Enhancing Accessibility and Engagement in Evidence-Based Parenting Programs to Reduce Maltreatment: Conversations With Vulnerable Parents

Abstract

11 focus groups (N = 160) of high-risk parents in Los Angeles County were asked to assess the value of social media to deliver an evidence-based parenting program, Triple P—Positive Parenting Program, to reduce child maltreatment. For feasibility, (N = 238) parents were surveyed regarding their internet use. Parents responded enthusiastically to the online program, and expressed the importance of a sense of community and learning through the experiences of others. 78% of the young, high-poverty, minority parents used the internet. An online evidence-based parenting program delivered in social media could enhance accessibility and engagement of high-risk parents – a powerful tool to reduce child maltreatment.

Abuse and neglect are painful realities that can set a child on a negative developmental trajectory toward emotional, social, and behavioral problems (Cicchetti & Valentino, 2006; Belsky & Jaffee, 2006). Children raised in coercive families have an increased probability of serious adult problems including antisocial disorder (Loeber, 1998), substance abuse disorders (Holmes & Robins, 1988; Mayes and Suchman, 2006), subsequent early arrests (Patterson, Reid, & Dishion, 1992), physical illnesses throughout their life, and can even lead to early death (Repetti, Taylor & Seeman, 2002). Using a stringent definition of child maltreatment, the U.S. Department of Health and Human Services Administration on Children, Youth and Families’ annual report to U.S. Congress, reported that “more than 1.25 million children (an estimated 1,256,600 children) experienced maltreatment during the NIS–4 study year (2005–2006); this corresponds to one child in every 58 in the United States” (Sedlak et al., 2010, p. 5). Furthermore, the financial cost of responding to maltreatment annually in the U.S. is conservatively estimated at $103.8 billion (Wang & Holton, 2007).

Given the high prevalence of problematic parenting and despite the imperative to provide evidence-based parenting interventions for these families, few high-risk families receive effective help. Over the last 30 years, there has been substantial progress in developing and testing effective parenting interventions that promote child and family wellbeing (Turner and Sanders, 2006). Unfortunately, there has been considerably less attention given to making these interventions widely accessible to and engaging for at-risk families.

The present study takes an effective parenting program, Triple P—Positive Parenting Program, for preventing maltreatment to examine issues related to program delivery rather than program content. Specifically, we explored the value consumers placed on online formats in general for the delivery of parenting supports, and on social media formats in particular. In addition, we examined the feasibility of delivering a parenting program through social media to support vulnerable families in urban Los Angeles.

The Challenges of Reaching High-Risk Parents with Evidence-Based Programs

Despite the effectiveness of evidence-based parenting programs, relatively few parents access them (Sanders, Bor, & Morawska, 2007; Turner & Sanders, 2006). In fact, families in which maltreatment occurs are less likely to participate in community parenting programs and are more likely to drop out if they do (Turner & Sanders, 2006). Likewise, stigma surrounding a child’s behavioral or emotional disorders constitutes a meaningful barrier to participation due to feelings of “blame and shame” (Corrigan, Watson, and Miller, 2006). Vulnerable populations face the additional barrier of racism. Hill (2010) argues that “the Black mental health crisis” (p. 2) results from the distrustful relationship among African Americans, the mental health profession, and the government. The disproportionately high number of black children in the child welfare system has exacerbated the crisis (Knott & Donovan, 2010).

Many barriers between families and effective programs also exist on the agency level. The costs of hiring, training, and maintaining professionals in evidence-based programs (EBPs) can be prohibitive for isolated and poorly resourced agencies (Baggett et al., 2010). Rural communities in particular are likely to have a paucity of mental health professionals trained in EBPs (Irvine, Biglan, Smolkowski, Metzler, & Ary, 1999).

It is also important to recognize consumer preferences. Metzler and colleagues asked 158 ethnically diverse parents to rate their preferred formats for receiving parenting information. The most preferred format was television, followed by online programs, written materials, and workshops. Parenting groups, individual therapist meetings, and home visits were the least preferred choices by parents; paradoxically, these are the most commonly provided approaches (Metzler, Sanders, Rusby, & Crowley, in press). Accordingly, there is an urgent need for innovative and appealing means of delivering programs to vulnerable parents in formats that engage them.

