Let’s Connect: A developmentally-driven emotion-focused parenting intervention

https://doi.org/10.1016/j.appdev.2019.05.007Get rights and content

Highlights

  • Emotion communication is important but overlooked in most parenting interventions.

  • Let's Connect is a novel parent intervention to teach emotion communication skills.

  • Let's Connect shows promising outcomes in groups of community parents.

Abstract

Research on emotional development and emotion socialization emphasize the importance of supportive parent-child emotion communication, yet most empirically supported parenting interventions omit guidance on emotion communication skills. The primary goal of this paper is to introduce the Let's Connect emotion-focused parenting intervention as an innovative treatment modality for increasing supportive emotion socialization in families, drawing on developmental theory as a guiding framework. We provide an overview of the background for and development of Let's Connect. Results of a pilot study with 34 caregivers of school-age children (Mage= 8.45) in a community sample demonstrated significant increases in supportive emotion communication practices (e.g., listening and connection, labeling feelings, emotion support) as well as significant reductions in unsupportive emotion communication practices (e.g., invalidating or critical responses) from pre- to post-intervention, with gains maintained over a three-month period. Future directions and clinical applications of this intervention module are discussed.

Introduction

Decades of clinical research have focused on parenting interventions to improve child socioemotional and behavioral functioning and to treat child behavior problems. On the whole, research on parenting interventions based in behaviorist theories has resulted in the development and evaluation of many effective strategies for managing child behavior via improvements in parenting practices such as reductions in harsh discipline and use of contingency management (Eyberg, Nelson, & Boggs, 2008). However, there is growing recognition that behaviorism-based interventions leave gaps in the promotion of positive parenting practices that build children's emotion competencies and supportive parent-child connection. This shift in focus is driven by research on emotional development and familial emotion socialization which emphasizes parental responses to children's emotions as critical to children's and adolescents' well-being (e.g., Baker, Fenning, & Crnic, 2011; Eisenberg, Cumberland, & Spinrad, 1998; Katz, Maliken, & Stettler, 2012; McElwain, Halberstadt, & Volling, 2007; Morris, Criss, Silk, & Houltberg, 2017). Compelling findings from a meta-analysis of parenting interventions have shown that the largest treatment outcome effect sizes were associated with the inclusion of emotion communication skills training (Kaminski, Valle, Filene, & Boyle, 2008), yet relatively few manualized and empirically-supported interventions yet exist to support clinicians in teaching these skills to parents.

The primary goal of this paper is to introduce the Let's Connect emotion-focused parenting intervention as an innovative prevention and intervention program for increasing supportive emotion socialization in families, consistent with developmental theory regarding the promotion of healthy emotional development and supportive adult-child relationships. We review the theoretical and empirical research that has guided the development of Let's Connect, and provide an overview of the intervention content. Accordingly, we present pilot data that show promising outcomes for Let's Connect when used as primary preventive intervention with community families. Finally, we briefly describe additional and anticipated treatment applications of the Let's Connect treatment module.

Let's Connect (Fitzgerald, Shipman, & Hackbert, 2017) has been developed and refined over the past 10 years and was originally known as AFFECT: A Family Focused Communication Training (Shipman & Fitzgerald, 2005). The program supports parents or other caregivers (e.g., kin/foster parents/adoptive parents, school professionals, community mentors) in identifying and responding to their child's emotional needs. The overarching goal of this program is to build connection and warmth and promotes children's development of healthy emotion regulation skills, emotional security, mental health, and psychosocial well-being. Concomitant with that goal, the program aims to identify and decrease unsupportive or invalidating responses that can undermine healthy psychosocial development. Let's Connect integrates developmental and clinical theory and research to build parents' own emotion awareness and regulation skills and to teach parents' behaviorally-specific emotion communication and connection skills. Let's Connect targets parents' awareness of their own and their child's emotions and emotion regulation skills, and uses concrete steps to guide parents to respond to children's emotional arousal and challenging behavior in supportive ways. The Let's Connect intervention also provides behaviorally-specific caregiver-child emotion communication skills to model and build children's emotional awareness and self-regulation.

Let's Connect is grounded in developmental theory and research that highlights the importance of parent emotion socialization and parent's own self-regulation to children's self-regulation. This intervention also draws upon clinical research on effective behavioral parenting programs. Below, we summarize findings from these areas that are foundational to Let's Connect.

