Part 1: Needs Assessment

  • Describe in detail the population and setting with which you will work. Identify the public health problem. Use surveillance data to support the needs of the community. As appropriate, discuss the health disparities of your target community. (20 points)

In our society today there are fewer and fewer family dynamics that portray the image of the “traditional family” that one has come to know from the past. In fact, it is much more likely for an adolescent to come from a “non-traditional” family setting. But, nonetheless, adolescence still “marks a critical period in a young person’s life, one fılled with pivotal biological, cognitive, emotional, and social changes.”(Burrus 2012) Therefore the need to target the general term of “caregivers” in protecting adolescent health is an ever-growing necessity.

Adolescents have been known to be risk takers. Risk taking allows adolescents to learn about who they are and who they want to be. It can allow them to create some sense of identify in a sometimes unidentifiable world. Thus being said, some adolescents can take risk taking to a whole other level and actually become a danger to themselves and those around them because of lack of caregiver intervention and education. Some of the biggest categories of risk taking include those linked to Sexual behaviors, Injury and Violence, Tobacco Use, as well as behaviors related to Motor Vehicle Safety. “Approximately 72% of all deaths among adolescents are attributed to injuries related to motor vehicle crashes.” (Burrus 2012). “Illicit drug use has declined among adolescents, rates of nonmedical, prescription, and over- the-counter drug use remain high. ”(Burrus 2012) One in four teenage girls is currently infected with at least one sexually trans- mitted infection (STI).” (Burrus 2012) These are just a few examples of statistics that caregiver and adolescents are up against in our world today.

Person-to person intervention can help caregivers be able to help decrease an adolescent’s desire to take extreme risks. There is much evidence to suggest that caregivers still have important behavioral influence well into the adolescent years of their children. (DeVore ER, Ginsburg KR 2005). There is even more evidence to suggest how important parenting style, family factors, communication, parental monitoring, and supervision are in the way an adolescent develops and the type of risk taker they will be. This project will benefit adolescents who’s caregivers truly want them to be the best versions of themselves they can be. This project will be beneficial across the United States, but specifically in the low income/ poorly educated areas such as the suburbs of NYC where caregivers can often times struggle to raise children in a crime ridden area. For example, those caregivers who live in Paterson, NJ, a suburb of NYC, are fighting a constant battle. Census Data from 2000 states that almost 14% of families live below the poverty line, and 10% of the families survive financially off of some type of Public Assistance Income. Caregivers in this area also struggle keep their kids in school with the 1999-2000 school dropout rate of 19.4%. (Passaic County Health Status Indicators Report, 2005) This project will target diverse communities who have caregivers with children under 18 and will preferably include those specifically who’s children are at 11-12 years of age to provide the most success. The intervention will occur outside of a clinical realm.

  • What stakeholders may be needed along the way? Describe the role of each stakeholder, and the questions they may want answered about the intervention. Also briefly describe how a successful intervention would impact that stakeholder, and how an unsuccessful program might impact that stakeholder. Stakeholders may be individuals, groups, or organizations. (20 points)
StakeholderRole in InterventionQuestions from StakeholderEffect on Stakeholder of a Successful ProgramEffect on Stakeholder of an Unsuccessful Program
Community CenterHosting classes/ providing meeting spaces-How much of the cost will be on us?

-How will this program benefit our community?

-What materials do we need to provide  for this project?

-Decrease in amount of high risk adolescents in community

– Increase in education of community

– time and resources lost

– no change in adolescent risk behavior

Middle School

Administration

Hosting classes/providing meeting spaces, providing information to help gather participants -How much of the cost will be on us?

-How will this program benefit our students/parents?

What materials will we need to provide for this project?

-Will this project interfere with school hours?

-Decrease in amount of high risk adolescents in school

– Increase in education of parents in community

-Increase in Parental involvement in school

– Time and resources lost

– No change in adolescent risk behavior

-No increase in parental involvement 

DFCS (Division of Family and Children Services)Providing Info/ Funding. Providing experts in area to be teachers.What will DFCS have to do for this project?

– What kind of time commitment will our expert need to plan on committing to?

What type of materials/how much funding is needed from usDCFS?

– Will be able to combine prevention efforts with other agencies

-Decrease in amount of high risk adolescents in community

-Create better family relationships

– Will need to continue their own prevention project

– No change in adolescent risk behavior

-Could be viewed as a wast of time and resources.