Triple P and the Prevention of Child Maltreatment

The Triple P—Positive Parenting Program (Sanders, 2008) was selected for this study as an example of an evidence-based parenting program with the potential to be delivered through a social media format. Triple P is one in a set of behavioral family interventions derived from social learning, functional analysis, and cognitive-behavioral principles (Sanders, Bor, & Morawska, 2007), and strategies to modify coercive interactional patterns (Taylor & Biglan, 1998). Triple P has unique attributes that make it particularly adaptable for social media delivery. Group Triple P is based on a collaborative learning model in which social interactions among participants assist in the learning process; this collaborative learning model makes Triple P ideal for social media delivery. Furthermore, Triple P has developed an online delivery format, Triple P Online (TPOL). TPOL is organized around the Triple P’s 17 core principles of positive parenting. The eight online modules of TPOL include a video mentor/avatar that welcomes the participant, interactive exercises that encourage the parent to set goals and track progress, brief videos to demonstrate parenting skills, and multiple activities that reinforce learning and encourage “in-vivo” parent-child practice. Triple P Online has recently been tested in two randomized controlled trials, which have demonstrated both the feasibility and promise of an online approach (Sanders, 2010a; Sanders, 2010b).

In a commentary published in the Journal of the American Medical Association regarding the imperative for programs and policies to improve long-term health outcomes for children, Mercer and Saul (2009) identified Triple P as a rigorously evaluated program that promotes safe and nurturing parenting skills and that is ready for broader expansion and dissemination. Perhaps most relevant to the current study, Prinz, Sanders, Shapiro, Whitaker, & Lutzker (2009) conducted the first published maltreatment prevention study to randomize large population units, and documented preventive effects on child maltreatment indicators. These authors randomly assigned 18 South Carolina counties to either the Triple P system of parenting supports or to usual services (control). After controlling for county baseline levels of maltreatment indicators, they found that training professionals in the Triple P system produced significantly lower out-of-home placements (Cohen’s d effect size = 1.22), child maltreatment injuries requiring hospital treatment (Cohen’s d = 1.14), and substantiated child abuse or neglect (Cohen’s d = 1.09).

Rationale for Adding Social Networking to an Online Parenting Program

This study explores the value of exploiting the power of social media — a sense of community and learning through the experiences of others — to catalyze parental participation when combined with an effective online parenting program.

The current popularity of social networking speaks to the extensive influence of social media. As of July 2010, Facebook alone reported 500 million active users (Johnson, 2010). An online community is a specific social networking site that is arranged around a common interest, in this case, positive parenting. An online community offers participants an opportunity to engage with peers, learn through the experiences of others, receive and provide feedback, and most of all, feel socially connected to others (Plantin and Daneback, 2009). Parenting can be isolating, especially when it is being done poorly (e.g. maltreatment) and the children present behavioral issues (Corrigan, et al., 2006). An online community offers a potentially effective vehicle for social connection. White and Dorman (2010) argue that the advantages of the use of social media in the behavioral sciences include: (1) it is welcoming to people with stigmatizing disorders, (2) it increases the possibilities for self-disclosure of embarrassing topics, (3) it encourages honesty and intimacy, and (4) it eliminates some socio-demographic factors and signs of physical appearances (e.g. obesity) as well as social skills levels.