Emotional development occurs within a relational context. Children learn to manage emotion within close interpersonal relationships, and particularly through caregiver-child interaction (Katz et al., 2012; Klimes-Dougan & Zeman, 2007). Beginning early in development, caregivers engage in emotion socialization to help children to regulate their emotions and emotion-related behavior. Aspects of adaptive emotion socialization include creating a climate with developmentally appropriate emotional demands, providing support and assistance in times of emotional distress, and teaching strategies for emotion management (Eisenberg et al., 1998). Emotion socialization processes also serve to teach children, directly and indirectly, about norms and values for the expression and management of emotions. Parental emotion socialization practices comprise supportive behaviors such as validation and labeling of child emotions, as well as invalidation of emotions and unsupportive behaviors such as criticizing or punishing emotional expression. These emotion socialization practices have been shown to predict child social and emotional competence (Baker et al., 2011; McElwain et al., 2007; Shaffer, Suveg, Thomassin, & Bradbury, 2012; Shewark & Blandon, 2015; Shipman et al., 2007), behavioral compliance (Havighurst et al., 2013; Shortt, Stoolmiller, Smith-Shine, Eddy, & Sheeber, 2010) and child mental health (Katz & Hunter, 2007; Silk, Steinberg, & Morris, 2003).

Despite the importance of these skills in fostering children's emotional competence and mental and behavioral health, relatively few parenting interventions have specifically focused on building emotion socialization practices or emotion-focused parenting skills (see Tuning in to Kids as an exception discussed more below; e.g., Havighurst, Wilson, Harley, & Prior, 2009). Several other programs have augmented existing interventions for child problems or disorders with emotion-focused content. For children with Attention Deficit/Hyperactivity Disorder (ADHD), researchers have blended traditional behavior management skills with emotion coaching skills for parents of young children (Herbert, Harvey, Roberts, Wichowski, & Lugo-Candelas, 2013) and school-age children (Chronis-Tuscano et al., 2016). Parent Management Training for children with oppositional behaviors has also been enhanced with brief training in parent-child emotion communication (e.g., labeling emotions, asking emotion-focused questions; Salmon, Dadds, Allen, & Hawes, 2009). A short-term two-day intervention targeting parents' emotional reactions and emotion coaching skills has also been associated with improved parent self-efficacy in family-based treatments for eating disorders among adolescents and young adults (Lafrance Robinson, Dolhanty, Stillar, Henderson, & Mayman, 2014).

The skills taught in Let's Connect are well-grounded in emotion socialization research, and focus on specific parenting practices that can be taught in a skills-based intervention format. Active listening and other attending skills are associated with increased efficacy of parenting interventions (Kaminski et al., 2008). Parental emotion support skills (e.g., validation, normalizing) and emotion coaching skills (e.g., emotion awareness/labeling, extending emotional understanding, coping and problem solving) relate to children's psychological adjustment, physical health, and social and academic competence in cross-sectional and longitudinal studies in both high-risk and typically developing samples (Cunningham, Kliewer, & Garner, 2009; Lunkenheimer, Shields, & Cortina, 2007; Suveg, Zeman, Flannery-Schroeder, & Cassano, 2005; Yap, Allen, & Ladouceur, 2008). These specific components of emotion socialization practices also predict low emotional reactivity (Shenk & Fruzzetti, 2011), children's comfort sharing emotionally-arousing topics with caregivers (Shipman & Zeman, 2001), and greater help-seeking from caregivers when faced with difficult life events (Brown, Fitzgerald, Shipman, & Schneider, 2007). Parents are also taught to avoid behaviors and responses that can undermine supportive emotion socialization, such as invalidation and criticism, that are associated with poorer psychosocial outcomes (e.g., Buckholdt, Parra, & Jobe-Shields, 2014; Krause, Mendelson, & Lynch, 2003; Shipman et al., 2007).

Parent emotion socialization practices, like many aspects of effective parenting, greatly depend on caregiver emotional awareness, beliefs about emotions, and emotion regulation skills (Cunningham et al., 2009; Garrett-Peters, Castro, & Halberstadt, 2017; Gottman, Katz, & Hooven, 1996; Morris et al., 2017). A caregiver who has very little capacity or skill regulating their emotional experience likely has challenges in scaffolding and supporting their children's efforts at their own self-regulation, which may be one process explaining the intergenerational transmission of self-regulation difficulties (Bridgett, Burt, Edwards, & Deater-Deckard, 2015). Caregiver emotional awareness and regulation skills are thus primary influences on the development of child emotional competence (Morris et al., 2017; Rutherford, Wallace, Laurent, & Mayes, 2015; Shaffer & Obradović, 2017). Caregivers who are aware of their own emotions are likely better able to separate their negative emotional reactions from parenting responses resulting in children having the experience of consistent and predictable caregiving (Duncan, Coatsworth, & Greenberg, 2009). Similarly, caregivers who are better able to regulate their own emotions effectively can model and coach healthy emotion regulation for children, and are more likely to choose sensitive parenting responses which convey empathy and strengthen emotional security (Havighurst, Wilson, Harley, Prior, & Kehoe, 2010; Morelen, Shaffer, & Suveg, 2016; Schutte et al., 2001; Shaffer & Obradović, 2017).