The National Resource Center for Child Protective Services (NRCCPS)Providing Info/ Funding. Providing experts in area to be teachers.What will NRCCPS have to do for this project?

– What kind of time commitment will our expert need to plan on committing to?

What type of materials/how much funding is needed from NRCCPS?

– Will be able to combine prevention efforts with other agencies

-Decrease in amount of high risk adolescents in community

-Create better family relationships

– Will need to continue their own prevention project

– No change in adolescent risk behavior

-Could be viewed as a wast of time and resources.

DCF (Department of children and families)Providing Info/ Funding. Providing experts in area to be teachers.-What will DCF have to do for this project?

– What kind of time commitment will our expert need to plan on committing to?

What type of materials/how much funding is needed from DCF?

– Will be able to combine prevention efforts with other agencies

-Decrease in amount of high risk adolescents in community

-Create better family relationships

– Will need to continue their own prevention project

– No change in adolescent risk behavior

-Could be viewed as a wast of time and resources.

NIDA (National Institute on Drug Abuse for Teens)Providing Info/ Funding. Providing experts in area to be teachers.-What will NIDA have to do for this project?

– What kind of time commitment will our expert need to plan on committing to?

What type of materials/how much funding is needed from NIDA?

– Will be able to combine prevention efforts with other agencies

-Decrease in amount of high risk adolescents in community

-Decrease the amount of Substance abuse

-Decrease in drug abuse tendencies.

-Decrease in Drug related adolescent teen injuries, hospitalizations and deaths.

– Will need to continue their own prevention project

– No change in adolescent risk behavior

-No change in drug abuse tendencies or numbers amongst  teens.

-Could be viewed as a wast of time and resources.

US Dept. of HHS (office of adolescent and teen health)Providing Info/ Funding. Providing experts in area to be teachers.-What will Dept. of HHS have to do for  this project?

– What kind of time commitment will our expert need to plan on committing to?

What type of materials/how much funding is needed from NIDA?

– Will be able to combine prevention efforts with other agencies

-Decrease in amount of high risk adolescents in community

-Increase overall health of adolescents

– Will need to continue their own prevention project

– No change in adolescent risk behavior

-Could be viewed as a wast of time and resources.

SIECUS (Sexual information and education council of the united states)Providing Info/ Funding. Providing experts in area to be teachers.-What will SIECUS’ have to do for this project?

– What kind of time commitment will our expert need to plan on committing to?

What type of materials/how much funding is needed from SIECUS?

– Will be able to combine prevention efforts with other agencies

-Decrease in amount of high risk adolescents in community

-Decrease the amount of STI in adolescents

-Increase in sexual health education

-Decrease in teen pregnancy 

-Increase in pathways of communication techniques for a difficult subject

– Will need to continue their own prevention project

– No change in adolescent risk behavior

-No decerase in sexual behaviors of adolescents 

-Could be viewed as a wast of time and resources.

CDC (centers for disease control and prevention)Providing Info/ Funding. Providing experts in area to be teachers.-What will the CDC have to do for this project?

– What kind of time commitment will our expert need to plan on committing to?

What type of materials/how much funding is needed from the CDC?

– Will be able to combine prevention efforts with other agencies

-Decrease in amount of high risk adolescents in community

-Increase physical health of adolescents

-Increase education of elements of disease prevention amongst adolescents

– Will need to continue their own prevention project

– No change in adolescent risk behavior

-Could be viewed as a wast of time and resources.

-No change in ability to control or prevent disease in adolescents

MVA (Motor vehicle association)Providing Info/ Funding. Providing experts in area to be teachers.-What will the MVA have to do for this project?

– What kind of time commitment will our expert need to plan on committing to?

What type of materials/how much funding is needed from the MVA?

– Will be able to combine prevention efforts with other agencies

-Decrease in amount of high risk adolescents in community

-Decrease amount of auto accidents and reckless incidents

– Increase motor vehicle  safety

-increase motor vehicle education 

– Will need to continue their own prevention project

– No change in adolescent risk behavior

-Could be viewed as a wast of time and resources.

-No change in motor vehicle safety and education.

-Continuous increase in amount of auto accidents and MV deaths

Caretakers of Adolescent childrenParticipants-What is the cost of participating in the program?

-What is the time commitment for participating in the program?

-Will I be able to better communicate with my child/children after this program?

-What benefits will this program provide me with when completed?

 

-Increased ways of communication with adolescent.

-Increased education on common tendencies and social health of adolescents. 

-Able to form better relationships with their children.