Baggett et al. (2010) assessed Infant-Net, an evidence-based parenting program to promote social-emotional development in an online community by adding a social network component to an online delivery program. The bulletin board provided a forum for both peers and professionals to tell stories, address questions or issues, and foster discussions within a general community of support. The program reported a high completion rate (89%) and the mothers described the online program as easy to use and satisfying (95%). Although this study had a small sample (19 mothers) it is consistent with an emerging body of evidence that documents the efficacy of using social networking strategies to engage and sustain vulnerable populations. Winzelberg et al. (2000), for example, used the power of social media to modify high-risk eating attitudes and behaviors; the online discussion group, moderated by a professional, helped to prevent eating disorders in an indicated college population. In another study, Takahashi et al. (2009) qualitatively explored online community for people with depression. They reasoned that the online support group provided participants with peer support while maintaining privacy. These findings are also consistent with Tate and Zabinski’s (2004) review of computer and internet applications for psychological treatments. They concluded that online chat rooms provided social support along with peer and therapist feedback to enhance online education programs. Dunham et al. (1998) used Computer-Mediated Social Support (CMSS) for single mothers as a treatment strategy to lower the risk of child maltreatment posed by social isolation: Sense of community with the online CMSS was significantly correlated with lower stress scores. In a content analysis of the computer postings, the authors discovered that increased isolation among mothers yielded higher rates of participation (reading and posting) in the CMSS. In addition, they found that the isolated mothers received positive peer support (98% of the replies); surprisingly, prior computer experience and other socioeconomic differences were not related to individual differences in participation and sense of community. Similar results were found in a small pilot study (Bragadottir, 2008) of a CMSS for parents; in fact, mothers’ depression and fathers’ anxiety decreased with the participation and perceived mutual support. In summary, social network online communities are emerging as a promising practice for bringing supportive interventions to vulnerable populations.

Using Social Media to Reach Vulnerable Parents

Age and gender are also salient factors in developing a successful delivery format for parents. According to the World Internet Project (Pierce, 2010), internet use data show increases among youth — approximately 79 percent or more of adults between 18 and 24 years old go online. Additionally, there has been a “sharp reversal” (Pierce, 2010) over the past three years, in which many more young women than men now report that they feel as strong about their internet communities as their real-world ones.

It is important to note that, according to a recently released Pew Foundation Report (2010), African American and English-speaking Latinos are more likely than Caucasian Americans to own a mobile device and use it for social networking. Seven out of ten Blacks and English-speaking Latinos use social networking sites, while nearly half of Blacks, compared to only a third of Whites, engage in social networking on a daily basis. All of these activities and attitudes are consistent with the potential value of delivering an effective parenting program on an internet platform that can be accessed on cell phones, laptops, or desktops.

The logic of adding social networking to the effective Triple P Online parenting program is built on a multitude of factors: (1) high percentages of young mothers cited as users of social media; (2) stigmatization and social isolation among high-risk parents involved in substantiated maltreatment; (3) distrust of professionals among vulnerable populations, especially African Americans, which deters them from seeking help; (4) increased reach and convenience for parents – the option of participating in a social group without leaving their home; and (5) consistency with documented consumer preference. Furthermore, delivering Triple P through social media is consistent with the ecology of Black and Latino populations.

This study conducted 11 focus groups of 160 vulnerable parents residing in Los Angeles County. Participants were asked for their views regarding the acceptability, feasibility, and helpfulness of an evidence-based parenting program delivered through both an online format (without a social network online community), and through a social network online community. Additionally, the study surveyed 238 parents in one of Los Angeles County’ poorest neighborhoods to assess patterns of current internet use. This study sought consumer input at the program design stage to determine how to enhance accessibility and engagement in evidence-based parenting programs.

METHODS

Los Angeles County

From a child maltreatment perspective, Los Angeles County stands out as a particularly troubled region. Although it represents only 3% of the U.S. population, it reports 5% of the nation’s maltreatment investigations. In 2010 alone, Los Angeles County’s Department of Child and Family Services (DCFS) received 145,157 maltreatment referrals, of which 10,847 received in-home services – the families most at risk for repeated maltreatment. The majority of children placed out-of-home (66%) had been investigated previously by a child welfare worker (National Survey of Child and Adolescent Wellbeing, 2005). Thus, children whose families receive ineffective services are at risk of being re-harmed and placed in out-of-home care (NSCAW, 2005), a risk in its own right (Courtney, Piliavin, Grogan-Kaylor & Nesmith, 2001). Delivering an effective and engaging parenting program is critical to these families’ success.