Let's Connect also builds on a strong history of parenting intervention and prevention programs that are based in principles of behaviorism (e.g., Parent-Child Interaction Therapy: Eyberg & Boggs, 1998; Triple P: Sanders, 1999; Incredible Years: Webster-Stratton & Reid, 2010). These programs focus on improving child behaviors (e.g., increasing child compliance and reducing oppositionality) and there is a large extant literature supporting the effectiveness of these parenting skills based in behaviorist principles of reinforcement. Of note, many of these parenting programs (e.g., PCIT) emphasize building warm parent-child relationships as central to their intervention. There is often an implicit assumption in these programs that parents are able to regulate their own emotions and behavior well enough to implement the parenting skills, and able to attune to or coach the child's emotions such that a positive parent-child relational context is the foundation on which these skills are deployed. However, these extant behaviorist parenting interventions provide limited explicit teaching or modeling of emotional support and coaching skills, and do not focus extensively on parents' own emotional awareness and regulation skills.

The core content of the Let's Connect program is designed to build caregiver understanding and knowledge about emotion and to teach the Let's Connect emotion communication skills. Emotion communication skill-building focuses on enhancing caregiver social-emotional competence and caregiver emotion communication skills. The goal of this training is to support caregivers in interacting and communicating with children in ways that builds socioemotional competence and the supportive quality of the caregiver-child relationship. Each of the intervention domains is described in more detail below.

Let's Connect builds parent insight and knowledge about the importance and function of emotions, the role of caregivers in developing, scaffolding, and supporting children's developing emotional competence, and the importance of building caregiver comfort talking with children openly about out emotion in everyday life situations. Caregivers also learn about and reflect on how their own emotional experience and default responses may interfere with skillful parenting and parent-child relationship quality, especially in times of stress or when responding to a challenging child behavior. This content is delivered to families through a combination of brief didactics providing psychoeducation, video presentations, self-reflection, written exercises, and home practice.

Caregivers are taught strategies to increase emotional awareness and acceptance (in self/other), emotion regulation, stress reduction and self-care. This helps them to be more attuned to their own needs and the feelings and needs of their children. One core strategy is the “Hand-to-Heart” Three Step process: 1) tuning in, 2) reaching out, and 3) connecting. Step 1 aims to increase emotion identification and healthy regulation of caregiver emotion. Step 2 aims to increase emotional awareness of the child's feelings and needs. Step 3 aims to increase caregivers' use of the specific emotion communication skills: connection skills, emotion support skills, and emotion coaching skills when interacting with their children (described below and in Table 1). This three-step process is taught with accompanying physical cues to facilitate learning and reinforce the overarching objectives of Let's Connect. The parent is first asked to mindfully attend to their own emotional experience and readiness to respond to their child; this step is accompanied by a “hand to heart” gesture. Next, the parent considers what the child is feeling and what their needs are in this moment by “reaching out” to their child with a hands-reaching-out gesture. This indicates a willingness to attune to the child's emotional experience and perspective, and value their emotional experiences in the moment. Finally, the “connect” gesture of placing hands together signals the strengthening of relationships and the building of caregiver and child resources (e.g., warmth, understanding, self-regulation skills) that occurs through this process and through the use of emotion communication skills.

The primary emotion communication skills of Let's Connect includes Connection Skills, Emotion Support Skills, and Emotion Coaching Skills. Connection Skills include “Notice and appreciate,” “Listen to learn more,” and “Label children's emotions.” These skills help caregivers to build positivity into daily interactions, show genuine interest in their children, and gain understanding about their children's emotional experiences and perspectives. They are key to building warmth, positivity, and connection in a relationship. “Notice and appreciate” includes verbalizations and actions that convey our positive attention and appreciation of a child's prosocial behaviors, their unique qualities and experiences, interests, and what excites them. “Listening to learn more” includes positive body language, reflecting and repeating what the child says, asking open-ended questions that focus on understanding the child's experience, and going slowly to give children time to respond. “Label children's emotions” builds children's emotional awareness and provides a foundation for building emotion regulation skills. Finally, Let's Connect teaches caregivers to avoid common traps that interfere with caregiver-child communication, such as criticizing or invalidating a child's emotions, or becoming distracted or self-focused when a child is disclosing emotional experiences (see Table 1 for examples).