-Better ability  to raise healthy children in a poverty and violence stricken community.

-Caretakers could view program as a waste of their time or not important.

-Will not be able to increase communication with their child.

– No change in adolescent risk behavior.

 

Part 2: Intervention Identification

  • State and define the intervention strategy – what does it mean? What populations has this strategy been used with? What settings has it been used in? How are your community characteristics similar or different to those of the communities in which the strategy has been effective? (20 points)
  • Is the strategy recommended by the Task Force? Why or why not? (10 points)
  • Provide at least 3 examples from existing articles (peer-reviewed preferably, but could come from other places). These should be different than the research-tested intervention programs(RTIP) listed already. You can include or link to this information, but you should provide different examples. (45 points total)
    • Describe the intervention – what did the authors do? What was the procedure? How long was the intervention? Please describe individual components as well as the broader intervention plan.
    • What were the outcomes measured?
    • What amount of change did they find?

 

  • The intervention strategy that I chose is Improving Adolescent Health: Person-to-Person Interventions to Improve Caregivers’ Parenting Skills. This strategy deals with developing person-to-person interventions between caregiver and adolescents that help to address the risk behaviors and certain health outcomes when caring for an adolescent. This intervention aims to significantly improve caregivers parenting skills and therefore reduce traditional risk factors associated with growing adolescents in our society. The intervention strategy has mostly been studied and found effective in adolescents between the ages of 11-15 and caregivers between the ages of 30-40. It is likely that the the strategy has been found to be most effective during the pre-teen and early adolescent ages, because it is a transitional period of time in their lives where they are unsure of the next step and may seek more advice, than those who are in their older teenage years and try to be self sufficient. The strategy has been studied across multiple different races and has been used in lower income and poorly educated areas across the United States. I have chosen the surrounding suburbs of NYC as my community, which is extremely similar to locations where the strategy has been proven to be effective. The surrounding suburbs of NYC are extremely culturally diverse, and usually have low income poorly educated families who are challenged with raising adolescents in a healthy and safe environment. Because of the lack of funds and diverse cultures in the area, the schools within these suburbs tend to “function” on the lowest budget possible therefore not being able to provide optimal learning experiences and resources. These schools also are predominantly made up of  children with diverse ethnic backgrounds, with White children being the minority, and Black and Hispanic/Latino children being the majority. (Passaic County Health Status Indicators Report, 2005)
  • The Task Force completed a systematic review of 12 different articles to determine their recommendation for this intervention. Their findings for the person to person intervention provided sufficient evidence for it to be recommended.(Am J Prev Med 2012) This recommendation was based on the task force findings that the intervention provided “sufficient evidence of effectiveness in reducing adolescent risk behaviors.” The intervention has been shown to effect many different aspects that caregivers will experience while raising an adolescent including: sexual behaviors, violence, delinquency, hyperactivity, suicide, and self-harm, alcohol, tobacco, and other drug use, behaviors related to motor vehicle safety, and teen pregnancy. The task force also found that this intervention is extremely beneficial because, “adolescents who have one risky behavior are more likely to engage in multiple risky behaviors, improving their caregivers’ parenting skills can have a cross-cutting impact on a variety of teens’ risk and protective behaviors.

Below are three different studies that utilize a caregiver intervention to improve adolescent health.

