Keeping Kids Safe - Pandemic Challenges

National and international experts are expressing grave concerns about increases in child abuse during the COVID pandemic. Parenting stress has increased significantly due to economic hardship, uncertainty for the future, and social isolation. 

The ACT Raising Safe Kids program is an educational prevention program focusing on parents of children from birth to age 10. The program teaches positive parenting skills with the goal of creating safe, stable, and nurturing environments and relationships.

Prior to the pandemic, ACT was being implemented through in-person groups across the US and in several other nations. With this funding, the project could resume using a remote implementation model, which would benefit children and parents worldwide. Program staff will assess the feasibility and effectiveness of the current model and identify any needed modifications for remote implementation. Development of an implementation guide for facilitating ACT remotely to be disseminated internationally for future remote implementation will be created.

In a study with parents done early in the pandemic, most were already worried about money [paying bills (50%) and money running out (55%; Lee & Ward, 2020)]. Rates of yelling at children were very high, with 61% of parents reporting they yelled at their children at least once in the past 2 weeks (Lee & Ward, 2020).  Furthermore, 1 in 5 spanked or slapped their child at least once in the past 2 weeks. Most parents said financial concerns, social isolation, and job insecurity were affecting their parenting.  Parents are spending more time with children with less respite from the usual caregivers such as childcare workers, causing stress. Parents who are helping their children with schoolwork, often using unfamiliar technologies, are very stressed. These factors are likely to significantly increase negative parent-child interactions, and may significantly increase the risk of harsh punishment, abuse, and neglect. This is in keeping with evidence from the Ebola Crisis that suggested that parents facing sickness and death were more likely to choose harsher discipline strategies (Green, Chase, Zayza, Finnegan & Puffer, 2018). In addition, limited contact between children and various professionals during the pandemic provides less opportunity for child maltreatment identification and reporting.

In addition to traditional aspects of parent training, the ACT program addresses media literacy. Parents are taught the dangers of media exposure to children and develop methods to monitor and limit children’s access to problematic media. The FBI (FBI National Press Office, 2020) is currently warning about online exploitation of children who are increasingly exposed to media and the internet, recommending education for parents about online child exploitation, and suggesting parents increase monitoring and educate children about internet safety. Many aspects of the ACT media literacy education are consistent with the FBI’s list of recommended topics to address with parents to prevent media-based abuse and exploitation of children. The ACT program is one of few child abuse prevention programs to directly address harsh of children and teach parents effective alternatives. Given the reported high rates of harsh punishment already evident during this pandemic, this content is critical. The social distancing made necessary by the epidemic has effectively shut down ACT programs in the US. This is concerning given that this is a time when parents likely need it the most. The proposed project will allow for remote implementation and research of the ACT Raising Safe Kids program. 

The target population of the ACT Program is parents and caregivers of children from birth to age 10. It is designed to serve as a universal intervention for all parents and caregivers of young children, regardless of risk or background. Materials are culturally sensitive and based on research and translated into several languages. Participants are taught about child development, including learning what the child may be feeling and understanding at different stages; the importance of creating a strong and healthy bond with their child(ren), and positive research-supporting parenting skills that will help reduce the risk of abuse to the child(ren). By helping parents to better understand how their child thinks and feels at different stages of development and arming them with tools designed to address issues that come up during these stages, they are better able to handle the stressors of parenthood. These stressors can be amplified during the current pandemic situation and the need for the program to be implemented remotely is clear. Remote application also allows participants to be involved regardless of geographical location, which will help further global expansion. 

The challenge of health security and pandemics is addressed by implementation of ACT. Child abuse and neglect are global health issues. Research shows that during crises such as the current global pandemic, the risk of child abuse and neglect is increased. This is especially concerning because children are not spending time with professionals such as teachers and childcare workers, who commonly are reporters of child abuse neglect. Providing parents with tools and education that is research-proven to reduce risk of abuse is crucial. Global remote implementation of the ACT Program will help to make children and families safer and happier. 

There are many organizations dedicated to child abuse prevention. While there are no "competitors" of this program, ACT has unique educational components that make it stand out. ACT helps to utilize resources from evidence-based practices around the globe; one of its core objectives is to create a community of learners contributing to reduce violence in communities. ACT Facilitators are highly trained specialists and dedicated to reducing child abuse and neglect and improving the lives of families. 

