementation, we will conduct a 6-month development phase in which we will adapt existing Infant Net PALS materials into the necessary context to translate program implementation into diverse communities by: a) adapting existing training and coaching materials to better reflect a community home visitor-program consultant support relationship; and b) overlaying the existing Spanish translation of the PALS program onto the computer-delivery platform to increase program reach to linguistically diverse communities; and

Objective 2) Following our provision of laptops with “eye-ball” cameras to community agency home visiting staff and installation of wireless Internet access in each community agency who does not already have it, we will proceed with implementation of our community-adapted intervention, Infant Net for Home Visitors (Infant Net-HV), within nine Healthy Families (HF) programs spanning a 13-county region in the state of Kansas. Our implementation approach will take the form of a 3-wave, iterative implementation design in which each wave will provide feedback to inform subsequent wave implementations. Across the 3 waves, we will implement with nine HF sites, 18 home visitors, and 270 at-risk families.

Translatability of the community-adapted, evidence-based program will be assessed relative to the impact of known barriers to dissemination on program reach, uptake, feasibility, fidelity and, by virtue, secondary mother and infant health outcomes. An initial cost analysis of the program will also be performed in order to provide this information to community sites for viewing relative to their own operating budgets and prior intervention efforts. All project information will be presented to Healthy Families leadership and assessed as to its potential for subsequent policy support related to maintenance and sustainability of the Infant Net-HV program. In further support of maintenance and sustainability efforts, iterative community feedback from each wave of
implementation, including the documentation of things that “didn’t work”, will be summarized and placed into a Community Implementation Manual to accompany project results.are helping fuel the demand for mental health services and on-line support. Internet programs can be interactive and provide social support from peers and professionals. Through the use of recent advances in multimedia technology and software as well as the rise of computer networking via the Internet, there now exists an opportunity to provide such monitoring of outcomes and remote contact for rural locations.

"InfantNet" adapted and pilot tested an existing empirically proven parenting program, for delivery via the Internet, enhanced with weekly professional contact. This exploratory research project provided parents of infants 3.5 to 7 months (at enrollment) with a computer, "eyeball" computer camera, Internet connection, and technical training/support for 6 months to evaluate the digital translation. This system enabled Parent Coaches to make treatment decisions with objective data, as well as
provide outcomes assessment from remote research sites.

Using an experimental design we will evaluate the impact of the interactive Internet parent training intervention as compared to usual-care (control). After recruiting from Early Head Start program in rural Oregon and Kansas, 40 families will be randomized to either the intervention or computer-control conditions. Parent coaches will make weekly, phone calls and email to assist parents with the use of the computer and questions/concerns about the program. Parenting practices will serve as the primary
outcome. The proposed design will provide important practical information about the feasibility and effectiveness of an Internet parenting intervention in effecting parenting behavior.

Relevance: This innovative interactive Internet-based parent education intervention helped serve to promote the social-emotional development and communication skills of infants to decrease the chances of psychopathology and increase school readiness of children from low-income families.