  • A cognitive–behavioral parenting intervention reduced problem behaviors in at-risk preschool children and improved parenting skills in socially disadvantaged families
    • The intervention was provided to parents in a weekly 2-hour, small group sessions. The sessions lasted for 12 weeks. The training sessions included topics such as praise and incentives, relationship building, limit setting, non-aversive management strategies for non-compliance and gentle consequences for problem behavior. The program used role-play, discussion, modeling, videotapes of family behavior, and skills practice as their method of distributing and explaining their intervention to their participants. The intervention was a blind RCT that used the Webster-Stratton’s Incredible Years Basic Parenting Program. The study was completed in the Wales, UK and included 153 families from low socioeconomic area.
    • The study measured outcomes including Child problem behavior, positive critical parenting, and child deviance behavior. At the follow-up period of 6 months, the parenting (experimental) group had greater reductions in children’s problem behavior and showed more positive parenting behaviors. But, there was no difference between the control and experimental group when looking at child deviance behavior. Overall, the study found that a community based parenting program reduced behavior problems in pre-school children while also improving parenting skills in families from low socioeconomic areas.
  • Community-based parenting training: do adapted evidence-based programs improve parent–infant interactions?
    • The intervention consisted of an attachment-focused parent-training program. The program in this study was a modified version based on the “Right from the start” (RFTS; Niccols et al., 2001) intervention of a previous study. The authors state, “The primary goals of RFTS are to increase maternal sensitivity and infant security.” The intervention was part of an RCT in which those who attended the RFTS program were compared to ones who did not attend as well as those receiving home visiting support. Participants included 18 mothers and 4 grandmothers. The modified RFTS intervention classes were offered at a community based children’s treatment center. The intervention classes were 1.5 hours long once a week for 8 weeks. The class was taught in a very spacious friendly, community centered environment by two childhood therapists. There were originally 25 participants in the study but two were eliminated before analysis because they missed more than two sessions of the program.
    • The study measured outcomes maternal sensitivity, cognitive growth fostering, parenting stress, and caregiver confidence. Overall, the modified intervention not successful in increasing maternal sensitivity, which was their main goal. But, The intervention did decrease parenting stress, as well as increase both growth fostering and caregiver confidence.
  • Efficacy of a Self-Administered Home-Based Parent Intervention on Parenting Behaviors for Preventing Adolescent Substance Use 
    • The intervention consisted of a program that aimed to address risk factors that effect substance abuse. The Program was called the Life Skills Training (LST) Parent Program. The program was 15-sessions long that was meant to last 15 weeks. LST was designed to be a flexible method of intervention that parents could complete in the comfort of their own home and was meant to be used without school-based prevention programming. The program is divided into four sections and includes a parenting skills DVD and a written guide with homework questions. The four sections include an introductory section, a protective family factors section, a general life skills section, and a resource section. The sample of parents in the study largely included females who were middle aged, married, white, and highly educated.
    • The study used five different questionnaires as outcome measures. The questionnaires included a Parental Role Modeling Scale, Parental Discipline Scale, Parental Communication Scale, Parental Monitoring Scale, and an Anti-Drug Message Scale. The results indicated that the LST Program resulted in positive changes in parenting outcomes including higher scores on the role modeling, parental disciplinary, parental communication, and parental monitoring scales. The parents in the study felt that this intervention was successful in gaining education and the correct advice on how to do their part in helping to prevent adolescent substance abuse.

 

Part 3: Intervention Fit

  • Provide a logic model and SMART Objectives for your intervention. You should have a SMART objective for each behavior you anticipate changing. (35 points; 10 points for SMART objectives, 25 points for the logic model)

 

SMART Objectives and Behavior Changes

Behavior Change: Increase caregiver’s ability to effectively communicate with at-risk adolescents in the suburbs if NYC.

SMART Objective: By the end of the 15-week program participants will note at least a 25% increase in their communication/eduability as compared to the value on the pre-program survey.

Behavior Change: Decrease risk tendencies in at-risk adolescents because of caregiver education.

SMART Objective: 3 years after the beginning of implementation of the 15 week program, risk tendencies of adolescents within the suburbs of NYC will decrease by 30%.

Behavior Change: Strengthen relationships between at-risk adolescents and their caregivers.

SMART Objective: 3 years post completion of the intervention 50% of caregiver’s will report an increase in their relationship with their adolescent.

Behavior Change: Creation of supportive caregiver communities within suburbs for advice and ideas.

SMART Objective: 6 Months post first intervention, 40% of those who completed the course will still be in supportive contact with other caregivers who took the course.

Logic Model 

Inputs/Resources Activities OutputsShort-term OutcomesIntermediate OutcomesLong-term Outcomes
Funding- DFCS, NRCCPS, DCF, NIDA, UD Dept. of HHS, SIECUS, CDC, Motor Vehicle Association

Personnel – Program Moderators, Program Educators, School Administration

Materials- Handouts DVD’s,

Equipment- Interactive workbooks/manuals, example props (different drugs/alcohols/etc.)

Space- classrooms and open space for role-plays and discussions. Local School and/or Community center.

Relationships- Coordination and communication between different program educators

 

Coordination and planning between program moderators and program educators.

 

Coordination and Planning between Program moderators and School Administration for use of the building.

 

 

– Caregiver participants will meet 1 time per week for 15 weeks.

– Each week the caregivers will be expected to do two things for homework. The first is to write down examples of interactions they had with their children that fit with the topic they learned about the previous week, as well as watch the 20-minute DVD segment (for the appropriate topic) for the upcoming week.