In addition, Los Angeles County has the largest Hispanic population of any city in the United States, 4.7 million, (US Census, 2010). This population faces unique social, economic and cultural issues. Since many Hispanic immigrants are undocumented, their legal status forces entire families to live in the shadows. They also face challenges of homelessness, severe poverty, community-level violence, and language and cultural barriers Los Angeles County Department of Health, 2009). This population comprises the majority (56%) of intakes into Los Angeles County-DCFS system (DCFS, 2010).

Efforts to reduce maltreatment in Los Angeles County face significant economic, logistical, and social barriers. Unfortunately, most treatment services for maltreating families are not evidence-based. In a preliminary study, for example, we surveyed all 33 DCFS community partners/agencies that deliver parenting classes for maltreating families and found that 90% of the parenting programs they deliver had no empirical support.

Study Participants

The study included 11 focus groups (n = 160) and an Internet parental use survey (n = 238) for a total of 398 participants in a purposive sampling strategy. Parents from nine of the 11 focus groups were recruited in two economically depressed neighborhoods in Los Angeles County. These nine groups were conducted in two separate agencies: Agency A, a community agency that serves African American families; and Agency B, a community agency that services primarily vulnerable Hispanic children and their families. The two remaining focus groups were conducted in Los Angeles Los Angeles County Unified School District’s non-public school for children with Autism Spectrum Disorder (ASD) and their families (Table 1). All 160 parents (153 mothers and 7 fathers) were attending a parenting class, not Triple P, at the time of their participation in the study.

Table 1.

Focus groups by date, agency, number of participants and reason that parents were gathered

Group	Date	Agency	N	Reason that parents were gathered
1	6/16/2009	Agency A	35	Mothers' Club
2	6/30/2009	Agency A	23	Recovery program
3	6/30/2009	Agency A	17	Parenting class
4	7/2/2009	Agency A	18	Parenting class
5	7/2/2009	Agency B	13	Parenting class in Spanish
6	5/25/2010	Agency A	5	Recovery program
7	5/25/2010	Agency A	15	Parenting class
8	5/27/2010	School	5	Parenting class for ASC child
9	5/27/2010	School	14	Parenting class for ASC child
10	6/1/2010	Agency A	7	Recovery program
11	6/1/2010	Agency B	8	Computer training lab

Agency A’s mission is to serve the needs of African American families. Most of the participants in the focus group were adolescents (under age 19); all were living in poverty. Some of the mothers (29%) in Agency A’s focus group were living in a substance abuse recovery housing program and some of them (20%) were under court supervision by Los Angeles County-DCFS. Agency B’s mission is to serve high-risk children and their families. It is located in one of the poorest and most troubled neighborhoods of Los Angeles; many of its residents are recent Hispanic immigrants. Both Agencies A and B are community partners with DCFS and in this role provide parenting classes; none of the agencies – A, B or the LAUSD’s non-public school for ASD – offer Triple P. See Table 1 for a list of all the participating agencies.

Additionally, 238 parents were recruited for the internet use survey. The respondents were participating in the Neighborhood Academic Initiative (NAI) in South Los Angeles. NAI was developed by University of Southern California to support the neighborhood in which USC resides. The NAI provides academic and financial support for youth living in poverty; to be eligible for a USC-sponsored NAI scholarship, parents must commit to attending parenting seminars, which meet on the University Park campus for four hours on Saturday mornings about 12 times per year. If parents are unable to attend due to work or other obligations, they may send an advocate such as an aunt or uncle, grandparent, godparent, adult sibling, neighbor, or friend who is involved with the child. The survey recruited parents or parent-substitutes at a monthly NAI seminar in the summer of 2009.

Measures

A semi-structured interview was used in each focus group. The groups were shown clips from Triple P Online for 35 minutes, followed by a group discussion, which was facilitated by a research team of graduate students and the lead researcher. The focus groups watched Triple P video clips via either a DVD, or from the Triple P Online via the internet. The team included three research assistants who took notes and also independently rated the parents’ responses in three areas: acceptability, feasibility, and perceived helpfulness. Specifically, a dialogue was facilitated along three avenues of inquiry: parents’ thoughts about the parenting strategies depicted in the videos; parents’ thoughts about learning parenting information online; and finally, parents’ perceptions of the advantages or disadvantages of learning parenting skills on a social networking site.

