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

Internet-based infant-focused parenting intervention: Infant-Net 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 1

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 3 participation

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 4

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. 5

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Barriers to behavioral health services in rural areas: • Distance • Few professionals • Higher risk due to poverty & isolation 8

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Conceptual and Practical Advantages and Promises • Convenience cost, scheduling, transportation • Availability 24 hours, there when needed • Accessibility home, work, libraries, community centers • Ease of use even my mother uses it 13

Methodological Features • Control over exposure to intervention • Extensive online data on utilization, participant preferences, & content of all messages • Multiple measures of key processes and outcomes 14

Virtual Community Social Support Group Focus Forums Social Networking 15

Home visiting program for mothers of infants at risk (very low birth weight) • 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. 16

Website Components • 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 17

Play and Learning Series (Landry & Smith, 1996) 18

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 19

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Demonstration file://localhost/Users/edf/presentations/Lehigh_Feb2011/standalone.htm l . 25

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

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 31

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 32

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 33

Satisfaction 90% 80% 70% 60% Do you think the videos in 50% the training sessions helped 40% you learn the information? 30% Would you recommend this 20% website to a friend? 10% 0% During calls: coach No, understood me and baby definitely No, not probably Uncertain not yes, Probably Yes, Definitely 34

Satisfaction How easy was it for you to use the InfantNet 90% website to find 80% information? 70% 60% How easy was it for you 50% to understand the 40% information (audio and 30% text) provided in the 20% training? 10% How easy was it for you 0% to use the camera to Very Difficult videotape your baby and Somewhat Uncertain difficult Somewhat you? Very easy easy 35

Infant Positive Behaviors Landry Observation Experimental Control p<.05 Medium/large effect size Eta- squared (η 2 )=.107 .01 ~ small .06 ~ medium .14 ~ large Pre Post 36

Parent Positive Behaviors Landry Observation Experimental p>.05 (ns) Medium effect size Control Eta- squared (η 2 )=.049 .01 ~ small .06 ~ medium .14 ~ large Pre Post 37

Usage: 393 hours (20.67 ave per parent) Mid-4am 5am-11am noon-5pm 6pm-11pm 38

Usage Hours by Participant 50.0 46.1 44.4 45.0 40.0 35.0 29.6 29.1 29.0 30.0 27.1 25.0 22.0 20.6 20.2 19.3 20.0 17.2 15.3 14.8 14.3 15.0 13.4 12.1 11.6 10.0 5.0 3.3 2.9 0.4 0.0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 39

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

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 41 states

Attention-Control 42

Development Awareness Skills (DAS) 43

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Parent Implementation Fidelity Checklist 45

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) 46

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Cohort 1 Progress Baby-Net DAS Mean Time in 6.00 hrs (1.09) 3.51 hrs (.66) Program Levels complete 4.45 (1.01) 3.24 (.81) Social Network 4.20 (2.23) 5.45 (2.10) Log-Ins Parent 3.04 (.75) Implementation Fidelity Checklist 48

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

Correlational Relationships Time in Levels Social Parent program complete Network Implemen Log-Ins tation Fidelity Checklist Time .82*** .39 .29 Levels .34 .18 SN Log-in .15 50

Discussion • 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 51 other factors relating to social networking

Implications for the Future • 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 52

Discussion and Questions 53