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      My Early Relational Trust-Informed Learning (MERTIL) for Parents: A study protocol for a brief, universal, online, preventative parenting program to enhance relational health

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          Abstract

          Background

          Early relational health is a key determinant of childhood development, while relational trauma in the parent-infant dyad can instigate a cascading pattern of infant risk. Fortunately, early relational trauma is detectable and modifiable. In 2018, Australian Maternal and Child Health (MCH) nurses participated in MERTIL (My Early Relational Trauma-Informed Learning), a program to identify and prevent relational trauma. Program evaluations revealed nurses felt competent and confident to identify and respond to relational trauma; however, response capacity was inhibited by inadequate parent referral options. In response, MERTIL for Parents (My Early Relational Trust-Informed Learning) was developed, which is an online, evidence-based, self-paced parenting program that focuses on enhancing parental knowledge of relational trust and its significance for infant development. This low-cost, accessible prevention resource targets emerging relational concerns to reduce later service system engagement. The potential for universal preventative online programs that target parental and relational wellbeing remains under-explored. This paper reports on a protocol for implementing a MERTIL for Parents pilot study describing practitioners’ and parents’ perspectives on program feasibility and efficacy.

          Methods

          This study is a mixed methods, parallel armed, uncontrolled, repeated measures design. We aim to recruit 48 Australian MCH practitioners from the states of Victoria and New South Wales. These professionals will in turn recruit 480 parents with a child aged 0–5 years. All parents will receive MERTIL for Parents, which entails a 40-minute video, tipsheets, posters, and support resources. Parent data will be obtained at three periods: pre-program, program exit, and program follow-up. Practitioner data will be collected at two periods: pre-parent recruitment and program follow-up. Data collection will occur through surveys and focus groups. Primary parent outcomes will be socioemotional assessments of program efficacy. Practitioners and parents will each report on program feasibility.

          Discussion

          This protocol describes the feasibility and efficacy of a new online parenting program, MERTIL for Parents, with pilot field studies commencing in March 2023. We anticipate that this resource will be a valuable addition to various child and family services, for use in individual support and group work.

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          Most cited references40

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          G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences

          G*Power (Erdfelder, Faul, & Buchner, 1996) was designed as a general stand-alone power analysis program for statistical tests commonly used in social and behavioral research. G*Power 3 is a major extension of, and improvement over, the previous versions. It runs on widely used computer platforms (i.e., Windows XP, Windows Vista, and Mac OS X 10.4) and covers many different statistical tests of the t, F, and chi2 test families. In addition, it includes power analyses for z tests and some exact tests. G*Power 3 provides improved effect size calculators and graphic options, supports both distribution-based and design-based input modes, and offers all types of power analyses in which users might be interested. Like its predecessors, G*Power 3 is free.
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            An ultra-brief screening scale for anxiety and depression: the PHQ-4.

            The most common mental disorders in both outpatient settings and the general population are depression and anxiety, which frequently coexist. Both of these disorders are associated with considerable disability. When the disorders co-occur, the disability is even greater. Authors sought to test an ultra-brief screening tool for both. Validated two-item ultra-brief screeners for depression and anxiety were combined to constitute the Patient Health Questionnaire for Depression and Anxiety (the PHQ-4). Data were analyzed from 2,149 patients drawn from 15 primary-care clinics in the United States. Factor analysis confirmed two discrete factors (Depression and Anxiety) that explained 84% of the total variance. Increasing PHQ-4 scores were strongly associated with functional impairment, disability days, and healthcare use. Anxiety had a substantial effect on functional status that was independent of depression. The PHQ-4 is a valid ultra-brief tool for detecting both anxiety and depressive disorders.
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              Parents' Stress and Children's Psychological Problems in Families Facing the COVID-19 Outbreak in Italy

              Objectives: The present study aimed to explore the effect of risk factors associated with the COVID-19 outbreak experience on parents' and children's well-being. Methods: Parents of children aged between 2- and 14-years-old completed an online survey reporting their home environment conditions, any relation they had to the pandemic consequences, their difficulties experienced due to the quarantine, their perception of individual and parent-child dyadic stress, and their children's emotional and behavioral problems. Results: Results showed that the perception of the difficulty of quarantine is a crucial factor that undermines both parents' and children's well-being. Quarantine's impact on children's behavioral and emotional problems is mediated by parent's individual and dyadic stress, with a stronger effect from the latter. Parents who reported more difficulties in dealing with quarantine show more stress. This, in turn, increases the children's problems. Living in a more at-risk area, the quality of the home environment, or the relation they have with the pandemic consequences, do not have an effect on families' well-being. Conclusions: Dealing with quarantine is a particularly stressful experience for parents who must balance personal life, work, and raising children, being left alone without other resources. This situation puts parents at a higher risk of experiencing distress, potentially impairing their ability to be supportive caregivers. The lack of support these children receive in such a difficult moment may be the reason for their more pronounced psychological symptoms. Policies should take into consideration the implications of the lockdown for families' mental health, and supportive interventions for the immediate and for the future should be promoted.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Writing – review & editing
                Role: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLOS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                16 March 2023
                2023
                : 18
                : 3
                : e0272101
                Affiliations
                [1 ] School of Psychology & Public Health, La Trobe University, Melbourne, Australia
                [2 ] Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
                [3 ] La Trobe Rural Health School, La Trobe University, Bendigo, Australia
                PLOS (Public Library of Science), UNITED KINGDOM
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                [¤]

                Current address: The Bouverie Centre, School of Psychology & Public Health, La Trobe University, Brunswick, Victoria, Australia

                Author information
                https://orcid.org/0000-0002-0559-0842
                Article
                PONE-D-22-17664
                10.1371/journal.pone.0272101
                10019699
                36928036
                c9b2d50a-a1e7-47fb-935b-94b437151feb
                © 2023 Opie et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 12 July 2022
                : 20 February 2023
                Page count
                Figures: 5, Tables: 3, Pages: 17
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100001215, La Trobe University;
                Award Recipient :
                YES- JO, JM, and LH received funding from La Trobe University’s ( www.latrobe.edu.au) ABC Internal Investment Scheme. This grant did not have an associated grant number as it was an internal university grant.
                Categories
                Study Protocol
                Research and Analysis Methods
                Research Design
                Survey Research
                Surveys
                People and Places
                Population Groupings
                Professions
                Medical Personnel
                Nurses
                Medicine and Health Sciences
                Health Care
                Health Care Providers
                Nurses
                Computer and Information Sciences
                Computer Networks
                Internet
                Medicine and Health Sciences
                Mental Health and Psychiatry
                People and Places
                Population Groupings
                Age Groups
                Children
                Infants
                People and Places
                Population Groupings
                Families
                Children
                Infants
                Computer and Information Sciences
                Software Engineering
                Computer Software
                Engineering and Technology
                Software Engineering
                Computer Software
                Research and Analysis Methods
                Research Design
                Pilot Studies
                Medicine and Health Sciences
                Pediatrics
                Child Health
                Medicine and Health Sciences
                Public and Occupational Health
                Child Health
                Custom metadata
                No datasets were generated or analyzed during the current study. All relevant data from this study will be made available upon study completion.

                Uncategorized
                Uncategorized

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