To begin the discussion, parents were prompted with several questions: (1) how interesting/boring did you find the video? (2) would this video be helpful/unhelpful to you or anyone you know? and (3) would you like to see more of the Triple P videos? All prompts were followed with requests for specific examples from the participants, including “what was most interesting?” or “what was helpful?” The discussion was further prompted with asking the parents: (1) do you think you would learn from these videos if they were available on the internet? and (2) what would be the advantages/disadvantages of learning on the internet? Finally, we asked parents directly if they participated in social network sites and if they thought that participating in social networking would improve their acquisition of parenting skills and, if so, how. Responses were written, independently, by three research assistants; quotes that best articulated the attitudes of the respondents were chronicled verbatim.

The Internet parental use survey was a single page—one side in English and the reverse side in Spanish. The questions were derived from the World Internet Project (WIP; Pierce, 2010). Questions addressed several topics, including frequency of using email, Facebook, Twitter, and YouTube, as well as ownership of cell phones, computers, and smart phones. The survey also asked the parents to rate TV, internet, radio, books/magazines, and family/friends regarding their importance as a source of general (i.e. news, health) information. Parents who connect to the internet were asked to identify sites of access (home, library, school, work, café, or other). Finally, the brief survey asked parents who do not use the internet to provide reasons (confusing, expensive, no access, or no interest/time).

Data Analysis, Qualitative

The research team (three team members per focus group) took notes in a “focus group observation log,” which was created specifically for this study. To add objectivity to the assessment, the research assistants independently assessed and rated (on a scale of 1 to 10) each focus group as a whole on their reactions regarding the acceptability, feasibility, and perceived helpfulness of the Triple P videos. The qualitative statements were evaluated for theme-based patterns and examples reported in verbatim quotes. After each focus group the research team members met and discussed perceptions to resolve any differences. Coder reliability strategies were not employed.

Data Analysis, Quantitative

The data generated from the Internet parental use survey were analyzed by univariate measures of dispersion and bivariate statistics. Chi Square statistics were employed to examine any possible relationships between demographic variables (i.e. ethnicity, age) and patterns of computer use.

Procedures

The project, including the semi-structured focus group guide and the internet use survey, was approved by the Human Subjects Protocol Committee at California State University, Northridge. The two principal social service agencies, the non-public school, and the NAI program administrators were recruited by the first author. The 90-minute focus groups were conducted in the summers of 2009 and 2010. The research team provided agencies with a computer, video player, projector, and a screen; the agencies provided internet access. Most of the focus groups were conducted during a previously scheduled (unrelated to the research) parenting class. The research team brought cookies or decorated pencils (for the children) to thank the parents for their time. The final two focus groups auctioned four $20 Target gift certificates. All “gifts” were chosen by the program administrators.

The internet parental use survey was administered to participants in the NAI seminar via a paper-pencil questionnaire. It took approximately 20 minutes to complete. The survey was introduced by the lead researcher in English and the NAI seminar instructor in Spanish. Four research assistants distributed the surveys, waited while they were being completed, and then collected them. As a token of appreciation for their time, NAI parents were given decorated pencils.

RESULTS

Participants

The mean age of the parent was 38.29 (SD = 9.17); 18.5% of the parents identified themselves as African American, 75.8% as Latina/o, and 4.8% as “other.” No parents’ self-identified as Caucasian or Asian American. There was a significant relationship between age (under 25 years old) and ethnicity (χ² (2, N= 224) = 7.47, p = .024); Hispanic parents were younger. By virtue of their participation in the NAI program, all families were living in poverty. All 286 parents participating in the monthly NAI parenting event were invited to participate and 238 volunteered, resulting in an 83% response rate.

Focus Groups

The 11 focus groups (n = 160) were organized by three avenues of inquiry: parents’ thoughts about the videos; parents’ thoughts about learning parenting information online; and finally, parents’ perceptions of the advantages or disadvantages of learning parenting skills from a social networking site. All responses were assessed by thematic analysis. Three research assistants were assigned per focus group; wrote non-verbatim notes during the focus groups; and took verbatim notes of specific comments that appeared to them as observes to best represent both views of individuals and the collective perspective of the group. The notes were then coded for themes with attention to acceptability, feasibility, and perceived helpfulness of Triple P and the delivery options. These constructs were selected based on previous qualitative inquiries regarding parenting interventions (Metzler, Sanders, Rusby, & Crowley, 2011).

