Internet-based infant-focused parenting intervention: Infant-Net Ed - - PowerPoint PPT Presentation

Ed Feil, Ph.D, Kathleen M. Baggett, PhD, Betsy Davis, Ph.D., Lisa Sheeber, Ph.D., Susan Landry, Ph.D. & Judith J. Carta, Ph.D. Oregon Research Institute , University of Kansas & University of Texas

2014 NRTRC Telemedicine Conference

For more information: edf@ori.org

Internet-based infant-focused parenting intervention: Infant-Net

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Disclosures

• Practice Gap: Lack of awareness on how to provide specialty care

services to under-served populations in the region.

• Desired Outcome:

– Providers will be able to apply knowledge acquired from the conference to better provide care using telemedicine to patients across the region. – Providers will be able to solve problems within their practice using telemedicine. – Providers will be able to identify the services available for their patients via telemedicine within their region. – Providers will be able to recognize the changes in telemedicine and how best to continue improving their practices during change.

• Disclosure of relevant financial relationships in the past 12

months: I have no relevant financial relationships with commercial interests that may have a direct bearing on the subject matter of this CME activity.

Research Team: Benjamin Largent, Stacia Mitchell, Aaron Elligsen, Nikki Ehrmantrout, Craig Leve,

• Sandra. Cintora, Claire Catania, Kevin Barrett,

Cynthia LaMorticella, Noni Canavan, Prisca Franklin, Gladys Fuentes, Ursula Johnson, Edie Larson, Stacy Johner, Yolanda Tapia & Laurie Levites Agenda:

• 1. Introduction & Description of Intervention

2.Demo & Pilot Study Results 3.New Projects and opportunities for participation

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Very Low Birth Weight Infants

• VLBW defined as < 1500 g (3.1 lbs.)
• Neonatal ICU in the 1960s resulted in

substantial improvements in survival

• Higher frequency in minority groups
• Comorbid in low-income (pre-natal)
• Poorer cognitive function
• Learning problems at school persist

into adolescence

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Language & Cognitive Development

• Reciprocal and responsive

parenting promote cognitive and social-emotional development

• Five parenting features that

predicted future achievement were: (1) language diversity; (2) feedback; (3) guidance style; (4) language emphasis; and (5) responsiveness.

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Barriers to behavioral health services in rural areas:

• Distance
• Few professionals
• Higher risk due to poverty & isolation

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• Convenience

cost, scheduling, transportation

• Availability

24 hours, there when needed

• Accessibility

home, work, libraries, community centers

• Ease of use

even my mother uses it Conceptual and Practical Advantages and Promises

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• Control over exposure to intervention
• Extensive online data on utilization, participant

preferences, & content of all messages

• Multiple measures of key processes and
• utcomes

Methodological Features

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Social Support Group Focus Forums Social Networking Virtual Community

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• Can we adapt for computer & Internet?
• Ease of use acceptable?
• Will moms use it?
• Can we create a similar personal connection

with “coach” as in in-vivo intervention. Home visiting program for mothers of infants at risk (very low birth weight)

• Play & Learning Program
• Internet display of interactive educational

content available 24/7

• Record video
• Weekly Coach Call for concepts & video

review

• Approximately 1 hour per topic for 11 topics
• Moderated peer support
• Internet access

Link to parenting websites Website Components

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Play and Learning Series

(Landry & Smith, 1996)

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Session Organization

• Discover

– Presentation of concepts, behaviors, and examples

• Check-in questions
• Make 5 minute mom-infant video
• Summary
• Daily Activity

– Homework

• Feedback
• Coach Call

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Demonstration

file://localhost/Users/edf/presentations/Lehigh_Feb2011/standalone.htm l

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Participants

• Recruited from flyers, WIC office,

nurse home visitors

• Not receiving other services (e.g.

