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J Prim Prev. 2017 Oct;38(5):465-480. doi: 10.1007/s10935-017-0481-8.

A Toddler Parenting Intervention in Primary Care for Caregivers With Depression Symptoms.

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Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, 3440 Market Street, 2nd Floor, Philadelphia, PA, 19104, USA.
Policylab, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Policylab, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.


Caregiver depression impacts parenting behaviors and has deleterious effects on child behavior. Evidence-based interventions to address parenting have not been adapted for use with depressed caregivers in pediatric primary care settings. Our study examined the feasibility and explored outcomes of an evidence-based parenting program implemented in primary care and adapted for caregivers with depressive symptoms caring for toddlers. We conducted a randomized controlled trial with a wait-list control. Participants were caregivers who screened positive for depressive symptoms in pediatric settings with a toddler. Our study was implemented from July 2011 to June 2012. We adapted the Incredible Years Parents, Babies and Toddlers program with the addition of depression psychoeducation (12 weekly sessions), and assessed caregivers at baseline and immediately post-intervention. We assessed participation rates, depressive symptoms, parenting discipline practices, social support, and parenting stress. Our results revealed that 32 caregivers participating in the intervention group had significantly greater improvement in self-reported parenting discipline practices compared to the 29 wait-list control group caregivers. We found no differences between groups in depressive symptoms, social support, or parenting stress. Our study demonstrated that the average attendance was poor (mean attendance = 3.7 sessions). We adapted an evidence-based parenting intervention for caregivers with depressive symptoms and toddlers in primary care; however, participation was challenging. Alternative intervention strategies are needed to reach and retain low-income caregivers with depression symptoms as they face multiple barriers to participation in groups within center-based services. Trial Registration Clinical identifier NCT01464619.


Depression; Intervention; Parenting; Toddlers

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