Emotion Support Skills include any behavior that validates a child's emotional experience and communicates support and acceptance. These skills include perspective taking, empathy, normalizing, and demonstrating affection/kindness in response to children's emotional displays. Using Emotion Support Skills conveys an openness and comfort with emotional expression and sends the message that feelings are natural, acceptable and a valuable source of information. Notably, Let's Connect emphasizes how caregivers can validate children's emotions while still setting limits on disruptive or inappropriate behavior (e.g., “I understand that you're feeling very angry, but it is not OK to hit people”). Specific emotion support skills include the use of perspective-taking (i.e., openness or curiosity about the child's experience), empathy to create a shared experience, and demonstrations of affection and kindness (e.g., verbalization of care, appropriate expressions of physical affection). Normalizing the child's emotional experience is also central to the emotion support skills. This can include communication to the child that their emotional reactions make sense or are shared by others in similar situations (e.g., “It makes sense that you feel ___;” “That's really normal;” “Other kids feel that way too”). As with the Connection Skills, Let's Connect facilitators also review common traps in the emotion support domain, increasing awareness of invalidating responses such as minimization, judgment, criticism, or lecturing (see Table 1).

Emotion Coaching skills focus primarily on increasing children's understanding of emotions and their relations to each other and to behavior. Caregivers are also given guidance on how to teach or scaffold children's strategies for emotion regulation. Emotion Coaching skills include recognizing and labeling children's emotions, including secondary emotions, mixed emotions and emotional intensity, which is fundamental to children's emotion management skills. Caregivers also support children in identifying the causes and consequences of their emotions, supporting both emotional awareness and problem-solving abilities. Finally, caregivers are guided in how to help their children with ways of responding to emotions, such as perspective-taking, problem-solving, and other coping skills (e.g., deep breathing, asking for help, distraction). Depending on the age and ability of the child, caregivers learn to either teach these skills or scaffold and prompt their children to employ these strategies as appropriate. For example, it would be more appropriate for parents of younger children to suggest and model a coping strategy directly, such as deep breathing. For older children and young adolescents, a more scaffolded response would be to prompt the child to generate a coping strategy, and for the parent to praise coping effort or offer observations on whether the strategy seemed effective. Of note, the intervention program does not identify traps to be avoided in the Emotion Coaching domain. Clinical experience suggests that using these skills is generally more effective than not using these skills. When parents use these skills inaccurately, like mislabeling a child's emotion or suggesting a coping strategy that is not likely to be effective, it typically still engenders productive communication between the parent and child through attempts to correct misunderstandings or generate new ideas.

The Let's Connect approach to skill building is highly interactive, based on adult learning theories and parenting intervention research indicating that behavior change and skill development are enhanced by active learning strategies (Beidas & Kendall, 2010; Humair & Cornuz, 2003; Joyner & Young, 2006; Kaminski et al., 2008). Caregivers are taught the primary EC skills sequentially and they have opportunities for in vivo practice in session and at home. Individualized facilitator feedback is provided as skills develop. In the group setting of Let's Connect, caregivers' in vivo practice with their children is observed not just by the group facilitator, but by at least one other caregiver; this provides the opportunity for peer feedback as well as learning via peer modeling. As caregivers learn and practice the Let's Connect skills, they generate a hierarchy of topics they would like to discuss with their child, in collaboration with the group facilitators. This approach offers caregivers the opportunity to clarify their emotion communication goals and to gradually work up to more difficult topics of conversation. In subsequent weeks, caregivers practice using their EC skills to learn more about their children's every day experiences and address these identified family topics, gradually moving up the hierarchy. Examples of topics include pleasant family activities, peer interactions at school, sibling conflict, family-related stress or changes such as new jobs, moving, divorce, separation, illness, loss, and adoption). The Let's Connect skills may be helpful for caregivers to connect with their children in everyday experiences, but are particularly designed for when children need connection or support with their emotional experiences. Furthermore, these skills can complement parent responses to child disruptive behavior such as limit-setting, contingencies, and consequences.