– Each week the first 30minutes of class will be role-play/discussion on the previous week’s lesson. Followed by a 5 minute break, and then the last 25 minutes will be the current weeks lesson.

– 15 1-hour educational sessions.

– 15

20-minute video segments on each lesson

– Each caregiver will receive 1 DVD and interactive workbook for the class, as well as supplemental handouts each session.

 

-Increased Participant awareness for the need for and importance of communication between caregivers and adolescents.

– Increased Caregiver awareness of risk behavior tendencies of adolescents.

-Increased Caregiver awareness of topics effecting adolescents.

-Moderate communication between caregivers and adolescents

– Caregivers beginning to implement knowledge learned in sessions

-Beginning to build a caregiver adolescent relationship

-Increased caregiver confidence and skill set

-Increased presence of caregivers in adolescent’s every day life.

– Increased Caregiver/Child Communication

– Decreased adolescent substance abuse because of caregiver involvement and education.

– Decreased adolescent sexual behavior and violent tendencies because of caregiver involvement and education

– Adolescent grows to trust/ confide in caregiver with tough decisions.

– Increased adolescent ability to avoid choosing risky behavior because of caregiver involvement.

 

 

Explain the logic of why this intervention may work. For example, why would teaching children about healthy eating change their actual eating behaviors? Or why would adding sidewalks increase physical activity for transportation or recreation? (15 points)

This intervention has the ability to work because it focuses largely on education and communication. It provides a safe space for interested caregivers to come and learn how to be able to effectively communicate with their child. (Griffin, Samuolis, Williams 2010) The participants are able learn the information needed in both media and lecture formats and then able take what they have learned and role-play and discuss any questions or roadblocks they foresee to be able to better apply it to their situation/child.(Hutchings, Bywater, Daley 20017) This intervention is logical because it provides opportunities for the caregivers to re-call things they have learned from the previous session and then apply it to their own experiences. This allows them to not only retain what they have learned but also helps them on how to apply it in the future. It creates an avenue for them to grow, learn and become confident in their ability to communicate and have a positive impact on the child’s life. (Bohr 2009)

Discuss limitations of the selected strategy, and things to look out for/be mindful of along the way. Examples may be limitations of resources, community capacity, or anticipated effect of the intervention. (15 points)

A major limitation to this study is definitely attendance. This strategy will work very well for those who are extremely interested and committed to it and attend all sessions. But it is very possible that those caregivers in low-income/at-risk areas may face a multitude of scheduling conflicts it is childcare, work, or any other conflict that may arise. Another could be community participation. Caregivers may feel that they are doing a phenomenal job with their children and may not feel the need to participate in this intervention despite the research that says otherwise. Finally another limitation to this study is the children involved. The caregivers may do their best and complete the 15-week sessions and learn all they can about effectively communicate, but unfortunately they just may not be able to do enough to positively effect/change some adolescents.

What data would you collect to know if you are implementing the strategy the way it was intended (process evaluation/implementation monitoring)? Refer back to your logic model and the Logic Model module as needed. Be sure to cover dose, reach, fidelity, and implementation. (40 points)

It is extremely important to determine if this intervention is working, as we are dealing with increasing the safety of children in at-risk communities. First, this program would need to be assessed to determine if it is effectively reaching the population and communities it is intended to, as well as if sessions were including the activities and content it was meant to. For this intervention the best way to determine that would be to look at behavior trends across adolescents who have caregivers that have taken and effectively completed the classes compared to those who live with caregivers who have not.  It also would be beneficial to have a community/program director at each session to make sure the all aspects of the class are being delivered appropriately. Each community/program director will be given a program policies and procedures hand book which will include a content check list which they will complete weekly  to make sure that all aspects of the program are being delivered to the participants appropriately.  I think it also would be important to evaluate the dose including the attendance rate, retention rate, and population characteristics of those who attend/complete the intervention sessions. This will allow us to determine trends in what types of caregivers attend, if 15 1-hour sessions is feasible and if the caregivers feel that the classes and knowledge they are gaining is beneficial and worth their time of completing all of the sessions. In order to determine fidelity and implementation it would be helpful to log attendance, as well as have participants fill out a survey at both the beginning and ending of the 15 weeks it would be beneficial to have the initial survey include participants’ expectations and base knowledge about the topics as well as demographic information. At the end of the sessions it would be beneficial to again asses their knowledge and the same topics assess prior to the class, as well as their recommendations for the future as to what they liked/did not like about their overall experience and what could be improved to make their experience better.