In the first line of inquiry, parents’ thoughts about the videos, we asked about acceptability, feasibility, and perceived helpfulness through multiple questions: Were the videos interesting? Could they relate to the parents on the videos? Was the information relevant to their family? Would the information be helpful to them or to someone they knew? And would they like to see more of the videos? The parents overwhelmingly reported that they found the videos acceptable. Overall response to the videos was enthusiastic and positive and included responses such as: “Loved it,” “excellent,” “I want to see more,” “makes you want to keep watching,” “realistic kids and parents [on the video],” “I saw myself in the video,” and “that helps because it is just like me.” A few parents (5 out of 160) were less positive, for example: “Didn’t hear solutions,” “unrealistic, parents don’t talk to their kids that way [as on the video],” “too difficult,” and “would need to do this from birth.” When parents were prompted to be specific, they responded with a range of comments, including: “Makes you think about how you parent,” “some parents think they are being good parents, but they are not,” “I saw myself in the video,” “that’s my family,” “I have a three year old and am glad I saw it,” “I thought it was realistic, I am inconsistent with my daughter,” and “helpful in my case, I raise my voice and spank my child.” With regard to the medium of video, common responses were: “Helps that it wasn’t a lecture,” “I learn better by watching than reading a book,” “the videos are not long and boring,” “visuals are easier to comprehend than a book or lecture,” and “seeing kids act the way my kids act was helpful.” One of the most memorable responses was, “In my case it would help me. I make the mistake of escalating situations, screaming and hitting. This is showing me that if I change, my child will change.” When parents were asked if they would like to see more Triple P videos, the response across all 11 focus groups was unanimously, “Yes.” This was particularly noteworthy, given that the participants were currently attending a parenting class (although not Triple P). One mother wrote her name and contact information on a scrap of paper and squeezed it into a researcher’s hand, saying “please contact me.”

The second line of inquiry, parents’ thoughts about learning parenting information online, addressed parents’ previous online experiences, internet access, and perceived importance of the internet as a source of information. The most common responses from parents were about convenience, such as: “Good for parents who work, can do it when kids are asleep,” and “saves time, don’t have to go to meetings.,” Other responses addressed the value of sharing the information with others, such as: “Keeps both parents involved,” “both parents could listen and learn together,” and “could work with divorced or separated parents.” Parents also talked about getting the information when and how they needed it: “Having classes on line is helpful; own pace, own time,” “it’s nice to be able to watch it again and again,” “great to keep track of goals,” “I like the suggestions for things to try,” “questions encourage you to keep watching,” and “good for my short attention span.” Lastly, parents talked about being more comfortable with an online format compared to an in-person learning experience: “I feel more comfortable at home, not distracted by other parents in the classroom,” “I have better attention when outside of a school environment,” and “it’s not embarrassing.”

The third line of inquiry, parents’ perceived advantages or disadvantages of learning parenting on a social networking site, was also written. Although not all of the parents were familiar with social networking sites, those who were were forthcoming in its potential value to them as parents: “Helps to create universality, support, and validation,” “can network with other parents,” “could be a shared learning experience,” “I will learn by hearing what other parents are saying,” “listening to different parents with the same problems makes me feel connected,” and, “if embarrassed to ask a question in person, I can do it in a social network discussion.” Concerns about learning on a social networking site were also expressed: “I think having a moderator would be important,” “if you don’t have access or you don’t know how to use [the internet], it could be difficult,” “sometimes it would be helpful to have a teacher in the room,” and “yes [to being interested in learning on a social networking site], but it is also important to have the option of face-to-face.” This sentiment was shared by other parents and expressed well in a parent’s remark: “Depends on the person, some people don’t like computers, some would prefer to take a class.”