Child abuse is the result of multiple factors, and the program curriculum consists of eight group sessions designed to address these complicated roots of abuse. The sessions include: Learning Child Development and Understanding Children’s Behavior, Young Children’s Exposure to Violence, Understanding and Controlling Parents/Adults’ Anger, Understanding and Helping Angry Children, Children and Electronic Media; Discipline and Parenting Style, Discipline for Positive Behaviors, and Parents as Teachers, Protectors and Advocates at Home and in the Community.

ACT was developed by a nationally recognized professional organization, the American Psychological Association. It has been evaluated and has strong evidence supporting its effectiveness. The lead of this proposal team, Dr. Michele Knox, is a nationally-recognized expert in the field of child abuse. Dr. Knox is currently taking part in a work group established by the American Psychological Association to adapt the ACT Program for remote implementation and potential adaptions of the program’s activities.  The project proposed in this application will provide the necessary next step of disseminating the program globally while examining its feasibility and outcomes.  

Technology needed for the remote expansion of this program varies, depending on the resources of the families, agencies, and/or locations participating. For remote application of ACT, participants will need internet access and a device that will allow group participation via video and audio; for example, a smart phone, tablet, desktop or laptop with video and audio capabilities. Without this ability, the program would lose it's interactive component and be far less personal. Program materials and curriculum are already developed; the dissemination of these materials is made much easier by use of technology.

The use of virtual classrooms, support groups, and other "online" learning has been in existence almost as long as the internet. For example, online education began to surface in 1989 when the University of Phoenix became the first institution to offer internet-based classes (Kentnor, 2015). Most colleges and universities offer some form of online classes today. 

Various platforms have been used since the onset of online learning, and even more options still exist today including Canvas, Blackboard, and Microsoft Teams. 

Internet-based support groups have become even more useful in today's post-COVID-19 world, offering support and help for people without the need to leave home. Being able to provide mental health services to those who need it, without increasing risk of coronavirus exposure to both the provider and the patient, has become increasingly valuable. 

The ACT Program takes advantage of the benefits of online learning, and virtual support groups, to offer both education and support to participants.

From 2012-2016, more than 8,000 parents/caregivers have attended ACT parenting classes. While the pandemic has put in-person trainings on hold, implementation of remote trainings will allow for continued successes. Removing the barriers of transportation and access can lead to an increased number of participants. Based on the 8,000 families impacted from 2012-2016, and expansion into previously uncharted locations, it is reasonable to predict outreach to another 10,000 families within the next five years.

The milestones involved in the next year of this project are as follows: 

1. The first month will be devoted to writing a research protocol to submit to our Institutional Review Board (IRB), identifying Facilitators, providing orientation for facilitators, and disseminating materials.
2. The next month will be devoted to completion of pre-program measures, recruitment of group participants and starting the parent groups.
3. The next seven months will be devoted to facilitating groups and collecting post-program data from parents and Facilitators. 
4. Focus groups will be completed over the course of the following month.
5. The last two months will be devoted to data entry, analysis, creation of an implementation guide for remote implementation, and submission of the manuscripts.

Milestones:

• Sessions conducted, facilitators trained, and participants recruited (at 1 year)
• Number of parents who complete the program and number of children affected (at 1 year)
• Evaluation and publication of all data collected (at 1 year and beyond)
• Implementation manual completed (at 1 year)

Outcomes to be measured over the next five years include both qualitative and quantitative data collection. 

Facilitators will complete the following:

• Demographic Questionnaire
• ACT Feasibility Checklist
• ACT fidelity checklist
• Journals documenting observations, barriers, and successes at each session
• Qualitative data will be collected through facilitator focus groups after parent groups have been completed. 

In order to collect data about changes to parenting behaviors and knowledge, parents will complete the following: 

• ACT Parent Feedback Measure
• ACT Raising Safe Kids pre/post-program evaluation for parents
• Parent Behavior Checklist. 

The major barrier to global implementation of the ACT Program is navigating through the COVID-19 pandemic. Fortunately, this can largely be solved by shifting to remote implementation and participation of the program. Finances related to the staffing hours of this shift to remote application, as well as addressing any technological deficits or needs of program participants, are also potential barriers.