Part 4: Reflection

Oftentimes when working with communities, the initial plan is not what ultimately happens. What would your second choice strategy be for your identified behavior and community? Why would you choose this strategy? In other words, in what ways would this strategy also address the needs of the community based on your assessment for Part 1? (25 points)

My second choice strategy would be a strictly media/informational strategy to help improve caregiver/parenting skills. While developing my first strategy a two major limitations I could think of were first, time commitment that these caregivers would have to give to complete the modules, as well as some caregivers not feeling comfortable or confident enough to be a part of an in person community wide strategy. This strategy would likely include some form of monthly newsletter with general information similar to each lesson the participants would attend weekly in my first strategy. I think it would be beneficial to also within each newsletter provide information on how parents could obtain more materials, such as the DVD used in the first strategy and/or a additional supplemental handout with more information on how to effectively communicate with those adolescents they care for as well as common struggles adolescents face. I would also possibly include media sources such as commercials/billboards and parenting radio shows. and options within each newsletter. This strategy would eliminate a specific time commitment limitation. Those who wished to, could read the information on their own time and at their own pace. I also think it would benefit those caregivers who may not come to the in person strategy because of feelings of anxiety of discussing their caregiver skills (or lack there of) in front of others. I also think that a much more public strategy like this has the potential to reach certain caregivers that would have never even considered taking part in my first strategy. The second strategy would still fulfill the major needs for education and communication on/about adolescent health topics that caregivers in these populations lack.

Reflect on how you may use the Community Guide, Nutrition Education Library, and other resources in the future. What did you like about these resources? What didn’t you like? Provide suggestions on how you would make the sites easier for practitioners to use. (20 points)

It was very interesting to use the Community Guide as their website was going through the process of changing. When first using the Community Guide while completing the beginning parts of the project with the older website format/set-up I did not think it was as easy to use or as visually friendly. With the website update, that I was able to use while completing Part 3 of my project, I thought that the Community Guide was an extremely helpful, visually friendly, and easy to use resource! In the future, I will definitely keep the Community Guide in my list of resources. I also felt the way that the Task Force presented their findings and relayed their information was extremely informative and easy to follow for anyone who was reading it. I feel that some aspects of the Community Guide do not directly relate to my profession, but there are also parts that may be helpful when dealing with certain athletes on a case by case basis including those who may suffer from asthma, as well as excessive alcohol consumption, STIs and Pregnancy as well as Mental Health. I think one of the main things that the Community Guide site could improve on would be to possibly include a either a frequently asked questions page or a online chat feature for each Topic page that they have on their website. I fell that this feature would help to provide readers, (whether healthcare providers or general public) the opportunity to fully understand the content for the topic they are focused on and allow them to put the recommendations into practice appropriately.

 

References:

Burrus B, Leeks KD, Sipe TA, Dolina S, Soler RE, Elder RW, Barrios L, Greenspan A, Fishbein D, Lindegren ML, Achrekar A, Dittus P, Community Preventive Services Task Force. Person-to-person interventions targeted to parents and other caregivers to improve adolescent health: a Community Guide systematic review Am J Prev Med 2012;42(3):316-26.

Community Preventive Services Task Force. Improving adolescent health through interventions targeted to parents and other caregivers: a recommendation. Am J Prev Med 2012;42(3):327-8.

DeVore, and Ginsburg. “The Protective Effects of Good Parenting on Adolescents.” Current Opinion in Pediatrics. U.S. National Library of Medicine, 17 Aug. 2005. Web. 29 Nov. 2016.

Hutchings J, Bywater T, Daley D, et al. Parenting intervention in Sure Start services for children at risk of developing conduct disorder: pragmatic randomised controlled trial. BMJ 2007;334:678.

Bohr, Halpert, Chan, Lishak, and Brightling. “Journal of Reproductive and Infant Psychology.” Community‐based Parenting Training: Do Adapted Evidence‐based Programmes Improve Parent–infant Interactions?: Journal of Reproductive and Infant Psychology: Vol 28, No 1. N.p., 13 Nov. 2009. Web. 29 Nov. 2016.

Griffin, K.W., Samuolis, J. & Williams, C. J Child Fam Stud (2011) 20: 319. doi:10.1007/s10826-010-9395-2

Peters. “Passaic County Health Status Indicators Report.” Passaic County Department of Health on Behalf of the Passaic County Governmental Public Health Partnership. Oct. 2005. Web. 29 Nov. 2016.