Healthy Start & net income with WIC guidelines

• N=38 (2 drops) randomized to

Experimental or Control

• Mother’s Age ave=25.7 (SD=4.8)
• Infant’s Age ave=4.8 month (SD=2.4)

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Participants

• Mother’s Race/Ethnicity

– 12.5% Hispanic, 2.5% American Indian, 5% Black, 12.5% Other

• Infant’s Race/Ethnicity

– 22.5% Hispanic, 5% American Indian, 2.5% Asian, 5% Black, 20% Other

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Participants

• Education

– 27.5% HS/GED & 42% Some College

• Employment

– 30% working (17.5% part) – 12.5% Looking for work – 55% not working by choice

• Marital Status

– 15% single, 45% married, 35% living together

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Participants

• Computer Familiarity

– 2.5% not at all – 15% somewhat – 30% moderately & – 50% Very

• Computer Comfortability

– 2.5% Not at all – 27.5 moderately & – 65% very

• 77.5% Computer Ownership

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0% 10% 20% 30% 40% 50% 60% 70% 80% 90% No, definitely not No, probably not Uncertain yes, Probably Yes, Definitely

Do you think the videos in the training sessions helped you learn the information? Would you recommend this website to a friend? During calls: coach understood me and baby

Satisfaction

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0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Very Difficult Somewhat difficult Uncertain Somewhat easy Very easy

How easy was it for you to use the InfantNet website to find information? How easy was it for you to understand the information (audio and text) provided in the training? How easy was it for you to use the camera to videotape your baby and you?

Satisfaction

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Infant Positive Behaviors Landry Observation Pre Post Experimental Control

p<.05 Medium/large effect size Eta-squared (η2)=.107 .01 ~ small .06 ~ medium .14 ~ large

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Parent Positive Behaviors Landry Observation Pre Post Experimental Control

p>.05 (ns) Medium effect size Eta-squared (η2)=.049 .01 ~ small .06 ~ medium .14 ~ large

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Usage: 393 hours (20.67 ave per parent)

Mid-4am 5am-11am noon-5pm 6pm-11pm

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Usage Hours by Participant

20.6 29.0 29.6 27.1 3.3 22.0 29.1 19.3 46.1 11.6 14.8 20.2 0.4 2.9 15.3 12.1 17.2 13.4 14.3 44.4 0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0 50.0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

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Usage Hours by Type and Session

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 01 02 03 04 05 06 07 08 09 10 11 Coach Call Video Discover Check-in Ques. Summary Daily Activity

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RCT: Baby Net

• Recruited from Early Head Start

waiting list, flyers, WIC office

• Targeted N=200 across 3 cohorts

randomized to Experimental or Attention-Control

• Projected demographics same except

Spanish speaking in Cohorts 2 & 3

• Coaches in 3 states and mothers in 2

states

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Attention-Control

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Development Awareness Skills (DAS)

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Parent Implementation Fidelity Checklist

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RCT Participants

• English only in Cohort 1 with Spanish

in Cohorts 2 & 3

• Aim for 30% Spanish-speaking
• Projected demographics same except

Spanish speaking in Cohorts 2 & 3

• Recruitment from Current Cohort 1 in

progress (N=47, Exp=18 [8 waiting], DAS=29)

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Cohort 1 Progress

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Baby-Net DAS Mean Time in Program 6.00 hrs (1.09) 3.51 hrs (.66) Levels complete 4.45 (1.01) 3.24 (.81) Social Network Log-Ins 4.20 (2.23) 5.45 (2.10) Parent Implementation Fidelity Checklist 3.04 (.75)

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Program Time per Levels by Condition

1:01:07 1:11:54 1:11:00 1:09:11 0:57:28 1:00:59 1:08:45 0:53:07 0:51:41 0:41:21 0:45:06 0:59:14 1:02:59 0:45:49 0:40:20 0:53:16 0:41:51 0:43:19 0:40:53 0:42:57 0:47:50 0:39:09 0:50:25 0:46:15 0:00:00 0:14:24 0:28:48 0:43:12 0:57:36 1:12:00 1:26:24 1 2 3 4 5 6 7 8 9 10 11 All

Baby Net DAS

Correlational Relationships

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Time in program Levels complete Social Network Log-Ins Parent Implemen tation Fidelity Checklist Time .82*** .39 .29 Levels .34 .18 SN Log-in .15

• Preliminary results – RCT in progress
• Social networking on small network difficult
• Small N – activity increasing with more people
• Competition from facebook
• Initial ratings of parenting does not relate to

use of SN

• Time in program does not relate to use of SN
• Future findings will explore demographic and
• ther factors relating to social networking

Discussion

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• Results very promising
• Need RCT with adequate power
• Extending the reach and penetration of

parenting interventions

• Emerging technologies

Handheld mobility iPhone & Wireless Internet access Voice recognition Convergence among technologies Implications for the Future

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Discussion and Questions