Despite the critical importance of these parental self-regulatory skills to child emotional well-being, only a select few existing evidence-informed parenting intervention programs include a focus on parents' own emotional self-awareness and regulation (e.g., Tuning in To Kids: Havighurst et al., 2009 and Tuning in to Teens: Kehoe, Havighurst, & Harley, 2014; Child-Parent Psychotherapy: Lieberman & Van Horn, 2005; Circle of Security: Hoffman, Marvin, Cooper, & Powell, 2006). These interventions focus primarily on parenting during infancy and early childhood, although Tuning in to Kids has been used tested with school-aged children (Havighurst et al., 2015) and the Tuning in to Teens program has been used with early adolescents (Havighurst, Kehoe, & Harley, 2015; Kehoe et al., 2014).

A few evidence-based parenting interventions for parents of older children explicitly focus on parental self-regulation as a treatment goal, such as recent versions of Triple P (Sanders & Mazzucchelli, 2013), and Alternatives for Families Cognitive Behavioral Therapy (AF-CBT) for parents who engage in physically abusive parenting behaviors or other harsh and coercive parenting behaviors (Kolko, Fitzgerald, & Laubach, 2014). Coatsworth, Duncan, Greenberg, and Nix (2010)’s mindfulness-enhanced version of the Strengthening Families Program (Molgaard & Spoth, 2001) focuses on increasing parents' mindful parenting through building parents' emotional awareness and attending and listening skills during parent interactions. There is also a considerable amount of research-informed self-help parenting literature available on parental attunement and responsiveness and mindful approaches to building emotional intelligence in children and using positive discipline (e.g., Kabat-Zinn & Kabat-Zinn, 2014; Shapiro & White, 2014; Siegel & Hartzell, 2013). However, these interventions do not include emphasis on emotion coaching or strategies to support youth emotion management. Thus, this remains an area of major clinical need (Deater-Deckard & Sturge-Apple, 2017).

Although Let's Connect and these programs have similarities in content and theoretical background, there are unique differences in the focus, structure, depth, and intensity of the intervention. Let's Connect not only focuses on teaching parents' active listening skills and emotion coaching skills, but it specifically focuses on teaching discrete emotion support skills (i.e., increasing validation and decreasing invalidating behaviors) that are critical for successful parent-child connection and relationship enhancement. Let's Connect offers depth and intensity in each of the skill areas and teaches techniques in a structured, sequenced way with ample in vivo scaffolding and coaching when parents are interacting with their own children. Finally, Let's Connect has strong emphasis on monitoring caregivers' practice and mastery of skills with their own children in session, which is critically important to caregivers' skill uptake and generalization, and a strong predictor of child behavior outcomes (Kaminski et al., 2008). Finally, Let's Connect is one of few behavioral interventions for caregivers and children that incorporates clear steps and strategies for caregivers to notice their emotional arousal and needs, build their child attunement and ability to take the child's perspective, and practice self-regulation through self-care and stress-reduction strategies.

A pilot study of the Let's Connect emotion-focused parenting program was conducted to evaluate feasibility and gain preliminary information on program efficacy. Given that this is an initial pilot/feasibility study, we used a pre/post design in which all participating families were enrolled in the intervention condition. With regard to program effectiveness, we hypothesized that caregivers would demonstrate significant gains in emotion communication skills (i.e., connection/listening skills, emotion support, emotion coaching) when talking with their child about emotionally-arousing events. Similarly, we expected that caregivers would reduce their engagement in negative emotion communication behaviors (i.e., “traps”) over the course of this study.

Section snippets

Participants

Participating caregivers comprised 31 biological mothers and three adoptive mothers, all of whom had lived with their children for at least two years prior to participation. Caregivers ranged in age from 24 to 55 years (Mage = 39.13; SD = 6.49). Caregivers were predominantly European American (71.9%); the remainder of the sample identified as African American (25%) or Latina (3.1%). Regarding marital status, the majority (69.7%) of caregivers was married; the remainder was never married (9.1%),

Sample retention

Of the 34 families who completed the baseline assessment, 23 families completed the treatment and all three assessments (i.e., 68% retention at 3-month follow-up). Families who dropped out typically did so after the first sessions, due to changes in family schedules or other perceived barriers to attendance. There were no group differences between treatment completers and non-completers on mother or child age, mother education, or household income. In addition, there were no group differences

Discussion

The goals of this paper were to provide an overview of Let's Connect and to present initial data from a pilot study of community-based Let's Connect groups. Let's Connect is a novel emotion focused parenting intervention that builds caregivers' own emotional competencies (e.g., awareness, regulation) and teaches caregivers behaviorally-specific emotion communication and connection skills. Let's Connect is unique to family-based interventions in its focus on supporting caregivers' own

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