Internet Parental Use Survey

More than three-quarters (78%) of this high-poverty, ethnic minority sample had access to the internet; 63% had an email account, 46% regularly checked their email, 33% used the social networking sites Facebook or MySpace, and fewer parents used Twitter (15%). Nearly half (49.5%) had watched a YouTube video. Almost 60% of the sample had internet access at home; libraries, schools, and work accounted for another 12% of participants’ internet access. These numbers are consistent with the WIP (2009) report of the general US population, and provide confidence that a reasonable proportion of families living in Los Angeles County’s poor neighborhoods have access to and use the internet.

A number of ethnic differences in internet access and computer use were found in this sample. Although, not statistically significant, χ² (3, 251) = 3.019, p = .389, different patterns emerged across ethnicities regarding reasons given by parents who did not access the internet (22% of the sample). Of African-Americans who did not use the internet, “not owning a computer” (40%) was the most common reason, followed by “no interest” (30%), “confusing” (20%), and expensive (10%); in contrast, for Hispanic-Americans, “not owning a computer” (44%) was also the most common reason, but the second reason was “confusing” (35%), followed by “no interest” (22%), and expensive (0%). In the World Internet Project (Pierce, 2010), the most frequent reasons given for not accessing the internet were “no interest/not useful” (50%), confusing (22%), and expensive (10%).

Ethnicity was found to be associated with where parents get online. Hispanic parents were more likely than African American parents to connect to the internet at home (81.3% vs. 62.5%) or the library (7.5% vs. 6.3%), but were less likely to connect at school or work (7.5% vs. 21.9%), χ² (3, 212) = 8.179, p = .042.

Computer ownership was also related to ethnicity in this high-poverty sample. Hispanics’ computer ownership rate was 82%, whereas only 49% of African Americans owned a computer. When younger parents (in their teens and twenties) were compared to older parents (thirties and older), important trends emerged. Although younger parents connected with the internet in similar numbers as the older cohort, their online activities were different. Younger parents checked their email more frequently than older parents (43.2% vs. 23.9%), χ² (1, 238) = 5.96, p = .015. They were also more likely to be on a social networking site (59.4% vs. 12%), χ² (4, 238) = 49.41, p = .000, and more likely to use YouTube (45.19% vs. 12%), χ² (4, 238) = 28.30, p = .000. Although younger parents were less likely to own a computer (59.5% vs. 75.1%), χ² (1, 238) = 3.86, p = .049, they were as likely as their older cohort to own a cell phone (83.8% vs. 84.6%), χ² (1, 238) = .015, p = .903. These figures may reflect the national trend among this generation as they move from the use of computers to hand-held devices to access information (Smith, 2010).

The other significant trend was the importance that younger parents placed on sources of information. Although younger parents identified television as an important source of information, they were less likely to do so than the older cohort (54% vs. 70%), χ² (1, 232) = 3.73, p = .053. Younger respondents demonstrated a trend, though not significant, toward less use of radio (18.9% vs. 27.2%), χ² (1, 232) = 1.11, p = .293, and books (10.8% vs. 17.9%), χ² (1, 232) = 1.13, p = .287, as important sources of information. Depending on family and friends for information was shared across age cohorts (27% vs. 27.7%), χ² (1, 232) = .007, p = .934, but the younger respondents tended to show greater preference for the internet as an important source of information, although this difference was not statistically significant (40.5% vs. 27.2%), χ² (1, 232) = 2.679, p = .102.

In summary, this sample of Hispanic and African-American parents in one of the poorest neighborhoods in Los Angeles County reported accessing the internet in similar numbers as the general population (about 78%). They reported accessing the internet primarily at home on a personal computer. Furthermore, young parents in the southern part of Los Angeles County appear to share the national youth trends toward participation in social networking sites, watching internet videos, and perceiving the internet as an important source of information, all of which support the relevance and feasibility of delivering an evidence-based parenting program to reduce maltreatment through a social networking site.

DISCUSSION

The success of any parenting program depends on the feasibility and the willingness of parent consumers to participate. It is important that during the program design stage, parent consumers are brought into the conversation. This study directly asked vulnerable parents how they perceived the acceptability, feasibility and helpfulness of a specific evidence-based parenting program, Triple P, delivered through an online format with and without a social media environment component. Triple P was used as an incidental example to illustrate the broader conceptual argument that evidence based parenting programs delivered in an online community could be an acceptable, feasible, and helpful option for low income vulnerable populations.

