January 22, 2010

Training helps parents revise discipline plans

Training helps parents revise discipline plans

The American Academy of Pediatrics has long recommended that pediatricians discuss discipline with parents during well-child visits.

Now, a study led by Seth Scholer, M.D., M.P.H., associate professor of Pediatrics at Vanderbilt, has found that even a short intervention can help parents develop an appropriate discipline plan.

“Violence is a huge public health problem. It is one of the 10 leading causes of death for people between the ages of 1 and 44 in the U.S. and,

Seth Scholer, M.D., M.P.H.

Seth Scholer, M.D., M.P.H.

The study, published this week in Pediatrics, was completed in the Pediatric Primary Care Clinic at the Monroe Carell Jr. Children's Hospital at Vanderbilt in June and July 2008. Two hundred fifty-nine parents (both English-speaking and Spanish-speaking) of children ages 1-5 were enrolled.

Those in the intervention group were asked to view a video with at least four discipline strategies of their choosing from Vanderbilt's Play Nicely program during their well-child visit. Play Nicely is a video program created by Scholer that teaches parents, teachers and health care professionals how to manage early childhood aggression. Each strategy takes approximately one to two minutes to view.

At the end of the visit, parents were asked a few questions, including if there were plans for changing the way they discipline their child as a result of the visit. Those in the control group did not view the video, but were asked the same questions at the end of their visit. Only one parent declined to participate.

Eighty-three percent of the 129 participants in the intervention group answered that it helped them develop methods of discipline — and those parents were 12 times more likely to have been helped than the 129 participants in the control group.

Caregivers in the intervention group were more likely to plan to do less spanking than caregivers in the control group. The study also found that both English-speaking and Spanish-speaking parents benefited from the intervention. Even further, all parents, regardless of gender, age, education level and race, were helped.

“To prevent violence it would be best for all parents to know the best ways to discipline and manage aggression,” Scholer said.

“Despite recommendations by the American Academy of Pediatrics that support this approach, most physicians counsel only if parents have questions about discipline or behavior. The findings have exciting implications for how primary care providers can help parents develop more appropriate ways to discipline on a routine basis.”

One caveat of the study is the difficulty for broad implementation of the findings because this kind of program is currently not a reimbursable service.

“This could help more than 80 percent of parents discipline their children at home, but there is no financial incentive for a busy pediatric practice to implement any program or additional counseling that extends the length of the office visit,” Scholer said.

Currently, the Pediatric Primary Care Clinic has implemented this program during each well child visit for 15-month-old patients.

The Morgan Family Foundation sponsored the development of the Spanish-language version of Play Nicely. Vanderbilt Interpreter Services developed the Spanish language version.

For more information about Play Nicely, visit www.vanderbiltchildrens.org/playnicely.