“When scientific pursuits integrate the knowledge and expertise of real-world service settings, their providers and the families served in those settings, it becomes more feasible for interventions to reach and be efficacious for the children and families facing the greatest risks,” Abby Bailin says. 

Abby Bailin

Abby Bailin

The Hogg Foundation awards its annual Henry E. And Bernice M. Moore Fellowship of $20,000 to one doctoral candidate at The University of Texas at Austin whose dissertation research pertains to the mental health impact of crises, stress and adversity. (Note: Frances Fowler Wallace Memorial Awards are also distributed annually, on a rolling basis, to graduate students that meet similar qualifications. This award is temporarily closed and will reopen on September 1, 2019.)

This year’s Moore Fellowship recipient, Abby Bailin, will earn her doctorate in school psychology from The University of Texas at Austin’s Department of Educational Psychology in 2020. We took the time to chat with her about her award-winning dissertation titled, “Promoting Positive Parenting for Families in Primary Care: Program Development and a Pilot Randomized Controlled Trial”:

Hogg Foundation: What led you to take a professional interest in this topic? 

Abby Bailin: My interest in this topic grew from my growing understanding of the limitations of the existing mental health service system, particularly as it relates to reaching underserved children and families in low-income communities in Austin. At the beginning of my graduate training, my various clinical and research engagements in Austin allowed me to see firsthand that we often fail to intervene preventatively with families who may face elevated risk for poor outcomes related to mental health, physical health and social functioning. We also often fail to appropriately adapt evidence-based interventions to best fit the needs of diverse families.

I was drawn to the primary care setting because of its potential to reduce barriers to mental health access. Primary care has gained much attention as a setting with the potential to enhance reach and access, and well-child visits are uniquely set up to deliver preventative care focused on overall well-being. Families develop uniquely long-lasting relationships with their primary care providers, who they see numerous times before a child ever sets foot in a school setting—at which point it may be too late for prevention for children with early onset behavioral and emotional difficulties. In focusing on the primary care setting, I was thinking of ways to maximize its potential to support the delivery of preventative services aimed at building resiliency and reducing risk.

Hogg Foundation: What questions are you trying to answer with this research?

Bailin: First, it’s important to highlight that my research is built on the backs of pioneers in psychology, medicine, social work, nursing and education who developed decades of research showing that teaching parents how to use positive parenting strategies is protective against the development of poor social, emotional, health and academic/employment outcomes. While there is a very large body of evidence supporting the efficacy of positive parenting practices (i.e., parental warmth, timely responsiveness, positive reinforcement), as scientists we still have much work to do related to increasing reach, access and effectiveness of such interventions to those traditionally underserved. My research therefore seeks to extend the existing literature by using of novel delivery approaches in the hopes of reaching more families. The novel approaches tested in this research include delivery in the primary care setting, use of technology and adaptations to enhance fit to setting and population.

The research seeks to determine how we adapt an evidence-based positive parenting intervention to fit a primary care setting with a largely low-income population that has been marginalized from mental health services. Additionally, I am interested in how feasible and acceptable it is to deliver an adapted, electronic intervention on positive parenting within the context of the primary care setting. And lastly, I am interested in how this brief, self-administered, electronic intervention on positive parenting delivered to caregivers during routine well-child visits impacts both caregivers (i.e., stress, use of effective parenting practices) and children (i.e., behavior problems).

Hogg Foundation: How do you think your research methods and approach help you answer the questions you’re posing?

Bailin: I utilized a mixed method design for this study, meaning that I included both qualitative and quantitative procedures and data. Mixed method approaches are particularly useful in the process of intervention development, as was a primary aim for my research study. The first phase of the study—the qualitative piece—included interviews with 13 caregivers recruited across three primary care partner clinics. They explained their preferences and experiences accessing mental health services for their children, shared their opinions about their child’s primary clinic, and gave feedback on a video prototype of the proposed parenting intervention.

Themes identified from these interviews directly informed the study procedures, as well as the content of the adapted parenting intervention that was tested in the second phase, the pilot randomized controlled trial. Using a randomized controlled trial within the research design allows us to systematically determine the impact of the adapted intervention on families, while also determining the feasibility and acceptability of its delivery in the primary care setting.

Hogg Foundation: What, from your perspective, is the biggest area of need—or the greatest opportunity—related to this topic? In other words, how could we really move the needle on this front?

Bailin: As scientists, we still have a lot of work to do related to sorting out just how much intervention (i.e., dosage) as well as which particular parenting skills (i.e., positive reinforcement, limit setting, time out) are needed to prevent problems in children and families. My dissertation study has developed a very brief, six-minute parenting intervention focused on just some of the strategies within the evidence base for parenting interventions. Our results will help move the field forward in determining the impact of such a brief intervention. Continued efforts within this vein—such as experimenting with different lengths of intervention and combining and distilling different parenting strategies—can contribute to greater understanding of the essential pieces of psychotherapeutic intervention needed to impact outcomes, while also pointing to efficient and accessible ways to do so. Scientific endeavors that test such questions using novel means of service delivery (i.e., service setting, technology) can further support our ability to enhance the reach of evidence-based interventions to all families.

We still have a lot of work to do, but I believe we can really move the needle forward by stepping outside of the laboratory setting and into the real world settings we intend to serve. When scientific pursuits integrate the knowledge and expertise of real-world service settings, their providers and the families served in those settings, it becomes more feasible for interventions to reach and be efficacious for the children and families facing the greatest risk.

For those looking to understand more about the science behind parenting strategies, Bailin recommends the following related resources: