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IES Grant

Title: Coach Facilitated Mobile Parent-Training Program for Women With Cognitive Delays Who Are Mothers of Infants
Center: NCSER Year: 2020
Principal Investigator: Feil, Edward Awardee: Oregon Research Institute
Program: Early Intervention and Early Learning      [Program Details]
Award Period: 3 Years (07/01/2020 - 06/30/2023) Award Amount: $1,399,285
Type: Development and Innovation Award Number: R324A200153

Co-Principal Investigator: Davis, Betsy; Landry, Susan

Purpose: This project aims to develop an adaptation of the existing online Play and Learning Strategies (ePALS) parenting program for mothers with infants when the mothers have significant cognitive delays. Infants of mothers with cognitive delays are at significantly elevated risk for a host of detrimental outcomes, including neglect and abuse of children and school readiness problems. Research indicates that early interventions to improve parenting practices are effective in ameliorating these outcomes. Yet, there is a dearth of these interventions for mothers with cognitive delays. In this project, the research team will modify ePALS for postnatal mothers with cognitive delays; evaluate its feasibility, usability, and acceptability; and test its promise for improving maternal responsiveness and infant social-emotional and communication outcomes.

Project Activities: This project will use an iterative process to adapt the ePALS intervention for postnatal mothers with cognitive delays, conduct a single-case design study to ascertain the optimum mode of distal and in-person coach contacts, and run a small randomized pilot study to determine its impact on maternal responsiveness and infant social-emotional development.

Products: The products of this project will include a fully developed intervention for infants of mothers with significant cognitive delays and evidence of its promise for improving outcomes for mothers and their infants. The project will also result in peer-reviewed publications and presentations as well as additional dissemination products that reach education stakeholders such as practitioners and policymakers.

Structured Abstract

Setting: The project will take place in home settings in Oregon.

Sample:The sample will include 10 mother-infant dyads participating in focus groups, 8 dyads in the single-case study, and 40 dyads in the randomized pilot study. Participating mothers, recruited through community agencies, will have an infant 3 to 10 months of age, be identified by the agency as a mother with a cognitive delay who may potentially benefit from the ePALS program, and will self-report having a cognitive delay or learning difficulty.

Intervention: ePALS is a computerized adaptation of the PALS parenting program. PALS is an in-home, empirically supported, cognitive-behavioral skills intervention for mothers of infants that targets improvement in sensitive and responsive parenting behaviors and minimizing insensitive, harsh, and intrusive behaviors to promote infants' social engagement and language. The web/app version of the intervention includes 11 sessions that take place over 2 to 3 months. Each session in ePALS includes (a) presentation of concepts, behaviors, and examples; (b) parent check-in questions for review by coach; (c) the creation and automatic upload of a 5-minute video of mother-infant interactions for later review; (d) a summary of topics; (e) daily activities (homework); (f) feedback about the program recorded to the database; and (g) weekly coach contact to review mother-infant interaction video as well as session topics and skills. For mothers with cognitive delays, the following adaptations to ePALS will be made: (a) adding exemplar videos of parents with cognitive delays and their infants, (b) modifying existing online content and check-in questions to be instructionally sound for this population, (c) creating a behavioral performance criterion of parenting skills, and (d) creating interactive and gamification features to promote engagement. For this adaptation, there will also be exploration of the combination of in-home and distal coach contact (phone or video) to support parenting skills learning.

Research Design and Methods:This project will begin with an iterative process of development using interviews, focus groups, and beta testers for the app. To evaluate the prototype ePALS program in the second year, eight mother-infant dyads will be randomized in a multiple-baseline single-case design, comparing coaching methods of delivery (all in-home or combination of home and distal). This study will examine the optimal dosage and delivery mode preferences to test in the pilot study. In the final year, the research team will test the promise of the intervention using a randomized controlled design with 40 mother-infant dyads assigned to experimental or wait-list control conditions. In order to determine the potential impact on maternal responsiveness and infant social-emotional development and communication, data will be collected at three timepoints: (a) baseline, (b) post-test for the treatment group and second baseline for wait-list control, and (c) follow-up for treatment group and post-test for the wait-list control. Cost analyses will use the ingredients method.

Control Condition: In the single-case design, participants serve as their own control. The waitlist control group in the pilot study will receive their usual-care services during the waiting period and will then receive ePALS.

Key Measures:Feedback from the advisory committee, focus groups, and beta-testing will guide development. For the single-case and randomized design studies, parent-child interaction videos will be coded using the Landry Parent-Child Interaction Scales to assess naturalistic parent-child interactions. The positive interactions will focus on maternal responsiveness (maternal positive affect, warmth, flexibility, and positive verbal content) and negative interactions will examine ratings of maternal physical intrusiveness as well as verbal and affective negativity. Additional outcomes will be assessed through questionnaires, including infant social-emotional and communication functioning (Ages and Stages Questionnaire-Social Emotional), parents' attitudes and knowledge (PALS Knowledge Questionnaire, Concepts of Development Questionnaire, and Parenting Sense of Competence), and consumer satisfaction. Post-intervention parent interviews will identify further adaptations to the implementation, additional module content, barriers to implementation and treatment fidelity, and strengths and facilitators of the program. Moderating variables will include demographics and adaptive behavior as an indication of disability severity (Vineland Adaptive Behavior Scales). Implementation fidelity and usability, including coaching fidelity, will be collected through session notes. Electronically captured user data will measure coaching dosage, participant app-use, and intervention dosage. Costs for the cost analysis will include start-up costs, including tablet purchase and app software installation; coach training costs, including trainer time and materials costs; technological implementation costs; and coach/supervisor implementation time costs.

Data Analytic Strategy:For the initial development phase, the research team will use content analysis techniques to analyze the focus group transcript text. The common themes derived from content analysis will then be applied to the prototype for alpha- and beta-testing. Interviews and app-collected user data from beta-testers will delineate factors for further revision. In the single-case design study, visual analysis will be used to analyze graphed data along with a case-specific approach to estimation of effect size. In the pilot study, the research team will use polynomial contrast function with MANOVA and ANOVA between-group analyses as well as multiple nonparametric procedures. Cohen's d and Hedges's g effect sizes will also be calculated. For the cost analysis, the team will estimate the total and per family costs of implementing ePALS and estimate the marginal cost (the cost of adding one family within an agency after staff are trained and the program has become operational) for the ePALS program.

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