Teaching Parents to be Responsive: A Network Meta-Analysis

• In Event: Poster Session 11
  In Poster Session: PS 11 Topic - Prevention and Interventions

Abstract

Children whose caregivers are consistently responsive during their early development are more likely to experience positive physical, neuro-physiological, and psychological outcomes over the life-course (Eshel et al., 2006; Shonkoff et al., 2012). Numerous interventions have demonstrated that responsivity is a skill which can be taught, and that improving parent responsivity can lead to subsequent improvements in child outcomes (Milgrom et al., 2010; Obradović et al., 2016). In this meta-analysis, we sought to identify the design features and instructional methods that maximize learning in programs teaching parents to be more responsive towards young children (ages zero to six). We searched PsycINFO, Medline, CINAHL, Social Work Abstracts, ERIC, ABI/INFORM, and the Cochrane Central Register of Controlled Trials from inception to May 2018. Only randomized trials of responsivity training programs for parents without elevated levels of psychopathology were included. The outcome of interest was parental responsivity, defined as parents’ ability to understand what their children are thinking or feeling and respond in a sensitive and stimulating manner. Following PRISMA guidelines, two reviewers independently extracted data and assessed risk of bias using the Cochrane risk of bias tool. Data were pooled with a random-effects pairwise meta-analysis, followed by a network meta-analysis comparing programs using different combinations of instructional methods. The synthesis included 91 studies with 9,893 participants. Programs had, on average, a medium effect size (standardized mean difference 0.58, 95% CI 0.47 to 0.69). Programs that included opportunities for participants to observe examples of responsivity (0.69, 95% CI 0.55 to 0.84), assigned tasks for parents to complete between sessions (0.90, 95% CI 0.67 to 1.12), and which used researchers as facilitators (1.00, 95% CI 0.70 to 1.29), were more effective compared to those which did not (p = 0.01, <0.001, 0.006, respectively). Program duration, use of video feedback, and home-visiting delivery did not explain any variance in program effectiveness. Rankings in the network meta-analysis revealed that the three most effective program types all used didactic teaching alongside opportunities for observation and reflection. Programs that also included opportunities for parents to practice being responsive and receive feedback were the most effective (0.95, 95% CI 0.67 to 1.23), but not significantly more effective than programs using just didactic, observation, and reflection teaching methods (0.86, 95% CI 0.27 to 1.44). Hence, having parents observe good examples of responsive caregiving and complete homework assignments in short programs may be an efficient and effective way to enhance parent responsivity and child outcomes in the general population, compared to more costly, individualized approaches that emphasize rehearsal and feedback. These results may make it easier to support more parents without using more resources, ultimately improving the lives of more children.

Authors

• Nina Sokolovic, University of Toronto
  Presenting Author

• Michelle Rodrigues, University of Toronto
  Non-Presenting Author

• Andrea C Tricco, Unity Health Toronto
  Non-Presenting Author

• Roksana Dobrina, Ryerson University
  Non-Presenting Author

• Jennifer Jenkins, University of Toronto
  Non-Presenting Author