Power Source Parenting Research

Posted March 7, 2018

Theoretically-Based Emotion Regulation Strategies Using a Mobile App and Wearable Sensor Among Homeless Adolescent Mothers:
Acceptability and Feasibility Study

Noelle R Leonard1,2, PhD; Bethany Casarjian, PhD; Richard R Fletcher4, PhD; Cathleen Prata5, MPH; Dawa Sherpa1,BA; Anna Kelemen1,2, EdM; Sonali Rajan2, EdD; Rasheeda Salaam1, BS; Charles M Cleland1, PhD; Marya ViorstGwadz1, PhD
1Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, New York, NY, United States
2Teachers College, Columbia University, New York, NY, United States
3Lionheart Foundation, Boston, MA, United States
4MIT Media Lab, Cambridge, MA, United States
5Independent Consultant, Boston, MA, United States
Corresponding Author:Noelle R Leonard, PhD
Center for Drug Use and HIV Research
Rory Meyers College of NursingNew York University433 1st Avenue, 7th FloorNew York, NY, 10010
Phone: 1 212 992 7167
Email: nrl4@nyu.edu
Background: Many adolescent mothers are parenting young children under highly stressful conditions as they are managing
first-time parenthood, poverty, lack of housing, school and work, and challenging peer and familial relationships. Mobile health
(mHealth) technology has the potential to intervene at various points in the emotion regulation process of adolescent mothers to
provide them support for more adaptive emotional and behavioral regulation in the course of their daily life.
Objective: The goal of this study was to examine the acceptability, feasibility, use patterns, and mechanisms by which a mobile
technology used as an adjunct to in-person, provider-delivered sessions fostered adolescent mothers’ adaptive emotion regulation
strategies under real-life conditions.
Methods: Participants (N=49) were enrolled in the intervention condition of a larger pilot study of homeless adolescent mothers
living in group-based shelters. The mHealth technology, Calm Mom, consisted of a mobile app and a wrist-worn sensorband for
the ambulatory measurement and alerting of increased electrodermal activity (EDA), a physiological measurement of stress. We
examined logs of mobile app activity and conducted semistructured qualitative interviews with a subsample (N=10) of participants.
Qualitative data analysis was guided by the theoretical frames of the intervention and a technology acceptance model and included
an analysis of emerging themes and concepts.
Results: Overall, participants indicated that one or more of the elements of Calm Mom supported their ability to effectively
regulate their emotions in the course of their daily life in ways that were consonant with the intervention’s theoretical model. For
many adolescent mothers, the app became an integral tool for managing stress. Due to technical challenges, fewer participants
received sensorband alerts; however, those who received alerts reported high levels of acceptability as the technology helped
them to identify their emotions and supported them in engaging in more adaptive behaviors during real-life stressful situations
with their children, peers, and family members.
Conclusions: Calm Mom is a promising technology for providing theoretically driven behavioral intervention strategies during
real-life stressful moments among a highly vulnerable population. Future research efforts will involve addressing technology
challenges and refining tailoring algorithms for implementation in larger-scale studies.

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Posted April 2016  (link: http://loop.frontiersin.org/publications/23619583)

Ambulatory Autonomic Activity Monitoring Among At-Risk Adolescent Mothers.

Sonali Rajan,  Noelle Leonard,  Richard Fletcher,  Bethany Casarjian,  Robin Casarjian,  Cathleen Cisse,  Marya Gwadz

