Do Cell Phones Enhance Parenting Interventions Over Long-Term?
Today 75% of U.S. adults own a smart phone, compared to 35% in 2011. A hefty 92% of 18- to 29-year-olds own a smartphone, versus 42% of adults ages 65 and older. As researchers Hirsh-Pasek and Golinkoff have found, when parents let screen time interrupt their social interactions with their young children, it can hinder their young children’s development. It’s up to parents to use cell phones responsibly, as a resource rather than a disruption, during their activities with their children. Can family services providers turn the ubiquitous presence of cell phones into an advantage for families and children?
Let’s explore this question in the context of parenting interventions with the help of a new research study. In a previous KIPS Blog, you may recall that we highlighted a study showing the positive parenting outcomes of a brief parenting intervention coupled with cell phone messages from home visitors. Jennifer Burke Lefever and her colleagues have now published a noteworthy follow-up study titled the “Long-Term Impact of a Cell Phone-Enhanced Parenting Intervention” in the journal Child Maltreatment. From their previous publication, we learned that a short, focused parenting intervention produced a remarkable change in parents’ behavior with their children. This follow-up study investigated if the impact of this brief parenting intervention lasts over time and whether cell phone messaging adds to the effects.
What Did Mothers & Children & Family Coaches Do?
The research team recruited 371 low-income mothers and their preschool children from community agencies in the Midwestern U.S. and randomly assigned them to 3 groups: 1) traditional PCI, 2) cell phone-supported PCI (PCI-C) and a 3) wait-list control group. The study compared the outcomes of the brief, evidence-based Parent-Child Interaction (PCI) component of the SafeCare model to PCI plus cell phone messaging (PCI-C). Each mother and her child engaged in an average of 5 biweekly play sessions in their homes as family coaches modeled, then mother and child practiced and received feedback on 10 PCI parenting skills. This follow-up study deserves special attention. It is one of few studies that went beyond pre/posttests to assess families’ behavior 12 months after the 5 parent-child sessions were completed.
The research team examined 12-month outcomes of special interest to practitioners, researchers, funders and early intervention policy makers:
- Parenting skills
- Maternal depression
- Children’s behavior
- Retention rates
Which Outcome Measures?
The researchers measured parenting behavior by direct observation of parent-child play interactions using the KIPS parenting assessment at pretest, posttest, as well as 6 and 12 months post-intervention. A PCI checklist measured generalization of the PCI strategies mothers learned during intervention to clean-up tasks. Like many early childhood family intervention programs, this study included a maternal depression screening. Mothers completed the Beck Depression Inventory II at the 4 assessment points. In addition, the researchers measured children’s behaviors by direct observation during mother-child play with a tool developed for this study, the Child Behavior Rating Scale (e.g., response to mother’s initiations, response to directions) and mothers’ reports on the Behavior Assessment Scale for Children-2-Parent Report Scale (e.g., adaptive and problem behaviors) at pretest and 6 and 12 months post-intervention. (For more details and references for these measures, read a preprint of the publication. Go to KIPS Publications – Scroll to Independent Researchers).
Here’s the tip of the iceberg of the complex findings of this valuable long-term study.
Parenting Behavior. KIPS scores showed improved parenting behavior from pretest to 12-month follow-up in both the PCI and PCI-C intervention groups. There was some decline from the post-intervention to 6 and 12 months, but KIPS parenting scores still remained higher than at pre-test and compared to the wait-list control group scores that showed no change over time. Mothers who received cell phone supports were more likely to use their newly learned parenting skills (according to the PCI checklist) during unstructured clean-up tasks.
Children’s behavior, as observed by researchers and also reported by mothers, showed more cooperation and less aggression at 12-month follow-up only in the PCI-C group, compared to the wait-list control group. No differences were found for the PCI group without cell phone messaging.
Maternal depression decreased in both the PCI and PCI-C groups at 12-moth follow-up even though this was not the focus of the intervention. Mothers in both groups who reported higher depression prior to intervention reported less depressive symptoms than the control group at 12-month follow-up.
Study retention rate was substantially higher for the PCI-C group than for the PCI group. This difference was first seen immediately at the end of the intervention (PCI-C 89% vs. PCI 77%), then carried through to 12-month follow-up post-intervention (PCI-C post to 12mos 93% vs. PCI post to 12mos 86%). The researchers suggested that the focus and brevity of this brief PCI intervention appeared to heighten family engagement as compared to the full SafeCare model. Then cell-phone supports extended the retention rate for the follow-up study after the intervention, perhaps due to deepened rapport and trust between mothers and family coaches which spilled over to research activities.
This study showed that brief interventions can have lasting effects on parenting behavior and generalization of skills to routine parent-child activities. The reduction of maternal depression was a significant byproduct of the parenting intervention which can boost parents’ sensitivity and responsiveness to their children. Furthermore, it showed that cell phone supports for parents can improve children’s behavior and family retention in services. Retention is a major hurdle facing many family service programs. As Lefever and her colleagues note, “Text messaging is a cost-effective and time-efficient tool for increasing intervention dosage beyond the scope of a weekly home visit, and thus supporting parents in using key strategies in their daily interactions with their child.” (Lefever, set al. p.313). That’s the purpose of family intervention services, isn’t it? We want to give parents the skills, reflective capacity and tools they need to engage in nurturing interactions with their children 24/7 when they are on their own. In this study, KIPS measured the long-term impact on parenting of the PCI component of the SafeCare model. This shows KIPS is sensitive enough to detect changes produced after only 5 sessions and still be present a year after the briefest of interventions was completed. Might KIPS be useful in showing the impact of the work you do?