Receiving funding to address the financial issues mentioned above (funding for staffing and funds for addressing technological needs of program participants) as well as working out the details of shifting program to remote-based will address any existing major barriers. 

This research team is part of the Department of Psychiatry at The University of Toledo Medical Center (UTMC) in Toledo, Ohio. The ACT Program has facilitators and members across the US and select other countries across the globe. 

On this research team at UTMC, the staffing consists of:

Dr. Michele Knox, PhD (full-time)

Dr. Jamie Dowling, PhD (full-time)

Student assistant Stephne Rasiah (part-time)

This team also collaborates with Dr. Kim Burkhart at Case Western Reserve University in Cleveland, Ohio (part-time).

Dr. Michele Knox is a professor of medical students and residents, researcher, family therapist specialized in children, adolescents and trauma, child abuse prevention, and parenting. Knox has been an ACT coordinator/master trainer for the program since 2002. She is also the evaluator for several of the ACT program studies published in peer reviewed journals.

Dr. Jamie Dowling is a public health researcher and an assistant professor of medical students and residents. She has research experience in a variety of public health topics from mental health to injury prevention. She has a strong background in program development, from planning to evaluation.

The ACT Program was created by a nationally recognized professional association, so it has facilitators across the country. This research team partners not only with the founding organization (American Psychological Association) but also with fellow researchers at Case Western Reserve University in Cleveland Ohio.

This research team is housed in a state-supported academic hospital. The mission of The University of Toledo Medical Center is to improve the human condition by providing patient-centered, university-quality care. 

More specifically, there are three primary goals of the ACT Raising Kids Safe Program:

• Educate parents and caregivers of young children to create safe, stable, nurturing relationships and environments that prevent child maltreatment; protect children and youth from long-term consequences of maltreatment
• Provide research-based knowledge, tools, and skills for effective parenting practices
• Provide a supportive, nonjudgmental, interactive, and fun environment for learning and sharing to occur; to nurture and promote the development of social support networks among participants
• Educate parents and caregivers on how to act as supportive teachers, advocates, and protectors of their children

The goods/services provided to participants (e.g. parents/families) is in form of education and skill building, which can greatly improve the health and well-being of the families involved. These goods and services are targeted towards parents and caregivers of children birth to age 10. Remote participation in this program help to widen the geographical outreach. Parents and caregivers of children want to be involved in the ACT Program to reduce the risk of child abuse and neglect, learn how to better navigate parenting challenges, and improve the health and well-being of their families.

This program does not generate income, nor is it intended to. It is sustainable by agencies and organizations supporting the training of their staff as facilitators, researchers evaluating and promoting the successes, and by individual research teams such as this one seeking external funding to support specific program needs. The financial needs of this research team include partial support of staffing (if allowable), as well as support and development of remote program application. 

The major barrier to global implementation of the ACT Program is navigating through the COVID-19 pandemic. Fortunately, this can largely be solved by shifting to remote implementation and participation of the program. Finances related to the staffing hours of this shift to remote application, as well as addressing any technological deficits or needs of program participants, are also potential barriers.

Solve can help address both of these barriers by providing funding support.

We are looking for help in spreading the program, and therefore it's messages, on a larger scale. Since technology is involved as well as goals of global access, it is a large undertaking. Guidance in this area will increase our successes. This mean reduced rates of child abuse and neglect, and healthier and happier families.

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The COVID-19 pandemic did not mean child abuse and neglect stopped. Rather, it removed much needed support and resources from families who faced additional challenges during this time. 

The proposed project has the goal of re-starting parent support/training and child maltreatment prevention while simultaneously collecting needed data on feasibility and effectiveness. The ACT Raising Safe Kids program is a well-established, evidence-based parenting and child maltreatment prevention program developed by the American Psychological Association. The proposed project involves implementation of ACT at several sites and evaluation of the feasibility and effectiveness of conducting it remotely during the pandemic. Outcome data and feedback will be collected from parent participants, and feasibility, fidelity and focus group outcomes will be collected from ACT Facilitators. In addition, the work will produce an implementation guide to promote the effective, remote implementation of the program in the future. The ACT program has sites in many areas of the US and in several other nations across the world, so the project has the potential for impacting many families and communities both during and after this health crisis.