 Abstract:  BACKGROUND: Many adolescent mothers experience significant challenges in regulating emotions due to adverse life experiences, which can place adolescent mothers and their children at risk for poor developmental outcomes. Ambulatory monitoring of stress that also provides immediate feedback using wearable biosensors has the potential to enhance clinician-delivered parenting interventions and help young mothers develop emotion regulatory skills.  METHODS: We conducted a pilot study to assess the acceptability, ease of use, and preliminary efficacy of a wearable biosensor, the iCalm sensor band, among a sample of four mothers, ages 15-18 years. Mothers wore the biosensor for a period of 24-36 hours while engaging in normal, daily tasks (e.g. caring for their child, attending school). Both quantitative electrodermal activity (EDA) data (via the iCalm sensor band) and qualitative data (via individual semi-structured interviews) were collected. RESULTS: The adolescent mothers were able to comfortably use and wear the iCalm sensor band. EDA data were collected and corresponded with stressful daily life events described by the mothers during qualitative interviews. CONCLUSION: The iCalm biosensor is acceptable to use among high-risk adolescent mothers and appears to help mothers with the development of emotion regulatory skills.

View Original Source:  http://www.journalmtm.com/2012/ambulatory-autonomic-activity-monitoring-among-at-risk-adolescent-mothers/

Posted March 2014
Power Source Parenting R34
The Power Source Parenting Program was developed after several years of piloting at numerous Teen Living Programs (group homes for teen mothers and their babies) under the auspices of the Massachusetts Department of Children and Families. Results of pilot testing showed statistically significant decreases in self-reported parenting stress, increases on items measuring positive parenting attitudes including increased empathic awareness of childrens’ needs, increased appropriate developmental expectations of children, and decreases in the endorsement of corporal punishment. This data helped garner an R34 grant from the National Institutes of Health, which is currently being conducted by the New York University School of Nursing, the Massachusetts Institute of Technology (MIT), and the Lionheart Foundation in Teen Living Programs across Massachusetts. This latest study integrates groundbreaking technology developed by the Affective Computing Lab at MIT that assists participants to effectively apply the emotional regulation and parenting skills learned in Power Source Parenting in vivo. Participants wear the iCALM bio-sensorband bracelet that measures electrodermal activity (EDA; also known as galvanic skin response) that reflects activity in the sympathetic nervous system that is not necessarily open to conscious awareness. The iCALM sensorband is linked to a smartphone application which sends messages to the participant to help her recognize her physiological arousal, determine associated thoughts and feelings, and assist her in using Power Source Parenting strategies learned in the group sessions to modulate her emotions and to engage in more adaptive behaviors. Through this grant, the CalmMom software application was developed. An ongoing goal is to have CalmMom be made available for all Power Source Parenting users to download, delivering Power Source Parenting content including videos, cognitive coping strategies and pdfs from the intervention via mobile technology. The response by participants has been overwhelmingly positive. Preliminary results from the R34 should be available in 8 months and plans to apply for a larger funding mechanism are underway.


Posted 2012
Thank you for your interest in the Power Source Parenting Program. Below find a brief theoretical overview of the program as well as results from our pilot testing. A grant from NIH was approved in March 2012 and preparations for the upcoming intervention have proceeded over many months to date.  The three- year randomized controlled trial began in 2013.  Poster Presentation — Enhancing Adolescent Mothers Positive Parenting through EMA- A feasibility study.  Please don’t hesitate to contact us should you have any further questions regarding the program or our initial research findings.

Overview of Power Source Parenting

Existing efficacious parenting interventions have mainly focused on the treatment of children with behavior problems with scant attention to maternal problems and risk behaviors. Moreover, the vast majority of these parenting programs were not designed for adolescent mothers and thus do not attend to the cultural and developmental needs of this population. The Power Source Parenting intervention integrates three theoretical frames. The overarching framework is drawn from Belsky’s (1984) parenting process model which posits two key reciprocally influenced determinants of parenting: (1) personal psychological resources of parents and (2) skills to manage the contextual sources of stress and support. We supplement the Belsky model with two theories of behavior change.  First, The Model of Emotion Regulation defines the specific personal psychological resources- that is, emotional and cognitive regulation skills that are critical for emotional, social, and behavior change: a) situation selection and modification, b) attention deployment, c) cognitive change, and d) response modulation.  To describe the means by which changes in parenting behavior and better management of contextual sources of stress and support come about, we integrate Social Cognitive Theory.  Mindfulness practice and social cognitive skill building conjointly increase maternal self-efficacy, building on nascent maternal protective attitudes and behaviors, and setting the stage for the adoption of more adaptive behavior.

