Supporting Strong Parent-Child Relationships through Increasing Fun Interactions: A Randomized Trial of a Group Home-Based Family Intervention on Zoom

Background:

The majority of American adults have experienced Adverse Childhood Experiences (ACEs) before age 18 (Felitti et al., 1998). ACEs predict a number of suboptimal outcomes in adulthood, including physical and mental health (Logan-Greene et al., 2014). Some research indicates that parents with more ACEs may be at-risk to have children with more ACEs (Schickendanz et al., 2021). Parenting is hard, and parenting after ACEs could be even harder. Recent surveys indicate that the majority of parents (62%) report that parenting is harder than they expected it to be, with 26% saying it is much harder (Minkin & Horowitz, 2023). Some research indicates that positive experiences for adults and children can buffer the impact of ACEs (Bethell et al., 2019; Bethell et al., 2023). The purpose of this project was to understand the impact of increasing positive interactions to improve the parent-child relationship and decrease negative parenting interactions with children.

Methods: The 12 week Better Together program was implemented at a community organization serving families with children. Families were randomly assigned to the treatment condition (N=28) or a waitlist control group (N=16; families in this group waited 3 months for the intervention). Treatment families met biweekly over 12 weeks (6 weeks participating in engaging activities on Zoom and 6 weeks learning more about child development in online video modules). Forty-four mothers (M age=30.54; white=98%; college or advanced degree=64%; married=91%; number of children=1.97; income < $40,000=48%; 0 ACEs= 27%; 4+ parental ACEs=18.1%) participated with their families. Child characteristics included M child age=3.01; 68% male; 0 ACEs=28%; 4+ ACEs=15.2%. Data were collected at baseline (for waitlist control group participants), pretest, posttest, and 3 and 12 months after the end of the intervention. Attendance was 88%. Measures included the Protective Factors Survey 2, the Outcome Questionnaire 45.2 (OQ 45.2), and the Emotional Availability measure.

Results:

Paired t-tests indicated that the Better Together program significantly improved parent-child relationships through increased nurturing and attachment on the Protective Factors Survey (Effect sizes .59 to .62), decreased parental hostility toward infants and young children on the Emotional Availability Scale (ES ranged from .34 to 1.01), and improved parents’ perceptions of their difficulties at home, school or work on the Outcome Questionnaire 45.2 Social Role subscale (ES ranged from .31 to .83) compared to the pretest scores at posttest, 3 months later, and at the 12-month follow-up.

Despite minimal staff-parent interaction because most of the interactions with parents occurred on Zoom as part of facilitating activities for parents and their children, an unanticipated finding was that the Protective Factors Caregiver and Parent Relationship subscale also improved significantly (ES ranged from .61 to .90). This is important, as Bethell and her colleagues learned that connection and support in adulthood predict positive well-being, even in the presence of ACEs (2023).

Conclusions: Focusing on building positive childhood experiences between parents and children may positively impact their relationship. Implementing universal programs that support positive family experiences could be a strategy to increase well-being in families, potentially decreasing the likelihood of ACE occurrences.