Adolescent Health: Person-to-Person Interventions to Improve Caregivers’ Parenting Skills
Findings and Recommendations
The Community Preventive Services Task Force (CPSTF) recommends person-to-person interventions intended to modify adolescents’ risk and protective behaviors by improving their caregivers’ parenting skills based on sufficient evidence of effectiveness in reducing adolescent risk behaviors. These interventions are conducted either face-to-face or by telephone and occur outside of clinical settings.
The full CPSTF Finding and Rationale Statement and supporting documents for Improving Adolescent Health: Person-to-Person Interventions to Improve Caregivers’ Parenting Skills are available in The Community Guide Collection on CDC Stacks.
Intervention
Parenting interventions have the potential to affect a variety of adolescent risk behaviors and associated health outcomes. The interventions addressed in this review are designed to modify adolescents’ risk/protective behaviors and health outcomes by improving their caregivers’ parenting skills through direct personal contact between the intervention provider and the caregiver using information or behavioral strategies.
About The Systematic Review
The CPSTF finding is based on evidence from a systematic review of 12 studies (search period January 1980 – August 2007).
The review was conducted on behalf of the CPSTF by scientists from Research Triangle Institute, Intl., through a contract mechanism and with input from a team of specialists in systematic review methods and experts in research, practice and policy related to adolescent health.
Study Characteristics
- Common elements across all interventions:
- Education component
- Discussion component
- Opportunity for caregivers to practice new skills
- Educational topics varied and included:
- Communication strategies
- Parental monitoring recommendations
- Specific topics such as teen sexual behaviors with guidance on approaching adolescents
- Delivery formats: Group sessions or one-on-one training targeting caregivers only, or caregivers and adolescents together or separately
- Participants: Volunteers sufficiently motivated to attend
- Setting: Majority of studies conducted in the United States
Summary of Results
Twelve studies qualified for the review.
- Outcomes assessed:
- Sexual behaviors (7 studies)
- Violence, delinquency, suicide, and self-harm (4 studies)
- Alcohol, tobacco, and other drug use (7 studies)
- Behaviors related to motor vehicle safety (1 study)
- Teen pregnancy (2 studies)
- Individual studies findings
- Outcomes varied substantially
- Most estimates of effect favored the intervention but were not statistically significant
- Meta-analysis findings:
- Approximately 20% reduction in overall set of risk behaviors evaluated (p<.05)
- Sexual behavior: RR=0.69 (95% CI 0.50, 0.94), approximately 30% decrease
- Violence: RR=0.68 (95% CI 0.49, 0.94), approximately 30% decrease
- Substance use: RR=0.87 (95% CI 0.73, 1.04), not statistically significant
- Youth reported increased refusal skills and self-efficacy for avoiding risky behaviors
Summary of Economic Evidence
An economic review of this intervention did not find any relevant studies.
Applicability
Results should be applicable to diverse populations and settings (including communities, homes, and schools) provided appropriate attention is paid to adapting the intervention to the target population.
Evidence Gaps
- What types of person-to-person formats lead to the greatest effectiveness in adolescent health outcomes?
- What types of caregiver behaviors, if changed, can lead to the greatest reduction or improvement in adolescent risk-taking behaviors?
- For what types of caregiver are these interventions most effective? As noted, the caregivers in these included studies were sufficiently motivated to participate. In addition, questions remain as to whether this intervention would work consistently well across all caregiver types. Specifically, are there types of caregivers for whom caregiver interventions will have no appreciable effect overall?
- Are certain types of caregiver-targeted interventions more effective in creating change for certain risk or protective behavior outcomes than others? Are there types of risk behaviors on which these interventions have only a minimal effect?
- How does the “problem behavior” construct hold up in terms of behavior changes within adolescents? For example, if one risk behavior changes for an adolescent, how likely are other risk behaviors to be affected?
- Once caregivers have received a targeted intervention, can they successfully extend the behaviors and skills to other children, so that potential benefits can be derived for those adolescents as well?
- Is there an optimal age of the child at which, or by which, a caregiver needs to have received the intervention to achieve the desired effects?
- What is the economic cost for these types of interventions?
Implementation Considerations and Resources
- It may be inadvisable to place high-risk youth together in groups, particularly without directly involving caregivers in the setting. Some studies noted potential for negative outcomes when adolescents gathered without caregivers present.
- Potential barriers include recruiting and retaining caregivers whose participation may be limited by time, transportation, childcare, or other constraints.
- Additional benefits include improvements in proximal outcomes, such as improved caregiver-child communication, which may lead to long-term improvements in outcomes such as improved school performance.
- Benefits also were reported for adolescents who did not directly participate in the intervention.
Crosswalks
Healthy People 2030 includes the following objectives related to this CPSTF recommendation.