When changes in these specific personal psychological resources and contextual sources of stress and support are achieved, Adolescent Mothers with At-Risk behaviors (AMARs) will increase their emotional regulatory skills, adopt competent, empathic, and sensitive parenting attitudes, and skills and increase adaptive relational skills, resulting in the avoidance of risk behaviors and more positive parenting. To date, we have completed significant work in the development of a multi-component intervention for AMARs who are at high risk for continued multiple problem behaviors and poor parenting of their young children. This formative work has involved developing and pilot testing components of the group sessions including a book for the adolescent mothers as well as the development of a facilitator’s manual.

Pilot Results

Pilot testing of Power Source Parenting has been ongoing for the past three years, with iterative field test of these intervention session components with several groups of (AMARs) residing in group homes in Massachusetts. Between sessions, text messages tied to the intervention content were sent to each AMAR (e.g., “Label and validate your baby’s feelings one time today”). AMARs provided feedback about the content and method of delivery at the end of each component session (number of component sessions varied for each AMAR and some were repeated after incorporating feedback). Process notes were completed by the facilitator after each component session.

Components testing was conducted with several groups of AMARs (N=36; X age = 19 (SD = 1.79; range, 14-23; 85% Latina or African-American) who reside with their children (X age = 17 mos., range 1-48 mos.) in several group homes. AMARs participated in a baseline interview prior to participation in the components testing and a post test 1-2 weeks after completion. Baseline lifetime risk behaviors included significant substance use (83% had ever used alcohol; 70% marijuana; 22% club drugs; 17% prescription drugs not prescribed; 11% cocaine; 8% inhalants; 6% heroin) as well as academic problems (67% held back at least one grade; 30% special education services), and reported diagnosis with a sexually transmitted infection (17%). Most (59%) were not currently intimately involved with the father of their child. AMARs (n=25) scored significantly below the normative mean on three scales of the Difficulties in Emotional Regulation Scale (DERS) (all p < .01 in one-sample t-tests). Reports of recent risk behaviors (at least once in the past 6 months) included alcohol (73%), marijuana (67%), club drugs (11%), prescription drugs (5%), and cocaine (3%). Of the sexually active respondents (n = 35), 57% (n = 20) did not use condoms over the past six months, although of those, 75% (15/20) reported using another method of birth control. Notably, 14% (n = 5) of the sexually active AMARs did not use condoms or other birth control over the past 6 mos. These data indicate while there was some decrease in substance use, AMARs residing in group homes continue to engage in risk behaviors at high rates.

Although the group intervention sessions AMARs received was an iterative process and varied in number of sessions, content, and methods of delivery, we found a significant decrease in self-reported parenting stress (Parenting Stress Index; Abidin, 1995; t(26) = 1.991, p = .057), as well as increases on items measuring positive parenting attitudes (Adult Adolescent Parenting Inventory-2 (AAPI-2; Bavolek & Keene, 1999) including increased empathic awareness of children’s needs (t(25) = -2.28, p = .031); increased appropriate developmental expectations of child (t(24) = -2.45, p = .02); and a decrease in the endorsement of corporal punishment (t(26) = 2.45, p = .02). On a computerized facial emotion recognition task (GNG, Casey et al., 20xx), AMARs were better able to recognize sadness (F(8, 16) = 3.526, p = .015).

Qualitative acceptability data indicated that among AMARs, a desire to increase their parenting skills is a powerful motivator for intervention engagement. AMARs gave us specific feedback regarding comprehensibility of the material and made useful suggestions for increasing the “buy-in” among their peers of concepts such as appropriate developmental expectations and positive discipline techniques. Importantly, AMAR’s enjoyed the text messages and asked that we increase the frequency because this reinforcement was extremely helpful in their daily life.

To View a Summary of Lionheart Research Click Here.