Despite the demonstrated effectiveness of evidence-based parenting programs, relatively few parents access them (Sanders et al., 2007; Turner & Sanders, 2006). Disadvantaged families are even less likely to participate in effective parenting programs, even though they can benefit (Heinrichs, 2006), and are more likely to drop out of a program, if they do not participate (Turner and Sanders, 2006). To attend an in-person class, high risk parents face multiple barriers: logistical difficulties; shame and blame by others; for African American families, the distrust of professionals; and for undocumented Hispanic families, the risk of discovery and deportation. The costs of hiring, training, and maintaining professionals in evidence-based programs can be out of reach for isolated or poorly resourced agencies (Baggett et al., 2010). Rural communities in particular are likely to have a paucity of mental health professionals trained in EBPs (Connell, Sanders & Markie-Dadds, 1997; Irvine et al., 1999).

This study explored consumer perceptions and preferences by conducting 11 focus groups. Focus groups have the capacity to describe and understand meanings and interpretations of consumers (Liamputtong, 2009) by not only eliciting a set of individual opinions, but by facilitating an interaction among the participants themselves. The active dialogue centered on the acceptability, feasibility, and helpfulness of a parenting program delivered through an online format (without social networking) and through a social networking site. Parents watching the brief online videos were enthusiastic, but just as importantly, they also discussed the value of learning through shared experiences. Furthermore, parents noted the value of a moderator and the concern that some parents may not have access to the internet.

Feasibility of reaching high-risk, high-poverty, minority families was also supported in this study. The findings were consistent with the most recent Pew Foundation Report (2010) that age is the strongest indicator of internet and social networking use. Additionally, the Pew Foundation (2010) reports that African American and English-speaking Hispanic youth are increasingly being “untethered” from desktop computers. Youth of color are more likely to own a mobile phone than their white cohorts and to use it for social networking—outpacing whites in their use of social technologies. Moreover, African Americans have gained substantial ground in in-home internet access in the last year (Pew, 2010). The internet divide is closing with the newer, more flexible, and cheaper technology of smart phones. Relevant to this study, research shows that young parents and parents of color are among the most active in the use of social media tools, and at the same time, are also specifically vulnerable for child maltreatment investigations. Knott and Donovan (2010) in an analysis of the National Survey of Child and Adolescent Wellbeing, found that African-American racial identity is a “significant predictor of foster care services” (p. 679) in the U. S. child welfare system.

Limitations

The findings from this study need to be interpreted with caution. Focus groups and purposive sampling pose serious limitations. The parents we spoke with are not representative of all vulnerable parents in Los Angeles, let alone other geographical locations. The most vulnerable parents may not have attended the parenting activities that hosted the focus groups; also for those who did attend, they may not have been comfortable speaking up in the group. Although an effort was made to keep the focus groups small (to increase comfort), familiar (groups already meeting for a purpose other than the research), and varied (11 focus groups across different parenting events), we do not know if these methodological strategies were successful in gathering the perceptions and experiences of parents most at risk for child maltreatment investigations. The Internet parental use survey also had limitations. Only those parents attending the NAI program—which could represent a select population (e.g. more motivated, more resources) of high-poverty parents in Los Angeles—participated in the study. Furthermore, the quantitative data from this survey cannot be directly compared to the qualitative data gained through the focus groups.

Conclusions

An online effective parenting program delivered in a social network online community has the potential to engage high-risk parents; maximize reach to address and overcome barriers such as limited availability of trained professionals, geography, logistics, social stigma, and distrust; and, at the same time, lower healthcare costs. The next step in this important work will be to build an online community around Triple P and test its effectiveness with vulnerable populations. The qualitative and quantitative information obtained in this study supports the notion that an online parenting program delivered through a social media environment is feasible and acceptable to high-risk parent consumers, providing valuable feasibility information before embarking on an expensive randomized controlled trial or population-level dissemination project.